Medical and surgical treatments for tinnitus: the efficacy of combined treatment with sulodexide and melatonin.

AIM: Tinnitus is the perception of sound in the absence of an apparent acoustic stimulus. A widespread and highly debilitating disease difficult to cure. Several treatments have been advocated for tinnitus in the last years, including surgery, pharmacotherapy, counseling, cognitive behavioral therapy, sound therapy, but unfortunately without definitive conclusions. The surgery treatments could represent an important therapeutic choice on specific subgroups of tinnitus with defined causes but obviously this approach represent an invasive treatment and it should be considered with extreme caution and then, alternative pharmacological options should be investigated. METHODS: In this retrospective study 30 patients with tinnitus were treated with sulodexide (250 LSU BID, in the morning and in the evening) and melatonin (3 mg in the evening before going to sleep) for 80 days. The evaluations were performed comparing different parameters at basal (T0) and after 40 days (T1) and 80 days (T2) of treatment. RESULTS: The results of Tinnitus Handicap Inventory (THI) and acufenometry showed a significative improvement of tinnitus after treatment with sulodexide and melatonin. In particular, THI total score was reduced from 37±20 to 27±18 (P<0.001) and 21±19 (P<0.001) at T1 and T2, respectively. The percentage of patients with improved symptoms (i.e. reduced score at THI) was 76.7% at T1 and 90.0% at T2. Finally a significant improvement was also detected in the tone audiometry test. No side effects were observed during the treatment period. CONCLUSION: In conclusion, the combined use of sulodexide, a natural glycosaminoglycan with antithrombotic, profibrinolytic and vascular anti-inflammatory properties used in the treatment of many vascular diseases, included the vertigo of vascular origin and melatonin, a neurohormone produced by the pineal gland and related to multiple physiological functions, confirms to an important and promising therapeutically option in the tinnitus management.

Fatal accidental ingestion of carbon tetrachloride: a postmortem distribution study.

This paper reports a fatality involving a 75-year-old white male, who ingested an unknown quantity of carbon tetrachloride (CCl4)--a toxic agent able to induce central nervous system depression and severe renal and hepatic damage--and who died after two days of intensive care. The analytical assessment of CCl4 concentration was performed on several biological fluids and tissues employing gas chromatography-flame ionization detection (GC-FID) head space method. Both urine (328.5 mg/L) and bile (169.8 mg/L) had high concentrations of CCl4, proving that the chemical undergoes extensive urinary and biliary excretion. In accordance with the high clearance power of lungs, systemic venous blood, (143.4 mg/L) had a concentration of CCl4 almost two and half times greater than in arterial blood (57.5 mg/L), representing the best specimen to correlate CCl4 blood concentration with the deep of narcosis. Vitreous humor, (170.5 mg/L) concentration of CCl4 proves the capability of the chemical to enter eyes and its relatively slow release into the systemic blood. Pancreas (657.9 mg/kg), brain (243 mg/kg) and testis (237.3 mg/kg) have great affinity for CCl4. The concentrations of the chemical in brain are cortex: 243.2 mg/kg, basal ganglia: 216.1 mg/kg, medulla oblongata: 243.3 mg/kg and cerebellum: 175.3 mg/kg. As the depth of narcosis is correlated with CCl4 concentration, brain represents the most suitable tissue for toxicologic analysis. Lower concentrations of the chemical are found in lungs (127.3 mg/kg), kidneys (150.5 mg/kg), muscle (71.1 mg/kg), myocardium (78.5 mg/kg) and spleen (68.3 mg/kg). Liver (58.6 mg/Kg), a frequently analyzed tissue in forensic toxicology, shows the lowest concentration.

Morphology of sweat glands in determining time of death.

This study demonstrates post-mortem autolytic alterations in the skin at cellular and subcellular levels and identifies parameters which may assist in determining the time of death in the first few hours post-mortem. Serial skin samples from the ventral surface of the arm were taken at intervals of 3, 6, 9 and 12 h after death in 29 subjects of various ages, with no signs of skin disease; causes of death were various. Three types of tests were performed: cytochemical (hematoxylin-eosin and alcian-PAS), immunohistochemical (S-100, CEA, Cytokeratin, ASM) and ultrastructural (electron microscopy). Electron microscopy proved useful for identifying transformations which were found to be specific for each chronological step considered: reduction of intracellular glycogen in clear cells and reduction of secretory granules in dark cells are typical signs of the first stage (3 h) after death; mitochondrial dilatation and rarefaction of cristae in clear and dark cells are typical of the second stage (6 h); rarefaction of microvilli in dark and clear cells is a sign of the last stage (12 h). Cytochemistry and immunohistochemistry supply useful information--not for all the chronological stage considered here, but for individual phases (3 h for hematoxylin-eosin and 6 h for alcian-PAS). However, it is particularly important to use the results from all such techniques simultaneously, so that the question of the exact time of death within the first 12 h post-mortem may be more accurately answered.

The anterior ligament of the human malleus.

The authors have studied the anterior ligament of the malleus (ALM) from a morphological and embryological point of view. Classical textbooks of anatomy stress the correlation between the ALM and the anterior pin of the sphenoid and define the ligament as a residual of Meckel's cartilage. This study demonstrates the y-shaped form of the ligament, one arm of which reaches the capsule of the temporomandibular joint and the other the pin of the sphenoid bone. Meckel's cartilage pilots the fibres of the ligament itself. Several clinical implications may be hypothesised on the basis of this study.