[Z-shaped surgical flaps in the treatment of acquired glottic stenosis: case report]. / I lembi plastici a Z nel trattamento delle stenosi glottiche acquisite: presentazione di un caso.

The Authors report a case of laryngeal stenosis initially treated through cervicotomy with the application of an Eliachar prosthesis and finally resolved, after recurrence, with two Z-shaped mucosa flaps. The Authors feel that this method is worthy of note because: its is simple to perform; provides excellent flap vitality; makes a stent unnecessary; and, above all, provides positive results.

[Head shaking test and low-frequency rotation-acceleration test: comparison of sensitivity and specificity]. / Head shaking test e prove rotoacceleratorie a bassa frequenza: sensibilità e specificità a confronto.

In studying the vestibular-oculomotor reflex (VOR) in patients with equilibrium disorders, both active and passive methods are used and at different stimulation frequencies, particularly to evaluate vestibular compensation. The present study compares the sensitivity and specificity of the low-frequency pendular test and the HST in normal subjects and in subjects suffering from various vestibular pathologies but showing no signs of spontaneous nystagmus, even under optimal evaluation conditions (infrared videonystagmoscopy). These spontaneous nystagmus-free subjects underwent a routine study including: case history, infrared videonystagmoscopy (HST with 2 Hz stimulation) and ENG recording (saccadic movement, smooth pursuit, OKN, VOR, VOR-fix during pendular stimulation at 0.05 Hz and VOR after Fitzgerald-Hallpike heat stimulation). On the basis of the results the subjects were classified as follows: normal (N): case history free of any equilibrium disorders and all tests negative (122 cases; 8.1%); peripheral vestibular pathology (P): case history of equilibrium disorders and labyrinthine predominance (LP) in excess of 20% upon caloric testing (716 cases; 47.6%); central pathology (C): case history of equilibrium disorders and at least 3 pathological results from among the following tests: saccadic movement, smooth pursuit, OKN, VOR-fix (226 cases; 15.0%); mixed pathology (M): with both signs of P and C (440 cases; 29.3%). The pendular test showed signs of directional dominance (DP) higher than 10% (normal limit) in 7 cases of N (5.7%), 308 P (43.0%), 33 C (14.6%) and 162 M (36.8%). DP was higher than 10% in 55.2% of the P and M cases with onset less than 1 month before, in 42.8% of those with onset within the year and in 37.2% of those with onset more than a year before. A pathological response to the HST was observed (characterized by a series of at least 3 nystagmus shakes after a maximum latency of 15 seconds) in 0 N (0.0%), 378 P (52.8%), 4 C (1.8%) and 247 M (56.1%). The nystagmus seen was nearly always monophasic (92.5%), biphasic nystagmus was only seen in only a few cases (7.5%); moreover it was predominantly horizontal in nature (94.9%) while it was vertical in only a few of the C cases (5.1%). The HST proved pathological in 46.5% of those pathologies with onset less than 1 month before, in 55.8% of those with onset within the year and in 54.4% of those with onset more than a year before. In 213 of the cases presenting pathological response to the HST there was agreement between VOR DP at the pendular test and the direction of the nystagmus evoked by the HST: 138 P (74.6%), 0 C (0.0%), 75 M (68.2%): moreover there was no agreement in 83 cases. When the DP was lower than 10% at the pendular test, the HST proved pathological in 213 P (52.2%), 3 C (1.6%), 150 M (53.9%). Both tests gave negative results in 112 N (91.8%), 163 P (22.8%), 186 C (82.3%), 123 M (27.9%). In cases of peripheral vestibular deficit (P and M) the sensitivity of the rotoacceleration test was 40.7%, specificity 88.5%. The sensitivity of the HST was 54.1%, specificity 98.8%. The sensitivity of the association using both tests was 75.2%, specificity 85.7%.

Extraction of a rubber bullet from a bronchus after 1 year: complete resolution of chronic pulmonary damage.

Inhalation of a foreign body (FB) into the bronchial tree rarely occurs asymptomatically and, if leading to recurrent pneumonia, can be very difficult to diagnose. The present report deals with the case of a 10-year-old boy who had three episodes of pneumonia in the left lower lobe caused by the asymptomatic inhalation of a FB 12 months before. Standard thoracic CT, done during the third episode, revealed a slight reduction in the volume of the left lung with air bronchograms, multiple areas of bronchiectasis, and parenchymal consolidation of a segment of the lower lobe. Flexible fiberoptic bronchoscopy revealed a FB at the distal end of the left lower lobar bronchus, surrounded by granulation tissue and fully obstructing the anterior basal segmental bronchus. High-resolution CT (HRCT) images showed an inverted C-shaped image obstructing a bronchus. Removal of the FB was successful only with rigid bronchoscopy under total anesthesia. The FB was an air-pistol rubber bullet that the boy remembered playing with 12 months before. Two months after removal of the FB (ie, 14 months from its asymptomatic inhalation) and treatment with oral steroids, antibiotics, and respiratory physiotherapy, the patient recovered completely, and HRCT showed complete normalization of the lung. We conclude that, when the radiographic density of the FB is greater than the surrounding pulmonary parenchyma, HRCT can reveal the FB, and diagnostic flexible fiberoptic bronchoscopy can be avoided.

Acute mastoiditis with complications: a report of two cases.

The authors report two cases of lateral sinus thrombosis (LST) which were recently observed after more than a 20-year absence of such pathology at their Institutions. After reviewing the epidemiologic data, the clinical observations are described in detail. Changes in symptomatology mainly due to the improper use of antibiotics are then discussed as well as the diagnostic improvement offered by modern imaging techniques. Problems still under debate concern the therapeutic strategy: internal jugular vein ligation or anticoagulation therapy versus aminoglycoside administration for patients refractory to the conventional antibiotic therapy. The necessity of close cooperation between general practitioner, pediatrician and otolaryngologist is stressed.

Avascular tympanojugular paraganglioma.

The avascular paraganglioma described in this article appears to be the second such tumor reported in the international literature and the first to be reported in the tympanojugular region. Despite a highly suggestive history and clinical appearance, the tumor showed no signs of vascularization on radiologic studies. The pathologic postoperative study confirmed the diagnosis of paraganglioma with extensive stromal fibrosclerosis and without the typical well-vascularized thin fibrous septa. In the authors' opinion, this observation is notable because of the difficulties encountered in the correct diagnostic interpretation of an avascular mass in the tympanojugular region. In such cases, the possibility of a paraganglioma should always be considered.

[Surgical treatment of androphonia]. / Il trattamento chirurgico dell'androfonia.

While numerous surgical procedures which aim at modifying the mass and tension of the vocal cords have been successfully adopted in dealing with androphonia, the most suitable and the least traumatic appears to be cricothyroid approximation. The Authors report the method employed and the satisfactory results obtained in the case of a woman whose highly masculine voice had brought about relational and psychological disorders. Studies of the instrumental phoniatric data gathered prior to surgery as well as a week, three months and a year afterwards show a change in the frequency characteristics of the voice-that is, a significant increase in the fundamental frequency. No substantial changes in aerodynamic indices or vocal range were detected.

[The therapy of cervical adenopathies in tumors of the lip and oropharynx]. / Terapia delle adenopatie cervicali nei tumori del labbro e dell'orofaringe.

The authors, after some notes of topographic anatomy about the lymph nodes of the cervical area, examine the different therapeutic managements of lymph node metastasis of lip and oropharynx carcinoma. From these data, the authors put in evidence that almost all the surgeons and the radiotherapists do agree about the inclusion of radiotherapy, polychemotherapy and, more often, surgery in the treatment of cervical lymph node metastasis. The authors experience suggests no treatment of the cervical region in case of N0 lower lip cancer, especially if the neck is thin, and easy to examine, but it is necessary a careful follow-up in order to discover as soon as possible a clinic metastasis. They do not exclude that this behaviour could be suggested also in other neoplastic disorders, but the decision should be based on the histologic kind and grading, on the extension and on the possibility to exclude any cervical involvement. Beside this, the authors come to the conclusion that, in case of N1, N2, N3, the treatment of the cervical regions can not be avoided. The surgical treatment is the neck dissection, functional or radical, alone or together with radiotherapy and polychemotherapy. They finally report that the postoperative radiotherapy for cervical metastasis must be properly used when the capsular rupture is histologically proved.