Treatment of recalcitrant ulcers with allogeneic platelet gel from pooled platelets in aged hypomobile patients.

We evaluated growth factor contents and clinical efficacy of allogeneic platelet gel (PG) prepared with standard blood banking procedures from routine platelet concentrates (PCs) obtained from buffy coats. The PGs were used to treat 11 hypomobile very elderly patients unable to undergo autologous blood processing and previously ineffectively treated with expensive advanced medications for 8-275 weeks. PGs were prepared by platelet activation with human thrombin or commercial batroxobin. Median and range growth factor contents (ng/mL) were: platelet derived growth factor (PDGF-AB/-BB) 112 (31-157) and 20 (3.8-34); transforming growth factor (TGF-ß1/-ß2) 214 (48-289) and 0.087 (0.03-0.28); basic-fibroblast growth factor (b-FGF) 0.03 (0.006-0.214); vascular endothelial growth factor (VEGF) 1.15 (0.18-2.46); epidermal growth factor (EGF) 4.50 (0.87-6.64); insulin-like growth factor (IGF-l) 116 (72-156). In the clinical study, 222 PGs were used within 2 h of activation to treat 14 chronic skin ulcers in the 11 patients. No improvement was seen in 3 patients with 24, 27 and 30 cm(3) ulcers who could be treated for no more than 4, 7 and 8 weeks due to progressively worsening clinical conditions, while 11 ulcers with 3.2 cm(3) median size (range 0.2-3.6) in the remaining 8 patients showed 91 ± 14 % reduction after a median of 12 weeks (range 1-20). Cost of PG treatment (19,976 euro) amounted to about 10% of the ineffective advanced medication hospital reimbursement fees (191,236 euro). This study supports efficacy and feasibility of allogeneic PG to treat recalcitrant ulcers in very elderly hypomobile patients for whom autologous blood processing may be difficult.

[Rehabilitation of deafness in the elderly: multidisciplinary intervention in experimental university center]. / La riabilitazione nella sordità dell'anziano: intervento multidisciplinare in un centro universitario sperimentale.

The loss of hearing abilities can be seen as a complex event because psychological discomfort and relational inhibitions interact and lead to behaviours and attitudes which are insidious and dangerous for the quality of life of the patient. The complexity of the psychological-organic inconvenience, such as impairement disability and handicap led to the testing of recovery patterns. In this specific context interventions coming from different fields sustained from a complex operative model where different professional competences and evaluation processes interact. Therapeutic interventions have been carried out by an audiologist, an audiometrist, a speech therapist, an audioprostethist and a psychologist, all sharing the obtaining of the same result. The role of the audiologist is simply clinical and concerns the knowledge of the entire process of rehabilitation through the use of a prosthesis. This process concerns the audiologist, who operates in close collaboration with the audiometrist and the audioprosthesist: it is therefore a therapeutic activity that is interested mainly in the prescription of the prosthesis and the restoring of the communicative function. The speech therapist and the psychologist carry their interventions through a relationship with the patient, which places the respect of the patient's personality before any other procedural and technical aspect. Therefore they pay attention more to ergonomic factors than to the hearing loss, through the obtaining of the patient's self-confidence and of a better general psychological situation. Therefore the main purpose of each intervention is to create a process of rehabilitation aimed at restoring the communicative functions and the individual motivation in trying to do so both in the domestic and in the social environment. The authors refer the experience and the informations put together during three years of research activity. The results of the therapeutic intervention have brought to the acceptance of the prosthesis help, the adaptation to amplification, the reduction of the subjective and relational uneasiness for the use of prosthesis, the use of the prosthesis, the reintroduction to the world of sounds, the restoring of levels of autonomy and of self-estime, the discover of eventual abilities, which had never been used or underestimated, the reactivation of more rewarding social relationships and the reduction of the conditions of dependency related to the hearing disability.

Distribution of neurotransmitters, neuropeptides, and receptors in the vestibular nuclei complex of the rat: an immunocytochemical, in situ hybridization and quantitative receptor autoradiographic study.

This article investigates the distribution of neurotransmitters, neuropeptides, and related receptors in the vestibular nuclei complex (VNC) of the adult rat by means of immunohistochemistry, in situ hybridization, and quantitative receptor autoradiography. The entire complex proves to be rich in muscarinic receptors and it shows a high density of imipramine and benzodiazepine binding sites. Peptidergic neurons and a few positive fibers are described in the caudal part of the VNC. In particular, the medial vestibular nucleus contains a number of neurons expressing both the enkephalin mRNA and peptide. This nucleus and the lateral vestibular nucleus are also rich in opiate receptors. Substance P, thyrotropin releasing hormone, and neurotensin receptors are also found in the medial and in the spinal vestibular nuclei. In spite of the presence of alpha 2 catecholaminergic receptors, no thyrosine-hydroxylase-immuno-reactive elements are seen in the caudal VNC. The possible functional meaning of these data is discussed.

[Disability: a proposal for an anamnestic questionnaire in the evaluation of the degree of disability caused by disorders of equilibrium]. / Disability: proposta di un questionario anamnestico per la valutazione del grado di handicap provocato dai disturbi dell'equilibrio.

Correct identification and evaluation of balance disorders and an assessment of their repercussions on a patient's life are common problems faced by the otoneurologist. These symptoms may not infrequently have a chronic or recurrent course and can lead to in restrictions in the patient's everyday life and even have consequences for the patient' mental health. In the doctor-patient relationship anamnesis is of crucial importance in diagnosis as well as in establishing a relationship of professional confidence with the patient which may influence the outcome of the treatment. An awareness of those situations of daily life which bring about or aggravate the symptoms provides the doctor with valuable information in formulating an etiopathogenetic hypothesis. This observation led us to design the anamnestic self-questionnaire "Disability" whose purpose is to describe the type of disability or impairment to daily life suffered by the patient as a result of the pathology, while at the some time measuring their effects. Our history questionnaire has confirmed the importance of careful history in assessing balance disorders, has highlighted the striking extent of disability and impairment caused by these disorders, and has enabled us to identify the chief features of all pathologies encountered in the specific field of balance disorders. The questionnaire enables us, in particular, to highlight the interference of extra-vestibular factors (muscle-strain, states of irritation, phobias, drugs, dietary factors, etc.). The use of this questionnaire has proved to be of great assistance, therefore, in carrying out routine clinical diagnosis, in the absence of complex technical equipment. Moreover, it constitutes a valuable method in monitoring the outcome of the therapy, or the natural course of the balance disorders.

[Considerations concerning respiratory physiopathology in a case of total arhinia]. / Considerazioni di fisiopatologia respiratoria a proposito di un caso di arina.

The Authors describe their personal experience in a rare case of total arhinia in a young boy, now seven years old, whose psycho-physical development is normal and who is healthy except for recurrent conjunctivitis due to the absence of nasolacrimal ducts. The Authors consider the possibility that in the case of total absence of the nasal function, as in total arhinia, the oropharyngeal and laryngotracheobronchial mucosa may acquire those functional and defensive properties typically belonging to nasal mucosa. In the subject in question, in fact, functional respiratory and immunosecretory parameters are normal. On the other hand, being well known how problematic acquired severely compromised nasal functions are one would think that only in the case of congenital absence of the nose can the lower aerodigestive structures compensate successfully. In the Authors' opinion this clinic observation contradicts the widely held belief that nasal respiration is absolutely necessary from the moment of birth on.

Efficacy and tolerability of brodimoprim in pharyngotonsillitis in children.

160 children with an average age of 9 years (range 6-15) affected by acute bacterial tonsillitis, were selected and assigned, following an open, parallel group design to: a) brodimoprim at the dose of 10 mg/kg on the first day, in single administration, and of 5 mg/kg on the following days; b) cotrimoxazole suspension, at the dosage of 6 mg of trimethoprim/kg/day, in two daily administrations; c) amoxicillin with clavulanic acid suspension (amoxi-clavulanate) 50 mg/kg every 12 hours. Quantity of pharynx and tonsillar exudate, pharynx pain, dysphonia and dysphagia were checked at the basal time, 3rd, 7th and at the last day of therapy. These symptoms were evaluated using a four-step rating scale. The evolution of body temperature was measured at two different times (1 and 5 o'clock p.m.), until the end of treatment, foreseen five days after disappearance of fever. Microbiological evaluation through a pharynx swab was performed at the beginning and at the end of therapy. Side-effects were registered during all the observation period. Lab-tests were carried out at the enrollment and at the end of treatment. The frequency and intensity of symptoms decreased significantly in all treatment groups. In comparison with amoxi-clavulanate, the brodimoprim group showed an earlier improvement (3rd day) of the clinical situation and a significantly better regression of pharynx exudate (p < 0.01), pharynx pain (p < 0.05) and dysphonia (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy and tolerability of brodimoprim in bacterial otitis media in children. Controlled study versus cefaclor.

78 pediatric patients affected by acute otitis media were selected and randomized into two balanced groups of treatment: brodimoprim, at the dosage of 200 mg once-a-day on the first day and of 100 mg once-a-day on the following days, and cefaclor at a dosage of 40 mg/Kg/day in three doses. Brodimoprim resulted more efficacious in the reduction of symptoms, especially hypoacusis and tinnitus (p < 0.05 between treatments); tympanometry showed a higher number of normalizations in the brodimoprim group, without significant differences between treatments. Both drugs resulted active against most of isolated bacterial strains. Side effects were reported in 4 patients treated with brodimoprim and in 6 patients in the control group.

[The treatment of ENT phlogosis: seaprose S vs. nimesulide]. / Il trattamento delle flogosi in ORL-seaprose s vs nimesulide.

In the present multicentre study, the antiphlogistic activity of seaprose S was assessed according to an experimental design of the controlled type versus nimesulide in patients with phlogistic pathology of ENT relevance and in patients undergoing otoiatric surgical operations. One hundred and sixty patients (87 M, 73 F) were treated with seaprose S in 30 mg tablets (3tab/day) while 160 patients (95 M, 65 F) were treated with nimesulide in 100 mg (2 tab/day). The treatment lasted 7 days. At the beginning of the study, on the 3rd, 7th and 14th day (follow-up) the most significant signs and symptoms present in the pathological forms under consideration were evaluated. Common haematological and haematochemical laboratory parameters were also evaluated and any side effects occurring during the treatment were recorded. Considering the efficacy demonstrated, it was shown how the two drugs used possess an analogous action (NS) and are always able to exert positive control over the symptoms under examination. Administering seaprose S there were 9 cases of unexpected events (5.6%) while with nimesulide 26 patients (16.3%) showed problems of intolerance, with a highly significant statistical difference (p < 0.01) between the two groups. The analysis of the data obtained allows us thus to support the therapeutic use of seaprose S in the treatment of phlogosis of ENT relevance, since it has shown efficacy comparable to that of a NSAID such as nimesulide, but with greater safety.

[The experience of early rehabilitation]. / Esperienze di riabilitazione precoce.

Functional laryngectomies permit a more or less ideal preservation of laryngeal functions whose recovery, especially in les conservative operations, occurs very slowly and depends on several conditions: post operative course, sensitivity and motility of the hypopharynx, patient's ability to restore swallowing mechanisms. The Authors relate their experience concerning use of a rehabilitative program partially based on the experiences of some French logopedic schools and partially original. They illustrate the steps and goals of this program which starts on the fifth post-operative day with respiration exercises immediately followed by eight days of exercises to re-establish arytenoid mobilization and swallowing movements. If deglutition is not completely recovered and important inhalation problems persist, the logopedic approach is integrated with surgical rehabilitation consisting of one or more injection of gax-collagen. It is possible to use the same surgical technique later, after hospital discharge, if a slight dysphagia is still present in spite of continuous logopedic rehabilitation. Voice restoration exercises are introduced in the last days of the hospital stay when the patient is tube-free and continues at the office or outpatient clinic for two or three times every week. Concerning removal priority (tracheotomy tube followed by nasogastric tube or vice versa), we propose a diversified strategy for each patient, depending on the anatomicofunctional postoperative situation. Up to now 25 patients have taken part in this rehabilitation program (14 cricohyoidopexy, 6 Cricohyoidoepiglottopexy, 5 supraglottic laryngectomies). The results with regard to the amount of time that nasogastric feeding as well as tracheal tube are kept and the length of the hospital stay, were compared to those ones of a similar number of consecutive cases operated at our institution (ENT Department of Modena University) before February 1990 but not rehabilitated. In the early rehabilitated group, we observe a quicker functional recovery with a shorter hospital stay (about a week).

Muscarinic and gamma-aminobutyric acid-ergic receptor changes during vestibular compensation. A quantitative autoradiographic study of the vestibular nuclei complex in the rat.

Involvement of the neurotransmitters acetyl choline and gamma-aminobutyric acid (GABA) in vestibular compensation has been suggested by electrophysiological and pharmacological experiments. In this investigation we used quantitative autoradiography to study the modification of muscarinic and benzodiazepine receptors in each nucleus of the rat's vestibular nucleus complex. Tissues were examined 3, 14, 23 h and 3, 12, 37 and 90 days after unilateral surgical labyrinthectomies. The present results demonstrated a muscarinic receptor supersensitivity in the deafferented side in the superior vestibular nucleus 90 days after surgery. This increase was not large enough to support the cholinergic receptor supersensitivity hypothesis for vestibular compensation. The changes in the benzodiazepine receptors observed for a short time following surgery were reversed after a few days. These findings support a transient involvement of GABAergic pathways in vestibular compensation.

Turbinoplasty: personal technique and long-term results.

An original conservative technique for surgical reduction of the inferior turbinates, called turbinoplasty, is described. We analyzed, in 308 cases, the functional objective and subjective outcome of turbinoplasty itself and in comparison with more destructive procedures called turbinotomies. The results show that both procedures (in skilled hands!) are good. Turbinoplasty is in any case a quick, safe, efficacious operation, well-accepted by the patient, and should therefore be considered one of the first choices.

Pupillary pharmacologic test in Ménière's disease: a useful method for routine diagnosis.

The role of the parasympathetic system in Ménière's disease was investigated by a pupillary pharmacologic test (methacholine test), using a computed infrared pupillograph. The test was performed in Ménière's disease (16 cases), other vertiginous disorders (23 cases) and normal subjects (10 cases). The results confirmed the presence, during the attack stage of Ménière's disease in 75% of cases, of an abnormal sensitivity of the iris musculature to methacholine, prevalent on the affected side, and an increasing pupillary asymmetry. These features were found in 17% of the patients with other vertiginous disorders and in none of the control subjects. The parasympathetic dysfunction is interpreted as a supersensitivity of central origin and seems directly related to the disease. It is proposed that the methacholine test acts as a complement to the glycerol test in the diagnosis of Ménière's disease.