Claudia Staffieri

Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006).

Conclusions. Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h. Objectives. Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (>40%). Patients and methods. We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006. Results. The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures.

Endoglin (CD105) expression in head and neck basaloid squamous cell carcinoma.

Conclusions. This comparison of neo-angiogenesis performed by analysing CD105 expression seems to suggest that the biological behaviour of head and neck BSCCs is similar to that of site- and stage-matched conventional SCCs. Objective. Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade biomorphic variant of SCC with a predilection for the head and neck region. It is a matter of controversy whether the biological and clinical behaviour of BSCC is more aggressive than that of SCC. Angiogenesis is essential for tumour growth. It has been established that endothelial cells of tumour-associated neovasculature proliferate more rapidly than endothelial cells of normal tissue. Endoglin (CD105) has been shown to be a useful marker for identifying proliferating endothelium involved in tumour angiogenesis. The aim of this study was to investigate the expression of CD105 in head and neck BSCCs and to compare it with that in SCCs. Material and methods. Nine head and neck BSCCs (five cases in the larynx, three in the tongue and one in the tonsil) were considered. A group of nine site- and stage-matched SCCs was examined simultaneously. For each sample, CD105 reactivity was evaluated immunohistochemically. The mean area fraction (percentage of fields occupied by vessels), the percentage of vessel-presenting fields and the vessel density were considered. Results. The median values of the mean area fraction were 1.01% and 0.9% in BSCCs and SCCs, respectively. The median values of the percentage of vessel-presenting fields were 57.5% and 46.67% in BSCCs and SCCs, respectively. The median values of vessel density were 2.07% and 1.58% in BSCCs and SCCs, respectively. Statistical analysis did not disclose any significant differences between BSCCs and SCCs for any of the above-mentioned parameters.

Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study

OBJECTIVES Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]). METHODS In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month. RESULTS An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month. CONCLUSIONS Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations.

Endoglin expression is associated with poor oncologic outcome in oral and oropharyngeal carcinoma

Conclusions. The present preliminary results suggest that endoglin (CD105)-assessed micro-vessel density (MVD) in primary oral and oropharyngeal squamous cell carcinomas (SCCs) may identify patients at risk of disease recurrence or poor oncological outcome after treatment. Objectives. MVD is an independent prognostic indicator in several human malignancies. Endoglin antibodies have shown a greater specificity for tumour vasculature in comparison with pan-endothelial markers. The present explorative study evaluated endoglin expression and its prognostic role in oral and oropharyngeal SCCs. Patients and methods. The study considered 13 consecutive cases of oral and oropharyngeal SCC with lymph node metastases (pN + ) and 13 consecutive pN0 cases. CD105-assessed MVD was calculated at 400× magnification. Results. The mean MVDs were 3.6 and 3.1 in pN+ and pN0 groups, respectively (p>0.05). The mean CD105-assessed MVDs were 4.7 in the group with locoregional recurrence and 2.9 in the group without locoregional recurrence or post-treatment diagnosis of distant metastasis (p=0.01). The mean CD105-assessed MVD in primary oral and oropharyngeal SCCs with poor oncological outcome (recurrence of disease or occurrence of distant metastasis) was 4.3. The mean MVD in primary oral and oropharyngeal SCCs with good outcome was 2.9. Statistical analysis showed a significant difference between CD105-assessed MVD in poor and good outcome groups (p=0.02).

The effects of sulfurous-arsenical-ferruginous thermal water nasal irrigation in wound healing after functional endoscopic sinus surgery for chronic rhinosinusitis: a prospective randomized study

PURPOSE Although several publications reported the benefits of nasal irrigation in the management of chronic rhinosinusitis and in sinonasal postoperative care, the available data are poorly controlled. The aim of this prospective randomized study was to compare the effects of sulfurous-arsenical-ferruginous thermal water nasal irrigation vs isotonic sodium chloride solution nasal irrigation after functional endoscopic sinus surgery (FESS) for chronic sinonasal disease considering the histomorphological characteristics of mucosal repair after sinus surgery. MATERIALS AND METHODS Eighty patients who consecutively underwent FESS were randomly assigned (1:1) to postoperative nasal irrigation with sulfurous-arsenical-ferruginous thermal water or isotonic sodium chloride solution for 6 months. Intraoperative and postoperative (1, 3, and 6 months) mean counts of lymphocytes, neutrophils, eosinophils, plasma cells, histiocytes, and mast cells in ethmoid biopsies were blindly determined by a pathologist. RESULTS Fifty-six patients underwent at least 2 postoperative biopsies. A statistically significant reduction of eosinophil count was disclosed 6 months postoperatively only after sulfurous-arsenical-ferruginous solution nasal irrigation (P = .04). After isotonic sodium chloride solution nasal irrigation, the mean eosinophil count in 6-month postoperative biopsies did not decrease. After both irrigation modalities, the mean mast cell counts in 6-month postoperative biopsies were significantly lower than in intraoperative biopsies (P < .05). Neutrophils, lymphocytes, histiocytes, and plasma cell counts were not significantly different between intraoperative vs 6-month postoperative biopsies independently from irrigation modality. CONCLUSIONS Considering the important role of eosinophils in allergic response, we should suggest sulfurous-arsenical-ferruginous solution nasal irrigation in particular, which significantly reduces local eosinophil count, for allergic patients after FESS for chronic rhinosinusitis.

MASPIN tumour-suppressing activity in head and neck squamous cell carcinoma: Emerging evidence and therapeutic perspectives

Conclusions. A large series confirmation may suggest elective neck dissection in cN0 MASPIN-negative oral squamous cell carcinomas (SCCs). Re-activated nuclear MASPIN in association with anti-angiogenic or cytotoxic drugs may be extremely effective in the treatment of laryngeal SCC. Objectives. MASPIN is a serpin showing a unique tumour-suppressing activity. Despite the significant incidence of head and neck SCC (HNSCC), a limited number of studies has considered MASPINs role in these malignancies. This review focuses on the attempts to translate MASPINs HNSCC suppressive properties toward a diagnostic/prognostic tool and a novel carcinoma therapy. Methods. A systematic literature review was performed to investigate available evidence about MASPIN subcellular localization and biological role in HNSCC. Results. Five studies have investigated MASPINs expression in oral SCC. Most of them concluded that low or absent MASPIN cytoplasmic expression was more frequent in oral carcinomas with lymph node metastases. Only our group evaluated MASPINs role in laryngeal SCC. Higher nuclear MASPIN expression was found in patients without SCC recurrence and was significantly associated with longer disease-free survival. Micro-vascular density was lower in laryngeal carcinomas with MASPIN nuclear staining. The relation between MASPIN and M30-assessed apoptosis in laryngeal SCC supports the hypothesis of an important apoptosis-sensitizing effect of nuclear MASPIN.

Nuclear localization of mammary serine protease inhibitor (MASPIN): is its impact on the prognosis in laryngeal carcinoma due to a proapoptotic effect?

PURPOSE Cell death by apoptosis is considered a regulator of cell number; cancer cells are defective in their response to apoptosis. Many potential markers of apoptosis are under study: M30 immunoreactivity is confined to the cytoplasm of apoptotic epithelial cells and is expressed during early apoptosis. Mammary serine protease inhibitor (MASPIN), a suppressor of tumor growth, seems to be involved in the induction of tumour cell apoptosis. The aim of our preliminary study was to investigate, for the first time, the relations between MASPIN subcellular pattern of expression, nuclear MASPIN expression, M30 expression, and prognosis in laryngeal carcinoma. MATERIALS AND METHODS Subcellular pattern of distribution of MASPIN and nuclear MASPIN expression were immunohistochemically determined in 66 consecutive cases of laryngeal carcinoma. M30 expression in correspondent carcinoma fields was also calculated. RESULTS M30 expression was significantly higher in the group of laryngeal carcinomas with MASPIN nuclear localization (P = .024). Our investigation found a reduced carcinoma recurrence rate in the group of patients with MASPIN nuclear localization (P value = .0086). The log-rank test showed a significantly longer disease-free interval in patients with nuclear MASPIN localization (P = .029). CONCLUSIONS These preliminary results support the hypothesis of an apoptosis-sensitizing effect of nuclear MASPIN in laryngeal carcinoma with the potential perspective of a clinical use of the tumour suppressive proapoptotic function of MASPIN.

Deep neck infection in elderly patients. A single institution experience (2000–2004)

Background and aims: Immunosenes-cence, the age-related decline in immunologic function in healthy individuals, seems to contribute to increased susceptibility to bacterial infections in the elderly population. The present study describes elderly patients’ susceptibility to deep neck infection and prognosis. Methods: Between January 2000 and March 2004, 103 patients were admitted to the Department of Otolaryngology, University of Padova for deep neck infection. Twenty-four patients (23%) were over 65 (elderly patients). The remaining 79 patients (77%) aged ≤65 years (adult non-elderly patients) were also studied. Presentation modalities, origin of infection, site of deep neck infection, radiological investigations, bacteriology, treatment and outcome were all studied. Results: Hypertension and diabetes mellitus were the most commonly associated systemic diseases in both elderly and non-elderly patients. The number of patients with associated systemic diseases was significantly higher in the elderly group. The most common cause of deep neck infection was dental infection in both age groups. In the elderly group, salivary gland origin had the same incidence as dental origin. Twenty-two patients (6 elderly patients) were treated only with intravenous antibiotic therapy and intravenous steroids. Overall, in 81 cases (78.6%) (18 elderly patients) medical plus surgical procedures were indicated. None of the treated patients died of deep neck infection or its complications. Conclusions: Although the incidence of associated systemic diseases and complications of deep neck infections were higher in the elderly group, our medical or medical plus surgical approaches to deep neck infections, based on clinical and radiological evidence, were successful in all patients treated.

Abducent nerve paralysis: first clinical sign of clivus metastasis from tonsillar carcinoma.

It is known that 15–20% of oropharyngeal carcinomas develop distant metastases that involve most commonly lung, liver and bone. Clival metastasis from oropharyngeal squamous cell carcinoma has not been previously reported in the English literature. We describe the rare occurrence of clival metastasis from tonsillar carcinoma presenting with abducent paralysis and discuss diagnostic and therapeutic rational approaches. Despite neoadjuvant chemotherapy (cisplatinum/etoposide/epirubicin followed by taxotere), extended left tonsillectomy and ipsilateral radical neck dissection and external radiotherapy (60 Gy) for tonsillar carcinoma, the patient developed clival metastasis and died of disease. The overall prognosis of patients with clival metastases is extremely poor, with an overall median survival of about 2.5 years. Cranial nerve palsy occurrence is associated with a poorer prognosis with an average survival of only 5 months.

Nm23-H1 nuclear expression is associated with a more favourable prognosis in laryngeal carcinoma: univariate and multivariate analysis.

Marioni G, Ottaviano G, Lionello M, Lora L, Lovato A, Staffieri C, Favaretto N, Giacomelli L, Stellini E, Staffieri A & Blandamura S 
(2012) Histopathology
Nm23‐H1 nuclear expression is associated with a more favourable prognosis in laryngeal carcinoma: univariate and multivariate analysis