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Stillo F, Mattassi R, Diociaiuti A, Neri I, Baraldini V, Dalmonte P, Amato B, Ametrano O, Amico G, Bianchini G, Campisi C, Cattaneo E, Causin F, Cavalli R, Colletti G, Corbeddu M, Coppo P, DE Fiores A, DI Giuseppe P, El Hachem M, Esposito F, Fulcheri E, Gandolfo C, Grussu F, Guglielmo A, Leuzzi M, Manunza F, Moneghini L, Monzani N, Nicodemi E, Occella C, Orso M, Pagella F, Paolantonio G, Pasetti F, Rollo M, Ruggiero F, Santecchia L, Spaccini L, Taurino M, Vaghi M, Vercellio G, Zama M, Zocca A, Aguglia M, Castronovo EL, DE Lorenzi E, Fontana E, Gusson E, Lanza J, Lizzio R, Mancardi MM, Rosina E. Guidelines for Vascular Anomalies by the Italian Society for the study of Vascular Anomalies (SISAV). INT ANGIOL 2022; 41:1-130. [PMID: 35546136 DOI: 10.23736/s0392-9590.22.04902-1] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Stillo
- SISAV Past President, Service of Vascular Anomalies Surgery, Casa di Cura Guarnieri accreditata SSN, Rome, Italy
| | - Raul Mattassi
- Service of Vascular Surgery, Casa di cura Humanitas accreditata SSN, Varese, Italy
| | - Andrea Diociaiuti
- Unit of Dermatology, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
| | - Iria Neri
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vittoria Baraldini
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Bruno Amato
- Service of Vascular and General Surgery, Federico II University Hospital, Naples, Italy
| | - Orsola Ametrano
- Department of Pediatric Dermatology, Santobono Hospital, Naples, Italy
| | - Giulia Amico
- Department of Medical Genetics, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Giuseppe Bianchini
- Department of Vascular Surgery, IRCCS - Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Corradino Campisi
- Department of Vascular and General Surgery, University of Genoa, Genoa, Italy
| | - Elisa Cattaneo
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesco Causin
- Unit of Neuroradiology, University Hospital of Padua, Padua, Italy
| | - Riccardo Cavalli
- Unit of Pediatric Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Colletti
- Private Practitioner in Maxillofacial Surgery, Associazione Italiana Sindrome di Sturge Weber, Milan, Italy
| | | | - Paola Coppo
- Unit of Pediatric Dermatology, Regina Margherita Children's Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Antonio DE Fiores
- Service of Diagnostic Imaging Ultrasound, Casa di Cura Guarnieri Accreditata SSN, Rome, Italy
| | | | - May El Hachem
- Unit of Pediatric Dermatology, Dipartimento Pediatrico Universitario-Ospedaliero (DPUO), Associazione Italiana Sindrome di Sturge Weber, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Esposito
- Unit of Emergency Radiology, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Ezio Fulcheri
- Unit of Pathological Anatomy and Histology, University of Genoa, Genoa, Italy
| | - Carlo Gandolfo
- Unit of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Grussu
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alba Guglielmo
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Miriam Leuzzi
- Department of Dermatology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Laura Moneghini
- Unit of Anatomy, Pathology and Medical Genetics, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nicola Monzani
- Pediatric Intensive Care Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Massimiliano Orso
- Regione Umbria, Direzione regionale Salute e Welfare, Perugia, Italy
| | - Fabio Pagella
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | | | | | | | | | | | - Luigina Spaccini
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea Hospital, Rome, Italy
| | | | | | - Mario Zama
- Unit of Plastic Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alfredo Zocca
- Unit of Internal Medicine, ASST Fatebenefratelli, Milan, Italy
| | - Maria Aguglia
- Unit of Clinical Pathology, PO "Vito Fazzi", Lecce, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Enza L Castronovo
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena DE Lorenzi
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elena Fontana
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- AOUI (Azienda Ospedaliera Universitaria Integrata) di Verona, Verona, Italy
| | - Elena Gusson
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Ophthalmology, Women and Children Hospital AOUI, Verona, Italy
| | - Jessica Lanza
- Unit of Vascular Malformation Surgery, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Roberta Lizzio
- ENT Department, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
- Associazione HHT Onlus, Rome, Italy
| | - Maria M Mancardi
- Associazione Italiana Sindrome di Sturge Weber, Vicenza, Italy
- Unit of Child Neuropsychiatry, Department of Neurosciences, IRCCS "G. Gaslini" Institute, Genoa, Italy
| | - Erica Rosina
- Service of Medical Genetics, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
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Pagella F, Maiorano E, Ugolini S, Lizzio R, Sovardi F, Mirabella R, Nanfitò L, Tinelli C, De Silvestri A, Olivieri C, Spinozzi G, Matti E. Epidemiological, clinical and endoscopic features of epistaxis severity and quality of life in Hereditary haemorrhagic telangiectasia: a cross-sectional study. Rhinology 2021; 59:577-584. [PMID: 34726201 DOI: 10.4193/rhin21.286] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Epistaxis is the main complaint in patients with Hereditary haemorrhagic telangiectasia (HHT). Even though the role of epistaxis in affecting the quality of life (QoL) is well-known, little is known about epidemiological and clinical factors contributing to epistaxis severity and QoL. METHODOLOGY This is a cross-sectional study, including adult patients with HHT with epistaxis. All patients underwent an otolaryngological evaluation with nasal endoscopy. Epistaxis severity was graded using the FID score, and QoL was evaluated with the Short-Form Health Survey (SF-36). Descriptive statistics were produced for demographic characteristics; the Shapiro-Wilk test was used to test the normal distribution of quantitative variables. Correlation between the quantitative variables was evaluated with Pearson's correlation coefficient. Both univariate and multivariate linear regression models were fitted to find associations between demographic or clinical factors and the FID score or SF-36. RESULTS A total of 234 patients with HHT were included in the study. The univariate analysis highlighted the association between high blood pressure, septal perforation, nocturnal epistaxis, surgery, blood transfusion, hormonal therapy and both FID score and QoL. Sex, allergic rhinitis and nasal polyposis were neither related to epistaxis severity nor perceived health. CONCLUSIONS Epistaxis severity and QoL in patients with HHT are influenced by several clinical factors both dependent and independent from HHT. Some of the results are consistent with those already published, but for the first time, we extended the analysis to different clinical parameters, such as endoscopic findings, never assessed before.
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Affiliation(s)
- F Pagella
- Department of Otorhinolaryngology, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Sovardi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Mirabella
- Department of Otorhinolaryngology, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Nanfitò
- Department of Otorhinolaryngology, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Tinelli
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Olivieri
- Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Italy
| | - G Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Matti E, Lizzio R, Ugolini S, Maiorano E, Zaccari D, De Silvestri A, De Sando E, Marseglia GL, Benazzo M, Olivieri C, Pagella F, Spinozzi G. Nasal Endoscopy in the Clinical Diagnosis of Hereditary Hemorrhagic Telangiectasia. J Pediatr 2021; 238:74-79.e2. [PMID: 34265342 DOI: 10.1016/j.jpeds.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the role of nasal endoscopy for early clinical diagnosis of hereditary hemorrhagic telangiectasia (HHT) in children and to investigate the characteristics of epistaxis and mucocutaneous telangiectases in our pediatric population. STUDY DESIGN From May 2016 to December 2019, a cross-sectional observational study was conducted, recruiting children aged 2-18 years with a parent affected by HHT. To identify the Curaçao criteria, all children underwent collection of clinical history, mucocutaneous examination, and nasal endoscopy. The clinical data were then compared with the genetic data acquired subsequently. RESULTS Seventy children (median age, 10.8 years) were included. All underwent nasal endoscopy without complications. Forty-six children were positive by genetic testing; of these, 26 % had skin and oral telangiectases and 91 % had nasal telangiectases. The diagnostic sensitivity of the Curaçao criteria increased from 28 % (95 % CI, 16%-43 %) to 85 % (95 % CI, 71%-94 %; P < .0001) when the nasal telangiectases were included. CONCLUSIONS The magnified and complete endoscopic view of the nasal cavities proved useful in increasing the diagnostic sensitivity of the Curaçao criteria. Such an examination turned out to be feasible and safe. For this reason, we believe that nasal endoscopy should be included in the diagnostic assessment of pediatric patients with suspected HHT.
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Affiliation(s)
- Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - Dario Zaccari
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisabetta De Sando
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Pediatrics, Università degli Studi di Pavia, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - Carla Olivieri
- Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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4
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Suppressa P, Pagella F, Lenato GM, Gaetani E, Serio I, Masala MS, Spinozzi G, Lizzio R, Matti E, De Silvestri A, Passali GC, Aguglia M, Crocione C, Sabbà C. Characterization of epidemiological distribution and outcome of COVID-19 in patients with hereditary hemorrhagic telangiectasia: a nationwide retrospective multi-centre study during first wave in Italy. Orphanet J Rare Dis 2021; 16:378. [PMID: 34496900 PMCID: PMC8424156 DOI: 10.1186/s13023-021-02000-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) continues to have a devastating impact across the world. A number of pre-existing common clinical conditions were reported to represent risk factors for more severe COVID-19 outcomes. Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular heritable disorders, characterized by complications secondary to visceral Arterio-Venous Malformations. The impact of HHT, as well as for many Rare Diseases (RDs) on infection susceptibility profile and clinical adverse outcome risk is an unresolved issue. Objectives The main objectives were: to assess the clinical features and outcomes of HHT patients infected with COVID-19; to compare the relative infection risk in these patients with the Italian general population throughout the first pandemic wave; to investigate the factors potentially associated with severe COVID-19 outcome in HHT patients, and the possible impact of COVID-19 infection on HHT-related symptoms/complications. Finally, we aimed to estimate how the lockdown-associated wearing of personal protective equipment/individual protection devices could affect HHT-related telangiectasia bleeding frequency. Methods The study is a nation-wide questionnaire-based survey, with a multi-Center retrospective cross-sectional design, addressed to the whole Italian HHT population. COVID-19 cases, occurring throughout the first pandemic wave, were collected by a questionnaire-based semi-structured interview. Only the cases ascertained by laboratory confirmation (molecular/serological) were included for epidemiological estimates. Information concerning eventual SarS-Cov-2 infection, as well as regarding HHT-related manifestations and HHT-unrelated co-morbidities were collected by the questionnaire. Prevalence data were compared to Italian general population in the same period. Results The survey disclosed 9/296 (3.04%) COVID-19 cases, 8/9 of them being resident in Lombardy, the main epidemic epicenter. Pneumonia was reported by 4/9 patients, which prompted hospital admission and intensive care management in 2 cases. No fatal outcome was recorded. After careful refinement of epidemiological analysis, the survey evidenced overlapping infection risk in HHT compared to general population. Conclusions COVID-19 infection profile parallels geographical distribution of epidemic foci. COVID-19 in HHT patients can lead to highly variable clinical profile, likely overlapping with that of general population. The HHT disease does not seem to involve a different approach in terms of hospital admission and access to intensive care with respect to general population.
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Affiliation(s)
- Patrizia Suppressa
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Gennaro Mariano Lenato
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy
| | - Eleonora Gaetani
- Department of Medical and Surgical Sciences, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Ilaria Serio
- Division of Internal Medicine, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | | | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Cesare Passali
- Division of Otorhinolaryngology, Multidisciplinary Gemelli Group for HHT, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy
| | - Maria Aguglia
- Clinical Pathology Unit, Vito Fazzi Hospital, Lecce, Italy.,HHT Onlus Patient Association, Rome, Italy
| | | | - Carlo Sabbà
- DIM-Interdisciplinary Department of Medicine, "Frugoni" Internal Medicine and Geriatrics Unit, HHT Interdepartmental Center, VascERN HHT Reference Center, Policlinico Hospital, University of Bari, P.zza Giulio Cesare, 70124, Bari, Italy.
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Pagella F, Ugolini S, Zoia C, Matti E, Carena P, Lizzio R, Benazzo M. Clivus pathologies from diagnosis to surgical multidisciplinary treatment. Review of the literature. ACTA ACUST UNITED AC 2021; 41:S42-S50. [PMID: 34060519 PMCID: PMC8172112 DOI: 10.14639/0392-100x-suppl.1-41-2021-04] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
The Clivus is a bone that lies in a central position of the skull base, and it is a crucial point that splits and connects different anatomical compartments at the same time. There is significant variability of diseases involving the clivus, from neoplasms to non-neoplastic, inflammatory or traumatic lesions. Each of these is rare in frequency, and this heterogeneity contributes to yield the management even more challenging. Clival pathologies can be asymptomatic or have manifestations ranging from aspecific headache to cranial nerves palsies, till life-threatening complications as cerebrospinal fluid rhinorrhoea, meningitis or brain abscess. There isn’t an univocal endorsement among experts with regard to the best approaches to manage the clivus. The paths described are many, the main division is between the transclival and transcranial lateral approaches. We performed a review of the literature, thus highlighting how authors seem to suggest that the surgical approach shouldn’t be chosen aprioristically, but based on a patient centred analysis, considering the combination of multiple surgical corridors. From diagnosis to surgery and medical therapy, clival pathologies require a team of multidisciplinary experts to ensure the best standard of treatment and higher survival rate.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
| | - Cesare Zoia
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Paolo Carena
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Italy
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Pagella F, Pusateri A, Maiorano E, Spinozzi G, Ugolini S, Lizzio R, Mirabella R, Tinelli C, Olivieri C, Matti E. Endoscopic surgical treatment of epistaxis in hereditary haemorrhagic telangiectasia: our experience. ACTA ACUST UNITED AC 2021; 41:59-68. [PMID: 33746224 PMCID: PMC7982753 DOI: 10.14639/0392-100x-n0915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
Objectives Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease characterised by epistaxis. Surgical procedures for epistaxis vary from diathermocoagulation to nasal closure. The aim of this paper is to report our experience in endoscopic surgical management of epistaxis in HHT patients. Methods This is a descriptive, longitudinal study carried out at the Otorhinolaryngology Department of IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent surgery for epistaxis from 1996 to 2015, including only those treated with endoscopic surgery. Results Among the 591 patients hospitalised and screened for HHT, 323 (54.7%) underwent endoscopic surgery for epistaxis, for a total of 679 procedures. General anaesthesia was used in 77.2% of procedures; argon plasma coagulation was the instrument of choice in the majority of patients, followed by lasers and quantum molecular resonance technology. Conclusions We report one of the largest cohorts undergoing endoscopic treatment of epistaxis in HHT patients. This mini-invasive surgical treatment allowed us to control epistaxis without major complications and nasal packaging and can be repeated over time. For these reasons, we recommend it as first choice in case of epistaxis in HHT patients.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Italy
| | - Alessandro Pusateri
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Italy
| | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rosolino Mirabella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,University of Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Carla Olivieri
- University of Pavia, Italy.,General Biology and Medical Genetics, Department of Molecular Medicine, Pavia, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Matti E, Lizzio R, Spinozzi G, Ugolini S, Maiorano E, Benazzo M, Pagella F. An alternative way to perform diagnostic nasopharyngeal swab for SARS-CoV-2 infection. Am J Otolaryngol 2021; 42:102828. [PMID: 33234296 PMCID: PMC7670921 DOI: 10.1016/j.amjoto.2020.102828] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022]
Abstract
On March 11, 2020, WHO has defined the novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak as a pandemic and still today continues to affect much of the world. Among the reasons for the rapid spread of SARS–CoV-2 infection, there is not only the high transmissibility of the virus, but also the role of asymptomatic or minimally symptomatic carriers. Therefore diagnostic testing is central to contain the global pandemic. Up to now real-time reverse transcriptase polymerase chain reaction (RT-PCR)–based molecular assays for detecting SARSCoV-2 in respiratory specimens is the current reference standard for COVID-19 diagnosis. Nasopharyngeal swab is the preferred choice for SARS–CoV-2 testing; however is not always a free of complications procedure. In patients with severe coagulopathies or diseases such as HHT, the risk of nosebleeding may be high. As in all those conditions like advanced stage sinonasal neoplasms or unfavorable anatomical characteristics, the nasopharyngeal swab may not be feasible. This work reports a safe and effective procedure of nasopharyngeal swab collection for COVID-19 testing, through the transoral way, in patients with contraindication to perform it transnasally. The procedure proved feasible and well tolerated. The discomfort for the patient is comparable with the execution of an oropharyngeal swab without exposing him to additional complications. In selected cases, the procedure described represents a valid alternative to nasopharyngeal swab performed transnasally. In particular, it allows reaching the area with the highest diagnostic sensitivity. Moreover it can be performed by Otolaryngology and, with adequate training, also by non-specialist staff.
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Affiliation(s)
- Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, University of Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, University of Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, University of Pavia, Italy
| | - Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, University of Pavia, Italy
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Pagella F, Lizzio R, Pusateri A, Ugolini S, Maiorano E, Mirabella R, De Silvestri A, Tinelli G, Matti E. Adenoidectomy: Anatomical variables as predictive factors of intraoperative adenoid residues. Int J Pediatr Otorhinolaryngol 2021; 140:110493. [PMID: 33199030 DOI: 10.1016/j.ijporl.2020.110493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Adenoid hypertrophy is a common cause of upper airway obstruction in children. However, after adenoidectomy, nasal obstructive symptoms may persist or recur, requiring surgical revision. The aim of this study is to evaluate if individual patient features can influence the efficacy of the traditional technique. METHODS A retrospective observational study was conducted by recruiting patients from candidates for adenoidectomy. All children underwent conventional transoral curettage adenoidectomy with endoscopic control at the end of procedure, and in presence of adenoid residues, a concomitant revision adenoidectomy was performed. For each patient, the following data were collected: age, sex, weight, height, length of the soft palate and surgical technique used. RESULTS In 18% of patients (113/612), the most critical areas of the nasopharynx were not reached by standard surgery, making a complete adenoidectomy difficult. In this group, the average length of the soft palate was 3.1 cm, 5 mm more than the average of the sample, and 6 mm more than the average length of patients undergoing standard surgery alone (p < 0.001). CONCLUSION Our study confirms the hypothesis that a greater length of the soft palate conditions the results of the intervention. The length of the soft palate can be considered an intraoperative criterion to select the cases in which perform endoscopic control after the standard procedure.
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Affiliation(s)
- Fabio Pagella
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy; Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Lizzio
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.
| | - Alessandro Pusateri
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Sara Ugolini
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Eugenia Maiorano
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Rosolino Mirabella
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Tinelli
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Elina Matti
- Department of Otolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Pagella F, Lizzio R, Ugolini S, Spinozzi G, Maiorano E, Suppressa P, Sabbà C, Matti E. Diagnostic testing for SARS-CoV-2 infection in HHT patients: nasopharyngeal versus oropharyngeal swab. Orphanet J Rare Dis 2020; 15:350. [PMID: 33339521 PMCID: PMC7746917 DOI: 10.1186/s13023-020-01628-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022] Open
Abstract
On March 11, 2020, WHO has defined the novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak as a pandemic that still today continues to affect much of the world. Among the reasons for the rapid spread of SARS-CoV-2 infection, there is the role of asymptomatic or minimally symptomatic carriers. Therefore diagnostic testing is central to contain the global pandemic. Up to now real-time reverse transcriptase polymerase chain reaction-based molecular assays for detecting SARS-CoV-2 in respiratory specimens is the current reference standard for COVID-19 diagnosis. Based on current knowledge regarding the sensitivity of the molecular test, the highest positive detection rate is from lower respiratory tract specimens; alternatively it is possible to perform a nasopharyngeal or oropharyngeal swab. Nasopharyngeal swab is the preferred choice for SARS-CoV-2 testing since it seems to have a greater sensitivity; however the procedure is not always free of complications and an epistaxis can occur. Among patients with greatest risk of massive nosebleed there are HHT patients. Hereditary hemorrhagic telangiectasia is an autosomal dominant disease that leads to multiregional mucocutanous telangiectases and visceral arteriovenous malformations. Clinically, the presence of telangiectases in nasal mucosa is the cause of recurrent epistaxis. In HHT patients the execution of the nasopharyngeal swab can determine from little or no consequences to a massive epistaxis leading to the necessity of nasal packing generally followed by hospital admission. In HHT patients undergoing a diagnostic test to evaluate the SARS-CoV-2 infection status, especially in those patients with frequent epistaxis with a history of anemia and repeated hospitalizations, it is therefore advisable to perform an oropharyngeal swab. This, compared to the nasopharyngeal swab, exposes to a lower risk of severe nosebleeds related treatments, such as blood transfusions or invasive procedures. According to the risk-benefit assessment and based on our experience, we consider that, despite a lower diagnostic sensitivity, oropharyngeal swab is preferable to nasopharyngeal swab for the diagnosis of SARS CoV-2 infection in patients with HHT.
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Affiliation(s)
- Fabio Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Pavia, Italy
| | - Roberta Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Sara Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Pavia, Italy
| | - Giuseppe Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenia Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Otorhinolaryngology, University of Pavia, Pavia, Italy
| | - Patrizia Suppressa
- Department of Internal Medicine and Rare Disease Centre "C. Frugoni" University Hospital of Bari, Bari, Italy
| | - Carlo Sabbà
- Department of Internal Medicine and Rare Disease Centre "C. Frugoni" University Hospital of Bari, Bari, Italy
| | - Elina Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Pagella F, Maiorano E, Matti E, Tinelli C, De Silvestri A, Ugolini S, Lizzio R, Olivieri C, Pusateri A, Spinozzi G. FID Score: an effective tool in Hereditary Haemorrhagic Telangiectasia - related epistaxis. Rhinology 2020; 58:516-521. [PMID: 32584331 DOI: 10.4193/rhin20.078] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia (HHT) is a rare disease characterized by a multisystemic vascular dysplasia and epistaxis, that is the most common cause of disability and social impairment. Patient management strictly depends on the severity of this symptom; therefore, it is of paramount importance for the clinicians to effectively grade epistaxis severity. The aim of this report was to validate the Frequency, Intensity and Duration score (FID) for grading epistaxis severity in patients with HHT; we studied repeatability and external validity comparing FID score with Epistaxis Severity Score (ESS). METHODS This is a descriptive, observational study that included 264 adult HHT patients with epistaxis. Diagnosis of HHT was established with Curacao criteria or positivity at genetic testing. Nosebleed severity was evaluated according to the FID score and the ESS. The first 30 patients were included in the validation of the FID score, which was graded on days 0, 1, 3 and 7. In the remaining 234 patients, a comparison between the ESS and FID score was performed. RESULTS The statistical analysis performed in order to validate the FID score showed very good agreement between scores calculated on different days; analysis comparing the FID score with the ESS revealed a high correlation between the two grading systems. CONCLUSIONS The FID score is a quick, easy and precise tool for evaluating HHT-related epistaxis and could be a possible alternative to the ESS. The FID score meets the need for an intuitive and smart grading system that is easy to manage in clinicians’ hands.
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Affiliation(s)
- F Pagella
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - E Maiorano
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - E Matti
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Tinelli
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Ugolini
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Otorhinolaryngology, Università degli Studi di Pavia, Pavia, Italy
| | - R Lizzio
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Olivieri
- Molecular Medicine Department, General Biology and Medical Genetics Unit, University of Pavia, Italy
| | - A Pusateri
- Otorhinolaryngology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Spinozzi
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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