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1.
Curr Neuropharmacol ; 20(10): 2001-2012, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35450527

RESUMEN

BACKGROUND: Olfactory training is the only evidence-based treatment for post-viral olfactory dysfunction. Smell disorders after SARS-CoV-2 infection have been attributed to neuroinflammatory events within the olfactory bulb and the central nervous system. Therefore, targeting neuroinflammation is one potential strategy for promoting recovery from post-COVID-19 chronic olfactory dysfunction. Palmitoylethanolamide and luteolin (PEA-LUT) are candidate antiinflammatory/ neuroprotective agents. OBJECTIVE: To investigate recovery of olfactory function in patients treated with PEA-LUT oral supplements plus olfactory training versus olfactory training plus placebo. METHODS: Multicenter double-blinded randomized placebo-controlled clinical trial was held. Eligible subjects had prior COVID-19 and persistent olfactory impairment >6 months after follow-up SARS-CoV-2 negative testing, without prior history of olfactory dysfunction or other sinonasal disorders. Participants were randomized to daily oral supplementation with ultramicronized PEA-LUT 770 mg plus olfactory training (intervention group) or olfactory training with placebo (control). Sniffin' Sticks assessments were used to test the patients at baseline and 90 days. RESULTS: A total of 185 patients, including intervention (130) and control (55) were enrolled. The intervention group showed significantly greater improvement in olfactory threshold, discrimination, and identification scores compared to controls (p=0.0001). Overall, 92% of patients in the intervention group improved versus 42% of controls. Magnitude of recovery was significantly greater in the intervention group versus control (12.8 + 8.2 versus mean 3.2 + 3), with >10-fold higher prevalence of anosmia in control versus intervention groups at the 90-day endpoint. CONCLUSION: Among individuals with olfactory dysfunction post-COVID-19, combining PEA-LUT with olfactory training resulted in greater recovery of smell than olfactory training alone.


Asunto(s)
COVID-19 , Trastornos del Olfato , Amidas , COVID-19/complicaciones , Suplementos Dietéticos , Etanolaminas , Humanos , Luteolina/uso terapéutico , Trastornos del Olfato/tratamiento farmacológico , Trastornos del Olfato/epidemiología , Trastornos del Olfato/etiología , Ácidos Palmíticos , SARS-CoV-2
2.
Am J Otolaryngol ; 42(2): 102821, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33162182

RESUMEN

BACKGROUND: The aim of this study was to describe the potential advantages of the transoral 3D 4K exoscope-assisted removal of calculus of the Wharton's duct. METHODS: A 24-year-old female with swelling in the left oral pelvis was diagnosed of sialolithiasis of distal Wharton's duct. A CT scan confirmed the lithiasic formation and a transoral removal in local anesthesia was planned through the 3D 4K exoscope (VITOM 3D, Karl Storz). RESULTS: A high-quality magnification of the oral pelvis was obtained, with an easy identification of the entrance of the left submandibular gland's duct and the calculus. After blunt dissection the Wharton's duct was incised and the calculus removed. An angiocatheter (20G) was carefully inserted in the duct and removed after 3 days. No postoperative complications occurred. At 7 days post-operative follow-up the patient had developed a neo-ostium 5 mm from the papilla. The exoscope provided a better involvement in the surgery and more interactions of all operating room personnel, residents and students, that had access to the same field of view of the first surgeon with the perception of the depth of the surgical field with 3D technology. CONCLUSIONS: The exoscope could represent a valid option for transoral removal of calculi, allowing for precise surgical dissection of the oral floor, thus reducing the risks for iatrogenic lesion of the lingual nerve. It showed also a high potential for training and educational purposes.


Asunto(s)
Imagenología Tridimensional/métodos , Procedimientos Quirúrgicos Orales/métodos , Conductos Salivales/cirugía , Cálculos de las Glándulas Salivales/cirugía , Glándula Submandibular/cirugía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anestesia Local , Percepción de Profundidad , Femenino , Humanos , Conductos Salivales/diagnóstico por imagen , Cálculos de las Glándulas Salivales/diagnóstico por imagen , Glándula Submandibular/diagnóstico por imagen , Adulto Joven
3.
Head Neck ; 41(11): 3940-3947, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31472003

RESUMEN

BACKGROUND: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. METHODS: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were "preventive" (oral calcium + vitamin D supplementation), "reactive" (therapy in hypocalcemia), and "predictive" (therapy if iPTH <10 pg/mL). RESULTS: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the "reactive" and "predictive" groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. CONCLUSIONS: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The "preventive" strategy was the most cost-effective, despite overtreatment.


Asunto(s)
Calcio/uso terapéutico , Hipocalcemia/terapia , Complicaciones Posoperatorias/terapia , Enfermedades de la Tiroides/cirugía , Tiroidectomía/efectos adversos , Vitamina D/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Calcio/sangre , Hormonas y Agentes Reguladores de Calcio/uso terapéutico , Análisis Costo-Beneficio , Femenino , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Enfermedades de la Tiroides/sangre , Enfermedades de la Tiroides/patología , Vitaminas/uso terapéutico , Adulto Joven
4.
Endocr Pract ; 25(4): 328-334, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30995431

RESUMEN

Objective: Well-differentiated thyroid cancer (WDTC) is characterized by favorable disease course and excellent survival. However, some histologic subtypes, known as aggressive histologic variants (AHVs), present a more aggressive behavior than conventional WDTC. The aim of this study was to evaluate the pattern of nodal involvement and factors influencing prognosis in N1b patients with AHVs. Methods: A multicentric retrospective analysis of patients who underwent therapeutic lateral neck dissection (ND) for WDTC between 1994 and 2015 was accomplished. AHVs included the following subtypes: tall cell, Hürtle cell, diffuse sclerosing, and poorly differentiated papillary thyroid cancer. Results: The study included a total of 352 N1b patients, 40 (11.4%) of whom had AHVs. AHVs present a similar distribution of positive nodes if compared with conventional WDTC. In AHV patients, 5-year overall survival (OS), disease-specific survival (DSS), locoregional control, and metastasis-free survival were 82.2%, 93.6%, 80.3%, and 87.3%, respectively. Advanced age (>55 years) was the only significant factor affecting survival (OS, P<.001; DSS, P = .011) in this group. In the AHV group, there were 9 (22.5%) recurrences; patients with regional recurrence and without distant metastases were effectively treated by surgery. Conclusion: The distribution of positive lymph nodes in case of AHVs is similar to that of conventional WDTC, with only level V at a relatively greater risk of harboring metastases in the former group. Survival outcomes in N1b patients with AHVs remain optimal. Total thyroidectomy, ND, and adjuvant radioiodine administration have been demonstrated to be effective treatments in the setting of AHVs. Abbreviations: AHV = aggressive histologic variant; DOD = died of disease; DSS = disease-specific survival; DSV = diffuse sclerosing variant; ETE = extrathyroidal extension; HCC = Hürthle cell carcinoma; LRC = locoregional control; LVI = lymphovascular invasion; MFS = metastasis-free survival; ND = neck dissection; NED = no evidence of disease; OS = overall survival; PDA = poorly differentiated areas; PTC = papillary thyroid carcinoma; RAI = radioiodine therapy; TCV = tall cell variant; WDTC = well-differentiated thyroid cancer.


Asunto(s)
Neoplasias de la Tiroides , Carcinoma Hepatocelular , Carcinoma Papilar , Humanos , Radioisótopos de Yodo , Neoplasias Hepáticas , Persona de Mediana Edad , Disección del Cuello , Recurrencia Local de Neoplasia , Pronóstico , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Tiroidectomía
5.
Head Neck ; 38 Suppl 1: E2118-21, 2016 04.
Artículo en Inglés | MEDLINE | ID: mdl-26849799

RESUMEN

BACKGROUND: Few studies have investigated the effect of vitamin E in reducing the cisplatin (CDDP)-induced ototoxicity. This study evaluated vitamin E supplementation as a protecting agent against CDDP-induced ototoxicity. METHODS: Patients who started CDDP were randomly assigned to receive vitamin E supplementation at 400 mg per day (group 1) or placebo (group 2). Audiograms and evoked brainstem responses were obtained at baseline, and after 1, 2, and 3 months. RESULTS: Twenty-three patients affected by solid malignancies were enrolled (13 in group 1 and 10 in group 2). At 1 month, a significant hearing loss in group 2 at both 2000 HZ (right ear: p = .05; left ear: p = .04) and 8000 HZ (right ear: p = .04; left ear: p = .03) was detected when compared to baseline values. Audiograms did not show significant changes. At 1 month, evoked brainstem responses remained unchanged in both arms without significant differences between groups. CONCLUSION: These preliminary findings confirm the neuroprotective properties of vitamin E against the CDDP-induced ototoxicity. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2118-E2121, 2016.


Asunto(s)
Antineoplásicos/efectos adversos , Cisplatino/efectos adversos , Suplementos Dietéticos , Pérdida Auditiva/prevención & control , Neuroprotección , alfa-Tocoferol/uso terapéutico , Anciano , Potenciales Evocados Auditivos del Tronco Encefálico , Femenino , Pérdida Auditiva/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad
6.
Auris Nasus Larynx ; 39(3): 310-3, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21855238

RESUMEN

Primary squamous cell carcinoma of the thyroid gland (PSCCT) is rare and its aetiology is debated. A 67-year-old man presented with neck mass. Fine-needle-aspiration (FNA) cytology and through-cut biopsy were suggestive of poorly differentiated or anaplastic carcinoma. The patient was offered tracheostomy and palliative cure for unresectable tumor of the thyroid; he refused and decided for other opinion. Lobe-isthmusectomy was performed with diagnostic and debulking intent. Final pathology report was of mixed squamous cell and follicular carcinoma of the thyroid. The tumor was a PSCCT. The patient underwent adjuvant chemoradiotherapy. After 2 years, an iliac crest metastasis of follicular carcinoma was diagnosed. The patient is disease free, after surgery and radio-active-iodine treatment. The hypothesis of squamous cell carcinoma transformation from well differentiated thyroid cancer has to be considered in case of PSCCT. Primary squamous cell carcinoma of the thyroid gland (PSCCT) is rare [1-3]; different theories on its aetiology do exist [4-6]. Mixed squamous cell and follicular carcinoma is even more rare than pure squamous cell of the thyroid gland and only few cases are reported in literature [7]. Preoperative diagnosis can be very challenging and the differential diagnosis with secondary squamous cell carcinoma of the thyroid (SSCCT) is manadatory in order to plan a correct management of the disease. The presence of PSCCT with distant metastasis of follicular carcinoma supports the histogenesis of squamous cell carcinomas arising from follicular epithelial cells.


Asunto(s)
Adenocarcinoma Folicular/patología , Carcinoma de Células Escamosas/patología , Neoplasias Primarias Secundarias/patología , Neoplasias de la Tiroides/patología , Anciano , Biopsia con Aguja Fina , Transformación Celular Neoplásica , Humanos , Masculino
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