Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience

La scialoadenite cronica ostruttiva rappresenta una delle più frequenti patologie non-neoplastiche delle ghiandole salivari e la scialoendoscopia è sempre più utilizzata nella sua diagnosi e nel suo trattamento, associata o meno con la litotripsia laser. La scialoendoscopia può essere inoltre associata ad approcci esterni mini-invasivi nelle litiasi troppo voluminose per essere rimosse con un approccio unicamente endoscopico. Il presente articolo riporta l’esperienza delle Cliniche Otorinolaringoiatriche dell’Ospedale Sant’Orsola-Malpighi di Bologna e dell’Azienda Ospedaliero Universitaria di Cagliari, Italia. È stata eseguita un’analisi retrospettiva su 48 pazienti (26 femmine, 22 maschi; età media di 45,3 anni; range 8-83 anni) trattati per patologia cronica ostruttiva delle ghiandole salivari maggiori mediante procedure chirurgiche endoscopiche o combinate da novembre 2010 ad aprile 2016 presso l’Azienda-Ospedaliero-Universitaria di Cagliari. I risultati dell’Ospedale Sant’Orsola-Malpighi di Bologna erano stati precedentemente pubblicati. Gli aspetti tecnici della scialoendoscopia sono stati accuratamente descritti. I pazienti trattati presso l’Azienda Ospedaliero Universitaria di Cagliari presentavano una patologia unilaterale in 40 casi e bilaterale in 8 casi; sono state trattate 56 ghiandole salivari maggiori (22 sottomandibolari e 34 parotidi). 5 pazienti sono stati sottoposti a scialoendoscopia bilaterale per parotite ricorrente giovanile, 10 per patologia ostruttiva non litiasica e 33 (68,75%) presentavano calcoli salivari (1 paziente presentava una litiasi parotidea bilaterale). Solo 8 pazienti sono stati sottoposti a scialectomia radicale per via esterna (5 scialectomie sottomandibolare e 3 parotidectomie). La chirurgia conservativa nei pazienti con scialoadenite cronica ostruttiva appare efficace e può essere realizzata mediante un approccio puramente endoscopico o combinato, con un’alta percentuale di successo. La procedura richiede una strumentazione adeguata e deve essere eseguita da un chirurgo esperto, che abbia svolto un training specifico scialoendoscopico, in modo da evitare le possibili complicanze maggiori e minori. La scialectomia tradizionale rappresenta la “extrema ratio”, limitata nei casi in cui un approccio conservativo sia risultato inefficace o controindicato.Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach

Neurology training and research in the Covid-19 pandemic: A survey of the Resident and Research Fellow Section of the European Academy of Neurology.

INTRODUCTION The COVID-19 (SARS-CoV2) outbreak has disrupted residency programs due to the university and hospital's priorities to face this emergency at all expenses. Most research projects and clinical trials were temporarily stopped or postponed. The Resident and Research Fellow Section (RRFS) of the European Academy of Neurology (EAN) has decided to assess the impact of the COVID-19 pandemic on neurology training. METHODS All EAN RRFS members were invited to fill out an online questionnaire of 40 items concerning their clinical involvement during the COVID-19 emergency, and the impact of the pandemic on their training. RESULTS Of the 227 RRFS members who completed the questionnaire, 222 were from Europe, and from those 111 were from Portugal, Italy or France. Responders highlighted that severe restrictions have been amended to face this pandemic, including reduction of inpatient beds, prohibition of in-person visits and limitation to hospitals access for patients' relatives. This was accompanied by an increase in email correspondence and phone calls with 50 % of countries allowing telemedicine to reach outpatients. Seventy-nine percent of the respondents felt that the pandemic will likely have a serious impact on their training and career. CONCLUSION The pandemic lead to a disruption of neurology activities, including medical training and research. The long-run impact of these changes remains unknown, but it will likely change the way neurology practice and training will be organized for future generations

The Bortoluzzi Mud Volcano (Ionian Sea, Italy) and its potential for tracking the seismic cycle of active faults

The Ionian Sea in southern Italy is at the center of active interaction and convergence between the Eurasian and African–Adriatic plates in the Mediterranean. This area is seismically active with instrumentally and/or historically recorded Mw > 7:0 earthquakes, and it is affected by recently discovered long strike-slip faults across the active Calabrian accretionary wedge. Many mud volcanoes occur on top of the wedge. A recently discovered one (called the Bortoluzzi Mud Volcano or BMV) was surveyed during the Seismofaults 2017 cruise (May 2017). Bathymetric backscatter surveys, seismic reflection profiles, geochemical and earthquake data, and a gravity core are used here to geologically, geochemically, and geophysically characterize this structure. The BMV is a circular feature ' 22m high and ' 1100m in diameter with steep slopes (up to a dip of 22 ). It sits atop the Calabrian accretionary wedge and a system of flowerlike oblique-slip faults that are probably seismically active as demonstrated by earthquake hypocentral and focal data. Geochemistry of water samples from the seawater column on top of the BMV shows a significant contamination of the bottom waters from saline (evaporite-type) CH4-dominated crustalderived fluids similar to the fluids collected from a mud volcano located on the Calabria mainland over the same accretionary wedge. These results attest to the occurrence of open crustal pathways for fluids through the BMV down to at least the Messinian evaporites at about 3000 m. This evidence is also substantiated by helium isotope ratios and by comparison and contrast with different geochemical data from three seawater columns located over other active faults in the Ionian Sea area. One conclusion is that the BMV may be useful for tracking the seismic cycle of active faults through geochemical monitoring. Due to the widespread diffusion of mud volcanoes in seismically active settings, this study contributes to indicating a future path for the use of mud volcanoes in the monitoring and mitigation of natural hazards.Published1-233SR TERREMOTI - Attività dei CentriJCR Journa

Neurology training and research in the COVID-19 pandemic: a survey of the Resident and Research Fellow Section of the European Academy of Neurology

Background and purpose: The COVID-19 (SARS-CoV-2) outbreak has disrupted residency programmes due to university and hospitals’ priorities to face this emergency at all cost. Most research projects and clinical trials were temporarily stopped or postponed. The Resident and Research Fellow Section (RRFS) of the European Academy of Neurology (EAN) has decided to assess the impact of the COVID-19 pandemic on neurology training. Methods: All EAN RRFS members were invited to fill out an online questionnaire of 40 items concerning their clinical involvement during the COVID-19 emergency, and the impact of the pandemic on their training (Appendix S1). Results: Of the 227 RRFS members who completed the questionnaire, 222 were from Europe, and of those 111 were from Portugal, Italy or France. Responders highlighted that severe restrictions have been imposed to face this pandemic, including reduction of inpatient beds, prohibition of in-person visits and limitation to hospital access for patients’ relatives. This was accompanied by an increase in email correspondence and phone calls with 50% of countries allowing telemedicine to reach outpatients. Seventy-nine per cent of the respondents felt that the pandemic will probably have a serious impact on their training and career. Conclusion: The pandemic led to a disruption of neurology activities, including medical training and research. The long-run impact of these changes remains unknown, but it will probably change the way neurology practice and training will be organized for future generations

Dementia care and COVID-19 pandemic: a necessary digital revolution

Due to the COVID-19 pandemic, most memory clinics have had to suspend their activities. On the other hand, international dementia experts have recommended to provide urgently worldwide support for people living with dementia. This situation urges to play out new strategies to guarantee adequate care. Telemedicine and digital technology (DT) devices, such as smartphones, can be very helpful in remote monitoring and care. Technological devices such as videoconference or smartphone apps might be used for follow-up visits and support to patients and caregivers and to acquire digital markers of clinical progression. Hopefully, this dramatic situation would facilitate the process of progressive familiarization of neurologists with telemedicine and DT approach

Neurological Consequences of COVID-19: A Systematic Review of the Pandemic’s Impact on Neurology Training

: The COVID-19 pandemic had a significant impact on neurology training programs, leading to disruptions and changes that may have long-term implications for neurological education. The objective of this study was to investigate the impact of COVID-19 on neurological training programs, collecting available data relating to residents' experience worldwide. We performed a systematic search of the literature published on PubMed from January 2020 to March 2023, including studies referring to quantitative analysis of residents'/trainees' perspectives. Specifically, we included studies that examined how the pandemic has affected clinical and research activities, the use of telemedicine, the delivery of education and the psychological status of residents. Of the 95460 studies identified through database searching, 12 studies met the full criteria and underwent data extraction. In conclusion, the COVID-19 pandemic has had significant impacts on neurology training programs, highlighting the need for resilience and flexibility in medical education. Future research should focus on the long-term outcomes of these adaptations in the quality of neurology education and patient care