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ABSTRACT: The infratentorial variety of the subdural empyema, with or without coexisting cerebellar abscess, is a rare clinical entity that carries a high mortality rate. We briefly describe the case of a 49-year-old man presented with severe debility, fever and an obviously neglected chronic otitis media. The patient had refused surgical treatment several months ago. After admission, his level of consciousness began to deteriorate, and the radiological studies showed infratentorial subdural suppuration extending into the right cerebellar hemisphere, along with chronic pyogenic infection of the middle ear and the mastoid process. Radical mastoidectomy was performed first, followed by extensive right posterior fossa craniectomy. The two subdural collections and the cerebellar abscess were successfully evacuated. Subsequently, he received post-operative antibiotic treatment for 6 weeks. At follow-up, 10 months after surgery, his neurological recovery was complete except for a minor residual cerebellar dysfunction on the right. This unusual case highlights that in patients presented with severe intracranial complications of chronic otitis media, early diagnosis and radical surgical intervention may be life saving.
International Journal of Clinical Practice 03/2004; 58(2):214-7. · 2.41 Impact Factor
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ABSTRACT: The infratentorial variety of the subdural empyema, with or without coexisting cerebellar abscess, is a rare clinical entity that carries a high mortality rate. We briefly describe the case of a 49-year-old man presented with severe debility, fever and an obviously neglected chronic otitis media. The patient had refused surgical treatment several months ago. After admission, his level of consciousness began to deteriorate, and the radiological studies showed infratentorial subdural suppuration extending into the right cerebellar hemisphere, along with chronic pyogenic infection of the middle ear and the mastoid process. Radical mastoidectomy was performed first, followed by extensive right posterior fossa craniectomy. The two subdural collections and the cerebellar abscess were successfully evacuated. Subsequently, he received post-operative antibiotic treatment for 6 weeks. At follow-up, 10 months after surgery, his neurological recovery was complete except for a minor residual cerebellar dysfunction on the right. This unusual case highlights that in patients presented with severe intracranial complications of chronic otitis media, early diagnosis and radical surgical intervention may be life saving.
International Journal of Clinical Practice 01/2004; 58(2):214 - 217. · 2.41 Impact Factor
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ABSTRACT: Solitary extramedullary plasmacytomas are rare tumors that often affect head and neck region. Because of the non-specific associated symptomatology, they frequently are misdiagnosed. We briefly describe a 69-year-old woman who developed solitary plasmacytoma in the left maxillary sinus and was initially treated as having sinusitis. We also report the diagnostic work-up that is necessary to establish a correct diagnosis in such cases. This case highlights that an appropriate investigation for neoplastic disease should be performed in patients presenting with persistent symptoms that resemble those of sinusitis, especially if these do not resolve after conservative medical treatment.
Acta oto-rhino-laryngologica Belgica 02/2003; 57(3):217-20. · 0.50 Impact Factor
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ABSTRACT: This retrospective study aims to search out the influence of temperature, atmospheric pressure and humidity on the frequency of epistaxis. The study includes 701 patients who have suffered from epistaxis and have been treated in the ENT department of the University of Ioannina Hospital, during the years 1995 and 1996. The statistical methods used are simple linear correlation and linear stepwise regression analysis. The results of simple correlation analysis showed that the daily number of epistaxes depends mainly on mean, maximum and minimum temperature and water vapour pressure. The corresponding correlation coefficients are statistically significant, indicating an influence of weather on epistaxis up to 9% of its total variance. By applying stepwise regression analysis, we managed to increase the linear correlation coefficient and the corresponding amount of variance of epistaxis explained by meteorological factors. This percentage was found to approach 20% for the cold period and 10% for the warm period of the year.
Clinical Otolaryngology 05/2002; 27(2):84-8. · 2.39 Impact Factor
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Diabetes Research and Clinical Practice 10/2001; 53(3):201-3. · 2.75 Impact Factor
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Otolaryngology Head and Neck Surgery 06/2001; 124(5):584-5. · 1.72 Impact Factor
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ABSTRACT: To investigate the middle and inner ear involvement in patients with progressive systemic sclerosis (PSS).
We prospectively evaluated 34 PSS patients. All patients underwent a complete ear-nose-throat physical examination and audiological evaluation with pure tone, impedance, and speech audiometry. In addition, systemic manifestations of the disease and drug therapy were recorded. Finally, all patients were tested for the presence of autoantibodies. The results were compared with those of 45 age-matched healthy subjects.
We found a sensorineural hearing loss in 20% and mixed type hearing loss in 3.3% of the patients. There was no correlation of hearing loss with age, systemic manifestations of the disease, presence of autoantibodies, and drug therapy. Ten percent of the patients had patulous eustachian tubes.
One fourth of PSS patients had a hearing loss affecting the middle and mainly the high frequencies. This is a lower percentage than that reported by other investigators. A significant prevalence of bilateral patulous eustachian tubes was noticed as well. Further investigation is needed for a better understanding of the mechanism of ear damage in PSS patients.
Otolaryngology Head and Neck Surgery 06/2001; 124(5):522-5. · 1.72 Impact Factor
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ABSTRACT: Chronic sinusitis, especially maxillary sinusitis is a common disorder in humans. Seromucous sinusitis is rarely described in the literature. The present study deals with the clinical and laboratory characteristics of a group of patients suffering from the above disorder. During the last 10 years, 32 patients suffering from seromucous maxillary sinusitis were enrolled in the study. Patients' charts were reviewed and tabulated according to age, sex, history, clinical symptoms and laboratory findings. Treatment was based on punction and drainage of the seromucous effluent. Results were also statistically evaluated. Flight trips and atypical episodes of nasal infection were the predisposing factors for seromucous maxillary sinusitis. The only clinical manifestation was coughing, for at least 12 weeks before diagnosis. Sinus effluent was composed by serous and mucous constituents with glue like structure. There were no differences between sexes in predisposing factors, or x-ray findings. The treatment is paracentesis and drainage and in one case of recurrence, middle meatotomy and sinus endoscopy.
Acta oto-rhino-laryngologica Belgica 02/2001; 55(1):65-9. · 0.50 Impact Factor
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ABSTRACT: An unusual case of recurrent tonsillitis due to pseudomonas aeruginosa. Pseudomonas (P.) aeruginosa in the head and neck region of an immunocompetent patient is mainly seen in ear infections, and sometimes in sinusitis. P. aeruginosa is an occasional finding in tonsil smears as part of normal microbial flora, but it rarely produces suppurative tonsil infection. We report a case of a previously healthy young female with recurrent episodes of tonsillitis due to P. aeruginosa infection. Although the patient received complete regimens of antibiotics (orally and intravenously) repeatedly, definitive eradication was only achieved after tonsillectomy.
Acta oto-rhino-laryngologica Belgica 02/2001; 55(3):203-5. · 0.50 Impact Factor
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ABSTRACT: Tenascin (TN) is an extracellular matrix glycoprotein expressed in areas of epithelial-mesenchymal interactions during embryogenesis and in neoplasia. We studied the expression of TN in a series of 35 squamous cell invasive carcinomas of the larynx, 13 in situ carcinomas, 41 cases of dysplasia, 10 papillomas and 18 cases of keratosis using the monoclonal antibody TN2 on paraffin-embedded tissue. TN expression was correlated with the expression of fibronectin, CD44 and cathepsin D (CD) proteins, with the proliferation indices Ki-67 and proliferating cell nuclear antigen (PCNA) as well as with conventional clinicopathological variables. Malignant tumours showed a significantly greater stromal TN staining than benign lesions. In invasive carcinomas, the immunoreactivity was statistically higher than that in situ (P=0.01), dysplastic lesions (P<0.0001), papillomas (P=0.004) and keratosis (P<0.0001). A statistically significant difference of TN expression between in situ and dysplastic lesions was observed (P=0.001). In invasive lesions, TN expression was statistically correlated with CD44 expression (P=0.02) and a trend for correlation with CD of tumour cells and fibronectin expression was found (P=0.06 and P=0.09, respectively). The relationship of TN expression with the histological grade and the proliferative activity was insignificant. In conclusion, stromal TN expression may be involved in the complex mechanism of development of laryngeal lesions and may help to predict the risk of progression of pre-cancerous lesions to cancer.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 07/2000; 436(6):579-84. · 2.49 Impact Factor
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Otolaryngology Head and Neck Surgery 05/2000; 122(4):618. · 1.72 Impact Factor
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ABSTRACT: CD44 is an integral membrane glycoprotein that has diverse functions in cell-cell and cell-substrate interactions. It has been suggested that it may be a determinant of metastatic and invasive behavior in carcinomas. The immunohistochemical expression of CD44 was examined in a series of 34 squamous cell carcinomas, 13 in situ carcinomas, 35 cases with various degrees of epithelial dysplasia, 10 papillomas and 17 cases of keratosis. We used the monoclonal mouse anti-human phagocytic glycoprotein-1 CD44 (clone DF 1485), on formalin-fixed, paraffin-embedded tissue. CD44 expression was correlated with the expression of Rb and p53 proteins, with the proliferative indices Ki-67 and PCNA as well as with conventional clinicopathological data. The mean value of CD44 expression was 78.84 in squamous cell carcinomas, 78.04 in situ carcinomas, 54.93 in dysplasia, 26.8 in papillomas and 24.97 in keratosis. There was no significant difference of CD44 expression between in situ and invasive carcinomas. However, a strong difference of reaction between carcinomas and the other cases was observed. CD44 expression was statistically higher in dysplastic lesions than the cases of keratosis (p < 0.0001) and papillomas (p = 0.01). In the group of invasive carcinomas, CD44 expression was statistically correlated with pRb (p = 0.011), while in preinvasive lesions it was correlated with PCNA (p = 0.016). The relationship with the degree of dysplasia or grade of carcinoma and p53 protein expression was insignificant. These observations suggest that CD44 expression may be involved in the multiple mechanism of the development and progression of laryngeal lesions and may help to predict the risk of transformation of the benign or precancerous lesions to cancer.
Histology and histopathology 11/1999; 14(4):1113-8. · 2.48 Impact Factor
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ABSTRACT: In this study we evaluated the immunohistochemical expression of metallothionein (MT) in 44 squamous cell carcinomas, 14 cases of in situ carcinoma, 47 with epithelial dysplasia, 11 papillomas and 21 cases of keratosis. The MT expression was studied in correlation with p53 protein expression and the proliferative cell nuclear antigen (PCNA). The monoclonal antibodies E9 (anti-MT), DO-7 (which reacts with a denaturation-resistant epitope in wild-type and mutant p53) and PC10 (anti-PCNA) on formalin-fixed, paraffin-embedded tissue were used employing the immunoperoxidase (ABC) method. The immunohistochemical localization of MT has shown its rather ubiquitous presence in the cytoplasm and nucleus of both benign and malignant epithelial cells. In most cases the adjacent "normal" epithelium showed low positivity in the basal portion. The mean value of metallothionein expression was 35.73 in squamous cell carcinomas, 32.21 in in situ carcinomas, 11.86 in dysplastic epithelium, 5.10 in papillomas and 3.5 in keratosis. In carcinomas, low MT expression (< 10% of neoplastic cells) was observed in 20.5% of the cases, moderate (10%-50% of neoplastic cells) in 54.5% and extensive expression (> 50% of neoplastic cells) in 25% of the cases. We did not find any statistically significant difference of MT expression between in situ and infiltrating carcinomas, while we did observe a significant difference between carcinomas and the other groups. There was a statistically significant difference in the PCNA values in both benign and malignant lesions, while no statistically significant difference was observed in p53 protein expression in the above groups. A positive correlation between MT expression and the PCNA value (p < 0.0001) in the benign and malignant groups was detected. The PCNA value was also correlated with the p53 protein expression (p = 0.001). No correlation was found between MT and p53 protein expression. In conclusion, these results suggest that the MT expression may play a role in the development of malignant disease of the larynx, from the early phase of laryngeal carcinogenesis, independently from the p53 expression. It is also possible to contribute to tumour cell growth, as determined by the PCNA score.
Pathology - Research and Practice 02/1999; 195(12):809-14. · 1.21 Impact Factor
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ABSTRACT: The purpose of this study was to investigate if there is any relationship between the age of a patient and the degree of facial nerve recovery in patients with Bell's palsy. Between 1987 and 1995 250 patients with peripheral idiopathic facial nerve palsy were examined at the ENT Clinic of the University of Ioannina. In this group 134 were male and 116 were female. The patients' ages ranged from 4 to 80 years and had an average of 47.7 years. The average age of the male patients was 46.5 years and that of the female patients was 49.1 years. In the overall group of 250 patients 129 presented with a paralysis of the right facial nerve and 121 on the left. There was no case of bilateral palsies. When comparing the age of the patients and the degree of recovery, measuring age was associated with a decrease in complete recovery. While the percentage of complete recovery between age 4 and 50 years varied from 83% to 74%, respectively, the percentage of complete recovery decreased to less than 54% at age 80. Our results show that the age of the patient is a very important factor for facial nerve recovery.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/1999; 256(10):520-2. · 1.29 Impact Factor
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Otolaryngology Head and Neck Surgery 06/1998; 118(5):735. · 1.72 Impact Factor
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The Lancet 02/1997; 349(9044):28-9. · 38.28 Impact Factor
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ABSTRACT: The aim of this prospective study was to investigate whether pregnancy predisposes to facial nerve palsy and what the specific properties of facial nerve palsy are during this period. Eight cases of idiopathic facial nerve palsy occurring during the last trimester of pregnancy are presented. Out of 50 women with idiopathic facial nerve palsy, 15 were in childbearing age; eight presented a facial nerve palsy during pregnancy of which 6 during the last trimester of pregnancy. The electrodiagnostic tests indicated nerve degeneration in two of the eight cases; they were treated with corticosteroids. In the other six patients, no nerve degeneration was observed, and therefore, no treatment was given. These data suggest that pregnancy is probably associated with an increased predisposition to facial nerve palsy.
Acta oto-rhino-laryngologica Belgica 02/1996; 50(2):131-5. · 0.50 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the ability of electroneuronography (ENOG), also called evoked electromyography (EEMG), and facial nerve latency testing (FNLT) to assess the prognosis of facial nerve palsy, using the House-Brackmann facial nerve grading system as criterion. From 1988 to 1994 these tests were employed at the ORL Clinic of the University of Ioannina in 250 patients with idiopathic facial nerve palsy. The ENOG test results indicated that when the amplitude of the compound muscle action potentials ranged from 51% to 95% of the normal value, 97% of the patients achieved complete functional recovery (grade I) within at least 2 months. When the muscle action potential decreased to a value below 51% of normal values, prognosis for recovery was considerably worse. FNLT test results indicated that as the latency time extended, the recovery grade of the facial nerve worsened. When latency time was within the normal range (group A patients), about 92% of patients had complete functional recovery. In contrast all patients having either a very extended latency time or unable to be monitored (groups C and D) demonstrated incomplete functional recoveries that ranged from grade II to grade VI. Comparing each test with the House-Brackmann facial nerve grading system, we ascertained that the percent accuracy for ENOG was 97.6%, and that for FNLT was 94.4%.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/1996; 253(1-2):35-8. · 1.29 Impact Factor
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ABSTRACT: Sensorineural hearing loss in rheumatoid arthritis (RA) has been reported to be the result of the extra-articular manifestation of the disease (rheumatoid nodular vasculitis) or due to drug ototoxicity. In an attempt to investigate the presence of sensorineural hearing loss and the possible causes for it we investigated prospectively 45 RA patients (42 female; three male) with a mean age of 52.5 +/- 10.7 years and a mean disease duration of 8.5 +/- 7.3 years. All patients underwent a complete physical examination and audiological evaluation which included pure tone audiometry and impedance audiometry (tympanogram, static compliance, acoustic reflex, reflex decay, acoustic reflex latency test. We found a sensorineural hearing loss > 20 dB HL in 44.4 per cent (40/90) ears. In all cases the site of hearing loss was the cochlea and in most of them it was bilateral and symmetric (16 patients out of 45 had bilateral sensorineural hearing loss i.e. 35.5 per cent. There was no correlation between sensorineural hearing loss and age, sex, disease duration, articular and extra-articular manifestations and the presence of autoantibodies in our patients. In addition, no correlation was found between sensorineural hearing loss and drug therapy for one at least of the following drugs: NSAIDs, D-penicillamine, plaquenil and methotrexate. We noticed a prologation of acoustic reflex latency in five patients (10 per cent) which was found to be correlated with the temporomandibular joint involvement and the presence of rheumatoid factor (RF). We conclude that inner ear involvement in RA is expressed by: (1) mild symmetric, bilateral sensorineural hearing loss of cochlear type in 35.5 per cent of patients; (2) normal acoustic reflex thresholds; (3) nondecay; and (4) prologation of acoustic reflex latency which appeared in a small number of patients (10 per cent).
The Journal of Laryngology & Otology 08/1995; 109(8):713-8. · 0.60 Impact Factor
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ABSTRACT: The cysts of the parotid gland are very rare lesions of congenital or acquired aetiopathogenesis. In most cases, the symptom is an unilateral painless swelling in the area of the parotid without any fixation to the overlying skin or any involvement of the facial nerve. These must be distinguished from neoplasms with a similar clinical presentation or neoplasms with a cystic component. Making the right preoperative diagnosis can be extremely difficult but the adequate therapy remains the superficial parotidectomy. However the final diagnosis is established histopathologically. The precise histological classification is often an elaborate task because of the similarities in the epithelial lining of the various cysts and the heterogeneity in their histogenic origin. In this study, the authors describe four cases of parotid cystis. They examine the clinical aspects, the preoperative diagnostic approach, the treatment and they analyse the histopathological findings. Finally, their results are compared with the data found in the international medical literature.
Revue de Stomatologie et de Chirurgie Maxillo-faciale 02/1995; 96(5):313-6. · 0.25 Impact Factor
