Influence of air temperature variations on incidence of epistaxis.

OBJECTIVE: Epistaxis is the most common ear, nose, and throat emergency observed in the emergency department (ED). An increased frequency of this condition has been observed during cooler months, but the results of available studies are controversial. The aim of this study was to investigate the seasonality and association of epistaxis presentations to a large urban ED with variations of air temperature and humidity. METHODS: This study was a retrospective case series. Information on all the patients who presented for epistaxis in the ED of the Academic Hospital of Parma during the years 2003-2012 and ages ≥ 14 years were retrieved from the hospital data base, excluding those attributable to trauma. The chronologic data of all visits were associated with climate data (air temperature and humidity) by univariate linear regression analysis. RESULTS: Among the 819,596 ED patients seen throughout the observational period, 5404 were admitted for epistaxis. Of these, 5220 were discharged from the ED, whereas 184 (3.4%) needed hospital admission. A strong seasonality of epistaxis was observed, with a peak during winter. A strong negative correlation was also found between the daily number of epistaxes and the mean daily temperature in the whole population as well as in patient subgroups (those undergoing anticoagulant or antiplatelet therapy, or those with hypertension, inherited bleeding disorders, liver cirrhosis, or advanced malignancy). A weaker correlation was also found between air humidity and epistaxis but only in certain subgroups. CONCLUSIONS: The results of this study provided a contribution to improve our understanding of the epidemiology of epistaxis and for specific health policies that should also be planned by considering the seasonality of nosebleed.

Pulmonary Rehabilitation After Total Laryngectomy: A Multicenter Time-Series Clinical Trial Evaluating the Provox XtraHME in HME-Naïve Patients.

BACKGROUND: Both the immediate beneficial physiological changes in a laboratory setting and the long-term clinical outcomes of heat and moisture exchanger (HME) use are well described. So far, there has not been any research published that provides detailed insight in the pattern of changes in both respiratory function and patients' experiences with HMEs in the first weeks of use. METHODS: A multicenter time-series study design with a 2-week double baseline period. All patients used the XtraHME for 12 weeks afterward. Data were collected 2 weeks, 6 weeks, and 12 weeks after the start of HME use. RESULTS: Data of 30 patients were analyzed. Pulmonary symptoms decreased significantly during the 12 weeks of HME use. After 2 weeks, a significant decrease in daily coughs and daily forced expectorations was seen. The general quality of life showed a significant increase throughout the study. More general physical complaints also significantly decreased with HME use. Patient satisfaction with the HME was high. CONCLUSIONS: This study shows that there is a significant influence of the XtraHME on pulmonary status that can already be observed after 2 weeks of using the XtraHME and continues to improve further after 6 weeks of XtraHME use.

Degradation of silicone rubber causes Provox 2 voice prosthesis malfunctioning.

OBJECTIVE/HYPOTHESIS: Provox 2 voice prosthesis requires periodic replacement due to biofilm proliferation which causes malfunctioning of the valve. The aim of this study was to show that Provox 2 voice prosthesis malfunctioning is due not only to valve obstruction caused by biofilm but also to the silicone variations. DESIGN METHODS: Prospective study on the malfunction of Provox2 voice prostheses. METHODS: Through photographic and electron microscopic assessment, the authors studied nine Provox 2 voice prostheses, which were removed due to malfunctioning. RESULTS: Findings revealed that the silicone undergoes a degenerative process, thus causing the surface to become rough, deformed, swollen, and translucent. Furthermore, electron microscopy confirmed the presence of immune system cells and biofilm on the prosthesis surface and their role in creating a structural nonhomogenous structure in the silicone, which is deformed due to the presence of "crests" caused by material degeneration. CONCLUSION: The degenerative process of the silicone seems to be related to the oxygen present in the trachea and esophagus and to the production of oxygen-free radicals on the biofilm's part and the immune system.

Use of electrochemotherapy in a case of neck skin metastasis of oral squamous cell carcinoma: case report and considerations.

BACKGROUND: Squamous cell carcinoma (SCC) is the most common oral cavity malignant tumor. Surgery, radiotherapy, and chemotherapy have been the major options for its treatment. Electrochemotherapy (ECT) is a novel local treatment successfully used in secondary or primary skin or subcutaneous tumors. This new cancer treatment is a modality in which a locally applied electrical field enhances cell membrane permeability, thereby allowing greater intracellular accumulation of a chemotherapeutic agent. METHODS: We report a case of a man affected by an ulcerated SCC. The man was treated with ECT with good results. RESULTS: In our case, ECT was successful in the management of extensive metastasis of SCC in clinical conditions, whereas other approaches were rejected. CONCLUSION: This case shows good clinical results; however, other studies are necessary to show that ECT should be considered as a promising treatment option.

Renal clear cell carcinoma and tonsil metastasis.

Renal cell carcinoma is the most common renal tumor in adults. Clear cell carcinoma represents 85% of all histological subtypes. In February 2012 a 72-year-old woman came to our department due to the appearance of massive hemoptysis and pharyngodinia. Previously, this patient was diagnosed with a renal cell carcinoma treated with left nephrectomy. We observed an exophytic, grayish, and ulcerated mass in the left tonsillar lodge and decided to subject the patient to an immediate tonsillectomy. Postoperative histology showed nests of cells with highly hyperchromatic nuclei and clear cytoplasm. These features enabled us to make the diagnosis of renal clear cell carcinoma metastasis. Only few authors described metastasis of renal cell carcinoma in this specific site.

Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation.

Rheumatoid arthritis rarely involves the cricoarytenoid joint. The possible consequent symptom includes hoarseness, dysphagia, odynophagia, dysfunctional dysphonia, and acute dyspnea. Etiologic diagnosis is possible with high-resolution computed tomography, which can show spacing of the articular cartilage, density and volume alterations, and subluxation of the cartilage. However, these radiologic signs are not pathognomonic for rheumatoid arthritis, and they should be combined with anamnestic data.