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Bal J, Fairhead RJ, Matloob S, Shapey J, Romani R, Gavin C, Shoakazemi A, Pollock J. The Use of the Suboccipital Transtentorial Approach to the Posterior Inferior Incisural Space. Cureus 2023; 15:e47705. [PMID: 38021782 PMCID: PMC10674890 DOI: 10.7759/cureus.47705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To describe our experience with the microsurgical technique of the suboccipital transtentorial (SOTT) approach in the removal of posterior fossa lesions located in the posterior incisural space. Method Between 2002 and 2020 we reviewed all patients who underwent microsurgical resection of lesions of the posterior incisural space at the Department of Neurosurgery, Essex Neuroscience Centre, London, England (eight patients, male to female 3:5, mean age: 51, range 35-69). We describe the preoperative symptoms, radiological findings, surgical techniques, histology and postoperative outcomes in this cohort of patients. Results Eight patients with tumours located in the posterior incisural space underwent surgery during the study period including four meningiomas (50%), two haemangioblastomas (25%), one metastasis (13%) and one giant prolactinoma (13%). Gross or near total resection was achieved in six patients (75%): the giant prolactinoma could not be radically removed and one of the meningiomas required a small fragment to be left in place to protect the Vein of Galen. No patient developed a visual field deficit due to occipital lobe retraction. One patient developed a temporary trochlear nerve palsy (13%). Five patients had mild disability (Glasgow Outcome Scale (GOS) = 5), and four had moderate disability (GOS = 4). Conclusion In our series, the SOTT approach provided excellent access for all cases of tumours in the posterior incisural space. The tumour's size and relationship to the deep venous system contributed to the choice of approach and in one patient who had previously undergone surgery via the supracerebellar route, the SOTT approach enabled the avoidance of gliotic scar tissue. Success is dependent on careful case selection, though from our series of 8 patients, we conclude that this approach allows safe access to the posterior incisural space, with acceptable outcomes with regard to postoperative disability and cranial nerve palsy. As such, the approach should be in the armamentarium of any neurosurgeon who regularly deals with posterior fossa pathology.
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Affiliation(s)
- Jarnail Bal
- Neurosurgery, Royal London Hospital, London, GBR
| | | | | | | | - Rossana Romani
- Neurosurgery, Southampton General Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | - Cormac Gavin
- Neurosurgery, The Royal Hallamshire Hospital, Sheffield, GBR
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Pastore S, Troisi A, Romani R, Bellezza I, Gargaro M, De Michele A, Orlandi R, Guerrera G, Bazzano M, Polisca A. Isolation of extracellular vesicles from bitch's amnion-derived cells culture and their CD59 expression: Preliminary results. Theriogenology 2023; 198:164-171. [PMID: 36587540 DOI: 10.1016/j.theriogenology.2022.12.017] [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: 10/26/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
Extracellular vesicles (EVs) are small spherical particles surrounded by a membrane with an unusual lipid composition and a striking cholesterol/phospholipidic ratio. About 2000 lipid and 3500 protein species were identified in EVs secreted by different cell sources. EVs mediate cell to cell communication in proximity to or distant from the cell of origin. In particular, it was suggested that they represent modulators of multiple processes during pregnancy. The aim of this study was to identify the presence of EVs in canine amnion-derived cells (ASCs) culture and the expression of CD 59 on their surface. Amniotic membrane was collected in PBS with antibiotics added from 2 bitches during elective caesarean section. Cells culture was prepared and EVs were isolated. EVs were used to evaluate CD59 expression by flow cytofluorimetry. We found that the majority of EVs expressed CD59. Our results could increase the knowledge about the complex mechanisms that regulate the pregnancy in the bitch.
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Affiliation(s)
- S Pastore
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy.
| | - A Troisi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024, Macerata, Italy
| | - R Romani
- Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06129, Perugia, Italy
| | - I Bellezza
- Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06129, Perugia, Italy
| | - M Gargaro
- Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06129, Perugia, Italy
| | - A De Michele
- Department of Physic and Geology, University of Perugia, Via Pascoli, 06123, Perugia, Italy
| | - R Orlandi
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100, Terni, Italy
| | - G Guerrera
- Veterinarian Freelance, Campobasso, Italy
| | - M Bazzano
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024, Macerata, Italy
| | - A Polisca
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126, Perugia, Italy
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Torregrossa L, Poma AM, Macerola E, Rago T, Vignali P, Romani R, Proietti A, Di Stefano I, Scuotri G, Ugolini C, Basolo A, Antonelli A, Materazzi G, Santini F, Basolo F. The Italian Consensus for the Classification and Reporting of Thyroid Cytology: Cytohistologic and molecular correlations on 37,371 nodules from a single institution. Cancer Cytopathol 2022; 130:899-912. [PMID: 35789118 PMCID: PMC9796474 DOI: 10.1002/cncy.22618] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) includes six diagnostic categories (TIR 1/1C, TIR 2, TIR 3A, TIR 3B, TIR 4, and TIR 5), each indicating a different risk of malignancy. The objective of this monocentric retrospective study was to evaluate the distribution of the ICCRTC classes at the authors' institution and assess their cytohistologic correlations. METHODS The authors retrospectively collected 37,371 consecutive cytologic reports of thyroid nodules and described the clinical-pathologic features of the different cytologic categories. The cytologic diagnoses also were compared with histologic outcomes in a subset of patients. RESULTS The cytologic classes were distributed as follows: nondiagnostic, 15.6%; benign, 66.5%; low-risk indeterminate, 10% (TIR 3A); high-risk indeterminate, 3.5% (TIR 3B); suspicious, 1.7%; and malignant, 2.6%. According to histology, the risk of malignancy was very high in the nondiagnostic category (29.8%), with young male patients more exposed to malignancy, and it was relatively high among benign (7.8%) and indeterminate nodules (32.5% in TIR 3A; 52.1% in TIR 3B), mainly because of the high prevalence of follicular architecture in malignant tumors. On histology, the malignancy rates were 92.4% and 99.3% for the suspicious and malignant categories, respectively; aggressive variants of papillary thyroid carcinoma were mostly diagnosed in these categories. CONCLUSIONS In this series, nondiagnostic nodules showed high prevalence and, surprisingly, high malignancy rates. Malignant tumors with follicular architecture represented a diagnostic pitfall in benign and indeterminate nodules. The suspicious and malignant categories had high specificity for malignancy. Importantly, the ICCRTC had high reliability for identifying preoperatively aggressive histotypes of thyroid carcinoma.
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Affiliation(s)
- Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Anello Marcello Poma
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Teresa Rago
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Paola Vignali
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Rossana Romani
- Section of PathologyUniversity Hospital of PisaPisaItaly
| | | | - Iosè Di Stefano
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | | | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Alessio Basolo
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
| | - Ferruccio Santini
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Clinical AreaUniversity of PisaPisaItaly
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Munro APS, Feng S, Janani L, Cornelius V, Aley PK, Babbage G, Baxter D, Bula M, Cathie K, Chatterjee K, Dodd K, Enever Y, Qureshi E, Goodman AL, Green CA, Harndahl L, Haughney J, Hicks A, van der Klaauw AA, Kanji N, Libri V, Llewelyn MJ, McGregor AC, Maallah M, Minassian AM, Moore P, Mughal M, Mujadidi YF, Holliday K, Osanlou O, Osanlou R, Owens DR, Pacurar M, Palfreeman A, Pan D, Rampling T, Regan K, Saich S, Bawa T, Saralaya D, Sharma S, Sheridan R, Thomson EC, Todd S, Twelves C, Read RC, Charlton S, Hallis B, Ramsay M, Andrews N, Lambe T, Nguyen-Van-Tam JS, Snape MD, Liu X, Faust SN, Feng S, Janani L, Cornelius V, Aley PK, Babbage G, Baxter D, Bula M, Cathie K, Chatterjee K, Dodd K, Enever Y, Qureshi E, Goodman AL, Green CA, Harndahl L, Haughney J, Hicks A, van der Klaauw AA, Kanji N, Libri V, Llewelyn MJ, McGregor AC, Minassian AM, Moore P, Mughal M, Mujadidi YF, Holliday K, Osanlou O, Osanlou R, Owens DR, Pacurar M, Palfreeman A, Pan D, Rampling T, Regan K, Saich S, Bawa T, Saralaya D, Sharma S, Sheridan R, Maallah M, Thomson EC, Todd S, Twelves C, Read RC, Charlton S, Hallis B, Ramsay M, Andrews N, Lambe T, Nguyen-Van-Tam JS, Snape MD, Liu X, Faust SN, Riordan A, Ustianowski A, Rogers C, Katechia K, Cooper A, Freedman A, Hughes R, Grundy L, Tudor Jones L, Harrison E, Snashall E, Mallon L, Burton K, Storton K, Munusamy M, Tandy B, Egbo A, Cox S, Ahmed NN, Shenoy A, Bousfield R, Wixted D, Gutteridge H, Mansfield B, Herbert C, Murira J, Calderwood J, Barker D, Brandon J, Tulloch H, Colquhoun S, Thorp H, Radford H, Evans J, Baker H, Thorpe J, Batham S, Hailstone J, Phillips R, Kumar D, Westwell F, Sturdy A, Barcella L, Soussi N, Mpelembue M, Raj S, Sharma R, Corrah T, John L, Whittington A, Roche S, Wagstaff L, Farrier A, Bisnauthsing K, Abeywickrama M, Spence N, Packham A, Serafimova T, Aslam S, McGreevy C, Borca A, DeLosSantosDominguez P, Palmer E, Broadhead S, Farooqi S, Piper J, Weighell R, Pickup L, Shamtally D, Domingo J, Kourampa E, Hale C, Gibney J, Stackpoole M, Rashid-Gardner Z, Lyon R, McDonnell C, Cole C, Stewart A, McMillan G, Savage M, Beckett H, Moorbey C, Desai A, Brown C, Naker K, Gokani K, Trinham C, Sabine C, Moore S, Hurdover S, Justice E, Stone M, Plested E, Ferreira Da Silva C, White R, Robinson H, Turnbull I, Morshead G, Drake-Brockman R, Smith C, Li G, Kasanyinga M, Clutterbuck EA, Bibi S, Singh M, Champaneri T, Irwin M, Khan M, Kownacka A, Nabunjo M, Osuji C, Hladkiwskyj J, Galvin D, Patel G, Grierson J, Males S, Askoolam K, Barry J, Mouland J, Longhurst B, Moon M, Giddins B, Pereira Dias Alves C, Richmond L, Minnis C, Baryschpolec S, Elliott S, Fox L, Graham V, Baker N, Godwin K, Buttigieg K, Knight C, Brown P, Lall P, Shaik I, Chiplin E, Brunt E, Leung S, Allen L, Thomas S, Fraser S, Choi B, Gouriet J, Perkins J, Gowland A, Macdonald J, Seenan JP, Starinskij I, Seaton A, Peters E, Singh S, Gardside B, Bonnaud A, Davies C, Gordon E, Keenan S, Hall J, Wilkins S, Tasker S, James R, Seath I, Littlewood K, Newman J, Boubriak I, Suggitt D, Haydock H, Bennett S, Woodyatt W, Hughes K, Bell J, Coughlan T, van Welsenes D, Kamal M, Cooper C, Tunstall S, Ronan N, Cutts R, Dare T, Yim YTN, Whittley S, Hamal S, Ricamara M, Adams K, Baker H, Driver K, Turner N, Rawlins T, Roy S, Merida-Morillas M, Sakagami Y, Andrews A, Goncalvescordeiro L, Stokes M, Ambihapathy W, Spencer J, Parungao N, Berry L, Cullinane J, Presland L, Ross Russell A, Warren S, Baker J, Oliver A, Buadi A, Lee K, Haskell L, Romani R, Bentley I, Whitbred T, Fowler S, Gavin J, Magee A, Watson T, Nightingale K, Marius P, Summerton E, Locke E, Honey T, Lingwood A, de la Haye A, Elliott RS, Underwood K, King M, Davies-Dear S, Horsfall E, Chalwin O, Burton H, Edwards CJ, Welham B, Appleby K, Dineen E, Garrahy S, Hall F, Ladikou E, Mullan D, Hansen D, Campbell M, Dos Santos F, Lakeman N, Branney D, Vamplew L, Hogan A, Frankham J, Wiselka M, Vail D, Wenn V, Renals V, Ellis K, Lewis-Taylor J, Habash-Bailey H, Magan J, Hardy A. Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial. Lancet Infect Dis 2022; 22:1131-1141. [PMID: 35550261 PMCID: PMC9084623 DOI: 10.1016/s1473-3099(22)00271-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19. METHODS The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 μg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 μg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (anti-spike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing. FINDINGS Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6-77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3-214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030-27 162), which increased to 37 460 ELU/mL (31 996-43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41-1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996-30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826-64 452), with a geometric mean fold change of 2·19 (1·90-2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37-14·32) and 15·90 (12·92-19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24-16·54] in the BNT162b2 group and 6·22 [3·90-9·92] in the mRNA-1273 group). INTERPRETATION Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose. FUNDING UK Vaccine Task Force and National Institute for Health Research.
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Affiliation(s)
- Alasdair P S Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Leila Janani
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Gavin Babbage
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Marcin Bula
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool, UK
| | - Katrina Cathie
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Krishna Chatterjee
- NIHR Cambridge Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kate Dodd
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool, UK
| | | | - Ehsaan Qureshi
- NIHR/Wellcome Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Christopher A Green
- NIHR/Wellcome Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Linda Harndahl
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - John Haughney
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alexander Hicks
- Wellcome-MRC Institute of Metabolic Science, Department of Clinical Biochemistry, University of Cambridge, Cambridge, UK
| | - Agatha A van der Klaauw
- Wellcome-MRC Institute of Metabolic Science, Department of Clinical Biochemistry, University of Cambridge, Cambridge, UK
| | - Nasir Kanji
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Alastair C McGregor
- Department of Infectious Diseases and Tropical Medicine, London Northwest University Healthcare, London, UK
| | - Mina Maallah
- Department of Infectious Diseases and Tropical Medicine, London Northwest University Healthcare, London, UK
| | - Angela M Minassian
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Kyra Holliday
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Orod Osanlou
- Public Health Wales, Betsi Cadwaladr University Health Board, Bangor University, Bangor, UK
| | | | - Daniel R Owens
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Mihaela Pacurar
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Adrian Palfreeman
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
| | - Daniel Pan
- University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
| | - Tommy Rampling
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karen Regan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Stephen Saich
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tanveer Bawa
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dinesh Saralaya
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sunil Sharma
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ray Sheridan
- Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Emma C Thomson
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Shirley Todd
- Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Chris Twelves
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Sue Charlton
- UK Health Security Agency, Porton Down, Porton, UK
| | | | - Mary Ramsay
- UK Health Security Agency, Colindale, London, UK
| | - Nick Andrews
- UK Health Security Agency, Colindale, London, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
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Macerola E, Poma AM, Proietti A, Rago T, Romani R, Vignali P, Ugolini C, Torregrossa L, Basolo A, Santini F, Basolo F. Down-regulation of miR-7-5p and miR-548ar-5p predicts malignancy in indeterminate thyroid nodules negative for BRAF and RAS mutations. Endocrine 2022; 76:677-686. [PMID: 35347579 PMCID: PMC9156468 DOI: 10.1007/s12020-022-03034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The value of molecular markers in refining preoperative risk assessment of indeterminate thyroid nodules is being widely investigated. MicroRNAs (miRNA) are emerging as promising biomarkers for diagnostic and prognostic purposes. The aim of this study is to identify miRNAs specifically deregulated in mutation-negative indeterminate thyroid nodules. METHODS Ninety-eight nodules preoperatively diagnosed as TIR 3A or TIR 3B with available histological diagnosis of follicular adenoma (FA), noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP), and follicular variant papillary thyroid carcinoma (FV-PTC) have been retrospectively selected. Mutations in BRAF and RAS genes have been tested in all samples by real-time PCR; miRNAs were purified from cytology slides of 60 samples; expression analysis of 798 miRNAs was measured by the nCounter system. RESULTS Point mutations in BRAF and RAS genes were detected in 32 out of 98 nodules (32.7%), the majority of which in FV-PTCs. Differential expression of miRNA in wild-type nodules highlighted that two miRNAs, namely miR-7-5p and miR-548ar-5p, were downregulated in FV-PTCs compared to FAs. The combined expression of these miRNAs, tested by ROC analysis, showed an area under the curve of 0.79. Sensitivity and negative predictive value were high both in wild-type (93% and 92%, respectively) and in mutated nodules (94% and 85%, respectively). CONCLUSION The analysis of miR-7-5p and miR-548ar-5p expression in indeterminate thyroid nodules demonstrated a promising value in ruling out malignancy.
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Affiliation(s)
- Elisabetta Macerola
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Anello Marcello Poma
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Agnese Proietti
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Teresa Rago
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Rossana Romani
- University Hospital of Pisa - via Roma, 67 56126, Pisa, Italy
| | - Paola Vignali
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Clara Ugolini
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Liborio Torregrossa
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Alessio Basolo
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Ferruccio Santini
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Fulvio Basolo
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy.
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6
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Scott T, Raza-Knight S, Solth A, Zhang C, Giannakaki V, Bjornson A, Romani R. Women in neurosurgery in the United Kingdom: past, present and future. J Neurosurg Sci 2021; 66:264-270. [PMID: 34763387 DOI: 10.23736/s0390-5616.21.05292-9] [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
Whilst a growing number of women in the United Kingdom (UK) are making a success of a career in medicine as a whole, a considerable gender imbalance persists in neurosurgery. The extent of this disparity and the factors that perpetuate it are difficult to assess. Furthermore, over the 70 years since the first female neurosurgeon in the UK commenced her postgraduate training, it is difficult to gauge the progress that has been made. In this article we present a snapshot of women who have played, and who are playing, a key role in UK neurosurgery, highlighting their diverse career paths. We also present the current training distribution and subspecialties of women in UK neurosurgery. We use these data to reflect upon the possible barriers to completion of neurosurgical training, obtaining a substantive consultant position, and reaching positions of academic and clinical leadership. We discuss potential interventions that may overcome these. Highlighting the role women play in UK neurosurgery's past, present and future should inspire more female neurosurgeons to become leaders in the coming years.
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Affiliation(s)
- Teresa Scott
- Department of Neurosurgery, University Hospitals Coventry & Warwickshire, Coventry, Warwickshire, UK
| | - Saba Raza-Knight
- Department of Neurosurgery, Royal Preston Hospital, Fulwood, Preston, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Anna Bjornson
- Department of Neurosurgery, Royal Hallamshire Hospital, Broomhall, Sheffield, UK
| | - Rossana Romani
- Southampton University Hospital NHS Foundation Trust, Southampton, UK -
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7
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Casillo SM, Venkatesh A, Muthiah N, Agarwal N, Scott T, Romani R, Fernández LL, Aristizabal S, Ginalis EE, Ozair A, Bhat V, Faruqi A, Bajaj A, Sonkar AA, Ikeda DS, Chiocca EA, Lonser RR, Sutton TE, McGregor JM, Rea GL, Schunemann VA, Ngwenya LB, Marlin ES, Porensky PN, Shaikhouni A, Huntoon K, Dornbos D, Shaw AB, Powers CJ, Gluski JM, Culver LG, Goodwin AM, Ham S, Marupudi NI, Bhat DI, Berry KM, Wu EM, Wang MY. Biographies of international women leaders in neurosurgery. Neurosurg Focus 2021; 50:E19. [PMID: 33789227 DOI: 10.3171/2021.1.focus201096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/06/2022]
Abstract
We received so many biographies of women neurosurgery leaders for this issue that only a selection could be condensed here. In all of them, the essence of a leader shines through. Many are included as "first" of their country or color or other achievement. All of them are included as outstanding-in clinical, academic, and organized neurosurgery. Two defining features are tenacity and service. When faced with shocking discrimination, or numbing indifference, they ignored it or fought valiantly. When choosing their life's work, they chose service, often of the most neglected-those with pain, trauma, and disability. These women inspire and point the way to a time when the term "women leaders" as an exception is unnecessary.-Katharine J. Drummond, MD, on behalf of this month's topic editors.
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Affiliation(s)
- Stephanie M Casillo
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anisha Venkatesh
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nallammai Muthiah
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nitin Agarwal
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Teresa Scott
- 2Department of Neurosurgery, University Hospitals Coventry and Warwickshire, Coventry, Warwickshire
| | - Rossana Romani
- 3Department of Neurosurgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Laura L Fernández
- 4Faculty of Medicine, El Bosque University, Semillero Investigación Neurotrauma, Group of Investigation INUB-MEDITECH, Institute of Neuroscience and Neurosurgery, El Bosque University, Bogotá, Colombia
| | - Sarita Aristizabal
- 4Faculty of Medicine, El Bosque University, Semillero Investigación Neurotrauma, Group of Investigation INUB-MEDITECH, Institute of Neuroscience and Neurosurgery, El Bosque University, Bogotá, Colombia
| | - Elizabeth E Ginalis
- 5Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ahmad Ozair
- 6Faculty of Medicine, King George's Medical University, Lucknow
| | - Vivek Bhat
- 7Faculty of Medicine, St. John's Medical College, Bangalore
| | - Arjumand Faruqi
- 6Faculty of Medicine, King George's Medical University, Lucknow
| | - Ankur Bajaj
- 8Department of Neurosurgery, King George's Medical University, Lucknow
| | - Abhinav Arun Sonkar
- 9Department of General Surgery, King George's Medical University, Lucknow, India
| | - Daniel S Ikeda
- 10Department of Surgery, US Naval Hospital Okinawa, Japan
| | - E Antonio Chiocca
- 11Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Russell R Lonser
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Tracy E Sutton
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John M McGregor
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gary L Rea
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Victoria A Schunemann
- 13Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Laura B Ngwenya
- 14Department of Neurosurgery and Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Ohio
| | - Evan S Marlin
- 15Department of Neurosurgery, St. Luke's University Hospital, Bethlehem, Pennsylvania
| | - Paul N Porensky
- 16Service of Neurosurgery, Naval Medical Center San Diego, California
| | - Ammar Shaikhouni
- 17Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Kristin Huntoon
- 18Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Dornbos
- 19Department of Neurosurgery, Semmes Murphey Clinic and University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew B Shaw
- 20Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida
| | - Ciarán J Powers
- 12Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jacob M Gluski
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Lauren G Culver
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Alyssa M Goodwin
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit
| | - Steven Ham
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit.,22Department of Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan
| | - Neena I Marupudi
- 21Department of Neurosurgery, Wayne State University School of Medicine, Detroit.,22Department of Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan
| | - Dhananjaya I Bhat
- 23Department of Neurosurgery, Aster RV Hospital, Bangalore, India; and
| | - Katherine M Berry
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eva M Wu
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Y Wang
- 24Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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8
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Buratta S, Shimanaka Y, Costanzi E, Ni S, Urbanelli L, Kono N, Morena F, Sagini K, Giovagnoli S, Romani R, Gargaro M, Arai H, Emiliani C. Lipotoxic stress alters the membrane lipid profile of extracellular vesicles released by Huh-7 hepatocarcinoma cells. Sci Rep 2021; 11:4613. [PMID: 33633289 PMCID: PMC7907093 DOI: 10.1038/s41598-021-84268-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/15/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) are well-known mediators in intercellular communication playing pivotal roles in promoting liver inflammation and fibrosis, events associated to hepatic lipotoxicity caused by saturated free fatty acid overloading. However, despite the importance of lipids in EV membrane architecture which, in turn, affects EV biophysical and biological properties, little is known about the lipid asset of EVs released under these conditions. Here, we analyzed phospholipid profile alterations of EVs released by hepatocarcinoma Huh-7 cells under increased membrane lipid saturation induced by supplementation with saturated fatty acid palmitate or Δ9 desaturase inhibition, using oleate, a nontoxic monounsaturated fatty acid, as control. As an increase of membrane lipid saturation induces endoplasmic reticulum (ER) stress, we also analyzed phospholipid rearrangements in EVs released by Huh-7 cells treated with thapsigargin, a conventional ER stress inducer. Results demonstrate that lipotoxic and/or ER stress conditions induced rearrangements not only into cell membrane phospholipids but also into the released EVs. Thus, cell membrane saturation level and/or ER stress are crucial to determine which lipids are discarded via EVs and EV lipid cargos might be useful to discriminate hepatic lipid overloading and ER stress.
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Affiliation(s)
- Sandra Buratta
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy.
| | - Y Shimanaka
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - E Costanzi
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - S Ni
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - L Urbanelli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - N Kono
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
| | - F Morena
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - K Sagini
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy.,Department of Molecular Cell Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - S Giovagnoli
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - R Romani
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - M Gargaro
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - H Arai
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan.,AMED-CREST, Japan Agency for Medical Research and Development, Tokyo, Japan
| | - C Emiliani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
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9
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Macerola E, Poma AM, Proietti A, Romani R, Torregrossa L, Ugolini C, Rago T, Vitti P, Basolo F. Digital Gene Expression Analysis on Cytology Smears Can Rule Out Malignancy in Follicular-Patterned Thyroid Tumors. J Mol Diagn 2019; 22:179-187. [PMID: 31751679 DOI: 10.1016/j.jmoldx.2019.09.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/03/2019] [Accepted: 09/27/2019] [Indexed: 01/06/2023] Open
Abstract
Patients with indeterminate thyroid nodules (Bethesda III and IV) are often treated with diagnostic lobectomy, which in most cases represents an overtreatment. A reliable rule-out molecular test could spare patients unnecessary surgery. Stained smears of 88 indeterminate thyroid nodules with histologic diagnosis of follicular-patterned tumors were selected: 34 follicular adenomas (FAs), 34 follicular variant papillary thyroid carcinomas (FVPTCs), and 20 noninvasive follicular neoplasms with papillary-like nuclear features (NIFTPs). The expression level of 126 genes was measured by digital counting. Mutation testing was performed for the main gene mutations and fusions. Performance of gene expression and mutation tests was calculated by receiver operating characteristic analysis. The gene expression model showed an area under the curve (AUC) of 88%, with 91% negative predictive value in FAs and FVPTCs only. Part of NIFTPs was labeled as benign, and part was labeled as malignant; thus, the classifier performance worsened. Two FAs (5.9%), eight NIFTPs (40%), and 22 FVPTCs (64.7%) were mutation positive. Mutation testing AUC was 79% in FAs and FVPTCs, and decreased by including NIFTPs. This gene expression-based test was feasible in thyroid-stained smears, showed higher AUC than mutation test, and had a high negative predictive value-making it a good candidate as a rule-out test for indeterminate thyroid cytology. NIFTPs have a heterogeneous phenotype, and their preoperative diagnosis requires further investigation.
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Affiliation(s)
- Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy
| | - Anello M Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Rossana Romani
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | | | - Clara Ugolini
- Division of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Teresa Rago
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, Pisa, Italy.
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10
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Masini P, Zampetti S, Miñón Llera G, Biancolini F, Moretta I, Romani R, Tramontana M, Hansel K, Stingeni L. Infestation by the tropical bedbug Cimex hemipterus (Hemiptera: Cimicidae): first report in Italy. J Eur Acad Dermatol Venereol 2019; 34:e28-e30. [PMID: 31419365 DOI: 10.1111/jdv.15876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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]
Affiliation(s)
- P Masini
- Cani Anti Cimici©, Perugia, Italy
| | | | | | | | - I Moretta
- Department of Veterinary Medicine, University of Perugia, Perugia, Italy
| | - R Romani
- Department of Agricultural, Food and Environmental Sciences, University of Perugia, Perugia, Italy
| | - M Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - K Hansel
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
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11
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Rago T, Scutari M, Loiacono V, Tonacchera M, Scuotri G, Romani R, Proietti A, Piaggi P, Elisei R, Basolo F, Latrofa F, Vitti P. Patients with Indeterminate Thyroid Nodules at Cytology and Cancer at Histology Have a More Favorable Outcome Compared with Patients with Suspicious or Malignant Cytology. Thyroid 2018; 28:1318-1324. [PMID: 30132418 DOI: 10.1089/thy.2017.0522] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The outcomes of patients with thyroid cancer proven by histology in patients in whom cytology was Thy 3 (indeterminate; Thy 3 patients in this study) based on the Italian consensus classification compared with those in whom cytology was Thy 4 (suspicious for malignancy) or Thy 5 (indicative for malignancy) (Thy 4-5 patients here) remains unclear. OBJECTIVE To analyze the outcome of 371 Thy 3 patients versus 269 Thy 4-5 patients homogeneously treated with total thyroidectomy and 131I activity. RESULTS T1 stage was observed in 46.0% of Thy 3 and in 38.8% of Thy 4-5 patients (p = 0.02), N0 in 95.9% of Thy 3 and in 75.5% of Thy 4-5 patients (p < 0.0001). 35/261 (9.6%) Thy 3 and 85/269 (31.5%) Thy 4-5 patients required >30 mCi of 131I (p < 0.0001). 359/371 (96.8%) Thy 3 and 232/269 (86.2%) Thy 4-5 patients were free of disease at the end of follow-up (p < 0.001). The time required to obtain 50% of patients in remission was 2 years in Thy 3 and 4 years in Thy 4-5 patients (p < 0.001). The most common histological type was the follicular variant of papillary thyroid carcinoma (FV-PTC) in Thy 3 patients (239/371, 64.4%) and the classic variant in Thy 4-5 patients (185/269; 68.8%). The FV-PTC had better prognostic features compared with the other PTC variants: T1 stage was observed in 133/277 (48.0%) FV-PTC patients and in 146/363 (40.0%) patients with the other variants (p < 0.001), N0 was present in 265/277 (96.0%) FV-PTC and in 290/363 (79.8%) patients with the other variants (p < 0.001). Overall, 267/277 FV-PTC patients (96.4%) and 324/363 patients (89.0%) with the other variants were free of disease (p < 0.0008) at the end of follow-up, and the time required to obtain 50% of patients in remission was 2 years in FV-PTC and 4.0 years in the other variants (p < 0.001). CONCLUSION Patients with Thy 3 cytology have better outcomes of thyroid cancer compared with patients with Thy 4 or Thy 5 cytology, and indeterminate cytology is commonly associated with the less aggressive FV-PTC.
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Affiliation(s)
- Teresa Rago
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Maria Scutari
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Valeria Loiacono
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Massimo Tonacchera
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Giuditta Scuotri
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Rossana Romani
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Agnese Proietti
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Paolo Piaggi
- 3 National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health , Phoenix, Arizona
| | - Rossella Elisei
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Fulvio Basolo
- 2 Department of Laboratory Medicine, Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Francesco Latrofa
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
| | - Paolo Vitti
- 1 Endocrinology Unit, Department of Clinical and Experimental Medicine, and Section of Histo-Cytopathology, Pathology, University of Pisa , Italy
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12
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Romani R, Ryan G, Benner C, Pollock J. Non-operative meningiomas: long-term follow-up of 136 patients. Acta Neurochir (Wien) 2018; 160:1547-1553. [PMID: 29876678 DOI: 10.1007/s00701-018-3554-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improving access to neuroradiology investigations has led to an increased rate of diagnosis of incidental meningiomas. METHOD A cohort of 136 incidental meningioma patients collected by a single neurosurgeon in a single neurosurgical centre is retrospectively analysed between 2002 and 2016. Demographic data, imaging and clinical features are presented. The radiological factors associated with meningiomas progression are also presented. RESULTS The mean age at diagnosis was 65 (range, 33-94) years. Univariate analysis showed oedema was most strongly correlated with progression (p = 0.010) followed by hyperintensity in T2-weighted (T2W) MRI (p = 0.029) and in Flair-T2W MRI (p = 0.017). Isointensity in Flair-T2W MRI (0.004) was most strongly correlated with non-progression of the meningioma followed by calcification (p = 0.007), older age (p = 0.087), hypointensity in Flair-T2W MRI (p = 0.014) sequences and in T2W MRI (p = 0.096). In multivariate analysis, the strongest radiological factor predictive of progression was peritumoural oedema (p = 0.016) and that of non-progression was calcification (p = 0.002). At the end of the median follow-up (FU) of 43 (range, 4-150) months, 109 (80%) patients remained clinically stable, 13 (10%) became symptomatic and 14 (10%) showed clinical and radiological progression. CONCLUSIONS One hundred and nine (80%) patients remained stable at the end of FU. Peritumoural oedema was predictive of meningiomas progression. Further prospective study is needed to identify the combination of factors which can predict the meningioma progression for an early surgery or early discharge.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Charing Cross Hospital, Imperial College NHS Trust, Fulham Palace Rd, London, W6 8RF, UK.
| | - George Ryan
- Department of Neurosurgery, Essex Neuroscience Centre, Queen's Hospital, Romford, RM7 0AG, UK
| | - Christian Benner
- Department of Mathematics and Statistics, University of Helsinki, 2b, P.O. Box 68, FI-00014, Helsinki, Finland
| | - Jonathan Pollock
- Department of Neurosurgery, Essex Neuroscience Centre, Queen's Hospital, Romford, RM7 0AG, UK
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13
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Gargaro M, Pirro M, Romani R, Zelante T, Fallarino F. Aryl Hydrocarbon Receptor-Dependent Pathways in Immune Regulation. Am J Transplant 2016; 16:2270-6. [PMID: 26751261 DOI: 10.1111/ajt.13716] [Citation(s) in RCA: 15] [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: 11/01/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 01/25/2023]
Abstract
The idea of possible involvement of the aryl hydrocarbon receptor (AhR) in transplant tolerance can be traced back >30 years, when very low doses of dioxin-the most potent AhR ligand-were found to markedly reduce the generation of cytotoxic T lymphocytes in response to alloantigen challenge in vivo. AhR is a ligand-activated transcription factor that is activated by dioxins and other environmental pollutants. We now know that AhR can bind a broad variety of activating ligands that are disparate in nature, including endogenous molecules and those formed in the gut from food and bacterial products. Consequently, in addition to its classical role as a toxicological signal mediator, AhR is emerging as a transcription factor involved in the regulation of both innate and adaptive immune responses in various immune cell types, including lymphocytes and antigen-presenting cells (APCs). Allograft rejection is mostly a T cell-mediated alloimmune response initiated by the recognition of alloantigens presented by donor and recipient APCs to recipient CD4(+) and CD8(+) T cells. Based on those findings, AhR may function as a critical sensor of outside and inside environments, leading to changes in the immune system that may have relevance in transplantation.
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Affiliation(s)
- M Gargaro
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - M Pirro
- Department of Medicine, Perugia, Italy
| | - R Romani
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - T Zelante
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - F Fallarino
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
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14
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Abstract
Background: “Watch, wait, and rescan” (WWR) has an established place as a successful management option for a significant proportion of vestibular schwannomas (VS) as an alternative to microsurgical removal or stereotactic radiotherapy. VS may grow slowly and continuously, followed by stagnation or even shrinkage. We present two case reports of spontaneous shrinkage of VS along with a review of the literature. Case Description: A 29-year-old female presented with a progressive history of visual blurring and intermittent diplopia over 2 months. A 29 mm of maximum intracranial diameter (ICD) VS with secondary obstructive hydrocephalus was diagnosed. The patient underwent a ventriculo-peritoneal shunt with resolution of her symptoms and opted for initial WWR management. Interval scanning between 2007 and 2014 showed progressive reduction in the maximum ICD together with reduction in the degree of central tumor enhancement. Maximum ICD at most recent follow up was 22 mm. A 28-year-old female was referred with right sensorineural deafness. A right VS of maximum ICD of 27 mm was diagnosed. Initial WWR management was planned after discussion. Serial imaging showed an initial increase in the size of the tumor followed by progressive reduction in size. The most recent follow up showed a maximum ICD of 20 mm. Conclusion: Early WWR management can be associated with spontaneous shrinkage of VS over time. Prospective clinical study of larger numbers of such cases using the UK VS database may help to identify predictive factors for the spontaneous regression of VS.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Queen's Hospital, Essex Neuroscience Centre, Romford, London, UK
| | - Jonathan Pollock
- Department of Neurosurgery, Queen's Hospital, Essex Neuroscience Centre, Romford, London, UK
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15
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Rago T, Scutari M, Latrofa F, Loiacono V, Piaggi P, Marchetti I, Romani R, Basolo F, Miccoli P, Tonacchera M, Vitti P. The large majority of 1520 patients with indeterminate thyroid nodule at cytology have a favorable outcome, and a clinical risk score has a high negative predictive value for a more cumbersome cancer disease. J Clin Endocrinol Metab 2014; 99:3700-7. [PMID: 24708101 DOI: 10.1210/jc.2013-4401] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT Clinical management of patients with thyroid nodules indeterminate at fine-needle aspiration (FNA) cytology is still unsettled. OBJECTIVE Our objective was to establish the clinical outcome of patients with thyroid nodules indeterminate at cytology and to identify the features associated with malignancy. DESIGN AND PATIENTS This was a retrospective evaluation of 1520 consecutive patients with indeterminate cytology among 100 065 patients who underwent FNA between January 2000 and December 2010. RESULTS Of 1520 patients, 371 (24.4 %) had thyroid cancer at histology, the follicular variant of papillary cancer being the most frequent histotype, and 342 patients with cancer were free of disease after thyroidectomy and (131)I remnant ablation, whereas 29 needed further treatment because of persistent disease. Among them, only 12 had persistence of disease at the end of follow-up. Atypias at cytology (P = .001), blurred nodule margins (P = .005), and spot microcalcifications (P = .003) at thyroid ultrasound (US) were significantly associated with malignancy. A clinical score including cytology and US characteristics was calculated; the lowest value showed a high negative predictive value (83.9%) for the presence of malignancy and even higher (99.5%) for the presence of a more cumbersome cancer disease, and only 4 of the 29 patients who needed further treatment were included in the group with the lowest risk score. CONCLUSIONS Patients with Thy 3 cytology and histology of thyroid cancer had an overall good prognosis. A clinical risk score including the results of cytology and US features is helpful in the management of patients with indeterminate thyroid nodules.
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Affiliation(s)
- Teresa Rago
- Endocrinology Unit (T.R., M.S., V.L., M.T., P.V.), University Hospital; Department of Electric Systems and Automation (P.P.); Department of Oncology Section of Cytopathology Pathology 1 (I.M., R.R.) and 3 (F.B.); and Department of Surgery (P.M.), University of Pisa, 56124 Pisa, Italy
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16
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Longo M, Marconi M, Orecchini A, Petrillo C, Monaco G, Calvitti M, Pirisinu I, Romani R, Sacchetti F, Sebastiani F, Zanatta M, Paciaroni A. Terahertz Dynamics in Human Cells and Their Chromatin. J Phys Chem Lett 2014; 5:2177-2181. [PMID: 26279530 DOI: 10.1021/jz500918w] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The terahertz dynamics of human cells of the U937 line and their chromatin has been investigated by high-resolution inelastic X-ray scattering. To highlight its dynamical features in situ, nuclear DNA has been stained by uranyl-acetate salt. The general behavior of the collective dynamics of the whole cell is quite similar to that of bulk water, with a nearly wavevector-independent branch located at about 5 meV and a propagating mode with a linear trend corresponding to a speed of sound of 2900 ± 100 m/s. We provide the first experimental evidence for the existence of two branches also in the dispersion curves of chromatin. The high-energy mode displays an acoustic-like behavior with a sound velocity similar to unstained cells, but in this case the branch likely originates from the superposition of intramolecular DNA optic modes. A low-energy optic-like branch, distinctive of the chromatin moiety, is found at about 2.5 meV.
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Affiliation(s)
- M Longo
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
- ‡Elettra-Sincrotrone Trieste, I-34149 Basovizza, Trieste, Italy
| | - M Marconi
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
| | - A Orecchini
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
| | - C Petrillo
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
| | - G Monaco
- §Dipartimento di Fisica, Università degli Studi di Trento, Via Sommarive 14, I-38123 Povo, Trento, Italy
| | - M Calvitti
- ∥Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Sant'Andrea delle Fratte, I-06132 Perugia, Italy
| | - I Pirisinu
- ∥Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Sant'Andrea delle Fratte, I-06132 Perugia, Italy
| | - R Romani
- ∥Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Sant'Andrea delle Fratte, I-06132 Perugia, Italy
| | - F Sacchetti
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
- ⊥CNR, Istituto Officina dei Materiali, Unità di Perugia, c/o Dipartimento di Fisica e Geologia, Università di Perugia, I-06123 Perugia, Italy
| | - F Sebastiani
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
- ⊥CNR, Istituto Officina dei Materiali, Unità di Perugia, c/o Dipartimento di Fisica e Geologia, Università di Perugia, I-06123 Perugia, Italy
| | - M Zanatta
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
| | - A Paciaroni
- †Dipartimento di Fisica e Geologia, Università degli Studi di Perugia, Via A. Pascoli I-06123 Perugia, Italy
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17
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Proietti A, Borrelli N, Giannini R, Romani R, Di Coscio G, Quilici F, Rago T, Miccoli P, Vitti P, Basolo F. Molecular characterization of 54 cases of false-negative fine-needle aspiration among 1347 papillary thyroid carcinomas. Cancer Cytopathol 2014; 122:751-9. [PMID: 24913568 DOI: 10.1002/cncy.21454] [Citation(s) in RCA: 16] [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: 03/04/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) has been widely accepted as the most crucial step in the preoperative assessment of thyroid nodules, but the false-negative rates are generally reported to be between 3.6% and 10.2%. To lower the overall incidence of this false-negative testing, new reporting systems encourage the molecular testing of thyroid nodules. However, to the authors' knowledge, the role of molecular testing in false-negative FNA has not yet been evaluated. METHODS In total, 1347 consecutive papillary thyroid carcinomas (PTCs) with both cytological and histological diagnoses were collected from the same center. A blinded revision of the false-negative cases was performed. An analysis of the BRAF and Ras genes in the false-negative cases was then performed. RESULTS The false-negative rate at the time of primary FNA diagnosis was 4.8% (65 of 1347 cases). False-negative cases were 15 follicular variant PTCs, 2 classical variant, and 1 solid variant that lacked peculiar PTC cytomorphological features. Adequate cellular material for molecular analysis was available only in 54 of the 65 false-negative cases. Mutations were found in 6 cases (11%), and Ras alterations were present in 16 cases (29.6%). The addition of molecular analysis decreased the false-negative rate to 0.4% (5 of 1347 cases). CONCLUSIONS The results of the current study confirm the feasibility of BRAF and Ras analysis in routine FNA. However, when the false-negative FNA rate is low, the cost-benefit analysis of the detection of BRAF and Ras mutations should be carefully evaluated. Consequently, the authors suggest that preoperative molecular assessment could be helpful for benign nodules, but only in the presence of clinical suspicion of malignancy.
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Affiliation(s)
- Agnese Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Pathological Anatomy, University of Pisa, Pisa, Italy
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18
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Lauretti L, Pallini R, Romani R, Di Rocco F, Ciampini A, Gangitano C, Del Fa A, Fernandez E. Lower trunk of brachial plexus injury in the neonate rat: effects of timing repair. Neurol Res 2013; 31:518-27. [DOI: 10.1179/174313208x355477] [Citation(s) in RCA: 5] [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: 10/31/2022]
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Rahmanian A, Jamali M, Razmkon A, Kivelev J, Romani R, Alibai EA, Hernesniemi J. Benefits of early aneurysm surgery: Southern Iran experience. Surg Neurol Int 2013; 3:156. [PMID: 23372972 PMCID: PMC3551498 DOI: 10.4103/2152-7806.105095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022] Open
Abstract
Background: Neurovascular surgery has been practiced in Shiraz, the main referral center of the Southern Iran, for over 30 years; however, the trend has accelerated tremendously in recent years following subspecialization of neurovascular surgery in Shiraz, Department of Neurosurgery. Over 100 patients are operated each year, and nearly all are addressed during the first 72 hours after presentation. Methods: In this paper, we focus on the description of techniques we apply for early clipping of ruptured intracranial aneurysms in the anterior circulation. Improvements in outcome, mortality, and rebleeding rates are also discussed. Results: Mortality and rebleeding rates have declined significantly since the institution of new techniques. Conclusion: The establishment of early surgery for ruptured anterior circulation aneurysms through the lateral supraorbital approach along with specific anesthetic protocol has resulted in significant improvement of morbidity, mortality, and rebleeding rates at our department.
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Affiliation(s)
- Abdolkarim Rahmanian
- Shiraz Neuroscience Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran
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20
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Carpi A, Rossi G, Romani R, Di Coscio G, Nicolini A, Simoncini T, Russo M, Mechanick J. Are risk factors common to thyroid cancer and nodule? A forty years observational time-trend study. PLoS One 2012; 7:e47758. [PMID: 23118895 PMCID: PMC3485253 DOI: 10.1371/journal.pone.0047758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/19/2012] [Indexed: 11/19/2022] Open
Abstract
A progressive increase in the incidence of thyroid cancer (TC) has been reported over the last few decades. This either reflects the increased number of newly discovered and accurately selected thyroid nodules with more sensitive technologies and a relative more potent carcinogenic effect of pathogenetic factors in malignant, but not benign nodules. This observational time-trend study addresses this issue by analysing the proportion of TC within 8411 consecutive thyroid nodule (TN) patients evaluated in Pisa by the same pathology Department and individual clinician over a four-decade period. From 1972 to 1979 surgery was used to detect TC among the TN patients: 1140 TN patients were operated on and 35 cancers were detected (3.1% of all the TN patients). Subsequently, needle aspiration techniques were used to select TN for surgery. From 1980 to 1992, 5403 TN patients were examined, 483 were selected for surgery, and 150 cancers were found (2.8% of all the TN patients). From 1993 to 2010, 1568 TN patients were examined, 143 were selected for surgery, and 46 cancers were found (2.9% of all the TN patients). Therefore, in the University Hospital of Pisa, and independent of preoperative TN selection protocols, these proportions of TN eventually found to harbor TC remained statistically unchanged over 40 years (p = 0.810). This finding suggests that pathogenic risk factors and more sensitive diagnostic technologies did not differentially affect the incidence of TN and TC.
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Affiliation(s)
- Angelo Carpi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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21
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Romani R, Laakso A, Kangasniemi M, Niemelä M, Hernesniemi J. Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurgery 2012; 70:1504-18; discussion 1518-9. [PMID: 22240812 DOI: 10.1227/neu.0b013e31824a36e8] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various surgical approaches for the removal of tuberculum sellae meningiomas (TSMs) have previously been described. OBJECTIVE To assess the reliability and safety of the lateral supraorbital (LSO) approach to remove TSMs. METHODS We identified all TSM patients operated on at the Department of Neurosurgery at Helsinki University Central Hospital, Finland, by the senior author (J.H.) using the LSO approach between September 1997 and August 2010. We retrospectively analyzed the clinical data, radiological findings, surgical treatment, histology, and outcome of patients and discuss the operative technique. RESULTS Apparent complete tumor removal was achieved in 45 patients (87%). Of 42 patients, preexisting visual deficit improved in 22, remained the same in 13, and worsened in 7, and de novo visual deficit occurred in 1 patient. At 3 months post-discharge, 47 patients (90%) had a good recovery, 4 (8%) were moderately disabled, and 1 (2%) died 40 days after surgery of unexplained cardiac arrest. Seven patients (13%) had minimal residual tumors, 2 of which required reoperation. During the median follow-up of 59 months (range, 1-133 months), tumor recurred in 1 of the patients who had undergone a second operation. CONCLUSION TSMs of all sizes can be removed via the LSO approach with minimal morbidity and mortality. Low-power or no coagulation is recommended near the optic nerves and the optic chiasm to preserve their vascular support from the internal carotid artery perforators. Our results are comparable to those obtained using more extensive and time-consuming approaches. We recommend the LSO approach to remove TSMs.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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22
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Luostarinen T, Silvasti-Lundell M, Medeiros T, Romani R, Hernesniemi J, Niemi T. Thromboelastometry during intraoperative transfusion of fresh frozen plasma in pediatric neurosurgery. J Anesth 2012; 26:770-4. [PMID: 22562643 DOI: 10.1007/s00540-012-1400-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/17/2012] [Indexed: 01/18/2023]
Abstract
Normal blood coagulation is essential in pediatric neurosurgery because of the risk of abundant bleeding, and therefore it is important to avoid transfusion of fluids that might interfere negatively with the coagulation process. There is a lack of transfusion guidelines in massive bleeding with pediatric neurosurgical patients, and early use of blood compounds is partly controversial. We describe two pediatric patients for whom fresh frozen plasma (FFP) infusion was started at the early phase of brain tumor surgery to prevent intraoperative coagulopathy and hypovolemia. In addition to the traditional laboratory testing, modified thromboelastometry analyses were used to detect possible disturbances in coagulation. Early transfusion of FFP and red blood cells preserved the whole blood coagulation capacity. Even with continuous FFP infusion, fibrin clot firmness was near to critical value at the end of surgery despite increased preoperative values. By using FFP instead of large amounts of crystalloids and colloids when major blood loss is expected, blood coagulation is probably less likely to be impaired. Our results indicate, however, that the capacity of FFP to correct fibrinogen deficit is limited.
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Affiliation(s)
- Teemu Luostarinen
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Töölö Hospital, PO Box 266, 00029 HUS, Helsinki, Finland.
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Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J. Tailored Anterior Clinoidectomy Through the Lateral Supraorbital Approach: Experience with 82 Consecutive Patients. World Neurosurg 2012; 77:512-7. [DOI: 10.1016/j.wneu.2011.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/08/2011] [Indexed: 11/16/2022]
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Koria M, Ramsey K, Niemelia M, Kivipelto L, Lehecka M, Kivelev Y, Lehto H, Romani R, Van Popta J, Dashti R, Hernesniemi Y. [Principles of revascularization in treatment of giant intracranial aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2012; 76:65-69. [PMID: 22708437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During recent decades extra-intracranial and intra-intracranial bypasses have deserved high interest among neurosurgeon, especially in management of giant cerebral aneurysms. Development of microsurgery and neuroanesthesiological techniques, advances in neuroradiology and neurophysiology prerequisite improvement of revascularization surgery. Evolution of competitive endovascular methods pushes the surgeons to improve microneurosurgical technique of revascularization and elaboration of new approaches to management of intracranial aneurysms. In this review we discuss principles of surgery of cerebrovascular bypasses in management of giant aneurysms applied in our clinic.
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Romani R, Silvasti-Lundell M, Laakso A, Tuominen H, Hernesniemi J, Niemi T. Slack brain in meningioma surgery through lateral supraorbital approach. Surg Neurol Int 2011; 2:167. [PMID: 22145086 PMCID: PMC3229811 DOI: 10.4103/2152-7806.90029] [Citation(s) in RCA: 11] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 09/23/2011] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgery of skull base meningiomas by the lateral supraorbital (LSO) approach requires relaxed brain. Therefore, we assessed combined effects of the elements of neuroanesthesia on neurosurgical conditions during craniotomy. METHODS The anesthesiological and surgical charts of 66 olfactory groove, 73 anterior clinoidal, and 52 tuberculum sellae meningioma patients operated on by the senior author (J.H.) at the Department of Neurosurgery of Helsinki University Central Hospital, Helsinki, Finland, between September 1997 and August 2010, were retrospectively analyzed. RESULTS One-hundred fifty-four (82%) patients had good surgical conditions, and this was achieved by (1) elevating the head 20 cm above the cardiac level in all patients with only slightly lateral turn or neck flexion, (2) administering mannitol preoperatively in medium or large meningiomas (n = 60), (3) maintaining anesthesia with propofol infusion (n = 46) or volatile anesthetics (n = 107) also in patients with large tumors (n = 37), and (4) controlling intraoperative hemodynamics. Brain relaxation was satisfactory in 18 (10%) and poor in 15 (8%) patients. The median intraoperative blood loss was 200 (range, 0-2000) ml. Only 9% of patients received red blood cell transfusion. The median time to extubation was 18 (range, 8-105) min after surgery. Extubation time correlated with the patients' preoperative clinical status and the size of tumor but not with the modality of anesthesia. CONCLUSIONS Slack brain during the LSO approach is achieved by correct patient positioning, preoperative mannitol, either by propofol or in small tumors inhaled anesthetics, and optimizing cerebral perfusion pressure. Under these circumstances, intraoperative brain swelling is prevented, bleeding is minimal, and no blood transfusions are needed.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J. Complications of anterior clinoidectomy through lateral supraorbital approach. World Neurosurg 2011; 77:698-703. [PMID: 22120307 DOI: 10.1016/j.wneu.2011.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/30/2011] [Accepted: 08/04/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We reviewed the surgical complications from our recent experience in vascular and tumor patients who underwent anterior clinoidectomy through the lateral supraorbital (LSO) approach. METHODS Between June 2007 and January 2011, a total of 82 patients with neoplastic and vascular lesions underwent anterior clinoidectomy by the senior author (J.H.) through the LSO approach. We analyzed the operative videos paying particular attention to the surgical technique used for removal of the anterior clinoid process (ACP) and compared the microsurgical nuances to postoperative complications related to anterior clinoidectomy. RESULTS Forty-five patients were treated for aneurysms; 35 patients for intraorbital, parasellar, and suprasellar tumors; and 2 patients for carotid-cavernous fistulas. Intradural anterior clinoidectomy was performed in 67 (82%) cases; in 15 (18%) cases an extradural approach was used. In 51 (62%) cases, ACP was removed completely, whereas in the remaining 31 (38%) a tailored anterior clinoidectomy was performed. Four (5%) patients had new postoperative visual deficits and 3 (4%) experienced a worsening of preoperative visual deficits. Twelve (15%) patients improved their preoperative visual deficits after intradural anterior clinoidectomy. Ultrasonic bone device is a useful tool but may damage the optic nerve when performing anterior clinoidectomy. There was no mortality in our series. CONCLUSION Anterior clinoidectomy can be performed through an LSO approach with a safety profile that is comparable to other approaches. Ultrasonic bone dissector is a useful tool but may lead to injury of the optic nerve and should be used very carefully in its vicinity.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Balik V, Lehto H, Hoza D, Phornsuwannapha S, Toninelli S, Romani R, Sulla I, Hernesniemi J. Post-Traumatic Frontal and Parieto-Occipital Extradural Haematomas: a Retrospective Analysis of 41 Patients and Review of the Literature. ACTA ACUST UNITED AC 2011; 72:169-75. [DOI: 10.1055/s-0031-1286261] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractThe purpose of this study was to analyse the differences between patients with frontal (FEDH) or parieto-occipital (POEDH) epidural haematomas and evaluate possible statistically significant prognostic factors.In this retrospective study of a group of 41 patients with a FEDH (17) or POEDH (24 individuals), the authors analysed the influence of gender, age, type of injury, clinical presentation, Glasgow coma scale (GCS) score on admission, radiological findings, and time interval from trauma to surgery on outcomes. A good recovery and moderate disability were considered a “good” or “favourable outcome”, whereas severe disability, a vegetative state or death was a “poor outcome”.In the POEDH subgroup, a higher GCS score on admission and a younger age were statistically significant prognostic factors for a better outcome (p=0.006, rs=0.702). In the subgroup of patients with FEDHs, the results were not significant. However, patients with FEDHs more frequently had “good outcomes” than members of the POEDH subgroup (88.2 vs. 70.9%). Children (≤ 18 years old) constituted a smaller portion of the POEDH subgroup (12.5%) than those in the FEDH subgroup (41.2%). The evaluation of time intervals between the accident and surgery (≤ 24 h vs. > 24 h) showed no significant influence on outcomes in any of the studied subgroups. However, patients undergoing surgery within 24 h of their injury had a less favourable GCS score on admission than those operated on more than 24 h after their injury. Subacute and chronic clinical courses predominated in patients with a FEDH (10/17 FEDH vs. 11/22 POEDH). Different accompanying intradural lesions occurred in 12 patients of the POEDH subgroup, but only in 2 of the FEDH subgroup (50 vs. 11.8%). However, the presence of such lesions did not significantly deteriorate surgical outcomes in either of the subgroups.
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Romani R, Niemelä M, Korja M, Hernesniemi J. In Reply:. Neurosurgery 2011. [DOI: 10.1227/neu.0b013e31821b7ee4] [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: 11/19/2022] Open
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Romani R, Laakso A, Kangasniemi M, Lehecka M, Hernesniemi J. Lateral Supraorbital Approach Applied to Anterior Clinoidal Meningiomas: Experience With 73 Consecutive Patients. Neurosurgery 2011; 68:1632-47; discussion 1647. [DOI: 10.1227/neu.0b013e318214a840] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND:
Anterior clinoidal meningiomas (ACMs) are a subgroup of meningiomas accounting for less than 10% of supratentorial meningiomas.
OBJECTIVE:
To assess the reliability and safeness of the lateral supraorbital approach (LSO) to remove ACMs.
METHODS:
Between September 1997 and October 2009, a total of 73 ACM patients were operated on at the Department of Neurosurgery, Helsinki University Central Hospital, by the senior author (J.H.). We retrospectively analyzed the clinical data, radiological findings, surgical treatment, histology, and outcome of patients, and discuss the operative technique.
RESULTS:
Seventy-three patients were operated on by applying the LSO approach. Apparently complete removal was achieved in 57 patients (78%). Anterior clinoidectomy was performed in 21 cases. Preexisting visual deficit improved in 11 of 39 patients and worsened in 4; 3 had de novo visual deficit. At 3 months after discharge, 60 (82%) patients had a good recovery, 9 (12%) patients were moderately disabled, 1 presented with severe disability, and 3 (4%) patients died of surgery-related causes. Sixteen (22%) patients had residual tumors, 6 of which required reoperation. During the median follow-up of 36 months (range, 3–146), tumor recurred in 3 patients: 2 were followed-up and 1 was reoperated on.
CONCLUSION:
ACMs can be removed via the LSO approach with relatively low morbidity and mortality. Anterior clinoidectomy is required only in selected cases, and we prefer the intradural approach during the LSO approach. High-power coagulation should be avoided in proximity of the optic nerve.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Marko Kangasniemi
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Romani R, Lehto H, Laakso A, Horcajadas A, Kivisaari R, Fraunberg M, Niemelä M, Rinne J, Hernesniemi J. Microsurgical technique for previously coiled aneurysms. J Neurosurg Sci 2011; 55:139-150. [PMID: 21623326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since the introduction of Guglielmi detachable coils to treat intracranial aneurysms in 1991, the number of patients undergoing endovascular coiling has continuously risen as well as the number of those residual and recurrent previously coiled aneurysms that necessitate a microsurgical occlusion. Between July 1995 and August 2009 we retrospectively analyzed 81 patients with 82 previously coiled aneurysms treated microsurgically at two Finnish Neurosurgical University Hospitals, Helsinki and Kuopio. Fifty-eight aneurysms (71%) were located at anterior circulation and 24 (29%) at posterior circulation. Fifteen patients were operated on within the first month (early surgery) after coiling, whereas 66 were treated later (late surgery). Complete or partial removal of coils during surgery may facilitate clipping, but is significantly (P<0.001) more difficult to accomplish in late surgery. Removal of coils may also increase the chance for poor outcome. Chance of poor outcome increased also with intraoperative aneurysm rupture, size of the aneurysm and posterior circulation location. Good clinical outcome, three months after surgery, was achieved in 71 patients (88%); four patients were severely disabled, and six patients died (three of them due to poor clinical condition). Complete microsurgical occlusion of the residual previously coiled aneurysm is a high-risk procedure in large and giant aneurysms, and these patients should be referred to a dedicated neurovascular center to minimize surgical complications. Bypass procedures may be the best option for demanding growing lesions, especially those in posterior circulation.
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Affiliation(s)
- R Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Stacconi MVR, Romani R. Ultrastructural and functional aspects of the spermatheca in the American harlequin bug, Murgantia histrionica (Hemiptera: Pentatomidae). Neotrop Entomol 2011; 40:222-230. [PMID: 21584404 DOI: 10.1590/s1519-566x2011000200011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/06/2010] [Indexed: 05/30/2023]
Abstract
The spermatheca of Murgantia histrionica (Hahn) was investigated using fluorescence, scanning and transmission electron microscopy. The aim of the study was to elucidate the structure of this organ, pointing out differences between mated and unmated females. Results have shown an elaborated cuticular structure associated with muscular and glandular tissues. The spermatheca is joined with the common oviduct by the spermathecal duct, forming a thin saccular dilation through two consecutive invaginations. The distal part of the organ is formed by a series of two communicating cuticular chambers. The first cylindrical-shaped chamber, corresponding to the coiled region, is wrapped by longitudinal muscular fibers suspended between two cuticular flanges. The contractions of these fibers compress a deformable zone of the cylinder, pumping the sperm toward the spermathecal duct. Without contractions the cylinder results to be isolated from the proximal part of the spermatheca by means of a valve. The second chamber, corresponding to the spermatheca, is made of two parts: a truncated-conical sub chamber, with a constant cuticular thickness, bearing on itself the distal flange, where muscular fibers are attached. The second part is a bulb-like structure wrapped in a glandular epithelium. The secretory units are composed by two cells: a secretory cell and an associated duct cell. Every evacuating duct shows a little reservoir just after the terminal apparatus, and converge inside the distal bulb after a tortuous path. The functional implications of this structure in the reproductive biology of M. histrionica are discussed.
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Affiliation(s)
- M V R Stacconi
- Dipartimento di Scienze Agrarie e Ambientali, Facoltà di Agraria, Università degli Studi di Perugia, Perugia, Italia.
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Proietti A, Giannini R, Ugolini C, Miccoli M, Fontanini G, Di Coscio G, Romani R, Berti P, Miccoli P, Basolo F. BRAF status of follicular variant of papillary thyroid carcinoma and its relationship to its clinical and cytological features. Thyroid 2010; 20:1263-70. [PMID: 20950194 DOI: 10.1089/thy.2009.0283] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The cytological discrimination between benign and malignant follicular-patterned lesions of the thyroid can represent a diagnostic challenge, even for experienced pathologists. To attempt to clarify this diagnostic problem, we analyzed the BRAF status of thyroid tumors in a group of patients with follicular variant of papillary thyroid carcinoma (FVPTC) and its correlation with cytomorphological features. METHODS The BRAF status was evaluated in a total of 187 patients in whom FVPTC was consecutively diagnosed by histology between January 2006 and January 2009. Each case had a previous fine-needle aspiration diagnosis classified according to the British Thyroid Association Guidelines categorized as inadequate (Thy1) (n = 19), benign (Thy2) (n = 19), follicular lesion and follicular lesion with atypia (Thy3) (n = 109), suspicious of PTC (Thy4) (n = 29), or malignant (Thy5) (n = 11). The first 68 cases were selected for a morphological study by a quantitative analysis of four cytological features (grooves, intranuclear cytoplasmatic inclusions, number of cells per high power field (400 ×), and mean nuclear diameter) of the carcinomas. RESULTS The BRAF status of each tumor was correlated with the cytological classes. 54.5% and 27.6% of Thy5 and Thy4, respectively, were BRAF-mutated, against 12.1% of follicular lesions and 9.3% of follicular lesion with atypia (Thy3). This comparison was statistically significative (p = 0.0017). Among the 68 cases selected for the cyto-morphological study, the BRAF status frequency was similar to that of the total case series. No significant differences were found correlating the cytological classes with the number of cells, the number of grooves, and the mean cell diameters. Only the number of intranuclear cytoplasmatic inclusions were associated (p < 0.05) with the Thy5 cytological class. CONCLUSIONS BRAF is mutated in a low percentage of FVPTC, and most of these mutated cases are suspicious or positive on fine-needle aspiration. BRAF analysis is of limited value in the preoperative diagnosis of FVPTC.
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Affiliation(s)
- Agnese Proietti
- Division of Pathology, Department of Surgery, University of Pisa, Pisa, Italy
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Romani R, Tuominen H, Hernesniemi J. Reducing Intraoperative Bleeding of Juvenile Nasopharyngeal Angiofibroma. World Neurosurg 2010; 74:497-500. [DOI: 10.1016/j.wneu.2010.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/25/2010] [Indexed: 10/18/2022]
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Hernesniemi J, Dashti R, Niemelä M, Romani R, Rinne J, Jääskeläinen JE. Microsurgical and angiographic anatomy of middle cerebral artery aneurysm. Neurosurgery 2010; 66:E1030. [PMID: 20404680 DOI: 10.1227/neu.0b013e3181d8ccab] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Celik O, Niemelä M, Romani R, Hernesniemi J. Inappropriate application of Yaşargil aneurysm clips: a new observation and technical remark. Neurosurgery 2010; 66:84-7; discussion 87. [PMID: 20173575 DOI: 10.1227/01.neu.0000348008.89027.c1] [Citation(s) in RCA: 4] [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: 11/19/2022] Open
Abstract
OBJECTIVE Recurrences after complete surgical clipping of an aneurysm base are rare. We describe a potential reason for such recurrences: the inappropriate application of a popular aneurysm clip. CLINICAL PRESENTATION We present 3 cases in which intraoperative indocyanine green video angiography after clipping clearly demonstrates filling of the aneurysm. INTERVENTION During surgery, the necks of the aneurysms were clipped with Yaşargil aneurysm clips (Aesculap AG & Co., Tuttlingen, Germany) without any problems; however, indocyanine green video angiography after clipping showed filling of the aneurysms through the point located at the junction of the blade and spring portions of the clips. In the first patient, the aneurysm sac was further coagulated, and a second, smaller clip was applied to completely occlude the untreated part. In the second patient, the clip was replaced with a different clip that had longer blades. In the third patient, 2 additional clips were applied, and the aneurysm sac was also coagulated. The postoperative computed tomographic angiographic examinations showed total occlusion of the aneurysms and patency of the parent arteries. All patients achieved full recovery after the operations. CONCLUSION We present here, for the first time, evidence that the small orifice located at the junction of the blade and spring portions of Yaşargil aneurysm clips can lead to failure of initial surgery and/or recurrence. This can be avoided by using clips with slightly longer blades to keep the orifice away from the aneurysm or by applying a second clip to occlude the untreated part.
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Affiliation(s)
- Ozgür Celik
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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36
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Rago T, Fiore E, Scutari M, Santini F, Di Coscio G, Romani R, Piaggi P, Ugolini C, Basolo F, Miccoli P, Pinchera A, Vitti P. Male sex, single nodularity, and young age are associated with the risk of finding a papillary thyroid cancer on fine-needle aspiration cytology in a large series of patients with nodular thyroid disease. Eur J Endocrinol 2010; 162:763-70. [PMID: 20083557 DOI: 10.1530/eje-09-0895] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the risk of papillary thyroid carcinoma (PTC) at fine-needle aspiration (FNA) cytology in 34 120 patients. RESULTS False positive and false negative rates of FNA cytology were 1.2 and 1.8% in comparison with the histology in 3406 nodules from 3004 patients who underwent surgery. PTC (901 cases) was more frequent in solitary nodule (SN; 446/13 549, 3.3%) than in multinodular goiter (MNG; 411/19 923, 2%, chi(2)=48.8; P<0.0001), and in males (209/6382, 3.3%) than in females (648/26 945, 2.40%, chi(2)=15.58; P<0.0001). PTC prevalence in Graves' disease (GD; 13/286, 4.5%) and Hashimoto's thyroiditis (HT; 31/508, 6.1%) was higher than in SN, this difference being significant in HT (chi(2)=8.7; P=0.003), but not in GD (chi(2)=1.6; P=0.2). Using the multiple logistic regression analysis, independent risk predictors of PTC were determined, which were younger age (odds ratio (OR)=0.97, confidence interval (CI) 0.964-0.974; P<0.0001), male gender (OR=1.44, CI 1.231-1.683; P<0.0001), and SN versus MNG (OR=0.63, CI 0.547-0.717; P<0.0001). The individual risk predictivity was highly improved by including serum TSH in the prediction model, which was measured at FNA in 11 919 patients. CONCLUSION A cytology suspicious or indicative of PTC was associated with younger age, male gender, and solitary versus multiple nodularity. These clinical parameters, together with serum TSH, may allow formulation of an algorithm that could be usefully applied to predict the risk of PTC in individual patients when cytology does not give a diagnostic result.
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Affiliation(s)
- T Rago
- Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
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Romani R, Niemelä M, Celik O, Isarakul P, Paetau A, Hernesniemi J. Ectopic recurrence of craniopharyngioma along the surgical route: case report and literature review. Acta Neurochir (Wien) 2010; 152:297-302; discussion 302. [PMID: 19499168 DOI: 10.1007/s00701-009-0415-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 03/27/2009] [Accepted: 05/12/2009] [Indexed: 11/26/2022]
Abstract
We present a 22-year-old woman with an ectopic recurrence of a craniopharyngioma. The patient presented first with a visual field deficit, and a craniopharyngioma was removed via an interhemispheric transcallosal approach. Magnetic resonance imaging (MRI) performed at 1 month, and then at 1 year after surgery showed complete removal of the lesion. However, at 4 years, MRI showed the presence of a small tumor in the right medial frontal lobe attached to the falx and along the previous surgical route. We present possible explanations for the ectopic recurrence and literature review.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki 00260, Finland.
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38
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Celik O, Piippo A, Romani R, Navratil O, Laakso A, Lehecka M, Dashti R, Niemelä M, Rinne J, Jääskeläinen JE, Hernesniemi J. Management of dural arteriovenous fistulas - Helsinki and Kuopio experience. Acta Neurochir Suppl 2010; 107:77-82. [PMID: 19953375 DOI: 10.1007/978-3-211-99373-6_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Dural arteriovenous fistulas (DAVFs) are complex disorders, some of them with aggressive clinical behaviour. During past decades their treatment strategy has changed due to increased knowledge of their pathophysiology and natural history, and advances in treatment modalities. In asymptomatic cases or cases with mild symptoms in the absence of cortical venous drainage (CVD) no treatment is necessarily required, whereas aggressive DAVFs should be treated promptly by endovascular or microsurgical means.In our series of 323 patients with 333 fistulas, treated in two neurosurgical units in Finland since 1944, there were 265 true DAVFs and 68 Barrow type A caroticocavernous fistulas. Among the DAVFs there was a slight female predominance, 140 women (55%) and 115 men (45%), and the majority of the cases were located in the area of transverse and sigmoid sinuses. Mode of treatment in the early series was proximal ligation of feeding artery, and later craniotomy, endovascular treatment and radiosurgery, or combination of these treatments, with total occlusion rate being 53%.
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Affiliation(s)
- O Celik
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
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Romani R, Laakso A, Niemelä M, Lehecka M, Dashti R, Isarakul P, Celik O, Navratil O, Lehto H, Kivisaari R, Hernesniemi J. Microsurgical principles for anterior circulation aneurysms. Acta Neurochir Suppl 2010; 107:3-7. [PMID: 19953364 DOI: 10.1007/978-3-211-99373-6_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Microneurosurgical techniques introduced by Prof. Yaşargil have been modified by the senior author (JH) when treating more than 4,000 patients with aneurysms at two of the Departments of Neurosurgery in Finland, Kuopio and Helsinki, with a total catchment area of close to three million people. This experience is reviewed, and the treatment of anterior circulation aneurysms by simple, fast, normal anatomy preserving strategy is presented.Most of the aneurysms of the anterior circulation are treated by using the lateral supraorbital approach, a less invasive, more frontally located modification of the pterional approach. To avoid extensive skull base surgery, a slack brain is needed and achieved by experienced neuroanesthesia and by surgical tricks for removal of CSF.Diagnosis of cerebral aneurysm before rupture improves treatment results more than any technical advances. Until this is realized, we continue to treat cerebral aneurysms by simple, fast, preserving normal anatomy-strategy, which has served our patients well.Patients with cerebral aneurysms should be treated at specialized neurovascular centers.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
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Hernesniemi J, Romani R, Lehecka M, Isarakul P, Dashti R, Celik O, Navratil O, Niemelä M, Laakso A. Present state of microneurosurgery of cerebral arteriovenous malformations. Acta Neurochir Suppl 2010; 107:71-6. [PMID: 19953374 DOI: 10.1007/978-3-211-99373-6_11] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Microneurosurgical excision is known to be the definitive treatment for brain arteriovenous malformation (AVMs). The most important factors governing the operability of an AVM are location, size, age of the patient, and the neurosurgeon's and team's experience. We present in this review the surgical experience of the senior author (JH) in microneurosurgical treatment of brain AVMs. This consists of the following steps: (1) accurate preoperative embolization; (2) optimal selection of the surgical approach; (3) accurate definition and preservation of the normal arterial vessels of passage; (4) temporary clipping of the feeding arteries; (5) a special method of coagulation called "dirty coagulation" of the deep small difficult vessels inside apparently normal brain around the AVM; (6) removal of all AVM; (7) meticulous hemostasis; (8) intra- and postoperative digital subtraction angiography (DSA); (9) clinical and radiological follow-up. These steps are not possible in AVMs lying entirely within central eloquent areas. Nine out of ten small- and medium-sized arteriovenous malformations (AVMs) are suitable for direct surgery, but surgical complications increase drastically with the size of the AVM. Nevertheless, the actual results of combined treatment with preoperative Onyx embolization followed by microsurgery have decreased these risks.
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Affiliation(s)
- Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
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Hernesniemi J, Lehecka M, Lehto H, Romani R, Niemelä M. Commentary. World Neurosurg 2010. [DOI: 10.1016/j.surneu.2009.05.001] [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: 10/20/2022]
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42
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Dashti R, Laakso A, Niemelä M, Porras M, Celik O, Navratil O, Romani R, Hernesniemi J. Application of microscope integrated indocyanine green video-angiography during microneurosurgical treatment of intracranial aneurysms: a review. Acta Neurochir Suppl 2010; 107:107-9. [PMID: 19953380 DOI: 10.1007/978-3-211-99373-6_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Indocyanine Green Video Angiography (ICG-VA) is recently introduced to the practice of cerebrovascular neurosurgery. This technique is safe and noninvasive and provides reliable real-time information on the patency of blood vessels of any size, as well as residual filling of aneurysms. In this article, a review of the literature and our experience with ICG-VA during microneurosurgery of intracranial aneurysms is presented.
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Affiliation(s)
- Reza Dashti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, 00260, Finland
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Romani R, Kivisaari R, Çelik Ö, Niemelä M, Perra G, Hernesniemi J. REPAIR OF AN ALARMING INTRAOPERATIVE INTRACAVERNOUS CAROTID ARTERY TEAR WITH ANASTOCLIPS: TECHNICAL CASE REPORT. Neurosurgery 2009; 65:E998-9; discussion E999. [DOI: 10.1227/01.neu.0000350877.43579.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Surgical treatment of an intracavernous carotid aneurysm (ICCA) is difficult because of the close relationship to bone, dura, and neurovascular structures. Intraoperative rupture of an ICCA is challenging, especially if the site of rupture is at the base of the aneurysm. We present a case of intraoperative rupture of an ICCA caused by clinoidectomy. We repaired it by using a single-clamp applicator (AnastoClip Vessel Closure System, 1.4 mm; LeMaitre Vascular, Burlington, MA).
CLINICAL PRESENTATION
In April 2007, a 40-year-old woman underwent neurosurgical treatment at another institution for a ruptured basilar bifurcation aneurysm, with good recovery. Digital subtraction angiography performed at this time showed the presence of left internal carotid artery aneurysms, 1 at the anterior wall of the paraclinoidal segment and 1 at the lateral wall of the intracavernous segment. In February 2008, the patient was referred from outside Finland to our department for microsurgical treatment of both aneurysms.
TECHNIQUE
A lateral supraorbital approach was used, and during extradural removal of the anterior clinoid with a rongeur, the ICCA ruptured. The base of the intracavernous aneurysm was involved in the rupture, and we used a single-clamp applicator to repair the internal carotid artery. Intraoperative digital subtraction angiography, indocyanine green video angiography, and Doppler ultrasonography showed a good flow in the artery. The paraclinoid aneurysm was uneventfully clipped during the same intervention.
CONCLUSION
Intraoperative rupture of ICCA was repaired quickly and effectively by using a single-clamp applicator. Our case and experimental data from other microsurgical vascular experiences suggest that the future of intracranial vessel repair/anastomoses will be using microclips and other simpler devices more, allowing the neurosurgeon to perform fast and effective vessel repair.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Özgür Çelik
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Giancarlo Perra
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
Detour tests provide a reliable indicator of the presence of visual lateralisation. Previous studies on fishes and birds suggest that preferences in choosing to detour an obstacle to reach a goal are due to asymmetries of eye use. We studied detour behaviour to reach a prey in males of Podarcis muralis in order to ascertain visual laterality for a predatory task. Lizards were found to be lateralised at both individual and population levels, although only a few lizards were found to express lateralisation at the level of the individual. The preferential direction of detouring is the left route around a transparent barrier, indicating a right eye/left hemisphere use to observe the prey and confirming the results of recent work. The eye used to fixate the prey was maintained longer in the same direction the lizards subsequently chose to approach it, confirming that the preference was basically due to visual asymmetry, not to motor asymmetry. To our knowledge this is the first study of detouring conducted on sauria, demonstrating how these lizards are right eye/left hemisphere lateralised for predatory tasks at individual and population level.
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Affiliation(s)
- D Csermely
- Dipartimento di Biologia Evolutiva e Funzionale, Università di Parma, Parma, Italy.
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Romani R, Lehecka M, Gaal E, Toninelli S, Çelik Ö, Niemelä M, Porras M, Jääskeläinen J, Hernesniemi J. LATERAL SUPRAORBITAL APPROACH APPLIED TO OLFACTORY GROOVE MENINGIOMAS. Neurosurgery 2009; 65:39-52; discussion 52-3. [DOI: 10.1227/01.neu.0000346266.69493.88] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
The lateral supraorbital approach for safely and completely removing olfactory groove meningiomas was assessed.
METHODS
Between September 1997 and June 2008, a total of 656 meningiomas were operated on by the senior author (JH) at the Department of Neurosurgery, Helsinki University Central Hospital; 66 were olfactory meningiomas. We retrospectively analyze the clinical data, radiological findings, surgical treatment, histology, and outcome of all the olfactory groove meningioma patients and discuss the operative techniques used.
RESULTS
Sixty-six patients were operated on by the lateral supraorbital approach. The median preoperative Karnofsky Performance Scale score was 80 (range, 40–100). Three patients were redo cases in which the primary operation had been performed elsewhere. Seemingly complete tumor removal was achieved in 60 patients (91%); there was no surgical mortality. Postoperatively, 6 patients (9%) had cerebrospinal fluid leakage, 5 (8%) had new visual deficits, 4 (6%) had wound infections, 4 (6%) had cotton granulomas, and 1 (2%) had a postoperative hematoma. The median Karnofsky score at discharge was 80 (range, 40–100). Six patients had recurrent tumors; 3 underwent reoperations after an average of 21 months (range, 1–41 months); 1 was treated with radiosurgery, and 2 were only followed. During the median follow-up time of 45 months (range, 2–128 months), there were 4 recurrences (6%) diagnosed on average 32 months (range, 17–59 months) after surgery.
CONCLUSION
The lateral supraorbital approach can be used safely for olfactory groove meningiomas of all sizes with no mortality and relatively low morbidity. Surgical results and tumor recurrence with this fast and simple approach are similar to those obtained with more extensive, complex, and time-consuming approaches.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Emilia Gaal
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Stefano Toninelli
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Özgür Çelik
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Porras
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Jääskeläinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Hernesniemi J, Romani R, Albayrak BS, Lehto H, Dashti R, Ramsey C, Karatas A, Cardia A, Navratil O, Piippo A, Fujiki M, Toninelli S, Niemelä M. Microsurgical management of pineal region lesions: personal experience with 119 patients. ACTA ACUST UNITED AC 2008; 70:576-83. [DOI: 10.1016/j.surneu.2008.07.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE AND IMPORTANCE Colloid cysts of the third ventricle are rare benign tumors of endodermal origin accounting for 1% of all intracranial tumors. Interestingly, a few familial cases have been reported previously. We present the first case of dizygotic twins with a symptomatic colloid cyst of the third ventricle. CLINICAL PRESENTATION A 10-year-old boy was admitted to a local hospital in 1993 because of severe progressive headache. Computed tomographic and magnetic resonance imaging scans revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst, which was removed after emergent ventricular drainage. Fourteen years later, a nonidentical twin brother complained of continuous headache with nausea and vomiting. A magnetic resonance imaging scan showed obstructive hydrocephalus and a third ventricle colloid cyst, which was removed by use of the transcallosal approach. INTERVENTION Both twins underwent complete removal of the cyst by the interhemispheric transcallosal approach without postoperative complications. CONCLUSION On the basis of a literature review, 2 cases of colloid cysts of the third ventricle in monozygotic twins and a few familial cases have been reported. Our case is the first in dizygotic twin brothers. These findings suggest that the prevalence of colloid cyst may be higher in twins than in the general population. We believe that the presence of this lesion in a twin necessitates magnetic resonance imaging of the other twin, and a clinical follow-up would be recommended in all other first-degree relatives.
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Affiliation(s)
- Rossana Romani
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
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Nardi F, Frati F, Romani R, Rosi G, Corsi I, Focardi S. Organophosphate-resistant acetylcholinesterase in Mytilus galloprovincialis: identification of a resistance Ace gene in cerebral ganglion, gills and adductor muscle. Comp Biochem Physiol A Mol Integr Physiol 2008. [DOI: 10.1016/j.cbpa.2008.05.056] [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: 10/21/2022]
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Hernesniemi J, Romani R, Dashti R, Albayrak BS, Savolainen S, Ramsey C, Karatas A, Lehto H, Navratil O, Niemelä M. Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach—experience of 134 patients. ACTA ACUST UNITED AC 2008; 69:447-53; discussion 453-6. [DOI: 10.1016/j.surneu.2007.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
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Rago T, Di Coscio G, Ugolini C, Scutari M, Basolo F, Latrofa F, Romani R, Berti P, Grasso L, Braverman LE, Pinchera A, Vitti P. Clinical features of thyroid autoimmunity are associated with thyroiditis on histology and are not predictive of malignancy in 570 patients with indeterminate nodules on cytology who had a thyroidectomy. Clin Endocrinol (Oxf) 2007; 67:363-9. [PMID: 17555501 DOI: 10.1111/j.1365-2265.2007.02892.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relationship between thyroid autoimmunity and cancer is still uncertain. PATIENTS We approached this issue in 570 consecutive patients submitted to thyroidectomy for an indeterminate nodule on cytology. Thyroid autoimmunity was defined as positivity of circulating thyroid autoantibodies (TAb), autoimmune hypo- or hyperthyroidism, thyroid hypoechogenicity on ultrasound, and lymphocytic infiltration on histology. RESULTS TAb were found in 122/570 (21.4%), hypoechogenicity in 115/570 (20.1%), and lymphocytic infiltration in 117/570 (20.5%) of patients. The three features of thyroid autoimmunity were highly concordant: hypoechogenicity was observed in 71/448 (15.8%) patients with negative TAb and in 44/122 (36%) with positive TAb (P < 0.0001); lymphocytic infiltration was found in 53/448 (11.8%) patients with negative TAb and in 64/122 (52.4%) with positive TAb (P < 0.0001); hypoechogenicity on ultrasound was observed in 73/453 (16.1%) patients without, and in 42/117 (35.9%) with lymphocytic infiltration (P < 0.0001). None of these parameters was associated with malignancy. TAb were found in 32/135 (23.7%) patients with carcinoma and in 90/435 (20.6%) with a benign lesion (P = NS); hypoechogenicity was observed in 26/135 (19.2%) patients with carcinoma and in 89/435 (20.4%) patients with benign lesions (P = NS); lymphocytic infiltration was present in 28/135 (20.7%) patients with carcinoma and in 89/435 (20.4%) with benign lesions (P = NS). The frequency of cancer in 11 patients with clinically overt thyroid autoimmune disease did not differ from that observed in the whole study group. CONCLUSION In this group of patients with indeterminate thyroid nodules at cytology, clinical and pathological criteria of thyroid autoimmunity were strongly concordant and not associated with malignancy.
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Affiliation(s)
- T Rago
- Department of Endocrinology, University of Pisa, Pisa, Italy
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