Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature.

PURPOSE: To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS: We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. RESULTS: In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. CONCLUSION: Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation.

Sentinel node biopsy versus elective neck dissection in early-stage oral cancer: a systematic review.

PURPOSE: To provide a summary of the evidence on the comparative effectiveness of two surgical treatment strategies, sentinel node biopsy (SNB) and elective neck dissection (END), in patients with T1-T2 oral cancer and clinically negative (cN0) neck, in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). METHODS: A systematic review was performed by including studies published up to April 2019. Meta-analysis was performed to compare NRRs between SNB and END. A narrative summary of the results was generated for OS, DFS and morbidity outcomes. The certainty of evidence was assessed according to the GRADE methodology. RESULTS: No randomized studies were retrieved. Five observational studies were included in the comparative effectiveness analysis and four observational studies were included in the comparative morbidity analysis. The pooled risk ratio showed no differences in NRRs between SNB and END (10.5% vs 11.6%; pooled RR 1.09; 95% CI 0.67-1.76). No differences in OS or DFS between the two treatments were found. SNB appears to be associated with a lower rate of postoperative complications and lower shoulder dysfunction than END. Conversely, the results of the quality of life (QoL) questionnaires are not sufficient to advocate a particular strategy. CONCLUSION: Our review highlights the lack of well conducted and randomized studies comparing SNB to END, leading to poor clinical evidence. Although our findings suggest no significant differences in OS, DFS and NRR between the two strategies, the certainty of our evidence is too low to make it useful for clinical decision making.

Tympanometric findings in superior semicircular canal dehiscence syndrome.

The diagnostic role of audio-impedancemetry in superior semicircular canal dehiscence (SSCD) disease is well known. In particular, since the first reports, the presence of evoked acoustic reflexes has represented a determining instrumental exhibit in differential diagnosis with other middle ear pathologies that are responsible for a mild-low frequencies air-bone gap (ABG). Even though high resolution computed tomography (HRCT) completed by parasagittal reformatted images still represents the diagnostic gold standard, several instrumental tests can support a suspect of labyrinthine capsule dehiscence when "suggestive" symptoms occur. Objective and subjective audiometry often represents the starting point of the diagnostic course aimed at investigating the cause responsible for the so-called "intra-labyrinthine conductive hearing loss". The purpose of this study is to evaluate the role of tympanometry, in particular of the inter-aural asymmetry ratio in peak compliance as a function of different mild-low frequencies ABG on the affected side, in the diagnostic work-up in patients with unilateral SSCD. The working hypothesis is that an increase in admittance of the "inner-middle ear" conduction system due to a "third mobile window" could be detected by tympanometry. A retrospective review of the clinical records of 45 patients with unilateral dehiscence selected from a pool of 140 subjects diagnosed with SSCD at our institution from 2003 to 2011 was performed. Values of ABG amplitude on the dehiscent side and tympanometric measurements of both ears were collected for each patient in the study group (n = 45). An asymmetry between tympanometric peak compliance of the involved side and that of the contralateral side was investigated by calculating the inter-aural difference and the asymmetry ratio of compliance at the eardrum. A statistically significant correlation (p = 0.015 by Fisher's test) between an asymmetry ratio ≥ 14% in favour of the pathologic ear and an ABG > 20 dB nHL on the same side was found. When "evocative" symptoms of SSCD associated with important ABG occur, the inter-aural difference in tympanometric peak compliance at the eardrum in favour of the "suspected" side could suggest an intra-labyrinthine origin for the asymmetry. Tympanometry would thus prove to be a useful instrument in clinical-instrumental diagnosis of SSCD in detection of cases associated with alterations of inner ear impedance.

Harmonized Italian version of the Aging Males' Symptoms scale.

INTRODUCTION: The interest in clinical investigations in health-related quality of life (HRQoL) of aging men has increased over recent years, particularly in the context of partial androgen deficiency. The aim of this paper is to inform the scientific community about a harmonized Italian Aging Males' Symptoms (AMS) scale. METHODS: There were two slightly different Italian AMS scales, which both underwent an up-to-date linguistic & cultural translation process, i.e., were both valid to be applied in clinical research. However, there are potential long-term problems associated with having two Italian language versions of the scale in the same country. Therefore, an ad hoc committee of key persons related to both versions met with the scale's developer, to create a harmonized single Italian AMS. RESULTS: The harmonization meeting came up with a consensus item-by-item and the new Italian reference scale was agreed upon. It was decided that this scale should be published to avoid any confusion among future users. CONCLUSION: The Italian AMS scale published in this paper should be used for future clinical and other research.

Antihistaminic and antiallergic properties of dextro-mequitamium iodide in upper and lower guinea pig airways: comparison with azelastine.

1. The ability of dextro-mequitamium iodide (d-Meq) to antagonize bronchomotor and inflammatory effects mediated by histamine and antigen challenge in the upper or lower guinea pig airways or both and its potential activity against the recruitment and activation of eosinophils in the bronchial wall have been evaluated in comparison with azelastine. 2. In receptor-binding studies, d-Meq displayed a nanomolar affinity for H1 and muscarinic receptors, and it was endowed with potent bronchodilating properties in the nanomolar range toward tonic contractions induced by histamine and carbachol. 3. d-Meq (100-1,000 nmol/guinea pig) and azelastine (100-5,000 nmol/guinea pig) administered by aerosol significantly inhibited histamine- and antigen-induced increases in insufflation pressure in sensitized animals. 4. d-Meq (1,000-6,000 nmol/kg i.v.) dose dependently inhibited the histamine- or antigen-induced increase in vascular permeability in the upper airways. 5. d-Meq was more effective against histamine than antigen challenge, and its potency was similar or greater than that of azelastine. 6. Aerosolized d-Meq (1,000 nmol/animal) reduced antigen-induced eosinophil accumulation in the bronchoalveolar lavage (BAL) fluid from sensitized guinea pigs. 7. Eosinophils recovered from the BAL fluid of antigen-challenged animals showed an increased chemotaxis in response to LTB4 or platelet-activating factor. Both d-Meq and azelastine (300 nmol/animal) reduced this increase without affecting direct chemotaxis induced by leukotriene B4 (LTB4). 8. These findings provide evidence that local administration of d-Meq might be useful in the treatment of allergic disorders, such as rhinitis and asthma.

Pharmacodynamic profile of the new potent antibronchospastic agent 7-[(2,2-dimethyl)propyl]-1-methyl xanthine.

The pharmacodynamic profile of a new xanthine derivative, 7-[(2,2-dimethyl)propyl]-1-methyl xanthine (CAS 155006-67-0, MX2/120), was investigated in comparison with theophylline. The compound reduces in vitro the bronchospastic tone induced by carbachol or histamine in guinea-pig bronchi, with a potency 11 and 5 fold greater than theophylline, respectively. MX2/120 is significantly more active and long-lasting than theophylline in in vivo experiments toward spasmogens such as acetylcholine (ED50 over 5 h = 15 mumol/kg p.o. vs 230 mumol/kg p.o.) or histamine (ED50 over 5 h = 122 mumol/kg p.o. vs 500 mumol/kg p.o.) while being almost equiactive to theophylline toward antigen and capsaicin induced cough strokes. MX2/120, if administered by i.p. route reduces hyperresponsiveness to histamine induced by PAF and extravasation of protein into bronchoalveolar lavage fluid induced by capsaicin. These anti-inflammatory effects of MX2/120 are of similar extent when compared to theophylline. Unlike theophylline, MX2/120 up to 275 mumol/kg p.o. possesses little or no CNS excitatory effects in mice in terms of reduction of sleeping time induced by chlordiazepoxide, increase in mortality and convulsions induced by pentetrazol and increase in locomotor activity. This reduced neuroexcitatory action is probably related to its lack of affinity to adenosine receptors that could also explain the absence of effect on basal gastric secretion. Chronotropic effects of MX2/120 in conscious rats are similar to those of theophylline while the effects of both drugs on blood pressure are of minor extent. The overall pharmacodynamic properties of MX2/120 are superior to those of theophylline in relation to its antibronchospastic activity and lack of excitatory effects on CNS.

A new class of antibronchospastic agents: 7-(2,2-dimethyl)propyl substituted xanthines.

A series of 7-(2,2-dimethyl)propyl substituted xanthines were synthesized and tested for their antibronchospastic activity in comparison with theophylline. In vitro, the inhibition of carbachol-induced increase in bronchial tone was determined. In vivo, the inhibition of antigen-induced bronchoconstriction in guinea pigs was determined 1, 3 and 5 h after oral administration. Central side effects were evaluated. In vitro, the majority of compounds were more effective than theophylline. In vivo, three compounds 2, 14 and 15 showed an effect comparable to theophylline but longer lasting. A mild sedative effect was generally observed. Compound 2, 7-(2,2-dimethyl)propyl-1-methyl xanthine, coded MX2/120, was selected for a deeper evaluation.

Pharmacology of LR-B/081, a new highly potent, selective and orally active, nonpeptide angiotensin II AT1 receptor antagonist.

1. The pharmacological profile of LR-B/081, (methyl 2-[[4-butyl-2-methyl- 6-oxo-5-[[2'-(1H-tetrazol-5-yl)[1,1'-biphenyl]-4-yl]methyl]-1(6H)- pyrimidinyl]methyl]-3-thiophenecarboxylate), a novel antagonist at the angiotensin II (AII) AT1-receptor, was studied in vitro and in vivo. 2. In rabbit aortic strips incubated with LR-B/081 (1-1,000 nM), the concentration-response curve to AII was displaced to the right in a nonparallel fashion and the maximal contraction was progressively reduced, indicating that the compound is an insurmountable antagonist in this preparation (apparent pKB = 9.50 +/- 0.23). However, the interaction of LR-B/081 with AII receptors was found to be reversible, since the maximal response to AII was restored by coincubation with losartan, a surmountable AII AT1-antagonist. Contractions elicited by KCl or phenylephrine were not affected by 10 microM LR-B/081. 3. In rat isolated perfused kidney, LR-B/081 and losartan antagonized the AII-induced vasoconstriction [IC50 (95% confidence limits) = 17(13-24) and 39(32-54) nM, respectively]. The LR-B/081 antagonism was incompletely reversed by excess AII, while losartan was fully displaced. The IC50 values of LR-B/081 and losartan obtained against vasoconstriction induced by endothelin-1 and noradrenaline were two orders of magnitude higher. 4. In pithed rats, the intravenous administration of LR-B/081 (0.2-2 mumol kg-1) dose-dependently shifted to the right in a nonparallel fashion the dose-pressor response curve to AII. The maximal pressor response to AII was reduced by LR-B/081 in a dose-dependent fashion. The coadministration of losartan induced a progressive recovery of the maximal pressor response to All, indicating that in vivo the interaction of LR-B/081 with All receptors is reversible. LR-B/081 at 6 micromol kg-1, i.v. also did not affect the vasopressor response induced by noradrenaline in the pithed rat.5. In conscious normotensive rats, single oral administration of LR-B/081 at 6 micromol kg-1 markedly inhibited the All-induced pressor response; the inhibition lasted more than 24 h.6. In conscious renal hypertensive rats, intravenous LR-B/081 appeared as potent as losartan (ED40mmHg(95% confidence limits) = 0.50(0.36-0.70) and 0.86(0.57-1.3) micromol kg-1, respectively). A single intravenous(2 micromol kg-1) or oral (6 micromol kg-1) administration of LR-B/081 induced a marked fall in blood pressure which lasted for at least 12 h.7. In conscious spontaneously hypertensive rats, LR-B/081 at 20 micromol kg-1 , p.o., induced a marked and sustained fall in blood pressure. The duration of the antihypertensive effect was longer than 12 h.Heart rate was not modified by LR-B/081 treatment. Repeated oral administration of 17 micromol kg-1LR-B/081 for 16 days did not result in the development of tolerance.8 These results demonstrate that LR-B/081 is a potent, selective and orally active antagonist of All at the AT1-receptor subtype, which markedly lowers the blood-pressure in conscious renal and spontaneously hypertensive rats.

Obturation of iatrogenically damaged root canals with injectable thermoplasticized gutta-percha: a case report.

A case is reported where the high flow characteristics of thermoplasticized gutta-percha provided an efficient seal even without adequate shaping of an iatrogenically damaged root canal system. Persistent periradicular irritation was reduced significantly, or isolated within the root canal space, thus allowing periapical repair.

A new method for assessing Ca2+ requirements for vasoconstriction in the rat isolated perfused kidney. Effect of norepinephrine and endothelin.

The consecutive perfusion with three different media containing 1) a high-K+, Ca(2+)-free solution with 1 mM of EDTA, 2) a high-K+, Ca(2+)-free solution with 1mM of EDTA and 0.3-10 microM of norepinephrine (NE) or 1-10 nM of endothelin (ET), and 3) a normal K+ solution without EDTA, NE, or ET, respectively, produced three rapid and transient vasoconstrictions of the isolated and perfused rat kidney. Results obtained from preincubation with prazosin (0.9 nM) and nifedipine (10 nM) or reperfusion at various Ca2+ concentrations showed that the responses involved are characterized by a different mobilization of cellular and extracellular Ca2+. The first phase greatly depends on the influx of extracellular Ca2+ and/or membrane Ca2+ through voltage-dependent channels, the second from mobilization of intracellular Ca2+, while the third is due mainly to the influx of extracellular Ca2+ through receptor-activated channels. NE elicited Ca2+ mobilization from both cellular and extracellular sources through activation of alpha-1 adrenoceptors. ET is particularly effective in producing extracellular Ca(2+)-dependent vasoconstriction in a prazosin-resistant manner. Present results show that this method could be suitable to distinguish different Ca2+ requirements for spasmogen-induced vasoconstriction in the isolated and perfused rat kidney.

Calcitonin gene-related peptide (CGRP)1 receptor mediates vasodilation in the rat isolated and perfused kidney.

The vasodilator activity of rat(r) alpha and beta calcitonin gene-related peptide (CGRP) as compared to the structurally related peptide, rAmylin, [Cys(ACM)2,7]human (h)CGRP and salmon calcitonin, was investigated in the rat isolated and perfused kidney which vascular tone was increased by 3 microM noradrenaline. The order of potency in producing vasodilation was alpha CGRP > beta CGRP >> rAmylin. [Cys(ACM)2,7]hCGRP and salmon calcitonin were ineffective. The activity of alpha and beta forms of rCGRP and rAmylin was antagonized by hCGRP (8-37), a CGRP1 receptor antagonist, at a concentration which did not affect acetylcholine-induced vasodilation. These results indicate the involvement of CGRP1 receptor in the CGRP-induced vasodilation in the rat kidney.

Effect of endothelin (ET)-1, ET-3 and ET-(16-21) on the isolated and perfused rat kidney from normotensive and spontaneously hypertensive rats.

We have investigated the effect of endothelin (ET)-1, ET-3 and ET-(16-21) on isolated and perfused rat kidney (IPK). ET-1 and ET-3 produced a similar dose-dependent increase in perfusion pressure of IPK, while ET-(16-21) was completely inactive. The ET-1 effects were greater in spontaneously hypertensive rats (SHR) as compared to normotensive rats (WKYR), whereas the ET-3 effects were greater in the SHR group only at the lowest doses. The pressure response of IPK induced by ET-1 was partially modified by prior application of the nitric oxide synthetase inhibitor L-nitroarginine in both WKYR and SHR.

[Carnitine metabolism in chronic kidney failure]. / Metabolismo della carnitina nell'insufficienza renale cronica.

Carnitine plays an important role in regulating the flow of energetic substrates and their balance through cellular membranes. Usually in chronic renal failure, increased plasma levels of carnitine are found. In early hemodialysis a slow decrease of the muscle concentrations of carnitine is found, followed by a decrease of plasma concentrations long after substitutive treatment. Several signs and symptoms are attributable to carnitine deficiency. It is reported that these changes regress with suitable supply of intravenous carnitine after dialysis end for 15-30 days, and subsequently with chronic administration in the dialysis fluid.

[Subjectivity in interpretation of radiographs in endodontics]. / Soggettività nella interpretazione delle radiografie in endodonzia.

This research found a substantial interobserver disagreement existing in endodontic success/failure interpretation from periapical radiographs. The diagnostic variability appears to be independent of the anatomic location of the endodontically treated tooth (even though it seems less for mandibular teeth), as well as it appears to be independent of the time interval between post-operative and recall radiographs. Extremely significant has also been the fact that an important percentage of observers have contradict themselves in the interpretation of the same radiograph.

Calcitonin gene-related peptide in the rat kidney: occurrence, sensitivity to capsaicin, and stimulation of adenylate cyclase.

The occurrence, effects and sensitivity to capsaicin and stimulation of adenylate cyclase of calcitonin gene-related peptide (CGRP) in the rat kidney have been investigated. CGRP-like immunoreactivity was higher in the medulla than in the papilla and the cortex. Capsaicin pretreatment significantly reduced CGRP-like immunoreactivity in the medulla and papilla while a small reduction was found in the cortex. CGRP-immunoreactive nerve fibres were observed surrounding blood vessels and occasionally in the vicinity of renal tubules and between the collecting ducts in the papilla. Some CGRP-immunoreactive fibres were also seen in kidneys from capsaicin-pretreated rats. Infusion of capsaicin (1 microM) through the renal artery of isolated and perfused rat kidney increased the CGRP-like immunoreactivity outflow from the venous effluent. This effect exhibited desensitization at the second challenge with the drug. Infusion of either capsaicin (1 microM) or CGRP (1 microM) reduced the increase of perfusion pressure induced by norepinephrine in isolated perfused rat kidney. Plasma protein extravasation was studied in the various regions of the rat kidney following infusion of capsaicin. No significant change was observed in the medulla, papilla or cortex after capsaicin administration. Adenylate cyclase activity was studied in membrane preparations from cortex, medulla and papilla of rat kidney. Cortical and medullary adenylate cyclase was stimulated in a concentration-dependent manner by salmon calcitonin, rat calcitonin and rat CGRP. Salmon calcitonin in these two areas showed half-maximal effective concentration approximately 1000 times lower and maximal stimulation only slightly higher than those of rat calcitonin and rat CGRP. However, in the papilla, only rat CGRP was able to induce a 60% increase of enzyme activity (half-maximal effective concentration, 19 +/- 1.6 nM). It is concluded that CGRP contained in capsaicin-sensitive sensory nerve may exert a local function in discrete areas of the rat kidney.

Resolution and pharmacological properties of the enantiomers of the potent alpha-adrenoceptor antagonist 1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxy-phenyl)piperazine.

Resolution of the optical isomers of the alpha-adrenoceptor antagonist IP-66 (1-[2-ethoxy-2-(3'-pyridyl)ethyl]-4-(2'-methoxy-phenyl)piperazine) and its intermediate IP-30 (1-[2-hydroxy-2-(3'-pyridyl)ethyl]-4- (2'-methoxy-phenyl)piperazine have been carried out. Optical purity was assayed by high-pressure liquid chromatography. The antagonistic potencies of racemic mixtures and stereoisomers toward phenylephrine- and norepinephrine-induced contraction in isolated rat aortic strips have been compared. (+)-IP-66 and (+)-IP-30 were resp. 363 and 170 times more potent than respective (-) isomers in eliciting competitive alpha 1-adrenoceptor blockade. Similarly IP-66 (+) or (+/-) were extremely more effective than the (-) isomer in antagonizing norepinephrine-induced pressor responses in pithed rat.