Notch-1 decreased expression contributes to leptin receptor downregulation in nasal epithelium from allergic turbinates

Abstract BACKGROUND: Allergic rhinitis is characterized by a remodeling of nasal epithelium. Since the Notch and TGF-β signaling pathways are known to be involved in cell differentiation and remodeling processes and leptin adipokine has already been identified as a marker for homeostasis in human bronchial and nasal epithelial cells of asthmatics, roles played by these pathways have been investigated for chronic allergic rhinitis. METHODS: The leptin/leptin receptor expression has been investigated in a study with 40 biopsies from allergic (AR, n = 18) and non-allergic (C, n = 22) inferior turbinates, using immunohistochemistry, immunofluorescence staining and RT-PCR. In addition, extracts …

Sialoendoscopy in the management of the salivary gland disorders

BACKGROUND: The aim of this study was to determine the long-term (> 6 month) outcome of patients suffering from obstructive sialadenitis treated by sialoendoscopy. METHODS: Between 2009 and 2013 seventy-six subjects underwent sialoendoscopy under local anesthesia at the University Hospital P. Giaccone of Palermo. RESULTS: The mean age of presentation was 50.5 years for male (56.6%) and 44.7 years for female (43.4%). The presenting symptoms were frequent pain in 72% of cases, frequent purulent secretions in 65% of cases, frequent swelling in 62% of cases and frequent bitter taste in 44% of cases. Affected glands were in 54 cases the submandibular unilaterally, in 21 cases the parotid unilate…

Pattern dinamico delle VAS nei grandi obesi mediante manovra di Muller

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and Januar…

Guide to the management of complications in endoscopic sinus surgery (ESS)

Endoscopic sinus surgery (ESS) is one of the most commonly performed procedures in otolaryngology. ESS complications should be distinguished in minor and major based on the treatment they need and the permanent sequelae they can cause. Over the years it has gone from an incidence of complications in endoscopic surgery of 8% for the major and 21% for the minor to a percentage of 0-1.5% and 1.1-20.8%, respectively. This is due to the considerable diffusion of the technique with a progressive increase over the years of the surgical experience but their presence help to educate otolaryngologists and patients about complication rates in ESS in a modern context. A complication occurs when injurie…

Advances in the Role of Pharyngeal Surgery in the Treatment of OSAS

The American Academy of Sleep Medicine and the American Academy of Otolaryngology–Head and Neck Surgery recommend surgery as an option for the treatment of OSAS, when noninvasive treatments such as CPAP or oral appliances have not been successful or are not tolerated. A gradual and logical approach must be taken into account when a patient seeks a surgical solution, and it is a fundamental requirement that the patient find a surgeon who understands both the pathophysiology of sleep apnea and anatomy of the upper airways (UA) to guarantee the best chances of success. The surgical options aim to solve the obstructive problem according to two ways, the first is the reduction of the content, an…

Sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSNHL), is an important otological disorder that affects up to 5-20 in 100,000 people. It is characterized by a rapid loss of the hearing, usually unilateral, with a sensorineural hearing loss greater than 30 dB over three consecutive frequencies, in less than 72 hours and can be associated with tinnitus and vertigo. It is a real sensorineural emergency that can become a permanent handicap if not adequately treated. Because of patients recovering rapidly or seeking no medical attention, the true figure might be higher, even if delaying SHL diagnosis and treatment may decrease the effectiveness of treatment. Sudden Hearing Loss can occur at any age but usua…

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in su…

Our Assessment Using Palate Postoperative Problems Score (PPOPS): Tool for the Evaluation of Results in Palatal Surgery Techniques

Obstructive sleep apnoea syndrome is a chronic condition characterized by frequent episodes of collapse of upper airways during sleep. Prevalence of the disease is settled at about 3–7%. Today, palatal surgery is a reference point in OSAHS treatment and there are many different surgical techniques. The purpose of our work is to compare post-operative results of palate surgery techniques used in our practice in OSAHS patients, studying the degree of patients’ satisfaction with a recent score recommended by Rashwan et al. called PPOPS (Palate Post-Operative Problems Score). A retrospective study was performed on a sample of 40 patients subject to different palate surgery techniques for OSAS. …

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for …

Impairment of leptin/leptin receptor pathway in nasal epithelium from allergic turbinates

BACKGROUND: Allergic rhinitis (AR) is characterized by a remodeling of nasal epithelium. Leptin adipokine has been already identified as a marker of homeostasis in human bronchial epithelial of asthmatics. TGF-β is a multi-functional cytokine and conflicting findings exist regarding its role in the remodeling responses of the upper airways in allergic rhinitis. OBJECTIVE: We sought to investigate ex-vivo the expression of leptin/leptin receptor pathway and TGF-β in human nasal epithelium. METHODS: 41 biopsies of inferior turbinates obtained from allergic patients with AR (A, n = 20) and from healthy control subjects (C, n = 21) were analyzed for leptin/leptin receptor and for TGF-β 1, 2, 3 …

Notch‐1 signaling activation sustains overexpression of interleukin 33 in the epithelium of nasal polyps

Abstract BACKGROUND: Alterations in the nasal epithelial barrier homeostasis and increased interleukin 33 (IL-33) expression contribute to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). AIMS: As Notch-1 signaling is crucial in repair processes of mucosa, the current study assessed Notch-1/Jagged-1 signaling and IL-33 in the epithelium of nasal polyps biopsies from allergic (A-CRSwNP; n = 9) and not allergic (NA-CRSwNP; n = 9) subjects by immunohistochemistry. We also assessed, in a model of nasal epithelial cells, the effects of stimulation of Notch-1 with Jagged-1 on the expression of IL-33 (by flow cytometry, immunofluorescence, and immunocytochemistry), Jagged-1 (…

Respiratory epithelial adenomatoid hamartoma: An unusual case report

Respiratory epithelial adenomatoid hamartoma is a rare lesion of the nasal cavity whose etiology and pathogenesis are unknown and symptoms are unspecific. It can be isolated or associated with inflammatory process, first of all nasal polyposis. It’s considered a rare lesion because it’s poorly known and consequently correctly diagnosing is important to a right surgical treatment and follow-up. A 54-year-old man presented with a 10-year history of epistaxis, rhinorrhea and anosmia. Computed tomography showed soft tissue densities in all sinus cavities consistent with nasal polyposis and without bilateral widening of the olfactory cleft >10 mm and without bone erosion. Functional endoscopi…

Postural changes in patients undergoing hyoid surgery for OSAS

The hyoid bone is the only â suspended boneâ in our body, and its suspension system has an important role in posture maintenance. We studied postural modification in a group of patients affected by Obstructive Sleep Apnea Syndromewho had undergone surgical treatment including hyoid suspension. The surgical procedure performed was section of supra- and infrahyoid muscle and mobilization of the hyoid bone through its suspension to the thyroid cartilage. We studied the postural changes with stabilometric tests. In the early post-operative (one week) follow-up, we performed a posturography test with closed eyes and occlusal disjunction, and saw a worsening of the average parameter of the centre…

A conservative treatment for chronic obstructive sialoadenitis by intraductal instillation of mucolytic, steroids and antibiotic solution

Abstract Purposes Reporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution. Methods Prospective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 mont…

The EBV-DNA Can be Used as a Diagnostic and Follow-up Parameter of the Rhinopharyngeal Tumors in the Non-Endemic Population of the Western Sicily

To evaluate whether EBV-DNA can be used as a diagnostic and follow-up parameter for nasopharyngeal tumors in a non-endemic population. The study was carried out in a university hospital. A retrospective study was conducted on 40 paraffin samples of histological preparations. EB-DNA was detected by real-time PCR technique. A prospective study was also conducted on a group of 30 patients who underwent nasopharyngeal biopsy for suspected nasopharyngeal carcinoma (NPC) by comparing EBV-DNA concentrations between the histological specimen and the serum. Quantification of genomic copies of EBV-DNA in serum and detection of anti-EBV antibodies was performed. In both groups the presence of high vir…

Delayed expansion of atrophic mandible (deam): a case report

Purpose. The present case report presents the clinical results of delayed expansion of mandibles by ultrasonic surgery in case of mono edentulous. Materials and methods. The patients with a residual alveolar ridge thickness between 2,3 and 4,1 mm in the coronal area of posterior mandible was threated. In the first stage, four linear corticotomies were carried out by ultrasonic surgical device; bone expansion was not performed. After 4 weeks, in the second stage, adequate bone expansion, without compromising cortical vascularisation, by utilising a combination of scalpel, thin chisels and threaded osteotomes was achieved and one implant was placement, after filling the gaps with a cortico bo…

Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome

Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome. Objectives: Aim of this study is to verify the presence of neurocognitive, neurobehavioral or sleep disturbances in children affected by adenotonsillar hypertrophy (ATH) and Obstructive Sleep Apnea Syndrome (OSAS) and verify their improvement after Adeno-Tonsillectomy (AT). Methods: Eighty children suffering from adenotonsillar hypertrophy and OSAS were recruited for AT in the ENT Department of the University of Palermo. All the children underwent clinical evaluation, including rhinofibroscopy for grading the obstruction due to the adenotonsillar hypertrophy (before and 6 …

Recurrent ossifying fibroma of the maxillary sinus in an adult patient.

In some aspects, the terminology of fibro-osseous lesions of the head remain equivocal. The WHO classification suggested to group cemento-ossifying fibroma and ossifying fibroma under the term "ossifying fibroma". Based on the different age of onset, localization and risk of recurrence, two types have been described: "juvenile ossifying fibroma", with early age of onset, which needs to be treated with wide surgical resection due to the high risk of recurrence; and "adult ossifying fibroma", arising in adult patients, with low recurrence rate, properly treated by conservative surgery. We describe a case of an "adult ossifying fibroma" of a 57-yearold woman with several relapses, for whom con…

The minimally invasive sinus surgery technique

The minimally invasive sinus technique, (MIST) is different from minimally invasive sinus surgery. MIST implies a treatment philosophy and surgical model that is quite different from functional endoscopic sinus surgery (FESS). The goals of this article are to discuss the origins of functional sinus surgery as it relates to the evolution of FESS and MIST, define MIST as a philosophy and surgical model, discuss treatment of surgical sinus disease, and challenge the rationale for our departure from Messerklinger's "functional" concepts into what will be referred to as "contemporary FESS. " Many authors address the reduced revision rate (compared with FESS) following initial intervention with M…

Bipolar Quantum Molecular Resonance versus Blunt Dissection tonsillectomy

Bipolar Quantum Molecular Resonance versus Blunt Dissection tonsillectomy. Objectives: This study compared a quantum molecular resonance tonsillectomy (QMRT) to a standard blunt dissection tonsillectomy (BDT) for effectiveness and safety. Methodology: From January 2011 to September 2012, we recruited 80 children (ages 3 to 16 y) with paediatric obstructive sleep apnoea syndrome and/or recurrent tonsillitis. Patients were randomly assigned to receive QMRT (N = 40) or BDT (N = 40). The operating time and blood loss during surgery were evaluated. During the first postoperative week, the patients' parents completed a questionnaire to evaluate bleeding, ear and neck pain, nausea, vomiting, inter…