[The problems of education in otosurgery: the current state-of-the-art].

An overview of the current problems of education in ear surgery is presented. The methods used for the purpose including the classical dissection of the temporal bone, application of synthetic and natural (animal) temporal bones are described alongside with the 3D models of the temporal bone and virtual dissection. In addition, the review covers the problem of enhancing effectiveness of the teaching methods, considers their advantages and disadvantages.

[Modern approaches to antimicrobial and anti-inflammatory photodynamic therapy in otorhinolaryngology].

The objective of the present study was to analyse the currently available methods and possibilities for antimicrobial photodynamic therapy (PDT) in medicine with special reference to otorhinolaryngology. The results of the treatment of 300 patients with various suppurative ENT pathologies using antimicrobial PDT were subjected to the analysis. It made it possible to elucidate the mechanisms and parameters of photodynamic treatment and to reveal disadvantages of the modern methods of antimicrobial photodynamic therapy. Special attention is given to the management of acute inflammation in the laryngopharynx and to the topical problems of up-to-date antimicrobial PDT.

[The new complex multimedia program for the training in otosurgery].

The objective of the present study was to develop the complex program for the training in otosurgery. The proposed complex program for teaching surgical procedures on the ear is described. The program consists of two steps, preparation and dissection. The first stage is designed to prepare the learner surgeons for dissection with the use of the teaching materials "Manipulations on the temporal bone" and the 3D model of the temporal bone. At the second stage, the learners perform successively two tasks: dissection of an artificial and cadaveric bones with the maximum possible number of surgical procedures on each bone. The aforementioned teaching materials and 3D model of the temporal bone are used at the dissection stage too.

Bilateral primary lymphoma of the breast: a case report initially diagnosed by FNAC.

Primary lymphoma of the breast (PLB) is a rare disease, representing 0.04-0.5% of all malignant breast neoplasms. We present a patient with bilateral breast involvement by a high-grade diffuse large B-cell lymphoma, which was diagnosed initially by fine-needle aspiration cytology (FNAC). Mammography revealed a diffuse increase in density of the right breast and a large solitary mass on the left breast, suggestive of an inflammatory carcinoma. The patient underwent FNAC and the diagnosis of a non-Hodgkin's lymphoma (NHL) was suggested. Physical examination revealed palpable bilateral axillary lymph nodes but no evidence of concurrent widespread disease. The patient underwent complete staging evaluation. The only positive findings were an elevated lactate dehydrogenase (LDH) and evidence of axillary lymphadenopathy on CT. Excisional biopsy was performed on the left breast. The morphological and immunohistochemical analysis confirmed the diagnosis of a high-grade diffuse large B-cell lymphoma with an immunophenotype suggestive of a germinal center cell origin.

Megavoltage pituitary irradiation lowers but seldom leads to safe GH levels in acromegaly: a long-term follow-up study.

Radiotherapy (RT) has long been used in the treatment of acromegaly, but confusion regarding the definition of biochemical cure has hampered interpretation of previous reports on the outcome of this treatment. In the present study we present additional data using the currently accepted criteria of biochemical cure in a large group of patients followed up by our department. Forty-six acromegalic patients were treated with external beam megavoltage RT and followed up for a mean of 7.6 years (range 2-22 years). Only four patients had had previous surgical treatment by either transsphenoidal or transfrontal routes. Following RT, mean basal GH levels decreased from 30.9 ng/ml (5-96 ng/ml) to 11.5 ng/ml (1-36 ng/ml) at 10 years of follow up with a further fall to 6.1 ng/ml (1-29 ng/ml) in those patients followed up for more than 10 years. As a result, although mean GH levels of less than 5 ng/ml were achieved in 9/28 (30.1%) at 5 years, 6/19 (31.6%) at 10 years, and in 6/11 (54.5%) of those patients followed up for more than 10 years post-RT, only 0/28 (0%), 7/28 (25%), 4/19 (21%) and 1/11 (1%) achieved GH levels of <2.5 ng/ml at 2, 5. 10 and >10 years following RT. Thus, in the whole series only 10/48 (20.8%) patients showed a decrease of GH level to less than 2.5 ng/ml at their latest follow up. Hypopituitarism as a result of RT was only infrequently observed in this series; gonadal deficiency developed in 12 (26.6%) patients, thyrotrophin (TSH) deficiency in 3 (6.6%) and adrenocorticotrophin deficiency in 2 (4.4%). In conclusion, megavoltage RT is an effective treatment for the control of GH hypersecretion in acromegaly, with a continuing lowering effect for several years following RT but seldom leads to safe GH levels.

Does acromegaly really predispose to an increased prevalence of gastrointestinal tumours?

OBJECTIVE: The few published prospective studies suggest a strong association of colonic tumours with acromegaly, but include small numbers of patients. In addition, the upper gastrointestinal tract of these patients has never been prospectively studied. The aim of the present study was to investigate the incidence of gastric and colonic tumours in a large cohort of acromegalic patients. DESIGN: Acromegalic patients consecutively admitted to an Endocrinology Department for diagnosis and follow-up, were submitted to gastroscopy and colonoscopy, to identify those harbouring gastrointestinal tumours. PATIENTS: Over a 5-year period, 54 out of 61 patients (78% with active disease) received colonoscopy and 42 out of 61 gastroscopy. No patient had a past history of gastrointestinal malignancy. MEASUREMENTS: All polypoid lesions found at colonoscopy and gastroscopy were separately recorded and biopsied. RESULTS: No case of gastrointestinal cancer or gastric polyp was discovered. Nineteen patients (35%) had 1-8 colonic polyps, including 5 (9.3%) with adenomas. When compared to patients with a normal colon, those with polyps were significantly older (44.5 +/- 14.2 vs 52.1 +/- 10.9 years, P = 0.047), but the duration of acromegaly (10.8 +/- 8.4 vs 10.9 +/- 7.1 years, P = 0.9) and the number of patients with active disease were similar in both groups. CONCLUSIONS: Acromegalic patients do not have an increased incidence of gastric tumours. The observed significant variation in the prevalence of colonic adenomas (9-35%, P = 0.03) and cancer (0-15%, P = 0.017), between our patients and those of the published prospective studies with similar demographic characteristics, suggest that environmental and hereditary factors may be more important than the presence of acromegaly.

Woringer-Kolopp disease (pagetoid reticulosis).

We report the clinical, histopathological, and ultrastructural features of a case of Woringer-Kolopp disease, review the literature, and discuss the relationship of the condition to mycosis fungoides. At the present time it is best to regard Woringer-Kolopp disease as a form of cutaneous T-cell lymphoma that may remain localized for many years or may eventually be associated with widespread mycosis fungoides.