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Background: Originally adopted for the cytological screening of cervical and uterine cancer, contact endoscopy (CE) is now widely used in several fields of oncological surgery. The CE method, with magnification power up to 150x, was designed to enhance visualization and identify microscopic changes indicative of precancerous and cancerous lesions at early stages. In this pilot study, we evaluated the multimodal applications of CE during different endoscopic intracranial neurosurgical procedures., Methods: Twenty patients with skull base lesions underwent surgery using different minimally invasive endoscopic approaches (endonasal, transorbital, and supraorbital). CE was used to distinguish the pathology from the surrounding healthy tissue by positioning the endoscope either in proximity or directly onto the target tissue. Special attention was given to the visualization of the margins of the lesion to differentiate compression/displacement from infiltration of the normal surrounding tissue., Results: With its unprecedented range of magnification, CE could clearly identify the microvascular pattern and cytological architecture of a tissue not detectable by simple white light endoscopy, with no reported damage due to heat transmission or iatrogenic injuries. All the lesions diagnosed as "presumed neoplastic tissue" by CE were confirmed by histopathology. The most promising results were observed in surgeries for meningioma and pituitary adenoma, as these lesions exhibit distinctive microvascular networks., Conclusions: CE represents a new and effective technique for the in vivo identification of pathological microvascular and tissue features, allowing preservation of normal tissue during different endoscopic approaches. The use of CE could improve diagnostic accuracy and assist in intraoperative decision-making, becoming a key tool in various applications in neurosurgical field., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30 days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22 days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1 days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term., Competing Interests: Conflict of interestNo conflict of interests to disclose., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis., Methods: A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process., Results: Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation., Conclusions: The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach., (© 2022 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence., Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors., Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage., Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsular rupture must always be avoided, and secure resection margins must always be pursued, independent of the type of parotidectomy being performed. Features that increase the risk of recurrence are an intraoperative rupture and the presence of satellite nodules (as recorded in the pathologist's report). In these cases, patients need a longer follow-up period.

Objectives: The authors studied the correlation between the grading TIP which evaluates three otoendoscopic characteristics of the tympanic membrane (TM) (transparency, integrity and position) with the gold standard represented by the impedenzometry., Methods and Materials: Cross-sectional studies with independent and blind comparison with the gold standard diagnostic. The setting was primary care and ambulatory. 115 TMs were examined (57 right and 58 left) of 60 children (36 males and 24 females) and classified according to the TIP grading (transparency, integrity, position). Each patient underwent otoendoscopy to obtain TIP grading and subsequently to tympanometry, which was considered the gold standard for diagnosis. The Transparency is the condition in which at least one or more structures behind the TM are visible: promontory, incudo-malleolar and incudo-stapedial articulations. The Integrity is such when no holes in the TM are visible. The TM must be displayed up to the anulus. The position of the TM is evaluated according to the handle and the short apophysis of the malleus. The correlation between TIP grade and tympanometry was measured by the "Chi Square" test., Results: The method showed an average sensitivity and specificity of the three TIP parameters (TIP1 TIP2, TIP 4) versus tympanometry of 95.6% (I.C. 90.1-98.5); PPV and PPN 95.6 (I.C 90.3%-98.1%) Positive Likelihood Ratio 22,000 (I.C. 9.327 to 51.894) Negative Likelihood Ratio 0.045 0.019 to 0.107., Conclusion: Grading TIP is a valid method for accurate diagnosis of pediatric otitis media and can predict the tympanometry result with high statistical significance., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The evolution of skull base surgery over the past decade has been influenced by advancement in visualization technology. Recently, as a result of such improvements, three-dimensional (3-D) scopes have been widely used during endoscopic endonasal approaches. In the present study, we describe the use of 3-D stereoscopic endoscope for the treatment of a variety of skull base lesions., Methods: From January 2010 to June 2015, a 3-D endoscopic endonasal approach (4 and 4.9 mm, 0°, and 30° rigid endoscopes) was performed in 70 patients with the following lesions: 42 large extrasellar pituitary macroadenomas, seven tuberculum sellae meningiomas, seven clivus chordomas, five craniopharyngiomas, three fibrous dysplasia of the clivus, three sinonasal malignancies, one orbital lymphangioma, one trigeminal neurinoma, one primary suprasellar lymphoma., Results: Total tumor removal was obtained in 50 patients (71.4 %) while in 14 (20 %), subtotal removal was possible in six (8.6 %) only partial removal was achieved. Overall complications included diabetes insipidus in eight patients (11.4 %), hypopituitarism in seven patients (10 %), CSF leak in five patients (7.1 %), cranial nerve injury in two patients (2.8 %), panhypopituitarism in two patients (2.8 %), meningitis in one (1.4 %) and one postoperative central retinal artery occlusion (1.4 %). There was no mortality in the series. The mean follow-up time was 39 months (range, 6-72 months)., Conclusions: In our experience, the 3-D endoscope represents a critical development in visualization, thus enabling improved hand-eye coordination and depth perception, which are mandatory for the management of complex intradural neurovascular structures during tumor removal surgery.

Treatment of Benign Paroxysmal Positional Vertigo is based on Semont's Liberatory Manoeuvre and on so-called "Canalith Repositioning Manoeuvres", derived from the original Epley technique. Both manoeuvres are very effective and choice of which to use depends on the experience of the physician. Semont's manoeuvre requires a quick movement of the patient in mass in the frontal plane, from the involved, to the contralateral side, which sometimes causes symptoms such as nausea or vomiting. In this technique, a secondary liberatory nystagmus is often observed as sign of the success of the manoeuvre. Repositioning manoeuvres are less fastidious because of the slow movements, but we rarely observe an objective sign of success like the liberatory nystagmus. In the present randomised trial, 300 patients with posterior canalo/cupulolithias were divided into 3 treatment groups: 100 treated by Semont Technique; 100 by a Repositioning procedure (Parnes technique); 100 by a new manoeuvre called "Quick Liberatory Rotation". Results of treatment are also compared with the natural evolution of Benign Paroxysmal Positional Vertigo observed in 18 untreated patients. Quick Liberatory Rotation is similar in the sequence of the positions of the head in the horizontal plane, to repositioning procedures, but is more like the Semont manoeuvre in the speed of the movement (about 180 degrees in less than one second). Quick Liberatory Rotation is easy to perform, well tolerated and very effective (success rate: 98% in one-three cycles). In the present investigation, a secondary liberatory nystagmus was observed in 76.1%, with a sensitivity of 81.9% in detecting patients who had completely recovered and a specificity of 43.8% in detecting failures. Effectiveness, in short and medium period (1-15 months), is similar to Semont and Parnes techniques. Authors consider Quick Liberatory Rotation, at present, a possible first choice technique in the treatment of posterior canalolithiasis.

Benign paroxysmal positional vertigo (BPPV) is the most frequently occurring dizzy syndrome. The literature provides ample descriptions of the forms determined by canalo/cupulolithiasis of the posterior canal, the most common, as well as canalo/cupulolithiasis of the horizontal canal. Descriptions of the forms of canalo/cupulolithiasis of the anterior canal are, instead, very rare and, sometimes questioned: this is fundamentally due to its superior position, which makes it a much less likely site for the accumulation of debris, both from a conceptual and practical point of view. For these reasons, the Authors feel that the presentation of this case of PPV is of particular interest. After analyzing and excluding other interpretations as less probable, they considered the syndrome as determined by the association of right posterior and anterior canalolithiasis. This form, as in the case of posterior canalolithiasis, responded to treatment with Semont's liberatory procedure.

Pleomorphic adenoma is the most common neoplasm of the major salivary glands, in particular of the parotid gland. Only occasionally can it be found in the cervicofacial area outside the major and minor salivary glands of the oral cavity. The present article describes three cases of pleomorphic adenoma, respectively of the external auditory canal, the nose, and the larynx. The three tumors showed no clinical or radiological signs of malignancy and were surgically excised with a suitable margin of healthy tissue. Histologically, the typical features of pleomorphic adenoma were observed in the larynx case alone. The pleomorphic adenoma of the external auditory canal evidenced an extensive apocrine glandular component; the neoplasm of the nose was itself characterized by ample proliferation of fused cells. Immunohistochemical findings revealed focal or widespread positivity to cytokeratin, S100 protein and muscle-specific actin in both the epithelial and mesenchymal components of the neoplasm. Cases of pleomorphic adenoma in sites other than the major salivary glands show clinical and radiological signs of benignity. Their histopathological identification is, however, not always straightforward; immunohistochemistry can contribute significantly to the formulation of a definitive diagnosis and to the realization of an appropriate follow-up.

The clinical picture of Positional Paroxysmal Vertigo (PPV) induced by vertical canal labyrintholithiasis has been clearly described, eliminating previous interpretations of pathogenesis of this disorder. The diagnosis of PPV is based on the well-known picture of positional paroxysmal Nystagmus. The Authors report a clinical sign which has not previously been reported in the literature: torsional Nystagmus induced by the Head-Shaking Test (HST). The Authors encoutered this sign in 30% of the cases of vertical canalolithiasis and in 50% of the cases diagnosed as vertical cupulolithiasis. This sign was also found in patients with a history of prior positional vertigo and in patients who, after treatment with release maneuver, no longer show clinical signs of positional vertigo. Such Nystagmus was not, however, found in the control group (normal subjects and patients suffering from other vestibular pathologies). In the present study the possible pathogenesis of this sign is discussed and some practical implications are considered.

In cases of central and/or peripheral vestibular system asymmetry, Head-Shaking test-induced Nystagmus (H.S.-Ny) can appear after a cycle of 20 horizontal head oscillations. Four types of H.S.-Ny have been described, all of which are horizontal: 1) deficit Ny; 2) recovery Ny; 3) biphasic Ny; 4) triphasic Ny. None of these forms are specific for any given vestibular asymmetry site, whether central or peripheral. The authors report another low vertical type of H.S.-Ny found in 13 of the 1500 cases where the test was performed. Ten of these cases are discussed here. Vertical H.S.-Ny was found in 7 cases of N.M.R.-confirmed central pathologies, in 1 case of complications from epidemic parotitis and in 2 cases for which N.M.R. did not confirm the presence of an organic pathology. Vertical H.S.-Ny was often associated with other vestibular signs (Gaze-Ny, Rebound Ny, variable direction Ny, down-beat positional Ny, labyrinthine hyper reflexia). The authors consider this form of nystagmus a simple, easily determined signal of great importance in diagnosing the presence of a central, tronco-encephalic and cerebellar pathologies.

A Rhesus D positive infant, born at 37 weeks of gestational age, admitted for neonatal passive immune thrombocytopenia was given 3 intravenous anti-Rhesus D immunoglobulin infusions at 3 weeks of age. This thrombocytopenia which had not responded to conventional therapy improved after the third of anti-Rhesus D immunoglobulin infusion, but the efficacy of this treatment could not be proven in this case report. However, the tolerance was good. No side-effects (jaundice, severe anemia) were observed.