Domenico M Testa - Academia.edu (original) (raw)
Papers by Domenico M Testa
Otolaryngology-Head and Neck Surgery, Aug 1, 2012
Current Pediatric Research, 2017
Recent national guidelines published in Italy on the appropriateness of tonsillectomy, as well as... more Recent national guidelines published in Italy on the appropriateness of tonsillectomy, as well as studies specifically devoted to the safety of surgical techniques in tonsillectomy, have supplied particularly rigid addresses on this topic, that appear to be in contrast with
Annali italiani di chirurgia, 2020
AIM In the last twenty years, the statement of the CO2 laser in laryngeal microsurgery has proved... more AIM In the last twenty years, the statement of the CO2 laser in laryngeal microsurgery has proved particularly useful in the surgical treatment of laryngotracheal stenosis. The Authors report their surgical experiences and discuss them considering the location, size and pathologic features of the disease. The aim of this study was to evaluate the results that may be obtained in the treatment of laryngotracheal stenosis by endoscopy using the CO2 laser, and analyze the advantages and limitations of surgical methods implemented. MATERIAL OF STUDY It includes 128 patients treated from 1981 to 2016 by endoscopy using the CO2 laser. RESULTS The healing occurred in 121 of the 128 patients (94.5%); in the remaining 7 cases (5.5%) - 4 subjects (3.1%) with supraglottic cicatricial stenosis and 3 patients (2.3%) with widespread laryngotracheal stenosis - it had to integrate the technique of endoscopic surgery with a traditional surgery of recovery. In particular, it has observed as follows: I...
Molecular Therapy - Nucleic Acids, 2020
Laryngeal cancer (LCa), a neoplasm of the head and neck region, is a leading cause of death world... more Laryngeal cancer (LCa), a neoplasm of the head and neck region, is a leading cause of death worldwide. Surgical intervention remains the mainstay of LCa treatment, but a crucial point is represented by the possible nodal involvement. Therefore, it is urgently needed to develop biomarkers and therapeutic tools able to drive treatment approaches for LCa. In this study, we investigated deregulated microRNAs (miRNAs) in tissues from LCa patients with either lymph node metastases (N+) or not (NÀ). miRNA expression profiling was performed by a comprehensive PCR array and subsequent validation by RT-qPCR. Results showed a significant decrease of miR-449a expression in N+ compared to NÀ patients, and miR-133b down-modulation in LCa tissues compared to paired normal ones. Receiver operating characteristic (ROC) curve analysis revealed the potential diagnostic power of miR-133b for LCa detection. According to the validation results, we selected miR-449a for further in vitro studies. Ectopic miR-449a expression in the LCa cell line Hep-2 inhibited invasion and motility in vitro, slowed cell proliferation, and induced the downregulation of Notch1 and Notch2 as direct targets of miR-449a. Collectively, this study provides new promising biomarkers for LCa diagnosis and a new opportunity to use miR-449a for the treatment of nodal metastases in LCa patients.
Archives of Otorhinolaryngology-Head & Neck Surgery, 2018
Adenotonsillar disease and the surgical treatments reveal that this condition may still raise con... more Adenotonsillar disease and the surgical treatments reveal that this condition may still raise concerns leading to the formulation of several guidelines [1,2], particularly in relation to potential post-operative complications [3]. Studies in literature present no uniform results regarding the general frequency of post-tonsillectomy haemorrhage [3] and the possible relationship between the type of surgical technique employed and the rate of haemorrhagic complications [4,5]. Post-tonsillectomy bleeding represents one of the most feared complications and constitutes an important cause of medical-legal dispute in otolaryngologic field [6]. Recent national guidelines on the appropriateness of tonsillectomy [7], as well as the studies specifically devoted to the safety of surgical techniques in tonsillectomy [8-12], give particularly rigid addresses that appear to be in contrast with some clinical research data [8,10,13,14] and that deserve a greater critical examination. The present study has set out to verify the frequency of post-tonsillectomy haemorrhagic complications and the possible differences in post-tonsillectomy haemorrhage rate according to the most employed surgical techniques. Materials and Methods A MEDLINE inquiry was carried out using PubMed, Scopus, and Inter-Wiley as database, inserting the keywords "post-tonsillectomy haemorrhage" and "post-tonsillectomy bleeding", and restricting the research to the studies published between 2000 and 2015. In total, 231 studies were identified. From these, the multi-centric English language papers were extrapolated, in which the three most commonly used dissection and haemostasis techniques [15] were analysed: cold dissection with cold haemostasis (CD/CH), in which the tonsillar dissection is achieved by the use of cold traditional instruments (scalpel, scissors, scaler) and the haemostasis is obtained by compression and ligature of blood vessels; cold dissection with hot haemostasis (CD/HH), in which the cold steel dissection is in combination with diathermy for haemostasis; hot dissection with hot haemostasis (HD/HH), in which the dissection and haemostasis are achieved by diathermy. The examined studies analysed such surgical techniques in relation to the percentage of post-surgical haemorrhage primary (occurring within the first 24 hours after surgery), secondary (occurring after 24 hours from surgery), and total, regardless of whether it had been necessary to return to the theatre to stop the bleeding.
BioMetals, 2018
Previous literature has highlighted the mechanisms of molecular toxicity induced by substances su... more Previous literature has highlighted the mechanisms of molecular toxicity induced by substances such as arsenic, cadmium, chromium, nickel, lead, barium and PCBs. The research was carried out on 20 volunteers, all the patients gave their consent to the research: the aim of the study was to evaluate the presence of metals and PCBs in these different matrices (blood and hair), correlating the biochemical data to pathological conditions present, and also to the area in which patients resided. Various quantitative determinations were carried out on samples of blood and hair for 14 heavy metals and on blood samples for 12 PCBs. For the 11 patients the results indicated that Keywords Heavy metals Á PCB Á Oncogenesis Á Head and neck tumors V. Petrosino (&)
Open Medicine, 2015
Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, gland... more Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and leftsided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, ...
Aging Clinical and Experimental Research, 2016
Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of po... more Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of population and has a significant effect on quality of life. In these patients, rhinosinusitis is linked to immune functions changes with age and to mucosal paraphysiological alterations such as crusting formations with atrophic epithelium, variations of nasal airflow and modifications of the mucociliary clearance. Failure of medical treatments leads to surgery in patients with persistent symptoms and radiographic signs of CRS. The choice of appropriate post-surgical topic treatments is important for healing time and for preventing mucosal complications such as synechiae, crusting formation and atrophy with secondary bacterial and fungal infections. Defining the effects of topic alpha-tocopherol acetate administration on nasal mucosa healing after endoscopic sinus surgery in CRS of elderly patients. In this study were included 32 patients, mean age 68.6, who underwent FESS because affected by CRS not responsive to medical treatments. After surgical treatment, we distinguish two groups basing on local nasal therapy. We investigated, in the postoperative time, the role of alpha-tocopherol acetate compared to gomenol oil. Follow-up was performed at 7-15 days and 1-3 months after surgery. We evaluated mucosal restoration using Rhinoscopy Sum Score and quality of life using Nasal Six Items Symptom Questionnaire. We observed a faster healing time and less recurrence of complications in patients who underwent topic treatment with alpha-tocopherol acetate. In our research, we observed that alpha-tocopherol acetate has no contraindications and side effects. Our study showed the effectiveness of alpha-tocopherol acetate topic treatment in elderly patients affected by CRS after FESS, in improving and speeding up the process of restoring the sinonasal mucosa, compared to another topic medication.
Open Medicine, 2016
Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hem... more Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hemotologic diseases. They are rarely seen to occur simultaneously in one individual patient. Here we demonstrate a case of HS associated with CML in this study. The patient is a young female, diagnosed with HS in 2005, and was given partial embolization of the splenic artery. She got significant remission after the procedure. In 2008, she was found abnormal in blood routine test, after bone marrow routine, chromosome and fusion gene tests, she was diagnosed with CML (chronic phase). She did not receive regular treatment until 3 months prior, and is currently being treated with Dasatimib. She achieved hematological remission, but had no significant improvement in chromosome and fusion gene figures. Due to her severe condition of hemolysis, a splenectomy or an allogeneic hematopoietic stem cell transplantation is considered.
BMC Research Notes, 2015
Background: This study aims at verifying relationships between the perception of medico-legal ris... more Background: This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Italian otolaryngologists, defensive medical behaviour and their understanding of professional liability insurance in matters of civil liability. One hundred specialists replied to a questionnaire pertaining to the psychological impact of medico-legal issues and to specific queries regarding insurance coverage, either privately stipulated or provided by the employer. Statistic analysis was carried out by χ 2 test and ANOVA multiple variance regression test, assuming P = 0.05 as the value of minimum statistical significance. Results: It was found that in 50 % of cases the behaviour of the doctor towards the patient had been decidedly influenced by concerns over medico-legal implications. In 29 % of the sample these concerns had "often to always" influenced the choice of diagnostic procedures or treatment options, in order to safeguard themselves in case of legal dispute. The data obtained showed a statistically significant correlation between the level of concern (regarding potential medico-legal disputes) experienced by specialists on the one hand and variations in the doctor/patient relationship (P < 0.05) and the choice of defensive medical procedures (P < 0.05) on the other. Furthermore, the perception of the medico-legal problem was statistically related to the absence or poor knowledge of some insurance clauses, regarding posthumous coverage (72 %), informed written consent (89 %), and the coverage provided by the healthcare centre where the specialist is employed (32 %) (P < 0.05). Conclusions: The results of this study indicate the necessity for a greater awareness of the actual guarantees provided by the insurance policy stipulated by specialists, to avoid inadequate coverage in the case of medico-legal disputes.
The Open Otorhinolaryngology Journal, 2011
The human saccule has preserved the ancestral ability to respond to high-intensity acoustic stimu... more The human saccule has preserved the ancestral ability to respond to high-intensity acoustic stimulations, generating a contraction reflex of the cervical tract muscles. Recording the muscular bioelectric potentials following saccular stimulation allows the evidence of the vestibular-evoked myogenic potentials (VEMPs). The aim of this study was to record VEMPs in alert and anesthetized guinea pigs to evaluate the possible different impacts of some anesthetic drugs on VEMP recording. Sixteen guinea pigs, divided into four groups, were employed for the study. Each group underwent general anesthesia induced using different pharmacological regimens; auditory and vestibular functions were examined with Auditory Brain Response (ABR) and VEMP methods. The analysis of the results showed that the VEMPs recording performance was strictly related to the alert status of the guinea pigs: VEMPs were not recordable during anesthesia while reappeared at awakening, with the same temporal and morphological characteristics of pre-anesthesia. ABR was instead normally present during anesthesia without showing any differences with all the various anesthetic drugs employed. These results prompted us to conclude that anesthetic drugs cause the disappearance of saccular reflex in guinea pigs, not minding the specific type of drugs employed. This evidence, in agreement with the data available in literature for humans, induces and encourages future studies about sacculocollic reflex and its possible application in clinical practice.
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2001
Classification of laryngeal dysplasia, the most appropriate treatments and criteria for evaluatio... more Classification of laryngeal dysplasia, the most appropriate treatments and criteria for evaluation of the results is still a highly controversial issue. The objectives of the present study on the treatment of laryngeal dysplasia lesions are to: 1) evaluate the relative incidence of the various forms of dysplasia in relation to grading of the histopathological findings; 2) establish the prognosis for the various forms of dysplasia considered; 3) determine the results achieved by the author's treatment protocol according to the characteristics of the dysplasia; 4) critically evaluate the classifications of laryngeal dysplasia found in the literature in view of the results of the present study. The study involved 141 patients with vocal cord dysplasia (134 men, 7 women; mean age: 56.2 years) who had come under observation at the E.N.T. Dept. of the University of Naples "Federico II" between January 1981 and April 1998. In all cases the dysplasia was removed by CO2 laser m...
The Laryngoscope, 2001
Background The inflammatory cells documented in chronic otitis media with effusion (OME) spontane... more Background The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense.Purpose To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME).Subjects and Intervention Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2‐minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment.Results Three months after therapy improvement had occurred in 66.6% of patients in the GSH‐treated group and in 8% of the control subjects (P <.01).Conclusi...
Surgery for Obesity and Related Diseases, 2016
Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. E... more Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. Objectives: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. Setting: University Hospital, Division of Bariatric and ENT Surgery, in Italy. Methods: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. Results: All patients completed the 5-year follow-up. A significant (P o .001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 Ϯ 1.7 to 5.8 Ϯ 1.2 (P o.001), 4.9 Ϯ 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. Conclusion: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
Otolaryngology -- Head and Neck Surgery, 2012
International Journal of Surgery, 2014
Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant e... more Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its usual final position in pre-tracheal region of the neck. Its specific prevalence accounts about 1 case per 100.000e300.000 persons and one in 4.000e8.000 patients with thyroid disease show this condition. The cause of this defect is not fully known. Despite genetic factors have been associated with thyroid gland morphogenesis and differentiation, just recently some mutation has been associated with human thyroid ectopy. Lingual region in the most common site of thyroid ectopy but ectopic thyroid tissue were found in other head and neck locations. Nevertheless, aberrant ectopic thyroid tissue has been found in other places distant from the neck region. Ectopic tissue is affected by different pathological changes that occur in the normal eutopic thyroid. Patients may present insidiously or as an emergency. Diagnostic management of thyroid ectopy is performed by radionuclide thyroid imaging, ultrasonography, CT scan, MRI, biopsy and thyroid function tests. Asymptomatic euthyroid patients with ectopic thyroid do not usually require therapy but are kept under observation. For those with symptoms, treatment depends on size of the gland, nature of symptoms, thyroid function status and histological findings. Surgical excision is often required as treatment for this condition.
International Journal of Surgery, 2014
The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common f... more The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection.
The Laryngoscope, 2001
Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic d... more Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon‐γ (IFN‐γ) and interleukin‐4 (IL‐4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T‐cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL‐4 in T‐cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNγ and IL‐4 that occurs in vivo in anti‐H2–treated patients with allergic rhinitis (AR).Methods Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment.Results A comparison of the serum cytokine values recorded before and after anti‐H2 treatment show...
Head & Neck, 2005
Background. The aim of the study was to assess the effectiveness of CO 2 laser endoscopic surgery... more Background. The aim of the study was to assess the effectiveness of CO 2 laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions. Methods. Seven hundred nineteen patients (687 men and 32 women; mean age, 60.4 years; range, 33-86 years) with glottic carcinoma (432 T1N0M0, 236 T2N0M0, 51 T3N0M0) underwent CO 2 laser surgery (mean follow-up, 5 years; range, 2-17 years). Statistical comparison was carried out with Wilcoxon test, considering p < .05 the minimum significance value. Results. Overall actuarial survival, adjusted actuarial survival, and percentage of patients with no evidence of disease at 5 years were 85%, 97%, and 85%, respectively, in patients with T1a disease; 84%, 96%, and 83% in those with T1b disease; 77%, 86%, and 61% in those with T2 unilateral tumors; 77%, 88%, and 55% in those with T2 bilateral tumors; and 64%, 72%, and 60% in those with T3 disease. The statistical analysis showed the following: significant differences in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01), with the exception of no evidence of disease in the comparison of T2 versus T3 (p > .05); and no significant differences in the comparison of unilateral and bilateral tumors (p > .05). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 85%, 98%, and 99%, respectively, in patients with T1 disease; and 66%, 82%, and 91% in patients with T2 disease; and 66%, 83%, and 95% in patients with T3 disease. The laryngeal preservation rate was 97.3% in the T1 group, 82.5% in the T2 group, and 80.5% in T3 group. Conclusions. CO 2 laser endoscopic surgery is effective in the treatment of glottic carcinoma not infiltrating the cartilaginous skeleton; the results achieved are competitive with those of open conservative operations, if we take into account the possibilities afforded by salvage surgery and the rate of laryngeal preservation achieved in the study patients.
Otolaryngology-Head and Neck Surgery, Aug 1, 2012
Current Pediatric Research, 2017
Recent national guidelines published in Italy on the appropriateness of tonsillectomy, as well as... more Recent national guidelines published in Italy on the appropriateness of tonsillectomy, as well as studies specifically devoted to the safety of surgical techniques in tonsillectomy, have supplied particularly rigid addresses on this topic, that appear to be in contrast with
Annali italiani di chirurgia, 2020
AIM In the last twenty years, the statement of the CO2 laser in laryngeal microsurgery has proved... more AIM In the last twenty years, the statement of the CO2 laser in laryngeal microsurgery has proved particularly useful in the surgical treatment of laryngotracheal stenosis. The Authors report their surgical experiences and discuss them considering the location, size and pathologic features of the disease. The aim of this study was to evaluate the results that may be obtained in the treatment of laryngotracheal stenosis by endoscopy using the CO2 laser, and analyze the advantages and limitations of surgical methods implemented. MATERIAL OF STUDY It includes 128 patients treated from 1981 to 2016 by endoscopy using the CO2 laser. RESULTS The healing occurred in 121 of the 128 patients (94.5%); in the remaining 7 cases (5.5%) - 4 subjects (3.1%) with supraglottic cicatricial stenosis and 3 patients (2.3%) with widespread laryngotracheal stenosis - it had to integrate the technique of endoscopic surgery with a traditional surgery of recovery. In particular, it has observed as follows: I...
Molecular Therapy - Nucleic Acids, 2020
Laryngeal cancer (LCa), a neoplasm of the head and neck region, is a leading cause of death world... more Laryngeal cancer (LCa), a neoplasm of the head and neck region, is a leading cause of death worldwide. Surgical intervention remains the mainstay of LCa treatment, but a crucial point is represented by the possible nodal involvement. Therefore, it is urgently needed to develop biomarkers and therapeutic tools able to drive treatment approaches for LCa. In this study, we investigated deregulated microRNAs (miRNAs) in tissues from LCa patients with either lymph node metastases (N+) or not (NÀ). miRNA expression profiling was performed by a comprehensive PCR array and subsequent validation by RT-qPCR. Results showed a significant decrease of miR-449a expression in N+ compared to NÀ patients, and miR-133b down-modulation in LCa tissues compared to paired normal ones. Receiver operating characteristic (ROC) curve analysis revealed the potential diagnostic power of miR-133b for LCa detection. According to the validation results, we selected miR-449a for further in vitro studies. Ectopic miR-449a expression in the LCa cell line Hep-2 inhibited invasion and motility in vitro, slowed cell proliferation, and induced the downregulation of Notch1 and Notch2 as direct targets of miR-449a. Collectively, this study provides new promising biomarkers for LCa diagnosis and a new opportunity to use miR-449a for the treatment of nodal metastases in LCa patients.
Archives of Otorhinolaryngology-Head & Neck Surgery, 2018
Adenotonsillar disease and the surgical treatments reveal that this condition may still raise con... more Adenotonsillar disease and the surgical treatments reveal that this condition may still raise concerns leading to the formulation of several guidelines [1,2], particularly in relation to potential post-operative complications [3]. Studies in literature present no uniform results regarding the general frequency of post-tonsillectomy haemorrhage [3] and the possible relationship between the type of surgical technique employed and the rate of haemorrhagic complications [4,5]. Post-tonsillectomy bleeding represents one of the most feared complications and constitutes an important cause of medical-legal dispute in otolaryngologic field [6]. Recent national guidelines on the appropriateness of tonsillectomy [7], as well as the studies specifically devoted to the safety of surgical techniques in tonsillectomy [8-12], give particularly rigid addresses that appear to be in contrast with some clinical research data [8,10,13,14] and that deserve a greater critical examination. The present study has set out to verify the frequency of post-tonsillectomy haemorrhagic complications and the possible differences in post-tonsillectomy haemorrhage rate according to the most employed surgical techniques. Materials and Methods A MEDLINE inquiry was carried out using PubMed, Scopus, and Inter-Wiley as database, inserting the keywords "post-tonsillectomy haemorrhage" and "post-tonsillectomy bleeding", and restricting the research to the studies published between 2000 and 2015. In total, 231 studies were identified. From these, the multi-centric English language papers were extrapolated, in which the three most commonly used dissection and haemostasis techniques [15] were analysed: cold dissection with cold haemostasis (CD/CH), in which the tonsillar dissection is achieved by the use of cold traditional instruments (scalpel, scissors, scaler) and the haemostasis is obtained by compression and ligature of blood vessels; cold dissection with hot haemostasis (CD/HH), in which the cold steel dissection is in combination with diathermy for haemostasis; hot dissection with hot haemostasis (HD/HH), in which the dissection and haemostasis are achieved by diathermy. The examined studies analysed such surgical techniques in relation to the percentage of post-surgical haemorrhage primary (occurring within the first 24 hours after surgery), secondary (occurring after 24 hours from surgery), and total, regardless of whether it had been necessary to return to the theatre to stop the bleeding.
BioMetals, 2018
Previous literature has highlighted the mechanisms of molecular toxicity induced by substances su... more Previous literature has highlighted the mechanisms of molecular toxicity induced by substances such as arsenic, cadmium, chromium, nickel, lead, barium and PCBs. The research was carried out on 20 volunteers, all the patients gave their consent to the research: the aim of the study was to evaluate the presence of metals and PCBs in these different matrices (blood and hair), correlating the biochemical data to pathological conditions present, and also to the area in which patients resided. Various quantitative determinations were carried out on samples of blood and hair for 14 heavy metals and on blood samples for 12 PCBs. For the 11 patients the results indicated that Keywords Heavy metals Á PCB Á Oncogenesis Á Head and neck tumors V. Petrosino (&)
Open Medicine, 2015
Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, gland... more Hemangiomas are benign tumors originating in the vascular tissues of skin, mucosa, muscles, glands, and bones. Although these tumors are common lesions of the head and neck, they rarely occur in the nasal cavity and paranasal sinuses. Cavernous haemangioma of the lateral wall of the nasopharynx has not previously been reported. We examined the clinical, radiological and therapeutic management of cavernous haemangioma of nasopharynx starting from a clinical case of a 26-year-old woman with a history of recurrent and conspicuous epistaxis and leftsided nasal associated severe obstruction. Nasopharynx examination, by flexible endoscopy, showed a cystic mass borne by the left side wall of the nasopharynx, in contact with the soft palate, covered by intact and regular mucosa. Contrast-enhanced computed tomography (CT) scan, confirmed these findings and showed contextual lamellar calcifications and inhomogeneous enhancement. The nasal endoscopic approach (FESS), under general anesthesia, ...
Aging Clinical and Experimental Research, 2016
Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of po... more Chronic rhinosinusitis (CRS) in European country ranges in elderly patients from 4.5 to 12% of population and has a significant effect on quality of life. In these patients, rhinosinusitis is linked to immune functions changes with age and to mucosal paraphysiological alterations such as crusting formations with atrophic epithelium, variations of nasal airflow and modifications of the mucociliary clearance. Failure of medical treatments leads to surgery in patients with persistent symptoms and radiographic signs of CRS. The choice of appropriate post-surgical topic treatments is important for healing time and for preventing mucosal complications such as synechiae, crusting formation and atrophy with secondary bacterial and fungal infections. Defining the effects of topic alpha-tocopherol acetate administration on nasal mucosa healing after endoscopic sinus surgery in CRS of elderly patients. In this study were included 32 patients, mean age 68.6, who underwent FESS because affected by CRS not responsive to medical treatments. After surgical treatment, we distinguish two groups basing on local nasal therapy. We investigated, in the postoperative time, the role of alpha-tocopherol acetate compared to gomenol oil. Follow-up was performed at 7-15 days and 1-3 months after surgery. We evaluated mucosal restoration using Rhinoscopy Sum Score and quality of life using Nasal Six Items Symptom Questionnaire. We observed a faster healing time and less recurrence of complications in patients who underwent topic treatment with alpha-tocopherol acetate. In our research, we observed that alpha-tocopherol acetate has no contraindications and side effects. Our study showed the effectiveness of alpha-tocopherol acetate topic treatment in elderly patients affected by CRS after FESS, in improving and speeding up the process of restoring the sinonasal mucosa, compared to another topic medication.
Open Medicine, 2016
Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hem... more Hereditary spherocytosis (HS) and Chronic myelocytic leukemia (CML) are both life threatening hemotologic diseases. They are rarely seen to occur simultaneously in one individual patient. Here we demonstrate a case of HS associated with CML in this study. The patient is a young female, diagnosed with HS in 2005, and was given partial embolization of the splenic artery. She got significant remission after the procedure. In 2008, she was found abnormal in blood routine test, after bone marrow routine, chromosome and fusion gene tests, she was diagnosed with CML (chronic phase). She did not receive regular treatment until 3 months prior, and is currently being treated with Dasatimib. She achieved hematological remission, but had no significant improvement in chromosome and fusion gene figures. Due to her severe condition of hemolysis, a splenectomy or an allogeneic hematopoietic stem cell transplantation is considered.
BMC Research Notes, 2015
Background: This study aims at verifying relationships between the perception of medico-legal ris... more Background: This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Italian otolaryngologists, defensive medical behaviour and their understanding of professional liability insurance in matters of civil liability. One hundred specialists replied to a questionnaire pertaining to the psychological impact of medico-legal issues and to specific queries regarding insurance coverage, either privately stipulated or provided by the employer. Statistic analysis was carried out by χ 2 test and ANOVA multiple variance regression test, assuming P = 0.05 as the value of minimum statistical significance. Results: It was found that in 50 % of cases the behaviour of the doctor towards the patient had been decidedly influenced by concerns over medico-legal implications. In 29 % of the sample these concerns had "often to always" influenced the choice of diagnostic procedures or treatment options, in order to safeguard themselves in case of legal dispute. The data obtained showed a statistically significant correlation between the level of concern (regarding potential medico-legal disputes) experienced by specialists on the one hand and variations in the doctor/patient relationship (P < 0.05) and the choice of defensive medical procedures (P < 0.05) on the other. Furthermore, the perception of the medico-legal problem was statistically related to the absence or poor knowledge of some insurance clauses, regarding posthumous coverage (72 %), informed written consent (89 %), and the coverage provided by the healthcare centre where the specialist is employed (32 %) (P < 0.05). Conclusions: The results of this study indicate the necessity for a greater awareness of the actual guarantees provided by the insurance policy stipulated by specialists, to avoid inadequate coverage in the case of medico-legal disputes.
The Open Otorhinolaryngology Journal, 2011
The human saccule has preserved the ancestral ability to respond to high-intensity acoustic stimu... more The human saccule has preserved the ancestral ability to respond to high-intensity acoustic stimulations, generating a contraction reflex of the cervical tract muscles. Recording the muscular bioelectric potentials following saccular stimulation allows the evidence of the vestibular-evoked myogenic potentials (VEMPs). The aim of this study was to record VEMPs in alert and anesthetized guinea pigs to evaluate the possible different impacts of some anesthetic drugs on VEMP recording. Sixteen guinea pigs, divided into four groups, were employed for the study. Each group underwent general anesthesia induced using different pharmacological regimens; auditory and vestibular functions were examined with Auditory Brain Response (ABR) and VEMP methods. The analysis of the results showed that the VEMPs recording performance was strictly related to the alert status of the guinea pigs: VEMPs were not recordable during anesthesia while reappeared at awakening, with the same temporal and morphological characteristics of pre-anesthesia. ABR was instead normally present during anesthesia without showing any differences with all the various anesthetic drugs employed. These results prompted us to conclude that anesthetic drugs cause the disappearance of saccular reflex in guinea pigs, not minding the specific type of drugs employed. This evidence, in agreement with the data available in literature for humans, induces and encourages future studies about sacculocollic reflex and its possible application in clinical practice.
Acta otorhinolaryngologica Italica : organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 2001
Classification of laryngeal dysplasia, the most appropriate treatments and criteria for evaluatio... more Classification of laryngeal dysplasia, the most appropriate treatments and criteria for evaluation of the results is still a highly controversial issue. The objectives of the present study on the treatment of laryngeal dysplasia lesions are to: 1) evaluate the relative incidence of the various forms of dysplasia in relation to grading of the histopathological findings; 2) establish the prognosis for the various forms of dysplasia considered; 3) determine the results achieved by the author's treatment protocol according to the characteristics of the dysplasia; 4) critically evaluate the classifications of laryngeal dysplasia found in the literature in view of the results of the present study. The study involved 141 patients with vocal cord dysplasia (134 men, 7 women; mean age: 56.2 years) who had come under observation at the E.N.T. Dept. of the University of Naples "Federico II" between January 1981 and April 1998. In all cases the dysplasia was removed by CO2 laser m...
The Laryngoscope, 2001
Background The inflammatory cells documented in chronic otitis media with effusion (OME) spontane... more Background The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense.Purpose To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME).Subjects and Intervention Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2‐minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment.Results Three months after therapy improvement had occurred in 66.6% of patients in the GSH‐treated group and in 8% of the control subjects (P <.01).Conclusi...
Surgery for Obesity and Related Diseases, 2016
Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. E... more Background: Obstructive sleep apnea syndrome (OSAS) is prevalent among morbidly obese patients. Evaluation of the specific effects of sleeve gastrectomy (SG) on upper airway function has not been reported. Given the possibility that some patients will not respond despite weight loss, no studies have investigated whether other mechanisms may be responsible for persistent OSAS after bariatric surgery. Objectives: To evaluate by subjective and objective assessment the impact of SG on upper respiratory physiology in the long-term. Setting: University Hospital, Division of Bariatric and ENT Surgery, in Italy. Methods: Thirty-six consecutive patients with OSAS who underwent laparoscopic SG were prospectively enrolled. The effect of SG on respiratory function and OSAS was followed for 5 years. Results: All patients completed the 5-year follow-up. A significant (P o .001) improvement in modified Epworth Sleepiness Scale questionnaire (ESS) was obtained in 91.6% (33/36) of patients. The Apnea/Hypopnea index (AHI) improved in 80.6% (29/36) of patients after surgery (from 32.8 Ϯ 1.7 to 5.8 Ϯ 1.2 (P o.001), 4.9 Ϯ 1.7). The remaining 19.4% (7/36) of patients with a positive ESS and/or AHI all had an associated respiratory resistance due to nasal obstructive diseases. Conclusion: SG improved OSAS overall, but patients who did not improve or only partially improved despite weight loss were found to have an associated nasal responsible pathology. How these patients will respond to nasal surgery and whether a 2-step procedure should be recommended for OSAS patients requires further study.
Otolaryngology -- Head and Neck Surgery, 2012
International Journal of Surgery, 2014
Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant e... more Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its usual final position in pre-tracheal region of the neck. Its specific prevalence accounts about 1 case per 100.000e300.000 persons and one in 4.000e8.000 patients with thyroid disease show this condition. The cause of this defect is not fully known. Despite genetic factors have been associated with thyroid gland morphogenesis and differentiation, just recently some mutation has been associated with human thyroid ectopy. Lingual region in the most common site of thyroid ectopy but ectopic thyroid tissue were found in other head and neck locations. Nevertheless, aberrant ectopic thyroid tissue has been found in other places distant from the neck region. Ectopic tissue is affected by different pathological changes that occur in the normal eutopic thyroid. Patients may present insidiously or as an emergency. Diagnostic management of thyroid ectopy is performed by radionuclide thyroid imaging, ultrasonography, CT scan, MRI, biopsy and thyroid function tests. Asymptomatic euthyroid patients with ectopic thyroid do not usually require therapy but are kept under observation. For those with symptoms, treatment depends on size of the gland, nature of symptoms, thyroid function status and histological findings. Surgical excision is often required as treatment for this condition.
International Journal of Surgery, 2014
The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common f... more The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection.
The Laryngoscope, 2001
Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic d... more Objectives/Hypothesis Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon‐γ (IFN‐γ) and interleukin‐4 (IL‐4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T‐cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL‐4 in T‐cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNγ and IL‐4 that occurs in vivo in anti‐H2–treated patients with allergic rhinitis (AR).Methods Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment.Results A comparison of the serum cytokine values recorded before and after anti‐H2 treatment show...
Head & Neck, 2005
Background. The aim of the study was to assess the effectiveness of CO 2 laser endoscopic surgery... more Background. The aim of the study was to assess the effectiveness of CO 2 laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions. Methods. Seven hundred nineteen patients (687 men and 32 women; mean age, 60.4 years; range, 33-86 years) with glottic carcinoma (432 T1N0M0, 236 T2N0M0, 51 T3N0M0) underwent CO 2 laser surgery (mean follow-up, 5 years; range, 2-17 years). Statistical comparison was carried out with Wilcoxon test, considering p < .05 the minimum significance value. Results. Overall actuarial survival, adjusted actuarial survival, and percentage of patients with no evidence of disease at 5 years were 85%, 97%, and 85%, respectively, in patients with T1a disease; 84%, 96%, and 83% in those with T1b disease; 77%, 86%, and 61% in those with T2 unilateral tumors; 77%, 88%, and 55% in those with T2 bilateral tumors; and 64%, 72%, and 60% in those with T3 disease. The statistical analysis showed the following: significant differences in the comparison of T1 versus T2 and T2 versus T3 tumors (p < .01), with the exception of no evidence of disease in the comparison of T2 versus T3 (p > .05); and no significant differences in the comparison of unilateral and bilateral tumors (p > .05). Actuarial local control, actuarial nodal control, and actuarial distant metastasis control at 5 years were 85%, 98%, and 99%, respectively, in patients with T1 disease; and 66%, 82%, and 91% in patients with T2 disease; and 66%, 83%, and 95% in patients with T3 disease. The laryngeal preservation rate was 97.3% in the T1 group, 82.5% in the T2 group, and 80.5% in T3 group. Conclusions. CO 2 laser endoscopic surgery is effective in the treatment of glottic carcinoma not infiltrating the cartilaginous skeleton; the results achieved are competitive with those of open conservative operations, if we take into account the possibilities afforded by salvage surgery and the rate of laryngeal preservation achieved in the study patients.