Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary.

The study aimed to investigate the impact of hip replacement surgery on the quality of life and to compare the outcomes by sociodemographic and surgical data in Hungarian public and private hospitals. Patients were selected at the Department of Orthopaedics (Clinical Centre, University of Pécs) and at the Da Vinci Private Clinic in Pécs. Patients completed the SF-36 and Oxford Hip Score (OHS) questionnaires before the surgery, 6 weeks and 3 months later. We also evaluated socio-demographic data, disease and surgical conditions. The research involved 128 patients, 60 patients in public, 68 patients in private hospital. Despite the different sociodemographic characteristics and surgical outcomes of public and private healthcare patients, both groups had significantly improved the quality of life 3 months after hip replacement surgery measured by OHS and SF-36 physical health scores (p < 0.001). In the mental health score, only the patients of the private health sector showed a significant improvement (p < 0.001). The extent of improvement did not differ between the two healthcare sectors according to the OHS questionnaire (p = 0.985). While the SF-36 physical health score showed a higher improvement for public patients (p = 0.027), the mental health score showed a higher improvement for private patients (p = 0.015).

Investigation of the short-term quality of life and socio-demographic factors of patients undergoing total hip arthroplasty / Csípoízületi protézismutéten átesett betegek szociodemográfiai jellemzoinek és rövid távú életminoségének vizsgálata

Introduction: Among the health needs related to an aging society, the increase in the number of hip replacement surgeries stands out. Objective: The study aimed to examine the socio-demographic data of patients operated in the private and state health care with total hip arthroplasty in different approaches, and to compare their quality of life before and after surgery. Data and methods: Patients were selected by simple convenience sampling technique at the Department of Orthopedics, Clinical Centre of the University of Pecs and at the Da Vinci Private Clinic in Pecs. Patients completed a complex questionnaire before the surgery and 6 weeks later. We evaluated socio-demographic data, disease and surgical conditions. Two international questionnaires were also completed (SF-36, Oxford Hip Score). Results: The research involved 164 persons, 75 persons of the state care, 89 persons of the private care. The proportion of villagers was significantly higher in the state care (p = 0.014), while mainly metropolitans were found in the private care. The proportion of primary (p < 0.001) and secondary education (p = 0.042) was significantly higher for state care patients, while higher education was prevalent among patients treated in the private sector (p < 0.001). In the state care the proportion of pensioners (p = 0.005), in the private care the proportion of intellectual workers and contractors was significantly higher (p < 0.001). Both groups' quality of life showed significant improvement (p < 0.001). Conclusion: Patients in the two groups significantly differed in socio-demographic characteristics, but both showed significant improvements in the quality of life 6 weeks after surgery.

Expression of NFkB1, GADD45A and JNK1 in salivary gland carcinomas of different histotypes.

The class of salivary gland tumours is very heterogenous, both in a histopathological and clinical sense. Since they are uncommon lesions, their clinical management is still problematic. Molecular mechanisms underlying the development of these cancer types may be fundamental for the diagnosis, treatment and prognosis of this disease. In this study, the gene expression of nuclear factor-kappa B (NKkB1/p65), c-Jun N-terminal kinase (JNK1) and growth arrest and DNA damage (GADD45A), which all play an important role in inflammatory and cell survival mechanisms, was assessed in benign and malignant neoplasms of the salivary gland. The absolute mRNA content of paraffin embedded samples of salivary gland cancer was determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) using specific primers for NFkB1, GADD45A and JNK1. Expression values (relative to HPRT) were statistically evaluated. Among the detected alterations in gene expression, the only difference reaching statistical significance was in the case of NFkB1 in adenocystic carcinomas (p=0.05). Given the importance of these signalling mechanisms in the biology of tumorigenesis, these results may be implemented in further research and these genes might become targets for innovative diagnostic and therapeutic strategies.

Changes in expression of oncogenes and TP53 tumour suppressor gene as biomarkers in head and neck cancers.

Despite modern diagnostic procedures and up-to-date therapy, the survival of head and neck tumour patients is unfavourable. This can be explained by several factors, one of which is the late recognition of the tumour. This study related to the changes in expression of the c-myc and Ha-ras oncogenes and the p53 tumour suppressor gene as biomarkers in head and neck cancer cases. The gene expressions were investigated on RNA gained from peripheral white blood cells of head and neck cancers patients before and after definitive treatment. The results were compared with those on a control group of patients with non-tumorous diseases. The gene expressions were significantly higher in the cancer group than that in the control group (volunteer medical staff and medical students). After definitive treatment, the expressions of all these genes were decreased in patients in whom there was no recurrence of the tumour, but enhanced in the event of recurrence. Such measurement may serve as reliable biomarkers to monitor tumour development and the efficiency of therapy. The method may also be useful for the early identification of populations exposed to noxe, which may lead to the development of head and neck cancers.

Association between XRCC1 polymorphisms and head and neck cancer in a Hungarian population.

BACKGROUND: Head and neck cancer is a significant current health problem in Hungary because the mortality of this cancer has increased by 387% in the last thirty-two years. Because of the important role of the XRCC1 gene in DNA repair, we wanted to test the effects of the Arg194Trp and Arg399Gln polymorphisms of XRCC1 on the clinical outcome of head and neck cancer. PATIENTS AND METHODS: A polymerase chain reaction-restriction fragment lenght polmorphism (PCR-RFLP) method was used. A total of 108 samples were taken from intraoperatively removed formalin-fixed, and paraffin-embedded blocks of tissue. An age- and sex-matched cancer-free control group was used to compare the frequency of polymorph variants. RESULTS: No significant difference was found between patients and controls in repect of the investigated polymorphisms. A significant difference was found between the patients with different XRCC1 194 polymorph status in clinical stage SIII. The survival proportion of patients with the Arg194Arg genotype was significantly lower than of those with the Arg194Trp genotype. CONCLUSION: The complex analysis of these factors may provide the basis for personal risk assessment and an opportunity for individualised therapy.

Early modification of c-myc, Ha-ras and p53 expressions by chemical carcinogens (DMBA, MNU).

7,12-Dimethylbenz[a]anthracene (DMBA) and N-methyl-N-nitrosourea (MNU) are important environmental carcinogens. Their different biological effects were examined in CBA/Ca H-2(K) haplotype inbred mice on the gene expression of c-myc, Ha-ras and p53 through a 24 hour period. Elevated expression of c-myc and Ha-ras genes was found in the spleen, lung, thymus and lymph nodes 6 and 12 hours after DMBA treatment and in the lung and thymus 3 hours after MNU treatment. In the liver, DMBA induced strong onco/suppressor gene expression as early as 6 hours after the treatment, but MNU increased the p53 gene expression 12 hours after the treatment. The gene expression patterns reflected the different mechanism of the direct acting MNU and metabolically activated DMBA. This phenomenon provides evidence as to the usefulness of detection of onco/supressor key gene expression as early molecular epidemiological biomarkers of carcinogenesis and carcinogenic exposure in animal model, useful in human cancer prevention practice as well.

Early modification of c-myc, Ha-ras and p53 expressions by N-methyl-N-nitrosourea.

Methylnitrosourea (MNU) is a well-known pluripotent direct-acting carcinogen. Formation of MNU following incubation of various meats with additional nitrite under in vitro acidic conditions is possible. It is possible that many species, including humans, are exposed to carcinogenic MNU, generated in their alimentary tract. Previously, an animal model was developed by our research group to investigate the expression of three genes c-myc, Ha-ras and p53 as early molecular epidemiological biomarkers of carcinogenic exposure or carcinogenesis caused by DMBA (dimethylbenz[alpha]anthracene). The aim of this study was to investigate the early effect of MNU on the gene expression levels. MNU is a direct-acting carcinogen which spontaneously and rapidly degrades, so any effect on the gene expression is observed in 24 hours. Our results show the maximum effect in vivo on the gene expression at 12 hours after the MNU treatment; on the other hand, 24 hours after the treatment, the elevated gene expressions decreased in target organs (bone marrow, lung, lymph nodes). Our results correspond to "long-term" experiments of the carcinogenic effect of MNU in different target organs. Our findings suggest that MNU has an impact on the expression of c-myc, Ha-ras and p53 genes in 12 hours, especially in bone marrow. Overexpression of these genes occurs as an early biological effect of exposure to chemical carcinogens. According to our results, the high expression of these genes could indicate MNU exposure and these genes could take part in MNU-induced tumorigenesis.

Primary carcinoma of the frontal sinus: a case report and a review of literature.

Paranasal sinus cancer is rather rare, with an incidence of less than 1 per 100,000 per year, the frontal sinus being the primary site in only 0.3%. Following clinical and radiological examinations, the diagnosis often remains elusive, the condition mistakenly being considered to involve mucocele, pyocele or osteomyelitis. This article reports on a 60-year-old pigeon breeder with squamous cell carcinoma originating in the frontal sinus. The presenting symptoms were a gradually worsening sharp headache, double vision and an oedematous left eyelid. CT and magnetic resonance imaging demonstrated erosion of the orbital roof around an area 10 mm in diameter, without direct infiltration of the bulbus. Twelve months following a frontal craniotomy, tumour excision and postoperative radiotherapy, the patient is symptom-free. A detailed description of this patient and a review of the published work are presented.

Tracheal ceramic rings for tracheomalacia: a review after 17 years.

BACKGROUND: Despite different support techniques, the surgical management of tracheomalacia is still a challenging problem. Satisfactory results after internal stenting are above 80%, whereas, when performing external stenting using biocompatible ceramic rings, results are reported at over 90%. OBJECTIVE: The purpose of this study was to examine the efficiency of surgical treatment in patients with segmentary tracheomalacia using external ceramic ring grafts. METHODS: In this retrospective study, we collected data from 12 patients who underwent surgery during the last 17 years for symptomatic segmentary tracheomalacia by use of biocompatible aluminum-oxide ceramic rings. All except one patient had undergone previous tracheostomy, six had a history of long-term intubation, two had previous trauma, and two patients had previous cancer treatment including radiotherapy. One of the patients still had an existing tracheostoma, which was closed when a ceramic ring was implanted. Tracheal wall collapse with pseudoglottis formation or flattened anterior-posterior tracheal diameter was documented with fiberoscopy at rest, and both pre- and postoperative airway resistance measurements were performed in all 12 patients using a spirometer. After malacic segments were found to be expandable using rigid tracheoscopy while the patient was under general anesthesia, preparation of the trachea was performed using a midline vertical incision in the neck. Subsequently, the malacic trachea was expanded by placing and suturing proper-sized ceramic ring(s) around it. RESULTS: In all patients, surgical expansion of the malacic segment using ceramic rings was successfully carried out without major complications while inspiratory stridor was resolved. Airway resistance decreased significantly from an average of 0.62 to 0.385 kPascal. CONCLUSION: Although the results of applying internal tracheal stents are encouraging, complications such as stent migration, granulation tissue and fistula formation, and mucociliary transport arrest are possible. Biocompatible ceramic rings do not cause foreign body reactions, remain stabile, and, with a proper suturing technique, provide a suitable long-term solution.