Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy.

PURPOSE: The need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. METHODS: A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days. RESULTS: The mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, and D-dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS-CoV2. CONCLUSION: We suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6 and D dimer > 4, tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.

Multicenter prospective crossover study on new prosthetic opportunities in post-laryngectomy voice rehabilitation.

The aim of this study was to assess the clinical experience of three Italian centers using the third generation Provox Vega prosthesis, in terms of device life and voice outcome, comparing the results with the second generation Provox 2 prosthesis in the same sample. A prospective multicenter crossover study was performed in three phases. In the first phase we performed a reassessment, for enrollment purposes, of patients who were categorized into four different groups [normal ­ group A; radio-treated ­ group B; gastroesophageal reflux disease (GERD) ­ group C; and elderly subjects ­ group D]. In the second and third phases, all patients were monitored for prosthetic device life and assessed for objective and subjective voice characteristics after introducing Provox 2 and Provox Vega prostheses. In patients with Provox 2 prosthesis, the mean life was 165 days in group A, 148 days in group B, 91 days in group C and 188 days in group D. In Provox Vega patients, mean in situ prosthesis life was 213 days in group A, 182 days in group B, 118 days in group C and 227 days in group D. The perceptual voice data showed a better rating across all parameters for the Provox Vega samples compared to those of Provox 2. In this paper, we report the first multicenter crossover study comparing different prosthetic models in the same patients, categorized in relation to different typologies of tracheoesophageal rehabilitative status. Result analyses confirmed an optimal stability of the Provox Vega compared to the Provox 2, in terms of device life and perceptual voice parameters.

[Highly malignant papillary cystadenocarcinoma of the tongue: a case report]. / Su un caso di cistoadenocarcinoma papillare della lingua ad alto grado di malignità.

Papillary cystadenocarcinoma (PC) of the tongue is an extremely rare malignant neoplasm arising from the minor salivary glands. Its anatomopathological features are sufficiently characterized although clinical manifestation and biological behavior are not yet well defined. The Authors describe a highly malignant case of PC of the tongue in a 71-year-old man treated with surgery, followed by radiotherapy. Clinical and anatomopathological characteristics of this rare neoplasm are described. A review of the international literature confirms how unusual this disorder is and explains the poor tumor histotype characterization. Finally the Authors assert that this is the first case of highly malignant PC with localization limited to the tongue reported in literature. The Authors conclude suggesting a clinical-therapeutic procedure to deal with this rare pathology.

[Traumatic auricular hematoma in athletes: histopathological findings and clinical considerations on the experimental animal model]. / L'otoematoma traumatico negli sportivi: aspetti istopatologici e considerzioni clinico-terapeutiche su modello sperimentale.

Surgical procedures used for treating hematomas of the auricle are often defective in obtaining complete cosmetic and functional results when hematoma is of traumatic origin, as often thickening and deformity may outcome. Up to date, some pathological aspects of the healing process of auricular hematomas due to blunt trauma are still unclear as only lesions similar to spontaneous hematoma were experimentally produced and studied. Traumatic auricular hematoma, a lesion caused by rough contacts in sports like rugby, judo, karate, wrestling, etc., was never experimentally induced and studied. The Authors have induced both traumatic and non-traumatic hematomas in a group of 5 rabbits, injecting blood clots under the perichondral layer of one auricle while in the contralateral the hematoma was induced by compressive friction as it is caused during the above referred sports activities. Lesions of both sides were examined after 15 and 60 days and it was found that histopathological picture and clinical course of traumatic hematoma deeply differ from those of non-traumatic one. Non-traumatic lesion appears like a circumscribed hematoma without any evident sign of surrounding reaction, while traumatic lesion shows clear signs of polymorphic and marked reaction. In traumatic hematoma reactive and reparative processes are observed which alter the cartilage and perichondrium associated with many which alter the microhematomas in the subcutaneous connective tissue, close to the main hematoma. Histological findings found 2 months after injury show cartilaginous auricolar skeleton to be thickened by chondrocytes grouped in islands or fingered from perichondrium.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mycosis of the paranasal sinuses: a report of 4 cases]. / Micosi dei seni paranasali: report su 4 casi.

With recent advances in medicine, fungal diseases are not only being better under stood, but are also becoming increasingly important in the management of patients with paranasal sinus disease. Fungal sinus diseases range from allergic fungal sinusitis to invasive and fulminant fungal sinusitis. Although patients often have some predisposing factor, such as local tissue hypoxia or massive fungal ++exposure, most patients are not immuno-compromised. Invasive fungal sinusitis may be treated with the traditional Caldwell-Luc surgical technique or with newer endoscopic procedures. Fulminant fungal sinusitis generally occurs in immuno-suppressed patients and requires aggressive surgical excision and debridement as well as systemic chemotherapy, usually amphotericin B. In this article we review fungal diseases of the paranasal sinuses and present four cases of paranasal fungal sinusitis.