Expression pattern of ALDH1, E-cadherin, Vimentin and Twist in early and late onset sporadic colorectal cancer

Aim: To evaluate the expression pattern of ALDH1 (aldehyde dehydrogenase 1), E-cadherin, Vimentin and Twist in early and late onset sporadic colorectal cancer (CRC) and to study association of their expression with the occurrence of CRC at a young age. Materials & methods: Immunohistochemistry of ALDH1, E-cadherin, Vimentin and Twist was performed on 103 pretreated CRC biopsy samples. Results: ALDH1 expression was found to have strong correlation with early onset CRC (p < 0.0001). Conclusion: High ALDH1 expression correlates with the early onset of CRC. ALDH1 over-expression correlates with poor overall survival in colon cancer.

Management of chyle fistulae following surgery in the neck

Chyle fistulae are seen in less than twenty percent of cases following head and neck surgery. At the Cancer Institute, Madras, India, chyle leaks were seen in 19 patients between 1990 and 1999. The leak subsided spontaneously in sixteen patients on conservative management. The neck was re-explored in three patient. The thoracic duct was ligated in one and the wound packed in two. Conservative management in the form of aspirations and strapping is more likely to succeed when the volume of drainage is low or decresing over time and the surgical incision and skin flaps remain healthy. Rightsided leaks and late appearing fistulae are also likely to close on conservative management. Dietary modifications may help in this process. Re-exploration of the neck would be required when conservative management fails. Early exploration would be advised when the drainage is large or does not decrease over a few days or if there is a tendency to wound breakdown. A thorough knowledge of the anatomy of lymphatic pathways from the thorax and abdomen, identification of the thoracic duct during surgery and detection and ligature of all lymphatic leaks intraoperatively using a trendelenburg position and valsalva maneuver will help reduce the occurrence of this problem.

Superficial temporal artery based flaps for reconstruction following resection of head and neck cancer

Head and neck cancers account for over twenty five percent of all cancers in the Indian subcontinent. Most of them are treated primarily with radiation therapy. Reconstruction following resection of post radiation residue or recurrent disease requires well vascularised, thin, pliable and easy to do flaps which could be used for reconstructing mucosal and cutaneous defects simultaneously to achieve a well healed wound with maximum function and cosmesis. Short of the microvascular technique the temperoparietal fasciocutaneous island or temperoparietal fascial flaps based on the superficial temporal vessels come closest to fulfilling these requirements.

Tracheal injury during transhiatal mobilization of the esophagus

In 50 transhiatal esophageal mobilizations done from 1988 to 1998 at the Cancer Institute (W.I.A.) in Chennai, India, injuries to the trachea were detected on 3 occasions: 1 in a woman with carcinoma of the hypopharynx and 2 in patients (1 male, 1 female) with squamous cell carcinoma of the esophagus. The incidence of tracheal injuries during esophageal mobilization varies in different series. This is usually on the membranous posterior wall of the trachea. When recognized on the table, repair of the rent must be carried out. Persistent air leak through the intercostal tube or surgical emphysema developing over the face and neck in the postoperative period indicates an injury to the airway. A bronchoscopy will reveal the site of injury. If the lung is fully expanded and the stomach abuts the rent completely, the patient may be observed. However, if the lung is collapsed and does not expand on applying negative suction to the intercostal tube or the injury is in the bronchi, the patient is best reexplored to close the rent. With proper case selection and careful dissection of the esophagus, the problem of tracheal injuries can be avoided.