A geo-chemo-mechanical study of a highly polluted marine system (Taranto, Italy) for the enhancement of the conceptual site model.

The paper presents the results of the analysis of the geo-chemo-mechanical data gathered through an innovative multidisciplinary investigation campaign in the Mar Piccolo basin, a heavily polluted marine bay aside the town of Taranto (Southern Italy). The basin is part of an area declared at high environmental risk by the Italian government. The cutting-edge approach to the environmental characterization of the site was promoted by the Special Commissioner for urgent measures of reclamation, environmental improvements and redevelopment of Taranto and involved experts from several research fields, who cooperated to gather a new insight into the origin, distribution, mobility and fate of the contaminants within the basin. The investigation campaign was designed to implement advanced research methodologies and testing strategies. Differently from traditional investigation campaigns, aimed solely at the assessment of the contamination state within sediments lying in the top layers, the new campaign provided an interpretation of the geo-chemo-mechanical properties and state of the sediments forming the deposit at the seafloor. The integrated, multidisciplinary and holistic approach, that considered geotechnical engineering, electrical and electronical engineering, geological, sedimentological, mineralogical, hydraulic engineering, hydrological, chemical, geochemical, biological fields, supported a comprehensive understanding of the influence of the contamination on the hydro-mechanical properties of the sediments, which need to be accounted for in the selection and design of the risk mitigation measures. The findings of the research represent the input ingredients of the conceptual model of the site, premise to model the evolutionary contamination scenarios within the basin, of guidance for the environmental risk management. The study testifies the importance of the cooperative approach among researchers of different fields to fulfil the interpretation of complex polluted eco-systems.

Encephalocele with spontaneous CSF otorrhea.

Spontaneous encephalocele of the temporal bone is an uncommon condition (37 cases to date) associated with cerebrospinal fluid otorrhea. It results from a congenital dehiscence of the tegmen tympani and tegmen mastoideum. The AA. report 3 additional cases and review methods for diagnosing and surgical treatment.

Distortion-product otoacoustic emissions and glycerol on the guinea pig hydropic ear.

OBJECTIVE: The aim of the present work was to investigate the therapeutic effects of glycerol on the distortion-product otoacoustic emissions in guinea pigs in which experimental endolymphatic hydrops had been surgically induced. METHODS: Thirty albino guinea pigs were used. The experimental protocol considered three groups of guinea pigs (10 animals each). Group 1 received no drug treatment, while group 2 and 3 were given glycerol orally 0.75 and 0.50 g/kg of body weight once a day for 24 days. RESULTS: The animals treated with glycerol showed an improvement of the distortion-product emission responses in the middle frequencies. This effect was not observed in the higher frequency region. This effect was evident 7 days after glycerol administration in the guinea pigs treated with a dose of 0.75 g/kg. The 0.50 g/kg dosage gave evidence of ameliorating effects 14 days after treatment. CONCLUSION: Glycerol given orally resulted in an improvement of distortion-product otoacoustic emissions in the guinea pig. Further studies are necessary before the effect of such a treatment can be assessed in humans.

[Liver transplantation. Selection criteria and risk evaluation]. / II trapianto di fegato. Criteri di selezione e valutazione dei rischi.

The significant advances achieved in the last years in the field of liver transplantation have led to an almost routinely performance of this therapeutic approach throughout North America and Western Europe. This has led to an increased demand so that today the real problem is the organ availability and the need to use those supplied only for patients with best chances of success. For this reason timing of the operation and patient selection are of critical importance. The ultimate success depends on better surgical procedures and advances in immunosuppressive therapy, but perhaps even more on an accurate patient evaluation. The patient selection is based on standardized medical criteria which constitute the indication in patients with end-stage liver disease and on a careful search for risk factors. To this purpose the evaluation of the tolerance of the hemodinamic stress during clamping of the inferior vena cava is of critical importance and must be carefully evaluated both in patients with known and unknown coronary disease. Another condition to be considered is lung hypertension which is frequently associated with portal hypertension. Finally, important conditions for a good evaluation are the epatopulmonary syndrome and diabetes. The last condition is not a contraindication unless associated with severe vascular, cardiac or renal complications.

Facial neuroma and magnetic resonance imaging.

The aim of this paper is to present a new case of facial neuroma. Its clinical appearance was uncommon, displaying symptoms characterized by sudden facial paralysis. Diagnostic armamentarium is discussed emphasizing the importance of magnetic resonance imaging (MRI). Therapeutical strategy with the techniques of facial rehabilitation are contemplated.

Acute mastoiditis in pediatric age.

The object of the present paper is to review 39 cases of acute mastoiditis treated surgically at the 2nd and 4th ENT Clinics of the University of Rome 'La Sapienza'. The aetiological factors were investigated observing an association of the acute mastoid abscess with cholesteatoma. Moreover 5 patients developed mastoiditis after previous mastoid surgery. The rationale of surgical management is discussed.

Acoustic neuroma in the pregnant patient.

We report the case history of a 24-year-old woman with an acoustic neuroma diagnosed during the 24th week of pregnancy. Diagnostic steps and surgical management of this uncommon condition, which represents a therapeutic challenge, are discussed.

Facial nerve monitoring in skull base surgery.

The purpose of this work was to compare pre- and post-operative facial nerve function between unmonitored and monitored cases of skull base lesions. The study involved 32 patients suffering from lateral skull base tumours (10 unmonitored and 22 monitored). Facial nerve function was monitored intraoperatively by an acoustic facial electromyographic system (NIM-2). Post-operative facial function was graded according to the House-Brackmann scale. In the group of monitored cases, facial nerve function was normal (Grade 1 or 2) in 79 per cent of the patients, while the unmonitored patients showed normal function in only 50 per cent of the cases. These results confirm previous observations that audible evoked electromyographic monitoring significantly reduces permanent facial nerve dysfunction.

An analysis of the costs and benefits of two strategies to decrease length of stay in children's psychiatric hospitals.

OBJECTIVE: We analyze the costs and benefits of two strategies-intensive home-based services and increased remuneration for providers of community-based placements--to decrease excessive length of stay in a children's psychiatric hospital. DATA SOURCES AND STUDY SETTING: Clinical, demographic, and financial data were collected retrospectively on all children discharged during 1987 through 1989 from the state children's psychiatric hospital that serves Wayne County, Michigan. Characteristics of the discharged children were similar to those reported in other studies of intensive home-based services. STUDY DESIGN: A sample of 22 children was used for a simulation analysis. Excessive length of stay was defined as the duration of hospitalization after readiness for discharge and associated planning were indicated in the record. For the simulated analysis of the intensive home-based program, costs included estimated charges for the program and charges for the children hospitalized due to failure of the intervention. For analysis of the increased remuneration strategy, costs included charges for the out-of-home placement and charges for hospitalization. For both strategies benefits were defined as averted hospitalization charges. DATA COLLECTION/EXTRACTION METHODS: Charts of the discharged children were reviewed and 21 clinical, demographic, and financial variables were extracted. PRINCIPAL FINDINGS: Analysis of costs and benefits of intensive home-based services produced a favorable cost-benefit ratio of .47. Analysis of the strategy to increase remuneration for providers of community-based placements resulted in a cost-benefit ratio of 1, indicating no financial savings. CONCLUSIONS: Intensive home-based services represent an efficient strategy to decrease excessive length of stay for children in psychiatric hospitals by averting hospitalization altogether. Although increased remuneration to providers of community-based placements in order to increase the supply of placements as a means to hasten discharge from the hospital has a neutral cost-benefit ratio, the opportunity to provide care in the "least restrictive" environment argues in its favor as well.

Experimental endolymphatic hydrops and glycerol. Electrophysiologic study.

The object of the present study was to evaluate electrophysiologically the therapeutic effect of glycerol on the cochlear function of guinea pigs in which experimental hydrops had been surgically induced. Fifteen albino guinea pigs were used. Each animal was chronically implanted to follow the evolution of hearing. The experimental protocol considered 3 groups of guinea pigs (5 animals each). Group 1 received no drug treatment, while groups 2 and 3 were given glycerol orally at 0.75 and 0.50 g/kg of body weight once a day for 4 months. The audiograms of the animals treated with glycerol showed a statistically significant hearing improvement compared with the control group. Clinically, our results seem to support the view of those who favor the use of glycerol for the medical treatment of Meniere's disease at an early stage.

[Mastocytosis. A case of urticaria pigmentosa with a systemic malignant evolution]. / Mastocitosi. Un caso di urticaria pigmentosa ad evoluzione sistemica maligna.

A case of systemic mastocytosis with a malignant course, started as urticaria pigmentosa in adult age, is reported. The progression from cutaneous to systemic involvement has been marked by increasing hypereosinophilia which can be considered an important sign of adverse prognosis.

The contralateral ear after surgery in different otoneurosurgical or neurosurgical pathologies.

The present study was specifically designed to ascertain the effect that otoneurosurgical or neurosurgical approaches may have on the contralateral ear. 18 patients suffering from different histologic lesions were examined. Pure-tone audiometry was performed before and after surgery each postoperative day up to the fourteenth day. The audiograms were abnormal after surgery in all but one of the patients tested. This hearing loss was transitory and the recovery occurred completely within 3 months. These outcomes suggest that the hearing loss was linked to a loss of cerebrospinal fluid.

[Experimental perilymphatic fistula: the electrocochleographic findings]. / Fistola perilinfatica sperimentale: rilievi elettrococleografici.

The aim of the present study was to evaluate the effect of experimental perilymphatic fistula on cochlear electrophysiological responses. Six albino guinea pigs, in which recording electrodes were implanted in order to record the electrocochleogram, were used. Experimental protocol investigated cochlear responses before the induction of the fistula in the round window membrane perforation and then two month later. Compound action potential thresholds increased immediately after perforation of the round window membrane. The thresholds rapidly recovered. This phenomenon was accompanied by clear-Out reduction in amplitude upon suprathreshold stimulation. This latter observation associated with a decrease in the amplitude of the threshold seems to be a specific audiologic sign of the fistula. The clinical implication are discussed.

Vestibular neurectomy by the infralabyrinthine approach.

There are a variety of approaches for treating vertigo with selective vestibular neurectomy but each has definite limitations proving that no ideal technique is yet available. An original posterior-inferior approach to the internal auditory canal (infralabyrinthine approach) has been recently proposed. It attempts to overcome the limitations and to combine the advantages of the previous procedures. This report presents our preliminary results using this particular technique in the management of vestibular symptoms of Menière's disease.