A rare cause of dysphagia due to retropharyngeal foregut duplication cyst: case report and review of the literature

Background: The retropharyngeal space is a deep compartment of the head and neck region which extends from the base of the skull to the mediastinum, between the posterior pharyngeal wall and vertebral muscles, delimited laterally by carotid sheaths. Pathological processes of the retropharyngeal space are rarely encountered, generally are isolated and painless masses often cystic, and they usually originate from branchial arch anomalies, but only in rare cases, they turn out to be foregut duplication cysts. Foregut duplication cyst is rare congenital malformations arising along primitively derived alimentary tract during the first trimester in the developing embryo, mostly seen in the thorax and abdomen, with just few cases reported in the head and neck region. We report an extremely rare case of a foregut duplication cyst lined with respiratory epithelium located in the retropharyngeal space, at the level of the oropharynx, of an adult patient with dysphagia surgically treated, and we also made an analysis of the published literature about this very uncommon condition. Case presentation: A 63-year-old male patient with chronic dysphagia was diagnosed with a retropharyngeal cystic lesion, which was surgically treated. Final pathologic evaluation confirmed the diagnosis of a rare foregut duplication cyst lined with respiratory epithelium. A review of the pertaining published literature about the head and neck foregut duplication cysts was made, with a particular emphasis on retropharyngeal ones. Conclusions: Retropharyngeal foregut duplication cysts are a very rare congenital cyst of the head and neck. Clinical symptoms such as dysphagia and dyspnea should be evaluated with fibrolaryngoscopy, and CT and MRI scans are of great significance for definitive diagnosis, which should include the possibility of a foregut duplication cyst in the differential diagnosis. Surgical excision is the elective treatment for this lesion, in order to prevent complications including infection and compression symptoms or eventually malignant transformation

Congenital Pyriform Sinus Fistula: Systematic Review and Proposal for Treatment Using a Novel Endoscopic Approach

The pyriform sinus fistula (PSF) is a congenital developmental defect of the third or fourth branchial pouch. It presents as acute inflammatory swelling of the neck with recurrent deep neck abscesses, recurrent neck cystic lesions or suppurative thyroiditis. The literature reports various surgical approaches to treat this condition in children. A systematic review of the literature related to management protocols for PSF was conducted and we report a case exemplifying treatment in our department. Traditionally, treatment for PSF has been open surgery; however, in the last few decades, the minimally invasive transoral endoscopic approach has gained in importance, demonstrating long-term outcomes comparable to open surgery and with lower morbidity, and it has now become the first-choice treatment. We further describe a case of PSF treated by a transoral endoscopic approach with electric cauterization, fibrin glue obliteration of the fistula and Polydimethylsiloxane (Vox-Implants®, Bioplasty, Geleen, The Netherlands) submucosal injection. According to the authors, application of Vox-Implants® injection, in addition to standard techniques, may be helpful to reduce fistula recurrence rate after surgery

Personal experience with the remote check telehealth in cochlear implant users: from COVID-19 emergency to routine service

Purpose: To critically illustrate the personal experience with using the “Remote Check” application which remotely monitors the hearing rehabilitation level of cochlear implant users at home and further allows clinicians to schedule in-clinic sessions according to the patients’ needs. Methods: 12-month prospective study. Eighty adult cochlear implant users (females n = 37, males n = 43; age range 20–77 years) with ≥ 36 months of cochlear implant experience and ≥ 12 months of stable auditory and speech recognition level volunteered for this 12-month long prospective study. For each patient, at the beginning of the study during the in-clinic session to assess the stable aided hearing thresholds and the cochlear implant integrity and patient’s usage, the “Remote Check” assessment baseline values were obtained. “Remote Check” outcomes were collected at different times in the subsequent at-home sessions, to identify the patients that had to reach the Center. Chi-square test has been used for statistical analysis of the comparison of the “Remote Check” outcomes and in-clinic session results. Results: “Remote Check” application outcomes demonstrated minimal or no differences between all sessions. The at-home Remote Check application reached the same clinical outcomes as the in-clinic sessions in 79 out 80 of participants (99%) with high statistical significance (p < 0.05). Conclusions: “Remote Check” application supported hearing monitoring in cochlear implant users that were not able to attend the in-clinic review during COVID-19 pandemic time. This study demonstrates that the application can be a useful routine tool also for clinical follow-up of cochlear implant users with stable aided hearing

Intervention model for natural and anthropogenic risk scenarios in the framework of Municipal Emergency Plans

Municipality Emergency Plans (MEPs) represent an essential tool for Italian municipalities, since they contain all the indications and procedures to face any expected or unexpected hazard in their territory. In the present work, the MEP of Palma Campania municipality (Napoli province, Southern Italy) completed in April 2016, is reported. The experience of Palma Campania is here reported since it has represented a significant test site where different risks, both natural and anthropogenic, have been considered, along with their potential mutual interaction. Palma Campania territory, indeed, has been affected by different calamitous events, both natural (landslides, earthquakes, and volcanic eruptions by the Somma-Vesuvius complex) and man-induced (wildfires, industrial risks). According to the guidelines provided, a standard methodology was applied (Augustus method), however risk characterization was enhanced by using the most advanced technologies and methodologies and performing ad hoc field surveys. In particular, landslide, hydraulic, fire, seismic, volcanic and industrial risks scenarios have been defined, with the support of high-resolution Digital Terrain Models and adopting advanced scientific procedures. An extremely detailed risk assessment has been fundamental for the implementation of a tailored intervention model, designed to make safe the population in case of calamities. Therefore, the MEP of Palma Campania represents a fundamental document for inhabitants’ safety during calamitous events, analyzing at a very local scale all the possible direct and indirect interactions between risks and people. Moreover, the MEP is intended to be a dynamic plan, representing a main basis linked to a series of activities, such as satellite and hydro-meteorological monitoring, seismic microzonation, etc. Thus, the main aim of a MEP is oriented towards the long-term prevention and risk awareness. Such experience may represent a valuable approach for municipalities affected by multiple risks, with the aim of defining the best strategies for risk reduction

Rainfall-Induced Shallow Landslide Detachment, Transit and Runout Susceptibility Mapping by Integrating Machine Learning Techniques and GIS-Based Approaches

Rainfall-induced shallow landslides represent a serious threat in hilly and mountain areas around the world. The mountainous landscape of the Cinque Terre (eastern Liguria, Italy) is increasingly popular for both Italian and foreign tourists, most of which visit this outstanding terraced coastal landscape to enjoy a beach holiday and to practice hiking. However, this area is characterized by a high level of landslide hazard due to intense rainfalls that periodically affect its rugged and steep territory. One of the most severe events occurred on 25 October 2011, causing several fatalities and damage for millions of euros. To adequately address the issues related to shallow landslide risk, it is essential to develop landslide susceptibility models as reliable as possible. Regrettably, most of the current land-use and urban planning approaches only consider the susceptibility to landslide detachment, neglecting transit and runout processes. In this study, the adoption of a combined approach allowed to estimate shallow landslide susceptibility to both detachment and potential runout. At first, landslide triggering susceptibility was assessed using Machine Learning techniques and applying the Ensemble approach. Nine predisposing factors were chosen, while a database of about 300 rainfall-induced shallow landslides was used as input. Then, a Geographical Information System (GIS)-based procedure was applied to estimate the potential landslide runout using the “reach angle” method. Information from such analyses was combined to obtain a susceptibility map describing detachment, transit, and runout. The obtained susceptibility map will be helpful for land planning, as well as for decision makers and stakeholders, to predict areas where rainfall-induced shallow landslides are likely to occur in the future and to identify areas where hazard mitigation measures are needed

Machine learning ensemble modelling as a tool to improve landslide susceptibility mapping reliability

Statistical landslide susceptibility mapping is a topic in complete and constant evolution, especially since the introduction of machine learning (ML) methods. A new methodological approach is here presented, based on the ensemble of artificial neural network, generalized boosting model and maximum entropy ML algorithms. Such approach has been tested in the Monterosso al Mare area, Cinque Terre National Park (Northern Italy), severely hit by landslides in October 2011, following an extraordinary precipitation event, which caused extensive damage at this World Heritage site. Thirteen predisposing factors were selected and assessed according to the main characteristics of the territory and through variance inflation factor, whilst a database made of 260 landslides was adopted. Four different Ensemble techniques were applied, after the averaging of 300 stand-alone methods, each one providing validation scores such as ROC (receiver operating characteristics)/AUC (area under curve) and true skill statistics (TSS). A further model performance evaluation was achieved by assessing the uncertainty through the computation of the coefficient of variation (CV). Ensemble modelling thus showed improved reliability, testified by the higher scores, by the low values of CV and finally by a general consistency between the four Ensemble models adopted. Therefore, the improved reliability of Ensemble modelling confirms the efficacy and suitability of the proposed approach for decision-makers in land management at local and regional scales

The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study

Background: To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up. Methods: It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL). Results: PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. Conclusions: A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI