[Prevention of psychosocial issues and drug addiction in workers employed in building great infrastructures: first outcomes of an experience in the Florence area]. / La prevenzione del disagio psicosociale lavorativo e delle dipendenze negli addetti alla realizzazione delle grandi opere infrastrutturali: primi risultati di uno esperienza in territorio fiorentino.

The research on stress, mobbing, and substance dependence in workers employed in the building of the great infrastructures is part of the project Euridice-Ten. The 75% of the workers employed took part in the research through an anonymous and structured questionnaire. The Clinica del Lavoro of the University of Milan elaborated the data. They point out a high risk of stress, a low level of control, a marked risk of mobbing, a high chronic fatigue in the most exhausting jobs, sleep disorders, problems in the social life as well as at home, in nourishment and at work. Many workers drink too much alcohol and the 9% of the workers know workers who use cocaine.

Surgery of thyroid cancer: twelve years' personal experience.

Diagnosis and treatment of thyroid carcinoma require a multidisciplinary approach. The close and long-standing collaboration between the Otorhinolaryngology, Pathological Anatomy and Nuclear Medicine Departments of Legnano Hospital has led to a precise diagnostic and therapeutic protocol in thyroid patients. In the 1990-2002 period, 131 patients underwent total thyroidectomy after diagnosis of thyroid cancer at the Otorhinolaryngology--Head and Neck Surgery Department. Patients submitted to lobectomy for differentiated thyroid cancer were excluded from the present study. The patient population is composed of 96 females (73%) and 36 males (27%) aged between 22 and 85 years. Of the 131 patients, 115 (87%) presented papillary carcinoma, 13 (10%) follicular carcinoma, 2 (2%) medullary carcinoma and one (1%) undifferentiated carcinoma. Two patients (2%) suffered from a preoperative monolateral recurrent nerve palsy. Total thyroidectomy was performed in all 131 patients. Selective neck dissection was performed only in patients with positive lymph nodes for papillary (37/115, 32%) and follicular carcinoma histotype (2/13, 15%) and, in both patients with medullary carcinoma (100%). Of the 131 patients, 15 (11%) did not undergo routine follow-up and were, therefore, excluded from the study, the remainder completed a mean follow-up of 47 months. During follow-up, the incidence of the two most frequent complications of thyroid surgery were evaluated: recurrent nerve paralysis and permanent hypoparathyroidism (exceeding the postoperative 6 months). Results of treatment have been evaluated considering the incidence of local and/or distant recurrences and patient survival rate. As far as concerns papillary and follicular histotype, we have considered as healed (absence of signs suggesting loco regional and distant recurrence) only those patients presenting both negligible levels of plasma thyroglobulin and a negative total-body 131I scintigraphy. Briefly, in 3 cases (3%), all papillary carcinomas, local recurrence occurred; 9 (8%), all with papillary carcinoma, developed lateral neck recurrence; 6 (5%), 5 with papillary carcinoma and one with follicular carcinoma, developed distant metastases, of which 3 pulmonary, 2 bone and 1 hepatic. Serum thyroglobulin values were considered during the last control visit in 95/113 patients (84%). Of these, 86 (91%) with negligible thyroglobulin levels and negative 131I scintigraphy, were considered healed. All 113 patients with differentiated thyroid carcinoma were alive at the last control visit. Both patients with medullary carcinoma are alive with no sign of illness at the last follow-up control. The patient presenting undifferentiated carcinoma died 2 months after surgery. In conclusion, at the last follow-up control, 1 (1%) patient has died, 5 patients (4%) are alive with disease (2 of whom suffered from multiple recurrences) and the remaining 110 (95%) patients are alive without evidence of disease. As far as concerns complications of surgery, iatrogenic recurrent palsy and permanent hypoparathyroidism are present in 2 (2%) and 10 patients (8%), respectively.

Posterior fossa vestibular neurotomy as primary surgical treatment of Menière's disease: a re-evaluation.

Fifty-eight patients underwent vestibular neurotomy via the posterior fossa approach between September 1992 and December 1998 at the ENT department of Legnano. All patients presented a history of disabling unilateral Menière's disease and underwent complete neuro-otologic evaluation following the 1985 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. All patients underwent MRI imaging, ABR and electronystagmographic testing before surgery. Objective analysis of results is reported using the criteria published by the Committee on Hearing and Equilibrium of the AAO-HNS in 1985. According to the AAO formula, 52 patients obtained a score of 0, indicating complete control of major vertigo spells, while four were classified within the 'substantial control' group. Immediate hearing results indicated that 93 per cent of the patients maintained a level within 10 dB from the pre-operative level. Only one patient experienced a subtotal hearing loss yet retained measurable hearing. No major complications were reported. We conclude that a retrosigmoid approach to vestibular neurotomy can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière's disease while preserving the hearing. Tinnitus and long-term hearing deterioration are not influenced by the procedure.

[Trans-labyrinthine approach for the resection large and giant acoustic nerve neuromas]. / Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico.

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current "enlarged" approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano.

Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico / Translabyrinthine approach for the resection large and giant acoustic nerve neuromas

El abordaje translaberíntico clásico para la exéresis de neurinomas del acústico fue introducido por William House en 1964. En el curso de los años el abordaje translaberíntico original ha sido progresivamente modificado hacia el actual abordaje "ampliado", extendiendo el área de resección ósea. Esta modificación permite la exéresis de tumores prácticamente de cualquier tamaño del ángulo pontocerebeloso. Se presentan los resultados de 71 neurinomas del nervio acústico grandes (52) o gigantes (19) operados entre los años 1993-1998 por abordaje translaberíntico en el Servicio de Otorrinolaringología del Hospital de Legnano. (AU)

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current «enlarged» approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano (AU)

[Petrous bone cholesteatoma: surgical strategy]. / I colesteatomi della rocca: strategia chirurgica.

Petrous bone cholesteatoma is a rare pathology which grows slowly and is often asymptomatic. This work presents a series of 25 cases of Petrous bone cholesteatoma and discusses the diagnostic impact, the surgical approach, the results and the complications. Currently our surgical orientation favors translabyrinthine and transcochlear approaches which, better than other ones, allow both radical excision of the lesion and preservation of the main neuro-vascular structures. Out of the 25 patients undergoing surgery, 22 were treated with the translabyrinthine (6 cases) or transcochlear (16 cases) approaches, in 1 case an infratemporal type A approach was used while the remaining 2 were treated with a median cranial fossa approach. Paralysis of the facial nerve is the most dreaded complication, particularly when a deficit is already present prior to surgery. In just a few cases did the hearing justify an attempt at preservation but in no case should this compromise radical removal of the cholesteatoma.

[8-year experience with force vector rhinoplasty by J.B. Tebbetts: comparative results]. / Otto anni di esperienza con la rinoplastica vettoriale aperta secondo J.B. Tebbetts: considerazioni comparative.

The aim of the present work is to make a contribution in resolving the controversy between the traditional and "open" approaches to rhinoseptoplasty. Over these last few years, particularly in the United States, the Rethi technique (1920) has encountered unceasing opposition among those using the "open" approach and those who, on the other hand, assert that they can achieve equivalent results without resorting to the supplementary columellar incision. Since 1989 we have been using the technique proposed by J.B. Tebbetts in 1987 and published in detail in the July, 1994 issue of "Plastic and Reconstructive Surgery". The authors feel that Force Vector Tip Rhinoplasty has been the only true innovation since Joseph (1931). Moreover, because of its content, this technique has exceeded the general term of open rhinoplasty. Indeed, this term is extremely general and simply indicates what surgical route is used. Nevertheless, the access route alone does not justify the choice of technique. On the other hand, what is truly innovative is the particular philosophy and technical aspects of Vector Rhinoplasty. In fact, by adding particular suture points and cartilaginous graft along calculated, extremely precise force lines, it is possible to modify the nasal skeleton. This is achieved with a steady, direct control and without damaging the delicate structures being supported. The term "Optimized Force Vector Tip Rhinoplasty" clearly depicts the concept, not only of a more complex access route; it also underlines the advantages in terms of intraoperative diagnostics, precision in performance and stability in time.