Search

Introduction Inadvertent perioperative hypothermia (a drop in core temperature to below 36 degrees C) occurs because of inter-ference with normal temperature regulation by anaesthetic drugs, skin exposure for prolonged periods and the introduction of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause signifi-cant heat loss. Warming irrigation fluids might prevent some of this heat loss and subsequent hypothermia and that is the role of warming irrigation fluid systems. Material and methods The video describes prone ultra mini PCNL with suction-evacuation access sheath under warming irrigation fluid system in a 15 month-old boy with a 2 cm-600HU staghorn calculi and one stone of 7 mm-500HU in proximal ureter. Results The surgery was performed without intraoperative complications and perioperative hypothermia was prevented. The patient started the surgery at 35.4 degrees C and the final temperature was 36.3 degrees C in 90 min of procedure, in addition to being free of stones. Conclusions The warming irrigation fluid system can be helpful in preventing inadvertent perioperative hypothermia in children, improving the safety of ultra mini PCNL with suction-evacuation access sheath and shows promising results with high stone-free rates and low complications.

AIM OF THE STUDY: In paediatric patients, recurrent febrile pharyngo-tonsillitis is usually due to chronic inflammation of the tonsils and/or adenoids: these episodes are often associated with other clinical manifestations (respiratory obstruction of naso-pharyngeal origin; auricular inflammation, especially effusive otitis media and acute otitis media; streptococcal beta-haemolytic Group A (SBEGA) infection, causing a distant disorder of varying severity and which may, therefore, give rise to serious pathological conditions). A retrospective multicentric investigation has, therefore, been carried out in order not only to further elaborate findings emerging from earlier studies, performed in other countries, in which random methods were used, but also to focus on: 1. the possible association of these clinical manifestations with recurrent febrile pharyngo-tonsillar inflammation in relation to frequency of the condition; 2. results obtained with adenoidectomy or with adeno-tonsillectomy, referring to the overall clinical outcome of the pathological condition, bearing in mind data emerging from the control groups, submitted to strict follow-up, associated with any medical treatment deemed necessary. MATERIAL AND METHODS: The study population comprised 692 patients (394 male, 298 female), age range 2-11 years and with a minimum follow-up of 2 years. Considering the clinical manifestations emerging from the case history, the following two investigations were carried out: 1. the first, on 501 patients, all previously submitted to adeno-tonsillectomy in whom the recurrent febrile pharyngo-tonsillar inflammation had occurred, respectively > 4 or < or = 4 episodes during the last 12 months; 2. the second, on 455 patients in whom recurrent febrile pharyngo-tonsillar inflammation, in the 12 months prior to the beginning of the study, had been < or = 4 episodes: in 264 cases, adeno-tonsillectomy was carried out; in 144, adenoidectomy; 47 children were studied as controls and, therefore, submitted to watchful waiting. The results obtained were statistically analysed by chi2 and Fisher test: a "p" value of < 0.05 was considered statistically significant. RESULTS: The first investigation showed that all symptomatological manifestations considered were resolved following adeno-tonsillectomy, in a significantly high percentage of cases (recurrent febrile pharyngo-tonsillar in flammation: 91.8%; naso-pharyngeal respiratory obstruction: 92.2%; pathological ASO titre: 69.8%; distant disorders probably due to SBEGA: 76%; effusive otitis media: 76%; acute recurrent otitis media: 87.5%). The most interesting clinical findings obtained can be summarized as follows: naso-pharyngeal respiratory obstruction is a frequent finding; the incidence is statistically higher in cases in which recurrent febrile pharyngo-tonsillar inflammation is less frequent (p < 0.05): in these patients, this is an important pathological manifestation indicating the need for surgery; the higher incidence is associated with at significant finding of pathological auricular processes; the percentages of recovery for naso-pharyngeal respiratory obstruction are statistically greater in the group of patients in whom the recurrent febrile pharyngo-tonsillar inflammation is more frequent: an identical result is found in patients with the effusive form of otitis media and in those with recurrent acute otitis media; a pathological ASO titre is more frequently found, the difference being statistically significant (p < 0.05), in the group of patients with more frequent recurrent febrile pharyngo-tonsillar inflammation, albeit this factor does not affect the percentage of recovery; also the favourable evolution and recovery of clinical distant manifestations, related to streptococcal beta-haemolytic Group A infection, are correlated with the return to normal of the ASO titre. The second investigation demonstrated the efficacy of surgical treatment, adeno-tonsillectomy and adenoidectomy, in all the clinical manifestations studied, the possibility of achieving resolution of recurrent febrile pharyngo-tonsillar inflammation even in the control subjects submitted to medical treatment, but also the lack of success, in the latter, as far as concerns naso-pharygeal respiratory obstruction, the pathological ASO titre and the inflammatory auricular processes. CONCLUSIONS: The present investigations confirm previous observations emerging from randomized clinical studies, regarding the possibility to achieve valid prevention of recurrent febrile pharyngo-tonsillar inflammation, also in a large percentage of control patients submitted to watchful waiting; these investigations, however, also demonstrated that, in the control group, the percentage of subjects in whom recovery of other symptoms was achieved was very low compared to that in the groups submitted to surgery. In other words, clearly emerges as far as concerns the overall symptomatological picture of the patients, the efficacy of the surgical treatment, but also the lack of success of the medical treatments in all clinical manifestations associated with recurrent febrile inflammations. Therefore, it is necessary to select and advise the most suitable treatment strategy, not in relation to the Guidelines elaborated on the basis of results emerging from statistical research, that, due to the intrinsic methodology limits cannot be applied to all cases in an acritical fashion, but in relationship to the specific clinical picture of each individual patient.

A recent uroselective alpha(1)-adrenoceptor antagonist, REC15/2739, has been joined with nitrooxy and furoxan NO-donor moieties to give new NO-donor alpha(1)-antagonists. All the compounds studied proved to be potent and selective ligands of human cloned alpha(1a)-receptor subtype. Derivatives 6 and 7 were able to relax the prostatic portion of rat vas deferens contracted by (-)-noradrenaline because of both their alpha(1A)-antagonist and their NO-donor properties.

To assess the efficacy and safety of specific local nasal immunotherapy (LNIT) in powder form in patients with allergic rhinitis, using subjective and objective parameters.A double-blind randomized multicenter trial of 102 patients with allergic rhinitis who were treated with specific LNIT for 8 consecutive months.After identifying allergens with the skin prick test and sensitization threshold dose with the specific nasal provocation test, 102 patients were selected, of whom 55 were allergic to mites and 47 were allergic to Graminaceae or Parietaria pollen. The specific treatments were self-administered using an insufflator in two phases (phase 1: increasing doses; phase: 2, maintenance dose). Patients were evaluated before and after 32 weeks of treatment by subjective analysis of their self-reported symptoms and by objective analysis of nasal provocation test, nasal resistance by anterior rhinomanometry, and mucociliary clearance time.Clinical efficacy of LNIT for allergy to mites and pollens was confirmed by the differences in the symptoms score between the active group and the placebo group. The nasal provocation test results confirmed that this difference was statistically significant. The rhinomanometric analysis gave positive results for the treated group mainly in LNIT for mites. No differences in mucociliary clearance time were found.Specific LNIT is effective for allergic rhinitis and appears to offer considerable advantages over other hyposensitization methods. It can be done at home, patient compliance is good, and the treatment is safe.

The therapeutic efficacy of the synthetic immunostimulant pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl) carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was evaluated in a double-blind placebo-controlled study in parallel groups in the management of recurrences in 235 children with recurrent tonsillitis. The ambulant study provided for 15 days of treatment with two oral vials of pidotimod 400 mg or placebo daily, in accordance with a randomisation list, 60 days of treatment with one oral vial of pidotimod 400 mg or placebo daily, and a 90-day follow-up period. The total trial period was 165 days. In addition to evaluating the number of tonsillitis recurrences which occurred during the 75 days of treatment and the 90-day follow-up period, the number of days on which the principal symptoms of the illness were present and on which drugs such as antibiotics or anti-inflammatory agents were used concomitantly, as well as the number of days' absence from school, were analyzed. The findings showed that, taking the treatment phase and the three-month follow-up period together, pidotimod significantly reduces the incidence of inflammatory upper airways episodes. The very low incidence of adverse effects, which was the same as that in the placebo group, confirmed the excellent safety of the product.

Serine proteinase inhibitors, in the seeds of several Leguminosae from the Pantanal region (West Brazil), were studied using bovine trypsin, Factor XIIa and human plasma kallikrein. The inhibitors were purified from Enterolobium contortisiliquum (Mr = 23,000), Torresea cearensis (Mr = 13,000), Bauhinia bauhinioides (Mr = 20,000), Bauhinia mollis (Mr = 20,000) and Bauhinia pentandra (Mr = 20,000). E. contortisiliquum inhibitor inactivates all three enzymes, whereas the T. cearensis inhibitor inactivates trypsin and Factor XIIa, but does not affect plasma kallikrein. B. bauhinioides and B. pentrandra inhibitors, on the other hand, inactivate trypsin and plasma kallikrein but only the B. pentandra inhibitor affects Factor XIIa, and B. mollis inhibitor causes trypsin inactivation only. Calculated Ki values were between 10(-7) and 10(-9) M. Chymotrypsin, like trypsin, is also inhibited, but with lower affinity. The trypsin inhibitors, isolated from E. contortisiliquum, B. pentandra, B. bauhinioides and B. mollis seem to be of the Kunitz type; the inhibitor purified from T. cearensis is of the Bowman-Birk type.

636 patients suffering from several laryngeal pathologies were treated with the CO2 laser. The results obtained confirm that this instrument is a valid alternative surgical tool, in comparison with the traditional surgery, because it allows to carry out the removal of the lesion with greater precision and more advantageously, when clinical indications are exact and surgical technique correctly performed. The results are as follows: Vocal nodules: no real advantages are offered by the CO2 laser in the treatment of these pathologies, whereas, in a small percentage of cases, the occurrence of reactive nodules or scars was noted; Cordal polyps are better removed with the traditional procedures, whereas the CO2 laser allows a more accurate excision of voluminous polyps or edemas of Reinke because of the bloodless operative field; Dyskeratoses: better functional results can be obtained using the laser. In these cases, however, an accurate preoperative evaluation is of fundamental importance to exclude any carcinomatous degeneration; Laryngeal amyloidosis is easily removed with minimal trauma and functional impairments using the laser; Laryngeal papillomatosis: the laser makes it possible to achieve complete recovery if radical excision, avoidance of accidental laryngeal damage and frequent postoperative controls are done; Laryngeal cancers: when clinical indications are correct, the main laser advantages in the treatment of T1 and T2 glottic cancers are the endoscopic removal of the lesion, avoidance of tracheotomy, shorter hospital stay and better quality of voice. Radical excision of the lesion is obtained by dissecting the tumor along the traditional cleavage plane, i.e. the inner perichondrium of the thyroid cartilage; Bilateral vocal cord paralysis: partial or total arytenoidectomy can be performed with the laser, with excellent functional results and minimal trauma and inconveniences; Laryngeal stenoses: chronic aditus edemas, vocal cord synechiae and webs are easily removed, taking care to avoid damage to the posterior commissure or to the elastic tracheal wall and performing frequent endoscopic removal of the fibrin clots in the postoperative period. Concentric stenoses and circumferential webs are firstly vaporized, then a silastic Montgomery T-tube is placed in the neocavity and left in place until re-epithelialization is completed. The insertion of a metallic tracheotomic cannula in the horizontal and descendant branches of the T-tube has been shown to be a useful precaution in order to achieve better results.

Chondrosarcoma of the larynx is a rare slow-growing malignant tumour with approximately 240 cases reported in the literature: the cricoid cartilage is the most commonly affected site (72-75%), in rare case was described of epiglottis (1-2%). We report a case of a chondrosarcoma of the epiglottis treated with CO2 laser epiglottectomy. The patient was referred with dysphonia, dysphagia and halitosis that started four months before. Indirect laryngoscopy revealed a large smooth mass with a roundish appearance and a pearly-grey colour, as big as a nut, apparently arising from the laryngeal surface of the epiglottis, causing obliteration of the piriform fossa. The definitive histopathological report showed microscopically, the tumour was low-grade (grade I) chondrosarcoma. A literature review regarding chondrosarcomas of the epiglottis is presented. The diagnosis, histology and treatment of these tumours are discussed. In particular we examine the controversy of conservative surgery vs. total laryngectomy. A conservative surgical approach is typically appropriate in light of this tumour's low-aggressive nature.

INTRODUCTION: Variation of respiratory care is described between centers around the world. The Italian Neonatal Network (INN), as a national group of the Vermont-Oxford Network (VON) allows to perform a wide analysis of respiratory care in very low birth weight infants. METHODS: We analyzed the dataset of infants enrolled in the INN in 2009 and 2010 and, for surfactant administration only, from 2006 to 2010 from 83 participating centers. All definitions are those of the (VON). A questionnaire analysis was also performed with a questionnaire on centers practices. RESULTS: We report data for 8297 infants. Data on ventilator practices and outcomes are outlined. Variation for both practices and outcome is found. Trend in surfactant administration is also analyzed. CONCLUSIONS. The great variation across hospitals in all the surveyed techniques points to the possibility of implementing potentially better practices with the aim of reducing unwanted variation. These data also show the power of large neonatal networks in identifying areas for potential improvement.

Maxillary sinus mucocele is an unusual clinic entity (incidence of 3-10%), represented by mucous secretion lined by respiratory stratified pavemented epithelium and its origin is mainly secondary to infections, inflammations, surgery, trauma or neoplasia.We present a case of maxillary sinus mucocele. Subject of the study is a 74 aged patient referring positive anamnesis for nasal cavity surgery. His symptoms appeared six months ago and he complainted vertical ocular diplopia and ocular tension sensation, without rhinologic complaints. Oculistic examination confirmed an isolated left inferior rectus palsy, and CT showed mucous secretion occupying left maxillary sinus, with bone erosion to the orbital floor until orbital muscles. MRI is the gold standard for differential diagnosis with neoplastic lesions but the patient refused to perform this radio-diagnostic exam. He underwent to Endoscopic sinus surgery, consisting in middle meatal antrostomy and removal of the mucocele. Four months later the endoscopic follow-up showed regular maxillary cavity and regular ocular motility.In our opinion the rebuilding of the eroded bone is not mandatory if the integrity of the maxillary upper wall mucosa is respected, and antrostomy with drainage allows to recover ocular and paranasal sinus function. KEY WORDS:, Diplopia, Endoscopic sinus surgery.Il mucocele del seno mascellare rappresenta un’entità clinica rara. La sua origine è più frequentemente secondaria a pregressi interventi di chirurgia dei seni paranasali, infezioni o patologia allergica delle fosse nasali, traumi facciali, neoplasie dei seni paranasali. Raramente è di origine primitiva. La relativa maggiore frequenza di casi nella letteratura asiatica è spiegabile col recente abbandono della tecnica Caldwell-Luc a favore dell’endoscopia chirurgica. La particolarità di questo caso che presentiamo è la pressochè completa assenza di sintomatologia naso-sinusale, a favore di sintomatologia oftalmica data dall’erosione del pavimento orbitale e da fenomeni di compressione. La compressione ha determinato un deficit della contrazione del muscolo retto inferiore di sinistra determinando diplopia. L’erosione del pavimento orbitale è stato dimostrato tramite TC. Il trattamento è stato eseguito con tecnica endoscopica effettuando un’ampia antrostomia e drenando il seno mascellare. Abbiamo notato il completo recupero della funzionalità oculare e dell’integrità anatomica e funzionale del seno mascellare già dopo due mesi, senza il bisogno di procedere alla ricostruzione. Ancora oggi il paziente non ha più presentato segni di recidiva né di alterata motilità oculare. Concludendo abbiamo voluto porre attenzione sulla particolare sintomatologia del caso e, grazie ad un approccio diagnostico multidisciplinare abbiamo notato che non è sempre obbligatorio ricostruire la lesione ossea ma è sufficiente procedere ad un’adeguata antrostomia e al drenaggio del mucocele, nel rispetto del sottile tessuto che ricopre la parete superiore del seno mascellare per ottenere il completo recupero della normalità anatomo-funzionale della cavità paranasale.

The present report concerns a case of Branchio-Oto-Renal (BOR) dysplasia. The syndrome is an autosomal dominant inherited disorder characterized by external ear malformations, branchial fistulas, conductive mixed or sensorineural hearing loss and renal anomalies of varying severity. The types of abnormalities that may be present are numerous and often difficult to identify preoperatively, despite modern imaging techniques. From the literature the reconstructive surgery of the middle ear in patients with the BOR Syndrome often has not been successful. In particular, the Authors report their experience in the surgical treatment of a case of BOR Syndrome. During intraoperative investigation a complex malformation of incus-malleus system was detected; thus, an ossiculoplasty, with PORP interposition, was carried out. Hearing results obtained with such intervention were successful, but they did not allow a complete closure of the cochlear reserve. Lastly, the Authors recommend a careful study of the different malformations of the middle ear, so that a more suitable preoperative therapeutic procedure may be planned.

New 1-(2-pyridinyl)piperazine derivatives were synthesized and tested as inhibitors of the reaginic passive cutaneous anaphylaxis in the rat (PCA), of the histamine-induced bronchospasm in the guinea pig, and of the rat mesenteric mast cell degranulation induced by compound 48/80. On the basis of test results, a series of N-(substituted phenyl)-omega-[4-(2-pyridinyl)-1-piperazinyl]alkanamides was prepared. The nature of substituents at the anilide ring strongly influenced mast cell stabilizing activity, whereas it was less determining in the case of the other two tests. No clear correlation between the most common physicochemical parameters (pi, sigma, Vw volume) of substituents and activity could be detected. With regard to the position of substituents at the anilide ring, the rank order of potency, in the PCA and bronchoconstriction tests, was para greater than meta greater than ortho. Introduction of substituents in the 1-(2-pyridinyl)piperazinyl moiety of the N-(substituted phenyl)propanamide derivatives hardly affected activity, or the effect was deleterious. Some of the new compounds exhibited a simultaneous remarkable activity in all the three assays employed.

A series of substituted 2-(2,3,5,6-tetramethylbenzyl)imidazolines and related compounds have been synthesized to study the steric and hydrophobic effects on the vasoactivity of the introduction of four methyl groups on the phenyl moiety. The 2-(2,3,5,6-tetramethylbenzyl)imidazoline (I) showed a high hypertensive activity, whereas the 2-benzylimidazoline possesses an adrenolytic activity. The 2-(2,3,5,6-tetramethylphenoxy)methylimidazoline (XVII) retained the hypertensive activity, whereas the corresponding thioether (XIX) was inactive. Some structure-activity relationships with regard to the presence of substituents in the 4-position of the phenyl moiety and on the benzylic CH2 are reported.

New 1-(2-pyridinyl)piperazine derivatives were synthesized and tested as inhibitors of the reaginic passive cutaneous anaphylaxis in the rat (PCA), of the histamine-induced bronchospasm in the guinea pig, and of the rat mesenteric mast cell degranulation induced by compound 48/80. On the basis of test results, a series of N-(substituted phenyl)-omega-[4-(2-pyridinyl)-1-piperazinyl]alkanamides was prepared. The nature of substituents at the anilide ring strongly influenced mast cell stabilizing activity, whereas it was less determining in the case of the other two tests. No clear correlation between the most common physicochemical parameters (pi, sigma, Vw volume) of substituents and activity could be detected. With regard to the position of substituents at the anilide ring, the rank order of potency, in the PCA and bronchoconstriction tests, was para greater than meta greater than ortho. Introduction of substituents in the 1-(2-pyridinyl)piperazinyl moiety of the N-(substituted phenyl)propanamide derivatives hardly affected activity, or the effect was deleterious. Some of the new compounds exhibited a simultaneous remarkable activity in all the three assays employed.