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Ferri A, Perlangeli G, Zito F, Ferrari S, Bianchi B, Arcuri F, Poli T. Technical refinements of the scapular tip-free flap for mandibular reconstruction. Microsurgery 2024; 44:e31176. [PMID: 38553855 DOI: 10.1002/micr.31176] [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] [Received: 11/06/2023] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients. PATIENTS AND METHODS Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy. RESULTS The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients. CONCLUSION The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.
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Affiliation(s)
- Andrea Ferri
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Giuseppe Perlangeli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Francesca Zito
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Silvano Ferrari
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
| | - Bernardo Bianchi
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Francesco Arcuri
- Operative Unite of Maxillo-Facial Surgery, Hospital of Genova, Genoa, Italy
| | - Tito Poli
- Operative Unite of Maxillo-Facial Surgery Head and Neck Department, University of Parma, Parma, Italy
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Arcuri F, Ardito E, Bianchi B. Skin Expander for Scalp Reconstruction: Reappraisal of a Reconstructive Procedure for Aplasia Cutis Congenita. J Craniofac Surg 2024:00001665-990000000-01386. [PMID: 38421169 DOI: 10.1097/scs.0000000000010053] [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: 01/31/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Aplasia cutis congenita (ACC) is a heterogeneous group of congenital disorders characterized by the absence of epidermis, dermis, appendages, subcutaneous tissue, and bone. The aim of the study is to describe a clinical report of ACC of the scalp treated with skin expanders. CLINICAL REPORT In October 2019, a 16-year-old female patient underwent scalp expansion with 2 rectangular devices (150 and 250 cm3; Radovan Mentor-Johnson&Johnson). The inflation started 30 days after surgery and continued once every 7 to 10 days to gain 10% of overexpansion. After 3 months, the patient underwent the second surgical step with the expanded scalp transposed to close the defect. Clinical examination 6 months after surgery revealed an acceptable cosmetic result with a hidden surgical scar and hair growth in the previous area of frontoparietal alopecia. CONCLUSION Skin expander for the reconstruction of extensive ACC defects of the scalp is a valid procedure.
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Raffaini M, Arcuri F. Maxillary advancement greater than one centimeter in non-cleft patients: Clinical evaluation of simple technical modifications. J Craniomaxillofac Surg 2024; 52:175-180. [PMID: 38199943 DOI: 10.1016/j.jcms.2023.11.002] [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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Francesco Arcuri
- Consultant of the Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa, Italy.
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Ferri A, Varazzani A, Tognin L, Bellanti L, Pedrazzi G, Bianchi B, Arcuri F, Ferrari S, Poli T. Perioperative pain management after scapular tip free flap harvesting for head and neck reconstruction using mini-catheters to inject the local anesthetic. Oral Maxillofac Surg 2024:10.1007/s10006-024-01212-7. [PMID: 38270706 DOI: 10.1007/s10006-024-01212-7] [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: 10/18/2022] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Although functional and esthetic results after the use of a scapular tip free flap (STFF) in head and neck reconstruction, and the related donor-site morbidity, have been extensively described, data regarding acute postoperative donor-site pain management are lacking. Purpose of this study is to explore the use of mini-catheters to administer local anesthetics for donor-site pain management after reconstruction using STFF. METHODS Patients who underwent head and neck reconstruction using a STFF were prospectively enrolled and, through a perineural catheter placed in the donor site during the surgical procedure, a bolus of chirochaine was injected before the patient regained consciousness and at 8, 16, and 24 h postoperatively. Before and 40 min after each dose administration, donor-site pain on a numerical rating scale (NRS; 0-10) was evaluated. RESULTS Study population consisted of 20 patients (40-88 years). At 8 h, the pain scores before and after the injection were 0-10 (mean 3.35) and 0-5 (mean 1.25), respectively. At 16 h, the pain scores before and after the injection were 0-8 (mean 2.55) and 0-4 (mean 0.55), respectively. At 24 h, the pain scores before and after the injection were 0-8 (mean 1.30) and 0-4 (mean 0.30), respectively. CONCLUSION Statistical analysis confirmed a significant difference between the pain scores before and after administration at 8, 16, and 24 h (p < 0.001, p < 0.001, and p = 0.003, respectively). Mini-catheters for local anesthetic administration represent an effective strategy for pain control after STFF harvesting for head and neck reconstruction.
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Affiliation(s)
- A Ferri
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | - A Varazzani
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | - L Tognin
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy.
| | - L Bellanti
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital of Parma, Parma, Italy
| | | | - B Bianchi
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital San Martino of Genova, Genoa, Italy
| | - F Arcuri
- Maxillo-Facial Surgery Division, Head Neck Department, University Hospital San Martino of Genova, Genoa, Italy
| | | | - T Poli
- University of Parma, Parma, Italy
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Cortese MD, Arcuri F, Vatrano M, Pioggia G, Cerasa A, Raso MG, Tonin P, Riganello F. Wessex Head Injury Matrix in Patients with Prolonged Disorders of Consciousness: A Reliability Study. Biomedicines 2023; 12:82. [PMID: 38255189 PMCID: PMC10813453 DOI: 10.3390/biomedicines12010082] [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: 12/04/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The Wessex Head Injury Matrix (WHIM) was developed to assess patients with disorders of consciousness (DOC) and was tested in terms of inter-rater reliability (IRR) and test-retest reliability (TRR) in the year 2000. The American Congress of Rehabilitation and Medicine reported that IRR and TRR were unproven. We aim to assess the reliability of the WHIM in prolonged DOC patients (PDOC). Methods: A total of 51 PDOC patients (32 unresponsive wakefulness syndrome (UWS/VS) and 19 minimally conscious state (MCS)) who were hosted in a dedicated unit for long-term brain injury care were enrolled. The time from injury ranged from 182 to 3325 days. Two raters administered the Coma Recovery Scale-Revised (CRS-R) and the WHIM to test the IRR and TRR. The TRR was administered two weeks after the first assessment. Results: For the CRS-R, the agreement in IRR and TRR was perfect between the two raters. The agreement for the WHIM ranged from substantial to almost perfect for IRR and from fair to substantial for the TRR. Conclusions: The WHIM showed a strong IRR when administered by expert raters and strongly correlated with the CRS-R. This study provides further evidence of the psychometric qualities of the WHIM and the importance of its use in PDOC patients.
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Affiliation(s)
- Maria Daniela Cortese
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
| | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
| | - Martina Vatrano
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98100 Messina, Italy;
| | - Antonio Cerasa
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98100 Messina, Italy;
| | - Maria Girolama Raso
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
| | - Paolo Tonin
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
| | - Francesco Riganello
- Research in Advanced Neurorehabilitation, S. Anna Institute, Via Siris, 11, 88900 Crotone, Italy; (M.D.C.); (F.A.); (M.V.); (A.C.); (P.T.)
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Arcuri F, Ferri A, Bianchi B, Laganà F. Modified Preauricular Transparotid Approach for Treating Mandibular Condylar Fractures. J Craniofac Surg 2023; 34:2181-2184. [PMID: 37403219 DOI: 10.1097/scs.0000000000009507] [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: 08/28/2022] [Accepted: 05/17/2023] [Indexed: 07/06/2023] Open
Abstract
AIM OF THE STUDY We introduce a technical variant of the standard preauricular approach to treat intracapsular and condylar neck fractures: the modified preauricular transparotid approach (MPTA). The main modification, when compared with the conventional submandibular approach, is that the incision of the superficial musculoaponeurotic system is performed directly above the parotid gland, and the buccal branch of the facial nerve is dissected in a retrograde way within the parotid gland. CASE SERIES Between January 2019 and December 2020 at the Maxillofacial Departments of "Ospedale Maggiore" of Parma and "Policlinico San Martino" of Genoa 6 patients affected by intracapsular and condylar neck fractures underwent open reduction and internal with MPTA. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 85 minutes, ranging from 75 to 115 minutes. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. CONCLUSION MPTA is particularly suited for intracapsular and condylar neck fractures. Morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and esthetic deformity.
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Affiliation(s)
- Francesco Arcuri
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa, Italy
| | - Andrea Ferri
- Unit of Maxillo-Facial Surgery, University Hospital of Parma, Italy
| | - Bernardo Bianchi
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa, Italy
| | - Francesco Laganà
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa, Italy
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Arcuri F, Laganà F, Bianchi B, Ferrari S, Ferri A. Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction. J Craniofac Surg 2023; 34:1744-1747. [PMID: 37433202 DOI: 10.1097/scs.0000000000009512] [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] [Received: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Scapular tip free flap (STFF) has become today one of the workhorse flaps for maxillary reconstruction; recently, the possibility of extending the vascular supply by adding to the angular branch of the circumflex pedicle up to its periosteal entrance in the lateral border of the scapula has been proposed as a reliable technique to improve the length of perfused bone when STFF is used for mandibular reconstruction. The purpose of this study was to evaluate the patients who had received microvascular reconstruction of the mandible with STFF vascularized by both the circumflex scapular artery via the periosteal branch and the thoracodorsal artery via the angular artery. METHODS A retrospective chart review was conducted for all patients who underwent reconstruction with an STFF for mandibular defect between January 2016 and December 2020 at the University Hospital of Parma. The outcome was evaluated by assessing dietary intake (unrestricted, soft, liquid, and tube feed) and speech (normal, intelligible, partially intelligible, and unintelligible). RESULTS The final study sample included 9 patients (5 men and 4 women). The average patient age was 68.9 years (range, 59.9-74.8 y) at the time of surgery. There was no flap loss. A 1-year postoperative computed tomography scan revealed full osteointegration of the flap. CONCLUSIONS Our results show that the STFF is a valuable reconstructive option, especially in patients with complex head and neck defects requiring soft and hard tissues.
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Affiliation(s)
- Francesco Arcuri
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa
| | - Francesco Laganà
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa
| | - Bernardo Bianchi
- Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Genoa
| | - Silvano Ferrari
- Unit of Maxillo-Facial Surgery, "Ospedale Maggiore di Parma" Parma, Italy
| | - Andrea Ferri
- Unit of Maxillo-Facial Surgery, "Ospedale Maggiore di Parma" Parma, Italy
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Laganà F, Arcuri F, Spinzia A, Bianchi B. Maxillomandibular Advancement for Obstructive Sleep Apnea Syndrome: Long-Term Results of Respiratory Function and Reverse Face-Lift. J Craniofac Surg 2023; 34:1760-1765. [PMID: 37322594 DOI: 10.1097/scs.0000000000009494] [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] [Received: 06/27/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Scientific literature considers maxillomandibular advancement (MMA) as the most effective surgical treatment for the management of adult obstructive sleep apnea syndrome (OSAS). Maxillomandibular advancement enlarges the pharyngeal space by expanding the skeletal framework. Moreover, it projects the soft tissue of the cheeks, the mouth, and the nose in the aging face, which is characterized by multiple signs affecting the middle third and the lower third. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support and to rejuvenate the face by a "reverse face-lift" is now recognized. The aim of this study was to review the surgical outcomes after MMA in terms of respiratory function and assessment of facial esthetics. METHODS We retrospectively reviewed the charts of all patients affected by OSAS who underwent maxillomandibular advancement between January 2010 and December 2015 in 2 tertiary hospitals (IRCCS Policlinico San Martino of Genoa and IRCCS Policlinico Ca' Granda of Milan). During the postoperative follow-up examination, all patients underwent polysomnographic examination and esthetic assessment to evaluate the respiratory function and facial rejuvenation after double jaw surgical advancement. RESULTS The final study sample included 25 patients (5 females, 20 males). The overall success rate of the surgical treatment (apnea/hypopnea index, AHI <20) was 79%; the overall rate of surgical cure (AHI <5) was 47%. Twenty-three patients (92%) showed a degree of rejuvenation after MMA. CONCLUSIONS Maxillomandibular advancement is currently the most effective surgical treatment for the management of OSAS in adult patients who are not responders to medical treatment. "Reverse face-lift" is the consequence of the double jaw surgical advancement.
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Cortese MD, Vatrano M, Arcuri F, Raso MG, Tonin P, Calabrò RS, Riganello F. Behavioral scales variability in patients with prolonged disorders of consciousness. Neurol Sci 2023; 44:3107-3122. [PMID: 37087504 PMCID: PMC10122542 DOI: 10.1007/s10072-023-06812-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/11/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The principal conditions differentiating disorders of consciousness (DOC) patients are the unresponsive wakefulness syndrome/vegetative state (UWS/VS) and the minimally conscious state (MCS). Many individuals who suffer from sudden-onset severe brain injury move through stages of UWS/VS and MCS before regaining full awareness. In some patients, the DOC condition is protracted for years (PDOC). In this study, we observed PDOC patients for 6 months to assess possible changes in their level of consciousness. METHODS We enrolled 40 PDOC patients, 23 UWS/VS and 17 MCS hosted in a dedicated unit for long-term brain injury care. The time from injury was 472 ± 533 days for UWS/VS and 1090 ± 1079 days for MCS. The Wessex Head Injury Matrix (WHIM), Coma Recovery Scale-R (CRS-R), and Nociception Coma Scale were administered monthly for 6 months. RESULTS During the period of assessment, the percentage of UWS/VS shifted from 58 to 45%, while for the MCS, from 42 to 55%. A positive correlation was found for the UWS/VS patients between the months of observation with the CRS-R total score and WHIM total numbers of behaviors (TNB). In the UWS/VS group, the CRS-R auditive and visual subscales correlated positively with the observation time. During the whole period of observation, 8 patients had constant CRS-R total scores while the WHIM TNB changed in 7 of them. CONCLUSION Our findings demonstrated that the monthly assessment of PDOC by means of the CRS-R and WHIM was able to detect also subtle changes in consciousness level.
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Affiliation(s)
- Maria Daniela Cortese
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy
| | - Martina Vatrano
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy
| | - Francesco Arcuri
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy
| | - Maria Girolama Raso
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy
| | - Paolo Tonin
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy
| | | | - Francesco Riganello
- S. Anna Institute, Research in Advanced Neurorehabilitation, Via Siris 11, 88900, Crotone, Italy.
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Laganà F, Arcuri F, Spinzia A, Renzetti P, Bianchi B. Frontal Pneumosinus Dilatans: Rare Complication After Draft III Procedure. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01828-w] [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: 12/23/2022] Open
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Raffaini M, Arcuri F. Re: Ambulatory sagittal split ramus osteotomy: strategy for enhanced recovery after surgery. Int J Oral Maxillofac Surg 2022:S0901-5027(22)00451-9. [DOI: 10.1016/j.ijom.2022.11.005] [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] [Received: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
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Siciliano M, Tornambè S, Del Corvo M, Granai M, Mundo L, Sapienza M, Arcuri F, Mancini V, Santi R, Di Stefano G, Marafioti T, Ott G, Siebert R, Fend LQ, Fend F, Pileri S, Leoncini L, Lazzi S. EPSTEIN-BARR VIRUS ORCHESTRATE THE TUMOR MICROENVIRONMENT OF BURKITT LYMPHOMA. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00206-5] [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: 11/06/2022]
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Del Corvo M, Sapienza M, Siciliano M, Tornambè S, Mazzara S, Granai M, Mundo L, Arcuri F, Mancini V, Ferrara D, Ott G, Siebert R, Fend LQ, Fend F, Pileri S, Lazzi S, Leoncini L. “BURKITT-LIKE LYMPHOMA WITH 11Q ABERRATION”: NEITHER BURKITT-LYMPHOMA NOR DIFFUSE LARGE B-CELL LYMPHOMA. WHAT THE MICROENVIRONMENT TELLS US. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00262-4] [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: 11/07/2022]
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Siciliano M, Vannucchi M, Tornambè S, Granai M, Arcuri F, Sorrentino E, Mancini V, de Leone N, Lazzi S, Siebert R, Leoncini L, Bellan C. BCR EXPRESSION IN BURKITT LYMPHOMA: NEW INSIGHT IN MUTATIONAL LANDSCAPE. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00196-5] [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: 11/05/2022]
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Scaturro D, Vitagliani F, Napolitano M, Pasta G, Passantino G, Arcuri F, Siragusa S, Vecchio M, Mauro G. Kinesiotaping for the Treatment of Haematomas in Haemophiliacs: a Case Control Study. Muscles Ligaments Tendons J 2022. [DOI: 10.32098/mltj.02.2022.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Bruschetta R, Maggio MG, Naro A, Ciancarelli I, Morone G, Arcuri F, Tonin P, Tartarisco G, Pioggia G, Cerasa A, Calabrò RS. Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial. Brain Sci 2022; 12:brainsci12040491. [PMID: 35448022 PMCID: PMC9024763 DOI: 10.3390/brainsci12040491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
The rehabilitation of cognitive deficits in individuals with traumatic brain injury is essential for promoting patients’ recovery and autonomy. Virtual reality (VR) training is a powerful tool for reaching this target, although the effectiveness of this intervention could be interfered with by several factors. In this study, we evaluated if demographical and clinical variables could be related to the recovery of cognitive function in TBI patients after a well-validated VR training. One hundred patients with TBI were enrolled in this study and equally randomized into the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received standard cognitive treatment. All the patients were evaluated by a complete neuropsychological battery before (T0) and after the end of the training (T1). We found that the VR-related improvement in mood, as well as cognitive flexibility, and selective attention were influenced by gender. Indeed, females who underwent VR training were those showing better cognitive recovery. This study highlights the importance of evaluating gender effects in planning cognitive rehabilitation programs. The inclusion of different repetitions and modalities of VR training should be considered for TBI male patients.
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Affiliation(s)
- Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy;
| | - Antonino Naro
- Stroke Unit, Azienda Ospedaliera Universitaria Gaetano Martino, 98123 Messina, Italy;
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
| | | | - Paolo Tonin
- S’Anna Institute, 88900 Crotone, Italy; (F.A.); (P.T.)
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
- S’Anna Institute, 88900 Crotone, Italy; (F.A.); (P.T.)
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
- Correspondence:
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18
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Contrada M, Arcuri F, Tonin P, Pignolo L, Mazza T, Nudo G, Pignataro ML, Quintieri M, Iozzi A, Cerasa A. Stroke Telerehabilitation in Calabria: A Health Technology Assessment. Front Neurol 2022; 12:777608. [PMID: 35126286 PMCID: PMC8815426 DOI: 10.3389/fneur.2021.777608] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/15/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telerehabilitation (TR) is defined as a model of home service for motor and cognitive rehabilitation, ensuring continuity of care over time. TR can replace the traditional face-to-face approach as an alternative method of delivering conventional rehabilitation and applies to situations where the patient is unable to reach rehabilitation facilities or for low-income countries where outcomes are particularly poor. For this reason, in this study, we sought to demonstrate the feasibility and utility of a well-known TR intervention on post-stroke patients living in one of the poorest indebted regions of Italy, where the delivery of rehabilitation services is inconsistent and not uniform. Materials and Methods: Nineteen patients (13 male/6 female; mean age: 61.1 ± 8.3 years) with a diagnosis of first-ever ischemic (n = 14) or hemorrhagic stroke (n = 5), who had been admitted to the intensive rehabilitation unit (IRU) of the Institute S. Anna (Crotone, Italy), were consecutively enrolled to participate in this study. After the discharge, they continued the motor treatment remotely by means of a home-rehabilitation system. The entire TR intervention was performed (online and offline) using the Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italy). All patients received intensive TR five times a week for 12 consecutive weeks (60 sessions, each session lasting about 1h). Results: We found a significant motor recovery after TR protocol as measured by the Barthel Index (BI); Fugl-Meyer motor score (FM) and Motricity Index (MI) of the hemiplegic upper limbs. Conclusions: This was the first demonstration that a well-defined virtual reality TR tool promotes motor and functional recovery in post-stroke patients living in a low-income Italian region, such as Calabria, characterized by a paucity of specialist rehabilitation services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonio Cerasa
- S. Anna Institute, Crotone, Italy.,Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), Messina, Italy.,Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Cosenza, Italy
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19
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Raffaini M, Magri A, Conti M, Arcuri F. Advanced Facial Rejuvenation After Bimaxillary Surgery in Three Different Facial Types. Aesthetic Plast Surg 2022; 46:183-193. [PMID: 34131790 DOI: 10.1007/s00266-021-02399-w] [Citation(s) in RCA: 2] [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: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Facial aging is the consequence of many mechanisms involving the bones and the "soft tissue" (skin, fat, ligaments, muscles, and periosteum) of the face such as downward migration of the soft tissue, adipose and muscular tissue atrophy, and skeletal resorption. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support is now recognized and widely popularized by several authors. The aim of this study was to analyze the rejuvenation change of the face after bimaxillary advancement for orthognathic surgery, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face. MATERIALS AND METHODS A retrospective monocentric chart review was conducted for all patients affected by aging signs of the face who underwent orthognathic surgery between January 2015 and December 2019 at the Face Surgery Center (Parma, Italy). During the postoperative follow-up examination, all patients underwent anthropometric photographs and esthetic assessment to evaluate facial rejuvenation after double jaw surgical advancement. RESULTS After application of the exclusion criteria, the final study sample included 85 patients (53 females, 32 males). Eighty-three patients (97%) showed a degree of rejuvenation after maxillo-mandibular advancement (MMA); the score of the postoperative face was less than the score of the preoperative face. Two patients reported no significant postoperative change; none reported a more aging face, with a successful "reverse face-lift" occurred in 97% of our cases. CONCLUSION "Reverse face-lift" by bimaxillary advancement is a surgical procedure which is indicated for a selected group of middle-aged patients with a diagnosis of bimaxillary skeletal retrusion or posterior divergence very motivated to an extreme rejuvenation; this procedure provides support for the facial mask resulting in whole facial rejuvenation.
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Affiliation(s)
| | - Alice Magri
- Private practitioner "Facesurgery" center, Parma, Italy
| | - Marco Conti
- Consultant of the Unit of of Maxillo-Facial Surgery, AOUC "Careggi", Florence, Italy
| | - Francesco Arcuri
- Consultant of the Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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20
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Cortese MD, Arcuri F, Nemirovsky IE, Lucca LF, Tonin P, Soddu A, Riganello F. Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients. Front Neurosci 2021; 15:771505. [PMID: 34975378 PMCID: PMC8714733 DOI: 10.3389/fnins.2021.771505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state.
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Affiliation(s)
- Maria Daniela Cortese
- Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, Italy
| | - Francesco Arcuri
- Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, Italy
| | - Idan E. Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Lucia Francesca Lucca
- Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, Italy
| | - Paolo Tonin
- Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, Italy
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Francesco Riganello
- Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, Italy
- *Correspondence: Francesco Riganello,
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21
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Arcuri F, Agostini T, Limbucci N, Laiso A, Mangiafico S, Spinelli G, Panisi I, Nappini S. Salvage transorbital approach for the endovascular treatment of carotid cavernous fistulas. Oral Maxillofac Surg 2021; 26:45-51. [PMID: 33821383 DOI: 10.1007/s10006-021-00961-z] [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] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Carotid cavernous fistulas (CCFs) are abnormal connections between the cavernous sinus (CS) and carotid arteries. In direct CCFs, a transarterial route is often the preferred vascular access; in case of indirect CCFs, the complex anatomy of the feeder vessels and their extra-intracranial anastomosis makes the transarterial embolization challenging and often ineffective. The aim of this study was to review our experience with the transorbital approach to treat patients affected by CCF who have already experienced an endovascular failure procedure, in order to assess this salvage technique feasibility, by analyzing possible risks and complications. METHODS We performed a retrospective study of all patients affected by CCFs who underwent transorbital embolization between February 2017 and February 2019 at our institution. RESULTS All patients (3 cases) tolerated both the retrograde embolization and the direct surgical approach with clinical improvement; the closure of the fistula was complete and verified intraoperatively by angiography. Esthetic result was acceptable in all cases with reduction of the proptosis and the intraocular pressure, and increased visual acuity. There were no complications or clinical recurrence. CONCLUSION Transorbital approach for the endovascular treatment of CCFs is a feasible and safe salvage procedure, which can find indication after other endovascular access failures.
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Affiliation(s)
- Francesco Arcuri
- Unit of Maxillofacial Surgery, IRCCS San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Tommaso Agostini
- Casa Di Cura San Paolo, Via del Quadrifoglio, 3, 51100, Pistoia, Italy
| | - Nicola Limbucci
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Antonio Laiso
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Salvatore Mangiafico
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Giuseppe Spinelli
- Unit of Maxillofacial Surgery, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Irene Panisi
- Unit of Maxillofacial Surgery, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
| | - Sergio Nappini
- Unit of Interventional Neuroradiology, Careggi Hospital, Largo Piero Palagi 1, 50139, Florence, Italy
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22
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Raso MG, Arcuri F, Liperoti S, Mercurio L, Mauro A, Cusato F, Romania L, Serra S, Pignolo L, Tonin P, Cerasa A. Telemonitoring of Patients With Chronic Traumatic Brain Injury: A Pilot Study. Front Neurol 2021; 12:598777. [PMID: 33868141 PMCID: PMC8047126 DOI: 10.3389/fneur.2021.598777] [Citation(s) in RCA: 6] [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: 08/25/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022] Open
Abstract
Telehealth systems have shown success in the remote management of several neurological disorders, but there is a paucity of evidence in disorders of consciousness (DOC). In this study, we explore the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients. This was a prospective, mono-center randomized controlled study. We included only traumatic brain injury (TBI) patients who required long-term motor/cognitive assistance having a stable clinical condition. We examined their clinical evolution over ~4 years of the follow-up period. Twenty-two TBI patients were enrolled and equally divided into two groups: one telemonitored at home with our service and the second admitted to a standard long-stay hospitalization (LSH) program. Patients enrolled in the telehealth service (age: 49.9 ± 20.4; 45% female; diagnosis: 36% VS/64% MCS) were demographically and clinically-matched with those admitted to the LSH program (age: 55.1 ± 15; 18% female; diagnosis: 54% VS/46% MCS). Thirty-six percent of patients in the LSH program died before completing follow up evaluation with respect to 18% of death in the group of TBI patients telemonitored at home. At follow-up, patients in LSH and telemonitoring groups showed similar clinical progression, as measured by CRS-r, NCS, WHIM, and LCF scales, as well as by the number of medical complications (i.e., bedsores, infections). Finally, we estimated the total daily cost per patient. Severe TBI patients enrolled in the conventional LSH program cost 262€ every single day, whereas the cost per patient in the telehealth service resulted to be less expensive (93€). Here, we highlight that our telehealth monitoring service is as efficacious as in-person usual care to manage a severe neurological disorder such as TBI in a cost-effective way.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Cerasa
- Sant'Anna Institute, Crotone, Italy.,Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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23
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Cortese D, Riganello F, Arcuri F, Lucca L, Tonin P, Schnakers C, Laureys S. The Trace Conditional Learning of the Noxious Stimulus in UWS Patients and Its Prognostic Value in a GSR and HRV Entropy Study. Front Hum Neurosci 2020; 14:97. [PMID: 32327985 PMCID: PMC7161674 DOI: 10.3389/fnhum.2020.00097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/13/2019] [Accepted: 03/02/2020] [Indexed: 01/18/2023] Open
Abstract
The assessment of the consciousness level of Unresponsive Wakefulness Syndrome (UWS) patients often depends on a subjective interpretation of the observed spontaneous and volitional behavior. To date, the misdiagnosis level is around 30%. The aim of this study was to observe the behavior of UWS patients, during the administration of noxious stimulation by a Trace Conditioning protocol, assessed by the Galvanic Skin Response (GSR) and Heart Rate Variability (HRV) entropy. We recruited 13 Healthy Control (HC) and 30 UWS patients at 31 ± 9 days from the acute event evaluated by Coma Recovery Scale–Revised (CRS-R) and Nociception Coma Scale (NCS). Two different stimuli [musical stimulus (MUS) and nociceptive stimulus (NOC)], preceded, respectively by two different tones, were administered following the sequences (A) MUS1 – NOC1 – MUS2 – MUS3 – NOC2 – MUS4 – NOC3 – NOC*, and (B) MUS1*, NOC1*, NOC2*, MUS2*, NOC3*, MUS3*, NOC4*, MUS4*. All the (*) indicate the only tones administration. CRS-R and NCS assessments were repeated for three consecutive weeks. MUS4, NOC3, and NOC* were compared for GSR wave peak magnitude, time to reach the peak, and time of wave's decay by Wilcoxon's test to assess the Conditioned Response (CR). The Sample Entropy (SampEn) was recorded in baseline and both sequences. Machine Learning approach was used to identify a rule to discriminate the CR. The GSR magnitude of CR was higher comparing music stimulus (p < 0.0001) and CR extinction (p < 0.002) in nine patients and in HC. Patients with CR showed a higher SampEn in sequence A compared to patients without CR. Within the third and fourth weeks from protocol administration, eight of the nine patients (88.9%) evolved into MCS. The Machine-learning showed a high performance to differentiate presence/absence of CR (≥95%). The possibility to observe the CR to the noxious stimulus, by means of the GSR and SampEn, can represent a potential method to reduce the misdiagnosis in UWS patients.
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Affiliation(s)
- Daniela Cortese
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Francesco Riganello
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy.,Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Francesco Arcuri
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Lucia Lucca
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Paolo Tonin
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Caroline Schnakers
- Neurosurgery Department, University of California, Los Angeles, Los Angeles, CA, United States.,Research Institute, Casa Colina Hospital and Centers of Healthcare, Pomona, CA, United States
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
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24
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Pignolo L, Serra S, Basta G, Carozzo S, Arcuri F, Pignataro LM, Ciancarelli I, Tonin P, Cerasa A. Data on a new neurorehabilitation approach targeting functional recovery in stroke patients. Data Brief 2019; 27:104685. [PMID: 31737755 PMCID: PMC6849111 DOI: 10.1016/j.dib.2019.104685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/05/2019] [Revised: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022] Open
Abstract
Robotic-assisted devices are known to positively affect the recovery of one specific motor effector after stroke. However, it has widely been reported that the functional status of patients is only partially ameliorated after application of this kind of advanced treatment. Here, data about the effect of a new rehabilitation approach has been described in a large population of stroke patients. We sought to validate an integrated rehabilitation system for stroke (IRSS) patients, which is composed of a set of robotic-assisted tools aimed at recovering the entire body. We evaluated the motor recovery in 84 stroke patients equally divided into experimental and control groups to assess the difference between IRSS approach and conventional rehabilitation treatment. We found that IRSS induced a significant improvement as measured by functional neurological scales, such as the barthel index and functional independence measure. The data provided in this article will assist therapists and physicians working for developing new rehabilitation protocols more focused on a holistic functional recovery approach. The data are available at Mendeley Data, https://doi.org/10.17632/wptmgm7zk2.1.
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Affiliation(s)
- Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Sebastiano Serra
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Giuseppina Basta
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Simone Carozzo
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Francesco Arcuri
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Nova Salus S.r.l., L'Aquila, Italy
| | - Paolo Tonin
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Nova Salus S.r.l., L'Aquila, Italy
| | - Antonio Cerasa
- S. Anna Institute, Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
- IBFM, National Research Council, 88100, Catanzaro, Italy
- Corresponding author. Neuroimaging Unit, IBFM-CNR, 88100, Catanzaro, Italy.
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25
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Mannelli G, Agostini T, Arcuri F, Comini LV, Spinelli G. Subclavicular flap: A valid reconstructive option among anterior chest flaps in oral cancer patients. J Surg Oncol 2019; 120:707-714. [PMID: 31364178 DOI: 10.1002/jso.25655] [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: 02/18/2019] [Accepted: 07/23/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for low-middle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results. METHODS Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018. Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. RESULTS No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. CONCLUSIONS The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width.
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Affiliation(s)
- Giuditta Mannelli
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Agostini
- Department of Plastic and Reconstructive Surgery, Casa di Cura San Paolo, Pistoia, Italy
| | - Francesco Arcuri
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lara Valentina Comini
- Head and Neck Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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26
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Riganello F, Napoletano G, Cortese MD, Arcuri F, Solano A, Lucca LF, Tonin P, Soddu A. What impact can hospitalization environment produce on the ANS functioning in patients with Unresponsive Wakefulness Syndrome? - 24-hour monitoring. Brain Inj 2019; 33:1347-1353. [PMID: 31335209 DOI: 10.1080/02699052.2019.1641841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/17/2022]
Abstract
Objectives: Studies showed that the recovery of patients with Unresponsive Wakefulness Syndrome (UWS) is also correlated to the recovery of circadian rhythms. In this study, we observed the correlations between patients with UWS biometrical and ambient parameters. Methods: A dedicated monitoring system was realized to record and correlate the level of noise and luminosity with biometric Heart Rate (HR), Heart Rate Variability (HRV) and Breath Rate (BR) parameters. Eleven patients with UWS were recruited and monitored for 13 ± 7 days. Correlation of ambient and biometric parameters was analyzed by Spearman's test. Wilcoxon's test was used to compare the biometric parameters in two different moments of daily activity in the rehabilitation unit (night and day). Patients showed a moderate negative or positive correlation between biometric and ambient parameters. Results: Significant differences between night and morning (0.0001 < p ≤ 0.001) were found for HR, HRV and BR in seven, five and four patients, respectively, at Wilcoxon's test. HR and BR were higher during the night while HRV was lower. Conclusion: In patients with UWS, lower HRV and higher HR and BR during the night might be indicative of interference in sleep/wake cycles. The modifications of the environment surrounding the patient due to the unit procedures of the staff and/or some interaction modalities of the relatives may have an effect on residual endogenous mechanisms of self-regulation. However, differences between night and day in the biometrical parameters are not necessarily linked to the changes in the environment care unit.
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Affiliation(s)
- F Riganello
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - G Napoletano
- b Department of Engineering, Modelling, Electronics and Systemistics, University of Calabria , Arcavacata di Rende (CS) , Italy
| | - M D Cortese
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - F Arcuri
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - A Solano
- b Department of Engineering, Modelling, Electronics and Systemistics, University of Calabria , Arcavacata di Rende (CS) , Italy
| | - L F Lucca
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - P Tonin
- a Reseach in Advanced Neurorehabilitation (RAN), S.Anna Institute , Crotone , Italy
| | - A Soddu
- c Brain and Mind Institute, Physics and Astronomy Department, Western University , London , ON , Canada
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Arcuri F, Cortese MD, Riganello F, Lucca LF, Serra S, Mazzucchi A, Cerasa A, Tonin P. The Reliability of the Progression of Autonomies Scale Applied on Acquired Brain Injured Patients. Front Neurol 2019; 10:342. [PMID: 31024435 PMCID: PMC6469362 DOI: 10.3389/fneur.2019.00342] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
The Progression of Autonomies Scale (PAS) is a behavioral scale useful to assess the autonomy levels in acquired brain-injured patients. It provides a broad profile, assessing different domains of human activities ranging from personal, domestic, and extradomestic autonomies. This cross-sectional study is aimed at evaluating the reliability of this scale on a large cohort of acquired brain injury (ABI) patients. Fifty-one ABI patients (49% traumatic, 33.3% hemorrhagic, 17.7% other etiologies), hospitalized in the S. Anna Institute of Crotone, Italy (mean age male 46.08 ± 14.53 and mean age female patients 43.2 ± 11.3) were recruited. We found a high level of reliability of the scale, with a coefficient at the inter-rater agreement between substantial (0.61 ≤ k ≤ 0.8) and almost perfect (0.81 ≤ k ≤ 1), and almost perfect at the test-retest (intra-rater). We confirm that the PAS is a well-structured tool for the assessment of the autonomy levels in brain-injured patients. These findings encourage the application of this scale in the clinical practice of rehabilitation unit to design a tailored rehabilitation treatment on real goals and to monitor the generalization of the recovered abilities to the daily routine activities.
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Affiliation(s)
- Francesco Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | | | | | | | - Sebastiano Serra
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Anna Mazzucchi
- Department for ABI Care and Rehabilitation, Don Gnocchi Foundation, Milan, Italy
| | - Antonio Cerasa
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy.,Neuroimaging Unit, IBFM-CNR, Catanzaro, Italy
| | - Paolo Tonin
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
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Mannelli G, Arcuri F, Comini L, Valente D, Spinelli G. Buccal Fat Pad: Report of 24 Cases and Literature Review of 1,635 Cases of Oral Defect Reconstruction. ORL J Otorhinolaryngol Relat Spec 2018; 81:24-35. [DOI: 10.1159/000494027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022]
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Cerasa A, Arcuri F, Pignataro LM, Serra S, Messina D, Carozzo S, Biafora A, Ceraudo C, Abbruzzino L, Pignolo L, Basta G, Tonin P. The cooking therapy for cognitive rehabilitation of cerebellar damage: A case report and a review of the literature. J Clin Neurosci 2018; 59:357-361. [PMID: 30337124 DOI: 10.1016/j.jocn.2018.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/26/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND IMPORTANCE The therapeutic approach for cerebellar damages heavily relies on neurorehabilitation since there are no medications that may improve clinical symptoms mainly those related to cognitive dysfunctions. Nevertheless, neurorehabilitation programs tailored to cerebellar damages have never been validated. Here we describe a new rehabilitation approach based on cooking training (CT). The idea that cooking may stimulate cerebellar activity relies on previous evidence demonstrating the beneficial effect on the executive functions as well as in promoting neural plasticity within the cerebellum. Indeed, CT requires motor/mental coordination, thinking flexibly, planning, implementing strategies, shifting and self-monitoring behaviors, all functions drastically affected in cerebellar disorders. CASE DESCRIPTION A 68-year-old male stroke patient with isolated right cerebellar ischemia in the posterior cerebellum characterized by mild executive dysfunctions. After intensive six weekly two-hour sessions, we found that CT was effective in improving some cognitive abilities in a context of mild motor impairment. In particular, deficits in the execution of the Symbol digit modality test and Wisconsin card-sorting test were recovered. CONCLUSION The comparison of our data with those reported in previous studies confirmed the Schmahmann's hypothesis on the effectiveness of neurorehabilitation approaches in cerebellar patients acting as external timekeeping of conscious thoughts.
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Affiliation(s)
- Antonio Cerasa
- IBFM, National Research Council, 88100 Catanzaro, Italy; S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy.
| | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | | | | | - Demetrio Messina
- Department of Neurology, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900 Crotone, Italy
| | - Simone Carozzo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Antonio Biafora
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Caterina Ceraudo
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Luca Abbruzzino
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Giuseppina Basta
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
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Cheng L, Cortese D, Monti MM, Wang F, Riganello F, Arcuri F, Di H, Schnakers C. Do Sensory Stimulation Programs Have an Impact on Consciousness Recovery? Front Neurol 2018; 9:826. [PMID: 30333789 PMCID: PMC6176776 DOI: 10.3389/fneur.2018.00826] [Citation(s) in RCA: 33] [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: 03/29/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: Considering sensory stimulation programs (SSP) as a treatment for disorders of consciousness is still debated today. Previous studies investigating its efficacy were affected by various biases among which small sample size and spontaneous recovery. In this study, treatment-related changes were assessed using time-series design in patients with disorders of consciousness (i.e., vegetative state-VS and minimally conscious state-MCS). Methods: A withdrawal design (ABAB) was used. During B phases, patients underwent a SSP (3 days a week, including auditory, visual, tactile, olfactory, and gustatory stimulation). The program was not applied during A phases. To assess behavioral changes, the Coma Recovery Scale-Revised (CRS-R) was administered by an independent rater on a weekly basis, across all phases. Each phase lasted 4 weeks. In a subset of patients, resting state functional magnetic resonance imaging (fMRI) data were collected at the end of each phase. Results: Twenty nine patients (48 ± 19 years old; 15 traumatic; 21 > a year post-injury; 11 VS and 18 MCS) were included in our study. Higher CRS-R total scores (medium effect size) as well as higher arousal and oromotor subscores were observed in the B phases (treatment) as compared to A phases (no treatment), in the MCS group but not in the VS group. In the three patients who underwent fMRI analyses, a modulation of metabolic activity related to treatment was observed in middle frontal gyrus, superior temporal gyrus as well as ventro-anterior thalamic nucleus. Conclusion: Our results suggest that SSP may not be sufficient to restore consciousness. SSP might nevertheless lead to improved behavioral responsiveness in MCS patients. Our results show higher CRS-R total scores when treatment is applied, and more exactly, increased arousal and oromotor functions.
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Affiliation(s)
- Lijuan Cheng
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Daniela Cortese
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Fuyan Wang
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | | | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy
| | - Haibo Di
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
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Sattin D, De Torres L, Dolce G, Arcuri F, Estraneo A, Cardinale V, Piperno R, Zavatta E, Formisano R, D’Ippolito M, Vassallo C, Dessi B, Lamberti G, Antoniono E, Lanzillotti C, Navarro J, Bramanti P, Marino S, Zampolini M, Scarponi F, Avesani R, Salvi L, Ferro S, Mazza L, Fogar P, Feller S, De Nigris F, Martinuzzi A, Buffoni M, Pessina A, Corsico P, Leonardi M. Analysis of Italian regulations on pathways of care for patients in a vegetative or minimally conscious state. Funct Neurol 2018; 32:159-163. [PMID: 29042005 PMCID: PMC5726352 DOI: 10.11138/fneur/2017.32.3.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories. The researchers found a total of 106 laws; differences emerged both between regions and versus the national model, showing that patients with the same diagnosis may follow different pathways of care. An ongoing cultural shift from a treatment-oriented medical approach towards a care-oriented integrated biopsychosocial approach was found in all the welfare and healthcare systems analysed. Future studies are needed to explore the relationship between healthcare systems and the quality of services provided.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit - Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura De Torres
- Neurology, Public Health, Disability Unit - Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuliano Dolce
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna, Crotone, Italy
| | - Francesco Arcuri
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna, Crotone, Italy
| | - Anna Estraneo
- Disorders of Consciousness Laboratory, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy
| | - Viviana Cardinale
- Disorders of Consciousness Laboratory, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Italy
| | - Roberto Piperno
- Neurorehabilitation Unit., Emergency Department., AUSL of Bologna, Italy
| | - Elena Zavatta
- Centro Studi per la Ricerca sul Coma - “Gli Amici di Luca” ONLUS. Casa dei Risvegli Luca De Nigris, Bologna, Italy
| | - Rita Formisano
- Unità Post-Coma, IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Mariagrazia D’Ippolito
- Unità Post-Coma, IRCCS Fondazione Santa Lucia, Roma, Italy
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Italy
| | - Claudio Vassallo
- Centro di Riabilitazione Ambulatoriale, Associazione Rinascita Vita ONLUS, Genova, Italy
| | - Barbara Dessi
- Centro di Riabilitazione Ambulatoriale, Associazione Rinascita Vita ONLUS, Genova, Italy
| | - Gianfranco Lamberti
- S.C. Neuroriabilitazione ASL CN1, Ospedale “SS. Trinità” - Fossano (CN), Italy
| | - Elena Antoniono
- S.C. Neuroriabilitazione ASL CN1, Ospedale “SS. Trinità” - Fossano (CN), Italy
| | | | - Jorge Navarro
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica (BR), Italy
| | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | - Mauro Zampolini
- Neurorehabilitation Unit, “S.Giovanni Battista “ Hospital, Foligno (PG), Italy
| | - Federico Scarponi
- Neurorehabilitation Unit, “S.Giovanni Battista “ Hospital, Foligno (PG), Italy
| | - Renato Avesani
- Ospedale Sacro Cuore Don Calabria, Dipartimento di riabilitazione, Verona, Italy
| | - Luca Salvi
- Ospedale Sacro Cuore Don Calabria, Dipartimento di riabilitazione, Verona, Italy
| | - Salvatore Ferro
- Emilia Romagna Region, Direzione Generale Cura della Persona, Salute e Welfare, Bologna, Italy
| | - Luigi Mazza
- Emilia Romagna Region, Servizio Integrazione Sociosanitaria e politiche per la Non Autosufficienza, Bologna, Bologna, Italy
| | - Paolo Fogar
- Federazione Nazionale Associazioni Trauma cranico, Carnago (VA), Italy
| | - Sandro Feller
- Federazione Nazionale Associazioni Trauma cranico, Carnago (VA), Italy
| | | | | | - Mara Buffoni
- IRCCS Medea Conegliano Research Centre, Conegliano (TV), Italy
| | - Adriano Pessina
- Bioethics University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Paolo Corsico
- Bioethics University Centre, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit - Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Spinelli G, Mannelli G, Arcuri F, Venturini E, Chiappini E, Galli L. Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections. Int J Pediatr Otorhinolaryngol 2018; 108:137-142. [PMID: 29605343 DOI: 10.1016/j.ijporl.2018.02.042] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-tuberculous mycobacteria are the most frequent cause of chronic lymphadenitis in children. We reviewed treatment and outcomes of paediatric patients with chronic cervical lymphadenitis, to better understand their differential diagnosis, surgical indication, complication and recover. METHODS A retrospective study was carried out on children who underwent surgery from 2013 to 2016 at Meyer Children's University Hospital, Florence, Italy. Time to cure, type of surgery, and complications rate were determined and etiologic agents were identified and correlated to their clinical presentation. RESULTS 275 children were evaluated. Nearly 98% of the patients were cured regardless of which therapeutic option was used and surgery was necessary in 38.2% of children. Complete excisional biopsy ensured recover in 97.7% of patients compared with the non-excisional surgical group 88.2% (p = 0.06). Re-interventions were needed in the 2.3% of complete excision group and in two cases of the incision and drainage group; all of them developed fistula and were caused by Mycobacterium avium complex. Excision followed by adjunctive antibiotic therapy was favoured in the majority of the patients (80.1%, n = 71). CONCLUSION In cases of non-tuberculous mycobacteria lymphadenitis, surgery is the treatment of choice and it is closely related to a favourable prognosis.
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Affiliation(s)
| | - Giuditta Mannelli
- Clinic of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy.
| | | | - Elisabetta Venturini
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - Elena Chiappini
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
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Mannelli G, Arcuri F, Agostini T, Innocenti M, Raffaini M, Spinelli G. Classification of tongue cancer resection and treatment algorithm. J Surg Oncol 2018; 117:1092-1099. [DOI: 10.1002/jso.24991] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Giuditta Mannelli
- Unit of Otorhinolaryngology−Head and Neck Surgery; Department of Surgery and Translational Medicine; University of Florence; AOU-Careggi; Florence Italy
| | | | | | - Marco Innocenti
- Department of Plastic and Reconstructive Microsurgery; Careggi University Hospital; Florence Italy
| | - Mirco Raffaini
- Maxillo-Facial Surgery Unit; AOU-Careggi; Florence Italy
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Sattin D, Morganti L, De Torres L, Dolce G, Arcuri F, Estraneo A, Cardinale V, Piperno R, Zavatta E, Formisano R, D'Ippolito M, Vassallo C, Dessi B, Lamberti G, Antoniono E, Lanzillotti C, Navarro J, Bramanti P, Corallo F, Zampolini M, Scarponi F, Avesani R, Salvi L, Ferro S, Mazza L, Fogar P, Feller S, De Nigris F, Martinuzzi A, Buffoni M, Pessina A, Corsico P, Leonardi M. Care pathways models and clinical outcomes in Disorders of consciousness. Brain Behav 2017; 7:e00740. [PMID: 28828206 PMCID: PMC5561306 DOI: 10.1002/brb3.740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care pathway for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients' clinical outcomes. MATERIALS AND METHODS A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by asking 90 patients' caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received. RESULTS Seventy-three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diagnosis. In long-term care units, the diagnosis at admission and the number of caregivers available for each patient (median value = 3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non-Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. CONCLUSION This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and actions are needed to guarantee equity and standardization of the care process in all European countries.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura Morganti
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura De Torres
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giuliano Dolce
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Francesco Arcuri
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Anna Estraneo
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Viviana Cardinale
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Roberto Piperno
- Neurorehabilitation Unit Emergency Department AUSL of Bologna Bologna Italy
| | - Elena Zavatta
- Centro Studi per la Ricerca sul Coma - "Gli Amici di Luca" ONLUSCasa dei Risvegli Luca De Nigris Bologna Italy
| | | | - Mariagrazia D'Ippolito
- Unità Post-ComaI RCCS Fondazione Santa Lucia Roma Italy.,Dipartimento di Psicologia Università "La Sapienza" Roma Italy
| | - Claudio Vassallo
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Barbara Dessi
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Gianfranco Lamberti
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Elena Antoniono
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Crocifissa Lanzillotti
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | - Jorge Navarro
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | | | | | - Mauro Zampolini
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Federico Scarponi
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Renato Avesani
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Luca Salvi
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Salvatore Ferro
- Emilia Romagna Region Direzione Generale Cura della Persona, Salute e Welfare Bologna Italy
| | - Luigi Mazza
- Emilia Romagna Region Servizio Integrazione Sociosanitaria e politiche per la Non Autosufficienza Bologna Italy
| | - Paolo Fogar
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | - Sandro Feller
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | | | | | - Mara Buffoni
- IRCCS Medea Conegliano Research Centre Conegliano Italy
| | - Adriano Pessina
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Paolo Corsico
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
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Agostini T, Spinelli G, Arcuri F, Perello R. Metastatic Squamous Cell Carcinoma of the Lower Lip: Analysis of the 5-Year Survival Rate. Arch Craniofac Surg 2017; 18:105-111. [PMID: 28913316 PMCID: PMC5556890 DOI: 10.7181/acfs.2017.18.2.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/28/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. Methods The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. Results Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). Conclusion Prophylactic neck dissection (level I–III) is recommended in T3–T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.
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Affiliation(s)
- Tommaso Agostini
- Department of Maxillo-Facial Surgery, CTO-AOUC, University of Florence, Florence, Italy.,Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
| | - Giuseppe Spinelli
- Department of Maxillo-Facial Surgery, CTO-AOUC, University of Florence, Florence, Italy
| | - Francesco Arcuri
- Department of Maxillo-Facial Surgery, CTO-AOUC, University of Florence, Florence, Italy
| | - Raffaella Perello
- Department of Plastic and Reconstructive Surgery, Centro Chirurgico San Paolo, Pistoia, Italy
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Mannelli G, Arcuri F, Conti M, Agostini T, Raffaini M, Spinelli G. The role of bone marrow aspirate cells in the management of atrophic mandibular fractures by mini-invasive surgical approach: Single-institution experience. J Craniomaxillofac Surg 2017; 45:694-703. [PMID: 28259617 DOI: 10.1016/j.jcms.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/12/2016] [Revised: 12/11/2016] [Accepted: 01/05/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The treatment of fractures involves addressing the biology of fracture repair and the mechanical stability of fracture fixation. Traditionally it has included the addition of bone graft to enhance healing. New advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors to accelerate bone healing. This study aimed to assess the advantages of autologous stem cell use for atrophic mandibular fracture treatment in comparison to standard technique. MATERIALS AND METHODS A total of 35 patients (14 male and 21 female) were treated for fractures of atrophic mandibles between January 2011 and December 2014. Surgical technique provided mini-invasive open reduction with or without immediate homologous bone graft, while selected patients received autologous bone marrow aspirate cell grafts in addition to the standard treatment. Demographic data and details of treatment and outcomes were recorded. RESULTS Patients were categorized according to the use of autologous stem cells, leaving 17 patients treated with standard technique and autologous stem cells (Group A) and 18 treated with standard osteosynthesis only (Group B). Of the 35 patients, 26 had bilateral fractures; most patients had significant medical co-morbidities. Immediate bone graft was used in 37.1% of patients (7 in group A and 6 in group B). Complications occurred in 5 patients (14.3%). Two patients in group B (11.1%) showed non-union of the fracture. One patient in group A (5.8%) and one patient in group B (5.5%) showed wound dehiscence and were treated conservatively; one patient in group B had a local infection (5.5%), one out of 35 (2.8%), that was managed by prolonged antibiotic treatment. CONCLUSIONS Despite the advanced age and medical co-morbidities of the vast majority of patients, mini-invasive open approach with autologous bone graft ensures a fast and excellent recovery. Moreover, the management of atrophic mandibular fractures by bone marrow aspirate cells is a safe and useful procedure which has a lower complication rate when compared to standard technique.
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Affiliation(s)
- Giuditta Mannelli
- First Clinic of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Arcuri
- Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Conti
- Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tommaso Agostini
- Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mirco Raffaini
- Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Spinelli
- Maxillo-Facial Surgery Unit, Neurosensorial Department (Head in Chief: Dr. G. Spinelli), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Spinelli G, Valente D, Mannelli G, Raffaini M, Arcuri F. Surgical management of ankyloses of the temporomandibular joint by a piezoelectric device. J Craniomaxillofac Surg 2016; 45:441-448. [PMID: 28223015 DOI: 10.1016/j.jcms.2016.12.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/26/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Piezosurgery is commonly used in different field of craniomaxillofacial surgery; since its introduction it has become one of the widely adopted technique for performing osteotomies in orthognathic surgery, distraction osteogenesis and dentoalveolar surgery. Little has been written regarding ultrasonic system for temporomandibular joint surgery (TMJ). In this prospective study we describe the use of piezoelectric device for ankylosis of the TMJ. MATERIALS AND METHODS We enrolled in this study 19 patients, 10 males and 9 females, mean (SD) age 24.6 (7.6) years, affected by unilateral ankylosis of TMJ who were surgically managed between January 2009 and December 2014 by interpositional arthroplasty with temporomyofascial muscle flap. We adopted in all cases a preauricular approach with temporal extension. The ankylotic block was removed with piezoelectric device in 9 patients and using traditional rotary bur in 10 cases. We investigated and compared the following parameters as surgical outcomes: intraoperative bleeding, duration of operation, incidence of infection, postoperative swelling and hematoma, mouth opening, nerve impairment and rate of recurrence. RESULTS We noticed a substantial reduction in bleeding with the piezoelectric bone cutter when compared to traditional mechanical surgery (103 ml versus 117 ml; p < 0.05); however, we did not report any severe bleeding from the pterygoid plexus or maxillary artery. Operating time was longer in the piezo group (101 min versus 88 min; p < 0.05). There was a lower incidence of postoperative hematoma and swelling following piezoosteotomy. However, regarding postoperative nerve impairment and infection we did not observe any differences between the two groups. At one year follow-up mean (SD) mouth opening was 34 (4.3) mm. We did not report recurrence of the disease. CONCLUSION Piezoelectric bone removal for the release of ankylosis of the TMJ is associated with minimal bleeding and few postoperative complications. We believe that piezosurgery allows surgeons to achieve better results compared to a traditional surgery. It is a possible alternative due to the clinical benefits demonstrated.
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Affiliation(s)
- Giuseppe Spinelli
- Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Domenico Valente
- Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Giuditta Mannelli
- First Clinic of Otorhinolaryngology Head and Neck Surgery, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Mirco Raffaini
- Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesco Arcuri
- Unit of Maxillo-Facial Surgery, (Head: Chief Dr. Giuseppe Spinelli), Orthopedic Traumatological Center, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
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Spinelli G, Lazzeri D, Arcuri F, Valente D, Agostini T. Management of Mandibular Angle Fractures by Two Conventional 2.0-mm Miniplates: A Retrospective Study of 389 Patients. Craniomaxillofac Trauma Reconstr 2016; 9:206-10. [PMID: 27516834 DOI: 10.1055/s-0036-1582457] [Citation(s) in RCA: 8] [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: 07/12/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022] Open
Abstract
Fractures of the mandibular angle account for 23 to 42% of all facial fractures with a high complication rate (0-32%). Although the ideal treatment remains debatable, two main procedures are commonly used to manage the majority of mandibular angle fractures that are open reduction and internal fixation by a noncompression miniplate placed on the external oblique ridge with or without a second miniplate on the outer cortex. The purpose of this study was to describe our management of mandibular angle fractures by two noncompression miniplates placed on the outer cortex via a transbuccal approach. Medical records and radiographic examination of 389 patients (258 males [66.3%] and 131 females [33.7%]) operated from January 2000 to December 2012 were retrospectively reviewed. Postoperative complications including malocclusion, infection, wound dehiscence, nonunion, and reoperative surgery were recorded and analyzed. Fifty-three patients developed postoperative complications (overall complication rate: 13.6%). No significant difference was found in the complication rate by age and gender variables and regarding the interval between the trauma and the operation and the presence of the teeth in the line of fracture. A higher rate of complications was found among patients with alcohol/drug addiction and in patients with multiple-site involvement. The findings of this study suggest that the use of two transbuccal miniplates placed on the outer cortex for the internal fixation of mandibular angle fracture provided a low rate of complications. The global incidence of screw loosening, wound dehiscence, plate exposure, infection, reoperation, and plate removal were similar with the data reported in the literature with improved health outcomes, lower postoperative morbidity, and a faster return to normal life.
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Affiliation(s)
- Giuseppe Spinelli
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - Francesco Arcuri
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Domenico Valente
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
| | - Tommaso Agostini
- Department of Maxillofacial Surgery, CTO-AOUC, "Careggi Hospital," Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital," Florence, Italy
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Riganello F, Cortese MD, Arcuri F, Dolce G, Lucca L, Sannita WG. Autonomic Nervous System and Outcome after Neuro-Rehabiliation in Disorders of Consciousness. J Neurotrauma 2016. [DOI: 10.1089/neu.2015.3906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Francesco Riganello
- Institute S. Anna and RAN - Research in Advanced Rehabilitation, Crotone, Italy
| | - Maria D. Cortese
- Institute S. Anna and RAN - Research in Advanced Rehabilitation, Crotone, Italy
| | - Francesco Arcuri
- Institute S. Anna and RAN - Research in Advanced Rehabilitation, Crotone, Italy
| | - Giuliano Dolce
- Institute S. Anna and RAN - Research in Advanced Rehabilitation, Crotone, Italy
| | - Lucia Lucca
- Institute S. Anna and RAN - Research in Advanced Rehabilitation, Crotone, Italy
| | - Walter G. Sannita
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Genova, Italy
- Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, New York
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Riganello F, Cortese MD, Arcuri F, Quintieri M, Dolce G. How Can Music Influence the Autonomic Nervous System Response in Patients with Severe Disorder of Consciousness? Front Neurosci 2015; 9:461. [PMID: 26696818 PMCID: PMC4674557 DOI: 10.3389/fnins.2015.00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 07/01/2015] [Accepted: 11/20/2015] [Indexed: 11/13/2022] Open
Abstract
Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. Previous studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). In this study, we analyzed retrospectively the autonomic response to musical stimuli by mean of normalized units of Low Frequency (nuLF) and Sample Entropy (SampEn) of Heart Rate Variability (HRV) parameters, and their possible correlation to the different complexity of four musical samples (i.e., Mussorgsky, Tchaikovsky, Grieg, and Boccherini) in Healthy subjects and Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients. The complexity of musical sample was based on Formal Complexity and General Dynamics parameters defined by Imberty's semiology studies. The results showed a significant difference between the two groups for SampEn during the listening of Mussorgsky's music and for nuLF during the listening of Boccherini and Mussorgsky's music. Moreover, the VS/UWS group showed a reduction of nuLF as well as SampEn comparing music of increasing Formal Complexity and General Dynamics. These results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way.
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Affiliation(s)
| | - Maria D Cortese
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Maria Quintieri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Giuliano Dolce
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
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Cortese MD, Riganello F, Arcuri F, Pugliese ME, Lucca LF, Dolce G, Sannita WG. Coma recovery scale-r: variability in the disorder of consciousness. BMC Neurol 2015; 15:186. [PMID: 26450569 PMCID: PMC4599033 DOI: 10.1186/s12883-015-0455-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. Methods We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. Results The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Conclusions Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.
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Affiliation(s)
- M D Cortese
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - F Riganello
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - F Arcuri
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - M E Pugliese
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - L F Lucca
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - G Dolce
- Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy.
| | - W G Sannita
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, 3, Largo P. Daneo, 16132, Genova, Italy. .,Department of Psychiatry, State University of New York, Stony Brook, NY, USA.
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Cortese MD, Riganello F, Arcuri F, Pignataro LM, Buglione I. Rehabilitation of aphasia: application of melodic-rhythmic therapy to Italian language. Front Hum Neurosci 2015; 9:520. [PMID: 26441615 PMCID: PMC4585219 DOI: 10.3389/fnhum.2015.00520] [Citation(s) in RCA: 18] [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: 04/01/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
Aphasia is a complex disorder, frequent after stroke (with an incidence of 38%), with a detailed pathophysiological characterization. Effective approaches are crucial for devising an efficient rehabilitative strategy, in order to address the everyday life and professional disability. Several rehabilitative procedures are based on psycholinguistic, cognitive, psychosocial or pragmatic approaches, including amongst those with a neurobehavioral approach the Melodic Intonation Therapy (MIT). Van Eeckhout's adaptation of MIT to French language (Melodic-Rhythmic Therapy: MRT) has implemented the training strategy by adding a rhythmic structure reproducing French prosody. The purpose of this study was to adapt MRT rehabilitation procedures to Italian language and to verify its efficacy in a group of six chronic patients (five males) with severe non-fluent aphasia and without specific aphasic treatments during the previous 9 months. The patients were treated 4 days a week for 16 weeks, with sessions of 30-40 min. They were assessed 6 months after the end of the treatment (follow-up). The patients showed a significant improvement at the Aachener Aphasie Test (AAT) in different fields of spontaneous speech, with superimposable results at the follow-up. Albeit preliminary, these findings support the use of MRT in the rehabilitation after stroke. Specifically, MRT seems to benefit from its stronger structure than the available stimulation-facilitation procedures and allows a better quantification of the rehabilitation efficacy.
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Affiliation(s)
- Maria Daniela Cortese
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Francesco Riganello
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Francesco Arcuri
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Luigina Maria Pignataro
- Intensive Care Unit, S. Anna Institute and Research in Advanced Neurorehabilitation Crotone, Italy
| | - Iolanda Buglione
- Casa di Cura Villa Margherita, San Giuseppe Moscati Institute Benevento, Italy
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Spinelli G, Lazzeri D, Arcuri F, Agostini T. Closed reduction of the isolated anterior frontal sinus fracture via percutaneous screw placement. Int J Oral Maxillofac Surg 2014; 44:79-82. [PMID: 25448407 DOI: 10.1016/j.ijom.2014.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 01/23/2014] [Revised: 07/16/2014] [Accepted: 09/25/2014] [Indexed: 11/24/2022]
Abstract
Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5-15% of all maxillofacial fractures. Conventional surgical approaches include the coronal flap, direct cutaneous incision, and endoscopic techniques. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. The medical records and radiological findings of all patients who underwent surgical treatment for anterior frontal sinus fractures from January 2009 to December 2013 at the study hospital in Florence, Italy, were reviewed. The final study sample consisted of 15 patients (13 males and two females) with isolated anterior frontal sinus fractures who were treated with closed reduction using percutaneous screws. The mean age was 32.1 years. The skin incisions healed without any visible scarring, and no depressions of the frontal sinuses were evident in the postoperative period. Computed tomography scans performed at 6 months postoperatively showed adequate reduction of the displaced fragments. This closed technique is a good option for displaced isolated fractures of the anterior frontal sinus. However, the technique is not adequate for complex fractures of the frontal sinus.
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Affiliation(s)
- G Spinelli
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy
| | - D Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - F Arcuri
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy.
| | - T Agostini
- CTO-AOUC, "Careggi Hospital", Florence, Italy; Unit of Cranio-Maxillo-Facial Surgery, "Meyer Children's Hospital", Florence, Italy
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Dolce G, Lucca LF, Riganello F, Arcuri F, Quintieri M, Cortese MD, Pignolo L. Advances in the neurorehabilitation of severe disorder of consciousness. Ann Ist Super Sanita 2014; 50:234-40. [PMID: 25292271 DOI: 10.4415/ann_14_03_06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The paper describes the evolution of knowledge concerning severe brain injury which determines the Vegetative State/Unresponsive Wakefulness Syndrome. BACKGROUND The term Vegetative State was proposed by Jennet and Plum in 1972. Later on, the Intensive Care Units progresses increased the survival of these patients and, contemporary, decreased their characteristic conditions of cachexia and severe dystonia. In 1994, the disease was conceived as a disconnection syndrome of the hemispheres from the brainstem, mainly due to a temporary or permanent deficit of the functions of the white matter. From 2005 on, the psychophysiological parameters relative to an emotional consciousness, albeit submerged, were described. Since then, it has been recognized that the brain of these patients was not only to be considered living but also working. CONCLUSION The latest studies that have greatly improved the knowledge of the physiopathology of this particular state of consciousness. These new insights have led to the formation of a European Union Task Force, which has proposed in 2009 to change the name from a Vegetative State to Unresponsive Wakefulness Syndrome, outlining the character of syndrome and not that of state, as forms of even late recovery in consciousness levels have been observed and described.
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Affiliation(s)
- Giuliano Dolce
- Giuliano Dolce, Istituto S. Anna, Crotone, Italy. E-mail:
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Riganello F, Cortese MD, Arcuri F, Candelieri A, Guglielmino F, Dolce G, Sannita WG, Schnakers C. A study of the reliability of the Nociception Coma Scale. Clin Rehabil 2014; 29:388-93. [PMID: 25172088 DOI: 10.1177/0269215514546767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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]
Abstract
OBJECTIVE In this study, we investigated the reliability of the Nociception Coma Scale which has recently been developed to assess nociception in non-communicative, severely brain-injured patients. DESIGN Prospective cross-sequential study. SETTING Semi-intensive care unit and long-term brain injury care. SUBJECTS Forty-four patients diagnosed as being in a vegetative state (n=26) or in a minimally conscious state (n=18). INTERVENTIONS Patients were assessed by two experts (rater A and rater B) on two consecutive weeks to measure inter-rater agreement and test-retest reliability. MAIN MEASURES Total scores and subscores of the Nociception Coma Scale. RESULTS We performed a total of 176 assessments. The inter-rater agreement was moderate for the total scores (k = 0.57) and fair to substantial for the subscores (0.33 ≤ k ≤ 0.62) on week 2. The test-retest reliability was substantial for the total scores (k = 0.66) and moderate to almost perfect for the subscores (0.53 ≤ k ≤ 0.96) for rater A. The inter-rater agreement was weaker on week 1, whereas the test-retest reliability was lower for the least experienced rater (rater B). CONCLUSIONS This study provides further evidence of the psychometric qualities of the Nociception Coma Scale. Future studies should assess the impact of practical experience and background on administration and scoring of the scale.
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Affiliation(s)
- F Riganello
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - M D Cortese
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - F Arcuri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - A Candelieri
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - F Guglielmino
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - G Dolce
- Research in Advanced Neurorehabilitation, S. Anna Institute, Italy
| | - W G Sannita
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Genova, Italy Department of Psychiatry, State University of New York, USA
| | - C Schnakers
- Coma Science Group, Cyclotron Research Center, University of Liege, Belgium
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Ambrosio MR, Rocca BJ, Mastrogiulio MG, Pesci A, De Martino A, Mazzei MA, Volterrani L, Arcuri F, Cintorino M, Tripodi SA. Cystic gastrointestinal stromal tumors of the pancreas simulating cystoadenocarcinoma. Report of three cases and short review of the literature. Histol Histopathol 2014; 29:1583-91. [PMID: 24918465 DOI: 10.14670/hh-29.1583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) represent a distinct subset of mesenchymal tumours of the gastrointestinal tract. They are more common in the stomach and small intestine, and are characterized by the proliferation of spindle or epithelioid cells and by the expression of CD117. Extra-gastrointestinal stromal tumors are rare and only 13 cases of pancreatic GISTs have been reported in the literature, only 1 of which presented as a cystic lesion. Mutational analysis of KIT and Platelet derived growth factor receptor-α genes was performed only in two out of the 13 cases. We report 3 cases of cystic GISTs of the pancreas, radiologically mimicking a cystoadenocarcinoma. Routine histopathology and molecular characterization of the tumours have been performed. In two of them, molecular analysis showed unusual genetic alterations (the internal repeat of codon 502 and 503 in exon 9 of the KIT gene and the KIT exon 9 single nucleotide substitution c.1427G⟩T). Pancreatic GIST should be included in the differential diagnosis of both cystic and solid masses of the pancreas. The diagnosis should be accomplished by a combination of radiology, histology, immunohistochemistry and molecular biology. The evaluation of CD117 expression and the sequence analysis of KIT and Platelet derived growth factor receptor-α gene is mandatory for therapy.
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Affiliation(s)
- M R Ambrosio
- Department of Medical Biotechnologies, University of Siena, Italy.
| | - B J Rocca
- Department of Medical Biotechnologies, University of Siena, Italy
| | - M G Mastrogiulio
- Department of Medical Biotechnologies, University of Siena, Italy
| | - A Pesci
- Ospedale Sacro Cuore, Verona, 3Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - A De Martino
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - M A Mazzei
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - L Volterrani
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - F Arcuri
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | - M Cintorino
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - S A Tripodi
- Azienda Ospedaliera Universitaria Senese, Siena, Italy, Italy
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Boffano P, Benech R, Gallesio C, Arcuri F, Benech A. Current opinions on surgical treatment of fractures of the condylar head. Craniomaxillofac Trauma Reconstr 2014; 7:92-100. [PMID: 25050145 PMCID: PMC4078111 DOI: 10.1055/s-0034-1371772] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 04/27/2013] [Accepted: 05/01/2013] [Indexed: 10/25/2022] Open
Abstract
Treatment of mandibular condyle fractures is still controversial, with surgical treatment slowly becoming the preferred option. However, fractures of the condylar head (diacapitular fractures) are still treated conservatively at many institutions. Recently, more and more surgeons have begun to perform open treatment for diacapitular fractures because it allows to restore the anatomical position of the fragments and disc, it allows an immediate functional movement of the jaw, and avoid the ankylosis of the temporomandibular joint induced by the trauma. Several techniques have been proposed to reduce and fix fractures of the condylar head, such as standard bone screws, resorbable screws, resorbable pins, and cannulated lag screws. Therefore, the aim of this article is to review the literature about the surgical treatment of fractures of the condylar head to resume the current knowledge about open treatment of such fractures.
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Affiliation(s)
- Paolo Boffano
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Rodolfo Benech
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Cesare Gallesio
- Division of Maxillofacial Surgery, Head and Neck Department, University of Turin, Turin, Italy
| | - Francesco Arcuri
- Department of Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Arnaldo Benech
- Department of Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
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Gerbino G, Boffano P, Benech R, Baietto F, Gallesio C, Arcuri F, Benech A. Orbital lymphomas: clinical and radiological features. J Craniomaxillofac Surg 2013; 42:508-12. [PMID: 24051193 DOI: 10.1016/j.jcms.2013.07.017] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 05/29/2013] [Accepted: 07/31/2013] [Indexed: 12/01/2022] Open
Abstract
The purpose of this prospective study was to evaluate the clinical and radiological features of a consecutive series of orbital lymphomas in two Institutions in the North West of Italy. A prospective study was performed of all cases of diagnosed orbital lymphomas. Data on patient demographics, symptoms and clinical findings, histological type of lymphoma, site of lesion, imaging, and systemic involvement were recorded in each case. The mean age of the enrolled 20 patients was 63.65 years. Most orbital lymphomas were located in the superior-lateral quadrant. Superior rectus muscle was the most frequently involved orbital structure. Most patients were affected by extranodal marginal-zone lymphomas. The diagnosis of orbital lymphomas may be challenging, because these neoplasms present few specific features. Although not typically performed by the maxillofacial surgeon, an understanding of the staging process is crucial for multidisciplinary management of orbital lymphomas.
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Affiliation(s)
- Giovanni Gerbino
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Paolo Boffano
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy.
| | - Rodolfo Benech
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Federico Baietto
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Cesare Gallesio
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
| | - Francesco Arcuri
- Division of Maxillofacial Surgery, Azienda Ospedaliera Maggiore della Carità, Piemonte Orientale University, Novara, Italy
| | - Arnaldo Benech
- Division of Maxillofacial Surgery, Azienda Ospedaliera Maggiore della Carità, Piemonte Orientale University, Novara, Italy
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Benech A, Nicolotti M, Brucoli M, Arcuri F. Intraoral extra-mucosal fixation of fractures in the atrophic edentulous mandible. Int J Oral Maxillofac Surg 2013; 42:460-3. [DOI: 10.1016/j.ijom.2012.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/03/2012] [Accepted: 11/13/2012] [Indexed: 11/26/2022]
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Arcuri F, Brucoli M, Baragiotta N, Stellin L, Giarda M, Benech A. The role of fat grafting in the treatment of posttraumatic maxillofacial deformities. Craniomaxillofac Trauma Reconstr 2013; 6:121-6. [PMID: 24436747 DOI: 10.1055/s-0033-1333877] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 05/11/2012] [Accepted: 05/20/2012] [Indexed: 01/24/2023] Open
Abstract
Purpose The first autologous adipose tissue grafting was performed by Neuber in 1893 with an open approach. In the early 1980s, Illouz and Fournier introduced closed liposuction. In the 1990s, Coleman published a new method of atraumatic fat transplantation. Recently, immunohistochemical studies of the extracellular matrix of the lipoaspirate showed the presence of adipose-derived stem cells. The purpose of this study is to describe the role of fat grafting in the management of posttraumatic facial deformities. Methods The study population was composed of all patients who underwent facial fat grafting between March 2008 and November 2010 as a secondary reconstructive procedure after an initial unsatisfactory treatment of the skeletal fractures. We analyzed the postoperative morphological changes by comparing the grafted side of the face to the contralateral side with the aid of a software package. Results Nineteen patients were surgically treated with fat transplantation for facial asymmetry due to a pathological postoperative healing of the soft tissue. Clinical examination and software analysis showed adequate postoperative facial balance without major complications. Conclusion Fat grafting is a very powerful tool to correct posttraumatic maxillofacial deformities and to ensure a long-term follow-up. Although we have achieved excellent clinical results in our reconstructive clinical cases, we are convinced that more complex prospective studies, enriched by long-term radiological controls, are needed to fully understand the biological behavior of the transplanted fat in the posttraumatic face.
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Affiliation(s)
- Francesco Arcuri
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Matteo Brucoli
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Nicola Baragiotta
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Livia Stellin
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Mariangela Giarda
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Arnaldo Benech
- Maxillo-Facial Surgery, Ospedale Maggiore della Carità, Novara, Italy
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