Hepatic Thermal Injury Promotes Colorectal Cancer Engraftment in C57/black 6 Mice

Background:Treatment of liver metastases (primarily colorectal cancer) is limited by high recurrence rates and tumor progression. Surgical approaches to management of these metastases typically utilize heat energy: including electrocautery; argon beam coagulation; thermal ablation of surgical margins for hemostasis; and preemptive thermal ablation to prevent bleeding or effect tumor destruction. Based on high rates of local recurrence, these studies assess whether local effects of hepatic thermal injury (HTI) might contribute to poor outcomes by promoting a hepatic microenvironment favorable for tumor engraftment or progression due to induction of pro-cancer cytokines and deleterious immune infiltrates at the site of thermal injury. Approach and Results:To test this hypothesis, an immunocompetent mouse model was developed wherein HTI was combined with concomitant intrasplenic injection of cells from a well characterized MC38 colon carcinoma cell line. In this model, HTI resulted in a significant increase in engraftment and progression of MC38 tumors at the site of thermal injury. Further, there were local increases in expression of mRNA for Hif1a, Arg1, and Vegfaand activation changes in recruited macrophages at the HTI site but not in untreated liver tissue. Inhibition of HIF1α following HTI significantly reduced discreet hepatic tumor development (p=0.03). Conclusions:Taken together, these findings demonstrate that HTI creates a favorable local environment that is associated with pro-tumorigenic activation of macrophages and circulating tumors implanting. Discrete targeting of HIF1α and/or its up and downstream pathways and/or inhibiting macrophages offer potential strategies for improving the outcome of surgical management of hepatic metastases where HTI is utilized.

Skin ligation and argon beam coagulation for giant pachydermatocele resection

Resection of giant neurofibroma in neurofibromatosis type 1 has a high risk of perioperative bleeding because the tumors are enriched in blood vessels, which are weakened due to the loss and thinning of vascular smooth muscle. Therefore, we combined skin ligation around the tumor and use of an argon beam coagulator (ABC) for hemostasis during resecting the giant neurofibroma. The ABC is a non-contact-type hemostasis device employing argon gas as a medium. We examined the usefulness of our method by retrospectively comparing the outcomes of the ABC-use group with those of the non-use group (7 patients, 9 tumors). Although there was no difference in resected tumor weight between the two groups, the operation time was slightly shorter and the volume of blood loss was smaller in ABC-use group than in the non-use group. Our method for hemostasis is easy and safe and is considered to be a useful method.

Management of Rhinophyma

ABSTRACT Rhinophyma is a condition that can cause significant disfigurement as well as functional impairment of the nose. It results from hypertrophy and hyperplasia of the sebaceous glands and can be a manifestation of advanced staged rosacea. If left untreated, not only can it cause disfigurement, rhinophyma can also result in nasal airway obstruction by marked ptosis and collapse of the external nasal valve. Surgical excision is the definitive treatment as rhinophyma does not spontaneously regress. Though various surgical techniques are available for the treatment of rhinophyma, a specific technique using tumescent anesthesia, sharp dissection, and argon beam coagulation has been found to be most efficacious. This technique and its advantages are described. How to cite this article Lian TS, Thompson RW. Management of Rhinophyma. Int J Head Neck Surg 2016;7(3):188-191.