D. Passali

Alterations of nasal mucociliary transport in patients with hypertrophy of the inferior turbinates, deviations of the nasal septum and chronic sinusitis

Abstract Mucociliary transport (MCT) represents the first barrier of the nasal fossae and paranasal sinuses against various biological and physical insults. We studied the nasal MCT time using a mixture of vegetable charcoal powder and 3% saccharin in three groups of patients suffering from hypertrophy of the inferior turbinates, deviations of the nasal septum or chronic sinusitis. The mean values of the nasal MCT in the first two groups were practically identical to the normal ones. In contrast, significantly delayed times were found in patients with chronic sinusitis (P < 0.01). Findings indicate that this delay is determined by an increase in viscoelasticity of the mucus following the acute release of mediators of inflammation, together with a reduction in the periciliary stratum, which slows down the metachronous wave of the MCT.

Foreign Bodies Causing Asphyxiation in Children: The Experience of the Buenos Aires Paediatric ORL Clinic

Inhalation or aspiration of a foreign body (FB) occurs relatively frequently in young children. The size, shape, type and site of arrest of the FB lead to variability in the clinical picture. The present study included data from 65 cases of FB inhalation presenting over 1 year at the Childrens Hospital Gutierrez, Buenos Aires, Argentina, compared with information from four well-known published case series chosen as representative of other cultural and geographical backgrounds: the USA, Europe, North Africa (Egypt) and Asia (India). The mean age of children studied was 4.03 years. Injuries happened mainly at home (53 cases [81.54%]) and under adult supervision (59 cases [90.77%]). The most frequently inhaled FB was nuts, however, in contrast to previous reports, the majority of incidents involved inhalation of an inorganic, rather than an organic (food) FB. Complications included pneumonia (three cases), atelectasis (two cases) and pneumonitis (one case). No deaths were recorded. These data suggest that children play with objects inappropriate for their age, such as pins and nails, that adults may not be aware of the choking risks, and that more effort is required in educating caregivers about these risks.

Efficacy of Inhalation Form of Furosemide to Prevent Postsurgical Relapses of Rhinosinusal Polyposis

The aim of the work is to demonstrate the efficacy of furosemide to prevent relapses of rhinosinusal polyps after surgical treatment. Two groups of people with rhinosinusal polyposis were enrolled: the study group consisted of 64 patients and the control group of 40 subjects. After surgical treatment, the study group started the therapy with topical furosemide; the control group had no treatment administered after the operation. Six years after the operation only 4 cases of relapse were noticed in the study group (10%), while there were 12 relapses, 4 slight (6.4%) and 8 severe (20%), in the control group. In conclusion, furosemide could represent a valid therapeutic aid in the prevention of nasosinusal polyps.

Oxidative stress in patients with obstructive sleepapnoea syndrome

SUMMARY Obstructive sleep apnoea syndrome (OSAS) is a disorder that leads to metabolic abnormalities and increased cardiovascular risk. The aim of this study was to identify early laboratory markers of cardiovascular disease through analysis of oxidative stress in normal subjects and patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in 20 adult patients with OSAS and a control group of 20 normal subjects. Laboratory techniques for detecting and quantifying free radical damage must be targeted to assess the pro-oxidant component and the antioxidant in order to obtain an overall picture of oxidative balance. No statistical differences in age, sex distribution, or BMI were found between the two groups (p>0.05). There were significant differences in the apnoea/hypopnoea index (AHI) between OSAS patients and the control group (p<0.05). Statistically significant differences in isoprostane, advanced oxidation protein products (AOPP) and non-protein bound iron (NPBI) levels were found between the study and control groups. No significant difference in the levels of thiol biomarkers was found between the two groups. The main finding of the present study was increased production of oxidative stress biomarkers in OSAS patients. The major difference between thiols and other oxidative stress biomarkers is that thiols are antioxidants, while the others are expressions of oxidative damage. The findings of the present study indicate that biomarkers of oxidative stress in OSAS may be used as a marker of upper airway obstructive episodes due to mechanical trauma, as well as a marker of hypoxaemia causing local oropharyngeal inflammation.

Multicentric study on the efficacy and tolerability of Streptococcus salivarius 24SMB and Streptococcus oralis 89a in respiratory tract infections

Abstract BACKGROUND. Bacteriocins are peptides with antimicrobial efficacy produced by certain bacterial species. Probiotics indeed seem a promising method in the prevention of upper respiratory infections and our study would like to contribute to the results available in the literature, in order to underlie their true therapeutic potential role. MATERIAL AND METHODS. Our multicenter pilot prospective study investigates 366 patients from September 2015 to February 2016. All the patients were treated with a topical device made up of a suspension of two specific bacterial strains: Streptococcus salivarius 24SMB and Streptococcus oralis 89a to be administered as nasal spray. The nasal spray was administered twice daily for 7 days per month for three consecutive months. A questionnaire about the subjective efficacy of the therapy correlated to an improvement of symptoms was also collected from patients. RESULTS. After one year from the enrolment, a 70.07% reduction in the number of events compared with the number of expected episodes was observed. CONCLUSION. The aim of our data is to propose a new therapeutic approach to treat the recurrence of upper airway infection and to support an adequate therapy in all cases where the traditional antibiotic therapeutic protocol did not obtain completely efficient results in terms of recurrence.

Foreign Bodies in the Airway inChildren: Experience in Argentina

Foreign Bodies in the Airway in Children: Experience in Argentina Foreign body aspiration is a serious and preventable cause of morbidity and mortality in childhood. Considering that the type of foreign bodies varies depending on diet and custom of each population, the aim of the current paper is to present foreign body aspiration cases treated in three Argentinian pediatric hospitals and to emphasize the need for preventive strategies and necessity of increasing community and healthcare professionals’ knowledge about this problem.

Risk posed to children by stationery items in the upper airways: evidence emerging from the ESFBI study

Rationale and aim The insertion, inhalation, aspiration or ingestion of a foreign body (FB) is a relatively frequent event in young children. Some classes of objects such as stationery items (including pencils, pens and their parts etc), are frequently listed in clinical registries among commonly inserted, inhaled, aspirated or ingested objects but rarely receive a specific attention. The aim of the present study is to characterise the risk of complications and prolonged hospitalisation due to stationery items according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study. Methods A retrospective study in major hospitals of 19 European countries was realised on children aged 0–14 having inhaled/aspired or ingested a stationery item, with regard to the characteristics of the child and the FB (shape volume consistency), the FB location the hospitalisations details and the occurrence of complications. Results In the years 2000–2003 a total of 2094 FB injuries occurred in children aged 0–14 years. Among them 62 (3%) were due to a stationery item: 32 were due to objects insertion in the ears while 30 occurred in the upper and lower respiratory tract. Objects most frequently involved are parts of pens in children younger than 3 years and eraser in older. 39% of children needed hospitalisation. The most documented complication was inflammation of external ear. Almost 24% of injuries happened under adults supervision. Conclusions Injuries are events that in many cases can be prevented with appropriate strategies. Passive environmental strategies, including product modification by manufacturers, are the most effective. However, regulation regarding small parts of potentially dangerous objects, covers products addressed to children use but objects not projected for children, such as stationary items, are excluded. Our study testifies that stationary is involved in a non-negligible percentage of FB injuries, mainly due to insertion in the ears. Frequently, injuries happens under adult supervision. This results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary and information about this issue should be included in all visits to family paediatricians.

Toys in the upper aerodigestive tract: New evidence on their risk as emerging from the Susy Safe Study

Rationale and aim Foreign body (FB) inhalation/aspiration or ingestion are relatively common events in young children and, despite many efforts made in several countries to reach acceptable safety levels for products devoted to children, small toys or toy parts are frequently mentioned among risky FBs. The aim of the present study is to characterise the risk of complications and prolonged hospitalisation due to toys inhalation/aspiration or ingestion according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study. Methods A retrospective study in major hospitals of 19 European countries was realised on children aged 0–14 having inhaled/aspired or ingested a toy, with regard to the characteristics of the child and the FB (shape volume consistency), the FB location the hospitalisations details and the occurrence of complications. Results In the years 2000–2003 a total of 2094 FB injuries occurred in children aged 0–14 years. Among them 121 (5.8%) were due to toys (mainly parts of toys) and 95 (4.5%) occurred in the lower/upper aero-digestive tract. 58 children needed hospitalisation. The first determinant of a damage requiring hospitalisation is the rigid consistence of the object. Almost 27% of toys related injuries happened under adults supervision. Conclusions Despite the adoption of preventive strategies, including products modification by manufacturers, has resulted in a decrease of childrens mortality for chocking in the last decades, our results seem to testify that preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated with other preventive intervention addressed to improve parents ability to be conscious of FB injuries and attentive towards a proper surveillance of children.

Modifications of moxifloxacin concentrations in plasma and tonsillar tissue after multiple administration in adults

Abstract Purpose : To evaluate modifications of moxifloxacin (MFX) concentrations in tonsillar tissue and plasma up to 24 h after three oral doses of 400 mg, and to assess the safety and tolerability of this drug in adult patients with chronic or recurrent tonsillitis undergoing tonsillectomy. Methods : Twenty-nine patients with normal renal and hepatic function were randomly placed into five groups according to the time between the last moxifloxacin dose administered and the time of sampling (group A: 2 h, group B: 3 h, group C: 6 h, group D: 12 h, group E: 24 h). Plasma, from heparinized venous blood, and tissue concentrations were determined using a validated HPLC assay with fluorescence. Results : Mean levels of moxifloxacin in the tonsillar tissue were on average at least 2-fold with respect to the correspondent values in the plasma. The time profile in tissue seems to be very similar to that in plasma. In particular, the peak concentration in the tissue occurred at the same time (hour 3) as in plasma, having a ratio of about three (2.85) in favour of the tissue mean level. No drug-related adverse effects developed in any of the patients. Conclusions : Moxifloxacin was well tolerated by all patients and achieves a good penetration in tonsillar tissue, which compares favourably with that reported for other fluoroquinolones.

Aetiological Considerations on Chronic Sinusitis and Therapeutic Consequences

The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily be based on the correct identification of the microbiological agents involved in causing the sinus affection. In our experience, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the germs responsible for most of the acute forms found in our country, in adults and children alike. In 1997, the FDA approved the use of antibiotics such as amoxicillin/clavulanic acid, clarithromycin, cefuroxime axetil, loracarbef and levofloxacin for acute forms. According to our experience, the administration of amoxicillin/clavulanic acid would appear to be particularly effective, also in the relapse of chronic forms. Regarding the duration of antibiotic treatment, consensus is practically unanimous. In acute rhinosinusitis, the therapy should be given for at least 10 days at full dosage. The duration of treatment may be extended up to 14 days at the physician’s discretion in the more serious cases of infection and in the case of debilitated patients. In the chronic forms, the common literature indicates a therapy targeted at eradication of coagulase-positive and coagulase-negative staphylococci and anaerobes having a duration of less than 5 weeks. In our opinion, chronic histological modifications of the sinoidal mucosa represent conditions of risk for the appearance of acute episodes, which should necessarily be treated with medical therapy. When the acute episodes recur with incessant regularity, leading to important problems and causing a decrease in quality of life, then functional surgery should be considered.