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Biomedical subjects

G Botti

Publications and source records attributed to G Botti.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Juvenile nasopharyngeal angiofibroma: comparison of blood loss during removal in embolized group versus nonembolized group.

PURPOSE: This retrospective study was performed to assess the beneficial effect of preoperative embolization of juvenile nasopharyngeal angiofibromas (JNA) in terms of blood loss during surgery. METHODS: Intraoperative blood loss in a group of 7 patients who underwent 10 procedures for JNA without preoperative embolization was compared with the blood loss of 13 patients who underwent 16 procedures after embolization of one or both external carotid arteries. RESULTS: Mean blood loss was 5380 ml in patients without embolization and 1037.5 ml in those with embolization. This difference was not statistically significant because of the high standard deviation in the nonembolized group. However, when data were analyzed by tumor stage, a significant difference was noted between the embolized and the nonembolized patients with high-grade tumors but not between those with low-grade tumors. CONCLUSION: Preoperative embolization of the branches of the external carotid appears to facilitate removal of high grade tumors. The benefit of embolization in those with low-grade tumors is less clear cut, probably because there is less vascularity in low-grade tumors and so removal is easier.

Adolescent↗
PubMedDate not supplied

Augmentation cheiloplasty by using mucomuscular flaps.

If one excludes the controversial use of silicone injections and the not fully researched new biomaterials for implant (e.g., Gore-Tex), there are no lip augmentation techniques that give stable and lasting results. Collagen and dermal or fascial grafts are almost always reabsorbed. Local flaps (either W or V/Y) give only a slight outward protrusion of the lips and do not increase volume and therefore have negligible cosmetic impact. In plastic surgery flap rotation is standard practice when the objective is stable tissue reconstruction. We feel that this technique achieves lasting increases in lip volume. Therefore, we propose the rotation of a mucous-muscle flap obtained from the inner cheek wall or from the other lip, the fulcrum of which is the labial commissure. The surgical technique is given in detail here together with the results and complications of 28 cases.

Cheek↗
PubMedDate not supplied

Thick skin and cosmetic surgery of the nasal tip: how to avoid the cutaneous polly beak.

Although thick skin is generally considered a disadvantage in cosmetic surgery of the nasal tip, responsible for the supra tip deformity known as "polly beak" and other aesthetic defects, there are surgical guidelines that can greatly reduce the occurrence of these problems, the most interesting of which is grafting. On the contrary, thick skin could even be considered an advantage, if it masks amputated cartilaginous margins following any dome-sectioning technique.

Adipose Tissue↗
PubMedDate not supplied

Thallium 201 for detection of viable myocardium: comparison of different reinjection protocols.

BACKGROUND: The finding fo false fixed 201Tl defects by the conventional stress-redistribution protocol is a well-known phenomenon. The aim of this study was to compare two different 201Tl reinjection protocols to identify viable myocardium in the same group of patients. METHODS AND RESULTS: Twenty-seven patients with ischemic heart disease and at least one persistent defect on 201Tl uptake redistribution images 3 hours after stress were investigated. In the same-day protocol (R1) patients were reinjected with 1 mCi 201Tl immediately after redistribution images, with imaging starting 15 minutes later; in the different-day protocol the patients were reinjected with 2 mCi 48 to 96 hours later. Two sets of images were obtained, 30 (R2) and 180 (R3) minutes after reinjection. The comparison of redistribution and reinjection versus stress images showed a significant (p < 0.01) frequency distribution. The uptake of 201Tl of the 111 irreversible segments at redistribution was enhanced in 35.1% with R1, 43.2% with R2, and 49.5% with R3. The agreement among the three procedures in classifying the segmental defects was high between R2 and R3 (r = 0.81) and lower between the same- and different-day protocols. Of the 19 patients with a dominant scar pattern demonstrated by the conventional stress-redistribution study, 37%, 47%, and 53% were judged mainly ischemic after R1, R2, and R3, respectively. All but three of the 55 segments-showing an increased 201Tl uptake by R3 had an echocardiographic score of 2 or greater. CONCLUSION: The best technique to differentiate scarred from viable myocardium seems to be the reinjection of a second dose of 201Tl on a different day followed by imaging 3 hours later.

Adult↗
PubMedDate not supplied

Blepharoplasty: A classification of selected techniques in the treatment and prevention of lower lid margin distortions.

In the past few years the approach to lower blepharoplasty complications has evolved. New and worthy preventive and curative treatments have been suggested for both scleral show and ectropion (operations with or without interruption of the lid margin, mucosal grafts, orbicularis flaps, etc.). Among these, several techniques have been chosen and analyzed, evaluating the advantages and disadvantages of each.

Blepharoplasty↗
PubMedDate not supplied

A Web terminology server using UMLS for the description of medical procedures.

The Model for Assistance in the Orientation of a User within Coding Systems (MAOUSSC) project has been designed to provide a representation for medical and surgical procedures that allows several applications to be developed from several viewpoints. It is based on a conceptual model, a controlled set of terms, and Web server development. The design includes the UMLS knowledge sources associated with additional knowledge about medico-surgical procedures. The model was implemented using a relational database. The authors developed a complete interface for the Web presentation, with the intermediary layer being written in PERL. The server has been used for the representation of medico-surgical procedures that occur in the discharge summaries of the national survey of hospital activities that is performed by the French Health Statistics Agency in order to produce inpatient profiles. The authors describe the current status of the MAOUSSC server and discuss their interest in using such a server to assist in the coordination of terminology tasks and in the sharing of controlled terminologies.

Computer Communication Networks↗
PubMedDate not supplied

Evaluation of the Unified Medical Language System as a medical knowledge source.

OBJECTIVE: The authors evaluated the use of the Unified Medical Language System (UMLS) as a medical knowledge source for the representation of medical procedures in the MAOUSSC system. DESIGN: MAOUSSC, a multiaxial coding system, was used for the representation of 1500 procedures from 15 clinical specialties, using UMLS concepts (augmented by full sources for three new vocabularies being added to the UMLS) and relationships whenever possible. Evaluation criteria for the UMLS included (1) completeness of representation of concepts and of inter-concept relationships, (2) consistency in the categorization of both concepts and inter-concept relationships, and (3) usability, including adaptability of the UMLS to a foreign language (French), its suitability to a geographic region with different medical practices than the USA, and issues relative to the annual update changes in the test vocabularies. RESULTS: During the MAOUSSC trial, the number of missing concepts or relationships identified in the augmented UMLS sources was deemed to be inconsequential relative to overall project goals. "Missing" UMLS inter-concept relationships were identified, although they were small in number. Some inconsistencies in the UMLS were noted, especially in the area of hierarchic relationships. CONCLUSION: After UMLS was used for five years as a knowledge source for representing 1500 complex medical procedures in MAOUSSC, its value is considered significant. Future editions of the UMLS are expected to improve representation of inter-concept relationships and global consistency.

Language↗
PubMedDate not supplied

Sentinel lymph node biopsy to stage patients with cutaneous melanoma at the National Cancer Institute of Naples. Results from 240 sentinel node biopsies.

AIMS AND BACKGROUND: The presence of lymph node metastases in patients with cutaneous melanoma represents the basis for correct therapy planning and is the most powerful prognostic factor to evaluate overall survival at diagnosis. METHODS AND STUDY DESIGN: Since 1992, when Dr. Morton published his first experience, the sentinel lymph node (SLN) biopsy technique seems to have resolved this matter by correctly staging patients. We analyzed our data from 240 SLN biopsies performed in the last five years at the National Cancer Institute of Naples, evaluating the total identification rate and the nodal recurrence rate, and compared them with the preliminary data of the MSLT (melanoma sentinel lymph node trial). RESULTS: Of all SLNs evaluated 18.5% were micrometastatic and 14% were identified by immunohistochemical staining. Forty-one patients had metastatic SLNs and nodal dissection of the positive basins revealed no other tumor-positive lymph nodes in more than 80% of them. All patients with a Breslow thickness of less than 2 mm had micrometastases only in the SLN, while with increasing thickness two, three or more positive nodes were found. Among SLN-negative patients nine (4%) developed lymph node recurrence in the previously treated basin and were therefore considered as false negative SLN biopsies. CONCLUSIONS: The prognostic value of SLN biopsy needs to be confirmed by the final results of the MSLT evaluating the therapeutic use of this procedure in patients with a Breslow thickness of less than 2 mm and its possible impact on the course of the disease.

Adolescent↗
PubMedDate not supplied

Epidermal growth factor receptor in human breast cancer comparison with steroid receptors and other prognostic factors.

The relationship between epidermal growth factor receptor (EGFR) status and various prognostic factors was investigated in 70 human breast cancer specimens. Epidermal growth factor receptor was determined by radioligand binding assay, standardized by the EORTC Receptor Study Group, using hydroxyapatite to separate receptor-bound and free ligand. The percentage of EGFR positivity was 80% when the cutoff was set at 5 fmol/mg of membrane protein; this percentage was among the highest hitherto reported. Regression analysis of EGFR versus ER and PR levels confirmed an inverse relationship between EGFR and ER (p = 0.022) as well as between EGFR and PR (p = 0.024). Univariate analysis of the EGFR data stratified according to steroid hormone receptor status showed EGFR to be negatively associated with ER and PR. No association was found between EGFR and menopausal status, axillary lymph node involvement, tumor size, and differentiation grade. A direct association between EGFR status and Ki-67 positive cell rate could be demonstrated.

Adult↗
PubMedDate not supplied

A system that facilitates the orientation within procedure nomenclatures through a semantic approach.

The representation of medical concepts should provide the flexibility required to support several purposes. We have implemented a model in which medical terms are represented in a standard format based on a semantic description of the terms. We have focused on the description of procedures. Underlying this project is the assumption that information about medical procedures is crucial in the healthcare system. A prototype has been developed for urology. Because of the large number of terms in the Unified Medical Language System (UMLS) and the abundance of links between them, we have experimented in the use of the UMLS as the foundation for our concept base. We assess the usefulness of this approach and discuss its improvements.

Algorithms↗
PubMedDate not supplied

Neoadjuvant chemotherapy for intermediate/high-grade soft tissue sarcomas: five-year results with epirubicin and ifosfamide.

BACKGROUND: Neoadjuvant chemotherapy for intermediate/high-grade soft tissue sarcomas (STS) may provide some advantages for facilitating the surgical resection of the tumor and for disease control. However its role as induction therapy before surgery should still be proved. PATIENTS AND METHODS: Twenty-one patients with intermediate/high-grade STS and tumor size > or = 5 cm were consecutively treated from 1997 to 2001 with neoadjuvant chemotherapy based on epirubicin 60 mg/m2/day on days 1 and 2 and ifosfamide 1.8 gr/m2/day on days 1 through 5 every three weeks. Evaluation of objective tumor response and toxicity were carried out according to WHO criteria. RESULTS: Nine partial responses were documented; stable disease in 11 patients, progressive disease in one patient. Apart from nine cases of grade 4 neutropenia, the treatment was generally well-tolerated. Twelve patients underwent conservative and limb salvage surgery. CONCLUSION: This therapeutic approach seems to be effective in facilitating surgery. Neutropenia was the most significant toxicity but it was preventable or medically treatable with G-CSF support.

Adult↗
PubMedDate not supplied

Expression of CD40 has no predictive value in soft tissue sarcomas.

BACKGROUND: CD40, a member of the tumor necrosis factor receptor superfamily, is capable of mediating the induction of apoptosis in tumors including sarcomas. The expression of proapoptotic receptor contribute to the induction of apoptosis by chemotherapeutic drugs. The present study was undertaken to determine if there is a correlation between the expression of CD40 in spindle-cell sarcomas and the response to epirubicin and ifosfamide chemotherapy. PATIENTS AND METHODS: Immunohistochemical analysis of CD40 expression was performed on 59 paraffin-embedded archival tissues. Evaluation of objective tumor response was carried out according to the WHO criteria. Correlations with response to chemotherapy and baseline patients' characteristics were investigated using Chi-square tests. RESULTS: Positive CD40 staining was observed in 42 tumors; it was expressed in < 10% of cells in 14 (24%), in 10 to 50% in 16 (27%) and in more than 50% of cells in 12 (20%) tumors. No significant association was found between CD40 expression, response to chemotherapy and other clinical and pathological characteristics. CONCLUSION: CD40 expression in spindle-cell soft tissue sarcomas is not associated with response to ifosfamide plus epirubicin chemotherapy.

Adult↗
PubMedDate not supplied

[Early evaluation using PET-FDG of the efficiency of neoadjuvant radiochemotherapy treatment in locally advanced neoplasia of the lower rectum].

BACKGROUND AND PURPOSE: Preoperative chemoradiation allows downstaging of locally advanced rectal cancer and in selected patients also a sufficient downsizing to ensure sphincter preservation. Selection of patients warranting a preoperative approach is improved by magnetic resonance imaging (MRI) which is able to define the involvement of mesorectal circumferential margin. Similarly it would be crucial to define the response to chemoradiation during the treatment but traditional morphologic imaging techniques may fail in differentiating neoplastic tissue from scarring. PET-FDG has been successfully used in the detection of metastatic colorectal cancer allowing imaging of deposits as small as 0.5 cm and may have a role in evaluating early response to chemoradiation. METHODS: In the present study, in patients with T3-T4 rectal cancer undergoing preoperative chemoradiation PET-FDG and flow cytometry analysis on endoscopic biopsy specimen have been performed before, during and after preoperative chemoradiation. RESULTS: Chemoradiation treatment has been successful in terms of downsizing and downstaging of the tumor. PET-FDG was able to demonstrate local response at only ten-fifteen days after the beginning of neoadjuvant therapy, also identifying non responding patients. CONCLUSIONS: FDG-PET may have a role in defining the response to chemoradiation and modulate the treatments strategy in patients with advanced rectal cancer.

Antineoplastic Combined Chemotherapy Protocols↗