An unusual case of hyalinizing clear cell carcinoma in a sinonasal cavity and cranial base.

Hyalinizing clear cell carcinoma (HCCC) is a rare, predominantly minor salivary gland tumor. Most of these tumors occur in the oral cavity, mainly the palate and tongue. Primary localization of the tumor in the region of the nasal cavity and paranasal sinuses is extremely rare and, with only a few cases reported in the literature so far. We present an extremely rare case of a 61-year-old woman with hyalinizing clear cell carcinoma (HCCC), occupying the left posterior nasal and nasopharyngeal cavity, as a primary tumor location. The patient total recovery was uneventful, and she is now free of disease at three years postoperative follow-up.

Radiotherapy-induced hearing loss in patients with laryngeal and hypopharyngeal carcinomas.

The purpose of this study was to investigate a hypothesized correlation of development of a sensorineural hearing loss and radiotherapy in patients with laryngeal and hypopharyngeal carcinoma. This prospective study included a total of 50 patients, which after strict exclusion critera (audiologic problems before RT primary tumors of the auditory system, spread of the primary tumor to any part of the auditory system) resulted in 23 analyzed patients, ranging between 50 and 76 years of age, with a mean age of 60. Audiometry measuring frequency-specific thresholds was performed in three time points: one month before radiotherapy, one and six months after radiotherapy. A significant statistical difference in hearing tresholds after radiotherapy was found in 6 out of 23 patients. An obvious tendency towards hearing loss without statistical significance at 250 and 4000 Hz was found for a whole tested population (p < or = 0.3 with Bonferroni correction). Observed tendency towards hearing loss after radiotherapy of laryngeal carcinoma was related to side of the tumor and less severe when chemotherapy was not added as adjuvant therapy. These results should help to decrease a rate of hearing loss by careful planing of ear protection, by using observed frequencies as relevant markers of hearing loss and by reconsidering adjuvant chemoterapy during radiotherapy of laryngeal carcinoma.

Myasthenic crisis as a side effect of methimazole therapy: case report.

Myasthenia gravis and Graves' disease are two autoimmune diseases with a similar mechanism, both having circulating organ autoantibodies and cell specific autoantibodies. It is not unusual for these diseases to occur together. There is a large body of data proving that antithyroid drugs such as methimazole and propylthiouracil have an immunomodulatory effect in addition to their thyrosuppressant action. This case report describes a 34-year-old woman hospitalized for just diagnosed myasthenic crisis (Osserman IV). She had a prior history of hyperthyroidism and treatment with methimazole was initiated. However, improvement in thyroid disease led to the burst of myasthenia. The phenomenon described as worsening of one disease while improving the other, the so-called 'see-saw' relationship, occurred in this case. The question is whether antithyroid drugs improve hyperthyroidism while unveiling or worsening myasthenia. Is the 'see-saw' relationship actually a therapeutic side effect of antithyroid drug? The proposed mechanism of methimazole action is intracellular: it lowers the level of proliferating cell nuclear antigen (PCNA). PCNA promotes selective apoptosis in some T lymphocyte clones. In this way, CD4+CD25+ regulatory T cells might 'skip' immune self-tolerance and autoantibodies against acetylcholine receptor may occur. Do antithyroid drugs actually create an immune 'thymic surrounding'?

Local or spinal anesthesia in acute knee surgery.

The aim of the study was to assess the efficacy, safety and complications of two anesthetic techniques including local and spinal anesthesia. A total of 436 patients received local (LA group = 250) or spinal (SA group = 186) anesthesia during a year period. SA group received 0.5% Bupivacaine 5 mg/mL. LA group received portal injection (5 mL lidocaine 2% with adrenaline) and intra-articular injection into the knee (10 mL lidocaine 2% with adrenaline). The following parameters were assessed: intraoperative pain (10 cm VAS: 0 = no pain, 10 = extreme pain), surgical operating conditions, patient satisfaction score (1 = very satisfied, 4 = very unsatisfied), postoperative analgesia, and time to discharge. In LA group, 97.6% (244/250) of patients experienced no pain throughout the procedure. Only six (2.4%) patients required conversion to general anesthesia. In SA group, two patients required conversion to general anesthesia. In both groups, 93.6% of patients were either satisfied or very satisfied with their anesthesia. The need ofpostoperative analgesics was higher in SA compared with LA group (p = 0.001). The mean postoperative stay was significantly shorter in LA than in SA group (p = 0.001). Ninety-four percent of LA and only 68% of SA patients were discharged from the hospital within 2 hours of the procedure. The rate of complications differed significantly between LA and SA groups (p = 0.037). Outpatient arthroscopy of the knee under local anesthesia is a simple, reliable, and safe alternative to spinal anesthesia, for patients in whom intraarticular disorders requiring diagnostic arthroscopy and arthroscopic surgery.