The use of hyaluronic acid as an adjuvant in the management of gingivitis

Recently, a specifically designed device was proposed that is able to nebulize particles with a diameter of approximately 16 micrometres to be used mainly in the management of diseases of the upper airway respiratory tract. The purpose of this pilot study is to evaluate the potential efficacy of nebulized hyaluronic acid in the management of gingivitis. The results of the statistical analysis demonstrate that there was no difference between the pocket depth as measured in the treated sites at time 0 (pre-treatment) and time 1 (15 days post-treatment). However, the difference between bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, with a slightly greater improvement on the side treated with HA.

The use of hyaluronic acid as a support of two different micronized biomaterials in crestal sinus lift procedures. A report on two case studies with volume comparison

In the context of the trans crestal maxillary sinus lift, a wide variety of biomaterials have been used to fill the sub-antral space over the years. The materials that have a pasty consistency and are smooth and free from lumps are the most suitable to come into contact with the Schneiderian membrane which, if torn, cannot perform its graft containment function. In this study, a micronized heterologous bone in a collagen matrix of two different percentages was used in order to fill the maxillary sinus. Before using biomaterial as filler, a spray form of hyaluronic acid was used to disinfect the surgical site before and after the surgery, along with more consistent and pasty form of gel of hyaluronic acid being used in order to facilitate the detachment of the membrane. The surgical procedures were designed and carried out using computer-planned surgery. The filling volume obtained was measured with a comparative software programme and using an ellissoid formula. This technique allows the surgery to be performed in a way that is both minimally traumatic and invasive, fully careful of the membrane and represents a viable alternative to those surgical techniques for crestal sinus lift currently in use.

The use of hyaluronic acid as an adjuvant in the management of periodontitis

The emollient and restructuring action exerted on the mucous membranes by hyaluronic acid is of particular significance. This is thanks to its reparative (it stimulates angiogenesis) and soothing properties (hyaluronic acid is used in wound care to improve the processes of wound healing), which are effective in treating the symptoms of local inflammation and irritation. The purpose of this clinical trial is to evaluate the potential efficacy of nebulized hyaluronic acid in the management of chronic periodontitis in adults. The results of the statistical analysis demonstrate that there was a slight improvement in the measurement of pocket depth in the side treated with HA at time 0 (pre-treatment) and time 1 (15 days post-treatment). Furthermore, the difference between bleeding on probing as measured at time 0 and time 1 indicated an improvement on both sides, with a slightly greater improvement on the side treated with HA.

The efficacy of topical hyaluronan in rhinosinusitis: a systematic review

Rhinosinusitis is one of the most common inflammatory conditions of the nasal cavity and paranasal sinuses and is one of the most common causes of absence from work and for visits to the family doctor. The treatment strategy in both acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) is to reduce the severity of the symptoms, minimize the duration of the disease and prevent complications. Topical therapy has become an important tool in otolaryngologists’ armamentarium for rhinosinusitis treatment. Recently, topical hyaluronic acid (HA), the major component of many extracellular matrices that promotes tissue healing, including activation and moderation of the inflammatory responses, cell proliferation, migration and angiogenesis, has been proposed for ARS and CRS adjuvant tool. The aim of the study is to systematically review the published literature regarding all the therapeutic effects of HA on the ARS and CRS. Relevant published studies were found in PubMed, Google Scholar and Ovid, using a combined keyword search or medical subject headings. At the end of our study selection process, 5 relevant publications were included: 2 of them investigated the potential role of HA in reducing symptoms and preventing exacerbations of CRS in adult population, two of them in paediatric patients affected by upper respiratory tract infections and one of them in cystic fibrosis patients with bacterial rhinopharyngitis. Data deriving from the present review of 5 clinical studies showed that the use of topical HA represents a relevant therapeutic advance in rhinosinusitis to minimize symptoms and prevent reacutization with a significant improvement of their quality of life, as it avoids systemic side effects and increases local drug activity. Further studies on larger populations and with new specific nebulization devices for upper airway are needed to confirm these encouraging results.

Topical hyaluronic acid in rhinitis medicamentosa: could our perspective be changed?

This study was designed to prospectively evaluate the role of nebulized hyaluronic acid (HA) administered for 10 days as treatment for patients with rhinitis medicamentosa (RM). RM is a pathological condition of the nasal mucosa induced by prolonged, excessive or improper use of topical decongestants. It is characterized by persistent nasal congestion that can lead the patient to increase the frequency of application and the quantity of the substance being applied, resulting in dependence on topical nasal decongestants. Twenty-five patients were treated with HA nebulized via Spray-sol twice a day for 10-days (T1) (HA Spray-sol treatment group). Subsequently, after 3 days of washout, patients were treated with physiological saline nebulized via Spray-sol twice a day for 10 days. (T2) (saline Spray-sol treatment group). The HA Spray-sol treatment group (tp) significantly improved visual analogue scale (VAS) scores (T0=6.25±1.64 vs T1=3.91±1.30; p less than 0.05), whereas there was no statistically significant difference in the saline Spray-sol treatment group (tp) (p>0.05), results confirmed by the anterior active rhinomanometry (AAR) data (HA Spray-sol tp T0=1.193±0.83 vs T1=0.44±0.25, p less than 0.05; saline Spray-sol tp (p>0.05). An improvement in the Global Rhinitis Score (GRS) was recorded in both groups (T0=15.37±5.16 vs T1=5.54±3.23, p less than 0.05; saline Spray-sol tp T0=15.37±5.16 vs T2=10. 7±5.43; p less than 0.05). Both groups showed a significant reduction in mucosal oedema and nasal secretions. Patients treated with HA Spray-sol reduced or even eliminated (11/25 patients) the use of topical decongestant within 10 days of treatment with HA. The results of this study suggest nebulized topical 9-mg sodium hyaluronate plays a pivotal role in the management of RM.

Post-operative nebulized sodium hyaluronate versus spray after functional endoscopic sinus surgery for chronic rhinosinusitis

We prospectively evaluated the efficacy of nebulized Hyaluronic Acid (HA) as an adjuvant treatment to hasten the improvement of nasal respiration and to minimize patients’ discomfort in the postoperative functional endoscopic sinus surgery (FESS) for chronic rhino-sinusitis (CRS). We enrolled 33 CRS adult patients who underwent endoscopic functional sinus surgery. They were randomly assigned into two groups: Spray-Sol group (18 patients) with HA nebulized with a new nasal device named Spray-Sol and Spray group (15 patients) with a HA nebulized with a common spray. Both groups were treated twice daily for 4 weeks. CRS questionnaire, Visual analogic scale (VAS) and nasal endoscopy were used to assess the outcomes of the treatments during the 1st month of follow up. The mean VAS score of the Spray-Sol group at 2 weeks was significantly lower than the Spray group (5.2±2.1 vs 10.5±3.7; p less than 0.05). The VAS score remained significantly lower in the Spray-Sol group also at the 4 weeks (2.9±0.8 vs 6.1±3.4; p less than 0.05). The CRS score was significantly better at week 2 and 4 in both groups in comparison with baseline values, with better results in the Spray-Sol group. Since the first visit the Spray-Sol group also showed significantly lower crusts, edema and secretions than the Spray group (p less than 0.05). The compliance to treatment was similar in both groups. The results of this prospective study suggest a role nebulized of HA through new device (Spray-sol) as a supportive treatment for faster improvement of nasal respiration, also minimizing patient discomfort, promoting nasal mucosa healing in postoperative FESS for CRS.

Effect of biostimulation on oral fibroblast: a pilot study

Bio-stimulation is a technique in aesthetic medicine in which different drugs such as nucleotides, antioxidants and glucosaminoglycans precursors are injected in the dermis to improving the anabolic function of dermal fibroblasts, i.e., protein synthesis, replication and production of extracellular matrix components. It can be achieved with multiple intra-dermal injections, using two protocols: 1) Polydeoxyribonucleotide (PDRN) plus glucosamine sulphate (Gluc); 2) N-acetylcysteine (NAC) and amino acids (Aa) (named Bio- NAC procedure). Since the role of drugs used in biostimulation on human dermal fibroblasts is not completely understood, the aim of this study is to evaluate the effect of these substances in primary cell cultures by using RT-PCR and a panel of specific genes (ELN, DSP, FN1, FBN1, ITGA1, ITGA2, ITGA5, ITGB1, COL1A1,COL3A1) to detect their effect on cell metabolism and extracellular matrix components. Both the treatments were responsible for Elastine and Desmoplakin genes activation. Only NAC plus Aa treatment enhance the expression of other genes related to tissue growth and elasticity like FBN1, ITGA1 and ITGB1. All the other genes investigated (FN1, ITGA5, ITGA2, COL1A1, COL3A1) were down-regulated by both treatments. Since the precise role of these proteins in tissue integrity and aging is not known, this study confirms the usefulness of biostimulation therapies in enhancing some of the genes responsible of cellular wellbeing. This study could be useful to consider the possibility of injective biostimulation in oral cavity, clinical applications in oral healing and in gingival atrophy as well.

Biorevitalization: an in vitro study on gingival fibroblast

Bio-revitalization is a therapy commonly used in aesthetic medicine to improve skin quality by di¬rectly integrating hyaluronic acid alone or added to other molecules (i.e. vitamins) through intradermal injections. These injections are not aimed to fill roughness but to achieve extracellular matrix optimi¬zation. The injective medical devices used in aesthetic medicine differ for hyaluronic acid content and for the presence of additional molecules that characterize the formulation of a particular company. The aim of the present study is to compare HA with different compounds in regard to their effects on cultured fibroblasts over time by using RT-PCR and a panel of genes (ELN, DSP, FN1, FBN1, ITGA1, ITGA2, ITGA5, ITGB1, COL1A1, COL3A1) involved in connective integrity. Bio-revitalization is able to activate genes involved in tissue integrity. The reported data add new insight in the comprehension of molecular mechanism related to BR. These preliminary data have to be developed through additional experiments. However, an injective therapy seems to be effective in gingival fibroblast stimulation.

Systematic review: the efficacy of topical hyaluronic acid on oral ulcers

The management of oral ulcers is a challenge for clinicians. Whilst there is widespread use of topical corticosteroids, antibiotics and antimicrobial, there is only weak evidence for the effectiveness of any of the topical treatments. Hyaluronic Acid (HA) has been recently proposed for topical administration in the treatment of oral ulcers and other painful oral lesions. The aim of the study is to systematically review the published literature regarding all the therapeutic effects of HA on painful oral lesions such as oral ulcers and oral lichen planus. Relevant published studies were found in PubMed, Google Scholar and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 4 relevant publications were included: two regarding oral lichen planus, one Behcet’s Disease and Recurrent Aphthous ulcer and one in oral ulcers in general. Both subjective parameters such as healing period, VAS for pain and objective assessments such as number of ulcers, maximal area of ulcer and inflammatory signs, significantly improved after HA treatment. These data allow us to suggest that HA may play a pivotal role in the treatment of oral ulcers.

Risk assessment of legionellosis in cardiology units

Infective Endocarditis (IE) is a disease with high morbidity and mortality. Nowadays, in addition to classic pathogens were isolated exigent Gram negative bacteria as A. baumannii, A. lwoffii, C. burnetii, Bartonella, Chlamydia and Legionella. We present our experience of Legionella isolations in environmental sample (water and air) collected from the Cardiology units belonging to two hospitals in Messina (Italy). A total of 80 samples were carried out, 30 and 50, respectively in the first and in the second structure: 55 of water and 25 of aerosol. The positivity of 30% of the water samples analyzed and 15% of those aerosol strengthens the conviction of the need for greater environmental monitoring, especially in the wards at high risk.

The use of various biomaterials in computer-guided crestal sinus lift procedures. A report on two case studies with volume comparison

PURPOSE

In the context of the transcrestal maxillary sinus lift a wide variety of biomaterials have been used to fill the subantral space over the years. In this study, two types of biomaterials were used in order to fill the maxillary sinus: a nano-crystallized hydroxyapatite in an aqueous solution and a micronized heterologous bone in a collagen matrix.

MATERIALS AND METHODS

The surgical procedures were designed and carried out using computer-guided surgery. The filling volume obtained was measured with a comparative software program.

RESULTS

A ≥ 6 millimeter augmentation of osseous volume was obtained. This result is comparable to those obtained in lifts where conventional techniques were applied. The technique used was very precise and the difference between the projected and clinical outcome of the implant position had an average of less than 0.3 millimeters.

CONCLUSIONS

This technique allows for the surgery to be performed in a way which is both minimally traumatic and invasive, and represents a viable alternative to those surgical techniques for crestal sinus lift currently in use.

A reddish pulsatile mass beyond tympanic membrane: think before act

We report a case of a 76-year-old man that referred to our hospital because of progressive mixed right hearing loss, aural fullness and pulsatile tinnitus synchronized with heart beats. Otoscopic examination revealed a reddish pulsatile mass beyond tympanic membrane. CT and MRI scans showed a class C glomus tumor. Anamnesis and a complete physical examination, with careful differential diagnosis, should be obtained to rule out highly vascularized middle ear lesion before any invasive procedure.

Breathing training on lower esophageal sphincter as a complementary treatment of gastroesophageal reflux disease (GERD): a systematic review

OBJECTIVE

Gastroesophageal reflux disease (GERD) represents one of the most common gastrointestinal disorders, but is still a challenge to cure. Proton pump inhibitors (PPIs) are currently the GERD's standard treatment, although not successful in all patients; some concerns have been raised regarding their long term consumption. Recently, some studies showed the benefits of inspiratory muscle training in increasing the lower esophageal sphincter pressure in patients affected by GERD, thereby reducing their symptoms.

MATERIALS AND METHODS

Relevant published studies were searched in Pubmed, Google Scholar, Ovid or Medical Subject Headings using the following keywords: "GERD" and physiotherapy", "GERD" and "exercise", "GERD" and "breathing", "GERD and "training".

RESULTS

At the end of our selection process, four publications have been included for systematic review. All of them were prospective controlled studies, mainly based on the training of the diaphragm muscle. GERD symptoms, pH-manometry values and PPIs usage were assessed.

CONCLUSIONS

Among the non-surgical, non-pharmacological treatment modalities, the breathing training on diaphragm could play an important role in selected patients to manage the symptoms of GERD.

LINAC-based radiosurgery for melanoma, sarcoma and renal cell carcinoma brain metastases

BACKGROUND

The aim of this study was to report response, overall survival (OS) and toxicity in patients with radioresistant brain metastases (BM) treated with stereotactic radiosurgery (SRS).

METHODS

Patients with renal cell carcinoma, melanoma and sarcoma with one to four brain metastases received SRS without whole brain radiotherapy.

RESULTS

Fifty patients with 77 BM were treated. 46 (92%) patients with 71 BM were evaluable. Median follow-up was 67 months and median OS 11.8 months. At the time of analysis all patients had died. Brain control was conditioned by response to SRS (P<0.0001), while OS by histology (renal cell carcinoma versus melanoma and sarcoma) (P=0.04) and status of the tumour outside the brain (P=0.05). Treatment was well tolerated without more than grade 2 acute toxicity.

CONCLUSIONS

Treatment of BM from radioresistant tumors with SRS assures good brain control and OS with low toxicity. Our data suggest a better prognosis associated to renal cell carcinoma histology.

The use of resorbable heterologous cortical lamina as a new sinus lift floor: a technical note

Some graft materials such as a heterologous porcine cortical lamina have an excellent capacity in creating recipient sites that can be filled with cortico-spongious collagenated bone paste that reabsorbs, allowing for the reformation of good-quality bone. In this work a technique is proposed which makes use of resorbable cortical lamina in order to create a new sinus floor that can be filled with cortico-spongious bone paste. The adequate vascularisation of the graft combined with the integration of the lamina, which does not need to be removed, makes it possible to propose this technique as a potential alternative to those used so far.

Lung reirradiation with stereotactic body radiotherapy

PURPOSE

We examined safety and efficacy of stereotactic body radiotherapy (SBRT) in reirradiation for lung recurrent lesions (LRLs).

MATERIALS AND METHODS

Eighteen patients, 4 with lung local failure from primary non-small cell lung carcinomas and 14 with lung metastases, were reirradiated with SBRT for 29 LRLs. Doses were recalculated to an Equivalent Dose of 2 Gy per fraction (EQD₂) and α/β ratio was assumed to be Gy₁₀ for primary and metastatic lung tumors and Gy₃ for organ at risk. Cumulative administered doses were calculated adding doses of prior radiotherapy and reirradiation.

RESULTS

Peripherally located lesions received 5 fractions of 8-10 Gy, while centrally ones lower doses (5 fractions of 5-8 Gy). Cumulative EQD₂ did not exceed 198 Gy₁₀ and reirradiated volumes were rather small (median 18 cc). Local control was obtained for all patients except one and lasted medially 43 months. Median overall survival was 40 months from reirradiation. Only acute grade 1 toxicity was recorded.

CONCLUSIONS

Reirradiation of LRLs with SBRT was feasible and effective. It is important to appropriately select patient and to adopt organ at risk constrains considering cumulative doses.

Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas

PURPOSE

The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas.

PATIENTS AND METHODS

In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23-82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60-100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 × 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 × 3 Gy).

RESULTS

After a median follow-up of 56 months, 49 (61 %) lesions received 14 × 3 Gy and 31 (39 %) 15 × 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed.

CONCLUSION

Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors.

Artificial nose, NIR and UV-visible spectroscopy for the characterisation of the PDO Chianti Classico olive oil

An authentication study of the Italian PDO (Protected Designation of Origin) olive oil Chianti Classico, based on artificial nose, near-infrared and UV-visible spectroscopy, with a set of samples representative of the whole Chianti Classico production area and a considerable number of samples from other Italian PDO regions was performed. The signals provided by the three analytical techniques were used both individually and jointly, after fusion of the respective variables, in order to build a model for the Chianti Classico PDO olive oil. Different signal pre-treatments were performed in order to investigate their importance and their effects in enhancing and extracting information from experimental data, correcting backgrounds or removing baseline variations. Stepwise-Linear Discriminant Analysis (STEP-LDA) was used as a feature selection technique and, afterward, Linear Discriminant Analysis (LDA) and the class-modelling technique Quadratic Discriminant Analysis-UNEQual dispersed classes (QDA-UNEQ) were applied to sub-sets of selected variables, in order to obtain efficient models capable of characterising the extra virgin olive oils produced in the Chianti Classico PDO area.

Reflux pattern and role of impedance-pH variables in predicting PPI response in patients with suspected GERD-related chronic cough

BACKGROUND

Gastro-oesophageal reflux disease (GERD) may contribute to the onset of chronic cough (CC); however, the multichannel intraluminal impedance-pH (MII-pH) monitoring is often within the normal range and the response to proton pump inhibitors (PPIs) unsatisfactory. The measure of impedance baseline (IB) increases the sensitivity of MII-pH in patients with typical symptoms.

AIM

To evaluate the role of MII-pH variables, including IB, in predicting PPI response and to define the characteristics of the reflux pattern in CC patients.

METHODS

Prospectively selected CC patients suspected GERD-related underwent MII-pH monitoring and, therefore, received a double dose of PPIs for at least 6 weeks. Patients filled symptom scores before MII-pH and after PPI therapy. MII-pH data were compared with those obtained in 60 non-erosive reflux disease patients with typical symptoms.

RESULTS

A total of 156 CC patients entered the study: 68 (43.5%) responders and 88 (56.5%) nonresponders to PPIs. The number of reflux episodes was significantly higher in CC compared with that in typical symptoms patients. Nonresponder CC patients with a pathological acid exposure time (AET) and/or IB value were 43/88 (49%), while 15/88 (17%) presented only pathological AET (P < 0.001). CC patients with a pathological AET or IB, or with both a pathological AET and IB, showed a probability of PPI response twofold greater than patients with normal AET and IB.

CONCLUSIONS

The presence of a pathological AET or pathological IB in CC patients is associated with a greater probability of PPI response. IB is a promising variable in patients with CC, as it increases the diagnostic yield of MII-pH and allows confirmation of the GERD diagnosis in these patients.

Perilimphatic fistula test: a video clip demonstration

Perilymphatic fistula (PLF) is an abnormal condition in which a communication is present between the perilymphatic space of the inner ear and the middle ear or mastoid, secondary to a dehiscence in the otic capsule, oval or round window. LF may induce hearing loss, tinnitus, aural fullness, vertigo, disequilibrium, or a combination of these symptoms; the vagueness of symptoms caused by PLF and the lack of specificity of clinical signs and symptoms make the diagnosis elusive. We report a video of a positive PLF test induced by the application of pressure on the tragus, just anterior to the left external auditory canal in a patient with cholesteatoma and PLF of lateral semicircular canal confirmed by CT scan imaging. https://www.youtube.com/watch?v=x5MhSILF9O4.

The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in simple snoring

BACKGROUND

Simple snoring represents a social problem, not only because it could affect the patient's married life, but it often goes along with sleep-disordered breathing. Chronic nasal obstruction has many sequel including snoring and the inferior turbinate hypertrophy (ITH) is its most common cause. The aim of the study is to evaluate the efficacy of video-assisted endoscopic radiofrequency volumetric tissue reduction (RFVTR) to reduce snoring in patients affected by chronic nasal obstruction due to ITH.

PATIENTS AND METHODS

This prospective study was conducted over 48 habitual snoring with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both it. Nasal symptoms were assessed both subjectively, by Visual Analog Scale (VAS) and NOSE Scale, and objectively by videorhinohygrometer. Snoring was measured by Snoring severity rated by the bed partner, in a longitudinal fashion, using VAS. All patients were evaluated pre-operatively, and after 45th day (range 35-50 days) post-operatively.

RESULTS

Thirty-two subjects completed study. All patients had significant symptomatic improvement in nasal breathing (5.53 ± 2.88 vs 1.87 ± 1.75; p < 0.05), confirmed by videorhinohygrometer values (p < 0.05). We had a significantly improvement of snoring in all patients (5.62 ± 2.80 vs 1.86 ± 1.43, p < 0.001) with a mean snoring Visual Analog Scale improvement of 77.4%.

CONCLUSIONS

Based on this study and literature review, it seems that RFVTR represents a safe, minimal invasive, easy performed, and time and cost effective surgery, which may decrease symptoms of snoring in patients with ITH, at least, in short-term follow-up.

Low and medium doses of hypofractionated stereotactic radiotherapy could be suboptimal for early-stage lung cancer

PURPOSE

This study aimed to analyze the outcome of low and medium doses of hypofractionated stereotactic body radiotherapy (SBRT) in early stage lung cancer.

METHODS

Thirty-five early stage lung cancer patients were treated with SBRT. Initially, SBRT was administered with a low dose of 5 x 8Gy in all cases. Subsequently, a medium dose of 5 x 10Gy for peripherally located lesions was given, continuing to prescribe 5 x 8Gy in centrally located ones. Study endpoints were local control (LC), LC duration, survival and toxicity.

RESULTS

Patients had a good performance status, and T1-2 stage cancer. The SBRT doses of 5 x 8Gy and 5 x 10Gy were administered to 57% and 43% of patients, respectively. At first evaluation after SBRT, local control was obtained in all cases but only 15 (43%) had a complete response. Median duration of LC was 41 months and there was a trend in favor of 5 x 10Gy with respect to 5 x 8Gy in 2- and 3-year LC rates (93% and 69%, versus 60% and 50%, p = 0.1). Four of the 15 (27%) complete responders had local relapse after a quite long median time of 31.5 months. Median overall survival was 40 months. No examined variables (i.e., dose, volume, T stage, and site) significantly conditioned LC, duration of LC, failure rate and survival. Both SBRT schedules were well tolerated.

CONCLUSION

Outcome of low and medium SBRT doses in terms of LC, duration of LC, patterns of failure and survival was suboptimal compared with recently reported results of SBRT in early stage lung cancer patients.

Upper airway study should always come before any sleep study in OSAS evaluation: a giant parapharyngeal lipoma behind OSAS

BACKGROUND

The parapharyngeal space (PPS) is a rare site for neoplasms in the head and neck and lipoma represents 0.5% of all head and neck tumors.

CASE REPORT

We describe a case of a giant parapharyngeal lipoma in obese adult patient causing anatomic pharyngeal obstruction with severe obstructive sleep apnea (OSA) syndrome. The patient was successfully operated with transcervical approach.

CONCLUSIONS

In patients presenting with symptoms suggestive of OSA, it is essential to rule out any physical cause and perform a comprehensive ear, nose and throat examination including fibro-endoscopic upper airway examination before referral for sleep study and management. The ideal management for OSA involves treating the underlying cause. If no definitive cause is identified, management should begin with conservative measures such as lifestyle changes and a weight loss program; if these are unsuccessful, continuous positive airway pressure (CPAP), oral appliances or upper airway surgery could be considered. Better diagnostic methods should be developed to identify the main OSA causes and improve therapeutic outcomes.

Meningeal Involvement in Wegener Granulomatosis: Case Report and Review of the Literature

Wegener Granulomatosis (WG) is a multisystem autoimmune disorder characterized by necrotizing granulomatous vasculitis that most commonly involves the upper respiratory tract, lungs, and kidneys. The involvement of the central nervous system (CNS) is infrequent and can cause stroke, cranial nerve abnormalities, cerebrovascular events, seizures, and meningeal involvement. Meningeal involvement is rare and may occur due to local vasculitis, directly spread from adjacent disease in the skull base, paranasal or orbital region. We describe the case of a 20-year-old Caucasian man who was diagnosed with sinonasal WG with frontal focal meningeal involvement. A literature review on diagnosis and treatment of meningeal involvement in course of WG was carried out. The importance of an early diagnosis and treatment of localized WG has been emphasized, in order to avoid the progression to a severe form of disease, especially in younger patients and in paucisymptomatic cases.

Distortion-product otoacoustic emissions: a useful test for monitoring ototoxicity induced by pegylated interferon and ribavirin treatment in patients with chronic hepatitis C

Pegylated-interferon (peg-IFN) and ribavirin combination therapy for the treatment of hepatitis C virus (HCV) infection is well known to be associated with significant adverse effects. Several studies have investigated a possible auditory pathway involvement during IFN therapy, but a method to monitor the potential auditory involvement during treatment has not yet been described. The aim of this study is to evaluate possible modifications of the outer hair cell (OHC) function in HCV patients receiving peg-IFN and ribavirin combination therapy. Thirteen adult HCV patients (8 F/5 M, mean age 52∓12 years) treated with peg-IFN and ribavirin combination therapy underwent Pure Tone Audiogram and Distortion Product Otoacoustic Emission (DPOAE) tests. We compared mean auditory thresholds (PTA) and mean DPOAE amplitude before, at month 3 during, and at the end of treatment (T0, T3, and Tend, respectively), and 3 months after treatment discontinuation (Tfu). No significant differences were found in hearing levels at the different time points analyzed. During treatment, three patients developed tinnitus, which in 2 cases resolved spontaneously after the end of therapy. Compared to T0 (19.5±0.83), a statistically significant DPOAE increase at T3 (30±1,26) and Tend (28.6±2.16) was found (p<0.05 at both time points), while DPOAEs returned to pre-treatment levels at Tfu (19.3±1.3). In our group, none of the patients reported a permanent auditory impairment, excluding one patient with persistent tinnitus. Peg-IFN could produce an increase of motility of the OHCs by means of intracellular pathways. DPOAE test could be considered a new method for monitoring ototoxicity induced by IFN. On the basis of recent literature and our audiological results, physicians should be aware of the possible ototoxic effects of peg-IFN, requiring appropriate surveillance, and the patient should be informed of the potential side effects of IFN therapy on the auditory pathway.

A congenital tympanic membrane cholesteatoma (CTMC) in the adult: a case report

OBJECTIVE

We present an additional very rare case of a congenital tympanic membrane cholesteatoma (CTMC) in the adult.

METHOD

Case report and literature review of CTMC.

CASE REPORT

A 54-year old man was referred to us by his primary care physician who noted a white mass on the right tympanic membrane without prior history of otorrhea, tympanic perforations or previous otologic procedures. The pearl was about 5 mm diameter, centered on the umbo of a normal tympanic membrane (TM). The audiogram and the tympanogram was absolutely normal. CT confirmed a soft round shape tissue mass, located in the centre of the TM near umbo. The mass protruded both in the auditory canal and in the middle ear space, touching the malleus extremity, without any relationship with medial wall of the cavum tympani. A surgical excision was performed using a "minimal" retroauricolar transcanalar approach: the CTMC was located into the thickness of the TM, between epidermic and mucous layers. The ossicular chain was preserved intact. A partial myringoplasty (underlay technique) using a temporalis fascia graft was necessary. Histopathology confirmed a cystic cholesteatoma. After two months and one year follow-up, otoendoscopy showed a well-healed TM with a preserved normal audiogram and tympanogram.

DISCUSSION

This exceptional (probably the first reported) case showed the possible localization of the CC in the TM, also in the adult. Criteria for classification of a TM cholesteatoma as congenital and possible pathogenetic mechanisms are discussed.