Predictive role of nasal functionality tests in the evaluation of patients before nocturnal polysomnographic recording

Obstructive sleep apnoea syndrome is a disease characterized by a collapse of the pharyngeal airway resulting in repeated episodes of airflow cessation, oxygen desaturation, and sleep disruption. It is a common disorder affecting at least 2-4% of the adult population. The role of nasal resistance in the pathogenesis of sleep disordered breathing and sleep apnoea has not been completely clarified. Aim of the present study was to establish whether nasal resistance and nasal volumes, measured by means of Active Anterior Rhinomanometry and Acoustic Rhinometry together with Muco-Ciliary Transport time play a positive predictive role in the evaluation of Obstructive sleep apnoea syndrome patients before running a nocturnal polysomnographic recording. A retrospective study was performed analysing 223 patients referred for suspected Obstructive sleep apnoea syndrome. All patients were submitted to complete otorhinolaryngological evaluation and underwent nocturnal polysomnography. On the basis of polysomnographic data analysis, the apnoea-hypopnoea index and snoring index, patients were classified into two groups: Group 1 (110/223 patients) with a diagnosis of mild-moderate Obstructive sleep apnoea syndrome (apnoea-hypopnoea index < 30) and Group 2 (113/223 patients) affected by snoring without associated hypoxaemia/hypercapnia. A control group of 76 subjects, not complaining of sleep disorders and free from nasal symptoms was also selected. The results showed, in all the snoring and Obstructive sleep apnoea syndrome patients, total nasal resistance and increased Muco-Ciliary Transport time compared to standard values. Furthermore, the apnoea-hypopnoea index was significantly higher in patients with higher nasal resistence and significantly different between the groups. These results allow us to propose the simultaneous evaluation of nasal functions by Active Anterior Rhinomanometry, Acoustic Rhinometry, and Muco-Ciliary Transport time in the selection of patients undergoing polysomnography

Surgical management of rhinosinusitis in onco-hematological patients

ObjectivesIn onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients.MethodsA retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction.ResultsLocal anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group.ConclusionBalloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure

Hyperfunctioning Parathyroid Giant Adenoma

Purpose: The objective of this paper is to report the management and treatment of a 47-year-old patient admitted with multiple problems including asthenia, nausea and bradycardia, and was diagnosed with a giant parathyroid adenoma. Case report: A 47-year-old man was admitted to the Department of General Surgery for acute and worsening asthenia, nausea and bradycardia. Blood tests showed hypercalcemia, hypophosporemia, very high serum parathormone level, so that he was diagnosed with primary hyperparathyroidism. Cervical ultrasonography and scintigraphy with technetium 99 mTc Methoxyisobutylisonitrile (99 mTc-MIBI) showed the presence of positive nodule at the isthmus of the thyroid gland. The patient underwent neck exploration. Intra-operative iPTH essay was measured. A giant parathyroid adenoma was identified and excised, with no macroscopic signs of malignancy. Discussion and conclusion: Hyper functioning parathyroid giant adenoma can present with typical symptoms of hypercalcemic crisis: ECG alterations, kidney failure, emotional lability, confusion, delirium, psychosis, asthenia, epilepsy. Elective treatment is the excission. The surgical technique contemplates neck exploration and to ensure the finding of the adenoma, previously identified with imaging tests. It is necessary to measure intra-operative iPTH assay

Integrated geophysical and geological investigations applied to sedimentary rock mass characterization

The Salento Peninsula (south-eastern Italy) is characterized by sedimentary rocks. The carbonatic nature of the rocks means they are affected by karst phenomena, forming such features as sinkholes, collapsed dolines and caverns, as a result of chemical leaching of carbonates by percolating water. The instability of these phenomena often produces land subsidence problems. The importance of these events is increasing due to growing urbanization, numerous quarries affecting both the subsoil and the surface, and an important coastline characterized by cliffs. This paper focuses on geological and geophysical methods for the characterization of soft sedimentary rock, and presents the results of a study carried out in an urban area of Salento. Taking the Q system derived by Barton (2002) as the starting point for the rock mass classification, a new approach and a modification of the Barton method are proposed. The new equation proposed for the classification of sedimentary rock mass (Qsrm) takes account of the permeability of the rock masses, the geometry of the exposed rock face and their types (for example, quarry face, coastal cliff or cavity), the nature of the lithotypes that constitute the exposed sequence, and their structure and texture. This study revises the correlation between Vp and Q derived by Barton (2002), deriving a new empirical equation correlating P-wave velocities and Qsrm values in soft sedimentary rock. We also present a case history in which stratigraphical surveys, Electrical Resistivity Tomography (ERT), and seismic surveys were applied to in situ investigations of subsidence phenomena in an urban area to estimate rock mass quality. Our work shows that in the analysis of ground safety it is important to establish the rock mass quality of the subsurface structures; geophysical exploration can thus play a key role in the assessment of subsidence risk

Relative costs of new water supply options for Front Range cities: phase 2 report

June 2011.Prepared for the Colorado Water Conservation Board and the Colorado Water Institute.Published as part of the Western Water Policy Program at the University of Colorado's Natural Resources Law Center.Includes bibliographical references.The following report is the second (and final) installment of a project examining the costs associated with meeting future M&I (municipal and industrial) water supplies along Colorado's Front Range. As summarized in the recently updated Statewide Water Supply Initiative (SWSI 2010) reports, M&I water demand in Colorado is expected to climb by 600,000 to one million AF (AF) by 2050 (CWCB, 2010). Some mixture of three strategies will likely be necessary to meet this target: new water projects, water transfers (i.e., agricultural to urban reallocation), and conservation. Determining which option(s) is "best" is a complex matter that requires weighing highly case-specific opportunities, constraints, trade-offs, risks, uncertainties, and values. Presumably, among the most important considerations is economic cost. In this Phase 2 report, we continue our consideration of what is known and unknown about the economic costs of meeting these future water demands