Review of the genus Saropogon Loew, 1847 (Diptera: Asilidae) from Russia, Transcaucasia and Central Asia, with description of three new species.

Nine species of the genus Saropogon Loew, 1847 are reviewed. Saropogon aliyevi Sakhvon sp. nov. (Azerbaijan), S. astakhovi Sakhvon sp. nov. (Armenia) and S. tajikistanensis Sakhvon sp. nov. (Tajikistan) are described and illustrated. The distribution of some species is increased. Saropogon pittoproctus Loew, 1873 is recorded from Russia (Kalmykia) for the first time. Records of prey of some of the Saropogon species are presented. An identification key to males of the species is given.

Enhancement of antibiotic activity by phytocompounds of Turnera subulata.

The present study aimed to evaluate the antibacterial and modulatory activity of the Turnera subulate methyl extract in isolation or in combination with aminoglycoside antibiotics, using the microdilution method. The Turnera subulata methyl extract was used in isolation in the antibacterial assays and in combination with antibiotics in the modulation assays. All tests were performed in triplicates. The Turnera subulata methyl extract presented both antibacterial and antibiotic-modulatory effects in vitro, in isolation and in association with aminoglycosides. The extract activity depends on the bacterial strain and may be associated with the presence of tannins and flavonols. However, further studies are required to characterize the Turnera subulata potential for the development of new drugs against multiresistant bacteria.

Review of the genus Heteropogon Loew, 1847 (Diptera: Asilidae) from Russia and Central Asia, with description of two new species.

Nine species of genus Heteropogon Loew, 1847 are reviewed. Heteropogon ater Sakhvon sp. nov. (Kazakhstan, Tajikistan) and H. hiemalis Sakhvon sp. nov. (Turkmenistan) are described and illustrated. A new synonymy is proposed for Heteropogon filicornis (Loew, 1871) = Cyrtopogon leleji Lehr, 1998, syn. nov. The status of Heteropogon lugubris mesasiaticus Lehr, 1970 is upgraded to species level that of mesasiaticus. The distribution of some species is increased. A key to males of the species is given.

Endonasal endoscopic repair of cerebrospinal fluid leaks versus craniotomy: comparison of the outcomes.

BACKGROUND: Cerebrospinal fluid (CSF) leaks have been traditionally managed via craniotomy with an intradural repair. The endonasal endoscopic approach represents a minimally invasive alternative. This study aimed to compare the outcomes of the two methods. CASE SERIES: This is a prospective case series of 18 consecutive patients who underwent endonasal repair of a CSF leak. Thirteen variables were evaluated during the study, including age, gender, body mass index, site of the defect, CSF leak etiology, days of hospitalization, use of lumbar drainage, the success of repair, complications, recurrence, duration, and cost of surgery as well as patient satisfaction. The outcomes were compared with a historical cohort of 25 patients treated for CSF leaks with a craniotomy. Though we found no significant difference in the success of the repair, the endoscopic group had a significantly shorter duration of the procedure and hospitalization, a lower rate of complications, lower cost, and higher patient satisfaction. CONCLUSION: The presented data further solidify the endoscopic approach as the preferred method to address CSF leaks located in the anterior and middle skull base in cases not associated with complex intracranial pathology. Hippokratia 2016, 20(4): 299-302.

Laryngeal cancer: epidemiological data from Νorthern Greece and review of the literature.

BACKGROUND: Cancer of the larynx accounts for 1% to 2.5% of all human neoplasms and is the most common malignancy of the Head and Neck region. The purpose of this study is to analyze epidemiological data of patients with laryngeal cancer and to point out the geographical variations. METHODS: This is the first systematic recording of the laryngeal cancer epidemiological data in Northern Greece. During the period 1992-2010 1,638 patients were diagnosed with and treated for malignant head and neck tumors. One thousand one hundred and four cases (67.4%) were malignant laryngeal tumors, 98.4% of which (1,088 cases) were squamous cell carcinomas (SCC). Only 16 patients (1.5%) presented with other types of malignancies. RESULTS: The average age of the SCC patients was 62.1 years. Only 35 patients were women (3.2%). More than 60% of the patients were farmers or labor workers, 86.9%, were smokers, 43.2% were consuming alcohol on a daily basis and 36.1% had a positive family history of malignancy. Concerning tumor location, 60.2% were glottic cancers. T staging revealed that 1.2% of the cases were carcinomas in situ, 28% T1 tumors, 19% T2, 32 % T3, and 20% T4. Tumor grading showed that 43% of the cases were G1, 42.1% were G2, and 11.8% were G3. CONCLUSIONS: The pathogenesis of laryngeal carcinoma is the result of the combined action of endogenous and environmental factors. The recording and analysis of the epidemiology of the disease is important for its better study and understanding.

Benign paroxysmal positional vertigo in the first acute attack of Ménière's disease.

A 69-year-old woman, with no history of vertigo attacks, presented with the classical triad of symptoms for Ménière's disease in the right ear (vertigo, tinnitus, fullness). Upon admission, the patient had a third-degree horizontal nystagmus beating to the right, after beating towards the left ear a few hours earlier. Audiometry confirmed a severe sensorineural hearing loss in the right ear, especially at low and high frequencies. The following day, the patient complained of short episodes of vertigo linked to head movement, and the Hallpike test was compatible with benign paroxysmal positional vertigo (BPPV) in the right ear. To our knowledge this is the first description of BPPV of the posterior semicircular canal manifesting during the first vertiginous attack of Ménière's disease in the same ear. It was possible that the hydropic distension or rupture damaged the otolithic apparatus, leading to the release of otoconia debris which migrated to the posterior semicircular canal where it resulted in BPPV.

The value of bilateral simultaneous nasal spirometry in the assessment of patients undergoing septoplasty.

PROBLEM: There is no consensus regarding the best approach to select patients for septoplasty. Patient dissatisfaction after septoplasty implies that clinical examination alone is inadequate to detect a clinically relevant nasal septal deviation (NSD). Objective testing provides an in-depth analysis of nasal obstruction and its underlying anatomic causes but it is effort consuming, requires training and it is not widely available. AIM: We studied the role of bilateral simultaneous nasal spirometry (BSNS) in the preoperative selection of patients for septoplasty. PATIENTS, SUBJECTS AND METHODS: Thirty patients with nasal obstruction and NSD were assessed by subjective measures and BSNS before and after septoplasty. The decongested nasal partitioning ratio (NPR) was used as a measure of the degree of NSD. Thirty healthy controls were recruited for providing a normal range of NPR values. RESULTS: All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits had a significant reduction of NPR. Patients with unilateral symptoms and NPR beyond normal limits were also able to identify the more obstructed side preoperatively. For this group of patients, physicians were able to identify the convex side of NSD preoperatively. No correlation between subjective measures of nasal obstruction or airflow asymmetry and NPR was observed. CONCLUSION: BSNS is a rapid, easily interpretable, noninvasive technique, which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BSNS is not applicable in cases with a septal perforation or an S type septal deviation, it cannot detect an insufficient nasal valve and it does not substitute rhinomanometry or acoustic rhinometry.

The role of tumor size and patient's age as prognostic factors in laryngeal cancer.

BACKGROUND AND AIM: The loco-regional recurrence of laryngeal carcinoma in patients who underwent total laryngectomy is related to numerous factors. Aim of the present study was to investigate the role of patient's age and tumor size in the recurrence rate of patients. Additional aim of the current study was to investigate the possible associations between the size of the tumor and other characteristics. PATIENTS AND METHODS: In 1st Department of Otorhinolaryngology of AHEPA University Hospital, from 1992 to 2007, 255 patients with laryngeal carcinoma underwent total laryngectomy. Accurate data regarding the size of the tumor were obtained. Total laryngectomy was the initial treatment in 212 patients, while in the remaining 43 patients was performed as salvage surgery after recurrence. RESULTS: The median tumor size was 2.74 cm (0.8-5.5 cm). There was no significant difference in the median tumor size between the patients who had recurrence (2.87 cm) and the disease free patients (2.69 cm). The median size of glottic tumors (2.47 cm) was smaller than that of supraglottic (2.95 cm) and of subglottic tumors (3.27 cm) (p<0.05). Among the 255 patients, recurrence of the tumor occurred in 73 (28.7%). Statistical analysis of the data showed that the tumor size was affecting the recurrence rate in a different manner, according the stage of the tumor. The recurrence rate in T3 neoplasms was higher in larger tumors than in smaller (13.2% for tumors<2cm, 62% for tumors>4cm), while T4 carcinomas appeared to have the opposite behavior (66.5% for tumors <2cm, 23% for tumors >4cm). The median tumor size in T4 patients that recurred was smaller than in those with no recurrence (2.8 cm Vs 3.3 cm). This behavior was observed in T4 tumors from all sites. Patients who experienced recurrence and had positive neck lymph nodes at the time of the initial diagnosis appeared to have smaller laryngeal tumors (2.7 cm), compared to with the same group of patients with no recurrence (3.5 cm). Supraglottic location and advanced T stage showed a statistically significant impact on disease free survival, based on Cox regression model. CONCLUSIONS: Smaller sized tumors in patients with locally advanced laryngeal cancer (T4) or regionally (N+) appear to have more aggressive behavior and higher recurrence rate. Thus, the small tumor size could be regarded as an unfavorable prognostic factor for those laryngeal cancer cases.

An alternative manoeuvre for posterior canal BPPV treatment.

OBJECTIVES: The aim of this study is to evaluate the effectiveness of a new manoeuvre in the treatment of posterior canal benign paroxysmal positional vertigo (p-BPPV) based on the idea that highly accelerated endolymphatic flow may lead a mass of otoconia to collide with the walls of the posterior semicircular canal, resulting in its disintegration and/or in the expulsion of the free particles from the posterior semicircular canal. MATERIAL-METHODS: Our study group included 146 patients with a diagnosis of p-BPPV. All patients underwent the new manoeuvre, which consisted of several high-acceleration successive head movements in the horizontal plane performed by the same physician. The results of the study group were compared with those of a sham control group of 30 patients with p-BPPV undergoing placebo treatment. The patients of both groups were reviewed in a follow-up appointment 1 month and 1 year after the initial treatment. RESULTS: Complete resolution of symptoms immediately after the manoeuvre was observed in 92% of patients. At 1-month and 1-year follow-up assessment, all the patients in the study group reported complete relief from their symptoms compared with only 13% and 43% of control patients respectively. Recurrence of symptoms was reported in 12 patients (8%) from the study group, who responded successfully to one additional session. CONCLUSIONS: This study establishes the efficacy of the new manoeuvre in the short- and long-term management of p-BPPV. It is a quick office procedure, usually resolving this disorder with a single session, although there some limitations in patients with underlying cervical spine pathology.

Spontaneous haematoma of the pharynx due to a rare drug interaction.

Spontaneous haemorrhage is a well known complication of oral anticoagulation therapy. Various sites of bleeding have been reported in the literature, most commonly being the gastrointestinal tract, genitourinary system and central nervous system. Spontaneous haematoma is rarely reported to involve the upper aerodigestive tract, being potentially a life threatening condition. We report a case of a 67 year-old female patient who developed spontaneous hematoma of the upper aerodigestive tract as a consequence of a rare interaction between acenocoumarol and clindamycin. Reversal of anticoagulation, careful observation, and when necessary prompt intervention to secure the airway are the main aspects of management. We highlight the need for a thorough evaluation of patients who develop new painful or other symptoms while being on anticoagulation therapy. Clinicians should be highly alerted as these could potentially be manifestations of haemorrhagic complications.

Castleman's disease of the neck: report of a case and review of the literature.

OBJECTIVES: Castleman's disease is an uncommon disease of benign lymph node hyperplasia primarily affecting the mediastinum, with the head and neck region being the second most common site. CASE REPORT: A 27-year-old woman was admitted to our department due to a left lateral cervical mass. After a complete clinical and imaging examination, a neck dissection was performed, in which a mass, size 3.5 x 2.7 x 4.5 cm, was excised. The patient was diagnosed with Castleman's disease of the neck after histopathological examination. CONCLUSIONS: The diagnosis of Castleman's disease is always a clinical challenge, as the patient commonly presents with nonspecific signs and symptoms resembling other lymphatic diseases. Consequently, Castleman's disease should be in the differential diagnosis of congenital, inflammatory, or neoplastic cervical alterations. A review of literature, including histopathological characteristics, differential diagnosis, and treatment options is also presented.

Management of the clinically negative neck (N0) of supraglottic laryngeal carcinoma: a systematic review.

AIM: The most effective therapeutic approach for patients with supraglottic laryngeal carcinoma (SGLC) and clinically negative neck (cN0) remains a subject of much debate. The purpose of this systematic review was to answer the following question: among patients with SGLC and cN0 neck, are the survival and occurrence of neck metastases significantly different between patients that received neck dissection and those that had another therapeutic treatment (radiotherapy, combined therapy, 'wait and see' policy)? MATERIALS AND METHODS: An electronic literature search was performed in MEDLINE, EMBASE, Cochrane Library and CENTRAL databases, followed by extensive hand-searching for the identification of relevant studies. The following inclusion criteria were established: the study should (a) include a comparison of neck dissection with one of the other therapeutic procedures for cN0 of SGLC; (b) report the therapy for the initial supraglottic cancer; and (c) use time-to-event analysis of its results. Six studies were eventually identified and systematically reviewed. RESULTS: All studies included in the systematic review were retrospective (n=792 patients). The survival (overall, disease-specific and neck disease-free) and the site of neck recurrence of the patients with N0 supraglottic cancer were not significantly different between patients in the neck dissection treatment group and those of the rest of the therapeutic strategies examined (neck radiotherapy, combined therapy and 'wait and see' policy). CONCLUSIONS: The present systematic review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of cN0 of SGLC. Currently, based on the best available evidence, it seems that neck dissection is not superior to radiotherapy or combined therapy or a 'wait and see' policy in terms of survival and control of neck disease.

Middle ear adenoma/carcinoid tumour: a case report and review of the literature.

UNLABELLED: Middle ear adenoma, a rare benign tumour with glandular and neuroendocrine differentiation, originates from the epithelial lining of the middle ear. CASE REPORT: We report a case of a 52-year-old woman, who presented with progressive hearing loss and fullness in the left ear for 3 months. Clinical examination revealed a mass in the left middle ear. Histological examination revealed tumour cells forming gland-like and cribriform structures, as well as compact groups. The nuclei were round and uniform, without atypia or mitotic activity. On immunohistochemical staining, the tumour cells were positive for epithelial (cytokeratins, epithelial membrane antigen) and neuroendocrine (neuron specific enolase, synaptophysin, chromogranin and pancreatic polypeptide) markers. CONCLUSION: Middle ear adenoma is a benign tumour that is treated by complete surgical removal. Follow-up of the patient is essential in order to detect possible recurrence. The immunohistochemical staining of the present case supports the suggestion that this tumour is best described by the term neuroendocrine adenoma of the middle ear.

Ectopic Warthin's tumour presenting as a neck mass.

INTRODUCTION: Warthin's tumour usually involves the parotid gland. However, it can also arise from ectopic salivary tissue in the para-parotid and latero-cervical lymph nodes. CASE REPORT: We present the case of a 60-year-old man with a 3-month history of a smooth, mobile mass on the right side of the neck. Computed tomography (CT) scanning (coronal, axial and sagittal sections) showed a cystic lesion in the right upper neck without connection to the major salivary glands (8 x 4 x 3 cm). Complete surgical excision with a transverse neck incision was performed. Histological findings of the specimen revealed Warthin's tumour. CONCLUSION: This neoplasm should be included in the differential diagnosis of cystic lesions of the neck. Although rare, it has potential for malignant transformation. Coronal and sagittal CT scans are necessary to accurately localize the tumour and to differentiate the diagnosis from earring lesions of the parotid tail.

Intra- and postoperative application of Mitomycin C in the middle meatus reduces adhesions and antrostomy stenosis after FESS.

AIM: Obstruction of the osteomeatal complex is the commonest anatomic finding in revision endoscopic sinus surgery. This study assesses the efficacy of topical mitomycin C in the middle meatus, intra- and postoperatively in the prevention of adhesion formation and restenosis of the maxillary sinus antrostomy. MATERIALS AND METHODS: At the end of endoscopic surgery for chronic rhinosinusitis and four weeks postoperatively 30 patients received a pledget soaked with 1 ml of mitomycin C (0.5 mg/ml) in the middle meatus for 5 minutes while a pledget soaked in saline was placed in the contralateral side. Patients were assessed at least 6 months postoperatively by a blinded observer for the presence of synechiae and antrostomy stenosis. Medical records were reviewed for episodes of recurrent sinusitis. RESULTS: Adhesions were observed in 8 patients. All adhesions rated as moderate to severe (4 patients) were observed in the control side (p = 0.043). Restenosis was observed in 2 sides treated with mitomycin C and in 9 control sides (p = 0.032). Recurrent symptoms of sinusitis occurred in three patients on the saline side. CONCLUSION: Mitomycin C is safe and effective in the prevention of severe adhesions and antrostomy stenosis when applied twice, during surgery and the early postoperative period.

Minimizing the dead ear in otosclerosis surgery.

OBJECTIVE: Assessment of a specific surgical technique regarding the postoperative hearing results and the incidence of "dead ear" comparing local and general anesthesia. METHODS: We present a retrospective review of all stapedectomies performed by the same surgeon under general and local anesthesia during a 9-year period (1997-2006) in non-revision cases. The analysis of our data (268 operations, 160 under general and 108 under local anesthesia) included hearing results based on the guidelines from the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery and complications recorded in the case notes. Excessive vertigo during stapedectomy under local anesthesia considered as a sign of possible profound sensorineural hearing loss. RESULTS: A postoperative air-bone gap up to 10dB (Grade A) was successfully obtained in 92.6% of operated ears. The mean postoperative air-bone gap in decibels was 6.8dB. There were no statistically significant differences between general and local anesthesia in hearing results. Excessive intraoperative dizziness occurred in five patients of local anesthesia group without postoperative sensorineural hearing loss. The incidence of dead ear was 1.8 % (three patients) under general and 0% under local anesthesia. CONCLUSION: Stapedectomy is a safe procedure in hands of an experienced otologist with minimum major complications especially when performed under local anesthesia. Local anesthesia offers the immediate evaluation of hearing restoration and the early recognition of possible dead ear. Training programs should consider stapedectomy under local anesthesia as a standard procedure for trainees in non-revision cases.

[Bilateral antrochoanal polyps originated from inferior meatal antrostomies]. / Beidseitige, von infraturbinalen Kieferhöhlenfenstern ausgehende Choanalpolypen.

We present the first reported case of simultaneously occurring bilateral antrochoanal polyps in a 49-year-old female patient, originated from previously performed inferior antrostomies as a treatment for chronic maxillary sinusitis. The antrochoanal polyps were removed by endoscopic surgery with combined approach through the inferior and middle meatal antrostomies. Microscopic analysis of the specimens showed benign inflammatory antrochoanal polyps. Follow-up appointment 6 months postoperatively showed patent antrostomies and no recurrence of the disease. Endoscopic treatment with middle meatal antrostomy is the recommended technique in most cases of antrochoanal polyps as the greater portion of the antral part of the polyp can be removed with the healthy antral mucosa left intact promoting epithelialization and mucociliary clearance of the antrum. Inferior antrostomy can be an additional part of the operation in selected cases.

Intraparotid facial nerve schwannoma: management options.

Intraparotid facial nerve schwannoma (FNS) is a very rare, benign tumour mimicking pleomorphic adenoma. Resection of this slow growing tumour may result in unnecessary facial nerve paralysis. The aim of this study is to present results of facial nerve schwannoma treatment at our institution and proposes a management plan. This is a retrospective case series of four patients, three male and one female with a mean age of 47.7 years who presented with a long-standing, asymptomatic parotid swelling. Two patients had facial weakness and underwent superficial parotidectomy, resection of tumour and facial nerve repair with a free graft from the greater auricular nerve. Two patients underwent biopsy without tumour resection. All tumours were confirmed histologically as facial nerve schwannomas. The mean follow up period was 3.5 years. Patients with resection of facial nerve schwannoma had a postoperative House Brackmann grade III and IV. Patients with biopsy had normal postoperative facial nerve function and the tumour did not grow significantly. No adverse effects or recurrence were reported. There is no preoperative diagnostic modality that can identify facial nerve schwannoma with certainty. Difficulty in locating the facial nerve intraoperatively raises suspicion of a neurogenous tumour of the facial nerve and this may prevent unnecessary damage to the nerve. Not every facial nerve schwannoma should be resected. This decision is based on (a) the extent of tumour (b) preoperative facial nerve function (c) best results achieved with nerve repair and (d) patient's preferences. Large tumours with extension into the mastoid cavity or encroachment of sensitive structures and preoperative facial weakness are indications for surgical intervention. In most other cases, biopsy and observation suffices.