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Parrilla C, Lucidi D, Petrone G, Bastanza G, Colosimo C. Idiopathic SIADH in young patients: don't forget the nose. Acta Otorhinolaryngol Ital 2018; 37:76-79. [PMID: 28374875 PMCID: PMC5384315 DOI: 10.14639/0392-100x-1141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
Abstract
Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine sinonasal cancer associated by many authors to ectopic production of several biologically active substances. We report a case of a 31-year-old male patient who presented with idiopathic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). During diagnostic work-up, a CT scan of the head was performed and an ethmoidal ONB was detected. Endoscopical surgery followed by radiotherapy was carried out. Immediately after surgery natraemia levels normalised. Five years later the patient is disease-free. To our knowledge, 17 cases of SIADH associated to ONB have been published. In nine reports, idiopathic SIADH promptly led to the diagnosis of the sinonasal mass as in our clinical case, however, in many reports, correct diagnosis was accomplished months to years later. In young patients with idiopathic inappropriate antidiuretic hormone secretion, a neuroendocrine malignancy of the sinonasal area must be excluded.
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Affiliation(s)
- C Parrilla
- Institute of Otolaryngology Catholic university of Sacred Heart, Rome, Italy
| | - D Lucidi
- Institute of Otolaryngology Catholic university of Sacred Heart, Rome, Italy
| | - G Petrone
- Institute of Pathological Anatomy and Cytopathology, Catholic University of Sacred Heart, Rome, Italy
| | - G Bastanza
- Institute of Otolaryngology Catholic university of Sacred Heart, Rome, Italy
| | - C Colosimo
- Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy
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2
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De Corso E, Bastanza G, Della Marca G, Grippaudo C, Rizzotto G, Marchese MR, Fiorita A, Sergi B, Meucci D, Di Nardo W, Paludetti G, Scarano E. Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea. Acta Otorhinolaryngol Ital 2017; 35:426-32. [PMID: 26900249 PMCID: PMC4755054 DOI: 10.14639/0392-100x-959] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p < 0.05)], in mean AHI [(21.4 ± 6 events per hour versus 8.85 ± 6.9 (p < 0.05)] and in mean ODI [(18.6 ± 8 events per hour to 7 ± 5.8 (p < 0.05)]. We observed that the apnoea/hypopnoea index (AHI) improved by up to 50% from baseline in 71.4% of patients selected after DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of selection of patients for oral device treatment.
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Affiliation(s)
- E De Corso
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Bastanza
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Della Marca
- Department of Neuroscience Catholic University of the Sacred Heart, Rome, Italy
| | - C Grippaudo
- Department of Head and Neck Surgery, Dental Clinic Catholic University of the Sacred Heart, Rome, Italy
| | - G Rizzotto
- Department of Neuroscience Catholic University of the Sacred Heart, Rome, Italy
| | - M R Marchese
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Fiorita
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - B Sergi
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Meucci
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - W Di Nardo
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - E Scarano
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
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Giannantoni NM, Minisci M, Brunetti V, Scarano E, Testani E, Vollono C, De Corso E, Bastanza G, D'Alatri L, Della Marca G. Evaluation of pharyngeal muscle activity through nasopharyngeal surface electromyography in a cohort of dysphagic patients with acute ischaemic stroke. Acta Otorhinolaryngol Ital 2017; 36:295-299. [PMID: 27734982 PMCID: PMC5066465 DOI: 10.14639/0392-100x-1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys–). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = –0.31; p < 0.05] and ASPECTS scores [r(48) = –0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.
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Affiliation(s)
| | - M Minisci
- Institute of Neurology, Catholic University, Rome, Italy
| | - V Brunetti
- Institute of Neurology, Catholic University, Rome, Italy
| | - E Scarano
- Institute of Otolaryngology, Catholic University, Rome, Italy
| | - E Testani
- Institute of Neurology, Catholic University, Rome, Italy
| | - C Vollono
- Institute of Neurology, Catholic University, Rome, Italy
| | - E De Corso
- Institute of Otolaryngology, Catholic University, Rome, Italy
| | - G Bastanza
- Institute of Otolaryngology, Catholic University, Rome, Italy
| | - L D'Alatri
- Institute of Otolaryngology, Catholic University, Rome, Italy
| | - G Della Marca
- Institute of Neurology, Catholic University, Rome, Italy
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De Corso E, Bastanza G, Di Donfrancesco V, Guidi ML, Morelli Sbarra G, Passali GC, Poscia A, de Waure C, Paludetti G, Galli J. Radiofrequency volumetric inferior turbinate reduction: long-term clinical results. Acta Otorhinolaryngol Ital 2017; 36:199-205. [PMID: 27214831 PMCID: PMC4977007 DOI: 10.14639/0392-100x-964] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/18/2015] [Indexed: 11/23/2022]
Abstract
The aim of our study was to assess long-term results of radiofrequency volumetric tissue reduction of inferior turbinates (RVTR). We performed a prospective long-term longitudinal evaluation of 305 patients affected by rhinitis (114 allergic and 191 non-allergic) who were unresponsive to medical treatment and underwent RVTR (January 2004 - December 2010). Subjects were followed for a mean period of 39.70 ± 19.41 months (range 24-60). Patients completed the NOSE-scale questionnaire pre- and post-operatively after 1 month and yearly for 5-years. Recurrence was assumed if the post-operative total NOSE score increased by at least 75% during follow-up and the patient restarted medical treatments. Estimation of relapse over time was performed by Kaplan-Meyer analyses. We documented overall good satisfaction of patients regarding the procedure, with a good rate of pain control and a low rate of complications. Post-operatively there was a significant improvement in nasal stuffiness, nasal obstruction and mouth breathing (p < 0.05). We observed a worsening trend for symptoms after 36 months with progressive increasing rate of recurrences that were significantly higher in allergic than non-allergic patients (p < 0.05). We also observed a slight worsening trend of global satisfaction of patients. Our study confirms the minor discomfort and low risk of side effects of RVTR. Our data showed good efficacy of the procedure in the majority of patients for at least 36 months after surgery, and in fact in this time period the cumulative probability to remain relapse-free was up to 0.8. In the following 2 years, we observed a worse temporal trend in term of recurrence rate, and in particular in allergic patients with a significant difference vs non-allergic individuals (p < 0.05).
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Affiliation(s)
- E De Corso
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
| | - G Bastanza
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
| | - V Di Donfrancesco
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
| | - M L Guidi
- Department of Intensive Care and Anesthesiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - G Morelli Sbarra
- Department of Intensive Care and Anesthesiology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - G C Passali
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
| | - A Poscia
- Department of Public Health, Catholic University School of Medicine and Surgery, Rome, Italy
| | - C de Waure
- Department of Public Health, Catholic University School of Medicine and Surgery, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
| | - J Galli
- Department of Head and Neck Surgery - Otorhinolaryngology, Catholic University of the Sacred Heart Rome, Italy
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Bastanza G, Gallus R, De Carlini M, Picciotti PM, Muzzi E, Ciciriello E, Orzan E, Conti G. Achieving effective hearing aid fitting within one month after identification of childhood permanent hearing impairment. Acta Otorhinolaryngol Ital 2016; 36:38-44. [PMID: 27054389 PMCID: PMC4825068 DOI: 10.14639/0392-100x-1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022]
Abstract
Diagnosis of child permanent hearing impairment (PHI) can be made with extreme timeliness compared to the past thanks to improvements in PHI identification through newborn hearing screening programmes. It now becomes essential to provide an effective amplification as quickly as possible in order to restore auditory function and favour speech and language development. The early fitting of hearing aids and possible later cochlear implantation indeed prompts the development of central auditory pathways, connections with secondary sensory brain areas, as well as with motor and articulatory cortex. The aim of this paper is to report the results of a strategic analysis that involves identification of strengths, weaknesses, opportunities and threats regarding the process of achieving early amplification in all cases of significant childhood PHI. The analysis is focused on the Italian situation and is part of the Italian Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children".
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Affiliation(s)
- G Bastanza
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
| | - R Gallus
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
| | - M De Carlini
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
| | - P M Picciotti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
| | - E Muzzi
- Audiology and Otolaryngology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - E Ciciriello
- Audiology and Otolaryngology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - E Orzan
- Audiology and Otolaryngology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - G Conti
- Department of Head and Neck Surgery, Otorhinolaryngology, Catholic University of the Sacred Heart, "A. Gemelli" Hospital, Rome, Italy
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Conti G, Gallus R, Fetoni AR, Martina BM, Muzzi E, Orzan E, Bastanza G. Early definition of type, degree and audiogram shape in childhood hearing impairment. Acta Otorhinolaryngol Ital 2016; 36:21-8. [PMID: 27054387 PMCID: PMC4825064 DOI: 10.14639/0392-100x-1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022]
Abstract
In the context of permanent childhood hearing loss, early audiological diagnosis is a prerequisite for activation of an adequate rehabilitation program to prevent or limit the known effects that auditory deprivation determines on language development and cognitive skills in neonates. Audiological diagnosis consists schematically of three phases: identification of subjects at risk, definition of hearing loss and/or children features, verification of appropriateness of diagnosis itself and a rehabilitation programme. Strategies and methods of audiological diagnosis are well defined and include an integration of data coming from objective methods with clinical and behavioural data. Although the substantial effectiveness of procedures and a general consensus on their use and interpretation have been defined, there are several critical issues concerning the achievement of this objective, which will be discussed in this paper.
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Affiliation(s)
- G Conti
- Department of Head and Neck Surgery, Otorhinolaryngology Catholic University of the Sacred Heart "A. Gemelli" Hospital, Rome, Italy
| | - R Gallus
- Department of Head and Neck Surgery, Otorhinolaryngology Catholic University of the Sacred Heart "A. Gemelli" Hospital, Rome, Italy
| | - A R Fetoni
- Department of Head and Neck Surgery, Otorhinolaryngology Catholic University of the Sacred Heart "A. Gemelli" Hospital, Rome, Italy
| | - B M Martina
- Department of Head and Neck Surgery, Otorhinolaryngology Catholic University of the Sacred Heart "A. Gemelli" Hospital, Rome, Italy
| | - E Muzzi
- Audiology and Otolaryngology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - E Orzan
- Audiology and Otolaryngology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - G Bastanza
- Department of Head and Neck Surgery, Otorhinolaryngology Catholic University of the Sacred Heart "A. Gemelli" Hospital, Rome, Italy
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Scarano E, Della Marca G, De Corso E, Dittoni S, Di Nardo W, Meucci D, Bastanza G, Gallus R, Losurdo A, Testani E, Paludetti G. Hyoid myotomy without suspension: a surgical approach to obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital 2014; 34:362-7. [PMID: 25709152 PMCID: PMC4299162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 10/06/2014] [Indexed: 11/12/2022]
Abstract
The aim of this study was to verify if hyoid myotomy without hyoid suspension is effective in surgical treatment of obstructive sleep apnoea syndrome (OSAS). We recruited six patients with OSAS, aged between 34 to 60 years, with retropalatal and retrolingual upper airway obstruction, non-obese (BMI < 27) and non-compliant to continuous positive airway pressure therapy. Pre-surgical clinical and instrumental evaluations included clinical examination, cephalometry, polysomnography (PSG) and sleep endoscopy. Surgical treatment included nasal surgery, uvulopalatopharyngoplasty, tonsillectomy and hyoid myotomy without hyoid suspension. Follow-up evaluations were performed with serial PSGs, performed early (one week after surgery), and at 1, 6 and 18 months after surgery. We observed that surgery was followed by immediate normalisation of breathing parameters evaluated by PSG that persisted after 18 months. Thus, hyoid myotomy without suspension combined with nasal and palatal surgery may be considered a valid treatment of non-obese OSAS patients with retrolingual and retropalatal collapse. Furthermore, we suggest that hyoid bone suspension, binding it to mandibular or to thyroid cartilage, might be unnecessary in selected cases.
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Affiliation(s)
- E. Scarano
- Institute of Otorhinolaryngology, Catholic University Rome, Italy;,Address for correspondence: Giacomo Della Marca, Institute of Neurology, Department of Neurosciences, Catholic University, l.go Gemelli 8, 00168 Roma, Italy. Tel. +39 06 30154276. Fax +39 06 35501909. E-mail:
| | - G. Della Marca
- Department of Neurosciences, Catholic University Rome, Italy
| | - E. De Corso
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - S. Dittoni
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - W. Di Nardo
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - D. Meucci
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - G. Bastanza
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - R. Gallus
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
| | - A. Losurdo
- Department of Neurosciences, Catholic University Rome, Italy
| | - E. Testani
- Department of Neurosciences, Catholic University Rome, Italy
| | - G. Paludetti
- Institute of Otorhinolaryngology, Catholic University Rome, Italy
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Bussu F, Hohaus S, Bastanza G, Bozzoli V, Tisi M, Martini M, Paludetti G, Almadori G. Clinical and prognostic features of lymphomas arising in the head and neck region: Our experience of preferential association of different histotypes with various sites of origin in ninety patients. Clin Otolaryngol 2013; 38:248-53. [DOI: 10.1111/coa.12090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 11/28/2022]
Affiliation(s)
- F. Bussu
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - S. Hohaus
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Bastanza
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - V. Bozzoli
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - M.C. Tisi
- Institute of Haematology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - M. Martini
- Institute of Histopatology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Paludetti
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
| | - G. Almadori
- Institute of Otolaryngology; Università Cattolica del Sacro Cuore; Policlinico Agostino Gemelli; Rome; Italy
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