A randomized controlled trial showing efficacy of once daily intranasal budesonide in nasal polyposis

A randomized, double-blind, placebo-controlled trial was performed to assess the efficacy of once daily budesonide in patients with nasal polyps. After a 2-week run-in period, 157 patients with symptomatic bilateral nasal polyposis were randomized to receive budesonide, 140 micrograms once or twice daily or 280 micrograms once daily (delivered doses) via Turbuhaler, or placebo for 8 weeks. Polyp size was assessed endoscopically and, in two centres, by magnetic resonance imaging (MRI). Nasal symptoms (blocked nose, runny nose, sneezing) were recorded daily, and patients provided an overall assessment of efficacy at the end of the study. Budesonide, 280 micrograms/day (280 micrograms o.d. and 140 micrograms twice daily), significantly reduced polyp size, compared with placebo, whereas budesonide, 140 micrograms once daily, had no significant effect. Nasal polyp mass score, measured by MRI, was also significantly reduced in patients receiving 280 micrograms/day. All three doses of budesonide significantly reduced symptom scores, and there were no significant differences between the groups. Overall, approximately 70% of patients receiving budesonide, 280 micrograms/day, reported substantial or total control of symptoms, compared with 45% of placebo-treated patients. It is concluded that budesonide, 280 micrograms once daily, reduces polyp size and relieves symptoms in patients with nasal polyposis.     

Conalbumin in the treatment of acute enteritis in the infant

Conalbumin, a glycoprotein derived from eggwhite, has the property, like lactoferrin, of binding iron ions. This property prompted the authors to undertake an experimental study on acute enteritis in infants in the first year of life. Forty infants with acute enteritis, not complicated by ionic imbalance or severe dehydration, were randomly allocated to two groups. The subjects of the first group were treated with the traditional dietetic therapy; those of the second were treated with the same diet plus conalbumin for periods ranging from 6 to 10 days. General condition, the alvus and body-weight trends were evaluated during and after the treatment period. Stool cultures were also carried out during treatment. In the group of children treated with conalbumin the results were: excellent in 5 subjects (25%), good in 13 (65%), fair in 1 (5%) and null in 1 (5%). The general status and the time needed to normalize the alvus were statistically significant (p less than 0.001) in favour of conalbumin. Body-weight in the two groups showed no significant difference. Neither metabolic alterations nor intolerance phenomena were noted during treatment with conalbumin. In conclusion, conalbumin demonstrated therapeutic properties against acute enteritis in infants through the rapid normalization of the alvus. No side-effects were noted.     

The epithelium of the excretory duct of the human submandibular gland: A transmission and scanning electron microscopic study

The duct of the human submandibular gland (Wharton) is lined by a pseudostratified epithelium consisting of principal and basal cells. Scattered among them are a few goblet and ciliated cells. The principal cells are columnar in shape with many mitochondria, numerous dense bodies and a central nucleus with some indentations. Their apical cytoplasm shows a number of clear vesicles, some of which are reactive to silver and are extruded by exocytosis into the lumen. Other vesicles, which are unreactive, may represent the products of the absorption process. A mechanism of apocrine secretion is also observed in the principal cells. Thus, with regard to its functions, the duct of the human submandibular gland modifies the composition of saliva by adding a secretory component to it. This latter material is derived from the goblet cells but chiefly from merocrine (exocytosis) and apocrine secretion of principal cells.     

Endoscopic-assisted transcolumellar approach to the clivus: an anatomical study

OBJECTIVE: Surgical exposure of the clivus and retroclival region is a challenging problem. Several extracranial and intracranial approaches using microsurgical techniques have been proposed in the search to optimize the exposure of the clival region. The objective of the present study was to develop an endoseopic-assisted transcolumellar approach to the anterior clivus. STUDY DESIGN: Experimental anatomic study. METHODS: The approach was studied in 10 consecutive cadaveric preparations. It included a preliminary external rhinoplasty technique with a septal displacement procedure, which gives a wide intranasal route to the posterior wall of the nasopharynx. By use of a drill system and instruments specially designed for endoscopic sinus surgery, the clivus and retroclival region were appropriately managed. Direct morphometric measurements were obtained during all steps of the procedure. RESULTS: The endoscopic-assisted transcolumellar approach developed in the present experimental study allowed a good exposure of the clivus area and anterior cranial-cervical junction. By performing a preliminary septoplasty, the nostrils were turned into a single passage with adequate space for endoscopic insertion and manipulation of one or two instruments. The authors were able to completely expose the posterior wall of the sphenoid sinus and clival dura after the thick bone of the vomer, the floor of the sphenoid, and the clivus were removed by a drill. Angled endoscopes provided a comprehensive view of the retrosellar area. CONCLUSIONS: The endoscopic-assisted transcolumellar approach, besides offering a wide opening for endoscopic management of the clivus, also allowed the surgeon to perform a double-handed procedure and to associate the use of a microscope if needed. The use of endoscopes, although lacking the three-dimensional view, gave a thorough and closer exposure of the surgical field with the advantage of a multiangled perspective.     

Balloon catheter sialoplasty: a safety and feasibility pilot study

Obstructive sialoadenitis is the most common non-neoplastic disorder of the salivary glands. With advances in the use of diagnostic and interventional sialoendoscopy in the major salivary glands, operations can often be less invasive and treatment can spare the gland and restore normal function. By using an expandable balloon catheter to dilate ductal stenosis during sialoendoscopy it is possible to dilate a stenotic duct and remove large stones with or without a basket. However, the use of different angiocatheters or dedicated balloons is still empirical. In this pilot study we assessed the feasibility and safety of balloon dilatation of the submandibular gland (Wharton's duct). We did balloon catheter sialoplasty on four ducts from two fresh adult cadavers. We used a non-compliant dilating balloon catheter 6 mm in diameter at a pressure of 12 × 10⁵ Pa for a total of three minutes and then examined the ducts histologically. There was no damage to the wall of Wharton's duct. Although this is a small study, we have shown the safety of balloon catheter sialoplasty for the first time as assessed histologically after dilatation of the duct. By virtue of the technique histological assessment is not possible after dilatation in patients. Long-term follow up is clearly required in this rapidly evolving area of surgery.     

Long‐term outcome after limited cortical resections in two cases of adult‐onset Rasmussen encephalitis

Rasmussen encephalitis (RE) is a progressive inflammatory disorder characterized by brain hemiatrophy, unilateral focal deficits, and drug‐refractory focal epilepsy. Epilepsia partialis continua (EPC) is a hallmark of the disease. Several immunomodulatory treatments may slow but not halt the disease progression. The treatment of choice still relies on surgical hemispheric disconnection, which is burdened by heavy neurologic morbidity. More limited cortical resections, although more tolerable, are usually considered to be, at best, only transiently effective in RE. Hemispheric disconnections may be not feasible when neurologic functions are preserved and the dominant hemisphere is affected. Adult patients with a milder RE course that preserves neurologic function for a long period are particularly at risk of developing severe deficits after surgery. In this study we present the histories of two patients with adult‐onset RE who have undergone selective cortical resections to control EPC, avoiding, at the same time, the severe postsurgical deficits that may be induced by hemispheric disconnective surgery. The good result obtained on EPC has been stable over a prolonged period; however, this result was not paralleled by the stop of neurologic progression in one of the two cases. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .     

The surgical treatment of epilepsy

Neurological Sciences - In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation...     

Long-duration epilepsy affects cell morphology and glutamatergic synapses in type IIB focal cortical dysplasia

To investigate hypothesized effects of severe epilepsy on malformed cortex, we analyzed surgical samples from eight patients with type IIB focal cortical dysplasia (FCD) in comparison with samples from nine non-dysplastic controls. We investigated, using stereological quantification methods, where appropriate, dysplastic neurons, neuronal density, balloon cells, glia, glutamatergic synaptic input, and the expression of N-methyl-d-aspartate (NMDA) receptor subunits and associated membrane-associated guanylate kinase (MAGUK). In all FCD patients, the dysplastic areas giving rise to epileptic discharges were characterized by larger dysmorphic neurons, reduced neuronal density, and increased glutamatergic inputs, compared to adjacent areas with normal cytology. The duration of epilepsy was found to correlate directly (a) with dysmorphic neuron size, (b) reduced neuronal cell density, and (c) extent of reactive gliosis in epileptogenic/dysplastic areas. Consistent with increased glutamatergic input, western blot revealed that NMDA regulatory subunits and related MAGUK proteins were up-regulated in epileptogenic/dysplastic areas of all FCD patients examined. Taken together, these results support the hypothesis that epilepsy itself alters morphology—and probably also function—in the malformed epileptic brain. They also suggest that glutamate/NMDA/MAGUK dysregulation might be the intracellular trigger that modifies brain morphology and induces cell death.     

Dental anomalies in the primary dentition and their repetition in the permanent dentition: a diagnostic performance study

This study investigated the recurrence in the permanent dentition of dental anomalies of the primary dentition. A sample of 189 subjects (100 males, 89 females, mean age of 5 years and 7 months) with anomalies of primary teeth (tooth hypodontia, supernumerary teeth, geminated teeth, and fused teeth) was selected and re-analyzed at a mean age of 11 years and 2 months for the recurrence of the dental anomalies in the permanent dentition. As a control group, 271 subjects (123 males, 148 females) without dental anomalies in the primary dentition were selected. The recurrence in the permanent dentition of the dental anomalies in the primary dentition was evaluated by measures of diagnostic performance. The results showed high values for the repetition of hypodontia (positive likelihood ratio = 102.0); low score for the repetition of hyperdontia (positive likelihood ratio = 6.5); low positive likelihood ratio (9.1) for gemination of primary teeth resulting in supernumerary permanent teeth; high positive likelihood ratio (47.0) for fusion of primary teeth followed by missing permanent teeth. Dental anomalies in the primary dentition are associated with an increased likelihood of anomalies of the succedaneous permanent.