Gábor Ráth

Propranolol for infantile haemangioma: Striking effect in the first weeks

OBJECTIVE Discuss effect and dynamics of propranolol (PR) treatment in infantile haemangioma (IH) of head and neck in children during follow-up. METHODS Between 2010 and 2011, 22 children with head and neck infantile haemangioma (IH) treated by PR were recruited into the study. In a retrospective chart review clinical data were analyzed at 5 consecutive, different check-up time from 1 week to 12-14 months. Effectiveness of PR treatment was assessed by a symptom score method. RESULTS In the whole series a significant regression was observed in 13 patients (59%) in the first week of the therapy. Further five patients showed this time a marked, two mild improvements, and two children did not respond initially to the PR therapy. In one of them (case #8) later on a mild improvement could be seen too. At the second check-up (1 month after initiating PR therapy) 50% of children showed definitive improvement compared to the first visit. Difference between first and second check-ups was significant, and between the 4th and 5th visits the improvement showed the lowest rate. Comparison of IH regression between the 2nd and the 5th check-ups resulted in a p value a little larger than 0.05. There was not significant correlation between the initial IH severity and the treatment effectiveness at the follow-ups (p>0.05). No significant differences were found in treatment effectiveness concerning the IH localizations, too. CONCLUSION PR treatment is highly effective in children with IHs. The most striking effect is seen at the first week of treatment; later improvement is much slower, sometimes with periods of stagnations. The cause of this is probably the spectacular early effect of vasoconstriction, though other impacts of PR to the individual molecular markers of IH seemed to be less impressive clinically. However, treatment should be continued for at least 6 months because early cessation can cause a relapse.

Extracorporal septal reconstruction with polydioxanone foil

•  Conventional septoplasty cannot be the answer to all types of septal deviation. •  Indications of extracorporal septal reconstruction with polydioxanone (PDS) foil: (i) selected cases of very high septal deviations, (ii) post‐traumatic and (iii) extremely pronounced congenital septal deviations and/or aesthetic deformities. •  Polydioxanone foil facilitates the incorporation of a newly implanted septal graft without significant postoperative complications and is absorbed within 25 weeks. •  The surgical technique is described in detail, and the early postoperative functional and aesthetic results (mean follow‐up: 11 months) on 16 patients (mean age: 42 years) are reported. Overall, 88% of the patients responded positively to the question of whether they would choose to undergo the same procedure again, knowing the postoperative result. •  The procedure is easy to learn and has already proved to be an excellent combination of modern functional and aesthetic nasal surgery.

Ionomer cement for reconstruction of the long process of the incus: the Pécs experience

•  Experience gained with the repair of the defects of the long process of the incus with ionomer cement in 35 patients is reported. •  The integrity of the reconstructed tympanic membrane and the four‐frequency average of the air‐bone gaps of the postoperative audiograms (best, most recent and at around 1 year) were evaluated. •  This ‘physiological’ reconstruction of the ossicular chain fulfilled our expectations in 40% of the patients (air‐bone gap ≤ 10 dB). •  The background of the unsuccessful cases was investigated.

Effects of cytochrome P450 1A1 and uridine-diphosphate-glucuronosyltransferase 1A1 allelic polymorphisms on the risk of development and the prognosis of head and neck cancers.

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 &khgr;2-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.

Laser stapedotomy – the up-to-date solution of otosclerotic stapes fixation

A vezeteses hallascsokkenest okozo otoscleroticus stapesfixatio műteti megoldasanak folyamatos fejlődese az elmult fel evszazad egyik fulsebeszeti sikertortenete. A stapedectomia, illetve parcialis stapedectomia mellett manapsag a stapedotomia is elterjedt műteti megoldasnak tekinthető. Cel: A minimalisan invaziv lezerstapedotomia hazai bevezetese, tapasztalatok szerzese, valamint a műteti hallaseredmenyek es a posztoperativ komplikaciok elemzese. Modszer: A szerzők kozlemenyukben KTP-lezerrel asszisztalt, Nitinol-pisztonnal vegzett 14 esetuk kapcsan ismertetik lezerstapedotomiakkal szerzett első tapasztalataikat. 2006 marciusa es 2007 aprilisa kozott 11 nőbeteget es 3 ferfi beteget operaltak. A betegek atlageletkora 42,2 ev volt, 6 esetben bal, 8 esetben jobb fulon tortent a műtet. A betegek atlagos kovetesi ideje 9 honap volt. Eredmenyek: A posztoperativ audiogramok ertekelesekor az 500–1000–2000–3000 Hz frekvenciakat figyelembe veve a legvezetes atlagos javulasa 21,5 dB volt. Ugyanezen frekvenciakon a ...

Application of ionomer cement onto the stapedial footplate: Impact on the perilymphatic aluminum level

From an acoustic aspect, fixation of the medial end of an ossicular replacement prosthesis to the stapedial footplate would be desirable. Technically, ionomer cement seems an ideal material for this purpose. The objective was to determine the aluminum level of the perilymph after the application of ionomer cement on the stapedial footplate.