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Biomedical subjects

P Castelnuovo

Publications and source records attributed to P Castelnuovo.

At least 19 recordsLinked to original sources
PubMed2005

[Rational treatment of nasal polyposis].

Despite the therapeutical advances of the last decade, nasal polyposis represents still a problem for rhinology, practitioners. A number of hypotheses have been formulated about its etiopathogenesis, but no one is confirmed, so that nowadays therapy continues to be only symptomatic and does not cure definitively the underlying pathology. Recurrences are frequent and discourage both the practitioner and the patient. Purpose of this paper is to illustrate Authors' therapeutical rationale aimed to reestablish nasal flow, reduce rhinorrhea, improve olfaction, decrease rhinosinusinusal infection rate and maintain as long as possible such a symptomatic improvement. These targets are best achieved by a combination of medical and surgical treatments in order to optimize the results and reduce the side-effects of both the therapeutical options. Moreover the treatment should be tailored on each patient and follow up should be careful and performed at regular interval. Authors reviewed the clinical records of patients who underwent surgery for nasal polyposis between 2002 and 2004 at Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy, with a minimum follow-up of 12 months. All patients underwent the complete set of diagnostic work-up. The choice between surgical or medical options was based on both the kind of the polyposis and the staging of the pathology. The therapy was as more "personalized" as possible, but a homogeneity of treatment was maintained. The results show that a correct "staging" of the patient allows an appropriate therapy and reduces recurrence rate. In conclusion, authors report their experience and propose a scheme of diagnostic work-up in order to define grading/staging of the pathology and establish a "tailored" therapeutic protocol aimed to control a pathology which is rarely definitively treated.

Adolescent↗
PubMed2004

Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas.

INTRODUCTION: Craniopharyngiomas are tumours of the central nervous system of dysontogenetic origin. They are most commonly localized in the sellar region and appear to originate from an embryogenetic defect of the Rathke cleft. It is universally accepted that radical surgery should be performed as first surgery because surgery after relapses usually causes more difficulty due to tighter adhesion to surrounding structures. It is essential when relapses occur to evaluate which technique to use for treatment. For this reason, any new approach is welcomed in order to have as many alternatives as possible. MATERIAL AND METHODS: In this paper we present the treatment, with a minimum follow-up of 4 years, of 5 paediatric patients affected by cystic craniopharyngiomas who went through first traditional surgery in other institutions and suffered relapses in various anatomical structures. One had a second successful endoscopic attempt at total gross resection. In 3 cases we endoscopically implanted a stent in the cystic cavity draining the cystic liquid out from the cystic cavity of the craniopharyngioma to the sphenoid sinus in order to form an accessory sinus. In 1 case a multiphase treatment has been undertaken. RESULTS: All patients treated using a transsphenoidal endoscopic approach are still living, without relapses and no postoperative complications. In particular, there where no episodes of vasospasm (a common complication reported in the literature when the "motor oil" comes into contact with the subarachnoid space) or infections. The patient treated using the multiphase approach recovered but suffered a recurrence 2 years later due to hypothalamic infiltration. DISCUSSION AND CONCLUSIONS: Craniopharyngioma relapse needs different treatments. Many alternative approaches have been reported but none of them is the first choice alternative. We believe endoscopic stent placement in the cystic cavity is an alternative method for the treatment of cystic relapses.

Adolescent↗
PubMed2004

Invasive fungal sinusitis due to Bipolaris hawaiiensis.

A phaeohyphomycotic sinusitis due to Bipolaris hawaiiensis, observed in an immunologically competent patient, is reported and a review of data from the literature is given. The patient was successfully treated by surgical drainage and amphotericin B.

Adult↗
PubMed2004

Nasal endoscopy in asthmatic children: clinical role in the diagnosis of rhinosinusitis.

The aim of the study was to determine the role of rigid nasal endoscopy in the diagnosis of rhinosinusitis and adenoiditis in asthmatic children. Hundred-forty-five asthmatic children (aged 2-15 years) with recurrent upper respiratory symptoms were evaluated with complete ENT examination and nasal endoscopy by rigid endoscope during local anaesthesia. A step by step endoscopic procedure is described. Endoscopy was successfully performed in 128 patients (88.3%). Purulent rhinosinusitis was diagnosed in 61 subjects (47.6%) and adenoiditis in 45 subjects (35.1%). Rhinosinusitis was associated with adenoiditis in 35 subjects (27.3%), more frequently in younger children (i.e. 2-5 years). Nasal bacteria occurred in 90% of rhinosinusitis patients. Numerous anatomical anomalies were identified. Endoscopy of nasal cavity and rhinopharynx is less traumatic and more readily accepted than other methods. Nasal endoscopy may be proposed as an appropriate routine diagnostic tool in children since it is well tolerated, easily and quickly performed, cost-efficient, and useful in diagnosing rhinosinusitis.

Adenoids↗
PubMed2001

Nasal endoscopy in asthmatic children: assessment of rhinosinusitis and adenoiditis incidence, correlations with cytology and microbiology.

BACKGROUND: Upper respiratory airway diseases may induce a worsening of asthma. Sinusitis represents one of the most common chronic diseases. The association of asthma and sinusitis varies greatly in different studies, depending on diagnostic procedures. OBJECTIVE: The aims were: (i) to demonstrate that nasal endoscopy may be easily feasible in asthma at paediatric age; (ii) to evaluate the incidence of rhinosinusitis and adenoiditis in children with asthma by nasal endoscopy; (iii) to correlate inflammatory parameters such as cytology and microbiological cultures with nasal endoscopy findings. SUBJECTS AND METHODS: One hundred and forty-five asthmatic children were evaluated, 48 males and 97 females, with an average age of 7.27 years. Evaluated parameters were the incidence of rhinosinusal infections in asthmatic children, and the role of: (i) nasal endoscopy, (ii) nasal cytology, and (iii) nasal microbiology in their diagnoses. RESULTS: Nasal endoscopy was successfully performed on 128 patients. Twenty-six children had endoscopic rhinosinusitis alone, 10 had adenoiditis alone, and 35 showed endoscopic rhinosinusitis associated with adenoiditis. There were significant correlations between endoscopic rhinosinusitis and adenoiditis (P < 0.001), between clinical and endoscopic rhinosinusitis (P < 0.001), between endoscopic rhinosinusitis and adenoiditis and microbiology (P < 0.05 and P < 0.0001, respectively), and between microbiology and cytology (P < 0.05). CONCLUSION: This study shows that rhinosinusal infections are common in asthmatic children. Moreover, nasal endoscopy might represent a fruitful tool in the management of asthmatic children.

Adenoids↗
PubMed2000

Endoscopic approaches to the cranial base: perspectives and realities.

We describe the development of transnasal endoscopic approaches to the cranial base in an interdisciplinary series of 103 patients, including 13 in the pediatric age group. Our aim was to define, with the aid of different case reports, the possibilities of endoscopic techniques in tumor resection, fistula repair, the treatment of mucoceles and meningoceles, and of combined intracranial and endoscopic approaches. The advantages of these minimally invasive approaches are panoramic visualization, rapidity and reduction of the cosmetic and functional disabilities in comparison with other conventional approaches, and a better capacity for identifying and developing key landmarks for surgery. On the other hand, endoscopic surgery requires an exsanguine operation field, technical improvements in instruments, and specific skills. Interdisciplinary collaboration in endoscopic approaches has proved useful in integrating experiences without overlap between fields, and in broadening possibilities: in our opinion endoscopic approaches will certainly be important in the future of cranial base surgery.

Adolescent↗
PubMed2000

Spontaneous compressive orbital emphysema of rhinogenic origin.

We report the case of a young patient who developed spontaneous compressive orbital emphysema after an attack of coughing. At admission the patient presented left proptosis, diplopia, vision impairment and headache. Computer tomography showed air in the lateral part of left orbit compressing the eyeball and the optic nerve medially. It also revealed a sphenoid bone dysplasia with hyperpneumatization of the left greater wing and with two dehiscences in its wall. It was very intriguing to discover that this sphenoid dysplasia and the flap of mucosa covering one dehiscence were causing a ball-valve effect, allowing air to enter but not leave the orbit. Endoscopic sinus surgery was successfully used to treat this case.

Adolescent↗
PubMed2000

[Paranasal sinus mycoses].

In recent years there has been a marked increase in mycosis infections of the paranasal sinuses, attributed both to an increase in the survival of subjects at risk and improved diagnostic techniques (endoscopy, CT, MR) able to identify cases which had previously gone unrecognized and treated as aspecific chronic sinusitis. The present study involves 45 cases (4.3%) out of a total of 1050 patients who had undergone endoscopic surgery for sinusopathy between April 1994 and December 1998. Following the Katzenstein classification, the cases were broken down into non-invasive chronic mycoses or fungus ball (34 cases), allergic mycoses (7), chronic indolent invasive mycoses (3) and fulminating invasive mycosis (1 case). The mycetes most often involved was Aspergillus Fumigatus (76.9%). The recurrent symptom was facial algia, followed by nasal obstruction. Paranasal sinuses endoscopy did not modify the specific picture. CT presented such indicative signs as focal areas with non-homogeneous intensity, images of metal-like foreign bodies and endosinus calcifications in 84.4% of the cases. MR--performed in only 6 cases--always presented T2 images showing the typical signal void area corresponding to pathological lesions. All patients underwent endoscopic surgery of the paranasal sinus. The effectiveness of this treatment differed according to the clinical form. In the fungus balls surgery always resolved the pathology without requiring subsequent pharmacological treatment. In allergic mycosis, surgery improved the symptom of nasal respiratory obstruction but local drug treatment was required. With the aid of drug treatment, surgery resolved chronic indolent invasive mycoses and prevented the endocranial progression of complications. In the cases of fulminating invasive mycosis, timely surgery prevented the onset of endocranial complications and made it possible to perform antimycotic polychemotherapy to control the disease. This experience shows how important a protocol involving several different tests is in diagnosing the many clinical forms of paranasal sinus mycoses and distinguishing them from sinusopathies. Endoscopic surgery is indicated for all forms of paranasal sinus mycoses although the realistic objectives differ according to type.

Adolescent↗
PubMed2000

[Revascularized jejunum loop in hypopharyngeal reconstruction: oncological and functional results].

The aggressiveness of hypopharyngeal cancer makes broad resectioning of the circular pharyngolaryngoesophageal segments necessary, followed by reconstruction to restore the anatomical gap created as fully as possibly creating a neoesophagus with thin walls that can easily be released. Over the years several procedures have been fine tuned for reconstruction of the upper digestive tract employing transposed viscera, miocutaneous pedunculated flaps, revascularized fascio-cutaneous or visceral free flaps. Currently the revascularized jejunum loop is one of the most commonly used methods in the reconstruction of the hypopharynx. Its popularity is due to some anatomical and physiological advantages: it requires transposition of a brief intestinal tract anatomically well adapted to the reconstruction site, ensuring rapid functional recovery. The authors report the oncological and functional results obtained in 25 patients who underwent circular pharyngolaryngectomy followed by reconstruction with a revascularized jejunum loop. The percentage of transplant survival was 90% and local and general complications were reduced to a minimum. The functional results--both in terms of deglutition and phonation--were satisfactory while patient survival (6-37 months follow-up) was in line with that reported by other authors for the same tumor (47%). Although prognosis for hypopharyngeal-esophageal neoplasms is still quite poor, this experience shows that circular pharyngolaryngectomy followed by reconstruction with autotransplant of the jejunum is an excellent choice since it offers the patient a prompt, acceptable functional recovery and a fair quality for his remaining life.

Aged↗
PubMed1999

Endoscopic limited septoplasty in combination with sinonasal surgery.

The systematic use of fiberoptic techniques in the sinonasal region has made it possible to assess the nasal septum with more precision. The presence of limited septal deviation or isolated septal spurs can cause airway obstruction in the sinuses or impede the execution of endoscopic sinonasal procedures for a disorder not related to the morphology of the nasal septum. This study assesses the indications, surgical technique, and results in 170 patients who underwent endoscopic limited septoplasty performed concomitantly with endoscopic sinonasal surgery.

Endoscopy↗
PubMed1999

[Surgical revision of the lateral nasal wall].

The purpose of rhinosinus revision through endoscopic surgery is to resolve recurrent, residual pathologies in patients with drug-resistant symptoms and to prevent ocular and endocranial complications. Surgical revision proves quite complex because of the destruction of the anatomical structures. More over the presence of tougher scare tissue which bleeds easily increases the risk of iatrogenous complications. Axial and coronal-projection tomography without contrast medium must be performed prior to surgery. Endonasal orientation is ensured by six main reference points. Three of these points--nasal septum, upper edge of the choana and upper edge of the nasolacrymal duct--are nearly always present while the others may or may not be, depending on what sort surgery has been performed. The present work gives the guidelines for a correct approach to patients who have undergone many previous procedures.

Endoscopy↗
PubMed1990

[Cytodiagnosis by fine needle aspiration biopsy in laryngeal diseases].

Aspiration cytodiagnosis is widely employed in head and neck tumors since it is atraumatic, it avoids neoplastic seeding and is highly reliable from a diagnostic standpoint. We used such method to support diagnosis in deep intramural laryngeal tumors, and in the post-radiotherapy evaluation of laryngeal areas coated with hard oedema and fibrosis. Needle aspiration was performed during direct laryngoscopy according to Kleinsasser. The method proved to be highly reliable for a diagnostic standpoint, with an agreement of 93% with the final histologic examination, higher than the one provided by traditional bioptic techniques.

Adult↗
PubMed1989

[A study using laser-Doppler velocimetry of modifications of the labyrinthine microcirculation induced by chemical and physical stimuli].

Vasomotor activity induced by physical and chemical stimuli in the cochlear microcirculation was evaluated by laser-doppler flowmetry. Cochlear flow changes were studied after pharmacological administration and noise exposure. The reaction of cochlear microcirculation after drug administration is similar to that observed in the brain. After phenylephrine injection the authors observed an increase of cochlear blood flow, contrary to that observed in the peripheral vessels. The authors studied the difference in time-activity and quantitative effect of several drugs commonly used in cochlear vascular diseases. Cochlear flow decrease after exposure to noise is proportional to the stimulus intensity and the exposure time.

Animals↗
PubMed1981

Impaired suppression of vestibular nystagmus by fixation of visual and acoustic targets in neurological patients.

Suppression of vestibular nystagmus induced by fixation of visual and acoustic targets moving with the head during sinusoidal rotation (0.1 Hz, 75 degrees/second peak velocity) was tested in cerebellar and noncerebellar patients. Visual suppression was impaired greatly in cerebellar patients, without correlation with visual smooth-pursuit defects. Acoustic suppression was equal to or slightly weaker than visual suppression. In noncerebellar patients, a disturbance of visual suppression was found only in the presence of a severe impairment of pursuit eye movements. Acoustic suppression did not parallel the visual-suppression pattern. In clinical vestibular examination, an impaired modulation of the vestibulo-ocular reflex suggests a cerebellar dysfunction, but also can occur in the presence of disorders of other parts of the CNS severely affecting the SP system.

Attention↗
PubMedDate not supplied

A computerized database for head and neck cancer registry.

AIMS: Over the last years, the management of patients with head and neck cancer has become extremely complex, and the knowledge and information needed to care for a patient can no longer be trusted to the memory or manual systems. Recent advances in data processing technology offer the potential for creating ideal instruments to organize, store and analyze such information. METHODS: We developed a computerized database management system (H&N-CDMS) which fulfils the following requisites: easy to use even by operators not expert in informatics; minimum possibility of insertion of ambiguous data; use for clinical and research purposes; can be interconnected in a network of similar database operating in other centers; can be expanded to image processing. CONCLUSIONS: The configuration of the system is described and its main characteristics are discussed: data entry and coding facilities, data accuracy and standardization, security and anonymity, data retrieval and analysis. H&H-CDMS is a user-friendly tool for head and neck cancer data management in clinical and research environments.

Head and Neck Neoplasms↗