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This study aimed at comparing the anesthetic efficacy of lidocaine injection versus pledgets soaked in lidocaine and epinephrine during radiosurgery of inferior turbinates. The study prospectively enrolled 120 outbound patients, who were randomly assigned to group 1 -anaesthesia with tampon soaked in lidocaine and adrenaline- or group 2 -anesthesia with tampon followed by lidocaine and adrenaline injection. The following parameters were evaluated by a visual analogue scale 1 h after surgery: pain, anxiety, chocking sensation and difficulty swallowing. Nasal obstruction, rhinorrhea, sneezing, headache and inferior turbinate size were evaluated preoperatively (T0), after 1 (T1), 2 (T2) and 3 months (T3) to surgery. The data collected were analyzed by statistic tests. Group 1 showed lesser pain than group 2 during the procedure ( p  < 0.01); no statistically significant differences were observed for anxiety, chocking sensation and difficulty swallowing. All patients, independently from the belonging group, significantly improved the nasal symptoms comparing T0 and T1 ( p  < 0.01), T2 ( p  < 0.01) and T3 ( p  < 0.01), without statistically significant differences among the groups. Radiofrequency turbinoplasty allowed to all patients to reduce the turbinates hypertrophy. Local anaesthesia with tampon allowed to obtain the same results the injective anaesthesia in term of surgical outcomes; the use of tampon allowed patients did not experience pain., Competing Interests: Competing interestsThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2024. 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.)

Objective: Scuba diving and freediving are popular activities around the world, and their growth has increased the frequency of related pathology. A good ability to equalize is of paramount importance for diving. This is especially true for freediving, during which dive time is limited to just one breath. Even though equalization disorders are quite common in divers, a scoring system does not exist to date. In this paper we propose a new scoring system for equalization problems of freedivers: the EP score, shorthand for "equalization problems.", Methods: We administered the EP score assessment to 40 Italian freediving spearfishermen who were divided in two groups: Group A comprised 20 freedivers complaining of equalization problems and multiple barotraumas but totally asymptomatic in their everyday lives. These individuals had already received medical treatment and nasal surgery without improvement and then had undergone Eustachian tube balloon dilation. Group B comprised 20 healthy freedivers without any history of equalization disorders. We performed a statistical analysis to evaluate the reliability of this scoring system and to evaluate its usefulness in diagnosis and follow-up., Results: Our data show substantial statistical differences between healthy freedivers and freedivers complaining of equalization disorders (Z-Score = -5.396 at p ⟨ 0.05); data do not show any statistical difference between healthy freedivers and patients successfully treated by Eustachian tube balloon dilation (U-value = 152.5 and Z-Score= -1.271 at p ⟨ 0.05)., Conclusion: The EP score assessment seems to be a reliable tool to quantify equalization disorders during freediving and to evaluate how the difficulty varies over time and after treatment. Since equalization disorders could be present in different populations, the EP score assessment could be applicable to a wider group., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

Background: Eustachian tube balloon dilation is a minimally invasive surgical procedure used to treat Eustachian tube dysfunction which is not responsive to conventional therapies., Methods: In this cohort intervention series we report the results of balloon dilation in treating refractory equalization problems in 20 freediving spearfishermen; in 19 cases the problem was unilateral and in one case bilateral. All the patients had already received medical and insufflation therapy and four patients had also had nasal surgery. None of these treatments or procedures had achieved improvement. We used a 20 mm x 3 mm disposable balloon catheter inserted through a 70-degree guide catheter and inflated up to 12 ATM three times at three different depths of insertion within the Eustachian tube. Every inflation lasted 120 seconds., Results: Fifteen out of 20 patients improved. Ten patients reported a complete resolution of equalization problems, five showed improvement with persistence of a slight equalization delay on the treated side. Five patients did not report any improvement. Two complications occurred: subcutaneous emphysema of the parotid region in one case; and a mild high frequency (4-8 KHz) sensorineural hearing loss in another patient., Conclusion: Balloon dilation of the Eustachian tube is an effective therapy in the treatment of equalization problems with a good success rate., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Background and Purpose: To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma., Patients and Methods: Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software., Results: A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001)., Conclusion: This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.

GD3 synthase is rapidly activated in different cell types after specific apoptotic stimuli. De novo synthesized GD3 accumulates and contributes to the apoptotic program by relocating to mitochondrial membranes and inducing the release of apoptogenic factors. We found that sialic acid acetylation suppresses the proapoptotic activity of GD3. In fact, unlike GD3, 9-O-acetyl-GD3 is completely ineffective in inducing cytochrome c release and caspase-9 activation on isolated mitochondria and fails to induce the collapse of mitochondrial transmembrane potential and cellular apoptosis. Moreover, cells which are resistant to the overexpression of the GD3 synthase, actively convert de novo synthesized GD3 to 9-O-acetyl-GD3. The coexpression of GD3 synthase with a viral 9-O-acetyl esterase, which prevents 9-O-acetyl-GD3 accumulation, reconstitutes GD3 responsiveness and apoptosis. Finally, the expression of the 9-O-acetyl esterase is sufficient to induce apoptosis of glioblastomas which express high levels of 9-O-acetyl-GD3. Thus, sialic acid acetylation critically controls the proapoptotic activity of GD3.

In 95% of the patients complaining of shoulder pain, pain is consequent to mechanical impingement of the coraco-acromial arch on the rotator cuff. Acromioclavicular joint conditions play a major role (well over 50%) in initiating the process. This study was aimed at assessing the value of acromioclavicular investigations during shoulder US studies. September 1992 to September 1993, a hundred and seventy-four patients with shoulder pain underwent US exams of both shoulders and acromioclavicular joints. In 62% of patients rotator cuff tears (from less to more severe) were demonstrated, in 48% biceps tendon conditions (effusion, tendonitis, dislocation or tear) and in 31% aspecific degenerative changes of the rotator cuff. Three acromioclavicular joint cysts, a clavicular fracture and an acromioclavicular dislocation were also observed. The patients with US patterns of acromioclavicular conditions were 105 (60%); in 38% of cases, only capsular hypertrophy due to joint degeneration was observed. In 22% of cases the latter was associated with arthrosis-like changes of the articular rim. In 63% of cases rotator cuff tears were associated and in 37% of cases there were aspecific degenerative cuff changes. The authors believe that, especially in the latter cases, acromioclavicular joint US can be a useful approach to diagnosis and treatment.

Adjustable gastric banding is the least invasive operation for morbid obesity. Forty-eight patients underwent surgical adjustable gastric banding between March 1990 and August 1991. In 15 of these patients, radiological examination was performed in the early postoperative period because of dysphagia and vomiting, revealing stenosis of the stoma in all cases (caliber less than 0.3 cm); in all patients we easily punched, with fluoroscopically guided observation, the inflatable portion and obtained a true calibration of the gastric banding. In seven patients radiological examination was performed 2 months after surgical treatment because of a lack of weight loss. Radiological findings explain surgical failure, revealing a too wide stoma in four patients, the absence of a gastric pouch due to a too high position of the band in two, and the caudal sliding of the banding in one patient.