Small acoustic neuromas: monitoring the growth rate by MRI.

In a proportion of small acoustic neuroma patients, monitoring with magnetic resonance imaging shows no volumetric increase of tumour size over the years. The object of the study was to identify some indications for the clinical choice between immediate surgery (with the related risks) and watchful waiting. We performed a retrospective study of 47 non-surgically-treated patients affected by acoustic neuroma and monitored by gadolinium-enhanced MRI between January 1990 and February 1999. Six clinical variables (tumour size, sex, age, initial symptoms, ABR pattern and duration of the symptoms) were examined by univariate analysis. Chi-square test and variance analysis were performed to evaluate the statistical significance. In 30/47 (63.8%) cases, no growth was observed during the entire period of follow-up. In the remaining 17/47 (36.2%) patients, a volumetric increase was detected, most often within the first year of observation. The clinical factors examined did not significantly correlate with growth. Despite the relatively short period of observation, we believe that immediate surgery does not need to be considered mandatory for small acoustic neuromas, even in young patients. However the irregular behaviour of the tumour underlines the importance of monitoring with MRI at least once a year.

[Acute epiglottitis in adults: a rare cause of acute respiratory insufficiency]. / L'epiglottite acuta nell'adulto: una rara causa di insufficienza respiratoria acuta.

Acute epiglottitis is an infective disease which may have a rapid and aggressive course to total upper airway obstruction. Due to its rarity (mostly in adults) and aspecific initial clinical features, it may present diagnostic problems to less experienced medical personnel. This is the principal reason why the mortality rate is still unacceptably high. Indirect or direct laryngoscopy is mandatory for diagnosis: as this might be difficult for non-specialist physicians, their awareness of the potentially severe consequences of epiglottic infections is fundamental to minimizing diagnostic delay. In fact, early involvement of experienced ENT and anaesthesiological staff is essential for diagnosis, which must be as prompt as possible and followed by thorough clinical monitoring to avoid fatal outcome.

The problem of the sensorineural component in otosclerotic hearing loss: a comparison between operated and non-operated ears.

The behaviour of bone conduction audiograms in the operated and non-operated ears of 200 otosclerotic patients was analysed. The majority (84%) of both operated and unoperated ears showed virtually unchanged bone conduction thresholds throughout the follow-up period (mean follow-up period = 13.4 +/- 5.3 years). Slight but statistically significant bone conduction deterioration was observed in the remaining 16% of cases, most frequently in the non-operated ears. However, this deterioration was generally within the usually accepted limits of the Carhart effect, and does not demonstrate the presence of any causative factor other than evolution of the ostosclerotic disease. Our findings do not support the hypothesis that total stapedectomy per se may be responsible for sensorineural deterioration.

[Effectiveness of and tolerance to azithromycin versus roxithromycin in the treatment of patients with acute infections of the upper respiratory tract]. / Studio sull'efficacia e la tollerabilità dell'azitromicina vs roxitromicina nel trattamento di pazienti con infezioni acute delle alte vie respiratorie.

A multicenter open prospective comparative study was carried out during two years enrolling 60 patients with upper respiratory infections. Thirty were treated with single daily 500 mg doses of azithromycin for three days, and 30 received two daily doses of roxithromycin of 150 mg each for seven days. Both treatments were equally well tolerated, and there was no substantial difference concerning clinical recovery. However, azithromycin treatment was more practical and of shorter duration.

[Perennial allergic rhinitis. Prophylaxis of acute episodes using thymomodulin]. / Rinopatia allergica perenne. Profilassi degli episodi acuti mediante l'impiego di timomodulina.

The therapeutical effectiveness of a calf thymic derivative (thymomodulin), orally administrable, in patients suffering from perennial allergic rhinitis is described. The use of thymomodulin for 4 months at the dosage of 120 mg daily in 20 patients significantly reduced (p less than 0.001), if compared with the previous year, the monthly mean frequency of allergic episodes. Also objective symptoms improved (p less than 0.05). The clinical course was associated with the normalization of IgE plasmatic levels (p less than 0.001) and consequently the mean of RAST and PRICK tests scores decreased (p less than 0.001). Eosinophil count was significantly reduced (p less than 0.001), while IgG serum levels were increased (p less than 0.02).

Investigations into vestibular evoked responses.

Acceleratory stimulations reproducing the characteristics of the physiological head rotation movement--a rotation by 90 degrees from the centre to the lateral position, or vice-versa, within a time space of 0.6-1 s--have been applied. Evoked responses were obtained from 34 normal individuals, the characteristics of which may be considered as sufficient proof of their essentially vestibular origin. No response was recorded in patients whose vestibular function was completely lost, bilaterally. A consistently reduced response has been observed in patients with unilateral complete loss of the vestibular function.

Anti-EBV antibody titers in Italian patients with nasopharyngeal carcinoma.

In September 1983 we started the serological examination of all patients with a nasopharyngeal carcinoma (NPC) to evaluate whether the association between NPC and EBV is present even in Italy. At present we have data from 60 patients. This paper confirms the presence of the antibodies to EBV in 75% of Italian NPC patients with a significant difference in respect to control groups. Thus, we consider this serological test as a good marker for NPC and especially useful in cases presenting a difficult diagnosis. In our brief experience it seems that the same test is not so useful to indicate healing, stationariness, or the initial relapse of the tumor.

Some experiments on temporary threshold shifts produced by short tones.

TTSs produced by short (500-1000 msec) pure frequency (2000, 3000, 4000 c.p.s.) tones on normal young subjects show, under comparable conditions, the same essential characteristics as TTSs which follow longer stimulations. In particular, they show a tendency to a displacement of their maximal values, as soon as the stimulating tone is presented at adequately high (100 dB SPL) intensity levels, towards a frequency about a halfoctave higher than that of the stimulating tone. In our experiments, however, this tendency was more clearly and constantly demonstrable following stimulations with 3000 c.p.s. tones. Significant individual variations in quantitative aspects of the TTSs have been observed. It is suggested that the use of short tones may be easier and more applicable in practice in investigations concerning the after effects of acoustical stimulation and possible also in procedures aimed at obtaining a better understanding of the significance of individual variations in the behaviour of the receptor organ upon exposure to high intensity stimulations.