Epidermal cyst of temporal bone as a delayed complication of myringoplasty

Epidermal cysts are benign tumors derived from the epidermis or the epithelial hair follicle filled with keratin and lipid-rich debris, typically occurring in areas with a high-density of sebaceous glands. These cysts commonly occur on the face, scalp, neck and trunk, where the sebaceous glands are more active. Their localization within the bone is extremely uncommon. The current study details the case of a 24-year-old male who presented with right otorrhea and ipsilateral hypoacusia having undergone right overlay myringoplasty for subtotal eardrum perforation. This patient represents a rare case of an epidermal cyst localized in the temporal bone (the fifth described in English-language literature), which may be considered as a complication of myringoplasty

Immunohistochemical patterns in the differential diagnosis of rhinopharyngeal granulocytic sarcoma

Granulocytic sarcoma (GS) is a rare extramedullary manifestation of acute myeloid leukemia (AML). GS may develop simultaneously to AML or as a relapse of leukemia, particularly following allogeneic hematopoietic stem cell transplant. Subperiosteal bone, lymph nodes and skin are commonly involved, whereas rhinopharyngeal involvement is less common, with only 14 cases reported in the literature. Due to its rarity, rhinopharyngeal GS may lead to diagnostic pitfalls, particularly when it is poorly differentiated or is without concomitant marrow involvement. Thus, immunohistochemical findings play a key role in diagnosis. The current report describes a case of a 53-year-old female suffering from rhinopharyngeal GS and with a history of AML treated with chemotherapy and radiotherapy, focusing on the importance of the immunohistochemical pattern to assess the right diagnosis. Recent studies have demonstrated that the immunophenotype is of utmost importance for the diagnosis of GS. The high expression of myeloperoxidase (MPO) is common in GS; however, ~30% of GSs do not contain MPO. Therefore, the presence of other markers is required to confirm the diagnosis of GS

Treatment of c-kit positive adenoid cystic carcinoma of the tongue: a case report

Adenoid cystic carcinoma (ACC) or ‘cylindroma’ is a malignant tumor that often occurs in the areas of the head and neck, affecting the secretory glands and the major and minor salivary glands. The present study describes a case of a patient who presented with a posterior tongue lesion. The case is of a 71-year-old female with an asymptomatic volume growth of the posterior left tongue perceived 8 months prior, and neoplastic cells positive for c-kit. A computed tomography of the head and neck showed asymmetry of the base of the tongue, which was enlarged in the left portion. A physical examination revealed a nodule on the posterior left tongue of ~3 cm in diameter, while the cervical lymph node chain had a normal size and consistency. Surgical exeresis of the tongue lesion and cervical lymph node dissection were performed. Subsequent to surgical removal of the cancer cells and adjuvant radiotherapy, the patient showed excellent health, although the follow-up remains in progress. ACC, one of the most biologically destructive tumors of the head and neck, is locally aggressive and gives rise to distant metastases. The tongue is the place of origin in 3.4–17.1% of cases. The treatment for ACC consists of primary surgical resection with adjuvant radiotherapy. To prevent the risk for distant metastasis, it is necessary to remove the first echelon nodes and monitor the patient with a long-term follow-up

Measurement of Sea Waves

Sea waves constitute a natural phenomenon with a great impact on human activities, and their monitoring is essential for meteorology, coastal safety, navigation, and renewable energy from the sea. Therefore, the main measurement techniques for their monitoring are here reviewed, including buoys, satellite observation, coastal radars, shipboard observation, and microseism analysis. For each technique, the measurement principle is briefly recalled, the degree of development is outlined, and trends are prospected. The complementarity of such techniques is also highlighted, and the need for further integration in local and global networks is stressed

Osteoma del mascellare associato a cisti odontogena omolaterale: approccio chirurgico combinato.

L’osteoma osteoide è una lesione osteogenica benigna la cui localizzazione nel seno mascellare è piuttosto rara, appena 7 casi descritti negli ultimi 15 anni. Di più frequente riscontro, sono le cisti odontogene del mascellare. Il riscontro contestuale delle due patologie è un evento piuttosto raro. Descriviamo il caso di osteoma del mascellare associato a voluminosa cisti odontogena omolaterale a partenza dalla radice dell’11mo. La paziente (42a), giungeva alla nostra osservazione per ostruzione respiratoria nasale, cacosmia, rinorrea mucopurulenta ed epifora monolaterali. L’imaging evidenziava la presenza di entrambe le lesioni che occupavano interamente il seno mascellare destro. La paziente veniva indirizzata a chirurgia e si optava per un approccio endoscopico combinato con doppio accesso transorale e transnasale con exeresi delle lesioni e ricostruzione del pavimento del mascellare con ausilio di membrana con PRGF (plasma ricco di fattori di crescita). Nessuna complicanza peri e post-operatoria è stata osservata. Il caso in esame pone l’attenzione sull’approccio multidisciplinare alla patologia e sulla scelta di una tecnica chirurgica conservativa con utilizzo di PRGF

Strategy for the treatment and follow-up of sinonasal solitary extramedullary plasmacytoma: a case series

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells outside bone marrow. It accounts for 4% of all non-epithelial sinonasal tumors. According to the literature, radiotherapy is the standard therapy for extramedullary plasmacytoma. However, the conversion rate of extramedullary plasmacytoma to multiple myeloma is reported to be between 11 and 33% over 10 years. The highest risk of conversion is reported during the first 2 years after diagnosis, but conversion has been noted up to 15 years after diagnosis. Once conversion to multiple myeloma is complete, less than 10% of patients will survive 10 years

ADC Benchmark Range for Correct Diagnosis of Primary and Recurrent Middle Ear Cholesteatoma

Objectives. Magnetic resonance imaging (MRI) and in particular diffusion-weighted imaging (DWI) have been broadly proven to be the reference imaging method to discriminate between cholesteatoma and noncholesteatomatous middle ear lesions, especially when high tissue specificity is required. The aim of this study is to define a range of apparent diffusion coefficient (ADC) values within which the diagnosis of cholesteatoma is almost certain. Methods. The study was retrospectively conducted on a cohort of 124 patients. All patients underwent first- or second-look surgery because primary or secondary acquired cholesteatoma was clinically suspected; they all had preoperative MRI examination 15 days before surgery, including DWI from which the ADC maps were calculated. Results. Average ADC value for cholesteatomas was 859,4 × 10−6 mm2/s (range 1545 × 10−6 mm2/s; IQR = 362 × 10−6 mm2/s; σ = 276,3 × 10−6 mm2/s), while for noncholesteatomatous inflammatory lesions, it was 2216,3 × 10−6 mm2/s (range 1015 × 10−6 mm2/s; IQR = 372,75 × 10−6 mm2/s; σ = 225,6 × 10−6 mm2/s). Interobserver agreement with Fleiss’ Kappa statistics was 0,96. No overlap between two groups’ range of values was found and the difference was statistically significant for p<0.0001. Conclusions. We propose an interval of ADC values that should represent an appropriate benchmark range for a correct differentiation between cholesteatoma and granulation tissue or fibrosis of noncholesteatomatous inflammatory lesions

The role of nasal washes in CF patients affected by chronic rhinosinusitis

Cystic Fibrosis (CF) presents multiorgan manifestations that include chronic rhinosinusitis (CRS) with or without nasal polyposis. Nasal washes (NWs) are widely used in clinical practice especially in CF patients, although their effectiveness on Ear Nose Throat (ENT) symptoms is controversial. In this study we evaluate the performance and the safety of a NWs solution, with or without surfactant, to reduce symptoms and bacterial load. Materials and methods We enrolled 20 CF patients (mean age: 27,6 years) with CRS, confirmed by nasal endoscopy. All patients, colonized by Pseudomonas Aeruginosa, performed daily a NW by physiological solution or by saline solution with surfactant (Naridek). All patients, at the time of enrollment, filled out a sinonasal questionnaire (SANQ11) and they received instructions for proper washing. During follow-up, we evaluated the reduction of the bacterial load in the nasal lavage. We assess the nasal cavities by endoscopy (2.7 mm 30° rigid endoscope - Storz, Tuttlingen, Germany) according to a modified Lund Kennedy endoscopic scoring system: - rhinorrhea (present = 0, mild = 1, purulent = 2); - edema, and hyperemia (absent = 0, mild = 1 or severe =2) - nasal mucosa (eutrophic = 1; hyperemic = 2; dystrophic = 3); - left and right turbinate hypertrophy (none = 0; mild = 1; medium = 2; and serious = 3). All subjects underwent the Sniffin’Sticks to evaluate the olfactory performance. Results Twelve patients completed 4 months of treatment: 6 patients performed the treatment with Naridek and 6 patients with physiological solution. Due to the small sample size, the scores were added together to have an overall indication of the treatment. (Table1) Nasal endoscopy ENT signs score Olfactory performance SNAQ 11 Naridek V1 80 72* 169 197** Naridek V4 15* 15* 159 98** Physiological solution V1 68 61 151 166 Physiological solution V4 52 39 159 152 *P<0.05 ** p< 0,01 The bacterial colonization in NWs shows no statistically significant difference. However, in 2 patients, we detected a reduction of the bacterial load. While there was no difference in the saline-treated group. Conclusions Considering our small sample we can only draw some great deal to think about: - treatment with NWs allows an improvement of the ENT symptoms and is well tolerated by patients. These data are confirmed by the ENT signs score and by the reduction of the SNAQ11 score in both treatment arms; - the solution with surfactant (Naridek) significantly improves the ENT signs and decreases the nasal endoscopy and the SNAQ11 scores; - no benefit was detected at the evaluation of olfactory performance. In conclusion, even if further confirmations are necessary on broader cases, it seems to emerge as significant the role of surfactant in the therapeutic advantage of NWs

CO2 Modulates the Central Neural Processing of Sucrose Perception

The five universally accepted tastes, sweet, salty, sour, bitter, and umami (a savory sensation elicited by monosodium glutamate) have specific receptors in oral, pharyngeal and laryngeal regions [1]. The most credited candidates to the function of human primary taste cortex are the frontal operculum and the anterior insula; while the opercular cortex and the orbitofrontal cortex are thought to code for secondary gustatory functions, while the amygdale and the dorsolateral prefrontal cortex are involved as hierarchically superior processing units [2]. Conversely, more is known on the peripheral pathway of taste, including the molecular dynamics of many receptor

RELATIONSHIP BETWEEN POLYMORPHISMS OF TAS2R38 BITTER TASTE RECEPTOR AND CHRONIC UPPER AIRWAY INFECTIONS

1Department of Neuroscience, ENT Section, “Federico II” University of Naples, Italy 2Department of Translational Medical Sciences, European Laboratory for Food Induced Diseases, Napoli, Italy The presence of taste receptors in extra-oral tissues may suggest additional roles apart from taste perception. Recently, an increasing number of reports demonstrated that the bitter taste G-protein coupled receptors family T2R, expressed in ciliated epithelial cells of the respiratory tract, are able to detect bacterial products and to stimulate innate immune defense against pathogens. Most microbial agents, secretes chemical signals known as quorum-sensing molecules that regulate the expression of genes involved in biofilm formation, virulence and other vital processes for microorganisms. Among the quorum-sensing molecules, the AHLs produced by P. aeruginosa, activate the receptor for bitter T2R38 expressed in ciliated epithelial cells of the respiratory tract, whereas mutants of P. aeruginosa lacking the AHL are not able to activate it. The activation of the receptor results in an increase of the Ca2+ flow and the ciliary beat frequency, as well as stimulating the production of NO which acts as a bactericide against the pathogen. The Caucasian population express three common polymorphisms (Pro49Ala, Ala262Val, Val296Ile) for TAS2R38 that lead to two major haplotypes PAV and AVI. The expression of either haplotype gives respectively 2 forms of receptors ̶ functional or non-functional ̶ i.e. unable to respond to specific agonists such phenylthiocarbamide and propylthiouracil (PROP). The two haplotypes PAV and AVI segregate into two major phenotypic classes: the "functional", sensitive to bitter, are homo- or heterozygous for the allele PAV, the "non-functional", are homozygous for the allele AVI. The genetic variations of the receptor TAS2R38 that affect sensitivity to bitter taste can help determine individual differences in susceptibility to bacterial infections of the respiratory tract allowing to plan a “target therapy”. Cellular cultures from homozygous PAV/PAV individuals showed a more effective NO production, mucociliary clearance and bactericide effect than cultures from AVI/PAV or AVI/AVI individuals. As a consequence it is reasonable to assume that patients with genotype AVI/PAV or AVI/AVI are at greater risk of contracting infections from gram-negative, compared with homozygous PAV. Some authors have studied the correlation between genotype and microbiological results TAS2R38 tissue of respiratory mucosa. The result of this analysis proved to be very interesting, because it showed a significant difference in the frequency of non-functional (AVI) than functional (PAV) among patients whose cultures were positive for Gram-negative bacteria, including P. aeruginosa. The aim of the study was to characterize phenotypically the sensitivity to PROP and the receptor polymorphisms of TAS2R38, in patients with chronic or recurrent infections of the upper respiratory tract to identify high risk patients. The identification of high-risk individuals would allow to draw up protocols for specific follow-up and appropriate “target therapy”