Double-blind, randomised controlled trial on the efficacy of saline nasal irrigation with sodium hyaluronate after endoscopic sinus surgery.

OBJECTIVE: There is a growing interest in sodium hyaluronate for the clinical management of patients who undergo functional endoscopic sinus surgery for chronic rhinosinusitis, because of the mucosal regenerative properties of this macromolecule. However, its role in post-operative care is still debated. This study aimed to evaluate the effect of sodium hyaluronate administered via nasal irrigation with saline, in the post-operative period, after functional endoscopic sinus surgery. METHODS: A multicentric, prospective, randomised, double-blind, parallel group study was conducted on 56 consecutive patients who underwent functional endoscopic sinus surgery for chronic rhinosinusitis without polyps. Group 1 received the standard therapy of normal saline; group 2 received saline plus sodium hyaluronate. RESULTS: Both objective and subjective measurements, in terms of endoscopic appearance and patient-reported satisfaction, were significantly better in group 2 compared to group 1. CONCLUSION: Sodium hyaluronate may be a useful adjunct to nasal saline irrigation in the early post-operative period following functional endoscopic sinus surgery.

Symptomatic sensorineural hearing loss in patients with ulcerative colitis.

BACKGROUND: Sensorineural hearing loss has been reported as an extraintestinal manifestation of inflammatory bowel disease, especially in adult patients with ulcerative colitis. However, to date only a few series have been reported in the literature, and none from Italy. The aim of the present investigation was to assess the prevalence of symptomatic sensorineural hearing loss in Italian patients with ulcerative colitis. METHODS: We retrospectively assessed the charts of all patients with ulcerative colitis who underwent otolaryngologic investigation in a 10-year period. RESULTS: Complete charts of 57 patients were available for the observation period. Reasons for head and neck investigation were transient, mild hearing loss and sporadic vertigo. Clinical and instrumental head and neck examination was unremarkable in all but one woman who complained of mild hearing loss without vertigo or tinnitus, in whom sensorineural hearing loss was diagnosed. CONCLUSIONS: In our series, sensorineural hearing loss was found in less than 2 % of adult patients with ulcerative colitis evaluated in a department of otolaryngology. Systematic evaluation for this extraintestinal manifestation should not be carried out unless hearing loss is present.

Salivary duct carcinoma of the parotid gland: a case report.

The authors report a case of a salivary duct carcinoma (SDC) of the parotid gland revealed by a facial palsy. The clinical and pathological features of this highly malignant neoplasm are described. The aggressive nature of this form demands a combined chemo-radio-surgical treatment; only early recognition and treatment are likely to result in a favourable outcome.

[Flow-cytometric study of familial paragangliomas of the carotid body]. / Studio citofluorimetrico di paragangliomi familiari del corpo carotideo.

Paragangliomas of the carotid body with an autosomal dominant genetic transmission have been described in a familial presentation in 7-10% of all the cases observed. In less than 10% malignancy is confirmed by secondary metastatic localization rather than by typical histological features of malignant diseases, such as vascular or perineural invasion, nuclear pleomorphism, mitotic activity. The purpose of the study is to present a familial group of paragangliomas of the carotid boy and a flow cytometric analysis of tumor content DNA and to discuss the prognostic value of the results. The paragangliomas of these related patients (father and daughter) are diploid, without regional lymph node or distant metastases; clinical and cytometric findings support a good prognosis even if an accurate follow up of such neuroendocrine tumors is nonetheless mandatory. Considering data in Literature, the Authors also propose a prognostic classification of paragangliomas as follows: noninvasive (capsulated, without vascular or perineural infiltration, diploid); locally invasive (histological signs such as vascular or perineural infiltration, nuclear pleomorphism, abnormal mitoses etc, diploid); potentially malignant (histological signs, non-diploid, expression of few antigens) and malignant (regional or distant metastases).

[Direct video-laryngoscopy]. / La videolaringoscopia diretta.

The combination of modern bivalved operative laryngoscopes, laryngeal telescopes and videotaping techniques has given us a new tool in the objective evaluation of organic laryngeal lesions. The purpose of the present study has been to describe a new method for direct video-laryngoscopy, an alternative to the classical Kleinsasser microlaryngoscopy technique, in diagnosis, clinical documentation and endolaryngeal microsurgery under video control without using an operating microscope. The direct video-laryngoscopy system consists of: a Weerda distending operating laryngoscope, Hopkins rod lens and Lumina telescopes (0 degrees, 25 degrees, 70 degrees or Mueller subglottoscope), an original telescope holder for a distending laryngoscope, a lightweight medical videocamera, a VHS videorecorder, laryngoscope holder and chest support. From November 1987 to May 1989, 370 patients with laryngeal lesions were examined and recorded. Only in 3 cases was the microlaryngoscopy technique used as it proved difficult to introduce the telescope into its holder because of patient anatomy: one short-necked, obese patient, and two with a prominent tongue base and limited ability to open the mouth. In 367 cases direct video-laryngoscopy made careful diagnosis possible leaving a permanent record of the size and extent of the lesion. Such information could be used in accurate staging and follow-up. 320 patients were also treated by endolaryngeal microsurgery under video control without an operating microscope. Thanks to the width of the bivalved scope, the space for microsurgical instruments would be appreciably extended laterally, making it possible to better control the instruments on the monitor. The telescope lies on the superior spatula of the laryngoscope without interfering with the surgical procedures. The video material obtained was of high quality and of great value for diagnosis, pre- and post-operative evaluation, follow-up and documentation of various laryngeal disorders.