[The hyoid bone in reconstructive laryngeal and cervical surgery]. / L'osso ioide nella chirurgia ricostruttiva laringea e cervicale.

The hyoid bone, with its complex system of connected muscles, ligaments and membranes, provides a highly resistant anchor point in all cases of larynx tumour surgery requiring a "pexy" to reconstruct the upper respiratory tract. This bone can also be important in reconstructive cervical surgery employing myocutaneous flaps, especially after extensive tissue removal, such as in locally advanced larynx tumours (primary T4 lesions or recurrences after partial or subtotal operations) and some primary or recurring malignant cancers of the thyroid, parathyroid or pharyngoesophageal tract involving the larynx. In this study the importance is underlined of preserving the hyoid bone in all cases of cervical surgery in which a strong anchor is needed for repair, due to the radical nature of intervention. The clinical-surgical data are reported of 39 patients, 38 of whom affected with epidermoid carcinoma of the larynx with various degrees of differentiation and 1 with "tall cell" papilliferous thyroid carcinoma, observed and treated over the last three years. In horizontal supraglottic laryngectomy (HSL), but particularly in subtotal larynx surgery with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP), the hyoid bone allows a sort of anastomosis to be performed, using residual cartilage to make a "neo-larynx". In reconstructive cervical surgery after extensive tissue removal, such as in forward widened total laryngectomy (FWTL), the hyoid bone offers an excellent anchor for myocutaneous pedunculate "repair" flaps, which may be thoraco-dorsal or free revascularized, to ensure continuity between the muscle tissue of the base of the tongue and of the flap itself. The hyoid bone and connected structures thus provide a real support apparatus whose great versatility, due to its resistance and extreme mobility, makes it particularly useful during the reconstructive phase of cervical surgery.

[Primary non-Hodgkin's lymphoma of the mandible: a description of a clinical case and review of literature]. / Linfoma non Hodgkin primitivo della mandibola: descrizione di un caso clinico e revisione della letteratura.

The authors present a rare case of primary non-Hodgkin lymphoma (NHL) of the mandible in an 81-year old woman. The location of this NHL caused problems in making a differential diagnosis between periodontal and tumoral disease as they have similar symptoms (i.e. dental pain, swelling, ulceration and radiologically detected rarefaction). The present work emphasizes how important correct diagnosis and staging of the primary NHL are to good therapy. The patient was treated with a combination of chemotherapy and radiotherapy and is alive and disease-free 12 months after treatment.

[Carcinoma in ectopic Warthin's tumor: a case study and review of the literature]. / Tumore di Warthin ectopico cancerizzato: descrizione di un caso clinico e revisione della letteratura.

Warthin's tumor is the second most common salivary gland tumor preceded only by pleomorphic adenoma. In most cases it involves the parotid gland and can, at times, be bilateral. It can also arise in ectopic salivary tissue in the latero-cervical and para-parotid lymph nodes. This neoplasm consists of two histologic components: one epithelial, the other lymphoid. Malignant transformation involving each of these tissues has been reported. However, few cases give clear-cut examples of the epithelial malignant change. Therefore, primary malignant transformation of Warthin's tumor is extremely rare. This event appears related to the initial time of tumor onset and/or past radiotherapy for other malignant cervico-facial lesions. The authors report a case of epidermoid carcinoma arising on an ectopic Warthin's tumor in a 57-year-old male. Physical examination revealed a recent, smooth tumor mass on the left, located near the laryngeal thyroid cartilage. Fine needle aspiration cytology was suspicious of a malignant epithelial neoplasm. Functional latero-cervical dissection, modified by excision of the digastric and sternohyoid muscles plus a 2 x 2 cm section of the overlying skin, was performed in this case. Histology and immunocytochemical tests on the surgical specimen revealed a 14 cytokeratin-positive, malignant epidermoid neoplasm arising from the adjacent 14 cytokeratin-negative, oncocytic epithelium. This relationship may rule out metastasis and may, therefore, be a case of Warthin's tumor associated with an epidermoid carcinoma or a case of branchial cyst.

["Prolonged" decay test and auditory brainstem responses in the clinical diagnosis of the chronic fatigue syndrome]. / Decay test "prolungato" e ABR per la diagnosi di sindrome da fatica cronica: confronto tra le metodiche.

The chronic fatigue syndrome (CFS) was formally defined to describe disabling fatigue of unknown etiology with immunologic disfunctions. In most cases occur abnormalities of neurophysiological tests. In this paper the Authors use the low (11 pps) and high (51-71 pps) frequency ABR for detecting the electrophysiological function of auditory brainstem responses and propose the "Prolonged Decay Test", a modified impedenzometric technique that explores any alterations of the stapedial contraction, as a new diagnostic test for CFS. Twenty-one patients with suspected CFS, with an age between 17 and 50 years, were examined and the instrumental data were correlated with the clinical findings. The results of the ABR study showed in the examined subjects no many abnormalities in the 11 pps frequency test. The high frequency stimulation trials (with 51 and 71 pps) proved many alterations in 10 patients (absence of the first wave in 6 cases, in 5 many wave latency delay and in 1 patient absence of the first wave and many wave latency delay). The high frequency trials showed no abnormalities in the 11 remaining patients. The clinical-audiological correlation showed a 61.9% of comparison with 33.3% of false negatives and 4.8% of false positives. The Prolonged Decay Test showed a 71.4% of clinical-audiological comparison with 23.8% of false negatives and 4.8% of false positives. The Prolonged Decay Test together with the ABR showed a 81.8% of clinical-audiological comparison with 18.2% of false negatives and 0% of false positives. These preliminary data show that the stapedial reflex together with the ABR test could be useful for the diagnosis of CFS.

[The history of nasal valve surgery]. / Storia della chirurgia della valvola nasale.

Nasal valve surgery involves the Nasal Valve Area and its deformities, as well as its surrounding structures. Since there is no single technique to solve every type of pathology, there are numerous works on this topic in the literature. The rhinologist to perform such surgery should thoroughly deal with all the components (i.e. nasal valve area, nasal bones, tip, spine, vestibulum and turbinates). However, even more so, he should be able to precisely locate the cartilaginous and/or osseous structural deformity impairing nasal air flow. Therefore, intuition and experience play a key role in planning such surgery. It is not easy to recognize the unique, or even more difficult, the partial defect the correction of which would improve overall nasal function. Every surgical technique has some "biologic cost": sclerosis, adhesions, and scar retraction. However, in this case the surgery could prove even more biologically costly as it could worsen the already poor nasal breathing. Therefore, the surgeon must strictly follow two basic rules: a) employ a proper approach to the region; b) do not endanger nasal valve function to satisfy esthetics. Valve area anomalies can be divided into primary and secondary. The latter are caused by trauma or surgery (1.2%). Among the wide range of techniques mentioned in the literature, the authors prefer the anatomical, surgical classification by Zijilker and Quaedvilieg as it incorporates the philosophy the rhinosurgeon must keep in mind when aiming to restore both nasal functions and esthetics through different, specific techniques.

[Multifrequency tympanometry in Meniere's disease: preliminary results]. / La timpanometria multifrequenziale nella malattia di Ménière: risultati preliminari.

Tympanometry with 220 Hz probe tone mainly measures compliance related components of the middle ear. Only higher frequency probe tones provide information on mass related components. In order to study the behavior of the mass related components in endolymphatic hydrops, the Authors tested 15 Ménière's disease patients and 10 healthy subjects using multifrequency tympanometry. In both groups tympanometry with 220 and 678 Hz probe tone was employed to evaluate resonance frequency. The presence of a "camel hump" ([symbol: see text]) pattern obtained with the 678 Hz probe tone test indicated an elastic tympano-ossicular system (low point of middle ear resonance); the presence of an inverted "V" ([symbol: see text]) pattern showed a more rigid system (high point of middle ear resonance). In Ménière's disease carriers multifrequency tympanometry revealed 21 ears (70%) with a resonance frequency higher and 6 (20%) lower than 678 Hz. Three patterns (10%) were not classifiable. In the healthy group resonance frequency resulted lower than 678 Hz in 23 ears (57.5%); in 13 ears higher (32.5%). Four patterns (10%) were not classifiable. In Ménière's disease carriers the tympanometric patterns found with 678 Hz probe tone indicated the presence of a more rigid tympano-ossicular system.

[Auditory brain stem evoked potentials in the evaluation of chronic fatigue syndrome]. / I potenziali evocati uditivi troncoencefalici nella valutazione della sindrome da fatica cronica.

The Chronic Fatigue Syndrome (CFS) was formally defined to describe disabling fatigue of multifactorial ethology with depression and immunologic dysfunctions linked to some currently recognized infectious agents. In most cases neurophysiological tests reveal abnormalities. In this paper the Authors use low (11 pps) and high (51-71 pps) frequency ABR to evaluate the electrophysiological function of auditory brainstem responses. Eighteen patients with suspected CFS, between the ages of 17 and 63, were examined. Eleven subjects had clinically diagnosed "true" CFS (CDC criteria modified by Fukuda). The 11 pps frequency test did not reveal a high number of abnormalities in the patients in question. However, the high frequency stimulation test (with 51 and 71 pps) which was statistically significant (P = 0.009) revealed numerous aberrations in 7 patients; absence of the first wave in 1 case, in 5 numerous wave gap delays and in 1 patient absence of the first wave and numerous wave gap delays. The high frequency test did not show many abnormalities for the 4 remaining patients. For the 7 "non CFS" subjects, the clinical-audiological comparison showed no statistical significance (P = 0.920). The Authors hypothesize that the absence of the first wave in the CFS Subject may well indicate a cyto-neural junction disease in the organ of Corti. The combined analysis of clinical and audiological data showed that the described tests are more reliable when employed in dealing with patients with clinically assessed "true" CFS.

[Widened forwarding total laryngectomy ("squared laryngectomy"). Hints of surgical techniques and personal experience]. / La laringectomia totale allargata in avanti (laringectomia "quadrata"). Cenni di tecnica chirurgica ed esperienza personale.

Primitive T4 laryngeal neoplasms with anterior invasion and neoplasm recurring after partial and subtotal intervention often invade the soft prelaryngeal tissues and in these cases the neoplastic illness can be no longer be controlled be "organ surgery". The widened forwarding total laryngectomy, "squared" or "carrè" laryngectomy according to some Authors of French School, is a surgical procedure not "on an organ" but "in an area" or "region" which proposes to delete, in one step, the larynx, the bone hyoid, the fasciae and the prelaryngeal muscles, the thyroid gland and, if necessary, a more or less large quantity of anterior cervical skin. If the removal involves a vast cutaneous area, it is necessary to mend the loss of substance by wrapping around a miocutaneous flap of pectoralis mayor muscle. In the last five years, 4 male patients, between 48 and 73 years, were treated with widened forwarding total laryngectomy. They were all carriers of epidermoid laryngeal carcinomas with various degrees of differentation: primitive in one patients, recidivist after performance of partial (cordectomy) and subtotal (two Labayle) surgery in the other three patients. In the only case of T4 primitive laryngeal neoplasm it was necessary to carry out a functional neck dissection bilaterally. Loss of substance always required the use of a miocutaneous flap of pectoralis mayor muscle except in one patient in which the removal of the prelaryngeal tissues was limited and therefore it was possible to make a direct seam. We always completely removed the thyroid gland, the prelaryngeal muscular system and skin of the preceding stomy (in the Labayle) sparing, on the other hand, the hyoid bone. Only one patient, who died due to recurrence a year after surgery, underwent complemental percutaneous radiotherapy. At present, three patients are alive and NED: one after 5 years, the others are in excellent conditions although the follow-up is still brief. According to our experience, we can affirm that in selected cases, after an accurate general evaluation of the patient (exclusion of distant metastases, preparation from a metabolic and psychological point of view) a widened forwarding total laryngectomy is a valid procedure since surgery (together with other complementary therapies), is still today the best treatment in forms with anterior evolution.

[Basal cell and basosquamous carcinomas of the external ear. Immunohistochemical study]. / Carcinomi basocellulari e basosquamosi dell'orecchio esterno. Tipizzazione immunocitochimica.

Malignant neoplasms of the external ear are difficult diseases of the cervical-facial area to study clinically and therapeutically. The most frequent malignant histological patterns are spinocellular and basocellular carcinomas. Melanomas, basosquamous or "metatypical" carcinomas are less frequent. The latter have a transition histological pattern halfway between a basocellular and spinocellular carcinoma. In our experience, some external ear neoplasms, diagnosed as basocellular, were clinically more invasive (aggressive). Therefore we studied the immunohistochemistry of operative specimens with monoclonal antibodies (MoAb) with the purpose of revaluating the diagnosis after follow-up, and of detecting unrecognized basosquamous carcinomas. We studied 4 patients (2 male and 2 female) aged between 58 and 78, examined in the period 1990-92 an a diagnosed as having an external ear basocellular carcinoma. The immunohistochemical study was carried out using anti-CEA (carcinoembryonal antigen) monoclonal antibodies, high molecular weight acid anticytokeratins (anti-AE3) and low molecular weight basic anticytokeratins (anti-AE1). Appendage origin of the neoplasms was excluded after carrying out MoAb anti-CEA tests, negative in all patients. Epithelial origin of the neoplasms were confirmed after carrying out MoAb anti-AE3 tests, positive in all patients. After carrying out MoAb anti-AE1 tests, positive in 3 patients out of 4, we reviewed the classification of 2 basocellular carcinomas out of 4. These tumors evidenced an atypical dyskeratosis and a positivity for intracellular keratinization. These aspects were not evidenced in the previous histological examinations using routine stains and could be an index of unfavourable clinical evolution of these two cases from a basocellular carcinoma toward a more aggressive basosquamous carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple primary malignant tumors of the larynx and lung]. / Tumori primitivi maligni multipli nella laringe e nel polmone.

The association of laryngeal and pulmonary neoplasms is one of the most frequent among multiple primary malignant tumors and represents an important problem in terms of prevention and diagnosis. The present study involves 22 cases of associated tumors observed from January 1st 1977 and December 31st 1992. All the patients involved were male, average age 62 years, who had been treated for laryngeal cancers, mostly laryngeal epidermoid carcinoma. Pulmonary cancers (simultaneous, synchronous, metachronous) were diagnosed in all these subjects and one patient presented 2 autonomous bronchial lesions which arose in different periods. Five patients out of 22 (23%) are still alive and with no evidence of disease (NED), 2 more patients are alive although not disease-free. After reporting some considerations regarding the neoplastic association involving the larynx and the lung as well as the increased risk of pulmonary neoplasm in those patients treated for supraglottic lesions, the authors emphasize the importance of personal and family history for cancer and suggest a classification of the risk to develop a second malignancy in these patients.

[Parotid metastases of malignant tumors of the head]. / Metastasi parotidee da tumori maligni della testa.

Tumors of the head as well as other distant tumors may metastasize to the lymph nodes of the parotid gland. Metastases from head malignancies are much more frequent than those arising in distant organs. The authors report their experience in three cases of parotid lymph nodal metastases from head neoplasms: nasal septum carcinoma, left external auditory canal carcinoma and right suborbital skin melanoma. In two cases nodal metastases appeared after the treatment of the primary malignant tumor; in one case metastases were simultaneous to it. All patients were treated surgically (total parotidectomy with facial nerve preservation) and in two cases a submaxillary and functional neck dissection was carried out. Only one patient is alive and disease-free at three years from operation. The authors believe that total parotidectomy performed for nodal metastases involving the parotid gland is to be considered a true "parotid dissection", either "curative" or "prophylactic", depending on whether it is carried out when lymph nodes are palpable or not.

[The surgical treatment of laterocervical adenopathies due to malignant cervicofacial tumors]. / Il trattamento chirurgico delle adenopatie latero-cervicali da tumori maligni cervico-facciali.

Head and neck malignant tumors show a high tendency to spread to cervical lymph nodes. Therefore, surgical approach to these neoplasms is primary tumor exeresis associated with functional or radical neck dissection, unilaterally or bilaterally at the same time, in relation to T site and N stage. In this paper the validity of such approaches is evaluated by correlating clinical and histopathologic N involvement in 168 patients with head and neck malignancies, observed in a 5-year period (1986-1990), and submitted to radical (65 pts.) and functional (198 pts.) neck dissection. The histopathologic findings showed 31 patients (14.7%) with N0+ (false negatives). The incidence of occult latero-cervical metastases confirms the importance of elective functional neck dissections in N0 patients with head and neck malignant tumors even though the risk of performing many unnecessary surgical procedures may be considerable (180 cases out of 211 in the Authors experience). Rare false positives (overall 4 cases) did not represent a significant clinical problem while N3 showed massive neoplastic invasion with extracapsular spread.

[Surgical treatment of post-thyroidectomy laryngeal paralysis]. / Il trattamento chirurgico delle paralisi laringee post-tiroidectomia.

A not infrequent complication of thyroid surgery is laryngeal nerve palsy with transitory or permanent deficiency of cordal motility. A very frequent cause of this condition is total thyroidectomy. Peripheral mono-or bilateral palsy in these cases may either occur, in adduction or abduction, and be complete or not complete. Therefore, different strategies in order to restore respiratory and phonatory functions are required. The Authors describe the main otorhinolaryngologic procedures used for the surgical treatment of laryngeal palsy, particularly for bilateral adducted ones. Their 10-year experience is also reported.

Bion, esse conhecido/desconhecido Uma memória do futuro da psicanálise / Bion, this Known/Unknon A memory of the future of psychoanalysis

Neste trabalho analisam-se os aportes de W.R.Bion à psicanálise, tomando-se como eixo os termos novos que introduziu na teoria e seu uso pela comunidade psicanalítica. Discutem-se alguns destes termos (os mais usados e também os menos usados) assim como suas características estilísticas e implicações. Alerta-se para o risco de que se convertam em um jargão, mais para reforçar a identidade daquele que os usa do que por uma compreensão autêntica daquilo que o autor quis transmitir(au)

[Thyroid gland and carcinoma of the hypopharyngeal-laryngeal region]. / La tiroide e i carcinomi della regione ipofaringo-laringea.

The thyroid gland harbours many diseases which require a surgical treatment; the gland may also be involved by some secondary malignant neoplasms. Such type of involvement by laryngeal and hypopharyngeal cancers is more often due to direct extension rather than metastases. In this paper the Authors report their experience of tumoral involvement of the thyroid gland in 35 patients with laryngeal or hypopharyngeal cancer observed from 1986 to 1990. All patients had an epidermoid carcinoma of the larynx or hypopharynx that required an hemithyroidectomy (always plus isthmectomy) or an isthmectomy associated to laryngectomy. On pathologic examination 5 thyroid specimens revealed tumoral involvement in patients with laryngeal neoplasms: 1 case of solitary metastasis and 4 cases of direct extension. In patients with hypopharyngeal lesions, on the contrary, the gland was, in all cases, undamaged. For this very interesting and uncommon finding the Authors agree with Harrison's proposal suggesting total thyroidectomy is necessary in case of subglottic lesions while in all the other laryngeal and hypopharyngeal lesions the homolateral lobe of the thyroid gland and the isthmus should be removed with the specimen also performing a frozen section examination of the contralateral lobe. In this study tumoral involvement of the thyroid gland appeared to be a very important negative prognostic factor and was higher in the subglottic and anterior commissure lesions.

[Thyroid gland involvement in cancer of the larynx]. / L'interessamento della ghiandola tiroide nel cancro della laringe.

Numerous diseases that require surgical treatment often occur in the thyroid, one of the most important organs in the neck. An example of such pathologies are benign and malignant neoplasms. It is still not well known, however, if certain secondary malignant neoplasms may also arise there. While this pathology is relatively frequent, and often asymptomatic, the incidence of secondary lesions observed clinically in the thyroid is much lower than that found in series based on necroscopy. The thyroid may be involved by metastatic spreading of systemic malignant neoplasms (of the kidney, breasts, lung, colon, rectum, etc.) or by direct extension of laryngeal, hypopharyngeal or esophageal cancer, the latter being more frequent. In this paper the Authors report their experience with regard to the incidence of tumorous involvement of the thyroid in 23 patients (22 of which were males between the ages of 48 and 69--average age, 65) under observation for laryngeal cancer from 1986 to 1990. All the patients had an epidermoid carcinoma of the larynx that, due to its location and size, required a hemithyroidectomy or an isthmectomy associated with laryngectomy (20 total laryngectomies with hemithyroidectomies and 3 subtotal laryngectomies with isthmectomy). Upon pathologic examination, 7 thyroid specimens (30%) revealed tumorous involvement of the thyroid and in those cases of males who had undergone total laryngectomy with hemithyroidectomy, thyroid involvement was found. In 5 cases, tumorous involvement was immediately evident upon microscopic examination (1 case of solitary tumor metastasis and 4 of direct extension).(ABSTRACT TRUNCATED AT 250 WORDS)

Survey of keratinophilic fungi in Alpine marmot (Marmota marmota) burrow soil and in adjoining soils.

Soil samples from 127 marmot (Marmota marmota) burrows were examined for keratinophilic fungi along with 48 soil samples from adjoining areas. The occurrence of keratinophilic fungi (especially Microsporum gypseum) was significantly higher in burrow soil. A review of the literature and our results support the hypothesis that the "animalization" (i.e. the enrichment of soil with hairs, crusts and other organic matters) of the environment may create conditions suitable for the growth of keratinophilic fungi. The presence of keratinophilic fungi in alpine mountain soil was noted for the first time.

First European report of swine infection by Microsporum nanum.

The first European case of swine infection by Microsporum nanum is reported. The infected pig came from a farm in the Emilia-Romagna region of Italy. European records of human and lower animal infections by this fungus and soil isolation records are discussed.