Respecting nasal mucosa during turbinate surgery: end of the dogma?

BACKGROUND: Chronic rhinitis with inferior turbinate hypertrophy is the most common cause of chronic nasal obstruction. Pharmacological treatment, mainly consisting of corticosteroids, is largely inadequate and, therefore, in the last few years several surgical techniques have been proposed (emptying, radiofrequency, cryotherapy, etc...). The aim of our work is to demonstrate that surgical removal of the inferior turbinate mucosa with the microdebrider, along with the submucosal chorion, results in a full restoration of mucosal physiological structure and function. METHODOLOGY: Thirteen symptomatic adult patients were subjected to bilateral inferior partial turbinoplasty with the microdebrider. All patients underwent endoscopic examination, functional nasal tests and nasal mucosa biopsy before and after surgery. RESULTS: The sensitivity in open airspaces improved after nasal surgery, and the results of functional tests returned to within a normal range. SEM examination confirmed that complete mucosal regeneration was within 4 months. CONCLUSION: Total removal of the inferior turbinate mucosa with the microdebrider in patients suffering from hypertrophic chronic rhinitis allows the perfect regeneration of physiological respiratory tissue and doesn`t have a negative impact on healing time and offsets any adverse postoperative event.

Ethical and medico-legal issues of TOETVA procedure and simulation on cadavers: a scoping review.

Conventional open thyroidectomy is still considered the gold standard for thyroid surgery. Transoral endoscopic thyroidectomy vestibular approach (also known as TOETVA) is often considered to be more advantageous than the other approaches, such as minimally invasive video assisted thyroidectomy, thyroidectomy via breast/axillary/retroauricular access, bilateral axillo-breast approach and axillo-bilateral breast approach. In this scoping review, we discuss the risks and the benefits of this surgical approach and its medico-legal and ethical implications, particularly focusing on the importance of practice on cadavers. Currently, there is little scientific evidence supporting TOETVA, since there are few papers on the comparison with the traditional open thyroidectomy that have been published and thus little data on the long-term outcomes of TOETVA are available. Since the better cosmetic outcome currently represents the main indication for this surgical technique, substantial medico-legal and ethical issues arise. Moreover, practice on cadavers can help surgeons to develop the technical and non-technical skills required to perform efficiently and safely this new surgical procedure.

[Is intermittent peritoneal dialysis with icodextrin a valid option in the long-term treatment of refractory congestive heart failure?]. / La dialisi peritoneale intermittente con i icodestrina e' una valida opzione nel trattamento a lungo termine dello scompenso cardiaco congestizio refrattario?

Refractory congestive heart failure (CHF) is affected by a very high morbidity and mortality. We report our experience in the long-term treatment of refractory CHF (NYHA class IV) by means of intermittent peritoneal dialysis (PD) with icodextrin (ICO) solutions in 4 male patients with a mean age of 71.5 + or - 5.6 (standard deviation) years and with a variable degree of chronic renal failure: 1 nocturnal exchange with ICO in 3 patients and 2 exchanges (ICO + isotonic dextrose solution) in 1 patient. The mean PD follow-up period was 24.3 + 15.6 months. After stabilization on PD, all patients had a statistically significant increase in daily diuresis (from 587.5 + or - 165.2 to 1700.0 + or - 141.4 mL, p < 0.003), a statistically significant decrease in body weight (11.3 + or - 3.4 kg, p < 0.007), and a statistically significant improvement in NYHA class (from 4.0 + or - 0.0 to 2.5 + or - 2.6, p < 0.01). Three patients had no hospitalizations due to cardiac illness in the PD follow-up period. No episodes of peritonitis occurred. Three patients died after 11, 13 and 43 months of PD treatment: 2 because of sudden death and 1 because of neoplastic cachexia. No death could be attributed to any complication related to PD treatment. Intermittent PD with ICO solutions can be proposed as a long-term treatment modality for refractory CHF. It allows an improvement in quality - if not quantity - of life. Randomized controlled trials are needed to confirm the evidence derived from case reports.

White-line: a new finding in laryngopharyngeal reflux objective evaluation.

Laryngopharyngeal reflux (LPR) indicates the reflux-induced extra-esophageal disorders. LPR and gastroesophageal reflux disease (GERD) occur by the same mechanism: the escape of gastric contents into the esophagus and beyond. However, the classic GERD symptoms are not typical in LPR disease, which can cause a lot of symptoms none of which is specific, making the diagnosis often elusive. The protective mechanisms present in the esophagus are entirely lacking in the larynx, and more generally in upper aerodigestive tract, making them particularly vulnerable to injury from acidic gastric contents. Since gastric acid backflow can affect supraesophageal structures, even in the absence of heartburn or regurgitation symptoms, an early diagnosis is important to prevent the onset of histological modifications in the supraesophageal mucosa. For this scope clinicians need to use different methods to get a diagnosis. We adopted two validated scoring systems: the reflux symptom index (RSI) for symptom assessing and the reflux finding score (RFS) for sign evaluation. In our experience we detect a new objective endoscopic rhinopharyngeal marker, called "white-line" characterized by mucosal metaplasia, that in a significant proportion of patients lines up to these validated indexes as a further element in the LPR diagnosis.