Hyperbaric oxygen therapy as salvage treatment for sudden sensorineural hearing loss: review of rationale and preliminary report.

BACKGROUND: The management of sudden sensorineural hearing loss has not yet been standardised. Hyperbaric oxygen therapy influences recovery from sudden sensorineural hearing loss, but the underlying mechanism is unknown and the appropriate indications and protocols undetermined. MATERIALS AND METHODS: Nineteen patients affected by sudden sensorineural hearing loss were treated after unsuccessful medical therapy, either in an acute or chronic setting. Pure oxygen inhalation at 2.5 atmospheres absolute pressure was administered for 90 minutes, for 30 sessions. Frequency-specific and average pure tone hearing thresholds were determined before and after hyperbaric oxygen therapy. The number of hyperbaric oxygen therapy sessions, the patient's age and any therapeutic delay were considered as quantitative variables possibly influencing outcome. Stepwise multivariate analysis was performed. RESULTS: Salvage hyperbaric oxygen therapy appeared to improve patients' pure tone hearing thresholds, particularly at low frequencies. Positive results were more likely with increased patient age and reduced delay in receiving hyperbaric oxygen therapy. CONCLUSION: Hyperbaric oxygen therapy has a strong scientific rationale, and improves pure tone hearing thresholds in cases of sudden sensorineural hearing loss unresponsive to medical therapy. Further research may be able to identify those patients with sudden sensorineural hearing loss for whom hyperbaric oxygen therapy would be most cost-effective.

Bilateral secondary syphilis of the tonsil.

A patient with bilateral tonsillar enlargement secondary to syphilis is presented. Clinical appearance, histological findings and serological tests permitted a correct diagnosis to be obtained, ruling out the suspicion of cancer.

[The history of nasal valve surgery]. / Storia della chirurgia della valvola nasale.

Nasal valve surgery involves the Nasal Valve Area and its deformities, as well as its surrounding structures. Since there is no single technique to solve every type of pathology, there are numerous works on this topic in the literature. The rhinologist to perform such surgery should thoroughly deal with all the components (i.e. nasal valve area, nasal bones, tip, spine, vestibulum and turbinates). However, even more so, he should be able to precisely locate the cartilaginous and/or osseous structural deformity impairing nasal air flow. Therefore, intuition and experience play a key role in planning such surgery. It is not easy to recognize the unique, or even more difficult, the partial defect the correction of which would improve overall nasal function. Every surgical technique has some "biologic cost": sclerosis, adhesions, and scar retraction. However, in this case the surgery could prove even more biologically costly as it could worsen the already poor nasal breathing. Therefore, the surgeon must strictly follow two basic rules: a) employ a proper approach to the region; b) do not endanger nasal valve function to satisfy esthetics. Valve area anomalies can be divided into primary and secondary. The latter are caused by trauma or surgery (1.2%). Among the wide range of techniques mentioned in the literature, the authors prefer the anatomical, surgical classification by Zijilker and Quaedvilieg as it incorporates the philosophy the rhinosurgeon must keep in mind when aiming to restore both nasal functions and esthetics through different, specific techniques.

[Modern corrective nasoseptal surgery]. / La moderna correzione chirurgica del setto nasale.

Inner nose surgery should be addressed to normalize the geometry of the nasal cavities in order to restore physiologic nasal resistance. As the nasal septum plays a key role in the form and the function of the nose, a successful rhinosurgeon must be able to deal with all septal problems ranging from localized spurs to severely traumatized or surgically damaged nasal septa. Nasal airway obstruction due to septal derangements cannot be successfully solved simply by submucous resections of septal window(s) but does often require a range of corrective maneuvers on the anatomic sub-units constituting the septum. Septal surgery is systematically performed by the Authors using the maxilla-premaxilla approach (MPA) which allows access to and manipulation of the entire nasal septum including the caudal and anterior septal margins, columella, upper lateral cartilages, inferior nasal spine as well as floor of the nasal cavities and maxillary crest areas. Correction of the septum combines mobilization and/or removal of any deranged portion of the bony and/or cartilaginous septum, followed by reconstruction of the septum support, preferably using autogenous septal grafts. Reconstruction procedures are designed to reconstitute a stable medial wall and at the same time minimize scar tissue formation. Reconstruction is indispensable to avoid septal flapping occurring when the medial wall consists of muco-periosteal tissue only without firm intermediary support. When reconstructing the medial wall, great care must be taken with the most important portion of the septum, i.e. the dorso-caudal margin and the cartilaginous elements. However, many common nasal problems require procedures to correct the inside of the nose and the external pyramid at the same time. To effectively and efficiently address the challenge posed by the combination of internal and external nasal problems, a thorough understanding of respiratory rhinology as well a familiarity with the many procedures involved in both extensive septal surgery and external nasal pyramid surgery are imperative for the modern-day rhinosurgeon.

Cirugía reconstructiva de la laringe: resultados oncológicos y funciones / Reconstructive surgery of larynge: oufcome oncology and function

En los últimos años el manejo quirúrgico del cáncer de la laringe ha tomado derroteros extraordinarios. El objetivo de la cirugía parcial es la preservación de las funciones de la laringe: lamentablemente este tipo de cirugía ha tenido indicaciones muy restringidas. La restauración quirúrgica de la voz después de la laringectomía total (LT) encara sólidamente uno de los muchos problemas que la investigación encaminada a mejorar la calidad de vida de los pacientes afectos en cáncer de laringe trata de resolver. La reconstrucción subtotal pretende por otro lado recuperar todas las funciones de la laringe y los cirujanos hoy día pueden efectuar esta operación en sujetos que presentan tumores relativamente avanzados. Los autores pretenden que este es el camino correcto a seguir en el futuro y presentan una revisión de la literatura cerca de las intervenciones cuyo objetivo es la reconstrucción. Esta revisión se refiere a la posibilidad de extender más y más las indicaciones oncológicas en especial, permitiendo abandonar las intervenciones destructivas clásicas paso a paso

Un abordaje racional para la rehabilitación de la voz después de la laringectomia total / Rational attack for the rehabilitation of the voice after total laryncectomy

La rehabilitación quirúrgica protésica de la voz después de la laringectomía serealiza en la actualidad mediante el uso de prótesis exclusivamente. Las prótesis vocales son fáciles de insertar y son satisfactorias, tanto para el paciente como para el cirujano: por lo que su colocación ha tenido cada vez mayor aceptación. A pesar de esto, las prótesis fonatorias presentan aspectos desfavorables, tales como: altos costos, dependencia del paciente respecto al cirujano, en cuanto a cambio y reposición dela prótesis. Los autores discuten acerca de la intervención quirúrgica para rehabilitación de la voz después de la laringectomía total sin prótesis, y los problemas de deglución en pacientes con dispositivos intraoperatorios. La colocación de prótesis por consiguiente se ha restringido a aquellos pacientes en quienesla intervención quirúrgica como único procedimiento, ha fallado para el desarrollo de producción de la voz

CD8 lymphocytes during Epstein Barr virus (EBV) infection: A CD29 positive population is expanded in acute infectious mononucleosis.

The expression of phenotypic markers on CD4 and CD8 lymphocytes during the acute and convalescent phases of Epstein Barr virus (EBV) induced infectious mononucleosis was examined by two colour flow cytometry. Activated CD8 cells constitute the major population increased during acute infectious mononucleosis; in this phase we observed a preferential expansion of the CD8 CD29+ compared to the CD8 CD45RA+ cells. Serum soluble CD8 levels were also raised during the acute phase and a correlation with CD8 CD38+ and CD8 CD29+ cell numbers was found. The convalescent phase of infectious mononucleosis was characterized by a progressive return of CD8 subset and of soluble CD8 to baseline normal values. These results demonstrate that acute EBV infection induces the expansion of a CD8 subset with peculiar surface antigenic profile.