An unusual foreign body in the upper aerodigestive tract: esophageal obstruction due to bran impaction.

Foreign bodies of the upper aerodigestive tract are common problems encountered by the otolaryngologist and general surgeons. While the diagnosis seems straightforward, it is sometimes delayed until after serious complications have occurred. The treatment of choice is endoscopic retrieval under general anesthesia. The procedure should be preceded by the completion of appropriate studies (radiographic and other specifically indicated for the patient) planned and performed by the endoscopy team. Time invested in preparation and planning will usually yield a speedy recovery of the patient. Bran is a natural fiber that undergoes considerable expansion and thickening when hydrated. Due to this property, it has been used in "weight loss" tablets that in the stomach undergo expansion and are expected to cause early satiety. These tablets are usually marketed as over-the-counter (OTC) diet products by a number of pharmaceutical manufacturers. These supplements consisting primarily of dietary fibers, so common and inoffensive-seeming, rarely may have severe side effects, such a sudden esophageal obstruction. We report a case of a bran dietary product impacted in the cervical esophagus in a 45 year old woman, presenting as an emergency complaining of retrosternal discomfort and difficult to swallow or drink. The technique for removal of such object that is also reported.

[Nutritional problems in the surgical patients with head and neck tumours. Literature review and personal experience]. / Problematiche nutrizionali nei pazienti chirurgici con patolo- gie oncologiche del distretto cervico-cefalico. Revisione della letteratura alla luce dell'esperienza professionale.

During the last years the importance of the correct nutritional assessment as a part of the therapeutic process of the human pathologies has a greatly increased relevance. Still more in oncology, such relationship among nutritional assessment and good result of the therapeutic treatment have a fundamental importance. Among the neoplastic diseases those of the head and the neck result to be particularly aggressive, both for their nature and for the particular anatomical organization of such body areas, and the affected patients also need a precise evaluation of the nutritional assessment to obtain an optimal therapeutic result. On the basis of such premises and to their own clinical experience, the authors describe the main nutritional problems of the patients with tumours of the head and the neck and the possible therapeutic solutions.

Major salivary gland diseases. Multicentre study.

This multicentre study involved 28 Italian ORL Centres responding to a questionnaire sent by us which allowed recruitment of a high large number of cases of parotid neoplasms observed over a 10-year period. Statistical data obtained partly confirmed previous findings. Benign tumours account for 80% of case histories with a relationship 1:4 M/F, the most frequent being pleomorphic adenoma (57.3% of cases), followed by Warthin's tumour (32.4%), this rating not having been confirmed in case histories (8-10%) in the literature. Malignant tumours instead were fewer in number compared to the literature (14% vs 25-30%); the most frequent being mucoepidermoid carcinoma (18.2%) of which 44% G1, 33% G2 and 23% G3. Adenoid-cystic carcinoma was observed in 15.3% and < or = 10% for all the other most frequent histological malignant neoplasms. Diagnostic work-up included echotomography and fine-needle aspiration biopsy, less used imaging techniques were computed tomography, magnetic resonance imaging, Sialo-computed tomography. During this multicentre investigation more widespread use of imaging techniques has, however, been observed. The greater use of ecotomography and of fine-needle aspiration biopsy was due to simplicity of application and low cost offering good sensitivity and specificity. Surgical treatment of benign tumours consisted, in 50% of cases, in superficial paroditectomy and in approximately 30% of total paroditectomy. Enucleoresection was limited to approximately 15% of neoplasms, enucleation to <10% of cases with only 2% of pleomorph adenoma due to the well-known anatomo-pathological characteristics which may lead to relapse. For malignant neoplasms, total parotidectomy was performed in approximately 50% of cases, while in the remaining 50% an almost equal rate of superficial parotidectomy was carried out and enlarged parotidectomy, with or without sacrificing the facial nerve, which was rebuilt in 60% of cases. The lateral neck dissection most frequently carried out was of functional type in 54% and selective type in 46% with removal of levels I-III and II-IV in approximately 60% of cases. Sentinel lymph node was observed in a limited number of centres. When no clinically evident lymph nodes were present (NO) considering the tumour histotype, two thirds of patients underwent surgery or radiotherapy, while in the remainder the wait-and-see attitude was prefered. Post-operative-complementary radiotherapy was very frequently performed instead of chemotherapy. Oncological results obtained were compared with those reported in the literature: in fact for all benign neoplasms relapse ratings are about 5%, while for malignant tumours the worst prognosis was in squamous cell carcinoma with median of 37.7 on survival and metastasis rate of 16.5%. Finally, mucoepidermoid carcinoma tumours showed best survival, followed by adenoid-cystic carcinoma with ranges, respectively, 83 and 81.

[Objective evaluation of dysphonia. Possibilities and limitations]. / La valutazione obiettiva della disfonia. Possibilità e limiti.

Today clinical evaluation of the presence and extent of dysphonia is still essentially based on subjective-perceptive criteria. The lack of objectivity and the one-sidedness of such an approach reinforces the desire for a quantitative, objective determination of dysphonia which could aid in making an modern, unequivocal evaluation of the presence, extent and variations in time of this disorder both upon onset and after treatment. The purpose of the present research was to determine the reliability, possibilities and limitations of an objective, parametric procedure to evaluate both the normal and pathological voice. This procedure is based on the detection of the relationship between the noise and harmonic portions in the voice (the Yumoto H/N ratio). The study involved a group of 208 subjects (148 with dysphonia and 60 normal) and the procedure was applied using computerized digital sonography and dedicated algorithms. The results of this research showed that the vocal analysis procedure developed by Yumoto is not only simple but also highly sensitive, providing an objective study of dysphonia. In fact, the comparison between the average H/N ratio recorded in our patients (1.697 dB) is significantly different from that recorded in the normal subjects (11.169 dB) (p < 0.001). This also showed a clear discrimination between the two groups with no borderline or overlapping data found. The initial evaluation does not appear to establish a relationship between abnormal H/N ratio values and the type of pathology although greater morphological destruction of the vocal cords corresponds to worse vocal quality and therefore increased noise. For the data obtained to be valid, a necessary condition is the application of a strict, precise, correct sampling and analysis method following well-defined rules. Finally, the values obtained can serve as a basis for the construction of an objective instrumental voice measurement protocol that can be used in forensic evaluation of dysphonia. Standardization of the regulations is essential to such a project.

[Carcinoma of unknown origin++ with latero-cervical metastasis. Diagnostic problems. Retrospective analysis of 110 cases of latero-cervical tumefaction]. / Carcinoma occulto con metastasi latero-cervicali. Problematiche diagnostiche. Analisi retrospettiva su 110 casi di tumefazioni latero-cervicali.

The cervical region, despite to its little extension, is very important by the surgical and anatomical point of view. This region, occupied by a lot of organs, sometimes is the site of metastasis from carcinomas located in various parts of the body. In some cases the origin site of cancer stays unknown. The aim of this paper is the retrospective analysis of 110 cases of latero cervical swellings and the related problems of differential diagnosis.

[Virtual reality: a simple joke or therapeutic instrument?]. / La realtà virtuale: semplice gioco o strumento terapeutico?

Virtual reality is a relatively new application for rehabilitative neurology, and achieve many successes in assessment and treatment of CNS damages. The Authors describe a prototype computer simulation for virtual environment reconstruction to assess the fundamental living skills of every day dedicated to persons in which CNS injury was occurred.