Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments

Early assessment of vestibular function after unilateral cochlear implant surgery

Introduction : Cochlear implantation (CI) has been reported to negatively effect on the vestibular function. The study of the vestibular function has variably been conducted by different types of diagnostic tools. The combined use of modern, rapidly performable diagnostic tools could reveal useful for standardizing the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video Head Impulse Test (vHIT), the cervical Vestibular Evoked Myogenic Potentials (cVEMPS) and the short-form of Dizziness Handicap Inventory (DHI) questionnaire were investigated pre-operatively and post-operatively (implant on and off) in both the implanted and the contralateral, non-implanted ear. All surgeries were performed with a round window approach (RWA), except for three otosclerosis cases were the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed a pre-operative vestibular involvement in nearly 50% of the cases, whilst the three canals were contemporarily affected in only 14% of them. In all the hypo-functional subjects, cVEMPs were absent. A low VOR gain in all the investigated SSCC was found in 4 subjects (14%). In those subjects, (21.7%) in whom cVEMPs were pre-operatively present and normal in the operated side, absence of response was post-operatives recorded. Discussion/Conclusion: The vestibular protocol applied for the study showed to be appropriate for distinguishing between the CI operated and the non-operated ear. In this regard, cVEMPs showed to be more sensitive than vHIT for revealing a vestibular sufferance after CI, although without statistical significance. Finally, the use of the RWA surgery was apparently not avoiding signs of vestibular impairment to occur

The impact of human papilloma viruses, matrix metallo-proteinases and HIV protease inhibitors on the onset and progression of uterine cervix epithelial tumors: A review of preclinical and clinical studies

Infection of uterine cervix epithelial cells by the Human Papilloma Viruses (HPV) is associated with the development of dysplastic/hyperplastic lesions, termed cervical intraepithelial neoplasia (CIN). CIN lesions may regress, persist or progress to invasive cervical carcinoma (CC), a leading cause of death worldwide. CIN is particularly frequent and aggressive in women infected by both HPV and the Human Immunodeficiency Virus (HIV), as compared to the general female population. In these individuals, however, therapeutic regimens employing HIV protease inhibitors (HIV-PI) have reduced CIN incidence and/or clinical progression, shedding light on the mechanism(s) of its development. This article reviews published work concerning: (i) the role of HPV proteins (including HPV-E5, E6 and E7) and of matrix-metalloproteinases (MMPs) in CIN evolution into invasive CC; and (ii) the effect of HIV-PI on events leading to CIN progression such as basement membrane and extracellular matrix invasion by HPV-positive CIN cells and the formation of new blood vessels. Results from the reviewed literature indicate that CIN clinical progression can be monitored by evaluating the expression of MMPs and HPV proteins and they suggest the use of HIV-PI or their derivatives for the block of CIN evolution into CC in both HIV-infected and uninfected women

Bone conductive implantation in asymmetric hearing loss (AHL)

Background: Bone conductive implants (BCI) represent one possible solution for rehabilitation of single sided deafness (SSD), being able to restore a pseudo-stereophonic hearing when the hearing threshold of the contralateral ear is normal. Objectives: The aim of the present study was to verify the efficacy of bone conduction implantation in subjects with unilateral severe-to-profound hearing loss and contralateral mild-to-moderate hearing loss, i.e. asymmetric hearing loss (AHL), and to compare it with known indications for SSD. Method: Twenty-one subjects, 9 females and 12 males, with a mean age of 55.6 years received BCI for either SSD or AHL. All of the subjects underwent a battery of audiological tests, including free-field pure tone audiometry (PTA) and free-field speech audiometry in quiet and in noise and under unaided and aided conditions. All subjects were administered subjective evaluation tests regarding quality of sound (QoS) and life (QoL), along with 2 questionnaires: the Glasgow Benefit Inventory (GBI) and the General Satisfaction for Bone Anchored Hearing Aids (proposed by the former manufacturer). Data were collected and statistically evaluated within and between the SSD group and the AHL group. Results: A PTA threshold gain was observed in AHL patients. The speech audiometry test in quiet showed an improvement in speech recognition of between 10% and 18% in AHL patients and of less than 10% in SSD patients. The speech audiometry test in noise showed improved values only in AHL patients. The two visual-analogue-scale evaluations (QoL and QoS) and the GBI showed significantly better scores in AHL patients compared to SSD patients

Epidemiology of Bell’s palsy in an Italian Health District: incidence and case-control study

The incidence of Bell’s palsy has been estimated in a health district of a major Italian city, taking also into consideration the potential risk factors that might influence the occurrence of Bell’s palsy. A matched case-control was therefore designed, by collecting data from the Emergency Departments of four Hospitals belonging to the same Health District in Rome (Italy), coordinated by a tertiary referral centre University Hospital. All patients affected by Bell’s palsy within the health district and four controls for each case were included. Controls were selected from other ENT patients, and were matched for hospital admission, week of disease onset, and climate conditions. Information regarding possible risk factors was collected using standardized telephone interviews. The resulting dataset was analyzed using multiple conditional logistic regression. The study group comprised 381 patients with acute, unilateral, peripheral facial palsy, clinically diagnosed as Bell’s palsy observed between 1st January 2006 and 31st December 2008. The cumulative incidence of Bell’s palsy was found to be 53.3/100.000/year. Among the risk factors, age was found to influence onset of Bell’s palsy, with an odds ratio of 2% for each one-year increase in age, with a linear trend (95% CI = 1-3%; p = 0.005). Bell’s palsy was found to occur with an annual incidence close to previous reports. Among the possible known risk factors (diabetes, pregnancy, etc.), only aging was found to play a significant role

Individualised headband simulation test for predicting outcome after percutaneous bone conductive implantation.

Trans-cutaneous bone conduction (BC) stimulators, when coupled to the HB (BC-HB), are generally used to predict the results that could be achieved after bone conductive implant (BCI) surgery, and their performance is generally considered inferior to that provided by the definitive percutaneous system. The aim of the present study was to compare the performances between BC-HB and BCI of the same typology, when the former's sound processor is fitted in accordance to the individual auditory situation. Twenty-two patients selected for surgical application of a BCI were evaluated and the same audiological protocol was used to select the candidate and assess the final outcome. The BC-HB was properly fitted based on individual hearing loss and personal auditory targets, and tested as primary step of the protocol to obtain the most reliable predictive value. The BAHA Divino and BP100 sound processors were applied in 12 patients with conductive/mixed hearing loss (CMHL) and in 10 subjects with single sided deafness (SSD). Audiometric evaluation included the pure tone average (PTA3) threshold between 250-1000 Hz; the PTA thresholds at 2000 and 4000 Hz; intelligibility scores as percentage of word recognition (WRS) in quiet and in noise; and subjective evaluation of perceived sound quality by a visual analogue scale (VAS). Statistical evaluation with a student's t test was used for assessment of efficacy of BC-HB and BCI compared with the unaided condition. Spearman's Rho coefficient was used to confirm the reliability of the BC-HB simulation test as a predictor of definitive outcome. The results showed that the mean PTA difference between BCI and BC-HB ranged from 2.54 to 8.27 decibels in the CMHL group and from 1.27 to 3.9 decibels in the SSD group. Compared with the BC-HB, BCI showed a better WRS both in CMHL (16% in quiet and 12% in noise) and in SSD (5% in quiet and a 1% in noise) groups. Spearman's Rho coefficient, calculated for PTA, WRS in quiet and in noise and VAS in the two aided conditions, showed a significant correlation between BC-HB and BCI, between PTA and VAS and between WRS in quiet and VAS. It is possible to conclude that the headband test, when the sound processor of the selected bone conductive implant is fitted and personalised for individual hearing loss and auditory targets of the candidate, may provide highly predictive data of the definitive outcome after BCI implant surgery

An objective, markerless videosystem for staging facial palsy

Background: The clinical classification of unilateral peripheral facial palsy (UPFP) is still based on subjective conventional methodology, leaving several missing points for an exact depiction of face deformity. Aim of the study: To propose a new objective, video recording method that relies on mathematical algorithms allowing the software to recognize numerical points on the face surface that would be indicative of facial nerve impairment, without positioning of markers on the face. Material and methods: Patients with UPFP of different House-Brackman (HB) degrees, from II to V, have been evaluated after video recording during two selected facial movements (forehead frowning and smiling) by a software trained to recognize the face points as numbers. Numerical parameters in millimeters have been obtained as indicative values of the shifting of the face points, and the shifting ratio between the healthy (denominator) and the affected side (numerator), i.e. the asymmetry index for the two movements taken into consideration. Results: For each HB grade, specific ranges of asymmetry index have been identified with a positive correlation for shift differences and negative correlation for asymmetry indexes. Conclusions: The use of the present objective system enabled the identification of numerical ranges of asymmetry index between the healthy and the affected side, that were found to be consistent with the outcome from the subjective methods currently in use

Theoretical approach based on Monte-Carlo simulations to predict the cell survival following BNCT

International audienceWe present here a very preliminary work on BNCT Dosimetry. The approach is as follows:A full Monte Carlo calculation is used to separate all dose components and determine the corresponding physical dose fractions with a realistic clinical model.These dose fractions are then used as mixed fields to predict cell-survivals and RBE values for a specific cell-line, thanks to the radiobiological model NanOxTM

Measurements of fiducial and differential cross sections for Higgs boson production in the diphoton decay channel at s√=8 TeV with ATLAS

Measurements of fiducial and differential cross sections are presented for Higgs boson production in proton-proton collisions at a centre-of-mass energy of s√=8 TeV. The analysis is performed in the H → γγ decay channel using 20.3 fb−1 of data recorded by the ATLAS experiment at the CERN Large Hadron Collider. The signal is extracted using a fit to the diphoton invariant mass spectrum assuming that the width of the resonance is much smaller than the experimental resolution. The signal yields are corrected for the effects of detector inefficiency and resolution. The pp → H → γγ fiducial cross section is measured to be 43.2 ±9.4(stat.) − 2.9 + 3.2 (syst.) ±1.2(lumi)fb for a Higgs boson of mass 125.4GeV decaying to two isolated photons that have transverse momentum greater than 35% and 25% of the diphoton invariant mass and each with absolute pseudorapidity less than 2.37. Four additional fiducial cross sections and two cross-section limits are presented in phase space regions that test the theoretical modelling of different Higgs boson production mechanisms, or are sensitive to physics beyond the Standard Model. Differential cross sections are also presented, as a function of variables related to the diphoton kinematics and the jet activity produced in the Higgs boson events. The observed spectra are statistically limited but broadly in line with the theoretical expectations

Measurement of the production of a W boson in association with a charm quark in pp collisions at √s = 7 TeV with the ATLAS detector

The production of a W boson in association with a single charm quark is studied using 4.6 fb−1 of pp collision data at s√ = 7 TeV collected with the ATLAS detector at the Large Hadron Collider. In events in which a W boson decays to an electron or muon, the charm quark is tagged either by its semileptonic decay to a muon or by the presence of a charmed meson. The integrated and differential cross sections as a function of the pseudorapidity of the lepton from the W-boson decay are measured. Results are compared to the predictions of next-to-leading-order QCD calculations obtained from various parton distribution function parameterisations. The ratio of the strange-to-down sea-quark distributions is determined to be 0.96+0.26−0.30 at Q 2 = 1.9 GeV2, which supports the hypothesis of an SU(3)-symmetric composition of the light-quark sea. Additionally, the cross-section ratio σ(W + +c¯¯)/σ(W − + c) is compared to the predictions obtained using parton distribution function parameterisations with different assumptions about the s−s¯¯¯ quark asymmetry