ABSTRACT
The objective of this study is to assess the results of labyrinthine fenestration for fixed stapes in chronic ear disease. Using a prospective database, pre- and postoperative audiometric data from patients undergoing labyrinthine fenestration for fixation of the stapes in chronic ear disease others than otosclerosis between 2002 and 2012 were evaluated. Twenty-three labyrinthine fenestrations in chronic ear disease were performed (17 malleo-stapedotomies, 4 incus-stapedotomies, 1 neo-malleus-stapedotomy, 1 TORP-stapedotomy). Overall, the mean short-term (2 months) and long-term (42 months) postoperative air-bone gap (0.5-3 kHz) were 17.5 and 16.5 dB, respectively; long-term air-bone gap of <20 dB was obtained in 73 % of patients. There was no significant difference in air-bone gap closure between tympanosclerotic and post inflammatory osteogenic fixation of the stapes (p = 0.267). Hearing benefit success using the 'Belfast rule of the thumb' was achieved in 48 %. Normal bilateral hearing was achieved in 17 % and bilateral symmetric hearing impairment in 26 %. Only in 4 %, bone conduction worsened by more than 5 dB. Labyrinthine fenestration is an option in selected cases of stapes fixation in chronic ear disease and provides hearing gain without significant risk for sensorineural hearing loss. In those already selected cases, hearing benefit success 'Belfast rule of the thumb' is achieved only in half of the cases. This and the possible alternatives, should therefore be discussed preoperatively.
Subject(s)
Fenestration, Labyrinth , Stapes Surgery/methods , Stapes/abnormalities , Adolescent , Adult , Audiometry , Bone Conduction , Child , Female , Humans , Male , Middle Aged , Myringosclerosis/surgery , Retrospective Studies , Young AdultABSTRACT
Cancer-testis (CT) antigens comprise families of tumor-associated antigens that are immunogenic in patients with various cancers. Their restricted expression makes them attractive targets for immunotherapy. The aim of this study was to determine the expression of several CT genes and evaluate their prognostic value in head and neck squamous cell carcinoma (HNSCC). The pattern and level of expression of 12 CT genes (MAGE-A1, MAGE-A3, MAGE-A4, MAGE-A10, MAGE-C2, NY-ESO-1, LAGE-1, SSX-2, SSX-4, BAGE, GAGE-1/2, GAGE-3/4) and the tumor-associated antigen encoding genes PRAME, HERV-K-MEL, and NA-17A were evaluated by RT-PCR in a panel of 57 primary HNSCC. Over 80% of the tumors expressed at least 1 CT gene. Coexpression of three or more genes was detected in 59% of the patients. MAGE-A4 (60%), MAGE-A3 (51%), PRAME (49%) and HERV-K-MEL (42%) were the most frequently expressed genes. Overall, the pattern of expression of CT genes indicated a coordinate regulation; however there was no correlation between expression of MAGE-A3/A4 and BORIS, a gene whose product has been implicated in CT gene activation. The presence of MAGE-A and NY-ESO-1 proteins was verified by immunohistochemistry. Analysis of the correlation between mRNA expression of CT genes with clinico-pathological characteristics and clinical outcome revealed that patients with tumors positive for MAGE-A4 or multiple CT gene expression had a poorer overall survival. Furthermore, MAGE-A4 mRNA positivity was prognostic of poor outcome independent of clinical parameters. These findings indicate that expression of CT genes is associated with a more malignant phenotype and suggest their usefulness as prognostic markers in HNSCC.
Subject(s)
Biomarkers, Tumor/genetics , Carcinoma, Squamous Cell/genetics , Head and Neck Neoplasms/genetics , Neoplasm Proteins/genetics , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/metabolism , Carcinoma, Squamous Cell/metabolism , Female , Head and Neck Neoplasms/metabolism , Humans , Immunoenzyme Techniques , Male , Middle Aged , Neoplasm Proteins/metabolism , Prognosis , Prospective Studies , RNA, Messenger/genetics , RNA, Neoplasm/genetics , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
OBJECTIVES: Tension is the limiting factor in long tracheal resection with end-to-end anastomosis. Complications such as dehiscence and restenosis are well correlated with the degree of anastomotic tension. The objective of our study was to investigate the effects of patches of auricular cartilage glued craniocaudally along a tracheal anastomosis. METHODS: Rupture tests were performed on sheep tracheas collected from a slaughterhouse. In group A (n = 5), 3 patches of auricular cartilage of 0.5 x 5 cm were glued with albumin-glutaraldehyde tissue adhesive (BioGlue) craniocaudally along the left, right, and anterior borders of the transected tracheas. In group B (n = 10), the patches were fixed with 2 transparietal intercartilaginous stitches without adhesive. In group C (n = 10), adhesive and stitches were used. RESULTS: Three patches of cartilage glued along the tracheal anastomosis held tension as high as 11.1 N. Adhesive maintained the tracheal extremities in closer contact than did stitches alone. It increased the anastomotic resistance strength (50.8 N in group C versus 29.6 N in group B). This increase was statistically significant. CONCLUSIONS: Gluing auricular cartilage patches along ex vivo tracheal anastomoses strengthened them and helped diminish tension on the suture line.
