How reliable is assessment of true vocal cord-arytenoid unit mobility in patients affected by laryngeal cancer? a multi-institutional study on 366 patients from the ARYFIX collaborative group.

PURPOSE: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension. METHODS: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated. RESULTS: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal. CONCLUSIONS: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.

Three-dimensional, high-definition exoscopic parotidectomy: a valid alternative to magnified-assisted surgery.

The authors report their experience regarding parotidectomy performed under a three-dimensional-high-definition (3D-HD) exoscope, with the aim of evaluating its effectiveness in parotid surgery. This is a prospective study on nine patients treated by the same surgeon. All patients underwent parotidectomy for extrafacial primary tumours without preoperative involvement of the skin or of the facial nerve from March 2019 to June 2019 with the use of a 3D-HD exoscope. Magnification was variable from 8x to 30x with direct vision supplied by a 3D monitor. Six men and three women, mean (range) age 47.8 (19-74) years underwent parotidectomy. No patient experienced postoperative complications or definitive facial palsy. The mean (range) time of surgery was 149.4 (115 - 210) minutes. The 3D exoscope represents a valid alternative to the operative microscope or surgical loupe for parotid surgery. It is a light instrument allowing for precise surgical dissection of the parotid region by reducing the risks for iatrogenic lesions of the facial nerve using a real 3D magnification of the anatomical structures in HD. Furthermore, its use does not prolong the operative time and shows high potential for training and educational purposes since the operating room staff can better perceive the procedure and the surgeon's fine gestures. Although the preliminary applications show promising results, there is still a need for wider scientific validation.

Parotid tumours: clinical and oncologic outcomes after microscope-assisted parotidectomy with intraoperative nerve monitoring.

Temporary and permanent facial nerve dysfunctions can be observed after parotidectomy for benign and malignant lesions. Intraoperative nerve monitoring is a recognised tool for the preservation of the nerve, while the efficacy of the operative microscope has been rarely stated. The authors report their experience on 198 consecutive parotidectomies performed on 196 patients with the aid of the operative microscope and intraoperative nerve monitoring. 145 parotidectomies were performed for benign lesions and 53 for malignancies. Thirteen patients treated for benign tumours experienced temporary (11 cases) or permanent facial palsy (2 cases, both of House-Brackmann grade II). Ten patients with malignant tumour presented with preoperative facial nerve weakness that did not improve after treatment. Five and 6 patients with malignant lesion without preoperative facial nerve deficit experienced postoperative temporary and permanent weakness respectively (the sacrifice of a branch of the nerve was decided intraoperatively in 2 cases). Long-term facial nerve weakness after parotidectomy for lesions not directly involving or originating from the facial nerve (n = 185) was 2.7%. Patients treated for benign tumours of the extra facial portion of the gland without inflammatory behaviour (n = 91) had 4.4% facial nerve temporary weakness rate and no permanent palsy. The combined use of the operative microscope and intraoperative nerve monitoring seems to guarantee facial nerve preservation during parotidectomy.

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.

Exploring QSARs of some benzenesulfonamides incorporating cyanoacrylamide moieties as a carbonic anhydrase inhibitors (specifically against tumor-associated isoforms IX and XII).

Benzenesulfonamides incorporating cyanoacrylamide moieties with activity against tumour-associated human (h) isoforms hCA IX and XII (which are validated antitumor targets) were investigated for their quantitative structural activity relationships (QSAR). Multiple linear regression analysis was used to develop model relationships between molecular descriptors and inhibition constants (Ki). The molecular geometry optimization were performed on all molecules at DFT-B3LYP/6-311++G(d,p) level. Over 1250 molecular descriptors were calculated using Gaussian 09, Hyperchem and EDRAGON programs. Multiple linear regression equations have been developed and validated using leave-one-out cross-validated technique. The derived QSAR models are found to be statistically significant and show good predictive ability.

Cardiac MRI in the diagnosis of complications of myocardial infarction.

The improvement in revascularization techniques and medicine treatment during infarction has substantially reduced mortality during the acute phase of this condition. Since the advent of kinetic sequences and the concomitant development of gadolinium chelates and delayed enhancement sequences, cardiac MRI has become the second-line reference examination for ischemic heart disease. The technique of delayed enhancement with the inversion recovery sequence performed after injection has been validated for numerous indications in ischemic disease. Delayed enhancement sequences make it possible in particular to look for "no-reflow" areas (microvascular obstructions), to quantify the infarction area, and to assess prognosis. MRI also allows us to define the area at risk, that is, the area with edema, and to look for and assess the mechanical complications of the infarction. The aim of this review is to summarize current knowledge about: the pharmacokinetic principles that regulate myocardial enhancement; the different sequences available to acquire delayed enhancement images, and; the value of cardiac MRI in the diagnosis of complications of myocardial infarction.

Discoid lupus erythematosus of the eyelids associated with staphylococcal blepharitis and Meibomian gland dysfunction.

Lower eyelid involvement occurs in 6% of patients with discoid lupus erythematosus (DLE). Eyelid lesions are rarely the initial manifestation of DLE. We describe a 25-year-old woman presenting with discoid lesions of the lower eyelids, staphylococcal blepharitis and Meibomian gland dysfunction, who later developed a discoid lesion on the chin. Histopathological and immunofluorescence studies of a biopsy specimen from this lesion established the diagnosis of DLE. We are unaware of any previously reported cases of DLE presenting with discoid eyelid lesions associated with staphylococcal blepharitis and Meibomian gland dysfunction. DLE should be considered as a differential diagnosis in chronic blepharitis that persists despite usual medical management and eyelid hygiene. Misdiagnosis may lead to eyelid margin deformities, necessitate a complicated full-thickness biopsy, and delay diagnosis of systemic lupus.

Corneal graft rejection after penetrating keratoplasty for keratoconus in Turner's syndrome.

PURPOSE: To report a patient with Turner's syndrome who developed graft rejection after penetrating keratoplasty (PK) for keratoconus and to review the ophthalmic literature on the association between keratoconus and Turner's syndrome. METHODS: A woman with bilateral keratoconus and Turner's syndrome (45,XO) was referred for progressive visual loss in the right eye. Best-corrected visual acuity was 20/400 in the right eye. Slit-lamp examination revealed corneal thinning with ectatic protrusion of the central cornea and Vogt's striae in the right eye. The patient underwent PK in the right eye in January 2001. She developed graft rejection in April 2003 and visual acuity dropped to hand motion. After treatment with topical and systemic steroids and systemic cyclosporine A, visual acuity recovered to 20/80 in July 2003. RESULTS: The authors know of only three other reported patients (six eyes) with keratoconus in Turner's syndrome. Five eyes underwent PK with good visual rehabilitation, but one developed immunologic graft rejection 7 years after surgery. On the whole, considering the current report and the other cases described in the literature, graft rejection occurred in 2 out of 6 eyes (33.3%). The graft survival rate was 80% after 2 years and 40% after 7 years. CONCLUSIONS: The results suggest that grafts for keratoconus in patients with Turner's syndrome might have an increased risk of immunologic rejection. Corneal grafts in Turner's syndrome need to be monitored closely. Early detection of graft rejection and aggressive treatment with topical and systemic steroids and systemic cyclosporine A can save the graft and restore useful vision.

Mortality for pancreatic cancer among aluminium smelter workers in Sardinia, Italy.

To investigate the relationship between exposure to polycyclic aromatic hydrocarbons (PAHs) and mortality for specifc cancer sites, 1152 men, employed for at least 1 year at a prebake aluminium smelter, were followed-up from 1972 until 31 December 2001. Exposure to PAHs was estimated from a detailed reconstruction of the working history experienced in the plant by each cohort member and from several environmental and personal shift-sampling measurements available, by task and working department, since 1979. Furthermore, information on smoking habits, previous jobs before engagement in the smelter and main clinical findings observed during the follow-up were collected from the personal medical files. This study showed no increased mortality for lung cancer or bladder cancer associated to exposure to PAHs. Mortality for pancreatic cancer, based on 6 observed deaths, was significantly higher than expected in the whole cohort (SMR 2.4; 95%CI 1.1-5.2) and particularly among workers employed in the anodes factory of the plant (SMR 5.0, 95%CI 2.1-12.1), where a relatively consistent exposure to PAHs has been estimated. The nested case-control study planned for pancreatic cancer cases, confirmed that, also after controlling for cigarette smoking, PAH exposure experienced in the anodes factory was associated with a significant increased risk of pancreatic cancer. A pre-existent diabetes mellitus and a potential occupational exposure to pesticides experienced in previous agricultural jobs were found as concurrent significant covariates increasing the risk. In conclusion, the relatively high exposure to PAHs, experienced in the anodes factory and particularly in the green-mill department of this prebake aluminium reduction plant, cannot be ruled out as one of the main factors in the multifactorial aetiology of the pancreatic cancers observed in this study.

Mycoplasma hominis and Trichomonas vaginalis symbiosis: multiplicity of infection and transmissibility of M. hominis to human cells.

We recently reported that most Trichomonas vaginalis isolates cultured in vitro are infected by Mycoplasma hominis. In this work, we have characterized some aspects of the relationships between the two microorganisms. PCR, cultivation, and immunological methods revealed that the number of M. hominis organisms carried by T. vaginalis in culture varied from isolate to isolate, suggesting a specific multiplicity of infection. Moreover, infected T. vaginalis isolates were able to pass bacteria not only to M. hominis-free protozoa, but also to human-derived epithelial cells. The in vitro transmission of the bacterium from T. vaginalis to both uninfected parasite isolates and human epithelial cells suggests a role for T. vaginalis as a carrier of the M. hominis infection in vivo.

Adherence of ocular isolates of staphylococcus epidermidis to ACRYSOF intraocular lenses. A scanning electron microscopy and molecular biology study.

PURPOSE: To investigate the adherence of two clinically relevant ocular isolates of Staphylococcus epidermidis to ACRYSOF intraocular lenses (IOLs) (Alcon Surgical, Fort Worth, Texas) and to determine whether the strains under study carried the intercellular adhesion (ica) locus, which encodes production of S. epidermidis antigens mediating adherence to biomaterials. DESIGN: Experimental study. PARTICIPANTS: The authors examined the in vitro adherence of two clinically relevant ocular isolates of S. epidermidis (S. epidermidis 1 and S. epidermidis 2). Adherence was tested on six ACRYSOF IOLs. METHODS: Three IOLs were placed in three separate test tubes containing 5 ml of S. epidermidis 1 suspension, and three other IOLs were placed in three test tubes containing 5 ml of S. epidermidis 2 suspension. At different times (3, 30, and 90 minutes), the IOLs were removed from the test tubes and rinsed in sterile phosphate buffered solution. The lenses were then fixed in glutaraldehyde, postfixed in osmium tetroxide, and serially dehydrated in ethyl alcohol. After critical point drying, they were sputter-coated with gold and then examined with a scanning electron microscope. In addition, polymerase chain reaction amplification was used to investigate whether the isolates under study carried the ica locus. MAIN OUTCOME MEASURES: The number of adhered bacteria per area (square millimeters) of IOL optic was calculated. Statistical analysis included calculation of arithmetic means and 95% confidence intervals (t test). Polymerase chain reaction amplification products were visualized in ethidium bromide-stained agarose gel. RESULTS: Direct counting of adherent bacteria in scanning electron microscopy photographs revealed that the total amount of adhered bacteria per area of IOL optic after 3, 30, and 90 minutes of incubation in bacterial suspension was 1306/mm(2), 3389/mm(2), and 7195/mm(2) (S. epidermidis 1) and 778/mm(2), 1056/mm(2), and 3861/mm(2) (S. epidermidis 2). Differences at 30 and 90 minutes were statistically significant (P: = 0.01 and 0.02, respectively). Polymerase chain reaction amplification revealed that S. epidermidis 1 contained the ica locus, whereas S. epidermidis 2 was ica negative. CONCLUSIONS: Different ocular isolates of S. epidermidis may differ significantly with regard to adherence to ACRYSOF IOLs. Adherence appeared to be greater when the bacterial DNA contained the ica locus. Strains of S. epidermidis carrying the ica locus may play an important role in the pathogenesis of some forms of endophthalmitis occurring after cataract surgery.

In vitro adherence of Staphylococcus epidermidis to polymethyl methacrylate and acrysof intraocular lenses.

PURPOSE: To investigate the adherence of one clinically relevant ocular isolate of Staphylococcus epidermidis to polymethyl methacrylate (PMMA) and Acrysof (Alcon Surgical, Fort Worth, TX) intraocular lenses (IOLs). DESIGN: Experimental study. PARTICIPANTS: The authors examined the in vitro adherence of one clinically relevant ocular isolate of S. epidermidis. Adherence was tested on 12 PMMA IOLs and 12 Acrysof IOLs. METHODS: Six IOLs (three of each type) were placed in different test tubes containing bacterial suspension (10(8) cfu/ml) and incubated at 37 degrees C. At different times (3 minutes, 30 minutes, and 90 minutes), each IOL type was removed from the test tube, rinsed in sterile phosphate-buffered saline, and transferred into sterile brain-heart infusion broth. The broth with the IOL was sonicated on low power for 3 minutes to remove adhered bacteria. Two serial 10-fold dilutions of the broth containing the dislodged bacteria were plated on mannitol agar plates. The plates were incubated overnight at 37 degrees C and then bacterial colonies were counted. All assays were performed in triplicate. Additional lenses (three of each type) were incubated with S. epidermidis for different times (3 minutes, 30 minutes, and 90 minutes) and then examined with scanning electron microscopy. MAIN OUTCOME MEASURES: The number of adhered bacteria per area (mm ) of IOL optic was calculated. Statistical analysis included calculation of arithmetic means and 95% confidence intervals (t test). RESULTS: Direct counting of viable adherent bacteria released by sonication showed that the amount of adhered bacteria per area of IOL optic after 3, 30, and 90 minutes' incubation in S. epidermidis suspension was 0.1 x 10(2)/mm2, 3.6 x 10(2)/mm2, and 11 x 10(2)/mm2 (PMMA IOLs), and 4.4 x 10(2)/mm2, 3.1 x 10(2)/mm2, and 2.3 x 10(2)/mm2 (Acrysof IOLs). Direct counting of adherent bacteria in scanning electron microscopy photographs revealed that the total amount of adhered bacteria per area of IOL optic after 3, 30, and 90 minutes' incubation in S. epidermidis suspension was 1.1 x 10(2)/mm2, 4.4 x 10(2)/mm2, and 5.5 x 10(2)/mm2 (PMMA IOLs) and 13 x 10(2)/mm2, 33.9 x 10(2)/mm2, and 72 x 10(2)/mm2 (Acrysof IOLs). CONCLUSIONS: Results suggest that in vitro adherence of S. epidermidis to IOLs is influenced by IOL materials. After 3 minutes' incubation, Acrysof IOLs appeared to be more permissive to S. epidermidis adherence than PMMA IOLs. The difference was statistically significant (P < 0.05). However, at 90 minutes, Acrysof IOLs had a lower viable bacterial count than did the PMMA IOLs. Bacterial adherence appeared to be greater in areas with surface irregularities. Adherence of S. epidermidis to IOLs may play a role in the pathogenesis of some forms of endophthalmitis after cataract surgery.

Removal of tumours of the orbital apex via a postero-lateral orbitotomy.

BACKGROUND: The surgical management of pure apical tumours of the orbit may be problematic with traditional approaches. A postero-lateral approach, specifically designed for apical growths, provides a more favourable angle of vision through a relatively small bone opening. METHODS: A series of 103 consecutive cases of intraorbital tumours, operated on in a community-based institution, was retrospectively reviewed. Out of this series, 8 patients, harbouring lesions located in the posterior intraconal space, underwent a postero-lateral orbitotomy. This approach, through a small opening on the orbital and temporal portions of the greater wing of the sphenoid, with the lesser sphenoidal wing, the orbital plate of the frontal bone, the lateral rim of the orbit being maintained intact, allowed adequate exposure of the orbital apex and successful extirpation of the tumours. In four patients the histological examination disclosed a cavernoma; the other patients had, respectively, a dermoid cyst, a lymphoma, a hemangiopericytoma and a metastatic melanoma. RESULTS: No recurrences were observed in a follow-up period ranging from 1 to 7 years postoperatively (the patient with melanoma died 16 months after operation for systemic complications of her illness). One patient showed transient weakness of lateral rectus muscle due to surgical manipulation, which subsided in few months. CONCLUSIONS: The postero-lateral orbitotomy represents a reliable alternative to other traditional surgical approaches when dealing with tumours of the orbital apex, providing excellent exposure of this region with a low rate of operative morbidity.

Susceptibility of Acanthamoeba castellanii to contact lens disinfecting solutions.

A corneal isolate of Acanthamoeba castellanii was exposed to commercial contact lens disinfecting solutions containing hydrogen peroxide, benzalkonium chloride, polyaminopropyl biguanide, polyquaternium 1, and chlorhexidine-thimerosal. The minimum trophozoite amebicidal concentration and exposure times required to kill trophozoites and cysts were determined. Solutions containing hydrogen peroxide or chlorhexidine-thimerosal were active against both trophozoites and cysts. The benzalkonium chloride-based solution was effective only against trophozoites. Solutions containing polyaminopropyl biguanide or polyquaternium 1 were completely ineffective. The need for adequate exposure times must be stressed.

The treatment and follow up of adult chlamydial ophthalmia.

Sixty two patients diagnosed as having adult chlamydial ophthalmia were treated with oral doxycycline and roxithromycin in association and tetracycline eye wash for 2 weeks. Chlamydial ophthalmia was diagnosed by laboratory detection of the micro-organism in ocular specimens using direct immunofluorescent monoclonal antibody staining for Chlamydia trachomatis, chlamydial culture in cycloheximide treated McCoy cells, and Giemsa staining. An immunoenzymatic method for detection of specific IgG and IgA in patients' serum was used as an additional test to confirm the diagnosis. All patients were reexamined 3 weeks after completing their course of antibiotics and in the case of persistent infection a further course of treatment was given. With this treatment regimen 48 out of 62 patients (77.4%) were cured after three courses. Because of the risks of an inadequate response to therapy, we recommend a proper post-treatment follow up in all patients with chlamydial eye infections.

Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures?

Encroachment upon the spinal canal, separation of the pedicles, associated fractures of the laminae are assumed to be related to dural lacerations consequent to burst fractures of the thoracolumbar spine. Owing to the possible occurrence of early or delayed complications of meningeal discontinuations, the predictive value of these signs has been analyzed in a consecutive series of 50 patients, who were submitted to surgery. Dural tears were found to occur at a rate of 60%, without any statistically significant relation with any of the examined signs. The results were not consistent with the thesis that lacerations of the dura can be predicted on the basis of radiological signs.

[Intermittent exotropia: evaluation of results on the basis of different treatments]. / Exotropie intermittente: évaluation des résultats sur la base des différents traitements.

The aim of the study is to evaluate the results obtained in treatment of Intermittent Exotropia with the therapeutic programme applied at the Orthoptic Centre of Sassari Oculist Clinic. 250 patients were considered; 176 completed treatment. The patients were divided into four groups according to the kind of treatment adopted: orthoptic exercises, surgery (double recession of lateral rectus), exercises and surgery, no therapy. Results were evaluated by measuring the acquired state of orthophoria or residual exotropia: less than 10 prismatic diopters (excellent result); residual exotropia between 11 and 20 prismatic diopters (unsatisfactory result); residual exotropia > 20. The highest percentage of excellent results was found in those patients who underwent surgery but only among those who completed the therapy with cycles of orthoptic exercises. Conversely, the worst results were evident in patients who followed no therapeutic programme.

Radicular compression by extradural spinal endometriosis. Case report.

The case of a 35 years old woman affected by endometriosis located inside the spinal canal in the extradural space at the level of the third left lumbar root, and developing through the corresponding foramen into the paraspinal muscles, is presented. The clinical aspect, radiological picture and surgical treatment are described. Pathogenesis is discussed on the basis of the literature. Furthermore it is stressed that only the histopathological examination gave the correct diagnosis and permitted the definitive hormonal treatment. To our best knowledge no comparable case has been published in the literature.

Subarachnoid buprenorphine administered by implantable micropumps.

This report concerns 23 patients, the majority of whom are suffering from low back and chest pain caused by chest, urological or gynaecological cancer. These patients were treated with subarachnoid buprenorphine, administered in a single bolus or by slow infusion from micropumps, at a daily dose adapted to patients need (0.06-0.15 mg). The painful symptomatology was successfully controlled in all the cases treated, allowing the patients to live a virtually normal life. In no cases was respiratory depression or tolerance observed.