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Biomedical subjects

Alberto Staffieri

Publications and source records attributed to Alberto Staffieri.

At least 19 recordsLinked to original sources
PubMed2006

Penetration of levofloxacin into paranasal sinuses mucosa of patients with chronic rhinosinusitis after a single 500 mg oral dose.

Respiratory fluoroquinolones are currently considered by several guidelines among the most effective antimicrobial agents for the treatment of acute bacterial rhinosinusitis. The aim of this study was to assess levofloxacin penetration into paranasal sinuses mucosa of 15 patients with chronic rhinosinusitis 1h (n = 4), 2 h (n = 5) and 3 h (n = 6) after a single 500 mg oral dose. Levofloxacin concentrations in plasma and tissue samples were assessed by means of HPLC. Median of mucosal concentrations were 0.96 mg l(-1) at 1 h, 2.50 mg l(-1) at 2 h, 5.84 mg l(-1) at 3 h. Average paranasal sinuses mucosa-to-plasma ratios raised from 1.46 at 1 h, to 1.81 at 2 h and to 2.56 at 3 h. These data are consistent with 500 mg oral levofloxacin ensuring appropriate therapeutic exposure in sinonasal tissue of patients with chronic rhinosinusitis, the concentrations between 1 and 3 h post-dosing being almost always higher than the MIC90 against the major bacterial pathogens responsible for upper respiratory tract infections.

Adult↗
PubMed2006

Current opinion in diagnosis and treatment of laryngeal carcinoma.

Laryngeal carcinoma is the 11th commonest form of cancer in men world-wide, with 121,000 new cases in 1985. More than 95% of all laryngeal malignancies are squamous cell carcinomas. Treatment indications in cancer of the larynx are often controversial, since there are few comparative studies of different available therapeutic approaches. Surgery and radiotherapy are both widely used, and the choice between these two procedures is the most common therapeutic decision which has to be taken. Laryngeal function preservation has gained more and more weight in the last decades and chemotherapy is also a significant component of several curative approaches. In the last decades, several organ-preserving surgical techniques have become available and consequently total laryngectomy results less applied. Regardless of the treatment modality, Tis, T1, T2 laryngeal carcinomas have an 80-90% probability of cure, whereas for more advanced tumours this is approximately 60%. The most effective approach to laryngeal cancer remains prevention and early diagnosis when this cancer is curable with function preserving treatments.

Carcinoma↗
PubMed2006

Cervical necrotizing fasciitis: a novel clinical presentation of Burkholderia cepacia infection.

Necrotizing fasciitis is a soft-tissue infection characterized by progressive destruction of fascia and adipose tissue which may not involve the skin. Cervical necrotizing fascitis (CNF) is an uncommon clinical entity. The development of CNF is frequently related to synergistic infections of aerobic and anaerobic organisms of the upper aerodigestive tract. We describe the first case of CNF due to multi-drug resistant Burkholderia cepacia and Peptostreptococcus infection in an immuno-competent patient without cystic fibrosis.

Adult↗
PubMed2006

Deep neck infection in elderly patients. A single institution experience (2000-2004).

BACKGROUND AND AIMS: Immunosenescence, the age-related decline in immunologic function in healthy individuals, seems to contribute to increased susceptibility to bacterial infections in the elderly population. The present study describes elderly patients' susceptibility to deep neck infection and prognosis. METHODS: Between January 2000 and March 2004, 103 patients were admitted to the Department of Otolaryngology, University of Padova for deep neck infection. Twenty-four patients (23%) were over 65 (elderly patients). The remaining 79 patients (77%) aged < or =65 years (adult non-elderly patients) were also studied. Presentation modalities, origin of infection, site of deep neck infection, radiological investigations, bacteriology, treatment and outcome were all studied. RESULTS: Hypertension and diabetes mellitus were the most commonly associated systemic diseases in both elderly and non-elderly patients. The number of patients with associated systemic diseases was significantly higher in the elderly group. The most common cause of deep neck infection was dental infection in both age groups. In the elderly group, salivary gland origin had the same incidence as dental origin. Twenty-two patients (6 elderly patients) were treated only with intravenous antibiotic therapy and intravenous steroids. Overall, in 81 cases (78.6%) (18 elderly patients) medical plus surgical procedures were indicated. None of the treated patients died of deep neck infection or its complications. CONCLUSIONS: Although the incidence of associated systemic diseases and complications of deep neck infections were higher in the elderly group, our medical or medical plus surgical approaches to deep neck infections, based on clinical and radiological evidence, were successful in all patients treated.

Adolescent↗
PubMed2006

Cost of tracheoesophageal prostheses in developing countries. Facing the problem from an internal perspective.

CONCLUSIONS: All the discussants of our questionnaire agreed that the price of tracheoesophageal (TE) prostheses was too expensive for developing countries. The problem could be addressed in terms of international laws regarding companies' patent rights. TE prosthesis manufacturers from rich countries could move their manufacturing in part to developing countries. High production standards could allow TE prostheses to be exported to developed countries. Another approach to the problem may be based on a partnership between non-profit-making Western laryngological societies with specific medical and technical prosthetic know-how and local manufacturers. The aim of this cooperation could be the low-cost production of advanced TE prostheses in the developing countries. OBJECTIVES: In communities in the developing world, most laryngeal and hypopharyngeal carcinomas are diagnosed at advanced stages and require total laryngectomy. Prosthetic TE voice restoration is the method of choice for voice rehabilitation after total laryngectomy in developed countries. Unacceptably high costs are a significant limitation to Third World use of TE voice prostheses. The aims of this paper are to discuss the consequences of the high costs of TE prostheses in developing countries with head and neck surgeons working in Third World hospitals and to propose how European and American laryngological societies can promote TE speech in the developing countries. MATERIAL AND METHODS: A questionnaire was given to a group of expert head and neck surgeons working in developing countries and their answers and suggestions discussed.

Costs and Cost Analysis↗
PubMed2006

High nuclear expression of the apoptosis inhibitor protein survivin is associated with disease recurrence and poor prognosis in laryngeal basaloid squamous cell carcinoma.

CONCLUSION: Nuclear expression of survivin should be studied as a promising marker of higher-risk laryngeal basaloid squamous cell carcinomas (BSCCs), which can then be treated more aggressively and followed more closely. OBJECTIVE: BSCC is an uncommon bimorphic variant of SCC. The hypothesized greater aggressiveness and poorer prognosis of head and neck BSCC compared to SCC are still under debate. The regulation of apoptotic cell death has a profound effect on the pathogenesis and progression of malignancies. Survivin is the smallest member of the inhibitor of apoptosis gene family. The aim of this study was to investigate for the first time the expression of the inhibitor of apoptosis protein survivin in laryngeal BSCCs and their neck lymph node metastases and to compare the results with those obtained with conventional SCCs. MATERIAL AND METHODS: Immunoreactivity to survivin was determined in nine laryngeal BSCCs and nine site- and stage-matched SCCs. RESULTS: A nuclear subcellular localization of survivin dominated in both primary laryngeal BSCCs and SCCs and in their lymph node metastases. There was no significant difference in mean survivin expression between primary laryngeal BSCCs (25.1%) and SCCs (25.6%) (p=0.86). Nuclear survivin expression was significantly higher in BSCCs associated with disease recurrence and poor prognosis (p=0.02).

Adult↗
PubMed2006

Extranodal Rosai-Dorfman disease: involvement of eye, nose and trachea.

Rosai-Dorfman disease (RDD) is a rare non-neoplastic histiocytic proliferative disorder characterized by painless lymphadenopathy. Extranodal lesions frequently occur in the head and neck regions. We report the clinical and histological features of extranodal RDD in a 43-year-old man with a previously unreported combination of multiple gross anterior epibulbar nodules in the right eye, submucosal masses of nasal septum and trachea, and no lymphadenopathy during the 12-year follow-up. The patient underwent ophthalmological, otolaryngological and systemic evaluation; gallium 67 scintigraphy; bronchoscopy; ophthalmic ultrasound; head and neck CT scan; biopsies of epibulbar, nasal and tracheal tissues; and septoplasty. Histological specimens showed lymphocytophagocytosis and positive immunoperoxidase staining for S100 protein in foamy histiocytes; both features were typical for RDD. No response to topical or systemic steroids or to radiation therapy was recorded. Removal of nasal septum masses resolved nasal obstruction. The diagnosis of RDD requires histological and, in challenging cases, immunohistological specimens and is difficult--especially with pure extranodal localizations as in our case. RDD should be suspected in cases of subconjunctival mass and/or submucosal nasal and tracheal swellings not responding to systemic steroids.

Adult↗
PubMed2006

Giant cell tumour (central giant cell lesion) of the maxilla.

The giant cell tumour (GCT) is a benign, locally invasive lesion that accounts for about 20% of benign bone tumours. Approximately 2% of all GCTs arise in the head and neck region. Giant cell lesions in the craniofacial skeleton other than the jaws are uncommon; the majority of them occur in the sphenoid, ethmoid and temporal bones. GCT of the maxilla has seldom been described. We present the case of an 83-year-old patient with an advanced GCT of the left maxilla who underwent en bloc resection through maxillectomy. Reconstruction of the orbitary frame and maxilla was performed with autologous calvaria and a temporalis muscle pedicled flap. Our successful maxillary reconstruction based on the association between autologous calvarial bone sticks bent with titanium miniplates and a temporalis muscle pedicled flap allowed the involvement of only one donor area for both hard and soft tissues. At 1-year follow-up, our patient showed no evidence of recurrent GCT, with satisfactory aesthetic results.

Aged, 80 and over↗
PubMed2006

The role of supracricoid laryngectomy for glottic carcinoma recurrence after radiotherapy failure: a critical review.

CONCLUSIONS: In the near future salvage supracricoid laryngectomy (SCL) will be used more extensively for failures of radiotherapy for glottic carcinoma. OBJECTIVES: Primary radiotherapy has been used for patients with early glottic carcinomas in northern Europe and North America for more than half a century. Local recurrences after radiotherapy for glottic malignancies occur in 5-25% for T1 carcinomas and in 15-50% for T2 carcinomas. The classic choice as salvage surgery in cases of glottic squamous cell carcinoma recurrence after irradiation failure is total laryngectomy. The development of extended conservation procedures such as SCL has permitted an increasing number of successful partial laryngectomies that save laryngeal functions after radiotherapy failure. SCL allows the creation of a neo-larynx, permitting both swallowing and speech; in most cases the tracheostoma can be closed. METHODS: The electronic database Pubmed was searched without publication date limits. RESULTS: Considering available data (103 cases), 84.5% of the cases treated with salvage SCL for irradiation failure did not present a new local recurrence; laryngeal recurrences after salvage SCL (15.5%) were successfully treated with total laryngectomy in 66.7% of the cases. Tracheostoma closure was possible in all except two cases after a mean period ranging between 12 and 28 days. Swallowing results seemed good, with longer recovery time in irradiated than in non-irradiated patients who underwent SCL. Voice quality determined with psychoacoustic methods had acceptable intelligibility.

Glottis↗
PubMed2005

Supracricoid laryngectomy with cricohyoidopexy for recurrence of early-stage glottic carcinoma after irradiation. Long-term oncological and functional results.

CONCLUSIONS: These results suggest that, in selected cases, SCL-CHP may be used to treat laryngeal carcinomas after radiation failure, with good oncological and functional results. OBJECTIVES: Radiotherapy and surgery are believed to be equally effective and highly successful in the management of T1-staged glottic carcinomas. An almost normal post-therapy voice is considered the main advantage of irradiation over the surgical approach. On the other hand, when a tumour recurs after radiotherapy, it is more likely to extend beyond its original site, making total laryngectomy necessary in most cases. However, in selected cases, conservative laryngeal surgery is possible. At present only a few reports in the literature have documented the oncological and functional outcome of supracricoid laryngectomy with cricohyoidopexy (SCL-CHP) in the treatment of laryngeal recurrence after irradiation. MATERIAL AND METHODS: We describe seven cases of rT2-T3 laryngeal squamous cell carcinomas that recurred after radiotherapy and were treated with salvage SCL-CHP between 1989 and 1997 at the Department of Otolaryngology, University of Ferrara. The disease-free interval following initial radiotherapy ranged from 13 to 132 months (mean 54 months) in 6 patients; 1 patient underwent 2 courses of irradiation treatment 103 and 8 months prior to surgery. RESULTS: The mean post-SCL-CHP follow-up period exceeded 10 years (range 72-173 months). Only the patient who underwent 2 courses of radiation therapy before surgery experienced laryngeal recurrence 48 months after surgery. All patients were decannulated and recovered the ability to swallow. Vocal quality was significantly rough and breathy but was satisfactorily intelligible in all patients. Four patients had wound healing problems; 1 of them developed a laryngotracheocutaneous fistula 15 months after SCL-CHP as a consequence of chondronecrosis, prompting total laryngectomy.

Aged↗
PubMed2005

Endoglin (CD105) expression in head and neck basaloid squamous cell carcinoma.

CONCLUSIONS: This comparison of neo-angiogenesis performed by analysing CD105 expression seems to suggest that the biological behaviour of head and neck BSCCs is similar to that of site- and stage-matched conventional SCCs. OBJECTIVE: Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade biomorphic variant of SCC with a predilection for the head and neck region. It is a matter of controversy whether the biological and clinical behaviour of BSCC is more aggressive than that of SCC. Angiogenesis is essential for tumour growth. It has been established that endothelial cells of tumour-associated neovasculature proliferate more rapidly than endothelial cells of normal tissue. Endoglin (CD105) has been shown to be a useful marker for identifying proliferating endothelium involved in tumour angiogenesis. The aim of this study was to investigate the expression of CD105 in head and neck BSCCs and to compare it with that in SCCs. MATERIAL AND METHODS: Nine head and neck BSCCs (five cases in the larynx, three in the tongue and one in the tonsil) were considered. A group of nine site- and stage-matched SCCs was examined simultaneously. For each sample, CD105 reactivity was evaluated immunohistochemically. The mean area fraction (percentage of fields occupied by vessels), the percentage of vessel-presenting fields and the vessel density were considered. RESULTS: The median values of the mean area fraction were 1.01% and 0.9% in BSCCs and SCCs, respectively. The median values of the percentage of vessel-presenting fields were 57.5% and 46.67% in BSCCs and SCCs, respectively. The median values of vessel density were 2.07% and 1.58% in BSCCs and SCCs, respectively. Statistical analysis did not disclose any significant differences between BSCCs and SCCs for any of the above-mentioned parameters.

Adult↗
PubMed2005

Distant muscular (gluteus maximus muscle) metastasis from laryngeal squamous cell carcinoma.

Clinical evidence of non-lymphatic distant metastasis has been reported in approximately 10% of cases of head and neck squamous cell carcinoma (HNSCC). The lungs are the commonest site of distant metastasis of HNSCC, followed by the bones, liver and skin. A 65-year-old male underwent supraglottic laryngectomy and left modified neck dissection for a carcinoma of the laryngeal surface of the epiglottis extending to both false cords. Eight months later the patient underwent right radical modified neck dissection for hypodermal metastatic disease involving the underlying (sternocleidomastoid) muscle. Thirty-two months later, surgical excision of a lesion in the right gluteus maximus muscle was performed. Histological study diagnosed a muscular metastasis with the same morphological aspect as the laryngeal carcinoma. The patient showed no evidence of cervical or distant recurrence at follow-up after 13 months. Although skeletal muscles represent approximately 50% of total body mass and receive a large proportion of total cardiac output, haematogenous metastases to skeletal muscle are extremely uncommon. Most skeletal muscle metastases are of pulmonary origin. Distant skeletal muscle metastasis from HNSCC is an extremely rare occurrence. Treatment options, depending upon the clinical setting, include observation, radiotherapy, chemotherapy and excision; these approaches rarely alter the patient outcome. The prognosis associated with skeletal muscle metastasis is thought to be poor, consistent with the fact that it generally occurs as a feature of systemic spread.

Aged↗
PubMed2005

Survivin expression is significantly higher in pN+ oral and oropharyngeal primary squamous cell carcinomas than in pN0 carcinomas.

CONCLUSIONS: The preliminary results reported here suggest that survivin expression in primary oral and oropharyngeal squamous cell carcinomas (SCCs) may identify patients at risk of disease disseminating to neck lymph nodes. If these results are confirmed in larger series of patients it may imply that elective neck dissection should be considered in clinically N0 patients with oral and oropharyngeal SCCs who show high expression of survivin. OBJECTIVE: To investigate the expression of survivin, a member of the inhibitor of apoptosis proteins family, in patients with primary oral and oropharyngeal SCCs with and without neck lymph node metastases. MATERIAL AND METHODS: We considered 13 consecutive cases of oral and oropharyngeal SCCs with lymph node metastases (pN + ) and 13 cases of pN0 oral and oropharyngeal SCCs. The survivin reactivity of primary SCCs and lymph node metastases was evaluated immunohistochemically. A lesion was considered positive if >9.5% of the tumour cells showed diffuse strong staining. RESULTS: Sporadic groups of normal basal and parabasal epithelial cells showed weak survivin staining. In SCCs, a nuclear reaction predominated. Eight primary pN+ SCCs were survivin-positive (mean expression 34.7%), compared to 5 primary pN0 SCCs (mean expression 12.3%; p=0.017). Statistical analysis disclosed significantly higher survivin expression in primary oral and oropharyngeal SCCs that developed distant non-lymphatic metastases (p=0.012).

Adult↗
PubMed2005

Simultaneous tumours of the larynx with the same histology: a case report and review of the literature.

Synchronous laryngeal malignancies are extremely uncommon. To the best of our knowledge, only four cases of primary synchronous squamous cell carcinoma (SCC) of the larynx are available in the literature. We report the case of a 52-year-old patient with simultaneous spindle-cell carcinoma and SCC in situ of the larynx. The pathogenesis, treatment and prognosis of this rare occurrence have been discussed.

Carcinoma↗
PubMed2005

Inverted papilloma involving the temporal bone and its association with squamous cell carcinoma: critical analysis of the literature.

Inverted papilloma is a rare, benign neoplasm, which usually originates from the lateral nasal wall and can be locally aggressive, extending into surrounding structures. Unusually, this disease involves temporal bone. There have been only 18 reported cases in the literature. The available data regarding inverted papilloma of the temporal bone are reviewed, and its etiopathogenesis, recurrence rate and association with squamous cell carcinoma are discussed.

Bone Neoplasms↗