Chiara Rosato

Parkinson's disease: Autoimmunity and neuroinflammation

Parkinsons disease is a neurodegenerative disease that causes the death of dopaminergic neurons in the substantia nigra. The resulting dopamine deficiency in the basal ganglia leads to a movement disorder that is characterized by classical parkinsonian motor symptoms. Parkinsons disease is recognized as the most common neurodegenerative disorder after Alzheimers disease. PD ethiopathogenesis remains to be elucidated and has been connected to genetic, environmental and immunologic conditions. The past decade has provided evidence for a significant role of the immune system in PD pathogenesis, either through inflammation or an autoimmune response. Several autoantibodies directed at antigens associated with PD pathogenesis have been identified in PD patients. This immune activation may be the cause of, rather than a response to, the observed neuronal loss. Parkinsonian motor symptoms include bradykinesia, muscular rigidity and resting tremor. The non-motor features include olfactory dysfunction, cognitive impairment, psychiatric symptoms and autonomic dysfunction. Microscopically, the specific degeneration of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies, which are brain deposits containing a substantial amount of α-synuclein, have been recognized. The progression of Parkinsons disease is characterized by a worsening of motor features; however, as the disease progresses, there is an emergence of complications related to long-term symptomatic treatment. The available therapies for Parkinsons disease only treat the symptoms of the disease. A major goal of Parkinsons disease research is the development of disease-modifying drugs that slow or stop the neurodegenerative process. Drugs that enhance the intracerebral dopamine concentrations or stimulate dopamine receptors remain the mainstay treatment for motor symptoms. Immunomodulatory therapeutic strategies aiming to attenuate PD neurodegeneration have become an attractive option and warrant further investigation.

Cytologic and Functional Alterations of Nasal Mucosa in Smokers Temporary or Permanent Damage

Objective Tobacco smoke is a significant risk factor for respiratory diseases. The purpose of this study is to analyze the cytologic and functional features of nasal mucosa in smokers, nonsmokers, and ex-smokers to evaluate if nasal alterations in smokers are permanent or reversible conditions after smoking cessation. Study Design Case series with planned data collection. Setting University medical center. Subjects and Methods Ninety healthy volunteers recruited from the staff of Alfredo Fiorini Hospital, Sapienza University of Rome, were enrolled in this prospective study from October to November 2013. We divided the cases according to smoking habits (smokers, nonsmokers, ex-smokers). Each group was composed of 30 subjects. Cytologic features of nasal mucosa and effectiveness of nasal mucociliary clearance were studied, focusing on 4 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time; (2) ratio between the number of ciliated cells and goblet cells, analyzed by microscopic observation of cytologic specimens of nasal mucosa that had undergone May Grunwald Giemsa staining; (3) evaluation of ciliary motility; and (4) time of ciliary movement of ciliated cells analyzed by phase-contrast microscopy. Results All parameters were significantly reduced in the smokers compared to the nonsmokers. There were no statistically significant differences between the nonsmoker and ex-smoker groups. Conclusion Cigarette smoking causes cytologic modifications of nasal mucosa that influence the effectiveness of mucociliary clearance. Our preliminary study suggests that these changes are not permanent and that nasal mucosa of ex-smokers recovers normal cytologic and functional features.

Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo

Objectives To assess factors related to residual dizziness (RD) in patients who underwent successful canalith repositioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV). Study Design Prospective cohort study. Setting Academic center. Subjects and Methods Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required ≥4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit. Results At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P < .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdomain score of the DHI questionnaire. Conclusion RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs.

Wharton’s Duct Repair after Combined Sialolithectomy Is Ductoplasty Necessary?

The aim of this prospective study is to establish whether ductoplasty is necessary to repair the Wharton’s duct after a combined endoscopic and external approach to remove large submandibular gland stones or if simple suturing of the oral floor mucosa after stent placement may be sufficient to achieve proper duct healing. Ten patients were enrolled. Ductoplasty was performed in 6 cases, whereas in 4 cases, only the mucosa of the oral floor was sutured. The stent was removed about 3 weeks after surgery. Sialoliths were completely removed in all cases. During follow-up, patient symptom evaluation, ultrasound, and physical examination showed no signs of recurrence or complications. In our limited experience, ductoplasty after the combined approach was not necessary. After stent placement, the mere suture of the oral mucosa overlying the damaged ductal wall allowed a correct recanalization of the ductal lumen as commonly observed after careful ductoplasty.

Myringotomy and ventilation tube insertion with endoscopic or microscopic technique in adults: a pilot study.

The purpose of this study is to assess the feasibility of endoscopic-assisted myringotomy and ventilation tube insertion in adults affected by chronic otitis media with effusion, comparing the outcomes of this approach with those obtained with the traditional microscopic technique. Twenty-four patients were enrolled in this trial and alternately assigned to 2 groups of 12 subjects each. In group A, patients underwent myringotomy and ventilation tube insertion under endoscopic view, whereas in group B, the same procedure was performed traditionally using a microscope. All cases were evaluated 1 week after surgery and then monthly until tube extrusion. Type A tympanogram was achieved in 10 of 13 ears in both groups (76.92%). No significant difference in operative times or complication rates was observed (P > .05). Endoscopic technique could be a viable alternative to the microscopic approach for myringotomy and ventilation tube positioning in adults affected by chronic otitis media with effusion.

Mucoepidermoid Carcinoma of the Tongue Base Mimicking an Ectopic Thyroid

A 69-year-old woman with mucoepidermoid carcinoma (MEC) of the tongue base came under our observation complaining of repeated episodes of haemoptysis. Mucoepidermoid carcinoma of the tongue base gives rise to a rather vague and aspecific symptomatology. Early symptoms include foreign body sensation in the oral cavity, undefined paraesthesia, and sialorrhoea. With the progression of disease, dysphagia, otalgia, and painful swallowing are usually referred. We report a case of mucoepidermoid carcinoma of the tongue base mimicking an ectopic thyroid.

Posttraumatic parotid fistula treated with transdermal scopolamine: a case report.

A parotid fistula is a rare and extremely unpleasant condition. In this paper, we present the case of a 53-year-old woman with a diagnosis of posttraumatic fistula of the parotid gland. After exclusion of other therapeutic alternatives, it was decided to use transdermal scopolamine patches at sustained release (Scopoderm TTS). This technique consists in the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24-hour period. The patient underwent periodic clinical followup over a period of three years, achieving satisfactory results with no significant adverse effects.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility A Study with Phase-Contrast Microscopy

Objective To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored. Study Design Prospective, single-group, pretest-posttest design. Setting Academic tertiary care medical center. Subjects and Methods This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility. Results Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up. Conclusions The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.

Endoscopic Stapes Surgery: A Prospective, Controlled Study

Objectives: (1) Describe basic and essential surgical steps of the endoscopic-assisted approach to stapedotomy. (2) Analyze advantages and disadvantages of the endoscopic technique. (3) Compare the outcomes of the endoscopic-assisted stapedotomy with those obtained with the traditional microscopic approach. Methods: The study was conducted from September 2011 to September 2013 at the ENT University Unit of the “A. Fiorini” Hospital, Sapienza University of Rome. Thirty patients (average age 47.5 years, 11 males, 19 females, 30 ears) with clinical otosclerosis undergoing stapedotomy under general anesthesia were enrolled in this prospective, controlled trial. Patients were randomly divided into 2 groups. Group A patients underwent stapedotomy under endoscopic viewing, whereas in Group B the same procedure was traditionally performed using a surgical microscope. The endoscopic set, originally used for endoscopic sinus surgery, included a 3 mm 0° endoscope, a 3CCD camera, and a video monitor. All procedures were performed by the same surgeon and the surgical steps were recorded. Videos were analyzed to compare the details of the anatomical structures in the operative field. Surgical times, functional results, and complications were recorded. Results: Functional results were comparable in both groups (air-bone gap ≤20 dB). No complications occurred. Surgical times were significantly longer in Group A (P < .05). Conclusions: Endoscopic stapedotomy is a feasible, viable alternative to traditional stapes surgery performed with the microscopic approach. The use of endoscopes improve the visualization of the operative field and allow a detailed view of the anatomical structures in an educational perspective.

Role of IL-5 and IL-8 in the Pathogenesis of Nasal Polyps:

Objectives: (1) Evaluate the histopathological and immunohistochemical characteristics of different types of nasal polyps. (2) Quantify the expression of IL-5 and IL-8 in 2 different histotypes of nasal polyps in order to evaluate the role of these cytokines in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) . Methods: This retrospective study was conducted on 44 specimens collected from nasal cavities of 44 patients with nasal polyposis who underwent functional endoscopic sinus surgery at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome, from January 2009 to January 2011. The specimens were analyzed at the histopathology unit of the university and divided into 2 groups according to their dominant histological features: Group A (polypoid mucosa and eosinophilia, 34 subjects) and Group B (polypoid mucosa associated with glandular hyperplasia, 10 subjects). Expression of IL-5 and IL-8 were analyzed on the specimens using immunohistochemical techniques. The same tests were run on nasal mucosa specimens drawn from 10 patients without sinusitis (control group). Results: IL-5 expression was significantly more expressed in Group A than in Group B (P < .05). Both IL-5 and IL-8 expressions were significantly more expressed in Groups A and B compared to the control group (P < .05). No significant difference was found in the expression of IL-8 between the 2 groups. Conclusions: The outcomes of this preliminary study suggest that IL-8 may play a role in the pathogenesis of both histological subtypes of nasal polyps, whereas IL-5 predominates in the eosinophilic subtype.