We obtained BVIc photometry of IRC-10443 on 85 different nights distributed over two years, and in addition low resolution absolute spectro- photometry and high resolution Echelle spectroscopy. Our data show that IRC-10443, which was never studied before in any detail, is a SRa variable, characterized by Delta(B)=1.27, Delta(V)=1.14 and Delta(I)=0.70 mag amplitudes and mean values =13.75, =11.33 and =6.18 mag. Two strong periodicities are simultaneously present: a principal one of 85.5 (+/-0.2) days, and a secondary one of 620 (+/-15) days, both sinusoidal in shape, and with semi-amplitudes Delta(V)=0.41 and 0.20 mag, respectively. IRC-10443 turns out to be a M7III star, with a mean heliocentric radial velocity -28 km/s and reddened by E(B-V)=0.87, a third of which of circumstellar origin. The same 0.5 kpc distance is derived from application of the appropriate period-luminosity relations to both the principal and the secondary periods. The long secondary period causes a sinusoidal variation in color of 0.13 mag semi-amplitude in V-Ic, with IRC-10443 being bluest at maximum and reddest at minimum, and with associated changes in effective temperature and radius of 85 K and 6%, respectively. This behavior of colors argues in favor of a pulsation nature for the still mysterious long secondary periods in AGB stars.

Aim of this study was to examine possible relationships between several clinical aspects of paroxysmal positional vertigo and factors better defined as "intrinsic" to the patient, above all age. The disorder can affect essentially all age groups; nevertheless, the onset of age-linked degenerative processes, such as vascular damage, can have a negative influence--at least in theory--on the pathogenic mechanisms of cupulolithiasis or canalolithiasis. The study was based on the review of 566 patients with the typical form of paroxysmal positional vertigo. Based on age, the patients were divided into two groups, respectively < or =50 years and > 50 years. For the purposes of this study, a series of clinical-laboratory conditions associated with the risk of, or clear, vascular damage were also considered. The results indicate that if there are no clinical or case-history elements that can be attributed to an aetiological hypothesis, the clinical behaviour of paroxysmal positional vertigo is not affected by the age factor. However, the existence of generic vascular damage, hypothesised by the presence of the above-mentioned conditions, influences certain clinical aspects of the disorder, particularly recovery time, the trend of the active phase and the number of relapses. In conclusion, paroxysmal positional vertigo with a presumed vascular aetiology, the incidence of which increases with age, presents a worse prognosis, not only with respect to the "idiopathic" form in childhood but also the "idiopathic" type in the elderly. The lithiasic model responds well to pathogenic interpretation requirements, which envisage macular degeneration with a vascular component. However, the observation, via imaging, of diffuse ischaemic lesions in critical areas of the brainstem and the cerebellum in many "vascular" patients, does not exclude the possibility of alternative pathogenic mechanisms that, in the final analysis, can lead to compromised VOR on a central level.

ABSTRACT As a fungal etiology has been proposed to underlie severe nasal polyposis, the present study was undertaken to assess local antifungal immune reactivity in nasal polyposis. For this purpose, microbial colonization, along with the pattern of T helper 1 (Th1)/Th2 cytokine production and Toll-like receptor (TLR) expression, was evaluated in patients with nasal symptoms and with and without polyposis and in healthy subjects. The results show that Th2 reactivity was a common finding for patients with nasal polyposis regardless of the presence of microbes. The production of interleukin-10 was elevated in patients with bacterial and, particularly, fungal colonization, while both TLR2 expression and TLR4 expression were locally impaired in microbe-colonized patients. Eosinophils and neutrophils, highly recruited in nasal polyposis, were found to exert potent antifungal effector activities toward conidia and hyphae of the fungus and to be positively regulated by TLR2 or TLR4 stimulation. Therefore, a local imbalance between activating and deactivating signals to effector cells may likely contribute to fungal pathogenicity and the expression of local immune reactivity in nasal polyposis.

If all degrees of permanent uni- or bilateral hypoacusis are taken into consideration, hearing impairment is the most common congenital disease. Early detection of permanent infantile hearing impairment has become extremely important in preventive medicine, since steps can be taken with hearing aids and rehabilitation to ensure better development of language and higher cognitive functions. Aim of this study is to provide a critical review of the time of diagnosis of hypoacusis at our audiology laboratory, where two methods were used to screen hearing of children with/without risk indicators. Results of approximately 10 years' work were re-examined during which time outpatient screening was conducted on children referred by colleagues in neonatology and paediatrics. All were carriers of congenital risk indicators associated with sensorineural and/or conductive hearing loss, based on the Joint Committee on Infant Hearing findings, or were suspected of being hypoacusic even if they had no known congenital risk factors. Hearing screening was conducted in hospital on newborns with no risk factors, within the first few days of birth. Results of the present study showed that when selective hearing screening was performed, the mean age of high-risk patients diagnosed with hypoacusis was slightly higher than that in international guidelines. Moreover, these patients represent approximately half the hypoacusic population identified in the study period. The other half of congenital hypoacusic subjects identified had no risk indicators and there was a significant delay in diagnosis due to later manifestation of symptoms indicating hypoacusis, and thus, in turn, delayed referral for hearing tests. In contrast, subjects without risk indicators who underwent in-hospital hearing screening and proved to be hypoacusic, were diagnosed early. In our experience, however, universal screening has considerable disadvantages, such as difficulty in covering the entire population, difficulty in follow-up after discharge from hospital, and last, but by no means least, significant organisational and professional commitments, making it impossible to perform in all hospitals. In order to ensure effective hearing screening for congenital hearing loss and, thus permit prompt identification of hypoacusic children, use of hearing aids and rehabilitation screening should incorporate two aspects. First, selection should be compulsory, thereby reducing waiting time between collecting case histories and performing outpatient tests; second, hospital screening of children without risk factors should be performed whenever possible. Integrating these two aspects would make it possible to approach the "utopia" of universal hearing screening.

The classification and the most appropriate treatment of dysplastic lesions of the larynx continue to be controversial issues. Aim of present study was to evaluate the incidence of precancerous lesions of larynx, their potential to evolve in relation to grade of dysplasia, and the most appropriate treatment. The study is based on the review of a series of 207 patients (157 (75.9%) male, 50 (24%) female) with keratosis of the laryngeal epithelium, with or without dysplasia. Patients were divided into four groups, according to Friedmann's classification (1986), based on presence and grade of any dysplasia. The follow-up period ranged from approximately 7 to 16 years. With regard to progression of the disease, 159 of the 185 patients considered were cured following initial treatment (85.9%), whereas 26 (14.1%) had recurrences. Of the latter, 19 had a single recurrence and 7 had multiple recurrences. Progression to carcinoma occurred in a total of 12 cases, above all in patients with the highest grades of dysplasia. Results emerging from this study confirm not only that dysplastic lesions of the larynx have the potential to evolve into frankly malignant lesions, but also that this capacity to evolve is significantly correlated with grade of dysplasia of the covering epithelium. Therefore, the histological classification of precancerous lesions of the larynx, based on the presence or absence of atypical cells and on their severity, is clearly valid from a clinical standpoint, representing, above all, an important prognostic factor. As far as treatment is concerned, mucosal stripping at site of the lesion is considered to be the treatment of choice for precancerous lesions of the larynx. Nevertheless, in patients presenting keratosis with a higher grade of dysplasia, it is mandatory to consider more aggressive treatment.

Between 1995 and 2001, eight Italian clinical centres used the same diagnostic and therapeutic protocol in order to assess the clinical progress of paroxysmal positional vertigo and the benefits of an appropriate follow-up in prevention of relapse. The study population comprises 794 patients affected by paroxysmal positional vertigo. The study protocol comprised diagnostic staging including a complete otoneurological test, an anamnestic questionnaire aimed at identifying any possible risk factor, a blood test in basal conditions and monitoring of blood pressure. If necessary, more specific instrumental tests have been carried out. Appropriate rehabilitative manoeuvres were performed from 1 to 3 times within the same session. The patient was checked 3-5 days later: in the presence of a positive result, the treatment was repeated; if negative, patients were seen at clinical follow-up 7, 30, 180 and 365 days after recovery. Wherever possible, patients have been contacted 2 years after the first treatment and asked to answer a questionnaire and to attend for a clinical check-up. The incidence of paroxysmal positional vertigo appeared to be higher in females and in patients aged 50-70 years, being low in patients under 30. In 88.8% of cases posterior semicircular canals showed a significant involvement; in 6.8% of cases, only involvement of lateral semicircular canals; monolateral (2.7%) and bilateral (1.7%) multicanalar forms were rare. Paroxysmal positional vertigo forms involving posterior semicircular canals have been treated with Semont (simplified by Toupet), Epley, Parnes Price-Jones manoeuvres; those, involving lateral semicircular canals with Vannucchi-Vicini forced position and "barbecue" or Gufoni manoeuvre. Whilst all these manoeuvres were equally effective, longer recovery times have been observed in paroxysmal positional vertigo forms involving lateral semicircular canals when the Vannucchi-Vicini forced position was ineffective. Any relapses have been evaluated at least 15 days after a negative clinical pattern. Possible involvement of other semicircular canals (recurrence) some time after the first onset has been considered separately. Follow-up at 6 months showed recurrence in 12.4% of cases, while being chronic in 1.5% of cases. Only 9.3% of cases showed recurrence at 6 months, no statistically significant difference being observed between vertical (8.9%) and lateral canal (9.6%), forms. Relapses occurred in 3.1% of cases, in one third of which at least two risk factors were detected.

The present study compares the efficacy and safety of betahistine dihydrochloride to that of a placebo in recurrent vertigo resulting from Meniere's disease (MD) or in paroxysmal positional vertigo (PPV) of probable vascular origin. The design was double-blind, multicentre and parallel-group randomised. Eleven Italian centres enrolled 144 patients: 75 of the patients were treated with betahistine (41 MD/34 PPV) and 69 with placebos (40 MD/29 PPV). The betahistine dosage was 16 mg twice per day for 3 months. Compared to the placebo, betahistine had a significant effect on the frequency, intensity and duration of vertigo attacks. Associated symptoms and the quality of life also were significantly improved by betahistine. Both the physician's judgement and the patient's opinion on the efficacy and acceptability of the treatment were in agreement as to the superiority of betahistine. The effective and safe profile of betahistine in the treatment of vertigo due to peripheral vestibular disorders was confirmed.

Laryngeal carcinoma-the prototype of epithelial tumors in the head and neck region-has been the greatest source of information on the biological behavior of such neoplasms. Many Authors have suggested that smoke, and to a lesser extent alcohol, play a role in the genesis of this carcinoma although the exact biological mechanism for such involvement is still not clear. The present study analyzed two important biological indicators (p53 and Ki67) in benign and malignant epithelial lesions of the larynx in an attempt to obtain information on what mechanism correlates the risk factors with the neoplasm. In a group of 172 patients, an in vivo sampling of cells was taken during microlaryngoscopy. These cells were then tested using the immunocytochemical method and the results showed that the neoplastic tissue was significantly more positive to these markers than the pre-cancerous tissues and benign lesions. Moreover, there was also an interesting correlation between the degree of positivity to p53 and exposure to smoke, and to a lesser extent to alcohol, in the oncological patients. Together with other similar results found in the literature, these results hint at a possible explanation for the carcinogenic power of smoke in the larynx and, in general, in the upper respiratory-digestive tract.

Alcune varianti anatomiche del complesso ostiomeatale (COM) possono contribuire al blocco del meato medio ed essere responsabili di sindromi cefalalgiche associate o meno a sinusopatia. Allo scopo di stabilire l'incidenza delle varianti anatomiche del COM in pazienti sottoposti a tomografia computerizzata (TC) del massiccio facciale per cefalea di presunta origine sinusale, abbiamo riesaminato 316 studi TC effettuati in oltre un anno di attività, escludendo la patologia traumatica e neoplastica, le poliposi massive, i papillomi invertiti, gli esiti di pregressi interventi chirurgici. I pazienti con sinusopatia evidente alla TC non hanno complessivamente mostrato una incidenza significativamente superiore di anomalie del COM. Tuttavia alcune di esse, come la pneumatizzazione della lamella verticale, la curvatura paradossa del cornetto medio, la presenza di cellule di Haller e la pneumatizzazione del processo uncinato, sono risultate più comuni nei pazienti affetti da malattia mucosa. I nostri risultati confermano che le anomalie del COM, pur non essendo l'unico fattore patogenetico, possono essere considerate predisponenti alla malattia sinusale.

Although anatomic variations of the nose and paranasal sinuses do not themselves represent a disease state, in many cases they are responsible for headache which may or may not be associated with sinusitis. For several reasons computed tomography (CT) is considered the examination of choice for evaluation of the ostiomental complex (COM) and of inflammatory diseases of the sinuses. In order to determine the incidence of anatomical variants of ostiomeatal complex in patients with non traumatic and non neoplastic sinus headache we carried out a retrospective study of 316 CT scans of the paranasal sinuses, performed over a I-yens period The scans were assessed for the presence of anatomical variants in the middle meatus and for signs of asymptomatic infection revealed by the presence of clouding or mucosal thickening in the sinuses Overall, patients with sinus disease did not have significantly more frequent variants in the ostiomeatal complex. Nevertheless some of them, Le. the pneumatized vertical lamella, paradoxical curvature of the middle turbinate, Haller cells and pneumatization of the uncinate process, were more common in patients with sinus disease Our findings suggest that ostiomeatal complex dysfunction can be considered a favouring factor in the pathogenesis of sinus disease.

Distortion Products (DP) are otoacoustic emissions evoked by emitting two pure tones. The principle advantage of this method vs. transient evoked otoacoustic emissions is the specificness of frequency. The purpose of the present work was to determine whether this technique could be applied in objective study of cochlear function in infants. This was done by setting standard data for infants and comparing them with the data obtained in a control population of adults. The input/output functions of the DP and the DP audiograms for 8 f2 frequencies ranging from 696 to 6006 Hz were studied in a group of 15 healthy, full-term infants. The data obtained were statistically compared to the data taken from a control group of 8 normal hearing adults. The infants showed significantly more intense DPs in the intermediate frequencies, with a greater detection threshold and dynamic range. On the other hand, at the high frequencies the amplitude of infant DPs was the same or lower than (f2 = 5005) those found in the adults. These differences can partially be attributed to the fact that the outer auditory channel is smaller in infants thus the probe and the middle ear are better matched. There is significantly greater background noise in infant DPs, particularly at low frequencies. This may be due to the fact that the skin of the outer auditory duct--which acts as a low-pass filter allowing suction and movement of the cervical muscles to contaminate the tracing--is thinner in infants. In conclusion, the study of DPs has shown its potential in the study of cochlear function in infants because it is non invasive and objective, it can be performed quickly and shows frequency specificness. Unfortunately, it cannot be considered a valid method for determining cochlear function at the low frequencies.

The authors present a retrospective case study of 132 subjects with sudden-onset hearing loss who had been observed during the course of 10 years. The results were compared with those available in the literature. These patients were divided into two subgroups based on age: over or under 40. The hearing loss was divided into 4 subgroups according to audiogram morphology. Then the presence, and entity, of any recovery in hearing was evaluated. There was no preference for sex while the greatest incidence was found in the VI and VII decade of life. The audiohistograms obtained when the patients were admitted to the hospital and 2 months later indicated an improvement in the hearing threshold localized above-all in the medium-low frequencies. This confirms a better evolution in those forms localized in the apex of the cochlea. The threshold of 60 dB HL is the dividing line between a totally favorable prognosis and a partially or totally unfavorable prognosis. This indirectly confirms that the intensity of the initial hearing damage is an important prognostic factor. From the morphological point of view the forms with the best evolution appear to be those with a flat or rising morphology. The forms with descending morphology do not present a favorable evolution although those with a threshold around 8000 Hz are worse than those with a threshold of 4000 Hz. As regards age no significant differences were found in the evolution of hearing loss between subjects under and over 40. In conclusion, the essential characteristics of sudden-onset hearing loss are as yet poorly defined. There are so many variables affecting the onset and evolution of hearing loss that it proves impossible to perform any statistically valid analysis which includes them all. To date the elements able to provide some degree of prognostic prediction are the audiogram morphology and the entity of the initial hearing loss.