[Labayle's supracricoid partial laryngectomy in the treatment of laryngeal cancer: personal experience and long term follow up]. / Laringectomia ricostruttiva sopracricoidea secondo Labayle: esperienze personali e valutazione di pazienti a prolungato follow-up.

The present study was carried out to assess the indications and to evaluate the functional and oncological results of the supracricoid laryngectomy with crico-hyoid-pexy proposed by J. Labayle. This technique consists of a sub-total laryngectomy where the cricoid cartilage, the hyoid bone and at least one of the arytenoids are spared. These structures can then be reassembled into a "neo-larynx", thus preserving respiration and phonation. The present paper deals with 23 laryngeal carcinomas: 13 glottic (2 T1bN0, 6 T2N0, 1 T2N1, 1 T2N1, 3 T3N0) and 10 supraglottic (4 T2N0, 3 T2N1, 3 T2N2). The follow-up shows a 5-year overall actuarial survival rate of 80.65%. The authors agree that when performed under very precise indications the crico-hyoid-pexy is a useful alternative to both radiotherapy and the extended-partial or total laryngectomy in the treatment of laryngeal carcinoma. It also appears useful in treating selected cases of post-surgical or post-radiotherapy recurrences.

[Wegener's and Stewart's granulomatosis: a case report of Stewart's granulomatosis]. / Le granulomatosi centrofacciali di Wegener e di Stewart: su un caso clinico di granuloma centrofacciale di Stewart.

Wegener's and Stewart's diseases are two rare pathologies of unknown origin; both can cause disruptive facial lesions. Wegener's disease is a systemic pathology and generally involves the kidneys and lungs. Granulomatosis lesions are characterized by the necrotizing vasculitis involving the small vessels. From a diagnostic point of view the systemic features of Wegener's disease and the specific immunological findings (i.e. IgG autoantibodies vs. monocyte and neutrophil cytoplasm) make it possible to diagnose the disease precisely. Stewart's disease can be differentiated from Wegener's disease by the absence of any systemic lesions and the lack of necrotizing vasculitis. Pathogenesis of the disease is still unknown although immunohistochemical findings indicate that it is related to extranodal Tcell lymphomas. Stewart's disease is very aggressive with massive destruction of the midface tissues and prognosis is very poor (from a few months to 23 years). Surgery is generally ineffective in such disorders. The treatment for Wegener's disease includes the use of systemic steroids, immunosuppressive drugs and the sulfametoxazole-thrimethoprime association while radiotherapy associated with chemotherapy appears most effective in Stewart's disease. The authors describe a case of Stewart's disease prevalently involving the nasal cavities, ethmoid and paranasal sinuses. Diagnosis was made on the basis of immunohistochemical, histomorphological and immunological data. Treatment--based initially on systemic steroids with the association thrimethoprimsulfometoxazole--induced significant disease remission. Subsequent use of cytostatic drugs has made it possible to control the disease progression to date.

[Otoneurological manifestations in Fhar's disease. A case report]. / Manifestazioni otoneurologiche nel morbo di Fhar. Descrizione di un caso clinico.

Fhar's disease is a rare idiopathic CNS pathology characterized by widespread calcifications of the basal ganglia, cerebellar nuclei and endocranial vessels. The origin of this disease is unknown and a lack of thyroid and parathyroid pathologies is the main statement. From the clinical point of view, extrapyramidal manifestations are common while vertigo and equilibrium disorders are rare. In the present case vertigo and disequilibrium were the main symptoms. Fhar's disease was diagnosed by CT and MRI showing calcification of the basal ganglia without any metabolism disorders or thyroid and parathyroid pathology. A battery of neurotological tests showed alterations of VOR and ocular movement. In particular the saccades movements showed significant hypometria while the smooth-pursuit showed gain diminution and corrective saccades. These anomalies imply dysfunction of sub-cortical centers regulating and modulating ocular movement. VOR alterations included both qualitative anomalies of nystagmus (i.e. dysrhythmia, square waves) and quantitative alterations (i.e. bilateral deficit response to caloric and rotatory stimuli). These alterations could be due to the impairment of cerebellum-vestibular and vestibular-thalamic pathways. Acoustic evoked potentials (ABR, MLR) ruled out central acoustic pathway dysfunction.

[Case report: pleomorphic adenoma of the lateral nasal wall]. / Su un caso di adenoma pleomorfo della fossa nasale.

Pleomorphic adenoma is a tumor which most often originates from one of the major salivary glands; it is rarely located in the lacrymal glands and it is highly exceptional in the nasal cavity. Cases of pleomorphic adenoma in the nasal cavity have been described by Spiro (40 cases), Compagno and Wong (40 cases) and Suzuki et al. (41 cases). This type of tumor generally originates from the septal mucosa even though the seromucosal glands are mostly located in the lateral nasal wall. This pathology is more frequently found in females. The clinical signs of this tumor are non specific, slow unilateral nasal occlusion, rhinorrhea and, at times, epistaxis. Evolution is generally local although locoregional and distant metastases have been described in the literature. This sort of tumor has no specific appearance and thus diagnosis is based on histology. Indeed, microscopically nasal pleomorphic adenoma differs from salivary gland adenoma for the predominance of the cellular component over the connective component. The epithelial cells are small, oval-shaped and often arranged in cordons; they are sometimes organized in small acinous structures. The connective component can be mixoid, condroid or collagenous; follicles with squamous metaplasia and mitosis are rare. Histologically differentiating this disorder from olfactory esthesione-uroblastoma can prove difficult; the lack of extra cellular neurifibrillar structures, neurotubules and neurosecretory granules in nasal pleomorphic adenoma are the main distinguishing criteria. The present work reports a case of a 45-year-old man who had suffered of an increasing unilateral nasal obstruction from 1 year. Endoscopic examination showed a smooth surface neoplasm involving the entire nasal cavity. CT scan showed the deformation of the medial bone wall of the maxillary sinus and of the ethmoid although without any osteolysis. Median maxillectomy surgical exeresis of the neoplasm was performed with the facial degloving technique. Histology revealed a 5 cm pleomorphic adenoma originating from the lateral nasal wall. This origin is extremely rare because this tumor generally originates in the nasal septum. Immunohistochemical stains proved positive for epithelial membrane antigen (MNF 116), for myoepithelial cells (PS100) and for stromal cells (Vimentine) with the epithelial elements predominating. After 9 months of follow-up the patient is still disease free.

[Nasal polyps: comparative immunological study of polyps with different histopathologic types]. / I polipi naso-sinusali: studio immunoistologico comparativo di formazioni con differente tipologia istopatologica.

Cellular Infiltrate as well as class I and II HLA molecule expression, on 22 nasal polyps and on 12 samples of corresponding hypsilateral mucous membrane were studied by means of immuno-histological methods. These nasal polyps were classified according to their histopathological structure. Five polyps, with a fibrous connective core infiltrated by cells of the monocyte-macrophage lineage, were classified mixed. The remaining seventeen polyps were characterized by the presence of central oedematous connective tissue infiltrated almost exclusively by eosinophils and either contained (glandular type) or did not contain (oedematous type) glands. A comparative study of different types of nasal polyps and corresponding hypsilateral nasal mucous membranes was carried out on atopic and non-atopic patients. No correlation between atopic status and polyp presence or polyp typology was found. On the other hand, different polyp types appear to have a structural correlation with the corresponding hypsilateral mucous membrane regarding infiltrate cell type, oedematous or fibrous connective tissue presence and expression of on HLA antigen positivity pattern. The characteristic histological structure of hypsilateral mucous membranes in patients with different types of polyps appeared to be brought about by a multifactorial etiology involving mucosal hyperreactivity. Lastly, both polyps and parapolypal nasal mucous membranes were found to be infiltrated mainly in the peripheral subepithelial connective tissue by lymphocytes (55%) as well as by other leukocyte types. The presence of growth factors capable of enhancing an increase of fibroblasts, endothelial cells, together with focal distrupture on the basal membrane, might well be a general mechanism responsible for polyp sprouting.

[Expression of HLA-DR, DP, DQ antigens in fibrous sino-nasal polyps]. / Espressione di antigeni HLA-DR, DP, DQ, in polipi naso-sinusali di tipo fibroso.

In the last years nasal polyps have been studied by several authors with different methodologies; however, their etiology is still unclear. In this paper we have analyzed in four nasal polyps of fibrous type, the HLA class II (HLA-DR, DP, DQ) molecule expression by means of immunohistochemical techniques (immunoperoxidase and immunophosphatase). A strong inflammatory cell infiltration, a percentage increase of both HLA-DR+ and HLA-DQ+ cells (normal nasal mucous membrane stroma infiltrating cells: DR+ < 40%, DP+ < 2%, DQ+ < 3%; fibrous polyps infiltrating cells: DR+ = 68%, DP+ < 2, DQ+ = 7%) as well as a clear positivity for DR expression of both surface and glandular epithelia were observed in all polyps. Furthermore, in the stalk area of one of the studied polyps DR+DQ+ cells with macrophagic features and having tight. connections with the vessels were observed. The scanty vascularization with the presence of activated mononuclear and mast cells might be responsible for polyp growth by locally producing an anomalous concentration of growth factors.

[Immunohistochemical study of the nasal mucosa of patients with fibrous polyps]. / Studio immunoistochimico della mucosa nasale in pazienti con poliposi di tipo fibroso.

Nasal polyps constitute a common pathology, but their etiology is not yet clear. In the present report, by means of immunohistochemical methods, both cell infiltrate and HLA-DR molecule expression were analysed in nasal mucous membrane fragments biopsied in the vicinity of fibrous polyps. Both surface and gland epithelia were positive for HLA-DR antigens in all sample whereas the epithelium of control nasal mucous membranes appeared to be negative. In addition only little delimited portions of the basement lamina seemed disrupted by an intense traffic of infiltrating cells. The poor venous drainage, the presence of activated mononuclear and mast cells capable of releasing soluble growth factors, together with basal lamina interruptions, might be factors for polyp sprouting.

[Analysis of the cellular infiltrate and epithelial class I and II molecular expression in edematous type nasal polyps]. / Analisi dell'infiltrato cellulare e della espressione epiteliale di molecole HLA di istocompatibilitá di classe I e II in polipi naso-sinusali di tipo edematoso.

Although in the last few years histopathological, immunohistochemical and immunological studies on nasal polyps have been carried out by several Authors, the etiology of these formations still remains unknown. Nasal polyps have a very characteristic structure and have been classified in three histologic types: edematous, glandular and fibrous. In the present report, 11 nasal polyps of edematous type, representing 61% of total number of collected polyps, were studied employing immunohistochemical methods. All the examined polyps were similar in histology and positivity pattern for HLA molecule expression. The edematous core appeared infiltrated (149 cells/mm.2) mainly by eosinophils (> 90%), whereas the peripheral subepithelial connective tissue contained cellular clusters (416 cells/mm2.) made up of different subsets of hematic cells (30.8% were monocytes-macrophages and 48.6% were lymphocytes largely represented by CD4+ cells). On the contrary, mast cells were quite rare (on the average 1.7 cells/mm2.) and located near T cell clusters. The epithelial positivity for HLA-DR and HLA-A,B,C molecules showed a characteristic discontinuous pattern. In the same patient, controlateral nasal mucosa showed a histological structure very similar to that of polyps. The above data suggest that the presence of polyps is the result of an inflammatory process brought about by a complex array of cellular and humoral components.

[The clinical problems of bacterial infections of the upper respiratory tract]. / Problemi clinici delle infezioni batteriche delle prime vie respiratorie.

ORL inflammations present particular pathogenetic and clinical characteristics due to the close anatomic and physiological connection among them and to their particular anatomic characteristics. The ear communicates with the rhinopharynx through the Eustachian tube, and this relationship explains how bacterial infections of the upper respiratory tract can cause otitis and how tubal dysfunctions are often responsible for chronic ORL infections, also favoured by the microcavity structure of the middle ear and the mastoid bone. Also the macro- and microcavity anatomic structure of the paranasal sinuses favours chronic infectious diseases, and their adjacency with the endocranial and facial structures justifies the secondary complications of these infections. The palatine tonsil and other structures of the Waldeyer's lymphatic ring play an important immune role in the first respiratory and digestive tract, and infections occurring in these structures (for example, streptococcal infection) can cause pathologies such as rheumatic disease. Other ORL infections are connected to immunodeficiency or atopy.

[The interactions between metal stapes prostheses and high-intensity magnetic fields during magnetic resonance tomography]. / Interazioni tra protesi stapediali metalliche e campi magnetici di elevata intensità in corso di tomografia a risonanza magnetica.

The ever-increasing use of magnetic resonance tomography (MR) as an investigation mean has created a new interest in the biological effects of magnetic fields (MF) and in finding protective measures to be taken in their event. At the moment, use of MR is contraindicated in the presence of pacemakers, vascular clips, liquoral shunts and orthopedic prostheses, all of which may be dislocated by the MF created by MR or may interact with the MF itself creating distorted or falsified images. The aim of our study was to verify if metallic stapedectomy prostheses are dislocated by the MF and if they produce enough interference to falsify MR images. Five types of metallic stapedial prostheses exposed to a MF of 0.5T were studied. We may conclude from our results that MR does not create any otological risks for patients with these prostheses in that none of them were dislocated during exposure. However, all the prostheses studied did instead bring about alterations in the MF and the MR image to varying degrees. In some cases (Robinson) there was notable image distortion, while in others (Schuknecht wire teflon and platinum piston) the distortion was practically negligible. It is our opinion, however, that even if the image distortion does not interfere with routine MR, use of prostheses made of materials not affected by MF are advisable in view of an eventual development of visualization of the labyrinth and intratemporal facial nerve portion with MR.

[Hematic infiltrates and the expression of HLA-DR antigens in naso-sinusoidal polyps of the fibrous type]. / L' infiltrato ematico e la espressione di antigeni HLA-DR in polipi naso-sinusali di tipo fibroso.

In this study fibrous nasal polyps, obtained from four patients, were analyzed by means of immunocytochemical methods for the presence of interstitial hematic cell infiltrate and HLA-DR molecule expression. This histologic type accounted for 36.4% of nasal polyps studied. Our results demonstrated that cells belonging to monocyte-macrophage lineage were mainly detected within fibrous and edematous zones (greater than 50%), whereas T cells were found within the subepithelial peripheral connective tissue (greater than 60%). Surface and gland epithelial cells appeared to be more intensely stained for HLA-DR molecules than nasal epithelium of normal subjects, thus indicating that the intensity of HLA-DR molecule expression correlated with the presence of a hematic cell infiltrate. Nasal polyps are a frequent pathology whose etiology has not yet been completely clarified. The present study provides additional information about the fibrous polyp structure and can support some speculations on the nasal polyp etiology.