INQUADRAMENTO CLINICO E MANAGEMENT DELLO SCHWANNOMA ESCLUSIVAMENTE INTRALABIRINTICO

Lo schwannoma intralabirintico (SIL) è un raro tumore benigno (prevalenza 0.1-0.4%) che origina dalle cellule di Schwann situate a ridosso della giunzione cito-neurale dell’VIII n.c. I sintomi clinici includono ipoacusia neurosensoriale monolaterale progressiva (95%), acufeni (51%), disequilibrio (35%), vertigine (22%), fullness (2%). Alla risonanza magnetica (RM) il tumore si presenta come una massa circoscritta, iperintensa in T1, ipointensa in T2 e con enhancement dopo gadolinio nelle immagini T1-pesate. Il management prevede in prima istanza osservazioni seriali con RM “wait and scan approach”. La chirurgia, considerando le complicanze descritte quali anacusia (100%), paralisi VII n.c. (4%), fistola liquorale (5.4%), meningite (1.8%), è riservata a casi limitati e dipende da: età, condizioni generali del paziente, sede e dimensioni del tumore ed è consigliabile in caso di un pattern di crescita invasivo e presenza di sintomi vertiginosi non responsivi al trattamento medico

The relationship of systemic markers of renal function and vascular function with retinal blood vessel responses

Purpose: To test the hypothesis of a significant relationship between systemic markers of renal and vascular function (processes linked to cardiovascular disease and its development) and retinal microvascular function in diabetes and/or cardiovascular disease.Methods: Ocular microcirculatory function was measured in 116 patients with diabetes and/or cardiovascular disease using static and continuous retinal vessel responses to three cycles of flickering light. Endothelial function was evaluated by von Willebrand factor (vWf), endothelial microparticles and soluble E selectin, renal function by serum creatinine, creatinine clearance and estimated glomerular filtration rate (eGFR). HbA1c was used as a control index.Results: Central retinal vein equivalence and venous maximum dilation to flicker were linked to HbA1c (both p<0.05). Arterial reaction time was linked to serum creatinine (p=0.036) and eGFR (p=0.039), venous reaction time was linked to creatinine clearance (p=0.018). Creatinine clearance and eGFR were linked to arterial maximum dilatation (p<0.001 and p=0.003 respectively) and the dilatation amplitude (p=0.038 and p=0.048 respectively) responses in the third flicker cycle. Of venous responses to the first flicker cycle, HbA1c was linked to the maximum dilation response (p=0.004) and dilatation amplitude (p=0.017), vWf was linked to the maximum constriction response (p=0.016), and creatinine clearance to the baseline diameter fluctuation (p=0.029). In the second flicker cycle, dilatation amplitude was linked to serum creatinine (p=0.022). Conclusions: Several retinal blood vessel responses to flickering light are linked to glycaemia and renal function, but only one index is linked to endothelial function. Renal function must be considered when interpreting retinal vessel responses

Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey

urpose: Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods: Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results: Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions: Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called "tailored follow-up", high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time

Valorisation of Biowastes for the Production of Green Materials Using Chemical Methods

With crude oil reserves dwindling, the hunt for a sustainable alternative feedstock for fuels and materials for our society continues to expand. The biorefinery concept has enjoyed both a surge in popularity and also vocal opposition to the idea of diverting food-grade land and crops for this purpose. The idea of using the inevitable wastes arising from biomass processing, particularly farming and food production, is, therefore, gaining more attention as the feedstock for the biorefinery. For the three main components of biomass—carbohydrates, lipids, and proteins—there are long-established processes for using some of these by-products. However, the recent advances in chemical technologies are expanding both the feedstocks available for processing and the products that be obtained. Herein, this review presents some of the more recent developments in processing these molecules for green materials, as well as case studies that bring these technologies and materials together into final products for applied usage

Diagnostic workup of rare tumors of rhinofarynx

Diagnostic workup in rare tumors of rhinopharynx

Il coefficiente di diffusione apparente “ADC” nella diagnosi differenziale della patologia colesteatomatosa.

nello studio dell’otite media cronica, la Risonanza Magnetica pesata in diffusione (RMDWI) può distinguere il colesteatoma dal tessuto di granulazione, quando altre tecniche - Tomografia Computerizzata e sequenze tradizionali di RM - sono insufficienti. A tale scopo la RM deve includere sequenze T1, T1 postgadolinium, T2, e DWI. Finora si tratta comunque di una valutazione qualitativa affidata ad un radiologo esperto. Per ottenere invece un'analisi quantitativa dell’intensità del segnale in RM-DWI, abbiamo valutato l’utilità del coefficiente di diffusione apparente (ADC) identificando un cut-off numerico per differenziare colesteatoma/tessuto di granulazione. METODI: lo studio retrospettivo ha riguardato 109 pazienti con sospetto clinico di colesteatoma primario o residuo/recidivante. Tutti i pazienti sono stati sottoposti a RM preoperatoria tra Aprile 2011 e Marzo 2016. Abbiamo usato la coorte di 109 soggetti che hanno subito un intervento chirurgico di timpanoplastica (TPL). L'analisi statistica è stata effettuata su 100 pazienti, ha impiegato il software R - version 3.2.5. Nove casi sono stati utilizzati per la prova di validazione. La presenza/assenza di colesteatoma è avvenuta attraverso reperti intraoperatori, sempre confermati istologicamente. Quindi nei 100 soggetti abbiamo retrospettivamente misurato il valore ADC della RM preoperatoria. RISULTATI: abbiamo confrontato i reperti chirurgici di 109 pazienti con i valori medi ADC ed analizzata la distribuzione di quest’ultimi per colesteatoma/tessuto di granulazione, evidenziando due gruppi di clusterizzazione. Solo 2 pazienti restano all’esterno dei clusters rappresentando un falso positivo ed un falso negativo. La differenza nel valore medio di ADC tra colesteatoma (0,86 × 10-3mm2 /s) e tessuto di granulazione (2.22×10-3mm2 /s) tramite il Welch Two Sample t-test ha rilevato una differenza statisticamente significativa del valore di ADC per i pazienti con/senza colesteatoma(p <2.2 × 10-16). Al fine di prevedere la probabilità dello stato patologico (colesteatoma/tessuto di granulazione) mediante il valore ADC, abbiamo impiegato il modello binomiale di regressione logistica. Il potere predittivo di questo modello è stato misurato mediante una curva ROC sulle probabilità stimate e applicando la statistica Youden J sulla curva abbiamo stabilito un valore di probabilità di ~ 0,6 per un cut-off ottimale (specificità = 1.0 sensibilità = 0.9861111) corrispondente al valore ADC=1,71×10-3mm2 /s. DISCUSSIONE: molti AA. sostengono che la RM-DWI può fornire informazioni supplementari ed una migliore accuratezza diagnostica. Finora pochi studi di esigua numerosità campionaria sono stati pubblicati in letteratura sull'importanza dei valori ADC per differenziare condizioni patologiche nell'orecchio medio. La concordanza riscontrata nel nostro studio tra i reperti chirurgici e i valori ADC suggerisce che tali valori possano consentire una maggiore specificità nel differenziare il colesteatoma dal tessuto di granulazione. CONCLUSIONI: il rilievo del valore ADC rappresenta un ulteriore contributo alla diagnostica preoperatoria del colesteatoma e può trovare utile applicazione, in associazione ad altre tecniche, specialmente nei casi in cui il colesteatoma non è evidenziabile in otomicroscopia e nel follow-up delle TPL chiuse

The CO2-laser in the treatment of laryngeal and tracheal stenosis Our personal experiences

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:In supraglottic stenosis:- oedematous forms healed without difficulty, a limited number of controls (1-2) was necessary to practice and any type of stent has not been used;- cicatricial forms required a greater number of controls (3-6) and the execution in 2 cases (1.6%) of an arytenoidectomy, we had 4 failures (3.1%) for which it had to implement a recovery surgery of traditional type;In glotticlipoglottic stenosis:- all oedematous forms healed with a number of checks less than 3, without use of stents;- scarring forms resolved after a higher number of controls (3-6), in 4 of them (3.1%) it was necessary to practice an arytenoidectomy (associated to exeresis of 1/3 posterior ipsilateral true vocal cord) and in 4 (3.1%) had to applied an endolaryngeal guardian (in one case a Traissac stent and in 3 ones a Montgomery T-tube);In tracheal stenosis has occurred healing in all cases, more specifically: -- in limited forms to the third anterior of the trachea were enough 1-2 checks and it was not necessary using stent;- in extended forms (involvement of the 2/3 anterior and/or of the whole tracheal circumference) a higher number of controls (3-6) was necessary;- in concentric forms, with total obstruction of the lumen, the application of endoluminal stent (3 Montgomery T-tubes and 2 tracheal cannulas of Silastic) was always necessary in addition to a number of controls superior to 7.- In laryngotracheal spread forms, 3 failures (2.3%) recorded, in all cases, however, many controls (greater than 7) was necessary and a Montgomery T-tube was placed.CONCLUSIONS: The introduction of the CO2 laser in the surgical treatment of laryngotracheal stenosis has undoubtedly improved the chances of endoscopic surgery; it is currently able to offer significant advantages compared to traditional techniques (cures faster, less traumatic interventions, post-operative elapsed better tolerated by patients, etc.) but it is also indisputable that to ensure the success of these operations is essential a correct understanding of the size and pathologic features of the same stenosir: the data, in fact, affect the choice of surgical addresses to adopt in individual cases and the prognostic judgment