Vasilis Danielides

Recurrent Focal Epithelial Hyperplasia due to HPV13 in an HIV-Positive Patient

There are few reports on focal epithelial hyperplasia (FEH) in association with human immunodeficiency virus (HIV) infection; thus the relationship between them has not been completely clarified yet. We present a case of recurrent FEH in an HIV-positive man (the first described in Belgium), which, according to the PCR-DNA testing, was due to human papilloma virus type 13 (HPV13). To our knowledge, based on the accessible literature, this type of HPV has not been detected in any other documented study of FEH in HIV-positive patients before. Our patient experienced three recurrences of FEH in 1 year. It is therefore suggested that immunodeficiency due to HIV infection is responsible for the HPV-related FEH and the subsequent recurrences. In order to support the consideration of FEH as an oral manifestation of an HIV-related opportunistic infection, every new ‘HPV-type’ oral lesion in HIV-positive patients must be completely documented.

Diagnosis, Management and Surgical Treatment of Non-Tuberculous Mycobacterial Head and Neck Infection in Children

The aim of this study was to present our experience with the clinical characteristics of non-tuberculous mycobacterial (NTM) head and neck lymph node infections, the use of modern diagnostic tools and the appropriate therapeutic measures. We have reviewed the cases of 14 Caucasian children with NTM head and neck lymphadenitis who were treated in our clinic in the last 5 years. Three of the patients were male and 11 were female. Their age ranged from 15 to 98 months (mean age 45.7 ± 21.76 months). Cervical lymph nodes were involved in all of our cases, while the submandibular region was found to be the area mostly affected. Overlying skin was involved in 7 cases. Diagnosis was based on intradermal skin testing with specific antigens for atypical mycobacteria, histological examination and specimen culture. Skin tests were positive for NTM in all of the patients with a predilection for Mycobacteriumavium complex. The diagnosis was confirmed by histological examination in 13 cases. Specimen culture was positive in 9 cases, most of them growing M. avium-intracellulare complex. Treatment included complete surgical excision of the affected lymph nodes and the overlying skin, as well as functional neck dissection when required. A second procedure was performed in 2 patients. Successful evaluation of NTM infections of the head and neck lymph nodes should include a detailed history, thorough physical examination and specific laboratory investigations. The treatment of choice is complete surgical excision of all affected tissue.

Effect of meteorological parameters on acute laryngitis in adults.

The aim of this study was to investigate the influence of weather conditions on the frequency of acute laryngitis in adults. The medical records of 825 patients with a diagnosis of acute laryngitis obtained over a 5-year period were reviewed. Meteorological data reviewed included the daily values of 13 parameters. The monthly distribution of the disease was assessed. In addition, a detailed 2-part statistical analysis was performed as follows: ( i ) the relationship between each meteorological parameter and the frequency of the disease was investigated, using contingency tables; and ( ii ) the 1825-day period was divided into 8 groups characterized by similar weather, using factor and cluster analysis, and the disease frequency in each group was assessed. Our observations were as follows: 1. Meteorological parameters, such as low temperature, low diurnal temperature range, low atmospheric pressure and low mean water vapor pressure, were associated with an increased occurrence of acute laryngitis. 2. Significant changes in maximum temperature or a significant drop in atmospheric pressure, as compared to the previous days conditions, favored new cases of the disease. 3. The cold period of the year was associated with an almost two-fold increase in the frequency of disease cases, which peaked in March and reaching a minimum during August. 4. The peak frequency of cases was associated with winter weather conditions, which were characterized by high humidity readings. In conclusion, meteorological parameters, and their variation and covariation, are strongly associated with acute laryngitis in adults.

Seasonal Distribution and Epidemiology of Bell’s Palsy

Objectives: The purpose of this study was to investigate the seasonal and epidemic distribution of the disease in the environment of Ioannina prefecture, with a population of 158,000 and a climate of a transitive zone between Mediterranean and continental. Patients: This retrospective study included 125 patients suffering from idiopathic peripheral facial paralysis, treated from 1995 until 1999. The male:female ratio was 62:63. The age of the patients ranged from 7 to 84 years, with a mean age of 50.4 ± 21.8. The annual incidence of the disease was 15.8 per 100,000 population during the 5 years. Results: Correlation between the disease frequency and the age of the patients revealed an increased frequency in patients over 40 years (67.2%) and peak morbidity during the 7th decade (36%). There was no significant difference in the number of cases occurring during the cold – warm half of the year, the four seasons, and in the monthly distribution. By calculating the mean intervals in days between successive cases per month and per season, we observed no significant differences. Conclusions: Our study did not provide any statistically significant results that could indicate seasonal or epidemic distribution of Bell’s palsy.

Weather conditions and Bell's palsy: five-year study and review of the literature

BackgroundClimatic or meteorological condition changes have been implicated in the pathogenesis of Bells palsy (BP). We evaluate the influence of meteorological parameters, such as temperature, humidity, and atmospheric pressure, and their variation and covariation on the incidence of BP and present a review of the literature on the effect of meteorological conditions on facial nerve function.MethodsA total of 171 cases of BP admitted to our Department over a five-year period were studied. The meteorological database included daily values of 13 distinct parameters recorded at the meteorological station of the University of Ioannina during this period. A relationship between each meteorological variable and the incidence of BP was investigated by applying (Χ2) test on data from 13 contingency tables. In addition, the influence of different weather types on the incidence of BP was also investigated. For this purpose Cluster Analysis was used to create eight clusters (weather types) for the Ioannina prefecture and (Χ2) test was applied on the contingency tables consisting of the days of BP cases for each cluster.ResultsNo significant correlation was found either between BP and each distinct meteorological parameter or between BP and any specific weather.ConclusionsMeteorological conditions, such as those dominating in the Northwestern Greece, and/or their changes have little effect on the incidence of BP. Multicenter studies taking into account atmospheric pollution, and climatic differences between countries, are necessary to scrutinize the environmental effects on facial nerve function.

Weather conditions and sudden sensorineural hearing loss

BackgroundClimatic or meteorological condition changes have been implicated in the pathogenesis of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). We investigated the seasonal distribution of ISSHL and evaluated the influence of meteorological parameters (such as temperature, humidity, and atmospheric pressure), their variation and covariation on the incidence of the disease.MethodsA total of 82 cases of ISSHL, admitted to our department over a five-year period, were enrolled in the study. Seasonal distribution of the disease was investigated by dividing the year in four seasons. Meteorological data included daily values of 13 distinct parameters recorded at the meteorological station of the University of Ioannina during this period. A relationship between each meteorological variable and the incidence of ISSHL was investigated by applying (χ2) test on data from 13 contingency tables as well as by using logistic regression and t-test approaches. In addition, the influence of different weather types on the incidence of ISSHL was investigated using Cluster Analysis in order to create eight clusters (weather types) characteristic for the prefecture of Ioannina.ResultsThe results of the study could not indicate any seasonal distribution of the disease. The incidence of ISSHL could not be significantly correlated either to any distinct meteorological parameter or to any specific weather type.ConclusionsMeteorological conditions, such as those dominating in the Northwestern Greece, and/or their changes, have no proven effect on the incidence of ISSHL.

Comparative study of evoked electromyography and facial nerve latency test in the prognosis of idiopathic facial nerve palsy in childhood

We report our results from the application of evoked electromyography (EEMG) and facial nerve latency testing (FNLT) in 30 children aged 4–14 years with idiopathic facial palsy. Our aim was to define the value of these tests as prognostic tools in Bells palsy. From the EEMG results we ascertained that, when the amplitude of the compound muscle action potential varied between 51% and 95% of the normal value, the neuronal damage is slight (neurapraxia). When the percentage value of muscle response decreases, the prognosis is worse. The results of the FNLT showed that, when the latency is within normal limits, the damage to the nerve is slight (neurapraxia). If the latency is prolonged, the prognosis is worse. Evaluation of our results and comparison with the index of facial nerve functional recovery showed that those two tests have a high percentage of correctness (100% for the EEMG and 96.7% for the FNLT) and a low percentage of error. We conclude that these tests are excellent for predicting the outcome of facial nerve palsy in childhood and we suggest that young patents undergo both so that the determination of the lesion may be as correct as possible.

Hemangioma of the left cheek: a case report.

A 44-year-old healthy white woman was referred to our department with a 15-year history of an asymptomatic and gradually enlarging soft tissue mass in the left cheek, which was noted for the first time during a pregnancy. There was no history of trauma or prior surgery. Physical examination revealed a 4 4-cm soft mass in the left cheek, located inferior to the zygoma, on the anterior border of the masseter muscle. There were no pulsations, bruits, adenopathy, or overlying skin discoloration. Magnetic resonance imaging (MRI) of the face revealed a mass lesion visible lateral to the wall of the left maxillary sinus, positioned anteriorly in the cheek and extending posteriorly to the pterygoid process and down to the alveolar process of the left maxilla. It was very homogeneous, sharply delineated, and clearly separated from the surrounding muscles. The mass had a very high signal on T2-weighted images compared with muscle and was isointense to muscle on T1-weighted images. After the administration of intravenous contrast medium, the scanty enhancement was similar to that of muscle. No pathologic lymph nodes could be seen (Fig 1A). Differential diagnosis included benign chondroma, cyst, and hemangioma. Surgical exploration was performed through an external incision in the nasolabial fold. A mass was found on the anterolateral wall of the left maxillary sinus, extending posteriorly to the pterygoid process and down to the alveolar process of the maxilla. It was a deeply located, nonintramuscular tumor, surrounded from the mimic muscles and developing as a horseshoe on the anterior border of the masseter muscle. The lesion was freed from the surrounding tissues, with no need to identify the facial nerve, and removed in one piece. The patient did not experience any postoperative complications. Histologic examination revealed a mixture of arteries and veins of varying caliber, with a predominance of veins. There was no evidence of intramuscular localization of the lesion. These histologic findings were consistent with arteriovenous hemangioma (Fig 1B).

Book Review / Announcement

The objective of this book is to provide profound knowledge of the impact of vitamins, electrolytes, trace elements, fatty acids and amino acids in the prevention and treatment of diseases caused by malnutrition and malabsorption. The book is divided into four parts covering the basics of micronutrients, the physiological and therapeutic impact of individual micronutrients and their link to civilization diseases such as diabetes, cancer and arteriosclerosis and possible therapeutic interventions. The last part of the book displays recommended daily reference doses in tables and contains a detailed glossary. The book is very well structured with short and precise sentences and well documented with good reference material. A very useful reference book for any kind of questions about micronutrients. P. Pedrazzetti