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Biomedical subjects

Gino Marioni

Publications and source records attributed to Gino Marioni.

At least 19 recordsLinked to original sources
PubMed2006

CO(2) laser treatment of laryngeal stenoses after reconstructive laryngectomies with cricohyoidopexy, cricohyoidoepiglottopexy or tracheohyoidoepiglottopexy.

Supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) is a conservative laryngeal surgery tailored to T1b-T2-T3 glottic-supraglottic carcinomas. Tracheohyoidopexy (THP) and tracheohyoidoepiglottopexy (THEP) allow a chance of conservative surgery also for selected transglottic carcinomas. These techniques are comprehensively named reconstructive laryngectomies (RLs). Post RL laryngeal stenosis not due to carcinoma persistence or recurrence is an unusual occurrence. The aim of the present study has been to analyse retrospectively and describe the treatment of the cases of laryngeal stenosis after RL, which occurred in Vittorio Veneto Otolaryngological Department in a 6 year period. In the period between 1999 and 2004, 225 patients underwent RL in our Department. In 18 of them (8%) a laryngeal stenosis after RL was diagnosed. The same evidence was shown in 2 patients who underwent RL in other Institutions. All patients underwent CO(2) laser surgical treatment of the laryngeal stenosis. The 14 patients who underwent RL-CHEP, the 5 patients who underwent THEP and the patient who underwent CHP were treated on average with CO(2) laser 1.2 (range 1-2), 4.2 (range 2-7), and 2 times, respectively. Decannulation was possible in all patients but one after CO(2) laser treatment of the stenosis in a mean period of 3.4 months. Laryngeal stenoses after RLs can be successfully treated with CO(2) laser excision with a very limited morbility. The only reasonable contra-indication to CO(2) laser excision could be a cranio-caudal length of the laryngeal stenotic tract longer than 1 cm: in this occurrence diagnosed after THP or THEP, an external surgical approach could be preferred.

Carbon Dioxide↗
PubMed2006

Non-specific immunological determinations in Meniere's disease: any role in clinical practice?

Several studies supported the hypothesis that an autoimmune response may be a pathogenetic factor in Meniere's disease occurrence. It has been demonstrated that the endo-lymphatic sac has an important role in the immuno-mediated reaction and it has also become evident that an immunological mechanism may be involved in the development of endo-lymphatic hydrops. The present study was carried out in order to analyse the validity of serological non-specific immune tests in determining the possible role of immune pathology in 200 Meniere's suffering patients. The immune activity was investigated determining the erythrocyte sedimentation rate (ESR), the C-reactive protein levels, the rheumatoid factor, the serum immunoglobulin levels by group, the complement levels, the lymphocyte sub-populations, the cryoglobulines, the circulating immune complexes (CIC), organ and non-organ auto-antibodies. Levels of Ig, ESR, C-reactive protein, rheumatoid factor, complement fractions and cryoglobulines were either negative or non-significant in the considered cohort of Meniere's disease suffering patients. On the other hand, in more than half of the sample group high values of CIC were found. Data concerning T-lymphocyte sub-population indicates a clear increase in T-helper compared to T-cytotoxic cells, with an increase in the CD4/CD8 ratio. The datum of particular interest concerns analysis of T-cells activation complexes. Our present findings show that early activated T-lymphocytes change and in particular changes occur in the expression of the interleukin-2 receptor. Moreover, it seems to be possible to correlate the alteration of the immunological tests and the phase of the disease. Present data showed that the immunological factor should be considered a relevant element in most of the cases of Menière's disease.

C-Reactive Protein↗
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

Adult laryngeal hemangioma CO2 laser excision. A single institution 3-year experience (Vittorio Veneto 2001-2003).

CONCLUSIONS: Adult supraglottic hemangiomas can be treated successfully with CO2 laser excision with limited morbidity. Extended laryngeal cavernous hemangiomas involving hypopharynx should be approached with staged CO2 laser surgical procedures. OBJECTIVES: Hemangioma of the adult larynx is an uncommon, benign lesion characterized by thin, friable mucosa overlying the vascular stroma. The optimal surgical approach to these lesions is still controversial because only anecdotal case reports or very limited series are available. We report a 3-year, retrospective, single institution study of the results of CO2 laser treatment of supraglottic hemangiomas in adults. PATIENTS AND METHODS: Six consecutive cases of adult laryngeal hemangioma were treated by the first author with CO2 laser microsurgery alone. RESULTS: In five of six cases, no recurrences have been diagnosed (median follow-up period: 29 months). One case presented limited persistence of disease in the retro-cricoid and arytenoids at 20-month follow-up control.

Adult↗
PubMed2006

Endoglin expression is associated with poor oncologic outcome in oral and oropharyngeal carcinoma.

CONCLUSIONS: The present preliminary results suggest that endoglin (CD105)-assessed micro-vessel density (MVD) in primary oral and oropharyngeal squamous cell carcinomas (SCCs) may identify patients at risk of disease recurrence or poor oncological outcome after treatment. OBJECTIVES: MVD is an independent prognostic indicator in several human malignancies. Endoglin antibodies have shown a greater specificity for tumour vasculature in comparison with pan-endothelial markers. The present explorative study evaluated endoglin expression and its prognostic role in oral and oropharyngeal SCCs. PATIENTS AND METHODS: The study considered 13 consecutive cases of oral and oropharyngeal SCC with lymph node metastases (pN+) and 13 consecutive pN0 cases. CD105-assessed MVD was calculated at 400x magnification. RESULTS: The mean MVDs were 3.6 and 3.1 in pN+ and pN0 groups, respectively (p>0.05). The mean CD105-assessed MVDs were 4.7 in the group with locoregional recurrence and 2.9 in the group without locoregional recurrence or post-treatment diagnosis of distant metastasis (p=0.01). The mean CD105-assessed MVD in primary oral and oropharyngeal SCCs with poor oncological outcome (recurrence of disease or occurrence of distant metastasis) was 4.3. The mean MVD in primary oral and oropharyngeal SCCs with good outcome was 2.9. Statistical analysis showed a significant difference between CD105-assessed MVD in poor and good outcome groups (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

Laryngeal metastasis from sigmoid colon adenocarcinoma followed by peristomal recurrence.

Considering clinical evidence,<2% of laryngeal malignancies are distant metastases. Cutaneous melanomas are the preponderant primaries metastasizing to the larynx, followed by renal cell carcinomas, breast and lung carcinomas. Colonic adenocarcinoma metastases to the larynx are extremely rare: only 13 cases have been described since 1972. We present the first case of sigmoid colon adenocarcinoma metastasis to the larynx in a patient who developed peristomal malignancy recurrence after total laryngectomy. Patients with metastasis of colonic adenocarcinoma to the larynx usually present with disseminated disease: in view of the poor chances of long-term survival of these patients conservative palliative laryngeal treatments should be carried out to improve the quality of life. Curative treatment should be considered only in isolated laryngeal metastasis.

Adenocarcinoma↗
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↗
PubMed2006

Western blot immunoassay for HSP-70 antibodies in idiopathic tinnitus: a preliminary report.

OBJECTIVES: Our preliminary study investigated the role of nonspecific immunologic tests and immunoassay for heat shock protein 70 (HSP-70) in supporting the possibility of an autoimmune inner ear process determining idiopathic tinnitus. METHODS: Thirty-six consecutive patients with idiopathic tinnitus without other otologic or autoimmune diseases and 20 healthy blood donor subjects underwent determinations of circulating immune complexes (CICs) and other nonspecific immunologic factors and immunoassay for HSP-70. RESULTS: The mean CIC values were 4.2 microg/mL in the tinnitus patients and 0.9 microg/mL in the control group (p = .012). Thirteen of the 36 tinnitus patients and none of the control group were HSP-70-positive. Ten of the 13 HSP-70-positive patients had CIC values higher than normal. In the tinnitus group, the mean CIC values were 6.9 microg/mL and 2.6 microg/mL in the HSP-70-positive and -negative subgroups, respectively (p = .024). CONCLUSIONS: It may be hypothesized that in a significant number of cases, idiopathic tinnitus could be induced by immune response to inner ear-specific HSP-70.

Adult↗
PubMed2006

Evolution of audiometric pattern in Meniere's disease: long-term survey of 380 cases evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery.

OBJECTIVES: Hearing loss in the early stages of Meniere's disease is characterized by a fluctuation in the audiometric pattern limited to the low frequencies, and then, during the disease's evolution, the hearing loss involves the medium and high frequencies. As far as the prevalence of different types of audiometric curves is concerned, there is no agreement among the various studies. The study of audiometric evolution in the course of the disease has been limited owing to the difficulties in following a relevant number of patients for a long period of time. The aim of the present study was to compare the auditory level and audiometric pattern evolution in a significant number of patients suffering from Meniere's disease who had undergone long-term follow-up (at least 10 years). METHODS: The study considered 380 patients with a confirmed diagnosis of Meniere's disease. The audiometric data were collected at the onset of the disease and after 5 and 10 years. Four patterns were considered: peak, rising, falling, and flat. Audiometric evolution analysis in four stages, defined by the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery, was evaluated. RESULTS: At the onset, in 190 cases, the audiometric pattern was a peak curve, with fluctuation of the threshold in 68% of cases. The mean threshold shift for the 500 to 3000 Hz range was between 26 and 40 dB. After 5 years, a peak type (41.9%) or a flat type (42.9%) was observed; the pure-tone average (PTA) ranged between 26 and 40 dB in 47.9% and between 41 and 70 dB in 51.8% of cases. After 10 years, in most cases (57.9%), a flat curve was observed, and the PTA in 100% ranged between 41 and 70 dB. CONCLUSION: The most common audiometric pattern at the onset of the disease is the peak type; long-term transformation of the initial audiometric pattern into a flat curve has been confirmed. High-frequency involvement seemed to be related more to Meniere's disease duration than to the influence of aging on hearing loss.

Adult↗