Histological Changes of the Middle Ear Ossicles Harvested during Cholesteatoma Surgery.

BACKGROUND: In the cholesteatoma surgery ossicles can be replaced to reconstruct middle ear function. It is important that these ossicles are free of squamous epithelium, to prevent residual disease. This study focuses on the histological findings of the malleus and incus harvested during cholesteatoma surgery. MATERIALS AND METHODS: Eighty middle ears ossicles were examined in vivo and histologically to consider the relationship of cholesteatoma to ossicles, grade of bone destruction and invasion of cholesteatoma to deeper layers of bone. RESULTS: Serious ossicular destruction was observed more frequently in incus compared to malleus (p=0.0065). Difference of ossicles destruction between children and adults was not significant (p=0.3032). Deep invasion of cholesteatoma into the vascular spaces or inner core of the bone was not observed. CONCLUSIONS: Autograft ossicles from cholesteatomatous ears should not necessarily be rejected for reconstruction of the ossicular chain. Regarding the histological finding, the authors suggest mechanical cleaning of the ossicle surface to eliminate residual disease.

The influence of repeated blood withdrawals before surgery on clinical outcome.

UNLABELLED: The aim of this study was to find the influence of blood withdrawals and diet iron on elective surgery. Male Wistar rats (n=24) were divided: 1. group (SLD) ate standard laboratory diet (SLD), 2. group (FE) an iron enriched diet (FE) with one blood withdrawal after 9 weeks. 3. group (SLD-w) SLD and 4. group (FE-w) ate the FE diet; with 9 withdrawals once a week. The rats were sacrificed 18 hour after partial hepatectomy (PH) in the 10th week. Liver DNA synthesis (3H-thymidin - kBq/mg DNA) was performed. Serum hepcidin (pg/ml), iron concentration, respiratory burst of polymorfonucleares (RB, spontaneous; stimulated, %), count of blood cells were determined. FE-w had a higher (2.36+/-0.36) liver DNA synthesis after PH vs. SLD (1.21+/-0.49). Higher hemoglobin in erythrocytes (pg) was in FE-w and SLD-w vs. FE and SLD. PMN count in SLD-w, FE-w increased vs. SLD, FE. Hepcidin after PH decreased in SLD (78.0), FE (68.0), FE-w (97.0), but increased in SLD-w (217). Serum iron increased in SLD-w. RB after PH increased in FE-w (4.5; 47.6) vs. SLD (1.15; 29.1), FE (3.20;17.8), SLD-w (3.30;13.7). CONCLUSIONS: The iron diet with stimulation of haematopoesis by withdrawals improves an organism's condition expressed as better response to elective surgery and better PMN functions.

Is it reasonable to consider second-line chemotherapy in patients with hormone-refractory prostate cancer?

At present, no consensus exists regarding the use of second-line chemotherapy in patients with hormone-refractory prostate cancer (HRPC). A total of 23 patients with evidence of disease progression during or after first-line chemotherapy (epirubicin, etoposide, and dexamethasone) were included in this study. Two second-line treatments were administered throughout the study period (2000-2004) with 15/23 patients receiving carboplatin AUC 3 on day 1 and vinblastine 5 mg/m2 on day 1 of a 21-day cycle and 8/23 patients treated with docetaxel 50 mg/m2 on day 1 of a 21-day cycle. The latter regimen has been used since 2003. The prostate-specific antigen (PSA) level decreased by > or =50% in 3 of 23 patients, corresponding to an overall PSA response rate of 13% (95% confidence interval, 3-34%). The median time to biochemical progression was 9, 24 and 33 weeks, respectively. The median overall survival was 39 weeks (range, 15-73 weeks) with no difference between the two chemotherapy groups (p=0.08). A significant reduction of analgesic use was observed in 2 of 10 patients (20%) who required analgesics for cancer pain upon study entry. The major toxicity was grade 3 thrombocytopenia in 2 of 23 patients (9%). Both second-line treatments, a combination of carboplatin and vinblastine and a monotherapy with docetaxel, showed modest activity at subtoxic doses in patients with HRPC.

Malformation of stapes in VACTERLS association: a histopathologic study and three-dimensional reconstruction.

OBJECTIVE: To investigate the temporal bone with a malformed stapes in VACTERLS association. STUDY DESIGN: The study design was a case report, histopathology of the temporal bone, and three-dimensional reconstruction of the ossicles and cochlea. SETTING: The study was carried out in the Temporal Bone Bank at Charles University, Hradec Králové, on a case from Temporal Bone Foundation, Boston. PATIENT: A 1540-g, 41-cm female neonate with VACTERLS association, histopathology of the temporal bone, and three-dimensional reconstruction of the middle ear ossicles and cochlea. RESULTS: The posterior part of the footplate was missing, and the posterior crura of the stapes was not connected to the footplate but found freely suspended in the sinus tympani. CONCLUSION: Computer-assisted three-dimensional reconstruction was performed from histologic sections of the temporal bone removed from a case of VACTERLS association. The reconstruction included structures such as the bony labyrinth and the middle ear ossicles. The abnormality observed in the reconstruction included the mislocation of the stapes and a shortened footplate.

Descriptive growth model of the height of stapes in the fetus: a histopathological study of the temporal bone.

Temporal bone histological findings can be evaluated from several points of view. The most basic consists of a description of the characteristics and abnormalities of particular temporal bones. The second one is the measurement of various structures in a larger set of temporal bones and the monitoring of these structures over time. The height of stapes was measured in a set of 40 temporal bones from 27 fetuses, and the growth of stapes from the 13th to 36th weeks of pregnancy was determined. A computer-assisted nonlinear regression analysis of diagnostics enabling simultaneous examination of data (influential points, i.e., outliers and leverages) was carried out, a growth curve model proposed and a mathematical method with Ratkowski criteria for estimation applied to find the best descriptive model of the height of stapes versus time y= f(x) growth curve; the results of 13 growth models were examined. It was found that the maximum growth of the height of stapes was between the 13th and the 24th weeks of pregnancy. The average height of stapes was 1.05 mm in the 13th week and 2.6 mm in the 24th week. Later, after the 25th week, the growth of the height of stapes was slower, and the average height in the 30th week was 3.0 mm.

Bi-weekly epirubicin, etoposide and low-dose dexamethasone for hormone-refractory prostate cancer.

BACKGROUND: Recent studies have demonstrated the efficacy and favorable toxicity profile of chemotherapy regimens given at lower doses and frequent intervals. The aim of our study was to evaluate the efficacy and toxicity of a bi-weekly chemohormonal regimen consisting of epirubicin, etoposide, and low-dose dexamethasone (EED) in patients with hormone-refractory prostate cancer (HRPC). METHODS: We treated a total of 32 patients who had failed hormonal therapy and antiandrogen withdrawal. Chemotherapy was given every 2 weeks and consisted of epirubicin (30 mg/m2 intravenously, day 1) and etoposide (50 mg/m2 orally, days 1-7). Dexamethasone (1.5 mg orally, every other day) was given continuously until disease progression. Twenty patients (63%) had received prior treatment with estramustine phosphate. Each patient's pain response was evaluated according to analgesic use. Toxicity was graded using the Common Toxicity Criteria (version 2.0). RESULTS: Prostate-specific antigen (PSA) levels showed a decline of 50% or greater in 16 of 32 patients (50%, 95% confidence interval [CI], 32-68%) with a median time to biochemical progression of 5 months (range, 4-9 months). The median survival for all patients was 10.5 months (range, 3-35 months). Four of 10 patients (40%) with measurable soft tissue lesions achieved partial response according to standard criteria. Eleven of 23 symptomatic patients (48%, 95% CI, 27-69%) experienced an improvement in pain with a median duration of 6 months. The regimen was tolerated well by the patients, with only four patients (12%) having grade 3 leukopenia. CONCLUSION: Chemohormonal EED regimen proved to be active and well-tolerated in patients with HRPC.

Influence of high cholesterol diet and pravastatin sodium on the initiation of liver regeneration in rats after partial hepatectomy.

OBJECTIVES: Liver regeneration is influenced by cholesterol and 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA-reductase). HMG-CoA-reductase is a key enzyme for cholesterol synthesis. Recent studies have shown that inhibitors of HMG-CoA-reductase improve liver functions after 67% partial hepatectomy (PH). METHODS: Male Wistar rats (W) and Prague hereditary hypercholesterolemic rats (PHHC) were used. Aqua pro injectione (AI) or pravastatin (prava; 1 mg/kg) was administered orally once daily. Group 1: W, standard diet (SD) + AI; group 2: W, SD + prava; group 3: W, cholesterol-enriched diet (chol) + AI; group 4: PHHC, chol + AI; group 5: PHHC, chol + prava. After 27 d, PH was performed in all groups. RESULTS: Groups fed chol before PH had significantly higher liver triacylglycerol content (group 3: 25.8 +/- 2.6 mg/g of liver weight; group 4: 16.0 +/- 1.0 of liver weight; group 5: 22.0 +/- 1.0 of liver weight) than did the groups fed SD (group 1: 6.1 +/- 0.5; group 2: 5.9 +/- 0.7). Liver DNA synthesis after PH was significantly lower in chol-fed groups (group 3: 561 +/- 78; group 4: 472 +/- 92) than in SD-fed groups (group 1: 1645 +/- 574; group 2: 2935 +/- 1298), except the chol-fed PHHC given prava (group 5: 3230 +/- 527). CONCLUSIONS: In prava-treated rats, the induction of HMG-CoA activity overcame the inhibitory capability of pravastatin. The induction of HMG-CoA-reductase activity had a stimulatory effect on the initiation of liver regeneration.