Search

[No abstract available]

Objective: to analyse a large series of patients with initial diagnosis of chronic otitis media (COM) with a polypoid mass in the external ear canal (EAC). Material and methods: 185 consecutive patients with COM were evaluated; 75 showed a polypoid mass in the EAC. Results: In 65 out of the 75 (86.7%) patients, histological examination after mastoidectomy revealed cholesteatoma. In the remaining 10 (13.3%) cases, the histological diagnosis was: glomus tumor, melanoma, mucosal adenoma, fibrous dysplasia, squamous cell carcinoma, adenoma of the endolymphatic sac, encephalocele, and tuberculosis. One patient (glomus tumor) had undergone biopsy of the polypoid mass twice preoperatively and the initial histological diagnosis was " inflammatory polyp" Therefore, we examined the temporal bones with a glomus tumor diagnosis from the temporal bone collection of the House Ear Institute. In 1560 temporal bones, a glomus tympanicum was found in 6. In four cases, the tumor extended to the EAC mimicking a polyp covered by squamous epithelium. Conclusion: A significant percentage of polyps in COM maybe the tip of an 'iceberg'. CT-scan and MRI techniques may be helpful but not always accurate, and biopsies have certain risks. Increased clinical suspicion may limit misdiagnosis and inappropriate management. © 2010 Elsevier Ireland Ltd.

In this study the performance of organic PCMs used as latent heat storage materials, when incorporated in coatings for buildings and urban fabric, is investigated. Thirty six coatings of six colors containing different quantities of PCMs in different melting points were produced. Accordingly, infrared reflective (cool) and common coatings with the same binder system and of the same color were prepared for a comparative thermal evaluation. The samples were divided in six groups of different color and eight samples each: three PCM coatings of different melting temperatures (18 °C, 24 °C, 28 °C) each one of two different PCM concentrations (20% w/w, 30% w/w), an infrared reflective and a common coating of matching color. Surface temperature of the samples was recorded at a 24 h basis during August 2008. The results demonstrate that all PCM coatings present lower surface temperatures than infrared reflective and common coatings. Analysis of the daily temperature differences showed that peak temperature differences occur between PCM and common or cool coatings from 7 am to 10 am. Investigating the temperature gradient revealed that for this time period the values for PCM coatings are lower compared to infrared reflective and common. From 10 am to 12 pm, temperature gradients for all coatings have similar values. Thus coatings containing PCMs store heat in a latent form maintaining constant surface temperatures and discharge with time delay. PCM doped cool colored coatings have the potential to enhance thermal inertia and achieve important energy savings in buildings maintaining a thermally comfortable indoor environment, while fighting urban heat island when applied on external surfaces. © 2010 Elsevier Ltd.

Spirulina or Arthrospira is a blue-green alga that became famous after it was successfully used by NASA as a dietary supplement for astronauts on space missions. It has the ability to modulate immune functions and exhibits anti-inflammatory properties by inhibiting the release of histamine by mast cells. Multiple studies investigating the efficacy and the potential clinical applications of Spirulina in treating several diseases have been performed and a few randomized controlled trials and systematic reviews suggest that this alga may improve several symptoms and may even have an anticancer, antiviral and antiallergic effects. Current and potential clinical applications, issues of safety, indications, side-effects and levels of evidence are addressed in this review. Areas of ongoing and future research are also discussed.

INTRODUCTION: Laryngopharyngeal reflux is perhaps the most extensively researched laryngology topic of the last decade. It has been suggested that some supraoesophageal symptoms, most notably asthma and laryngospasm, may be associated with night-time, or supine, reflux. The aim of this review was to assess the levels of evidence regarding a correlation between night-time reflux, snoring and apnoea. METHODS: A Medline search was performed using the terms 'reflux', 'night-time', 'larynx', 'gastroesophageal', 'laryngopharyngeal', 'sleep', 'apnoea', 'snoring' and 'ear nose throat'. The retrieved literature was reviewed, focusing on randomised and non-randomised, controlled, prospective trials. Papers on both paediatric and adult populations were included. Non-English language papers were excluded. RESULTS: We found no randomised, controlled trials or meta-analyses addressing the possible correlation between reflux and snoring and/or apnoea. CONCLUSIONS: The role of night-time reflux in paediatric and adult snoring and apnoea is well described in the literature, but is based on poor levels of evidence from uncontrolled studies and case reports. Journal of Laryngology and Otology

Otolaryngol Head Neck Surg

American Journal of Medicine

Aims: to assess etiology, treatment and outcome of Grisel's syndrome. Methods: A Medline search was performed using the terms Grisel's syndrome, spontaneous atlantoaxial subluxation, head, neck, ear, nose and throat. A systematic review of the literature was performed. Case series of both adult and pediatric cases were included. Only papers focusing on true non-traumatic atlantoaxial subluxation were included. Results: Seventy-one papers have been published from 1950 to 2006. Forty-eight of these fulfilled our inclusion criteria, totaling 103 patients for review. The main causes of Grisel's syndrome were infection (48%) and post-adenotonsillectomy (31%). Less common causes included other postoperative cases such as pharyngoplasty and ear operations. Neurosurgical consultation was paramount in all cases. In the majority of cases conservative management in the form of bedrest, antibiotics, muscle relaxants, traction and collar was effective; in a few cases only surgery in the form of arthrodesis was deemed necessary. Morbidity was significant in those cases where diagnosis was delayed, with the most devastating consequence a permanent neurological deficit in one case. Conclusions: Grisel's syndrome is a rare but dangerous complication that can go unnoticed in its early phase and can be a major cause of morbidity and mortality following infection or head and neck procedures/interventions. Early recognition of any cervical complication following routine otolaryngological operations together with early neurosurgical consultation is mandatory to prevent devastating consequences. (C) 2007 Elsevier Ireland Ltd. All rights reserved. International Journal of Pediatric Otorhinolaryngology

Objective: To detect the most common causes of vertigo in children. Methods: Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. Results: Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo. Conclusions: A peripheral type of vertigo was found in most cases. Diagnostic approach in vertigo in children should include a detailed history and clinical examination in conjunction with a test battery of audiological and neurotologic tests. When a central cause of vertigo is suspected an MRI or CT scan should be ordered. (C) 2006 Elsevier Ireland Ltd. All rights reserved. International Journal of Pediatric Otorhinolaryngology

Clinical Otolaryngology

OBJECTIVES: Systemic sclerosis (SSc) is a multisystem disease characterized by abnormalities of small blood vessels, and fibrosis of the skin and internal organs including gastrointestinal tract. This article reviews the esophageal involvement in SSc, emphasizing the gastroesophageal reflux, which is a common problem in SSc patients. METHODS: We conducted a Medline search from 1966 to 2005. The keywords "systemic sclerosis," "esophageal involvement," "gastroesophageal reflux," "esophagitis," and "treatment" were used. RESULTS: The gastrointestinal tract is frequently affected in diffuse and limited disease. Although any part of the gastrointestinal tract can be involved, esophageal disease occurs in nearly all patients with SSc. Common esophageal manifestations in SSc include motility abnormalities and gastroesophageal reflux (GER), Barrett's esophagus, adenocarcinoma, infectious esophagitis, and drug-induced esophagitis. Common complications of GER include esophagitis with erosions and bleeding and stricture formation. Extraesophageal manifestations of GER include mouth ulcers, chronic cough, hoarse voice, sore throat, pharyngitis, laryngospasm, asthma, and recurrent pneumonia. Diagnostic procedures used in the investigation of esophageal involvement include barium esophagram, esophageal manometry, 24-hour ambulatory pH, and endoscopy. Treatment of GER in SSc includes behavioral modification and medical therapy, mainly with proton pump inhibitors. Surgical intervention has a limited role in the management of GER in selected SSc patients. CONCLUSIONS: Esophageal involvement is frequent in SSc patients. Gastroesophageal reflux may cause high morbidity. Careful examination of the patients reveals gastrointestinal abnormalities even in patients without symptoms. Appropriate treatment of esophageal involvement ameliorates symptoms and prevents complications. Semin Arthritis Rheum

A study of laryngeal carcinomas was performed in order to analyze (a) the expression of p53/p21, cyclin D1/cyclin E, p21/p27 (b) the relation of normal and abnormal protein expression, with the proliferation status, as determined by the expression of Ki67 and PCNA and (c) the correlation of our findings with prognosis. We performed a retrospective analysis of 57 cases of squamous cell carcinomas of the larynx. We applied monoclonal antibodies against p53, p21, p27, cyclin D1, cyclin E, Ki67 and PCNA, using streptavidin-biotin method. Analysis of the p53/p21 proteins, revealed abnormalities in 25/37 cases (67.57%), while 12/37 (32.43%) cases displayed normal phenotype (p53-/p21-). Analysis of cyclins revealed overexpression in 17/48 cases (35.42), while the majority 31/48(64.58%) displayed normal phenotype (cyclin D1-/cyclin E-). Concerning CDKIs expression, the majority 30/50(60%) presented high levels of both inhibitors (p21+/p27+). Cases with simultaneous overexpression of CDKIs demonstrated significantly higher levels of Ki67 protein (p = 0.05). Analysis of p53/p21, cyclin D/cyclin E, p21/p27 patterns showed no association between the presence of one or two alterations and prognosis. In conclusion, we demonstrated that p53 tumor suppressor pathway is frequently disrupted in laryngeal cancer. Furthermore, levels of CDKIs, although they act as cell cycle activity blockers, are not reliable markers for the estimation of laryngeal neoplastic cells growth fraction. J Exp Clin Cancer Res

OBJECTIVES: Schwannomas (neurilemmomas) are benign solitary tumours which arise from the Schwann cells of the neural sheath, most often from the VIII cranial nerve. Extracranially, 25% of all schwannomas are located in the head and neck. Intra-oral development is uncommon and a location in the tongue has been reported in individual cases. METHODOLOGY: We present a young patient with a schwannoma in the distal right side of the tongue. RESULTS: The tumour had grown slowly producing no symptoms. The diagnosis was made on histological examination. Surgical enucleation of the mass was uncomplicated and there was no recurrence. CONCLUSIONS: We report a further case of a schwannoma of the tongue, highlighting the need for this to be considered in the differential diagnosis. B-Ent

The expression of cell-cycle progression molecules cyclin D1 and cyclin E were immunohistochemically examined in a series of 64 squamous cell invasive carcinomas of the larynx, 10 in situ carcinomas, 34 cases of dysplasia, 11 papillomas and 23 cases of keratosis. The results of their expression were compared with two cell-cycle implicated tumor suppressor proteins p53 and pRb as well as with two proliferation associated indices PCNA and Ki-67 in an attempt to elucidate their potential role in the pathogenesis and progression of these lesions. Nuclear staining for cyclin D1 and E (>5% positive cells) was observed in 19% and 39.7% of the laryngeal carcinomas, respectively. Significantly elevated levels of cyclin D1 and E in invasive laryngeal carcinomas compared with in situ carcinomas were revealed (p=0.045 and p=0.0003, respectively). High levels of cyclin D1 and E expression were correlated with increased Ki-67 score (p=0.037 and 0.017 respectively). A significant positive correlation between cyclin D1 and E was also detected in carcinomas (p=0.018). Decreased levels of cyclins D1 and E in the group of in situ carcinomas compared with those of dysplastic cases and papillomas were also observed. In the dysplastic lesions cyclin D1 expression was correlated with pRb expression (p=0.02). In the cases of keratosis cyclins D1 and E expression were correlated with pRb (p=0.002 and p=0.036, respectively), while cyclin D1 was associated with PCNA (p=0.008) and Ki-67 score (p=0.009). The prognostic significance of cyclins D1, E in determining the risk of recurrence and overall survival with both univariate (long-rang test) and multivariate (Cox regression) methods of analysis showed no statistically significant differences. We conclude that the expression of cyclins D1 and E in squamous cell carcinomas of the larynx does not seem to have a prognostic significance. In addition, their expression may be involved in the development of laryngeal lesions, implicated in cell proliferation, with other cell cycle related proteins, probably by different molecular pathways. J Exp Clin Cancer Res

Objectives : The pathogenesis of middle ear infections in children is multifactorial and includes infection, anatomical factors, impaired immunologic status, allergy, familial predisposition, mate sex, method of feeding and environmental factors. Glue ear remains the commonest cause of deafness in childhood. Gastroesophageal reflux (GOR) is a common problem in the newborn and preschool periods. Recent research suggests that it may be related to eustachian tube dysfunction and otitis media. Methods : We review the literature and discuss the possible relationship between Gastroesophageal reflux and otitis media in children. Conclusions : The current data are not enough to support antireflux treatment in children with refractory middle ear infections. More prospective randomised placebo-controlled studies are needed. (C) 2004 Elsevier Ireland Ltd. All rights reserved. International Journal of Pediatric Otorhinolaryngology

During recent years, the Internet has gradually evolved into a worldwide network, allowing access to vast amounts of information and providing various set-vices. The benefits of medical professionals of using it are growing rapidly, as even more scientific, technical and biomedical resources become available on line. The Internet has always provided useful resources to rhinologists, with the number of relevant sites increasing daily, at a rapid pace. In this article, a review of the information included in several selected rhinology web sites is presented, in order to provide guidance and context for the vast amount of information which is available on the Internet, and to promote the use of the medium to rhinologists who do not have extensive experience in computers or telecommunications. Rhinology

Anticancer Research

The goal of this report is to describe the therapeutic methods and surgical techniques used by Hippocrates (5th century BC) in the treatment of nasal injuries. We studied the original Greek texts of the (generally considered genuine) Hippocratic book Mochlicon and, especially, the analytical On Joints. We identified the treatments and techniques applied to the restoration of injured noses. We found that Hippocrates classified nasal injuries, from simple contusions of soft tissues to complicated fractures. Hippocrates provided detailed instructions for each case, from poultice application and bandaging to reconstruction and reshaping of the nasal bones in cases of fractures and deviation. Hippocrates' texts reflect the interest of the classical period in nasal injuries, a common enough accident in athletics. Hippocratic conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine. Ann Otol Rhinol Laryngol

Objectives. To present selected highlights from the evolution of diagnosis of laryngeal disease and treatment of laryngeal cancer from ancient Greece until the 20th century. Study Design: Historical study of diagnosis of laryngeal disease and treatment of laryngeal cancer from the ancient Greek medical scriptures until the most recent evolutional steps in the 20th century. Methods: Original Greek-language texts of ancient and Byzantine medical writers were studied and literature on history of medicine was investigated to reveal early knowledge of diagnostic and therapeutic techniques for laryngeal disease and cancer of the larynx. Results: Diseases of the upper aerodigestive tract were known and treated by ancient Greek physicians, and, later, Byzantine doctors, apart from preserving ancient medical concepts, contributed their own ideas, mainly about surgery and postoperative care. The initial therapeutic approach for the disorders caused by laryngeal tumors was either tracheotomy or endotracheal intubation in an attempt to prevent suffocation. In more recent times, construction of the laryngoscope and other modern examination instruments, as well as the final acceptance of histological diagnosis based on tissue biopsy, has allowed for accurate diagnosis and successful treatment of laryngeal lesions. Preoperational biopsy, application of pharyngoesophageal speech and advanced vocal devices for the laryngectomees, and invention of antibiotic and anesthetic agents had led, by the middle of the 20th century, to the establishment of extended and radical surgical techniques as optional treatment for laryngeal cancer. In addition, the discovery of x-rays and radium introduced radiotherapy as an alternative in the treatment procedure for cancer of the larynx. Conclusion. Progress in the evolution of laryngological diagnosis and practice demanded efforts by many daring and courageous investigators and surgeons, contributing new ideas and techniques in the development of modern laryngology.

Meniere's disease is a vestibular disorder characterized by episodic vertigo, tinnitus, fluctuant hearing loss, and ear fullness, with vertiginous attacks being the most disabling complaint. The effectiveness of conservative treatment has been variable, while surgical techniques provide more permanent relief from vertigo, but pose possible morbidity and cochlear risk. Intratympanic administration of gentamicin has been proposed as an alternative for patients with debilitating Meniere's disease who have failed to respond to standard medical treatment. The goal of such treatment is to control vertigo by partially or completely destroying the vestibular system, while at the same time maintaining hearing. In this review we present the current medical literature on pathophysiology, pharmacokinetics, administration methods, dosage, treatment protocols, and problems related to intratympanic administration of gentamicin for patients with MD. Intratympanic gentamicin administration is a simple medical modality for treatment of persistent vertigo in patients with Meniere's disease. According to recent world research protocols, we propose the instillation of gentamicin by transtympanic injection, as a quick, easy, well-tolerated, ambulatory and cost-effective technique. Drug solution concentrations should be dependent on the frequency, intensity and duration of vertigo spells, as well as the degree of existing hearing loss, thus providing progressive vertigo relief with a low possibility of secondary deafness. Journal of Laryngology and Otology

OBJECTIVE: To report on the career of Professor Nicolas Taptas of Constantinople (1871-1955) and his contribution to the development of an artificial larynx. STUDY DESIGN: Historical review. METHODS: The unpublished documents of Taptas's family archives and one of his papers, describing his own original technique for voice rehabilitation after total laryngectomies, were studied. RESULTS: In his texts, Taptas described the application of external laryngeal prostheses in one of his patients who underwent total laryngectomy. Taptas meticulously recorded his own first successful attempt in a woman with cancer of the larynx. He was one of the first scientists who, at the end of the 19th century, devised an external laryngeal prosthesis, which had the advantage of rehabilitating a sufficiently strong whispering voice; by using a prototype valve, he avoided problems of aspiration of liquids and food to the bronchi. CONCLUSION: Nicolas Taptas's contribution to the development of the artificial larynx was vital because he devised and applied one of the first external laryngeal artificial prostheses with satisfactory functional results. Laryngoscope

Ramsay Hunt syndrome (RHS) is herpes zoster of the facial nerve, frequently associated with VIII cranial nerve involvement, but on rare occasions other cranial nerves are affected as well. We present the case of a 63-year-old woman with RHS with involvement of V, VII, VIII, IX, and XII cranial nerves. The patient showed significant improvement after treatment with acyclovir and prednisolone. RHS should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves, including the facial nerve and the auditory-vestibular apparatus. Early institution of treatment with antiviral agents may help hasten healing. Involvement of the XIIth cranial nerve has not been reported previously. Acta Otorhinolaryngol Belg

CD44, the product of a single gene, exists as several isoforms generated by alternative exon splicing and posttranslational modifications, and is widely distributed in different cells and tissues including those of squamocellular origin. CD44 is a cell surface glycoprotein involved in many cellular processes acting as a receptor for cell to cell or cell to matrix adhesion, as a signal transmitter and as a growth factor-presenting molecule. Numerous studies based on immunohistochemical analyses of paraffin-embedded or frozen tissue sections using different monoclonal antibodies to CD44 isoforms and molecular biological techniques have provided evidence that in many types of tumours there is overexpression of CD44 isoforms and aberrant processing of immature CD44 transcripts relative to nonneoplastic control tissues, suggesting a role of CD44 in tumour development and progression. In contrast to these malignancies, one or more of the CD44 splicevariant isoforms are down-regulated in squamous cell carcinomas of the head and neck. CD44-deficient mice develop normally without giving rise to spontaneous tumours, but CD44-negative cells appear to be more susceptible to oncogenic transformation. Reduction in the expression of CD44 may confer growth advantage and malignant properties to tumour cells. The clinical significance of CD44 in squamous cell carcinomas of the head and neck as a tumour marker for cancer diagnosis and prognosis is discussed.

In this paper we present an uncommon tumor found in the nasal cavity, the result of a metastasis from primary tumor of testis (embryonal carcinoma) in a young patient of 24 years of age. For this uncommon tumor we discuss the case with the Greek and foreign bibliography. Acta Otorhinolaryngol Belg

Extracts of plants have been widely tested for possible anticarcinogenic properties. In the present study a traditional remedy, consisting of an aqueous extract of mixed parts of the tree Abies alba and its mistletoe Viscum album se abies was tested on benzo(alpha)pyrene(BaP)-induced tumors in Wistar rats and on the L-1210 malignant cell line. Two main groups of male Wistar rats subcutaneously injected by 10 mg of BaP, a dose inducing 100% carcinogenesis, a control group (C-G, 15 rats) and a treatment group(TR-G, 18 rats), were used for the study. Five animals bearing BaP-induced tumors were also tested (TR-1-G). Animals of the TR-G were orally administered with the aqueous extract at doses of 50 ml/kg b.w, from the day of BaP injection and of the TR-1-G, from the 120th day of injection, till death. L-1210 malignant cells in cultivation, were administered with a powder obtained by condensation and lyophilization of the extract, at various concentrations and cytotoxicity was measured by the microculture tetrazolium assay. Autopsy of the rats, revealed metastasis in the lungs of the animals of all groups and the tumors developed were histologically identified as leiomyosarcomas. The results indicated that the extract of the above plants possess anticarcinogenic effects, documented by: a) its antiproliferative effects on L-1210 cells (IC50 = 49.6 +/- 1.4 micrograms/ml), b) the significant prolongation of life and reduction of tumor growth rate of the animals of the TR-G in comparison to the C-G, c) the inhibition by 16.6% of tumor induction in the TR-G and d) the prolongation of life and the necrotic effects of the extract on the tumors of the animals in the TR-1-G. The antiproliferative effects of the Abies alba and Viscum album se abies extract may be due to the lectins and thionins contained in Viscum album, as well as to the monoterpenes contained in Abies alba. Soft tissue tumors sensitive to the extract, are widespread among human organs, even in larynx, and are usually resistant to chemotherapy. Anticancer Research

We present the techniques of various operations on the larynx and pharynx (incision of abscesses of the tonsils, tonsillectomy, tracheotomy, uvulectomy, and removal of foreign bodies) found in the Greek texts of Byzantine physicians. The techniques of these operations were the first to be so meticulously described and were compiled from the texts, now lost, of the ancient Greek physicians. These medical texts, which followed and enriched the Hippocratic, Hellenistic, Roman, and Galenic medical traditions, later influenced medieval European surgery, either directly through Latin translations or indirectly through works of Arab physicians.

OBJECTIVE: To estimate the diagnostic accuracy and reliability of exfoliative laryngeal cytology. STUDY DESIGN: Over three years (1996-1999) cytologic smears were obtained from clinically suspicious laryngeal lesions during laryngoscopy in a total of 31 selected patients (28 males and 3 females with an age range from 28-90 years). The cytologic diagnoses were analyzed and correlated with the histologic and final clinical diagnoses in 17 and 14 cases, respectively. Cytologic identification of the exact histologic type of the lesion was evaluated in 17 patients from whom both cytologic smears and biopsy material were obtained. RESULTS: The overall specificity was 100%, with no false positive diagnoses. The overall sensitivity was 93.3%, with one false negative cytologic diagnosis, in a case of non-Hodgkin's lymphoma. Cytohistologic correlation showed complete agreement between cytologic and histologic diagnoses in five of six benign lesions, in four cases of dysplasia and in six cases of squamous cell carcinoma. The overall diagnostic accuracy of cytology was 96.7% CONCLUSION: Exfoliative cytology by the smear technique is a reliable and accurate method in clinically suspected laryngeal lesions. Moreover, exfoliative cytology may be applied as the only alternative diagnostic method, especially in elderly patients with coexistent cardiorespiratory problems, when biopsy is not advisable or indicated. Acta Cytol

The goal of this study was to describe the therapeutic methods and surgical techniques used during Byzantine times (AD 324-1453) for a disease that has occupied physicians since antiquity: nasal polyps. The original Greek-language texts of the Byzantine medical writers, most of which were published after the 17th century, were studied in order to identify the early knowledge of the definition, symptoms, conservative treatments, and surgical intervention in cases of this disease. A considerable number of conservative treatments, etiologic and local (with inunctions or blowing of caustic substances), with evident influence from Roman medicine, were identified even in the early Byzantine medical texts (4th century). Further, some surgical techniques were described that seem to constitute evolution of the Hippocratic tradition. From the study of the original texts of Byzantine medical writers, their interest in the rhinological diseases is evident; in the case of nasal polyps, new techniques were mentioned. The first meticulous intranasal surgical removal of polyps was described. These techniques, obviously developed during the Hellenistic period, initially influenced European medicine and later the rest of the world. Ann Otol Rhinol Laryngol

Tenascin (TN) is an extracellular matrix glycoprotein expressed in areas of epithelial-mesenchymal interactions during embryogenesis and in neoplasia. We studied the expression of TN in a series of 35 squamous cell invasive carcinomas of the larynx, 13 in situ carcinomas, 41 cases of dysplasia, 10 papillomas and 18 cases of keratosis using the monoclonal antibody TN2 on paraffin-embedded tissue. TN expression was correlated with the expression of fibronectin, CD44 and cathepsin D (CD) proteins, with the proliferation indices Ki-67 and proliferating cell nuclear antigen (PCNA) as well as with conventional clinicopathological variables. Malignant tumours showed a significantly greater stromal TN staining than benign lesions. In invasive carcinomas, the immunoreactivity was statistically higher than that in situ (P=0.01), dysplastic lesions (P

Clinical studies in several tumour types have shown a strong correlation between cathepsin D expression and tumour progression. Immunohistochemical staining for cathepsin D (clone D13A) was performed in paraffin embedded-tissues from 39 invasive squamous cell carcinomas, 13 in situ carcinomas, 35 cases of dysplasia, 10 papillomas and 17 cases of keratosis. The association between cathepsin D expression and CD44, p53, Rb proteins and proliferation indices (Ki-67, PCNA) was assessed by univariate analysis. Cathepsin D was highly positive in the groups of carcinomas compared to other lesions (p < 0.0001). A statistically significant correlation of cathepsin D expression with CD44 expression was observed in invasive cancers (p = 0.037). The relationship of cathepsin D immunoreactivity with p53, Rb and proliferation indices was insignificant. The results show that cathepsin D is expressed in a higher proportion of cancerous lesions of the larynx than in non cancerous or premalignant lesions, a fact which suggests that cathepsin D may be involved in laryngeal tumour cell growth process. Anticancer Res

Hypothesis: The aim of this study is to present the therapeutic methods and surgical techniques in diseases of the ear during Byzantine times (324-1453 A.D.). Background/Methods: The original creek language texts of the Byzantine medical writers were studied to research early otologic knowledge of symptomatology, conservative treatments, and surgical confrontation of diseases of the ear. Results: A considerable number of conservative treatments for many otologic conditions were identified; these therapies were especially based on herbs, animal and mineral substances applied either as eardrops: clysters, poultices, or by using special instruments and apparatus. Among these were identified otitis, rupture of the eardrum, hemorrhage from the ears, deficiency of hearing and deafness, vertigo, tinnitus, and earwax. Furthermore, in these early texts, there were also described some surgical techniques in cases of atresia of the external auditory canal, of defects in or lack of the pinna, and for removal of foreign bodies and fleshy tumors. Some of the earliest hearing aids were also mentioned. Conclusions: From the study of the original works of Byzantine writers, it is evident that numerous treatments and surgical techniques relating to otology were practiced; these were derived not only from compilation of knowledge obtained from the ancient Greek medical sources, a considerable part of which are now lost, but also enriched by Byzantine physicians' personal experience. This knowledge influenced medieval European medicine and, through it, that of the rest of the world. American Journal of Otology

CD44 is an integral membrane glycoprotein that has diverse functions in cell-cell and cell-substrate interactions. It has been suggested that it may be a determinant of metastatic and invasive behavior in carcinomas. The immunohistochemical expression of CD44 was examined in a series of 34 squamous cell carcinomas, 13 in situ carcinomas, 35 cases with various degrees of epithelial dysplasia, 10 papillomas and 17 cases of keratosis. We used the monoclonal mouse antihuman phagocytic glycoprotein-1 CD44 (clone DF 1485), on formalin-fixed, paraffin-embedded tissue. CD44 expression was correlated with the expression of Rb and p53 proteins, with the proliferative indices Ki-67 and PCNA as well as with conventional clinicopathological data. The mean value of CD44 expression was 78.84 in squamous cell carcinomas, 78.04 in in situ carcinomas, 54.93 in dysplasia, 26.8 in papillomas and 24.97 in keratosis. There was no significant difference of CD44 expression between in situ and invasive carcinomas. However, a strong difference of reaction between carcinomas and the other cases was observed. CD44 expression was statistically higher in dysplastic lesions than the cases of keratosis (p