Acoustic neuroma surgery and delayed facial palsy

Delayed onset of facial palsy is possibly an underestimated but distressing complication of acoustic neuroma surgery. The incidence of this complication reported in the literature has varied from 11.7 to 41%. This study reviewed retrospectively 60 primary acoustic neuroma surgeries performed by a single neurotologist. The dee-layed onset of facial dysfunction was defined according to the guidelines described by of Lalwani Butt, Jackler, Pitts and Jingling in 1995. They considered either a deterioration of facial function from normal to abnormal or an increased severity of the degree of facial paralysis, which was grouped using the House-Brackmann scale system. Fifteen of the 60 patients (25%) were found to have a deterioration of facial function. The incidence of delayed facial palsy was not influenced by age, sex or tumor size. The majority of the patients had a favorable prognosis. Only three patients had a grade III-IV facial function at 1 year. It is possible that these latter cases might have benefited from intraoperative meatal facial nerve decompression, as advocated by Sargent, Kartush and Graham

PIDOTIMOD IN TREATMENT OF RECURRENT PHARYNGOTONSILLITIS

In order to assess the efficacy of two immunostimulant treatments for prevention of recurrent pharyngotonsillitis, a controlled, parallel group clinical study was conducted. 40 subjects, adults and children, with a positive history of at least acute, febrile, infectious episodes in the oropharyingeal region, were randomized to treatment with pidotimod or with lyophilized polybacterial lysates (LPL). 90 days after the start of treatment, the pidotimod group showed a significant in crease in multitest response by comparison to the LPL group. During the observation period, moreover, a significantly lower incidence of infectious episodes was seen in the pidotimod group than in the LPL group. Tolerance and compliance were good for both drugs.Key word: recurrent pharyngotonsillitis, pidotimod, treatment

Analisi di polimorfismi del DNA genomico e mitocondriale in tessuti fissati: confronto fra formalina e Complucad\uae

Sia in ambito di indagini di paternit\ue0 che in ambito penale sempre pi\uf9 frequentemente il genetista forense si trova a effettuare analisi di campioni provenienti da tessuti conservati e fissati per esami istologici. Scopo del lavoro era di valutare in modo pi\uf9 ampio rispetto ad uno studio gi\ue0 condotto nel nostro laboratorio se il Complucad\uae (Complucad International S.A., Zaragoza, Spagna), fissativo a base alcoolica, possa esser pi\uf9 adatto per l\u2019analisi genetica rispetto alla formalina. A tale fine sono stati prelevati in sede di autopsia 25 mg di tessuto cerebrale, polmonare, epatico, cardiaco e renale da 5 individui. Una parte \ue8 stata impiegata per definire il profilo genetico e il mitotipo del donatore, una parte \ue8 stata conservata in doppio con le due metodiche per 3, 7, 30 e 300 giorni. Il DNA \ue8 stato estratto con NucleoSpin\uae Tissue (Macherey-Nagel, D\ufcren, Germany) e quantificato con QuantiBlot\uae Human DNA Quantitation Kit (Applied Biosystem, Foster City, CA, USA). Di ciascun campione \ue8 stata eseguita una PCR quadruplex dei loci LPL, F13B, FESFPS, F13A01 (Promega, Madison, WI, USA). Per i soli campioni conservati per 300 giorni sono stati analizzati ulteriori 15 loci STR ed il locus dell\u2019Amelogenina impiegando il kit AmpFlSTR\uae Identifiler\uae (Applied Biosystem); gli stessi estratti sono stati inoltre sottoposti a sequenziamento delle regioni HV1 e HV2 del mtDNA. I risultati ottenuti dimostrano come la concentrazione di DNA sia pressoch\ue9 simile per le due metodiche, ma mediante corsa elettroforetica su gel di agarosio si \ue8 osservata una cospicua degradazione del DNA dei tessuti conservati in formalina per pi\uf9 di 3 giorni. Unicamente per i campioni fissati con Complucad\uae \ue8 stato ottenuto un buon profilo STR ad ogni tempo analizzato, mentre nessun profilo genetico utilizzabile per un confronto si \ue8 avuto dai campioni fissati in formalina per pi\uf9 di 7 giorni. Viceversa il sequenziamento del mtDNA \ue8 risultato utile per un confronto in entrambi i casi

[Day surgery and otologic diseases].

The aim of the present work was to check the results obtained in a group of patients suffering from otological pathologies who had undergone day surgery. In addition, to determine the reliability and validity of this form of out-patient surgery in otology, complications were compared with a similar group of patients who had undergone surgery under normal hospital in-patient conditions. The study only viewed patients hospitalized for otological pathologies from January 1995 to April 1998. During this period of time 90 patients with varying degrees of otological pathologies underwent out-patient day surgery. This surgical activity was then compared to the same type of surgery performed under normal in-patient hospitalization. During the post-operative phase of day surgery, only 7 patients (7.7%) had to be fully hospitalized: 5 complaining of dizziness, the other 2 with fever that ruled out discharge in the evening. In all cases, after hospitalization for the night the patient could be safely discharged. In the normally hospitalized in-patients, complications arose in 14 cases (8.6%) with fever being the most common complication (8 patients). On the basis of the results, it appears that nearly all otological pathologies can be treated in day surgery. This solution limits complications and ensures good economic management; it results in savings and improved organization, reduces the waiting lists and rationalizes use of the operating rooms. Moreover, it must be pointed out that the program was highly appreciated by the patients who could better schedule their own activities, both work and social-family obligations. This aspect is quite important in view of a broader outlook on the economics of the national health system as it shows a savings, not only in the health costs, but also in the overall labor costs

Multiple paragangliomas of the head and neck.

Multiple paragangliomas of the head and neck are rare conditions. The incidence of multiple paragangliomas is reported to the approximately 10% of the total patients, but in familial cases it increases up to 35-50%. In the head and neck region, the most common association is represented by bilateral carotid body tumors or by carotid body tumor associated with tympanic-jugular glomus. The presence of three synchronous glomus tumors is really rare, as well as association with vagal glomus and carotid body. In this paper the authors present a patient affected ipsilaterally by a carotid body tumor and vagal paraganglioma, focusing on the diagnostic options offered by imaging techniques (CT and MRI)

Cerebrospinal fluid leak management following cerebellopontine angle surgery

Objective: Postoperative cerebrospinal fluid leak (CSF) is a serious complication of the cerebellopontine angle surgery. In the current literature, CSF leak rates vary from 8.1 to 20%. The various options in managing this troublesome complication include conservative treatment or invasive surgical repair. The focus of this report is to retrospectively analyze our experience on this specific topic reviewing the incidence of CSF leak and the outcomes of its treatment in a group of patients who underwent surgery for different pathology of the cerebellopontine angle. Method: Eighty-five patients who underwent primary surgical procedures performed by a single neurologist were selected for this study. There were 70 surgical removals of acoustic neuromas, and 15 other cerebellopontine lesions. Results: The overall incidence of CSF leak in the total group analyzed was 17.6%. There were five CSF rhinorrheas and 10 wound CSF leaks. Ten acoustic neuromas and five other cerebellopontine angle lesions exhibited this complication. The leak was cured in 53.3% of the cases using a continuous lumbar cerebrospinal fluid drainage (CLCFD). In two patients, the leak was treated with an extradural repair. Conclusions: Although CLCFD is not routinely used in the treatment of the CSF leak, it proved to be an efficacious and safe option, confirmed by no meningitis observed in our patients treated with this method