Unilateral vocal fold paralysis post-thyroidectomy: does early intervention allow for better voice recovery?

OBJECTIVE: Thyroidectomy is the primary cause of unilateral vocal fold paralysis (UVFP). A delay in rehabilitation may cause dysfunctional phenomena and worsen dysphonia. The main aim is to investigate the impact of early Speech Therapy (ST) on voice recovery in UVFP post-thyroidectomy and propose an appropriate treatment schedule. PATIENTS AND METHODS: 93 patients with UVFP were analysed. 72 presented transient paralysis and 21 permanent ones. Individuals with permanent paralysis were retrospectively divided in two groups. Group A was composed of 11 patients (8 F, 3 M; mean age: 50.5 ± 8.6) who received ST within 8 weeks; Group B comprised 10 patients (7 F, 3 M; mean age: 57 ± 11.5) treated after more than 8 weeks. Videolaryngostroboscopy (VLS) was assessed and both objective and subjective voice parameters were collected. The non-parametric Wilcoxon test was applied to the sample. RESULTS: The resolution of supraglottic compensations was observed in 91% of cases in Group A, whereas in only 40% of cases in Group B. A functional glottal closure occurred in 73% of patients in group A, while it was completely absent in group B. Group A showed a statistically significant difference between the values of Jitter, NHR, TMF and VHI collected pre-ST compared to that collected after 1 year. Conversely, a statistically significant difference was found only for VHI values in group B. CONCLUSIONS: Early ST brings benefits to patients with permanent UVFP, both on voice recovery and on quality of life. A ST protocol should be applied both before and after thyroidectomy. The ST treatment should start early after surgery.

Acute liver and renal failure during treatment with buprenorphine at therapeutic dose.

Buprenorphine is a semi-synthetic opioid derivative commonly used in the treatment of heroin addiction. Life-threatening complications have been described following overdoses while few cases of hepatotoxicity due to drug use at therapeutic doses have been recently described in hepatitis C virus carriers. In these cases, however, histological assessment was not exhaustive and no extra-hepatic organ failure was observed. We describe herein a case of acute liver and kidney failure in a patient with previously latent hepatitis C virus chronic infection following recommended doses of buprenorphine. Histology did not demonstrate any feature compatible with hepatitis C virus reactivation or liver cirrhosis and suspension of the treatment led to the resolution of both liver and kidney failure. Causality criteria fulfillment indicates a high probability of buprenorphine-induced liver toxicity. No signs of pre-existant kidney impairment or of pre- or post-renal causes were observed. Since buprenorphine is metabolized through cytochrome P450 3A4, we genotyped six genetic polymorphisms previously described in poor metabolizers but could not confirm these pharmacogenetic bases in this case. In conclusion, we surmise that buprenorphine at suggested doses can induce liver and kidney failure in susceptible individuals, possibly through direct mitochondrial toxicity.

[Nonconventional therapy in a case of systemic juvenile rheumatoid arthritis]. / Terapia non convenzionale in un caso di artrite reumatoide giovanile sistemica.

We report a systematic-onset juvenile rheumatoid arthritis in an adolescent girl inadequately controlled by a prolonged course of conventional therapy. After ACTH in combination with elevated dosages of intravenous ascorbic acid therapy she rapidly improved, becoming afebrile. A complete clinical remission one month later was obtained, with no recurrences of the disease in five years followup. The excellent response to ACTH and ascorbic acid in our patient, suggests that a controlled trial of this therapy in juvenile rheumatoid arthritis should be considered.

[Middle lobe syndrome in children. Critical review]. / La sindrome del lobo medio nel bambino. Rivisitazione critica.

The clinical, radiological and anatomo-evolutive pictures of this syndrome are typical. It is suggested that cases are more frequent than is generally thought and that their recognition is delayed on account of the considerable time that often elapses before repeated infection of the respiratory system, particularly the middle lobe, results in the onset of the syndrome.

[Infantile idiopathic scoliosis with onset in the 1st year of life]. / La scoliosi idiopatica infantile ad insorgenza entro il primo anno di vita.

The clinical and radiological characteristics of idiopathic scoliosis with onset in the first year of life is described. The importance of a careful objective examination of nurslings with respect to scoliosis is stressed.

[The emotional rapport between mother and child during the first months of life]. / Rapporto emozionale tra la madre e il bambino nei primi mesi di vita.

Feeding children involves a mutual interaction between their parents and them; interaction in which everyone is influenced by and, contemporarily, influences the others. In fact the act of administering food is considered to be fundamental inside the relationship between the mother and her child. Such a relationship can supply consequences that are important for the children's physical, emotional and cognitive growth, particularly in their first two years of life. Therefore, any time a child arrives at the pediatrician's attention showing a nourishment matter, and anamnesis and examination are indicative of a lack of evidence that may address to a physical disease, the next zone to be indagated must be the existing relationship between the child and his family.

[Recent advances in the use of essential fatty acids in pediatrics within the limits of diet, prevention and therapy]. / Recenti acquisizioni sull'uso degli acidi grassi essenziali in pediatria ai limiti tra dieta, prevenzione e terapia.

The authors review the origins and the metabolism of omega-6 and omega-3 fatty acids and particularly consider the implications of desaturase's deficiency and of the usual imbalanced supply of fatty acids in the diet of children. The peculiarity of the fatty acids is to be, while proteins express the genome, the expression of the diet on the cell's membranes, with a subtle influence of an enzyme's equipment varying during the life. All that gains an extraordinary relief, because the omega-6 and omega-3, and constituents of the membranes, are precursors of different series of prostaglandins, which are wholebody mediators of multiple phenomenons like inflammation, immunity, allergy, platelet aggregation, ecc. The authors point how a balanced diet or a supplementation with omega-3, omega-6 and PUFA can help a good development especially of the nervous tissue and of the mucosal barrier. Furthermore modulating the above physiopathological mechanism, also in children could influence recurrent and chronic diseases.

[An open non-comparative study of the efficacy and tolerability of sultamicillin in the therapy of respiratory infections in childhood]. / Studio aperto non comparativo dell'efficacia e tollerabilità della sultamicillina nella terapia delle infezioni respiratorie in età pediatrica.

Forty-eight children (25 males + 23 females), mean age 3.5 years +/- 2.6 (range 1-11), were treated for the following respiratory infections: pharyngotonsillitis (9), bronchitis (18), bronchopneumonia (14), asthmatic bronchitis (4) and pneumonia (3). The average duration of treatment was 5.3 +/- 2.0 days (range 3-13). Sultamicillin was administered at the dose of 50 mg/kg/day. Patients with fever experienced a defervescence on the second day of therapy. Forty-six children (96%) showed a good clinical response. The tolerability of the drug was excellent or good in 93.8% of the cases.

[Changes in the ambulatory arterial pressure of normotensive obese children]. / Modificazione della pressione arteriosa ambulatoriale in bambini obesi normotesi.

Obesity represents an important risk factor for cardiovascular disease and in children it is often associated to the future development of essential hypertension. To evaluate the early hemodynamic alterations in obese normotensive children, ambulatory monitoring was performed in 18 obese children aged 9.6 +/- 2.9 and in 33 controls of equivalent age by ICR 5200 (Spacelabs, USA). Blood pressure daily curves in the two groups were compared by MANOVA. Basal blood pressure did not differ in the two groups (115 +/- 17 mmHg and 79 +/- 7 mmHg respectively systolic and diastolic in controls and 115 +/- 12 mmHg and 79 +/- 6 mmHg in obese children). On the contrary ambulatory monitoring showed higher systolic values in obese children when compared to controls (112 +/- 7 versus 107 +/- 7, p less than 0.04) (MANOVA test, p less than 0.03). The difference was observed both during the day time (115 +/- 6 vs 111 +/- 7, p less than 0.03) and during the night (107 +/- 9 vs 102 +/- 8, p less than 0.5). No differences in diastolic pressure and in heart rate were observed. Those findings indicate that in obese children blood pressure alterations unrecognized at usual blood pressure checks are detectable by ambulatory 24 hour monitoring.

Evaluation of GH secretion.

The Authors analyse the main body of somatotropin function test: insulin hypoglycemia; arginine; ornithine; I-dopa; clonidine; galanin; GH-RH; physical exercise; sleep; combined stimuli; spontaneous GH secretion of varying duration. The advantages and disadvantages of the different tests are pointed out and some recent contradictory findings concerning the newest prolonged techniques are reported. The Authors claim priority for the clinical/auxological examination, with measurement of bone age and growth velocity and suggest the procedure for GH deficit diagnosis to be followed, also in the light of their personal experience.