Journal of Endocrinological Investigation, Feb 1, 2001
ABSTRACT Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitar... more ABSTRACT Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitary adenomas. We report the clinical features, treatment and follow-up of 10 pediatric patients affected by pituitary adenomas. All patients underwent clinical evaluation, endocrine tests, magnetic resonance imaging and visual field assessment. Follow-up ranged from 8 to 132 months (median 52.6). All patients were older than 10 years of age; 60% were males. In 50% the initial complaints were headache and/or visual impairment, all except one had clear evidence of endocrine dysfunction. Ninety percent were macroadenomas. According to hormone measurements and immunostaining 50% were prolactinomas, 20% were pure GH-secreting and 30% were non-functioning adenomas. Prolactinomas in two females were successfully treated with cabergoline. The other patients underwent surgery: three prolactinomas are still being treated with dopamine agonists and a GH-secreting adenoma is being treated with octreotide LAR and cabergoline. Two patients were also treated with conventional radiotherapy. Treatments were completely successful in 50% of patients: these have normal hormone secretion, full pubertal development, no significant tumor mass and normal visual field. Hypersecretion of prolactin persists in two cases; partial or complete hypopituitarism is present in four, relevant tumor remnant in another four and impairment of visual field is present in two cases. In conclusion, pediatric adenomas occur mostly in pubertal age, are prevalently macroadenomas and clinically functioning. Medical therapy should be preferred for secreting adenomas, but in some cases, notably prolactinomas in males, surgery and eventual radiotherapy may be needed.
The aim of pharmacological therapy in subarachnoid haemorrhage (SAH) is to prevent cerebral ische... more The aim of pharmacological therapy in subarachnoid haemorrhage (SAH) is to prevent cerebral ischemia and consequent events. Vasospasm, energy decrease, altered Ca++ homeostasis, lactic acidosis and free radicals are responsible for cerebral ischemic damage. Drug therapy in SAH is necessary before, during and after surgical treatment. Nimodipine is the only drug used today and supported by many clinical trials; scientific trials, on using known and new substances in SAH drug therapy, are in progress.
Neurogenic tumors of the brachial plexus are very rare lesions. A few reports are found in the li... more Neurogenic tumors of the brachial plexus are very rare lesions. A few reports are found in the literature, and they concern a small number of cases. Excluding cases of von Recklinghausen’s disease, the total number of surgically treated cases that have undergone pathological evaluation is 171. Das Gupta et al. [1] presented in 1969 the pathological features of 60 neurilemmomas of the neck, but they did not specify the exact site of implantation. Horak et al. [4] in 1983 reviewed 11 neurofibromas and 5 schwannomas. Only the other 95 cases [2, 5, 7] of solitary schwannomas are clearly diagnosed and described in their clinical and pathological features.
Computed tomography (CT) is a universally employed diagnostic tool of proven utility. While it is... more Computed tomography (CT) is a universally employed diagnostic tool of proven utility. While it is routinely used in central nervous system pathology, it has rarely been employed in the study of peripheral nervous system lesions, particularly if the involved specialist is not a neurosurgeon. We present here our experience in a preoperative study of patients in whom anatomical and pathological data have been sought by means of CT scans.
The complications associated with the employment of neurosurgical techniques for the management o... more The complications associated with the employment of neurosurgical techniques for the management of cerebrospinal fluid rhinorrhoea has led to the development of extracranial approaches. he nasal endoscope can be used to improve visualisation of the site of the leak and to facilitate free graft or septal flap placement. This ensures a high rate of dural defect healing with minimal morbidity. This study describes four cases with CSF fistulas that were repaired endoscopically and the specific surgical techniques that were used. The authors believe that, in carefully selected cases, transnasal endoscopic management of CSF leaks can be the initial surgical treatment of choice.
Purpose The use of opioids in patients with chronic non-cancer pain is common and can be associat... more Purpose The use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD. Methods A database search was performed in Medline, Embase and Cochrane using terms such as “analgesics”, “opioids” and “testosterone”. Relevant literature from January 1969 to March 2018 was evaluated. Results The prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment. ...
Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no c... more Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no clinical relevance. After the refinement of the endoscopic technique and supported by the extensive experience gained at the authors’ institution since 1994, endoscopic exploration of the fourth ventricle has been performed by the same surgeon in 54 patients. In all cases reviewed, endoscopic navigation of the fourth ventricle was successfully performed with no related neurological deficit. This preliminary experience shows the feasibility of transaqueductal navigation of the fourth ventricle, which is made possible by the use of small, flexible endoscopes in expert hands.
Abstract Background Despite the high prevalence of neck pain, few studies have addressed the phar... more Abstract Background Despite the high prevalence of neck pain, few studies have addressed the pharmacological treatment of this condition. Purpose We evaluated the effectiveness of tapentadol prolonged-release (PR) in patients with or without a neuropathic pain component, with a focus on functional movements, disability and Quality of Life (QoL). Study design/setting Observational, retrospective study. Patient sample Ninety-four adult patients with severe neck pain not responsive to opioid step III treatment. Outcome measures The primary endpoint was a ≥ 30% improvement of pain intensity at 4 weeks (W4). Several secondary outcomes were evaluated, including neck disability index (NDI), range of motion (ROM), and QoL. Methods Patients received tapentadol PR at the starting dose of 100 mg/day. Dose titration was allowed in 50 mg increments, up to 500 mg daily. Results At W4, the primary endpoint of ≥30% improvement of pain was reported in 70% (n = 35; 95% confidence interval [CI]: 55–82%) of patients with a neuropathic pain component and in 69% (n = 20; 95% CI: 49–85%) of those without a neuropathic component. The percentage of patients reporting a neuropathic pain component significantly decreased from baseline (64.2%) to W4 (27.8%). NDI significantly improved in both groups at W12. ROM significantly improved in all three planes of motion (p < .01), with no difference between the two groups. Interference of pain with sleep and QoL also improved. Conclusions The reduction in pain provided by tapentadol is associated with functional recovery, which may in turn be linked to an improvement in QoL.
Journal of Endocrinological Investigation, Feb 1, 2001
ABSTRACT Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitar... more ABSTRACT Pituitary adenomas in childhood and adolescence constitute 2-6% of all operated pituitary adenomas. We report the clinical features, treatment and follow-up of 10 pediatric patients affected by pituitary adenomas. All patients underwent clinical evaluation, endocrine tests, magnetic resonance imaging and visual field assessment. Follow-up ranged from 8 to 132 months (median 52.6). All patients were older than 10 years of age; 60% were males. In 50% the initial complaints were headache and/or visual impairment, all except one had clear evidence of endocrine dysfunction. Ninety percent were macroadenomas. According to hormone measurements and immunostaining 50% were prolactinomas, 20% were pure GH-secreting and 30% were non-functioning adenomas. Prolactinomas in two females were successfully treated with cabergoline. The other patients underwent surgery: three prolactinomas are still being treated with dopamine agonists and a GH-secreting adenoma is being treated with octreotide LAR and cabergoline. Two patients were also treated with conventional radiotherapy. Treatments were completely successful in 50% of patients: these have normal hormone secretion, full pubertal development, no significant tumor mass and normal visual field. Hypersecretion of prolactin persists in two cases; partial or complete hypopituitarism is present in four, relevant tumor remnant in another four and impairment of visual field is present in two cases. In conclusion, pediatric adenomas occur mostly in pubertal age, are prevalently macroadenomas and clinically functioning. Medical therapy should be preferred for secreting adenomas, but in some cases, notably prolactinomas in males, surgery and eventual radiotherapy may be needed.
The aim of pharmacological therapy in subarachnoid haemorrhage (SAH) is to prevent cerebral ische... more The aim of pharmacological therapy in subarachnoid haemorrhage (SAH) is to prevent cerebral ischemia and consequent events. Vasospasm, energy decrease, altered Ca++ homeostasis, lactic acidosis and free radicals are responsible for cerebral ischemic damage. Drug therapy in SAH is necessary before, during and after surgical treatment. Nimodipine is the only drug used today and supported by many clinical trials; scientific trials, on using known and new substances in SAH drug therapy, are in progress.
Neurogenic tumors of the brachial plexus are very rare lesions. A few reports are found in the li... more Neurogenic tumors of the brachial plexus are very rare lesions. A few reports are found in the literature, and they concern a small number of cases. Excluding cases of von Recklinghausen’s disease, the total number of surgically treated cases that have undergone pathological evaluation is 171. Das Gupta et al. [1] presented in 1969 the pathological features of 60 neurilemmomas of the neck, but they did not specify the exact site of implantation. Horak et al. [4] in 1983 reviewed 11 neurofibromas and 5 schwannomas. Only the other 95 cases [2, 5, 7] of solitary schwannomas are clearly diagnosed and described in their clinical and pathological features.
Computed tomography (CT) is a universally employed diagnostic tool of proven utility. While it is... more Computed tomography (CT) is a universally employed diagnostic tool of proven utility. While it is routinely used in central nervous system pathology, it has rarely been employed in the study of peripheral nervous system lesions, particularly if the involved specialist is not a neurosurgeon. We present here our experience in a preoperative study of patients in whom anatomical and pathological data have been sought by means of CT scans.
The complications associated with the employment of neurosurgical techniques for the management o... more The complications associated with the employment of neurosurgical techniques for the management of cerebrospinal fluid rhinorrhoea has led to the development of extracranial approaches. he nasal endoscope can be used to improve visualisation of the site of the leak and to facilitate free graft or septal flap placement. This ensures a high rate of dural defect healing with minimal morbidity. This study describes four cases with CSF fistulas that were repaired endoscopically and the specific surgical techniques that were used. The authors believe that, in carefully selected cases, transnasal endoscopic management of CSF leaks can be the initial surgical treatment of choice.
Purpose The use of opioids in patients with chronic non-cancer pain is common and can be associat... more Purpose The use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD. Methods A database search was performed in Medline, Embase and Cochrane using terms such as “analgesics”, “opioids” and “testosterone”. Relevant literature from January 1969 to March 2018 was evaluated. Results The prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment. ...
Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no c... more Transaqueductal navigation of the fourth ventricle has long been considered dangerous and of no clinical relevance. After the refinement of the endoscopic technique and supported by the extensive experience gained at the authors’ institution since 1994, endoscopic exploration of the fourth ventricle has been performed by the same surgeon in 54 patients. In all cases reviewed, endoscopic navigation of the fourth ventricle was successfully performed with no related neurological deficit. This preliminary experience shows the feasibility of transaqueductal navigation of the fourth ventricle, which is made possible by the use of small, flexible endoscopes in expert hands.
Abstract Background Despite the high prevalence of neck pain, few studies have addressed the phar... more Abstract Background Despite the high prevalence of neck pain, few studies have addressed the pharmacological treatment of this condition. Purpose We evaluated the effectiveness of tapentadol prolonged-release (PR) in patients with or without a neuropathic pain component, with a focus on functional movements, disability and Quality of Life (QoL). Study design/setting Observational, retrospective study. Patient sample Ninety-four adult patients with severe neck pain not responsive to opioid step III treatment. Outcome measures The primary endpoint was a ≥ 30% improvement of pain intensity at 4 weeks (W4). Several secondary outcomes were evaluated, including neck disability index (NDI), range of motion (ROM), and QoL. Methods Patients received tapentadol PR at the starting dose of 100 mg/day. Dose titration was allowed in 50 mg increments, up to 500 mg daily. Results At W4, the primary endpoint of ≥30% improvement of pain was reported in 70% (n = 35; 95% confidence interval [CI]: 55–82%) of patients with a neuropathic pain component and in 69% (n = 20; 95% CI: 49–85%) of those without a neuropathic component. The percentage of patients reporting a neuropathic pain component significantly decreased from baseline (64.2%) to W4 (27.8%). NDI significantly improved in both groups at W12. ROM significantly improved in all three planes of motion (p < .01), with no difference between the two groups. Interference of pain with sleep and QoL also improved. Conclusions The reduction in pain provided by tapentadol is associated with functional recovery, which may in turn be linked to an improvement in QoL.
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Papers by Domenico Billeci