[Clinical study on 40 cases of inflammatory pathologies of upper respiratory and digestive tract treated by inhalatory crenotherapy]. / Studio clinico su 40 casi di fl ogosi delle alte vie aereo-digestive trattati con crenoterapia inalatoria.

OBJECTIVES: Authors present beneficial effects of crenotherapy on 40 patients suffering from inflammatory mucosal conditions of upper respiratory-digestive tract (URDT). MATERIALS AND METHODS: Our study was realized at the hydrothermal premises in Telese Terme (BN, Italy). Subjects selected for this study are 40 patients (22 males and 18 females) aged 20-68 years (mean 38.6 years) who suffered from catarrhal and inflammatory mucosal diseases of URDT. The patients, who are informed about the modalities of the study, undergo E.N.T. examination and nasal mucosal brushing for cytologic analysis before and after crenotherapy. RESULTS: At the end of the therapeutic course we observed a relevant improvement of clinical indicators and of mucociliary transport time in URDT. Moreover, a satisfactory control of local inflammation is highlighted by a rhinocytogram, performed after crenotherapy and showing an increase in plasma cells, a decrease in granulocytes and a normalization of mucous secretion (nasal mucosal histology). CONCLUSIONS: Our study shows that sulphurous waters are particularly effective in anti-catarrhal and anti-inflammatory therapy of URDT.

[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.

[Pleomorphic adenoma in unusual anatomic sites: case reports and review of literature]. / Adenoma pleomorfo in sedi atipiche: casi clinici e revisione della letteratura.

Pleomorphic adenoma is the most common neoplasm of the major salivary glands, in particular of the parotid gland. Only occasionally can it be found in the cervicofacial area outside the major and minor salivary glands of the oral cavity. The present article describes three cases of pleomorphic adenoma, respectively of the external auditory canal, the nose, and the larynx. The three tumors showed no clinical or radiological signs of malignancy and were surgically excised with a suitable margin of healthy tissue. Histologically, the typical features of pleomorphic adenoma were observed in the larynx case alone. The pleomorphic adenoma of the external auditory canal evidenced an extensive apocrine glandular component; the neoplasm of the nose was itself characterized by ample proliferation of fused cells. Immunohistochemical findings revealed focal or widespread positivity to cytokeratin, S100 protein and muscle-specific actin in both the epithelial and mesenchymal components of the neoplasm. Cases of pleomorphic adenoma in sites other than the major salivary glands show clinical and radiological signs of benignity. Their histopathological identification is, however, not always straightforward; immunohistochemistry can contribute significantly to the formulation of a definitive diagnosis and to the realization of an appropriate follow-up.

[Case report: ipsilateral association of posterior and anterior canalolithiasis]. / Case-report: associazione omolaterale di canalolitiasi posteriore e anteriore.

Benign paroxysmal positional vertigo (BPPV) is the most frequently occurring dizzy syndrome. The literature provides ample descriptions of the forms determined by canalo/cupulolithiasis of the posterior canal, the most common, as well as canalo/cupulolithiasis of the horizontal canal. Descriptions of the forms of canalo/cupulolithiasis of the anterior canal are, instead, very rare and, sometimes questioned: this is fundamentally due to its superior position, which makes it a much less likely site for the accumulation of debris, both from a conceptual and practical point of view. For these reasons, the Authors feel that the presentation of this case of PPV is of particular interest. After analyzing and excluding other interpretations as less probable, they considered the syndrome as determined by the association of right posterior and anterior canalolithiasis. This form, as in the case of posterior canalolithiasis, responded to treatment with Semont's liberatory procedure.

[Sign-report: torsional nystagmus from head-shaking in patients with labyrinth lithiasis of the vertical canal]. / Sign-report: nistagmo torsionale da head-shaking test in pazienti con labirintolitiasi dei canali verticali.

The clinical picture of Positional Paroxysmal Vertigo (PPV) induced by vertical canal labyrintholithiasis has been clearly described, eliminating previous interpretations of pathogenesis of this disorder. The diagnosis of PPV is based on the well-known picture of positional paroxysmal Nystagmus. The Authors report a clinical sign which has not previously been reported in the literature: torsional Nystagmus induced by the Head-Shaking Test (HST). The Authors encoutered this sign in 30% of the cases of vertical canalolithiasis and in 50% of the cases diagnosed as vertical cupulolithiasis. This sign was also found in patients with a history of prior positional vertigo and in patients who, after treatment with release maneuver, no longer show clinical signs of positional vertigo. Such Nystagmus was not, however, found in the control group (normal subjects and patients suffering from other vestibular pathologies). In the present study the possible pathogenesis of this sign is discussed and some practical implications are considered.

[Vertical nystagmus induced by the head-shaking test: 10 cases]. / Nistagmo verticale da head-shaking test. Presentazione di dieci casi.

In cases of central and/or peripheral vestibular system asymmetry, Head-Shaking test-induced Nystagmus (H.S.-Ny) can appear after a cycle of 20 horizontal head oscillations. Four types of H.S.-Ny have been described, all of which are horizontal: 1) deficit Ny; 2) recovery Ny; 3) biphasic Ny; 4) triphasic Ny. None of these forms are specific for any given vestibular asymmetry site, whether central or peripheral. The authors report another low vertical type of H.S.-Ny found in 13 of the 1500 cases where the test was performed. Ten of these cases are discussed here. Vertical H.S.-Ny was found in 7 cases of N.M.R.-confirmed central pathologies, in 1 case of complications from epidemic parotitis and in 2 cases for which N.M.R. did not confirm the presence of an organic pathology. Vertical H.S.-Ny was often associated with other vestibular signs (Gaze-Ny, Rebound Ny, variable direction Ny, down-beat positional Ny, labyrinthine hyper reflexia). The authors consider this form of nystagmus a simple, easily determined signal of great importance in diagnosing the presence of a central, tronco-encephalic and cerebellar pathologies.

[Use of CO2 laser in conservative surgery of glottic tumors]. / L'impiego del laser a CO2 nella chirurgia conservativa dei tumori glottici.

The present work evaluates the results obtained in a group of 360 patients with laryngeal-glottic tumors (classification T1/T2-N0-M0) who, in the last 10 years, have undergone direct microlaryngoscopy surgery employing a CO2 Laser. In the T1 glottic carcinomas the neoplasm was limited to the vocal cord on one side or it involved the anterior commissure and, most likely, the vocal cord on the opposite side; in T2 glottic tumors the extension reached the hypoglottic region and/or the Morgagni ventricle and the false vocal cords on one or both sides but without compromising laryngeal motility. The five year healing rate for the T1 tumors proved to be 84.7% while it was 74% for the T2 forms. In 36 cases complications were found which can be broken down as follows: - limited local recurrences (13 patients) requiring subsequent direct microlaryngoscopy; - regional lymph node metastases (6 patients) without reproduction of the primary neoplasm; in general (5 of the 6 cases) these patients underwent lateral neck dissection; - spreading of the neoplastic process (17 cases) which made total laryngectomy with lateral neck dissection necessary; this procedure was performed in 15 cases. When these subsequent surgical procedures are also taken into account the percentage healing rises to 94.3% for T1 glottic tumors and to 84.9% for T2. Detailed analysis of the case study, comparison with the data found in the relative literature regarding patients treated with traditional techniques, a series of observations on the advantages and disadvantages inherent to the techniques employed have all led to the conclusion that the use of a CO2 laser in the treatment of laryngeal tumors gives excellent results in terms of prognosis. Moreover, this technique offers significant advantages over the traditional methods and constitutes a reliable technique for partial laryngectomies as long as the indications are accurately applied and the proper techniques used.

CO2 laser in laryngeal microsurgery.

The CO2 Laser is used in the treatment of several laryngeal diseases and offers considerable advantages over traditional techniques. New applications of this surgical tool are currently under study for other laryngeal and ENT pathologies. It should be pointed out that there are some limitations to the use of the CO2 Laser; an accurate examination of its indications is needed, as well as a precise knowledge of its techniques and possibilities.

The CO2 laser in the laryngeal microsurgery.

636 patients suffering from several laryngeal pathologies were treated with the CO2 laser. The results obtained confirm that this instrument is a valid alternative surgical tool, in comparison with the traditional surgery, because it allows to carry out the removal of the lesion with greater precision and more advantageously, when clinical indications are exact and surgical technique correctly performed. The results are as follows: Vocal nodules: no real advantages are offered by the CO2 laser in the treatment of these pathologies, whereas, in a small percentage of cases, the occurrence of reactive nodules or scars was noted; Cordal polyps are better removed with the traditional procedures, whereas the CO2 laser allows a more accurate excision of voluminous polyps or edemas of Reinke because of the bloodless operative field; Dyskeratoses: better functional results can be obtained using the laser. In these cases, however, an accurate preoperative evaluation is of fundamental importance to exclude any carcinomatous degeneration; Laryngeal amyloidosis is easily removed with minimal trauma and functional impairments using the laser; Laryngeal papillomatosis: the laser makes it possible to achieve complete recovery if radical excision, avoidance of accidental laryngeal damage and frequent postoperative controls are done; Laryngeal cancers: when clinical indications are correct, the main laser advantages in the treatment of T1 and T2 glottic cancers are the endoscopic removal of the lesion, avoidance of tracheotomy, shorter hospital stay and better quality of voice. Radical excision of the lesion is obtained by dissecting the tumor along the traditional cleavage plane, i.e. the inner perichondrium of the thyroid cartilage; Bilateral vocal cord paralysis: partial or total arytenoidectomy can be performed with the laser, with excellent functional results and minimal trauma and inconveniences; Laryngeal stenoses: chronic aditus edemas, vocal cord synechiae and webs are easily removed, taking care to avoid damage to the posterior commissure or to the elastic tracheal wall and performing frequent endoscopic removal of the fibrin clots in the postoperative period. Concentric stenoses and circumferential webs are firstly vaporized, then a silastic Montgomery T-tube is placed in the neocavity and left in place until re-epithelialization is completed. The insertion of a metallic tracheotomic cannula in the horizontal and descendant branches of the T-tube has been shown to be a useful precaution in order to achieve better results.

[Yersinia enterocolitica infection has taken hold even in our country]. / L'infezione da Yersinia enterocolitica e' da tenere presente anche nel nostro paese.

The Yersinia enterocolitis is a kind of disease whose diffusion is gradually increasing in North Europe. The authors relates about the outcomes of a serum-immunologic research conducted during the period 1982-84 on a sample of 965 adults coming from three different italian districts (Roma, Siena, Napoli) and 65 children coming from Napoli. They interpret antibody titers painted out by their research comparing them with ones reported in bibliography. The issue of this research, even if it was conducted only in three bordering central-southern Italy regions, can anticipate an indicative epidemiological image of this Country.