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Myxomas are benign lesions which can arise in any anatomic location but are mainly found in the heart. Exceptionally they interest the head and neck district, where the most frequently involved sites are the mandible and the maxilla. There are only few described cases of myxomas of the larynx. Here we report a new case of a laryngeal myxoma of the left true vocal fold, the second occurred in a female patient, presenting with severe dyspnea, dysphonia and dysphagia. We describe this case for two reasons. First is because it presents intubation which was safely treated through careful planning. Ameticulous treatment planning by surgeon and anaesthetist was made mutually carried out prior to microlaryngoscopic excision in case di large vocal cord polyps causing severe airway obstruction. The second reason is because a laryngeal myxoma is a very rare lesion. We provide a review of the literature, focusing on possible risk factors, and discuss the differential diagnosis and the best treatment options in laryngeal myxoma.

This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated ‘morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation’ (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient’s medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin–etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended.

Relapsing polychondritis (RP) is a rare systemic disease that is characterized by recurrent episodic inflammation of the cartilaginous structures of the body, resulting in their progressive destruction and subsequent replacement with fibrotic scar. We present a case of RP that initially manifested with subglottic involvement and we propose an innovative strategy for the treatment for laryngeal RP in phase of active inflammation. A multidisciplinary approach (rheumatologist, otolaryngologist, immunologist, internist, cardiologist, etc) and adequate follow-up are essential. The timeliness of the diagnosis is fundamental to contain the destructive effects on the cartilages involved.

Introduction: The hemangioma is the most common vascular tumor, involving the head and neck in 60% of cases. It is rare in the larynx. In children, hemangiomas are more frequent on the subglottis, whereas in adults the most common site is the supraglottis. Laryngeal hemangioma with cavernous features isolated to the free edge of the vocal fold is a very rare clinical finding. We present 2 cases of glottic hemangioma. Both patients reported severe hoarseness. Cases: In the first patient, an extensive blue-purple mass was seen on the right vocal cord. The patient was posted for microlaryngeal surgery with carbon dioxide (CO2) laser. Second patient had a large, smooth, flesh-colored polypoid mass emanating from the left vocal cord. The patient was posted for microlaryngeal surgery. After 2 months, both patients showed a considerable voice improvement. Discussion: Vocal cord hemangiomas are very rare, and they usually cause problem in the voice of the patient. A vascular lesion that may mimic a hemangioma may sometimes result from an organizing hematoma following a hemorrhage on the vocal cords due to voice abuse. Laryngeal hemangiomas also need to be distinguished pathologically from polypoidal vascular granulation tissue that may be produced by laryngeal biopsy, intubation, or trauma. Indirect endoscopy is enough to diagnosis. No active treatment is advised for adult laryngeal hemangiomas unless the lesions are symptomatic or show a tendency to involve other parts. There is no uniformly accepted treatment of head and neck hemangiomas. Surgical excision with laser CO2 microlaryngoscopic techniques gives satisfactory results.

Folate deficiency may be directly associated with carcinogenesis. Folate supplementation may reduce the risk of progression in a mucosa that is already genetically altered. The aim of the present study was to determine the role of folic acid in the treatment of mild and moderate laryngeal dysplasia recurring after surgery. The data obtained by laryngoscopy, measurement of serum folate levels and functional vocal assessment with the GIRBAS scale and VHI questionnaire were compared in patients who had received folic acid with a homogeneous group of patients with dysplasia who had not undergone any therapy. A total of 24 patients suffering from recurrence of mild or moderate laryngeal dysplasia (n=12, group A) were treated with 400 mg folic acid per os, once daily for 6 months. The patients in group B (n=12) received no treatment and were used as the control group. In group A, 7 (58%) patients exhibited a complete response, with clinically evident regression of leukoplakia, 3 (25%) displayed a partial decrease in the lesions with reduced volume of the area involved, whereas 2 patients exhibited no change. As regards patients in control group B, 8 (67%) exhibited no change, in 1 case there was a spontaneous regression, and in 3 (25%) there was disease progression with suspected malignant transformation, leading to repeat surgery. Therefore, folate deficiency may be considered to be a factor predisposing to precancerous lesions, and dietary folate supplementation may prevent and reduce the emergence of cancer.

// Filippo Ricciardiello 1 , Michele Caraglia 3 , Brigida Iorio 2 , Teresa Abate 1 , Mariarosaria Boccellino 3 , Giuseppe Colella 4 , Flavia Oliva 1 , Pierpaolo Ferrise 1 , Silvia Zappavigna 3 , Mario Faenza 4 , Giuseppe A. Ferraro 4 , Giulio Sequino 1 , Giovanni Francesco Nicoletti 4 and Massimo Mesolella 2 1 Division of Otolaryngology, “A. Cardarelli” Hospital, Naples, Italy 2 Department of Neurological, Reproductive and Odontostomatological Sciences, University “Federico II” of Naples, Naples, Italy 3 Department of Biochemistry, Biophysics and General Pathology, University of Campania “L. Vanvitelli”, Naples, Italy 4 Department of Medical, Surgical and Dental Specialties, University of Campania “L. Vanvitelli”, Naples, Italy Correspondence to: Michele Caraglia, email: michele.caraglia@unina2.it , michele.caraglia@fastwebnet.it Keywords: laryngea lbasaloid squamocellular carcinoma (BSCC); prognosis of laryngeal basaloid squamous cell carcinoma; mortality of laryngeal BSCC; loco-regional recurrence in laryngeal BSCC Received: July 26, 2017 Accepted: August 23, 2017 Published: September 28, 2017 ABSTRACT Basaloid squamous cell carcinoma (BSCC) is a rare, aggressive and distinct variant of squamous cell carcinoma (SCC) of the upper respiratory and digestive tract. We have evaluated disease specific survival (DSS) and overall survival (OS) through Kaplan-Meier method and mortality risk through univariate statistical analysis of Cox in 42 cases of BSCC and other 42 of laryngeal SCC (LSCC) matched for both age and sex. We demonstrated that laryngeal BSCC is a more aggressive tumor than LSCC as is associated to higher nodal recurrence of pathology ( 5 vs 2 patients, overall risk, OR 2.7), a reduced survival (median survival 34 vs 40 months, OR 3.2 for mortality); in addition, basaloid patients have a higher risk to be affected by second primary tumors (13 vs 3 patients, OR 5.8) and a higher probability to die for this second tumor (Hazard Risk, HR 4.4). The analysis of survival shows an increased mortality risk concurrent with the parameters assessed by univariate analyses that assume a predictive and statistical significance in second tumor and grading in basaloid LSSC.

Objectives To evaluate the relationship between metabolic 18Fluoro-Deoxyglucose-Positron Emission Tomography (18FDG/PET) and morpho-functional parameters derived by Magnetic Resonance Imaging (MRI) in patients with histologically proven laryngeal cancer. To assess the clinical impact of PET/MRI examination on patient's staging and treatment planning. Methods 16 patients with histologically proven laryngeal cancer were enrolled and underwent whole body PET/CT followed by a dedicated PET/MRI of the head/neck region. Data were separately evaluated by two blinded groups: metabolic (SUV and MTV), diffusion (ADC) and perfusion (K trans , V e , k ep and iAUC) maps were obtained by positioning regions of interest (ROIs). Tumoral local extension assessed on PET/MRI was compared to endoscopic findings. Results A good inter-observer agreement was found in anatomical location and local extension of PET/MRI lesions (Cohen's kappa 0.9). PET/CT SUV measures highly correlate with ones derived by PET/MRI (e.g., p=0.96 for measures on VOI). Significant correlations among metabolic, diffusion and perfusion parameters have been detected. PET/MRI had a relevant clinical impact, confirming endoscopic findings (6 cases), helping treatment planning (9 cases), and modifying endoscopic primary staging (1 case). Conclusions PET/MRI is useful for primary staging of laryngeal cancer, allowing simultaneous collection of metabolic and functional data and conditioning the therapeutic strategies.

Neuroendocrine tumors are a spectrum of rare and highly heterogeneous neoplasms with distinct functional and biological behavior in relation to location, tumor size, and histological differentiation. Neuroendocrine tumors arise from the neuroendocrine cells of the diffuse neuroendocrine system located in almost every organ. Neuroendocrine tumors in the head and neck district are usually reported in sinonasal cavities and larynx. We present the case of a nasopharyngeal small-cell neuroendocrine carcinoma, which, as far as we know, is the 16th case reported in literature.

Amyloidosis is a group of idiopathic clinical syndromes caused by the deposition of insoluble fibrillar proteins (amyloid) in the extracellular matrix of organs and tissues. These deposits disrupt the function of the target organ. Amyloidosis can manifest as a systemic disease or a single-organ involvement (local form). Its etiology still remains unclear. Deposits of amyloid in the larynx are rare, accounting for between 0.2 and 1.2% of benign tumors of the larynx. In this retrospective study, we report the clinical aspects, diagnosis, treatment and follow-up of five female patients with localized laryngeal amyloidosis without systemic involvement. The patients were all treated successfully using microlaryngoscopy with CO2 laser or cold instruments. Prognosis is excellent; however, appropriate follow-up is an important part of the long-term management of this disease in order to prevent and control the possibility of local recurrence.

The purpose of the study was to assess by simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) the response to chemotherapy (CHT) and/or radiotherapy (RT) in patients with head and neck squamous cell carcinoma (HNSCC). Five patients with HNSCC underwent simultaneous PET/MRI examination before and after CHT and/or RT. Standard uptake volume (SUV), apparent diffusion coefficient (ADC), Ktrans, Kep, Ve, and iAUC pre- and post-treatment values were extracted and compared. The response to treatment was assessed according to RECIST criteria and classified as complete response (CR), partial response (PR), stable disease (SD), and progression disease (PD). In patient 1, PR was observed with increased ADC, Ktrans, and Ve values and reduction of SUV, iAUC, and Kep values; during clinical and instrumental follow-up, the patient experienced disease progression. Patient 2, classified as PR, showed increased ADC values and reduction of SUV and all perfusion parameters; follow-up demonstrated disease stability. Patient 3, considered as SD, showed increase of ADC and all perfusion values with a mild decrease of SUV; PD was observed during clinical and instrumental follow-up. Patients 4 and 5 showed a CR with no detectable tumor lesions at post-treatment PET/MRI examination, confirmed by 1-year follow-up. Multiparametric evaluation with simultaneous PET/MRI could be a useful tool to assess and predict the response to CHT and/or RT in patients with HNSCC.

Granular cell tumor (GCT), a relatively rare neuroectodermal tumor occurring most often in the head and neck region, is not uncommonly associated with pseudoepitheliomatous hyperplasia of the overlying surface epithelium, which may be at times nonreadily distinguishable from well-differentiated squamous cell carcinoma (SCC). To the best of our knowledge, only a handful of coexisting SCC and GCT, mostly described in the esophagus, have been reported in (the current) literature so far. We herein report 2 new cases of coexisting GCT and SCC of the head and neck region, located, respectively, in larynx and tongue; comment on their clinical, imaging, and pathologic features; and discuss their management. In the present work, we also review the literature concerning this association to contribute to the head and neck pathologists’ and surgeons’ awareness regarding the possibility of this association for an adequate surgical excision and a better management of these patients.

Lymph node tuberculosis (TB) represents the most common form of extrapulmonary TB that affects most often laterocervical lymph nodes. The disease, favored by states of immunosuppression, manifests itself by usually unilateral swelling, which may be associated with skin changes (hyperaemia, infiltration or fistula) and poor systemic symptoms. Our study included 75 patients arrived at the hospital “V. Monaldi” of Naples from 2008 to 2012, in order to evaluate some aspects of clinical, diagnostic and therapeutic characteristics of tuberculous lymphadenopathy. All patients were subjected to clinical, microbiological and radiological findings, surgical biopsy (alternatively, fine needle aspiration cytology, FNAC) of lymph nodes affected by pathology, antituberculosis chemotherapy for six months and subsequent followup. 49% patients were female and 51% male (mean age 44.5 years). 50.7% of patients were immunocompromised (6.7% of HIV-positive cases, 4% with type II diabetes mellitus, 16% of drug users, 6.7% treated with immunosuppressive drugs, 4% affected by malnutrition, 12% homeless). The laterocervical lymphadenopathy was unilateral in 70.7% of cases, smaller than 2 cm in 66.7%, single in 62.7%, with normal overlying skin in 72%. 9.3% of cases showed pulmonary involvement. 68% of cases excisional biopsy was performed for microbiological and histopathological examination and in 32% patients FNAC (integrated with excisional biopsy in more than half of the cases). Lymph node tuberculosis is still a problem of high clinical significance. Diagnosis requires excisional biopsy for differential diagnosis from other forms of adenopathy; treatment utilises a multi-agent chemotherapy scheme that allows a good cure rate, with few side effects. © 2014 Bentham Science Publishers

Lipoma is a common benign tumor affecting the soft tissues arising in every location where fat is normally present. About 15% of lipomas occur in head and neck region. The lipoma of parotid gland is a rare entity, comprising 0.6% - 4.4% of all parotid tumors. The etiology remains unclear. The case described a lipoma of the superficial lobe of the parotid gland in a 46-year-old male.

Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hemotologic diseases. They are rarely seen to occur simultaneously in one individual patient. Here we demonstrate a case of HS associated with CML in this study. The patient is a young female, diagnosed with HS in 2005, and was given partial embolization of the splenic artery. She got significant remission after the procedure. In 2008, she was found abnormal in blood routine test, after bone marrow routine, chromosome and fusion gene tests, she was diagnosed with CML (chronic phase). She did not receive regular treatment until 3 months prior, and is currently being treated with Dasatimib. She achieved hematological remission, but had no significant improvement in chromosome and fusion gene figures. Due to her severe condition of hemolysis, a splenectomy or an allogeneic hematopoietic stem cell transplantation is considered.

The authors present a case with a sublingual giant dermoid cyst, rapidly enlarged during pregnancy, which showed itself with deglutition and mild respiratory problems. Dermoid cysts (DCs) are benign lesions arising from entrapment of epithelial rests during embryogenesis. They are most frequently located in the ovaries and testes. Up to 6.9% are found in the head and neck and 1.6% within the oral cavity, representing less than 0.01% of all oral cavity cysts. They usually present early in life as asymptomatic masses with slow and progressive growth. However, they may reach a large size with a potential impact on deglutition, speech, and respiration. It is suggested that the rapid growth of DCs during pregnancy is associated with the increase of plasma levels of estrogens and progesterone. In order to eliminate respiratory and deglutition issues, it was decided to perform the surgical excision after a cesarean delivery at 29th week.

Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and leftsided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, allowed removal of the mass, without complications, after careful hemostasis of arterial branches. It was possible to establish the precise site of origin of the tumor only during the surgical procedure. Histopathological study showed mucosa with extensive vascular proliferation, with framework of lacunar/cavernous haemangioma, also present at lamellar bone tissue level. An unusual site and an unspecific clinical appearance can make diagnosis and treatment of a cavernous hemangioma of the nasopharynx difficult. The nasal endoscopic technique proved to be reliable in terms of adequate exposure and visualization of the lesion, control of bleeding, and complete removal of the mass.

To evaluate the role of simultaneous hybrid PET/MR imaging and to correlate metabolic PET data with morpho-functional parameters derived by MRI in patients with head-neck cancer.Forty-four patients, with histologically confirmed head and neck malignancy (22 primary tumors and 22 follow-up) were studied. Patients initially received a clinical exam and endoscopy with direct biopsy. Next patients underwent whole body PET/CT followed by PET/MR of the head/neck region. PET and MRI studies were separately evaluated by two blinded groups (both included one radiologist and one nuclear physician) in order to define the presence or absence of lesions/recurrences. Regions of interest (ROIs) analysis was conducted on the primary lesion at the level of maximum size on metabolic (SUV and MTV), diffusion (ADC) and perfusion (K(trans), Ve, kep and iAUC) parameters.PET/MR examinations were successfully performed on all 44 patients. Agreement between the two blinded groups was found in anatomic allocation of lesions by PET/MR (Primary tumors: Cohen's kappa 0.93;Cohen's kappa 0.89). There was a significant correlation between CT-SUV measures and MR (e.g., CT-SUV VOI vs.ρ=0.97, p0.001 for the entire sample). There was also significant positive correlations between the ROI area, SUV measures, and the metabolic parameters (SUV and MTV) obtained during both PET/CT and PET/MR. A significant negative correlation was observed between ADC and K(trans) values in the primary tumors. In addition, a significant negative correlation existed between MR SUV and ADC in recurrent tumors.Our study demonstrates the feasibility of PET/MR imaging for primary tumors and recurrent tumors evaluations of head/neck malignant lesions. When assessing HNC, PET/MR allows simultaneous collection of multiparametric metabolic and functional data. This technique therefore allows for a more complete characterization of malignant lesions.

Respiratory infections are the most frequent nosocomial infections after those urinaries and surgicals. We analysed respiratory infection incidences in patients treated with different kinds of respiratory assistance (non-invasive ventilation and invasive mechanical ventilation trough tracheostomy), studying 640 patients recovering in the intensive area of respiratory disease from 2010 to 2013. We had 113 cases of respiratory infections: 42.5% in patients of non-invasive ventilation group and 57.5% of patients treated with invasive ventilation with a statistically significant difference between the two groups. The patients treated with non-invasive ventilation showed a lower incidence of nosocomial respiratory infections. Prevention guidelines are important to reduce nosocomial infections frequency.

Adenoid cystic carcinoma (ACC) or 'cylindroma' is a malignant tumor that often occurs in the areas of the head and neck, affecting the secretory glands and the major and minor salivary glands. The present study describes a case of a patient who presented with a posterior tongue lesion. The case is of a 71-year-old female with an asymptomatic volume growth of the posterior left tongue perceived 8 months prior, and neoplastic cells positive for c-kit. A computed tomography of the head and neck showed asymmetry of the base of the tongue, which was enlarged in the left portion. A physical examination revealed a nodule on the posterior left tongue of ~3 cm in diameter, while the cervical lymph node chain had a normal size and consistency. Surgical exeresis of the tongue lesion and cervical lymph node dissection were performed. Subsequent to surgical removal of the cancer cells and adjuvant radiotherapy, the patient showed excellent health, although the follow-up remains in progress. ACC, one of the most biologically destructive tumors of the head and neck, is locally aggressive and gives rise to distant metastases. The tongue is the place of origin in 3.4-17.1% of cases. The treatment for ACC consists of primary surgical resection with adjuvant radiotherapy. To prevent the risk for distant metastasis, it is necessary to remove the first echelon nodes and monitor the patient with a long-term follow-up.

Keratin 5 (K5) is present in the basal layer of a stratified squamous keratinized and non-keratinized epithelium. K5 and K14 have been demonstrated in the mucosa and tumors of the oral cavity, oropharynx, hypopharynx and larynx, and in the mitotic active basal cells of a stratified squamous epithelium. The aim of the present study was to assess K5 expression in squamocellular carcinoma with various localizations in the head and neck. A total of 13 biopsy fragments were included from patients diagnosed with squamocellular carcinoma of the larynx area (n=2), pharynx (n=2), hard palate (n=1), tongue (n=2), submandibular (n=1), lip (n=1), gingival sulcus (n=1), nasal pyramid (n=1), maxilla (n=1) and zygomatic (n=1). The immunohistochemical staining for K5 was evaluated according to the following score criteria: 0 (0% positive cells); 1 (30% positive cells). K5 expression was observed in all squamocellular carcinomas included in the present study with scores between 1 and 3. For well- and moderately-differentiated histopathological types, a maximum score of 3 was recorded for all of the cases, not including the laryngeal area, which presented a score of 2. The following scores were identified in the regions of the poorly differentiated carcinomas: Jaw, 3; gingival sulcus, 2; and tongue and submandibular area, 1. These observations may aid with an improved stratification of head and neck squamocellular carcinoma, thus improving the diagnosis and treatment strategies for this type of cancer.

Developments in surgical technique and, more importantly, the use of increasingly sophisticated biocompatible prostheses have meant that good results can be achieved for otosclerosis sufferers in terms of restored hearing and very little postsurgical discomfort. We set out to assess whether the diameter of the prostheses used for stapedotomy (platinum piston/polytetrafluoroethylene, i.e. Teflon) has any effect on surgical outcome. Two groups of otosclerotic patients were selected, and these underwent stapedotomy surgery during the second phase of the disease. A piston-Teflon type prosthesis was used, 5.50 mm in terms of length but of different diameters (group A: 0.4 mm; group B: 0.6 mm). All the patients underwent the same pure-tone audiometry test before surgery, and then at 1 week and 1 month after surgery, to assess function. We compared air conduction after surgery with bone conduction before surgery. The data collected was analysed using the χ2 (p < 0.05) test. This analysis showed that the results obtained with a 0.4-mm prosthesis or a 0.6-mm prosthesis are almost identical. There was no statistically significant difference in terms of hearing results when comparing either average tonal threshold or when analysing audiometric data frequency by frequency. It can be concluded, therefore, that in stapedotomy surgery, functional recovery is not affected by the diameter of the prosthesis used. A smaller diameter prosthesis is, however, the one of choice when the facial nerve is prominent or the oval window particularly narrow.

Cystic fibrosis (CF) is one of the most common inherited life-shortening diseases with an incidence of 1:2.500–3500 and a carrier frequency of 4–5% [1] . It is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, which encodes a protein expressed in the apical membrane of exocrine epithelial cells, resulting in changes to the fluid and electrolytes on cell surface. More than 1500 mutations have been described so far in the CFTR gene, grouped in 5 classes on the basis of the impact on protein synthesis or activity [2] . In the last years a mounting number of reports described patients that did not meet all diagnostic criteria for CF [4] ; in particular, atypical or nonclassic CF is characterized by normal or borderline sweat test, pancreatic sufficiency and a monosymptomatic phenotype; the most studied forms are: congenital bilateral absence of vasa deferentes, acute or chronic recurrent pancreatitis, idiopathic bronciectasis [5] . These patients typically bear a severe and a mild (classes 4–5) CFTR mutation, the latter being dominant [6] . The involvement of upper airways is observed in up to 100% of classic CF patients, including recurrent sinusitis and rhinitis. Nasal polyps are present in 6–48% of overall CF patients and in 5–15.2% of less than 10 years old CF patients. Surgery is required for syntomatic polyps. It is the second most common class of operations performed on CF patients. In spite of the best of operations CF patients will have recurrence, because of systemic disease. We describe a patient diagnosed as “atypical CF” on the basis of persisting chronic rhinosinusitis, that showed a very rare CFTR genotype.

Osteoma of the nose is a rare and benign tumor that develop slowly. We present an unusula and rare case.

Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon-γ (IFN-γ) and interleukin-4 (IL-4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T-cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL-4 in T-cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNγ and IL-4 that occurs in vivo in anti-H2–treated patients with allergic rhinitis (AR). Methods Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment. Results A comparison of the serum cytokine values recorded before and after anti-H2 treatment showed a significant increase in INF-γ serum level (P = .003) and a decrease in IL-4 (P = .016). Negligible variations were found in the placebo-treated group. Conclusion H2 antagonists probably induce their effects by enhancing the amount of IFN-γ and by reducing IL-4 cytokines, which, respectively, induce a decrease and an increase in the IgE synthesis.

Lymphocyte T cell subsets, total and Parietaria IgE levels were studied in 68 allergic rhinitis patients. In treated patients we observed an increase in the lymphocyte T cell subsets, which express a suppressor function, defined by several monoclonal antibodies, i.e., CD8, CD8 + CD11b-, CD4 + CD62L+, CD4 + CD45RO. This increase was significant for T suppressor cells, CD8 + CD11b- (p0.046) and T memory cells, CD4 + CD45RO (p0.013), whereas a slight decrease was observed in the control group. A decrease in total serum IgE levels was observed in anti-H2 treated patients; only a slight increase was noted in placebo groups; and no variations were found in Parietaria levels in either group. In vitro culture of T lymphocyte clones, T memory cells, from atopic subjects produces IL-4, which induces an increase in IgE synthesis. An increase in T memory cells, observed in the treated group, should have accompanied an increase and not a decrease in total serum IgE levels, if the in vivo data correlated with those in vitro. Consequently, the behaviour of lymphocytes in vivo is not homologous to in vitro data.

The biological effects of anti-H2 in allergic reactions are dose dependent: low doses enhance, and high doses significantly decrease the reaction of hypersensitivity. The administration of cimetidine H2 antagonist to 20 perennial allergic rhinitis patients brought about an abatement in the symptoms and a decrease in the total serum immunoglobulin E (IgE) levels in 72% of treated patients, but no variation was perceived in placebo-treated patients. These results strengthen the hypothesis of anti-H2-induced immunoregulatory effects and suggest a possible way of inhibiting IgE synthesis in vivo.

Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its usual final position in pre-tracheal region of the neck. Its specific prevalence accounts about 1 case per 100.000–300.000 persons and one in 4.000–8.000 patients with thyroid disease show this condition. The cause of this defect is not fully known. Despite genetic factors have been associated with thyroid gland morphogenesis and differentiation, just recently some mutation has been associated with human thyroid ectopy. Lingual region in the most common site of thyroid ectopy but ectopic thyroid tissue were found in other head and neck locations.Nevertheless, aberrant ectopic thyroid tissue has been found in other places distant from the neck region. Ectopic tissue is affected by different pathological changes that occur in the normal eutopic thyroid. Patients may present insidiously or as an emergency. Diagnostic management of thyroid ectopy is performed by radionuclide thyroid imaging, ultrasonography, CT scan, MRI, biopsy and thyroid function tests. Asymptomatic euthyroid patients with ectopic thyroid do not usually require therapy but are kept under observation. For those with symptoms, treatment depends on size of the gland, nature of symptoms, thyroid function status and histological findings. Surgical excision is often required as treatment for this condition.