Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

The current treatment options for acoustic neuromas (AN) - observation, microsurgery and radiotherapy - should assure no additional morbidity on cranial nerves VII and VIII. Outcomes in terms of disease control and facial function are similar, while the main difference lies in hearing. From 2012 to 2016, 91 of 169 patients (54%) met inclusion criteria for the present study, being diagnosed with unilateral, sporadic, intrameatal or extrameatal AN up to 1 cm in the cerebello-pontine angle; the remaining 78 patients (46%) had larger AN and were all addressed to surgery. The treatment protocol for small AN included observation, translabyrinthine surgery, hearing preservation surgery (HPS) and radiotherapy. Hearing function was assessed according to the Tokyo classification and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. Sixty-one patients (71%) underwent observation, 19 (22%) HPS and 6 (7%) translabyrinthine surgery; 5 patients were lost to follow-up. Median follow-up was 25 months. In the observation group, 24.6% of patients abandoned the wait-and-see policy for an active treatment; the risk of switching from observation to active treatment was significant for tumour growth (p = 0.0035) at multivariate analysis. Hearing deteriorated in 28% of cases without correlation with tumour growth; the rate of hearing preservation for classes C-D was higher than for classes A-B (p = 0.032). Patients submitted to HPS maintained an overall preoperative hearing class of Tokyo and AAO-HNS in 63% and 68% of cases, respectively. Hearing preservation rate was significantly higher for patients presenting with preoperative favourable conditions (in-protocol) (p = 0.046). A multi-option management for small AN appeared to be an effective strategy in terms of hearing outcomes.

Cytochemical features of the digestive tract mucosa of Hemisorubim platyrhynchos (Siluriformes: Pimelodidae).

Membranous organelles, acid glycoconjugates and lipids were characterized in the digestive tract mucosa of Hemisorubim platyrhynchos by cytochemistry techniques. Two types of mucous-secreting cells were observed in the digestive tract epithelium: goblet cells in the oesophagus and intestine and epithelial cells in the stomach. These cells had a Golgi apparatus more developed than the other cell types. The cytochemical analysis revealed that secretory granules are reactive to acid glycoconjugates, varying in reaction intensity according to the region of the digestive tract. Acid glycoconjugate reactions were also observed in oesophageal epithelial cell microridges and in enterocyte microvilli. In the digestive tract, acid glycoconjugates act to protect the epithelial surface, increasing mucous viscosity, which facilitates the passage of food, prevents the binding of parasites and facilitates their removal. Through lipid staining, a coated membrane was observed around each secretory granule of the oesophageal and intestinal goblet cells, while gastric epithelial cells granules were fully reactive. Oxynticopeptic cells of the gastric glands showed lipid droplets in the cytoplasm and also in the mitochondrial matrix, which act as an energy reserve for these cells that have a high energy demand. Enterocytes showed a well-developed smooth endoplasmic reticulum, especially in the apical region of the cell, being related to absorption and resynthesis of lipids.

Acoustic schwannoma with intracochlear extension and primary intracochlear schwannoma: removal through translabyrinthine approach with facial bridge cochleostomy and transcanal approach.

Intracochlear schwannomas can occur either as an extension of a larger tumor from the internal auditory canal, or as a solitary labyrinthine tumor. They are currently removed via a translabyrinthine approach extended to the basal turn, adding a transotic approach for tumors lying beyond the basal turn. Facial bridge cochleostomy may be associated with the translabyrinthine approach to enable the whole cochlea to be approached without sacrificing the external auditory canal and tympanum. We describe seven cases, five of which underwent cochlear schwannoma resection with facial bridge cochleostomy, one case with the same procedure for a suspect tumor and one, previously subjected to radical tympanomastoidectomy, who underwent schwannoma resection via a transotic approach. Facial bridge cochleostomy involved removing the bone between the labyrinthine and tympanic portions of the fallopian canal, and exposing the cochlea from the basal to the apical turn. Patients' recovery was uneventful, and long-term magnetic resonance imaging showed no residual tumor. Facial bridge cochleostomy can be a flexible extension of the translabyrinthine approach for tumors extending from the internal auditory canal to the cochlea. The transcanal approach is suitable for the primary exclusive intralabyrinthine tumor. The indications for the different approaches are discussed.

Closure of the sigmoid sinus in lateral skull base surgery.

Closure of the sigmoid-jugular complex is generally planned during various surgical procedures on the skull base, either to repair a jugular foramen lesion or as the oncological boundary of the resection. A series of 218 cases of skull base tumour surgeries was analysed in which closure of the sigmoid-jugular complex was systematically planned (bilaterally in one case) in patients treated for jugular foramen paragangliomas, squamous cell carcinomas and other temporal bone tumours. Surgery was performed via a petro-occipital trans-sigmoid approach in 61 cases, an infratemporal A in 128, en bloc subtotal temporal bone resections in 10 and other approaches in 20. In our experience, planned unilateral (and, in one case, bilateral) closure of the sigmoid-jugular complex had no clinical consequences. The vicarious drainage of the skull base was always assessed preoperatively, revealing no contraindications to intraoperative sinus closure. Given the scarcity of literature on this subject, the present report shows that the procedure is associated with low morbidity and helps to improve our understanding of cerebral venous discharge.

Stroop effects from 3 to 10 years: the critical role of reading acquisition.

We studied 241 nursery and primary school 3- to 10-year old children with a discrete-trial version of the Stroop Test, including both a Color-Naming and (for the 6- to 10-year olds only) a Word-Reading task. The classic Stroop effect was present across all the ages, with an inverted U-shaped pattern: increasing from 3- to 7-year olds, then decreasing. Preschool children who were able to read showed a Stroop effect larger than same-age, unable to read children. The reverse Stroop effect was present across all the studied ages but the 6-year-olds, who instead displayed some facilitation in reading congruent vs. black words. Since the acquisition of reading skills turned out to be crucial for the Stroop effects, the present research may be useful to study developmental reading impairments by providing normative data.

Cytogenetic damage in workers exposed to ethylene oxide.

Sister-chromatid exchanges (SECs) and chromosomal aberrations (CAs) were detected in the peripheral lymphocytes of 41 sanitary workers exposed to ethylene oxide (EO) in the sterilizing units of 8 hospitals in the Venice Region. The first group (19 workers) was exposed to 10.7 +/- 4.9 ppm EO, expressed as the time-weighted average concentration for an 8-h working day (TWA/8 h conc.), and the second group (22 workers) to 0.35 +/- 0.12 ppm. Each exposed worker was paired with a control of similar age and smoking habits. A highly significant (P less than 0.001) increase in the mean frequency of SCEs was found in the higher exposure group, 14 (74%) exposed subjects having significantly increased levels of SCEs compared to their matched controls. In the lower exposure group, the increase in mean frequency of SCEs was lower, though still significant (P less than 0.05): 7 (33%) exposed subjects had higher and 1 (5%) had a lower SCE level than the matched controls. From the first group, 10 subjects, 7 of whom had increased SCE levels, were reanalysed 12-18 months after their exposure had been lowered or interrupted: in only 2 of them the SCE level was significantly decreased. A statistically significant correlation between SCE frequency and level of EO exposure (TWA/8 h conc.), as well as a multiple correlation between SCE level and EO exposure, smoking and age were found. However, no interaction could be detected between EO exposure and smoking in the induction of SCEs. In controls, SCE frequency was correlated with smoking and age. In the higher exposure group, the number of both chromatid- and chromosome-type aberrations, independent of gaps, was significantly increased, whereas in the lower exposure group only the frequency of chromosome-type aberrations, excluding gaps, was statistically higher than in controls. The level of CAs remained to a great extent unchanged in the 10 subjects re-examined at a later stage after lowering or halting exposure. Taking the group as a whole, the frequency of cells with total CAs was found to be weakly (P = 0.05) correlated with EO exposure, and was not correlated with smoking, age or SCE frequency.

Workers exposed to ethylene oxide have increased incidence of sister chromatid exchange.

We have determined the frequencies of sister chromatid exchange (SCE) in 41 workers engaged in the sterilization of medical equipment. Each exposed subject was paired with a control matched for age, smoking habits and sex. The frequencies of SCE were markedly higher in the exposed than the control workers. The exposed subjects were divided into two groups according to time-weighted average concentrations of ethylene oxide (EtO) in the air, that were determined at the work place of each worker during the 5 min following the sterilizer opening, during the entire sterilization cycle or during the 8-h working day. One group (19 subjects) was exposed to a range of 3.7-35.5 ppm (mean, 15.8 +/- 9.8 for a sterilization cycle) and showed a mean of 13.0 +/- 1.8 SCE compared to 10.2 +/- 1.2 in controls (variance, F = 31.2; p less than 0.001). The second group (22 subjects) was exposed to 0.3 - 2.6 ppm (mean, 1.1 +/- 1.0) and had a mean of 11.0 +/- 1.6 SCE compared to 9.8 +/- 1.4 in controls (F = 4.7; p less than 0.05). Statistical evaluation of the SCE frequencies correlates SCE induction with the level of EtO exposure and also with smoking and age. Our data show that EtO can induce human chromosomal damage at very low environmental exposure levels, lower than the present Italian official limits and lower than those found even in the most technologically advanced hospitals.