Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery?

Main goals: To analyze how and when the endoscope is used in vestibular schwannoma surgery and identify the benefits of using endoscopy in this type of surgery. Background: It is currently unclear if there is any benefit from using an endoscope in vestibular schwannoma surgery so this retrospective analysis set out to study this. Methods: All the patients who underwent vestibular schwannoma surgery at our clinic were included for all the vestibular schwannoma approaches taken. We studied when endoscopy was used during surgery and the goal of using endoscopy. Several pre- and postoperative factors were assessed such as complications, facial function, and hearing function in the case of techniques that allow hearing preservation. Results: From January 2015 to September 2018, 280 patients underwent lateral skull base surgery. Of these, 112 were included in this study. The endoscope was used in all 112 patients, and in eight cases it was possible to identify residual disease using the endoscope to check the surgical field, and then to remove the disease under endoscopic view. Moreover, in two other cases, the endoscope was used to resolve a vasculoneural conflict between the anterior inferior cerebellar artery (AICA) loop and facial nerve in one case, and for deafferentation of the superior and inferior vestibular nerves in the second case. No major intraoperative complications occurred in our series. There was no statistically significant difference in postoperative facial nerve function between patients in whom the endoscope was used as a diagnostic tool and patients in whom it was used as an operative tool (p = 0.3152). Conclusions: The endoscope may be useful, especially in surgical techniques where there is poor control of the internal auditory canal (IAC). An endoscopic support technique is strongly recommended to avoid residual disease, particularly in retrosigmoid and retrolabyrinthine approaches. Moreover, the recent introduction of the transcanal transpromontorial approach allows the endoscope to be used during all the procedures in patients affected by a vestibular schwannoma limited to the IAC or to support surgical procedures during an enlarged microscopic approach

Leiomyosarcoma of the Larynx: A Complex Diagnosis

An 84-year-old man was referred to our institution for dysphonia present for 2 months. Fiberoptic laryngoscopy demonstrated a polypoid lesion of the right true vocal fold with normal motility. Excisional biopsy of a submucosal thickening of the right vocal fold with vocal ligament calcification was performed. Histology revealed squamous cell epithelium without malignancy. Postoperative endoscopic follow-up was regular. Six months after surgery, dysphonia and dyspnea occurred. Flexible laryngoscopy demonstrated right hemilaryngeal paralysis, edema, and partial airway obstruction. Necrotic tissue and purulent secretions were visible at the anterior commissure, right vocal fold, and ipsilateral vestibule. A second microlaryngoscopic surgery included multiple biopsies and debridement of the necrotic tissue. Histological report was negative for malignancy, and purulent chondritis was diagnosed. Intravenous antibiotic therapy was administered with improvement of infection, inflammation, dysphonia, and dyspnea. The patient was discharged

Complications in endoscopic ear surgery

Objective: The aim of this study was to examine the premise that endoscopic ear surgery (EES) is associated with a low rate of complications (intraoperative and postoperative). Study design: Retrospective review at two institutions. Setting: Tertiary referral center. Patients: The study included 825 patients who underwent exclusive EES between 2008 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Modena University Hospital, and between 2014 and 2016 at the Otorhinolaryngology-Head and Neck Surgery Department of Verona University Hospital. Interventions: Exclusive endoscopic ear surgery between 2008 and 2016 (tympanoplasties, second look or revision tympanoplasties, myringoplasties, stapedoplasties, canalplasties, ossiculoplasties, and exploratory tympanotomies). All surgical procedures were performed by two experienced surgeons. Main outcome measure: For each procedure, intraoperative, and early and delayed postoperative complications were evaluated. Results: The most common ear pathologies for which patients were sent for EES were cholesteatoma (33.6%), chronic otitis media (36.3%) and otosclerosis (26.8%). There was no case of major intraoperative complications such as injury to the dura or vascular structures. We observed minor intraoperative complications in 4.1% of the cases. Only 1.3% of patients experienced early postoperative complications. Delayed complications affected less than 1% of the cohort. Conclusions: Data from this study confirm the safety of the endoscopic technique, with very low complication rates, indicating that EES is a reliable therapeutic option, in particular, for tympanoplasties, myringoplasties, and stapedoplasties, as well as second look procedures. We have reported our experience with EES morbidity so that it can be compared with data from other centers using the same surgical technique

Results on entire solutions for a degenerate critical elliptic equation with anisotropic coefficients

In this paper, we study the following degenerate critical elliptic equations with anisotropic coefficients $$-div(|x_{N}|^{2\alpha}\nabla u)=K(x)|x_{N}|^{\alpha\cdot 2^{*}(s)-s}|u|^{2^{*}(s)-2}u {in} \mathbb{R}^{N}$$ where $x=(x_{1},...,x_{N})\in\mathbb{R}^{N},$ $N\geq 3,$ $\alpha>1/2,$ $0\leq s\leq 2$ and $2^{*}(s)=2(N-s)/(N-2).$ Some basic properties of the degenerate elliptic operator $-div(|x_{N}|^{2\alpha}\nabla u)$ are investigated and some regularity, symmetry and uniqueness results for entire solutions of this equation are obtained. We also get some variational identities for solutions of this equation. As a consequence, we obtain some nonexistence results for solutions of this equation.Comment: 29 page

Studi confraternali: orientamenti, problemi, testimonianze

Il volume raccoglie interventi di studiosi italiani e stranieri miranti a offrire una panoramica di percorsi storiografici e di problematiche relativi alla storia del movimento confraternale, così come sono emersi nell'ambito di discipline storiche, sociali, giuridiche, letterarie e artistiche sviluppatesi nel corso del Novecento. I contributi si riferiscono al contesto storico dell'Europa occidentale, con più specifico riguardo per l'Italia, nel periodo compreso fra medioevo e prima età moderna. La raccolta si articola in quattro sezioni: Individui e gruppi, che sonda l'emergere di un interesse verso le comunità confraternali all'interno di ambiti di studio come la storia dei gruppi sociali, del mondo rurale, delle donne, dei giovani; L'inquadramento giuridico e istituzionale, che affronta problemi di legittimità e di assetto istituzionale; L'economia della carità, che analizza il rapporto delle confraternite con gli enti ospedalieri, le modalità amministrative dei patrimoni confraternali, le culture di governo che sottostanno a politiche assistenziali di cui le confraternite sono tramite principale; Testimonianze teatrali, musicali, artistiche, documentarie dedicata alle fonti che le confraternite hanno saputo trasmettere

The Future of International Investment Regulation: Towards a World Investment Organisation?

With growth in foreign investment and in the number of companies investing in foreign countries, the application of general principles of public international law has not been deemed adequate to regulate foreign investment and there is, as yet, no comprehensive international treaty on the regulation of foreign investment. Consequently, states have resorted to bilateral investment treaties (BITs), regional trade and international investment agreements (IIAs) and free trade agreements (FTAs) to supplement and complement the regime of protection for foreign investors. In the absence of an international investment court, states hosting foreign investment or investor states have opted for investor-state dispute settlement mechanism (ISDS). This mechanism has brought about its own challenges to the international law of foreign investment due to inconsistency in the application and interpretation of the key principles of international investment law by such arbitration tribunals, and further, there is no appellate mechanism to bring about some cohesion and consistency in jurisprudence. Therefore, there are various proposals mooted by scholars to address these challenges and they range from tweaks to BITs and IIAs, the creation of an appellate mechanism and the negotiation of a multilateral treaty to proposals for reform of ISDS only. After assessing the merits and demerits of such proposals, this study goes further, arguing for the creation of a World Investment Organisation (WIO) with a standing mechanism for settlement of investment disputes in order to ensure legal certainty, predictability and the promotion of the flow of foreign investment in a sustainable and responsible manner

Lombardia

Bibliografia Statutaria Italiana (1985-1995

Regulatory autonomy and liberalization of trade and investment flows: how are these competing interests balanced by international economic law?

Introduced by Giovanna Adinolfi, Claudio Dordi and Tarcisio Gazzini It has often been argued that trade and investment treaties unduly restrain the host State\u2019s prerogatives and in particular its capacity to meet its responsibilities in areas such as the protection of the environment, human rights and other social values. The extent to which this argument..