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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Department of Biomedical, Metabolic and Neural Sciences, Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Castellucci
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Piro
- Pneumology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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2
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Alicandri-Ciufelli M, Marchioni D, Pipolo C, Garzaro M, Nitro L, Dell'Era V, Ferrella F, Campagnoli M, Russo P, Galloni C, Ghidini A, De Corso E, Lucidi D. Influence of Prior Endoscopic Sinus Surgery Extent on Dupilumab Effectiveness in CRSwNP Patients. Laryngoscope 2024; 134:1556-1563. [PMID: 37632705 DOI: 10.1002/lary.30983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Guidelines recommend that the vast majority of patients with severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) should have at least one endoscopic sinus surgery (ESS) prior to starting biologics. Because ESS can be performed with a variable extension, the aim of this study would be to evaluate the association between surgical extensiveness, as measured by ACCESS score, and outcomes collected in patients treated with Dupilumab. MATERIALS AND METHODS This is a multicentric retrospective study; patients affected by CRSwNP who were subjected to Dupilumab therapy and who underwent at least one ESS prior to Dupilumab initiation were included. ACCESS score was assigned to each patient's pre-Dupilumab CT scan. Subjective and objective parameters (SNOT-22, NPS, VAS scores, Sniffin' Sticks) were collected before and during the administration of therapy. Statistical correlations between ACCESS scores and clinical outcomes were investigated. RESULTS A total of 145 patients were included; mean time from last previous ESS was 68.6 months, and on average, patients were subjected to 2.2 surgeries. Many correlations with ACCESS scores were demonstrated: better NPS at all timepoints and subjective scores (30-days SNOT-22, VAS nasal obstruction, and rhinorrhea) were achieved in patients with low ACCESS score (more extensive ESS). On the other hand, significantly worse VAS loss of smell values were demonstrated in patients with lower ACCESS scores. CONCLUSION Dupilumab patients subjected to a prior extensive ESS may have reduced size of polyps and improved subjective indicators, together with a decreased chance to recover smell, when compared with patients who underwent a minimal excision. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1556-1563, 2024.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Letizia Nitro
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Valeria Dell'Era
- ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy
| | - Francesco Ferrella
- Otolaryngology Unit, Department of Health Sciences, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Massimo Campagnoli
- ENT Division, Eastern Piedmont University Hospital of Novara, Novara, Italy
| | - Paolo Russo
- ENT Department, Azienda USL Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Costanza Galloni
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Eugenio De Corso
- Department of Head, Neck and Sensory Organs, A. Gemelli University Hospital IRCCS, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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3
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Bonacini M, Rossi A, Ferrigno I, Muratore F, Boiardi L, Cavazza A, Bisagni A, Cimino L, De Simone L, Ghidini A, Malchiodi G, Corbera-Bellalta M, Cid MC, Zerbini A, Salvarani C, Croci S. miR-146a and miR-146b regulate the expression of ICAM-1 in giant cell arteritis. J Autoimmun 2024; 144:103186. [PMID: 38428111 DOI: 10.1016/j.jaut.2024.103186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
Giant cell arteritis (GCA) is an inflammatory disease of large/medium-sized arteries. MiRNAs are small, non-coding RNAs that inhibit gene expression at post-transcriptional level. Several miRNAs have been shown to be dysregulated in temporal artery biopsies (TABs) from GCA patients, but their role is unknown. The aims of the present work were: to gain insight into the link between inflammation and miRNA up-regulation in GCA; to identify the role of miR-146a and miR-146b. Primary cultures from TABs were treated with IL-1β, IL-6, soluble IL-6R (sIL6R), IL-17, IL-22, IFNγ, LPS and PolyIC. Correlations between cytokine mRNA and miRNA levels were determined in inflamed TABs. Primary cultures from TABs, human aortic endothelial and smooth muscle cells and ex-vivo TAB sections were transfected with synthetic miR-146a and miR-146b to mimic miRNA activities. Cell viability, target gene expression, cytokine levels in culture supernatants were assayed. Treatment of primary cultures from TABs with IL-1β and IL-17 increased miR-146a expression while IL-1β, IL-6+sIL6R and IFNγ increased miR-146b expression. IFNγ and IL-1β mRNA levels correlated with miR-146a/b levels. Following transfection, cell viability decreased only in primary cultures from TABs. Moreover, transfection of miR-146a/b mimics increased ICAM-1 gene expression and production of the soluble form of ICAM-1 by primary cultures from TABs and by ex-vivo TABs. ICAM-1 expression was higher in inflamed than normal TABs and ICAM-1 levels correlated with miR-146a/b levels. Expression of miR-146a and miR-146b in GCA appeared to be driven by inflammatory cytokines (e.g. IL-1β, IFNγ). miR-146a and miR-146b seem responsible for the increase of soluble ICAM-1.
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Affiliation(s)
- Martina Bonacini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Rossi
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Ferrigno
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Boiardi
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy; Unit of Ocular Immunology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca De Simone
- Unit of Ocular Immunology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Unit of Otolaryngology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Malchiodi
- Unit of Vascular Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marc Corbera-Bellalta
- Unit of Vasculitis Research, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Maria Cinta Cid
- Unit of Vasculitis Research, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Alessandro Zerbini
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Croci
- Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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Castellucci A, Dumas G, Abuzaid SM, Armato E, Martellucci S, Malara P, Alfarghal M, Ruberto RR, Brizzi P, Ghidini A, Comacchio F, Schmerber S. Posterior Semicircular Canal Dehiscence with Vestibulo-Ocular Reflex Reduction for the Affected Canal at the Video-Head Impulse Test: Considerations to Pathomechanisms. Audiol Res 2024; 14:317-332. [PMID: 38666899 PMCID: PMC11047701 DOI: 10.3390/audiolres14020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Posterior semicircular canal dehiscence (PSCD) has been demonstrated to result in a third mobile window mechanism (TMWM) in the inner ear similar to superior semicircular canal dehiscence (SSCD). Typical clinical and instrumental features of TMWM, including low-frequency conductive hearing loss (CHL), autophony, pulsatile tinnitus, sound/pressure-induced vertigo and enhanced vestibular-evoked myogenic potentials, have been widely described in cases with PSCD. Nevertheless, video-head impulse test (vHIT) results have been poorly investigated. Here, we present six patients with PSCD presenting with a clinical scenario consistent with a TMWM and an impaired vestibulo-ocular reflex (VOR) for the affected canal on vHIT. In two cases, an additional dehiscence between the facial nerve and the horizontal semicircular canal (HSC) was detected, leading to a concurrent VOR impairment for the HSC. While in SSCD, a VOR gain reduction could be ascribed to a spontaneous "auto-plugging" process due to a dural prolapse into the canal, the same pathomechanism is difficult to conceive in PSCD due to a different anatomical position, making a dural herniation less likely. Alternative putative pathomechanisms are discussed, including an endolymphatic flow dissipation during head impulses as already hypothesized in SSCD. The association of symptoms/signs consistent with TMWM and a reduced VOR gain for the posterior canal might address the diagnosis toward PSCD.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Georges Dumas
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Nancy, France;
| | - Sawsan M. Abuzaid
- Otorhinolaryngology Department, Royal Medical Services, Amman 11855, Jordan;
| | - Enrico Armato
- Ph.D. Program in Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France;
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | - Mohamad Alfarghal
- Otorhinolaryngology—Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah 21556, Saudi Arabia;
| | - Rosanna Rita Ruberto
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Francesco Comacchio
- ENT Unit, Regional Vertigo Specialized Center, University Hospital of Padova, Sant’Antonio Hospital, 35039 Padova, Italy;
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, 38043 Grenoble, France;
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Tozzi A, Castellucci A, Ferrulli G, Brandolini C, Piras G, Martellucci S, Malara P, Ferri GG, Ghidini A, Marchioni D, Presutti L. Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma. Otol Neurotol 2024; 45:299-310. [PMID: 38291792 DOI: 10.1097/mao.0000000000004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Five patients with concurrent SCD and VS. INTERVENTION Clinical-instrumental assessment and imaging. MAIN OUTCOME MEASURE Clinical presentation, audiovestibular findings, and imaging. RESULTS The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. CONCLUSION Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.
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Affiliation(s)
- Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Casa Di Cura Privata "Piacenza" S.P.A., Gruppo Otologico, Piacenza-Rome, Italy
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Gian Gaetano Ferri
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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6
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Argenziano G, Cavallieri F, Castellucci A, Fioravanti V, Di Rauso G, Gessani A, Campanini I, Merlo A, Napoli M, Grisanti S, Rossi J, Toschi G, Zini C, Ghidini A, Valzania F. Vestibular Hypofunction in ARSACS Syndrome: A Possible Pitfall in the Differential Diagnosis of Recessive Cerebellar and Afferent Ataxias. Neurol Clin Pract 2024; 14:e200239. [PMID: 38152064 PMCID: PMC10751013 DOI: 10.1212/cpj.0000000000200239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/15/2023] [Indexed: 12/29/2023]
Abstract
Objectives Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset ataxia characterized by cerebellar dysfunction, spasticity, and sensory-motor polyneuropathy due to variations in the SACS gene (13q11). To date, no studies have instrumentally assessed vestibular function in this condition. Methods We report a 36-year-old woman with diagnosis of ARSACS syndrome due to homozygous mutation (c.12232 C>T, p.Arg4078Ter) in the SACS gene. Neurologic examination showed spastic-ataxic gait, dysarthric speech, 4-limb ataxia, and spastic hypertonia with lower limb hyperreflexia. Results A vestibular instrumental evaluation including bedside oculomotor testing found gaze-evoked and rebound nystagmus on horizontal and vertical gaze, saccadic movements within normality ranges, saccadic pursuit, and slightly impaired visually enhanced vestibulo-ocular reflex (VVOR). A near-normal VOR suppression (VORS) was recorded. Neither head shakings, skull vibrations, nor supine positionings could evoke nystagmus. Finally, the video-head impulse test detected a symmetrical VOR impairment for all the semicircular canals (SCs), mostly involving the horizontal SCs, with corrective saccades in all planes. Discussion Vestibular hypofunction may be found in ARSACS syndrome and may represent a possible pitfall in the differential diagnosis of recessive cerebellar and afferent ataxias. In this setting, ARSACS syndrome should be considered in the differential diagnosis of CANVAS.
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Affiliation(s)
- Giacomo Argenziano
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Francesco Cavallieri
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Andrea Castellucci
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Valentina Fioravanti
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Giulia Di Rauso
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Annalisa Gessani
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Isabella Campanini
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Andrea Merlo
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Manuela Napoli
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Sara Grisanti
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Jessica Rossi
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Giulia Toschi
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Chiara Zini
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Angelo Ghidini
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit (GA, GDR), Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena; Neurology Unit (GA, FC, VF, GDR, JR, GT, CZ, FV), Neuromotor and Rehabilitation Department; Otolaryngology Unit (AC, A. Ghidini), Azienda USL-IRCCS di Reggio Emilia; Neurology (A. Gessani), Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena; LAM-Motion Analysis Laboratory (IC, AM), Neuromotor and Rehabilitation Department; Neuroradiology Unit (MN), Azienda USL-IRCCS di Reggio Emilia; and Clinical and Experimental Medicine PhD Program (SG, JR), University of Modena and Reggio Emilia, Italy
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7
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Tozzi A, Castellucci A, Ferrulli G, Martellucci S, Malara P, Brandolini C, Armato E, Ghidini A. Low-Frequency Air-Bone Gap and Pulsatile Tinnitus Due to a Dural Arteriovenous Fistula: Considerations upon Possible Pathomechanisms and Literature Review. Audiol Res 2023; 13:833-844. [PMID: 37987331 PMCID: PMC10660785 DOI: 10.3390/audiolres13060073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Low-frequency air-bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window syndromes. Other inner disorders, including Meniere's disease (MD), perilymphatic fistula and intralabyrinthine schwannoma, might sometimes result in a similar scenario. On the other hand, PT is frequently associated with dural arteriovenous fistula (DAVF), while conductive hearing loss (CHL) is extremely rare in this clinical setting. A 47-year-old patient was referred to our center with progressive left-sided PT alongside ipsilateral fullness and hearing loss. She also experienced headache and dizziness. Otoscopy and video-oculographic examination were unremarkable. Conversely, a detailed instrumental audio-vestibular assessment revealed low-frequency CHL with normal impedance audiometry, slight left-sided caloric weakness, slightly impaired vestibular-evoked myogenic potentials on the left and normal results on the video-head impulse test, consistent with an MD-like instrumental profile. Gadolinium-enhanced brain MRI revealed an early enhancement of the left transverse sinus, consistent with a left DAVF between the left occipital artery and the transverse sinus, which was then confirmed by angiography. A trans-arterial embolization with Onyx glue was performed, resulting in a complete recession of the symptoms. Post-operatively, the low-frequency ABG disappeared, supporting the possible role of venous intracranial hypertension and abnormal pressure of inner ear fluids in the onset of symptoms and offering new insights into the pathomechanism of inner ear CHL.
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Affiliation(s)
- Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy;
| | - Enrico Armato
- Faculty of Medicine, University of Lorraine, 54000 Vandoeuvre-lès-Nancy, France;
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
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8
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De Corso E, Ottaviano G, Pipolo C, Cantone E, Mattavelli D, Alicandri-Ciufelli M, Lucidi D, Caminati M, Senna G, Cavaliere C, Ghidini A, Gallo S, Macchi A, Torretta S, Seccia V, Garzaro M, Fadda GL, Trimarchi M, Pasquini E, Pagella F, Canevari FR, Preti A, La Mantia I, Galli J. Chronic Rhinosinusitis with Nasal Polyps: A Survey on Routine Management and Evaluation of Disease Control in Practice. J Pers Med 2023; 13:1531. [PMID: 38003847 PMCID: PMC10672031 DOI: 10.3390/jpm13111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a significant impact on quality of life. The overall goal of CRSwNP management, as with other chronic conditions, is to achieve "disease control", and for that reason, a definition of control of disease is pivotal in deciding the best treatment strategy. Although many staging systems have already been developed to evaluate the disease, disease control is not yet to be standardized, and a specific tool that is consistently applied and accepted by all practitioners is still missing in daily clinical practice. To gain an overview of the implementation and limitations of existing guidelines and to shed light on real-life definitions of control and disease severity, we conducted a nationwide survey of otorhinolaryngologists routinely treating CRSwNP to identify unmet clinical needs in Italy. The results showed homogeneous responses regarding the knowledge contained in international guidelines while highlighting the difficulty of their implementation in day-to-day practice. Respondents called attention to the importance of clinical symptoms, giving more weight to the patient's perspective. Among the symptoms to be considered, respondents emphasized nasal obstruction, followed by loss of sense of smell and rhinorrhea. Others also believe that the physician's perspective should be considered, and the inclusion of endoscopy as a measure of control was warranted by many. The need for a specific tool that is able to unequivocally ascertain disease control is increasingly pivotal in this new era of biologics for treating CRSwNP.
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Affiliation(s)
- Eugenio De Corso
- Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, 00168 Rome, Italy;
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35122 Padova, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples 29 Federico II, 80131 Naples, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Daniela Lucidi
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, 42123 Reggio Emilia, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Alberto Macchi
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University-Maggiore Hospital, 28100 Novara, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy;
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Dip Chirurgie Specialistiche, Ospedale Bellaria AUSL BO, 47814 Bologna, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Frank Rikki Canevari
- Otorhinolaryngology Unit, IRCCS Policlinico San Martino Genova, Dipartimento 1 DISC Università di Genova, 16124 Gernova, Italy;
| | - Andrea Preti
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica Milan, 20099 Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies-“G.F. Ingrassia” Director of E.N.T. Unit P.O. “G. Rodolico” University of Catania, 95123 Catania, Italy;
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, 00168 Rome, Italy
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9
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Castellucci A, Malara P, Martellucci S, Alfarghal M, Brandolini C, Piras G, Armato E, Ruberto RR, Brizzi P, Presutti L, Ghidini A. Impaired Vestibulo-Ocular Reflex on Video Head Impulse Test in Superior Canal Dehiscence: "Spontaneous Plugging" or Endolymphatic Flow Dissipation? Audiol Res 2023; 13:802-820. [PMID: 37887852 PMCID: PMC10604197 DOI: 10.3390/audiolres13050071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Surgical plugging of the superior semicircular canal (SSC) represents an effective procedure to treat disabling symptoms in superior canal dehiscence (SCD), despite resulting in an impaired vestibulo-ocular reflex (VOR) gain for the SSC. On the other hand, SSC hypofunction on video head impulse test (vHIT) represents a common finding in patients with SCD exhibiting sound/pressure-induced vertigo, a low-frequency air-bone gap (ABG), and enhanced vestibular-evoked myogenic potentials (VEMPs). "Spontaneous canal plugging" has been assumed as the underlying process. Nevertheless, missing/mitigated symptoms and/or near-normal instrumental findings would be expected. An endolymphatic flow dissipation has been recently proposed as an alternative pathomechanism for SSC VOR gain reduction in SCD. We aimed to shed light on this debate by comparing instrumental findings from 46 ears of 44 patients with SCD exhibiting SSC hypofunction with post-operative data from 10 ears of 10 patients with SCD who underwent surgical plugging. While no difference in SSC VOR gain values was found between the two groups (p = 0.199), operated ears developed a posterior canal hypofunction (p = 0.002). Moreover, both ABG values (p = 0.012) and cervical/ocular VEMP amplitudes (p < 0.001) were significantly higher and VEMP thresholds were significantly lower (p < 0.001) in ears with SCD compared to operated ears. According to our data, canal VOR gain reduction in SCD should be considered as an additional sign of a third window mechanism, likely due to an endolymphatic flow dissipation.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland;
| | | | - Mohamad Alfarghal
- Otorhinolaryngology—Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah 21556, Saudi Arabia;
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy; (C.B.); (L.P.)
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura Privata “Piacenza” S.P.A., 29121 Piacenza, Italy;
| | - Enrico Armato
- Faculty of Medicine, University of Lorraine, 54000 Vandoeuvre-lès-Nancy, France;
| | - Rosanna Rita Ruberto
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (R.R.R.); (P.B.)
| | - Livio Presutti
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy; (C.B.); (L.P.)
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
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10
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Di Rauso G, Castellucci A, Cavallieri F, Tozzi A, Fioravanti V, Monfrini E, Gessani A, Rossi J, Campanini I, Merlo A, Ronchi D, Napoli M, Pascarella R, Grisanti S, Ferrulli G, Sabadini R, Di Fonzo A, Ghidini A, Valzania F. Speech, Gait, and Vestibular Function in Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome. Brain Sci 2023; 13:1467. [PMID: 37891834 PMCID: PMC10605709 DOI: 10.3390/brainsci13101467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is characterized by late-onset cerebellar ataxia, bilateral vestibulopathy, and sensory neuronopathy mostly due to biallelic RFC1 expansion. (2) Objectives: The aim of this case series is to describe vestibular, gait, and speech alterations in CANVAS via a systematic approach. (3) Methods: All patients (n = 5) underwent a standardized clinical-instrumental examination, including the perceptual and acoustic analysis of speech, instrumental gait, and balance analysis (posturographic data were acquired using a force plate [Kistler, Winterthur, Switzerland] while 3D gait analysis, inclusive of surface electromyography, was acquired using a motion capture system [SMART DX, BTS Bioengineering, Milan, Italy], a wireless electromyograph [FreeEMG, BTS Bioengineering, Milan, Italy]), and vestibular assessment with video-oculography. (4) Results: Five patients were included in the analysis: three females (patients A, B, C) and two males (patients D and E) with a mean age at evaluation of 62 years (SD ± 15.16, range 36-74). The mean age of symptoms' onset was 55.6 years (SD ± 15.04, range 30-68), and patients were clinically and instrumentally evaluated with a mean disease duration of 6.4 years (SD ± 0.54, range 6-7). Video-Frenzel examination documented spontaneous downbeat nystagmus enhanced on bilateral gaze in all patients, except for one presenting with slight downbeat nystagmus in the supine position. All patients exhibited different degrees of symmetrically reduced VOR gain for allsix semicircular canals on the video-head impulse test and an unexpectedly normal ("false negative") VOR suppression, consistent with combined cerebellar dysfunction and bilateral vestibular loss. Posturographic indices were outside their age-matched normative ranges in all patients, while 3D gait analysis highlighted a reduction in ankle dorsiflexion (limited forward rotation of the tibia over the stance foot during the stance phase of gait and fatigue of the dorsiflexor muscles) and variable out-of-phase activity of plantar flexors during the swing phase. Finally, perceptual-acoustic evaluation of speech showed ataxic dysarthria in three patients. Dysdiadochokinesis, rhythm instability, and irregularity were observed in the oral diadochokinesis task. (5) Conclusions: CANVAS is a recently discovered syndrome that is gaining more and more relevance within late-onset ataxias. In this paper, we aimed to contribute to a detailed description of its phenotype.
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Affiliation(s)
- Giulia Di Rauso
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, 41125 Modena, Italy;
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, 41126 Modena, Italy;
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
| | - Andrea Castellucci
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.C.); (A.G.)
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
| | - Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | - Valentina Fioravanti
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
| | - Edoardo Monfrini
- Neurology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (D.R.); (A.D.F.)
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Annalisa Gessani
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, 41126 Modena, Italy;
| | - Jessica Rossi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Reggio Emilia, Italy;
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (I.C.); (A.M.)
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (I.C.); (A.M.)
| | - Dario Ronchi
- Neurology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (D.R.); (A.D.F.)
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.N.); (R.P.)
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.N.); (R.P.)
| | - Sara Grisanti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Reggio Emilia, Italy;
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, 41125 Modena, Italy; (A.T.); (G.F.)
| | - Rossella Sabadini
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
| | - Alessio Di Fonzo
- Neurology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (D.R.); (A.D.F.)
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.C.); (A.G.)
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (V.F.); (J.R.); (R.S.); (F.V.)
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11
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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. Acta Otorhinolaryngol Ital 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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12
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De Corso E, Pasquini E, Trimarchi M, La Mantia I, Pagella F, Ottaviano G, Garzaro M, Pipolo C, Torretta S, Seccia V, Cantone E, Ciofalo A, Lucidi D, Fadda GL, Pafundi PC, Settimi S, Montuori C, Anastasi F, Pagliuca G, Ghidini A, Cavaliere C, Maffei M, Bussu F, Gallo S, Canevari FRM, Paludetti G, Galli J. Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL). Allergy 2023; 78:2669-2683. [PMID: 37203259 DOI: 10.1111/all.15772] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. METHODS This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. RESULTS We observed a significant decrease in NPS from a median value of 6 (IQR 5-6) at baseline to 1.0 (IQR 0.0-2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49-70) at baseline to 11 (IQR 6-21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. CONCLUSIONS Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, A.Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL, Bologna, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University, Maggiore Hospital, Novara, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", University of Milan, Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Head and Neck Department-ENT Section, University of Naples Federico II, AOU Federico II, Naples, Italy
| | - Andrea Ciofalo
- Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Pia Clara Pafundi
- Epidemiology and Biostatistics Core Facility, Gemelli Science and Technology park, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Francesca Anastasi
- Otorhinolaryngology Unit, Ospedale San Giovanni Evangelista, Tivoli, Italy
| | - Giulio Pagliuca
- Otolaryngology University Unit, "S. M. Goretti Hospital", Latina, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marianna Maffei
- Otolaryngology Head and Neck Surgery Unit, AORN Ospedali della Colli, Naples, Italy
| | - Francesco Bussu
- Division of Otorhinolaryngology, Department of Medicine, Surgery and Pharmacy, Azienda Ospedaliera Universitaria di Sassari, University of Sassary, Sassari, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | | | - Gaetano Paludetti
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
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Torricelli F, Santandrea G, Botti C, Ragazzi M, Vezzani S, Frasoldati A, Ghidini A, Giordano D, Zanetti E, Rossi T, Nicoli D, Ciarrocchi A, Piana S. Medullary Thyroid Carcinomas Classified According to the International Medullary Carcinoma Grading System and a Surveillance, Epidemiology, and End Results-Based Metastatic Risk Score: A Correlation With Genetic Profile and Angioinvasion. Mod Pathol 2023; 36:100244. [PMID: 37307881 DOI: 10.1016/j.modpat.2023.100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
Due to the lack of a standardized tool for risk-based stratification, the International Medullary Carcinoma Grading System (IMTCGS) has been proposed for medullary thyroid carcinomas (MTCs) based on necrosis, mitosis, and Ki67. Similarly, a risk stratification study using the Surveillance, Epidemiology, and End Results (SEER) database highlighted significant differences in MTCs in terms of clinical-pathological variables. We aimed to validate both the IMTCGS and SEER-based risk table on 66 MTC cases, with special attention to angioinvasion and the genetic profile. We found a significant association between the IMTCGS and survival because patients classified as high-grade had a lower event-free survival probability. Angioinvasion was also found to be significantly correlated with metastasis and death. Applying the SEER-based risk table, patients classified either as intermediate- or high-risk had a lower survival rate than low-risk patients. In addition, high-grade IMTCGS cases had a higher average SEER-based risk score than low-grade cases. Moreover, when we explored angioinvasion in correlation with the SEER-based risk table, patients with angioinvasion had a higher average SEER-based score than patients without angioinvasion. Deep sequencing analysis found that 10 out of 20 genes frequently mutated in MTCs belonged to a specific functional class, namely chromatin organization, and function, which may be responsible for the MTC heterogeneity. In addition, the genetic signature identified 3 main clusters; cases belonging to cluster II displayed a significantly higher number of mutations and higher tumor mutational burden, suggesting increased genetic instability, but cluster I was associated with the highest number of negative events. In conclusion, we confirmed the prognostic performance of the IMTCGS and SEER-based risk score, showing that patients classified as high-grade had a lower event-free survival probability. We also underline that angioinvasion has a significant prognostic role, which has not been incorporated in previous risk scores.
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Affiliation(s)
- Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Cecilia Botti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Moira Ragazzi
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Vezzani
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eleonora Zanetti
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Teresa Rossi
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Nicoli
- Laboratory of Molecular Pathology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Simonetta Piana
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
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14
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Castellucci A, Botti C, Delmonte S, Bettini M, Lusetti F, Brizzi P, Ruberto R, Gamberini L, Martellucci S, Malara P, Armato E, Renna L, Ghidini A, Bianchin G. Vestibular assessment in sudden sensorineural hearing loss: Role in the prediction of hearing outcome and in the early detection of vascular and hydropic pathomechanisms. Front Neurol 2023; 14:1127008. [PMID: 36873440 PMCID: PMC9975513 DOI: 10.3389/fneur.2023.1127008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction Predicting hearing outcome in sudden sensorineural hearing loss (SSNHL) is challenging, as well as detecting the underlying pathomechanisms. SSNHL could be associated with vestibular damage since cochleo-vestibular structures share the same vascularization, along with being in close anatomical proximity. Whereas viral inflammations and autoimmune/vascular disorders most likely represent the involved aetiologies, early-stage Menière's disease (MD) can also present with SSNHL. Since an early treatment could beneficially influence hearing outcome, understanding the possible etiology plays a pivotal role in orienting the most appropriate treatment. We aimed to evaluate the extent of vestibular damage in patients presenting with SSNHL with or without vertigo, investigate the prognostic role of vestibular dysfunctions on hearing recovery and detect specific lesion patterns related to the underlying pathomechanisms. Methods We prospectively evaluated 86 patients with SSNHL. Audio-vestibular investigation included pure-tone/speech/impedance audiometry, cervical/ocular-VEMPs, vHIT and video-Frenzel examination. White matter lesions (WML) were evaluated on brain-MRI. Patients were followed-up and divided into "SSNHL-no-vertigo," "SSNHL+vertigo" and "MD" subgroups. Results Hearing was more impaired in "SSNHL+vertigo" patients who exhibited either down-sloping or flat-type audiograms, and was less impaired in "MD" where low frequencies were mostly impaired (p < 0.001). Otolith receptors were more frequently involved than semicircular canals (SCs). Although the "SSNHL-no-vertigo" subgroup exhibited the lowest vestibular impairment (p < 0.001), 52% of patients developed otolith dysfunctions and 72% developed nystagmus. Only "MD" subjects showed anterior SC impairment and upbeating spontaneous/positional nystagmus. They more frequently exhibited cervical-VEMPs frequency tuning (p = 0.036) and ipsilesional spontaneous nystagmus (p < 0.001). "SSNHL+vertigo" subjects presented with more frequently impaired cervical-VEMPs and posterior SC and with higher number of impaired receptors (p < 0.001). They mainly exhibited contralesional spontaneous and vibration-induced nystagmus (p < 0.05) and only they showed the highest WML score and "vascular" lesion patterns (p < 0.001). Concerning the outcomes, hearing was better in "MD" and worse in "SSNHL+vertigo" (p < 0.001). Hearing recovery was mostly affected by cervical-VEMPs impairment and the number of involved receptors (p < 0.05). Patients with "vascular" lesion patterns presented with the highest HL degree and WML score (p ≤ 0.001), while none of them exhibited a complete hearing recovery (p = 0.026). Conclusions Our data suggest that vestibular evaluation in SSNHL can provide useful information on hearing recovery and underlying aetiologies.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Ph.D. Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Brizzi
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosanna Ruberto
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lisa Gamberini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Enrico Armato
- ENT Unit, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Luigi Renna
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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15
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Macchi A, Giorli A, Cantone E, Carlotta Pipolo G, Arnone F, Barbone U, Bertazzoni G, Bianchini C, Ciofalo A, Cipolla F, De Massimi A, De Vita C, Di Lieto C, Ghidini A, Govoni M, Gramellini G, Maselli Del Giudice A, Ottaviano G, Seccia V, Sireci F, Sollini G, Staffieri C, Gallo S, Heffler E, Mantia IL, De Corso E, Canevari FR, Lombardo N, Malvezzi L, Orietti G, Pasquini E, Presutti L, Monti G. Sense of smell in chronic rhinosinusitis: A multicentric study on 811 patients. Front Allergy 2023; 4:1083964. [PMID: 37152304 PMCID: PMC10160403 DOI: 10.3389/falgy.2023.1083964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The impairment of the sense of smell is often related to chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP, CRSsNP). CRSwNP is a frequent condition that drastically worsens the quality of life of those affected; it has a higher prevalence than CRSsNP. CRSwNP patients experience severe loss of smell with earlier presentation and are more likely to experience recurrence of their symptoms, often requiring revision surgery. Methods The present study performed a multicentric data collection, enrolling 811 patients with CRS divided according to the inflammatory endotype (Type 2 and non-Type 2). All patients were referred for nasal endoscopy for the assessment of nasal polyposis using nasal polyp score (NPS); Sniffin' Sticks olfactory test were performed to measure olfactory function, and SNOT-22 (22-item sinonasal outcome test) questionnaire was used to assess patients' quality of life; allergic status was evaluated with skin prick test and nasal cytology completed the evaluation when available. Results Data showed that Type 2 inflammation is more common than non-type 2 (656 patients versus 155) and patients suffer from worse quality of life and nasal polyp score. Moreover, 86.1% of patients with Type 2 CRSwNP were affected by a dysfunction of the sense of smell while it involved a lesser percentage of non-Type 2 patients. Indeed, these data give us new information about type-2 inflammation patients' characteristics. Discussion The present study confirms that olfactory function weights on patients' QoL and it represents an important therapeutic goal that can also improve patients' compliance when achieved. In a future - and present - perspective of rhinological precision medicine, an impairment of the sense of smell could help the clinician to characterize patients better and to choose the best treatment available.
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Affiliation(s)
- Alberto Macchi
- ENT Clinic Asst Sette Laghi – University of Insubria, Varese, Italy
| | | | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat. Federico II University, NaplesItaly
| | - Giorgia Carlotta Pipolo
- Otorhinolaryngology Unit ASST Santi Paolo e Carlo Hospital. Department of Health Sciences, University of Milan, Milan, Italy
| | - Flavio Arnone
- Otorhinolaryngology Unit ASST Santi Paolo e Carlo Hospital. Department of Health Sciences, University of Milan, Milan, Italy
| | | | | | | | - Andrea Ciofalo
- Ent Department, Azienda Ospedaliera Universitaria S.Anna, Ferrara, Italy
| | - Federica Cipolla
- Unit of Otorhinolaryngology – IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio De Massimi
- Istituto di ORL, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carla De Vita
- SS ORL San Vito al Tagliamento – Azienda Sanitaria Friuli Occidentale, S. Vito al Tagliamento, Italy
| | - Cristina Di Lieto
- SS ORL San Vito al Tagliamento – Azienda Sanitaria Friuli Occidentale, S. Vito al Tagliamento, Italy
| | | | - Marco Govoni
- ENT Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | - Veronica Seccia
- UOC Azienda Ospedaliero Universitaria Mater Domini, Catanzaro, Italy
| | | | - Giacomo Sollini
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | - Stefania Gallo
- ENT Clinic Asst Sette Laghi – University of Insubria, Varese, Italy
| | | | - Ignazio La Mantia
- Unit of Otorhinolaryngology – IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Frank Rikki Canevari
- Otorhinolaryngology Section, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND) University of Palermo, Palermo, Italy
| | | | | | - Gabriele Orietti
- ENT Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Livio Presutti
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | - Giulia Monti
- ENT Unit Bari Adria Trani, Bari, Italy
- Correspondence: Giulia Monti
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Martellucci S, Castellucci A, Malara P, Ralli G, Pagliuca G, Botti C, Gallo A, Ghidini A, Asprella Libonati G. Is it possible to diagnose Posterior Semicircular Canal BPPV from the sitting position? The role of the Head Pitch Test and the upright tests along the RALP and LARP planes. Am J Otolaryngol 2022; 43:103474. [PMID: 35561430 DOI: 10.1016/j.amjoto.2022.103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the posterior semicircular canal (PSC) is traditionally entrusted to positioning tests where patients are rapidly brought in the supine position. This prospective study aims to define the role of a diagnostic protocol for PSC-BPPV including only upright tests. MATERIALS AND METHODS 109 patients with PSC-BPPV were enrolled. The Head Pitch Test (HPT) was carried out first. If uneventful, the patient's head was turned 45° to each side and bent back-and-forth along the plane aligning either with the right anterior-left posterior (RALP) or left anterior-right posterior (LARP) canals, thus performing the upright RALP / upright LARP (uRALP/uLARP) test. Nystagmus observed was used to predict the diagnosis, which was therefore confirmed by Dix-Hallpike tests. RESULTS PSC-BPPV could be correctly diagnosed in 75.2% of cases with the sole HPT and in 87.2% of cases by adding the uRALP/uLARP test (Upright Protocol). The time elapsed from symptoms onset was closely related to the protocol sensitivity, as it reached 100% (64/64) in acute patients while decreased to 68.9% (31/45) in cases evaluated after 7 days (p < 0.001). CONCLUSIONS Upright maneuvers could correctly diagnose PSC-BPPV in most cases. uRALP/uLARP test demonstrated to improve the sensitivity of the HPT, mainly in recent-onset BPPV.
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Giordano D, Botti C, Iotti V, Ghidini A. Foreign Body in the Cervical Oesophagus: A Case Report. Curr Med Imaging 2022; 18:1117-1119. [PMID: 35379156 DOI: 10.2174/1573405618666220404110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. CASE PRESENTATION A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. CONCLUSION A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Iotti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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18
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Botti C, Menichetti M, Marchese C, Pernice C, Giordano D, Perano D, Russo P, Ghidini A. The role of tracheotomy in patients with moderate to severe impairment of the lower airways. Acta Otorhinolaryngol Ital 2022; 42:S73-S78. [PMID: 35763277 PMCID: PMC9137380 DOI: 10.14639/0392-100x-suppl.1-42-2022-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 01/08/2023]
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19
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Giordano D, Botti C, Piana S, Castellucci A, Frasoldati A, Zini M, Fornaciari M, Crocetta FM, Ghidini A. Hemithyroidectomy and ipsilateral central neck dissection for T1 low-risk papillary thyroid cancer: single-institution retrospective observational study. Eur J Endocrinol 2022; 186:535-542. [PMID: 35230264 DOI: 10.1530/eje-21-0813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/01/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to report the rationale and selection criteria for hemithyroidectomy and ipsilateral central neck dissection in patients with selected papillary thyroid cancer and to report the surgical and oncological outcomes. DESIGN Single-institution retrospective observational study. METHODS The clinical records of patients with a histopathological diagnosis of low-risk pT1 papillary thyroid cancer who underwent hemithyroidectomy with or without ipsilateral central neck dissection between March 2000 and April 2018 at a tertiary referral center were retrospectively reviewed. Demographic, clinical, and histopathological data were collected. RESULTS During the study period, 176 patients underwent hemithyroidectomy for PTC. Thirteen patients (13/176, 7.39%) were lost to follow-up and 74 patients (74/163 45.40%) underwent completion thyroidectomy within 1 month because they were classified intermediate ATA initial risk based on definitive pathology. The final study group was composed of 89 patients, who had a median follow-up of 5.3 years. The mean follow-up was 6.3 years (range: 36-207 months). Eighty-four patients (94.38%) did not experience recurrence in the follow-up period. A total of 5/89 patients (5.62%) underwent delayed completion thyroidectomy with or without neck dissection for recurrent malignancy in the residual lobe (3/5) or regional lymph nodes (2/5). The median time from surgery to recurrence was 24.8 months (range: 6-60). The follicular variant was an independent risk factor for recurrence. CONCLUSIONS Hemithyroidectomy with or without prophylactic ipsilateral central neck dissection is a valuable treatment option in selected low-risk papillary thyroid cancers and ensures a low risk of recurrence. Prophylactic ipsilateral central compartment dissection could have a role in improving cancer staging, and accurate ultrasonographic follow-up is essential to identify local recurrence.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Castellucci
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Zini
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Fornaciari
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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20
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Leone AG, Petrelli F, Ghidini A, Raimondi A, Smyth EC, Pietrantonio F. Efficacy and activity of PD-1 blockade in patients with advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis with focus on the value of PD-L1 combined positive score. ESMO Open 2022; 7:100380. [PMID: 35093742 PMCID: PMC8804258 DOI: 10.1016/j.esmoop.2021.100380] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Recently, several randomized controlled trials (RCTs) investigated immunotherapy-based regimens versus chemotherapy alone in patients with advanced esophageal squamous cell carcinoma (ESCC). Here we conducted a systematic review and meta-analysis on the efficacy and activity of programmed cell death protein 1 blockade in these patients, with focus on the value of programmed death-ligand 1 combined positive score (CPS) for selecting patients who may benefit the most. METHODS RCTs investigating treatment with or without immune checkpoint inhibitors for advanced ESCC were selected. The hazard ratio (HR) and the odds ratio were used to compare the treatment effect on survival outcomes and tumor response, respectively, for immunotherapy-based regimens compared with standard chemotherapy, overall and according to geographic region or treatment line. We carried out a subgroup analysis comparing patients with CPS ≥10 or <10 and the evidence for treatment effect was evaluated by interaction test. RESULTS A total of 5257 patients and 10 RCTs were included. Overall, the HR for overall survival benefit with immunotherapy-based regimens was 0.71 [95% confidence interval (CI) 0.66-0.76] compared with chemotherapy alone; such effect was independent from geographical region (Asia versus rest of the world) and treatment line (upfront versus second/further lines). The HR for progression-free survival benefit and the odds ratio for overall response rate increase were 0.78 (95% CI 0.66-0.93) and 1.50 (95% CI 1.22-1.83), respectively. The HR for overall survival benefit with immunotherapy-based treatment was 0.60 (95% CI 0.51-0.70) for CPS ≥10 subgroup versus 0.83 (95% CI 0.69-1.00) for CPS <10 (P for interaction 0.009). CONCLUSIONS Immune checkpoint inhibitors have a consistent benefit in reducing the risk of death for ESCC patients which is dependent on programmed death-ligand 1 CPS status. Further investigations of biomarkers for immunotherapy in the subgroup of patients with CPS <10 are needed.
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Affiliation(s)
- A G Leone
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - F Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Treviglio, Italy
| | - A Ghidini
- Oncology Unit, Casa di Cura Igea, Milan, Italy
| | - A Raimondi
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - E C Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - F Pietrantonio
- Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.
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21
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Castellucci A, Botti C, Martellucci S, Malara P, Delmonte S, Lusetti F, Ghidini A. Spontaneous Upbeat Nystagmus and Selective Anterior Semicircular Canal Hypofunction on Video Head Impulse Test: A New Variant of Canalith Jam? J Audiol Otol 2021; 26:153-159. [PMID: 34802218 PMCID: PMC9271735 DOI: 10.7874/jao.2021.00297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022] Open
Abstract
We describe a rare case of spontaneous upbeat nystagmus (UBN) attributable to a canalith jam involving the anterior semicircular canal (ASC) in a patient in whom comprehensive vestibular assessment was useful to identify the underlying pathomechanism. A 56-year-old woman with unsteadiness following repositioning procedures for left-sided benign paroxysmal positional vertigo (BPPV) presented with spontaneous UBN that showed slight right torsional components. A vestibular test battery detected isolated left ASC hypofunction on a video-head impulse test (Video-HIT). We postulated a persistent utriculopetal deflection of the left ASC cupula, which was attributable to entrapment of debris in a narrow canal tract, with consequent sustained inhibition of the ampullary afferents. Although spontaneous UBN receded after impulsive physical therapy, unsteadiness deteriorated into positional vertigo secondary to canalolithiasis involving the ipsilateral posterior canal. In our view, physical therapy possibly fragmented the canalith jam and released free-floating otoconia that eventually settled into the ipsilateral posterior canal. Video HIT revealed normalization of ASC hypofunction, and left-sided posterior canal canalolithiasis was successfully treated using appropriate repositioning procedures. We propose that a canalith jam involving the ASC should be considered in the differential diagnosis of spontaneous UBN, particularly in patients with a history of BPPV and isolated ASC hypofunction detected on video HIT.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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22
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Murri D, Botti C, Bassano E, Fornaciari M, Crocetta FM, Ghidini A. Reduction in healthcare services during the COVID-19 pandemic: Patient screening based on symptoms is an effective strategy for avoiding delayed laryngeal cancer diagnosis. Am J Otolaryngol 2021; 42:103162. [PMID: 34325180 PMCID: PMC8302476 DOI: 10.1016/j.amjoto.2021.103162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022]
Abstract
Objective Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. Methods Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). Results The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). Conclusion During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.
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23
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Giordano D, Botti C, Piana S, Zini M, Frasoldati A, Lusetti F, Cavuto S, Savoldi L, Pernice C, Ghidini A. Postoperative hypoparathyroidism after completion thyroidectomy for well-differentiated thyroid cancer. Eur J Endocrinol 2021; 185:413-419. [PMID: 34232122 DOI: 10.1530/eje-21-0353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid surgery may lead to postoperative complications. The aim of this paper was to determine whether the rate of postoperative hypoparathyroidism (HPT) is influenced by whether surgery is staged. DESIGN Single-institution retrospective observational study. METHODS The clinical records of 786 patients treated at the Otolaryngology Unit of the Azienda USL-IRCCS di Reggio Emilia between January 1990 and December 2015 were reviewed. Patients were divided into two groups according to the surgical treatment received: group TT (637 patients, 81.04%) underwent single-stage total thyroidectomy; Group cT (149 patients, 18.96%) underwent loboisthmusectomy and delayed completion total thyroidectomy. Transient and permanent HPT, assessed after 6 months of follow-up, were the primary endpoints. Risk factors of postoperative HPT were also analysed as secondary outcomes. RESULTS Rates of transient HPT in group TT were higher than those observed in group cT, (P = 0.0057). Analysis of risk factors identified sex as an independent risk factor for transient HPT only for group TT (P = 0.0012) and the number of parathyroid glands remaining in situ (PGRIS) as an independent risk factor for transient and permanent HPT for group TT (P < 0.0001 and P = 0.0002, respectively). CONCLUSIONS This study suggests that the risk of transient postoperative HPT is lower in patients that undergo completion thyroidectomy. Further independent risk factors for postoperative HPT are female sex and PGRIS score. In light of the growing use of conservative surgery for thyroid neoplasms, these findings could help to adequately plan surgery in order to reduce endocrine complications.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Michele Zini
- Endocrinology Unit, Department of Internal Medicine
| | | | - Francesca Lusetti
- Otolaryngology Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Infrastructure for Research and Statistics, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luisa Savoldi
- Clinical Trials and Statistics Unit, Infrastructure for Research and Statistics, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmine Pernice
- Otolaryngology Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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24
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Castellucci A, Martellucci S, Malara P, Botti C, Del Vecchio V, Brandolini C, Ferri GG, Ghidini A, Armato E. Possible pathomechanisms accounting for both sound/pressure-induced eye movements and video head impulse test data in superior canal dehiscence. Acta Otolaryngol 2021; 141:749-753. [PMID: 34236943 DOI: 10.1080/00016489.2021.1944664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Del Vecchio
- UOC Audiology and Vestibology, University Hospital Federico II, Naples, Italy
| | - Cristina Brandolini
- ENT and Audiology Unit, DIMES, S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Gian Gaetano Ferri
- ENT and Audiology Unit, DIMES, S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
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25
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Botti C, Crocetta FM, Giordano D, Menichetti M, Polese A, Colla R, Frasoldati A, Ghidini A. Reduced surgical manipulation in a cohort of patients treated by minimally invasive parathyroidectomy with ultrasonography-based visual map. Clin Otolaryngol 2021; 46:1389-1394. [PMID: 33969627 DOI: 10.1111/coa.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcella Menichetti
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Polese
- Chemical-Clinical Analysis and Endocrinology Laboratory, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rossana Colla
- Chemical-Clinical Analysis and Endocrinology Laboratory, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Frasoldati
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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26
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Botti C, Castellucci A, Crocetta FM, Fornaciari M, Giordano D, Bassi C, Ghidini A. Pneumolabyrinth: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:4619-4632. [PMID: 33881577 DOI: 10.1007/s00405-021-06827-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to provide a systematic review of the literature about the etiology, clinical and radiological presentation, surgical management, and outcomes of pneumolabyrinth (PNL). METHODS A systematic review of the literature was performed including studies published up to September 2020 in electronic databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus). The PRISMA standard was applied to identify English, Italian, or French-language studies mentioning PNL. Full texts lacking information on the etiology were excluded. Data concerning the cause, site of air bubbles/fistula, clinical presentation, treatment, and outcome were collected. A qualitative synthesis of the results was performed. RESULTS Seventy-eight articles were eventually included; 132 patients were involved in the qualitative synthesis. The most common causes were: stapes surgery (24/132, 18.2%), temporal bone fracture (42/132, 31.8%), head trauma without temporal bone fracture (19/132, 14.4%), penetrating trauma (21/132, 15.9%), and barotrauma (15/132, 11.4%). The site most commonly involved was the vestibule (102/107, 95.3%), followed by cochlea (43/107, 40.2%) and semicircular canals (25/107, 23.4%). CONCLUSION The etiopathogenesis of PNL can be summarized in traumatic, iatrogenic, or inflammatory/infective. Its management consists in exploratory tympanotomy and sealing the fistula, but also conservative treatments can be attempted. Vestibular symptoms disappear in the majority of cases. Instead, the prognosis of hearing function is widely variable, and complete recovery is less probable. The certainty of evidence is still too low to make it useful for clinical decision-making.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 41125, Modena, Italy.
| | - Andrea Castellucci
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Maria Crocetta
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Fornaciari
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Giordano
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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27
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Castellucci A, Botti C, Bettini M, Fernandez IJ, Malara P, Martellucci S, Crocetta FM, Fornaciari M, Lusetti F, Renna L, Bianchin G, Armato E, Ghidini A. Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula. Front Neurol 2021; 12:634782. [PMID: 33854475 PMCID: PMC8039292 DOI: 10.3389/fneur.2021.634782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
We describe a case series of labyrinthine fistula, characterized by Hennebert's sign (HS) elicited by tragal compression despite global hypofunction of semicircular canals (SCs) on a video-head impulse test (vHIT), and review the relevant literature. All three patients presented with different amounts of cochleo-vestibular loss, consistent with labyrinthitis likely induced by labyrinthine fistula due to different temporal bone pathologies (squamous cell carcinoma involving the external auditory canal in one case and middle ear cholesteatoma in two cases). Despite global hypofunction on vHIT proving impaired function for each SC for high accelerations, all patients developed pressure-induced nystagmus, presumably through spared and/or recovered activity for low-velocity canal afferents. In particular, two patients with isolated horizontal SC fistula developed HS with ipsilesional horizontal nystagmus due to resulting excitatory ampullopetal endolymphatic flows within horizontal canals. Conversely, the last patient with bony erosion involving all SCs developed mainly torsional nystagmus directed contralaterally due to additional inhibitory ampullopetal flows within vertical canals. Moreover, despite impaired measurements on vHIT, we found simultaneous direction-changing positional nystagmus likely due to a buoyancy mechanism within the affected horizontal canal in a case and benign paroxysmal positional vertigo involving the dehiscent posterior canal in another case. Based on our findings, we might suggest a functional dissociation between high (impaired) and low (spared/recovered) accelerations for SCs. Therefore, it could be hypothesized that HS in labyrinthine fistula might be due to the activation of regular ampullary fibers encoding low-velocity inputs, as pressure-induced nystagmus is perfectly aligned with the planes of dehiscent SCs in accordance with Ewald's laws, despite global vestibular impairment on vHIT. Moreover, we showed how pressure-induced nystagmus could present in a rare case of labyrinthine fistulas involving all canals simultaneously. Nevertheless, definite conclusions on the genesis of pressure-induced nystagmus in our patients are prevented due to the lack of objective measurements of both low-acceleration canal responses and otolith function.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Proam in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico, Bellinzona, Switzerland
| | | | | | - Martina Fornaciari
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Renna
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
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28
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Pernice C, Murri D, Valli R, Crocetta FM, Iori M, Asti M, Ghidini A, Capponi PC. Complete response of cutaneous SCC to topical treatment with ascorbic acid solution: A case report. Clin Case Rep 2021; 9:1060-1065. [PMID: 33768783 PMCID: PMC7981708 DOI: 10.1002/ccr3.3585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical use of topical ascorbic acid solution could have both the role as an adjunct to consolidated therapies and as an alternative to them, for the treatment of BCC and SCC of the skin.
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Affiliation(s)
- Carmine Pernice
- Otolaryngology UnitDepartment of SurgeryAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Domenico Murri
- Otolaryngology UnitDepartment of SurgeryAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Riccardo Valli
- Pathology UnitAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Francesco M. Crocetta
- Otorhinolaryngology Head and Neck Surgery Unit, Head and Neck and Sensory Organs DepartmentSant'Orsola ‐ Malpighi HospitalUniversity of BolognaBolognaItaly
| | - Michele Iori
- Radiopharmaceutical Chemistry SectionAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Mattia Asti
- Radiopharmaceutical Chemistry SectionAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Angelo Ghidini
- Otolaryngology UnitDepartment of SurgeryAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Pier C. Capponi
- Radiopharmaceutical Chemistry SectionAzienda Unità Sanitaria Locale IRCCS di Reggio EmiliaReggio EmiliaItaly
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Castellucci A, Malara P, Martellucci S, Delmonte S, Ghidini A. Fluctuating Posterior Canal Function in Benign Paroxysmal Positional Vertigo Depending on How and Where Otoconia Are Disposed. Otol Neurotol 2021; 42:e193-e198. [PMID: 33273306 DOI: 10.1097/mao.0000000000002913] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Though fluctuations in vestibular function represent a common finding in Menière's disease, we describe how benign paroxysmal positional vertigo (BPPV) may result in fluctuations of vestibulo-ocular reflex for the involved canal depending on the disposition of otoliths. PATIENT A 54-year-old woman suffering from refractory posterior canal (PC)-BPPV resulting in fluctuating PC function. INTERVENTIONS Diagnostic evaluation and rehabilitative treatment for BPPV involving the affected PC. MAIN OUTCOME MEASURES Video-Frenzel and video-head impulse test (vHIT) findings before and after canalith repositioning procedures for PC-BPPV. RESULTS BPPV involving the nonampullary arm of right PC was diagnosed based on presenting positional downbeat nystagmus and selective right PC hypofunction at the vHIT. During physical treatment, nystagmus first became positional paroxysmal upbeat likely due to a shift of debris into the ampullary arm of the canal, then turned to spontaneous downbeat nystagmus consistently with a plug effect exerted by particles entrapped within the nonampullary arm of PC and finally receded proving an otoliths fall within the utriculus. Simultaneously, vHIT documented fluctuations for right PC vestibulo-ocular reflex gain as it first increased to normal values, then severely declined and finally normalized, respectively. High-resolution computed tomography scan detected ipsilateral superior canal dehiscence. CONCLUSIONS In accordance with recently reported vHIT findings in different types of BPPV, fluctuation of PC function could be likely explained by the effect of particles on cupular dynamic responses depending on the portion of the canal gradually involved. Superior canal dehiscence may have played a role facilitating otoliths mobilization by reducing labyrinthine impedance.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico, Bellinzona, Switzerland
| | | | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL - IRCCS, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS, Reggio Emilia, Italy
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30
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Castellucci A, Pepponi E, Bertellini A, Senesi C, Bettini M, Botti C, Martellucci S, Malara P, Delmonte S, Crocetta FM, Fornaciari M, Lusetti F, Bianchin G, Ghidini A. Case Report: Filling Defect in Posterior Semicircular Canal on MRI With Balanced Steady-State Gradient-Echo Sequences After Labyrinthine Ischemia in the Common Cochlear Artery Territory as an Early Sign of Fibrosis. Front Neurol 2021; 11:608838. [PMID: 33519688 PMCID: PMC7838557 DOI: 10.3389/fneur.2020.608838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
We describe a rare case of posterior semicircular canal (PSC) fibrosis following acute labyrinthine ischemia in the territory supplied by the common cochlear artery (CCA) and review the relevant literature. A 71-year-old man with multiple vascular risk factors presented 12 days after the onset of acute vertigo and profound left-sided hearing loss. Right-beating spontaneous nystagmus with downbeat components elicited by mastoid vibrations and headshaking was detected. The video head impulse test (vHIT) revealed an isolated hypofunction of the left PSC, whereas vestibular evoked myogenic potentials (VEMPs) showed ipsilateral saccular loss. The clinical presentation and instrumental picture were consistent with acute ischemia in the territory supplied by left CCA. Compared to previous imaging, a new MRI of the brain with 3D-FIESTA sequences highlighted a filling defect in the left PSC, consistent with fibrosis. Hearing function exhibited mild improvement after steroid therapy and hyperbaric oxygen sessions, whereas vHIT abnormalities persisted over time. To the best of our knowledge, this is the only case in the literature reporting a filling defect on MRI, consistent with semicircular canal fibrosis following acute labyrinthine ischemia. Moreover, PSC fibrosis was related with poor functional outcome. We therefore suggest using balanced steady-state gradient-echo sequences a few weeks following an acute lesion of inner ear sensors to detect signal loss within membranous labyrinth consistent with post-ischemic fibrosis. Besides addressing the underlying etiology, signal loss might also offer clues on the functional behavior of the involved sensor over time. In cases of acute loss of inner ear function, a careful bedside examination supplemented by instrumental assessments, including vHIT and VEMPs, of vestibular receptors and afferents may be completed by MRI with balanced steady-state gradient-echo sequences at a later time to confirm the diagnosis and address both etiology and functional outcome.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emanuela Pepponi
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Bertellini
- Department of Radiology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Senesi
- Department of Neurology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Silvia Delmonte
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Martina Fornaciari
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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31
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Mattioli F, Fernandez IJ, Bassano E, Luppi MP, Bonali M, Ghidini A, Trebbi M, Bergamini G, Presutti L, Botti C. Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long-term functional results and quality of life. Head Neck 2020; 43:1161-1173. [PMID: 33355954 DOI: 10.1002/hed.26584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Swallowing disorders are common problems after partial laryngectomy. The aim of this study is to illustrate the long-term functional results of rehabilitation of swallowing by polydimethylsiloxane (PDMS) injection. METHODS Twenty-eight patients with dysphagia after partial laryngectomy who underwent injection of PDMS for rehabilitation of swallowing were included in the study. Impairment of swallowing and quality of life (QoL) were investigated with questionnaires: M. D. Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for Head and Neck Cancer (PSS-HNC). Functional results at fiberoptic endoscopic evaluation of swallowing (FEES) were analyzed using a modified penetration-aspiration scale. RESULTS Mean follow-up was 8.5 years. Twenty-six patients showed an improvement at questionnaires (p < 0.001). Median improvement was 6 (p < 0.001) in the modified penetration-aspiration scale. Total laryngectomy was required in one patient. CONCLUSIONS PDMS injection is a good option for rehabilitation of swallowing in case of dysphagia after partial laryngectomy. It improves QoL and the results persist after a long follow-up period.
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Affiliation(s)
- Francesco Mattioli
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Bassano
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria Pia Luppi
- Department of Head and Neck, University Hospital of Modena, Modena, Italy
| | - Marco Bonali
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Trebbi
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Giuseppe Bergamini
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
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32
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Martellucci S, Malara P, Castellucci A, Pecci R, Giannoni B, Marcelli V, Scarpa A, Cassandro E, Quaglieri S, Manfrin ML, Rebecchi E, Armato E, Comacchio F, Mion M, Attanasio G, Ralli M, Greco A, de Vincentiis M, Botti C, Savoldi L, Califano L, Ghidini A, Pagliuca G, Clemenzi V, Stolfa A, Gallo A, Asprella Libonati G. Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers. Front Neurol 2020; 11:578305. [PMID: 33329319 PMCID: PMC7711159 DOI: 10.3389/fneur.2020.578305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV. Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT. Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80). Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.
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Affiliation(s)
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico Bellinzona, Bellinzona, Switzerland
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rudi Pecci
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Beatrice Giannoni
- Audiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | | | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | | | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Francesco Comacchio
- Department of Neurosciences, Regional Specialized Vertigo Center, Institute of Otolaryngology, University of Padua, Padua, Italy
| | - Marta Mion
- ENT Unit, Department of Surgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Giuseppe Attanasio
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luisa Savoldi
- Department Infrastructure Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Califano
- Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulio Pagliuca
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Veronica Clemenzi
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Stolfa
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Botti C, Lusetti F, Neri T, Peroni S, Castellucci A, Salsi P, Ghidini A. Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits. Auris Nasus Larynx 2020; 48:511-517. [PMID: 33143935 PMCID: PMC7598348 DOI: 10.1016/j.anl.2020.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
Objective Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. Methods We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Results Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. Conclusion PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Francesca Lusetti
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Peroni
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Castellucci
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Pierpaolo Salsi
- Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
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34
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Castellucci A, Malara P, Martellucci S, Botti C, Delmonte S, Quaglieri S, Rebecchi E, Armato E, Ralli M, Manfrin ML, Ghidini A, Asprella Libonati G. Feasibility of Using the Video-Head Impulse Test to Detect the Involved Canal in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Front Neurol 2020; 11:578588. [PMID: 33178119 PMCID: PMC7593380 DOI: 10.3389/fneur.2020.578588] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Positional downbeat nystagmus (pDBN) represents a relatively frequent finding. Its possible peripheral origin has been widely ascertained. Nevertheless, distinguishing features of peripheral positional nystagmus, including latency, paroxysm and torsional components, may be missing, resulting in challenging differential diagnosis with central pDBN. Moreover, in case of benign paroxysmal positional vertigo (BPPV), detection of the affected canal may be challenging as involvement of the non-ampullary arm of posterior semicircular canal (PSC) results in the same oculomotor responses generated by contralateral anterior canal (ASC)-canalolithiasis. Recent acquisitions suggest that patients with persistent pDBN due to vertical canal-BPPV may exhibit impaired vestibulo-ocular reflex (VOR) for the involved canal on video-head impulse test (vHIT). Since canal hypofunction normalizes following proper canalith repositioning procedures (CRP), an incomplete canalith jam acting as a "low-pass filter" for the affected ampullary receptor has been hypothesized. This study aims to determine the sensitivity of vHIT in detecting canal involvement in patients presenting with pDBN due to vertical canal-BPPV. We retrospectively reviewed the clinical records of 59 consecutive subjects presenting with peripheral pDBN. All patients were tested with video-Frenzel examination and vHIT at presentation and after resolution of symptoms or transformation in typical BPPV-variant. BPPV involving non-ampullary tract of PSC was diagnosed in 78%, ASC-BPPV in 11.9% whereas in 6 cases the involved canal remained unidentified. Presenting VOR-gain values for the affected canal were greatly impaired in cases with persistent pDBN compared to subjects with paroxysmal/transitory nystagmus (p < 0.001). Each patient received CRP for BPPV involving the hypoactive canal or, in case of normal VOR-gain, the assumed affected canal. Each subject exhibiting VOR-gain reduction for the involved canal developed normalization of vHIT data after proper repositioning (p < 0.001), proving a close relationship with otoliths altering high-frequency cupular responses. According to our results, overall vHIT sensitivity in detecting the affected SC was 72.9%, increasing up to 88.6% when considering only cases with persistent pDBN where an incomplete canal plug is more likely to occur. vHIT should be routinely used in patients with pDBN as it may enable to localize otoconia within the labyrinth, providing further insights to the pathophysiology of peripheral pDBN.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, "Centromedico Bellinzona", Bellinzona, Switzerland
| | | | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | - Enrico Armato
- ENT Unit, "SS Giovanni e Paolo" Hospital, Venice, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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35
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Botti C, Lusetti F, Peroni S, Neri T, Castellucci A, Salsi P, Ghidini A. The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19. Ear Nose Throat J 2020; 100:116S-119S. [PMID: 33035129 PMCID: PMC7548540 DOI: 10.1177/0145561320965196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: Patients with acute respiratory failure due to coronavirus disease 2019
(COVID-19) have a high likelihood of needing prolonged intubation and may
subsequently require tracheotomy. Indications and timing for performing
tracheotomy in patients affected by severe COVID-19 pneumonia are still
elusive. The aim of this study is to analyze the role of tracheotomy in the
context of this pandemic. Moreover, we report the timing of the procedure
and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years)
with severe COVID-19 pneumonia who were admitted to the intensive care unit
(ICU) of the tertiary care center of Reggio Emilia (Italy). All patients
underwent orotracheal intubation with invasive mechanical ventilation,
followed by percutaneous or open surgical tracheotomy. Indications, timing
of the procedure, and time needed to complete weaning and decannulation were
reported. Results: Forty-four patients were included in the analysis. Median time from
orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%)
patients died during the follow-up period (median 22 days, range 8-68) after
the intubation. Weaning from the ventilator was first attempted on median
25th day (range 13-43) from orotracheal intubation. A median of 35 (range
18-79) days was required to complete weaning. Median duration of ICU stay
was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days
from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing
tracheotomy, decision-making should be made on case-by-case basis. It should
be adapted to the context of the pandemic, taking into account the
availability of intensive care resources, potential risks for health care
workers, and benefits for the individual patient.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, 208968University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Stefano Peroni
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Pierpaolo Salsi
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
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36
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Taboni S, Paderno A, Giordano D, Albano D, Piana S, Zanetti E, Bertagna F, Grammatica A, Ghidini A, Cappelli C, Bozzola A, Baronchelli C, Nicolai P, Lombardi D. Differentiated Thyroid Cancer: The Role of ATA Nodal Risk Factors in N1b Patients. Laryngoscope 2020; 131:E1029-E1034. [PMID: 33319385 DOI: 10.1002/lary.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/12/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nodal involvement is frequent in patients with differentiated thyroid cancers (DTCs), but its prognostic relevance is not univocal. Some characteristics of nodal metastases can increase the risk of recurrence. We attempted to quantify the impact on survival of nodal factors included in the American Thyroid Association (ATA) risk stratification system in N1b patients with DTC. STUDY DESIGN Retrospective study. METHODS A retrospective analysis of patients affected by DTC who underwent therapeutic lateral neck dissection (ND) was performed. The impact on the prognosis of the number of positive lymph nodes (LNs), dimension of nodal metastasis, and microscopic and macroscopic extranodal extension (miENE and maENE, respectively) was investigated. RESULTS The study included 347 N1b patients who underwent 401 therapeutic lateral NDs. Mean number of positive LNs was nine, mean nodal ratio was 0.27, and mean diameter of metastasis was 15.5 mm. ENE was detected in 25.9% of patients (22.5% miENE and 3.5% maENE). In univariate analysis, the presence of maENE had an impact on disease specific survival (DSS) (P = .023); increasing number of positive LNs affected DSS and locoregional control (LRC) (P = .009 and =.006, respectively); increasing metastatic node dimension was a risk factors for overall survival, DSS, and metastases free survival (MFS) (P = .05, =.013 and =.016). In multivariate analysis, number of positive LNs and LN dimension were independent risk factors for LRC and MFS, respectively (HR 1.1, P = .028; HR 1.1, P = .026). CONCLUSIONS In our analysis on a cohort of N1b patients, the number of positive LNs and LN dimension were confirmed as independent risk factors for locoregional and distant recurrence, respectively. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1029-E1034, 2021.
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Affiliation(s)
- Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Eleonora Zanetti
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | | | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Angelo Ghidini
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Department of Pathology, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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Crocetta FM, Farneti P, Sollini G, Castellucci A, Ghidini A, Spinosi MC, Fernandez IJ, Zoli M, Mazzatenta D, Pasquini E. Endoscopic management of frontal sinus diseases after frontal craniotomy: a case series and review of the literature. Eur Arch Otorhinolaryngol 2020; 278:1035-1045. [PMID: 32880737 DOI: 10.1007/s00405-020-06335-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate frontal sinus complications developed after previous external craniotomies requiring frontal sinus reconstruction and their treatment with an endoscopic approach. METHODS We retrospectively evaluated 22 patients who referred to Sant'Orsola-Malpighi University Hospital and Bellaria Hospital (Bologna, Italy) between 2005 and 2017. All patients presented with frontal sinus disease after frontal craniotomy with sinus reconstruction performed to treat various pathological conditions. We reported our experience in the endoscopic management of such complications and we reviewed the current literature concerning the endoscopic treatment of these conditions. RESULTS In total, 14 frontal mucoceles, 4 cases of chronic frontal sinusitis, 2 mucopyoceles and 2 fungus ball of the frontal sinus were identified. Endoscopic surgical treatment included 7 DRAF IIa, 1 DRAF IIb, 11 DRAF III and 3 DRAF IIc (modified DRAF III) approaches. The success rate of the surgical procedure was 86% (19/22 patients). Recurrence of the initial pathology occurred in three patients (14%) requiring a conversion of previous frontal sinusotomy into a DRAF III sinusotomy. CONCLUSION Frontal sinusopathy can be a long-term complication following craniotomies and may lead to potentially severe pathological conditions, such as mucoceles and frontal sinus inflammation. Its management is still debated and requires recovery of the patency of nasal-frontal route. Our study confirms that the endoscopic endonasal approach may offer a valid solution with low morbidity avoiding re-opening of the craniotomic access. For selected cases, endoscopic approach could also be performed simultaneously to craniotomy as a combined surgery to reduce the risk of short- and long-term complications. Long-term follow-up is mandatory in patients with a history of opened and reconstructed frontal sinus and should include imaging and endoscopic outpatient evaluation.
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Affiliation(s)
- F M Crocetta
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. .,ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - P Farneti
- ENT Department, Santa Maria Della Scaletta Hospital, Imola, BO, Italy
| | - G Sollini
- ENT Department, Bellaria Hospital, Bologna, Italy
| | - A Castellucci
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - A Ghidini
- ENT Department, Azienda USL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - M C Spinosi
- ENT Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - I J Fernandez
- ENT Department, University Hospital of Modena, Modena, Italy
| | - M Zoli
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - D Mazzatenta
- Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery - IRCCS, Bologna, Italy
| | - E Pasquini
- ENT Department, Bellaria Hospital, Bologna, Italy
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Ghidini A, Botti C, Vezzani S, Piana S, Frasoldati A. Large intrathyroidal lipoma with radioiodine uptake. Endocrine 2020; 69:692-694. [PMID: 32333267 DOI: 10.1007/s12020-020-02322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Vezzani
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Frasoldati
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Botti C, Iannella E, Lusetti F, Giordano D, Pernice C, Perano D, Ghidini A. Congenital Nasal Pyriform Aperture Stenosis: Successful Management of Restenosis After Primary Surgery by Stent Placement. Ear Nose Throat J 2020; 101:NP58-NP61. [PMID: 32697108 DOI: 10.1177/0145561320942368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare anomaly causing respiratory distress in newborns. While the primary surgical technique is well established, the timing of the removal of the stents and the management of restenosis remain a matter of debate. We report a case of a female newborn affected by CNPAS with the recurrence of respiratory distress after primary surgery due to the early removal of nasal stents, causing an overgrowth of granulation tissue. This report notes that restenosis was successfully managed by repeating the procedure over a 14-day period, with soft polyvinyl chloride uncuffed tracheal tubes acting as nasal stents.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy.,Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Elisa Iannella
- Anaesthesiology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | | | - Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Carmine Pernice
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Daniele Perano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy
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Castellucci A, Malara P, Ghidini A. Spontaneous downbeat nystagmus in posterior semicircular canal benign paroxysmal positional vertigo: a canalith jam? Neurol Sci 2020; 42:313-315. [PMID: 32592106 DOI: 10.1007/s10072-020-04529-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, AUSL, IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Viale Officina 7, 6500, Bellinzona, Switzerland
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, AUSL, IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
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Castellucci A, Piras G, Del Vecchio V, Crocetta FM, Maiolo V, Ferri GG, Ghidini A, Brandolini C. The effect of superior canal dehiscence size and location on audiometric measurements, vestibular-evoked myogenic potentials and video-head impulse testing. Eur Arch Otorhinolaryngol 2020; 278:997-1015. [PMID: 32592013 DOI: 10.1007/s00405-020-06169-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To correlate objective measures of audio-vestibular function with superior canal dehiscence (SCD) size and location in ears with SCD and compare results with literature. METHODS We retrospectively evaluated 242 patients exhibiting SCD and/or extremely thinned bone overlying superior canals (SC) on CT scans and selected 73 SCD patients (95 ears with SCD). Data concerning audiometry, impedance audiometry, video-head impulse test (vHIT), cervical vestibular-evoked myogenic potentials (cVEMPs) and ocular VEMPs (oVEMPs) to air- (AC) and bone-conducted (BC) stimuli were collected for each pathologic ear and correlated with dehiscence size and location. RESULTS AC pure-tone average (PTA) (p = 0.013), low-frequency air-bone gap (ABG) (p < 0.001), AC cVEMPs amplitude (p = 0.002), BC cVEMPs amplitude (p < 0.001) and both AC and BC oVEMPs amplitude (p < 0.001) positively correlated with increasing SCD size. An inverse relationship between dehiscence length and both AC cVEMPs and oVEMPs thresholds (p < 0.001) and SC vestibulo-ocular reflex (VOR) gain (p < 0.001) was observed. Dehiscences at the arcuate eminence (AE) exhibited lower SC VOR gains compared to SCD along the ampullary arm (p = 0.008) and less impaired BC thresholds than dehiscences at the superior petrosal sinus (p = 0.04). CONCLUSION We confirmed that SCD size affects AC PTA, ABG and both amplitudes and thresholds of cVEMPs and oVEMPs. We also described a tendency for SC function to impair with increasing SCD size and when dehiscence is located at the AE. The latter data may be explained either by a spontaneous canal plugging exerted by middle fossa dura or by a dissipation through the dehiscence of mechanical energy conveyed to the endolymph during high-frequency impulses.
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Affiliation(s)
- Andrea Castellucci
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy. .,ENT Unit, Department of Surgery, Azienda USL - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
| | - Gianluca Piras
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy.,Department of Otology and Skull Base Surgery, Casa Di Cura Privata ''Piacenza'' S.P.A Gruppo Otologico, Piacenza, Rome, Italy
| | - Valeria Del Vecchio
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy.,UOC Audiology & Vestibology, University Hospital Federico II, Naples, Italy
| | - Francesco Maria Crocetta
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy.,ENT Unit, Department of Surgery, Azienda USL - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Vincenzo Maiolo
- Radiology Department, S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Gian Gaetano Ferri
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Cristina Brandolini
- ENT & Audiology Unit, Department of Diagnostic, Experimal and Specialty Medicine (DIMES), S.Orsola - Malpighi University Hospital, Bologna, Italy
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Chitty LS, Hui L, Ghidini A, Levy B, Deprest J, Van Mieghem T, Bianchi DW. In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2019. Prenat Diagn 2020; 40:287-293. [PMID: 31875323 DOI: 10.1002/pd.5632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022]
Affiliation(s)
- L S Chitty
- London North Genomic Laboratory, Great Ormond Street NHS Foundation Trust, and Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - L Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - A Ghidini
- Antenatal Testing Centre, Inova Alexandria Hospital, Alexandria, VA
| | - B Levy
- Departments of Pathology and Cell Biology, Columbia University, New York, NY
| | - J Deprest
- Departments of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - T Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - D W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Castellucci A, Malara P, Brandolini C, Del Vecchio V, Giordano D, Ghidini A, Ferri GG, Pirodda A. Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss. Am J Otolaryngol 2019; 40:319-322. [PMID: 30665622 DOI: 10.1016/j.amjoto.2018.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly. METHODS Case report and literature review. RESULTS A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers. CONCLUSIONS In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Azienda USL - Center for Clinical and Basic Research (IRCCS), viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Viale Officina 7, 6500 Bellinzona, Switzerland
| | - Cristina Brandolini
- ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Valeria Del Vecchio
- ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Davide Giordano
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Azienda USL - Center for Clinical and Basic Research (IRCCS), viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Azienda USL - Center for Clinical and Basic Research (IRCCS), viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Gian Gaetano Ferri
- ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
| | - Antonio Pirodda
- ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Napolitano M, Bertolini F, D'Angelo E, Spallanzani A, Tassi S, Meduri B, Bettelli S, Depenni R, Ghidini A, Lohr F, Presutti L, Cascinu S. Incidence and survival of secondary malignances (SM) in oropharingeal squamous cell carcinoma (OPSCC): A homogeneous single report institution. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ghidini A, Murtola M, Strömberg R. Influence of conjugation and other structural changes on the activity of Cu²⁺ based PNAzymes. Org Biomol Chem 2016; 14:2768-73. [PMID: 26856621 DOI: 10.1039/c5ob02394g] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We have previously shown that PNA-neocuproine conjugates can act as artificial RNA restriction enzymes. In the present study we have additionally conjugated the PNA with different entities, such as oligoethers, peptides etc. and also constructed systems where the PNA is designed to clamp the target RNA forming a triplex. Some conjugations are detrimental for the activity while most are silent which means that conjugation can be done to alter physical properties without losing activity. Conjugation with a single oligoether close to the neocuproine does enhance the rate almost twofold compared to the system without the oligoether. The systems designed to clamp the RNA target by forming a triplex retain the activity if the added oligoT sequence is 5 PNA units or shorter and extends the arsenal of artificial RNA restriction enzymes. Changing the direction of a closing base pair, where the target RNA forms a bulge, from a GC to a CG pair enhances the rate of cleavage somewhat without compromising the selectivity, leading to the so far most efficient artificial nuclease reported.
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Affiliation(s)
- A Ghidini
- Karolinska Institutet, Department of Biosciences and Nutrition, Novum, Hälsovägen 7, S-14183 Huddinge, Sweden.
| | - M Murtola
- Karolinska Institutet, Department of Biosciences and Nutrition, Novum, Hälsovägen 7, S-14183 Huddinge, Sweden. and Turku University, Department of Chemistry, Turku 20014, Finland
| | - R Strömberg
- Karolinska Institutet, Department of Biosciences and Nutrition, Novum, Hälsovägen 7, S-14183 Huddinge, Sweden.
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Galetti G, Martini A, Bergamini G, Dallari S, Ghidini A, Mazzoli M, Cantini L, Monici Preti P. Efficacy and Tolerability of Brodimoprim in Bacterial Otitis Media in Children. Controlled Study versus Cefaclor. J Chemother 2016. [DOI: 10.1080/1120009x.1993.11741117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- G. Galetti
- Clinica O.R.L., Università di Modena, Italy
| | - A. Martini
- Clinica O.R.L., Università di Ferrara, Italy
| | | | - S. Dallari
- Clinica O.R.L., Università di Modena, Italy
| | - A. Ghidini
- Clinica O.R.L., Università di Modena, Italy
| | - M. Mazzoli
- Clinica O.R.L., Università di Ferrara, Italy
| | - L. Cantini
- Direzione Medica, Master Phanna, Parma, Italy
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Piccinini A, Alicandri-Ciufelli M, Ghidini A, Vincenti V, Ferri T, Presutti L. Prognostic factors in stage IV oropharyngeal squamous cell carcinoma: the "punto" experience. Acta Biomed 2016; 87:86-96. [PMID: 27163901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Squamous Cell Carcinoma (SCC) of Oropharynx is often diagnosed in advanced stages. Treatment options have improved during recent years, however the choice of most appropriate treatment is still controversial. Prognostic factors can help to optimize the care. This study investigate the role of 9 potential prognostic factors, including HPV status, in Oropharyngeal SCC. MATERIALS AND METHODS Nine prognostic factors were investigated in a retrospective chart of 98 patients treated for stage IV SCC of Oropharynx from january 2006 to january 2012, including age (<60 or >60), gender, tumor subsite , histological grading, T stage, N stage, AJCC stage, BMI pre-treatment and HPV status. Moreover treatment modalities were compared and the data regarding the treatment factors, like radiotherapy technique and kind of chemotherapy were collected and compared.Primary endpoint was the impact of the prognostic factors on OS, DFS and DSS.Seconrdary endopoint were the impact of these factors on QOL and Toxicity. RESULTS On univariate analisys significant improved OS was associated with age < 60 (p= 0,004), grading G3 (p=0.003), BMI > 25 (p= 0.03), radiotherapy with IMRT/SIB IMRT technique (p=0,01) and AJCC stage IVa (p=0,01).No prognostic factor was associated to DFS improvement.Instead a significant improved DSS was associated with age <60 (p=0,01) , Grading G3 (p=0,04), T stage (p=0,02), AJCC stage IVa (p=0,03) and tonsil subsite (p=0.04). in the analysis of hazards ratios for OS age (HR 2.22; 95% CI 1.00-4.93; p=0.019), grading (HR 0.17; 95% CI 0.047-0.64 ; p= 0.008), AJCC stage (HR 4.81; 95% CI 1.34-17.2; p=0.016) and radiotherapy technique (HR 0.2; 95% CI 0.08-0.87; p=0.02) maintained significance, whereas BMI (HR 0.45; 95% CI 0.09- 2.2; p=0.3) did not. In the analysis for DSS only age (HR 2.22; 95% CI 1.22-7.81; p= 0.017) and grading (HR 0.11; 95% CI 0.02- 0.59; p=0.009) maintained significance. CONCLUSION improved outcomes were significantly associated with lower age and tumor stage, grading G3, tonsil subsite, radiotherapy performed with IMRT technique, and BMI > 25.
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Piccinini A, Alicandri-Ciufelli M, Ghidini A, Bergamini G, Vincenti V, Bacciu A, Ferri T, Cesinaro AM, Presutti L. FDG-PET/CT appearance of injected silicone particles (VOX Implants®) in head and neck tissues. Acta Biomed 2015; 86:283-289. [PMID: 26694157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/16/2015] [Indexed: 06/05/2023]
Abstract
OBJETIVES In head and neck surgery, Positron Emission Tomography/Computed Tomography imaging (FDG-PET/CT) is often used to identify primary tumor site in patients with unknown primary carcinoma, to predict response after chemoradiotherapy and in some cases, to detect recurrence. To rehabilitate swallowing after surgery in patients with persistent dysphagia, an injectable suspension of silicone (VOX® Implants) can be used to reduce the gaps in the neoglottis. The purpose of this report is to document the PET appearance of PDMS in a series of 3 patients who underwent partial laryngectomy with subsequent VOX® Implants injection. MATERIAL AND METHODS a retrospective chart and imaging review was performed at our institution. Three patients were identified and included in the study. Appearance of PDMS at PET was described and discussed. RESULTS An increased uptake of 2-fluoro-2-deoxy-d-glucose (FDG) was noticed at PET in all patients. CONCLUSIONS the increased uptake was possibly due to active inflammatory reactions that are necessary for tissue integration of textured silicone particles.
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Ghidini A. Re: Risk of miscarriage following amniocentesis and chorionic villus sampling. Ultrasound Obstet Gynecol 2015; 45:755. [PMID: 26032712 DOI: 10.1002/uog.14850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/13/2015] [Indexed: 06/04/2023]
Affiliation(s)
- A Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA, 22304, USA
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Alicandri-Ciufelli M, Bonali M, Piccinini A, Marra L, Ghidini A, Cunsolo EM, Maiorana A, Presutti L, Conte PF. Surgical margins in head and neck squamous cell carcinoma: what is 'close'? Eur Arch Otorhinolaryngol 2012; 270:2603-9. [PMID: 23271033 DOI: 10.1007/s00405-012-2317-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 12/06/2012] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review is to evaluate the definition of close margin in head and neck squamous cell carcinoma (HNSCC), and its possible prognostic significance. An appropriate string was run on PubMed to retrieve articles discussing the 'close' surgical margin issue in HNSCC. A double cross-check was performed on citations and full-text articles retrieved. In total, 348 articles were identified. Further references were included by using the option "Titles in your search terms" option in PubMed. 15 papers were finally included for qualitative synthesis. In vocal cord surgery of HNSCC, a close margin could be considered to be ≤1 mm, in the larynx ≤5 mm, in the oral cavity ≤4 mm, and in the oropharynx ≤5 mm. In each patient, the choice of extent of close margin should be balanced against general condition, tumor stage, and functional issues to indicate appropriate adjuvant therapy.
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Affiliation(s)
- Matteo Alicandri-Ciufelli
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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