[How to harvest and prepare cartilage for tympanoplasty].
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Cartilage↗
Biomedical subjects
S Tringali
Publications and source records attributed to S Tringali.
[Traumatic luxation of the stapes: radiology and surgical outcome].
OBJECTIVES: To describe the value of high resolution computed tomography scan (HRCT scan) in post traumatic hearing loss. METHOD: HRCT scan of the temporal bone in millimetric cut with axial and coronal views was performed. RESULTS: CT scan confirmed pneumolabyrinth with intact stapes depressed deeply into the vestibule. Surgical exploration was performed and the stapes was gently removed from the vestibule. CONCLUSION: CT scan confirmed the diagnosis and studied the stapes integrity. Hearing deteriorated postoperatively is increased in case of stapes fracture. When a luxation of the stapes into the vestibule is suspected, it is important to determine how deeply and whether it is fractured. When such a case is encountered, high resolution CT scan of the temporal bone must be performed to confirm the diagnosis and to confirm integrity of the stapes.
Audiometry↗
[Malignant triton tumor of the sinonasal tract].
INTRODUCTION: The combination of a malignant peripheral nerve sheath tumor with rhabdomyosarcomatous elements has been termed Malignant Triton Tumor (MTT). This tumor was first reported in 1932 and the prognosis was poor. Involvement of the sinonasal tract is rare with only 10 case reports. CASE: We report the case of a 80-year-old woman who presented an obstruction of the right nasal fossa which developed over several years without anosmia. She consulted because of recurrent epistaxis. The CT-scan revealed a tumor occupying the right ethmoid the right maxillary sinus and the homolateral nasal fossa. Resection was achieved via an extended mediofacial route. The histological diagnosis was low-grade schwannosarcoma with a discretely extended rhabdomyosarcomatous component, i.e. MTT. No complementary treatment was given. Eight months later, the tumor relapsed with cerebral involvement. Despite new surgery with two teams, a neurosurgical and a radiotherapy team, the tumor relapsed at the ethmoid-nasal level. After five years, the patient is alive with local progression without metastasis. DISCUSSION: MTT of the sinonasal tract is a rare disease that clinicians should be aware of and that must be included in the differential diagnosis of malignant lesions involving the sinonasal tract. Most of the reported cases involving localizations other than the ethmoidonasal cavities, are associated with von Recklinhausen neurofibromatosis and occurr in young subjects (mean age 35 years). There have however been sporadic cases, mainly in older women or after radiotherapy. The prognosis is somewhat better for ethmoidonasal localizations.
Aged↗
[Cochlear otosclerosis and pseudo fourth turn of the cochlea].
OBJECTIVE: To describe different sequences on magnetic resonance imaging (MRI) in otosclerosis with peri-cochlear involvement. METHOD: MRI T1 and T2 sequences with T1 gadolinium injection and computed tomography (CT) scans with millimetric slices on axial and coronal views were obtained. The diagnosis of bilateral otosclerosis was confirmed by surgical exploration. RESULTS: On the CT scan, there was a fourth turn of the cochlea which appeared on the MRI T1 sequence with an intermediate signal and on the T2 sequences with a high intensity signal. After gadolinium injection, there was signal enhancement, suggestive of active otospongiosis. On the CT scan, there was another lesion in front of the cochlea with endosteal involvement. This was no however visible on the MRI, even after gadolinium infusion, in accordance with inactive otospongiosis. DISCUSSION: We reviewed the literature concerning MRI and results in otosclerosis. CONCLUSION: MRI of the labyrinth with T1 sequences and gadolinium injection can be contributive to the diagnosis of otosclerosis to differentiate inactive from inactive otospongiosis. However, prospective studies must be conducted to confirm this hypothesis.
Audiometry, Pure-Tone↗
[Benign paroxysmal positional vertigo of the horizontal canal. Clinical features in 25 patients].
OBJECTIVES: To review the clinical features of benign paroxysmal positional vertigo of the horizontal canal (HC-BPPV). PATIENTS AND METHODS: Retrospective study (September 1999 to March 2001) of 25 patients with HC-BPPV. Patients complained of positional vertigo associated with direction changing horizontal positional nystagmus, either geotropic or ageotropic. RESULTS: The horizontal nystagmus was triggered in all patients when rolled to either side in a supine position (head raised 30 degrees) and in 14 patients by the Dix Hallpike manoeuvre. The nystagmus was geotropic in 15 patients and ageotropic in 10. It varies in time in 4 patients with one change in 3 (from geotropic to ageotropic in 2 and ageotropic to geotropic in 1) and 4 changes in 10 days in another patient. In one patient with head trauma, the HC-BPPV was currently associated with ipsilateral posterior canal benign paroxysmal positional vertigo (PC-BPPV), and its characteristic rotatory-up beat nystagmus. Interestingly, 4 patients had a previous history of ipsilateral PC-BPPV and in 5 others an ipsilateral PC-BPPV occurred after the HC-BPPV. Although spontaneous recovery of HC-BPPV was common in most patients, a 270 degrees "barbecue rotation" or a "prolonged position on the healthy side" was effective in some patients. CONCLUSION: Patients with positional vertigo should undergo Dix Hallpike positioning and supine lateral head turns as this latter manoeuvre is more efficient to diagnose an HC-BPPV. Both the transformation of the positional horizontal nystagmus (geotropic-ageotropic) and the association with a PC-BPPV support the diagnosis of an HC-BPPV.
Adult↗
[Attical fixation of the malleus head associated with obstruction of the round window niche by a high jugular bulb].
OBJECTIVE: To report the case of a 52 year-old-woman presenting with a left mixed hearing loss. Surgical exploration revealed an attical fixation of the malleus head associated with obliteration of the round window by a high jugular bulb. METHOD: Surgical exploration revealed this rare association. Attical fixation of the malleus head was treated by a partial prosthesis. The mobility of the chain was normal at the end of the surgical exploration but it was not possible to search for the round window sign because the niche of the round window was obliterated by an high Jugular bulb. RESULTS: Audiogram was unchanged even if CT-scan confirm the good position of the partial prosthesis. CONCLUSION: Surgical treatment of an attical fixation of the malleus head do not seem to be necessary if it is associated with a simultaneous obliteration of the round window. Indeed, obstruction of the round window by a high Jugular bulb can caused a conductive hearing loss.
Female↗
Autologous transplantation in multiple myeloma: a GITMO retrospective analysis on 290 patients. Gruppo Italiano Trapianti di Midollo Osseo.
BACKGROUND AND OBJECTIVE: Autologous transplantation is a better treatment for multiple myeloma (MM) than chemotherapy, but uncertainty remains about patient selection, optimal timing of autograft, conditioning regimen, need for a second autograft, and role of maintenance. To provide partial answers to these questions we assessed the results of autologous transplantation in a large cohort of patients whose data were reported to the GITMO registry. DESIGN AND METHODS: We retrospectively analyzed data from 290 patients with MM (M = 150; F = 140; median age 52 years, range 19-70; stage I = 34, stage II = 75, stage III = 167) reported to the GITMO. At the time of autograft, 20% were in CR, 66% in PR, while the remaining had non-responsive or progressive disease. Median time between diagnosis and transplant was 16 months (1-90). Seventy-two patients (26%) had been planned to receive a double autograft, but this was actually done in only 35 (12%). The conditioning was chemotherapy in 90%. Peripheral blood was the only source of stem cells in 94%, and purging was applied in 10% of cases. For statistical analysis of data, differences between patient subsets were analyzed using the chi-square test, while the Kaplan-Meier method was used to estimate event-free survival (EFS) and survival (OS) probabilities. The Cox model was used for multivariate analysis. RESULTS: Following the autograft, 116 patients (40%) were in CR, 144 (50%) in PR, 24 (8%) did not respond or progressed and 6 (2%) died before response evaluation. Transplant-related mortality occurred in 3%. At a median follow-up of 23 months, 223 (77%) patients are alive, 71 (24%) of them in CR, and 67 (23%) patients have died at a median time of 20 months (0-70). OS and EFS at 6 years are 47% and 28%, respectively, but the EFS curve shows no plateau. In multivariate analysis, age, beta2-microglobulin level and status at transplant emerged as significant prognostic factors for both OS and EFS, while time from diagnosis to transplant showed borderline significance. INTERPRETATION AND CONCLUSIONS: Based on the prognostic factors identified in multivariate analysis, we were able to assess the weight of a single prognostic factor or their combinations on transplant outcome. We also calculated the probability of OS and EFS by the number of factors at the time of autograft. Autologous transplantation is a safe and effective procedure, not only in sensitive patients, but also in resistant cases, provided they are <55 years of age and have low beta2-microglobulin. It should be applied early after the diagnosis of multiple myeloma, following the delivery of brief primary chemotherapy.
Adult↗
PBSC mobilization, collection and positive selection in patients with chronic lymphocytic leukemia.
We report the results of PBSC mobilization and immune selection in 17 patients with advanced chronic lymphocytic leukemia (CLL) enrolled in a multicenter Italian study of autologous transplantation with peripheral CD34+ selected cells. Mobilization was achieved by cyclophosphamide (CY) 4 g/m2 + G-CSF 5 microg/kg. CD34+ cells were positively selected by means of avidin-biotin immunoaffinity columns (Ceprate SC) or immunomagnetic beads (Isolex 300i) systems. Evaluation of minimal residual disease was performed by PCR analysis of the IgH gene rearrangment on the apheresis product before and after selection. Our results showed that after CY a median of 3.6 x 10(6)/kg (0.5-12.8) CD34+ cells were collected with a median of two aphereses in 14 out of 17 patients; three failed to mobilize a number of CD34+ cells adequate for subsequent manipulation. We found that in CR patients CD34+ cell yield per apheresis was significantly higher than in PR patients (P < 0.05). Sixteen selection procedures were performed in 13 patients. CD34+ cell recovery was 33.5% (10-85) with a median final yield of 1 x 10(6)/kg CD34+. Two patients underwent marrow collection due to the low number of CD34+ cells recovered. Final purity was 59% (range 22-94) and CD5/20+ cell depletion was 2.7 log (1.6-4.4). Our data showed a statistically higher CD34+ cell recovery and purity with the Isolex device compared to Ceprate (P < 0.01 and 0.01, respectively). All the evaluable samples remained PCR positive after selection. The main issues to be addressed in the future are the identification of patients who fail mobilization and the improvement of purging methods.
Adult↗
High-dose cyclophosphamide for mobilization of circulating stem cells in chronic myeloid leukemia.
Experimental and clinical data suggest that Ph-negative myeloid progenitor cells are present, albeit suppressed, in the bone marrow of chronic myeloid leukemia (CML) patients. These residual Ph-negative cells might, in certain circumstances, regain their proliferative advantage over the leukemic Ph-positive clone. Treating CML patients with intensive chemotherapy might allow the harvest, in the early phase of recovery, of Ph-negative stem cells to be used as graft after myeloablative regimen. In our study, 6 CML patients were admitted to a program of autograft with circulating stem cells (CSC) collected after high-dose (5 or 7 g/m2) cyclophosphamide (HD-CY) mobilization. All were autografted, using busulphan 16 mg/kg and melphalan 60 mg/m2. As graft, 4 patients received CSC only, while 2 patients were also given bone marrow, as their peripheral blood CFU-GM yield was unsatisfactory. Two previously alpha-IFN-responding patients showed a slow hematologic recovery, but achieved a marked and further reduction of their Ph-positive metaphases post-graft. Moreover, in one of them, cytogenetic analyses performed on apheresis product showed a more pronounced reduction of his Ph-positive metaphases, as compared to bone marrow samples, suggesting a potential purging effect of the mobilization procedure.
Adolescent↗
Poor circulating CFU-GM harvest and slow hematologic reconstitution in a patient with chronic granulocytic leukemia undergoing autologous transplantation.
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Adolescent↗
[Extrinsic allergic alveolitis of occupational origin: apropos of 2 cases].
Extrinsic Allergic Alveolitis (E.A.A.) is an immunological disorder caused by inhalation of various etiological agents (vegetable and animal dusts, fungi, organic simple chemicals) mostly present in work environment. Intensive and prolonged occupational exposure to antigens dimensionally able to reach peripheral airways, where they bring about their immunological effects, allows to consider hypersensitivity pneumonitis as a typical work-related disease. The wide range of pathological findings and evolution of E.A.A. often imply difficulty in diagnosis inspite of availability of diagnostic consolidated criteria. The integrated assessment of history and physical findings, radiological features, pulmonary functions tests, and specific and aspecific immunological data, often allows to make diagnostical conclusion without use of invasive methods (BAL and lung biopsy). In this note we refer two cases of E.A.A. occurred respectively in agricultural and industrial environment, whom etiological and evolutive features suggest an occupational pathogenesis. The first one is a typical "farmer's lung", the second one a hypersensitivity pneumonitis in a cheese washer. The diagnosis was performed by means of historical, clinical, radiological and pulmonary functional outcomes. In the first case specific serum precipitins against M. Faeni were present, in the second one the immunological pathogenesis of the pneumonitis was demonstrated by means of bronchial lavage cytological data and serum IgG dosage. In both cases the removal from specific antigen exposure and the prolonged steroid treatment induced symptomatological regression and complete recovery of functional tests.
Adult↗
[An annual decrement in the spirometric parameters of those employed in producing refractory materials. A longitudinal study].
Results of a longitudinal study on the yearly decline of two pulmonary parameters are reported. All subjects were workers in a refractory material factory and exposed to dust with low silica content. The study brought about an annual measurement of two spirometric parameters (VC and FEV1) during a 13 year period of follow up on 113 subjects. 56% and 57.5% of them showed annual decreases of VC and FEV1 statistically significant. The trend of the two functional parameters over time was studied both in the whole group of workers and in subgroups obtained from occupational exposure levels, smoking habit, age. The most affected volumetric index was the VC. The 3 risk indicators considered (occupational exposure, smoking habit and age) all negatively influence the VC decrease; however, the effect is statistically significant only for smoking habit. The FEV1 changes with reference to the above mentioned risk indicators are less clear. From the whole group a number of 15 losers were selected.
Adult↗
[The evaluation of the individual thermal load in work activity with uneven energy expenditure].
It is often very difficult to quantify the potential thermal stress in jobs characterized by sudden variations of energy expenditure and thermal overload for time periods of short duration. Heart rate varies rapidly with the changes of energy expenditure and thermal load and the application of the mathematical model, proposed by Givoni and Goldmann for prediction of heart rate response to work in hot environments, to values of the physiological parameter, continuously measured during the periods of work and rest, allows the calculation of the two components of the HSI stress index (Er, Emax) from which to derive safe times of exposure. In this study practical applications of the theoretical method are verified in the control of the potential thermal stress of workers engaged in the carbon coke production. In that job the variability of thermal conditions make unfeasible a complete and whole evaluation of thermal overload only based on the measure of the microclimatic environmental parameters.
Coke↗
[Decrement of respiratory function indices in a case series of workers exposed to cement dust: a longitudinal study].
Longitudinal changes in some respiratory parameters (FEV1 and VC) have been examined in a sample of cement workers (163 male subjects differently exposed to cement dusts); the subjects have been surveyed over a period of 10 years performing yearly spirometric tests (Vital capacity--VC and Forced Expiratory Volume in 1 second--FEV1 measurements). Three possible risk indicators have been considered: occupational exposure, smoking habit and age. 65.6% and 60.7% of the cases showed significant individual annual decreases of VC and FEV1 throughout the time of follow up. According to our results the occupational risk indicator has not significantly influenced the normal trend of decreases of the respiratory parameters; instead age brings about an increase of longitudinal changes of VC and smoke habit an increase of longitudinal changes of FEV1, (but only in the younger group, people less than forty years old). 16 subjects characterized by abnormal losses (more than 100 ml/year) have been selected as "VC-FEV1, losers".
Adult↗
[Assessment of risk in occupational tasks with exposure to environmental noise of variable duration and intensity].
The discontinuous exposure to environmental working noise often brings about risk situations hardly assessable by means of phonometric measurements and studying the exposure time, even if accurate. The use of the personal dosimetry can simplify the measurements and give a time-weighted value (Leq) comparable to a fixed limit value. Such a measurement is effective only for the considered time (usually a work shift); nevertheless it is assumed to be representative of the usual exposure to the job even though the variability of the working conditions constitute a limiting factor. In this work we tried to verify the possible use of the measurements of environmental sound pressure levels given by the dosimeter every 0.25 sec. The first aim being the study of the type of distribution of these values (during 5 consecutive shifts) and the estimate of mean and standard deviation values. The mean and the standard deviation values were used to get a OTL (one sided tolerance limits) usually employed for assessing the working chemical pollution. The second aim being the compliance control and the possible need of more measurements.
Environmental Monitoring↗
The short-term effects of an intervention programme on the modifications of plasma lipids in workers. The pilot study.
The purpose of the pilot study was to determine the effectiveness of a medical intervention program in the reduction of plasma lipids in a group of hyperlipemic persons. Two groups were compared in this study over a one year period. The groups consisted of a group of hyperlipemic persons with TG levels greater than 150 mg% and a second group with plasma lipids within normal limits. The plasma lipids concerned in this study were cholesterol, triglycerides, and HDL-C. The group of hyperlipemic subjects received intense nutritional counselling while the normal subjects received only printed guidelines to normal healthy nutrition. The results of this study, confirm positive results obtained by other intervention programs. A substantial reduction in TG levels was observed in 37.7% of the hyperlipemic group while 14.1% of the normal group had considerable increases in their TG levels during this one year study period. The results of the serum lipid surveys proved the high interyear correlation for both HDL-C and TC, but a very much weak interyear correlation for TG.
Body Weight↗
Serum lipids and lipoproteins in relation to smoking among the apparently healthy workers: a preliminary survey. The Pavia Study.
This pilot study is concerned mainly with the interrelationships between serum lipids and lipoproteins, and personal variables like age, body mass index (BMI) and smoking habit. The analysis was limited to the male workers employed in the Lombardia region. The results of the study confirm the findings of the other investigators on the interaction between smoking and lipid metabolism. The effect of smoking on the cholesterol level appeared to have been the most pronounced and the clear strong relationship with the exposure was established. Also triglycerides concentration was related to the smoking exposure. The HDL lipoproteins were lower and LDL-VLDL higher in smokers than in nonsmokers, however, the association with the smoking exposure was insignificant. The findings showed that HDL-cholesterol level was inversely dependent on the plasma triglycerides both in nonsmokers and smokers. The paper discusses the implications of the research carried out on the interpretation of the HDL-cholesterol values as a eventual potential risk factor for the coronary heart disease.
Age Factors↗
[Phenomenon of occupational accidents in hospitals: a retrospective study with reference to introduction of preventive measures and safety specified by D.Lgs 626/94].
The work analyzes the phenomenon of the professional accidents in the Policlinico S. Matteo in Pavia, in the quadrenium 1995-1998 to appraise the effects of the application of the D. Lgs 626/94. The obtained data highlight an aggregative diminution of the number of accidents in the biennium 1997-1998 in comparison with the previous biennium 1995-1996. The reduction of the phenomenon of professional accidents is linked substantially with a diminution of the number of accidents with biologic risk. In the quadrennium considered no case of serum conversion has been recorded. It doesn't result significantly altered the number of events of professional accidents linked with the manual handling of loads and with different traumatisms without biological risk. It is highlighted the necessity of more and more close collaboration between the operators of the prevention and the workers.
Accidents, Occupational↗