Mucoepidermoid carcinoma associated with osteosarcoma in a true malignant mixed tumor of the submandibular region

True malignant mixed tumor, also known as carcinosarcoma, is a rare tumor of the salivary gland composed of both malignant epithelial and malignant mesenchymal elements. Frequently carcinosarcoma arises in the background of a preexisting pleomorphic adenoma; however, if no evidence of benign mixed tumor is present, the lesion is known as carcinosarcoma "de novo." We reported the first case of true malignant mixed tumor of the submandibular gland composed of high grade mucoepidermoid carcinoma associated with osteosarcoma. Case Presentation. A 69-year-old Caucasian male came to our department complaining of the appearance of an asymptomatic left submandibular neoformation progressively increasing in size over 3 months. We opted for surgical treatment. Histological examination confirmed the diagnosis of carcinosarcoma with the coexistence of high grade mucoepidermoid carcinoma and osteosarcoma. Conclusion. To the best of our knowledge, in the true malignant mixed tumor of the submandibular gland, mucoepidermoid carcinoma associated with osteosarcoma has never been previously reported

Generalised Minkowski spacetime

The four dimensional spacetime continuum, as first conceived by Minkowski, has become the default framework within which to describe physical laws. In this paper, we show how a four-dimensional Minkowski spacetime structure naturally arises from three-dimensional physical space when modeled with Clifford geometric algebra $C\ell(\Re^3)$. This expanded eight-dimensional framework allows a generalisation of the invariant interval and the Lorentz transformations. Also, with this geometric oriented approach the fixed speed of light, the laws of special relativity and the form of Maxwell's equations, arise naturally from the intrinsic properties of the algebra without recourse to physical arguments. We also find new insights into the nature of time, a unified treatment of energy-momentum and spin, a Lagrangian unifying gravity and electromagnetism as well as predictions of a new class of physical effects and interactions.Comment: 20 pages, no figure

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

Unusual symptomatology in eagle syndrome

A 20-year-old female presented a history of isolate left external ear pain. ENT valuation showed no alteration of the district, but an aberrant styloid process was tender to palpation in the left tonsillar fossa. Computer tomography was performed and confirmed it. Thereafter, the diagnosis of Eagle syndrome was made. The auricular branch of the vagal nerve (ABVN) was pressed by the styloid process causing the pain. This case pointed out the importance to consider anatomical alteration as elongated styloid process as a possible cause of external ear pain

Tympano-mastoid cholesterol granuloma: case report and review of the literature

Cholesterol granuloma (CG) is a rare condition histological consisting of a foreign body, giant cell reaction to cholesterol crystals and haemosiderin derived from the ruptured of the erythrocytes. A 25-year-old man came to our Department presenting signs and symptoms of tympano-mastoid cholesterol granuloma. He showed all the specific sign and symptoms of the disease. However, considering the lack of literature regarding TMCG, this study was performed with the aim of presenting the main characteristics of tympano-mastoid CG, describing the case report and reviewing the literature

Risk factors for obstructive sleep apnea syndrome in children: state of the art

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management

Eustachian tube dysfunction in children with adenoid hypertrophy: the role of adenoidectomy for improving ear ventilation

Introduction: To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME). Aim: The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients. Methods: Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months. Results: Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value (P =.0015). Conclusions: Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation

Facial nerve dehiscence and cholesteatoma: a comparison between decades

OBJECTIVES: To evaluate the incidence of facial canal dehiscence (FCD) and other intraoperative findings over the last 20 years as well as correlation with the Japanese Otological Society/European Academy of Otology and Neurotology classification in patients with cholesteatoma. MATERIALS and METHODS: A total of 469 patients operated from 1998 to 2018 were selected and divided into 2 groups of 10 years each. RESULTS: Dehiscence was significantly higher in patients with a history of pathology longer than 5 years (22.7%). Higher values were observed in revision surgery, 44.4% in the first period and 41.7% in the second. The tympanic segment was the one most frequently involved, affecting 92% of patients in the first period and 97% of patients in the second. Dehiscence occurred significantly more often in patients with a semicircular canal fistula, 14.8% in the first decade and 8.8% in the second. The incidence of FCD was significantly higher in patients with primary cholesteatoma (especially in those with combined pars tensa-flaccida) than in those with a secondary acquired one, 31.5% vs 7.4% in the first period, 21.1% vs 7.4% in the second, and in those with a stage III disease, 42% in the first period, 33.3% in the second. CONCLUSION: Patients with a shorter history of cholesteatoma as well as those not previously operated had a lower incidence of FCD. The tym-panic tract of the facial nerve remains the most frequent site of dehiscence, while the association between dehiscence and fistula of the semicircular canal remains strong. Patients with combined pars tensa-pars flaccida and stage III cholesteatoma have a higher incidence of FCD