Experimental investigation on a geocontainer Submerged reef

Geotextile sand containers (GSC) have been used as permanent construction elements in coastal works for more than 20 years,becoming more and more popular as an alternative to the most typical coastal structures. Aim of this work is to analyze the hydrodynamic, stability and morphodynamic response of a GSC submerged reef by means of an experimental campaign. The first investigated aspect concerned the hydrodynamics. The reflection and transmission coefficients for regular and random waves were determined: the reflection coefficient decreases with increasing of kh; the transmission coefficient decreases with the increase of the incident wave. As regards the stability of the structure, it was observed that the strongest waves were able to lift the row of GSC more exposed to the wave action. An instability curve for the GSC as a function of the hydrodynamic characteristics was then found. Flow visualization close to the reef was performed by means of ink, showing that the flow becomes asymmetric in the proximity of the structure. Concerning the morphodynamics, long-term tests were performed to calculate the scour. This reached its maximum value at the end of each test and it is present in all three cases. The scour causes serious problems of instability to the structure

Cerebrospinal fluid leak during stapes surgery: Gushing leaks and oozing leaks, two different phenomena.

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications

Drug-Induced Sleep Endoscopy: Clinical Application and Surgical Outcomes

The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer recording, and endoscopic evaluation. Drug-induced sleep endoscopy (DISE) is a diagnostic tool that allows the dynamic, three-dimensional evaluation of the patterns of vibration and collapse of the upper airway of SDB patients. DISE may change the initial surgical planning in a high percentage of cases. A universally accepted and methodologically standardized DISE could provide significant insight into its role to improve surgical outcomes. However, up to now the ideal DISE protocol remains an open question

Mandibular advancement devices vs nasal-continuous positive airway pressure in the treatment of obstructive sleep apnoea. Systematic review and meta-analysis

Obstructive sleep apnoea (OSA) is a common disorder that may affect at least 2 to 4% of the adult population. Nasal-Continuous Positive Airway Pressure (N-CPAP) is today considered the gold standard for the treatment of OSA. The development of oral appliances (OAs) represents a new approach for the management of this pathology. The aim of this systematic review is to compare the efficacy of OAs and N-CPAP in the treatment of patients with mild to severe OSA. A PubMed-MEDLINE and Cochrane databases search of articles published between 1982 and 2016 comparing the effect of N-CPAP and OAs in OSA patients was conducted during July 2016. The studies were selected and stratified according to PRISMA and SORT criteria. The main outcome measure was post-treatment Apnoea-Hypopnoea Index (AHI) while secondary outcomes included post-treatment Epworth Score Scale (ESS) score and lowest Oxygen Saturation level. N-CPAP was significantly more effective in suppressing AHI than OA. Moreover, N- CPAP was significantly more effective in increasing post-treatment lowest Oxygen Saturation level than OA. However, no significant different in decreasing ESS values was found between the two treatments. On the basis of evidence in this review it would appear appropriate to offer OA therapy to those who are unwilling or unable to persist with CPAP therapy. N-CPAP still must be considered the gold standard treatment for OSA and, therefore, OAs may be included in the list of alternative options

Dental implants after the use of bichat’s buccal fat pad for the sealing of oro-antral communications. A case report and literature review

Oro-antral communications are frequent complications in oral surgery, and generally occur after molar extractions, maxillary sinus elevations or dental implant procedures. The presence of these defects may increase the morbidity and often need a surgical approach. The present report describes an oro-antral communication in a 52-year-old female who presented a 2 week-course of painless nasal obstruction and rhinorrea after a right maxillary sinus floor elevationwith simultaneous dental implant placement. Based on the anamnesis, clinical examination and a computed tomographyof the paranasal sinuses, a diagnosis of odontogenic rhinosinusitis associated with a 1.5 cm diameter oro-antral communicationwas establishedand its surgical closure using Bichat’s buccal fat pad was planned.After 15 months, the patient was successfully rehabilitated with an implant-supported 3 unit fixed partial denture

MALIGNANT EXTERNAL OTITIS. A CASE SERIES FROM AN ITALIAN TERTIARY-CARE HOSPITAL

Objectives: Malignant external otitis (MEO) is an. aggressive and potentially fatal disease that affects the external. auditory canal (EAC) it occurs almost exclusively in elderly, diabetic patients or immune compromised ones. The aim of this study was to describe epidemiological and clinical characteristics of a consecutive series of patients affected by malignant external otitis (MEO) and to conceive a flow-chart for its management. Material and methods: Adult patients diagnosed with and treated for MEO at the University Hospital of Messina, Italy between 2003 and 2013 were identified. Charts were reviewed for history, clinical presentation, laboratory data treatment, and outcomes. Results: Data of 11 patients were analyzed. Patients' mean age was 67.6 years; and ten were males. All but one suffered from diabetes and one was HIV infected. Average time of arrival at our department from onset of symptoms was 123 weeks. Intravenous antibiotics were administered in seven cases whereas exclusively oral antibiotics were given to four patients. Local antibiotic therapy was associated to systemic administration in seven cases. Four patients underwent surgical treatment. The median duration of antibiotic treatment was 12.4 weeks. Ten patients experienced a complete recovery even if in one of these residual facial palsy Was reported; one patient died Of a skull base Osteomyelitis with Multiple nerve involvement. A flow-chart which could guide physicians in the management of MEO is proposed. Conclusions. Malignant external otitis still remains today a very challenging issue Randomized clinical trials are needed to better clarify which Medical and surgical treatment could be the gold standard. A consensus diagnostic flow diagram could help in the management of this pathology

Current challenges in the diagnosis and treatment of obstructive sleep apnea syndrome in the elderly

Obstructive sleep apnea syndrome (OSAS) is a respiratory sleep disorder characterized by repeated episodes of partial or complete obstruction of the upper airway that occur during the night. OSAS is a common disease in the elderly population with an estimated incidence of between 20% and 60% in people over the age of 65. Due to the high prevalence of OSAS in older people and considering the increase in the average age of the world population, it is essential to know how to diagnose and treat this disease in elderly patients

Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review

The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent

Oxidative stress and inflammation biomarker expression in obstructive sleep apnea patients

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO2). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade's activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease's severity and treatment