Microplastics in water surface and in the gastrointestinal tract of target marine organisms in Salento coastal seas (Italy, Southern Puglia).

Microplastic pollution is a major global environmental threat that has attracted increasing interest from the scientific community over the past decade. The semi-closed and highly urbanized Mediterranean Sea has been investigated since 2012, in several specific studies that have identified it as a target hotspot for microplastic contamination. The marine coastal zone of the Salento peninsula (Apulia, Italy) has peculiar geographical and hydrodynamic features, although there are few published data detailing the level of microplastics present in this area. The present manuscript contains both data on the concentration of microplastics in surface waters and the level of microplastics ingested by selected marine organisms in the Salento coastal zone. Microplastics floating on the water surface were monitored during Autumn 2020 and Spring 2021 using neuston Manta net at three different distances from the coasts (Lizzano, Gallipoli and Otranto). The level of microplastic ingestion was monitored in fish species (Sardina pilchardus, Boops boops, Mullus barbatus) and in mussels (Mytilus galloprovincialis). Episodic peaks of microplastic concentrations were found on the sea surface during transects performed in the 3 nautic miles from the seashore. High values of ingested microplastics were found in S. pilchardus. and B. boops (5.4 and 4.6 items/individual respectively). A higher concentration of microplastics was detected in the Adriatic Sea than in the Ionian Sea by comparing the gastrointestinal tract of S. pilchardus and B. boops, in the monitored areas. These results are correlated with the concentration of floating microplastics, although this last result is not validated by statistical analysis. These results support the effectiveness of S. pilchardus and B. boops used as targets in monitoring activity for these pollutants. Results show a worrying increase in the concentration of microplastics on the sea surface and in the gastrointestinal tract of the target species compared to data reported in the literature.

Respiratory presentation of diffuse idiopathic skeletal hyperostosis (DISH): Management and review of the literature.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs and symptoms include stiffness, pain, loss of range of motion, and difficulty swallowing.Clinical Presentation: The authors present two less typical respiratory manifestations of DISH due to cervical osteophytes protrusion and obstruction of the upper airway. The first patient was treated conservatively (application of CPAP during nighttime), while the second required emergency intubation and a combined ENT-neurosurgical operation for the removal of osteophytes.Clinical Relevance: Even though dysphagic symptoms are more frequent, DISH may be a cause of airway obstruction and should be included in the differential diagnosis of respiratory distress and OSA.

The various meanings and imperfections of words.

In this reply to a letter, the Authors discuss the raised points regarding the nomenclature and management of Lymphatic Malformations / Lymphangiomas.

A single-center experience in the management of head and neck lymphangiomas.

INTRODUCTION: Lymphangiomas are relatively uncommon head and neck region lymphatic malformations. Although surgery can be still considered the mainstay of treatment, sclerotherapy by OK-432 is becoming a widespread treatment option. The aim of this article is to present and discuss the management and outcomes of a series of cases of lymphangiomas. METHODS: All patients with lymphangiomas who were treated from 2010 to 2018 were reviewed. The following data were recorded: age, gender, subtype, staging, type of treatment, outcome, and recurrence. RESULTS: Fifteen patients (9 females, 6 males) were included with 2 microcystic and 13 macrocystic lymphangiomas. Six patients underwent surgery with excision (5 with a complete success, one with a fair success), whereas the remaining 9 subjects underwent sclerotherapy by OK-432 (6 with a complete success, 3 with a fair success). No postoperative complications were observed. CONCLUSIONS: All modes of treatment are important in properly selected patients affected by lymphangiomas. OK-432 therapy is a safe and effective option in the treatment of head and neck lymphangiomas.

Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis.

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.

Skull Base Metastasis From Occult Renal Cell Carcinoma.

Skull base metastases are extremely rare. The authors report a case of a 65-year-old man who presented with a headache and diplopia secondary to a skull base metastasis from occult renal cell carcinoma. Since there were no other systemic metastases, radical nephrectomy and radiotherapy of the unresectable skull base location were performed. He subsequently received immunotherapy with sunitinib, everolimus, and sorafenib with local and systemic control of the disease after 53 months from surgery. When metastasis is unresectable radical nephrectomy and radiotherapy aimed at the metastasis may be of benefit improving quality of life. Immunotherapy may provide alternative treatment strategies improving the outcomes of patients affected by this rare pathology with historically poor prognosis.

Percutaneous Sclerotherapy With OK-432 of a Cervicomediastinal Lymphangioma.

The present study reports a case of percutaneous sclerotherapy of a giant cystic cervicomediastinal lymphangioma using OK-432. To the best of our knowledge, percutaneous sclerotherapy of a mediastinal lymphangioma using OK 432 has not previously been reported in the English literature.

Extramedullary Plasmacytoma of the Larynx Treated by a Surgical Endoscopic Approach and Radiotherapy.

Extramedullary plasmacytoma (EMP) is a rare variant of plasma cell myeloma that affects soft tissues. The head and neck region are the most affected sites, although others have also been described. Herein we report an uncommon case of EMP of the larynx in a 65-year-old male who presented with a history of progressive dysphonia and hoarseness. Laryngeal fiberscopy evidenced a reddish pedicled voluminous mass in the left false cords and ventricle. Microscopic suspension laryngoscopy was performed under general anaesthesia and a 4 W Acublade CO2 Laser was used for transoral resection of the lesion. This was followed by adjuvant radiotherapy, with the widely recommended doses on the supraglottic region, to achieve better local control. Diagnosis of EMP is based on immunohistochemistry and the exclusion of systemic plasma cell proliferative disorders. Diagnosis of solitary EMP can be made only if studies for disseminated disease and X-ray and/or magnetic resonance imaging of the spine, pelvis, femurs, and humerus and bone marrow biopsy are negative. As there are no internationally established guidelines, treatment of EMP is mainly based on consensus of expert opinion.

Persisting subcutaneous emphysema of eyelids mimicking orbital tumor.

Eyelids emphysema is a rare condition due to air trapping in subcutaneous tissue of the orbit. It has been clinically and radiologically documented, but histologic evaluation has not been noted. We report a case of a middle-aged woman with periorbital swelling due to self-induced Valsalva maneuver, persisting after decompressive therapy. A fine-needle biopsy was performed and showed a mixed population of osteoclastic-like giant cells and mononuclear epithelioid cells, which were suspected of pathological proliferative disease. Specimens from blepharoplasty indicated pseudocystic empty spaces surrounded by epithelioid cells and giant cell granulomas. Immunohistochemical stains favored diagnosis of benign granulomatous disease, such as subcutis cystic pneumatosis. Histologic examination represented an important tool for differential diagnosis with soft tissue neoplasms of the orbit in subcutis emphysema with unusual clinical presentation and abnormal course.

Delayed carotid pseudoaneurysm: a life-threatening complication after endoscopic sinus surgery.

Internal carotid artery pseudoaneurysm is a rare but potentially lethal complication of sinus surgery. We present 2 cases of delayed carotid pseudoaneurysm development after internal carotid laceration during functional sinus surgery for chronic sinusitis to emphasize the need to follow up the patients with profuse bleeding perioperatively and to identify when to suspect iatrogenic vascular malformations.

Clinical and molecular features of mucosa-associated lymphoid tissue (MALT) lymphomas of salivary glands.

BACKGROUND: To analyze clinical features and to discuss the modality of investigation and treatment of a series of mucosa-associated lymphoid tissue (MALT) lymphomas. To investigate the prevalence of aberrant promoter methylation, responsible for gene inactivation, in a selected panel of genes potentially involved in the pathogenesis of B-cell malignancies as O6-methylguanine-DNA methyltransferase (MGMT), p73, death-associated protein kinase (DAP-k). METHODS: Nine patients with primary MALT lymphoma of the salivary glands were retrospectively reviewed. MGMT, p73, DAP-k apoptotic pathways were tested. RESULTS: Methylation of DAP-k was common (5/8; 63%). Histological examination ensured diagnostic confirmation, whereas fine-needle aspiration cytology was not definitively diagnostic. CONCLUSION: Histological assessment is the gold standard in the diagnosis of salivary gland lesions. Parotidectomy represents a safe and reliable diagnostic tool leading to a definite diagnosis of MALT lymphomas in all cases and curative without other treatment in early-stage MALT lymphoma.

[Prognostic factors for definitive hypoparathyroidism following total thyroidectomy]. / Factores pronósticos de hipoparatiroidismo definitivo tras tiroidectomía total.

INTRODUCTION AND OBJECTIVE: Hypocalcaemia, transient in most cases, is the main complication after thyroid gland surgery with regard to functional impairment of the parathyroid glands or other reversible factors. Sixty-seven patients who underwent thyroidectomy were evaluated to identify potential clinical, pathological and surgical factors that might be predictive for frank hypocalcaemia following total thyroidectomy. METHODS: Serum samples were taken preoperatively and postoperatively to measure total calcium levels. Patients' plasma calcium levels were recorded post-operatively along with such factors as age, gender, thyroid function, definitive pathology-based diagnosis, accidental removal and auto-transplantation of parathyroid glands, re-intervention to identify risk factors for the development of definitive hypoparathyroidism (DH). All comparisons were made between patients with hypocalcaemia and normal levels of post-operative calcaemia. RESULTS: Transient acute hypocalcaemia was identified in 25 of 67 patients (43.3 %). DH was identified in 8 (11 %) patients. CONCLUSIONS: Our study revealed that the only risk factor for DH was a calcium level of less than 7.5 mg/dL within the first 24 hours following surgery; this is a reliable, inexpensive and rapid parameter that is highly predictive of the onset of HD. No statistical significant associations were detected with other factors such as thyroid function, histology, accidental removal or autotransplantation of parathyroid glands, thus it is possible to state that careful manipulation of the parathyroid to preserve the periglandular vascularization is of vital importance to ensure correct post-operative functionality.

Factores pronósticos de hipoparatiroidismo definitivo tras tiroidectomía total / Prognostic factors for definitive hypoparathyroidism following total thyroidectomy

Introducción y objetivo: La hipocalcemia tras tiroidectomía total constituye la mayor complicación, en la mayoría de los casos, transitoria, en relación con un daño funcional de las paratiroides u otros factores reversibles. Se trata de un estudio sobre 67 pacientes sometidos a tiroidectomía total para identificar posibles factores clínicos, anatomopatológicos y quirúrgicos predictivos de hipocalcemia definitiva tras tiroidectomía total. Métodos: Recogida de valores plasmáticos de calcio en el período postoperatorio y factores como edad, sexo, funcionalidad tiroidea, diagnóstico anatomopatológico definitivo, extirpación accidental de las paratiroides y su autotrasplante, reintervención para identificar factores de riesgo para el desarrollo de hipoparatiroidismo definitivo. Las comparaciones han sido efectuadas entre los pacientes con hipocalcemia y concentraciones normales de calcemia post-operatoria. Resultados: La hipocalcemia aguda transitoria ha sido identificada en 25/67 pacientes (43,3 %). El hipoparatiroidismo definitivo ha sido identificado en 8 (11 %) pacientes. Conclusiones: En nuestro estudio ha supuesto que una calcemia después de 24 h de la intervención quirúrgica inferior a 7,5 mg/dl sea un factor altamente pronóstico de hipoparatiroidismo definitivo; esta determinación es un parámetro fiable, económico, rápido y muy predictivo del desarrollo de hipoparatiroidismo definitivo. No se han encontrado asociaciones estadísticamente significativas con otros factores, como funcionalidad tiroidea, histología, extirpación accidental o autotrasplante de las paratiroides, así que podemos afirmar que una atenta manipulación de las paratiroides conservando cuidadosamente la vascularización glandular representa un factor de fundamental importancia para garantizar una normal funcionalidad paratiroidea postoperatoria

Introduction and objective: Hypocalcaemia, transient in most cases, is the main complication after thyroid gland surgery with regard to functional impairment of the parathyroid glands or other reversible factors. Sixty-seven patients who underwent thyroidectomy were evaluated to identify potential clinical, pathological and surgical factors that might be predictive for frank hypocalcaemia following total thyroidectomy. Methods: Serum samples were taken preoperatively and postoperatively to measure total calcium levels. Patients' plasma calcium levels were recorded post-operatively along with such factors as age, gender, thyroid function, definitive pathology-based diagnosis, accidental removal and auto-transplantation of parathyroid glands, re-intervention to identify risk factors for the development of definitive hypoparathyroidism (DH). All comparisons were made between patients with hypocalcaemia and normal levels of post-operative calcaemia. Results: Transient acute hypocalcaemia was identified in 25 of 67 patients (43.3 %). DH was identified in 8 (11 %) patients. Conclusions: Our study revealed that the only risk factor for DH was a calcium level of less than 7.5 mg/dL within the first 24 hours following surgery; this is a reliable, inexpensive and rapid parameter that is highly predictive of the onset of HD. No statistical significant associations were detected with other factors such as thyroid function, histology, accidental removal or autotransplantation of parathyroid glands, thus it is possible to state that careful manipulation of the parathyroid to preserve the periglandular vascularization is of vital importance to ensure correct post-operative functionality

[Hydrological indications in the therapy of pharyngitis]. / Indicazioni idrologiche nella terapia delle faringiti.

Pharyngitis is an inflammatory disease of the mucosal and submucosal structures of the throat. Infection may or may not be a component of the disease. Pharyngitis is one of the common illness for which patients visit primary care physicians. Most of them are diagnosed by clinical evaluation and usually respond to treatment with antibiotics, but exceptions occur when pharyngitis is caused by non bacterial inflammatory processes like virus, mycoses, reflux of gastric juices, tobacco or alcohol abuse. In these cases, as alternative and preventive, could be indicated the thermal therapy. For many centuries thermal waters have been used in the treatment of chronic inflammations of the upper respiratory airway, such as pharyngitis, with good results. Different thermal waters are currently used, in particular sulfur or sulfur- salty- bromine-, iodine- or sulfur-sulfate-bicarbonate-carbonate alkaline or sulfur-arsenical-ferruginous, normally utilized by inhalation or irrigation or aerosol-therapy. The principal pharmacological activity of these waters is connected to the concentrations of H2S, halogens (Iodine e Bromine), sulfates, arsenic and the level of radioactivity, concerning their antimicrobial power and the mucolytic effect of sulphur.