Stapedotomy: functional results with different diameter prostheses.

Developments in surgical technique and, more importantly, the use of increasingly sophisticated biocompatible prostheses have meant that good results can be achieved for otosclerosis sufferers in terms of restored hearing and very little postsurgical discomfort. We set out to assess whether the diameter of the prostheses used for stapedotomy (platinum piston/polytetrafluoroethylene, i.e. Teflon) has any effect on surgical outcome. Two groups of otosclerotic patients were selected, and these underwent stapedotomy surgery during the second phase of the disease. A piston-Teflon type prosthesis was used, 5.50 mm in terms of length but of different diameters (group A: 0.4 mm; group B: 0.6 mm). All the patients underwent the same pure-tone audiometry test before surgery, and then at 1 week and 1 month after surgery, to assess function. We compared air conduction after surgery with bone conduction before surgery. The data collected was analysed using the χ(2) (p < 0.05) test. This analysis showed that the results obtained with a 0.4-mm prosthesis or a 0.6-mm prosthesis are almost identical. There was no statistically significant difference in terms of hearing results when comparing either average tonal threshold or when analysing audiometric data frequency by frequency. It can be concluded, therefore, that in stapedotomy surgery, functional recovery is not affected by the diameter of the prosthesis used. A smaller diameter prosthesis is, however, the one of choice when the facial nerve is prominent or the oval window particularly narrow.

Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report.

Visceral leishmaniasis, a protozoan disease caused by Leishmania infantum, is endemic in the Mediterranean basin, especially southern and Tyrrhenian Italy. Its aetiological agent can also sporadically cause isolated laryngeal localization in at-risk patients (i.e., heavy smokers, immunocompromised patients). This rare localization is often pauci-symptomatic and thus can easily escape diagnosis. A case of isolated leishmaniasis limited to the left vocal cord in an immunocompetent Italian male without significant risk factors, randomly discovered upon histological examination, is described herein. We inquire how many patients affected by non-specific symptoms such as dysphonia and live in countries where Leishmania infantum infection is reported, could be truly affected by Leishmania spp infection.

Overexpression of chromatin assembly factor-1/p60 predicts biological behaviour of laryngeal carcinomas.

This study analysed the immunohistochemical expression of the CAF-1/p60 protein in laryngeal cancers. CAF-1/p60 assumes an independent discriminative and prognostic value in laryngeal neoplasms; the presence of this protein in carcinoma in situ compared with laryngeal precancerous and larynx infiltrating tumours. We assessed the immunohistochemical expression of CAF-1/p60 in 30 cases of moderate and/or severe dysplasia, 30 cases of carcinoma in situ and 30 cases of laryngeal squamous cell carcinoma (LSCCs). CAF-1/p60 expression increased significantly according to the high index of neoplastic cellular replication; therefore, CAF-1/p60 was overexpressed in neoplastic cells and its moderate-severe expression is correlated with poorer prognosis compared to less expression. In conclusion, overexpression of the CAF-1/p60 protein is related to a risk of higher morbidity and mortality and is a reliable independent prognostic index of laryngeal carcinoma. CAF1-p60 protein overexpression can be used in cancer management as an indicator of malignant evolution, especially in carcinoma in situ.

Papillomatosis of the larynx: treatment with CO2 laser.

OBJECTIVES: We report our experience treating papillomatosis of the larynx using CO2 laser which has a lower risk of post surgical complications. Papillomatosis has a high incidence of recurrence after surgical treatment. METHODS: We treated 42 patients (10 adults and 32 children) affected by multiple papillomatosis of the larynx. Smaller papillomas were vaporized with a 7-8 Watt CO2 laser and larger papillomas were resected at the base of their implantation. A strict follow-up during the first 3 years after surgical treatment was necessary to manage recurrences with CO2 laser endoscopy. RESULTS: All patients presented with recurrences after the first surgical treatment, but within 18-60 months all patients presented a solution of their pathology. Post-operative complications were observed in patients who did not comply with the strict follow-up protocol and presented with large lesions requiring more invasive surgery. CONCLUSIONS: CO2 laser endoscopy, although it did not prevent recurrences of papillomatosis in the larynx, is a valid surgical approach in the management of this pathology.

Submandibular gland myoepithelioma.

Benign myoepithelioma is a very rare form of salivary gland tumor, composed entirely of myoepithelial cells. It accounts for approximately 1% of all salivary gland tumors and is most frequently located in the parotid gland and in the minor salivary glands of the hard palate. We describe herein the ninth reported case of myoepithelioma of the submandibular gland. Benign myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. Immunohistochemical staining can help differentiate between these conditions, but histopathology remains the gold standard for diagnosing this neoplastic process.

Mucoepidermoid carcinoma of the base of tongue.

Mucoepidermoid carcinoma (MEC) is the most common malignant, locally-invasive tumour of the salivary glands, and accounts for approximately 35% of all malignancies of the major and minor salivary gland. Minor salivary glands are scattered in different areas of the oral cavity such as palate, retromolar area, floor of the mouth, buccal mucosa, lips and tongue. MECs of tongue base are not common. We present a rare case of MEC localised at the tongue base in a 42-year-old Caucasian woman and discuss the histopathological types, management and review the literature. Adequate intra-oral excision was the treatment of choice in this case and in low-grade MEC. Prognosis of MEC is a function of the histological grade, adequacy of excision and clinical staging.

Simultaneous PET/MR head-neck cancer imaging: Preliminary clinical experience and multiparametric evaluation.

PURPOSE: To evaluate the role of simultaneous hybrid PET/MR imaging and to correlate metabolic PET data with morpho-functional parameters derived by MRI in patients with head-neck cancer. METHODS: Forty-four patients, with histologically confirmed head and neck malignancy (22 primary tumors and 22 follow-up) were studied. Patients initially received a clinical exam and endoscopy with direct biopsy. Next patients underwent whole body PET/CT followed by PET/MR of the head/neck region. PET and MRI studies were separately evaluated by two blinded groups (both included one radiologist and one nuclear physician) in order to define the presence or absence of lesions/recurrences. Regions of interest (ROIs) analysis was conducted on the primary lesion at the level of maximum size on metabolic (SUV and MTV), diffusion (ADC) and perfusion (K(trans), Ve, kep and iAUC) parameters. RESULTS: PET/MR examinations were successfully performed on all 44 patients. Agreement between the two blinded groups was found in anatomic allocation of lesions by PET/MR (Primary tumors: Cohen's kappa 0.93; FOLLOW-UP: Cohen's kappa 0.89). There was a significant correlation between CT-SUV measures and MR (e.g., CT-SUV VOI vs. MR-SUV VOI: ρ=0.97, p<0.001 for the entire sample). There was also significant positive correlations between the ROI area, SUV measures, and the metabolic parameters (SUV and MTV) obtained during both PET/CT and PET/MR. A significant negative correlation was observed between ADC and K(trans) values in the primary tumors. In addition, a significant negative correlation existed between MR SUV and ADC in recurrent tumors. CONCLUSION: Our study demonstrates the feasibility of PET/MR imaging for primary tumors and recurrent tumors evaluations of head/neck malignant lesions. When assessing HNC, PET/MR allows simultaneous collection of multiparametric metabolic and functional data. This technique therefore allows for a more complete characterization of malignant lesions.

The role of H2 antagonists in perennial allergic rhinitis.

The biological effects of anti-H2 in allergic reactions are dose dependent: low doses enhance, and high doses significantly decrease the reaction of hypersensitivity. The administration of cimetidine H2 antagonist to 20 perennial allergic rhinitis patients brought about an abatement in the symptoms and a decrease in the total serum immunoglobulin E (IgE) levels in 72% of treated patients, but no variation was perceived in placebo-treated patients. These results strengthen the hypothesis of anti-H2-induced immunoregulatory effects and suggest a possible way of inhibiting IgE synthesis in vivo.

Changes in serum interferon-gamma, interleukin-4, and interleukin-12 cytokine levels in anti-histamine type 2-treated allergic rhinitis patients.

OBJECTIVES/HYPOTHESIS: Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T-cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL-4 in T-cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNgamma and IL-4 that occurs in vivo in anti-H2-treated patients with allergic rhinitis (AR). METHODS: Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment. RESULTS: A comparison of the serum cytokine values recorded before and after anti-H2 treatment showed a significant increase in INF-gamma serum level (P = .003) and a decrease in IL-4 (P = .016). Negligible variations were found in the placebo-treated group. CONCLUSION: H2 antagonists probably induce their effects by enhancing the amount of IFN-gamma and by reducing IL-4 cytokines, which, respectively, induce a decrease and an increase in the IgE synthesis.

Management of chronic otitis media with effusion: the role of glutathione.

BACKGROUND: The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense. PURPOSE: To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME). SUBJECTS AND INTERVENTION: Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2-minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment. RESULTS: Three months after therapy improvement had occurred in 66.6% of patients in the GSH-treated group and in 8% of the control subjects (P <.01). CONCLUSION: On the basis of these results, GSH treatment could be considered for the nonsurgical management of chronic OME.

Histamine 2 antagonists in allergic rhinitis. Relationship of clinical response and serum concentrations of total and specific IgE antibody levels.

During a double-blind clinical trial of a histamine (H2) antagonist (ranitidine) in monitoring allergic rhinitis, the clinical response, total serum IgE levels, and Parietaria IgE antibody levels were measured. Ranitidine induces an improvement in scores of subjective and objective symptoms, a decrease in total serum IgE levels, and no significant variations in Parietaria IgE antibody levels. Since H2 antagonists seem to induce these improvements by acting on suppressor T cells bearing H2 receptor, as shown in our previous studies, it is hypothesized that the lymphocytic subset that regulates the total IgE synthesis is not the same as that governing specific IgE synthesis.

Glutathione in the upper respiratory tract.

Glutathione (GSH), a major extracellular antioxidant, has been found in high concentrations in the epithelial lining fluid of the lower respiratory tract. The GSH concentrations in nasal fluid, in normal and pathologic conditions, were investigated and found to be very low. A GSH aerosol (600 mg daily for 10 days) increased GSH levels in the nasal mucosa and induced a statistically significant improvement in nasal obstruction, rhinorrhea, and ear fullness. Thus, GSH administered by aerosol could be a means of defending the epithelial respiratory cells against a toxic oxidant.

Suppressor T cell subsets in allergic rhinitis patients.

Lymphocyte T cell subsets, total and Parietaria IgE levels were studied in 68 allergic rhinitis patients. In treated patients we observed an increase in the lymphocyte T cell subsets, which express a suppressor function, defined by several monoclonal antibodies, i.e., CD8, CD8 + CD11b-, CD4 + CD62L+, CD4 + CD45RO. This increase was significant for T suppressor cells, CD8 + CD11b- (p < 0.046) and T memory cells, CD4 + CD45RO (p < 0.013), whereas a slight decrease was observed in the control group. A decrease in total serum IgE levels was observed in anti-H2 treated patients; only a slight increase was noted in placebo groups; and no variations were found in Parietaria levels in either group. In vitro culture of T lymphocyte clones, T memory cells, from atopic subjects produces IL-4, which induces an increase in IgE synthesis. An increase in T memory cells, observed in the treated group, should have accompanied an increase and not a decrease in total serum IgE levels, if the in vivo data correlated with those in vitro. Consequently, the behaviour of lymphocytes in vivo is not homologous to in vitro data.

[Herpes of the larynx. Apropos of 3 cases]. / Herpès du larynx. A propos de trois cas.

Herpes laryngis is a rare inflammatory disease, caused by herpes simplex (HSV) or herpes zoster virus (HZV). Three cases of acute viral laryngitis are described. The first case of laryngitis is caused by HZV, with involvement of VII., VIII., IX. and X. cranial nerves. In the second and third cases, caused by HSV, only the laryngeal mucosa is involved. Laryngeal symptoms, diagnostic criteria and therapeutic results are described.

[Malformation processes in the middle ear. Branchio-oto-renal syndrome (BOR)]. / I processi malformativi dell'orecchio medio. La sindrome branchio-oto-renale (BOR).

The present report concerns a case of Branchio-Oto-Renal (BOR) dysplasia. The syndrome is an autosomal dominant inherited disorder characterized by external ear malformations, branchial fistulas, conductive mixed or sensorineural hearing loss and renal anomalies of varying severity. The types of abnormalities that may be present are numerous and often difficult to identify preoperatively, despite modern imaging techniques. From the literature the reconstructive surgery of the middle ear in patients with the BOR Syndrome often has not been successful. In particular, the Authors report their experience in the surgical treatment of a case of BOR Syndrome. During intraoperative investigation a complex malformation of incus-malleus system was detected; thus, an ossiculoplasty, with PORP interposition, was carried out. Hearing results obtained with such intervention were successful, but they did not allow a complete closure of the cochlear reserve. Lastly, the Authors recommend a careful study of the different malformations of the middle ear, so that a more suitable preoperative therapeutic procedure may be planned.

[Adenotonsillectomy: the evaluation of the long-term results after more than 7 years from the intervention]. / L'adenotonsillectomia: valutazione dei risultati a distanza di oltre 7 anni dall'intervento.

A study was carried out on 110 patients with various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids. Sixty-two of these patients underwent adenotonsillectomy, while the others were followed clinically and, where necessary, given medical treatment. At the first observation the patients were between the ages of 2 and 12 (mean age 6.1 years). At the start of the present study the patients ages ranged from 10 to 22 (mean age 17 years). Clinical follow-up was carried out on the patients 2 and 7 years after the first observation and/or adenotonsillectomy. The patients were divided into homogeneous groups according to the severity of symptoms. The A.A. evaluated changes of the following clinical parameters: annual frequency of inflammatory pharyngotonsillar episodes, nasal respiratory obstruction, sore throat, otologic pathology. Evaluations were carried out statistically in each group. After more than 7 years from surgery, the significant reduction of various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids, in accordance with the findings after 2 years from surgery, underline the effectiveness of adenotonsillectomy in correctly selected candidates.

Tonsillolith. Case report and review of the literature.

Large oropharyngeal concretions--giant tonsillolith--are not very common. Over the last few years only some 50 cases have been reported in the literature. Many tonsilloliths, especially small concretions, are asymptomatic; large concretions, on the contrary, may produce several symptoms. The case is described of a 56-year-old female complaining of dysphagia, odynophagia, sore throat, right otalgia and swelling in right tonsillar fossa. Routine panoramic radiography revealed a radio-opaque area in right tonsil region. Computed tomography of oropharynx was performed and axial slices revealed a calcified cylindrical lesion in posterior pharyngeal region, between palatoglossus and palatopharyngeus muscles. The tonsillolith was easily excised under local anaesthesia. The post-operative course was good with no recurrence. Microscopic examination of the specimen revealed necrotic debris, "ghost" cells, calcifications and inflammatory cells, confirming the diagnosis of tonsillolith. Authors stress that large tonsillar concretions are uncommon, and may be difficult to diagnose since the tonsillolith can also be mistaken for other anatomic and pathologic structures in the oropharyngeal area.

Use of Remifentanil for sedo-analgesia in stapedotomy: personal experience.

Stapedotomy for otosclerosis presents particular anaesthesiology demands as the surgeon has to assess functional results during the operation, work with some bleeding, be ensured the collaboration of the patient, and limit the occurrence of intra- and post-operative symptoms (dizziness, nausea, vomiting and pain). Remifentanyl, a micro-opioid selective agonist characterised by short latency and duration, has been used for about 2 years at the Otolaryngological Unit of the "Federico II" University of Naples for patients with otosclerosis undergoing stapedotomy. Aim of the study was, therefore, to assess: efficacy and tolerability of Remifentanyl in combination with a local anaesthetic in surgical procedures for otosclerosis; intra- and post-operative reduction in patient symptoms of dizziness, nausea, vomiting and pain; reduction of intra-operative bleeding; degree of patient collaboration and optimisation of anaesthesiological and vital parameters monitored during surgery. The study was carried out on 92 patients with otosclerosis, (17 M, 75 F), median age 41 years (range 25-56), undergoing stapedotomy. Patients were randomly assigned to one of two groups, which were homogeneous as far as concerns age, sex and pre-operative hearing: i. Group A (50 patients), received Remifentanyl infusion in combination with canal injection for local anaesthesia with Mepivacaine 2% and Adrenalin 1/100,000; ii. Group B (42 patients), received only local anaesthetic by infiltration of the external canal ear. Remifentanyl led to an improvement over the local anaesthetic technique previously used, with a clear decrease in intra- and post-operative neurovegetative symptoms such as dizziness, nausea, vomiting and pain, as well as reduced bleeding.