Effects of branched-chain amino acids on changes in body composition during the recovery period following tonsillectomy.

PURPOSE: In recent decades studies have examined body weight changes following tonsillectomy. In nutrition science, the focus has shifted from body mass index to body composition analysis. However, no studies have explored body composition changes post-tonsillectomy. In oncology and digestive surgeries, the potential benefits of branched-chain amino acids (BCAAs) have been investigated; however, their effects on pharyngeal surgery remain unknown. Therefore, the aim of the present study was to investigate the body composition changes after tonsillectomy and to explore the potential benefits of branched-chain amino acids. METHODS: This prospective interventional controlled study enrolled 48 patients who were randomly assigned to a control group (CG) and an experimental group (EG). These groups were further divided into active and inactive subgroups on the basis of their activity levels. The EG consumed 2 × 4 mg of BCAA daily. Body composition was measured using bioimpedance (InBody 270) on the day of surgery and again on days 7 and 21 postoperatively. RESULTS: Both groups experienced similar weight loss; however, significant differences in body composition emerged. The CG showed significant muscle mass loss (from 30,29 to 28,51 kg), whereas active EG members maintained muscle mass (from 35,33 to 35,40 kg); inactive EG members increased muscle mass (from 26,70 to 27,56 kg) and reduced body fat percentage (from 31.94% to 29.87%). The general health status (InBody score) remained stable or improved in the EG (from 75,13 to 75,96); however, it decreased in the CG (from 75,42 to 72,67). CONCLUSION: The negative effects of tonsillectomy on body composition are mitigated by BCAA supplementation.

A new method of preoperative assessment of correct electrode array alignment based on post-operative measurements in a cochlear implanted cohort.

PURPOSE: During cochlear implantation surgery, a range of complications may occur such as tip fold-over. We recently developed a method to estimate the insertion orientation of the electrode array. The aim of the study was to determine the optimal angle of orientation in a cohort of cochlear implanted patients. METHODS: On eighty-five CT scans (80 uncomplicated insertions and 5 cases with tip fold-over), location of the electrode array's Insertion Guide (IG), Orientation marker (OM) and two easily identifiable landmarks (the round window (RW) and the incus short process (ISP)) were manually marked. The angle enclosed by ISP-RW line and the Cochlear™ Slim Modiolar electrode array's OM line determined the electrode array insertion angle. RESULTS: The average insertion angle was 45.0-47.2° ± 10.4-12° SD and was validated with 98% confidence interval. Based on the measurements obtained, patients' sex and age had no impact on the size of this angle. Although the angles of the tip fold-over cases (44.9°, 46.9°, 34.2°, 54.3°, 55.9°) fell within this average range, the further it diverted from the average it increased the likelihood for tip fold-over. CONCLUSION: Electrode array insertion in the individually calculated angle relative to the visible incus short process provides a useful guide for the surgeon when aiming for the optimal angle, and potentially enhances good surgical outcomes. Our results show that factors other than the orientation angle may additionally contribute to failures in implantation when the Slim Modiolar electrode is used.

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion.

BACKGROUND AND PURPOSE: Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. METHODS: For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. RESULTS: The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. CONCLUSION: We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

Review of electrode placement with the Slim Modiolar Electrode: identification and management.

Background - Several cochlear implant recipients experience functionality loss due to electrode array mal-positioning. The application of delicate perimodiolar electrodes has many electrophysiological advantages, however, these profiles may be more susceptible to tip fold-over. Purpose - The prompt realization of such complication following electrode insertion would be auspicious, thus the electrode could be possibly repositioned during the same surgical procedure. Methods - The authors present three tip fold-over cases, experienced throughout their work with Slim Modiolar Electrode implants. Implantations were performed through the round window approach, by a skilled surgeon. Standard intraoperative measurements (electric integrity, neural response telemetry, and electrical stapedial reflex threshold tests) were successfully completed. The electrode position was controlled by conventional radiography on the first postoperative day. Results - Tip fold-over was not tactilely sensated by the surgeon. Our subjects revealed normal intraoperative telemetry measurements, only the postoperative imaging showed the tip fold-over. Due to the emerging adverse perception of constant beeping noise, the device was replaced by a CI512 implant after 6 months in one case. In the two remaining cases, the electrode array was reloaded into a back-up sheath, and reinserted into the scala tympani successfully through an extended round window approach. Discussion - Future additional studies using the spread of excitation or electric field imaging may improve test reliability. As all of these measurements are still carried out following electrode insertion, real-time identification, unfortunately, remains questionable. Conclusion - Tip fold-over could be reliably identified by conventional X-ray imaging. By contrast, intraoperative electrophysiology was not sufficiently sensitive to reveal it.

[Endoscopic ultra dream pulse laser surgery of laryngomalacia. Our experiences gained during the introduction of the method in Hungary]. / A laryngomalacia endoszkópos ultrapulzációs-lézeres (ultra dream pulse) sebészete. A módszer hazai bevezetése során szerzett tapasztalataink.

INTRODUCTION: Congenital stridor and dyspnoe are caused by laryngomalacia in most cases. AIM: In this article we present a new, surgical method for treating severe laryngomalacia in patients under the age of 1, where ultrapulsated (UDP) laser beam is used for supraglottoplasty. Ultra dream pulse laser creates lesser thermical side damage in the tissue, therefore the risk of postoperative laryngeal oedema and scarring is lower. METHOD: We present 10 cases and the endoscopic UDP-laser surgery of patients under the age of 1 with severe laryngomalacia. RESULTS: After the surgery the stridorous symptoms disappeared, and there was no evidence of postoperative laryngeal oedema, there was no need for reoperation or tracheotomy in any of the cases. CONCLUSION: UDP-laser surgery of laryngomalacia is proven to be a safe and effective surgial modality. During the follow up visits we experienced neither recurrence of stridor nor laryngeal scarring. Orv Hetil. 2017; 158(33): 1288-1292.

Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy.

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

[More than 50 years' experience in the treatment of patients with congenital heart disease at a Hungarian university hospital]. / Több mint 50 év tapasztalat a congenitalis szívbetegek ellátásában egy magyar egyetemi központban. A CSONGRÁD Regiszter alapadatai.

Improvements in surgical techniques and technical advancements have made possible for several patients with congenital heart disease to grow up to adulthood. It has been decided to create a registry for their more precise treatment. This registry now includes 2770 patients with data on 3043 operations, with almost 30 different diagnoses. The purpose of this paper is to review the facts and the basics leading to the establishment of this registry.

pH-Triggered Hydrogel Nanoparticles for Efficient Anticancer Drug Delivery and Bioimaging Applications.

In this work, we developed multifunctional hydrogel nanoparticles (NPs) that can encapsulate anticancer drugs and imaging contrast agents as well. Mitomycin C (MMC) and rhodamine B (RB) were selected as models for anticancer drugs and imaging contrasting agents, respectively. Both MMC and RB were linked to the succinated polyvinyl alcohol polymer (PVA-SA). The selected labeled hydrogel NPs ((0.5% RB)-PVA-SA NPs and (1.5% RB)-PVA-SA NPs) improved the RB quantum yield from 29.8% to a minimum of 42.7%. Moreover, they showed higher emission stability compared to free RB when they were repeatedly excited at 554 nm for 2 h. Furthermore, the dye polymeric interactions significantly increased the RB fluorescence lifetime by approximately twofold. All these optical properties pave the way for our labeled hydrogel NPs to be used in imaging-guided therapy. For the labeled MMC-loaded NPs, the MMC-binding efficiency was found to be exceedingly high in all synthesized samples: a minimum of 92% was achieved. In addition, the obtained pH-dependent drug release profiles as well as the cytotoxicity evaluation demonstrated the high potential of releasing MMC under acidic cancerous conditions. Moreover, the in vitro cellular uptake experiment confirmed the accumulation of MMC NPs throughout the cytoplasm.

Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy.

Objectives: Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Methods: Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Results: Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Conclusion: Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. Level of Evidence: 4 (retrospective case series review).

Hypertrophic cardiomyopathy is associated with abnormal echocardiographic aortic elastic properties and arteriograph-derived pulse-wave velocity.

OBJECTIVE: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease and defined by the presence of unexplained left ventricular hypertrophy (LVH). Vascular alterations are frequently associated with HCM including microvascular and/or peripherial endothelial dysfunction. This study was designed to evaluate echocardiographic ascending aortic elastic properties and arteriograph-derived pulse-wave velocity (PWV) and augmentation index (Aix) in HCM. METHODS: This study comprised 38 patients with typical features of HCM. Their results were compared to 20 hypertensive patients with LVH and 23 controls. Systolic and diastolic ascending aortic diameters were recorded in M-mode at a level of 3 cm above the aortic valve from a parasternal long-axis view. The following echocardiographic aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility, and stiffness index. Arteriograph-derived PWV and AIx were also measured. RESULTS: Aortic stiffness index (18.4 ± 17.6 vs. 6.88 ± 3.63, P < 0.05), PWV (9.44 ± 4.08 vs. 7.97 ± 1.20 m/sec, P < 0.05) and Aix (-24.9 ± 32.6 vs. -41.4 ± 24.3, P < 0.05) were increased, while aortic strain (0.061 ± 0.053 vs. 0.100 ± 0.059, P < 0.05) and aortic distensibility (1.94 ± 1.68 cm(2) /dynes 10(-6) vs. 3.08 ± 1.77 cm(2) /dynes 10(-6) , P < 0.05) were decreased in HCM patients compared to controls. Aortic elastic properties of hypertensive patients with LVH showed similar alterations to HCM patients. CONCLUSIONS: Abnormal echocardiographic aortic elastic properties and arteriograph-derived PWV and Aix could be demonstrated in HCM patients compared to matched controls.

Transoral CO2 laser management for selected supraglottic tumors and neck dissection.

This study aimed to evaluate transoral laser resection as a method of choice for conservation surgery for supraglottic laryngeal carcinoma in carefully selected patients. Between 1987 and 2006, 55 patients with early supraglottic carcinoma were selected for transoral laser surgery. The outcome of the endoscopic CO(2) laser resection and larynx-sparing functional results without tracheotomy was evaluated. Fifty-five patients with T1, T2 supraglottic carcinomas underwent transoral CO(2) laser resection and seven patients with manifest neck metastasis required a neck dissection at one session with additional postoperative radiation therapy. There was no need for tracheotomy; deglutition was moderately disturbed. Forty of the 55 (73%) patients had no signs of recurrence to date. Fifteen patients with local recurrences underwent salvage therapies: six repeated laser excisions, three radiotherapies, four supraglottic laryngectomies and two total laryngectomies. Laser-specific survival is 84% and larynx preservation is 96%. The overall 5-year-survival after salvage treatment is 98%. Development of late metastasis required five radical neck dissections (RND) and radiation therapy. The results indicated that transoral laser resection can control early supraglottic cancer in selected patients and can be combined with simultaneous neck dissection with less morbidity than "open surgery".

Detection of "tip fold-over" of the cochlear implant electrode array with transimpedance matrix (TIM) measurement / Az elektródasor visszatekeredésének kimutatása transzimpedanciamátrix (TIM)-vizsgálattal cochlearis implantátumban.

Összefoglaló. Bevezetés: Az elmúlt években a cochlearis implantátum a súlyos halláskárosodás vagy a teljes siketség rutinszeru és hatékony kezelési eszközévé vált. Korunk egyik leggyakrabban használt és leghatékonyabb újítása a cochlearis implantációban a perimodiolaris vékony elektródasorok alkalmazása. A cochlea középtengelyét, a modiolust szorosan ölelo atraumatikus elektródasor igen meggyozo eredménnyel bizonyítja népszeruségét, mind az elektrofiziológiai mérések során, mind az akusztikus hallás megorzése terén nyújtott teljesítményével. Ugyanakkor igen kevés publikáció írja le az elektródasor nem megfelelo helyzetének elofordulási gyakoriságát, pontosabban a visszatekeredését a csúcsi szakaszon. Célkituzés: Tanulmányunk célja olyan szoftveres technika, a transzimpedancia-mátrix (TIM) beillesztése a rutin intraoperatív elektrofiziológiai mérési metodikák közé, amely képes objektív diagnosztikai lehetoséget biztosítani ahhoz, hogy korán felismerhessük a cochlearis implantátum elektródasorán keletkezett hurkot. Módszer: Hároméves kisgyermek kétoldali cochlearis implantációját követoen, posztoperatív röntgenfelvételen a bal oldalon az elektródasor megfelelo pozíciója figyelheto meg, míg a jobb oldalon az intracochlearis elektródasor végének visszatekeredése igazolódott. Képalkotó vizsgálatot követoen elektrofiziológiai metódusként TIM-vizsgálatot végeztünk. Az eljárás során a méroeszköz a kijelölt stimuláló elektródákon 1 V nagyságrendu feszültséget közöl állandó áramerosség mellett a cochlea közel eso struktúrái felé. Méroelektródák segítségével regisztráljuk a szöveteken mérheto feszültséget, majd transzimpedancia-mátrixszá alakítjuk a mért értékeket. Eredmények: Az elektródasor visszatekeredése, amelyet korábban radiológiai vizsgálattal igazoltunk, az objektív elektrofiziológiai mérések segítségével is jól azonosítható, és a vizsgálatok szoros párhuzamot mutatnak. Következtetés: Az elektródák helyzetének megjelenítésére szolgáló standard radiológiai képalkotási technikák kiegészíthetok, illetve kiválthatók egyszeruen elvégezheto, hatékony, objektív elektrofiziológiai vizsgálatokkal. Intraoperatíven, még a sebzárás elott kimutatható, ha az elektródasor nem megfelelo helyzetbe került, így csökkenthetjük a radiológiai vizsgálatokkal járó sugárterhelés és annak finanszírozási problémáját. Orv Hetil. 2021; 162(25): 988-996. INTRODUCTION: In recent years, the cochlear implant has become a routine and effective treatment tool for severe hearing loss and total deafness. One of the commonly used and effective innovations of our time in cochlear implantation is the perimodiolar thin electrode array. The atraumatic electrode array, which closely embraces the central axis of the cochlea (modiolus), has served its popularity with very convincing results, with its performance in both electrophysiological measurements and acoustic hearing preservation. However, very few publications describe the frequency of improper positioning of the electrode array, which is known as 'tip fold-over'. OBJECTIVE: The aim of our study is to incorporate a software technique, the transimpedance matrix (TIM), into routine intraoperative electrophysiological measurement methodologies to provide a potential objective diagnostic opportunity for early detection of tip fold-over of the electrode array. METHOD: Following bilateral cochlear implantation of a three-year-old child, postoperative radiography showed the correct position of the electrode array on the left side, while tip fold-over of the intracochlear electrode array was detected on the right side. Following imaging, a TIM study was performed as an electrophysiological method. During the procedure, the measuring device transmits a voltage of the order of 1 V to the nearby structures of the cochlea at a constant current at the designated stimulus electrodes. Measuring electrodes were used to register the voltage measured on the tissues, and then converted into a TIM. RESULTS: Electrode tip fold-over was previously diagnosed by radiological examination, while it can also be diagnosed by objective electrophysiological measurements now, and these two tests correlate well. CONCLUSION: Standard radiological imaging techniques for electrode positioning can be supplemented or replaced by easy-to-perform, effective objective electrophysiological studies. Tip fold-over can be detected intraoperatively, even before wound closure, if the electrode array is in the wrong position, thus reducing the radiation exposure associated with radiological examinations as well as reducing relevant costs. Orv Hetil. 2021; 162(25): 988-996.

Application field of VOXEL-MAN Tempo 3D virtual reality simulator in surgery of pars petrosa of temporal bone / A VOXEL-MAN Tempo 3D virtuálisvalóság-szimulátor alkalmazása a sziklacsont sebészetében.

Összefoglaló. Bevezetés: Az emberi sziklacsont a halántékcsont része, egy bonyolult és változatos anatómiai felépítésu struktúra. A sziklacsonton végzett beavatkozások elott, a mutéti szövodmények megelozése érdekében, nélkülözhetetlen a biztos anatómiai tudás és kézügyesség megszerzése, valamint az egyes mutéti lépések és mozdulatok begyakorlása. A VOXEL-MAN Tempo 3D fül-orr-gégészeti szimulátor a virtuális valóság és a robotika alkalmazásával nyújt gyakorlási lehetoséget. Célkituzés: A Szegedi Tudományegyetem 2019-ben VOXEL-MAN fül-orr-gégészeti szimulátort helyezett üzembe az Orvosi Készségfejlesztési Központban. A cikk fül-orr-gégész szakorvos szerzoi a VOXEL-MAN Tempo szimulátor megismerését követoen bemutatják a készüléket, és megfogalmazzák a szimulátorral végzett beavatkozásokkal szemben támasztott igényüket. Módszer: A szerzok a megfogalmazott szempontoknak megfeleloen értékelik a VOXEL-MAN Tempo szimulátort, és meghatározzák, milyen szerepet szánnak neki a gyakorlati képzésben. Eredmények: A szimulátor virtuálisan, mégis valósághuen mutatja meg a sziklacsont anatómiai viszonyait, a fontos anatómiai struktúrák valós térbeli elhelyezkedését és egymástól, illetve a sebészi eszköztol mért távolságát. A rendszer lehetové teszi a fülmutétek valósághu elvégzését (kétkezes csontmunka fúróval és szívóval, vérzés szimulálása) taktilis visszacsatolással. Az egy- vagy kétkezes feladatokkal fejleszthetjük a sebészi készségeket. A fülmutétek csontmunkája reprodukálható módon elvégezheto valódi beteg halántékcsontjáról készített rutin, nagy felbontású komputertomográfiás vizsgálat anyagából. Következtetés: Tapasztalataink alapján a szimulátor kiválóan alkalmas az egyes mutéti lépesek begyakorlására. A jövoben fontos szerepet szánunk a virtuális rendszernek a fül-orr-gégészeti graduális és a fülsebészeti posztgraduális képzésben. Orv Hetil. 2021; 162(16): 623-628. INTRODUCTION: The pars petrosa of the human temporal bone is a structure of complex and diverse anatomy. Prior to surgical interventions, in order to prevent surgical complications, it is essential to acquire sound anatomical knowledge and dexterity as well as to practice each surgical step and movement. The VOXEL-MAN Tempo 3D simulator uses virtual reality and robotics to provide an opportunity to practice. OBJECTIVE: In 2019, the University of Szeged installed a VOXEL-MAN Virtual Reality simulator at the Medical Skills Development Center. After learning about the VOXEL-MAN Tempo simulator, the authors present the device and articulate their need for interventions with the simulator. METHOD: The VOXEL-MAN Tempo simulator is evaluated according to the formulated criteria and the role assigned to it in the practical training is determined. RESULTS: The simulator shows the anatomical structure of the temporal bone virtually, yet realistically, the real spatial location of the important anatomical structures and their distance from each other and from the surgical instrument. The system allows ear surgery to be performed realistically (two-handed bone work with a drill and suction) with tactile (vibration) and visual (bleeding) feedback. One can improve surgical skills with one- or two-handed tasks. Bone work in ear surgeries can be performed in a reproducible manner from routine, high-resolution computer tomography of the temporal bone of a real patient. CONCLUSION: With reference to our experience, the simulator is excellent for practicing each surgical step. In the future, we intend to use this virtual system in undergraduate and postgraduate training in otolaryngology. Orv Hetil. 2021; 162(16): 623-628.

A novel intraoperative imaging tool to follow the cochlear implant electrode array insertion dynamics / Új mutéti képalkotó lehetoség a belsofül-implantátum elektródasorának dinamikus helyzetmeghatározására.

Összefoglaló. Bevezetés: A cochlearis implantátum egy mutétileg behelyezett elektromos eszköz, amely az akusztikus hanghullámokat elektromos jelekké alakítja, közvetlenül a hallóideget stimulálja, így segíti a súlyos fokú hallássérüléssel vagy teljes hallásvesztéssel élok életét. Cochlearis implantációt követoen a legjobb rehabilitációs eredmény elérésének technikai feltétele többek között az esetre szabott elektródaválasztás és az elektródasor teljes, kontrollált, szövodménymentes bejuttatása a scala tympaniba, miközben a cochlea belso struktúrája a leheto legkisebb mértékben sérül. A rutin intraoperatív elektrofiziológiai tesztek fontos információt adnak a készülék muködoképességérol és a hallóideg stimulációjáról, azonban nem hagyatkozhatunk rájuk az elektródasor cochleán belüli helyzetének igazolásában. Mivel elofordulhat, hogy a rendelkezésre álló elektrofiziológiai vizsgálatok eredménye megfelelo, és mégis rendellenes helyzetbe kerül az elektróda, az arany standardot a képalkotó vizsgálatok jelentik. Módszer: Közleményünkben egy modern, hibrid muto által nyújtott technológiai háttér új alkalmazási területét mutatjuk be. Szimultán kétoldali cochlearis implantációt végeztünk Cochlear Nucleus Slim Modiolar típusú perimodiolaris elektródasorral, a belso fül fejlodési rendellenességével rendelkezo betegen. Az intraoperatív képalkotást Siemens Artis pheno C-karos robot digitális szubtrakciós angiográfiás rendszer biztosította valós ideju átvilágító és volumentomográfiás funkcióval. Eredmények: Az intraoperatív képalkotás által dinamikusan követheto az elektródasor bevezetésének folyamata, ellenorizheto az elektródasor statikus helyzete, így kiváltható a rutinnak számító posztoperatív képalkotó vizsgálat. A rendellenes helyzetbe kerülo elektródasor pozíciója egy ülésben korrigálható, az újból bevezetheto, így elkerülheto az újabb altatással járó, bizonytalan kimenetelu revíziós mutét. Következtetés: A hibrid muto jól kontrollált, minimálisan invazív eljárások elvégzését biztosítja. Különösen a hallószerv fejlodési rendellenessége vagy egyéb, az elektródának a cochleába vezetését nehezíto rendellenesség esetén javasolt a mutoi képalkotó diagnosztika. Orv Hetil. 2021; 162(22): 878-883. INTRODUCTION: The cochlear implant is a surgically inserted electrical device that converts acoustic sound waves into electrical signals to stimulate the cochlear nerve, thus helps the rehabilitation of people with severe to total hearing loss. One of the most important technical conditions for achieving the best rehabilitation result after cochlear implantation is the personalized choice of electrodes. Additionally, it is vital that there is a complete, controlled, uncomplicated delivery of the electrode array to the scala tympani while minimizing damage to the inner structures of the cochlea. Routine electrophysiological tests provide important information about device functionality and auditory nerve stimulation. However, they probably do not show an abnormal position of the electrode array within the cochlea. Thus, imaging studies remain the gold standard. METHOD: In our paper, we present a novel application field of the modern technological background provided by a hybrid operating room. Simultaneous bilateral cochlear implantation was performed with cochlear implants with perimodiolar electrode array (Nucleus Slim Modiolar) in a patient with cochlear malformation. Intraoperative imaging was provided by a Siemens Artis pheno C-arm robot digital subtraction angiography system with real-time fluoroscopy and volume tomography function. RESULTS: Intraoperative imaging ensures dynamic follow-up of the introduction and static determination of the position of the electrode array and replaces routine postoperative imaging. If the electrode array was inserted in an abnormal position, the revision can be performed in the same sitting. Also, the revision surgery with a potential risk of uncertain outcome, alongside additional anaesthesia, can be prevented. CONCLUSION: The hybrid operating room ensures that well-controlled, minimally invasive procedures are performed. Intraoperative imaging can be imperative in malformed cochleae and conditions that may complicate electrode insertion. Orv Hetil. 2021; 162(22): 878-883.

Simultaneous improvement in aortic distensibility and coronary flow velocity reserve after successful coronary interventions.

OBJECTIVE: Deteriorations in coronary flow velocity reserve (CFR) and aortic distensibility have been demonstrated in coronary artery disease. The objective of the present study was a simultaneous echocardiographic evaluation of the CFR and aortic distensibility indices before and after successful percutaneous coronary interventions (PCI) in patients with left anterior descending coronary artery (LAD) disease. METHODS: The study population, comprising 12 patients (4 women and 8 men) with significant proximal LAD stenosis, were compared with matched controls. Transesophageal echocardiography (TEE) was carried out to evaluate the CFR and aortic distensibility indices (the aortic elastic modulus E(p) and Young's circumferential static elastic modulus E(s)) before and after PCI to the LAD. The subjects underwent TEE on average 8 +/- 11 days before PCI and 25 +/- 6 weeks after PCI. RESULTS: An improvement in CFR was demonstrated in patients with LAD stenosis after successful PCI (1.71 +/- 0.36 vs. 2.08 +/- 0.28, P < 0.05), which paralleled the decreases in E(p) (936 +/- 544 mmHg vs. 567 +/- 184 mmHg, P < 0.05) and E(s) (10,207 +/- 6,295 mmHg vs. 5,831 +/- 2,010 mmHg, P < 0.05) during the follow-up. CONCLUSION: The aortic distensibility improves in parallel with the increase in CFR in patients with LAD stenosis after successful PCI.

Long-term prognostic significance of coronary flow velocity reserve in patients with significant coronary artery disease not involving the left anterior descending coronary artery (results from the SZEGED study).

OBJECTIVE: Coronary flow velocity reserve (CFR) by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate the coronary microcirculatory dysfunction in the left anterior descending coronary artery (LAD). The present study was designed to evaluate the long-term predictive value of CFR for mortality in patients with right (RC) and/or left circumflex coronary artery (CX) stenosis without epicardial LAD disease. METHODS: A total of 49 patients with significant RC and/or CX stenosis were enrolled in this prospective follow-up study. All patients had undergone coronary angiography demonstrating significant RC and/or CX stenosis without LAD disease and dipyridamole stress transoesophageal echocardiography as CFR measurement. RESULTS: The success rate of follow-up was 43 out of 49 (88%). During a mean follow-up of 97 +/- 29 months, 14 patients suffered cardiovascular deaths (12 sudden cardiac deaths and 2 strokes), and 1 patient died of pulmonal tumor. Patients who died during the follow-up had significantly lower CFR values (1.85 +/- 0.43 vs. 2.31 +/- 0.57, P < 0.05). Using ROC analysis, CFR <2.09 had the highest accuracy in predicting cardiovascular survival (sensitivity 80%, specificity 57%, area under the curve 73%, P = 0.003). The logistic regression model identified only CFR as an independent predictor of survival (hazard ratio [HR] 6.26, 95% CI of HR 1.23-19.61, P = 0.024). CONCLUSIONS: Long-term prognostic significance of CFR for the prediction of mortality has been demonstrated during a 9-year follow-up in patients with significant coronary artery disease not involving the LAD.

[Long-term prognostic value of coronary flow reserve in patients without significant left anterior descending coronary artery stenosis: results from the SZEGED Study]. / A coronariaáramlási rezerv prognosztikus jelentosége a koronarográfia során a bal koszorúér leszálló szárában szignifikáns szukületet nem mutató betegekben. Eredmények a SZEGED Tanulmányból.

UNLABELLED: Coronary flow reserve (CFR) measured by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate coronary microcirculatory (dys)function in the left anterior descending coronary artery (LAD), in the absence of macrovascular lesions. AIMS: The present study was designed to evaluate long-term prognostic value of CFR in patients without significant epicardial LAD stenosis. METHODS: A total of 166 patients without significant LAD stenosis were enrolled in this prospective follow-up study. Coronary angiography demonstrated absence of significant LAD disease in all cases. All patients underwent transthoracic and stress transesophageal echocardiography (CFR measurement) and coronary angiography. RESULTS: The success rate of follow-up was 124 out of 166 (75%). During a mean follow-up of 93+/-34 months 27 patients died, including 16 sudden cardiac deaths, 3 acute heart failures, 2 strokes, while 6 patients had pulmonary or gastrointestinal malignancies. Using ROC analysis, the best cut-off value for CFR was 2.13 to predict survival (sensitivity 67%, specificity 60%, area, under the curve 62%, p = 0.046). Patients with CFR < 2.13 had significantly more events (32% vs. 13%, p<0.05). The logistic regression model identified CFR (hazard ratio (HR) 2.43, p = 0.04) and left ventricular end-systolic volume (HR 1.09, p = 0.03) as independent predictors of survival. CONCLUSIONS: Long-term prognostic significance of CFR for prediction of survival has been demonstrated during a long-term follow-up in patients without significant LAD stenosis.

Tracheostomy during novel corona virus pandemic. / Tracheotomia az új típusú koronavírus okozta járvány idején(A COVID-19-pandémia orvosszakmai kérdései).

Recently, 6 percent of COVID-19 patients required prolonged mechanical ventilation due to severe respiratory failure. Early tracheostomy prevents the risk of postintubation upper airway stenosis. In the pandemic, all surgical interventions that generate aerosol increase the risk of contamination of the medical staff, for which reason the "traditional" indications of tracheostomy have to be revised. Authors present their recommendations based on international experiences. Orv Hetil. 2020; 161(19): 767-770.

Long-term prognostic value of coronary flow velocity reserve in patients with hypertrophic cardiomyopathy: 9-year follow-up results from SZEGED study.

Reduction in coronary flow velocity reserve (CFR) is a recognized feature in hypertrophic cardiomyopathy (HCM). We sought to assess the long-term prognostic value of CFR by pulsed-wave Doppler transesophageal echocardiography (TEE) in HCM patients. The study comprised 20 patients with typical features of HCM. The patients were enrolled in 1999. All patients underwent a standard transthoracic echo-Doppler study to evaluate left ventricular function and a stress vasodilator TEE study to evaluate CFR. The success rate of follow-up was 18 out of 20 (90%). During a mean follow-up of 90 +/- 24 months, four patients suffered cardiovascular death (2 sudden cardiac deaths and 2 strokes). The other seven patients underwent invasive procedures (coronary angiography, implantable cardioverter defibrillator implantation, percutaneous transluminal septal myocardial ablation) or showed cerebrovascular events. Using receiver operator characteristic analysis, CFR < 2.35 was a significant predictor for cardiovascular event-free survival (sensitivity 91%, specificity 71%, area under the curve 74%, P = 0.05). Multivariable regression analysis showed that only CFR (hazard ratio (HR) 4.21, P < 0.05) was an independent predictor of cardiovascular event-free survival. Despite the relatively small number of patients involved in the study, results could suggest that CFR should be considered as an independent predictor for future cardiovascular events in HCM patients. However, further studies with larger HCM patient populations are warranted.

Coronary flow velocity reserve and aortic distensibility indices in hypertensive patients with hypercholesterolaemia and normal epicardial coronary arteries.

The aim of the present study was to assess the relationship between coronary flow velocity reserve (CFR), aortic distensibility indices, and levels of plasma total cholesterol (TC) in arterial hypertension. We studied 39 consecutive hypertensive patients free of coronary artery disease. Eighteen of them had normal TC and 21 had 1(8) high TC. Coronary flow velocity reserve and aortic elastic moduli were measured during stress transoesophageal echocardiography. Reduced CFR (2.41 + or - 0.75 vs. 1.97 + or - 0.60, p < 0.05), increased aortic elastic modulus (in 10(3) mmHg) (0.56 + or - 0.41 vs. 0.77 + or - 0.29, p < 0.05) and Young's modulus (in 10(3) mmHg) (5.42 + or - 4.03 vs. 8.57 + or - 4.79, p < 0.05) were found in hypercholesterolaemia.