Nasal Vestibulitis and Vestibular Furunculosis: a systematic review about two common nasal infections and considerations about correct diagnosis and management.

Background: Nasal vestibulitis (NV) and nasal vestibular furunculosis (NVF) are two infectious processes of the nasal vestibule, sharing common etiology, the same risk of complications, and similar treatment while remaining two different pathological entities. Methods: We performed a comprehensive literature research on NV and NVF in PubMed, Cochrane, and Google Scholar databases, with the aim to review the evidence on these two conditions and discuss the therapeutic approaches. Results: We identified a total of 248 records; according to our inclusion/exclusion criteria, 27 of them, published over a period of 59 years (1962-2021), were included in this review. Conclusion: NV and NVF are reported to be common conditions, with well-known etiological agents and risk factors. The diagnosis is clinical and topical antibiotics are the mainstay of treatment. Complications appear to be infrequent. Further studies are necessary to clarify the pathogenetic mechanisms and the exact prevalence of both conditions.

Intraparotid facial nerve schwannoma: two case reports and a review of the literature.

SUMMARY: Schwannomas are rare benign tumours that arise from Schwann cells. The most known and studied is the intracranial vestibular schwannoma, even if it is not the most frequent. More often schwannomas arise from peripheral sensitive nerves, and the vagous is most involved among the cranial nerves. Intraparotid schwannomas account for just 10% of all facial involvement, so they are an extremely rare localisation. At present, there are less than 100 cases described in the literature. We performed a retrospective analysis of parotidectomy in two Italian hospitals and present two cases of intraparotid schwannoma and a review of the literature. In the first case, we performed a parotidectomy with a stripping of tumour from the nerve. In the other case, a hypoglossal-facial neurorrhaphy was performed. Follow-up was 24 months in the first (House-Brackmann II degree in temporal-ocular and III in facial-cervical branches) and 30 months in the second case (House-Brackmann III degree in both temporal-ocular and facial-cervical branches). Preoperative diagnosis of facial nerve schwannoma is a challenge; however, it is extremely important since post-operative palsy is common and often higher grade. Unfortunately, schwannoma has similar radiologic finding as more common pleomorphic adenoma and often FNAC is not helpful. Due to its rarity and benign nature, there is debate in the literature on the need for surgical removal. Wait-and-see is a valid option, but may could give problems in secondary surgery. Stripping or near-total removal can be useful in cases of limited involvement of the nerve. Neurorrhaphy can provide good functional results when facial sacrifice is needed.

A single-centre, before-after study of the short- and long-term efficacy of Narivent(®) in the treatment of nasal congestion.

OBJECTIVE: Nasal congestion is a common symptom in allergic and nonallergic rhinitis, rhinosinusitis and nasal polyposis. The present study evaluated the clinical effectiveness of Narivent(®), an osmotically-acting medical device with anti oedematous and anti-inflammatory effects, in nasal congestion. METHODS: A single-centre, prospective study with a pre- post design and consecutive patient enrolment was conducted in an Italian otolaryngology department. Patients with persistent nasal congestion were allocated to treatment groups as follows: group 1 (n = 36) treated for 7 days; group 2 (n = 56) treated for 30 days. In each group, patients received two puffs of Narivent(®) into each nostril twice daily. Symptom severity was assessed subjectively on a 0-10 visual analogue scale, and objectively by the presence/absence of signs and symptoms. Differences in subjective and objective severity measures before and after treatment were compared using Wilcoxon's signed rank test. RESULTS: All symptoms and objective scores improved after treatment with Narivent(®) for 7 or 30 days and no adverse effects were reported by the patients in either group. CONCLUSION: Narivent(®) appears to be efficacious in treating nasal congestion over a 7- or a 30-day period.

Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps.

Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm fasciocutaneous flap group, with permanent forearm movement impairment in 35.3% of cases; in the anterolateral thigh cutaneous flap group, only transitory gait impairment occurred in 12.9% of patients. In conclusion, in our experience, the thinned anterolateral thigh cutaneous flap is comparable to radial forearm fasciocutaneous flap in terms of functional results at receiving site, but, having no limitation in availability of donor tissue, it allows a more extended resection of the tumour. Moreover, the donor site can be closed primarily with only an inconspicuous curvilinear scar left over the thigh and with significantly reduced functional impairment.

[Glucan solution nasal spray vs saline in the treatment of chronic rhinosinusitis: a multi-centric double blind randomised clinical trial]. / Soluzione spray nasale di glucano vs soluzione fisiologica nel trattamento della rinosinusite cronica: studio multicentrico in doppio cieco randomizzato.

OBJECTIVES: The aim of our study was to evaluate the efficacy of 30 days treatment with glucan solution nasal spray vs. saline in the treatment of signs and symptoms of chronic rhinosinusitis. MATERIALS AND METHODS: 100 patients affected by chronic rhinosinusitis were enrolled. At the beginning and at the end of the study were evaluated: nasal congestion, headache, rhinorrea, facial pain, rhinopharyngeal exudate, inferior turbinate hypertrophy; a complete instrumental analysis of nasal functions by Active Anterior Rhinomanometry, nasal Muco-Ciliary Transport time and scraping of nasal mucosa was also performed. The patients were randomized 1:1 for receiving intranasal saline or intranasal glucan solution spray. Treatment was administered as follows: 2 puffs/nostril 3 times a day for 30 days. RESULTS: The patients in therapy with the glucan solution showed a significant improvement concerning rhinorrea facial pain, intensity of headache, inferior turbinate hypertrophy, rhinopharyngeal exudates, inspiratory/expiratory nasal resistences, Muco-ciliary transport time, normalization of nasal mucosas and rhinocytogram; saline lavage didn't show this effects. Both treatment improved rhinorrea, instead both treatment didn't affect nasal congestion. CONCLUSIONS: According to the results of our multicentric double blind randomized study, we suggest the use of glucan solution nasal spray as an efficacious therapeutic tool in the management of nasal symptoms in patients affected by chronic rhinosinusitis.

Control of mouse cumulus cell-oocyte complex integrity before and after ovulation: plasminogen activator synthesis and matrix degradation.

During the preovulatory period, cumulus cells (CCs) form a hyaluronan-protein extracellular matrix (cumulus expansion) that positively influences oocyte fertilization. Degradation of this matrix and CC-oocyte complex (COC) dissociation occurs within a few hours of ovulation and parallels the aging of oocytes. Modulation of CC proteolytic activity by gonadotropins and oocyte soluble factors has been hypothesized to determine such cumulus matrix changes. In the present study, we investigated plasminogen activator (PA) synthesis by COCs during the expansion and disassembly processes. Our results show that the secretion of tissue type PA and urokinase type PA (uPA) by oocytes and CCs, respectively, does not change significantly during expansion but dramatically increases thereafter. Compact COCs were isolated from immature mice, primed 48 h earlier with 5 IU PMSGs, and were induced to expand in vitro with 100 ng/ml FSH in the presence of 1% FCS. Full expansion was achieved at 16 h, when hyaluronan synthesis ceased. Release of hyaluronan and CCs from the COC matrix began between 18 and 20 h of culture, which indicates that matrix degradation started at this time. PA activities in culture media were determined by SDS-PAGE, followed by a zymography at various time intervals between 4 and 32 h of culture. Secreted tissue type PA and uPA activity abruptly increased between 16 and 20 h after FSH stimulation. Slot blot hybridization of CC messenger RNA showed that uPA messenger RNA levels correlated with the increase in uPA activity. Similar temporal patterns of PA synthesis and matrix degradation were found in COCs induced to expand in vivo by injection of 5 IU human CG into PMSG-primed mice. Cultures of CCs, both in the presence and absence of oocytes, revealed that uPA synthesis is repressed in FSH-stimulated CCs by an oocyte-soluble factor for the first 16 h of culture, whereas CC responsiveness to this factor is lost thereafter. In conclusion, the data show that a sophisticated interplay between oocyte and CCs causes the two cell types to simultaneously secrete PA activity after ovulation. The fact that matrix degradation parallels PA production strongly supports the hypothesis that these enzymes may destabilize the expanded COC matrix.

Hyaluronan and proteoglycans in ovarian follicles.

Proteoglycans are macromolecules formed by a protein backbone to which one or more glycosaminoglycan side chains are co-valently attached. They can be secreted by the cells, retained at the cell surface, or stored in intracellular vacuoles. Hyaluronan is an extremely long glycosaminoglycan which, at variance with other glycosaminoglycans, is released into the extracellular matrix as a free polysaccharide not co-valently linked to a core protein. Both proteoglycans and hyaluronan influence many aspects of cell behaviour by multiple interactions with other molecules. They are involved in matrix formation, cell-cell and cell-matrix adhesion, cell proliferation and migration, and show co-receptor activity for growth factors. Both proteoglycan and hyaluranon synthesis change significantly during ovarian follicle development and atresia. This review describes the structure of these molecules and their possible function in ovarian physiology.

[Inverted papilloma. Modality of treatment]. / Il papilloma invertito. Modalità di trattamento.

According to World Health Organization (WHO, 1991) papillomas of nasal cavity is subdivided in three main histopathological types: 1) Inverted papilloma; 2) exophytic papilloma; 3) vestibular papilloma. In particular, inverted papilloma represents 0.5%-4% of all nasal tumors and is characterized by local aggressivity and malignant evolution. During the years controversies arose about therapeutical treatment of inverted papilloma, with different results concerning conservative treatment (endoscopic resection; Caldwell-Luc operation) and an external approach resection (Weber-Fergusson approach). Our clinical experience is related to 33 patients submitted to surgery for inverted papilloma of nasal and paranasal cavity in the period 1982-1993. Diagnostic method was based on endoscopy and CT/RM integration in order to demonstrate local extension of tumor and to plan surgical approach. In particular 8 patients were submitted to endoscopic surgical approach (small and anterior papillomas). In 10 cases we performed a combined approach (endoscopic microsurgery plus Caldwell-Luc approach) and in 15 patients an external approach was carried out. Long-term results of the therapy are presented and discussed and a review of Literature is carried out.

Proteoglycans and proteins in the extracellular matrix of mouse cumulus cell-oocyte complexes.

In the preovulatory follicle, the oocyte is surrounded by approximately 1000 closely associated cumulus cells forming the compact form of the cumulus cell-oocyte complex (COC). In response to the gonadotropin surge, the COC in a follicle destined for ovulation undergoes expansion when the cumulus cells synthesize and organize an extensive extracellular matrix enriched in hyaluronan. Successful expansion of the COC appears to be essential for ovulation and ultimately for fertilization. We studied this process in vitro by isolating compact COCs from preovulatory mouse follicles and incubating them under conditions which promote COC expansion by retention of newly synthesized hyaluronan (HA in the extracellular matrix around the cells. [3H]-Leucine and [35S]sulfate were used as precursors to label macromolecules synthesized by the cells that may be necessary for organizing the HA in this matrix. After labeling, expanded COCs were washed to remove medium and any labeled molecules that were not associated with the matrix. Macromolecules selectively associated with the matrix were then solubilized by digesting the expanded COCs briefly with Streptomyces hyaluronidase, an enzyme that specifically cleaves HA. Cells were removed by centrifugation, and the digest supernate was analyzed by molecular sieve chromatography and SDS-PAGE. A dermatan sulfate proteoglycan of large hydrodynamic size ( > 1 million Da) and a approximately 46-kDa protein were the predominant labeled species identified. The proteoglycan has properties similar to proteoglycans such as aggrecan and versican which interact specifically with HA. The approximately 46-kDa protein has the same molecular size as the link protein which interacts with HA and HA-binding proteoglycans to form stable ternary complexes in a variety of extracellular matrices. We propose that the dermatan sulfate proteoglycan and the approximately 46-kDa protein synthesized by the cumulus cells form similar ternary complexes that are necessary for retaining HA in the COC matrix and hence are required for successful COC expansion.

Hyaluronic acid and proteoglycan accumulation in the cumulus oophorus matrix.

A factor produced by the oocytes induces in vitro FSH-treated cumulus and mural granulosa cells to synthesize hyaluronic acid. In the present study we examined hyaluronic acid synthesis by the two cell populations in vivo. After injection of hCG into PMSG-primed immature mice, cumulus and mural granulosa cells adjacent to the antrum synthesized a large amount of such glycosaminoglycan, while the outermost layers layers of mural granulosa cells did not. The results suggest that in vivo differences in hyaluronic acid synthesis between follicle cell subpopulations depend on a diffusion gradient of the oocyte factor. We also identified a proteoglycan species synthesized by cumulus cells which may contribute to hyaluronic acid organization in the intercellular spaces.

Clinical experiences with surgical techniques and treatment results in patients undergoing subtotal laryngectomies.

After a period of critical evaluation, subtotal laryngectomies are now considered to be valuable additions to the surgical management of laryngeal neoplasms. It is now possible to obtain good functional and oncological results in treating clinical situations that until a few years ago appeared curable only by radical surgery. We now report our clinical experiences with Labayle and Majer-Piquet types of subtotal laryngectomies and discuss indications and contra-indications to such surgery. Our current preference is to use Labayle technique, since it permits better functional recovery and a shorter clinical course.

Clinical experiences with surgical therapy of cervical metastases from head and neck cancer.

Indications for the various techniques of neck dissection can undergo substantial variations according to the metastatic picture found, biological aggressiveness of tumor, nodal volume and personal philosophies of the attending clinician. In the present paper we report our clinical experience with radical neck dissections, "functional" neck dissections and selective neck dissections-in total, 1658 neck dissections carried out between 1976 and 1991. We discuss the indications and contra-indications of the various surgical techniques of neck dissection and evaluate the long-term results. Our current preference is to use the Suarez-Bocca "functional" technique of neck dissection for prophylactic treatment of the neck and for therapeutic treatment of the neck when intracapsular metastases already exist.

Efficacy and tolerability of brodimoprim in otitis.

Eighty adult patients affected by acute bacterial otitis media were selected and randomized into two balanced groups of treatment: 1) brodimoprim 200 mg tablets at the dosage of 2 tablets in single dose on the first day and one tablet on the following days; 2) josamycin 500 mg tablets at the dosage of 3 tablets/day. The average duration of treatment was 8 days: all patients completed the trial. The symptoms were evaluated by score method (on the 3rd, 7th and on the last day of therapy) and a thermometric curve was made daily. Microbiological examination of the exudate was performed in the patients with auricular discharge (28), at the beginning of the treatment and 7 days after the end of therapy. The tolerability was assessed through registration of side effects. Brodimoprim resulted more effective in the reduction of hypoacusis and tinnitus; other symptoms demonstrated higher percentage reductions in the group under brodimoprim therapy. Bacteriological exams were negative at the second checkup, except in 6 patients (3 per group). Side effects were reported in 5 patients (12.5%) treated with brodimoprim and in 9 (22.5%) treated with josamycin. Abnormal values in laboratory tests were not observed.

Effects of exogenous hyaluronic acid and serum on matrix organization and stability in the mouse cumulus cell-oocyte complex.

Compact cumulus cell-oocyte complexes (COCs) isolated from preovulatory mouse follicles undergo expansion in vitro when high levels of hyaluronic acid (HA) are synthesized and organized into an extracellular matrix. We studied the effects of fetal bovine serum (FBS) and of exogenous HA and HA-oligomers on the expansion process. Maximum retention of HA in the COC matrix, and hence complete COC expansion, occurs when 1% FBS is continuously present during the first 18 h of culture. Irrespective of the culture time, HA synthesized when serum is absent is primarily in the medium, whereas HA synthesized when serum is present is primarily in the cell matrix. These findings support the hypothesis that the serum factor, identified as an inter-alpha-trypsin inhibitor by Chen et al. (Chen, L., Mao, S. J., and Larsen, W. J. (1992) J. Biol. Chem. 267, 12380-12386), is a structural component of the matrix. Addition of exogenous HA or of HA oligomers of decasaccharide size (GlcUA-GlcNAc)5 or larger effectively displaces endogenously synthesized HA from the matrix into the medium, thereby preventing COC expansion. Addition of exogenous chondroitin sulfate affects neither matrix organization nor COC expansion, thus indicating specificity of the binding of some structural component(s) to HA. Fully expanded COCs disassemble when cultured longer than 18 h, a process which occurs also in vivo and which correlates with loss of oocyte fertilizability both in vivo and in vitro. This process involves release of macromolecular HA from the matrix into the medium, with loss of 50% of the HA in the first 8 h of incubation after full expansion. The release is not facilitated when HA oligomers, long enough to prevent matrix formation, are added to the culture medium after the COCs are fully expanded. This suggests that cooperative binding to HA of either the serum factor, an endogenously synthesized factor(s), or both is required to stabilize the fully expanded COC matrix.

Uptake of exogenous DNA by mammalian spermatozoa: specific localization of DNA on sperm heads.

When mouse spermatozoa were briefly exposed in culture to radioactively labelled DNA (pSV2CAT plasmid), radioactivity could be detected by high-resolution autoradiography on the surface and within the nucleus of the spermatozoa. Spermatozoa from other mammalian species (boar, bull, man) could also bind foreign DNA. With the exclusion of human spermatozoa, which in most experiments showed very low labelling values, labelling percentages (evaluated by light microscope autoradiography) ranged between 39 and 78%. In all four species the DNA-binding ability was mainly confined to a specific region of the sperm head (equatorial segment and postacrosomal region), and the sperm-DNA association kinetics were rapid (maximum values were reached within 20-40 min). The data also indicate that factor(s) in seminal plasma might protect spermatozoa from accidental transfection by foreign DNA that may be present in the genital tracts from bacterial or viral sources.

Comparative efficacy and safety of roxithromycin and clarithromycin in upper respiratory tract infections.

Roxithromycin 300 mg once daily was compared with clarithromycin 250 mg b.i.d. in an open randomized trial in 200 patients with upper respiratory tract infection: sinusitis, pharyngotonsillitis, and otitis media. Average treatment duration was 9 days. Roxithromycin was more effective (p less than 0.01) particularly in otitis media and pharyngotonsillitis, and better tolerated (only 4% side effects, p less than 0.05).

Selective binding of mouse and human spermatozoa to beads coated with extracellular matrix components.

The ability of mouse epididymal and human ejaculated spermatozoa to bind to beads coated with various extracellular matrix components was examined. Mouse spermatozoa preferentially bound to beads coated with heparin (average values ranging between 6.2 and 8.8 sperm per bead were obtained in different experiments) and with chondroitinsulfate (6.2-7.0), and also, although with significant differences across replicate experiments, to beads coated with laminin (7.9-15.6 sperm per bead) and with collagen type I (6.1-18.5). Human spermatozoa bound to collagen-coated beads (15.4-22.6 sperm per bead) and, to a much lower extent, to chondroitin-sulfate-coated beads (3.2-4.7); they were also able to bind heparin-coated beads, although with ample differences between individual sperm donors (ranging between 0.8 and 18.7 sperm per bead). Very few human and mouse sperm bound fibronectin-coated beads; beads coated with albumin, hyaluronic acid, and chondronectin were always totally free of adhering sperm. The possible physiological role of the interactions between spermatozoa and extracellular matrix components are discussed.