A new strategy for endoscopic staging of laryngeal carcinoma: multistep endoscopy

At present, it is difficult to identify a gold standard for endoscopic staging of laryngeal cancer, especially considering the large number of endoscopic instruments available. We have coined the term multistep endoscopy to describe a method for staging laryngeal precancerous and neoplastic lesions that sequentially uses several endoscopic tools including high definition white light endoscopy (HDTV), stroboscopy and autofluorescence endoscopy. During the period from November 2007 to November 2009, 140 patients with a suspect laryngeal lesion underwent multistep endoscopy at the Department of Otorhinolaryngology at Martini Hospital in Turin. All patients were subjected to a series of endoscopic examinations in indirect laryngoscopy (white light endoscopy coupled to a HDTV camera, laryngostroboscopy, indirect autofluorescence) followed by white light endoscopy coupled to a HDTV camera and autofluorescence in direct microlaryngoscopy. The aim of the present prospective study was to evaluate the utility of multistep endoscopy in the diagnostic work-up of laryngeal lesions. Multistep endoscopy showed a higher sensitivity and "biological" predictive value in early cancer and precancerous lesions of the larynx (sensitivity, 97.9%; specificity, 90.5%) compared to individual endoscopic tools. It allows for better therapeutic planning of superficial lesions and more accurate orientation when performing mapping biopsies on diffuse lesions. In our opinion, more widespread use of indirect autofluorescence endoscopy during follow-up may be warranted to search for synchronous/metachronous second tumours of the upper aerodigestive tract

A process algebra based simulation model of a Diagnostic Radiology Department

In the last years, it's possible to observe a growing interest in applying in the health care sector tools and methods, which have been successfully applied in other service and industry sectors and have helped to improve planning and efficient use of resources, while maintaining high quality of the delivered service or product. Discrete event simulation represents a powerful and proven tool, which enables the experimentation of several possible solutions at relatively low cost. This paper is focused on the modeling and analysis of a Diagnostic Radiology Department (DRD) in an important Southern Italy hospital and adopts a discrete-event simulation approach based on a process algebra dialect, called $. Some "scenario" results are then illustrated in order to derive basic performance indicators of the system, which could be useful to hospital decision-makers and constitute a starting point for a deeper cost-benefit evaluation

Tumori dello spazio parafaringeo: approccio transcervicale video-assistito mini invasivo

L'obiettivo dello studio è stato valutare i vantaggi di un approccio transcervicale mini-invasivo video-assistito per l'exeresi di neoformazioni maligne e benigne dello spazio parafaringeo. Sono stati trattati 10 pazienti con approccio trans-cervicale mini-invasivo videoassistito con l'utilizzo di telescopi di Hopkins. Viene descritta la tecnica chirurgica e una revisione della letteratura. L'esame istologico definitivo è stato in 3 casi di adenoma pleomorfo, in 2 casi di schwannoma, 2 metastasi linfonodali da carcinoma tiroideo, un carcinoma ex adenoma pleomorfo, un emangioma cavernoso ed un adenoma a cellule basali. La dimensione massima delle neoformazioni è stata in media di 37,2 mm (da 19 a 60 mm). Il tempo chirurgico è stato dai 75 ai 185 minuti (media 146,7). In un caso è stata necessaria la conversione ad approccio transcervicale-transparotideo. I pazienti sono stati dimessi dalla seconda alla quinta giornata postoperatoria. In un caso è stata osservata paresi definitiva del nervo ipoglosso. L'approccio trans-cervicale mini-invasivo video-assistito è sicuro e offre la possibilità di seguire esattamente il piano di clivaggio, permettendo un'emostasi accurata e avendo sempre il controllo delle strutture anatomiche più critiche

Fibrolipoma gigante de la mejilla: a propósito de un caso

El fibrolipoma es una neoplasia de origen mesenquimal, rara en la cavidad oral, representando el 1% de todos los tumores benignos orales. Es una variante histológica del lipoma simple, que normalmente se manifiesta a nivel de la mucosa oral, suelo de la boca, lengua y labios. La etiología suele ser traumática cuando afecta localizaciones extraorales, mientras se considera idiopática al manifestarse a nivel bucal. En este artículo se presenta un raro caso de fibrolipoma de mejilla, y se discuten los aspectos diagnósticos, histo-patológicos y de tratamiento de acuerdo a la literatura. Lipomas are common soft tissue mesenchymal neoplasms, rare in the oral cavity, representing 1% of all benign oral tumors. Fibrolipoma is a histological variant of the classic lipoma which normally affects buccal mucosa, floor of the mouth, tongue and lips. In this article is presented a rare case of fibrolipoma of the cheek and are discussed all the aspects of diagnosis, histology and surgical treatment, according to literature data

Predicting microRNA modulation in human prostate cancer using a simple String IDentifier (SID1.0).

To make faster and efficient the identification of mRNA targets common to more than one miRNA, and to identify new miRNAs modulated in specific pathways, a computer program identified as SID1.0 (simple String IDentifier) was developed and successfully applied in the identification of deregulated miRNAs in prostate cancer cells. This computationally inexpensive Fortran program is based on the strategy of exhaustive search and specifically designed to screen shared data (target genes, miRNAs and pathways) available from PicTar and DIANA-MicroT 3.0 databases. As far as we know this is the first software designed to filter data retrieved from available miRNA databases. SID1.0 takes advantage of the standard Fortran intrinsic functions for manipulating text strings and requires ASCII input files. In order to demonstrate SID1.0 applicability, some miRNAs expected from the literature to associate with cancerogenesis (miR-125b, miR-148a and miR-141), were randomly identified as main entries for SID1.0 to explore matching sequences of mRNA targets and also to explore KEGG pathways for the presence of ID codes of targeted genes. Besides genes and pathways already described in the literature, SID1.0 has proven to useful for predicting other genes involved in prostate carcinoma. These latter were used to identify new deregulated miRNAs: miR-141, miR-148a, miR-19a and miR-19b. Prediction data were preliminary confirmed by expression analysis of the identified miRNAs in androgen-dependent (LNCaP) and independent (PC3) prostate carcinoma cell lines and in normal prostatic epithelial cells (PrEC)

Prevalenza dei sintomi vertigine e instabilità in un campione di 2672 soggetti e correlazione con il sintomo cefalea

La vertigine e l’instabilità sono sintomi molto comuni nella popolazione la cui prevalenza è stimata tra il 20 e il 56%. L’obiettivo del nostro lavoro è stato quello di determinare la prevalenza di questi sintomi in una popolazione di 2672 soggetti. È stato somministrato loro loro un questionario; nella prima parte sono stati richiesti i dati demografici e se avessero mai sofferto di vertigine o instabilità nella loro vita. L’età media del campione è stata di 48,3 ± 15 anni, il 46,7% erano maschi. Sul totale della popolazione 1077 (40,3%) hanno riferito di aver sofferto di vertigine o instabilità nella loro vita, con un primo episodio occorso all’età di 39,2 ± 15,4 anni. Nella seconda parte del questionario sono state indagate le caratteristiche delle vertigini (età del primo episodio, il tipo di vertigine, presenza di più episodi, esacerbazione posizionale della vertigine, presenza di sintomi cocleari infine la presenza di cefalea da moderata o severa nel corso della vita e le sue caratteristiche cliniche (riferita a un emicrania, pulsante, associata a fono o fotofobia, peggiore con l’attività fisica). È stata osservata una correlazione della vertigine con l’età e con il sesso, essendo la prima 4,4 volte più frequente nelle donne e 1,8 volte nei soggetti con oltre 50 anni. Sul campione complessivo di 2672 soggetti, 13,7% hanno riferito vertigine rotatoria, 26,3% episodi recidivanti, 12,9% esacerbazione correlata alla posizione e il 4,8% presenza sintomi cocleari; il 34,8% ha lamentato cefalea nel corso della loro vita. I soggetti affetti da cefalea presentavano un’incidenza aumentata di vertigini recidivanti, di esacerbazione correlata alla posizione, di sintomi cocleari e un’età più giovane di comparsa del primo episodio di vertigine/instabilità. Nella discussione i nostri dati sono stati confrontati con quelli di precedenti studi. Gli autori sottolineano la correlazione tra vertigine/instabilità da un lato e cefalea con caratteristiche emicraniche dall’altro

Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST)

Background: In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. Objective: This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. Methods: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure‐freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. Results: A total of 1029 patients with a median age of 45 years (33–56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). Conclusion: The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations

Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy

Contemporary management of primary parapharyngeal space tumors

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.Peer reviewe