ABSTRACT
(1) Background: Endoscopy and morphological imaging are the mainstay of the diagnostic work up of laryngeal squamous cell carcinomas (LSCCs), which can be integrated in a multidisciplinary discussion to obtain a shared pretreatment staging. (2) Methods: A retrospective evaluation of patients, managed at a tertiary university hospital in Italy and submitted to major laryngeal surgery, has been performed. Four different stagings have been defined and compared: epTN (based on endoscopy and physical ENT examination); radTN (based on CT scan); cTN (based on multidisciplinary integration of the two above); pTN based on pathology on surgical samples. Oncological outcomes have been assessed. (3) Results: Three-year relapse free and disease specific survival were 88% and 92.5%, respectively, without significant differences between partial surgeries (n = 13) and total laryngectomies (n = 32). As for the pretreatment staging, and in particular the T classification, the cTN has been revealed as more reliable than epTN and radTN alone in predicting the final pT (Cohen kappa coefficient: 0.7 for cT, 0.44 for radT, 0.32 for epT). In the partial surgery group, we did not record any positive margin nor local recurrence, with a 100% overall and disease-specific survival. (4) Conclusions: The multidisciplinary approach is fundamental in the definition of the primary lesion in LSCC, in particular in order to safely perform surgical preservation of laryngeal function, which is associated with a higher laryngectomy-free survival than irradiation but to a lower salvageability in case of recurrence.
ABSTRACT
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) has a reported recurrence ranging from 26.8 to 50%. Osteoporosis and Vitamin D deficiency seems to have an impact on recurrence of BPPV. OBJECTIVE: to evaluate the impact of osteoporosis and Vitamin D deficiency on recurrence of BPPV. METHODS: 73 consecutive patients were divided in two groups according to the presence (group 1) or absence (group 0) of a recurrent episode. BMD, femoral and lumbar T-scores and Vitamin D levels were recorded. Statistical analysis was performed to investigate correlations. RESULTS: patients in group 1 had statistically significant lower values of both femoral (-1,62±1,06 vs. -0,53±1,51; pâ=â0,001), lumbar T-score (-2,10±1,19 vs -0, 53±1.51, pâ=â0.001) and Vitamin D (19.53±15.33). The values of femoral T-score and Vitamin D could be combined in a model able to properly classify 65.8% of the cases (pâ=â0.002) as isolated or recurrent BPPV, with high accuracy (AUC 0.710 [0.590 -0.830]). CONCLUSION: present data show a probable correlation between osteoporosis and Vitamin D with recurrent BPPV.
Subject(s)
Benign Paroxysmal Positional Vertigo/blood , Benign Paroxysmal Positional Vertigo/epidemiology , Bone Density/physiology , Calcium/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/epidemiology , Adult , Aged , Benign Paroxysmal Positional Vertigo/diagnosis , Calcium/metabolism , Cohort Studies , Female , Humans , Italy/epidemiology , Male , Middle Aged , Osteoporosis/blood , Osteoporosis/diagnosis , Osteoporosis/epidemiology , Prospective Studies , Vitamin D Deficiency/diagnosisABSTRACT
RT-PCR detection of SARS-CoV-2 mRNA on nasopharyngeal swab is the standard for diagnosing active Covid-19 disease in asymptomatic subjects and in symptomatic patients without the typical radiological findings. Nasopharyngeal swabbing appears a trivial procedure, still an inappropriate nasopharyngeal sampling, performed by untrained operators, can be a relevant cause of false negative findings with a clear negative impact on the effort to control the epidemic and, when PPE is not properly used, this can expose healthcare workers and patients to risks of contagion.
Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Nasopharynx/virology , Pneumonia, Viral/diagnosis , Specimen Handling/methods , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/instrumentation , Humans , Pandemics , SARS-CoV-2 , Specimen Handling/instrumentationABSTRACT
BACKGROUND: Objective data on chemosensitive disorders during COVID-19 are lacking in the Literature. METHODS: Multicenter cohort study that involved four Italian hospitals. Three hundred and forty-five COVID-19 patients underwent objective chemosensitive evaluation. RESULTS: Chemosensitive disorders self-reported by 256 patients (74.2%) but the 30.1% of the 89 patients who did not report dysfunctions proved objectively hyposmic. Twenty-five percentage of patients were seen serious long-lasting complaints. All asymptomatic patients had a slight lowering of the olfactory threshold. No significant correlations were found between the presence and severity of chemosensitive disorders and the severity of the clinical course. On the contrary, there is a significant correlation between the duration of the olfactory and gustatory symptoms and the development of severe COVID-19. CONCLUSIONS: Patients under-report the frequency of chemosensitive disorders. Contrary to recent reports, such objective testing refutes the proposal that the presence of olfactory and gustatory dysfunction may predict a milder course, but instead suggests that those with more severe disease neglect such symptoms in the setting of severe respiratory disease.
