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Biomedical subjects

G Felisati

Publications and source records attributed to G Felisati.

17 recordsLinked to original sources
PubMed2006

Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings.

Common carotid artery pseudoaneurysm is a rare disease, which has been previously unreported in association with neck dissection. We describe the Doppler ultrasound and multidetector computed tomography (CT) findings of a case of carotid pseudoaneurysm, one month after pharyngolaryngectomy with bilateral neck dissection. Multidetector CT confirmed the diagnosis made on the basis of Doppler ultrasound; the high image quality of axial and three-dimensional reconstructions avoided the need for pre-operative conventional angiography. In the presence of a pulsatile cervical mass after neck surgery, pseudoaneurysm of the carotid artery should be included in the differential diagnosis, and multidetector CT can be the sole pre-operative diagnostic imaging modality.

Aged↗
PubMed2005

The role of the ear, nose and throat specialist in diagnosing headaches.

The revised International Headache Society classification (2004) represents a very good reference also for ear, nose and throat (ENT) specialists and can be largely shared. The authors follow the classification outline and comment on the chapters of ENT interest. The classification leaves unsolved problems and most of them are of ENT competence, such as mucosal contact point headache. It will be a task for ENT specialists to clarify the real role of very hypothetical primary forms frequently assigned to diagnosis without a correct rationale.

Ear↗
PubMed2005

Deep brain stimulation and cluster headache.

In recent years, neuroimaging data have greatly improved the knowledge on trigeminal autonomic cephalalgias' (TACs) central mechanisms. Positron emission tomography studies have shown that the posterior inferior hypothalamic grey matter is activated during cluster headache attacks as well as in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Voxel-based morphometric MRI has also documented alteration in the same area in cluster headache patients. These data suggest that the cluster headache generator is located in this region and leads us to hypothesise that stimulation of this brain area could relieve intractable cluster headache just as deep brain stimulation improves intractable movements disorders. This view received support by the observation that high frequency stimulation of the ipsilateral hypothalamus prevented attacks in an otherwise intractable chronic cluster headache patient previously treated unsuccessfully by surgical procedures to the trigeminal nerve. So far, 16 patients with intractable cronic cluster headache (CCH) and one intractable SUNCT patient have been successfully treated by hypothalamic stimulation. The procedures were well tolerated with no significant adverse events. Hypothalamic DBS is an efficacious and safe procedure to relieve otherwise intractable CCH and SUNCT.

Cluster Headache↗
PubMed2004

Nicergoline in the treatment of dizziness in elderly patients. A review.

In elderly patients, dizziness occurs very frequently with significant effects on the patient's life. Its frequency increases with age, and may arise from a variety of causes. Chronic dysequilibrium in elderly patients is most probably related to disturbances within the central nervous system, due either to altered neuronal functions or to an underlying vascular disease. Nicergoline, a drug used in the treatment of cognitive disturbances in geriatric patients, improves dizziness in elderly demented and non-demented patients. In a double blind,placebo controlled trial the drug improved (i) the severity of symptoms, measured by the dizziness assessment rating scale (DARS), (ii) the overall clinical conditions revealed by global impression scale, and (iii) the perceived quality of life estimated by the dizziness handicap inventory (DHI). These results indicate a possible positive effect also on posturographic measures. Moreover, the improvement occurred at no expense of the established strategy of postural control suggesting that the effect is mediated by a substitute compensatory mechanism allowing the patient to preserve consolidated postural strategies. The results of previous open clinical studies in about 3000 patients are in agreement with those findings. Overall, severity of symptoms decreased by 68 % (57 % in the control study). Globally, the results indicate a beneficial effect of nicergoline on symptoms related to balance disorders of central origin. Animal studies show that the drug displays a broad spectrum of actions on cellular and molecular mechanisms. Moreover, animal research specifically aimed at vestibular pathophysiology has revealed that nicergoline improves vestibular compensation in models of vestibular lesion. Chronic treatment with nicergoline improved the time-course of behavioral recovery in old rats after hemi-labyrinthectomy and counteracted the regulation of cholinergic receptors observed after lesion in old rats. Nicergoline interacts at several levels by various mechanisms, from the molecular level to cognitive function, probably enhancing spontaneous plasticity phenomena underlying the central vestibular compensation. This effect is not dependent from the interaction with a single-transmitter-identified neural pathway, but from anatomical, functional and neurochemical synergistic adjustments in several brain areas.

Aged↗
PubMed2003

Pulmonary and sinus diseases in primary humoral immunodeficiencies with chronic productive cough.

AIMS: To prospectively evaluate sinopulmonary disease in 24 patients with primary humoral immunodeficiency (11 with agammaglobulinaemia, nine with isolated IgA deficiency, and two with common variable immunodeficiency) and chronic productive cough, ascertain the usefulness of chest high resolution computed tomography (HRCT) in evaluating the progression of lung disease, and test a therapeutic approach to chronic sinusitis. METHODS: Pulmonary abnormalities were evaluated using lung function tests and HRCT (Bhalla score); chronic sinusitis was diagnosed clinically and confirmed by flexible fibreoptic endoscopy. Sixteen patients entered the three year follow up. RESULTS: Lung function testing revealed an obstruction in four patients; chest HRCT was abnormal in 16. There was a linear relation between the Bhalla score > or =4 and the number of months with cough/year over the previous two years (clinical score), and between the difference in clinical scores during follow up and in the previous two years and the difference in Bhalla score. The pulmonary lesions did not significantly progress over a three year period. Thirteen patients had chronic sinusitis; 6/10 patients followed up were successfully treated with antibiotics plus topical therapy and two with nasal polypoid disease with endoscopic sinus surgery. CONCLUSIONS: In patients with primary humoral immunodeficiency and chronic productive cough, HRCT is very useful in delineating the extent of lung damage. The correlation between Bhalla score and clinical findings and the favourable outcome of the disease suggests that in most patients chest HRCT should not be repeated annually as previously suggested. Medical therapy seems to be effective in many cases of chronic sinusitis.

Adolescent↗
PubMed2001

Otorhinolaringologic manifestation of Smith-Magenis syndrome.

Smith-Magenis syndrome (SMS) is a multiple congenital anomaly/mental retardation (MCA/MR) syndrome link to a contiguous-gene deletion syndrome, involving chromosome 1 7p 11.2,whose incidence is estimated to be 1:25,000 livebirth. SMS is characterised by a specific physical, behavioural and developmental pattern. The main clinical features consist of a broad flat midface with brachycefaly, broad nasal bridge, brachydactily, speech delay, hoarse deep voice and peripheral neuropathy. Behavioural abnormalities include hypermotility, self-mutilation and sleep disturbance. This report defines the otorhinolaryngological aspects of a new case of SMS, confirmed by cytogenetic-molecular analysis, in a 9 year old girl affected by chronic otitis media, deafness and sinusitis, who presented with typical clinical signs and symptoms.

Abnormalities, Multiple↗
PubMed1997

Secondary rhinoplasty: analysis of the deformity and guidelines for management.

Secondary rhinoplasty aims at modifying the functional and cosmetic defects caused by an improperly performed a primary procedure. Correction follows a logical sequence from which there is no reason to deviate if one wishes to achieve sure results. The sequence includes analysis of the deformity, accurate photographic documentation, functional and diagnostic examination, consultation with the patient, and precise planning of the different steps of surgery. Deformities are grouped in four different sectors depending on the characteristics of the repair: upper, intermediate, lower, and inner. However, defects may involve more than one sector, making it difficult or impossible to establish a precise boundary between them. The surgical technique requires a wide exposure of the operating field so that the surgeon can clearly evaluate the anatomical deformities and carry out the necessary corrections. For this reason, the open approach is the solution of choice. Two types of grafts are commonly used in revision rhinoplasty, cartilage and bone. They become necessary to reestablish function and to restore volume and/or contour. We strongly believe that only autologous grafts can be used. Grafting materials, their sources, and applications in different clinical cases are described here.

Bone Transplantation↗
PubMed1991

[Postoperative infections in otorhinolaryngologic surgery. Open study on efficacy and tolerability of antibiotic prophylactic treatment with sulbactam-ampicillin].

The paper reports the results of an open study on the efficacy and tolerability of the association of sulbactam-ampicillin in antibiotic prophylaxis in ENT surgery. The study include 55 cases and confirmed both the total absence of major side-effects and a notable therapeutic efficacy of the drug in question. It is interesting to note the results obtained in ENT cancer surgery: out of 12 cases of partial or total laryngectomies there were 2 cases of infection in extra-operative sites (polmoniti ab ingestis from Pseudomonas aeruginosa) and none within the site of operation. Data regarding the efficacy of the drug were in line or better than previously published results and its low toxicity indicates the elective use of sulbactam/ampicillin in ENT surgical prophylaxis.

Adolescent↗
PubMed1989

Substance P-like immunoreactive nerve fibers of the human laryngeal mucosa--preliminary report.

Substance P (SP) is considered a primary sensory transmitter and is widely distributed within the autonomic nervous system. This study is concerned with the distribution of SP-like immunoreactive nerve fibers in the human larynx. Individual SP-like immunoreactive nerve fibers were detected in the subepithelial connective tissue of the laryngeal mucosa, in the ventricular and subglottic glandular regions and in a few nervous ganglia in the deep connective tissue. No intraepithelial SP-like immunoreactive fibers were present in our material.

Humans↗
PubMed1986

Auditory brain stem response test battery for multiple sclerosis patients: evaluation of test findings and assessment of diagnostic criteria.

A battery of auditory brain stem response (ABR) tests has been used to evaluate 39 multiple sclerosis (MS) subjects (9 with probable, 8 with possible, 6 with suspected and 16 with definite MS, according to conventional classification of the disease). Test battery included evaluation of ABR waveform, latencies and interpeak intervals, test-retest variability, rate-induced ABR changes, binaural increase of wave-V amplitude and effect of ipsilateral masking with broad-band noise. Test results allowed a measure of the sensitivity, specificity and efficiency of each test in the battery. The high efficiency values thus obtained validated each test in the battery when normals were compared with definite MS patients. No single test, however, proved to be sufficient--by itself--to reliably distinguish subjects with earlier stages of the disease, suggesting that a combined evaluation of tests is necessary to fit better the clinical classification. When compared with 'conventional' ABR analysis, 'sensitized' ABR tests--i.e. the measures of test-retest variability, binaural increase of wave-V amplitude and the effect of ipsilateral broad-band noise masking--showed higher percentages of positive results in subjects with no clinical signs of brainstem and midbrain involvement. Sensitized tests therefore appeared more suitable to reveal a brainstem subclinical involvement.

Adolescent↗
PubMed1984

[Influence of the stimulation frequency on the morphology of auditory evoked potentials in multiple sclerosis].

The Rate-linked modifications observed in the Auditory Brainstem Responses (A.B.R.) in normal subjects are now well known. On the other hand they are a subject of controversy among groups studying multiple sclerosis (M.S.). 49 patients were observed in parallel studies in Milan and Creteil. The A.B.R. obtained for slow stimulus rates (11-21 Hz) were compared to fast ones (51 Hz). The A.B.R. were not significantly modified in 32% of the cases (deterioration: 21%, improvement: 11%). The variations don't seem to depend on the kind of curves involved. This phenomena can be explained by a frequency linked block of conduction of the pathological fibres, either partial or total. These data seem to be specific to demyelinating diseases. A research project is being conducted to study their specificity.

Adolescent↗
PubMed1984

[Ipsilateral masking of auditory evoked potentials: a method of studying multiple sclerosis].

20 normal subjects and 39 patients with multiple sclerosis were the control and the test groups. Auditory brainstem potentials to 60 dB nHL, 11/s clicks, were recorded under ipsilateral broad-band noise masking at S/N ratio of + 60 dB (unmasked condition), + 20 dB, + 10 dB and 0 dB. In the control group the ABP were absent only in 1 subject at S/N = 0 dB. In the group of 16/39 patients with definite multiple sclerosis, 11 had no ABP at S/N = 0 dB, 6 at S/N = + 10 dB and 5 at S/N = + 20 dB. The ABP waveform per se, in the same subjects, was abnormal in 7 and doubtful in 5. These results are discussed in terms of sensitivity, specificity and efficiency of the test to be applied. The best predictive value is achieved by combining a strict morphological criterion with the results of the ipsilateral masking. Moreover, the ipsilateral masking test positive findings are equally distributed in the group of patients with and without signs of neurological involvement of the brainstem.

Adolescent↗