[Morphofunctional correlations in children with upper maxillary endognathia]. / Corrélations morpho-fonctionnelles chez les enfants atteints d'endognathie maxillaire supérieure.

In this study 23 oral breathing children suffering from maxillary hypoplasia (endognathia associated with skeletal class II or III), selected for rapid maxillary expansion (RME) have been investigated by active anterior rhinometry. None of these patients presented O.R.L. pathologies during clinical examination except for some sporadic cases of adenoid hypertrophy (5 cases). Rhinomanometric and cephalometric examinations carried out before and after RME treatment showed a good correlation between the nasal respiratory function parameters and the structural cephalometric elements investigated by means of teleradiography. In particular, an important reduction in nasal respiratory resistance in all patients with conversion from oral to nasal respiration in the majority of cases corresponds, together with cross-bite resolution, to increased transversal dimension of the maxilla produced by RME. A clear regression in adenoid hypertrophy, where present, is also noted without any type of O.R.L. treatment. The improved respiratory situation could therefore produce benefits on the trophism of the nasal mucous and the lymphatic rhinopharyngeal tissue. Agreement between clinical, radiological and rhinomanometric findings confirm the usefulness of this method in diagnosing and following-up patients with this problem.

[Incidence of Ménière's disease in the Siena Local Health Unit 30 area]. / L'incidenza della malattia di Ménière nella USL 30 area senese.

Incidence of Ménière's disease has been the subject of many epidemiologic papers in Literature. Nevertheless, it varies greatly in studies from different countries and it is unclear to what degree these differences can be attributed to epidemiologic differences and to what degree to problems of methodology (selection and assessment of the patient). The objective of this paper is to evaluate the incidence of Ménière's disease in the USL district 30 of the Siennese Area following definite and easily reproduced criteria. A total of 33 new cases of Ménière's disease was identified during a 10-year period from 1981 to 1990. Thus, in relation to the total number of residents in the USL 30 of the Siennese Area (120,000), the average annual incidence rate may be calculated at 27.5 x 10, a relatively modest figure in comparison with other studies. Given this, the Authors discuss the methodological problems relative to the epidemiological assessment.

[Nasal dimorphism and respiratory dysfunction. Preoperative selection of patients and follow-up using computerized rhinomanometry]. / Dismorfismi nasali e disfunzione respiratoria. Selezione preoperatoria dei pazienti e follow-up mediante rinomanometria computerizzata.

Indications and results of corrective nasal surgery are at times uncertain with the traditional clinical evaluation. To find more certain parameters a study was made with active anterior computerized rhinomanometry (C.R.) pre- and post-operatively in 50 patients randomly chosen from those proposed for rhinoseptoplasty during 1990. The level of total basal resistance (TR) and total residual resistance after pharmacological decongestion were used as objective indicators of respiratory stenosis. Clinically these patients showed some degree of nasal deformity, usually associated with septal deviation. Difficulty in breathing did not always correspond to the level of TR recorded. At times habit or psychological factors related to nasal aesthetics could play an important role. Using CR it was possible to divide the patients into three categories: a) the first (9 patients with normal total basal resistance) required treatment for exclusively aesthetic reasons; b) the second (18 patients with increased basal TR but normal residual TR) required treatment of the conchae and medical therapy; c) the third (23 patients with increased basal and residual TR) had the broadest functional and aesthetic indications. Six months after surgery normal residual TR was found in 96% of these cases. Only 12% of the patients were functionally unsatisfactory, with residual anatomical alteration (4%), phlogosis (4%) or sensations "sine materia" (4%). The present experience confirms the value of CR as an objective test for surgical selection and functional results.

Chemo-radiotherapeutic management of advanced head and neck cancer.

Stage III and IV head and neck cancer patients usually achieve poor therapeutic results after radiotherapy. The search for more effective treatment modalities is justified, provided that tolerance is not lower than that of the usual radiation therapy schedules. Chemotherapy has been shown to be effective, and cis-platinum and bleomycin based treatments are reported to result in objective remissions in a substantial proportion of cases. There is also experimental evidence of a radiosensitizing activity of cis-platinum. Thirty-five locally advanced head and neck cancer patients were given combined chemo-radiotherapeutic treatment consisting of a cis-platinum and bleomycin induction followed by a standard radiotherapy course integrated with weekly administrations of cis-platinum. Before radiotherapy, an overall 48.5% objective remission rate was achieved, that rose to 85.8% after completion of the entire treatment, with a 31.5% complete response rate. Incidence and severity of radiation mucositis seem not to be increased, and systemic toxicity is very low, with the adopted drug administration schedule. Overall results do not show any obvious superiority over those of radiotherapy alone.

Oncocytic adenoma of the nasal cavity. A case report.

The authors present a case of benign oncocytoma (oxyphil cell adenoma) of the nasal cavity in a young woman. This is the fifth case reported in that region. Immunohistochemical stains revealed positivity only for cytokeratin.