Postural control and risk of falling in bipodalic and monopodalic stabilometric tests of healthy subjects before, after visuo-proprioceptive vestibulo-postural rehabilitation and at 3 months thereafter: role of the proprioceptive system.

Nine healthy volunteers (6 males, 3 females), mean age 34.5 years (SD = 11.52), underwent a vestibulo-postural rehabilitation cycle with a visuo-proprioceptive-type stimulus. All subjects in the study group were evaluated by means of stabilometric bipodalic and monopodalic tests both before and immediately after treatment, and again 3 month thereafter. The Delos Postural Proprioceptive System®, DPPS (Delos, srl, Turin, Italy), was used in performing these stabilometric tests and in the rehabilitation exercises. The first aim of the study was to evaluate to what extent the functional level of the proprioceptive system was reliable, in healthy subjects, in the control of postural stability; the second was to demonstrate the possibility to increase this level by means of a novel visuo-proprioceptive feedback training; the last was to establish whether or not the increase achieved was permanent. The bipodalic test did not reveal any deficit in posture either before or after rehabilitation. The monopodalic test prior to treatment, with eyes closed, revealed, in 2/3 of the study group, evidence of the risk of falling, expressed as the precautional strategy (8.57 ± 6.18% SD). An increase in the proprioceptive activity, obtained in the subjects examined immediately after the visuo-proprioceptive vestibulo-postural rehabilitation, led, in the monopodalic test, with eyes closed, to a significant reduction in the risk of falling (with the precautional strategy equal to 1.09 ± 2.63% SD, p = 0.004). The monopodalic test, with eyes closed, 3 months after rehabilitation, demonstrated results not unlike those pre-treament with values, therefore, not more significant than those emerging from the pre-treatment test. Thus, from the above-mentioned data, it can be observed that, also in healthy subjects, there may be different levels of postural proprioceptive control related to a high risk of falling. These levels can be maintained constant for a certain period of time, until a significant reduction in the risk of falling is achieved, only if continuously stimulated by appropriate sensorial information.

[Primary tuberculosis of the middle ear: description of 2 cases and review of the literature]. / Tubercolosi primitiva dell'orecchio medio: descrizione di due casi e revisione della Letteratura.

Recently, a recrudescence of tuberculosis (TBC) as been found, even in Western world and in Italy, most likely in relation to the increase in immigration from developing countries and to the pathologies that cause immunodepression. The present paper reports two cases of primitive TBC of the middle ear, both coming under observation for facial paralysis. These cases highlight the clinical-therapeutic features of this disease, the difficulty in diagnosis and the need to include TBC in the differential diagnosis of phlogistic processes of the middle ear. The clinical-diagnostic features of presented cases focus attention on the consideration of TBC in the differential diagnosis of chronic otitis, particularly in presence of unusual symptoms, such as facial paralysis, and in case of otitis with rapid onset, unresponsive to conventional treatment. In one case, first examination of the ear showed normal tympanic membrane (absence of any tympanic perforation) and normal timpanometry; these facts steered diagnosis away from a middle ear phlogosis pathology. Both cases showed how radiological semeiology, CT and NMR are not enough to diagnose the nature of the disorder, particularly in case of cholesteatoma. Moreover, both patients were in good general conditions at the time of the examination, they didn't show history of previous immunodepression or other risk factors. The cases reported call attention to the aspecific characteristics of the onset of primitive tuberculous otitis media and difficulty in making a diagnosis. They underline the need for post-operative anti-tuberculous chemotherapy which provided a rapid and definitive resolution of infectious process.

[Mastoid osteomas: review of literature and presentation of 2 clinical cases]. / Gli osteomi della mastoide: revisione della letteratura e presentazione di due casi clinici.

The authors report two cases of mastoid osteoma in patients at the "S. Filippo Neri" Hospital in Rome, Italy. The literature on this topic is critically reviewed. This review includes the 48 cases between 1875 and 1955 reported by Kecht, as well as the 92 cases Probst reported in 1991 in a review running from 1861. The literature published since 1991 has presented eight cases which, when added to the two presented here and the 92 indicated by Probst, total 102 cases of mastoid osteoma. The most widely accepted theories on the etiopathogenesis of mastoid osteoma are presented. These include: embryogenesis, metaplasia, inflammation, and trauma. The conclusions underline the complications of this disorder which are mainly linked to osteoma growth, and the importance of the differential diagnosis with other mastoid lesions for which prognosis is poorer.

[Mucocele of sphenoid sinus: presentation of 3 cases]. / Il mucocele del seno sfenoidale: presentazione di tre casi clinici.

Sphenoidal mucoceles are equally distributed between males and females occur rarely and have an incidence of 1%. Their low incidence is certainly to be ascribed to their deep position with respect to the superior respiratory tract as well as to the characteristics of the mucosa coating of the sinus (where the scarce muciparous component does not cause drainage problems). During endocranial manifestation, it is important to make a differential diagnosis between tumors at the base of the skull and adenomas of the hypophysis. The most feasible etiopathogenetic hypotheses are insufficient drainage of the sinus, cystic degeneration of the ghiandolar epithelium, presence of embryonal remnants and previous surgery. The Authors report three cases of mucoceles located in the sphenoid, two of which with destruction of the sellar floor and upward invasion, one with posterior invasion and involvement of the clivus. Sphenoidal mucoceles generally tend to spread more frequently in an anterior-inferior fashion with invasion of the etmoid, the nasal fossae and the rhinopharynx. In some cases we observe upward invasion with destruction of the sellar floor, as in the first two patients. There may by an invasion in the orbital cavity when spreading occurs sideways. More rarely, the intermediate cranial fossa is invaded through the lateral wall and the posterior cranial fossa through the posterior wall. Therefore, it is evident that an early diagnosis is always desirable because it may spare the patient the neurological manifestations resulting from the evolution of the disease. The treatment for a sphenoidal mucocele is surgical. The Authors report a synthesis of the surgical techniques most frequently used by otorhinolaryngologist and neurosurgeons, and present a critical analysis of the cases presented.

[Rare manifestation of nasal polyposis in the Peutz-Jeghers syndrome]. / Rare manifestazioni della poliposi nasale nella sindrome di Peutz-Jeghers.

We are relating a case of the Peutz-Jeghers syndrome, a disease characterized by hamartomatous polyposis and by mucocutaneous melanic pigmentation, in a rare variant identified by the presence of nasal polyposis. At the objective E.N.T. examination, the patient's nasal fossae were completely obstructed by translucid masses of a polypoid appearance and, moreover, a melanic pigmentation of the cutis, of the perilabial mucosa and of the oral cavity was encountered. At the X-ray examination and, later, during the operation, also the right maxillary sinus appeared completely obstructed by polypoid masses. At the histologic examination, such polypoid neoformations were quite similar to common polyps of an inflammatory nature and, so, absolutely without any peculiar structural features. The nasal polyposis in patients suffering from the Peutz-Jeghers syndrome has been mentioned by Peutz since his first observation but it has been seldom described in the subsequent publications, even in relation to the presentation of rare causes to Congresses and Magazines of an exclusively gastroenterological interest, in which the main concern was that of identifying both the clinical and histological aspects of gastrointestinal hamartomatous polyposis and the correlation between the syndrome and the formation of malignant neoplasias in other organs to the prejudice of the secondary manifestations of the disease. Nevertheless, the nasal polyposis and, at any rate, the tendency to the formation of polyps in other districts (urinary tract, bronchi) are described among the less important features also in gastroenterological treatises of most recent publication. Clinical observations, even occasional, are completely missing in the E.N.T. ambit.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cholesteatoma of the Prussak's space. Diagnosis with computerized tomography]. / I colesteatomi della tasca di Prussak. Diagnosi con tomografia computerizzata.

Prussak's space localization represents the early stage of the cholesteatoma arising from the pars flaccida of the tympanic membrane. From Prussak's space the mass spreads to the antrum and to mastoid air cells. Its demonstration is infrequent probably due to the limited use of CT in inflammatory diseases of the middle ear. On CT scans, cholesteatomas present as small soft-tissue masses, and their growth is responsible for scutum and ossicular chain erosion. The mass may also spread posteriorly to the aditus and antrum, and involve tendons and ligaments, which is a different behavior than that of fluid collections or granulation tissue. The authors report 9 cases of Prussak's cholesteatoma evaluated by means of HRCT.