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The objective of this study is to analyse the complications of orbital decompression in Graves' orbitopathy. The clinical records of 946 patients who had been operated on with orbital decompression for Graves' orbitopathy were reviewed and the intra- and post-operative complications with minimum follow-up of six months were analysed. An extensive review of the literature was carried out to compare results. In the case-series reported here the most frequent complications were: wasting of the temporal region (100%) in patients operated on using a coronal approach; permanent hypoesthesia of V2 (13%) and V1 (8%) in patients operated on with an upper eyelid incision. In only one patient was a total monolateral lesion of V2 reported. The most severe complications consisted in reduction of visual acuity in 5 patients, and CSF leak with cerebral complications in 2 patients, who were operated on with a non-endoscopic endonasal approach. Three patients had intra-operative haemorrhages and 3 patients had post-operative haemorrhages requiring further surgical intervention. The incidence of symptomatic sinusitis/mucoceles was 0.75%. In conclusion, orbital decompression carried out with endoscopic endonasal technique and via transpalpebral accesses appears to be associated with a low incidence of complications. Knowledge of the causes of the possible complications in the different surgical approaches can definitely help to reduce their incidence.L’obiettivo di questo studio è analizzare le complicanze della decompressione orbitaria in pazienti affetti da oftalmopatia Basedowiana. Abbiamo analizzato 946 pazienti sottoposti a decompressione orbitaria per orbitopatia di Graves e le complicanze intra- e post-operatorie con un follow-up minimo di 6 mesi. Abbiamo eseguito inoltre un’estesa revisione della letteratura per comparare i risultati. Nel nostro studio le più frequenti complicanze sono state: atrofia della regione temporale (100%) nei pazienti sottoposti a decompressione con approccio coronale; ipoestesia permanente di V2 (13%) e V1 (8%) in pazienti sottoposti a decompressione con approccio transpalpebrale superiore. Un solo paziente ha avuto una lesione totale monolaterale di V2. Le complicanze più gravi sono state la riduzione dell’acuità visiva, che si è verificata in 5 pazienti, e la perdita di liquido cerebrospinale con complicanze cerebrali, verificatesi in 2 pazienti, entrambi operati con approccio endonasale non endoscopico. 3 pazienti hanno avuto un’emorragia intraoperatoria mentre 3 pazienti un’emorragia postoperatoria che ha richiesto un secondo intervento chirurgico. L’incidenza delle sinusiti/mucoceli sintomatici è stata dello 0,75%. In conclusione abbiamo evidenziato come la decompressione orbitaria eseguita con tecnica endoscopica endonasale e con accessi transpalpebrali sia una procedura chirurgica con una bassa incidenza di complicanze. La conoscenza delle cause delle possibili complicanze nei differenti approcci chirurgici può sicuramente aiutare a ridurre la loro incidenza.

The superior orbital fissure is a critical three-dimensional space connecting the middle cranial fossa and the orbit. From an endoscopic viewpoint, only the medial aspect has a clinical significance. It presents a critical relationship with the lateral sellar compartment, the pterygopalatine fossa and the middle cranial fossa. The connective tissue layers and neural and vascular structures of this region are described. The role of Muller's muscle is confirmed, and the utility of the maxillary and optic strut is outlined. Muller's muscle extends for the whole length of the inferior orbital fissure, passes over the maxillary strut and enters the superior orbital fissure, representing a critical surgical landmark. Dividing the tendon between the medial and inferior rectus muscle allows the identification of the main trunk of the oculomotor nerve, and a little laterally, it is usually possible to visualize the first part of the ophthalmic artery. Based on a better knowledge of anatomy, we trust that this area could be readily addressed in clinical situations requiring an extended approach in proximity of the orbital apex.

Aim: To compare the outcome of various surgical approaches of orbital decompression in patients with Graves' orbitopathy (GO) receiving surgery for disfiguring proptosis.Method: Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed.Results: Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 (SD 2.1) mm. After three-wall decompression the proptosis reduction was significantly greater than after two-wall decompression. Additional fat removal resulted in greater proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life (QOL) in the appearance arm of the GO-QOL questionnaire was 20.5 (SD 24.8) points.Conclusions: In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The extent of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but was rare in this series after the swinging eyelid approach.

The objective of this study is to report the initial results of a prospective trial assessing instrumental deglutition function in nasopharynx and oropharynx cancers after radio or chemoradiotherapy using intensity-modulated radiotherapy (IMRT). IMRT was delivered aiming to spare the swallowing organ at risk (SWOARs) for Stage II-IV naso- and oropharynx cancer. Objective instrumental assessment included videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngeal-oesophageal scintigraphy (OPES) at baseline and at 1 month after radiotherapy. Dysphagia parameter scores were calculated at each exam after liquid (L) and semi-liquid (SL) bolus intake: pre-deglutition penetration, aspiration, pharyngeal transit time (PTT) and hypopharyngeal retention index (HPRI). Overall, 20 patients (6 nasophaynx and 14 oropharynx) completed treatment and instrumental assessment after 1 month. Comparison between pre- and post-treatment HPRI score values showed a significant worsening in both FEES-L (p = 0.021) and SL (p = 0.02) and at VFS-L (p = 0.008) and SL (p = 0.005). Moreover, a relationship between HPRI worsening at FEES-L and FEES-SL (p = 0.005) as well as at VFS-L and VFS-SL (p0.001) was observed. PTT was not significantly affected by radiotherapy (p0.2). Only a few patients experienced pre-deglutition penetration (1 patient with base of tongue cancer at FEES-L and SL) and aspiration (1 patient with nasopharynx cancer at OPES-L and FEES-SL) after radiotherapy. Our early results showed that IMRT-SWOARs sparing caused a significant increase in the post-deglutition HPRI score. Longer follow-up will be necessary to evaluate if the increase of HPRI is related to a high risk of developing late aspiration.In questo lavoro vengono riportati i risultati a breve termine di uno studio prospettico, finalizzato alla valutazione strumentale della funzionalità deglutitoria in pazienti affetti da tumore del rinofaringe e orofaringe sottoposti a trattamento radio o radiochemioterapico con tecnica ad intensità modulata (IMRT). L’ IMRT è stata finalizzata, oltre che al miglioramento della conformazione della dose radiante al volume tumorale, alla riduzione della stessa alle strutture responsabili della deglutizione (SWOARs). I criteri dello studio hanno previsto in tutti i pazienti la valutazione strumentale della deglutizione con Videofluoroscopia (VFS), Fibroscopia Endoscopica della deglutizione (FEES) e Scintigrafia Orofaringea (OPES) prima dell’inizio del trattamento e ad 1 mese dal termine dello stesso. Ogni esame è stato eseguito rispettivamente in seguito all’assunzione di un bolo liquido (L) e semiliquido (SL) e per ognuno sono stati calcolati i seguenti valori strumentali: presenza o meno di caduta pre-deglutitoria, presenza o meno di aspirazione, tempo di transito faringeo (PTT) ed indice di ritenzione ipofaringeo (HPRI). Dal Gennaio 2012 al Giugno 2013, un totale di 20 pazienti ha terminato il trattamento ed ha eseguito la valutazione strumentale a 1 mese dal termine della radioterapia. Il confronto tra i valori dell’HPRI prima e dopo il trattamento radiante ha mostrato un peggioramento significativo sia alla FEES-L (p = 0,021) e SL (p = 0,02) che alla VFS-L (p = 0,008) che SL (p = 0,005). Inoltre è stata riscontrata una significativa correlazione tra i valori dell’HPRI basale ed a 1 mese alla FEES-L e SL (p = 0,005) così come alla VFS-L e SL (p0,001). Diversamente, il tempo di transito faringeo (PTT) non è risultato essere influenzato dalla radioterapia (p0,2). Solo in pochi pazienti è stata riscontrata la comparsa di caduta pre-deglutitoria ( 1 paziente con tumore della base linguale alla FEES-L e SL) e la presenza di aspirazione (1 paziente con tumore del rinofaringe alla OPES-L e FEES-SL). Nel complesso i risultati iniziali del nostro studio mostrano che l’ IMRT, finalizzata al risparmio delle SWOARs, determina soltanto un significativo incremento della ritenzione di bolo a livello del distretto ipofaringeo. Un follow-up più lungo sarà necessario per valutare se tale incremento sia associato o meno ad un maggior rischio di sviluppare fenomeni di aspirazione tardivi.

The aim of this paper is to analyse, after clinical experience with a series of patients with established diagnoses and review of the literature, all relevant anamnestic features in order to build a simple diagnostic algorithm for vertigo in childhood. This study is a retrospective chart review. A series of 37 children underwent complete clinical and instrumental vestibular examination. Only neurological disorders or genetic diseases represented exclusion criteria. All diagnoses were reviewed after applying the most recent diagnostic guidelines. In our experience, the most common aetiology for dizziness is vestibular migraine (38%), followed by acute labyrinthitis/neuritis (16%) and somatoform vertigo (16%). Benign paroxysmal vertigo was diagnosed in 4 patients (11%) and paroxysmal torticollis was diagnosed in a 1-year-old child. In 8% (3 patients) of cases, the dizziness had a post-traumatic origin: 1 canalolithiasis of the posterior semicircular canal and 2 labyrinthine concussions, respectively. Menière's disease was diagnosed in 2 cases. A bilateral vestibular failure of unknown origin caused chronic dizziness in 1 patient. In conclusion, this algorithm could represent a good tool for guiding clinical suspicion to correct diagnostic assessment in dizzy children where no neurological findings are detectable. The algorithm has just a few simple steps, based mainly on two aspects to be investigated early: temporal features of vertigo and presence of hearing impairment. A different algorithm has been proposed for cases in which a traumatic origin is suspected.In questo articolo vengono analizzate, alla luce dell'esperienza clinica e della conoscenza della Letteratura più recente in merito, tutte le caratteristiche anamnestiche della vertigine in età pediatrica, con lo scopo di costruire un semplice algoritmo diagnostico applicabile ai casi di vertigine in età pediatrica. Lo studio si basa sull'analisi retrospettiva dei reperti clinici e strumentali di 37 bambini sottoposti a completa valutazione otoneurologica per riferita sintomatologia vertiginosa. Tutte le diagnosi sono state confermate applicando i più recenti criteri diagnostici internazionali. Nella nostra casistica la più comune causa di vertigine in età pediatrica è risultata quella di origine emicranica (38%), seguita dalla nevrite vestibolare (16%) e dalla vertigine psicogena (16%). La vertigine parossistica benigna dell'infanzia è stata diagnosticata in 4 pazienti (11%), mentre il torcicollo parossistico in 1 bambino di un anno. In un 8% (3 pazienti) la vertigine aveva un'origine post-traumatica. La Malattia di Ménière è stata diagnosticata in 2 casi (5%). Una vestibolopatia bilaterale di origine sconosciuta è stata riconosciuta come causa di una dizziness cronica in un paziente. In conclusione, questo algoritmo può rappresentare un ottimo strumento per guidare il sospetto clinico del medico verso una corretta formulazione della diagnosi nel bambino vertiginoso senza chiari segni di coinvolgimento neurologico. L'algoritmo ha pochi semplici step, basati principalmente su due aspetti fondamentali: andamento temporale della vertigine e presenza di sintomi uditivi. Un algoritmo differente è stato costruito per i casi di vertigine post-trauma cranico.

One of the hypotheses that explains the pathogenesis of thyroid-associated ophthalmopathy (TAO) is that thyroglobulin (Tg) is transported through a retrograde lymphatic route to orbital tissues (OT), where it elicits autoimmune damage. In a previous study we demonstrated the presence of intact Tg of thyroid origin in OT from three patients with TAO. The present study was undertaken to investigate this issue further, by increasing the number of patients, by analyzing the distribution of Tg in OT, and by investigating possible relations between the presence of Tg in OT and the clinical features of patients. OT was obtained from seven patients with TAO who underwent decompressive orbitotomy via a transpalpebral approach. Patients were designated P10 to P16. Inflamed palpebral skin, retrobulbar fibroadipose tissue and extraocular muscle surgical samples were collected separately. Tissue extracts were prepared by homogenization and analyzed for the presence of Tg using two different techniques. We first performed immunoprecipitation experiments, in which a rabbit polyclonal anti-Tg antibody was used to capture Tg on protein A and a mouse monoclonal anti-Tg antibody was used to re-veal captured Tg by Western blotting. Intact 330-kd Tg was detected in retrobulbar fibroadipose tissue extracts from three patients (P10, P11, and P16), whereas no Tg was detected in retrobulbar fibroadipose tissue extracts from the remaining four patients. Tg was not detected in the extraocular muscle extracts from all patients studied. In addition, intact 330-kd Tg was found in the inflamed palpebral skin extract from one patient (P10). No Tg was detected in OT extracts from two patients without thyroid or eye disease and in abdominal adipose tissue extracts from two obese patients without thyroid or eye disease. We then searched for Tg by enzyme-linked immunosorbent assay (ELISA), using the same antibodies used for immunoprecipitation. Tg was detected in retrobulbar fibroadipose tissue extracts from four patients (P10, P11, P12, and P16) and in the inflamed palpebral skin extract from patient P10, in amounts ranging from approximately 125 to approximately 400 pg/microg of tissue protein. Again, Tg was not detected in extraocular muscle extracts. A positive gradient between Tg in OT and Tg in the serum was observed in patient P12. Using an ELISA approach, we found that Tg in OT from three TAO patients (P10, P11, and P12) contained thyroxine (T4) residues (mean T(4) CONTENT: 2.42 molecules per molecule of Tg), indicating that Tg had originated in the thyroid. Combining the results obtained in our previous and present study, we found a possible relation between the presence of Tg in OT and the previous treatment with radioiodine. Thus, of the seven patients (3 in the previous and 4 in the present study) in whose OT Tg was found, six had been treated with radioiodine, whereas of the three patients with no Tg in their OT none had been treated with radioiodine. In conclusion, Tg was found in OT extracts from patients with TAO by immunoprecipitation in three of seven cases and by ELISA in four of seven cases. Tg was found in retrobulbar fibroadipose tissue, but not in extraocular muscles. There was a relation between the presence of Tg in OT and the previous treatment with radioiodine. Our results support the hypothesis that Tg may play a role as a coantigen in the pathogenesis of TAO. Further studies are needed to investigate this possibility.

Objective: The present study had the objective of comparing the lipid profile, nutritional status and body composition of adolescents and their parents. Methods: A cross-sectional study was conducted with 120 adolescents from 10 to 13 years old, public schools students from the city of Viçosa, Minas Gerais, Brazil and their respective biological parents (104 mothers and 82 fathers). Data was collected regarding weight, height, waist and hip circumference, body fat, triglycerides, total and fraction cholesterol. Besides, taking the skinfold measurements (bicipital, tricipital, subscapular and suprailiac) of the adolescents; and evaluation of sexual maturity, excluding those that were in stage 1 according to Tanner. The statistical treatment includes descriptive analysis, the use of the Student's t-test, Mann Whitney, and Pearson and Spearman correlation. An Odds Ratio was conducted with a confidence interval of 95%, considering p < 0.05 significant. Results: A positive and significant correlation was seen for weight, BMI and total cholesterol between father and son; for all the variables, except body fat and wait/hip ratio between father and daughter; for weight and height between mother and son and BMI between mother and daughter. Adolescents that had both parents with hypertriglyceridemia, with inadequacies of LDL or HDL presented, respectively 19, 20 and 4 times more chances of presenting the same alterations. Conclusion: This study confirmed differences in the anthropometric measurements, body composition and lipid profile between children of overweight, eutrophic and underweight parents, as well as greater chance for the adolescent to present an altered lipid profile when the parents also have presented that alteration. Objetivo: El presente estudio tenía por objeto comparar el perfil lipídico, le estado nutricional y la composición corporal de adolescentes y sus padres. Métodos: Se realizó un estudio transversal en 120 adolescentes de 10 a 13 años de edad, estudiantes de escuelas públicas de la ciudad de Viçosa, Minas Gerais, Brasil y sus respectivos padres biológicos (104 madres y 82 padres). Se recogieron datos de peso, talla, circunferencia de la cintura y la cadera, la grasa corporal, los triglicéridos y el colesterol total y fraccionado. Además, se tomaron medidas de los pliegues cutáneos (bicipital, tricipital, subescapular y suprailíaco) de los adolescentes; y una evaluación de la madurez sexual, excluyendo a aquellos que estaban en el estadio 1 de Tanner. El tratamiento estadístico incluye un análisis descriptivo, el uso del test t de Student, Mann Whitney, y la correlación de Pearson y Spearman. Se realizó la razón de probabilidades con un intervalo de confianza del 95%, considerando significativa una p < 0,05. Resultados: se observó una correlación positiva significativa para el peso, el IMC y el colesterol total entre padre e hijo; para todas las variables, excepto para la grasa corporal y el cociente cintura/cadera entre padre e hija; para el peso y la talla entre madre e hijo, y para el IMC entre madre e hija. Los adolescentes cuyos progenitores tenían ambos hipertrigliceridemia, con inadecuaciones entre la LDL y HDL, presentaron, respectivamente, 19, 20 y 4 veces más posibilidades de presentar las mismas alteraciones. Conclusión: Este estudio confirmó diferencias en las medidas antropométricas, la composición corporal y el perfil lipídico entre los niños de padres con sobrepeso, normal y baja, así como una mayor posibilidad de que los adolescentes presentasen un perfil lipídico alterado cuando los padres también tenían esta alteración.

Objective: The present study had the objective of comparing the lipid profile, nutritional status and body composition of adolescents and their parents. Methods: A cross-sectional study was conducted with 120 adolescents from 10 to 13 years old, public schools students from the city of Viçosa, Minas Gerais, Brazil and their respective biological parents (104 mothers and 82 fathers). Data was collected regarding weight, height, waist and hip circumference, body fat, triglycerides, total and fraction cholesterol. Besides, taking the skinfold measurements (bicipital, tricipital, subscapular and suprailiac) of the adolescents; and evaluation of sexual maturity, excluding those that were in stage 1 according to Tanner. The statistical treatment includes descriptive analysis, the use of the Student's t-test, Mann Whitney, and Pearson and Spearman correlation. An Odds Ratio was conducted with a confidence interval of 95%, considering p < 0.05 significant. Results: A positive and significant correlation was seen for weight, BMI and total cholesterol between father and son; for all the variables, except body fat and wait/hip ratio between father and daughter; for weight and height between mother and son and BMI between mother and daughter. Adolescents that had both parents with hypertriglyceridemia, with inadequacies of LDL or HDL presented, respectively 19, 20 and 4 times more chances of presenting the same alterations. Conclusion: This study confirmed differences in the anthropometric measurements, body composition and lipid profile between children of overweight, eutrophic and underweight parents, as well as greater chance for the adolescent to present an altered lipid profile when the parents also have presented that alteration.

Aims: To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double-blind and placebo-controlled trial. Methods and Results: Fifty-five women diagnosed with VVC by vaginal discharge positive for Candida spp. (according to culture method) associated with at least one of the symptoms (itching and burning vaginal feeling, dyspareunia and dysuria), were treated with single dose of fluconazole (150 mg) supplemented every morning for the following 4 weeks with two placebo or two probiotic capsules (containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14). At 4 weeks, the probiotic treated group showed significantly less vaginal discharge associated with any of the above mentioned symptoms (10·3%vs 34·6%; P = 0·03) and lower presence of yeast detected by culture (10·3%vs 38·5%; P = 0·014). Conclusion: This study has shown that probiotic lactobacilli can increase the effectiveness of an anti-fungal pharmaceutical agent in curing disease. Significance and Impact of the Study: This novel finding of probiotic lactobacilli augmenting the cure rate of yeast vaginitis, not only offers an alternative approach to a highly prevalent condition that adversely affects the quality of life of women around the world, but also raises the question of how this combination works. © 2009 The Society for Applied Microbiology.

Naturalis® is a bioinsecticide based on living conidiospores of the naturally occuring Beauveria bassiana strain ATCC 74040. The entomopathogenic fungus acts primarily by contact: once attached to the insect’s cuticle, the conidiospores germinate producing penetration hyphae, which enter and proliferate inside the insect’s body. The fungus invades and feeds on its host, causing its death due to dehydration and/or depletion of nutrients. Several years of laboratory, semi-field and field studies showed that also Tephritid flies (Ceratitis capitata, Rhagoletis cerasi, Bactrocera oleae) are susceptible to infection by B. bassiana strain ATCC 74040. The results of efficacy trials conducted in 2004-05 are reported. Naturalis was tested both alone and in an integrated pest management strategy. The product showed high efficacy in controlling R. cerasi, comparable to or higher than that of the chemical reference treatment. The B. bassiana-based product Naturalis can thus be considered an efficient tool for the control of the cherry fruit fly.

Metabolic, hormonal and vascular disorders are considered to cause hearing dysfunction such as progressive sensorineural hearing loss (PSNHL). The diseases most commonly associated with PSNHL are diabetes mellitus, congenital and acquired hypothyroidism, chronic renal failure, chronic labyrinthine ischemia determined by non-hematologic factors (tissue perfusion pressure, blood vessel diameter) or by hematologic factors (blood viscosity and/or rigidity of the red blood cells). In this study a review of data on the relationship between these clinical disorders and the presence and deterioration of the hearing function was carried out. PSNHL seems to be significantly associated with diabetes mellitus, in particular the mitochondrial type: a progressive deterioration of the hearing function is reported in 60% of the patients suffering from this type of disease with mitochondrial mutations. Regarding hypothyroid disorders, the data do not support a pathogenetic link between PSNHL and acquired hypothyroidism, whereas in subjects with congenital hypothyroidism both clinical and experimental results indicate a progressive damage of hearing function if the thyroid disorder is not treated early in life. Also, in patients with chronic renal failure the hearing thresholds seem to be significantly worse than in control subjects, particularly in patients undergoing dialysis, whereas the effect of kidney transplantation on auditory function is still not understood. Finally a relationship between PSNHL and chronic labyrinthine ischemia due to alterations of hematologic factors (increase of blood viscosity and/or increase of rigidity of the red blood cells) has been reported by several authors. However, data on high blood pressure and hyperlipoproteinemia as causes of deterioration of hearing acuity are controversial, and it is often difficult to understand whether the progressive hearing deficit is due only to these factors or also to the elderly age of patients.