Outpatient laser ablation of palatine tonsils is a very interesting procedure that has been recently introduced as a routine in head and neck surgery departments. The aim of this study was to describe a new strategy using a Doppler-guided fibre optic neodymium-yttrium–aluminium–garnet (YAG) laser to remove up to 80 % of tonsillar tissue, as assessed in the long-term postoperative clinical evaluation of the volume of the tonsils at the follow-up, and leaving the capsule in place, thus avoiding any haemorrhagic complication and minimize pain. A total of 20 patients (men, n013; women, n07), aged between 6 and 63, were recruited for the procedure. They were affected by chronic hypertrophic tonsillitis with a recurrent fever and other symptoms that were related to oral inflammation. Among the 20 patients, no serious adverse events, including haemorrhagerelated complications, were observed. Treatment was well tolerated, even in patients displaying an overall low pain threshold. No dropout or uncompleted procedure occurred in the present study. Minor complications included sore throat, moderate oedema, mild acute pharynx inflammation, slight peritonsillar exudate and local burning. The postoperative pain, measured by Scott–Huskisson visual analogue scale, was between 5 and 40 mm and was easily counteracted by means of external ice packages and nonsteroidal anti-inflammatory drugs, according to the individual patient’s need. During the 12–36- month follow-up patients showed improved symptoms (n=7) and complete recovery (n=13). A relapse episode was observed in two patients. This study supports fibre optic laser neodymium-YAG tonsil surgery, named “cribriform intracapsular tonsillectomy” or “Swiss-cheese laser tonsillectomy”, as an effective alternative to the traditional cold knife approach or electrosurgery. This approach could become the gold standard for tonsil surgery in the third millennium for safety reasons, acceptable cost–benefit ratio, the precise targeting of the beam across the affected tissues and the short- and long-term recovery.  

I medici rappresentano una categoria professionale sottoposta a un forte stress. Esso è dovuto alla posizione di estrema responsabilità che rivestono, al poco tempo e alle povere relazioni interpersonali chepossono condurre ad ansia, depressione, abuso di sostanze stupefacenti, alcolismo e, in sporadici casi, anche al suicidio. Il progetto MedicoCura-Te-Stesso nasce dalla necessità di un servizio che si occupi della salute dei medici, anche in pensione, che spesso sottovalutano i propri problemi di salute. Abbiamo eseguito un sondaggio su un campione di 251 medici. Essi hanno aderito a rispondere a un questionario riguardante le loro malattie e l’uso di medicinali per curarsi, la prevenzione, il sovrappeso in relazione all’attività fsica praticata e la dieta associata, le loro attitudini artistiche e modalità e tempi di svago.  

Bisphosphonates are pharmacological compounds that have been used for the prevention and treatment of several pathological conditions including osteoporosis, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions characterized by bone fragility. Many studies have been performed to date to analyze their effects on inflammation and bone remodelling and related pathologies. The aim of this review is, starting from a background on inflammatory processes and bone remodelling, to give an update on the use of bisphosphonates, outlining the possible side effects and proposing new trends for the future. Starting from a brief introduction on inflammation and bone remodelling, we collect and analyze studies involving the use of bisphosphonates for treatment of inflammatory conditions and pathologies characterized by bone loss. Selected articles, including reviews, published between 1976 and 2011, were chosen from Pubmed/Medline on the basis of their content. Bisphosphonates exert a selective activity on inflammation and bone remodelling and related pathologies, which are characterized by an excess in bone resorption. They improve not only skeletal defects, but also general symptoms. Bisphosphonates have found clinical application preventing and treating osteoporosis, osteitis deformans (Paget’s disease of bone), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions that feature bone fragility. Further clinical studies involving larger cohorts are needed to optimize the dosage and length of therapy for each of these agents in eachclinical field in order to be able to maximize their properties concerning modulation of inflammation and bone remodelling. In the near future, although ‘‘old’’ bisphosphonates will reach the end of their patent life, ‘‘new’’ bisphosphonates will be designed to specifically target a pathological condition.  

The aim of this study was to validate the safety and effectiveness of a new therapeutic procedure for the treatment of lower leg telangiectasia without clinical vein insufficiency. A group of 20 healthy women aged between 24 and 47 years (mean±sem 37.05±1.47) with lower leg telangiectasia without clinical vein insufficiency, previously investigated by echo colour Doppler sonography, wererecruited and were treated with neodymium:YAG laser (mean±sem 2.5±0.11 sessions). Good or excellent results were obtained in 16 patients and the improvements were statistically significant (p<0.01). Out of the 20 patients, 16 were satisfied with the procedure. We strongly support laser treatment of lower leg telangiectasia since it allows injection of chemicals to be avoided, and changes the stromal microarchitecture rearranging the fibroblast network into a more resistant pattern reducing the likelihood of relapse.  

Background: Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. Aim: We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Conclusion: Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.

Duchenne muscular dystrophy (DMD) is a degenerative disease primarily affecting voluntary muscles with secondary consequences on heart and breathing muscles. DMD is an X-linked recessive disease that results in the loss of dystrophin, a key muscle protein. Inflammation can play different roles in DMD; it can be a secondary response to muscle degeneration, a primary cause of degeneration, or can contribute to the disease progression. Several immunosuppressants have been used with the aim to reduce the inflammation associated with DMD.Most recently, myoblast transplantation has shown the possibility to restore the dystrophin lack in the DMD patient’s muscle fibers and this evidence has emphasized the importance of the use of immunosuppressants and the necessity of studying them and their secondary effects. The aim of this review is to analyze the main immunosuppressants drugs starting from the mdx mice experiments and concluding with the most recent human clinical studies.

Osteoarthritis (OA), also called degenerative joint disease, is the most frequently occurring chronic musculoskeletal disease, particularly affecting the aging population. The use of viscosupplementation, i.e. intra-articular (IA) hyaluronic acid (HA) drug therapy, to treat OA, is growing worldwide, due to important results obtained from several clinical trials, which reported IA HA-related improvements in functional activity and pain management. This review is an update of the IA use of this compound in the treatment of OA, with clinical evidence from the last few years being discussed and used to delineate new trends for the future.  

L’espressione “second opinion” e’ stata ampiamente utilizzata, fino dagli anni ’70, negli ospedali americani con l’intento di ridurre i costi legati almiglioramento dei sistemi di assistenza ma, al tempo stesso, anche la diagnosi, la cura del paziente e i tempi di guarigione. In questo lavoro,dopo una breve revisione dell’impatto della “second opinion” in molti ambiti della medicina, descriviamo come oggi il paziente sia decisamenteorientato ad un comportamento di ricerca della seconda opinione. Infatti, in conseguenza della diffusione di internet, il paziente puo’ trovare nelworld wide web ogni tipo di informazione medica che pero’, talvolta, non e’ di qualita’ adeguata. Di conseguenza, il paziente si trova immerso nel mare di informazioni offerte dal web finendo in una ricerca ossessiva che lo porta a confusione e disorientamento. Abbiamo denominato questa situazione come “Web Babel Syndrome”. Basandoci su questi presupposti, pensiamo che un poliambulatorio medico del secondo parerevada decisamente incontro alle necessita’ del paziente, e possa essere in grado di aiutare quei pazienti che presentano condizioni irrisolte o cheabbiano bisogno di cure multi specialistiche per raggiungere una migliore qualita’ di vita