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Biomedical subjects

M Stura

Publications and source records attributed to M Stura.

At least 19 recordsLinked to original sources

Safety of electronic molecular resonance adenoidectomy.

Adenoidectomy is one of the most frequent operations in children. In order to reduce hospital stay costs, today, this procedure is performed as day surgery. Even though adenoidectomy is not considered risky, some minor complications may occur, the most important being bleeding (0.5-8% incidence). The surgical technique used can influence considerably postoperative pain and time to recovery. This aspect is essential in the management of day surgery patients, for whom the need of safe and rapid maneuvers associated with early recovery determines the choice of the surgical procedure. Recently, we developed a surgical technique based on the use of an electronic molecular resonance tool associated with bendable suction electrocautery. This study was carried out on 600 patients, divided into two groups, the first undergoing ablation using the molecular resonance tool and the second undergoing curette adenoidectomy. The two groups were homogeneous for age, sex, surgical indications, and grade of adenoid hypertrophy. The following parameters were considered: duration of surgery, importance of intraoperative bleeding, time to cicatrization, incidence of bleeding complications. Duration of surgery and intra- and postoperative bleeding were much lower in the first group than in the group undergoing traditional adenoidectomy. In addition, rhinopharyngeal complete cicatrization, defined as absolute absence of pseudomembrane, was much quicker in the first group, as assessed by postoperative endoscopy. Another major advantage offered by the molecular resonance tool is the accuracy of surgery performed under visual control in a practically bloodless field. To sum up, this method, thanks to its technical features and safety, is particularly indicated in children and in patients with coagulation disorders.

Adenoidectomy↗

Acute mastoiditis: a 10 year retrospective study.

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.

Acute Disease↗

[Therapeutic use of a peptide fraction derived from bovine factor VIII in epistaxis in children].

The results obtained in patients suffering from essential epistaxis in paediatric age using a peptide fraction derived from the enzymatic hydrolysis of bovine factor VIII (VUEFFE-Baldacci) are reported. Carbazochrome sodium sulphate was employed for comparison purposes. Vueffe is effective in reducing haemorrhagic episodes without modifying the laboratory parameters investigated.

Adolescent↗

Resistant and relapsing neuroblastoma: improved response rate with a new multiagent regimen (OC-HDP) including high-dose cisplatinum.

From September 1984 to July 1985, 11 children from 6 months to 6 years of age were treated with a three-drug regimen (OC-HDP), including vincristine, cyclophosphamide, and cisplatinum 200 mg/m2 given as five dose-fractions over 5 days. Nine had resistant and two relapsed neuroblastoma. Nine children had previously been treated with cisplatinum at conventional doses; nine had not received cyclophosphamide and ten had not received vincristine. Nine of eleven patients had a good response to treatment; six are presently alive in continuous complete remission 11-23 months (median 13 months) after diagnosis. Toxicity was moderate: no child showed either severe myelotoxicity or clinical or laboratory evidence of nephrotoxicity. No child had clinically significant ototoxicity. In six children audiometry showed hearing loss for high frequencies after the third cycle of treatment. It is concluded that OC-HDP regimen could be considered as a first-line treatment for advanced neuroblastoma.

Antineoplastic Combined Chemotherapy Protocols↗

High-dose cisplatin and etoposide in advanced malignancies of childhood.

Thirty-two children with poor-prognosis solid tumors were treated with a combination of high-dose cisplatin (CDDP) (200 mg/m2 over 5 days) and VP16. In the 30 children evaluable for antitumor effect, there were 7 complete, 12 partial, and 3 minor tumor responses. Wilms' tumor and rhabdomyosarcoma responded best. There were no therapy-related deaths. Severe neutropenia (PMN less than 500/mmc) developed after 29 out of the 45 evaluable courses and lasted a median of 8 days; during periods of neutropenia 8 episodes of fever occurred, 1 of which was caused by streptococcal sepsis. Platelet levels were depressed to less than 50,000/mmc after 17/45 cycles and this thrombocytopenia lasted a median of 8 days. No neurological toxicity occurred. One case developed acute renal failure. A hearing deficit for high frequencies was documented in 14/22 patients evaluated after the first cycle and in all cases after the subsequent cycles; the deficits correlated with the total dose of CDDP administered. High-dose cisplatin and VP16 is an effective association in children with advanced cancer, but cumulative dosage is limited by ototoxicity.

Antineoplastic Combined Chemotherapy Protocols↗

Comparison of cefatrizine and erythromycin for pediatric ear, nose, and throat infections.

A comparison was made of cefatrizine in dosages of 75 mg/kg/day administered once daily or twice daily and erythromycin in a mean daily dosage of 50 mg/kg given in three divided doses for the treatment of acute infections of the ear, nose, and throat in children. Temperature was recorded twice a day during therapy. At the end of treatment, a clinical evaluation of cure, improvement, or failure was made, based on defervescence and abatement of symptoms. All ten children given cefatrizine once daily were cured (P less than or equal to 0.05), as were eight of ten given cefatrizine twice daily and four of ten given erythromycin. The remaining eight patients were improved. One patient given cefatrizine had diarrhea, which appeared on the fifth day of treatment. No other side effects were observed. Cefatrizine appeared to be similarly effective whether given once a day or twice a day; further trials are warranted to confirm the efficacy of once-daily treatment with this cephalosporin.

Cefatrizine↗