Italian version of the Brief Questionnaire of Olfactory Disorders (Brief-IT-QOD).

Objective: To evaluate the reliability and validity of the Italian version of the Brief Questionnaire of Olfactory Disorders (Brief-IT-QOD). Methods: The study consisted of six phases: item generation, reliability analysis (112 dysosmic patients for internal consistency analysis and 61 for test-retest reliability analysis), normative data generation (303 normosmic subjects), validity analysis (comparison of Brief-IT-QOD scores of healthy and dysosmic subjects and scores correlation with psychophysical olfactory testing TDI and SNOT-22 scores), responsiveness analysis (10 dysosmic chronic rhinosinusitis with nasal polyps patients before and after biologic therapy), and cut-off value determination (ROC curve analysis of Brief-IT-QOD sensitivity and specificity). Results: All subjects completed the Brief-IT-QOD. Internal consistency (α > 0.70) and test-retest reliability (ICC > 0.7) were acceptable and satisfactory for both questionnaire subscales. A significant difference between dysosmic and control subjects was found in both subscales (p < 0.05). Significant correlations between subscales scores and TDI and SNOT-22 scores were observed. Brief-IT-QOD scores before treatment were significantly higher than after biological therapy. Conclusions: Brief-IT-QOD is reliable, valid, responsive to changes in QoL, and recommended for clinical practice and outcome research.

Endoscopic sinus surgery for foreign body extraction in an adult patient.

Foreign bodies are an unusual indication for endoscopic sinus surgery. If outpatient extraction is not possible and acute sinusitis ensues, thorough exploration and extended surgical dissection should be considered to clear the nasal cavities.

Laparoscopic Versus Open Major Hepatectomy: Analysis of Clinical Outcomes and Cost Effectiveness in a High-Volume Center.

BACKGROUND: Considering the increasing evidence on the feasibility of laparoscopic major hepatectomies (LMH), their clinical outcomes and associated costs were herein evaluated compared to open (OMH). METHODS: Major contributors of perioperative expenses were considered. With respect to the occurrence of conversion, a primary intention-to-treat analysis including conversions in the LMH group (ITT-A) was performed. An additional per-protocol analysis excluding conversions (PP-A) was undertaken, with calculation of additional costs of conversion analysis. RESULTS: One hundred forty-five LMH and 61 OMH were included (14.5% conversion rate). At the ITT-A, LMH showed lower blood loss (p < 0.001) and morbidity (global p 0.037, moderate p 0.037), shorter hospital stay (p 0.035), and a lower need for intra- and postoperative red blood cells transfusions (p < 0.001), investigations (p 0.004), and antibiotics (p 0.002). The higher intraoperative expenses (+ 32.1%, p < 0.001) were offset by postoperative savings (- 27.2%, p 0.030), resulting in a global cost-neutrality of LMH (- 7.2%, p 0.807). At the PP-A, completed LMH showed also lower severe complications (p 0.042), interventional procedures (p 0.027), and readmission rates (p 0.031), and postoperative savings increased to - 71.3% (p 0.003) resulting in a 29.9% cost advantage of completed LMH (p 0.020). However, the mean additional cost of conversion was significant. CONCLUSIONS: Completed LMH exhibit a high potential treatment effect compared to OMH and are associated to significant cost savings. Despite some of these benefits may be jeopardized by conversion, a program of LMH can still provide considerable clinical benefits without cost disadvantage and appears worth to be implemented in high-volume centers.