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Nasal turbinate hypertrophy is a major cause of nasal airway obstruction that affects up to 20% of the European general population. This study aims to determine the efficacy of radiofrequency treatment as perceived by patients during a 2-years period. From 2007 to 2009, an observational study was conducted on 36 patients who consecutively underwent temperature-controlled radiofrequency tissue volume reduction. A questionnaire was administered to each patient in order to collect demographic data, lifestyle habits, health status and visual analogue scale (VAS) score of perceived symptoms. Mean VAS scores of nasal obstruction, headache, rhinorrhoea and anosmia after treatment were significantly lower than that at baseline. Urban residence and allergic rhinitis were significantly associated with lower mean improvement (2.9 vs. 5.6; P = 0.04 and 2.3 vs. 5.3; P = 0.01, respectively). A non significant association with scarce nasal obstruction improvement was present in older aged patients, in patients other than students and in active and passive smokers. Our data enrich the general knowledge on radiofrequency treatment of turbinate hypertrophy identifying the rate of long-term efficacy of radiofrequency treatment as perceived by patients and focusing on several risk factors involved in patient prognosis after treatment.

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No abstract

Churg-Strauss (CSS) syndrome is rare and of unknown etiology. It is associated with vasculitis, blood eosinophilia and granulomatosis, and affects multiple organs and systems at various stages of the disease. Specific diagnostic and monitoring tests are not yet available. This study aims to assess the changes in MMP-2 and MMP-9 along with the histopathological alterations in two cases of CSS, as possible potential diagnostic and monitoring criteria. Two adult male patients were diagnosed with CSS in the otorhinolaryngology clinic in the University of Palermo, based on multiple clinical and histopathologic criteria. Biopsies of respiratory mucosa were taken after the consent of the patients, processed for routine histopathology and immunohistochemistry as well as quantitative polymerase chain reaction (qPCR). Similar biopsies were also taken from a non- CSS patient. The Assessment of MMP-2 and MMP-9 was performed using both immunohistochemistry and qPCR techniques. Histopathological alterations in the respiratory mucosa were consistent with vasculitis and granulomatous tissue formation, in addition to inflammatory cell infiltration with abundance of eosinophils. Immunohistochemistry assay performed on the samples derived from the two CSS patients showed a relative and remarkable increase of both MMP-2 and MMP-9 compared to controls. Such an increase was consistent with the qPCR results which depicted a significant increase between 20 and 30% for both MMP-2 and MMP-9, respectively. Since the secretion of MMPs is an essential step in angiogenesis, could these enzymatic factors be used as parameters to diagnose or monitor the evolution of CSS? The small number of samples analyzed in this study does not allow us to suggest a general statement correlating the increase in expression of MMP-2 and MMP-9 to the appearance or evolution of vasculitis; it is only speculative.

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We describe a case of the isolation of Bartonella quintana from the parotid gland of an apparently healthy man. Pathological examination showed intraparotid granulomatous abscessual lymphadenitis. Diagnosis was made on the basis of high titers of immunoglobulin G (IgG) and IgM antibodies and of culture isolation of a causative agent from parotid aspirate. CASE REPORTAn apparently healthy 58-year-old man presented in April 2001 to the emergency room of our Dipartimento di Scienze Otorinolaringoiatriche of the University of Palermo with a swollen, indolent mass in the right retromandibular region that had appeared 3 days earlier. He did not report other relevant clinical data and had no cats or other pets at home.His general condition was satisfactory, and the patient was apyrexial. Clinical investigation revealed a palpable, not pulsating, indolent mass (approximately 3 by 2 cm) behind the mandibular angle in the region of the right parotid, not adhering with the overlying erythematous skin. The cervical lymph nodes were enlarged only on the right side. The physical examinations of the other systems were essentially normal. In addition, 2 days after admission, the patient reported the appearance of a little (0.4-by 0.4-cm), painful phlogistic ulceration on the skin of the right cheek.For differential diagnosis, we considered infectious causes, collagen vascular diseases, sarcoidosis, neoplasms, sialolithiasis, alcoholism, and congenital masses. Particularly, we considered viral (i.e., cytomegalovirus, Epstein-Barr virus, and human immunodeficiency virus infection), bacterial (Brucella), tuberculosis, and protozoan (Leishmania infantum and Toxoplasma gondii) etiology, using both in vivo (i.e., Mantoux test) and in vitro (i.e., serologic assays) tests and direct examination of parotid mass aspirate (see below). Table 1 shows the results of the routine hematochemistry and serologic assays performed during hospitalization. Ultrasonography and computed tomography of the neck showed a mass (3.5 by 3 cm), attributable to the right parotid gland, with swelling of the intraparotid lymph nodes. Chest X ray, transthoracic echocardiography, and ultrasonography of the abdomen were normal.Aspirate from the right parotid mass showed an inflammatory infiltration of lymphocytes in different phases of follicular nodulation together with polymorphonuclear leukocyte and epithelioid histiocyte populations-pathological findings that are compatible with the diagnosis of intraparotid granulomatous abscessual lymphadenitis. The approximate relative percentages of cells in the parotid aspirate were as follows: lymphocytes, 30%; polymorphonuclear leukocytes, 30%; and epithelioid histiocytes, 40%.The serum sample was examined by the indirect fluorescent antibody test for the presence of immunoglobulin G (IgG) and IgM class antibodies to Bartonella quintana and Bartonella henselae. For antigens, we used either our prepared in-house slides or commercial slides (Focus Technologies, Cypress, California, distributed in Italy by Alifax). We prepa...

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