Cancer costs and gender: a snapshot of issues, trends, and opportunities to reduce inequities using Australia as an example.

As the cancer burden increases, so too does the cost, to health systems, economies, and individuals. There is increasing interest in productivity and out-of-pocket costs for individuals and their carers, but these remain poorly understood. The costs of cancer in women, often carers themselves, are less understood. This summary analysis explored data on the cancer burden in Australia (and health costs in comparable countries), including expenditure reports and literature on macroeconomic outcomes and out-of-pocket costs, to highlight the cost impacts of a cancer diagnosis in women, at a societal and an individual level. Data on productivity costs were skewed toward men, as men are over-represented in paid work compared with women. Data on societal and individual costs of cancer in women were scant, yet the predominance of women in unpaid work suggests the cost is significant. Evidence for the benefits of cancer prevention and early detection suggests that improved targeting of interventions to women would reduce costs at a societal and an individual level. More research is needed on the specific impacts of cancer on women and those they care for, to better target public health and support services to need.

Correction: Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors.

Correction for 'Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors' by S. Teracciano et al., Chem. Commun., 2016, 52, 12857-12860.

Identification of the key structural elements of a dihydropyrimidinone core driving toward more potent Hsp90 C-terminal inhibitors.

Hsp90 C-terminal modulation represents an attractive strategy for the development of potent and safer antitumor compounds. Continuing our investigation on DHPM type inhibitors here we report a new set of potent C-terminal ligands which allowed us to identify the key structural features crucial for the biological activity.

Direction-fixed paroxysmal nystagmus lateral canal benign paroxysmal positioning vertigo (BPPV): another form of lateral canalolithiasis.

Benign paroxysmal positioning vertigo (BPPV) is the most frequent vertiginous syndrome. It is caused either by free-floating otoliths in the semicircular canals (canalolithiasis) or by otoconial debris adhering to a canal cupula (cupulolithiasis). The posterior canal is the most frequently involved (80%), while the lateral canal is involved less frequently (15%), and the rarest conditions are anterior canalolithiasis and apogeotropic posterior canalolithiasis (5%). The main diagnostic sign of lateral canal BPPV is paroxysmal horizontal bidirectional positioning nystagmus evoked through Pagnini-McClure's test (head roll in the yaw plane in supine position). In the geotropic variant, which is more frequent, the fast phase of the nystagmus is directed towards the lowermost ear, when the patient lies on the affected side or on the healthy side; in the apogeotropic variant, which is less frequent, the fast phase is directed always toward the uppermost ear, regardless of which side the patient lies on. Paroxysmal nystagmus is more intense on the affected side in the geotropic form, and more intense on the healthy side in the apogeotropic form. The authors describe five cases of another primitive and rare form of lateral BPPV, defined as "direction-fixed paroxysmal nystagmus lateral canal BPPV", which has previously been described by other authors as a transitory step observed during the transformation from an apogeotropic into a geotropic form. It is characterized by typical BPPV symptoms and diagnosed by the presence of a paroxysmal horizontal unidirectional positioning nystagmus, evoked through Pagnini-McClure's test, which is apogeotropic on the affected side and geotropic on the healthy side. In the reported cases, direction-fixed horizontal paroxysmal nystagmus was always transformed into a typical geotropic form. The clinical features and pathophysiology of direction-fixed nystagmus lateral canal BPPV are discussed.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

AIM: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. METHODS: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. RESULTS: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. CONCLUSION: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis

Objetivo. Comparar la contribución de la adquisición con 18F-FDG-PET/TC a 180 min con la de 60 min en sospecha de vasculitis de grandes vasos (VGV). Material y métodos. Este estudio prospectivo incluyó 23 pacientes. El estudio PET/TC fue adquirido a 60 y 180 min (precoz y tardío) tras la administración de 18F-FDG. Se realizó un análisis visual de las imágenes valorando los troncos supraaórticos (TSA), la aorta torácica (AT), la abdominal (AA), las arterias ilíacas (AI) y las femoro/tibioperoneas (AFT). En las 115 regiones vasculares se evaluó la intensidad (0-3) y el patrón de captación (difuso/lineal). Resultados. En 20/115 regiones vasculares (17,4%) no hubo captación en la adquisición precoz y tardía. De las 95 regiones (82,6%) con captación en la adquisición precoz la intensidad no cambió en la tardía en 46 y cambió en 49. De esas 49 regiones en las que la intensidad cambió, esta disminuyó en 36 y aumentó en 13 (AT: 8, TSA: 5). En ningún caso la intensidad aumentó en la AA, las AI y las AFT. El patrón de captación en la AT fue difuso en la adquisición precoz en 16 pacientes, en 7 de ellos cambió a lineal en la tardía y desapareció en 9. El patrón precoz fue lineal en 7 pacientes, 6 de ellos mostraron un aumento de intensidad en la tardía y en uno permaneció igual. Conclusión. La adquisición tardía de 180 min con FDG-PET/TC proporciona una más detallada visualización de la pared vascular, mostrando la desaparición de la actividad del pool vascular y contribuyendo a un más correcto diagnóstico de VGV(AU)

Purpose. To compare the contribution of the 18F-FDG-PET/CT acquisition at 180 min and at 60 min in suspicion of large vessel vasculitis (LVV). Material and methods. A prospective study including 23 patients was performed. PET/CT was acquired at 60 and 180 min (early and delayed scan) after 18F-FDG injection. A visual analysis was performed at the supra-aortic trunks (SAT), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA) and femoral/tibioperoneal arteries (FTA). Intensity (0–3) and uptake pattern (diffuse/linear) were assessed in the 115 vascular regions. Results. There was no FDG uptake in the early and delayed acquisition in 20/115 vascular regions (17.4%). Of the 95 regions (82.6%) showing FDG uptake at the early, delayed or both acquisitions, intensity did not change in the delayed acquisition in 46 and changed in 49. Of the 49 regions in which the intensity changed, it decreased in 36 and increased in 13 (TA:8, SAT:5). AA, IA and FTA intensity did not increase in any of the cases. Uptake pattern at the TA in the early acquisition was diffuse in 16 patients. In 7, it changed to linear and in 9 the uptake disappeared. The early pattern was linear in 7 patients and 6 of them showed increased intensity in the delayed acquisition and in 1 remained the same. Conclusion. The 180 min delayed FDG-PET/CT acquisition provides a more detailed visualized of the vessel wall, showing the washout of the blood pool activity. Therefore, it may contribute to a more accurate diagnosis of LVVAU)(AU)

Comparison of early (60 min) and delayed (180 min) acquisition of 18F-FDG PET/CT in large vessel vasculitis.

PURPOSE: To compare the contribution of the (18)F-FDG-PET/CT acquisition at 180 min and at 60 min in suspicion of large vessel vasculitis (LVV). MATERIAL AND METHODS: A prospective study including 23 patients was performed. PET/CT was acquired at 60 and 180 min (early and delayed scan) after (18)F-FDG injection. A visual analysis was performed at the supra-aortic trunks (SAT), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA) and femoral/tibioperoneal arteries (FTA). Intensity (0-3) and uptake pattern (diffuse/linear) were assessed in the 115 vascular regions. RESULTS: There was no FDG uptake in the early and delayed acquisition in 20/115 vascular regions (17.4%). Of the 95 regions (82.6%) showing FDG uptake at the early, delayed or both acquisitions, intensity did not change in the delayed acquisition in 46 and changed in 49. Of the 49 regions in which the intensity changed, it decreased in 36 and increased in 13 (TA:8, SAT:5). AA, IA and FTA intensity did not increase in any of the cases. Uptake pattern at the TA in the early acquisition was diffuse in 16 patients. In 7, it changed to linear and in 9 the uptake disappeared. The early pattern was linear in 7 patients and 6 of them showed increased intensity in the delayed acquisition and in 1 remained the same. CONCLUSION: The 180 min delayed FDG-PET/CT acquisition provides a more detailed visualized of the vessel wall, showing the washout of the blood pool activity. Therefore, it may contribute to a more accurate diagnosis of LVV.

Evaluation of the contribution of the dynamic phase of lymphoscintigraphy to the detection of sentinel lymph node in breast cancer.

Aim: The aim of this study was to evaluate the contribution of an early dynamic phase (DP) of the lymphoscintigraphy (LS) to the detection of the sentinel lymph node (SLN) in breast cancer. Methods: This prospective study included 164 breast lesions in 161 consecutive patients (160 women, mean age 57.5 years). Patients with tumor >5 cm, multicentric, palpable nodes, axillary involvement, previous surgery, lymphadenectomy, radio or chemotherapy were not included. All patients underwent preoperative LS before surgery. DP immediately after injection of [99mTc]Nanocolloid followed by early and delayed planar images (EPI and DPI) were acquired. Results: SLN was detected in 162/164 lesions (98.8%). In 115 (71%) DP showed no lymph node uptake and the SLN was identified only by EPI and DPI. A focal uptake by at least one lymph node was observed in DP in the remaining 47 lesions (29%). Although in 30/74 lesions DP did not provide additional information to EPI and DPI, nevertheless in 17 cases (10.5%) DP was essential to identify correctly the SLN. Conclusion: We concluded that DP, by allowing a better interpretation of the lymphatic drainage pattern, provides unique information to distinguish the correct SLN from other lymph nodes and is recommended as the first part of LS.

Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification / Caracterizacion de la calcificacion del ateroma carotideo mediante 18F-fluoruro PET/TAC

Aim. To assess the calcification process of the carotid plaque by 18F-sodium fluoride PET/CT imaging. Material and methods. A prospectively designed study including 15 patients in whom an atheroma plaque was detected by contrast enhanced CT scan during a neurological work-up was performed. A total of 29 plaques, 19 asymptomatic and 10 symptomatic, were studied. An 18F-sodium fluoride PET/CT scan was acquired 180min after the i.v. injection of 370 MBq of 18F-sodium fluoride in all the patients. The images obtained were analyzed visually according to the intensity of the uptake. Results. All the plaques showed 18F-sodium fluoride uptake, regardless of the intensity. However, the plaques of the symptomatic group showed a level of 2 or greater intensity while the intensity in 6 of the 19 in the asymptomatic group was lower than 2. Conclusions. Although the study is limited by the small number of cases, the results show the feasibility of the technique to study the calcification of the atheroma using 18F-sodium fluoride and suggest an association between symptomatology and higher uptake of 18F-sodium fluoride. Thus, these results encourage us to continue this study, with the inclusion of a larger number of patients (AU)

Objetivo. Estudiar el proceso de calcificación de la placa de ateroma carotideo mediante 18F-fluoruro sódico PET/TAC. Material y métodos. Estudio prospectivo en 15 pacientes con ateromatosis carotidea detectada por angio-TAC durante su estudio neurológico. El total de placas de ateroma estudiadas fue de 29, 19 asintomáticas y 10 sintomáticas. En todos los pacientes se adquirió un estudio PET/TAC a los 180min De la administración intravenosa de 370 MBq de 18F-fluoruro sódico. Las imágenes se analizaron visualmente considerando la intensidad de captación. Resultados. Todas las placas captaron 18F-fluoruro sódico, con independencia de la intensidad. Sin embargo las placas del grupo sintomático mostraron una intensidad de 2 o mayor mientras que 6 de las 19 del grupo asintomático mostraron una intensidad inferior a 2. Conclusiones. Aunque el estudio está limitado por el pequeño número de casos, los resultados muestran la aplicabilidad de la técnica al estudio de la calcificación del ateroma con 18F-fluoruro sódico y sugieren una asociación entre la sintomatología y una mayor captación de 18F-fluoruro sódico. Por ello, estos resultados nos animan a continuar este estudio incluyendo un mayor número de pacientes (AU)

Contribution of 18F-sodium fluoride PET/CT to the study of the carotid atheroma calcification.

AIM: To assess the calcification process of the carotid plaque by (18)F-sodium fluoride PET/CT imaging. MATERIAL AND METHODS: A prospectively designed study including 15 patients in whom an atheroma plaque was detected by contrast enhanced CT scan during a neurological work-up was performed. A total of 29 plaques, 19 asymptomatic and 10 symptomatic, were studied. An (18)F-sodium fluoride PET/CT scan was acquired 180min after the i.v. injection of 370 MBq of (18)F-sodium fluoride in all the patients. The images obtained were analyzed visually according to the intensity of the uptake. RESULTS: All the plaques showed (18)F-sodium fluoride uptake, regardless of the intensity. However, the plaques of the symptomatic group showed a level of 2 or greater intensity while the intensity in 6 of the 19 in the asymptomatic group was lower than 2. CONCLUSIONS: Although the study is limited by the small number of cases, the results show the feasibility of the technique to study the calcification of the atheroma using (18)F-sodium fluoride and suggest an association between symptomatology and higher uptake of (18)F-sodium fluoride. Thus, these results encourage us to continue this study, with the inclusion of a larger number of patients.

Histochemical and morphometric analyses of the musculature of the forelimb of the subterranean rodent Ctenomys talarum (Octodontoidea).

Histochemical and morphometric analyses were performed to characterize the fibre-type composition of two forelimb muscles of the South American subterranean rodent Ctenomys talarum. The studied muscles were the triceps lateralis, an extensor of the elbow, and the teres major, a flexor of the shoulder. It was found that these muscles had an elevated proportion of fast oxidative-glycolytic (FOG) fibres, and lower proportions of slow oxidative (SO) and fast glycolytic (FG) fibres. This composition probably qualifies the teres major and triceps muscles to perform the sustained effort required in tunnelling excavation. The results were discussed considering published data on fibre-type composition of mammals having different modes of life and digging behaviour. We here suggest that C. talarum has the potential of generating forces linked to rapid, powerful movements during sustained periods by means of an elevated proportion of FOG fibres, together with osteological changes that result in a great mechanical advantage of the forelimb muscles.

Hyperventilation-induced nystagmus in a large series of vestibular patients.

The Hyperventilation Test is widely used in the "bed-side examination" of vestibular patients. It can either activate a latent nystagmus in central or peripheral vestibular diseases or it can interact with a spontaneous nystagmus, by reducing it or increasing it. Aims of this study were to determine the incidence, patterns and temporal characteristics of Hyperventilation-induced nystagmus in patients suffering from vestibular diseases, as well as its contribution to the differential diagnosis between vestibular neuritis and neuroma of the 8(th) cranial nerve, and its behaviour in some central vestibular diseases. The present study includes 1202 patients featuring, at vestibular examination, at least one sign of vestibular system disorders or patients diagnosed with a "Migraine-related vertigo" or "Chronic subjective dizziness". The overall incidence of Hyperventilation-induced nystagmus was 21.9%. It was detected more frequently in retrocochlear vestibular diseases rather than in end-organ vestibular diseases: 5.3% in Paroxysmal Positional Vertigo, 37.1% in Menière's disease, 37.6% in compensated vestibular neuritis, 77.2% in acute vestibular neuritis and 91.7% in neuroma of the 8(th) cranial nerve. In acute vestibular neuritis, three HVIN patterns were observed: Paretic pattern: temporary enhancement of the spontaneous nystagmus; Excitatory pattern: temporary inhibition of the spontaneous nystagmus; Strong excitatory pattern: temporary inversion of the spontaneous nystagmus. Excitatory patterns proved to be time-dependent in that they disappeared and were replaced by the paretic pattern over a period of maximum 18 days since the beginning of the disorder. In acoustic neuroma, Hyperventilation-induced nystagmus was frequently observed (91.7%), either in the form of an excitatory pattern (fast phases towards the affected site) or in the form of a paretic pattern (fast phases towards the healthy side). The direction of the nystagmus is only partially related to tumour size, whereas other mechanisms, such as demyelination or a break in nerve fibres, might have an important role in triggering the situation. Hyperventilation-induced nystagmus has frequently been detected in cases of demyelinating diseases and in cerebellar diseases: in multiple sclerosis, hyperventilation inhibits a central type of spontaneous nystagmus or evokes nystagmus in 75% of patients; in cerebellar diseases, hyperventilation evokes or enhances a central spontaneous nystagmus in 72.7% of patients. In conclusion the Hyperventilation Test can provide patterns of oculomotor responses that indicate a diagnostic investigation through cerebral magnetic resonance imaging enhanced by gadolinium, upon suspicion of neuroma of the 8(th) cranial nerve or of a central disease. In our opinion, however, Hyperventilation-induced nystagmus always needs to be viewed within the more general context of a complete examination of the vestibular and acoustic system.

Evaluación de la gammagrafía ósea y la 18F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón / Evaluation of bone scintigraphy and 18F-FDG PET/CT in bone metastases of lung cancer patients

Objetivo. Comparar los hallazgos de la gammagrafía ósea (GO) y la gammagrafía PET/TAC con FDG (FDG PET/TAC) en la detección de metástasis óseas en el cáncer de pulmón. Material y métodos. Se estudió a 32 pacientes con cáncer de pulmón que fueron sometidos a una GO y una FDG PET/TAC en un periodo de tiempo de 15,9±18,6 días. Los resultados de ambas técnicas se compararon con la histología, cuando estuvo disponible, con técnicas estructurales radiológicas y con el seguimiento clínico. En 30 pacientes se llegó a un diagnóstico definitivo de los hallazgos gammagráficos. En 2 pacientes no se obtuvo diagnóstico final. Resultados. La GO fue positiva en 25/30 pacientes (83,3%) y negativa en 5 pacientes. La FDG PET/TAC fue positiva en 21/30 pacientes (710%) y negativa en 9. La GO y la FDG PET/TAC fueron positivas en 19/30 pacientes (63,3%). En 6 de los 19, ambas técnicas mostraron igual número de lesiones óseas. En 10 de los 19, la FDG PET/TAC mostró mayor número de metástasis óseas que la GO. En 3 de los 19 pacientes la GO mostró más lesiones que la FDG PET/TAC. En 2/30 pacientes (6,6%), la GO fue normal y la FDG PET/TAC demostró lesiones óseas confirmadas como metástasis. En 6/30 pacientes (20%) la FDG PET/TAC fue negativa y la GO positiva. La GO y la FDG PET/TAC fueron normales en 3/30 pacientes (10%). Conclusión. En pacientes con cáncer de pulmón, la FDG PET/TAC detecta un mayor número de lesiones óseas metastásicas que la GO. Asimismo identifica metástasis óseas en GO negativas. En nuestra experiencia, cuando la GO fue positiva y la FDG PET/TAC negativa las lesiones observadas estuvieron en su mayoría relacionadas con procesos óseos degenerativos y fracturas. En la práctica clínica la FDG PET/TAC y la GO tienen un papel complementario en la valoración ósea de los pacientes con cáncer de pulmón(AU)

Objective. To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. Material and methods. We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. Results. BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). Conclusions. In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients(AU)

[Evaluation of bone scintigraphy and (18)F-FDG PET/CT in bone metastases of lung cancer patients]. / Evaluación de la gammagrafía ósea y la (18)F-FDG PET/TAC en las metástasis óseas del cáncer de pulmón.

OBJECTIVE: To compare the bone scintigraphy (BS) findings and PET/CT scintigraphy with FDG (FDG PET/CT) in the detection of bone metastases in lung cancer. MATERIAL AND METHODS: We studied 32 patients with lung cancer who underwent FDG PET/CT and BS in a period of 15.9±18.6 days. The results of both techniques were compared with the histology, where available, radiological structural techniques and the clinical follow-up. In 30 patients, a definitive diagnosis was reached with the scintigraphic findings. No final diagnosis was obtained in 2 patients. RESULTS: BS was positive in 25/30 patients (83.3%) and negative in 5 patients. FDG PET/CT was positive in 21/30 patients (70%) and negative in 9. The BS and the FDG PET/CT were positive in 19/30 patients (63.3%) for the detection of bone metastases. In 6/19, both techniques showed the same number of bone lesions. In 10/19, FDG PET/CT showed a greater number of bone metastases than BS. In 3/19 patients, BS showed more lesions than FDG PET/CT and in 2/30 patients (6.6%), the BS was normal and the FDG PET/CT showed bone lesions which were confirmed as metastasis. In 6/30 patients (20%), the FDG PET/CT was negative and the BS was positive. BS and FDG PET/CT scan were normal in 3/30 patients (10%). CONCLUSIONS: In patients with lung cancer, FDG PET/CT scan detected more metastatic bone lesions than BS. It also identified bone metastasis in negative BS. In our experience, when the BS was positive and the FDG PET/CT scan was negative, the lesions observed were mostly related with degenerative bone conditions and bone fractures. In the clinical practice, the FDG PET/CT and BS have a complementary role for the assessment of bone status in lung cancer patients.

"Secondary signs of lateralization" in apogeotropic lateral canalolithiasis.

The diagnosis of lateral canalolithiasis is based on the typical finding of the horizontal paroxysmal positional nystagmus induced by the Pagnini-Mc Clure manoeuvre. This technique usually identifies also the affected side, namely, the side where the paroxysmal nystagmus is more intense in geotropic forms and the side where the paroxysmal nystagmus is less intense in apogeotropic forms. However, this method is not always applicable since, especially in apogeotropic forms, the intensity of the nystagmus is not so distinctly different between the two sides. Further useful signs to identify the affected side have been described in the Literature: Pseudo-spontaneous nystagmus in the sitting position; Leaning and Bowing nystagmus; Null-point in the vertical plane; Sitting to supine positioning nystagmus; Null-point in the horizontal plane. They are fully explained at pathophysiological level by the mechanism of canalolithiasis, as they are caused by otoliths moving in the ampullopetal direction in the non-ampullary segment (geotropic canalolithiasis) of the lateral canal or in ampullofugal direction in the ampullary segment (apogeotropic canalolithiasis) of the lateral canal. In other words, the movement of otoliths determines excitatory or inhibitory endolymphatic flow that generates specific nystagmic eye-movements. Authors analyse the characteristics of these signs, that they define as "Secondary signs of lateralization", in 64 cases of apogeotropic lateral canalolithiasis. A decisive contribution of the "Secondary signs of lateralization" to diagnose the pathological side has been verified in 13 out of 64 cases, whereas, in all other cases, Pagnini-Mc Clure diagnostic manoeuvre proved successful in correctly identifying the affected side by itself. Among the "Secondary signs of lateralization", the Pseudo-spontaneous nystagmus in the sitting position and the Sitting to the supine positioning nystagmus were particularly useful, due to both their frequency and their easy detection, as they do not require additional manoeuvres besides those usually performed during health examination of a patient affected by lateral canalolithiasis. In conclusion, the Authors propose a decision-making algorithm to diagnose and treat lateral canalolithiasis based on the attempt to obtain as much information as possible for a correct diagnosis, with the least trouble and inconvenience for patients.

[Clinical study on 40 cases of inflammatory pathologies of upper respiratory and digestive tract treated by inhalatory crenotherapy]. / Studio clinico su 40 casi di fl ogosi delle alte vie aereo-digestive trattati con crenoterapia inalatoria.

OBJECTIVES: Authors present beneficial effects of crenotherapy on 40 patients suffering from inflammatory mucosal conditions of upper respiratory-digestive tract (URDT). MATERIALS AND METHODS: Our study was realized at the hydrothermal premises in Telese Terme (BN, Italy). Subjects selected for this study are 40 patients (22 males and 18 females) aged 20-68 years (mean 38.6 years) who suffered from catarrhal and inflammatory mucosal diseases of URDT. The patients, who are informed about the modalities of the study, undergo E.N.T. examination and nasal mucosal brushing for cytologic analysis before and after crenotherapy. RESULTS: At the end of the therapeutic course we observed a relevant improvement of clinical indicators and of mucociliary transport time in URDT. Moreover, a satisfactory control of local inflammation is highlighted by a rhinocytogram, performed after crenotherapy and showing an increase in plasma cells, a decrease in granulocytes and a normalization of mucous secretion (nasal mucosal histology). CONCLUSIONS: Our study shows that sulphurous waters are particularly effective in anti-catarrhal and anti-inflammatory therapy of URDT.