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Several therapeutic options are used for treatment of early stage glottic carcinoma (Tis/T1/T2): open partial laryngectomy (OPL), radiotherapy and CO2 laser-assisted endoscopic surgery. Laser surgery has gradually gained approval in the management of laryngeal cancer. We present our experience in endoscopic laser surgery for early stage glottic carcinomas. This was a retrospective analysis of 72 patients with T1-T2 glottic cancer treated with laser cordectomy between 2006 and 2012. All patients had at least a 36-month follow-up period. Percentages for disease-specific survival, disease-free survival (DFS) and laryngeal preservation rates were 98.6%, 84.7% and 97.2% respectively. Considering neoplastic features that could predict long-term oncological outcome, tumoural involvement of anterior commissure and pathological staging (pT) significantly correlate with local recurrence (p = 0.021 and p = 0.035) and with a lowered DFS (p = 0.017 and p = 0.023). Other variables such as clinical staging, type of cordectomy, involvement of other structures and surgical margin status showed no significant impact on oncological endpoints. CO2 laser surgery is a reliable technique for T1-T2 glottic cancer considering oncological outcomes. The recurrence rate seems to be affected by involvement of anterior commissure and pT stage.Esistono numerose strategie terapeutiche per il trattamento del carcinoma glottico in stadio iniziale (Tis/T1/T2): la laringectomia parziale a cielo aperto, la radioterapia e la chirurgia endoscopica condotta mediante laser CO2. In particolare quest’ultimo approccio ha gradualmente, ma inesorabilmente, acquisito un ruolo sempre più centrale nel management del cancro laringeo. In questo lavoro presentiamo la nostra esperienza in materia di chirurgia endoscopica laser-assistita delle neoplasie glottiche in stadio iniziale. è stata realizzata un’analisi retrospettiva su un campione di 72 pazienti affetti da carcinoma glottico in classe T1-T2 trattati con cordectomia laser endoscopica nel periodo compreso tra il 2006 e il 2012. Tutti i pazienti avevano almeno 36 mesi di follow-up. La disease-specific survival, la disease-free survival (DFS) e il tasso di preservazione laringea rilevati con il presente studio sono stati rispettivamente del 98,6%, 84,7% e 97,2%. Analizzando l’influenza sull’outcome oncologico a lungo termine di alcune tra le principali caratteristiche della malattia o del trattamento eseguito, abbiamo riscontrato come il coinvolgimento da parte del tumore della commissura anteriore e lo staging patologico della neoplasia (pT) correlino significativamente con un aumentato tasso di recidiva locale (p = 0,021 e p = 0,035) e con una ridotta DFS (p = 0,017 e p = 0,023). Gli altri parametri presi in esame, come staging clinico, tipo di cordectomia, coinvolgimento di altre specifiche sottosedi laringee e stato dei margini di resezione, non si sono dimostrati, invece, correlare significativamente con gli endpoint oncologici stabiliti. La chirurgia endoscopica laser-assistita è quindi una tecnica estremamente affidabile per il trattamento dei tumori glottici in stadio iniziale in termini di outcome oncologico. Il tasso di recidiva risulta significativamente influenzato dal coinvolgimento della commissura anteriore e dal pT.

The purpose of the present study was to evaluate the advantages of a video-assisted, minimally invasive transcervical approach to benign and malignant parapharyngeal space (PPS) tumours. Ten patients affected by benign and malignant PPS neoplasms underwent a combined transcervical and video-assisted minimally invasive approach, using Hopkins telescopes. We describe the operative technique and perform a review of the literature. Definitive histology revealed 3 pleomorphic adenomas, 2 schwannomas, 2 metastatic papillary thyroid carcinomas, one carcinoma ex pleomorphic adenoma, one cavernous haemangioma and one basal cell adenoma. Mean tumour size was 37.2 mm (range: 19-60). Operation time ranged from 75 min to 185 min (mean: 146.7). One case was converted to transcervical-transparotid approach. Patients were discharged on postoperative day 2-5. One patients presented hypoglossal nerve paresis. The minimally invasive video-assisted transcervical approach is safe and feasible for selected benign and malignant PPS tumours. Furthermore, it offers harmless dissection in a deep and narrow space, accurate haemostasis and continuous control of critical anatomic structures.L’obiettivo dello studio è stato valutare i vantaggi di un approccio transcervicale mini-invasivo video-assistito per l’exeresi di neoformazioni maligne e benigne dello spazio parafaringeo. Sono stati trattati 10 pazienti con approccio trans-cervicale mini-invasivo videoassistito con l’utilizzo di telescopi di Hopkins. Viene descritta la tecnica chirurgica e una revisione della letteratura. L’esame istologico definitivo è stato in 3 casi di adenoma pleomorfo, in 2 casi di schwannoma, 2 metastasi linfonodali da carcinoma tiroideo, un carcinoma ex adenoma pleomorfo, un emangioma cavernoso ed un adenoma a cellule basali. La dimensione massima delle neoformazioni è stata in media di 37,2 mm (da 19 a 60 mm). Il tempo chirurgico è stato dai 75 ai 185 minuti (media 146,7). In un caso è stata necessaria la conversione ad approccio transcervicale-transparotideo. I pazienti sono stati dimessi dalla seconda alla quinta giornata postoperatoria. In un caso è stata osservata paresi definitiva del nervo ipoglosso. L’approccio trans-cervicale mini-invasivo video-assistito è sicuro e offre la possibilità di seguire esattamente il piano di clivaggio, permettendo un’emostasi accurata e avendo sempre il controllo delle strutture anatomiche più critiche.

In vielen Randvierteln des Grosraumes Buenos Aires treffen extreme stadtische Armut und eine hohe Umweltzerstorung aufeinander. Am Beispiel einer Schule im Armutsviertel La Carcova berichtet dieser Text daruber, wie diese schwierigen Bedingungen den Alltag der Schulen beeinflussen und wie SchulerInnen und Lehrkrafte damit umgehen. Nach einer ausfuhrlichen Beschreibung des Viertels und der Schule werden Fragmente aus den Erfahrungsberichten der padagogischen Arbeit dargestellt, die die Autorin gemeinsam mit einer Forschergruppe in dieser Schule durchgefuhrt hat. Die Passagen zeigen die Sorgen und Forderungen von Jugendlichen und Schulpersonal, die zugleich – so die Annahme – die Note und Empfindungen eines ganzen Viertels spiegeln.

Vertigo and dizziness are common symptoms in the general population, with an estimated prevalence between 20% and 56%. The aim of our work was to assess the point prevalence of these symptoms in a population of 2672 subjects. Patients were asked to answer a questionnaire; in the first part they were asked about demographic data and previous vertigo and or dizziness. Mean age of the sample was 48.3 ± 15 years, and 46.7% were males. A total of 1077 (40.3%) subjects referred vertigo/dizziness during their lifetime, and the mean age of the first vertigo attack was 39.2 ± 15.4 years; in the second part they were asked about the characteristics of vertigo (age of first episode, rotational vertigo, relapsing episodes, positional exacerbation, presence of cochlear symptoms) and lifetime presence of moderate to severe headache and its clinical features (hemicranial, pulsatile, associated with phono and photophobia, worse on effort). An age and sex effect was demonstrated, with symptoms 4.4 times more elevated in females and 1.8 times in people over 50 years. In the total sample of 2672 responders, 13.7% referred a sensation of spinning, 26.3% relapsing episodes, 12.9% positional exacerbation and 4.8% cochlear symptoms; 34.8% referred headache during their lifetime. Subjects suffering from headache presented an increased rate of relapsing episodes, positional exacerbation, cochlear symptoms and a lower age of occurrence of the first vertigo/dizziness episode. In the discussion, our data are compared with those of previous studies, and we underline the relationship between vertigo/dizziness from one side and headache with migrainous features on the other.La vertigine e l’instabilità sono sintomi molto comuni nella popolazione la cui prevalenza è stimata tra il 20 e il 56%. L’obiettivo del nostro lavoro è stato quello di determinare la prevalenza di questi sintomi in una popolazione di 2672 soggetti. È stato somministrato loro loro un questionario; nella prima parte sono stati richiesti i dati demografici e se avessero mai sofferto di vertigine o instabilità nella loro vita. L’età media del campione è stata di 48,3 ± 15 anni, il 46,7% erano maschi. Sul totale della popolazione 1077 (40,3%) hanno riferito di aver sofferto di vertigine o instabilità nella loro vita, con un primo episodio occorso all’età di 39,2 ± 15,4 anni. Nella seconda parte del questionario sono state indagate le caratteristiche delle vertigini (età del primo episodio, il tipo di vertigine, presenza di più episodi, esacerbazione posizionale della vertigine, presenza di sintomi cocleari infine la presenza di cefalea da moderata o severa nel corso della vita e le sue caratteristiche cliniche (riferita a un emicrania, pulsante, associata a fono o fotofobia, peggiore con l’attività fisica). È stata osservata una correlazione della vertigine con l’età e con il sesso, essendo la prima 4,4 volte più frequente nelle donne e 1,8 volte nei soggetti con oltre 50 anni. Sul campione complessivo di 2672 soggetti, 13,7% hanno riferito vertigine rotatoria, 26,3% episodi recidivanti, 12,9% esacerbazione correlata alla posizione e il 4,8% presenza sintomi cocleari; il 34,8% ha lamentato cefalea nel corso della loro vita. I soggetti affetti da cefalea presentavano un’incidenza aumentata di vertigini recidivanti, di esacerbazione correlata alla posizione, di sintomi cocleari e un’età più giovane di comparsa del primo episodio di vertigine/instabilità. Nella discussione i nostri dati sono stati confrontati con quelli di precedenti studi. Gli autori sottolineano la correlazione tra vertigine/instabilità da un lato e cefalea con caratteristiche emicraniche dall’altro.

In order to investigate the relationship between chronic dizziness and vestibular function in patients with panic disorder, in the present study neurotologic findings in 15 patients with panic disorder and chronic dizziness were compared with those in 15 patients with chronic dizziness, without panic disorder. All underwent neurotologic screening for spontaneous, positional and positioning nystagmus with head-shaking and head-thrust tests, an audiometric examination and electronystagmography with bithermal stimulation according to Freyss. A significantly higher number of patients with panic disorder and chronic dizziness showed pathological neurotologic findings in comparison to subjects with chronic dizziness only (9 and 2 patients, respectively; p < 0.05). Most patients with panic disorder showed signs of peripheral vestibular disorders. These results suggest that the complaint of dizziness in patients with panic disorder may be linked to a malfunction of the vestibular system and vestibular disorders may play a role in the pathophysiology of panic disorder. Possible mechanisms underlying this finding are discussed. In patients with panic disorder and chronic dizziness between panic attacks, a careful neurotologic examination is warranted.

The present work reviews the authors personal experience and applies a meta-analysis of the data in the literature (approximately 800 cases) to better focus on the opportunities and difficulties involved in the Majer-Piquet technique. Particular attention is focused on the problems involved in deglutition. The study involves 44 patients who underwent cricohyoidoepiglottopexy (CHEP) between 1989 and 1998. Given that surgical and rehabilitation techniques have been refined over the years, to better analyze the functional results, the data were separated into two subsequent periods. Of the 23 patients who underwent surgery between 1989 and 1992 (group I), 6 were benefited from bilateral preservation of the arytenoids while this was only possible in two of the 21 cases operated in the second period from 1993 to 1998 (group II). Functional rehabilitation was started earlier in the second group and was routinely monitored with digital viedeofluorography. The average recovery time was 34 days for group I and 27 days for group II. The tracheostomy closed in an average 91 days vs. the 13 days found by the meta-analysis of the literature. The authors normally leave the tracheostoma in place for a long time, even when closed with an easily removed plug, and only perform plastic surgery when the patient has shown stable deglutition for several weeks. The naso-gastric tube was removed from both groups of patients after an average 16 days while the review of the literature shows an average 21 days. On the whole the authors record good deglutition in 41 of the 44 cases (93.18%) with adequate deglutition in the remaining 3 cases. Likewise the literature reports good deglutition in 86.4% of the cases. The only difference found between the two groups of patients was a quicker recovery in the second group; there were no qualitative differences. The results are described and discussed. In conclusion, the present experience places CHEP in favorable light as long as the limits inherent to the method are recognized. However, these limitations relegate the technique to a "sporadic" role and the review of the literature appears to confirm this attitude.

The parapharyngeal space is a deep neck region and can be the site of a wide range of neoplasms, including primary benign or malignant tumors, metastatic tumors, neoplasms invading the parapharyngeal space from the adjacent regions and neoformations stemming from systemic processes. Tumors of the parapharyngeal space are, nevertheless, relatively rare and account for 0.5-0.8% of all head and neck tumors. Most are benign tumors originating in the deep lobe of the parotid gland and the minor salivary glands. The most frequent tumor is pleomorphic adenoma while myoepithelioma accounts for just 1% of all salivary gland tumors. The present case report involves a case of myoepithelioma of the deep parotid gland lobe, arising in the parapharyngeal space. Together with a review of the literature, considerations are presented on the clinical and radiological evaluation, differential diagnosis and treatment of these lesions.

Inverted papilloma (IP) is a rare and yet complex pathology, particularly due to the risk of recurrence (approximately 50%) and the onset of carcinoma (approximately 15%). Moreover, in clinical practice it is difficult to diagnose and treat. The present work reviews a personal case study in order to make an essentially clinical evaluation of the problems of diagnosis and treatment. From 1989 to 1997, among approximately 1200 cases of surgery for phlogistic or neoplastic nasal-sinus pathologies, 26 cases of IP were treated. Of these 22 underwent a minimum follow-up of 12 months. In 5 out of the 22, it was a recurrence of 'nasal polyps' which had been surgically treated at another site (with histology performed for only 2 of the patients). In 8 of the 22, imaging did not indicate IP, resulting in an underestimation of the disorder and most likely affecting treatment. The following procedures were performed: 6 sphenoethmoidotomies through an endonasal approach (with and without endoscopy); 19 radical spheno-ethmoidomaxillotomies extended to varying degrees to the demolition of bone and, in 3 cases, using a paralatero-nasal approach (because of invasion of the anterior ethmoid); 4 endonasal exereses for IP arising in the septum (1 with reconstructive naso-genieno flap); 1 maxillectomy. Of the patients (22) who had undergone surgery in our Division, 5 showed recurrences and 3 of these had undergone spheno-ethmoidotomy through the endonasal approach. Moreover, all the cases of recurrence involved underestimated preoperative diagnosis (i.e. the 8 patients for whom IP was only recognized after histology). Among the 5 recurrences, for 2 carcinoma fields were diagnosed; for 3 additional surgery was required: one patient underwent additional surgery twice while another 3 times (lastly with a maxillectomy). The surgery did not lead to serious complications and at the present time all patients are alive and macroscopically disease free. Analysis of the literature and personal experience has lead to the following considerations: routine diagnostic evaluation of "polyps" is most likely still inadequate; it appears that the risk of recurrences can be controlled only with adequately aggressive surgery; endonasal forms (above all septal) could be disconnected, normally leading to peculiar histological and clinical features.

In head and neck squamous cell carcinomas (HNSCC), metastasis to cervical lymph nodes is a major determinant of patient outcome. To detect metastases, we used the MET oncogene as marker, which encodes the receptor for hepatocyte growth factor/scatter factor, mediating epithelial cell motility and invasiveness. The MET gene is expressed in epithelia and over-expressed in carcinomas of specific histotypes, but not in lymphatic tissue. A total of 151 lymph nodes from 20 squamous cell carcinomas were studied with both in-depth histology and end-point and real-time quantitative RT-PCR. MET-encoded sequences were found in 61 of 151 nodes (40%), of which 24 (16%) were found metastatic by in-depth histopathology. Parallel routine histopathologic analysis of 654 lymph nodes from the same cases identified 36 metastases (5%). Real-time quantitative RT-PCR was used to measure MET gene-specific mRNA in normal tissues, primary tumors and lymphatic metastases and showed a 2-8-fold increased expression in tumor cells which metastasize. RT-PCR for 3 cytokeratins expressed in HNSCC (K4, K10 and K13) proved to be less sensitive in detecting occult lymphatic metastases. Western blot analysis demonstrated the presence of the full-size MET receptor in primary tumors and lymph node metastases; immunohistochemistry showed receptor localization in tumor cells. Altogether, these data demonstrate that the MET gene product is a valuable marker with which to detect occult tumor cells in lymph nodes, thanks to its high expression in metastatic cells. After RT-PCR analysis we were able to attribute a more advanced stage to 10 out of 20 HNSCC cases, including 5 cases classified as tumor-free after routine histopathology.

Today, surgery is the treatment of choice for nasal sinus polyposis. Nevertheless, although meticulous surgery does "per se" reduce the percentage of recurrences, there are cases where even the most painstaking removal of the entire pathology cannot prevent recurrence. Therefore recurrences do not appear linked to the type of surgery; rather onset appears linked to intrinsic, only partially recognizable factors responsible for the primary and secondary polypogenesis. In order to identify negative prognostic factors which might be implicated in recurrences, the present study extrapolated the data from forms on 181 patients who had undergone surgery for nasal sinus polyposis and subjected it to multivariance analysis. These patients were recruited during the course of a multicenter study with the participation of 12 ENT Centers in Piemont and Liguria. The recurrence rate was 13%. In analyzing unfavorable factors prognosticating recurrence, thirteen parameters were examined. Nine of these (age, sex, severe deviation of the septum causing restriction, severe turbinate hypertrophy, surgery or repeat surgery for recurrence, type of macro-micro endoscopic surgery, allergy to seasonal inhalants, allergy to perennial inhalants, mixed allergies) did not prove to have any significance in recurrences. The presence of bilateral involvement of the sinus system presented a negative trend as regards recurrences while involvement of more than one subsite (anterior ethmoid, posterior ethmoid, maxillary sinus, sphenoid), ASA and NSAID intolerance and abundant eosinophilic infiltration in the mucous chorion proved statistically significant (p0.05 for all three parameters) for recurrence. Post-operative topic prophylactic treatment with steroids (beclomethasone) or anti-H1 drugs (azelastin, HCl) did not appear to affect the onset of recurrence although it did have a positive effect on subjective symptoms.

The indications for myringoplasty in children has always been a controversial subject since many authors feel the high frequency of the phlogistic auricular processes in children constitute an unfavorable prognostic factor to success of the procedure. The authors present the results obtained in 23 patients under 17 years of age who had undergone myringoplasty for simple perforation of the tympanum. In cases of posterior and inferior perforations, surgery was performed using the underlay technique and a transmeatal approach; in all other cases the overlay technique was used with a retroauricular approach. An average 30 month follow-up (range 12-55 months) revealed new perforations in only 2 cases (9%). From the functional point of view the average air/bone conduction gap was reduced to 10 dB. As a control, the results were compared to those obtained in 150 patients over 16 years of age, again affected by simple perforation of the tympanic membrane and treated by myringoplasty using the same methods. In the adults, 22 new perforations were found (15%) while the functional results were analogous to those obtained in the children group. In this light, it can be asserted that myringoplasty can be considered a safe procedure to be used in children and it does not appear essential to wait until they have finished growing before performing this procedure.

Many studies have been performed to determine some prognostic factors for malignant head and neck tumors. Defining the clinical and biological features would enable one to predict the progression of the disease and plan treatment. The aim of the present study has been to identify what host and neoplasm characteristics provide prognostic indication of possible recurrences. A group of 380 patients with squamous cell carcinoma of the head and neck was studied. The neoplasm was located in the following sites: 257 larynx-hypopharynx, 69 oropharynx, 54 oral cavity. At the present time 309 of these subjects are still alive and disease free while 71 have had recurrences. Analyses were performed on various variables regarding the patient, neoplasm and histology. Multivariante analysis of these prognostic factors was performed using the PLR-BMDP program. The time of recurrence in the primary tumor site and at the lymph node level was evaluated using the Kaplan-Meier method. Of the 28 variables analyzed 16 had no effect on the probability of recurrence. Two variables reduced the risk of recurrence: age over 61 years (p0.05) and primarily intra and peritumoral lymphocyte infiltration (p = 0.06). Of the data regarding the patient, age lower than 61 years and presence of associated internal pathologies (i.e. bronchial pneumonia and hepatitis) appeared to significantly facilitate the appearance of recurrence. The characteristics of the neoplasm which appear to effect recurrences are: tumor site (hypopharynx), presence of lymph node metastases, morphological elements of tissue spread (vascular invasion, plasmocyte infiltration), capsular breakdown, positive margins and post-operative infection. In conclusion, it can be asserted that technical development of multifactorial analysis has made it possible to identify important prognostic factors and quantify their impact on the evolution of a neoplasm.

Recurrent nasal polyposis is one of the most common unsolved problem in clinical rhinology. In the last few years a great number of histopathological, immunohistochemical and immunological studies on nasal polyps have been carried out by several Authors. Notwithstanding this, the aetiology of these formations still remains unknown. Many data suggest that the presence of polyps is the result of various inflammatory, allergic and pseudo-allergic processes which finally lead to the formation of the oedema constitutive of the polyp itself. In the present report a preliminary trial was carried out in order to evaluate the possibility of preventing recurrences by means of a locally administered anti-H1 receptors drug (Azelastine HCl). In the reported first phase of the study 10 allergic patients with bilateral polyposis were evaluated. Attention was given to the anti-edemigen activity of the drug, as well as to its influence on the local production of Secretory IgA, 7SIgA and albumines. Data are presented and discussed.

We examined a homogeneous group of 116 patients with laryngeal and hypopharyngeal carcinomas, treated with surgery followed by radiotherapy according to the conventional procedure. The tumors occurred in the larynx in 88 cases (75.86%) and in the hypopharynx in 28 (24.14%); correlations between overall survival and disease-free survival on the one hand, and clinical and histological parameters on the other hand were established with a multivariate analysis using the Cox method. After 5 years 75.86% of the patients were alive. This variable was negatively influenced by pN (pN0 89.8%, pN1 76.2%, pN2 69%); pT (pT3 82.5%, pT4 62.5%), by vascular embolization (90% of patients alive with no vascular embolization versus 69.7% with vascular embolization), by the grade of peritumoral inflammation (64.3% of patients alive with slight peritumoral inflammation, 69.2% with medium-grade inflammation and 87.3% with strong inflammation), and finally by a great number of plasma cells and few granulocytes; 78.44% of these patients remained disease-free. This variable was negatively affected by pN (pN0 91.8%, pN1 76.2%, pN2 60%), patients' age and extracapsular spread (85.5% of disease-free patients with no extracapsular spread, vs. 51.55% with extracapsular spread); and positively influenced by basal cell differentiation (95% of disease-free patients versus 71.8%). Overall and disease-free survival rates which differed at the beginning, coincided after two years because of local recurrences. On the basis of these results we conclude that the correct assessment of morphologic variables should be considered as a useful tool for treatment planning.

Eighty-one patients with recurrent squamous cell carcinoma of the head and neck (60 patients) or undifferentiated carcinoma of the nasopharyngeal type (21 patients) were treated with cisplatin (80-100 mg/m2iv d1) and 5-fluorouracil (750-1000 mg/m2Cl d1-5). In squamous cell carcinoma patients there were 7 complete responses (11.6%), 25 partial responses (41.7%), 20 stable disease situations (33.3%) and 8 progressions (13.3%). In nasopharyngeal carcinoma patients there were 6 complete responses (28.6%), 9 partial responses (42.8%), 3 stable disease situations (14.3%) and 3 progression (14.3%). There were 5/60 patients (8.3%) with disease-free survival18 months in the squamous cell carcinoma group and 2/21 (9%) in the nasopharyngeal carcinoma group. All long-term survival patients had the following characteristics: good performance status (0-1 ECOG scale), disease- free interval from the first treatment12 months, local non-bulky relapse (rT1-2). A re-irradiation with palliative doses (20-48 Gy) was conducted in 3/7 patients. This treatment may have improved the response to drugs with regard to length and quality.

As a preliminary of the study of the possibility of upper aerodigestive tract reconstruction using "myomucosal" flaps derived by the classical pectoralis major myocutaneous flap, the evaluation of histologic and immunohistochemical modifications of epidermidis implanted in oral cavity and oropharynx has been conducted in 10 patients. The patients were operated for cancer of oral cavity and oropharynx and then reconstructed using the pectoralis major flap and biopsies from the mucosal-cutaneous junction were taken at different times from operation. Histologically, epidermidis preserved its morphology (a keratinized layer thinner but still present at 24 months by the operation, all the cutaneous annexes). A progressive modification of basal characteristics at the cutaneous side and rapid repair of the basal membrane were observed both histologically and immunohistochemically. In addition, a rich inflammatory infiltrate was present in the derma of the cutaneous area. Histochemistry demonstrated that mucosa and skin keep their own cytokeratin production although they repair in the absence of a fibrotic scar.

Acute infection the paranasal sinus is a rather frequent pathology in children. On the contrary, local orbital complications are rare. The employment of antibiotics reduces the incidence of complications but can sometimes conceal their appearance so that diagnosis is delayed. Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood. Within a brief time span, 8 patients with complicated frontal and ethmoid-maxillary sinusitis were diagnosed and treated: 4 cases of periorbital cellulitis, 2 of subperiorbital abscess and 2 of orbital abscess (one of which with cavernous sinus thrombosis). Particularly relevant from the diagnostic point of view was the employment of C.T. scan which furnished an accurate definition of the orbit and its surrounding structures which influenced treatment choice. Under antibiotic cover all patients but one (who had been treated very early and had responded immediately to intensive antibiotic therapy) were treated surgically and the clinical course of the disease showed significant improvement very shortly after surgical drainage.

As Aufricht has said, rhinoplasty is "... an easy operation to do, but it is hard to get good results". As it clearly observed in ENT rhinoplasties which deal with severe and combined defects of the nose which result in functional impairment. The aim of this study was to analyse complications in a personal series of open rhinoplasties as well as those in literature in order to standardize different surgical approaches possible in correcting various nasal deformities, divided according to a personal classification. Other than the classical intramucosal technique (following Roe, Joseph and Weir), the more conservative extramucosal operation (described by Jost and Aiach) and the more aggressive external approach are available to the surgeon. Intramucosal rhinoplasty is still the most dependable and widely used technique. However open rhinoplasty which brings about complications in less than 10% of the procedures, offers clear-cut advantages if employed following precise indications. In our experience, the main indications for open rhinoplasty are: severely crooked nose, above all of the II and III arch: crooked nose with saddle deformity; asymetrical defects (including those due to a cleft lip); 50% of the secondary rhinoplasties (excluding minor procedures).

Pathological modification in secretory IgA values as well as in circadian rhythms were found in tracheotomized patients in both nasal and tracheo-bronchial secretions. The protective role of the mucosal immune system in addition to the frequency of severe infectious respiratory diseases in laryngectomized patients justifies the efforts of clinicians to prevent and treat such modifications. Mucoregulatory drugs have a peculiar role in these therapeutical attempts. Forty tracheotomized subjects with neoplastic disease were studied. Twenty received SCMC-Lys as a mucoregulatory drug. IgA 7S, 11S and albumin values in nasal and tracheo-bronchial secretions, were evaluated at surgery, 15 and then 40 days later. In accordance with clinical data, an improvement in local antibody production, damaged by tracheostomy, was found in the treated group. The influence of SCMS-Lys on SIgA production, whose evaluation was made by means of an original, highly selective and sensitive Immuno-IsoElectroFocusing procedure, seems to encourage the use of mucoregulatory drugs in laryngectomized patients.

Twenty pediatric patients with recurrent infectious diseases of the upper respiratory tract (tonsillitis, adenotonsillitis with or without involvement of the ear and/or lower respiratory tract) were studied. An immunological assay of the nasal secretum was performed at time of diagnosis and following treatment with a local immunomodulator drug, administered by spray. The 7S, 11S IgA and albumin rates were evaluated. The authors emphasize the importance of SIgA in mucose defense mechanisms as well as the need for a selective method for determining the 11S IgA level. An original method for immuno-isoelectrofocusing (IIEF) determination was employed in the present study. After treatment a significant increase in 11S IgA level was observed, especially in those patients with a significant basal SIGA deficit. The authors describe details of the technique for determination and discuss the results.

Nasal and paranasal sinus tumors extending through the cribriform plate to the overlying dura of the frontal lobe can be successfully treated by anterior craniofacial resection. During the period from 1986 to 1990, 14 patients (11 males, 3 females, age 18-67) with nasal/paranasal tumors extended to the nasal basis underwent craniofacial resection. From a histological point of view these patients were classified as follows: --8 adenocarcinomas --2 squamous cell carcinomas --2 esthesioneuroblastomas --1 cylindroma --1 haemangiopericytoma. In 6 of the 14 patients post-operative complications were encountered, 3 being resolved. Radical surgery was realised in 12 cases; post-operative radiotherapy was performed in 7. No contraindications were found because of previous chemo- and/or radiotherapy, even if it had been performed as treatment. Four of the patients died because of recurrences between the 6th and 20th month after surgery; 5 patients (all adenocarcinoma subjects) are disease-free respectively 8, 16, 17, 22 and 24 months after surgery.

Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-free period. The present work investigates loco-regional recurrences. In the first part of the work the most frequent recurrence sites, types and their characteristics (i.e. infiltrating, exophytic, ulcerating) are studied along with the problems in clinical and pathological diagnosis, new diagnostic imaging (CT and MR) and the UICC classification system. The second part of the work is dedicated to examining classical treatments (surgery, radiotherapy, chemotherapy and radiochemotherapy associations) as well new therapies (i.e. cryosurgery, hyperthermia, immunotherapy, photodynamic therapy). A review of the literature is made for indications, results and complications. An extensive study of the cases of the Head and Neck Group of the University of Turin during the 1983-1990 period is also reported. This experience is based on 312 cases: 68 (oropharynx and larynx) treated by surgery, 51 (neck nodes and stomal recurrences) treated by radiotherapy and hyperthermia, 35 (neck nodes) by hyperthermia alone, 168 (all sites) by chemotherapy and 20 by immunotherapy. In the third part of this work supportive therapies and practical problems are reported. In conclusion a therapeutic approach is proposed in relation to the site of the recurrence and previous treatments.

Forty-seven laryngeal and 21 oropharyngeal recurrences were treated with salvage surgery alone or combined with radiotherapy at the ENT Clinic and Radiotherapy Division of the University of Turin, Italy. Primary tumors had been treated with surgery alone in 10 cases (larynx) and in 21 cases (oropharynx), with combined surgery and radiotherapy in 2 and 8 patients, and with radiotherapy alone in 9 and 18 cases. We observed 26/47 (larynx) and 12/21 (oropharynx) recurrences at the site of primary tumor, 20/47 and 9/21 in loco-regional nodes, and 9/47 and 3/21 in locations adjacent to the primary tumor. Salvage treatment employed surgery alone in 12 (oropharynx) and 16 (larynx) cases; radiotherapy was combined in 9 and 31 cases. Five-year actuarial NED survival was 45.5% for laryngeal and 24% for oropharyngeal cancer patients. After salvage surgery, 50% of laryngeal lesions and only 25% of oropharyngeal recurrences were completely cured. In our series, in 2 cases only the complications caused the patient's death, while in the extant cases a prolonged postoperative hospitalization was necessary. Our study was aimed at investigating the curative potentials of secondary therapy for recurrent carcinomas. A review of the literature on the subject is reported. The small amount of published data prevents "universal" treatment protocol from being assessed. The authors suggest the opportunity of employing a multimodal treatment policy for recurrences of head and neck cancers.

We investigated the relationships between tumor associated macrofages (TAM) and tumor tissues and their possible prognostic significance in a laringeal carcinomas of patients operated in our Department for sovraglottic or total laringectomy. In our analysis we found a positive trend in Grade 3, but we could not find any correlations in the other cases. That shows that TAM have antithetic activities in the life of neoplasia.

The gravimetric determination of aluminium in bronzes and brasses is described. After separation of copper by thioglycolic acid, aluminium is determined with ammonium benzoate.

The present paper reports the results of an investigation on the influence of cryopreservation methods of human lymphocytes on the leukocyte migration inhibition factor (LIF) production following PHA stimulation. The optimal freezing and thawing procedures, fetal calf serum and dimethyl sulphoxide concentrations are reported.

We have evaluated in 80 patients suffering with laryngeal carcinoma their specific and aspecific immune responsiveness. We used the E rosette-test, the PHA-induced in vitro stimulation and the in vitro specific LIF production. We chose to use the LIF production test both for its marked sensitivity and because the lymphokines--which are soluble mediators--act as a "bridge" between the different fields of the immune response. Furthermore in our previous research, we observed that the specific LIF production was influenced in a negative way by adherent cells of the peripheral blood that could behave as blocking factors. For what attains the autologous LIF production, before and after the removal of adherent cells, our results show that the patients suffering with a cancer staged as T3T4N1N2N3 exhibit much more marked blocking phenomena than the patients with a cancer staged as T1T2T3N0. In fact the results demonstrate that in this second group only 62% of the cases, after the removal of the adherent cells, showed an increase of LIF production, while this percentage rose to 83% for the patients with a more advanced disease. A similar pattern was found in those patients who showed a recurrence two of three years after the primary disease.

Natural killer (NK)-mediated cytotoxicity against the K562 cell line was evaluated in normal subjects and in patients with laryngeal cancer. Results showed reduced lymphocyte cytotoxicity in patients with neoplastic disease and further reduction in NK activity following postoperative radiation therapy. The authors discuss the possibility of using this test in the immunological monitoring of patients with laryngeal carcinoma.

The role of lymphokines in modulating the immune response in patients suffering from neoplastic disease is still controversial. Recent studies indicate that in patients with head and neck cancer, a decrease in LIF (leukocyte migration inhibiting factor) production is usually present in advanced disease. In this study, the authors investigate: the LIF production in lymphocytes derived from the peripheral blood and cervical nodes of patients with laryngeal carcinoma by using an autologous pattern (i.e., for each patient, the specific LIF production was challenged by means of an autologous cell extract derived from his own tumor); the influence of histologically confirmed cervical node metastases on LIF production. Our results indicate that: There is a significant decrease in LIF production in patients with histologically proven cervical node metastases as compared to patients with no metastatic foci. The decrease of LIF production is related to the presence of mononuclear adherent cells. When the latter are removed, there is a significant reversal of specific LIF suppression. The possible meaning of the data is discussed.