Biomedical subjects

R Fiorella

Publications and source records attributed to R Fiorella.

At least 19 recordsLinked to original sources

PubMed2006

Treatment of recurrent epistaxis in HHT.

No optimal treatment modality is currently available for the treatment of recurrent epistaxis in HHT. In this review, different therapeutic concepts are discussed together with their pathophysiologic background. Patients often profess a preventive effect for nasal ointments and use packings which can be self-administered in the case of bleeding. An effective first-line treatment for physicians is the endonasal laser coagulation or argon plasma coagulation. A second line surgical procedure is septodermoplasty according to Saunders which can provide long-lasting relief if performed correctly. There have been reports on antifibrinolytic agents and hormones, but their efficacy has yet to be determined.

Animals↗

PubMed2006

Acoustic analysis of voice in patients treated by reconstructive subtotal laryngectomy. Evaluation and critical review.

Aim of this investigation was to analyse the voice in a group of 20 patients submitted to supracricoid partial laryngectomy (cricohyoidopexy, sparing two arytenoids) by the Multi Dimensional Voice Programme acoustic analysis system. Results revealed the following sound characteristics: high rate of noise, lack of periodic component of the signal, high rate of segments with no sound signal, vocal segments with marked air-turbulent flow, variation amplitude and frequency coefficients doubled compared to normal values, average fundamental frequency, if present, extremely variable and unsteady. These results show that the phonatory ability of the residual larynx, due to the altered anatomo-physiology of the structure after surgery, has to be completely re-estimated. In fact, the residual larynx determines a definitely reduced periodic acoustic signal, rich in noise and which can not be modulated. Good phonatory results of this treatment are basically due to preservation of a still understandable (but not perfect!) speech which, by ensuring the subjects' speech ability, overcomes and has little influence on the really poor quality of the vocal signal in these patients. However, the patient obtains a "new voice" as far as concerns acoustic features and this is very important for communication and social life. Moreover, the possibility of objectively estimating acoustic vocal function ability allows monitoring of the trend and results of possible speech therapy and/or phonosurgical rehabilitation treatment which should start from new anatomical and physiological bases, as well as from the new physical acoustic mechanism of signal production.

Aged↗

PubMed2005

Major salivary gland diseases. Multicentre study.

This multicentre study involved 28 Italian ORL Centres responding to a questionnaire sent by us which allowed recruitment of a high large number of cases of parotid neoplasms observed over a 10-year period. Statistical data obtained partly confirmed previous findings. Benign tumours account for 80% of case histories with a relationship 1:4 M/F, the most frequent being pleomorphic adenoma (57.3% of cases), followed by Warthin's tumour (32.4%), this rating not having been confirmed in case histories (8-10%) in the literature. Malignant tumours instead were fewer in number compared to the literature (14% vs 25-30%); the most frequent being mucoepidermoid carcinoma (18.2%) of which 44% G1, 33% G2 and 23% G3. Adenoid-cystic carcinoma was observed in 15.3% and < or = 10% for all the other most frequent histological malignant neoplasms. Diagnostic work-up included echotomography and fine-needle aspiration biopsy, less used imaging techniques were computed tomography, magnetic resonance imaging, Sialo-computed tomography. During this multicentre investigation more widespread use of imaging techniques has, however, been observed. The greater use of ecotomography and of fine-needle aspiration biopsy was due to simplicity of application and low cost offering good sensitivity and specificity. Surgical treatment of benign tumours consisted, in 50% of cases, in superficial paroditectomy and in approximately 30% of total paroditectomy. Enucleoresection was limited to approximately 15% of neoplasms, enucleation to <10% of cases with only 2% of pleomorph adenoma due to the well-known anatomo-pathological characteristics which may lead to relapse. For malignant neoplasms, total parotidectomy was performed in approximately 50% of cases, while in the remaining 50% an almost equal rate of superficial parotidectomy was carried out and enlarged parotidectomy, with or without sacrificing the facial nerve, which was rebuilt in 60% of cases. The lateral neck dissection most frequently carried out was of functional type in 54% and selective type in 46% with removal of levels I-III and II-IV in approximately 60% of cases. Sentinel lymph node was observed in a limited number of centres. When no clinically evident lymph nodes were present (NO) considering the tumour histotype, two thirds of patients underwent surgery or radiotherapy, while in the remainder the wait-and-see attitude was prefered. Post-operative-complementary radiotherapy was very frequently performed instead of chemotherapy. Oncological results obtained were compared with those reported in the literature: in fact for all benign neoplasms relapse ratings are about 5%, while for malignant tumours the worst prognosis was in squamous cell carcinoma with median of 37.7 on survival and metastasis rate of 16.5%. Finally, mucoepidermoid carcinoma tumours showed best survival, followed by adenoid-cystic carcinoma with ranges, respectively, 83 and 81.

Adult↗

PubMed2004

Hereditary haemorrhagic telangiectasia: state of the art.

Hereditary haemorrhagic teleangiectasia (HHT) or Rendu-Osler-Weber disease is a genetic autosomal-dominant disorder characterised by the presence of vascular telangiectases in mucocutaneous tissues, visceral organs and the Central Nervous System. Pulmonary arteriovenous malformations have a variable incidence rate ranging between 15-33%, and the safest treatment is transcatheter embolotherapy. Haemmorrhages from the gastrointestinal tract occur in 10-40% of patients with HHT localized in duodenum and colon and can be treated with endoscopy and laser coagulation, but this procedure is not efficacious for vascular anomalies in small intestine since this site cannot be easily reached. The prevalence of cerebrovascular malformations in hereditary haemorrhagic telangiectasia patients is 5-27%, and there are several types described including telangiectasias, cavernous angiomas, arteriovenous malformations, and aneurysms. Cerebrovascular malformations can be treated by: neurovascular surgery, embolization, and stereotactic radiosurgery, but the appropriate course of action for dealing with asymptomatic cerebrovascular malformations is still debated. The most common symptom in HHT patients is epistaxis, which can sometimes be so profuse that it requires multiple transfusions and iron supplementation. Nose bleeds begin before 10 years of age and become more severe in later decades. A multitude of different treatments are available, tailored to the severity of epistaxis. These include: hormonal therapy with oestrogens, application of fibrine tissue sealant, laser coagulation, embolization and septal dermoplasty using Saunder's technique. Aim of this study is to review diagnostic and therapeutic techniques, since continuous growth and danger of these arteriovenous malformations require early diagnosis, adequate treatment, prolonged follow-up and screening of the family.

Embolization, Therapeutic↗

PubMed2003

Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: a novel approach to therapeutic management.

OBJECTIVE: A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification. METHODS: Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry. RESULTS: In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions). CONCLUSIONS: In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

Adenoidectomy↗

PubMed2001

[Objective evaluation of dysphonia. Possibilities and limitations].

Today clinical evaluation of the presence and extent of dysphonia is still essentially based on subjective-perceptive criteria. The lack of objectivity and the one-sidedness of such an approach reinforces the desire for a quantitative, objective determination of dysphonia which could aid in making an modern, unequivocal evaluation of the presence, extent and variations in time of this disorder both upon onset and after treatment. The purpose of the present research was to determine the reliability, possibilities and limitations of an objective, parametric procedure to evaluate both the normal and pathological voice. This procedure is based on the detection of the relationship between the noise and harmonic portions in the voice (the Yumoto H/N ratio). The study involved a group of 208 subjects (148 with dysphonia and 60 normal) and the procedure was applied using computerized digital sonography and dedicated algorithms. The results of this research showed that the vocal analysis procedure developed by Yumoto is not only simple but also highly sensitive, providing an objective study of dysphonia. In fact, the comparison between the average H/N ratio recorded in our patients (1.697 dB) is significantly different from that recorded in the normal subjects (11.169 dB) (p < 0.001). This also showed a clear discrimination between the two groups with no borderline or overlapping data found. The initial evaluation does not appear to establish a relationship between abnormal H/N ratio values and the type of pathology although greater morphological destruction of the vocal cords corresponds to worse vocal quality and therefore increased noise. For the data obtained to be valid, a necessary condition is the application of a strict, precise, correct sampling and analysis method following well-defined rules. Finally, the values obtained can serve as a basis for the construction of an objective instrumental voice measurement protocol that can be used in forensic evaluation of dysphonia. Standardization of the regulations is essential to such a project.

Adult↗

PubMed1999

Indications for frontolateral laryngectomy and prognostic factors of failure.

The aim of this study was a retrospective analysis of the oncological results in a group of patients treated by frontolateral laryngectomy using clinical and histopathological correlations in order to review the indications for surgery. In all, 150 patients underwent frontolateral laryngectomy as described by Leroux-Robert. All were staged according to the 1992 UICC TNM classification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumors (2.7%). Among the different correlations examined, microscopic infiltration of the anterior commissure was related to a greater number of local relapses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NED). The crude 5-year NED survival was 66% and was influenced by second primary tumors and metastases (7.4%) and non-oncological diseases (14.6%). These data show the need for a re-evaluation of the indications for frontolateral laryngectomy because subtotal reconstructive laryngectomy could be performed more safely in the more advanced cases. In contrast, cases with more limited tumors might be better treated by laser for a more functional and cost-beneficial result.

Adult↗

PubMed1999

[Evaluation of resection margins as a prognostic factor in the surgical treatment of laryngeal carcinoma].

A series of 564 patients who underwent conservative or radical surgery for laryngeal carcinoma were studied in a postoperative follow-up. In particular the onset of local recurrences was studied in relation to the histopathological typing of the resection margin. Histology was performed both on the surgical sample and performing an additional biopsy on the surgical margin. The incidence of local recurrences--in relation to the positive or negative tumor infiltration at the resection margins of the surgical sample--was analogous throughout the entire case study (11.1% vs. 11.7%). Only as light increase in the incidence of recurrence was found in those patients with partial laryngectomy (12% vs. 8.9%) although this was not statistically significant. On the contrary, when the marginal biopsy tested positive for neoplasm, it was clearly and significantly related to a higher incidence of T recurrences. This held true for all cases as a whole (36.4% vs. 10.1%, p < 0.04) and, in particular for those treated with partial laryngectomy (46.2% vs. 3%, p < 0.02). On the basis of these observations it can be concluded that, where possible, additional biopsy should be performed to integrate the traditional evaluation of the margins of the surgical piece in order to gain greater prognostic reliability, particularly in cases of partial surgery. From the therapeutic point of view, the authors assert that scheduling supplementary radiation therapy and shorter intervals between follow-up examinations is timely if the resection margin tests positive.

Adult↗

PubMed1997

Myelomatous pleural effusion.

Malignant pleural effusions due to multiple myeloma are rare. Effusion in such patients is usually due to congestive heart failure or another process. Malignant myeloma cells identified in cytologic examination of the pleural fluid or by pleural biopsy establish the diagnosis of a myelomatous effusion. This finding portends a poor prognosis and death usually within 4 months.

Aged↗

PubMed1997

Clinical, radiographic, and pathologic features of medical calcific sclerosis in the breast.

Medial calcific sclerosis (MCS), a nonocclusive calcification of the media of small to medium-sized muscular arteries, may occur in the breast. To ascertain whether MCS causes difficulty with mammographic interpretation of breast calcifications and to determine its clinical and pathologic associations, we reviewed the records and biopsy specimens from 62 patients who had had screening mammography and breast biopsy, lumpectomy, or mastectomy. Ten specimens from 7 patients showed MCS. Average age of patients without MCS was 48.8 years, and that of the 7 patients with MCS was 61.3 years. Microcalcifications were found in 25 of 62 mammograms (34%). Of the 7 patients with MCS, 2 had hypertension, 1 diabetes mellitus, 2 diabetes mellitus and hypertension, and 2 neither hypertension nor diabetes mellitus. In 5 specimens, calcification only was associated with MCS. In 2 of these specimens, the mammographic calcifications were thought to be suggestive of malignancy on the basis of clustering and spiculation. One of the 2 was benign on histopathology; the other was malignant. Overall, carcinoma was identified in 3 of 7 patients with MCS (compared with 11 of 55 patients without MCS) and in 2 of 5 specimens (2 patients) with mammary MCS as the only type of calcification. The mammographic appearance of the microcalcification in MCS may suggest malignancy.

Adult↗

PubMed1997

Infected abdominal aortic aneurysm due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae.

The clinical course for a patient hospitalized with pneumonia and meningitis due to penicillin-, ceftriaxone-, and cefotaxime-resistant Streptococcus pneumoniae is described. The pneumonia and meningitis responded to antimicrobial therapy, but the patient died following rupture of an infected abdominal aortic aneurysm; gram-positive cocci resembling S. pneumoniae were detected within the aneurysm.

Aortic Aneurysm, Abdominal↗

PubMed1997

Molecular biopathology of metaplastic, dysplastic, and neoplastic laryngeal epithelium.

In a large series of more than 100 cases of laryngeal carcinomas, the presence of steroid hormone receptors was demonstrated in the cytosol and in the nuclear fraction. Their presence was confirmed by the identification of estrogen receptor isophorms and by the detection of hormone-related proteins such as ER-D5. EGFr, and cathepsin D. These molecules were also variably expressed in normal, hyperplastic, and dysplastic epithelium. These data suggest a possible role of hormone receptors during laryngeal carcinogenesis. Finally, the presence of an Angiotensin II receptor was studied in neoplastic and preneoplastic laryngeal epithelium.

Carcinoma, Squamous Cell↗

PubMed1997

Epidemiological and clinical relief on hyperplastic lesions of the larynx.

Chronic hyperplastic laryngopathies are considered precancerous lesions because of their possible transformation in time into malignant epithelial neoplasia. We studied 130 patients affected by "hyperplastic laryngeal lesions" according to their semeiological characteristics. The lesions affected the vocal cords in 127 cases and in only 3 cases the ventricular bands. All patients underwent microlaryngoscopy while under general anesthesia and were treated by limited excision (37%) or total stripping (63%). The histomorphological classification by Kleinsasser (7) was used. The following clinical checks showed that 30 out of 48 patients (62.5%) treated by partial stripping recovered; in 11 the lesion relapsed (23%) and in 7 cases (14.5%) a carcinoma appeared. Of those cases treated by total stripping 65 patients (79%) recovered, 12 (15%) relapsed and 5 (6%) showed carcinoma. In conclusion we noticed the appearance of a malignant lesion after surgery in 12 out of 130 cases (9.2%). The cancerization was about 3 times more frequent in patients with histological results of degree II than in those with degree I (17% vs. 6%). Our study confirms that the laryngeal hyperplastic lesion represents a possible passage to cancer in a limited number of cases (< 10%), but with a triple probability for degree II dysplasia in respect to degree I. The patients affected by dyskeratosis, regardless of type of lesion, need a regular follow-up and immediate radical surgery because of the frequent incidence of relapse.

Alcohol Drinking↗

PubMed1995

[Invasion of cricoid cartilage by T2-T3 laryngeal cancer].

This paper reports a study of microscopic infiltration of the cartilage of the cricoid carried out in 335 patients with T2-T3 carcinomas of the larynx who had undergone total laryngectomy. The results of the investigation revealed microscopic infiltration of the cricoid cartilage in 12% (14/335) of the cases examined. The incidence, however, was much higher in those cases of extension to the hypoglottis (28% vs 5%, p < 0.0001) or in cases of an even greater extension of the tumor (13% vs 7%). In the 161 patients with neoplasias situated in the glottis, there was cricoid invasion in 30 cases regardless of the tumor class. However, with regard to cases with extension to the hypoglottis, a higher incidence of cricoid infiltration (20% vs 8%, p < 0.002) for all T classes was observed. As for as those cases with neoplasias in the supraglottis are concerned, there were no patients classified T2 (0/50) with cricoid infiltration against 8% in T3 subjects (10/124). In these subjects extension to the hypoglottis led to microscopic invasion of the cricoid cartilage in a greater number of patients (31% vs 3%, p < 0.0001). These observations confirm that microscopic infiltration of the cartilagenous skeleton of the larynx, especially of the cricoid, is relatively frequent. Factor of even higher risk are occurrence in the glottis and, in all the situations examined, extension to the hypoglottis. In addition, except in cases of vestibular T2, there is a 5 to 8% possibility of microscopic infiltration of cricoid cartilage even in the absence of clinical signs of hypoglottic invasion.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma↗

PubMed1995

Rare primary signet ring carcinoma of the pancreas.

Signet ring carcinoma of the pancreas is a rare mucin-producing variant occurring in less than 1% of pancreatic carcinoma. The fourth leading cause of cancer deaths in the U.S., pancreatic carcinoma is increasing in incidence and mortality. It is difficult to detect during the early stages of the disease and usually become apparent when extrahepatic biliary obstruction occurs. Early radiologic findings may be negative and there is no well defined tumor marker for this neoplasm.

Aged↗

PubMed1995

[Multiple primary tumors in patients with laryngeal carcinoma: incidence and prognostic factors].

An a series of 1.053 treated surgically for laryngeal cancer, a noteworthy incidence of secondary tumors (S.T.) was observed. This occurrence was correlated to various oncological parameters of primitive laryngeal tumors in order to reveal any eventual predictive factors. A S.T. occurred in 80 patients (7.6%): in 22 cases (27.5%) in the upper aero-digestive tract; in 23 (28,8%) in the lungs; in 15 (18.7%) in the gastro-intestinal tract (stomach, intestines, liver, esophagus); in 9 (11.2%) in the genitourinary tract (bladder, prostate); in 4 (5%) on the skin; in 3 (3.8%) in the thyroid; in 2 (2.5%) in the skeletal system; in one case each in the nervous system and in the mediastinum (1.2% respectively). On slightly more than one half of the cases (56.3%) diagnosis was made in the first 5 years following laryngeal surgery; in 26.2% in the following 6-10 years; in 26.2% in the 17.5% after 10 years. Only in two cases (stomach and thyroid) a S.T. appear within 6 months (simultaneous S.T.). No predictive correlation was revealed with regard to site or laryngeal tumor extension; to the presence of lymph node metastases or capsular rupture. However, in patients that had undergone functional surgery, S.T. incidence was double that of those who had been treated with total laryngectomy. Furthermore, in comparing the incidence of pulmonary metastases with that of a pulmonary S.T., it appeared that these is a higher probability of occurrence of the former in cases of supraglottic carcinomas, of laterocervical lymph node metastases or of capsular rupture. This findings clearly demonstrate that during pre-operative staging and post-operative follow-up an extremely accurate clinical and instrumental examination, aimed furthermore at revealing any eventual second neoplasms which, on the basis of our observations, may strike anywhere in the body, is absolutely indispensable.

Adult↗

PubMed1991

[Invasion of the thyro-hyoid-epiglottic space by carcinoma of the vestibulum laryngis: prognostic and therapeutic implications].

Invasion of the thyro-hyoid-epiglottic (TIE) space in supraglottic carcinoma is a frequent occurrence which, in most cases, only reveals itself upon post-surgical histology. In order to verify the current feeling that subclinical invasion does not in any way worsen prognosis the authors performed a retrospective study on the oncological results of 98 patients with T1-T2 supraglottic carcinoma. Of these 67 were treated by supraglottic laryngectomy while 31, taken as controls, had undergone total laryngectomy because of contraindications of a general nature. Histological examination of the surgical samples showed signs of space invasion in 60% of the cases. In these cases, there was a higher percentage of poor results (greater than 20%; mainly T recurrence) no matter what type of surgery had been performed. Therefore, subclinical invasion of the space must be considered as having an effect on prognosis and the authors feel that, whenever the pre-operative semiological criteria are insufficient to optimize surgical results, the patients presenting subclinical invasion of the space should be subjected to complementary radiotherapy.

Adult↗

PubMed1991

Multivariate analysis of metastasis risk in laryngeal carcinoma. I. Tumor factors.

A multivariate analysis with a logistic regression model was performed in 181 cases of patients affected by laryngeal cancer, in order to evaluate the histologic tumor factors in predicting metastatic risk. The patterns used were: grading, localization, extension to the extralaryngeal structures, mode of growth. Nodal metastases are less influenced by the localization and the differentiation grade of the tumor. Cancer extended to the extralaryngeal tissues and with "infiltrating" type of growth are significantly correlated with nodal involvement. Multivariate analysis seems to be the best method to identify the exact value of each histological parameter used in prognosis of laryngeal carcinoma.

Carcinoma↗