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The role of cVEMPs and vHIT in the evaluation of otosclerosis and its eventual vestibular impairment: preliminary findings., Objectives: Otosclerosis is one of the most common causes of hearing loss in adults, with a prevalence of 0.3% to 0.4% in Caucasians. Vestibular symptoms may occur, with an incidence ranging between 5% and 57% of patients. The aim of our study is to evaluate the vestibular function and its eventual changes after stapes surgery in patients affected by otosclerosis., Methods: Prospective case-control study. Twenty patients (17 females; age range 33-58; mean age 44) who underwent surgery for otosclerotic disease between April 2012 and February 2014 were prospectively studied. These patients underwent preoperative and postoperative audiological tests. Furthermore, vestibular function was evaluated using the cervical evoked myogenic potentials test (cVEMPs) and video head impulse test (vHIT), preoperatively and postoperatively. A case-control study was also performed. Quantitative and statistical analysis of patients' vestibular function was carried out both before and after stapes surgery., Results: The means of the vHIT gains in the case group were 1.03 on the right side and 1.01 on the left side. A significant difference between case and control groups was seen, with a lower left gain registered in the control group. No cases with a gain of less than 0.8 were found in either group. Moreover, a significant postoperative reduction in P1/NI amplitude was seen in patients complaining of postoperative dizziness or vertigo., Conclusions: These findings indicate a probable traumatic saccular impairment in patients with vestibular symptoms. However, a longer follow-up may help in understanding the behaviour of cVEMPs in post-stapes surgery vertigo.

Background: Although endoscopic submucosal dissection (ESD) is becoming accepted as an established treatment for superficial esophageal squamous cell neoplasia, the majority of data on this endoscopic modality has been provided by Japanese series., Objective: To assess the efficacy and safety of ESD for esophageal squamous cell neoplasia in a consecutive series of patients treated in a Western setting., Design and Setting: Single-center, prospective observational study., Patients and Intervention: From January 2005 to July 2008, 20 patients with superficial esophageal squamous cell neoplasia were treated by ESD., Main Outcome Measurements: Rates of en bloc resection, complete resection, and complications were evaluated as short-term outcomes. Overall survival, local or distant recurrence, and postoperative stricture rates were evaluated as long-term outcomes., Results: ESD was performed in 20 patients (mean age 64 years, range 46-81 years; 16 men). The mean size of the lesion was 32 mm (range 15-60 mm); it was 30 mm or larger in 14 patients (70%). The mean time of ESD was 89 minutes (range 58-180 minutes). En bloc resection with resection-free margins was achieved in 18 patients (90%), whereas 2 patients presented with incomplete or indeterminate resection. Two cases (10%) of mediastinal emphysema without overt perforation and 1 case (5%) of post-ESD symptomatic stricture were reported. No local or distant post-ESD recurrence occurred in those with resection-free margins at a median follow-up of 18 months., Limitations: Small number of patients and limited follow-up., Conclusion: This Western series study confirms that ESD is a potentially curative treatment for superficial esophageal squamous cell neoplasia. Early and late complication rates were comparable to those of Japanese series. ESD should be probably considered as the treatment of choice in all large lesions amenable to endoscopic treatment., (Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Malignant obstruction of the colon occurs in 7-25% of patients with colorectal cancer. As emergency laparotomy is reported to have relatively high morbidity and mortality rate, there is a need for alternative procedures with reduced complication rates. Over the last decade colorectal stenting has been reported as an alternative endoscopic method to relieve acute colonic obstruction. With the availability of more sophisticated stents and stent delivery systems, this approach has been used as a palliative method and as a pre-operative bridge to facilitate one-stage surgical resection of primary colonic tumors. Technical and clinical successes have been reported in 80-100% of treated patients. Distal lesions are more common and theoretically easier to stent although lesions within the ascending colon have been successfully managed. Minor complications include transient anorectal pain, tenesmus and rectal bleeding. However, stent migration and colonic perforation are also well recognized. Despite the fact that no randomized controlled studies have yet been performed, literature data show that colonic stenting is a safe and effective procedure and can reduce costs, avoiding the need for colostomy and improving the quality of life of patients with advanced disease.

It is generally assumed that the oral contraceptives cause the carrier proteins to change. Notoriously this effect is used to evaluate indirectly their estrogenicity/gestagenicity ratio. In order to assess the residual intrinsic androgenic activity of two new 19-nor-derivative components, Desogestrel (DG) 150 micrograms and Gestodene (GD) 75 micrograms, both in association with Ethinylestradiol (EE) 30 micrograms, Sex Hormone Binding Globulin, Thyroxine Binding Globulin, Ceruloplasmin and Free Androgen Index (FAI), were studied in 40 young normally cycling healthy volunteers, matched for body mass index and age. The participants were randomly assigned to either EE-DG or EE-GD treatment. A marked significant increase in all the carrier proteins was found. Conversely, the values for FAI decreased significantly. The changes in the two groups were substantially of the same magnitude. These results are an indirect confirmation of the well-known negligible receptor binding affinity of the two progestogen in vitro, also supporting for these compounds the lack of relevant androgenic effects.