An unusual case of antrochoanal polyp with sudden laryngeal dyspnoea and stridor onset.

Antrochoanal polyps usually present with nasal obstruction. An exceptional case is described occurring in an elderly patient with sudden laryngeal dyspnoea and stridor due to an antrochoanal polyp. The symptoms were so serious that an emergency surgical procedure was mandatory. A 14 cm antrochoanal polyp was excised in toto in endoscopy through the right nostril.

Internal carotid pseudo-occlusion: early and late results.

Internal carotid pseudo-occlusion (ICP) is a pathology of difficult diagnostic evaluation and treatment in the group of extracranial carotid diseases. The authors report the results of 24 ICP(S) surgically treated in the last five years. No perioperative death was reported. The neurological morbility rate was as low as 4% (1/24), which is quite a good results for this high-risk pathology. Clinical and instrumental follow-up was performed (at 1-3-6-12-24 months from surgery). Six early asymptomatic thromboses (25%) were observed, and the remaining patients showed patent vessels and no symptoms at all. In conclusion surgical treatment of ICP is often able to prevent cerebral ischaemia, and the high rate of early occlusion should not limit surgical indication.

Pigmented villonodular synovitis of the temporomandibular joint: report of a case.

Pigmented villonodular synovitis is a benign reactive process of the synovial tissue, that usually involves the knee or other major joints. Reports of this entity in the temporomandibular joint are rare. The authors describe a case involving this joint, initially clinically diagnosed as a parotid tumour.

[Kallmann's syndrome. Apropos of 2 personal cases]. / La sindrome di Kallmann. A proposito di due personali osservazioni.

The Kallmann's syndrome is a rare nosological phenomenon characterized by hypogonadotropic hypogonadism and anosmia. In 1944, Kallmann first studied the genetic aspects of this syndrome in three different families in which 11 subjects suffered of deafness, syncinesis, brain disorders or skeletal anomalies along with olfactory dysfunction. In these patients histological studies revealed either a degeneration in the olfactory bulb tract or a generalized hypoplasia of the olfactory system. In the light of the presence of brain lesions and the possible association with several other endocrine pathologies, hypogonadism should be related to a diminished increase of releasing factors from the hypothalamus. At present the Kallmann's syndrome is considered a genetic syndrome linked to the X-chromosome. The hypothalamus is a genetic disorder target gland and its eventual close connection to the olfactory system could explain endocrine as well as olfactory pathology. Several recent studies carried out on mice by M. Schwanzel-Fukuda and D. Pfaff showed that neurons expressing Luteinizing hormone-releasing hormone (LH-RH) are located in the nervus terminalis, a cranial nerve that is a part of the accessory olfactory system and which projects directly from the nose to the septal-preoptic nuclei in the brain. Clinically, these data could explain the gonadotropin deficiency in association with olfactory dysfunction in the Kallmann's syndrome. In this paper the Authors report two cases of Kallmann's syndrome: a 41-year-old male with eunuchoidism and anosmia, and a 7-year-old child with hypospadia and anosmia.

[Carcinoma of the lip: a retrospective study of 86 cases]. / Carcinoma del labro. Studio retrospettivo su 86 casi.

Carcinoma of the lip is a common lesion which is not always acknowledged as as a potentially lethal disease. The risk of cancer occurs most commonly among aging white men. The risk factors normally associated with lip cancer are rural residence and outdoor occupation. In addition, both actinic radiation and tobacco smoking have been considered casually related to lip cancer. The present study is based on a retrospective review of 86 patients (82 males, 4 females, mean age 65) affected by carcinoma of the lip, treated in Florence from 1970 to 1988. The most frequent site for carcinoma of the lip proved to be the lower lip (71 cases); other sites included the upper lip (7) and the commissure (8). The lip tumor was a squamous cell carcinoma in 82 patients and a basal cell carcinoma in the remaining four. Good prognosis was found for all those with relatively small lesions (T1-T2). On the contrary, the prognosis proved quite poor for those who exhibited tumor fixation to the mandible or erosion of the mandible (23.5%, 5 year survival). Primary radiotherapy may be used for the smaller lesions as cure rates proved equivalent to those achieved surgically although the authors found surgery is always preferable as a primary method of treatment. Surgical excision of the tumor is a relatively minor procedure with a minimum of morbidity as compared with radiation therapy which may lead to local tissue reaction and may disturb function. Surgical management is also recommended as it bears the advantage of being to give a histologically accurate tumor margin assessment. Moreover, with surgery, functional results are good.(ABSTRACT TRUNCATED AT 250 WORDS)

An original technique for the treatment of symptomatic common carotid artery occlusion and concomitant ipsilateral internal carotid artery stenosis.

Successful hybrid treatment of the total symptomatic acute occlusion of a common carotid artery (CCA) concomitant to ipsilateral internal carotid artery (ICA) stenosis has only been described once in the literature to date. The management of this anatomic distribution of disease can be a challenge both to plan and perform. The aim of this paper is to report an original hybrid revascularization technique for the treatment of two patients with symptomatic CCA acute occlusion and ipsilateral ICA stenosis. Details of the surgical technique and mid-term follow-up are provided.

Antrochoanal polyp: analysis of 200 cases.

Antrochoanal polyp was described by Professor Gustav Killian, in 1906, giving a specificity among polyposis; it represents 4-6% of all nasal polyps and displays both analogies and differences with bilateral nasal polyposis. Antrochoanal polyp is a benign lesion originating from the mucosa of the maxillary sinus, growing through the accessory ostium into the middle meatus and, thereafter, protruding posteriorly to the choana and nasopharynx. Incomplete excision of antrochoanal polyp almost always leads to recurrence. The Authors, therefore, provocatively question? Whether the antrochoanal polyp is a benign tumour or not? The Authors analyse the largest series of antrochoanal polyps present in the literature and report on a series of 200 patients treated consecutively at the ENT Clinic at the University of Florence, Italy. Clinical-aetiological data related to these 200 patients, treated between January 1988 and April 2006, have been analysed. Evaluation of the data presents some analogies and some disagreement with results from other series. In conclusion, based on the data obtained, it is tempting to suggest that the antrochoanal polyp develops from an increase in pressure in the Highmoro antrum due to a phlogistic-anatomical alteration at ostio-meatal complex/middle meatus level, in patients with a pre-existing silent antral cyst, subsequently forced to herniation outside, through the accessory ostium.

Laryngeal neurinoma. A case report and review.

A case of neurinoma of the larynx is presented. Pathological, clinical, diagnostic and therapeutic findings are discussed and the relevant literature is reviewed.