The surgical management of monostotic fibrous dysplasia of the inferior turbinate.

Fibrous dysplasia is a non-neoplastic, sporadic, slowly progressing disease of the bone in which normal bone is replaced by abnormally overgrowing lesions. There are three different types of fibrous dysplasia: monostotic (affecting a single bone), poliostotic (affecting multiple bones) and syndromic, when it is associated with other diseases (such as McCune Albright syndrome). Fibrous dysplasia affects cranio-facial bones in 10% of the cases. However, its occurrence in the inferior turbinate is extremely rare. To the best of our knowledge, only four cases of monostotic form have been reported so far. Hereafter we describe a case of monostotic FD of the inferior turbinate surgically treated with a trans-nasal endoscopic partial maxillectomy type II.

Palatability, digestibility and emotional pattern in 60 healthy volunteers after ingestion of an iced dessert presented in four different flavours: a subjective evaluation.

Several variables lead to changes in human and animal eating behaviour and food choices. A pivotal role is played by food palatability, represented by food, smell, taste, texture, appearance and temperature. The aim of our study is to assess the potential differences in palatability and digestibility of four different flavoured iced desserts, consumed at the end of a standardized meal, and their impact on the emotional status of 60 healthy volunteers. Sixty healthy volunteers, after ENT and psychological assessment, were asked to fill out a Psycho-Emotional Questionnaire (PEQ) to assess their basal emotional pattern before the consumption of an iced dessert at the end of a standard meal, after which they completed an Organoleptic-Sensory Questionnaire (OSQ), a Dynamic Digestibility Questionnaire (DDQ) and again the PEQ. Four different flavors (lemon, tangerine, pineapple and chocolate) were tested on 4 consecutive days on the same subjects. Most of the 60 subjects, by means of OSQ, found taste, aspect, texture and smell of the 4 flavours pleasant, lemon and tangerine were the freshest and lightest. The DDQ identified pineapple and chocolate dessert as those less digestible. By means of PEQ we recorded an improvement in joy, mood and activation, associated with good data of digestibility and palatability after the consumption of all flavors. Our data showed that all flavors improve joy, mood and activation, after their consumption, without statistically significant differences. However, among the tested flavours, lemon and tangerine appear to be the most pleasant and those which facilitate the digestive process.

The expression of TSLP receptor in chronic rhinosinusitis with and without nasal polyps.

Chronic Rhinosinusitis with or without Nasal Polyps (CRSwNP and CRSsNP) may be characterized by different cytokine profiles. Generally, Th2 cytokines and eosinophilic infiltration have been reported to be more specific of CRSwNP compared to CRSsNP, where neutrophils seem to play a major role. The epithelial cell-derived thymic stromal lymphopoietin (TSLP) has been recently identified as a key factor in Th2-inflammatory response. The aim of this study is to investigate the expression of TSLP Receptor (TSLP R) in surgical specimens obtained from patients affected by CRSwNP (n=10) and CRSsNP (n=5) by immunohistochemical techniques (immunostaining score, IS). TSLP R expression was significantly higher in the inflammatory infiltrate and in the epithelial cells of CRSwNP, CRSsNP patients compared to the control group (IS 4.5±0.68, 4.4±1.44 and 0.43±0.3 respectively, p=0.0024 for inflammatory infiltrate and IS 5.8±0.92, 7.8±2.06 and 0.86±0.55 respectively, p=0.0018 for epithelial cells). No significant difference was observed in IS of inflammatory infiltrate and epithelial cells in CRSwNP compared to CRSsNP. Very low IS for TSLP R was found in connective tissue of all the samples, with no difference among the groups. TSLP receptor is highly expressed in CRS compared to controls and independently from the polyps suggesting an early common inflammatory pathway in the two CRS phenotypes.

Digestibility, palatability and emotional status after ingestion of an iced dessert: analysis of subjective responses in 100 healthy volunteers.

Food choices are influenced by many factors, perhaps the most important being availability. However, the desire to consume one item over another may be viewed as an outcome of sensory hedonic likes, situation and current internal state. In a previous preliminary report, an improvement of joy and mood, associated with good data of digestibility and palatability, was observed in a group of 30 healthy female subjects who consumed a coffee-flavoured iced dessert immediately after a standardized meal. The aim of this study is to confirm the results previously obtained in a smaller population and to investigate whether any differences between male and female subjects could be observed concerning the digestive process and emotional status. One hundred volunteers, after ENT and psychological assessment, were asked to fill out a Psycho-Emotional Questionnaire to assess their basal emotional pattern before the consumption of an iced coffee-flavoured dessert after a standard meal. After the meal they completed an Organoleptic-Sensory questionnaire, a Dynamic Digestibility questionnaire and again the Psycho-Emotional Questionnaire. In our study, most of the 100 subjects found the tested coffee-flavoured iced dessert pleasant according to the Organoleptic-Sensorial Questionnaire (OSQ), in terms of taste, aspect, texture and smell; moreover, the Dynamic Digestibility Questionnaire (DDQ) showed a good digestive experience in 71 subjects. According to the Psycho-Emotional Questionnaire (PEQ), an improvement of joy, activation and mood, associated with good data of digestibility and palatability was recorded. All these observations are statistically significant and the results seem to show a positive correlation between pleasure in eating such a product and emotional status. No statistically significant differences were recorded between male and female subjects.

[Clinical and biological prognostic factors in 135 patients affected by sinonasal carcinoma treated in Piedmont]. / Fattori prognostici clinici e biologici in 135 casi di carcinomi naso-sinusali trattati in Piemonte.

Clinical and biological prognostic factors in 135 patients affected by sinonasal carcinoma treated in Piedmont. Long-term survival of patients with sinonasal carcinoma remains disappointing in spite of aggressive treatment. The aim of the study is the assessment of overall survival in a group of patients treated with a fixed protocol and the positivity of proliferation and neoangiogenesis markers (Ki-67 and VEGF). From our data it comes out that staging, histological type and treatment are the most important clinical and pathological prognostic factors, moreover surgery +/- radiotherapy is the first line treatment for these tumors. Proliferation index and neoangiogenesis plays a pivotal role in the natural history of such neoplasms.

[Effect of noise and reverberation on vocal effort and fatigue of primary school teachers]. / Effetto del rumore e della riverberazione sullo sforzo vocale degli insegnati di scuola primaria.

Teachers are at a higher risk for occupation-related voice disorders than the general population. The aim of this work is the investigations on the relationships between vocal doses and clinical status, acoustical conditions (noise and reverberation) in the classrooms and subjective evaluations of vocal effort and fatigue. At clinical evaluation 41% of the teachers showed no sign of vocal disease. Students talking in the classroom is the most annoying, noise source in classrooms. The consequence of the poor acoustics in all the schools was the decrease in students question perception. The main cause of a vocal pathology was time dose.

[The monitoring role of otoacoustic emission and oxidative stress markers in the protective effects of antioxidant administration in noise-exposed subjects: a pilot study]. / Il ruolo del monitoraggio delle emissioni otoacustiche e dei marcatori dello stress ossidativo negli effetti protettivi dello somministrazione di antiossidanti in soggetti esposti al rumore: uno studio pilota.

The aims of this study is to assess how DPOAEs can discriminate normal subjects with a risk of damage induced by noise, the effectiveness of OAEs in monitoring the effect of Q-Ter, and the role of blood tests to monitor therapy. In the placebo group, the amplitude of DPOAEs was reduced 1 hour and 16 hours after exposure, the group treated with Q-Ter showed normal DPOAEs. This pilot study confirms that DPOAEs represent a sensitive test for monitoring the effects of noise in preclinical conditions and pharmacological treatment.

Subjective assessment of palatability, digestibility and emotions in healthy volunteers after ingestion of an iced dessert: preliminary report.

Dietary habits can be influenced by several factors such as emotional status and food palatability represented by food smell, taste, texture, appearance and temperature. The aim of this study is to assess the palatability and digestibility of a coffee-flavored iced dessert ingested at the end of a standardized meal and its impact on emotional status in a sample of 30 healthy female volunteers. Thirty healthy female volunteers, after ENT and psychological assessment, were asked to fill in a Psycho-Emotional Questionnaire to assess their basal emotional pattern before the consumption of an iced coffee-flavored dessert after a standard meal. After the meal they filled in an Organoleptic-Sensory questionnaire, a Dynamic Digeribility questionnaire and again a Psycho-Emotional Questionnaire. In our study, most of the subjects found the tested coffee-flavoured iced dessert pleasant according to the Organoleptic-Sensorial Questionnaire (OSQ), in terms of taste, aspect, texture and smell; moreover, in 29 subjects the Dynamic Digestibility Questionnaire (DDQ) resulted in a good digestive experience. By means of the Psycho-Emotional Questionnaire (PEQ), an improvement of feelings and mood, associated with good data of digestibility and palatability was recorded. Although this observation is not statistically significant, the results seem to show a positive correlation between pleasure in eating such a product and emotional status. These data are preliminary and need further investigations on a larger population, in order to confirm this association, also in a mixed population, comparing male and female eating behaviour.

Nasopharyngeal polymorphous low-grade adenocarcinoma in a patient with nonfunctioning pituitary macroadenoma.

BACKGROUND: Polymorphous low grade adenocarcinoma (PLGA) is a rare malignant neoplasm of the minor salivary glands occurring in the fifth and sixth decade with a 2:1 female predominance. The nasal cavity is involved in less than 1% of cases. The incidence of clinically recognisable pituitary adenoma is 15 cases/million/year. The prevalence of non-functioning pituitary adenoma (NFPA) is estimated to be 70-90 cases/million. Both types of adenoma represent 20-45% of pituitary tumours. CASE REPORT: The report describes the first case of PLGA associated with NFPA, both incidentally diagnosed. Three months after the exeresis of the NFPA using a trans-sphenoidal approach, an endoscopic resection of the PLGA was performed. No recurrence was observed during a 13 months follow-up. CONCLUSIONS: Complete surgical excision is the preferred management for PLGA. Radiotherapy has not been demonstrated to be effective in treating PLGA. The prognosis is good with a very low rate of metastasis and local recurrence.

Self-esteem and personality in subjects with and without body dysmorphic disorder traits undergoing cosmetic rhinoplasty: preliminary data.

BACKGROUND: Many individuals with body dysmorphic disorder (BDD) seek non-psychiatric treatment. BDD occurs in about 5% of patients who seek cosmetic surgery, and rhinoplasty is the most frequently sought treatment. A correlation exists between individuals' self-esteem and demand for cosmetic surgery. OBJECTIVE: To investigate whether those subjects with BDD traits requesting cosmetic rhinoplasty differ from those without BDD traits in self-esteem, personality and quality of life. METHODS: This study included 54 patients applying to the 1st ENT Division of Turin University. Assessment of the patients before cosmetic rhinoplasty includes: nasal obstruction symptom evaluation, health-related quality of life, Rosenberg self-esteem scale, body dysmorphic disorder questionnaire (BDDQ) and temperament and character inventory (TCI). Based on their responses to BDDQ questions 1, 3 and 4, patients were subdivided into subgroups and then compared. RESULTS: No difference emerged in the objective data. Lower self-esteem, higher harm avoidance (HA) and lower self-directedness (SD) are found in subjects who are worried about how they look, in those with interference in their social life due to this worry and in those who spend more than 3h per day thinking about the way they look. Novelty seeking (NS) is significantly higher in subjects who think about their looks for up to 3h than in those who spend less than 1h. CONCLUSION: Different subgroups of patients are identified. The first group includes pessimistic, shy, insecure subjects; people with fragile and immature personality and poor self-esteem; individuals concerned about the way they look and those who spend more time thinking about it. The second group includes more confident subjects with stronger personality and greater self-esteem. A third, less differentiated group, includes more impulsive (high NS) subjects who spend an intermediate amount of time thinking about the way they look. Patients should be carefully screened and assessed before cosmetic surgery interventions to avoid frustration to both, clinicians and patients.

Noise-induced hearing loss and hearing aids requirement.

Subjective disturbances, due to hearing loss, are auditory disability and handicap which can be evaluated with a questionnaire. The present study refers to a population of industrial workers affected by noise-induced hearing loss. Aim of the study is to identify the minimal level of hearing loss over which the patient felt changes in his quality of life, and the average auditory threshold at which the patient considered the application of a hearing aid useful or necessary. The sample comprised 180 males with noise-induced hearing loss. Each subject received a questionnaire designed for this study. Data show a correlation between disability, handicap and the degree of noise-induced hearing loss. The most relevant problems in noise-induced hearing loss are correlated with disability rather than handicap. 35 dB can be considered as the level above which these devices can be suggested to patients. Hearing aids can become a therapeutic instrument even in the presence of a low degree of hearing loss.

Improvement of clinical response in allergic rhinitis patients treated with an oral immunostimulating bacterial lysate: in vivo immunological effects.

Allergic rhinitis is known to be one of the most common chronic diseases in the industrialized world. According to the concept that allergic rhinitis patients generally suffer from an immune deficit, in order to stimulate specifically or aspecifically their immune system, immunomodulating agents from various sources, such as synthetic compounds, tissue extracts or a mixture of bacterial extracts, have been used. The aim of the present trial is to evaluate the efficacy of the treatment with an immunostimulating vaccine consisting of a polyvalent mechanical bacterial lysate (PMBL) in the prophylaxis of allergic rhinitis and subsequently to analyze its in vivo effects on immune responses. 41 allergic rhinitis patients were enrolled: 26 patients were randomly assigned to the group for PMBL sublingual treatment and 15 others to the group for placebo treatment. For all 26 patients blood samples were drawn just before (T0) and after 3 months of PMBL treatment (T3) to evaluate plasma IgE levels (total and allergen-specific) and the cytokine production involved in the allergic response (IL-4, IFN-gamma). The results of our study indicate that PMBL is effective in vivo in the reduction or in the elimination of the symptoms in rhinitis subjects during the treatment period in comparison to a non-immunostimulating treatment. A significant and clinically relevant improvement was found in 61.5%, a stationary clinical response was registered in 38.4% and no negative side effects associated with the medication or worsening were recorded. At the end of a 3-month follow up period the clinical picture remained the same as that observed at T3. PMBL treatment did not affect the serum IgE levels (either total or allergen-specific) and did not induce significant changes in IFN-gamma concentration. In contrast, PMBL therapy may be accompanied, in some patients, by a potential immunomodulating activity by decreasing IL-4 cytokine expression.

[Role of salvage surgery in the recurrence of mouth and oropharynx tumors]. / Il ruolo della chirurgia di salvataggio nelle recidive dei tumori del cavo orale ed orofaringe.

Educational objectives at the conclusion of this presentation, the participant should be able to identify the different criteria that lead to the surgical approach rather than to the medical treatment (radiation therapy -RT--and/or chemotherapy--CT). Introduction. When we have to deal with medium or big recurrence of an oral or oropharingeal cancer is very difficult to make the right choice between the surgical or medical therapy: what we have to ask to ourselves is whether is legitimate to reoperate considering the sequences due to surgery and the results expected. Methods. From January 1997 to December 2002 we have treated by surgery 135 patients (mean age, 54) with oral and/or oropharingeal squamous cell carcinoma (SCC). The percentage of local recurrence was 30% (41/135 patients) and nodal recurrence was 6% (8/135 pt). Twenty-two/53 patients underwent to a salvage surgery; the others 31 patients to a RT and/or CT therapy. Conclusion. The overall survival was 29% in surgical patients after 3 years and 14% after 5; in the other patients the survival was 11% after 3 and 3% after 5 years. The comparison between the results in case of recurrent cancer of this distrect shows that the best approach is the surgery, where is possible; the choice is conditioned by the following parameters: the extension of the tumor, primary and recurrent; the presence of lymph node or distant metastases; time of recurrence; grading and histological characteristics of the tumor and performance status of patients.