Search

Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest.

In laryngeal mucocele, Morgagni's ventricle fills with mucous resulting from proliferation of the innner glandular epithelium and simultaneous closure of the ventricular opening. In making a diagnosis, the physician must first rule out any underlying neoplasm in Morgagni's ventricle which would give rise to a secondary mucocele. The present work reports a clinical case which came under observation because of cough, dysphonia and swelling of the left ventricular band with normal motility of the true vocal cords. CT of the neck, performed with contrast medium and axial scanning, showed a solid neoformation starting from the left laryngeal ventricle; densitometry proved moderately non homogeneous and showed radiological signs of hypervascularization. On the basis of these data the patient underwent direct bioptic laryngoscopy. During the beginning of the endoscopic maneuver, the pressure exerted by the stiff laryngoscope forced out dense, sticky mucous-like material and caused the laryngeal ventricle to collapse. Subsequently, multiple bioptic samples were taken from the walls and floor of the ventricle. The histological and microbiological examination confirmed the diagnosis of laryngeal mucocele. Six months later the laryngoscopic picture was nearly normal. In the years since computerized tomography came into clinical practice, diagnosis of this pathology has become easier and quicker Computerized tomography provides radiological indication of benignness which is certainly valid for laryngocele, a tumefaction containing air and which is therefore clearly differentiated from the radiodensity of the surrounding tissues. Vice versa, the homogeneous mucous content of the laryngeal mucocele can be altered by bacterial proliferation and may not show up on the CT as a uniformly hypodense area. Phlogosis due to the presence of colonies of bacteria can lead to greater blood flow in the ventricular site, thus making it impossible to distinguish the hyperdense boundary surrounding the hypodense mass. This, in turn, creates a blurry, ambiguous area of hyperdensity typical of increased vascularization. The rarity of the lesion, the relative likelihood of a simultaneous neoplasm and the ambiguousness of the clinical diagnostic elements available justify the use of preliminary bioptic microlaryngoscopy before surgically treating laryngeal mucocele.

Multiple sclerosis is a neurological disease that affects the I/II motor neurons of the CNS and its symptoms include oropharyngeal dysphagia. The onset and course of this dysphagia significantly conditions the progression of the disease. The present study evaluates the incidence on deglutition and type of alterations in a sampling of 10 multiple sclerosis patients of which 4 showed clinical signs of dysphagia. The results, obtained by combining quantitative (clinical severity) and qualitative (functional alterations) parameters showed that 9 of the 10 patients (90%) presented radiological abnormalities in the progression of the bolus. The conclusion drawn is that the high prevalence of dysphagia in multiple sclerosis, even if not always manifest clinically, justifies drawing up a standard protocol for radiological evaluation and clinical follow-up in order to screen those patients at greater risk of pulmonary complications and delay them as long as possible.

Background: Early caries lesions present a greater porosity in the deep layers than in the superficial layer of the enamel. The "white spot" lesion is a dynamic lesion which is subjected to the changes occurring in the oral cavity; it can regress, stabilize or progress. The aim of this study is to show if there are considerable morphological differences in the superficial ultrastructural aspect of early caries lesions, active or stabilized, in persons of different age., Methods: To carry out this SEM observation, 15 patients aged from 12 to 50 presenting early caries lesions have been selected. Some of them had been recently subjected to orthodontic treatment, others several years ago. Five of these patients have been called back to examine again the demineralized area by microscope in the very same place of the first observation. The replica technique was used utilizing a silicon-based impression material, an epoxy resin for replicas casting, little steel nets to fix the silicon material., Results: At the level of white spot lesions it is evident a tissural structure scattered with small overlappings and micropits with a diameter of 0.5-2 mu. The patients who removed orthodontic bands more than 10 years before show a shining white aspect, corresponding to the nearly complete loss of enamel perikymata with well defined abrasions, but without any micropits at SEM examination., Conclusions: The replica technique has shown to be useful to record the defects of active and stabilized caries lesions. However this technique can't be utilized as a diagnostic instrument because it would be too expensive, but it is certainly a valid support for in vivo research.

Optical and electron microscopy have been widely used to study the structural features of olfactory epithelium in several Vertebrate species. To date, however, understanding of histopathological alterations in the human olfactory neuroepithelium has been quite limited due to the difficulty in obtaining well preserved, intact fragments of mucosa. The recent introduction of endoscopic biopsy techniques has made it possible to analyze this epithelium in greater detail. In the present work, endoscopic biopsy has been performed on samples from 10 rhinologically healthy subjects. The technique used proved quite simple and did not present any risks or complications. Moreover, all samples were well preserved, as confirmed by histology. In addition, the histological pictures suggest that normal rearrangement of neuroepithelium is not an uniform process but takes place following a zone pattern with distinct dynamics between neurosensorial and support cells. Greater diffusion of this technique would not only make it possible to use different techniques to gain more detailed knowledge of tissue structure, ultrastructure and dynamics in human neuroepithelium, but it would also provide improved diagnostic and forensic evaluation in cases of anosmia, disosmia and hyposmia.

In chronic rhinopharyngotubaric phlogoses, the key pathogenic element sustaining phlogosis is a persistent modification of the biological, rheological features of the nasal mucus. For centuries sulphurous thermal waters have proved effective in clinically curing such phlogoses. In order to evaluate the effect of such sulphurous-salty-bromic-iodic thermal waters a randomized, double blind study was undertaken on a sampling of 50 patients. The effect such waters have on secretory IgA (sIgA) and albumin in the nasal secretions was tested against a placebo made of distilled water. Using the method of radial immunodiffusion, the response in the IgAs (mg/l) and albumin (mg/dl) concentrations in the nasal secretions was measured for 25 patients treated with the thermal waters and 25 patients treated with distilled water. The average concentrations were statistically compared using the Student t-test for paired samples. A significant increase (p < 0.0001) was seen in the mean IgAs concentration in the patients treated with the thermal waters. On the other hand, there was a weak, not statistically significant increase in the same data mean for the group treated with distilled water. The average increase in the albumin concentration in the nasal secretions proved significant in both cases although the significance was much more marked in the group treated with the thermal waters (p = 0.001) vs. the placebo group (p = 0.039).

The present work analyzes subjective judgement of the voice and speech qualities of intelligibility, pleasantness and acceptability expressed for two groups of total laryngectomy patients. The first group was composed of ten patients who had undergone esophageal voice rehabilitation. The second had nine patients with tracheo-esophageal voice rehabilitation. A group of ten listeners was set up to evaluate the voice and language parameters. These were all persons who, because of their jobs (i.e. physicians, nurses, rehabilitation therapists, etc.), had nearly daily contacts with laryngectomized patients. The listeners had to evaluate the acoustic and qualitative features of the voices reproduced on magnetic tape and score them on a specially designed sheet. This study has revealed a significant difference in the voice and speech acceptability scores for the two different groups of patients. In fact, most of the listeners found the tracheo-esophageal voice more pleasant and more acceptable than the esophageal voice.

Modern clinical pathology is mainly based on the analysis of blood samples, carried out through more and more sophisticated techniques. Being the blood test an invasive technique, it certainly reduces the possibility of carrying out blood analysis, especially in patients such as children, old people, handicapped people and every person who needs continuous biochemical or pharmacological monitoring. In these cases it is very important to find other body fluids that can be easily obtained and that can offer the same reliable data as blood. Due to some of its characteristics, sometime saliva may be a good alternative to venous blood, as it presents the same features of plasma or urine. The chemical analysis of saliva provides some information that are useful for metabolic, inflammatory, neoplastic and genetic diseases; furthermore radioimmunological dosages allow to assess small concentrations of active substances. On the basis of an accurate review of literature, the aim of this study is to analyse the importance of saliva in diagnosing and monitoring certain systemic diseases, the utilization of saliva in hormonal and pharmacological dosages and the use of saliva in some epidemiological studies. Finally, it is emphasized that saliva in monitoring may help to manage several clinical conditions.

Background: Oxytalan fibers were identified by Fullmer and Lillie in 1958 for the first time, using the same coloring methods utilized for the elastic fibers. However, the istologic preparation had been previously treated with strong oxidation. Oxytalan fibers were found in many organs and tissues of different animal species and seem to be a type of "immature" elastic fiber in a precocious state of development. Anyway, the functional role of oxytalan fibers is still not clear. The oxytalan fibers, located in particular mechanical stress anatomic sides, seem to be connected to a more compact connective tissue in this sides. The purpose of our study is to analyze the anatomic arrangement of the oxytalan fibers in the temporomandibUlar joint of three different animal species: the rat [correction of mouse], the rabbit and the dog., Materials and Methods: Up to now, a coloring method specific for the oxytalan fibers has not been developed. Therefore, a correct evaluation of their presence requires a systematic approach in which two contiguous sections of a sample, one heavily oxidized and the other non oxidized, are compared., Results: Our results show the presence of the oxytalan fibers differently located depending of the animal species and the age of the animals.

Septorhinoplasty plays an important role in childhood, particularly from the functional point of view. In fact, normal nasal respiration makes it possible to develop physical harmony throughout the entire body, particularly within the facial area. Nasal respiration serves as a defense mechanism, filtering air, thus relieving the lower respiratory tract of some work during the episodes of upper aero-digestive tract infection and inflammation so typical of childhood and early adolescence. The surgical indications should consider the central points in nasal surgery in childhood: there must be marked functional compromise; the aesthetic defect, if present, must be highly evident; the surgical treatment must be as limited and focused as possible as to prevent interfering with subsequent development of the nose, paranasal sinuses and facial structures. In those cases where the above conditions are not found, it is advisable to postpone surgery until the child has reached 16 years of age, when the development of the nasal and facial skeleton has been completed.

Functional and aesthetic nasal surgery has been undergoing a process of fine-tuning. The surgical approaches lean toward greater conservation-particularly aesthetic- and functional selectivity. This has been made possible by improved diagnostic methods and pre-operative programming techniques such as computerized morphometry, computerized axial tomography, rhinosinus endoscopy, rhinomanometry, acoustic rhinometry and electromyography. Another important point in functional and aesthetic nasal surgery is that a) it can be divided into different techniques for each anatomo-functional sector considered and b) these can be used together in various combinations. Experience and the literature have underscored some issues which are most pertinent to the modern methodological viewpoint. The first large-scale controversy involves a comparison of open and closed techniques for access. The advantages and disadvantages of both techniques are described, although the disadvantages can be reduced to a minimum if the right indication is chosen. In the authors' opinion, the open technique should be reserved for general revision surgery, particularly in conjunction with difficult tips, labiopalatoschisis reconstruction, septal perforation and saddle nose. The second basic point involves how to deal with the perichondrium-periostium-mucosal flaps. The two main techniques for nasal skeletizing in rhinoseptoplasty include the extra-mucosal approach which is conservative and the trans-mucosal approach which is apparently more traumatic. Curiously, however, it is the latter technique which leads to fewer medium-long term complications. The nasal tip is the crux for the neophyte to rhinoseptoplasty. Through knowledge of the indications and the risks of the various techniques makes it possible to predict the result before-hand, although with certain margin of error. Indeed, this is one of the regions of the nose where errors reap the greatest damage. In this anatomical site, the use of conservative techniques is, therefore, strongly suggested. Finally, not only has research into the field of functional nasal surgery been unable to find concrete applications in humans (for obvious ethical reasons), it has likewise been unable to provide an answer to the question most rhinosurgeons pose: why do some patients still complain of difficulty breathing, even after successful surgery? It is our conviction that the problem is due to the fact that research into the endonasal receptors has not progressed.

Capacity and temporal characteristics of auditory short-term memory have been investigated through a simple multi-tonal sequence paradigm in five normally hearing subjects. They were required to judge whether the tonal sequence contained or not a tone probe following the sequence. Performance was evaluated relative to the sequence length (2, 4, 6 stimuli) and sequence-probe interval (1, 3, 6 s.). The subjects' performance has been proven to be mainly dependent on the number of the sequence components (90% of the explained variance), while sequence-probe interval represents a factor of minor weight. Furthermore, a strong recency effect has been shown for the last sequence component, extending to the preceding components in dependence of the sequence-probe interval. Contrasting to studies on the verbal short-term memory, a primary effect has been not demonstrated. As these results reflect the typical effects of auditory short-term memory, it is likely that memory tests based on simple tonal sequences may be suitable for clinical use.

The Speech Reception Threshold (SRT) was adaptively measured using sentences in two groups of subjects: young, normal-hearing subjects and elderly hearing-impaired subjects with high frequency loss. SRT was recorded in quiet and in noisy conditions with competition consisting in "speech noise" and continuous discourse delivered at intensities between 11.4 and 98.6 dBA SPL. A significant difference was found between the groups in that elderly subjects had higher SRTs in noise than the young counterparts expressed as signal to noise (s/n) ratio. Moreover, at noise intensities typical of everyday life, the SRTs of the elderly is 6 and 11.4 dBs/n higher than normal-hearing subjects, with speech noise and discourse respectively as competition. Communicative strategies that enhance s/n ratio should be considered in order to overcome the heavy effects of hearing loss in the elderly.

Primitive glandular neoplasms of the middle ear are a rare entity. Under this definition epithelial neoplasms are classified according to structure as adenomas or adenocarcinomas, with intact tympanic membrane. Review of the literature shows that four histopathological patterns can be identified among these neoplasms: adenoma, adenocarcinoma, ceruminous adenoma and ceruminous adenocarcinoma. The present work describes a case of primitive ceruminous adenoma of the middle ear (6 cases have been reported in the literature) discovered during exploratory tympanotomy performed on a presumed otitis media which had not responded to medical treatment. The case description is followed by a review of the literature on the subject. The rarity of such neoplasms arises from this review as well as the fact that the histogenesis of ceruminous neoplasms of the middle ear is not clearly defined. Further study is required and more reports need be made in order to establish the best therapeutic approach to such neoplasms. It is the authors' opinion that the term "ceruminoma" is a generic term and not a clear definition and that its use in labeling the most various neoplasms of the middle and external ear must be abandoned.

An unusual case presenting congenital malformations involving the face and mastication apparatus is described. It has been classified as a mandibular-ocular-facial syndrome (Françise's"new syndrome".

The Authors have proposed to develop this research employing a preparation containing exclusively a cortisonic, the desametazone, in order to evaluate the alterations of the dentinogenesis to be attributed to such component. 32 cavities have been carefully drilled in dogs' cuspids. The 16 experimental cavities were dressed with desametazone, asbestos and amalgam in successive strata while in the 16 control cavities only asbestos and amalgam were used. Stainless steel bands were cemented on the processed teeth. The animals received 9 I.V. injections of tetracycline (10 mg per kg) each at 7 days interval. In the observation of the tetracycline markings under the experimental cavities (with desametazone) alterations of the dentinogenesis were not observed. Consequently, it seems that the action of desametazone is not to be considered harmful for the pulp tissue under the freshly cut dentine, as far as duration of the experiment is concerned.

Tetracycline labelling was employed to assess pulp and dentin reactivity to the use of oxyphosphate cement in the dog. A comparison was made of dentine conditions below control cavities and those containing the cement. In the former, the pulp and dentin response consisted of enhanced dentinogenesis, whereas in the latter this parameter showed no particular changes throughout the experimental period.

Odontomix (reg'd) cement was used at the bottom of cavities prepared in healthy dog canines in a attempt to prevent pulp and dentine alterations caused by the preparation and filling of cavities. 24 dogs were used along with 24 controls. I.v. tetracycline was afterwards given 10 times at weekly intervals. Examination of tetracycline labelling under the cavities showed that the cement caused pulp and dentine changes in confined areas, though it has not yet been possible to determine whether these are due to the corticosteroid, the antibiotic, or the excipient employed in the preparation.

An association of trimethoprim and sulphamethoxazol (Bactrim, Roche) was employed in the indirect capping of healthy teeth in the dog. Tetracycline labelling showed dentinogenesis in these teeth and comparison was made with the controls, A quantitative and qualitative change in dentinogenesis was noted below the control cavities. This alteration was less marked in Bactrim-treated teeth. It is deduced, therefore, that the operations involved in the preparation and filling of cavities in healthy teeth leads to pulp damage that can be partly prevented by using a bactericide.