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Biomedical subjects

A Staffieri

Publications and source records attributed to A Staffieri.

At least 19 recordsLinked to original sources
PubMed2004

Facial nerve paralysis secondary to acute otitis media in infants and children.

Nowadays, facial paralysis is an uncommon complication of acute inflammation of the middle ear, with an estimated incidence of 0.005%; it was not so rare in the pre-antibiotic era, occurring in 0.5-0.7% of middle ear inflammatory processes. We would like to highlight this complication of acute otitis media, a common paediatric complaint. We present three new cases of facial palsy in children with acute otitis media and discuss the etiological mechanisms and different approaches to the treatment; a flow chart for facial paralysis in acute otitis media is also presented. Our three patients recovered completely after mastoidectomy (first two cases) and myringotomy with antibiotic therapy (third case). Facial paralysis is an uncommon complication of otitis media which requires appropriate care. Following our experience and revision of literature on the subject, antibiotic therapy and myringotomy are the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.

Acute Disease↗
PubMed2003

Deep neck infection: a present-day complication. A retrospective review of 83 cases (1998-2001).

Deep neck infections are less and less frequent today than in the past. Nevertheless, their complications are often life-threatening. The present study reviews the experience of the Department of Otolaryngology and Head and Neck Surgery of Padua with deep neck infections during the period from 1998 to 2001. Eighty-three patients (55 males and 28 females) were retrospectively considered. The site of origin of deep neck infection was identified in 76 patients (91%). The most common cause was dental infection, occurring in 35 cases (42%). In 12 cases (14%) deep neck infection was a complication of oropharyngeal infection. The relatively high incidence of Peptostreptococcus sp, Streptococcus viridans, Streptococcus intermedius and constellatus isolation was consistent with the high rate of odontogenic cases. Surgery was advocated as the treatment for any infection of the deep neck spaces. The recent series has demonstrated that medical treatment did not seem to increase complication rates or mortality. Our tailored approach (medical or medical and surgical) based on clinical and radiological evidence was successful in 97% of the patients.

Adolescent↗
PubMed2002

Treatment of patients with arthrosis of the temporomandibular joint by infiltration of sodium hyaluronate: a preliminary study.

Patients with degenerative disease of the temporomandibular joint (TMJ) who did not respond to conservative medical therapy (splint therapy, selected grinding or physiotherapy) can be treated by arthrocentesis, which is associated with intra-articular injections of sodium hyaluronate (Hyalgan). In this study, we treated ten dysfunctional patients with degenerative joint disease (DJD) who had been diagnosed clinically and had had the diagnosis confirmed by MRI. All subjects presented impaired mouth opening, joint pain at rest and on movement and impaired masticatory efficiency. We performed one cycle of five infiltrations with joint arthrocentesis and the injection of sodium hyaluronate at weekly intervals. The following parameters were assessed before and after infiltration and at follow-up after 6 months: mouth opening (with a mean of between 36.5 mm and 41.9 mm); sideways movements (to the right 4.9 mm to 8.9 mm and to the left 4.7 mm to 9.2 mm); pain at rest (VAS=1.8 to 0.5) and on movement (VAS=7.8 to 1.1); masticatory efficiency (VAS=5.7 to 8.6); subjective judgement of the functional TMJ limitation level (from 2.8 to 0.8); judgement of efficacy (from 2.4 to 3.2); judgement of tolerability to the therapy (from 2.0 to 3.1). The therapeutic benefits observed can be attributed both to joint arthrocentesis and to the characteristics of sodium hyaluronate itself. All the parameters considered revealed a statistically significant positive variation that persisted over time ( P<0.05). The results obtained by this minimally invasive, fast and easy technique proved to be valid and lasting. This infiltration technique using sodium hyaluronate looks very promising for patients affected by symptomatic DJD who do not respond to conservative medical therapy, reflecting similarly encouraging findings in the orthopaedic treatment of degenerative knee pathology.

Adjuvants, Immunologic↗
PubMed2002

Differential expression and topography of adhesion molecules in laryngeal and oropharyngeal carcinomas.

This work describes the different patterns of expression of integrins and extracellular matrix proteins in normal and transformed mucosa in laryngeal and oropharyngeal carcinomas. Samples from each tumor group were sectioned and examined by immunohistochemistry using monoclonal antibodies raised against integrin chains (alpha2, alpha3, alpha6, beta1 and beta4) and their ligands (laminins 1 and 5, collagen type IV and two fibronectin isoforms: ED-A and ED-B). Controls were provided by samples of tumor-free laryngeal and oropharyngeal mucosa that had been removed during the surgical procedure. We found that the known distinct topographical pattern of integrins and the continuity of basement membrane components was altered in both groups but that the extent of changes was significantly more marked in oropharyngeal tumors, which are known to be more infiltrating and diffusive and to have a bad prognosis. These molecular patterns of expression can be used as an additional prognostic factor as they suggest a greater biological tumor aggressiveness of oropharyngeal tumors. We suggest that performing immunohistochemical analysis on biopsy samples may help in selecting the correct therapeutic strategy for these tumors and enable more accurate follow-up. The above-mentioned molecules may become part of the diagnostic toolbox of head and neck surgical pathologists.

Biomarkers↗
PubMed2002

[The surgery of the tip of the nose].

Surgery of the nasal tip has stimulated the creation of more surgical techniques than any other aspect of rhinoplastic surgery, to achieve an improved shape that seems natural while enhancing the balance and harmony of the face. The region described as tip of the nose is extremely varied from person to person, because of the different shape of its anatomical structures. For that reason to obtain a good result is necessary for the surgeon the perfect knowledge of the anatomy, the acquisition of surgical concepts and technical skill. The purpose of this paper is to describe the anatomy, the surgical technique and the principal method to correct the most common defects of the nasal tip; some of these proposed by many Authors are also discussed critically. Concerning the anatomy, the Authors describe the upper and the lower lateral cartilages, the lateral and medial crura of the alar cartilages, that form the "dome", the sesamoid complex: smaller cartilage that support the lateral crus, the septum cartilage, their ligaments and the maxillary spine. Are also exposed some concepts regarding the weak triangle of Converse and, in general, the soft tissues of the nasal tip. They also described some basilar incisions to approach the tip cartilage: marginal, intercartilaginous, intracartilaginous and transfixion. This surgical techniques allow to modified the cartilages that can be corrected in different manner. Some of these modifications concerning alar cartilages, septal cartilage, area of dome cartilage, and the most common techniques to operated on it, eversion and luxation, are also exposed. The last part of the paper concerning: a) the exposition of some anesthetical problems and their surgical approach; b) the description and discussion of some surgical techniques proposed in the literature by many Authors. Regarding the most common necessities to modified the nasal tip we include: a) to change the tip projection: in its two opposite directions, increasing and decreasing, where the first purpose is one of the most difficult objectives in tip surgery, using the medial cruras or in more difficult cases a colummellar strut; b) to reduce tip fullness, that normally requires a partial resection and/or a weakening of the lateral crura; c) to alter tip rotation: normally to obtain a upward, rarely for a down ward rotation to increase the length of the nose. In this case all these modifications are described following the theoretical concept of tripod, where the nasal tip is considered mechanically as a tripod with a lower leg represented by the medial crura and the two upper legs of the two lateral cruras.

Female↗
PubMed2001

Bezold's abscess in children: case report and review of the literature.

The introduction of antibiotics in the treatment of suppurative otitis media has significantly decreased the incidence of complications. Reports of Bezold's abscess secondary to this disorder are rare, particularly in infants and young children, in whom mastoid bone pneumatization is not yet complete. We present a case of Bezold's abscess occurring in a child aged 18 months. The literature is reviewed and methods to accurately diagnose this complication are emphasized.

Abscess↗
PubMed2001

Violence against women and the assaulted staff action program.

Women have been subjected to high rates of victimization at home, in the community, and at work. An earlier study found female inpatient staff to be at risk for same-gender patient assaults in psychiatric hospitals and female community residential staff to be at increased risk for assaults from male patients in residences. This study sought to revisit the original 2-year findings during a subsequent 6-year period. Inpatient and community assault data were gathered within the context of the Assaulted Staff Action Program (ASAP), a post-incident crisis response approach. Female inpatient staff were again found to be at increased risk in both inpatient and community settings. However, in this second study, female community residential staff were found to be at increased risk for assault from both male and female patients. The findings and their implications are discussed.

Adult↗
PubMed2001

Langerhans' cell histiocytosis: temporal bone involvement.

In Langerhans' cell histiocytosis, radiological findings on temporal bone involvement show destructive bone lesions involving the mastoid, with the squamous part and middle ear less affected. Computed tomography (CT) is the preferred imaging modality for describing the extent of temporal bone involvement. CT also has an important role in monitoring disease activity and response to treatment. Bone scintigraphy seems to be less sensitive than radiography in detection of these lesions.

Histiocytosis, Langerhans-Cell↗
PubMed2001

[Objective evaluation of dysphonia. Possibilities and limitations].

Today clinical evaluation of the presence and extent of dysphonia is still essentially based on subjective-perceptive criteria. The lack of objectivity and the one-sidedness of such an approach reinforces the desire for a quantitative, objective determination of dysphonia which could aid in making an modern, unequivocal evaluation of the presence, extent and variations in time of this disorder both upon onset and after treatment. The purpose of the present research was to determine the reliability, possibilities and limitations of an objective, parametric procedure to evaluate both the normal and pathological voice. This procedure is based on the detection of the relationship between the noise and harmonic portions in the voice (the Yumoto H/N ratio). The study involved a group of 208 subjects (148 with dysphonia and 60 normal) and the procedure was applied using computerized digital sonography and dedicated algorithms. The results of this research showed that the vocal analysis procedure developed by Yumoto is not only simple but also highly sensitive, providing an objective study of dysphonia. In fact, the comparison between the average H/N ratio recorded in our patients (1.697 dB) is significantly different from that recorded in the normal subjects (11.169 dB) (p < 0.001). This also showed a clear discrimination between the two groups with no borderline or overlapping data found. The initial evaluation does not appear to establish a relationship between abnormal H/N ratio values and the type of pathology although greater morphological destruction of the vocal cords corresponds to worse vocal quality and therefore increased noise. For the data obtained to be valid, a necessary condition is the application of a strict, precise, correct sampling and analysis method following well-defined rules. Finally, the values obtained can serve as a basis for the construction of an objective instrumental voice measurement protocol that can be used in forensic evaluation of dysphonia. Standardization of the regulations is essential to such a project.

Adult↗
PubMed2000

Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records.

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.

Fistula↗
PubMed2000

[Paranasal sinus mycoses].

In recent years there has been a marked increase in mycosis infections of the paranasal sinuses, attributed both to an increase in the survival of subjects at risk and improved diagnostic techniques (endoscopy, CT, MR) able to identify cases which had previously gone unrecognized and treated as aspecific chronic sinusitis. The present study involves 45 cases (4.3%) out of a total of 1050 patients who had undergone endoscopic surgery for sinusopathy between April 1994 and December 1998. Following the Katzenstein classification, the cases were broken down into non-invasive chronic mycoses or fungus ball (34 cases), allergic mycoses (7), chronic indolent invasive mycoses (3) and fulminating invasive mycosis (1 case). The mycetes most often involved was Aspergillus Fumigatus (76.9%). The recurrent symptom was facial algia, followed by nasal obstruction. Paranasal sinuses endoscopy did not modify the specific picture. CT presented such indicative signs as focal areas with non-homogeneous intensity, images of metal-like foreign bodies and endosinus calcifications in 84.4% of the cases. MR--performed in only 6 cases--always presented T2 images showing the typical signal void area corresponding to pathological lesions. All patients underwent endoscopic surgery of the paranasal sinus. The effectiveness of this treatment differed according to the clinical form. In the fungus balls surgery always resolved the pathology without requiring subsequent pharmacological treatment. In allergic mycosis, surgery improved the symptom of nasal respiratory obstruction but local drug treatment was required. With the aid of drug treatment, surgery resolved chronic indolent invasive mycoses and prevented the endocranial progression of complications. In the cases of fulminating invasive mycosis, timely surgery prevented the onset of endocranial complications and made it possible to perform antimycotic polychemotherapy to control the disease. This experience shows how important a protocol involving several different tests is in diagnosing the many clinical forms of paranasal sinus mycoses and distinguishing them from sinusopathies. Endoscopic surgery is indicated for all forms of paranasal sinus mycoses although the realistic objectives differ according to type.

Adolescent↗
PubMed2000

[Revascularized jejunum loop in hypopharyngeal reconstruction: oncological and functional results].

The aggressiveness of hypopharyngeal cancer makes broad resectioning of the circular pharyngolaryngoesophageal segments necessary, followed by reconstruction to restore the anatomical gap created as fully as possibly creating a neoesophagus with thin walls that can easily be released. Over the years several procedures have been fine tuned for reconstruction of the upper digestive tract employing transposed viscera, miocutaneous pedunculated flaps, revascularized fascio-cutaneous or visceral free flaps. Currently the revascularized jejunum loop is one of the most commonly used methods in the reconstruction of the hypopharynx. Its popularity is due to some anatomical and physiological advantages: it requires transposition of a brief intestinal tract anatomically well adapted to the reconstruction site, ensuring rapid functional recovery. The authors report the oncological and functional results obtained in 25 patients who underwent circular pharyngolaryngectomy followed by reconstruction with a revascularized jejunum loop. The percentage of transplant survival was 90% and local and general complications were reduced to a minimum. The functional results--both in terms of deglutition and phonation--were satisfactory while patient survival (6-37 months follow-up) was in line with that reported by other authors for the same tumor (47%). Although prognosis for hypopharyngeal-esophageal neoplasms is still quite poor, this experience shows that circular pharyngolaryngectomy followed by reconstruction with autotransplant of the jejunum is an excellent choice since it offers the patient a prompt, acceptable functional recovery and a fair quality for his remaining life.

Aged↗
PubMed2000

[Human olfactory mucosa biopsy with endoscopic technique: clinical and structural observations on neurosensory epithelium rearrangement].

Optical and electron microscopy have been widely used to study the structural features of olfactory epithelium in several Vertebrate species. To date, however, understanding of histopathological alterations in the human olfactory neuroepithelium has been quite limited due to the difficulty in obtaining well preserved, intact fragments of mucosa. The recent introduction of endoscopic biopsy techniques has made it possible to analyze this epithelium in greater detail. In the present work, endoscopic biopsy has been performed on samples from 10 rhinologically healthy subjects. The technique used proved quite simple and did not present any risks or complications. Moreover, all samples were well preserved, as confirmed by histology. In addition, the histological pictures suggest that normal rearrangement of neuroepithelium is not an uniform process but takes place following a zone pattern with distinct dynamics between neurosensorial and support cells. Greater diffusion of this technique would not only make it possible to use different techniques to gain more detailed knowledge of tissue structure, ultrastructure and dynamics in human neuroepithelium, but it would also provide improved diagnostic and forensic evaluation in cases of anosmia, disosmia and hyposmia.

Adult↗
PubMed2000

[Post-parotidectomy Frey's syndrome. Treatment with botulinum toxin type A].

The Frey's syndrome, manifest after parotid trauma, is characterized by head and neck hyperemia and abundant sweating of the hyperemic skin in response to gustatory stimuli. The use of the botulin toxin to treat the symptoms in patients with Frey's syndrome has been described in numerous studies. For some time up until now our Center has achieved excellent results using the group A botulin toxin to overcome the hypertonus of the cricopharyngeal muscle in patients who had undergone laryngectomy and were rehabilitated with voice button. We have sought to extend the use of this toxin to Frey's syndrome, a relatively frequent complication of parotidectomy. A total of 86 patients participated in the study: 41 males (47.6%) and 45 females (52.4%) ranging in age from 25 to 77 years (average age 51 years). Of these patients 7 (8.1%) had undergone post-operative radiotherapy. Of the 86 patients studied, 18 referred significant symptoms in terms of abundance and frequency. The syndrome was considered severe if the symptoms were present at each meal and if the patient indicated a significant worsening of his quality of life. Intermittent episodes were indicated by 22 patients. The remaining 46 (43.5%) did not complain of any symptoms. The exact extension of the cervicofacial gustatory sweating was evaluated using the Minor test and the involved region was divided into 1 square centimeters sections. The amount of skin surface involved ranged from 10 to 80 square centimeters. The type A neurotoxin was frozen and was reconstituted with a sterile saline solution at a final concentration of 2.5 UI/0.1 ml. The intracutaneous infiltration was performed without anesthesia, infiltrating 0.1 ml of solution, containing 2.5 UI of toxin into the center of each 1 square centimeters section. Statistical analysis was performed to evaluate the potential relationship between how long the treatment was effective, incidence of recurrence, seriousness of the crises and the following variables: age, sex, histology, cutaneous surface involved, injected dose of botulin toxin and post-operative radiotherapy. In the group of 18 patients with severe symptoms (20.9%) the benefit was immediate in all cases although the recurrence rate was 50%. The Frey's syndrome symptoms disappeared within 7 days of infiltration. In the group of 22 patients with less severe involvement (25.5%), the treatment gave positive, definitive results in 16 patients (72.7%). Those patients whose symptoms persisted were treated a second time with an infiltration of 2.5 UI per square centimeters. We feel that the use of the type A botulin toxin is the most appropriate treatment for the Frey's syndrome. In fact, such treatment offers the following advantages: it is effective within 7 days, has limited side effects, can be applied on an outpatient basis, is inexpensive and is positively considered by the patients.

Adult↗