Sialoendoscopy in the management of the salivary gland disorders

BACKGROUND: The aim of this study was to determine the long-term (> 6 month) outcome of patients suffering from obstructive sialadenitis treated by sialoendoscopy. METHODS: Between 2009 and 2013 seventy-six subjects underwent sialoendoscopy under local anesthesia at the University Hospital P. Giaccone of Palermo. RESULTS: The mean age of presentation was 50.5 years for male (56.6%) and 44.7 years for female (43.4%). The presenting symptoms were frequent pain in 72% of cases, frequent purulent secretions in 65% of cases, frequent swelling in 62% of cases and frequent bitter taste in 44% of cases. Affected glands were in 54 cases the submandibular unilaterally, in 21 cases the parotid unilaterally and in 1 case the submandibular bilaterally. Preoperative ultrasound showed in 30 cases a sialolitiasis and in 19 cases a ductal stenosis, in 3 cases were both associated. In 46 cases showed a ductal dilatation, variably combined with the previous two and in 13 cases ultrasound gave no indication. Average operating time was 60.7 minutes (range 35-125 min). In 35 cases it was necessary to perform a papillotomy. Presence of stones was shown in 36 patients, in 3 cases these stones were multiple. Endoscopic removal of stones was achieved in 72.2%, with a mean size of 3.6 mm (range 0.7-5.5 mm), only two were larger than 5 mm. In five of this cases was performed a trans-oral combined approach. In 15 cases was highlighted a ductal stenosis, in 6 cases associated with mucus plugs, that were treated with daily irrigations with Thiamphenicol glycinate acetylcysteinate. A percentage of 64.8% of patients had complete resolution of symptoms after sialendoscopy, with 25% having partial resolution of symptoms and 6.6% required the removal of the gland. CONCLUSIONS: Sialendoscopy is the procedure of choice for the diagnosis and treatment of chronic non-lithiasic sialoadenitis, but unlike its apparent simplicity has a significant learning curve, and need appropriate selection of patients

Sjogren syndrome and parotid marginal zone lymphoma: Report of a case and review of literature

Five percent of the cancers in the parotid region are non-hodgkin lymphomas. This lymphoma, involving the mucosa-associated lymphoid tissue (MALT), is called MALToma. A chronic autoimmune inflammatory process of the parotid gland, such as Sjogren's syndrome, results in an increased incidence of parotid MALToma. Biopsy of the parotid is essential for appropriate diagnosis; this can then be completed by radiotherapy, chemotherapy or therapy with monoclonal antibodies according to the stage of the disease. This study shows a clinical case of a 50-year-old patient with Sjogren's syndrome who developed a parotid MALToma

APPRENDERE E PRATICARE LA SCRITTURA: LE ATTIVITÀ DEI MANUALI DI ITALIANO L2 PER LO SVILUPPO DELLE COMPETENZE DI PRODUZIONE SCRITTA

Il contributo introduce i primi risultati di una ricerca sullo sviluppo e la pratica dell’abilità di scrittura nell’ambito dei manuali di italiano L2 che hanno per destinatario un pubblico di adulti e giovani adulti. L’obiettivo è quello di evidenziare come e in quale misura i manuali rispondano ai bisogni linguistico-comunicativi degli apprendenti e li aiutino a imparare a produrre testi scritti in L2, abilità che spesso viene posta in secondo piano in seno ai più moderni approcci e metodi glottodidattici, maggiormente focalizzati sull’oralità e sulla comprensione scritta. Dopo la ricostruzione del quadro teorico delle diverse interpretazioni della scrittura in L2 e delle conseguenti ricadute didattiche, viene presentata la scheda SAMIL2-Scrittura, uno strumento di indagine validato da un gruppo di docenti esperti di italiano L2, finalizzato all’analisi dei manuali, in particolare dei modelli testuali, delle riflessioni metalinguistiche, delle attività proposti per la scrittura. Il campione di manuali analizzato, dal livello A1 al C2, ha consentito di mettere in evidenza alcuni elementi chiave come i generi testuali più ricorrenti, i tipi di compiti di scrittura richiesti all’apprendente, la collocazione delle attività di scrittura nell’unità didattica e lo spazio a loro riservato, la congruenza dei task rispetto al livello di competenza del QCER e ai sillabi di italiano L2.   Learning and performing writing: the tasks of textbooks of Italian as L2 to develop the writing skill   The paper presents the first results of a research on the development and practice of writing skills in the Italian as L2 textbooks addressed to adults. The goal is to highlight how and to what extent textbooks are able to respond to the linguistic and communicative needs of learners and if they help them to learn to write a text in a second language, skill that is often overlooked in modern approaches and methods, focused mainly on oral skills and reading comprehension. After an introduction to the theoretical framework of different interpretations of writing in L2 and of the teaching consequences, SAMIL2-Scrittura will be introduced, a research tool validated by a group of skilled teachers of Italian L2, created to analyze textbooks, in particular text models, explanations, and tasks to develop and practice writing. The sample of textbooks analyzed, from A1 to C2 level, will let us point out a few key elements, such as the main textual genres, the kinds of writing tasks, the position of the writing tasks in the unit and their role, the consistency of the tasks with the levels of the CEFR and the syllabuses of Italian L2. &nbsp

Localization of the atrial natriuretic factor in the human inferior turbinates. An immunohistochemical study

In man, the architecture of the turbinates is able to modify some of the physiochemical characteristics of the air inhaled. These modifications depend on the nervous system and on the action of neurotransmitters such as vasoactive intestinal peptide. Substance P, calcitonin gene-related peptide and other neuropeptides. As atrial natriuretic factor has been detected in the trachea and lung, the present immunohistochemical study was carried out to establish the presence and localisation of the atrial natriuretic factor on the inferior turbinates of the human being. The findings show atrial natriuretic factor to be present in the serous epithelial cells and in some cells of the tonaca propria near the sinusoids and the arteriovenous shunts and the acinar cells of the glands. Atrial natriuretic factor, therefore, could play a part in the stratification of mucus on the luminal surface and also regulate the blood flow of the capillaries, modifying, in this way, the physiochemical features of the air inhaled

Uvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS

Objective: To establish the efficacy of uvulopalatopharyngoplasty with tonsillectomy for treating selected patients with severe obstructive sleep apnea syndrome Methodology: Retrospective study of patients who underwent clinical/instrumental evaluation and surgical treatment. Setting: University ENT division with a tertiary snoring referral center Participants: Twenty-two patients with normal body mass index affected by severe obstructive sleep apnea syndrome- Main outcome measures: Pre and post operative cardiopulmonary monitoring during sleep, daytime sleepiness evaluation, post treatment complication recording. Results: Complete response to therapy was obtained in 78% of patients. Four patients had relief of symptoms but retained apnea-hypopnea index scores greater than 5 Conclusions: Uvulopalatopharyngoplasty associated with tonsillectomy can be employed safely to treat patients with normal body mass index who suffer from severe obstructive sleep apne

Anterior palatoplasty: Effectiveness for treatment of simple snoring and mild osas

Positive airway pressure is the treatment of choice among obstructive sleep apnea syndrome patients. Among surgical options, multilevel approach is a good option in patients with an involvement of all tract of first airway. The aim of the present work is to establish the efficacy of anterior palatoplasty in the treatment of selected patients with mild obstructive sleep apnea syndrome or simple snoring, within a multilevel surgery. The group was composed of 16 mild obstructive sleep apnea syndrome adult patients collected from January 2015 to June 2016 at University of Palermo, Ear, Nose and Throat Department. To make diagnosis of obstructive sleep apnea syndrome, we employed polysomnography, the Epworth Sleepiness Scale and an endoscopic study of aerodigestive tract in order to identify the sites of collapse. All patients underwent to inferior turbinate reduction, anterior pharyngoplasty and hyoid suspension. After treatment, 11 patients had Apnea Hypopnea Index â ¤5 and 4 patients less than 50% compared to the starting one. According to Epworth Sleepiness Scale, the daytime sleepiness enhanced from 12.6 to 8.6 post-operative average. Pre-operative mean value of Mullerâ s maneuver was N (nose):2.6, O (oropharinx): 3.4, H (hypopharinx):2.5 Before performing surgical procedure each patient was subjected to sleep endoscopy to evaluate better the pattern of collapse. The post-operative mean outcomes of Muellerâ s Maneuver was: N 1.5, O 1.3, H 1.3. Barbed Anterior pharyngoplasty, combined with other surgical procedures, can be considered a valid surgical option to relieve snoring, and mild apnoic events. Our preliminary results, show that the anterior palatoplasty, combined with other surgical procedures, can be considered a valid surgical option to relieve snoring and mild apnoic events

Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Objective: The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma. Methods: This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic BPPV was done. Results: Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2 years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases. The instrumental neurotologic assessment did not show any alteration of either vestibulospinal reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3 to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning maneuver. The Dizziness Handicap Inventory score improved in all patients treated with repositioning maneuvers, but no difference emerged with idiopathic BPPV data. Conclusion: BPPV after whiplash injury could be unveiled with a simple bedside examination of peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more maneuvers to achieve satisfactory results

Expression pattern of estroprogestinic receptors in sinonasal inverted papilloma

open13openSerra A; Caltabiano R; Spinato G; Gallina S; Caruso S; Rapisarda V; Di Mauro P; Castro V; Conti A; Licciardello L; Maiolino L; Lanzafame S; Cocuzza SSerra, A; Caltabiano, R; Spinato, G; Gallina, S; Caruso, S; Rapisarda, V; Di Mauro, P; Castro, V; Conti, A; Licciardello, L; Maiolino, L; Lanzafame, S; Cocuzza,