From epithelial dysplasia to squamous carcinoma in the head and neck region: an epidemiological assessment.

The evolution of 97 cases of epithelial dysplasia in the head and neck region was retrospectively controlled, with a mean follow-up of 30 months. Dysplastic mucosal areas were observed in the oral cavity in 11 cases, in the pharynx (oro- and hypopharynx) in 39 cases and in the larynx (supraglottic and glottic regions) in 47 cases. According to the criteria defined by the WHO the dysplasia was classified as mild, moderate and severe. Fifty out of the 97 patients developed a squamous carcinoma in the same area, demonstrating a significant direct correlation between age and neoplastic evolution. A direct correlation was also observed between severity of dysplasia and carcinomatous evolution. Further direct correlations were observed between degree of dysplasia, carcinomatous evolution and amount of exposure to cigarette smoke and alcohol.

From epithelial dysplasia to squamous carcinoma of the head and neck region: evolutive and prognostic histopathological markers.

Ki67 immunoreactivity, p53 expression and apoptotic index were examined in 26 non-malignant lesions of the head and neck region, 22 dysplastic lesions of patients without evidence of head and neck carcinoma during follow-up time, 24 dysplastic lesions of patients who subsequently developed a squamous carcinoma in the same area, and 42 squamous cancer cases. A directly proportional relation between Ki67 immunoreactive pattern, apoptotic index and histological evolution from normal to dysplastic or neoplastic mucosa was evident. As far as p53 protein is concerned, its expression became higher and frequently transmural in neoplastic mucosa. A strict correlation between frequency and density of Ki67/p53 immunoreactivity according to invasive cell grading (ICG) scores and poor prognosis of patients were found. On the contrary, malignant cells highly expressing p53 seemed not to undergo apoptosis. Ki67 antigen and p53 protein detection in premalignant lesions and in carcinomas of the head and neck tract could be a useful marker for the management of patients at risk.

High relative risk of a second pulmonary cancer in patients affected by laryngeal cancer: differences by specific site of occurrence and lung cancer histotype.

The frequency of a second primary lung tumor in patients affected by laryngeal cancer has been evaluated on the basis of 128,532 biopsies and 27,753 autopsies carried out from January 1, 1979 through December 31, 1988. Among these cases, 432 laryngeal cancers and 44 synchronous or metachronous pulmonary cancers have been detected (7 during life, 37 at autopsy). The highest risk of developing a lung tumor has been evidenced in patients affected by supraglottic cancer during the first 2 years of follow-up (relative risk [RR]: 32.56 for supraglottic patients versus 5.55 for glottic patients). This is particularly true of patients affected by multicentric supraglottic tumors (RR: 62.5). A significant hyperfrequency of undifferentiated lung cancers also has been noted in supraglottic patients (RR: 45.45 for supraglottic versus 14.28 for glottic patients). The information provided by autopsy allows for a more realistic and detailed outlining of the issue of tumor multiplicity, stressing the importance of strict preventive and follow-up protocols.

[Effectiveness of and tolerance to azithromycin versus roxithromycin in the treatment of patients with acute infections of the upper respiratory tract]. / Studio sull'efficacia e la tollerabilità dell'azitromicina vs roxitromicina nel trattamento di pazienti con infezioni acute delle alte vie respiratorie.

A multicenter open prospective comparative study was carried out during two years enrolling 60 patients with upper respiratory infections. Thirty were treated with single daily 500 mg doses of azithromycin for three days, and 30 received two daily doses of roxithromycin of 150 mg each for seven days. Both treatments were equally well tolerated, and there was no substantial difference concerning clinical recovery. However, azithromycin treatment was more practical and of shorter duration.

Audio-phonological and neuropsychological aspects of simultaneous interpretation. Role of auditory shadowing.

Two groups of female interpreter students (3rd year and 4th year) at the School for Interpreters and Translators of the University of Trieste (SIT) underwent a paradigm of complex shadowing. All subjects were polyglots, with Italian as first language (L1) and German, learned after age 10, as second language (L2). In the first part of the experiment, they were asked to listen to and immediately repeat 60 lists of 50 words each in Italian passed through earphones to the right ear (RE) and the same number of words to the left ear (LE). In the second part, the subjects were asked to do the same thing, but this time with German words to be listened to and immediately translated into Italian. The 3rd-year students generally made significantly more errors than the 4th-year students, both in L1 and in L2, and in particular when listening to the words with their left ear, as opposed to the right. No significant difference between ears or languages was shown by the 4th-year students. Moreover, no significant difference was found between the two groups in tasks requiring verbal long-term memory, i.e. repetition of lists of words with 'target words' to remember. The longer exercise in simultaneous interpreting apparently improves the students' performances in shadowing, and probably modifies the organization of some aspects of hemispheric specialization for L1 and L2.

[Clinical aspects of sudden deafness and vestibulopathy]. / Clinica delle sordità e vestibulopatie improvvise.

Clinical aspects of sudden deafness and sudden vestibular loss. The cases of sudden deafness and/or sudden vestibular loss are 90% idiopathic. Initially they can be overlooked but they can be responsible for an important sensorial impairment. In 65% of cases, and within the first two weeks, there may be a relevant or complete recovery or functional compensation. Etiology and pathogenesis are considered to be pluri-factorial; multiple virus infection including the Herpesvirus family, is the most relevant and better documented cause. Such an infection is responsible for a derangement of inner ear microcirculation, ions imbalance at labyrinthine fluids level, reduction of receptors and nervous supply function. Therapy is essentially symptomatic and therefore the most widely used drugs are cortisonics and heparin. In the Author's opinion also dextran 40, by slow endovenous drip, and carbogen (O2 95% + CO2 5%), by inhalations, are very effective with only rare contraindications. The occurrence of an important number of spontaneous improvements or even recoveries does not authorize therapeutic abstension especially in severe or delayed cases.

Reflex "delay" in sensorineural hearing-loss.

Delay of the acoustic reflex is concerning the latency and the rise-time of the response. The magnitude of these parameters is correlated with the stimulus characteristics but it is also modified by the instrumentation. Normative data obtained with commercial instruments demonstrate statistically meaningful differences of latency depending on age groups, ipsi-or contralateral recording, monophasic or biphasic deflection, which is also a normal response in about 12% of ears. The value are comprised within 150 ms for ipsilateral recording and 200 ms for the contralateral recording. The interaural latency difference (ILD) is not exceeding 40 ms. In cochlear deafness (50 cases with Ménière's disease and 50 cases with acoustic or ototoxic lesions) the latency values are slightly shorter than normal in 25% of the cases. This is better demonstrated when ILD can be evaluated with the normal ear. Also rise-time is similarly reduced. In retrocochlear lesions, when a cochlear involvement is not superimposed latency and rise-time are lengthened. Also in these cases ILD values are very important. It must be recalled that an acoustic reflex delay has been observed also in cases of brain-stem involvement.

Comparison between central tonal tests and central speech tests in elderly subjects.

A battery of tonal tests investigating the performance of the central auditory pathways (auditory lateralization, temporal order, auditory pattern) has been applied, together with a battery of central speech tests (sensitized speech and synthetic sentences), to a group of 50 subjects aged from 60 to 80 years, affected only with presbycusis. The results demonstrate that the speech tests undergo a considerable reduction of the performance-intensity function with age whereas the tonal tests remain within the values obtained in younger subjects. The topodiagnostic implications of these data are discussed.

Sensitivity of auditory lateralization and temporal order tests to benzodiazepines.

The responses to tests of auditory lateralization and temporal order to the administration of desmethyldiazepam (DMDZ) and of chlorodesmethyldiazepam (Cl-DMDZ) have been investigated. Therapeutic doses of these two benzodiazepines were used. We have tested four groups of 10 healthy normally hearing subjects. It was demonstrated that both DMDZ and Cl-DMDZ cause a temporary disturbance in the lateralization tests: delta i but especially delta t. The temporal order test is not altered after drug administration. The physiopathological and topodiagnostic value of these tests and the site of action of the benzodiazepines are discussed.

Pathology of the nervous arc of the acoustic reflexes.

A short comment is made on the pathological conditions of the input and efferent arc of the stapedius reflex. The modifications of this reflex during pathological and experimental inpairment of the intermediate portion of the arc, at the brain stem level, in human subjects are analyzed in more detail. The graphic and oscilloscopic records demonstrate a modification of the latency, amplitude and particularly of the speed of onset of the reflex. A concomitant modification of the electronystagmogram and tonal tests of lateralization is also demonstrated. Some abnormal responses observed in cases of facial palsy (efferent arc) as compared with electrogustometry and the problem of eliciting an isolated reflex contraction of the tensor tympani are briefly commented upon.

Bipolar electric stimulation to elicit and isolated tensor tympani reflex.

A bipolar electrode is described, designed to obtain improved reflex responses from the tensor tympani muscle by electric stimulation of the under surface of the tongue, d.c. generator, 7-9 V d.c. In comparison with the previous unipolar method of stimulation the responses under oscilloscopic analysis appear very constant and of greater size. The latency, in normal subjects, is 117 msec.

Oscilloscopic analysis of the stapedius muscle reflex in brain stem lesions.

An oscilloscopic analysis of several features of the stapedius muscle reflex was carried out in a group of normal subjects and in patients affected by dysfunction at the brain stem level due to a pathologic lesion or temporary reduction by small doses of barbiturates. Under these conditions, the increased latency and reduced amplitude of the reflex, but particularly the reduced velocity and, not infrequently, the step-like pattern of the tracings, are considered to be data of considerable value in disorders of the brain stem structues.

Directional hearing, temporal order and auditory pattern in peripheral and brain stem lesions.

Tests have been applied to the following subjects: (1) 25 normal individuals; (2) the same individuals during temporary impairement of the brain stem by barbiturate (3 mg/kg); (3) 32 patients affected by acute nucleo-reticular vestibular syndrome; (4) 7 patients affected by unilateral Menière's disease, and (5) 1 patient affected by acoustic neuroma with well preserved hearing. Directional hearing was tested by changing the delta i and delta t of two pure tones 400 and 600 Hz) presented through earphones or two fixed loudspeakers placed at +/- 30 degrees from the azimuth and with balanced intensity: temporal order and auditory patterns were tested with the same frequencies by changing the delta t or the order of presentation of the stimuli at fixed intensity. On the basis of the results obtained in the normal subjects, a distinction can be made between the patients affected by brain stem impairment and those affected by Menière's disease. In these patients it was very difficult to obtain reliable discriminations due to the failure of the affected cochlea, especially during an acute phase of the disease, to perform adequate time, intensity and frequency analysis. In brain stem patients, spontaneous or pharmacological, the directional hearing judgments were impaired whereas temporal order and auditory pattern discrimination were normal. It is suggested, therefore, that these various central-hearing tests do not investigate analogous performances, but on the contrary different ones. This difference can be attributed to different structures, or to different performance along the same pathways but also to an identical structure of different sensitivity to the noxious agents.

Modifications of the stapedius muscle reflex under spontaneous and experimental brain-stem impairment.

An oscilloscopic plus a graphic method of recording of the stapedius muscle reflex has revealed peculiar modifications in the latency, threshold, and shape of development of the reflex in cases of brain-stem impairment. Many subjects have been examined who were affected by nucleo-reticular vestibular syndrome, vascular insufficiency, disseminated sclerosis, tumours, etc. and a comparison has also been made in normal subjects and in the same subjects during a temporary impairment of the brain-stem structures following barbiturate administration. The greatest semeiological value is attributed to the modifications in the shape of the reflex.

Tympanic muscle reflex elicited by electric stimulation of the tongue in normal and pathological subjects.

A bilateral reflex contraction of the tensor tympani muscle has been obtained in man by electric stimulation of the tongue (1-2 mA). The stimulus is well tolerated and always effective. The advantage is stressed of eliciting a contraction of this muscle without involvement of the stapedius, as occurs with other methods. An analysis has been subsequently conducted in normal subjects and in patients affected by pathology of the tympano-ossicular system: tympanosclerosis, otosclerosis, suprastapedial facial paralysis; in cases of interruption of the afferent arch: section of the homo-lateral lingual nerve; in cases of involvement of its central portion: cerebello-pontine-angle tumours; and in cases of section of chorda tympani. A chiasm-like central nervous pattern is suggested.