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M Iengo

Publications and source records attributed to M Iengo.

7 recordsLinked to original sources
PubMed2004

Use of Remifentanil for sedo-analgesia in stapedotomy: personal experience.

Stapedotomy for otosclerosis presents particular anaesthesiology demands as the surgeon has to assess functional results during the operation, work with some bleeding, be ensured the collaboration of the patient, and limit the occurrence of intra- and post-operative symptoms (dizziness, nausea, vomiting and pain). Remifentanyl, a micro-opioid selective agonist characterised by short latency and duration, has been used for about 2 years at the Otolaryngological Unit of the "Federico II" University of Naples for patients with otosclerosis undergoing stapedotomy. Aim of the study was, therefore, to assess: efficacy and tolerability of Remifentanyl in combination with a local anaesthetic in surgical procedures for otosclerosis; intra- and post-operative reduction in patient symptoms of dizziness, nausea, vomiting and pain; reduction of intra-operative bleeding; degree of patient collaboration and optimisation of anaesthesiological and vital parameters monitored during surgery. The study was carried out on 92 patients with otosclerosis, (17 M, 75 F), median age 41 years (range 25-56), undergoing stapedotomy. Patients were randomly assigned to one of two groups, which were homogeneous as far as concerns age, sex and pre-operative hearing: i. Group A (50 patients), received Remifentanyl infusion in combination with canal injection for local anaesthesia with Mepivacaine 2% and Adrenalin 1/100,000; ii. Group B (42 patients), received only local anaesthetic by infiltration of the external canal ear. Remifentanyl led to an improvement over the local anaesthetic technique previously used, with a clear decrease in intra- and post-operative neurovegetative symptoms such as dizziness, nausea, vomiting and pain, as well as reduced bleeding.

Adult↗
PubMed2000

[Anatomo-functional study of 37 patients with monolateral chord paralysis].

The authors present a study of 37 patients affected by monolateral vocal cord paralysis in order to analyze etiology, degree of dysphonia and possible recovery of vocal function. The patients underwent the following tests: case history to determine the vocal characteristics prior to the lesion; video-laryngoscopy to define the position of the paralytic cord on the horizontal glottic plane and any compensation mechanisms; determination of the degree of dysphonia (light, moderate, severe, aphonia) on the basis of psycho-perceptive parameters; spectrography evaluated in classes (I, II, III and IV) according to Yanagihara. Analysis of the data obtained makes it possible to draw the following conclusions: the most frequent etiology encountered by the otorhinolaryngologist is surgical (particularly subsequent to thyroidectomy); the position taken by the paralytic vocal cord does not appear to determine the degree of dysphonia; during the period immediately after occurrence of the lesion (0-4 months) the vocal disorder is more intense and tends to be reduced thereafter, attenuated by a spontaneous compensation mechanism. In this regard, it must be pointed out, however, that such compensation can prove bad or even dangerous for good vocal function (falsetto voice); speech therapy makes it possible to nearly totally normalize vocal function in all patients presenting moderate dysphonia and in 60% of those with severe dysphonia. In the remaining 40% of those patients with severe dysphonia a partial improvement of vocal function was seen (from severe dysphonia to moderate dysphonia). This was determined by the fact that several negative prognostic factors came into play simultaneously in these patients (i.e. advanced age, longer time gap since the lesion occurred, position assumed by the paralytic cord) which prevented them from achieving better phonatory results.

Adolescent↗
PubMed2000

[CO2 laser cordectomy: analysis of morpho-functional results].

The authors have conducted a study of a large sampling of subjects who had undergone different types of cordectomy. The purpose of this study has been to analyze the anatomo-functional variables encountered with such procedures. In particular, the following were studied: post-surgical vocal recovery; type of glottic sphincter scarring, particularly as related to the extent of surgical excision; effect commissure synecchia has on the post-operative voice, again related to type of exeresis; different types of functional compensation related to the various surgical excisions and means by which the new scarring cord is built; severity of dysphonia resulting after each type of surgery. The study involved 69 patients who had undergone different types of cordectomy: from limited procedures--the so-called submucosal cordectomies for circumscribed, superficial neoplasms--to more radical ones, performed on tumours extending to the laryngeal ventricle of one or both sides. A history was taken of all the cases and they underwent videolaryngoscopy, psychoacoustic evaluation and voice spectrography. This study revealed the following: vocal recovery is achieved within 1-3 months after surgery, particularly when the exeresis was limited; longer recovery times were required for more radical surgery; with horizontal exeresis the prognosis for sphincteric recovery--characterized by a good neocord--is better than with procedures removing structures on the vertical plane (true vocal cord + ventricle + false cord) where scarring generally proves inadequate to re-establish a satisfactory sphincter; commissure synecchia is unusual in all types of surgery and is more frequent in bilateral forms. This is not specifically responsible for aggravating the dysphonia although, except in a few cases, it can make an important contribution in limiting the glottic opening and facilitating vocal sounds; as regards functional compensation, the observations show that the larynx is able to adapt to anatomic damage, the entire organ playing a part in reducing the air space to create a more or less valid phonatory sphincter, each part in its own way. Among the most noteworthy mechanisms for functional compensation we find the cord-neocord, the glottic mechanism at the false cords and ary-arythenoid compensation. There is no direct relationship between phonatory mode and neocord conformation since not all cases achieving a satisfactory neocord actually use glottic phonation. Although the Yanagihara spectrographic classification of dysphonia cannot distinguish between severe dysphonia and aphonia, it can be applied in the objective classification of limited post-cordectomy vocal compromise. In fact, spectrography is able to document that: Type II dysphonia--light--is unusual and was only found in 2 cases with a excellent neocord and a perfect pneumo-phonic picture; Type II dysphonia--moderate--is most often found in submucosal cordectomies and in other cases of monolateral exeresis with adequate scarring; Type IV dysphonia actually corresponds to the most important forms. It is present in all types of cordectomy and is most prevalent in those with a severe adductor deficit associated with inadequate or poorly balanced supraglottic functional compensation.

Adult↗
PubMedDate not supplied

[Vocal physiopathology].

Cordectomies usually result in alteration of the glottic sphincter which in turn effects the activity of the entire larynx bringing about different types of dysphonia according to the resulting scarring pattern in the glottic floor and to the functional recompensation made by the cordectomized patients themselves. Today, study of those anatomic dynamics which determine voice typology in cordectomized patients is possible thanks to various means: synthesis of data obtained from psycho-perspective analyses of the vocal product, video-fiber-laryngoscopic observation of the vocal tract and spectrographic study. The above-mentioned examinations show how the type of dysphonia in these patients is determined by the various combinations of different scarring patterns, which also depend on the entity of surgical exeresis, and the position taken on by various laryngeal district during phonation? The authors present paradigmatic clinical cases in order to demonstrate the different phonatory capabilities achieved by patients who had undergone either cordectomy or cordectomy extended to the ventricle and false vocal cords.

Humans↗
PubMedDate not supplied

[The clinical presuppositions and results of logopedic therapy].

Logopedic therapy is proposed in helping cordectomized patients learn to best use pneumo-phonal structures to compensate for the glottic insufficiency often resulting from this type of surgery. Rehabilitation showed be initiated as soon as possible following surgery before the patients starts using compensation mechanisms negative for voice quality. However, precisely those patients often receive therapy tardively when the anatomo-functional results have already been consolidated and the voice quality is poor. The rehabilitation discussed uses classical feed back mechanisms through which the subjects learn to recognise those factors which enable them to better their voice quality. The type of exercises to be employed depends on whether or cordectomy extended to the ventricle and to false vocal cord. On the farmer case, the principle aim of therapy is that of nearing the healthy vocal cord to the neocord through appropriate exercises. On the better case, instead, the main vocal compensation is the result of the perfect coordination of expiratory energy and the activity of the healthy vocal cord. In fact, in extended cordectomized patients, in the light of the modest amount of scarring, it is necessary to cause the healty voice cord to shift entirely towards and beyond the median line as to as compensate for a sphincteric loss. The authors report two clinical case, particularly difficult from a rehabilitation point of view, in which, relatively speaking, in light of the initial voice conditions, satisfactory results were obtained.

Humans↗