Search

Introduction and objective: Mastoid obliteration technique combines the advantages of canal wall-up (CWU) and canal wall-down (CWD) approaches in the surgery of chronic suppurative otitis media with cholesteatoma. We aim to demonstrate our experience with mastoid obliteration technique using bone dust and BonAlive® (S53P4) bioactive glass granule in a comparative prospective clinical study. Patients and methods: Between 1st of March 2012 and 31st of November 2021, mastoid obliteration surgery was performed in 14 patients using bone dust (7 cases) and BonAlive® granule (7 cases). Prior to these interventions, the patients had undergone more than three ear surgeries (CWU and CWD) generally in both groups. Changes of complaints, audiological results, and changes in quality of life were analysed in both groups, postoperatively. Results: Having performed the mastoid obliteration technique, cochlear damage did not occur in either patient group. Long-term ear discharge and vertigo were occasionally observed after performing obliteration with bone dust. However, these complaints disappeared after a while. Complications were not reported in the case of obliteration with BonAlive®. Outstanding improvement was experienced in both groups. Conclusion: In our practice, mastoid obliteration surgery, using either bone dust or BonAlive® granule, has proved to

Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsődleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezőként felmerül a perilymphafistula lehetősége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép műtéti kezelése a dobüreg feltárását követően a belső fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelő hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmű okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követően exploratív tympanotomiát végeztünk, melynek során a belső fül ablakait obliteráltuk. Hallásjavulást ezt követően sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az előzetes kerekablak-obliteráció nem zárja ki a későbbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055-2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055-2060.

Összefoglaló. A Vibrant Soundbridge aktív középfül-implantátum vezetéses, sensorineuralis és kevert típusú halláscsökkenés esetén is megoldást jelenthet a beteg hallásrehabilitációja során. Sensorineuralis halláscsökkenés esetén akkor indikálható, ha a légvezetéses hallásküszöb nem haladja meg a 80-85 dBHL-t a 3-4 kHz frekvenciákon, vezetéses, illetve kevert típusú halláscsökkenés esetén pedig akkor, ha a csontvezetéses hallásküszöb nem haladja meg a 45-65 dBHL-t a 0,5-4 kHz közti frekvenciatartományban. Az implantátum beültetését eleinte tisztán sensorineuralis halláscsökkenés esetén végezték, és csupán egyféleképpen történhetett: a rezgéskeltő rendszer oldalán lévő rögzítőcsipeszt rá kellett applikálni az incus hosszú nyújtványára. Azokra az esetekre, amikor a rezgéskeltő rögzítése nem kivitelezhető, különböző rögzítőelemeket (coupler) fejlesztettek ki. Az incusra való rögzítés hosszúnyújtvány-couplerrel, illetve rövidnyújtvány-couplerrel lehetséges. Vezetéses és kevert típusú halláscsökkenés esetén a kerek ablak membránjához is illeszthető a rendszer, előrehaladott otosclerosis esetén pedig a Soundbridge-implantáció stapedotomiával kiegészített változata ("power stapes") hozhat kielégítő halláseredményt. Ezek a technikák meglehetősen megnövelték a sebész szabadságát, így széles körben alkalmazott, megbízható megoldássá váltak. A Pécsi Tudományegyetem Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikáján az elmúlt évtizedben számos incusvibroplastica történt, de kerekablak-vibroplasticára is több alkalommal sor került. A jelen összefoglaló tanulmányban a Vibrant Soundbridge implantátum technikai fejlődésének történeti áttekintésén felül az alkalmazható műtéti megoldásokat mutatjuk be. Orv Hetil. 2021; 162(40): 1619-1626. Summary. The Vibrant Soundbridge active middle ear implant can provide a reliable solution for hearing rehabilitation of patients with conductive, sensorineural or mixed hearing loss. For sensorineural hearing loss, the air conduction threshold of the patient should not be more increased than 80-85 dBHL at the range of 3-4 kHz, and for conductive and mixed hearing loss, the bone conduction threshold should not be more increased than 45-65 dBHL between 0.5 and 4 kHz. The standard surgical procedure was originally designed for purely sensorineural hearing loss, and the fixation clip of the vibrating transducer needed to be crimped onto the long process of the incus. In many cases, it is impossible to crimp the vibrator onto the incus. In order to solve such circumstances, fixation clips (couplers) have been developed. There are two options to crimp the device on the incus: applying a long process coupler or a short process coupler. For conductive or mixed hearing loss, a round window soft coupler has been introduced. In advanced otosclerotic cases, a special combined technique of Soundbridge implantation with simultaneous stapedotomy can result in sufficient hearing rehabilitation. These techniques significantly broadened the scale of possibilities for the implantation, therefore, it became a widely utilized, reliable procedure. At the Department of Otorhino-laryngology, Clinical Center, University of Pécs, in addition to a noteworthy amount of incus vibroplasty, several cases of round window vibroplasty have also been performed. The aim of the present study is to summarize the history of development of the Vibrant Soundbridge and to present an overview of the applicable surgical techniques. Orv Hetil. 2021; 162(40): 1619-1626.

Objective: Compare intraoperative and postoperative outcomes of endoscopic and microscopic stapes surgery to provide objective evidence on whether the former is a better alternative than the latter., Methods: We performed a systematic review and meta-analysis for studies that compared endoscopic stapes surgery with microscopic stapes surgery. Only studies that met predetermined criteria were selected and assessed for bias and quality. Primary outcomes were postoperative air-bone gap (ABG) and chorda tympani nerve injury. Secondary outcomes were average operating time, tympanic membrane (TM) perforation, and postoperative taste disturbance, pain, and dizziness. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. A confidence interval starting above 1.0 was considered as statistically significant. I 2 and χ 2 tests were used to quantify statistical heterogeneity. We used funnel plots to look for publication bias and performed a sensitivity analysis., Results: Six nonrandomized cohort studies were eligible. The primary outcomes were ABG < 10 dB: OR = 1.80 (95% CI: 0.96 to 3.38), ABG = 11 dB to 20 dB: OR = 1.49 (95% CI: 0.76 to 2.93), ABG > 20 dB: OR = 2.51 (95% CI: 0.77 to 8.22), and chorda tympani injury: OR = 3.51 (95% CI: 1.55 to 7.93). Secondary outcomes were taste: OR = 2.36 (95% CI: 1.01 to 5.51), average operation time: WMD = 0.14 (95% CI: -11.69 to 11.98), TM perforation: OR = 1.70 (95% CI: 0.44 to 6.58); pain: OR = 0.84 (95% CI: 0.36 to 1.96), and dizziness: OR = 2.15 (95% CI: 0.94 to 4.89)., Conclusions: Endoscopic stapes surgery is a valid alternative to the microscope., Level of Evidence: 2a Laryngoscope, 130: 2019-2027, 2020., (© 2019 The Authors. The Laryngoscope published by Wiley Periodicals, Inc. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Subtotal petrosectomy (STP) has been known for decades and it is considered being on the borderline between ear and skull-base surgery. Due to its excessive radicalism and adverse effects on hearing, it has been a forgotten surgical technique until recently. Over the last decade, due to its many benefits and the ability to combine it with modern hearing rehabilitation methods, STP has reappeared, providing a definitive solution to a number of problematic middl-ear disorders. Aim: In our retrospective clinical study, we wanted to highlight the effectiveness of STP, analyzing the efficiency of this surgery for the first time in domestic patient records, and to report our own experiences to date. Method: We processed data from 45 surgeries on our 44 patients. In addition to presenting the various surgical indications, we review the steps of the operation, analyze the audiological results, including the various methods of hearing rehabilitation, and also analyze the complications that have occurred. Our results are also summarized in the light of international professional literature. Results: Of our 44 patients, 23 were female and 21 were male. Patients had a mean age of 44.6 ± 20.5 years and a mean follow-up of 23 ± 16 months. Of our patients, 25 (57%) had undergone at least two previous unsuccessful ear operations, and 6 (14%) had deafness before surgery. The most common indication was chronic otitis media with cholesteatoma. 13 patients underwent 14 cochlear implantations (23%), in addition 6 patients received bone anchored hearing aids (BAHA) (14%), and 2 patients (5%) underwent VSB (Vibrant Soundbridge) placement against the round window membrane. Complications occurred in 11 of our patients, the most common of which was cerebrospinal fluid leak (5 cases, 11%) and wound dehiscence (3 cases, 7%). Data from 3 patients were available for processing the audiological results. Conclusion: STP is an extremely favorable surgical solution for a number of middle-ear pathologies that have previously caused major problems. The main reason for its growing popularity is that it can be combined with a number of modern, effective methods of hearing rehabilitation. Orv Hetil. 2020; 161(14): 544-553.

Background: Several studies have suggested that monitoring the depth of anaesthesia might prevent the development of postoperative cognitive decline. We aimed to conduct a meta-analysis to investigate the effects of bispectral index (BIS) monitoring in anaesthesia., Methods: We searched in six major electronic databases. Trials were included if they discussed anaesthesia with and without BIS monitoring or low (<50) and high (≥50) BIS levels and which measured the risk of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD)., Results: We included fourteen studies in the systematic review, eight of which were eligible for meta-analysis. BIS proved to be protective against POD at 1 day postoperatively in a cohort of 2138 patients (16.1% vs. 22.8% for BIS vs. no BIS groups, respectively; relative risk [RR] 0.71; 95% confidence interval [CI] 0.59 to 0.85, without significant between-study heterogeneity I2 = 0.0%, P = 0.590). The use of BIS was neutral for POCD at 1 week but protective for POCD at 12 weeks (15.8% vs. 18.8% for BIS vs. no BIS groups, respectively; RR = 0.84, CI: 0.66 to 1.08), without significant between-study heterogeneity (I2 = 25.8%, P = 0.260). The neutral association at 1 week proved to be underpowered with trial sequential analysis. In the comparison of low BIS versus high BIS, the incidence of POD at 1 day was similar in the groups., Conclusion: Our findings suggest a protective effect of BIS compared to not using BIS regarding the incidence of POD at 1 day and POCD at 12 weeks. However, limitations of the evidence warrant further investigation to identify those groups of patients by age, comorbid conditions and other individual variables who would benefit the most from the use of BIS monitoring., Competing Interests: The authors have declared that no competing interests exist.

The aim of this study was to visualize the tumor propagation and surrounding mucosal field in radiography-based 3D model for advanced stage HNSCC and combine it with HPV genotyping and miRNA expression characterization of the visualized area. 25 patients with T1-3 clinical stage HNSCC were enrolled in mapping biopsy sampling. Biopsy samples were evaluated for HPV positivity and miR-21-5p, miR-143, miR-155, miR-221-5p expression in Digital Droplet PCR system. Significant miRNA expression differences of HPV positive tumor tissue biopsies were found for miR-21-5p, miR-143 and miR-221-5p compared to the HPV negative tumor biopsy series. Peritumoral mucosa showed patchy pattern alterations of miR-21-5p and miR-155 in HPV positive cases, while gradual change of miR-21-5p and miR-221-5p was seen in HPV negative tumors. In our study we found differences of the miRNA expression patterns among the HPV positive and negative tumorous tissues as well as the surrounding mucosal fields. The CT based 3D models of the cancer field and surrounding mucosal surface can be utilized to improve proper preoperative planning. Complex evaluation of HNSCC tissue organization field can elucidate the clinical and molecular differentiation of HPV positive and negative cases, and enhance effective organ saving therapeutic strategies.

Herpes zoster (HZ) causes considerable pain and distress, and γ-Aminobutyric acid (GABA) and its derivatives are assumed to control this, but the available data are inconsistent. This meta-analysis and systematic review aimed to assess the effectiveness of GABA derivatives in the prevention of acute herpetic pain. The metaanalysis was conducted following the PRISMA guidelines using PICO format, registered in PROSPERO number CRD42018095758. PubMed, Web of Science, Ovid, Scopus, and EMBASE databases were searched. Records were included if they were randomized controlled trials of patients undergoing HZ infection, investigating the effect of GABA derivatives versus placebo in the treatment of HZ pain. Eligible trials were evaluated for the risk of bias. Then data were extracted and analysed. The number of patients with observed presence of pain after treatment was used to calculate odds ratio in a random effect model with the DerSimonian-Laird estimator. The I2 statistic was analysed for heterogeneity. The potential risk of bias was measured using Egger's regression test. The meta-analysis included three randomized controlled trials with a total of 297 patients. The incidence of acute HZ pain events for GABA group was significantly lower compared to placebo group,18/148 vs 44/149, respectively (OR = 0.36; 95% CI = 0.14 to 0.93; Z = 2.11; P = 0.035), Egger's test yielded P = 0.308. In conclusion, the present meta-analysis demonstrates that GABA derivatives reduce the incidence of acute herpetic pain. However, additional, well-designed randomized clinical trials are needed to determine their dose- and time-dependency regarding this symptom., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Endoscopic type I tympanoplasty was originally introduced in the 1990s, and the extensive spread of this practice can be easily observed. The conventional technique performed involves the repair of a tympanic membrane perforation, and is defined as microscopic type I tympanoplasty., Objective of Review: The aim of this study was the comparison of postoperative outcomes of both the endoscopic and the microscopic type I tympanoplasty., Type of Review: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines., Search Strategy: A systematic literature search was performed in the databases of PubMed, Embase, Cochrane Library, Clarivate Analytics-Web of Science, ClinicalTrials.gov, World Health Organization Library, and Scopus by inserting, 'myringoplasty OR (tympanoplasty AND perforation)' into the search query. We applied only a 'human' filter. We excluded non-English studies. Additional records were identified by checking the references of relevant studies., Evaluation Method: Comparative studies were included in our analysis. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and weighted mean difference (WMD) with a 95% CI for continuous outcomes. Additionally, we assessed the risk of bias and estimated the quality of evidence for each outcome., Results: Our systematic search yielded 16 studies (involving 1179 interventions), eligible for analysis. The pooled graft uptake rate (OR: 1.21, CI: 0.82-1.77; I 2  = 0.0%), the postoperative hearing results (WMD = -1.13; 95% CI: -2.72-0.45; I 2  = 78.1%) and the operation time (WMD = -21.11; 95% CI: -42.60-0.38; I 2  = 99.3%), were all comparable amongst the two techniques. In contrast, the endoscopic type I tympanoplasty outperforms when regarding the pooled canaloplasty rate (OR = 7.96; 95% CI: 4.30-14.76; I 2  = 0.0%, P = 1.000) and features an increase in desirable cosmetic results (OR = 19.29; 95% CI: 11.37-32.73; I 2  = 0.0%, P = 0.839), when compared with the microscopic approach., Conclusions: Based on our meta-analysis, the surgical outcomes of endoscopic type I tympanoplasty in terms of graft uptake rate, postoperative hearing results and operation time were comparable to the microscopic type I tympanoplasty. In regards to cosmetics, an increase in desirable results was achieved in the endoscopic group, particularly the incidence of canaloplasty which proved to be significantly lower., (© 2019 The Authors. Clinical Otolaryngology Published by John Wiley & Sons Ltd.)

Background/aim: The role of microRNAs (miRNA) in carcinogenesis is related to their genome-regulatory function. The aim of the present study was to identify and compare miRNA expression signatures of meso- and hypopharynx squamous cell cancers in consideration of the cancer field hypothesis., Patients and Methods: Thirteen snap-frozen biopsy series of tumors and peritumoral tissues from the meso- and hypopharynx were analyzed regarding their miRNA expression with quantitative real-time polymerase chain reaction (qRT-PCR)., Results: Significant miRNA expression changes of miR-21, -27a, -34a, -143 and -146a were found in peritumoral tissues that were dependent from the tumor location and the distance from the primary tumor site., Conclusion: miRNA expression analysis was found to be appropriate for molecular segregation of tumor location and peritumoral tissue segments, and appears to be a promising marker for cancer field characterization., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

The aim of this study was to evaluate the short and medium-term effects of radiofrequency (RF) and potassium titanyl phosphate (KTP) and neodymium-yttrium-aluminum garnet (Nd:YAG) laser treatment on the inferior turbinate mucosa in a porcine model. Following randomization, the inferior turbinates were treated either with RF submucosally or with the KTP or the Nd:YAG laser on the surface under videoendoscopic control. Tissue samples were taken at the end of postoperative weeks 1 and 6, and were evaluated macroscopically and histopathologically. Scanning electron microscopy was implemented to demonstrate the morphological changes in the respiratory epithelium. Six weeks following the RF procedure, the mucosa was intact in all cases, and the volume of the inferior turbinates was reduced in the majority of the cases. Although a volume reduction occurred in both laser groups, more complications associated with the healing procedure were noted. With hematoxylin and eosin and periodic acid-Schiff staining, intact epithelium, and submucosal glands remained after the RF procedures at the end of postoperative week 6. Following the KTP-laser intervention, necrotizing sialometaplasia and cartilage destruction occurred, and squamous metaplasia was also apparent in the Nd:YAG group. In both laser groups, dilated glands with excess mucus were seen. The scanning electron microscopic findings demonstrated that cilia were present in all cases. In conclusion, the medium-term macroscopic results were similar in all 3 groups, but the postoperative complications were less following the RF procedure. RF procedure is minimally invasive due to the submucosal intervention that leads to a painless, function preserving recovery.

The aim of this retrospective study was to compare the 3-month postoperative hearing results following laser stapedotomy with the use of NiTiBOND versus Nitinol prostheses (31 and 39 patients, respectively). The operations were performed between September 2012 and September 2014, and between March 2006 and December 2012 regarding NiTiBOND and Nitinol, respectively. Twenty of the consecutive 31 patients were female and 11 were male for NiTiBOND, while 11 were male and 28 were female for Nitinol. The mean age was 43.8 years (range 22-61) and 46.9 years (range 28-83) for NiTiBOND and Nitinol, respectively. No significant cochlear trauma was documented postoperatively. The mean air-bone gap (ABG) for the frequencies 0.5, 1, 2 and 3 kHz at the 3-month postoperative follow-up was 7.6 dB (SD 4.7), and 9.3 dB (SD 4.1) for NiTiBOND and Nitinol, respectively. The differences between the mean pre- (p = 0.179), and postoperative (p = 0.059) ABG of the two groups were not significant. ABG closure within 10 dB was achieved in 77.4 and 59 % for NiTiBOND and Nitinol, respectively, the difference was not significant (p = 0.10). Two cases of delayed facial paralysis occurred, 1 with Nitinol and 1 with the NiTiBOND. All patients attained an ABG <20 dB following surgery. Laser stapedotomy with the application of either heat-memory piston prosthesis allowed an easy and minimally invasive approach with excellent short-term hearing results when the NiTiBOND prosthesis was applied. Laser application allowed manipulation in a bloodless environment and avoided manual crimping of the incus.

Introduction: MicroRNAs play a role in carcinogenesis through their genome regulatory function., Aim: The aim of the authors was to identify and compare microRNA expression signatures of meso- and hypopharynx squamous cell cancers on the basis of the cancer field hypothesis., Method: Using standard mapping biopsy (tumour tissue and macroscopically normal tissues obtained 1, 2 and 3 cm from margin) 13 snap frozen sample series were analysed for microRNA expression with quantitative real-time polymerase chain reaction., Results: MiR-221 was significantly overexpressed in mesopharynx cancers, whole miR-21, miR-143 and miR-155 showed significant overexpression in hypopharynx cancers., Conclusions: Using microRNA expression profiles the authors were able to distinguish peritumoural tissues according to distance from the primary tumour site. Future application of the method may prove to be useful in early detection of the altered epigenetic regulation in tissue fields representing normal phenotype. This may be helpful in cancer risk assessment and prevention.

The class of salivary gland tumours is very heterogenous, both in a histopathological and clinical sense. Since they are uncommon lesions, their clinical management is still problematic. Molecular mechanisms underlying the development of these cancer types may be fundamental for the diagnosis, treatment and prognosis of this disease. In this study, the gene expression of nuclear factor-kappa B (NKkB1/p65), c-Jun N-terminal kinase (JNK1) and growth arrest and DNA damage (GADD45A), which all play an important role in inflammatory and cell survival mechanisms, was assessed in benign and malignant neoplasms of the salivary gland. The absolute mRNA content of paraffin embedded samples of salivary gland cancer was determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) using specific primers for NFkB1, GADD45A and JNK1. Expression values (relative to HPRT) were statistically evaluated. Among the detected alterations in gene expression, the only difference reaching statistical significance was in the case of NFkB1 in adenocystic carcinomas (p=0.05). Given the importance of these signalling mechanisms in the biology of tumorigenesis, these results may be implemented in further research and these genes might become targets for innovative diagnostic and therapeutic strategies.

Background: Over- or underexpression of miR-146a has been reported in several different human tumor types, and a polymorphism in its precursor form (pre-miR-146a rs2910164 G/C) has been recently studied in connection with cancer susceptibility. The aim of the present study was to investigate the possible influence of the pre-miR-146a rs2910164 polymorphism on the risk of squamous cell carcinoma of the head and neck (HNSCC)., Patients and Methods: The study included 468 patients with HNSCC and 468 cancer-free, age-, gender-, and smoking-matched controls. The miR-146a genotypes were determined using polymerase chain reaction with confronting two-pair primers, and their distribution was compared by multivariate binary logistic regression analysis., Results: Occurrence of heterozygous (odds ratio, OR=1.46, 95% confidence interval, CI=1.10-1.95, p=0.009) and C/C homozygous (OR=2.37, 95% CI=1.01-5.60, p=0.048) individuals was significantly more frequent among patients with HNSCC than in the control group., Conclusion: The pre-miR/146a C allele may contribute to an increased susceptibility to HNSCC.

We studied the effect of allelic polymorphisms of cytochrome P450 1A1 (CYP1A1) and uridine-diphosphate-glucuronosyltransferase 1A1 (UGT1A1) on the risk of development of head and neck cancers and overall survival. One hundred and forty-two head and neck cancer patients (48 with laryngeal, 42 with hypopharyngeal and 52 with mesopharyngeal tumours) were included in the study. The control group (150 individuals) included volunteers without malignant tumours. There was no statistically significant difference in age, sex distribution, or smoking habits between the two groups. The participants were genotyped for the CYP1A1 isoleucine/valine (Ile/Val) polymorphism in exon 7 and for the UGT1A1 thymine-adenine-repeat polymorphism (*1 and *28 alleles) in the promoter region of the gene. The effect of the allelic variants on survival was studied using the log-rank test, whereas the χ-test and odds ratios (OR) with 95% confidence intervals (CI) were used to compare the allelic frequencies between patients and controls. Our study revealed a significant link between the occurrence of the CYP1A1 Ile/Val, Val/Val (OR: 1.72, 95% CI: 1.02-2.96, P=0.044) and UGT1A1*28 alleles (OR: 2.74, 95% CI: 1.45-5.18, P=0.002) and an increased risk of head and neck cancers. These alleles decreased the duration of survival significantly (P=0.018 and 0.006). The survival was significantly more strongly reduced when the two high-risk alleles were carried simultaneously (OR: 2.149, 95% CI: 1.111-4.157, P=0.001). Our results suggest that the use of the CYP1A1 Ile/Val and Val/Val variants and UGT1A1*28 as biomarkers can aid risk assessment while their prognostic value can aid planning of individual therapy.

Despite modern diagnostic procedures and up-to-date therapy, the survival of head and neck tumour patients is unfavourable. This can be explained by several factors, one of which is the late recognition of the tumour. This study related to the changes in expression of the c-myc and Ha-ras oncogenes and the p53 tumour suppressor gene as biomarkers in head and neck cancer cases. The gene expressions were investigated on RNA gained from peripheral white blood cells of head and neck cancers patients before and after definitive treatment. The results were compared with those on a control group of patients with non-tumorous diseases. The gene expressions were significantly higher in the cancer group than that in the control group (volunteer medical staff and medical students). After definitive treatment, the expressions of all these genes were decreased in patients in whom there was no recurrence of the tumour, but enhanced in the event of recurrence. Such measurement may serve as reliable biomarkers to monitor tumour development and the efficiency of therapy. The method may also be useful for the early identification of populations exposed to noxe, which may lead to the development of head and neck cancers.

Background: Head and neck cancer is a significant current health problem in Hungary because the mortality of this cancer has increased by 387% in the last thirty-two years. Because of the important role of the XRCC1 gene in DNA repair, we wanted to test the effects of the Arg194Trp and Arg399Gln polymorphisms of XRCC1 on the clinical outcome of head and neck cancer., Patients and Methods: A polymerase chain reaction-restriction fragment lenght polmorphism (PCR-RFLP) method was used. A total of 108 samples were taken from intraoperatively removed formalin-fixed, and paraffin-embedded blocks of tissue. An age- and sex-matched cancer-free control group was used to compare the frequency of polymorph variants., Results: No significant difference was found between patients and controls in repect of the investigated polymorphisms. A significant difference was found between the patients with different XRCC1 194 polymorph status in clinical stage SIII. The survival proportion of patients with the Arg194Arg genotype was significantly lower than of those with the Arg194Trp genotype., Conclusion: The complex analysis of these factors may provide the basis for personal risk assessment and an opportunity for individualised therapy.

Background: Increased production of reactive oxygen species (ROS) by anticancer drugs has been described in patients with various malignancies, which might attribute to their nephrotoxicity., Materials and Methods: The effects of two epigenetic modifiers - trichostatin A (TSA) and 5-aza-deoxycytidine (5AZA) - on ROS production and cell injury alone or in combination with mild oxidative stress were studied in mouse renal proximal tubule cells., Results: Both agents increased mitochondrial ROS production and consequent lactate dehydrogenase (LDH) release either alone or in combination with a low dose of H(2)O(2). The antioxidant N-acetyl-cysteine (NAC) abolished LDH release. It was also found that CREB-mediated transcription, vital for survival of proximal tubule cells, is attenuated by these anticancer agents., Conclusion: The ROS-inducing activity of TSAI and 5AZA might explain the in vivo nephrotoxicity of epigenetic modifiers. The mechanisms that are responsible for this injury could involve attenuation of pro-survival signaling and/or activation of death signaling pathway(s) associated with mitochondrial ROS release.

Objectives/hypothesis: The most frequent complication (generally recognized during revision procedures) following seemingly successful stapedotomies and stapedectomies is necrosis of the long process of the incus. This is currently ascribed to a malcrimped stapes prosthesis or to a compromised blood supply of the incus. The two-point fixation can cause a mucosal injury with a resulting toxic reaction, and also osteoclastic activity. An important aspect in the engineering of ideal stapes prostheses is that they should be fixed circularly to the long process of the incus with appropriate strength. The objective of this study was to compare current knowledge relating to the blood supply of the ossicular chain with the present authors' observations on cadaver incudes. Most of the papers dealing with this issue appeared in the mid-20th century., Methods: The published data were compared with the authors' findings gained from photodocumentation on 100 cadaver incudes. The photos were taken with a Canon EOS 20 digital camera (Canon, Inc., Lake Success, NY) with a 5:1 macro-objective. The long processes of the incudes were examined from four directions under a Leica surface-analyzing microscope (Leica Microsystems GmbH, Wetzlar, Germany)., Results: Analysis of the positions of the entrances of the feeding arteries (nutritive foramina) on the incudes revealed 1-4 nutritive foramina on the long processes of 48% (24) of the left-sided incudes and 56% (28) of the right-sided incudes. The positions of these foramina differed, however, from those previously described in the literature. They were mostly located not on the medial side of the incus body or on the short process or on the cranial third of the long processes, but antero-medially, mostly on the middle or cranial third. In 48% of all the incudes examined, an obvious foramen was not observed either in the body or in the long process of the incus. No relationship was discerned between the chronological age of the incus specimens and the numbers and/or locations of the nutritive foramina. In each case, the opening of the foramen was the beginning of a tunnel running obliquely and medially upward through the corticalis of the long process of the incus. The foramina are thought to be capable of ensuring a richer blood supply between the surface and the inside of the long process, allowing the arteries to run in and out., Conclusions: These observations indicate that conclusions drawn from classical anatomical works appear to need reconsideration. The present authors consider that the reason for the necrosis of the long process of the incus is not a compromised blood supply, except in some exceptional anatomical situations. They discuss the possible reasons why malcrimping may lead to necrosis of the long process of the incus. To prevent such malcrimping, attention is paid to the new generation of prostheses.

Paranasal sinus cancer is rather rare, with an incidence of less than 1 per 100,000 per year, the frontal sinus being the primary site in only 0.3%. Following clinical and radiological examinations, the diagnosis often remains elusive, the condition mistakenly being considered to involve mucocele, pyocele or osteomyelitis. This article reports on a 60-year-old pigeon breeder with squamous cell carcinoma originating in the frontal sinus. The presenting symptoms were a gradually worsening sharp headache, double vision and an oedematous left eyelid. CT and magnetic resonance imaging demonstrated erosion of the orbital roof around an area 10 mm in diameter, without direct infiltration of the bulbus. Twelve months following a frontal craniotomy, tumour excision and postoperative radiotherapy, the patient is symptom-free. A detailed description of this patient and a review of the published work are presented.

Unlabelled: Development of surgical treatment of otosclerotic stapes fixation has been one of the success stories of otology for the past five decades. Nowadays not only stapedectomy and partial stapedectomy, but stapedotomy can also be considered a well established otological procedure., Aim: To introduce this minimally invasive surgical technique into the Hungarian otolaryngology practice, to gain useful experiences, and to analyze the hearing improvements and postoperative complications., Methods: The authors give account of their first clinical experiences with 14 patients with KTP laser assisted stapedotomies using the self-crimping Nitinol piston. A total of 14 patients (11 females, 3 males) who have undergone the procedure between March 2006 and April 2007 were reviewed. The average age of the patients was 42,2 years, 6 procedures were carried out on left ears and 8 on right ones. The average length of follow-up was 9 months (ranged from 6 weeks to 1 year)., Results: Pure tone audiograms documented a hearing threshold improvement of 21,5 dB averaged across 0,5-1-2-3 kHz frequencies. The air-bone gap improvement averaged on the same frequencies was 18,7 dB. After an average 9 months postoperative follow-up period, the average air-bone gap was < 10 dB in 85% of the patients, however, < 20 dB in 100% of the patients. As for the average air conduction result: it was < 30 dB in each patient except for one. In this series, neither facial nerve paresis nor high frequency deterioration of the bone conduction thresholds was reported in the postoperative follow-up period., Conclusions: Based on the authors' favourable experiences and the review of the literature, KTP laser assisted stapedotomy with the use of Nitinol piston has several advantages: 1) the laser-activated memory effect of the piston prevents the disadvantages of the crimping manoeuvre made around the long process of the incus; 2) vertigo, experienced in the early postoperative period is milder and takes shorter time, reducing the length of hospitalisation; 3) the procedure is cost-effective and minimally invasive; 4) application of KTP laser assures bloodless operating field and minimal cochlear trauma; 5) migration of the prosthesis can be prevented, the degree of the surrounding granulation is less; 6) high frequency hearing improvement can be achieved in the long run; 7) the frequency and seriousness of complications is less, therefore this technique can be recommended for inexperienced ear surgeons, too; 8) the procedure can be used in difficult situations, too, e.g.: in the presence of stapedial artery, obliterative otosclerosis, flooting footplate, abnormal position of the facial nerve in the middle ear, revision cases; 9) the interindividual differences of hearing results are much less. Based on their favourable initial experiences, the authors plan to conduct a long-term follow-up on greater number of patients.

Background: Afobazole, a new 2-mercapto-benzimidazole derivative, exhibited antimutagenic activity in chromosome aberration tests and antioxidant properties. The aim of this study was to demonstrate the potential chemopreventive effect of afobazole on the level of early biological effects by analysing changes in oncogene and tumor suppressor gene expression., Materials and Methods: Single intraperitoneal (i.p.) treatment with 7,12-dimethylbenz[alpha]anthracene (DMBA) combined with afobazole was administered to CBA/Ca (sensitive H-2K haplotype) female mice. The expression of Ha-ras and p53 was determined in the vital organs (liver, spleen, lung, kidney, thymus, lymph nodes and bone marrow) 24, 48 and 72 hours later., Results: Coadministration of afobazole and DMBA resulted in a decrease of DMBA-induced overexpression of Ha-ras and p53. Reduction of the DMBA-induced gene expression was most striking when afobazole was given in parallel with DMBA., Discussion: Our results strengthen the previous assumption, which was based on in vitro results, that afobazole has a chemopreventive effect in vivo.

Background: Microarray analysis offers the opportunity of screening transcriptional expression profile of neoplastic cells on a genomic level. Defining consistent changes in gene expression pattern of tumours enables the detection of genes essential for tumorigenesis and might provide biomarkers to early recognition of malignant behaviour and new therapeutical targets., Patients and Methods: A high-density oligonucleotide array with 20,000 human gene-specific oligonucleotide was used to analyze benign and early-stage malignant thyroid tumours of epithelial origin: follicular adenoma, follicular carcinoma and papillary carcinoma, compared to normal thyroid tissue., Results: Significant expression differences of 279 genes -- underexpression of 252 and overexpression of 27 genes -- were found. The overlapping genes of the different histological types were examined extensively. Among these genes a limited set acting on the same transcriptional pathway, through NF-kappaB, were found., Conclusion: The role of overlapping genes in histologically different tumours has not been clarified, but might represent early or pivotal steps of carcinogenesis. All investigated histiotypes of tumours contained significantly modulated genes acting on the NF-kappaB regulatory pathway. Our findings suggest that modulation of NF-kappaB signalling plays a crucial role in early thyroid carcinogenesis.

A retrospective study was performed on patients who underwent myringoplasty for either anterior or subtotal perforations over an 8-year period (from 1994 till 2004). We used the KTP-laser assisted anterior anchoring technique combining with anterior "pull-back" method. Patients' ages ranged from 6-62 years (median 36.5). The mean follow-up period was 2.8 years (minimum 6 months). The audiological results were analysed with the "Pytel software", which was developed in our department. As for the procedure, the drum remnant was freed from the malleus handle with the use of the laser and elevated out of it's sulcus anterior-superiorly. Large fascia graft was fashioned with a split of 4-5 mm in the middle of one edge. The graft was placed using the underlay technique medial to the handle of the malleus. A pull-back tunnel was created at the border of the anterior quadrants to further facilitate the survival of the graft. In this series the graft taking rate was 100%. Reperforation due to an undersized fascia was observed in one case. Post-operative audiological results indicated no bone conduction threshold elevation in any frequencies. Using the laser, cochlear trauma can be prevented, double fixation of the drum prevents lateralisation and blunting. Wide canalplasty makes both the approach and the follow-up very easy. Thorough soft tissue and bone work is advantageous from the fascia taking rate point of view.

The authors investigated the usefulness of the interphase cytogenetic approach to reveal numerical chromosomal abnormalities. Experiments performed on normal human cells using chromosome specific (peri)centromeric probes indicated that disomy was recognized in a range of 89.1 +/- 5.4%-96.8 +/- 0.4% for the somatic chromosomes and in 98.1 +/- 0.8% for the sex chromosomes. Using positivity threshold of mean percentage of the fals monosomy and trisomy + 2 SD, chromosome loss or gain for the somatic chromosomes could be revealed beyond clonal ratio of 3.6-13.2% and 1.1-6.8%, respectively. The same value for the sex chromosomes was 3.2% and 0%, respectively. Eleven pediatric acute lymphoid leukaemia were investigated for chromosomal aneuploidy by interphase cytogenetics using chromosome specific (peri)centromeric probes for all the somatic and sex chromosomes. Results were compared with metaphase cytogenetic and flow cytometry derived gross DNA aneuploidy data. In 5 cases the leukaemic cells proved to be diploid with all three methods at both gross DNA and chromosome levels. Interphase cytogenetics revealed chromosome loss or gain in all the remaining 6 cases, however, metaphase analysis indicated numerical aberration in only 2 patients. In one of them only the increased chromosome number could have been detected without identifying the chromosomes involved and in the other one the two methods indicated trisomy for not the same chromosome. Flow cytometry data showed aneuploidy in 3 out of the 6 aneuploid leukaemia. The results imply that interphase cytogenetics might be more accurate as compared with flow cytometry and metaphase analysis to reveale aneuploidy.