Giuseppe Sambataro

Nasal Rinsing with Hypertonic Solution: An Adjunctive Treatment for Pediatric Seasonal Allergic Rhinoconjunctivitis

Background: Recent but limited evidence suggests that nasal lavage with hypertonic saline may be useful as an adjunctive treatment modality in the management of pediatric allergic rhinitis. The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis. Methods: Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited. Twenty-two patients were random ized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season, which lasted 7 weeks. Twenty-two patients were allocated to receive no nasal irrigation and were used as controls. Twenty patients per group completed the study. A mean daily rhinoconjunctivitis score based on the presence of nasal discharge and obstruction as well as ocular symptoms as reddening and itching were calculated for each week of the pollen season. Patients were allowed to use oral antihistamines when required and the mean number of drugs taken per week was also calculated. Results: The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period. This difference was statistically significant in week 6 and 7 of therapy. A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing, being statistically significant in 5 of the 7 weeks. No adverse effect was reported in the active group. Conclusions: This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis. This treatment proved to be tolerable, inexpensive and effective.

Comparative ultrasonographic, magnetic resonance sialographic, and videoendoscopic assessment of salivary duct disorders.

Objectives: Salivary duct disorders are the second most common cause of obstruction after calculi. Magnetic resonance sialography has been recently proposed as a means of diagnosing a heterogeneous group of salivary disorders, and so we compared it with sialoendoscopy in evaluating stenoses and sialectasia in 24 patients with obstructive symptoms and ultrasonographic results negative for calculi or masses. Methods: All of the patients (19 of whom had recurrent unilateral or bilateral swollen parotid glands and 5 of whom also had recurrent swollen submandibular glands) underwent dynamic color Doppler ultrasonography and dynamic magnetic resonance sialography with lemon juice stimulation of saliva; 18 patients also underwent diagnostic sialoendoscopy. Results: Ultrasonography and color Doppler ultrasonography showed duct dilatation in all patients (bilateral in 5 with parotid stenosis). Magnetic resonance sialography confirmed duct dilatation and stenosis in all of the patients, and revealed the simultaneous presence of calculi in 4 cases. A parotid sialocele was found in 4 cases. The magnetic resonance sialographic findings were confirmed in the patients who underwent sialoendoscopy. No side effects were observed. Conclusions: Magnetic resonance sialography following prediagnostic ultrasonography allows an adequate diagnosis of salivary duct disorders such as stenosis and sialectasia, as confirmed by objective sialoendoscopic assessment. Magnetic resonance sialography also makes it possible to visualize the salivary duct system up to its tertiary branches and, in this regard, may be considered a valid, noninvasive method for the evaluation of salivary duct disorders.

Antioxidant Effect of Sulphurous Thermal Water on Human Neutrophil Bursts: Chemiluminescence Evaluation

Background: The activities of the HS (sulfhydryl or thiolic) group in the cysteine of glutathione or various low-weight soluble molecules (thiolic drugs), such as N-acethylcysteine, mesna, thiopronine and dithiotreitol or stepronine and erdosteine (prodrugs), include its antioxidant activity in the airways during the release of reactive oxygen or nitrogen species (ROS, RNS) by polymorphonuclear neutrophils (PMNs) activated in response to exogenous or endogenous stimuli. Objective: In addition to being administered by means of thiolic molecules, the HS group can also be given by means of the inhalation of sulphurous thermal water. The aim of this study was to investigate the effect of sulphurous thermal water on the release of ROS and RNS during the bursts of human PMNs. Methods: The luminol-amplified chemiluminescence methodology was used to investigate the ROS and RNS released by PMNs stimulated with N-formyl-methionyl-leucyl-phenylalanine and phorbol-12-myristate-13-acetate, before and after incubation with sulphurous water. Effects on cell-free systems were also investigated. Results: The water significantly reduced the luminol-amplified chemiluminescence of N-formyl-methionyl-leucyl-phenylalanine- andphorbol-12-myristate-13-acetate-activated PMNs on average from 0.94 to 15.5 µg/ml of HS, even after the addition of L-arginine, a nitric oxide (NO) donor. Similar findings have also been obtained in a cell-free system, thus confirming the importance of the presence of the HS group (reductive activity). Conclusions: The positive effects of the activity of sulphurous thermal waters has been partially based on the patients’ subjective sense of wellbeing and partially on not always easy to quantify symptomatic (or general) clinical improvements. Our findings indicate that, in addition to their known mucolytic activity and trophic effects on respiratory mucosa, the HS groups present in the sulphurous thermal water of this spring also have antioxidant activity that contributes to the therapeutic effects of the water in upper and lower airway inflammatory diseases.

Botulinum toxin therapy : a tempting tool in the management of salivary secretory disorders

PURPOSE The aim of the study was to investigate the feasibility and effectiveness of botulinum toxin therapy in salivary secretory disorders. MATERIALS AND METHODS We treated 24 patients with botulinum neurotoxin type A for drooling, salivary fistulas, sialoceles, recurrent parotitis, and Freys syndrome; each parotid gland and submandibular gland received 25 to 60 and 10 to 40 mouse units, respectively, per session. All the patients other than those with Freys syndrome underwent, for diagnostic purpose, color Doppler ultrasonography (Hitachi H 21; frequency, 7.5 MHz, Scanner, Kashiwa, Japan), and Minors test was carried out for gustatory sweating; pretreatment magnetic resonance sialography (Philips Gyroscan Intera, Eindhoven, The Netherlands) and sialoendoscopy were also performed in selected cases. The follow-up included clinical and ultrasonographic examinations and Minors test. RESULTS A clinical improvement was observed in all patients: complete clinical recovery in 12, subtotal in 6, and partial in 6. A self-assessment test suggested the cessation of sweating by the 10th day in most patients with Freys syndrome. Botulinum toxin lost its effectiveness approximately after 4 months, requiring further administrations especially for drooling. No major side effects were observed with the exception of transitory paresis of the lower branch of the facial nerve in a patient with concomitant autonomic diabetic neuropathy. CONCLUSIONS Our findings suggest that botulinum toxin therapy is valid for the nonsurgical management of patients with salivary secretory disorders; the use of color Doppler ultrasonographic monitoring warrants the safety of the procedure.

Extended Supraglottic Laryngectomy Review of 84 Cases

Extended supraglottic laryngectomy is a surgical procedure by which the boundaries of standard supraglottic laryngectomy are extended to include the base of the tongue and/or pyriform sinus and/or one of the arytenoids, according to the extent of epilaryngeal or extralaryngeal invasion by vestibular cancer. We report the results of 84 extended supraglottic laryngectomies performed by our group from 1970 to 1980. Besides the highly favorable 5-year cure rate (75%), full functional rehabilitation followed in all but three patients, who were therefore submitted to secondary total laryngectomy. Rehabilitation time is often somewhat longer than in standard supraglottic laryngectomy, especially when an ample resection of the base of the tongue is required. Combined resection of the base of the tongue, aryepiglottic fold, and one of the arytenoids may further lengthen the rehabilitation period. We believe that extended supraglottic laryngectomy should be performed more often, not only for actual invasion, but also for suspected invasion of extralaryngeal structures.

Maturation of Vestibular Responses: Preliminary Report

64 full‐term and three preterm, normal infants, appropriate for gestational age (AGA), were tested for the appearance of vestibular response to rotatory stimulation at a minimal postconceptional age of 44 weeks. A total of 56 positive responses was obtained. The majority of the full‐term AGA infants responded by the 45th postconceptional week (60 per cent of the 50 infants tested at that age). Greater duration of extra‐uteri ne life significantly accelerated the appearance of the response.

Guidelines for pharyngostome closure

The reconstructive procedure for pharyngostome closure includes single-stage restoration in three steps: lining, intermediate layer, and covering. The lining repair is the key factor to the successful outcome of the operation. Three clinical situations may be distinguished. First, the mucosa is sufficient to restore a new gullet. In this case, it is widely undermined and sutured along the midline without any tension. Second, the mucosa is only partially sufficient. The same procedure as above is adopted to close the lower two-thirds of the pharyngostome, while an advancement flap is outlined from the base of the tongue to restore the upper third. Third, the mucosa is not sufficient. A musculocutaneous flap solves the problem. Reconstruction of the intermediate layer involves rotation of one (or both) sternomastoid muscle(s), if present. The possibilities for coverage include a submandibular flap, a thoracoacromial flap, and/or musculocutaneous flaps. By following these guidelines, the authors have successfully closed 37 pharyngostomes.

Use of submandibular flap to close pharyngostomes and other defects of lower anterior neck region

We describe the use of a suprahyoid flap for reconstruction in the lower anterior neck. It has been most useful for immediately closing pharyngostomes and for resurfacing defects from the excision of squamous cell carcinoma of the larynx or other neoplasms involving the skin. This flap provides a good deal of viable tissue, it can easily be rotated without a delay procedure, and the donor area is closed by direct suture. We present our experience with 22 cases.

Prognostic significance of P27 and cyclin D1 co-expression in laryngeal squamous cell carcinoma: possible target for novel therapeutic strategies.

Summary Tumour cells are characterised by uncontrolled growth due to alterations in the genes that play a key role in cell repair systems and apoptosis: pro-mitotic oncogenes such as cyclin D1, and tumour suppressor genes such as p27. Recent studies have demonstrated that these genes are involved in different epithelial neoplasms and that their expression is generally associated with prognosis. The aim of this immunohistochemical study was to analyse the clinical relevance of cyclin D1/p27 co-expression in a homogeneous series of 132 laryngeal squamous cell carcinomas. Multivariate analysis showed that cyclin D1 and p27 were the only statistically significant predictors of disease-free and overall survival. In relation to the simultaneous expression of p27 protein and cyclin D1, the patients with a cyclin D1+/p27-phenotype had the poorest disease-free and overall survival rates. On the basis of these immunohistochemical results, it was possible to select a subgroup of patients with a high risk of recurrence and poor prognosis to undergo more extended surgical treatment and/or combination antitumoral therapeutic procedures.

Protein biochip array of adhesion molecule expression in peripheral blood of patients with nasal polyposis

Nasal polyposis is a chronic non-infectious inflammatory disease of the nasal and paranasal cavity mucosa of unknown multifactorial origin in which inflammatory cells, and in particular eosinophils, seem to play a pivotal role. Eosinophil migration from the bloodstream to nasal polyps is considered to be specific and is a complex process involving several different molecules such as ICAM-1, VCAM-1, and L-, P- and E-selectins. The aim of this study was to investigate, using a protein biochip array technology, the concentrations of these molecules in the peripheral blood of a group of patients affected by nasal polyposis. Patients exhibited a significantly higher expression of VCAM-1, E-selectin, and L-selectin compared to healthy controls, and Spearmans rank correlation test limited to the molecules with significant betweengroup differences demonstrated a significant correlation between VCAM-1 and E-selectin, VCAM-1 and L-selectin, and Eselectin and L-selectin. The results of this investigation are in line with those coming from various imunohistochemical analyses, and seem to confirm the role of inflammation in the pathogenesis of nasal polyposis. These molecules may also represent novel therapeutic targets in the treatment of nasal polyps, and may allow the selection of pharmacological prophylactics that would allow effective inhibition of the inflammation induced by a given allergen.