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Biomedical subjects

E Polito

Publications and source records attributed to E Polito.

At least 19 recordsLinked to original sources
PubMed2003

Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein.

We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres.

Aged↗
PubMed2002

Effect of general and epidural anaesthesia on thyroid hormones and immunity in neonates.

BACKGROUND: The aim of this study was to verify if variations of thyroid hormones related to circumstances of delivery and mode of maternal anaesthesia can contribute to neonatal neutrophil respiratory burst and natural killer cell activity. METHODS: We evaluated 10 infants born by vaginal delivery (group A), 10 infants born by caesarean section after epidural anaesthesia with lidocaine (group B) and 10 infants born by caesarean section after general anaesthesia with sevoflurane (group C). RESULTS: A significant reduction of neutrophil respiratory burst test was found in groups A and C compared with group B. Natural killer cell (NK) activity with an effector : target ratio of 30 : 1 (NK30) and 10 : 1 (NK10) was significantly higher in group A compared with the B and C groups. In addition, thyroid stimulating hormone (TSH) concentration was significantly reduced in group A compared with the B and C groups. A significant negative correlation was found between TSH and NK30 or NK10. CONCLUSIONS: Our results suggest that the mode of delivery and anaesthesia can significantly modify the endocrine-immune system in the newborn. Caesarean section delivery with regional anaesthesia seems to produce fewer modifications of neonatal immune function compared with general anaesthesia.

Anesthesia, Epidural↗
PubMed1996

Clinical and radiological presentation of 95 orbital lymphoid tumors.

BACKGROUND: Although most orbital lymphoid tumors are characterized by a slow, painless onset and a mass that molds to orbital structures, different presentations may occur. Intensity on T2-weighted MRI is a possible means for differentiating lymphoid tumors (hyperintense) from pseudotumors (hypointense). In addition, it is generally assumed that 75% of orbital lymphomas are at stage I on presentation. METHODS: The clinical, CT, and MRI presentation of 95 primary and secondary orbital lymphoid tumors (63 non-Hodgkin lymphomas and 32 lymphoid hyperplasias) and their histological grade and staging were reviewed. Immunohistochemistry and PCR were used to determine clonality. RESULTS: No significant differences were found between non-Hodgkin lymphomas and lymphoid hyperplasias, except for the mean age of the patients (6.3 years older in non-Hodgkin lymphomas). In both groups the most common presentation was a mass with an indolent course; visual impairment was seen in 13%, conjunctival redness in 25%, pain in 12%, and acute orbital inflammation in 15% of the patients. In most cases, the CT showed one or more lobulated or rounded masses, molding to adjacent structures, or a wedge-shaped enlargement of the lacrimal gland. Intramuscular lymphomas were rare and always associated with extramuscular masses. On T2-weighted MRI, only 35% of lymphoid tumors were hyperintense. Only 49% of lymphomas were at stage I on presentation. CONCLUSION: An inflammatory presentation is not uncommon in orbital lymphoid tumors. Shape, molding and multiple masses can help radiological diagnosis, whereas MRI T2 intensity is unreliable. Accurate staging can disclose systemic disease in more than 50% of cases of non-Hodgkin lymphoma.

Adolescent↗
PubMed1996

Prognosis of orbital lymphoid hyperplasia.

BACKGROUND: Orbital lymphoid hyperplasia can be associated with systemic non-Hodgkin lymphoma (NHL), even when polyclonal proliferation is found in the orbit. Although irradiation is recommended, some orbital lymphoid hyperplasias are treated by steroids (when inflammation is clinically presumed) or left untreated. METHODS: The incidence of concurrent NHL and the incidence of future NHL after oral prednisone, radiotherapy, or no treatment were retrospectively evaluated in 33 cases of lymphoid hyperplasia (22 benign lymphoid hyperplasias, BLH, and 11 atypical lymphoid hyperplasias, ALH), after follow-up of 2-13 years. RESULTS: NHL occurred in 12 of 33 cases (36.4%). In seven patients it was concurrent; in five patients it occurred 2-6 years later. In the actuarial curve, at 5 years 55% of patients were free of lymphoma, at 10 years, 46%. NHL was more commonly observed when the lacrimal gland was involved (57% vs 21%; P = 0.03). Of the 13 patients treated with oral steroids, 46% had complete response, 39% partial response, and 15% future NHL. Of the seven irradiated patients, five (71%) had complete response, two (29%) partial response, and none future NHL. Of the eight untreated patients, five (63%) had partial response and three (37%) future NHL. Irradiated lacrimal gland BLHs only achieved partial response, one having radiation-induced orbital inflammation. CONCLUSION: Because of a high risk of NHL, in all orbital lymphoid tumors systemic staging and follow-up are mandatory. The advised management is irradiation, except for Sjögren syndrome, an initially inflammatory lacrimal gland BLH, where a course of steroid is suggested before considering radiotherapy.

Anti-Inflammatory Agents↗
PubMed1995

Primary and secondary orbital melanomas: a clinical and prognostic study.

The clinical, radiologic, and histologic features of 14 cases of orbital melanoma are reviewed. Two cases were presumed to be primary orbital melanomas because no primary pigmented lesion was found in the globe, conjunctiva, or skin. Five cases originated from a conjunctival melanoma, one case from an eyelid cutaneous melanoma, and the remaining six patients had extrascleral extension of a choroidal melanoma. Four patients at the time of first diagnosis already had extraorbital metastases (one patient with extrascleral extension of a choroidal melanoma also had a metastasis to the opposite orbit). The median time interval between diagnosis and metastasis was 14 months. Patients without metastatic disease received radical surgery (partial or total orbital exenteration, in addition to regional lymph node resection if indicated) or conservative treatment (tumor excision plus chemotherapy and interferon). Log-rank test showed an equally poor prognosis for both groups (median time to metastasis was, respectively, 19.5 and 8 months), with no statistically significant difference between the two groups. The authors' reconstructive techniques (dermis-fat grafting and transplantation of temporalis muscle) following partial- and total orbital exenteration are described.

Adipose Tissue↗
PubMed1995

Colobomatous ocular cyst excision with globe preservation.

Colobomatous ocular cyst is a rare malformation consisting of a cavity lined by neuroectodermic tissue and communicating with the vitreous cavity, generally associated with microphthalmos. The usual treatment for unsightly cases is enucleation and cyst excision, followed by prosthesis fitting. The authors treated a case of colobomatous ocular cyst associated with a mild microphthalmos by cyst excision and pedicle ligature, via a transconjunctival orbitotomy. The postoperative appearance was satisfactory. Pathology confirmed a thick fibrous wall with calcifications, lymphocytic infiltrates, and neurofilaments and internally lined by dysplastic retinal elements. A conservative approach is advised for colobomatous cysts associated with a globe almost normally in size, in order to avoid cosmetic complications associated with enucleation in childhood.

Coloboma↗
PubMed1995

MRI in Graves orbitopathy: recognition of enlarged muscles and prediction of steroid response.

The purpose of this study is to compare MRI to CT in the recognition of Graves orbitopathy and to compare MRI to clinical examination in the prediction of steroid response. Sixteen patients with dysthyroid orbitopathy (21 orbits) were examined by CT and MRI; muscle enlargement was measured by ultrasonography. Sensitivity in recognizing enlarged muscles was 85.4% for CT and 61.2% for MRI; CT recognized all affected orbits but 1, while MRI failed in 4 cases. Clinical inflammatory signs (p = 0.17) were more reliable predictors of steroid response than muscular T2 hyperintensity on MRI (p = 0.64). In a patient where histological examination documented edematous changes, MRI failed to reveal edema. MRI adds no morphologic information to CT; moreover, T2 intensity is less specific than clinical examination in documenting active disease and forecasting therapeutic outcome.

Adult↗
PubMed1995

Imaging techniques in the diagnosis of lacrimal sac diverticulum.

Lacrimal sac diverticulum is a rare condition characterized by a cystic structure communicating with the sac. This abnormality may be directly demonstrated by dacryocystography only in a few cases; in the remaining cases, preoperative diagnosis may be arduous. We report 3 cases of lacrimal sac diverticulum. In all patients, symptoms were represented by a palpable mass in the lacrimal sac region, associated with permanent (case 1) or episodic (cases 2 and 3) epiphora. In the first case, CT-dacryocystography revealed an apparently solid mass causing inferior lacrimal obstruction, and ultrasonography disclosed a cystic space, not communicating with the sac. At surgery, a sac diverticulum was identified and excised. In the second patient, CT showed a homogeneous rounded mass, whereas a cystic character was revealed by T1-weighted MRI. Dacryocystography showed a lateral impression on the lateral wall of the sac. Ultrasonography revealed a cystic space communicating with the lacrimal sac. In the third case, ultrasonography demonstrated a diverticulum. CT is often unable to discriminate tumors from lacrimal cysts, both showing a parenchymal density. MRI can differentiate lacrimal cystic spaces from solid tumors by T1 intensity and by demonstration of their walls, but it is nonspecific for diverticula. Only dacryocystography and B-scan ultrasonography can reveal the narrow communication between the sac and the diverticulum. Observation is the recommended management for asymptomatic cases.

Adolescent↗
PubMed1993

Cosmetic possibilities and problems in eyelid neurofibromas.

Neurofibromatosis type 1 (NF1) is an inherited systemic disease with frequent ocular involvement. A typical alteration observed in NF1 is the eyelid plexiform neurofibroma, often associated with facial homolateral hypertrophy. In such cases, surgical cosmetic results are rather unsatisfactory, since plexiform neurofibromas classically show a non-capsulated mass, with a marked tendency to local recurrence. The techniques for a cosmetic attempt are discussed on the basis of a personal series of eyelid reconstructions in NF1. The results can be considered satisfactory in some cases, when the orbital shape is preserved and the eyelid structure has not been excessively altered by the neurofibroma; in all other cases, the cosmetic outcome is inferior to the patient's and parents' expectations. The serious problem of recurrence is however a limitation to cosmetic surgery in eyelid neurofibromas.

Child↗
PubMed1993

Epithelial malignancies of the lacrimal gland: survival rates after extensive and conservative therapy.

We reviewed 96 cases of lacrimal gland tumors; 20 patients had epithelial malignancies (11 adenoid cystic carcinomas, 7 carcinomas in pleiomorphic adenomas, 1 mucoepidermoid tumor, 1 adenocarcinoma, and 1 carcinoma in an epidermoid cyst). Classic computed tomographic scan changes associated with lacrimal gland malignancies were found in only 55% of cases. The median survival was 6.75 years in the seven patients treated with extensive surgery (orbital exenteration, possibly associated with osseous resections) and nine years in the 12 cases treated with eye-saving procedures (tumor excision, possibly followed by radiotherapy). Our data demonstrated that extensive surgery for lacrimal gland malignancies does not improve survival. Therefore, a therapeutic protocol is suggested, in which all suspected epithelial tumors (discriminated from inflammatory and lymphoid lesions by computed tomographic scan findings) undergo dacryoadenectomy, without a previous biopsy. Subsequently, in the case of carcinomas, the choice between extensive and eye-saving procedures is based on the extent and aggressiveness of the tumor and clinical findings.

Adolescent↗
PubMed1992

Radical orbital resections.

The authors describe the techniques for subtotal, total and radical orbital exenteration. The aspects of primary and late reconstructive surgery are also discussed, with special reference to Frezzotti's personal technique for temporalis muscle transplantation after subtotal exenteration.

Eye, Artificial↗
PubMed1984

[Fluoroangiography of various pathological pictures in unusual observations of the anterior segment].

Fluorangiography is a very important investigation in order to have a differential diagnosis in all pathological pattern of the conjunctiva of scleral corneal limbus of the sclera of the iris of the ciliary-body. We have in the literature two different patterns: A) Fluorescein negative pattern (cystic neoformations, benign tumors with or without pigment) B) Fluorescein positive pattern (inflammatory pseudotumors, malignant tumors). Authors agree more or less with this classification; they have, moreover, worked out some variations. In our case of a localised carcinoma, fluorescein positive, we did not observe less of fluorescein; in the iris melanoma, even this fluorescein positive, in all observed cases has shown only a small loss of fluorescein near his edges. In the other cases as in the leiomyoma and cystis we agree with the literature even with prudence.

Anterior Eye Segment↗