Solitary fibrous tumour of the laterocervical spaces

Solitary fibrous tumours are rare mesenchymal neoplasms usually arising in the pleura. Extra-pleural locations are uncommon although some cases of head and neck involvement have been reported in the recent literature. In such cases, nose, paranasal cavities and parapharyngeal spaces are the most frequently affected sites. The Authors present a case of a solitary fibrous tumour involving the laterocervical spaces. The histological diagnosis of solitary fibrous tumours gives rise to significant problems since parameters for determining their aggressiveness are still controversial. Immunohistochemical techniques are considered to provide a decisive identification. Follow-up plays a crucial role, as recurrences can occur even after several years. Usually, complete surgical excision is adequate whilst curative and radiochemotherapy may be indicated if complete resection of the tumour mass is impossible.

Adeno-tonsillar surgery in Italy

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

The role of positron emission tomography (PET) in the management of cervical lymph nodes metastases from an unknown primary tumour

Cervical lymph node metastases may be the initial manifestation of occult cancer. Despite a very exhaustive search, the primary site of approximately 2-10% of these tumours remain undetected. Evaluation of the patient includes: detailed physical examination of skin, upper airways (fiberoptic endoscopy), salivary glands and thyroid; fine-needle biopsy, multiple endoscopic biopsies, and imaging studies (ultrasonography, computed tomography scan or magnetic resonance imaging). Recently, positron emission tomography scan has been demonstrated to be a useful diagnostic imaging study in these patients. The records of 11 patients were reviewed. End-points were the usefulness of positron emission tomography in the detection of an unknown primary tumour and/or distant metastatic disease. In 5 patients, positron emission tomography detected a primary lesion, confirmed pathologically and revealed distant metastases in 2 patients. Two cases were false-positive and 1 false-negative. In 3 patients no primary tumour was found after 3 years follow-up. In conclusion, positron emission tomography was not of any significant advantage in detecting occult primary tumour vs. computed tomography scan or magnetic resonance imaging. Positron emission tomography, as "ab initio" total body examination, is important in detection of unsuspected distant diseases.

Parathyroid cysts: description of two cases and review of the literature

Parathyroid cysts are a relatively rare cause of neck swelling, and their anatomo-pathological and clinical features are still under debate. Two types of parathyroid cysts have been recognized: the non-functioning or essential forms, which are more frequent, and the adenomatous or functioning parathyroid cysts, which are rarer and cause hyperparathyroidism. Two cases of parathyroid cysts are reported and the treatment is described bearing in mind the various therapeutic procedures proposed in the literature. Attention is focused on pre-operative differential diagnosis from other masses, in the same area, and, to this end, the importance is stressed of assaying parathyroid hormone levels in the cystic fluid, obtained by fine-needle aspiration, and correlating these values with serum levels of the hormone.

Malignant fibrous histiocytoma of the pharynx

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.

Schwannoma of the tongue: one case report

The schwannomas are nervous tissue tumours that arise from Schwann cells; they are uncommon in peripheral nerves and rare in the tongue. After, a review of the literature, we present a case of schwannoma which arose in the ventral part of the body of the tongue. The tumour presented as a slowly growing mass producing few symptoms. The diagnosis of schwannoma is usually made post-operatively by histological identification although modern imaging techniques can provide useful indications. The treatment is exclusively surgical and usually enucleation of the mass is uncomplicated. There are no reports of malignant transformation.

Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study

STUDY DESIGN

Single case study.

OBJECTIVES

To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the effect of inter-subject variability.

SETTING

The Centre of Sport Medicine and Bioengineering Centre 'Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy.

METHODS

A single patient (lesion level T5-T6) was trained specifically for each walking system and was evaluated after each training period. The effects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/VO2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at different speeds.

RESULTS

The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/VO2 curves with ARGO was higher (slope difference=51.1 b 1O2(-1)), with ARGO+FES was similar (slope difference=-5.3 b 1O2(-1)) and with Parastep was smaller (slope difference=-55.6 b 1O2(-1)); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject.

CONCLUSIONS

(a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric effort of the stimulated muscles.

SPONSORSHIP

This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25).

Nasal paraganglioma. A case report

Nasal paraganglioma. A case report. Nonchromaffin paragangliomas or chemodectomas arise in paraganglia distributed in various parts of the body. The jugular bulb, the vagal body and the bifurcation of the carotid artery are the most common sites of origin of paraganglioma in the head and neck region. Paragangliomas in the nose and paranasal sinuses are extremely rare and very few cases of definite paraganglioma arising primarily in the nose or paranasal sinuses have been reported. The paraganglioma is a slow-growing tumour that produces nasal obstruction, profuse epistaxis and facial swelling. Complete excision of the glomus tumour is normally curative. We report a case of nasal paraganglioma and discuss the diagnosis and therapy.

Myositis ossificans traumatica of the temporal muscle: a case report

Myositis ossificans traumatica (MOT) is a pathological condition characterized by extraskeletal formation of bony tissue, induced by violent or repeated trauma. Reports of this pathology occurring in the region of the head and neck are rare, and even more so in the muscles of mastication. We present the case of patient with MOT of the temporal muscle, the etiology of which seems to be related to traumatic manipulations during dental treatment. A review of the literature is presented and the surgical approach, which resolved this case is discussed.

Stapes surgery and psychiatric complications

Changes in auditory perception can cause disturbances in development and personality. This phenomenon has been studied in particular in children hearing loss or in progressive or sudden hearing loss in the adult. We present the case of a patient with psychobehavioural alterations after restoration of hearing following a small fenestra stapedectomy for bilateral otosclerosis with moderate-severe hearing impairment. The diagnosis, physiopathology and medicolegal implications are discussed.

[Modification in some nasal function parameters after metacholine stimulation and pretreatment with ipratropium bromide]

Experimental research conducted on normal subjects and on perennial rhinitis sufferers demonstrates that the application of metacholine stimulates nasal secretions and that this effect is inhibited by pretreatment with ipratropium bromide. Using the Baroody et al. method, a group of 20 healthy volunteers was used to check the effect metacholine and ipratropium/metacholine had on nasal secretions. At the same time a study was performed to determine whether these treatments modify other nasal functions: turbinate blood flow, nasal resistance, mucociliar transport. The data confirm earlier observations regarding the effect of metacholine and ipratropium on nasal secretions. A parallel effect is also seen in mucociliary transport time, most likely linked to modifications in the rheological characteristics of the mucous. On the other hand, no significant difference was found in the other functions studied: turbinate blood flow and nasal resistance. We can consider metacholine and ipratropium selective and specific, acting on the secretory function of the nasal mucosa.

Unusual extracranial complications of otitis media in a young HIV patient: retropharyngeal and Mouret's abscess

Since the introduction of antibiotic therapy, the incidence of intra- and extracranial suppurative complication of acute and chronic purulent otitis media has sharply decreased. In particular, reports of laterocervical abscesses secondary to this disorder are quite rare, not more than twenty cases of Bezold's or Mouret's abscesses having been reported in the literature during the last ten years. The authors present a case of retropharyngeal and Mouret's abscess developed as a consequence of acute purulent otitis media in a young Aids patient. True otologic manifestations of Aids are rare while the incidental association of otologic disease with Aids is more common. The development of complication in the present case is favoured by the patients severe immunodepression.

[Complex maxillofacial trauma: diagnostic contribution of multiplanar and tridimensional spiral CT imaging]

INTRODUCTION

Adequate radiologic assessment of the maxillofacial trauma patient is the basis for planning reparative surgery. We investigated the yield of the integration of axial CT with multiplanar (MP) and three-dimensional (3D) reconstructions with the Spiral technique.

MATERIAL AND METHODS

Thirty-five patients (21 men and 14 women, mean age: 31.2 years) with complex maxillofacial traumas were submitted to Spiral CT. Images were acquired with 2-3-mm collimation, 1:1 to 2:1 pitch, 210 mAs, 120 kV, 15-24 s Spiral scan, RI = 1. 3D reconstructions were always obtained and used to guide MPRs targeted on the single injury. The examinations were retrospectively given a score, namely 1 if 3D and MPR yielded no more important diagnostic information than axial CT, 2 if 3D and MPR permitted better detailing of some axial CT findings and thus improved image reading, and 3 if 3D and MPR showed new injuries missed on axial images. Then, a radiologist and a maxillofacial surgeon reviewed the 3D images together only to assess in which cases they were useful to optimize surgical planning.

RESULTS

Nine cases (25.7%) scored 1, seventeen (48.6%) scored 2 and nine (25.7%) scored 3. MP and 3D reconstructions were useful or determinant (2 + 3) in over 74% of cases. 3D images made surgical planning easier in 15 of 32 surgical patients (46.8%), allowing the surgeon a better panoramic view of the complex fracture.

CONCLUSIONS

The greatest advantage of multiplanar imaging is the improved depiction of skeletal injuries along a horizontal plane, paralleling that of axial scans. The depiction of fractures of cribrum and of orbital roof and floor was particularly useful from a clinical viewpoint. MPRs clearly depicted herniation and incarceration of the lower rectus muscle in blow-out fractures. MP and 3D reconstructions better defined the presence and grade of displaced bone fragments in nearly vertical structures, such as the upward branches and coronoid apophysis of the mandible. 3D images alone never showed any more fractures than those seen on axial and MP images. 3D images are especially useful to the surgeon because they permit the panoramic depiction of the fracture complex, which facilitates treatment planning. The radiologist can use 3D reconstructions to guide the acquisition of targeted MP reconstructions, for better diagnostic yield. The Spiral technique, with its pitch increases up to 2, permits to limit the radiation dose while preserving the quality of postprocessing reconstructions. Finally, decreasing the execution time is important in multiple trauma patients who are often clinically unstable or have damaged vital organs.

Reduction of 0.1 Hz microcirculatory fluctuations as evidence of sympathetic dysfunction in insulin-dependent diabetes

OBJECTIVE

Loss of spontaneous fluctuations in resting microcirculatory flow has been described in diabetes mellitus, but its mechanism remains unexplained.

METHODS

The autonomic control of forearm skin microcirculation was investigated in 23 insulin-dependent diabetic human subjects (median age 39 years, range 27-50) and in 23 age-matched controls (median age 38 years, range 20-57), by laser-Doppler flowmetry. Using spectral analysis of spontaneous microvascular fluctuations, we measured the power of 0.1 Hz ('10-second rhythm') fluctuations, dependent on sympathetic control, and of respiration-related, high-frequency fluctuations, due to the transmission of mechanical chest activity. Autonomic function abnormalities were assessed by 5 tests of cardiovascular reflexes.

RESULTS

Abnormalities in cardiovascular autonomic tests were present in 7/23 patients: deep breathing was abnormal 4 in patients, standing in 2, handgrip in 3, cross-correlation in 4, and Valsalva ratio in 0. The power of 0.1 Hz microcirculatory fluctuations was significantly lower in diabetic than in control subjects (2.57 +/- 0.16 vs 3.48 +/- 0.09 In-mV2, mean +/- s.e.m., P < 0.001), whereas that of respiratory fluctuations was similar (2.60 +/- 0.24 vs 2.56 +/- 0.19 In-mV2, P = n.s.). The 0.1 Hz power was 2 standard deviations below the mean of controls (P < 0.05) in 13/23 diabetic patients; this abnormality was significantly more frequent than abnormalities in any other autonomic test (P < 0.001).

CONCLUSIONS

Since the observed reduction was confined to those microvascular fluctuations under autonomic control, but not to those dependent on passive mechanical transmission, the reduction in spontaneous microcirculatory vasomotion appears to be determined mainly by sympathetic dysfunction. Sympathetic impairment of skin microvascular control seems to be a common finding, and is probably an early index of autonomic dysfunction in insulin-dependent diabetes.

[Benign symmetrical lipomatosis: Madelung's disease]

Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngeal-tracheal area and of the esophagus. This disease normally affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Surgical removal of the lipomatose mass is the treatment of choice even though there are frequently recurrences. A case is presented of a rare laryngeal localization of this disease and diagnosis and treatment are discussed.

Sinus infection in intensive care patients

Sinusitis is a complication known to accompany nasotracheal intubation, but its frequency has not been well established. During a two-year-period, 1,126 patients in an intensive care unit have been studied. Twenty-seven of them (2%) developed a bacterial sinusitis. The diagnosis is established on the basis of an unexplained clinical sepsis, imaging evidence of fluid in the maxillary sinus, and antral puncture. Microbiological samples showed Gram-negative micro-organisms, in particular Pseudomonas aeruginosa, and an elevated percentage of Staphylococcus aureus and Escherichia coli. The likely predisposing factors (nasogastric and/or nasotracheal tubes) are discussed. Aetiology, diagnosis and management of the disease are discussed in detail. The importance of prompt removal of nasal instrumentation and of early sinus drainage, in addition to broad-spectrum antibiotic therapy, is emphasized.

Chronic tonsillitis in children: activation of polymorphonuclear cells from peripheral blood and tonsillar tissue. In vitro production of MPO, ECP and EPX

Activation of polymorphonuclear cells (PMNs), neutrophils and eosinophils, occurs in response to infections. Myeloperoxidase (MPO) is an enzyme contained in neutrophils with toxic activity for many microorganisms including bacteria. Fosinophil cationic protein (ECP) and eosinophil X protein (EPX) are released by activated eosinophils in response to different inflammatory stimuli. Determination of serum levels of MPO, ECP and EPX permits assessment of the state of activation of these cells. The purpose of this study was to evaluate the state of activation of neutrophils and eosinophils present in tonsillar tissue and peripheral blood from 30 children (18 boys and 12 girls) undergoing tonsillectomy for chronic tonsillitis. For determination of serum levels of MPO, ECP and EPX, peripheral blood samples were obtained at the time of surgery: PMNs were separated by erythrosedimentation from peripheral blood and from tonsillar tissue after surgery and cultured for 7 days. The cells were plated (10(5) well) and the plates were incubated in 5% CO(2), 7% O(2), 80% N(2). After 2, 24, 48, 72, 96, 120, 144 h, supernatants were removed from the cultures of both tonsillar tissue and peripheral blood PMNs for determination of in vitro release of MPO, ECP and EPX. The assays were carried out using a radioimmunotechnique (RIA, Pharmacia) and the concentrations of the three proteins (mean/6 wells) for each time were expressed in mu g/l. The data suggest activation of PMNs in children with chronic tonsillitis.

The role of tissue colonization and bacterial resistance in recurrent tonsillitis

Unsuccessful medical therapy for treatment of acute tonsillitis frequently results in onset of recurrent or chronic forms rendering surgical treatment necessary. We have studied some of the factors involved in the evolution of these chronic or recurrent forms and, in particular, the distribution of different bacterial strains in tonsillar tissue, their response to treatment with antibiotics and mechanisms of bacterial resistance. The distribution of bacterial flora (saprophytic and pathogenic) present on the surface of the tonsils, in the crypts and in the tonsillar tissue was studied in a control population of 30 children (20 boys and 10 girls) aged between 2-13 years, all affected with chronic tonsillitis and submitted to tonsillectomy. The same study was performed in a group of 80 sex and aged matched children, also presenting with chronic or recurrent tonsillitis and treated with amoxicillin or amoxicillin-clavulanic acid or cefaclor or clarithromycin 72 h before surgery. The 80 subjects were randomly divided into four groups so that each antibiotic was tested on 20 subjects. The distribution of the bacterial population on the surface of tonsillar tissue, in the crypts and in the deeper tonsillar tissue is of particular interest concerning the affinity of bacteria to the different tissue areas. In particular the interaction between crypt and tonsillar core, which could be a factor involved in the process of worsening of bacterial infection in the tonsils, is evidenced. The four antibodies tested showed different abilities to eradicate infection: Haemophilus influenzae was found to be the most resistant germ to antibiotic therapy and was thus the most frequent cause of recurrent infections. The characteristics and the mechanisms of adherence and resistance to beta lactam antibiotics were also analysed.

[Spiral computerized tomography with tridimensional reconstruction (spiral 3D CT) in the study of maxillofacial pathology]

Three dimensional computer reconstruction of CT scans provide head and neck surgeons with an exciting interactive display of clinical anatomy. The 3D CT reconstruction of complex maxillo facial anatomic parts permits a more specific preoperative analysis and surgical planning. Its delineation of disease extension aids the surgeon in developing his own mental three-dimensional image of the regional morphology. Three-dimensional CT permits a clearer perception of the extent of fracture comminution and resulting displacement of fragments. In the case of maxillo-facial tumors, 3D images provide a very clear picture of the extent of erosion involving the adjacent critical organs. Three-dimensional imaging in first generation 3D scanners did have some limitations such as long reconstruction times and inadequate resolution. Subsequent generations, in particular the spiral 3D CT, have eliminated these drawbacks. Furthermore, costs are comparable with those of other computer reconstruction technology that might provide similar images. Representative cases demonstrating the use of 3D CT in maxillofacial surgery and its benefits in planning surgery are discussed.

Oral therapy with flurithromycin in ear, nose and throat infections

In this study efficacy and tolerability of flurithromycin ethylsuccinate (FE) were evaluated in ear, nose and throat infections. One hundred and three patients were treated with FE tablets 375 mg 12-hourly for a mean duration of treatment of 8.2 days and they were divided into groups according to the pathology: pharyngitis/tonsillitis (chronic 7, acute 38), rhinosinusitis (chronic 7, acute 12), otitis (chronic 6, acute 32) and sialadenitis (acute 1). Patients evaluable for clinical efficacy were 101, among them a complete recovery was registered in 88.2%, an improvement in 9.9% and a treatment failure in 1.9%. Bacteriological evaluation was possible in 95 patients, showing the eradication of the pathogen in 94.7%. Tolerability was judged to be excellent in 81.6%, good in 15.5% and discrete in 2.9%. These results demonstrate that FE is safe and effective in the treatment of infections established on acute or chronic inflammatory states.

Proliferative characteristics of head and neck tumors. In vivo evaluation by bromodeoxyuridine incorporation and flow cytometry

Cell proliferation of head and neck cancers was studied in 52 patients using in vivo bromodeoxyuridine (BUDR) incorporation. Patients received 250 mg BUDR intravenously several hours prior to biopsy of the tumor tissue. Bivariate flow cytometry was used and enabled us to rapidly obtain DNA ploidy, labelling index (LI), DNA synthesis time (TS) and tumor potential doubling time (Tpot). This method was found to be suitable to obtain complete cytokinetic data in 46/52 (88.5%) patients. The mean BUDR LI was 7.9% (range 2-18%); mean TS was 11.6 h (range 6-28.5 h); mean Tpot was 5.7 days (range 2-30 days). BUDR LI and TS were significantly correlated with histological differentiation grading: G3 tumors showed higher LI values and shorter TS values than G1/G2 tumors. A similar correlation was found between LI or TS and tumor dimensions. Tpot was also significantly lower in larger tumors, such as in those with a higher grading. No significant correlation was found between LI or TS and DNA ploidy (50% of the tumors in our series were DNA aneuploid), while Tpot was found to be 10 days in diploid tumors, compared to only 6.3 days for the aneuploid tumors (p < 0.05). All cases with documented lymph node involvement (N+) showed significantly higher LI, and shorter TS and Tpot values if related to nodal free ones (Tpot = 10 days in N+ patients and 6.3 days in N- patients; p < 0.05). The results of this study suggest that the method employed is clinically feasible and could be a useful aid in defining the prognosis of head and neck cancer patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Phasic changes in human nasal and skin blood flow: relationship with autonomic tone

To assess the autonomic control of the microcirculation in human skin and nasal mucosa, the spontaneous fluctuations of a laser Doppler signal recorded on forearm skin and nasal mucosa were compared with heart rate fluctuations and the respiratory signal in 11 healthy subjects by means of spectral analysis. Possible direct mechanical-thermal effects of airflow on the nasal mucosa were evaluated by comparing recordings obtained when the subjects were breathing through either the nose or the mouth. Comparison of the spectral analysis of the signal obtained for skin and nasal mucosa blood flow allowed us to define the characteristics of the autonomic tone of the microcirculation in these two areas. The skin is mainly influenced by sympathetic activity, and the nasal blood flow is regulated by both sympathetic and parasympathetic activity.

[Anaerobic cervical cellulitis: a therapeutic approach]

The possibility of life-threatening complications arising from cervico-facial infections is well known. Deep cervical infections, however, rarely spread to the mediastinus. Organisms responsible for these infections usually include either aerobic or anaerobic microorganisms, whose synergistic activity provokes virulence and contributes to the violent nature of infection. Prompt recognition is vital if appropriate treatment is to be given. Initial management of deep-neck infections consists in intensive parenteral antibiotic therapy. Nevertheless, in spite of antibiotic therapy, mortality due to suppurative mediastinitis remains high. The Author emphasizes the importance and gives priority to surgical drainage and debridement, another fundamental part of treatment.

[Evaluation of the fluidifying effect on nasal mucus of physiologic solution combined with increasing concentrations of polysorbates]

Nasal decongestants are widely used in the treatment of rhinitis. Decongestant drugs are one of the main components, but numerous reports gave been made concerning side, local and general effects. The problem is particularly important in the treatment of infantile rhinitis for which the use of saline solution alone is often preferred. The paper evaluates the fluidifying action of a saline solution and polysorbate 20, a tensioactive molecule, on nasal mucous. Changes in mucous viscosity were assessed using a "filancemeter" and thromboelastograph. At the same time a clinical study on the efficacy of treatment and the possible presence of side effects was carried out in a population of rhinitic subjects. The study highlighted the fluidifying effect of the preparation on nasal mucous and the complete absence of side effects.

HLA haplotype segregation and ultrastructural study in familial immotile-cilia syndrome

The immotile-cilia syndrome (ICS) is a congenital disorder characterized by dysmotility or even complete immotility of the cilia in the ciliated epithelia. The most frequent consequences include recurrent airway infections from early childhood. Neonatal asphyxia often occurs. Males are usually sterile, whereas females may be fertile or infertile. The disease is inherited as an autosomal recessive trait, but previous attempts to localize the ICS susceptibility gene have so far been unsuccessful. Here, we present the case of two sib pairs affected by ICS from two unrelated families. The electron microscopic investigation of nasal biopsies showed structural anomalies of the cilia, characterized by single microtubules or doublets, arranged randomly in the axoneme. Histocompatibility antigen (HLA)-genotyping of all family members revealed: 1) a significant association of ICS with the HLA-DR7; DQW2 haplotype, which is shared by all the affected sibs (P = 0.0099; RR = 25.94); 2) a possible linkage of the ICS susceptibility gene with HLA, both the affected sibs being HLA-identical, the healthy brother in family B being HLA-different (sib-pair analysis: P less than 0.001).

Modifications of the nasal cycle in patients with hypothalamic disorders: Kallmann's syndrome

The nasal cycle is a phenomenon characterized by cyclic changes in the airflow resistance of each nasal fossa from congestion or constriction of the nasal erectile tissue. This phenomenon is caused by alterations in the influence exerted by the autonomic nervous system and is believed to be regulated by a hypothalamic center. In order to verify this hypothesis on the hypothalamic regulation of the nasal cycle, the authors studied a group of subjects with Kallmann's syndrome. This disorder is characterized by coexisting hypothalamic hypogonadism and hyposmia or anosmia due to hypothalamic and olfactory center hypoplasia. An anomalous nasal cycle was found in all the subjects with Kallmann's syndrome. This disorder might be related to hypothalamus atrophy.

Use of serum markers in the diagnosis and management of laryngeal cancer

Many neoplastic diseases are reported to be accompanied by the presence or associated with an increase in biological substances identified as tumour markers. The most common markers implicated in head and neck cancers are CEA, TPA, LASA, SCC, CA 19-9, and ferritin. These markers (except SCC) were evaluated in 50 patients with a laryngeal carcinoma, in 20 patients with benign lesions, and in 20 healthy subjects. The results show for each marker assayed the following sensitivity values (true positives): CEA, 10%; CA 19-9, 30%; TPA, 30%; LASA, 90%; ferritin, 60%. Specificity (true negatives) was as follows: CEA, 85%; CA 19-9, 99.4%; TPA, 98%; LASA, 99.8%; ferritin, 97%. LASA and ferritin seem to be the most suitable markers for patient monitoring because of their higher sensitivity in all phases of cancer disease.

Autonomic nervous system and microcirculation in diabetes

In order to evaluate the occurrence of sympathetic impairment of skin microvascular control in diabetes, we evaluated the spectral analysis of forearm skin laser-Doppler fluctuations in nine insulin-dependent diabetic subjects and in 21 controls of similar age. Low-frequency oscillations (around 0.1 Hz) were significantly lower in diabetics than in controls (2.333 +/- 0.340 (mean +/- SEM) units vs. 3.486 +/- 0.093 units, P less than 0.001), whereas no significant differences were found between the two groups regarding high-frequency respiration-related oscillations. These results suggest that the loss of rhythmicity in diabetic subjects is selectively related to low-frequency oscillations, mostly under sympathetic control, and is likely to be dependent on autonomic abnormality.

Concentrations of flurithromycin in serum and tonsils

The concentrations of flurithromycin in serum and palatine tonsils of eleven adult male patients undergoing tonsillectomy were determined. Each patient received 500 mg t.i.d., in all ten doses, before tonsillectomy. Flurithromycin concentrations were measured by a microbiological method. Mean serum levels (+/- SE) were 0.72 microgram/ml (+/- 0.19) after 8 h from the 9th dose and 0.67 microgram/ml (+/- 0.13) after 4 h from the 10th dose. Average concentrations (+/- SE) in tonsils were: 1.43 +/- 0.20 microgram/g (right) and 1.32 +/- 0.21 (left) 4 h after the last administration. Therefore, the mean tissue/serum ratio was about 2:1. These results indicate a good diffusion of flurithromycin from serum to tonsillar tissue.

Relationship between phasic changes in human skin blood flow and autonomic tone

Heart rate beat-to-beat oscillations synchronous with respiration and blood pressure waves, have been found to be a marker of sympathovagal interaction in man and animals. Oscillations of heart rate, respiration, and cutaneous blood flow were simultaneously recorded to assess the relationship between autonomic nervous control and cutaneous circulation in a group of 21 healthy subjects and in a group of 6 healthy patients after brachial plexus anesthesia and consequent sympathetic blockade. In the first group, changes in posture were employed to modify autonomic tone. Relative changes in cutaneous blood flow were recorded by laser-Doppler flowmetry. Spectral analysis techniques (cross-correlation) were used to quantify the relationship between oscillations common to the recorded signals. A standing maneuver induced a significant decrease of the cross-correlation between respiratory and heart rate fluctuations (from 4.93 +/- 0.16 to 4.44 +/- 0.16 a.u.; P less than 0.001), and a significant increase of the cross-correlation between heart rate and skin blood flow fluctuations (from 0.64 +/- 0.31 to 1.33 +/- 0.21 a.u.; P less than 0.001), but did not modify the cross-correlation between respiratory and skin blood flow fluctuations (from 2.87 +/- 0.15 to 3.04 +/- 0.14 a.u.; NS). After the standing maneuver the maximum correlation between heart rate and skin blood flow was always due to oscillations in the range of 0.1 Hz (or 10-sec period), similar to the oscillations described in large arteries. Sympathetic blockade reduced significantly the cross-correlation between heart rate and skin blood flow (P less than 0.001). These results suggest that the cross-correlation between skin blood flow and heart rate at 10-sec period fluctuations can be used as an index of the influence of the autonomic tone on skin blood circulation.

Roxithromycin disposition in tonsils after single and repeated administrations

Levels of roxithromycin in serum and tissue were investigated in 29 subjects undergoing tonsillectomy. A total of 13 subjects received a single oral dose of 300 mg, and 16 received four oral doses 12 h apart as follows: a 300-mg loading dose followed by three 150-mg doses. Measurable levels of roxithromycin were present in tonsil samples of 11 of 13 subjects in the first group. The mean levels in tonsils and serum were 0.8 microgram/g and 6.7 micrograms/ml, resulting in a mean tissue/serum ratio of 0.16. In the multiple-dose group, roxithromycin was found in 14 of 16 subjects at mean levels in tonsils and serum of 1.6 micrograms/g and 8.7 micrograms/ml, and the tissue/serum ratio was 0.23.

Prognostic parameters in metastatic spread of laryngeal cancer: clinico-histopathological correlations

The authors present a series of 130 patients with laryngeal tumours submitted to total or horizontal laryngectomy and to neck dissection. The possible correlations between the staging and histology of the primary lesion, tumour marker (LASA) and the incidence of lymph node metastases are examined. The information provided by clinical and histopathological parameters is no doubt useful, but the margin of clinical error is high. On the contrary, the tumour marker concentration (LASA) was significantly higher in the patients whose lymph nodes were found to be histologically invaded, than in those without metastatic spread. Consequently, the LASA test may assume clinical importance before surgical therapy and in the follow-up of treated patients.

Harmonic versus impulsive acceleration testing of the vestibulo-ocular reflex in normal humans

Vestibulo-ocular reflex (VOR) was tested in 9 normal humans by using both harmonic (sinusoidal) and impulsive (post-rotatory) angular accelerations. VOR gain and main time constant were 0.49 +/- 0.20 and 15.48 +/- 2.26 s, respectively, when computed from sinusoidal responses, 0.45 +/- 0.17 and 14.28 +/- 3.07 s when computed from impulse responses. Paired comparison could not prove statistically significant differences between the two sets of data. The conclusion is drawn that, in normals, equivalent information about VOR static and dynamic characteristics can be derived from either harmonic acceleration or post-rotatory tests.

Polygraphic study of vestibular stimulation in epileptic patients

Vertigo, vestibular function and the effect of labyrinthine stimulation on the EEG were studied in 29 epileptic patients. Vertigo has no distinguishing characteristics and the epileptic nature of this symptom can be only tentatively inferred from its chronological relationship with the other epileptic features. In a high percentage of epileptic subjects, especially those with focal seizures, abnormal vestibular responses can be observed. This finding may be ascribed to the existence of a common cerebral lesion responsible for both focal seizures and vestibular abnormalities, even though the data do not allow us to exclude the role played by antiepileptic treatment in modifying the vestibular response. Caloric labyrinthine stimulation in the method employed by us shows a limited activating effect on the EEG and clinical epileptic pattern. Even in the positive cases this method does not allow us to reach any precise anatomo-physiological conclusions.

IgM and IgD concentrations in the serum and secretions of children with selective IgA deficiency

Serum IgG and serum and secretory IgM, IgA and IgD levels were determined in 14 children with selective IgA deficiency and in 12 age and sex matched healthy controls. IgD was determined using a highly sensitive ELISA technique. In the healthy controls serum IgG, IgA and IgM were all in the age normal range, and serum IgA was significantly higher than secretory IgA with IgA in nasal secretions being significantly higher than in saliva. In the IgA deficient children serum IgG and IgM and secretory IgM were present in higher concentrations than in the controls but the difference was statistically significant only for serum IgG and salivary IgM. IgD was detectable in the serum and secretions of all patients and all but one control subject. Like IgM, serum IgD levels were significantly higher than secretory IgD levels and IgD was present in greater concentrations in nasal secretions than in saliva both in the patients and the controls, with no difference between the two groups. Thus, the data of this study show that while serum and secretory IgM levels are elevated in children with selective IgA deficiency, serum and secretory IgD are present in normal concentrations, supporting the hypothesis of a compensatory increase in IgM but not in IgD in such patients.

[Tranexamic acid in the prevention of oropharyngeal radiomucositis]

The therapeutic effect of tranexamic acid in prevention of radiomucositis has been evaluated in a double blind study. The results suggest that tranexamic acid can be the useful for the treatment of radiomucositis in head and neck cancer patients submitted to radiotherapy.

Oculomotor abnormalities after labyrinthine and cerebellar lesion. A case report

A subject presenting a rare association of left labyrinthine and left hemispheric cerebellar lesion was examined, with recording and analysis of eye movements at different intervals. A complete compensation of the vestibular deficit and recovery of cerebellar postural ataxia, with persistence of limb incoordination and oculomotor abnormalities, were observed. The saccadic, smooth pursuit and optokinetic nystagmus systems were impaired. Ocular signs, in combination, may suggest a cerebellar dysfunction but they do not supply sufficient diagnostic criteria for localizing the cerebellar damage. Only the direction-specific impairment of smooth pursuit and optokinetic nystagmus is indicative of the side of the lesion.

Impaired suppression of vestibular nystagmus by fixation of visual and acoustic targets in neurological patients

Suppression of vestibular nystagmus induced by fixation of visual and acoustic targets moving with the head during sinusoidal rotation (0.1 Hz, 75 degrees/second peak velocity) was tested in cerebellar and noncerebellar patients. Visual suppression was impaired greatly in cerebellar patients, without correlation with visual smooth-pursuit defects. Acoustic suppression was equal to or slightly weaker than visual suppression. In noncerebellar patients, a disturbance of visual suppression was found only in the presence of a severe impairment of pursuit eye movements. Acoustic suppression did not parallel the visual-suppression pattern. In clinical vestibular examination, an impaired modulation of the vestibulo-ocular reflex suggests a cerebellar dysfunction, but also can occur in the presence of disorders of other parts of the CNS severely affecting the SP system.