Carotidynia: new aspects of a controversial entity.

Idiopathic carotidynia or Fay syndrome is a little known pathology, which in the past was the subject of much controversy. Even though carotydinia was removed as a pathological entity from the second International Headache Society classification in 2004, recent reports seem to confirm that the disease demonstrates unusual radiological findings. The presence of a typical amorphous enhancing soft tissue surrounding the carotid artery by MRI, CT and ultrasonography in patients with carotidynia has reopened discussion on the hypothesis that carotidynia may represent a distinctive inflammatory process. The aetiology of carotidynia is unknown. We report a case of carotidynia that developed after an upper airway infection, wherein MR studies demonstrated typical enhanced tissue surrounding the common carotid artery in contiguity with pathological enhancement in laryngeal tissue.

Deep neck infection: a present-day complication. A retrospective review of 83 cases (1998-2001).

Deep neck infections are less and less frequent today than in the past. Nevertheless, their complications are often life-threatening. The present study reviews the experience of the Department of Otolaryngology and Head and Neck Surgery of Padua with deep neck infections during the period from 1998 to 2001. Eighty-three patients (55 males and 28 females) were retrospectively considered. The site of origin of deep neck infection was identified in 76 patients (91%). The most common cause was dental infection, occurring in 35 cases (42%). In 12 cases (14%) deep neck infection was a complication of oropharyngeal infection. The relatively high incidence of Peptostreptococcus sp, Streptococcus viridans, Streptococcus intermedius and constellatus isolation was consistent with the high rate of odontogenic cases. Surgery was advocated as the treatment for any infection of the deep neck spaces. The recent series has demonstrated that medical treatment did not seem to increase complication rates or mortality. Our tailored approach (medical or medical and surgical) based on clinical and radiological evidence was successful in 97% of the patients.

Radiological evidence of subclinical dysphagia in motor neuron disease.

Dysphagia in motor neuron disease (MND) may lead to dangerous complications such as cachexia and aspiration pneumonia. Functional evaluation of the oropharyngeal tract is crucial for identifying specific swallowing dysfunctions and planning appropriate rehabilitation. As part of a multidisciplinary study on the treatment of dysphagia in patients with neuromuscular diseases, 23 MND patients with different degrees of dysphagia underwent videofluoroscopy, videopharyngolaryngoscopy and pharyngo-oesophageal manometry. The results of the three instrumental investigations were analysed in order (1) to define the pattern of swallowing in MND patients complaining of dysphagia; (2) to evaluate whether subclinical abnormalities may be detected; and (3) to assess the role of videofluoroscopy, videopharyngolaryngoscopy and manometry in the evaluation of MND patients with deglutition problems. Correlations between the instrumental findings and clinical features (age of the patients, duration and severity of the disease, presence and degree of dysphagia) were also assessed. The results of our study showed that: (1) The oral phase of deglutition was compromised most often, followed by the pharyngeal phase. (2) In all patients without clinical evidence of dysphagia, subclinical videofluoroscopic alterations were present in a pattern similar to that found in the dysphagic group. (3) Videofluoroscopy was the most sensitive technique in identifying oropharyngeal alterations of swallowing. Impairment of the oral phase, abnormal pharyngo-oesophageal motility and incomplete relaxation of the upper oesophageal sphincter were the changes most sensitive in detecting dysphagia. Videofluoroscopy was also capable of detecting preclinical abnormalities in non-dysphagic patients who later developed dysphagia. Practical guidelines for the use of instrumental investigations in the assessment and management of dysphagia in MND patients are proposed.

Unusual nasal and orbital involvement of glioblastoma multiforme: a case report and review of the literature.

We describe a case of glioblastoma treated with chemoradiotherapy that spread to the dura mater with direct invasion of the skull base, protrusion into the homolateral nasal fossa, and penetrated of the frontal sinus, the orbital wall and the ethmoidal sinuses. Only eight cases of glioblastoma showing this development have been described in the literature; one of these, however, had a sarcomatous component which was absent in our case.

Tinnitus as a Presenting Symptom in Secondary Neuropathy: a Case Report.

The authors describe a case of neuropathy characterized by involvement of most of the right cranial nerves, the initial symptom of which was tinnitus. The most likely etiopathogenetic hypothesis seems to be the paraneoplastic syndrome in which a primitive neurogenic axon lesion is more likely, although a myelinopathic lesion cannot be ruled out. It is feasible to suggest that the tinnitus was caused by a central neuron demyelination associated with concomitant peripheral nervous system involvement. Observation of present case allows the authors to point out that tinnitus may be the early sign of neurological disease which can evolve into the central and/or peripheral neurologic disease.

[1% bifonazole lotion in the therapy of otomycosis]. / Bifonazolo lozione 1% nella terapia delle otomicosi.

Twenty-five patients suffering from otomycosis were treated once daily with bifonazole lotion 1% for a period of 4-15 days (means +/- DS 9.5 +/- 2.6 days). Two days before the end of the treatment complete resolution of the clinical picture in 23/23 patients was observed. Direct mycological and cultural examinations undertaken during the same control visit showed complete eradication of the responsible fungi in all 23 patients. Two-four weeks after the end of therapy a further control visit was carried out, during which 2/21 cases with clinical and mycological relapses were seen; both patients had chronic otitis. Tolerability of bifonazole was satisfactory in all cases but one, who interrupted treatment because of pain and local hyperemia where the lotion had been applied. In some patients suffering from chronic otitis application of the lotion caused slight and short-lasting pain and burning of the ear.

Mucoepidermoid carcinoma of the larynx. A clinicopathological study of 11 cases with review of the literature.

A series of 11 cases of mucoepidermoid carcinoma of the larynx is presented. The neoplasm is uncommon and the present series has been selected from 872 primary malignant neoplasms of the larynx evaluated at the Section of Pathology of ENT Department of Padua University from January 1975 to December 1979. The median age of the patients was 59 years. The most common location was the epiglottis. The tumors were classified on the basis of cellular differentiation, and common and/or uncommon pathologic features were recorded. Differential diagnosis must be made from several neoplasms, in particular from squamous cell carcinoma, adenoid cystic carcinoma and adenosquamous carcinoma. The treatment of choice is surgery. The prognosis is better than that of the commoner squamous carcinoma and depends both upon the stage and the histologic grading.