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The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.

Background: Because the orbital-malar complex has a peculiar anatomic constitution and position, it is at the third place for frequency of the fractures especially if we compare it with another skeleton's parts. Till now have been tested numerous materials with advantages but also some disadvantages used to rebuild the orbital floor. We thought it right to test a material with biocompatibility, easy handiness, chemical stability and elasticit, as PTFE membrane., Methods: We studied 40 cases of both sexes (age between 19 and 70 years) of orbital-malar complex fractures: 14 with isolated fractures, 20 with complexes fractures and 6 politraumatized. They show various degree prolapse of the orbital contents in the maxillary sinus. We make clinic examination and orthoptic analysis by Hess's screen, test of forced traction, axial and coronal TC. In all patients, surgery approach and methodology of plate application were the same., Results: All the floors had a optimal and immediate functional renewal; there wasn't any inflammatory reaction neither immediately nor after a two years follow-up., Conclusions: In conclusion, the results show a lot of clinical and practical advantages of the PTFE membrane: the extreme biocompatibility and the easy handiness, the ductility and the low cost.

The purpose of this report is to describe a 64-year-old woman who presented an 8 month history of recurrent spontaneous cerebrospinal fluid leakage into the left middle ear. High resolution computed tomography and computed tomography cisternography showed only a mild protrusion of the tympanic segment of the left facial canal into the ipsilateral middle ear but no definitive fistula. At surgical exploration, cerebrospinal fluid leakage resulted from a fistula in the tympanic segment of the left facial canal. In conclusion, in the adult patient reported herein, the fistula leading to spontaneous CSF otorrhea was identified definitely only intraoperatively. Furthermore, although there were no signs or symptoms of facial nerve dysfunction, it was located in a rare site such as the second segment of the facial canal. When the clinical history, physical examination, and laboratory analysis are strongly suggestive for spontaneous CSF otorrhea, surgical exploration is mandatory even if neuroimaging evaluation is negative or questionable.

Stenosis of the naso-lachrymal duct as a consequence of acute or chronic inflammation, trauma or congenital malformation is a relatively frequent lachrymal duct pathology. The symptoms include epiphora and intermittent tumefaction of the medial ocular canthus, indicative of a deficiency in lachrymal drainage. If such conditions do not respond to medical treatment, lavage and transcanicular probe, surgery proves necessary. Modern techniques for endonasal surgery place the otologist in the forefront in the surgical treatment of this disorder. Endonasal dacryocystorhinostomy (DCR) is indeed a valid alternative to traditional extra-nasal surgery; once exclusively the domain of the ophthalmologist. However, it does require a certain expertise in micro-endoscopic surgery. In most cases sophisticated equipment is not required and the procedure can be performed with just a few instruments: electric knives, scalpel and Citelli forceps. Endonasal DCR makes skin incisions unnecessary and makes it possible to reveal, and possibly, correct, any sequela subsequent to traditional DCR such as ethmoidal rhino-sinusitis or the presence of adhesions. In the present work 67 patients--24 with recurrence after traditional surgery--underwent endonasal DCR within the last 22 months and with an average follow-up of one year. Surgery was successful in 90% of the cases.

The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.

We report a rare case of adenocarcinoma of the sphenoid sinus in which the very rarity of the site made for considerable uncertainty in the early diagnosis despite major neurological deficits at onset. Only the subsequent course of the tumor enabled us to identify the site in the sphenoid sinus, an atypical area surrounded by numerous neurovascular structures which, if involved, may give rise to a protean and nonspecific symptom-complex.