TRH site-specific methylation in oral and oropharyngeal squamous cell carcinoma.

BACKGROUND: The incidence of oral squamous cell carcinoma (OSCC) continues to increase each year. Clinical examination and biopsy usually detect OSCC at an advanced stage that is difficult to treat, leading to poor prognosis. DNA methylation pattern is tissue specific and has emerged as a biomarker for the detection of cancers of tissue origin. Herein, we aimed to discover a novel site-specific methylation marker for OSCC. METHODS: We selected OSCC datasets analyzed using the IlluminaHumanMethylation27 BeadChip from the Gene Expression Omnibus repository of the National Center for Biotechnology Information using a bioinformatics approach. From 27,578 CG dinucleotide (CpG) sites, the CpG site with the highest difference in methylation level between healthy and cancerous cells was selected for further validation. A total of 18 mucosal tissue samples were collected from nine healthy controls and nine from OSCC subjects and subjected to microdissection for cell purification, followed by DNA extraction, bisulfite conversion, and pyrosequencing. Additionally, epithelial cells were collected from 2 cohorts including oral rinse from healthy controls, oral rinse and oral swab from OSCC subjects and oral rinse from oropharyngeal squamous cell carcinoma (SCC) were examined for their methylation status using real-time polymerase chain reaction (PCR). RESULTS: Among the 27,578 differentially methylated CpG sites, cg01009664 of the thyrotropin-releasing hormone (TRH) gene showed the greatest difference in methylation level between healthy and cancerous cells. Validation of the TRH gene using pyrosequencing revealed a methylation percentage of 7% ± 3.43% in healthy cells in contrast to 63% ± 19.81% in cancerous cells. Screening of epithelial cells using real-time PCR showed that the DNA methylation level was significantly higher in oral swab and rinse samples collected from OSCC and oropharyngeal SCC subjects than those from healthy controls (p < 0.001). In addition, when using a cutoff at 3.31 ng/µL, the TRH methylation biomarker was able to distinguish OSCC and oropharyngeal SCC subjects from healthy controls with high level of area under the curve, sensitivity and specificity. CONCLUSION: We demonstrated cg01009664 of TRH as a potential biomarker for OSCC and oropharyngeal SCC screening using oral rinse and swab techniques.

Tonsillar fossa steroid injection for reduction of the post-tonsillectomy pain.

Fifty patients (26 males and 24 females) who underwent tonsillectomy were then treated with injection of the long acting steroid (Kenacort-A) into the right tonsillar fossa after the operation. The left side was used as the control. Post-operative pain was assesed by the patients and was graded and recorded daily as mild, moderate, and severe pain on both sides of the throat for 2 weeks. A significant reduction of pain in the tested side (right side) was noted in the majority of the patients. The duration of pain was shorter in the right side than the left side. It seemed to significantly reduce the post-tonsillectomy pain. Because of its simplicity, cost effectiveness, and no complications, the technique should be used for pain-free tonsillectomy in non-contraindicated cases.

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report.

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

Upper aerodigestive tract burn: a case report of firework injury.

The case of a 46 year-old German man with upper aerodigestive burn by firework was reported. He presented with the symptoms and signs of upper airway obstruction. Tracheostomy was done and direct laryngoscopy with microscopic examination revealed swelling and denudation of the mucosa of the oral cavity and supraglottic area. Intravenous steroids and antibiotics were administrated for treatment. It is suggested that proper management needs an understanding of the mechanism and effect of the corrosive agent. Careful airway management resulted in a good outcome in this patient.

Auricular pseudocysts: a treatment with the Chulalongkorn University vacuum device.

Auricular pseudocysts are rare lesions that present as an asymptomatic cystic swelling of the anterior surface of the auricle, particularly the antihelix. Typically, the pseudocysts contain viscous straw-yellow fluid similar in appearance to olive oil; however, a clear pale yellow serous transudate may also be encountered. Various therapeutic approaches have been used with variable success. We describe a simple small vacuum device called the Chulalongkorn University vacuum device, which was developed in our center. The device can be easily made anywhere by any surgeon. We report the outcome in 17 patients treated by means of needle aspiration plus application of the Chulalongkorn University vacuum device for 5 days. A complete resolution of the lesion was obtained in 15 (88.2%) patients. Because the procedure is safe and effective and does not require an operating room setting, it may be accepted as an option in the treatment of auricular pseudocysts.

Telomerase assay and nested polymerase chain reaction from nasopharyngeal swabs for early noninvasive detection of nasopharyngeal carcinoma.

The main purpose of this study was to analyze sensitivity and specificity of combining nested polymerase chain reaction for detection of Epstein-Barr virus (EBV) genome and telomerase assay for identifying nasopharyngeal carcinoma (NPC). Eighty patients with NPC and 27 healthy control subjects were included in this study; 97. 5% and 94.9% of NPC patients were positive for EBV genome and telomerase activity, respectively. When nasopharyngeal swabs were tested, 95.7% presented the EBV genome and 85.5% were positive for telomerase expression. The sensitivity for counting either positive result of these two techniques was 100%. Among the 27 control subjects, only 6 and 5 cases were positive for EBV DNA and telomerase activity, respectively. This indicated a specificity of 92.6% when both positive results were included. At present, early diagnosis of NPC requires multiple biopsy specimens, especially to identify subclinical cases. Because this study showed a very high sensitivity for detecting NPC from swabs when combining the telomerase assay and nested polymerase chain reaction technique, this noninvasive technique may be a good candidate for screening of subclinical NPC, especially before multiple biopsy specimens are obtained.

Lingual osseous choristoma: report of three cases.

Osseous choristoma represents the dense, mature, bony tissue in an abnormal location. We reported three cases of lingual osseous choristoma, herein, a year after the report of eight cases in 1998. All three lesions were at or close to the foramen caecum. The lesions were smooth, round or lobulated and pedunculated in shape and stony hard in consistency. All of them were preoperatively diagnosed, based on the above unique clinical findings without any radiography. The lesions were simply excised without local recurrence.

Comparison of ofloxacin otic solution with oral amoxycillin plus chloramphenicol ear drop in treatment of chronic suppurative otitis media with acute exacerbation.

The efficacy and safety of 0.3 per cent Ofloxacin otic solution (OFLX) 6 drops twice daily was compared with those of oral Amoxycillin 500 mg three times daily plus 1 per cent Chloramphenicol ear drop at 3 drops three times daily (AMOX + CRP) in a two-week treatment of chronic suppurative otitis media (CSOM) with acute exacerbation. 80 adult patients were enrolled in a prospective, randomized, investigator-blind study at the outpatient ENT service of Chulalongkorn University Hospital. The most common pathogens isolated at the pretreatment visit were Staphylococcus aureus (30.3%) and Pseudomonas aeruginosa (24.7%). The susceptibility of all the pathogenic isolates to ofloxacin, amoxycillin and chloramphenicol were 96.4, 57.1 and 51.8 per cent respectively. The overall response expressed as an improvement or cure of otalgia, otorrhea and middle ear mucosal inflammation was recorded. It revealed that the improvement rate of the OFLX-treated patients was better than that of AMOX + CRP-treated, but was not statistically significant. However, the cure rate was significantly better in OFLX-treated than in AMOX + CRP-treated groups in terms of painless (p = 0.05) and dry (p < 0.001) ears. Ototoxicity was assessed by an elevation in bone conduction threshold (BC) and/or speech reception threshold (SRT) of greater than 5 dB or a presence of high tone hearing loss resulting from treatments. A significant decrease in BC and SRT was revealed in OFLX-treated ears (p < 0.0001; p = 0.002 respectively) but a significant elevation of BC was found in AMOX + CRP-treated ears (p = 0.007). The ototoxic rate was significantly higher in AMOX + CRP-treated than in OFLX-treated ears whether assessed by BC (p < 0.001) or SRT (p = 0.03). In conclusion, OFLX was more effective and safer than AMOX + CRP in the treatment of CSOM with acute exacerbation.

Myringoplasty: a simple procedure for out-patients.

The standard treatment of tympanic membrane perforation is myringoplasty. We describe a new myringoplasty technique requiring only a partial removal of skin on the ear drum remnant followed by lateral placing of fascia and free skin graft. The overall cure rate in our series is 97 per cent. The hearing gains for the overall cases are 13.9 dB (p < 0.001) for the AC, 13.6 dB (p < 0.001) for the air bone gap closure, 13.1 dB (p < 0.001) for the SRT and 4.2 per cent (p = 0.005) for the SDS. Minor complications are observed in only 14 per cent. Our technique is simple, effective and can be performed on an out-patient basis.

Lingual osseous choristoma: a study of eight cases and review of the literature.

A choristoma is a tumor-like mass of normal tissue in an "abnormal" location. Lingual osseous choristoma, previously known as osteoma of the tongue, is a rare entity: we found documentation of eight cases at our center during the 10-year period between 1987 and 1996. These cases were analyzed along with 50 others reported in the English language literature between 1913 and 1996. Lingual osseous choristoma frequently occurs during the third and fourth decades of life, and predominantly affects women (81%). Most of the osseous choristomas in our review were located in the posterior third of the tongue, primarily at or close to the foramen cecum or circumvallate papillae (87.9%). While 39.7% of the patients were asymptomatic, the remaining patients complained of symptoms including a lump in the throat (25.8%), dysphagia (6.9%), gagging (5.1%), nausea (3.4%) and irritation (3.4%). Treatment of lingual osseous choristoma consists of simple excision. The tumor's origin has been discussed elsewhere.

Genomic alterations in nasopharyngeal carcinoma: loss of heterozygosity and Epstein-Barr virus infection.

Nasopharyngeal carcinoma is a subset of head and neck squamous cell cancers with unique endemic distribution and aetiological co-factors. Epstein-Barr virus has been revealed to be an important aetiological factor for most nasopharyngeal carcinomas. Nevertheless, additional genetic alterations may be involved in their development and progression. The aim of this study was to determine the likely chromosomal locations of tumour-suppressor genes related to Epstein-Barr virus-associated nasopharyngeal carcinoma. Fifty-six microsatellite polymorphic markers located on every autosomal arm were used to estimate the incidence of loss of heterozygosity in 27 Epstein-Barr virus-associated nasopharyngeal carcinomas. High frequencies of allelic loss were observed on chromosome 3p (75.0%) and 9p (87.0%). Chromosome 9q, 11q, 13q and 14q displayed loss in over 50%, while chromosome 3q, 6p, 16q, 19q and 22q exhibited loss in 35-50%. Furthermore, several other chromosomal arms demonstrated allelic loss in 20-35%. Additionally, 1 of the 27 cases showed microsatellite instability at multiple loci. These findings provide evidence of multiple genetic alterations during cancer development and clues for further studies of tumour-suppressor genes in Epstein-Barr virus-associated nasopharyngeal carcinoma.

Loss of heterozygosity for chromosome 11 in Epstein-Barr-virus associated nasopharyngeal carcinoma.

In order to demonstrate and define possible tumor suppressor gene loci on chromosome 11 associated with NPC, we used 7 STR to test for LOH on 25 NPC samples. LOH was detected in 46 per cent of cases. Most LOH loci were clustered on the long arm. Further study demonstrated 22 per cent and 45.5 per cent of cases with LOH on 11q13 and 11q23 respectively.

Microsatellite instability in Epstein-Barr virus associated with nasopharyngeal carcinoma.

The result reported here represents the first human genomic screen for MSI in Epstein-Barr-Virus associated NPC. The analysis revealed the incidence of MSI only 1 of 23 cases (4%) which indicates that MSI is less common in NPC development.