Biomedical subjects

M Magnano

Publications and source records attributed to M Magnano.

At least 37 records · Page 2Linked to original sources

PubMed1995

Extrathoracic and intrathoracic airway responsiveness in sinusitis.

BACKGROUND: Asthma associated with sinusitis is supposed to be sustained by bronchoconstrictive reflexes originating in extrathoracic airway (EA) receptors. OBJECTIVE: The study was designed to evaluate the relationship between EA responsiveness and bronchial responsiveness in sinusitis. METHODS: We performed histamine inhalation challenge in 106 patients with chronic sinusitis, during disease exacerbation and after treatment with antimicrobials and nasal flunisolide (100 micrograms daily) for 2 weeks. Forced expiratory volume in 1 second (FEV1) and maximal mid-inspiratory flow (MIF50) were the respective indexes of bronchial and EA narrowing; the histamine concentrations causing a 20% fall in FEV1 (PC20) and 25% drop in MIF50 (PC25MIF50) were used as thresholds of bronchial and EA responsiveness. Thresholds of 8 mg/ml or less were assumed to indicate bronchial hyperresponsiveness (B-HR) or EA hyperresponsiveness (EA-HR). RESULTS: During sinusitis exacerbation 76 patients had EA-HR, which in 46 was associated with B-HR. The values of PC20 were closely related with those of PC25MIF50 (p < 0.001). EA-HR and B-HR were strongly associated with pharyngitis. After treatment, mean PC25MIF50 and PC20 were significantly increased (p < 0.001). The improvement of PC25MIF50 was closely related to that of PC20 (p < 0.001) and to the decrease in neutrophils in nasal lavage (p < 0.05). EA-HR reversed in 58 patients and improved in 10; B-HR reversed in 29 and improved in 12. CONCLUSIONS: Our findings suggest that in sinusitis, B-HR may be sustained by constrictive reflexes originating in pharyngeal receptors, made hypersensitive by seeding of the inflammatory process.

Analysis of Variance↗

PubMed1995

Prognostic factors for head and neck tumor recurrence.

The introduction of new treatment methods has stimulated the identification of further prognostic factors capable of defining the clinical and biological characteristics of the tumor type in question and improving treatment programming. The aim of this study was to identify which characteristics of the host and tumor are of prognostic value in relation to the onset of locoregional tumor recurrence. A total of 396 patients were studied. The tumor site distribution can be summarized as follows: 267 laryngohypopharyngeal, 74 oropharyngeal, 55 oral cavity. Variables regarding patient, tumor and histology were evaluated for the purpose of analysis. Multivariate analysis of these prognostic factors was performed using PLR software by BMDP. Mean tumor recurrence time was 19 months. Seventeen of the 29 variables analysed did not influence the probability of tumor recurrence. Two variables reduced the risk of tumor recurrence: age > 61 years and abundant and prevalently lymphocytic intra-and peritumoral infiltrate. The study of tumor recurrence onset mechanisms is justified by its impact on the evolution of disease. The use of multivariate analysis in this study showed that some clinical and pathological characteristics of squamous cell carcinoma of the head and neck have a statistically significant impact on tumor recurrence.

Adult↗

PubMed1995

[Autonomic nervous system disturbance as a possible cause of vertigo or dizziness].

In the present study possible interactions between dizziness, or vertigo, and eventual malfunctioning of the Autonomic Nervous System were evaluated. Two groups of ten patients each were patients each were tested. All the patients had vertigo or dizziness of uncertain etiology and ten had arterious hypotension. A careful anamnestic research was carried out in order to individualize symptoms or elements which could induce dysautonomia. A series of 6 tests aimed at evaluating cardiovascular responses was performed in all the patients. Alterations were present in 65% of the test responses. In particular, results were altered in patients with arterious hypotension. The Authors, underline the effectiveness of an adequate anamnesis in identifying patients with possible dysautonomia and affirm the validity of cardiovascular tests (non-invasive, specific and sensitive in obtaining information concerning the etiology of particular forms of dizziness.

Adolescent↗

PubMed1995

[Carcinoma of the base of the tongue: a case series].

A carcinoma of the base of the tongue is diagnosed with difficulty and therapy offers a poor clinical prognosis. Between November 1988 and April 1993 45 patients were evaluated (38 men and 7 women, mean age 60 years). These patients were in poor clinical conditions and advanced clinical stage. Surgical treatment alone or in association with radiotherapy was employed in 17 patients. In the remaining patients radiation therapy alone or associated with chemotherapy was employed. Three-year overall actuarial survival was 39.5% and 3-year NED survival was 21%. Certain prognostic factors were evaluated: T stage, lymph nodes, TNM staging, extension to near anatomical areas and treatment. A Cox multivariate regression analysis revealed that clinical N stage was significant for prognosis (3-year overall actuarial survival was 76.9% for NO and 28% in subjects with clinical nodes). Subjects with neoplasm extension to pharyngo-laryngeal area could have better prognosis and, a finally, patients treated with surgery alone or in association with other treatment would achieve better local control than others.

Adult↗

PubMed1994

Carcinoma of the external auditory meatus and middle ear. Results of the treatment of 28 cases.

AIMS: The authors report their experience on the treatment of 28 cases of middle ear (3) and external auditory meatus (EAM) cancers (25) with surgery and/or radiation therapy. According to histologic type, there were 23 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenocystic carcinoma. METHODS: Surgery alone was performed in 2 cases, surgery combined with radiotherapy in 11 cases, and radiotherapy alone in 15 cases. Postoperative radiation therapy dose ranged between 4500 and 5500 cGy; the definitive dose was 6000-7000 cGy. The median follow-up was 61 months. RESULTS: Complete response rate 6 weeks after the end of the treatment, evaluated by CT scan, was 85.7% (24/28). Definitive local control was obtained in 20/28 cases for the primary site and in 26/28 cases for the neck. Nine of the 10 recurrences were retreated with low-dose radiotherapy combined with surgery, chemotherapy or hyperthermia. A new local control was obtained in 2 cases. Four patients were lost during the follow-up at 13, 14, 17 and 23 months after the end of the treatment. The survival rate was 54% (13/24); disease-free survival was 50% (11/22). CONCLUSIONS: Despite a not very aggressive treatment, our results are quite good.

Adult↗

PubMed1992

Vestibular apparatus disorders after external radiation therapy for head and neck cancers.

External irradiation of different head and neck cancers may involve parts of the ear. The vestibular function of 25 patients in which the inner ear was comprised in the irradiated volume was investigated by electronystagmography (ENG). Doses administered to the vestibular system ranged between 2800 and 5120 cGy. Five patients suffered subjective vertigo or dizziness. Eleven patients (three out of five with vertigo) showed vestibular abnormalities to ENG (44% of the total). Altered responses to specific tests were as follow: six patients to the bithermal caloric stimulation, two to the pendular-sinusoidal test and the other three to both of them. Patients were evaluated 3 and 6 months after the ending of the radiation therapy course. At the first evaluation, abnormalities to caloric test were noted in three patients (12%) and to sinusoidal rotatory test in one patient (4%). At the second evaluation, rates of abnormal response increased to 36% and 20%, respectively. Vestibular disorders seemed to be scantly related to the total radiation dose. Data of literature are discussed in order to identify possible implications on treatment planning.

Adult↗

PubMed1990

[CT in the staging of neoplasms of the gallbladder].

The authors report the results of 50 cases of gallbladder carcinoma studied by means of CT, which were observed since 1984. Twenty-five cases were confirmed at surgery and 25 were selected among those in which CT, clinical history, natural disease evolution and matching with other instrumental and laboratory examinations were highly suggestive of gallbladder carcinoma. The high incidence is reported of such CT signs, which may be considered typical, as the presence of soft tissue in gallbladder area (92%), liver infiltration (78%), and the presence of metastatic lymph nodes (36%); they may or may not be associated to less specific signs. CT appears as the most reliable examination for both diagnosis and staging of the disease. Unfortunately, due to the wide range of aspecific clinical signs, diagnosis is in most cases late and the disease has therefore a fatal outcome.

Adult↗

PubMed1989

Prognostic significance of the expression of immunohistochemically detectable differentiation markers in laryngeal carcinomas.

Expression of immunocytochemically detectable markers in 100 cases of laryngeal carcinomas, homogeneous for staging and treatment, was correlated with clinical evolution of the disease. Follow-up for a minimum of 5 years was obtained in all cases. Paraffin sections were re-cut and stained in immunoperoxidase with monoclonal KL1, detecting medium-to-low molecular weight keratins, and with monoclonal HMFG2, revealing a surface glycoprotein. Expression of KL1-related antigen did not correlate with prognosis, whereas cases extensively positive for monoclonal HMFG2 (more than 50% cells stained) had a significantly better recurrence-free rate. In a group of tumors classified as Grade 3 (histologically poorly differentiated) and expressing a low degree of HMFG2-detectable surface glycoprotein (less than 50% cells stained), a high rate of recurrences (93%) was observed. This study indicates that the combined use of morphologic and biologic (immunohistochemical) criteria may constitute an independent parameter of primary importance in predicting the evolution of laryngeal carcinomas.

Antigens, Neoplasm↗

PubMedDate not supplied

Prognostic factors of cervical lymph node metastasis in head and neck squamous cell carcinoma.

AIMS AND BACKGROUND: The metastatic spread of squamous cell carcinoma of the head and neck (SCCHN) to the cervical lymph nodes is a negative prognostic factor in terms of survival. We have used multivariate analysis to identify the possible prognostic significance of a number of clinical and pathological characteristics in relation to possible involvement of the cervical lymph nodes in a series of 396 patients. METHOD: 396 patients with SCCHN were studied. Variables regarding the patient, the carcinoma and histology were analysed by multivariate analysis using BMDP's PLR programme. RESULTS: Some variables appear to represent predisposing factors for tumor spread to the lymph nodes: tumor site (supraglottic larynx: P = 0.005; base of the tongue: P = 0.02; hypopharynx: P = 0.02), grading (P = 0.001), and a number of histological parameters (lower degree of histological differentiation: P = 0.001; vascular permeation: P = 0.04; perineural invasion: P < 0.05; prevalently plasmocytic infiltrate: P < 0.05). CONCLUSION: The identification of cases at risk for metastasis can be improved by the assessment of prognostic factors, with a consequent improvement in treatment strategies.

Adult↗

PubMedDate not supplied

Surgery or radiotherapy for early stages carcinomas of the glottic larynx.

AIMS AND BACKGROUND: The choice of treatment in limited squamous cell carcinoma of the glottic larynx often depends on individual and tumor factors. Data of the literature clearly show that surgery and radiotherapy tend to give identical results in terms of survival. We examined 196 cases of T1-T2/N0 cancers of the glottic larynx. We review the literature and discuss the indications and the efficacy of the various available treatments. METHODS AND STUDY DESIGN: 196 consecutive cases of T1-T2/N0 cancers of the glottic larynx were examined. In 54.5% the tumor was confined to the vocal cord; in 38.2% it extended to the anterior commissure, in 4.6% to the arytenoid cartilage and in 2.5% to the floor of the ventricle. We performed partial laryngeal surgery in 41.3% (81 cases). Radiotherapy alone was employed in 58.6% (115 cases). RESULTS: In T1a and T1b cases there was no statistically significant difference in 5-year disease-free survival. In T2 cases the NED survival of patients who underwent partial laryngectomies (90% of cases) was significantly better (P <0.05) than among patients given radiotherapy (73%). NED survival at 5 years in patients with the primary tumor on a vocal cord, ventricle or anterior commissure was 78%, 80% and 81%, respectively, with no statistically significant difference among the various sites. It is possible that involvement of the anterior commissure exposes patients to greater risk of recurrence when radiotherapy alone is used (5 out of 23 cases, 21.7%, compared to 3 out of 52 cases, 5.7%, among our surgically treated patients). CONCLUSIONS: When the tumor is confined to the vocal cord and mobility is not impaired (T1a), surgery and radiotherapy give comparable results, and the latter yields a better functional outcome. When the anterior commissure is involved, recurrences appear to be less likely after surgery. In T2 glottic carcinoma, surgery gives better results than radiotherapy alone. In any event, the choice of treatment should be patient-specific and based on a careful analysis of the factors involved in each case.

Adult↗

PubMedDate not supplied

Impedance measurement as a noninvasive technique for the monitoring of intracranial pressure variations.

In previous reports it has been demonstrated that jugular compression causes a modification of middle ear acoustic impedance; this phenomenon has been named the jugulotympanic reflex (JTR). The aim of the present study was to contribute to the understanding of the origin of this reflex. We have analyzed the middle-ear impedance modifications induced by unilateral and bilateral jugular compression in 12 normal subjects, in 12 patients afflicted with otosclerosis, in 3 patients with Menière's disease and in 6 patients demonstrating intracranial hypertension. In the latter group, the cerebrospinal fluid (CSF) pressure was simultaneously recorded. The JTR was elicited in each normal subject and in each patient affected by Menière's disease and intracranial hypertension, while it was usually absent or modified in otosclerotic patients. The absence of the JTR in otosclerotic patients and, above all, the correspondence between CSF pressure and the middle-ear impedance modification induced by jugular compression suggest that it is due to the transmission of pressure changes from the CSF to the perilymph through the cochlear aqueduct.

Acoustic Impedance Tests↗

PubMedDate not supplied

[Modification of vestibular function after radiation therapy for head and neck tumors].

The effect of radiation on the vestibular apparatus of animals and man have not been widely investigate. Referred symptoms are disequilibrium and spontaneous nystagmus in animals while histological features are intralabyrinthic haemorrhage, edema of the endolymphatic spaces and alterations of sensory hair cells. A group of 20 patients with head and neck cancer located in different sites (nasal cavity, oropharynx, oral cavity, parotid gland) underwent to vestibular investigations before and 3-6 months after radiation therapy. Ten patients (50%) showed an alteration of the vestibular function of peripheral origin after radiation treatment. Complications appeared from a few weeks up to several months following termination of radiotherapy. The slow development of the lesion permitted central compensation. Few patients had symptoms and vestibular symptomatology was always of secondary importance with respect to the initial pathology.

Adult↗

PubMedDate not supplied

[The measurement of cochlear flow by laser Doppler in man: the preliminary results].

Laser-Doppler flowmetry is presently one of the methods of choice in measuring cochlear blood flow. The techniques is non-invasive and is based on the frequency shift of the laser beam induced by the red blood cell movement. Previous studies of cochlear blood flow carried out on animals and humans demonstrated the reliability of laser-Doppler flowmetry and its usefulness in understanding inner ear microcirculation physiology. In this paper we present preliminary data obtained from three patients examined under general anesthesia while undergoing tympanoplasty. Results showed that tracings, whose baseline is proportional with the blood flow, are characterized by waves correlated to pulse beat and automatic ventilation. Moreover, intrinsic contractions of inner ear vessels (waves of vasomotion) as exist in cerebral microcirculation, were observed. Pharmacological hypotension hypocapnia and the application of epinephryne determine a significant reduction of cochlear blood flow. These results suggest that while cochlear blood flow is related to systemic pressure, it has an intrinsic control system. As well since we did not obtain any modification in bone conduction threshold after surgery, we conclude that laser-Doppler flowmetry is a safe technique.

Adolescent↗

PubMedDate not supplied

[Orbital and endocranial complications in acute sinusitis in childhood].

Acute infection the paranasal sinus is a rather frequent pathology in children. On the contrary, local orbital complications are rare. The employment of antibiotics reduces the incidence of complications but can sometimes conceal their appearance so that diagnosis is delayed. Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood. Within a brief time span, 8 patients with complicated frontal and ethmoid-maxillary sinusitis were diagnosed and treated: 4 cases of periorbital cellulitis, 2 of subperiorbital abscess and 2 of orbital abscess (one of which with cavernous sinus thrombosis). Particularly relevant from the diagnostic point of view was the employment of C.T. scan which furnished an accurate definition of the orbit and its surrounding structures which influenced treatment choice. Under antibiotic cover all patients but one (who had been treated very early and had responded immediately to intensive antibiotic therapy) were treated surgically and the clinical course of the disease showed significant improvement very shortly after surgical drainage.

Abscess↗

PubMedDate not supplied

[Identification of the waveform of cortical auditory evoked potentials].

Slow vertex response (SVR) audiometry is presently one of the methods of choice in objective auditory threshold assessment. The aim of this study, carried out on twenty subjects with various degrees and types of hearing loss, was to evaluate the difficulties found in N1P2 complex identification. Tracings, presented as single averages and super-imposed averages, were examined separately by two Authors who had not been received any information concerning the audiometric thresholds of the subjects under investigation. Results showed that erroneous identification of SVR waveforms occurred frequently, especially near threshold level. The rate of false negatives (i.e. a waveform present but not identified) was higher than the rate of false positives (i.e. erroneous identification of a non-existing N1P2 complex). High intra- and interindividual discrepancies were also found. Our results appear to indicate that the SVR waveform is not easily identifiable and thus that SVR audiometry cannot, therefore, be considered a truly objective audiometric test since analysis of the tracings may be influenced by the high degree of variability in individual interpretation.

Adolescent↗

PubMedDate not supplied

[Relations between pure-tone audiometry and cortical evoked auditory potentials].

Slow vertex response (SVR) audiometry is presently one of the methods of choice in objective auditory threshold assessment. The aim of this study was to evaluate, as objectively possible, the relationship existing between the thresholds of SVR and or pure tone audiometry (PTA). The study was carried out on twenty subjects with hearing losses of various degrees and types. While mean differences between SVR and PTA thresholds ranged between 6 to 13 dB, in some cases values over 30 dB were found. No statistically significant intra- and interindividual discrepancies were found, even though in some cases the thresholds were given different in evaluations by different examiners. No statistically significant difference in SVR versus PTA thresholds was found in patients with sensory-neural and conductive hearing loss, while in subjects with normal hearing the difference between the thresholds was greater. Our results suggest that SVR is a reliable technique in objective threshold evaluation but that in single cases its threshold cannot be directly compared to that of pure tone audiometry.

Audiometry, Pure-Tone↗

PubMedDate not supplied

[Transcranial magnetic stimulation of the facial nerve: evaluation of a new method in neurophysiological study of Bell's palsy].

Transcranial magnetic stimulation is a new technique used to stimulate brain areas as well as peripheral nerves in healthy, waking persons. To date this technique has appeared safe. The aim of the present study was to assess the clinical application of this method in patients with Bell's palsy. Electromyographic responses were elicited by electrical and magnetic transcranial stimulation of the facial nerve in 26 patients affected by Bell's palsy. Electrical stimulation: stimuli of 0.1 ms duration, and up to 15 V, were delivered through surface electrodes set 2.5 cm apart over the facial nerve at the stylomastoid foramen. Magnetic stimulation: the coil was placed tangent to the parieto-occipital surface of the scalp. The stimulus intensity was then increased stepwise until a supramaximal response was obtained. Recording: the focal recording electrode was placed ipsilateral to the side stimulated over the superior orbicularis oculi; the reference electrode was placed over the nasal bone. The patients were tested with two neurophysiological determinations: the first 15-30 days from the onset of the palsy; the second 30-60 days after the first. A clinical follow-up was performed six months after the second determination. The results indicate that, contrary to traditional electroneurography, transcranial magnetic stimulation is not able to supply useful neurophysiological indications in patients with Bell's palsy. Although the absence of compound muscle action potential upon stimulation of the side with the lesion did demonstrate some impediment to conduction, it did not have any prognostic value since it was also present in patients who were clinically well at the time of the second check-up.

Adult↗

PubMedDate not supplied

[Modified Semont's maneuver in the treatment of benign paroxysmal positional vertigo].

Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It is characterized by a peripheral balance impairment which occurs during specific movements or positions of the head. The etiology of BPPV is not clear although recent studies by Harada have given more weight to the otolithic theory. The present author has found frequent otoconia attached to the dark cell area around the crista of the semicircular canals. The treatment of BPPV is based on functional re-education of the patient (Semont maneuvers, the Brandt Daroff technique, Norre's V.H.T). The present study involves 62 patients affected by BPPV. The Hallpike maneuver was employed to define the affected side and then the modified Semont maneuver was performed. Recovery was obtained in all patients. The cure rate proved to be 82% after the first examination. The modified Semont maneuver is easier to perform than the traditional maneuver and has given excellent therapeutic results.

Adolescent↗