363 research outputs found
Sinonasal angioleiomyoma with adipocyte differentiation: clinicopathologic study of 2 cases and review of the literature
Angioleiomyoma (ALM) is a benign tumor of the skin and soft tissues composed of well differentiated smooth muscle cells arranged around and among many vascular channels. Few cases have been reported in the sinonasal region, where ALM may show a variable amount of mature adipose tissue that may make hard the distinction from angiomyolipoma.
We report here two cases that presented with a three- and six-month history of left nasal obstruction respectively. In both patients, clinical examination and imaging studies failed to reveal features of tuberous sclerosis complex and demonstrated a mass obliterating the nasal cavity arising from the inferior turbinate. Both masses were endoscopically excised. Pathologic analysis revealed highly vascularized tumors composed of well differentiated smooth muscle cells intermingled with a variable number of mature adipocytes. Immunostaining for melanocytic markers was negative. Based on these findings, both tumors were diagnosed as sinonasal-ALM with adipocytic differentiation.
These two cases indicate that both clinical data (i.e. absence of features of tuberous sclerosis complex) and immunohistochemistry (i.e. absence of melanocytic markers) are mandatory for the recognition of sinonasal-ALM with adipocytic differentiation. The term angiomyolipoma to identify these lesions is confusing and should be abandoned
Letter to the editor: autoimmune pathogenic mechanisms in amyotrophic lateral sclerosis
The innate immune system may affect the function and survival of motor neurons in ALS by at least three mechanisms. First, there is evidence to suggest that aggregates of mutant SOD1—which is derived from microglial and astroglial cells—activate neighbouring microglia by binding to TLR2, TLR4, and CD14, and subsequently promote neuronal cell death [9]. Second, the release of pro- inflammatory cytokines may drive motor neuron damage. Third, although poorly understood, a mechanism has been suggested on the basis of the functional analysis of microglial cells that express mutant SOD1 [10]. These cells showed impaired overall motility and a reduced capacity to clear neuronal cell debris. Impairment of microglial cell phagocytosis may therefore contribute to the accumulation of further immunostimulatory proteins, including mutant SOD1, chromogranin A, and dsRNA, thereby resulting in disease progression
Social geography of rhinoscleroma and qualitatively and quantitatively abnormal cell-mediated immunity
Rhinoscleroma is a progressive chronic granulomatous disease of the upper respiratory tract that may extend to the tracheobronchial tract. It is common belief that the pathology is determined by Klebsiella Rhinoscleromatis. In the authors' opinion, the infection with Klebsiella Rhinoscleromatis may not represent the only etiopathogenic factor of the disease. Rhinoscleroma is reported in many countries, but has a peculiar social and geographic distribution, in that it assumes an endemic character only in some regions of the Middle East, West Russia, North Africa, Indonesia, Central and South America. In Europe, most of the cases are reported in Poland, Hungary and Romania. In Italy, Rhinoscleroma is almost exclusively located in the southern and island regions. Rhinoscleroma is predominantly reported in rural areas, in the presence of poor socio-economic conditions, which according to many authors would be a co-factor triggering the disease. In this article, the authors review some inconsistencies in etiology, histology and epidemiology of Rhinoscleroma. Based on the overall picture, they propose that intrinsic factors, possibly of genetic origin, may give rise to the disease, and suggest possible lines of research to distinguish between extrinsic and intrinsic factors as determinants for Rhinoscleroma
Letter to the editor: autoimmune pathogenic mechanisms in Huntington’s disease
Letter to the Editor: Autoimmune pathogenic mechanisms in Huntington's disease
The Effects of the COVID-19/SARS-CoV-2 pandemic outbreak on otolaryngology activity in Italy
The coronavirus disease 2019 (COVID-19) pandemic during the first months of 2020 is causing profound changes in worldwide health care systems, resulting in a major reduction of surgical interventions and routine non-urgent outpatient diagnostic procedures. The lockdown due to the COVID-19 pandemic in Italy, one of the most affected countries in Europe, is having severe effects on the otolaryngology medical and surgical activities. The main changes are represented by the postponement of outpatient visits and scheduled surgery, while the only guaranteed service is reserved to diagnostics and surgery for oncology and urgent patients. In these cases, given the sites of action typical of the otolaryngology practice, physicians and nurses are exposed to a high risk of contagion through virus aerosol transmission. Furthermore, as the current measures of lockdown continue, it will be difficult to perform scheduled and new diagnostic assessments, medical treatments and surgical procedures in a timely manner favoring the risk of diagnostic and therapeutic delays with severe impact on patients’ health
Advances in the management of HPV-related oropharyngeal cancer
Patients with human papillomavirus- (HPV-) related oropharyngeal squamous cell carcinoma (OPSCC) have a better prognosis
than HPV-negative OPSCC when treated with standard high-dose cisplatin-based chemoradiotherapy. Consistent with this
assertion and due to younger age at diagnosis, novel approaches tominimize treatment sequelaewhile preserving survival outcomes
become of paramount importance. Here, we critically reviewed the evidence-based literature supporting the deintensification
strategies in HPV-related OPSCC management, including radiotherapy dose and/or volume reduction, replacement of cisplatin
radiosensitising chemotherapy, and the use of transoral surgery. Undoubtedly, further researches are needed before changing the
standard of care in this setting of patients
Large neck metastasis of hypopharyngeal cancer
Lateral neck masses may be due to congenital, infectious, or malignant disease. Sometimes, the mass can be the only sign of an asymptomatic cancer. A correct clinical approach and the differential diagnosis are the key points for a correct diagnosis
Clinical recommendations for epistaxis management during the COVID-19 pandemic
Epistaxis is a common complaint in the general population, and its treatment is a common procedure in emergency departments. In the COVID-19 era, procedures involving airway management are a particular risk for health care workers due to the high virulence of the virus, the transmission through aerosol, and the risk of contagion from asymptomatic patients. In this article, we propose a simple memorandum of clinical recommendations to minimize the risk of operator infection deriving from epistaxis management. The correct use of personal protective equipment and strict compliance with the behavioral guidelines are essential to reduce the potential risk of infection. In particular, the use of filtering masks is strongly recommended since all patients, including those referring for epistaxis, should be treated as being COVID-19 positive in the emergency department. The safety of health care workers is essential not only to safeguard continuous patient care but also to limit virus transmission
Olfactory evaluation in obstructive sleep apnoea patients
The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin’ Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition
Nasal pathologies in patients with obstructive sleep apnoea
Nasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which
is thought to destabilise the upper airway to aggravate the condition. Three conditions could be considered as the cause of the nasal breathing
obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and
chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of
all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a
diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSAS patients, whereas one or more pathological rhino-sinus
conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis
was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed
in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients.
Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swellin
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