László Iván

ALA (5-aminolevulinic acid)-induced protoporphyrin IX fluorescence in the endoscopic diagnostic and control of pharyngo-laryngeal cancer.

Photodynamic diagnosis is a modern method for the fluorescence imaging of superficial pharyngeal and laryngeal tumours. 5-aminolevulinic acid (ALA)-induced protoporphyrin IX fluorescence benefits the tumour selective accumulation of protoporphyrin; therefore, tumours can be differentiated from healthy tissue. ALA-induced fluorescence of laryngo-pharyngeal tumours and precancerous and benign lesions were evaluated by endoscopy. At the Department of Otorhinolaryngology, Head and Neck Surgery, Szeged, Hungary, 31 patients underwent ALA-induced protoporphyrin fluorescence imaging. After topical application of ALA, mesopharyngeal tumours were visualised by direct fluorescence endoscopy. Laryngeal and hypopharyngeal tumours were examined with a laryngomicroscope with the patients under general anaesthesia after inhalation of an ALA solution. Intensity of PPIX fluorescence was classified and compared with pathological findings. The examination of all 13 laryngeal and 12 pharyngeal tumours resulted in a middle or strong intensity of red fluorescence, but for one cancer, four praecancerous and two benign lesions. Healthy tissues showed green autofluorescence. Margins of mesopharyngeal and vocal cord tumours were clearly outlined under fluorescent vision, giving a helpful contribution to diagnosis and therapy even in clinically non-visible tumours. Laryngomicroscopy combined with laser surgery also indicated PPIX fluorescence examination visualising margins of the tumour intermediately with the endoscope. The ALA-induced PPIX fluorescence imaging method revealed a sensitivity of 96%. This method is applicable for detecting early superficial tumours, margins of tumours and follow-up after surgery/radiation therapy in the laryngo-pharynx.

Cholesterol granuloma of the maxillary sinus resembling an invasive, destructive tumor

The case of a maxillary sinus cholesterol granuloma posing as a malignant tumor is presented. The patient was referred to the authors’ clinic with symptoms typical of maxillary sinusitis, but physical examination suggested the presence of neoplasm. Radiology also resulted in confusing, tumor-like pictures. Histological examination of a preoperative tissue sample identified the process as a cholesterol granuloma, which was removed by a classic Caldwell-Luc operation. The patient has been symptom free since the operation. The pathogenesis of cholesterol granuloma is described, and the problems of establishing a diagnosis without preoperative histology are discussed.

Peroral Endoscopic Removal of a Regurgitated Giant Polisegmented Fibrovascular Polyp of the Esophagus

BACKGROUND Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper esophagus and hypopharynx. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpretedMaterials and methods: The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removalResults: After one-year of follow-up, the patient is going well, without recurrence of his polypConclusion: Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation.

Pharyngeal and hypopharyngeal reconstruction after mutilating surgery for malignant hypopharyngeal cancers

Abstract The authors summarise their reconstructive surgical experience after the radical excision of hypopharyngeal tumours. In selective cases the preservation of the larynx is a reliable surgical option and supraglottic surgery is sufficient to remove the tumour. Myocutaneous paddle flaps were used in every case after the surgical resection for the reconstruction of the pharyngo-oesophageal entrance. After total circular pharyngo-laryngectomy, the continuity of the upper digestive tract was reconstructed by tubed myocutanous flaps.

Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation

BackgroundNasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique—as much as the uniqueness of each case allowed it—based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire.Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test.ResultsBased on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4–6 months, compared with the preoperative scores.ConclusionsIn our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

Epicutaneous patch test—A new diagnostic option to prevent the rejection of silicone-covered cochlear implants in children

OBJECTIVES Cochlear implantation (CI) is a revolutionary method for hearing rehabilitation in patients with severe or profound sensorineural hearing loss. One of the surgical complications may be the necrosis of the skin flap above the receiver-stimulator coil, resulting in device extrusion. Our aim was to find the plausible causes of the silicone covered implant rejection. PATIENTS AND METHODS Authors present four cases of cochlear implant rejection, briefly describe their dermato-surgical solutions and analyse their innovative method - the epicutanoeus patch testing with silicone samples. RESULTS They observed positive skin reaction in three of the four cases. CONCLUSION Authors analyse the applicability and results of their surgical solutions and the epicutaneous testing in connection with the prevention of skin flap necrosis and rejection of silicone-covered cochlear implants.

Esophageal ATP synthase and keratinocyte growth factor gene expression changes after acid and bile-induced mucosal damage

Abstract.Objective and design: Intramural gene expression changes may be critically involved in tissue damage, defense and repair after esophageal regurgitation. The aims were to characterize the consequences of short-term exposure to luminal bile, acid, or bile mixed with acid on the β-ATPase, keratinocyte growth factor 1 (KGF-1) and KGF receptor (KGF-R) expressions within the mucosa and the muscle layer in a large animal model.Materials and subjects: Esophageal segments of anesthetized dogs were exposed to saline (n = 3), diluted canine bile (n = 6), hydrochloric acid (n = 5) or bile + hydrochloric acid (n = 5), and tissue biopsies were taken at the end of the 180-min observation period. Semiquantitative reverse transcriptase polymerase chain reactions were carried out and the degree of histological damage was evaluated on the 0–16-grade Geisinger scoring scale.Results: Acid exposure was followed by a significant decrease in the level of β-ATPase expression in the mucosa, and parallel increases in KGF-1 and KGF-R expression. Corresponding changes in the muscle layer were not significant. Bile alone evoked more severe tissue damage, with significantly decreased β-ATPase levels in both the mucosa and the muscle, whereas the KGF-1 expression did not change significantly. The bile + acid treatment induced an intermediate state, with significant β-ATPase transcription level decreases in both layers, while the mucosal KGF-1 expression was lower than that following acid treatment alone.Conclusions: The acid-induced transcriptional level downregulation of mucosal β-ATPase gene expression in the smooth muscle layer was exacerbated by bile, but the concomitant KGF and KGF-R gene expression changes may indicate the start of a consecutive repair process.

Extended lower trapezius myocutaneous flap to cover a deep lateral neck defect on irradiated skin: a new application.

Abstract Defects of the skin and underlying soft tissue of the neck are uncommon, and the surgeons main objective is to achieve reliable long-term coverage of the exposed vital organs with well-vascularised tissue harvested from a distant donor site. We present a patient whose extended irradiation site together with the previous unsuccessful attempt to cover it with a latissimus dorsi myocutaneous flap, needed an extended lower trapezius myocutaneous flap, which seemed to be the only way in which to close the large and deep cervical defect.

Kombination partialer Pharynx-Larynx-Resektion und rekonstruktiver Defektdeckung mit myokutanem Insellappen bei erweitertem perilaryngealem Karzinom

Vorgestellt wird eine neuartige Operationskombination fur ausgewAhlte FAlle von perilaryngealen multiregionalen Laryngopharynxtumoren, d.h. eine operative LOsung, bei der die kehlkopffu