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Laryngeal hemangiomas in adults are uncommon. We report four such cases seen at our clinic during an 18-month period in 1996 and 1997. All masses were detected by endoscopy, and all were biopsied and ablated uneventfully with a CO2 laser. All four patients recovered without incident. We feel that laryngeal hemangiomas that affect only the glottic area can be treated endoscopically with a CO2 laser without consequences.

Rhinophyma is an acne rosacea which primarily affects the midface of elderly men, and causes disfigurement as well as obstruction. There are numerous ways of treating this condition and, in our institution, a CO2 laser is the treatment of choice.

Eighty-four out of 100 enrolled female patients affected by osteoporosis completed a double-blind, randomized trial, using ipriflavone (IP) in a dose of 3 x 200 mg/day (41 patients) or placebo (P)(43 patients). All patients received 1 g/day oral calcium supplementation. Inclusion criteria were: age over 65 years; at least one vertebral fracture in the past; bone mineral density measured at the distal tenth of the radius lower than the normal average -2 x S.D. The trial period was between June 1990 and November 1993. Patients of the IP group showed a significant increase in bone mineral density (P < 0.05) compared with the starting values during the whole study period. Pain decreased rapidly, intake of analgesics dropped, and often significant decreases in calciuria, hydroxyprolinuria, alkaline phospatase, osteocalcin and parathormone values were observed. Only two new fractures occurred during the trial in the IP group. Patients of the P group at the end of the study displayed decreased bone mineral densities (P < 0.05), increased pain, greater consumption of analgesics, and often significant increases in the bone metabolism parameters listed for the IP group. In the

ObjectivesBalloon sinuplasty is a new procedure that is gaining popularity in the United States. However, with all new technology, there is an increase in cost. Balloon sinuplasty increases the overhead for the facility where it is being performed and does not affect reimbursement. To decrease the cost of new technology, the physician, facility, and the company must all think of creative methods to acheive this goal.MethodsIn our institution, we had 60 patients that had balloon sinuplasties performed, with all of them involving both maxilary and frontal sinus. Re-useable olive-tip cannula was used instead of the company's recommended disposable guide catheter for the frontal and maxillary sinuses. In using the olive-tip as a guide catheter, the guide wire and balloon catheter are easily directed to the opening of both the maxillary and frontal sinus.ResultsThe outcome from all 60 patients was successful, with none returning for revision. In using the olive-tip cannula instead of the disposable catheter gu...

This is case report of extramedullary plasmacytoma occurring in the nasal cavity. These are unusual tumors especially in the nasal area. Patients present mainly with nasal symptoms on the same side of the tumors. The treatment consists of surgery resection, or, radiation, or both. There is a fifty percent survival rate in five years.

Objectives: Hypertropic lingual tonsils are a known obstruction in the upper airway. Enlarged linguals are responsible for obstructive sleep apnea, potential infections, and difficult intubations for routine surgeries. In our institution all patients were treated with protection of the airway, and ablation of lingual tonsils with a CO 2 laser. Methods: The patients were diagnosed with direct visualization and a CT scan of the neck. All patients were intubated with a laser reinforced endotracheal tube and fire precautions were taken when draping patient. One patient had a tracheotmy performed before being treated for hypertrophic lingual tonsils. A wide funnell larynscope was suspended. The CO 2 laser was used at 15 watts continuous along with an operating microscope to ablate the tissue. Results: All patients were admitted for a 23-hour stay. Postoperatively, no patient required intubation to protect the airway. Three of the 50 patients required a revision surgery to completely ablate all the lingual tonsils. The patient with the tracheotomy was decannulated. All patients were relieved and asymptomatic after surgery. Conclusion: CO 2 laser is a safe and acceptable method for lingual tonsillectomy. All patients in our institution had no complications and were free of all symptoms. The laser compleletly ablated the lingual tonsils removing the obstruction in the airway.

(Editorial Comment: The authors describe a rare entity that may mimic a common benign parotid neoplasm. The clinical presentation, work-up, and treatment are summarized.) Preauricular masses are usually parotid tumors. Rarely, they are temporomandibular joint cysts. These cysts are divided between ganglion cysts and synovial cysts. Twelve temporomandibular joint cysts have been reported. Eight have been ganglion cysts and 4 have been synovial cysts. 1 This is the 5th synovial cyst reported as a temporomandibular joint cyst. Treatment is uncertain; however, surgical excision of the temporomandibular joint cyst has the highest success rate. CASE REPORT A 47-year-old woman presented to the Ear, Nose, and Throat Clinic with a preauricular mass. She admitted to the mass growing slowly and being present for approximately 1 year. She had left preauricular pain and discomfort when chewing. The pain had become worse before her visit. She had a history of temporomandibular joint dysfunction and was being treated by her dentist. Her past medical history was basically unremarkable. Her physical examination showed a 2-cm mass in the left preauricular region. The mass was tender to the touch and mobile. There was no facial nerve paralysis or paresis. The rest of her head and neck examination was unremarkable. A fine-needle aspiration was performed. The results were nondiagnostic. Epithelial cells were obtained, but we could not make a diagnosis. She was offered an additional fine-needle aspiration, even with the use of ultrasound needle-guided aspiration, but she refused. Therefore, a computed tomography (CT) scan was obtained, which showed a cystic lesion near the parotid gland but did not involve the parotid gland (Fig 1). Because the pain was becoming unbearable and there was no diagnosis of this cystic lesion, she was offered surgery. She was taken to the operating room where a superficial parotidectomy was performed for exposure. The cystic lesion involved the left temporomandibular joint. The cystic lesion was removed, and the entire joint and capsule of the temporomandibular joint was reconstructed at the time of surgery. Pathological examination showed that this was a synovial ganglion cyst of the left temporomandibular joint. She was followed up in 1 week with no complications. She admitted her pain was gone. Postoperatively, she had no pain on chewing. Six months postoperatively, she only complained of occasional temporomandibular joint problems, which were very mild compared with her past history.

Müllerian duct alterations in development or fusion in the embryo cause congenital uterine anomalies which may be responsible for decreased fertility or problems in carrying out a normal pregnancy. In this study, the MR findings in uterine agenesis (1 case), unicornuate (2 cases), didelphys (3 cases), bicornuate (3 cases), arcuate (6 cases) and septate uterus (8 cases) are described, together with the optimal section planes for their demonstration. The examinations were performed with an 0.5-T superconductive magnet, the spin-echo technique and mostly T2-weighted sequences. The anomalies were grouped according to Buttram and Gibbons classification, which is the most used in clinics. In particular, the bicornuate uterus was distinguished from the septate uterus, the latter associated with the highest spontaneous abortion rates, on the basis of external fundal outline appearance. In such anomalies, the muscular or fibrotic nature of any intracavitary septum was assessed based on septal thickness more than on signal intensity at this level. MR diagnostic accuracy in 23 patients with Müllerian anomalies, compared with surgical, hysteroscopic, laparotomic and laparoscopic findings, was 100%. Nevertheless, if Müllerian duct anomalies responsible for gynecologic-obstetric problems are known or suspected, MRI should always be used, on the basis of a close gynecologist-radiologist collaboration, for classification agreement and the evaluation of any intracavitary septum morpho-biometric appearance and possibly nature, to discuss treatment options.

In uterine cervical canal carcinoma, the current clinical FIGO criteria often fail not only to differentiate stage IA2 from stage IB but also to demonstrate possible parametrial involvement. Moreover, the analysis of tumor volume and of the depth of neoplastic stromal invasion is not very reliable. The authors investigated MR accuracy in the definition of such variables: to this purpose, 24 patients with histologically confirmed endocervical adenocarcinoma were submitted to MRI, which was performed with an 0.5-T superconductive magnet. Sagittal and oblique transverse or sometimes coronal SE images, oriented so as to be perpendicular to longitudinal cervical major axis were obtained with T2 weighting (TR 1800 ms, TE 25-90 ms). MR data were correlated with pathologic findings. MR accuracy in demonstrating parametrial involvement was 92%, its sensitivity was 86% and specificity 97%. Volumetric MR data showed a high correlation (r = 0.970) with those derived from pathologic findings. In 92% of cases stromal invasion exceeded 5 mm. MRI, thanks to its high accuracy, should be included in diagnostic pretreatment protocols, even though FIGO criteria do not require it yet, especially in the presence of an endocervical adenocarcinoma. Moreover, the accurate definition of tumor volume can allow less extensive surgery with the same survival rates and fewer complications, which are frequently observed after radical hysterectomy.

From June 1989 to September 1990, 255 women with recurrent vaginitis, were evaluated, at the "Service of Precocious Diagnosis and Therapy of Gynecological Tumor" of the 1st Department of Obstetrics and Gynecology. They were compared with a control group of 255 women selected in the same time. All patients between the ages of 18-40 years, with normal sexual behaviour, had a negative colposcopy for HPV and HSV2 infections. The cervical smear with Papanicolaou technique and direct immunofluorescence (DIF) was performed in all patients. The specimens were examined with a fluorescence microscope (Leitz). Positive determinations were confined by examination a tha magnification of 600 X. Slides were scored as positive if at least 5 distinct apple-green fluorescence-stained elementary body per field was observed. The two groups were entirely comparable in age, parity, method of contraception, and number of sexual contacts over the preceding three months. Our data confirmed a higher incidence of Chlamydial infections in women with recurrent vaginitis (34.1%) than in control group (8.23%). In symptomatic women, more cases of metaplastic cells with cytoplasmic vacuolation, less inflammatory alteration and a lack of specific agents like CA and TV, were found than in the control group. The DIF positivity, in both groups, was connected with a cytological findings of metaplastic cells with cytoplasmic vacuolation in 72.3% and 50% respectively.