Ion concentrations in nasal airway surface liquid: a prediction model for the identification of cystic fibrosis carriers.

BACKGROUND: Cystic fibrosis (CF) carriers seem to have a higher risk to develop chronic rhino-sinusitis (CRS), although the full underlying mechanisms are unknown. Ion concentrations in nasal airway surface liquid (ASL) may be influenced by the heterozygosity for CF gene mutation, with possible impacts on the development of CRS. METHODS: A cheap and feasible standardized technique was designed to measure the ion levels in nasal ASL. With this purpose we collected, under basal conditions, samples from the nasal cavity of 165 adults: 14 homozygous for CF, 83 carriers and 68 healthy controls. Sodium (Na) and Chlorine (Cl) concentrations were then evaluated among different groups. RESULTS: Statistical analysis revealed a significant difference of Na and Cl values between controls and carriers and between controls and homozygotes. Receiver operating characteristic (ROC) curves and derived indicators (Youden's index and Area Under the Curve, AUC) were used to further evaluate the diagnostic capability of Na and Cl concentrations to differentiate heterozygotes from controls. ROC curves demonstrated that the optimal diagnostic cut-off value of Na is at 124, and the optimal cut-off value of Cl is at 103,2. CONCLUSION: ASL sampling can be considered a new diagnostic tool for providing quantitative information on nasal ion composition. According to our findings, Na and Cl concentrations of nasal ASL could represent a useful tool to assess heterozygotes and healthy controls.

Identification and molecular characterization of Taro bacilliform virus and Taro bacilliform CH virus from East Africa.

Taro (Colocasia esculenta) and tannia (Xanthosoma sp.) are important root crops cultivated mainly by small-scale farmers in sub-Saharan Africa and the South Pacific. Viruses are known to be one of the most important constraints to production, with infections resulting in severe yield reduction. In 2014 and 2015, surveys were conducted in Ethiopia, Kenya, Tanzania and Uganda to determine the identity of viruses infecting taro in East Africa. Screening of 392 samples collected from the region using degenerate badnavirus primers revealed an incidence of 58-74% among the four countries surveyed, with sequence analysis identifying both Taro bacilliform virus (TaBV) and Taro bacilliform CH virus (TaBCHV). TaBCHV was identified from all four countries while TaBV was identified in all except Ethiopia. Full-length sequences from representative TaBV and TaBCHV isolates showed that the genome organization of TaBV isolates from East Africa was consistent with previous reports while TaBCHV isolates from East Africa were found to encode only four ORFs, distinct from a previous report from China. Phylogenetic analysis showed that all East African TaBV isolates form a single subgroup within known TaBV isolates, while TaBCHV isolates form at least two distinct subgroups. To the authors' knowledge, this is the first report describing the occurrence and genome organization of TaBV and TaBCHV isolates from East Africa and the first full-length sequence of the two viruses from tannia.

Listeria Monocytogenes: an uncommon pathogen of cervical necrotizing fasciitis.

The aim of this paper is to present a unique case of neck-necrotizing fasciitis caused by Listeria Monocytogenes in a young woman, successfully treated by surgery and IV antibiotic therapy. Necrotizing fasciitis is a rare, rapidly progressing and potentially life-threatening infection that infrequently occurs in the head and neck region. Pathogens involved in necrotizing fasciitis are heterogeneous and include aerobic and anaerobic bacteria. To the best of our knowledge, this is the only case of neck necrotizing fasciitis caused by Listeria Monocytogenes studied in literature so far.

Simultaneous nasopharyngeal and parotid gland Warthin's tumour: a case report.

Herein, a rare case of synchronous cystoadenolymphoma (Warthin's tumour) of the right parotid gland and the nasopharyngeal space is described. Although Warthin's tumour (WT) of the parotid gland is a common benign pathology, the occurrence of extra-parotid cystoadenolymphoma is rare. Extra-parotid WT have been mainly localised in the submandibular gland, periparotid region and occasionally in other sites, such as the oral cavity, hard palate and nasopharynx. The simultaneous occurrence of an intra-parotid and extra-parotid WT localisation, as in the case presented, is extremely uncommon.

Analysis of Il-10 gene sequence in patients with sinonasal polyposis.

Sinonasal polyposis (SNP) is a chronic inflammatory disease of nasal and paranasal cavities. Human leukocyte antigen-G molecules (HLA-G) are non-classic HLA-I molecules with anti-inflammatory and tolerogenic properties. HLA-G production is mainly induced by interleukin (IL)-10. IL-10 is an anti-inflammatory cytokine that inhibits the production of proinflammatory cytokines and induces HLA-class II down-modulation. Recent studies suggest that HLA-G could play a role in SNP pathogenesis; in SNP patients physiological levels of IL-10 (produced by activated peripheral blood CD14+ monocytes) are not able to induce production of HLA-G. Different mechanisms could justify these findings: genomic or amino-acidic sequence alterations in IL-10 lower IL-10 receptor expression, lower IL-10 receptor affinity, or alterations of the intracellular signal transmission. This study analyzes nucleotidic sequence of IL-10 gene in SNP patients. Sequencing of IL-10 gene shows that the lack of HLA-G production by peripheral blood CD14+ monocytes is not related to alterations in IL-10 gene nucleotidic sequence.

Preoperative assessment of salivary gland neoplasms with fine needle aspiration cytology and echography: a retrospective analysis of 357 cases.

Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure usually well tolerated, easy to perform, quick, cheap and easy to repeat in case of doubts or non-diagnostic results. Echography is also a fast, cheap and non-invasive tool; however, the role of FNAC and echography in the diagnosis of salivary gland pathology is not universally recognised. Three hundred and fifty-seven patients with a cytological diagnosis at FNAC, and 247 of these who were also studied with echography, were enrolled for this retrospective study. The final histopathological diagnoses, obtained after surgery, were then compared to the preoperative FNAC diagnoses and echographic findings. From the analysis of our data, the overall FNAC specificity resulted 93 percent, sensitivity 83 percent, and diagnostic accuracy 92 percent. Echography sensibility was 57.1 percent specificity 98.2 percent, while positive and negative predictive value were respectively 80 percent and 94.8 percent. While echography can be useful in order to provide a better characterization of salivary gland lesions, FNAC can then be considered a safe diagnostic tool with reliable sensitivity and specificity for the assessment of salivary gland pathology and thus for selecting patients and indicating the best surgical treatment.

Comparison of subjective and objective tools in transoral laser cordectomy for early glottic cancer: importance of voice handicap index.

Several studies in recent years have already reported good oncologic results with laser microsurgery in the treatment of early glottic carcinoma. We conducted a longitudinal voice evaluation, in patients with early glottic cancer who underwent transoral laser cordectomy, in order to assess the voice quality outcome and its relationship with objective and subjective (voice handicap index questionnaire and GIRBAS scale) means. Twenty-four previously untreated patients underwent transoral laser cordectomy for early glottic cancer. All patients underwent subjective and objective voice assessment according to the multidimensional voice protocol recommended by the European Laryngological Society including acoustic, perceptual and stroboscopic analysis combined to patient self assessment of voice (voice handicap index-VHI). These evaluations were performed before treatment and 6 months after the treatment. Vocal fold healing was complete in all cases by 6 months following surgery. Main voice parameters (subjective and objective) resulted improved at the 6-month control after surgery. In particular, voice handicap index (VHI) and GIRBAS scale resulted reliable for voice assessment and for the postoperative follow-up. In conclusion, VHI, GIRBAS, multidimensional voice program (MDVP) and spectroacoustic parameters showed a close trend in the present study, and this confirms the validity of the voice analysis performed by each tool.

Transnasal endoscopic management of petrous apex and clivus selected lesions.

The objective of this study was to report a series of selected primary skull base benign lesions midline located by transnasal endoscopic transsphenoidal approach. A retrospective review of 5 cases is presented: four cholesterol granuloma of the petruos apex and one of the clivus. All patients have been successfully treated via transnasal endoscopic transsphenoidal approach. The mean duration of follow-up was 27 months (range 12-50 months). No postoperative complication such as CSF leak, meningitis, or encephalocele and no signs of recurrence have been noticed. The transnasal route is a minimally invasive, safe, and efficient technique to approach the petrous apex and clivus for selected midline skull base lesions removal.

Free anterolateral thigh flap versus free forearm flap: Functional results in oral reconstruction.

Nowadays, microsurgery performed for oral reconstruction of cancer patients, has become the standard treatment in restoring oral functions. The free radial forearm flap (FRFF) is still apparently the first reconstructive choice in oral cavity cancers. Recently the anterolateral thigh flap (ALTF) seemed to challenge the superiority of FRFF. The lack of functional data on which to base this recent supposition is the reason for this new research. Twenty reconstructed patients were enrolled for this study. Speech, swallowing, and donor site complications were studied to assess differences between the two techniques. Results show that difference in function between ALTF and FRFF groups is statistically insignificant. Donor site risks and complications seem to be the only variables among groups. These variables may be used as indicators when making a surgical choice.

Cytomorphologic and ultrastructural study of nasal mucosa by means of brushing: a comparison between asymptomatic and rhinitic subjects.

The authors compared the cytomorphologic and ultrastructural features of nasal epithelium collected by means of brushing from asymptomatic subjects with these of patients affected by nasal polyposis (NP), allergic (AR) and non-allergic rhinitis (NAR). A brushing of nasal epithelium was taken from each member of both groups, and analysed under light and electron microscopy. The observation showed normal ciliary patterns and preserved intercellular joints in the great majority of asymptomatic subjects, while in all subjects of the pathologic group the junctions appeared variously damaged or absents, with ciliary abnormalities. The damage to the intercellular joints, rather than the alterations of ciliary patterns, seemed to represent in this study the border between the absence of symptoms and the presence of chronic inflammation. Therefore, a reduced tightness of the intercellular joints could contribute to the impairment of the mucociliary clearance, priming the vicious circle that leads to the condition of chronic inflammation.

Computerised tomography evaluation of the frontal recess in inflammatory diseases of the frontal sinus: standardisation of a new technique.

The authors present a new investigation technique by means of CT of the frontal sinus drainage pathway, the frontal recess, which could be of considerable help in defining its potential role in determining a chronic or recurrent inflammatory process of this cavity. Among the main characteristics of this technique are: (1) a clear presentation of the course and conformation of the recess and its relations with surrounding structures; (2) speedy, and therefore economical, operation (12 min for a complete examination); and (3) tolerability, because this examination starts off with axial-scans, which, compared to CT coronal projections and MRI scans, are less prone to defects and do not require strained postures. This this means that all kinds of patients can be assessed, which is a basic requirement for achieving standardisation. With axial scans the authors work from paraxial reconstructions (oblique sagittal) which, in their opinion, give the best definition of the frontal recess so far recorded.

[Coronal CT in the indication of the endoscopic surgery of the sinus]. / La T.C. coronale nelle indicazioni alla chirurgia endoscopica sinusale.

In this paper the Authors affirm that Functional Endoscopic Sinus Surgery is the technique of choice for treatment of nonneoplastic pathologies of paranasal sinuses, particularly in chronic infective and polypoid sinusitis. Furthermore, they confirm CT scans are mandatory in preoperative planning in order to delineate precisely the structures surrounding the surgical field (the lamina papyracea and possible dehiscences, the brain, the lacrimal duct, the internal carotid artery and the optic nerve), and thereby avoid any possible damage during surgery. If endoscopic examination and clinical history suggest a massive involvement of ethmoid cavities, both axial and coronal CT scans are necessary. Inasmuch as the crucial point in the development of chronic sinus pathology is the ostio-meatal complex, the Authors indicate that this structure can be clearly identified and studied by means of coronal CT scans, since in this case it is not necessary to clarify the depth of the nasal fossae, but, instead, to reveal the exact situation and configuration of the two fundamental lamellae, the uncinate process and the bulla. These structures lie on a vertical plane and cannot be studied with axial CT scans without reviewing several series scans made in close proximity, which increases the patient's exposure to x-rays as well as the expense of the study. This paper is an attempt to shorten and rationalize routine radiologic procedures when a limited ethmoid involvement, previously detected by careful endoscopic examination, is under investigation.

Anatomic variations of surgical importance in ethmoid labyrinth and sphenoid sinus. A study of radiological anatomy.

The present study was performed on axial and coronal CT scans of 100 patients, most of whom were affected by nasal polyposis. Five observers had to analyse the radiograms and answer a questionnaire including the following items: presence of a supraorbital recess; identification of anterior and posterior ethmoidal canals; dehiscences in the lamina papyracea; pneumatized middle turbinate; presence of a sphenomaxillary plate; presence of Haller's cells; presence of Onodi's cells; relationships of the optic canal; relationships of the internal carotid artery; relationships of the maxillary nerve; relationships of the vidian nerve; level difference between the ethmoid roof and nasal vault; depth of the sphenoethmoidal recess. The data obtained were compared with those drawn from anatomical studies. The fair agreement between them proves the value of CT as an alternative method for studying paranasal sinuses anatomy.

Transnasal sinusectomy with combined microscopic and endoscopic technique.

Severe, diffuse polyposis can be adequately treated through a transnasal approach which combines microscopic and endoscopic surgery. The operating microscope is used to perform ethmoidectomy, usually from the front to the back, and to open the sphenoid sinus and the antral window. The telescopes allow the sphenoid and maxillary sinuses to be cleaned under direct view control as well as enabling good drainage to be performed from the frontal sinuses. The results from 22 consecutive patients were good, with a very low rate of minor post-operative complications.

[The problem of the mandible in surgery of tonsillar tumors: proposal of a technique]. / Il problema della mandibola nella chirurgia dei tumori tonsillari: proposta di una tecnica.

The Authors report a technique of a conservative transmandibular approach for the surgical treatment of tonsillar region malignancies. The procedure is based upon the preparation of a vascular mandibular flap through two osteotomies, which are performed, the first above the mandibular foramen and the second below the mental foramen. The main advantages of present technique are: lip-chin-splitting is avoided and, due to the preservation of mandibular vascular and nervous supply, it is possible to accomplish, without risk, postoperative radiotherapy. Moreover, if dictated by oncologic reasons, this conservative procedure may easily be transformed into a radical surgery (commando or neck-jaw operation).

[Post-operative recurrence of naso-sinus polyposis]. / Il problema delle recidive post-chirurgiche nella poliposi naso-sinusale.

Maxipolyposis, i.e. severe, diffuse nasosinusal polyposis, is generally treated with an onerous surgery. Therefore, recurrence, roughly rangling from 15% to 25%, are quite a disagreable outcome which is to be minimized. To this purpose, it may be useful to differentiate the residual from the recurrent polyposis, as is usually done in cases of cholesteatoma. Residual polyposis can be reduced by a thorough surgical resection. The authors detail their present technique, which joins microsurgery, used to perform ethmoidectomy, with endoscopic surgery, employed to manoeuvre within the sphenoid and maxillary sinus, as well as to drain the frontal sinus, i.e. to treat areas out of the direct view. Moreover, patients are warned of the need for close postoperative controls which should always be performed through telescopes in order to secure a sound inspection of the surgical cavities. Any slight, incipient recurrence should be immediately resected in the office by means of endoscopic technique. Recurrent polyposis must be treated with the drug therapies now in use, a waiting complete elucidation of the pathogenic mechanism. Association with systemic diseases, such as asthma, may contraindicate major surgery, as it increases the recurrence expectancy. Simple polypectomy often attains the same result in these cases, that is temporary ventilation of the nasal fossae.

[Possibilities of diagnostic errors in paralysis of the 7th cranial nerve]. / Possibilità di errori diagnostici nelle paralisi del VII.

Approximately 5% of all facial paralyses are of neoplastic origin while approximately 80% represent idiopathic or Bell's palsies. Whenever a tumor is suspected accurate testing is imperative; testing aimed at the nerve trunk both above and especially below the stilomastoid foramen. In fact, occult neoplasms are much more frequently located within the parotid. The present work presents a case where facial palsy was associated with profound ipsilateral hearing loss. Diagnostic efforts were, therefore, focussed on the cerebello-pontine angle and the Fallopian canal, thus delaying recognition of its real etiology (a mucoepidermoid carcinoma of the parotid).