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Sudden hearing loss can be found in systemic autoimmune diseases or it can be a symptom of an autoimmune disease of the inner ear. The present work has studied a group of patients with idiopathic sudden hearing loss to determine what role anti-endothelial cell antibodies (AECA) play as markers of immuno-mediated vasculitis of the inner ear. The study involved 32 patients with sudden deafness and 14 controls. The patients underwent otofunctional, neuroradiological, sero-microbiological and immunological testing. Using the indirect immunofluorescence technique, serum AECA were determined within 24 hours of hospitalization and three days after the onset of deafness. AECA positive patients (AECA+) were administered corticosteroid therapy (methylprednisone 1 mg/kg/die) for 1 month. A clinical follow-up was performed, including audiometry, 1 month after discharge and thereafter at three-month intervals (follow-up range: 8-18 months). AECA proved positive in 15/32 patients (47%) and in 2/14 of the controls (14%). The difference between the patients and the controls was statistically significant (p = 0.03). The 7 patient who showed no recovery after 1 month were all AECA+. None of the AECA+ patients showed other symptoms or a worsening of the hearing loss. In conclusion, the determination of non-specific autoantibodies vs. the inner ear, such as AECA, can be considered a useful clinical tool in differentiating between patients with idiopathic sudden hearing loss and those for which a diagnosis of immuno-mediated vasculitis of the inner ear is likely and for which prognosis is particularly unfavorable.

After underlining recent progress in nuclear medicine diagnostics, even in oncology, the authors describe the most important methods used and oncotropic capacity of some radiodrugs currently used in clinical practice: i.e. perfusion tracers. Then they present the results of a personal experience using Tc99m-SestaMIBI SPET in detail. Fifteen patients suffering from various primary head and neck neoplasms underwent systematic clinical evaluation, endoscopy, CT and/or MRI and Tc99m-SestaMIBI SPET. The authors then briefly describe the method and underline the fact that the literature lacks any homogeneous data on the use of Tc99m-SestaMIBI SPET in the study of head and neck neoplasms. The results indicate that the method is reliable in identifying both primary tumors and laterocervical metastases. Then, taking indication from the only case currently available on post-radiotherapy recurrence, the authors suggest an interesting field of application for this technique: the study of post-radio-chemotherapy and/or surgery recurrences. In conclusion, the authors underline the valid contribution this method currently offers both in diagnosis and follow-up as well as its future of ever expanding clinical applications.

A case of pleomorphic adenoma of the lower turbinate salivary glands is presented. A careful review of the literature has revealed that this is a highly unusual site for such neoplasms. The scarcity of symptoms is underlined as the lesion can long go unrecognized. Moreover, it is pointed out that, since only a small number of cases have thus far been presented for this benign lesion the prognostic factors indicating a clinical evolution to malignancy are as yet unknown. For this reason the authors feel it advisable to perform conservative surgery and carry out a careful follow-up.

The modern concept of oncogenesis is based upon the interaction between factors which modulate cellular growth and differentiation, in particular oncogenes and tumor suppressor genes. The molecular events which induce laryngeal carcinogenesis are not yet known. Protoncogenes seem to be the target of the risk factors (cigarette smoking, alcohol abuse, ionizing radiations and, not least HPV-DNA) that are commonly considered related to laryngeal squamous cell carcinoma. New information on the role of alterations of oncogenes and/or their proteic products in laryngeal cancer will be useful in identifying new diagnostic and clinical therapeutical applications. The Authors investigated Epidermal Growth Factor Receptor (EGFR) expression in 103 primary laryngeal squamous cell carcinoma and 42 normal laryngeal tissue specimens in order to assess its clinical significance in primary laryngeal cancer. Significantly higher EGFR levels were found in cancer specimens compared with normal mucosa (p < 0.001). EGFR expression did not correlate with age, tumor localization, T classification, cervicallymphonode involvement or surgery, whereas in G3 tumors it was significantly higher than in G1-G2 (p < 0.05). Follow-up data were available for 74 cases: EGFR levels resulted significantly higher in patients who had a recurrence of the disease than those in recurrence-free patients (p < 0.05). The 24-month disease-free survival (DFS) was 58% for EGFR+ patients and 82% for EGFR-subjects. Multivariate analysis permitted identification of EGFR status and tumor localization as significant independent prognostic factors. Data reported here suggest that EGFR expression probably plays a role not only by regulating the growth of laryngeal cancer, but also by identifying a sub-set of laryngeal cancer patients at a higher degree of relapse risk and with an unfavorable prognosis. Furthermore, in this study p21-ras expression in 43 primary laryngeal cancers and in 7 normal laryngeal mucosa specimens was evaluated. Scattered p21 levels, expressed as optical density (O.D), were found in normal mucosa (median = 1.94) and in primary laryngeal tumours (median = 1.74). Higher p21 levels were found in neoplastic tissue than in normal laryngeal tissue (median = 2.54 vs median = 1.94; p = 0.023). The correlation between p21 ras protein and EGFR levels was also investigated. EGFR+ cases do not show any difference in p21 expression with respect to EGFR- cases (median = 1.52 O.D. vs median = 1.84). Our findings suggest that overexpression of p21 is associated with malignant phenotype in laryngeal cancer.(ABSTRACT TRUNCATED AT 400 WORDS)

The parapharyngeal space is a rare site of parapharyngeal neoplasms: their diagnosis and therapeutic treatment offer peculiar challenges. Parapharyngeal tumours may be primary, metastatic or diffused with regaed continuity. They are mostly benign (mixed, neurogenic, vascular tumours, etc.) rather than malignant neoplasms (adenocystic carcinoma, adenocarcinoma, lymphoma, etc.). In order to diagnosis parapharyngeal tumours differentially it is important to consider very rare type of neoplasms such as hemangiopericytomas. In this paper the Authors describe a case of hemangiopericytoma of the parapharyngeal space indicating the main diagnosis procedures, especially CT scan, Magnetic resonance and angiography. They discuss pathological aspects with particular regard to the differential diagnosis between benign and malignant tumour of this kind as well as prognoses. The Authors also describe surgical treatment in relation to particular parapharyngeal localization.