1,721,118 research outputs found
Role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps
No full textBackground/Objective: The pathophysiological and prognostic role of blood inflammatory cells in chronic rhinosinusitis with nasal polyps (CRSwNP) emerging from recent studies was investigated. Material and Methods: The main available evidence and largely-recent publications were critically analyzed. Results: Several authors reported a direct association between blood eosinophilia and CRSwNP recurrence rates. In some large series, a direct association between recurrent CRSwNP and blood basophil values emerged too. CRSwNP patients’ blood eosinophil and basophil values were strongly related. It was also found that preoperative neutrophil-to-lymphocyte, eosinophil-to-lymphocyte, and basophil-to-lymphocyte ratios were significantly higher in patients who experienced a disease relapse than in those who did not. In histologically-confirmed eosinophilic-type CRSwNP treated with endoscopic sinus surgery, mean blood eosinophil values dropped significantly from before to after the surgical procedure. Conclusions/Significance: CRSwNP endotypes have different inflammatory profiles reflected in the relative proportions of different types of blood cells. The available data support the theory that blood eosinophil and basophil levels should be included in the routine preoperative work-up of CRSwNP patients in order to give patients accurate prognostic information, adopt rational follow-up protocols after surgery, and provide dedicated postoperative medical treatments
Structured histopathology for endotyping and planning rational treatment in chronic rhinosinusitis.
No full textIn chronic rhinosinusitis (CRS), endotyping, being based on the pathogenic mechanism, provides a precise picture appropriate for use in clinical practice. Structured histopathological examination of CRS is considered a necessary step in efforts to establish its pathogenesis and improve our endotyping capabilities. Herein we discuss the associations between histopathology and clinical characteristics of CRS patients to assist medical and surgical treatment choices
Non specific immunologic determinations in Meniere's disease: any role in clinical practice?
No full textSeveral studies supported the hypothesis that an autoimmune response may be a pathogenetic factor in Meniere's disease occurrence. It has been demonstrated that the endo-lymphatic sac has an important role in the immuno-mediated reaction and it has also become evident that an immunological mechanism may be involved in the development of endo-lymphatic hydrops. The present study was carried out in order to analyse the validity of serological non-specific immune tests in determining the possible role of immune pathology in 200 Meniere's suffering patients. The immune activity was investigated determining the erythrocyte sedimentation rate (ESR), the C-reactive protein levels, the rheumatoid factor, the serum immunoglobulin levels by group, the complement levels, the lymphocyte sub-populations, the cryoglobulines, the circulating immune complexes (CIC), organ and non-organ auto-antibodies. Levels of Ig, ESR, C-reactive protein, rheumatoid factor, complement fractions and cryoglobulines were either negative or non-significant in the considered cohort of Meniere's disease suffering patients. On the other hand, in more than half of the sample group high values of CIC were found. Data concerning T-lymphocyte sub-population indicates a clear increase in T-helper compared to T-cytotoxic cells, with an increase in the CD4/CD8 ratio. The datum of particular interest concerns analysis of T-cells activation complexes. Our present findings show that early activated T-lymphocytes change and in particular changes occur in the expression of the interleukin-2 receptor. Moreover, it seems to be possible to correlate the alteration of the immunological tests and the phase of the disease. Present data showed that the immunological factor should be considered a relevant element in most of the cases of Menière's disease
The role of supracricoid laryngectomy for glottic carcinoma recurrence after radiotherapy failure: a critical review
No full textCONCLUSIONS: In the near future salvage supracricoid laryngectomy (SCL) will be used more extensively for failures of radiotherapy for glottic carcinoma. OBJECTIVES: Primary radiotherapy has been used for patients with early glottic carcinomas in northern Europe and North America for more than half a century. Local recurrences after radiotherapy for glottic malignancies occur in 5-25% for T1 carcinomas and in 15-50% for T2 carcinomas. The classic choice as salvage surgery in cases of glottic squamous cell carcinoma recurrence after irradiation failure is total laryngectomy. The development of extended conservation procedures such as SCL has permitted an increasing number of successful partial laryngectomies that save laryngeal functions after radiotherapy failure. SCL allows the creation of a neo-larynx, permitting both swallowing and speech; in most cases the tracheostoma can be closed. METHODS: The electronic database Pubmed was searched without publication date limits. RESULTS: Considering available data (103 cases), 84.5% of the cases treated with salvage SCL for irradiation failure did not present a new local recurrence; laryngeal recurrences after salvage SCL (15.5%) were successfully treated with total laryngectomy in 66.7% of the cases. Tracheostoma closure was possible in all except two cases after a mean period ranging between 12 and 28 days. Swallowing results seemed good, with longer recovery time in irradiated than in non-irradiated patients who underwent SCL. Voice quality determined with psychoacoustic methods had acceptable intelligibility
The contribution of oncological lateral skull base surgery to the management of advanced head-neck tumors.
No full textBackground: Lateral skull base is a complex area between the brain and the neck that is characterized
by a large anatomic variability in narrow spaces and wide heterogeneity of tissues. The complexity of
the anatomy makes it more difficult to accurately identify tumor spread and surgical planning is here
particularly demanding.
Aims: Oncological skull base surgery is conceived for malignant lesions originating in, secondarily infiltrating,
or in close proximity to the lateral skull base. It is also conceived for selected aggressive or
benign lesions of the parapharyngeal space and infratemporal fossa abutting the skull base, or crossing
it from above downwards to the neck. This paper is focused on the role that oncological skull
base surgery plays to resect tumors in this area.
Methods and results: Three main types of head and neck lesions can be identified as paradigms of
the philosophy of oncological lateral skull base surgery, and are herein presented: (i) primary malignant
tumors of the ear; (ii) advanced malignant parotid tumors; (iii) primary malignant or locally
aggressive tumors of the infratemporal fossa-parapharyngeal space. The en-bloc lateral and subtotal
temporal bone resections, the en-bloc temporo-parotid resection and the combined subtemporaltranscervical-
transparotid resection are described, respectively.
Conclusions and significance: Different histologies are found in the lateral skull base and adjacent
areas, and each histology has its own pattern of growth and undetected spreading in a difficult-to-reach
surgical area. The leading principle is to create a wide access through soft tissues and bone removal far
enough from the tumor to obtain a complete resection, en-bloc radical resection in malignancies. The
entity of dissection is obviously modulated on the tumor triad (histology, pattern of growth, extent) and
is achieved through the en-bloc and combined approaches that are here described
Coexisting otosclerosis and acoustic neuroma: report of a new case and literature review
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Laryngeal malignant neoplasms in children and adolescents
Full text linkAn exhaustive literature review of the last two decades discloses 47 laryngeal malignant neoplasms in children and adolescents. The most frequent malignant neoplasm is the embryonal variant of rhabdomyosarcoma. The timely diagnosis of a laryngeal neoplasm depends on maintaining a high index of suspicion in a patient with progressive airway obstruction, dysphagia or dysphonia, and conducting an efficient work-up-including magnetic resonance imaging and direct laryngoscopy under general anesthesia in association with bronchoscopy-in order to define the extent of the lesion, rule out multiple lesions, establish and maintain an airway, and perform a biopsy of the tumor. The authors observed that several risk factors, such as previous radiation therapy for juvenile laryngeal papillomatosis, intrauterine exposure to ionizing radiation, chemical carcinogens, smoking or tobacco exposure were lacking in those patients with a detailed clinical history. Probably, cancer of the larynx in these unusual patients is the final result of an interaction of immunological and genetic factors. The choice of therapy depends on several factors, including the clinical stage at presentation, histological type and potential radio-chemosensitivity of the tumor
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