Nasal cytological assessment after crenotherapy in the treatment of chronic rhinosinusitis in the elderly.

Chronic rhinosinusitis (CRS) determines irreversible alterations of the nasal mucosa with consequent impairment of ciliary movements and, therefore, mucociliary clearance (MCC). People of all ages can be affected by CRS but the elderly are subjects at the highest risk. CRS in the elderly with an age-related physiological impairment of nasal respiratory function, often accompanied by other chronic diseases, requires additional therapies to be added to the numerous daily medications. Since the currently available therapies for CRS include the use of drugs that can have adverse effects and contraindications, crenotherapy could represent a therapeutic option. Indeed, because the adverse effects and contraindications of crenotherapy are scarce, it can be safely used in elderly patients with comorbidities. The aim of this study is to evaluate the nasal cytological assessment after crenotherapy in elderly subjects with CRS. Two groups, comprising a total of 84 elderly subjects with CRS, were treated with crenotherapy with sodium chloride sulphate hyperthermal water rich in mineral salts (group I, n=49) and saline solution (group II n=35). Cytological assessment for both groups took place at baseline (T0) and 1 month after treatment (T30). At T30 the nasal cytological assessment showed statistically significant improvements in the ciliary motility and in the count of neutrophils and spores in group I, but not in group II. Conversely, there were no significant differences in the count of eosinophils, mast cells, bacteria and biofilm in either group. Our data for the first time focused on the role of crenotherapy in the improvement of cytological assessment of CRS in the elderly.

Efficacy of sublingual specific immunotherapy on allergic asthma and rhinitis in children's real life.

BACKGROUND: Sublingual-specific immunotherapy (SLIT) is considered as a valid treatment of respiratory allergies. AIM: We performed a case-control study to evaluate the effect of SLIT in children with allergic asthma and rhinitis. PATIENTS AND METHODS: The study plan included 140 patients (age 6-14 yr, 43% girls and 57% boys) presenting allergic rhinitis and/or asthma, 70 treated with SLIT actively for three years and 70 controls never treated with specific immunotherapy (only symptomatic drugs). Rhinitis Symptom Score (RSS), Asthma Symptom Score (ASS) and Medication Score (MS) were evaluated at beginning and during the 3 years of immunotherapy. results: There was a significant improvement of RSS (mean ± SD) in the SLIT group: baseline 5.31 ± 2.01, third year 1.38 ± 1.06 (p < 0.0001 vs baseline). CONTROL GROUP: baseline 5.00 ± 1.08, third year 4.68 ± 1.152 (P » NS). ASS (mean ± SD) in the SLIT group: baseline 4.09 ± 2.21, third year 1.23 ± 1.4 (p < 0.0001 vs baseline). CONTROL GROUP: baseline 4.04 ± 2.46, third year 3.62 ± 2.26 (p » NS). MS (mean ± SD) in the SLIT group: baseline 3.30 ± 1.4, third year 0.88 ± 1.26 (p < 0.0001 vs baseline). CONTROL GROUP: baseline 3.19 ± 1.23, third year 3.39 ± 1.12 (p » NS). There are no statistically significant differences among monosensitized/polysensitized patients and at different age ranges. None of the patients included reported severe systemic reactions or anaphylaxis. CONCLUSIONS: During the treatment, the active group showed sustained reductions in mean asthma and rhinitis symptom scores when compared with controls to confirm the efficacy and safety of sublingual immunotherapy.

Rosiglitazone is more effective than metformin in improving fasting indexes of glucose metabolism in severely obese, non-diabetic patients.

AIM: In obese patients, the diet-induced weight loss markedly improves glucose tolerance with an increase in insulin sensitivity and a partial reduction of insulin secretion. The association with metformin treatment might potentiate the effect of diet alone. METHODS: From patients admitted to our Nutritional Division for diet programme, we selected obese, non-diabetic, uncomplicated patients with age 18-65 years and body mass index 35-50 kg/m(2) and studied the effects of a 6-month pharmacological treatment with either metformin (850 mg twice daily) or rosiglitazone (4 mg twice daily) on possible changes in body weight, fat mass, glucose and lipids metabolism. RESULTS: A significant weight loss and reduction of fat mass was demonstrated with metformin (-9.7 +/- 1.8 kg and -6.6 +/- 1.1 kg) and also with rosiglitazone (-11.0 +/- 1.9 kg and -7.2 +/- 1.8 kg), without fluid retention in either treatment group. Rosiglitazone administration induced a significant decrease in glucose concentration (4.7 +/- 0.1 vs. 4.4 +/- 0.1 mmol/l, p < 0.005) and insulin-circulating level (13.6 +/- 1.5 vs. 8.0 +/- 0.,7 microU/ml, p < 0.005), an increase in insulin sensitivity as measured by homeostatic model assessment (HOMA) of insulin sensitivity (68.9 +/- 8.8 vs. 109.9 +/- 10.3, p < 0.005) with a concomitant decrease in beta-cell function as measured by HOMA of beta-cell function (163.2 +/- 16.1 vs. 127.4 +/- 8.4, p < 0.005). In contrast, metformin did not produce any significant effect on blood glucose concentration, insulin level and HOMA2 indexes. No adverse events were registered with pharmacological treatments. CONCLUSION: Our study shows that in severely obese, non-diabetic, hyperinsulinaemic patients undergoing a nutritional programme, rosiglitazone is more effective than metformin in producing favourable changes in fasting-based indexes of glucose metabolism, with a reduction of both insulin resistance and hyperinsulinaemia. In spite of previous studies reporting rosiglitazone-induced body weight gain, in our study the joint treatment with diet and rosiglitazone was accompanied by weight loss and fat mass reduction.

Metabolic syndrome in white European men presenting for primary couple's infertility: investigation of the clinical and reproductive burden.

Despite complex interactions between obesity, dyslipidemia, hyperinsulinaemia, and the reproductive axis, the impact of metabolic syndrome on human male reproductive function has not been analysed comprehensively. Complete demographic, clinical, and laboratory data from 1337 consecutive primary infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (categorised 0 vs. 1 vs. 2 or higher). NCEP-ATPIII criteria were used to define metabolic syndrome. Semen analysis values were assessed based on the 2010 World Health Organisation (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and metabolic syndrome. Metabolic syndrome was found in 128 (9.6%) of 1337 men. Patients with metabolic syndrome were older (p < 0.001) and had a greater Charlson Comorbidity Index of 1 or higher (chi-square: 15.6; p < 0.001) compared with those without metabolic syndrome. Metabolic syndrome patients had lower levels of total testosterone (p < 0.001), sex hormone-binding globulin (p = 0.004), inhibin B (p = 0.03), and anti-Müllerian hormone (p = 0.009), and they were hypogonadal at a higher rate (chi-square: 32.0; p < 0.001) than patients without metabolic syndrome. Conversely, the two groups did not differ significantly in further hormonal levels, semen parameters, and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis, testicular volume (OR: 0.90; p = 0.002) achieved independent predictor status for WHO pathological semen concentration; conversely, age, Charlson Comorbidity Index scores, metabolic syndrome, and inhibin B values did not. No parameters predicted normal sperm morphology and total progressive motility. Metabolic syndrome accounts for roughly 9% of men presenting for primary couple's infertility. Although metabolic syndrome patients have a lower general male health status, semen analysis values seem independent of the presence of metabolic syndrome.

Concha bullosa related headache disability.

OBJECTIVE: Rhinogenic headache (RH) is a headache or facial pain syndrome secondary to mucosal contact points in the sino-nasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sino-nasal polyps or masses. It may result from pressure on the nasal mucosa due to anatomical variations among which the pneumatization of the middle turbinate, concha bullosa, a variant of the development of ethmoidal cells, is the most commonly observed. Clinical practice suggests a close correlation between concha bullosa, mucosal contacts and rhinogenic headache, with high impact on the QoL. However diagnostic and therapeutic difficulties still remain. Aim of the present study is to evaluate the impact of medical or surgical care on the QoL of patients suffering from concha bullosa related headache from the patients' perspective. PATIENTS AND METHODS: One-hundred-two subjects with concha bullosa and headache anamnesis were randomized into two groups and given medical or surgical treatment. To assess the Quality of life (QoL) we used visual analogue scale and for the first time, the migraine disability score before and after treatment. RESULTS: After treatment the severity of the headache decreased as well as the discomfort in the surgical group compared with medical group. CONCLUSIONS: The improvement of symptoms and QoL suggests that the endoscopic surgical plastic may promote the rapid resolution of concha bullosa related headache improving the and reducing health care costs.

Lower urinary tract symptoms among Caucasian-European men who have sex with men: findings from a real-life survey.

BACKGROUND: Prevalence of and severity of lower urinary tract symptoms (LUTS) according to male sexual orientation have been scantly analysed. We aimed to assess the prevalence and severity of LUTS in a cohort of Caucasian-European men who have sex with men seeking medical help for uroandrologic reasons other than LUTS. METHODS: Data from 949 consecutive individuals in an outpatient setting were analysed. Severity of LUTS was measured with the International Prostate Symptom Score (IPSS). Men with storage symptoms scored 1-3 and ⩾ 4 (of 15), and voiding symptoms scored 1-4 and ⩾ 5 (of 20) were considered as having mild and moderate-to-severe symptoms, respectively. For individual symptoms, patients with scores ⩾ 1 were deemed symptomatic (according to Apostolidis et al.(15)). Descriptive statistics and logistic regression models tested the association between LUTS and sexual orientation. RESULTS: Complete data were available for 213 (22.4%) men who have sex with men (MSM) and 736 (77.6%) heterosexuals (mean age (s.d.): 41.0 (12.2) vs 39.9 (12.1) years). Compared with heterosexuals, MSM reported higher rates of total IPSS scores suggestive of moderate (21.6% vs 20%) and severe LUTS (3.8% vs 2.4%) (P=0.004). Similarly, MSM showed higher rates of mild (48.8% vs 45.2%) and moderate-to-severe (39.4% vs 30.4%) storage symptoms (all P<0.001), and of mild (45.1% vs 34.8%) and moderate-to-severe (20.2% vs 19.2%) voiding symptoms (all P<0.01). MSM status was an independent predictor of mild voiding symptoms (odds ratio (OR): 1.40; P=0.004), moderate-to-severe storage symptoms (OR: 1.40; P=0.04) and severe total IPSS (OR: 1.49; P=0.03), after adjusting for other variables. CONCLUSIONS: These findings suggest a higher prevalence and severity of LUTS in MSM compared with heterosexual men seeking medical help for uroandrologic reasons other than LUTS.

Ascorbic acid and intestinal metaplasia in the stomach: a prospective, randomized study.

BACKGROUND: Intestinal type metaplasia plays a role in intestinal type gastric carcinoma development. Ascorbic acid demonstrates a protective effect against gastric carcinogenesis, due to its ability to inactivate oxygen free-radicals as well as its nitrite-scavenging effects. AIM: To assess whether long-term ascorbic acid administration following Helicobacter pylori eradication could affect intestinal metaplasia regression in the stomach. METHODS: Sixty-five patients were included in the study. The inclusion criterion was the presence of intestinal metaplasia on the gastric mucosa after H. pylori eradication. An upper gastrointestinal endoscopy was performed and 3 biopsy specimens were taken in the antrum, 3 in the gastric body, and 2 in the incisura angularis. Patients were randomized to receive 500 mg of ascorbic acid o.d., after lunch (32 patients) for 6 months or no treatment (33 patients). All patients underwent to endoscopic control at the end of the 6 months. RESULTS: H. pylori infection recurrence was detected in 6 (9.4%) patients (three from each group), and these patients were excluded from further analysis. We were unable to find evidence of intestinal metaplasia in any biopsied site of the gastric mucosa in 9/29 (31%) patients from the ascorbic acid group and in 1/29 (3.4%) of the patients from the control group (P=0.006). Moreover, a further six (20.7%) patients from the ascorbic acid group presenting chronic inactive pangastritis with widespread intestinal metaplasia at entry, showed less extensive antritis with intestinal metaplasia at control, whilst a similar finding was only seen in one patient from the control group (P=0.051). CONCLUSION: The administration of ascorbic acid significantly helps to resolve intestinal metaplasia of the gastric mucosa following H. pylori eradication, and its use as a chemoprevention treatment should be considered.

Choroidal calcification in Bartter syndrome.

PURPOSE: Bartter syndrome is characterized by hyperplasia of the renal juxtaglomerular apparatus, hyperaldosteronism, and hypokalemic alkalosis. We report a case of Bartter syndrome associated with normal serum calcium levels and posterior choroidal calcification. METHODS: Case report. A 59-year-old man with bilateral cataract and Bartter syndrome underwent a complete ophthalmic examination, including standardized echography before and after cataract surgery. RESULTS: Before cataract surgery, echography identified small, hyperreflective, multifocal, bilateral choroidal lesions with posterior shadowing. After surgery, these lesions appeared as yellow-white, barely elevated plaques with smooth edges and were diagnosed as choroidal calcification. CONCLUSIONS: Choroidal calcification may occur in patients with Bartter syndrome. This condition should be added to the differential diagnosis of posterior segment calcification.

Molecular genetic analysis of TGF-beta1 in ovarian neoplasia.

Malignant ovarian tumours have been associated with a loss of autocrine growth inhibition by transforming growth factor-beta. This study aimed to detect abnormalities in the gene structure, expression and localization of TGF-beta1, in paraffin-embedded samples from 31 ovarian neoplasias (21 malignant, 5 borderline and 5 benign). Gene mutations in the region coding for the active protein were detected by PCR-SSCP analysis of exons 5, 6 and 7. mRNA expression and localization was studied by nonisotopic in situ hybridization (NISH) using cDNA probes generated by the reverse transcriptase polymerase chain reaction (RT-PCR), and immunohistochemistry, using antibodies against both intracellular and extracellular (matrix-associated) forms of TGF-beta1. Four mutations were found: one in exon 6 (serous adenocarcinoma), one in exon 7 (Mullerian tumor), and two in exons 5 and 6 from a serous cystoadenoma. TGF-beta1 mRNA was expressed in 87% and proteins in 90% of ovarian tumours. Most tumours expressing large amounts of TGF-beta1 mRNA, also contained a large number of protein binding sites. In malignant tumors, TGF beta1 was more strongly expressed in high-grade ovarian carcinomas with a cystic-papillary pattern than in tumours with a solid growth pattern. Normal ovarian tissue (follicles, granulosa cells) adjacent to tumor showed weak epithelial labeling and staining. Gene mutation did not correlate with histological type of tumor, mRNA or protein expression. TGF-beta1 mutation and abnormalities in its expression seem to occur in benign and malignant ovarian tumors, and could be involved in their pathogenesis. TGF beta1 gene mutations may act in multistage ovarian neoplasia, by reducing epithelial cell responsiveness to TGF-beta1 negative growth control.

Molecular genetic analysis of TGF beta1 in breast cancer.

Conflicting data suggest that TGF-beta1 can either inhibit or promote the progression of breast cancer. To determine the biological role of TGF beta1 in mammary carcinoma, in this study we examined the gene structure, expression and localization of TGF-beta1 using paraffin-embedded samples from 32 (27 IDC, 1 ILC, 1 DCIS, 1 ADH) breast lesions. Gene mutations in the region coding for the active protein were investigated by PCR-SSCP of exons 5, 6, and 7. mRNA -TGF-beta1 expression and distribution was examined by NISH using cDNA probes generated by RT-PCR and immunohistochemistry. We detected two mutations in exon 6 TGF-beta1 from IDC; and TGF beta1 mRNA and proteins in 28 (87%) of the tumors. Invasive breast carcinomas had more intense TGF-beta1 activity than CIS and than normal tissue adjacent to tumor. TGF beta1 mRNA and proteins were higher at the edge of the tumor than in the center and were also higher in less differentiated breast neoplasms. TGF-beta1 mRNA transcription and protein levels did not correlate either with TGF-beta1 exon 6 mutation or type and grade of differentiation of breast tumors. These observations suggest that TGF beta1 mutations in breast neoplasms might cause loss or inactivation of the growth inhibitory effects of TGF-beta1. They also support the proposed role of TGF-beta1 in the pathogenesis of breast cancer.

Androgen receptors in ovarian tumors: correlation with oestrogen and progesterone receptors in an immunohistochemical and semiquantitative image analysis study.

The expression and distribution of androgen, estrogen and progesterone receptors was examined by immunohistochemical staining in 31 paraffin-embedded sections from ovarian tumors and the results were assessed by semiquantitative image analysis. Immunohistochemical staining showed heterogeneous patterns of steroid receptor distribution, with mainly nuclear immunoreactivity. Eighty-four percent of benign and malignant ovarian tumors expressed androgen receptors (AR), 74.19% estrogen receptors (ER) and 41.16% progesterone receptors (PR). All benign tumors showed immunoreactivity for the three steroid receptors. Malignant tumors expressed higher AR and ER histochemical scores (H-scores) than PR (82% vs 71% vs 39%). The incidence and expression levels of the steroid receptors varied widely in the different histological types of malignant tumors. Spearman rank analysis showed a positive significant (P < 0.05) correlation between AR- and ER and between ER- and PR-H-scores. In malignant ovarian tumors, neither AR, ER nor PR immunohistochemical scores correlated with tumor FIGO stage. Densitrometric analysis of immunostained steroid receptors is a valid method for assessing the steroid status, because it reduces subjective elements in scoring sections and increases the reliability of results. The high incidence of AR expression confirms the functional role of AR in ovarian tumors and suggests that the determination of AR content in ovarian cancer could have prognostic value.

Epidermal growth factor receptor, MUC-1 and MUC-2 in bladder cancer.

The aim of this study was to investigate the immunohistochemical expression of epidermal growth factor receptor (EGFR), mucin-1 (MUC-1) and mucin-2 (MUC-2) proteins in primary bladder carcinomas and to compare EGFR and MUC staining patterns with the histological findings, grade and stage of bladder carcinoma. Fifty-six surgical specimens obtained from superficial and deeply invasive bladder carcinomas were studied. Of the 56 bladder tumors 42 (75%) expressed EGFR, 34 (60.71%) MUC-1 and 15 (26.78%) MUC-2; while 7 tumors (12.5%) coexpressed MUC-1 and MUC-2 proteins. Immunohistochemical scores showed higher levels of EGFR than of MUC-1 (P <0.05) and MUC-2 (P = 0.000) and higher levels of MUC-1 than MUC-2 (P = 0.0010). EGFR and MUC-1 expression was stronger in high-grade tumors (grade 2/3) than in low-grade (grade 1/2) ones (P <0.05) and stronger in muscle invasive tumors (T2-T4) than in superficial (Ta-T1) ones. Linear regression showed a significant (P <0.05) correlation between EGFR and MUC-1 proteins, but no correlation between EGFR and MUC-2 or between MUC-1 and MUC-2. Immunohistochemical expression of EGFR, MUC-1 and MUC-2 increases as primary bladder carcinomas acquire a more aggressive phenotype. Differences in the distribution of EGFR and mucins within the urothelium may be of diagnostic and prognostic value. These antigens may be useful as markers for bladder malignancy.

[Blue nevus of the endocervix]. / Nevo blu dell'endocervice.

We report a case of blue nevus of the uterine cervix discovered in a cone removed for other reasons. The lesion can be interpreted as a visceral analogue of the cutaneous blue nevus. Histological and Immunohistological studies suggest the melanocytic nature of the lesion.

[Vocal physiopathology]. / Fisiopatologia vocale.

Cordectomies usually result in alteration of the glottic sphincter which in turn effects the activity of the entire larynx bringing about different types of dysphonia according to the resulting scarring pattern in the glottic floor and to the functional recompensation made by the cordectomized patients themselves. Today, study of those anatomic dynamics which determine voice typology in cordectomized patients is possible thanks to various means: synthesis of data obtained from psycho-perspective analyses of the vocal product, video-fiber-laryngoscopic observation of the vocal tract and spectrographic study. The above-mentioned examinations show how the type of dysphonia in these patients is determined by the various combinations of different scarring patterns, which also depend on the entity of surgical exeresis, and the position taken on by various laryngeal district during phonation? The authors present paradigmatic clinical cases in order to demonstrate the different phonatory capabilities achieved by patients who had undergone either cordectomy or cordectomy extended to the ventricle and false vocal cords.

[The clinical presuppositions and results of logopedic therapy]. / I presupposti clinici ed i risultati della terapia logopedica.

Logopedic therapy is proposed in helping cordectomized patients learn to best use pneumo-phonal structures to compensate for the glottic insufficiency often resulting from this type of surgery. Rehabilitation showed be initiated as soon as possible following surgery before the patients starts using compensation mechanisms negative for voice quality. However, precisely those patients often receive therapy tardively when the anatomo-functional results have already been consolidated and the voice quality is poor. The rehabilitation discussed uses classical feed back mechanisms through which the subjects learn to recognise those factors which enable them to better their voice quality. The type of exercises to be employed depends on whether or cordectomy extended to the ventricle and to false vocal cord. On the farmer case, the principle aim of therapy is that of nearing the healthy vocal cord to the neocord through appropriate exercises. On the better case, instead, the main vocal compensation is the result of the perfect coordination of expiratory energy and the activity of the healthy vocal cord. In fact, in extended cordectomized patients, in the light of the modest amount of scarring, it is necessary to cause the healty voice cord to shift entirely towards and beyond the median line as to as compensate for a sphincteric loss. The authors report two clinical case, particularly difficult from a rehabilitation point of view, in which, relatively speaking, in light of the initial voice conditions, satisfactory results were obtained.

[Clinical-experimental models for the identification of immunologic parameters to be integrated in traditional staging systems of colorectal neoplasms]. / Modelli clinico-sperimentali per la definizione di parametri immunologici da integrare ai sistemi di stadiazione tradizionali delle neoplasie colo-rettali.

The Authors evaluate new possible models for the staging of colorectal cancer based on clinico-morphological, histo-pathological and bio-immunological parameters. Particularly, they evaluate the possibility of studying host's immunological response against tumor spread by the examination of the "in situ" cellular responses. This study was performed by cytotoxic test and immunohistochemical evaluation of the lymphocytes. The latter seems to give better results compared to the first in the evaluation of the host's immunological response.

Prevalence and predictors of concomitant low sexual desire/interest and new-onset erectile dysfunction - a picture from the everyday clinical practice.

Prevalence and risk factors of concomitant primary low sexual desire/interest (LSD/I) and subsequent new-onset erectile dysfunction (ED) in men have been only partially investigated. We looked at the sociodemographic and clinical predictors of the concomitant condition of primary LSD/I - defined as the reduction in the usual level of SD/I which precedes ED or another sexual dysfunction - and new-onset ED (LSD/I + ED) in a cohort of consecutive Caucasian-European patients seeking their first medical help for sexual dysfunction at a single outpatient clinic in the everyday clinical practice setting. Data from 439 sexually active patients were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients' LSD/I were evaluated according to the findings of a comprehensive sexual history. Moreover, patients completed the International Index of Erectile Function (IIEF). Descriptive statistics and logistic regression models tested the prevalence and predictors of LSD/I + ED as compared with ED only. Of the 439 men, LSD/I + ED was observed in 33 (4.2%) individuals. One of three men with LSD/I + ED was younger than 40 years. Patients complaining of LSD/I + ED or ED alone did not differ in terms of hormonal milieu. No significant differences emerged between groups in terms of sexual orientation, rates of stable sexual relationships, educational status, recreational habits and comorbid sexual dysfunctions. Patients with LSD/I + ED had significantly lower IIEF-sexual desire and IIEF-overall satisfaction scores than ED-only individuals (all p ≤ 0.003). At multivariable analysis younger age and severe CCI scores emerged as independent predictors of LSD/I + ED (all p ≤ 0.04). These findings showed that primary LSD/I is concomitant with new-onset ED in less than 5% of men seeking first medical help. Younger age and severe CCI emerged as independent predictors of LSD/I + ED. Patients with both conditions reported an impaired overall sexual satisfaction.