[Perforations of nasal septum: surgical considerations]. / Le perforazioni del setto nasale: considerazioni chirurgiche.

Perforations of the nasal septum vex both patients and physicians. A variety of methods have been devised to close septal perforations although none has gained universal acceptance. The following report presents a new approach for closing septal perforations using a modification of the Fairbanks technique. The "open" approach is performed as it provides easier access. A supporting graft is only used in the temporalis fascia, not in the cranial periosteum. Furthermore, the graft is sutured only on one side of the septum. Forty patients were treated with this technique and good results were obtained with small and mid-sized perforations (respectively 80% and 83%). In cases of large perforations the results were good enough (37.5%) to warrant recommendation of this technique.

Angioneurosis in Menière's disease.

The main aim of this paper was to analyse whether labyrinthic angioneurosis, Menière's disease, can be provoked by immunity reaction at labyrinth level. The Menière's disease immunologic thesis dates back to the 1920's when Duke supposed an allergic origin for Menière's disease. Actually, this allergy could show local autonomic nervous system disturbances. This would be cholinergic and as a consequence, it would involve vascular elements of the inner ear. In any case, one should not forget that it has been found out that some patients suffering from Menière's disease have showed hypersensitivity to inhalants and food. A new theory has recently drawn scientists' attention. It states that atopic hypersensitivity cannot be mediated just from an immunologic point of view. Therefore, labyrinthic angioneurosis is not to be considered as immunomediated allergy but as a sort of altered reactivity of autonomic activities, to chemical mediators. These mediators can be released thanks to various stimulations: mental, physical, chemical and infective. We think that in some cases labyrinthic angioneurosis is not to be ascribed to labyrinth immune reaction which is immunomediated but this disease must be analysed from a chemical neuromediation point of view.

Modifications of the nasal cycle in patients with hypothalamic disorders: Kallmann's syndrome.

The nasal cycle is a phenomenon characterized by cyclic changes in the airflow resistance of each nasal fossa from congestion or constriction of the nasal erectile tissue. This phenomenon is caused by alterations in the influence exerted by the autonomic nervous system and is believed to be regulated by a hypothalamic center. In order to verify this hypothesis on the hypothalamic regulation of the nasal cycle, the authors studied a group of subjects with Kallmann's syndrome. This disorder is characterized by coexisting hypothalamic hypogonadism and hyposmia or anosmia due to hypothalamic and olfactory center hypoplasia. An anomalous nasal cycle was found in all the subjects with Kallmann's syndrome. This disorder might be related to hypothalamus atrophy.

Use of serum markers in the diagnosis and management of laryngeal cancer.

Many neoplastic diseases are reported to be accompanied by the presence or associated with an increase in biological substances identified as tumour markers. The most common markers implicated in head and neck cancers are CEA, TPA, LASA, SCC, CA 19-9, and ferritin. These markers (except SCC) were evaluated in 50 patients with a laryngeal carcinoma, in 20 patients with benign lesions, and in 20 healthy subjects. The results show for each marker assayed the following sensitivity values (true positives): CEA, 10%; CA 19-9, 30%; TPA, 30%; LASA, 90%; ferritin, 60%. Specificity (true negatives) was as follows: CEA, 85%; CA 19-9, 99.4%; TPA, 98%; LASA, 99.8%; ferritin, 97%. LASA and ferritin seem to be the most suitable markers for patient monitoring because of their higher sensitivity in all phases of cancer disease.

[Tiaprofenic acid: levels in plasma and upper airway tissues]. / Acido tiaprofenico: livelli plasmatici e tissutali nelle vie aeree superiori.

Inflammatory processes of the upper airways can be successfully improved by using non steroid anti-inflammatory drugs, alone or in association with antibiotics. Recent clinical reports suggest that tiaprofenic acid (TA) is particularly suited for this purpose. This fact can be explained on the basis of the drug's pharmacokinetics and by the high concentration TA can achieve in the respiratory tract mucous membranes. In order to confirm this hypothesis TA levels were studied in the plasma as well as in tonsillar and turbinal tissue. Patients admitted for tonsillectomy or turbinectomy were given two tablets (600 mg) of TA from one and a half to five hours before surgery. In all cases blood and tissue samples were taken at the same time during surgery and drug levels determined by HPLC. Plasma levels ranged from 12 to 26 to 32.2 microgram/ml; tissue levels ranged from 3.9 to 5.4 to 4.9 micrograms/g, respectively, depending on time of administration. There was no significant difference between tonsillar and turbinal tissue. These results suggest a good penetration of nasal and airway mucosa by TA and are in agreement with the clinical data on the efficacy of TA in dealing with upper airway inflammatory conditions.

Neurofibroma of vocal cord: case report.

A case of neurofibroma of the vocal cord is presented. Such an occurrence is quite rare, because of the unusual involvement site and because the lesion was not related to Von Recklinghausen disease. The pertinent literature is reviewed.

Concentrations of flurithromycin in serum and tonsils.

The concentrations of flurithromycin in serum and palatine tonsils of eleven adult male patients undergoing tonsillectomy were determined. Each patient received 500 mg t.i.d., in all ten doses, before tonsillectomy. Flurithromycin concentrations were measured by a microbiological method. Mean serum levels (+/- SE) were 0.72 microgram/ml (+/- 0.19) after 8 h from the 9th dose and 0.67 microgram/ml (+/- 0.13) after 4 h from the 10th dose. Average concentrations (+/- SE) in tonsils were: 1.43 +/- 0.20 microgram/g (right) and 1.32 +/- 0.21 (left) 4 h after the last administration. Therefore, the mean tissue/serum ratio was about 2:1. These results indicate a good diffusion of flurithromycin from serum to tonsillar tissue.

[A study using laser-Doppler velocimetry of modifications of the labyrinthine microcirculation induced by chemical and physical stimuli]. / Etude par vélocimétrie au laser-Doppler des modifications de la microcirculation labyrinthique induites par des stimuli chimiques et physiques.

Vasomotor activity induced by physical and chemical stimuli in the cochlear microcirculation was evaluated by laser-doppler flowmetry. Cochlear flow changes were studied after pharmacological administration and noise exposure. The reaction of cochlear microcirculation after drug administration is similar to that observed in the brain. After phenylephrine injection the authors observed an increase of cochlear blood flow, contrary to that observed in the peripheral vessels. The authors studied the difference in time-activity and quantitative effect of several drugs commonly used in cochlear vascular diseases. Cochlear flow decrease after exposure to noise is proportional to the stimulus intensity and the exposure time.

Presence of phospholipidic lamellar bodies on the mucosa of rabbit eustachian tube. Ultrastructural aspects.

Electron microscopy of the rabbit eustachian tube showed the presence of osmiophilic lamellar bodies in the cytoplasm of secretory cells and of osmiophilic free lamellar membranes in the lumen of tubal glands or above the epithelium. Similar structures have been reported in other parts of the respiratory system and in the pulmonary alveoli. The functional significance of these morphological observations is suggestive of a surface-tension-lowering effect on the mucosal lining layer of the eustachian tube and of a possible relationship to the phospholipid surfactant of the lung.

Bacterial adherence and upper respiratory tract disease: a correlation between S. pyogenes attachment and recurrent throat infections.

The attachment of bacteria to mucosal surfaces is the initial event in the pathogenesis of infectious diseases. The authors present a study about the adherence of strain of S. pyogenes isolated in subjects with recurrent tonsillitis. A correlation was found between the adherence ability of the bacterium and the number of episodes per year. The study about the SIgA, the infection development and the bacterium adherence showed a direct correlation between SIgA levels and the number of phlogistic episodes. The importance of the role assumed by bacterial adherence in the genesis of the phlogistic process is to be emphasized yet again.

[Determination of sialic acid in cancer of the upper aero-digestive tract]. / Le dosage de l'acide sialique (LSA) dans les cancers des voies aéro-digestives supérieures.

The determination of serum lipid sialic acid (LSA) in subjects with laryngeal and oral cavity carcinomas demonstrated an important correlation between the presence of carcinoma and tumor marker elevation. 90% of positivity has been found in 60 cases of laryngeal carcinoma; 100%, on the contrary in 19 cases of oral cavity. The authors affirm the importance of LSA as a tumor marker, in particularly in monitoring patients submitted to surgical excision.