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Biomedical subjects

G Motta

Publications and source records attributed to G Motta.

At least 55 records · Page 3Linked to original sources
PubMed1997

T1-T2-T3 glottic tumors: fifteen years experience with CO2 laser.

This research aims at reporting the results of endoscopic treatment of glottic carcinomas by CO2 laser. The cases cited concern 516 patients with glottic T1-T2-T3 carcinomas. The patients have been divided into 5 groups: a) T1a: 194 patients with monolateral carcinoma involving the true vocal cord who underwent simple cordectomy; b) T2a: 104 patients with monolateral cordal carcinoma involving the ventricle and the false cord; c) T1b: 127 cases of monolateral or bilateral carcinoma involving the anterior commissure; d) these patients underwent bilateral cordectomy; T2b: 54 cases of monolateral or bilateral carcinomas involving the anterior commissure and extending to the hypoglottic or supraglottic region; in these patients a bilateral extended cordectomy was performed; e) T3: 37 selected cases of monolateral or bilateral cordal carcinoma with fixed vocal cord, fixity was due to the substantial size of the tumor or to the infiltration of the paraglottic space; these patients underwent a monolateral or bilateral extended cordectomy. The following are the results at 5 years: group a: overall observed survival rate (OSR) was 79% and the adjusted survival rate (ASR) 94.5%; group b: OSR 67% and ASR 77%; group c: OSR 88.4% and ASR 96.5%; group d: OSR 82% and ASR 90%; group e: OSR 55% and ASR 67%. The above data are evidence of the fact that our surgical techniques offer similar or better advantages in terms of survival rate compared to the traditional procedures. It must be noted that endoscopic surgery of glottic tumors carried out by CO2 laser offers relevant benefits when compared with traditional surgery: i) rapidity of operation and reduced surgical trauma; ii) the possibility of avoiding tracheotomy; iii) the respect of the integrity of the cartilaginous skeleton; iv) short postoperative course and low incidence of complication; v) better functional results; vi) a shorter stay in hospital with positive psychological effects on the patients and lower social costs.

Carcinoma, Squamous Cell↗
PubMed1996

Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years' follow-up.

A prospective case-control study is presented to assess an allergy prevention programme in children up to 36 months of age. Infants born at three maternity hospitals were followed from birth: 279 infants with high atopic risk (intervention group) were compared with 80 infants with similar atopic risk but no intervention (non-intervention group). The intervention programme included dietary measures (exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet) and environmental measures (avoidance of parental smoking in the presence of the babies, day care > 2 years of life). Mothers in this group who had insufficient breast milk were randomly assigned to one of two coded formulas: either a hydrolysed milk formula (Nidina HA, Nestlé) or a conventional adapted formula (Nan, Nestlé). Other environmental measures remained the same as for the breastfeeding mothers. The non-intervention group were either breastfed or received the usual Italian milk feeding and weaning diet, without environmental advice. The main outcome measures were anthropometric measurements and allergic disease manifestations. Normal anthropometric data were observed both in the intervention group and in the non-intervention group. The incidence of allergic manifestations was much lower in the intervention group than in the non-intervention group at 1 year (11.5 versus 54.4%, respectively) and at 2 years (14.9 versus 65.6%) and 3 years (20.6 versus 74.1%). Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non-intervention group from birth up to the second year of life, while urticaria and gastrointestinal disorders were only present in the non-intervention group in the first year of life. Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non-intervention group. Relapse of the same allergic symptom was less in the intervention group (13.0%) than in the non-intervention group (36.9%). In comparison to the non-intervention group, there were fewer intervention group cases with two or more different allergic symptoms (8.7 versus 32.6%), and they were more likely to avoid steroid treatment (0 versus 10.8%) and hospital admission (0 versus 6.5%). Babies in the non-intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group. In the intervention group the breastfed infants had the lowest incidence of allergic symptoms, followed by the infants fed the hydrolysed formula (ns). Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants, although less than their counterparts in the non-intervention group. Of the affected subjects in the intervention group, 80.4% were RAST and/or Prick positive to food or inhalant allergens. Total serum IgE values detected at birth in the intervention group were not predictive, but at 1 and 2 years of age, IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy. In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups. Of the various factors tested in the non-intervention group, the following were the most important in the pathogenesis of allergic symptoms: (i) formula implementation begun in the first week of life; (ii) early weaning (< 4 months); (iii) feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6 months); and (v) parental smoking in the presence of the babies and early day care admission (< 2 years of life). All the preventive measures used in this study (exclusive breastfeeding and/or hydrolysed milk feeding, delayed and selective introduction of solid foods, and environmental advice) were effective at the third year of follow-up, greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions

Air Pollution, Indoor↗
PubMed1996

[Evolution of the operative technique. The rigid system stapedectomy].

In our Clinic, from 1987 up to 1993, 296 patients suffering from otosclerotic disease underwent stapedotomy, either using a classical or modified technique. The Authors reported the almost total disappearance of post-operative vertiginous symptomatology and a very good functional recovery; they believe that the placing of the prosthesis before disjointing the stapes, thereby allowing operation on a rigid structure, helps reduce labif1nthine traumatism. Moreover, stapedotomy with inversion of surgical times requires only a 24-hour hospitalization, with obvious advantages both for patient and clinic.

Adolescent↗
PubMed1996

[Evolution of the operative technique. CO2 laser stapedotomy and stapedoplasty].

In recent years in the literature on stapes surgery several changes have been proposed concerning the adoption either of new technologies (Laser) or of surgical techniques preserving middle ear functional structures (stapedoplasty). The Authors carried out a personal case-report on 30 patients suffering from otospongiotic disease, in order to clarify the real advantages and possible applications of the latest developments in small fenestra stapedectomy. Twenty subjects underwent platinotomy with preservation of the stapedial tendon (stapedoplasty), while a simple stapedotomy was performed in the remaining 10 cases, with or without inversion of surgical times (a "rigid system" technique was adopted in 7 patients). CO2 Laser was used on 10 of these patients (33%) in order to carry out certain surgical steps; in particular it was used on 7 subjects who underwent stapedotomy with stapedoplasty (35%) and in 3 cases of traditional stapedotomy (100%). An audiometric examination was conducted on all subjects 1 and 6 months after the operation, in order to evaluate functional recovery; the post-operative stapedial reflex was also studied in patients who underwent stapedoplasty. This research points out the advantages that CO2 Laser gives in the execution of stapes surgery, whatever the type of technique adopted; in particular, the advantages of using this instrument are: -an easier and bloodless performance of the operation, particularly in the case of the preservation of the stapedial tendon; -a greater regularity and precision of the footplate hole than that obtained by drilling, especially in subjects whose stapes are thin, floating, fractured or even obliterated; -less mechanical traumatism on the labyrinth during either the fracturing of the crura or the footplate fenestration, resulting in the reduction of both perceptive hearing loss an dizziness; -a higher incidence of air-bone gap closure mostly in the case of stapedial tendon preservation. On the other hand, the use of inadequate lasers or the lack of reference to exact parameters (beam power and frequence, time of exposure and defocalization), could cause the heating of labyrinthine liquids and so damage the receptorial structures of the inner ear.

Humans↗
PubMed1996

[The small fenestra vs large stapedectomy: comparative evaluation of failures and complications].

The Authors discuss post-operative failures and complications detected in their case-report of 1857 patients, operated for otosclerotic disease between 1982 and 1993 (399 large fenestra and 1458 small fenestra stapedotomies), with reference to the data from international literature. Their study reveals that the most frequent clinical event caused by complications arising is still hypoacusia of various degree, both conductive (2.7%) and sensorineural (6.6%); more precisely, conductive hearing loss points to revision surgery, while sensorineural lesions, often limited to high frequencies (5.7%), may unfortunately take the form of anacousia (0.9%). Some extra-auditory complications (temporary facial paralysis, ear drum perforation, disgeusia, tinnitus) are also present with relative frequency in stapes surgery (4.2%); among them, however, only impairment or appearance of tinnitus (0.6%) turn out to be a persistent disorder. Analysis of the results underlines that the complications rate is higher in the case of coexisting morphological anomalies (such as stenosis of the external ear canal, disjointing or amputation of the incus, difficulty in approaching the oval window, reobliteration of the oval window, facial nerve prolapse) or when intraoperative problems arise (excessive bleeding, profuse perylymph flow), which make the operation more difficult to perform. The data obtained in this study show that stapedotomy (using a 0.6 mm diameter prosthesis), gives a significantly lower rate of sensorineural complications (4.1%), than platinectomy (15.6%), because of the reduction of labirinthine traumatism. Lastly, the Authors performed 64 revision operations, evaluating intraoperative findings and hearing recovery rate. Causes of failure most frequently detected during revision surgery were: incus necrosis (24.6%) and prosthesis displacement (21.3%) with possible reobliteration of the oval window (23%); however it has not always been possible to detect pathogenesis of a postoperative conductive hearing loss. All things considered, results of revision surgery seem to be less satisfactory (56% improvements, 4.9% severe sensorineural hearing loss) than those obtained after the first operation.

Humans↗
PubMed1996

[Stapedotomy vs stapedectomy. Comparison of hearing results].

The Authors investigated 200 patients, selected at random from an operative case-report of 1857 subjects, in order to evaluate hearing results of stapes surgery and to compare the recovery obtained using both small (0.7 mm footplate hole) and large fenestra stapedectomy. More precisely, after 1 week and 6 months, they examined audiological findings (air, bone conduction and cochlear reserve) before performing the operation in order to evaluate the following problems: persisting conductive gap at low frequencies, sensorineural hearing loss at high frequencies, prognosis in advanced stages (compromised pre-operative bone conduction), preservation of hearing over time. Firstly, data from our research indicate extremely successful results in stapes surgery; in particular, hearing improvement seems to be more frequent for middle-low tones (in 98% of patients), due to the higher rate of sensorineural deficit at high frequencies, which are however characterized by a more complete closure of the conductive gap. However with stapedotomy better hearing recovery is obtained and in a greater number of patients with a lower evidence of bone conduction impairment. Such an advantage increases even further from the time of surgery (p significant after 6 months on every frequency) and particularly in cases where disease is advanced.

Adult↗
PubMed1996

[Malformation processes in the middle ear. Branchio-oto-renal syndrome (BOR)].

The present report concerns a case of Branchio-Oto-Renal (BOR) dysplasia. The syndrome is an autosomal dominant inherited disorder characterized by external ear malformations, branchial fistulas, conductive mixed or sensorineural hearing loss and renal anomalies of varying severity. The types of abnormalities that may be present are numerous and often difficult to identify preoperatively, despite modern imaging techniques. From the literature the reconstructive surgery of the middle ear in patients with the BOR Syndrome often has not been successful. In particular, the Authors report their experience in the surgical treatment of a case of BOR Syndrome. During intraoperative investigation a complex malformation of incus-malleus system was detected; thus, an ossiculoplasty, with PORP interposition, was carried out. Hearing results obtained with such intervention were successful, but they did not allow a complete closure of the cochlear reserve. Lastly, the Authors recommend a careful study of the different malformations of the middle ear, so that a more suitable preoperative therapeutic procedure may be planned.

Adult↗
PubMed1996

[Techniques of iconographic documentation].

The Authors describe modalities of photography and videorecording that should be used in stapes surgery and report the solutions they adopted to get iconographic documentation of high quality standard. As regards videorecording systems, the authors used both S-VHS and U-Matic equipment; with both types high fidelity shootings are obtained in the active documentation of each phase of the operation. Moreover, U-Matic master copying guarantees a final copy of higher quality. Technical difficulties that the authors met in videorecording are connected to the restricted field of view, limited by the speculum, which may itself cause dazzling phenomena or light refraction. A 2/3 inch CCD Sony camera, with a modified ELC(Electronic Light Control), was used to get round these problems, so as to eliminate the reflection of surgical instruments. In order to build up a photographic archive, it is also possible to get slides from single pictures of the recorded tapes, although their definition quality is lower than the one obtained foff photos; these, however, must be taken with reference to precise optical parameters and in particular: for shooting view pictures low enlargements (1,6x) were used with an intermediate aperture (f44), while, to better visualize details(footplate hole, stapedial tendon), it was considered right to u se restricted frames (2,5x) and a low aperture (f22). Such a technical solution, in fact, gives a better relation between depth of field and brightness. Finally the Authors underline that the constant use of the intraoperative videorecording system allows: greater participation of every member of the team in the operation; a delayed critical revision of th e operation; medico-legal documentation of possible intraoperative complications; iconographic material available both for scientific and didactic purposes.

Humans↗
PubMed1996

Reimbursement challenges and how to meet them.

How we deliver healthcare in the U.S., and how that care is paid for, is evolving. Reimbursement and payment issues now directly impact patient care and clinical decisions. Comprehensive documentation is essential to receiving reimbursement. Therapeutic positioning used by therapists is considered a skilled service. The key to Medicare reimbursement for therapeutic positioning and other services is documentation which clearly outlines the required skills of the professional, the medical necessity and reasonableness of the service, and the significant functional and safety goals that have been met, along with the progress over time. Medicare coverage and payment policies for surgical dressings and support surfaces have been revised in the last few years. The current surgical dressings policy has a number of points that must be understood: X1 modifiers, border versus non-border dressings, wound fillers and covers, solutions (saline), wound fillers (amorphous), dressing kits, staging, sterile versus non-sterile gauze, and normal utilization parameters. Many restrictions in both surgical dressings and support surfaces policies are efforts to curb fraud and abuse. The future of reimbursement depends of the involvement of healthcare professionals by developing research-based protocols, comprehensive documentation, education of both peers and patients, and political empowerment.

Bandages↗
PubMed1995

Production of a functional anti-scorpion hemocyanin scFv in Escherichia coli.

A58 is a murine monoclonal antibody raised against the internal dimeric subunit A alpha 1 of the hemocyanin of the scorpion Androctonus australis. When A58 is tested against a range of related hemocyanins, it exhibits cross-reactivity with a limited number of scorpion species. All of them belong to a single Scorpion Family: the Buthidae. We have utilized a bacterial expression-export system in which the variable regions of A58 are expressed as a single-chain variable fragment (scFv). Polymerase chain reaction (PCR) was used for the cloning and modification of the heavy and light variable regions which were assembled into a scFv. After insertion into a vector which contains the pectate lyase signal sequence from Erwinia caratovora for periplasmic expression, a scFv protein was produced in high yield as a soluble and functional protein. The bacterial produced A58 scFv has binding properties similar to those of the original murine antibody. It binds specifically the heterodimeric subunit of Androctonus australis hemocyanin, cross-reacts with only one subunit of each Buthidae investigated, and blocks the recognition of the hemocyanin by antibody A58 in competitive enzyme-linked immunosorbant assay. Previous reports have demonstrated the value of monoclonal antibodies in taxonomical and molecular evolution studies. A58scFv is the first of a new generation of antigen-binding proteins which should prove useful both in taxonomical studies and in the analysis of VH--VL structure-function relationships of antibodies.

Amino Acid Sequence↗
PubMed1995

Auditory brainstem responses in thyroid diseases before and after therapy.

The aim of this study was to evaluate through the auditory brainstem responses (ABRs) the electrical events generated along the auditory pathway in 56 adult patients affected with hyper- and hypothyroidism. Twenty-four normal-hearing hyperthyroid patients affected with Graves' disease and 32 normal-hearing hypothyroid patients (9 with subclinical and 23 with overt hypothyroidism) were subjected to standard (clicks at 21 pps) and sensitized ABR with masking wide-band (masking noise). In addition, thyroid scintiscan and ultrasonography, free T3 and T4, total T3 and T4, TSH, antimicrosomal and antithyroglobulin antibodies, audiogram and impedance tests were performed in all the patients. This study was repeated after 6-12 months of treatment in conditions of euthyroidism. The results showed changes of ABRs both in the standard procedure as well as in the sensitized test in 6 hyperthyroid (25%) and 8 hypothyroid patients (25%). All the patients with abnormal ABRs had overt hypothyroidism (8/23; 34.7%). The ABRs became normal in 5 out of 6 Graves' patients after 6-12 months of methimazole treatment. ABRs remained abnormal in all the hypothyroid patients despite their having been on L-thyroxine treatment for 6-12 months and were euthyroid for at least 5 months before the study was repeated. These findings suggest that ABR abnormalities are indicative only of a nonspecific injury in the bulbo-ponto-mesencephalic centers. Alterations of ABRs in thyroid diseases are not specific in relation to hyper- or hypothyroidism. Lastly, there is a relationship between ABR abnormalities and the degree of hypothyroidism, even if ABR alterations are not always reversible after long-term therapy.

Adult↗
PubMed1995

[The treatment of allergic vasomotor rhinitis: diagnostic problems and local immunotherapy].

Treatment of allergic vasomotor rhinitis is to be regarded with the factors that modify the symptomatology. In fact must be considered the morphological changes (septum deviation, adenoids, turbinates hypertrophy, polyps) infections (bacteria, chlamydiae, micetes) and specific allergens. Identification of allergens and sensitization threshold is to be studied; then specific hyposensitization will be assessed. In the present study, 68 subjects having nasal reactivity have been observed and underwent to different ways of treatment: 18 with permanent stenosis identified by rhinomanometry and not modified with vasoconstrictors were operated; 25 of the 50 patients with normal nasal cavities showed contemporary infections: after a specific antimicrobic or antimycotic treatment, a clear improvement was obtained documented by rhinomanometry before and after nasal stimulations. The 50 patients with normal morphology underwent a local hyposensitization against the allergens. As a matter of fact: a) in all cases a clear improvement was obtained in phase of increasing; b) after one year of maintainance just 13 over 50 (26%) returned to previous conditions. The Authors remark how local immunotherapy by the nasal way give good possibilities in a high percentage of cases in the following conditions: correct clinical evaluation, especially concerning the identification of factors determining vasomotor rhinitis; employment of precise techniques for diagnosis; observation of clinical data and results turning out from instrumental investigations, especially concerning the nasal provocation test evaluated by rhinomanometry.

Humans↗
PubMed1995

[The use of hearing aids in children with profound deafness. Methodology and results].

The early application of hearing aids in children with severe and profound hearing loss is rather an hard problem that has to be solved, according to the Authors, by taking care of several factors. Usually, as far as these patients concern, two kinds of hearings aids are used. The first one emphasizes all the frequencies in the same way, including low tones that, in the early ages, are very important for improving prosodic pattern, occlusive and liquid phonemas, primary words and sentences. The second type, emphasizing only medium and high frequencies, is useful for discrimination processes. The Authors suggest to applicate the hearing aids in these patients, following a behavior be themselves named "dynamic application". In the first phase the Authors use hearing aids emphasizing also low tones; in the second one they modify the device, according more precise data turning out form audiometric evaluation and speech therapy. The results concerning a research on 27 children with profound hearing loss are debated; the application of hearing aids occurred in early age and the speech therapy followed the same criteria for all patients. The subjects were divided in two groups, homogeneous for age, degree of hearing loss and social environment. For the 12 children of groups A the "dynamic application" was used. For the 15 patients of group B the traditional strategy, using only devices for the amplification of medium and high tones, was applied. The best results concerning voice intonation and learning occlusive phonemas were obtained in group A subjects. The Authors, introducing their results and discussion, compare them with references data. In conclusion, the "dynamic application" is effective because of the better results in speech therapy and also because its ratio permits the application of hearing aids in children with hearing loss of different degrees, especially in the most difficult cases.

Child↗
PubMed1995

[Spiral computed tomography in the diagnosis and staging of bronchopulmonary carcinoma].

Spiral or helical technology is a new computed tomographic technique based on the continuous acquisition of volumetric CT data during continuous x-ray beam rotation and continuous patient transportation at constant velocity. It has many advantages over conventional CT: the authors briefly review the basic principles of spiral CT and discuss the applications and the possible advantages in the assessment of lung cancer. The most important characteristics of spiral CT are rapid image acquisition, allowing a single-breath-hold scan of the lung, and the ability to obtain axial image reconstructions at arbitrary and overlapping intervals, thus allowing the detection of small lesions that otherwise would be inconspicuous because of respiratory misregistration or partial volume averaging. This leads to better identification of small pulmonary nodules and to high quality multiplanar reconstructions that can be useful in the study of mediastinal lymph nodes and the vascular and tracheobronchial spreading of lung cancer. Many of the spiral CT scanners allow for 40 sec extended spiral acquisition during a single-breath-hold, permitting the evaluation of the thorax and the upper abdomen. This usually includes the adrenals and the whole liver, thus allowing a rapid staging of thoracic neoplasms, with an accuracy higher than that of conventional CT.

Carcinoma, Bronchogenic↗
PubMed1995

[Lobar bronchoplasty for tumor. Surgical technique and long-term results].

Between 1978 and 1994, 55 patients (53 men and 2 women) with a mean age of 62 years underwent an extended lobectomy to the main bronchus, with bronchial re-anastomosis, for bronchogenic tumours located around the lobar orifice. There were 32 upper sleeve lobectomies (58%) with a wedge resection of carina in one instance, 7 lower mono/bilobectomies with an upper lobe "turn up" re-anastomosis (13%) and 16 upper wedge lobectomies (29%). Squamous cell carcinoma was predominant (32 patients, 58%), while the adenocarcinoma was present in 16%, adenosquamous in 5%, microcitoma in 9%, carcinoid in 4% and a well differentiated neuro-endocrine carcinoma in 2%. The indication for the bronchoplastic procedure was judged to be when the FEV, value was about -25% of the normal; in a few patients still in good respiratory condition, an elective indication was also admitted. Postoperative staging was: Stage 0 in 1 patient, Stage I in 7 patients; Stage II in 10 patients; Stage III A in 31 patients; Stage III B in 5 patients and Stage IV in 1 patient. Follow-up was completed with a mean extension of 40 months (range 3 months-16 years). There was no operative mortality in Stages I and II as well as in Stages III B and IV, while it was 9% in Stage III A patients. Survival rates according to the stage were as following: 66% 5 and 10 year for Stage I disease; 56% 5 year and 45% 10 year for Stage II disease; 7% 4 year for Stage III A. None of 5 patients belonging to Stage III B has survived for more than 18 months (mean 7). Some single survivals are mentioned because of their special clinical features. Besides stressing the absolute value of survival rates obtained in Stage I and II disease, the Author also point out the clinical role of these advanced surgical techniques in improving both the survival length and the quality of life, when applied for the treatment of more advanced Stage III A.

Adult↗