Publications by authors named "Rossana Izzetti"

24 Publications

  • Page 1 of 1

Oral Mucosal Melanoma.

J Craniofac Surg 2021 Jul 30. Epub 2021 Jul 30.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

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http://dx.doi.org/10.1097/SCS.0000000000008054DOI Listing
July 2021

How dental activity has changed following COVID-19: single centre experience.

Minerva Dent Oral Sci 2021 Jul 26. Epub 2021 Jul 26.

Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Background: COVID-19 outbreak had an extremely relevant impact on dental activity. Since the beginning of the pandemic, a previously unseen change in terms of procedures, organization of patient flow, and personal protective equipment (PPE) employed led to a reorganization of all the aspects of patient management. The aim of the present study was to report and compare current dental activity with pre-COVID era.

Methods: Data on the dental activity in the period 9th March - 9th September 2020 were retrieved and compared with the same period of the previous year. The differences with pre-COVID era in terms of patient schedule and PPE were evaluated using Student t-test for independent data. Significance was set at p<0.05.

Results: During the lockdown, dental activity was reduced by almost the 90%, although emergencies and urgent treatments were still performed in a high number of patients. In the six months comprised between March and September 2020, the overall activity decreased by the 50% compared to the same period of the previous year. The access to the department was modified in order to guarantee a safe patient flow. Triage and temperature measurement were performed in all patients to exclude both the presence of symptoms and potential contact with infected subjects. Moreover, appointments were scheduled every 45 minutes, and the waiting rooms reorganized. A higher number of PPE items was employed by dental health care workers.

Conclusions: Overall, the measures adopted appear effective in guaranteeing a safe dental activity both for patients and dental health care workers.
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http://dx.doi.org/10.23736/S2724-6329.21.04548-4DOI Listing
July 2021

Experimental Evaluation of Aerosol Production after Dental Ultrasonic Instrumentation: An Analysis on Fine Particulate Matter Perturbation.

Int J Environ Res Public Health 2021 03 24;18(7). Epub 2021 Mar 24.

Hygiene and Epidemiology Unit, Department of Translational Research and the New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.

Aerosol production represents a major concern during the majority of dental procedures. The aim of the present study is to investigate the dynamics of aerosol particles after 15 min of continuous supragingival ultrasonic instrumentation with no attempt of containment through particle count analysis. Eight volunteers were treated with supragingival ultrasonic instrumentation of the anterior buccal region. A gravimetric impactor was positioned 1 m away and at the same height of the head of the patient. Particles of different sizes (0.3-10 µm) were measured at the beginning of instrumentation, at the end of instrumentation (EI), and then every 15 min up to 105 min. The 0.3-µm particles showed non-significant increases at 15/30 min. The 0.5-1-µm particles increased at EI ( < 0.05), and 0.5 µm remained high for another 15 min. Overall, all submicron aerosol particles showed a slow decrease to normal values. Particles measuring 3-5 µm showed non-significant increases at EI. Particles measuring 10 µm did not show any increases but a continuous reduction ( < 0.001 versus 0.3 µm, < 0.01 versus 0.5 µm, and < 0.05 versus 1-3 µm). Aerosol particles behaved differently according to their dimensions. Submicron aerosols peaked after instrumentation and slowly decreased after the end of instrumentation, whilst larger particles did not show any significant increases. This experimental study produces a benchmark for the measurement of aerosol particles during dental procedures and raises some relevant concerns about indoor air quality after instrumentation.
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http://dx.doi.org/10.3390/ijerph18073357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036889PMC
March 2021

Ultra-high-frequency ultrasound monitoring of plaque psoriasis during ixekizumab treatment.

Skin Res Technol 2021 Mar 2;27(2):277-282. Epub 2021 Feb 2.

Department of Dermatology, University of Pisa, Pisa, Italy.

Background: High-frequency ultrasound (HFUS) is a non-invasive method that detects superficial skin features. Ultra-high frequencies (50-100 MHz) can reveal epidermis and dermis structures.

Objectives: In this study, we describe the psoriatic plaque using a new device equipped with a 70 MHz probe (VEVO MD, Fujifilm, VisualSonics) and we assess the lesion before and after ixekizumab.

Methods: We examined the superficial hyperechoic band, the subepidermal hypoechoic band (SLEB), and the vascularization of the plaque in ten patients affected by plaque psoriasis.

Results: The average superficial hyperechoic band thickness was 0.2157 mm before treatment, 0.1611 mm after 15 days, and 0.1354 mm (P < .05) after 30 days. The SLEB thickness was 0.7535 mm at baseline, 0.3300 mm after 15 days (P < .05), and 0.2007 mm (P < .05) after 30 days. The average percentage vascularization was 50.21% at baseline, 13.15% after 15 days (P < .05), and 5.97% after 30 days. UHFUS assessment highlighted the rapid action of the drug in terms of the decrease in vascularization after 15 days. It revealed a statistically significant reduction in SLEB thickness after 15 days and a significant reduction in the hyperechoic superficial band after 30 days.

Conclusions: VEVO MD provides physicians with high-resolution details of the psoriatic plaque, thus enabling tailored-made treatments.
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http://dx.doi.org/10.1111/srt.12942DOI Listing
March 2021

Ultra-high frequency ultrasonography (UHFUS)-guided minor salivary gland biopsy: A promising procedure to optimize labial salivary gland biopsy in Sjögren's syndrome.

J Oral Pathol Med 2021 May 15;50(5):485-491. Epub 2021 Feb 15.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Unit of Dentistry and Oral Surgery, University of Pisa, Pisa, Italy.

Background: Sjögren's syndrome (SS) is an autoimmune disease characterized by an inflammatory infiltrate of exocrine salivary and lachrymal glands. Diagnosis is complex, and minor salivary gland biopsy and subsequent focus score (FS) calculation appear of extreme importance in the diagnostic work-up of the disease. Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique, which is gaining an increasingly important role in intraoral imaging. This study aims at exploring the usefulness of UHFUS for obtaining valuable labial salivary gland samples to assess the histopathological features of SS patients.

Methods: Patients with clinical suspect of SS and eligible for minor salivary gland biopsy were enrolled. UHFUS scan of the lower lip was performed. Glandular echostructure was classified according to Outcome Measures in Rheumatology (OMERACT) scoring system. The glands to be sampled were selected on the basis of UHFUS evaluation and biopsied. The areas of the samples were recorded and compared with those obtained without UHFUS guidance. The correlation between UHFUS grade and labial gland FS was also assessed.

Results: The areas of the samples obtained with UHFUS guidance were significantly higher (7.25 ± 3.98 mm ) than those obtained by conventional procedures (5.79 ± 3.49 mm , P = .02). UHFUS correlated significantly with the salivary gland FS (r = .532, P = .001).

Conclusion: UHFUS seems a promising tool in SS diagnostic algorithm, being able to provide a valuable support to the biopsy procedure. Further studies are mandatory to confirm the role of UHFUS in SS.
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http://dx.doi.org/10.1111/jop.13162DOI Listing
May 2021

Ultra-high frequency ultrasound (UHFUS) applications in Sjogren syndrome: narrative review and current concepts.

Gland Surg 2020 Dec;9(6):2248-2259

Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Primary Sjogren's syndrome (SS) is a systemic autoimmune chronic inflammatory disease with predominant involvement of the exocrine glands, particularly the salivary glands (SGs). The role of salivary glands ultrasound (SGUS) in the work-up of patients with primary Sjogren syndrome (SS) is progressively increasing due to its useful support in diagnosis and follow-up as a widely available, repeatable, non-invasive and safe technique. Although SGUS is not yet included in the dominant primary SS classification, several studies supported its inclusion in the American College of Rheumatology/European League Against Rheumatism criteria. In this context, a novel imaging technique, ultra-high frequency ultrasound (UHFUS), is being explored. Compared to the frequencies used in conventional ultrasound (US) (up to 22 MHz), UHFUS operates with higher frequencies (30-100 MHz) allowing for outstanding image resolution, up to 30 µm. UHFUS permits the scan of both major and minor SGs, opening new avenues for the integration of tissue and imaging biomarkers. Although further studies are needed to confirm its role, this novel imaging technique might lead to several potential improvements, including earlier diagnosis, reduction of unnecessary and inadequate biopsies and better management and follow-up of patients with primary SS.
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http://dx.doi.org/10.21037/gs-20-529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804531PMC
December 2020

Ultra-high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study.

Skin Res Technol 2021 Jan 6. Epub 2021 Jan 6.

Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed.

Materials And Methods: Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05.

Results: Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP.

Conclusions: UHFUS appears a valuable tool in the diagnosis of PV and MMP. Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.
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http://dx.doi.org/10.1111/srt.13000DOI Listing
January 2021

The Application of Ultra-High-Frequency Ultrasound in Dermatology and Wound Management.

Int J Low Extrem Wounds 2020 Dec 25;19(4):334-340. Epub 2020 Nov 25.

University of Pisa, Pisa, Italy.

The management of lower extremity wounds is frequently performed by means of clinical examination, representing a challenge for the clinician due to the various conditions that can potentially enter differential diagnosis. Several diagnostic techniques are available in the dermatologist's arsenal as a support to diagnosis confirmation, including dermoscopy and ultrasonography. Recently, a novel ultrasonographic technique involving the use of ultra-high ultrasound frequencies has entered the scene, and appears a promising tool in the diagnostic workup of skin ulcerative lesions. The focus of this review is to discuss the potential role of ultra-high-frequency ultrasonography in the diagnostic workup of wounds in the light of the current applications of the technique.
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http://dx.doi.org/10.1177/1534734620972815DOI Listing
December 2020

Total area of inflammatory infiltrate and percentage of inflammatory infiltrate identify different clinical-serological subsets of primary Sjögren's syndrome better than traditional histopathological parameters.

Clin Exp Rheumatol 2020 Jul-Aug;38 Suppl 126(4):195-202. Epub 2020 Oct 23.

Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Objectives: Recently, the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate have been proposed as novel histopathological parameters to improve the stratification of patients with Sjögren's syndrome (SS) in clinical trials. Both these parameters provide a more accurate assessment of the extent of the infiltrate in minor salivary gland biopsies (MSGBs) and may overcome the bias related to the Focus score (FS). To date, however, only few studies have investigated their clinical value and feasibility. In this study we revised consecutive MSGBs obtained routinely in a real-life clinical setting and correlated the total area of the inflammatory infiltrate and the percentage of inflammatory infiltrate both with the other MSGB histopathological parameters and with patients' clinical features in order to explore their usefulness in SS diagnostic work-up.

Methods: We assessed the area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in consecutive MSGBs and correlated these parameters with the number of foci, the FS and the presence of ectopic lymphoid structures (ELS). We also correlated these additional parameters with patients' clinical and biological data.

Results: We revised 69 MSGB samples: 46 from patients with a diagnosis of SS and 23 from subjects with no SS. The total area of inflammatory infiltrate and the percentage of inflammatory infiltrate appeared significantly higher in patients fulfilling the ACR/EULAR classification criteria for SS and correlated significantly with both the number of foci (p<0.001) and the FS (p<0.001). Particularly, they correlated better with the ELS in MSGBs than the number of foci and the FS. When we limited the analysis to the 32/69 patients with a FS<1, both the total area of the inflammatory infiltrate (p=0.02) and the percentage of the inflammatory infiltrate (p=0.03), but not the number of foci (p=0.12) remained significantly higher in the 10/32 anti-Ro/SSA positive patients fulfilling the ACR/EULAR classification criteria. Finally, the total area of inflammatory infiltrate and the percentage of inflammatory infiltrate correlated significantly with several biological and haematological SS-related abnormalities including hypergammaglobulinaemia, C4 levels, total number of white blood cells and the number of circulating lymphocytes.

Conclusions: The total area of the inflammatory infiltrate and the percentage of the inflammatory infiltrate in SS referral centres, and particularly for selected cases, may maximise the information on disease activity at tissue level, ultimately improving SS patients' assessment.
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October 2020

Ultra-high frequency ultrasonography of labial glands is a highly sensitive tool for the diagnosis of Sjögren's syndrome: a preliminary study.

Clin Exp Rheumatol 2020 Jul-Aug;38 Suppl 126(4):210-215. Epub 2020 Oct 23.

Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Objectives: Ultra-high frequency ultrasonography (UHFUS) has been recently introduced in oral medicine due to its ability to image small anatomical structures including labial salivary glands (LSG). To date no ultrasonography morphological studies of labial salivary glands (LSG) have been carried out in SS. In this pilot study we aimed at analysing the distribution of UHFUS findings in LSG of patients with suspected SS, focusing in particular on the association with patients' oral dysfunction, antibody profiles and histopathology.

Methods: Consecutive patients undergoing a LSG biopsy for clinically suspected SS were included in this study between January 2018 and January 2020. Intraoral UHFUS scan of the lip mucosa was performed with Vevo MD equipment, using a 70 MHz probe with a standardised protocol. LSG were assessed by using a four-grade semiquantitative scoring system (0-3), similar to the OMERACT scoring system used for major salivary glands. The distribution of UHFUS grades was compared in patients stratified according their final diagnosis, patients antibody profiles and LSG histopathology.

Results: We included 128 patients with suspected SS: out of them, 54 (42.2%) received a final diagnosis of SS, made according to the ACR 2016 criteria and 74 (57.8%) were diagnosed as no-SS sicca controls. We found that LSG inhomogeneity was significantly greater in patients with SS than in no-SS subjects (p<0.0001). We also found that higher UHFUS pattern of inhomogeneity (i.e. grade 2 and 3) were significantly more frequent in both SSA+/SSB- and SSA+/SSB+ patients (p=0.001). A normal UHFUS pattern, by contrast, was significantly more common in SSA-/SSB- subjects (i.e. 15/83 (18.1%) vs. 1/33 (3%) vs. 0/12 (0%), p=0.001). Finally, LSG inhomogeneity was significantly associated with both the number of foci (p<0.001) and focus score (p<0.001). Particularly, we found that both the number of foci and the FS were significantly higher in patients presenting a UHFUS grading of 2 and 3 with respect to those presenting a UHFUS grading of 0 and 1 (p=0.01).

Conclusions: This preliminary study demonstrates the optimal feasibility of UHFUS and its high sensitivity in identifying negative patients on subsequent lip biopsy, thus avoiding invasive procedures in selected cases. Further studies are in progress to define the clinical and predictive role of the various patterns observed and their added value with respect to traditional salivary gland ultrasonography.
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October 2020

A perspective on dental activity during COVID-19: The Italian survey.

Oral Dis 2021 Apr 15;27 Suppl 3:694-702. Epub 2020 Sep 15.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: During the months of March and April 2020, Italy saw an exponential outbreak of COVID-19 epidemic. Dental practitioners were particularly limited in their routine activity, and the sole performance of urgent treatments was strongly encouraged during the peak of the epidemic. A survey among dental professionals was performed between 6th and 13th of April, in order to evaluate the status of dental practice during COVID-19 in Italy.

Materials And Methods: An online anonymous questionnaire was administered to retrieve data on the dental procedures performed, the preventive measures adopted, and the predictions on the future changes in dentistry following the pandemic.

Results: The survey was completed by 3,254 respondents and, according to the results obtained, dental activity was reduced by the 95% and limited to urgent treatments. The majority of the surveyed dentists employed additional personal protective equipment compared to normal routine, although in a non-negligible number of cases difficulty in retrieving the necessary equipment was reported.

Conclusions: The survey provided a snapshot of dental activity during the SARS-CoV-2 outbreak. Overall, following the peak of the epidemic, it is probable that dental activities will undergo some relevant changes prior to fully restart.
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http://dx.doi.org/10.1111/odi.13606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436518PMC
April 2021

Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience.

Can Assoc Radiol J 2021 Aug 28;72(3):418-431. Epub 2020 Jul 28.

Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, 9310University of Pisa, Pisa, Italy.

Objectives: Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center.

Materials And Methods: A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects.

Results: In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy.

Conclusion: Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.
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http://dx.doi.org/10.1177/0846537120940684DOI Listing
August 2021

Oral intramuscular myxoma: case report and brief review of the literature.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 Feb 2;131(2):e52-e58. Epub 2020 Jun 2.

Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.

Objective: Myxomas are rare benign mesenchymal soft tissue tumors that seldom affect the head and neck area. The present report describes a rare case of intramuscular myxoma of the oral cavity and briefly reviews the literature regarding the occurrence of these lesions in the maxillofacial area.

Study Design: A 59-year-old patient was referred for the development of a slow-growing tumefaction in the right buccal mucosa in the previous 12 months. Magnetic resonance imaging was performed to characterize the lesion's dimensions and its relationship with the surrounding structures, and it revealed intramuscular localization in correspondence with the medial pterygoid muscle. Incisional biopsy was carried out to aid in the final diagnosis.

Results: Histology revealed the presence of an intramuscular myxoma, characterized by discontinuous margins and locally infiltrating muscular fibers. A second surgery was performed to totally remove the lesion. Follow-up at 6 months did not show any signs of recurrence. A literature search was performed to retrieve data on the incidence of oral intramuscular myxomas.

Conclusions: To the best of our knowledge, this is the first case of intramuscular myxoma of the medial pterygoid muscle reported in the literature. Although rarely encountered, intramuscular myxomas should be considered when performing differential diagnoses of soft tissue masses at the level of the masticatory muscles.
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http://dx.doi.org/10.1016/j.oooo.2020.03.053DOI Listing
February 2021

Renal Cell Carcinoma Metastases to the Oral Cavity: Report of 2 Cases and Review of Literature.

J Oral Maxillofac Surg 2020 Sep 10;78(9):1557-1571. Epub 2020 Apr 10.

Full Professor, Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa, Italy.

The localization of renal cell carcinoma (RCC) metastases in the oral cavity has been reported, accounting for about 15% of patients with metastasizing renal disease. In this work, we report 2 cases of oral metastases of renal carcinoma and provide a review of the current literature on the occurrence of oral metastases of renal origin. The first patient (a 61-year-old man) presented with a tumefaction of the body of the tongue. The second patient (a 71-year-old man) showed a large mass localized in the buccal mucosa. In both patients, incisional biopsy was performed to better characterize the nature of the lesions. Histologic evaluation showed the metastatic origin of the 2 lesions, which were distant metastases of clear cell RCC. After systemic evaluation, a second surgical procedure was performed to obtain a wider resection of the mass to reduce the development of complications and improve the patients' quality-of-life. After the second surgical treatment, both patients showed an improvement in symptoms, and no further complications and/or signs of recurrence were detected. At present, 132 cases of oral metastases of RCC have been described in the literature. This article reviews and discusses the clinical, diagnostic, and pathologic features and the treatment options reported in the literature. Localization of renal metastases to the tongue was the most frequently described localization in the literature. In general, surgical treatment appears to be effective in controlling metastasis development and associated symptoms. Although relatively rare, renal metastases to the oral cavity should be taken into account when creating the differential diagnosis of oral lesions of unknown origin.
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http://dx.doi.org/10.1016/j.joms.2020.04.001DOI Listing
September 2020

Discovering a new anatomy: exploration of oral mucosa with ultra-high frequency ultrasound.

Dentomaxillofac Radiol 2020 Oct 29;49(7):20190318. Epub 2020 May 29.

Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Objectives: Ultra-high frequency ultrasound (UHFUS) is a recently developed diagnostic technique involving the use of ultrasound frequencies up to 70 MHz, allowing to obtain 30 µm resolution of targets located within 1 cm from the surface. Oral mucosa can be affected by diverse pathological conditions, which are currently investigated by means of clinical examination. In this scenario, intraoral UHFUS can provide additional information and support clinical assessment of oral mucosa. In this preliminary study, typical features of normal oral mucosa are described, in order to set a benchmark for the future identification of oral soft tissue alterations.

Methods: Twenty healthy subjects (10 males and 10 females, mean age 30 years) were enrolled and underwent intraoral UHFUS examination. In all the subjects, tongue, buccal mucosa, gingiva, lip mucosa, and palate were scanned, and images acquired. Intraoral UHFUS scan included Brightness-mode and Doppler mode acquisitions performed with a standardized protocol. UHFUS images were postprocessed and analyzed using a dedicated software. UHFUS-based biomarkers (epithelial thickness, echogenicity, and vascularization) were employed for image description.

Results: Normal oral anatomy of the different sites analyzed was described. For all the sites, UHFUS biomarkers were characterized, and information on typical aspect of oral mucosa was retrieved.

Conclusions: In this explorative study, we suggest a potential role for intraoral UHFUS in the study of oral mucosa, giving insights into the possibility to improve the assessment, diagnosis, and management of the conditions involving oral mucosa. UHFUS seems a promising tool, which could potentially support clinical examination in daily oral medicine practice.
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http://dx.doi.org/10.1259/dmfr.20190318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549524PMC
October 2020

Surgical Management of Medication-Related Osteonecrosis of the Jaw Patients Related to Dental Implants.

J Craniofac Surg 2020 Jun;31(4):1037-1041

Department of Surgical Pathology, Medicine, Molecular and Critical Area, University of Pisa, Pisa.

Objectives: The aim of the present study is to report a case series of patients with peri-implant medication-related osteonecrosis of the jaw (MRONJ), in particular describing the onset of the condition and surgical treatment outcome.

Material And Methods: Fifteen consecutive patients with clinical diagnosis of peri-implant MRONJ were retrospectively included in the study. The sample was stratified on the base of oral, pharmacological, and general health variables. The number of affected implants was recorded in all patients, and MRONJ staging applied. Surgical treatment was performed with a standardized operative protocol, involving implant removal, sequestrectomy, debridement of soft tissue, and bone curettage. Follow-up evaluating surgical outcome was performed at twelve months after surgery.

Results: in our study sample, patients were almost equally distributed in terms of underlying diseases in osteoporotic and oncologic patients. All MRONJ lesions were symptomatic, and in 6 patients bone exposure was detected. 40 implants in total were evaluated, with MRONJ being present around 29 implants. 12 patients were diagnosed with Stage III MRONJ, and 3 patients with Stage II MRONJ. Surgical treatment leads to complete healing in 86.7% of cases, with 100% success for maxillary MRONJ.

Conclusions: Surgical treatment seems to have a positive impact on MRONJ treatment also in cases of peri-implant involvement. However, monitoring and prevention are fundamental in patients under pharmacological treatment with anti-resorptive/antiangiogenic drugs, as peri-implant MRONJ can develop also in absence of specific traumatic events.
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http://dx.doi.org/10.1097/SCS.0000000000006283DOI Listing
June 2020

The efficacy of Ultra-High Frequency Ultrasonography in the diagnosis of intraoral lesions.

Oral Surg Oral Med Oral Pathol Oral Radiol 2020 Apr 26;129(4):401-410. Epub 2019 Sep 26.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.

Objectives: The aim of the present study was to evaluate the diagnostic efficacy of ultra-high frequency ultrasound (UHFUS) imaging of intraoral soft tissue lesions.

Study Design: The study included 160 patients presenting with oral soft tissue lesions classified into 4 categories: autoimmune diseases, mucosal growths, potentially (pre)malignant lesions, and oral cancer. Each lesion was evaluated by means of intraoral UHFUS, through B-mode and C-mode acquisitions of the area of interest. The UHFUS findings were compared with the histopathologic findings.

Results: All values for sensitivity, specificity, and negative predictive value exceeded 90%. Sensitivity was perfect (100%) for mucosal growths and oral cancer. Specificity was almost perfect for all 4 categories of lesions, ranging from 97% to 99%. Values for positive predictive value ranged from 83% to 99%.

Conclusions: UHFUS was beneficial in imaging the oral mucosa and the superficial aspects of the underlying soft tissue in detail because of the high spatial resolution of the technique. Consistent patterns were recognized for different categories of lesions. UHFUS holds the promise of being a valuable support to the clinician in terms of diagnosis, treatment, and follow-up of oral lesions.
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http://dx.doi.org/10.1016/j.oooo.2019.09.012DOI Listing
April 2020

Cone-Beam Computed Tomography vs. Multi-Slice Computed Tomography in paleoimaging: where we stand.

Homo 2020 Feb;71(1):63-72

Division of Paleopathology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Italy.

Paleopathology and anthropology are fields of research which have benefited from the use of diagnostic imaging since its introduction in the clinical setting. The deriving discipline, that is, paleoimaging, has effectively employed several diagnostic techniques. However, while Multi-Slice Computed Tomography (MSCT) has found its role in paleoimaging, Cone-Beam Computed Tomography (CBCT), despite its several advantages with regard to MSCT, is still struggling to find a clear position in this field. The aim of our study is to evaluate the possible advantages CBCT could bring to paleoimaging. We describe the characteristics and role of CBCT in clinical applications, in forensic and legal medicine, and in paleopathology. We report the study of an ancient mandible by means of CBCT and MSCT, in order to compare the quality of the images in terms of spatial resolution. CBCT allows to obtain good quality images of mineralized tissues. Moreover, the possibility of imaging metallic manufacts makes the technique suitable for the study not only of bony remains, but also of museum and archaeological artifacts. Our study highlights the strengths of CBCT as a valid imaging technique for the study of ancient bone remains and manufacts. A revision of the current uses of CBCT is provided and gives insights into the possible role it can cover in bioarchaeological studies. Further evaluation is needed in terms of possible applications of this technique to paleopathology. We strongly encourage the use of CBCT in paleoimaging, and suggest a broader application of the technique to the study of archaeological samples.
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http://dx.doi.org/10.1127/homo/2020/1063DOI Listing
February 2020

Advanced evaluation of hidradenitis suppurativa with ultra-high frequency ultrasound: A promising tool for the diagnosis and monitoring of disease progression.

Skin Res Technol 2020 Jul 11;26(4):513-519. Epub 2019 Dec 11.

Department of Dermatology, University of Pisa, Pisa, Italy.

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease. An ultrasound staging (SOS-HS) using frequencies from 7 to 18 MHz has been proposed to evaluate the severity of the disease.

Materials And Methods: We retrospectively evaluated the most significant lesions in 50 patients with hidradenitis suppurativa (32 females and 18 males, aged from 12 to 68 years old), who had undergone high-frequency ultrasound (HFUS) (18-22 MHz) and ultra-high frequency ultrasound (UHFUS) (48 and 70 MHz). A MyLab™ Touch system (Esaote) equipped with a 18-22 MHz linear probe was used for the HFUS, and a Vevo MD (VisualSonics) was used for the UHFUS, equipped with two linear probes (70 and 48 MHz).

Results: A total of 116 lesions were observed, of which 66 were fluid collections, 32 were tunnels, 6 pseudocysts, 5 bridge scars, 5 tombstone comedones, and 2 granulation tissues. Structures that had already been described with HFUS were then observed with UHFUS but with a better definition. In addition, structures that had not been detected by HFUS were also observed with UHFUS such as drop-shaped hair follicles, micro-tunnels, and microcysts.

Conclusion: Ultra-high frequency ultrasound provides a better understanding of hidradenitis suppurativa. Patients can be monitored more effectively thereby preventing the most severe changes.
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http://dx.doi.org/10.1111/srt.12823DOI Listing
July 2020

Intraoral Ultra-High Frequency Ultrasound study of oral lichen planus: A pictorial review.

Skin Res Technol 2020 Mar 24;26(2):200-204. Epub 2019 Sep 24.

Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy.

Background: Ultra-High Frequency Ultrasound (UHFUS) is a recently introduced diagnostic technique involving the use of higher frequencies compared to conventional ultrasound. Among the several fields of application, intraoral usage of UHFUS appears still limited. We report the intraoral evaluation of Oral Lichen Planus (OLP) by means of UHFUS and describe typical UHFUS aspect of different forms of presentation of OLP.

Materials And Methods: Patients with clinical and histological diagnosis of OLP were enrolled in the study. OLP lesions were evaluated by means of intraoral UHFUS performed at 70 MHz, using B-mode and C-mode, in order to characterize the echostructure of each form of presentation.

Results: Fifty patients in total were enrolled, and UHFUS features were described for different OLP forms. All the lesions showed a thick, hypoechoic superficial layer in the mucosal stratum, suggesting that such UHFUS alteration can be pathognomonic of OLP.

Conclusion: Ultra-High Frequency Ultrasound was able to differentiate superficial alterations of the oral mucosa, giving insight on possible applications of UHFUS in the study of OLP beyond clinical and histological investigations. Due to a limited study sample, we cannot draw firm conclusions. However, it is reasonable to think that UHFUS evaluation of OLP may provide useful information to the clinician.
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http://dx.doi.org/10.1111/srt.12777DOI Listing
March 2020

Cone Beam CT study of a case of eosinophilic granuloma of the mandible in a young patient.

BMJ Case Rep 2019 May 5;12(5). Epub 2019 May 5.

Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.

Eosinophilic granuloma (EG) is a rare bony disease deriving from abnormal proliferation of histiocytes, and is the most common form of presentation of Langerhans cell histiocytosis. EG predominantly affects the axial skeleton. However, when localised in the head and neck district, mandibular lesions account for the majority of cases. Mandibular lesions can mimic other pathological conditions, making biopsy fundamental for differential diagnosis. Treatment depends on the severity of the disease, ranging from pharmacological treatment to surgical approach. However, EG is also reported to possibly undergo spontaneous resolution. In this case report, we describe a rare case of EG with particularly aggressive behaviour in a young patient. Initially, local pharmacological treatment with intralesional administration of corticosteroids lead to worsening of the symptoms, increase in lesion's dimensions, and disruption of the cortical bone. A more invasive therapeutic approach involving radical surgery was then performed, with consequent resolution of the disease.
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http://dx.doi.org/10.1136/bcr-2018-228455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506101PMC
May 2019

Severe atherosclerosis in the natural mummy of Girolamo Macchi (1648-1734), "major writer" of Santa Maria della Scala Hospital in Siena (Italy).

Atherosclerosis 2019 01 14;280:66-74. Epub 2018 Nov 14.

Division of Paleopathology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Italy.

Background And Aims: A small crypt in the Santissima Annunziata Church of Santa Maria della Scala Hospital in Siena (Italy) contained three well-preserved mummies, two of which, dated back to the 15th-16th century, were identified as Salimbene Capacci (1433-1497), Rector of the Hospital, and his wife, Margherita Sozzini (?-1511). The third mummy, dressed in clothes of the 17th century, was not initially identified.

Methods: Accurate bibliographical, taphonomic and anthropological studies allowed the identification of the mummy of Girolamo Macchi, who lived between 1648 and 1734 and worked as "major writer", an accountant, for the Hospital. He was present when the corpses of the Rector and his wife were discovered in 1678 and, impressed by this finding, wanted to be buried in the same chapel after his death, which occurred at the age of 86. A complete study, including macroscopic, radiological, isotopic and histological analyses, was performed on the natural mummy of Girolamo.

Results: Macroscopic investigation showed a large inguinoscrotal hernia and a good preservation of the internal organs. The circulatory system revealed severe atherosclerosis, with multiple calcifications stenosing the lumen of the vessels, in particular of the lumbar aorta and the iliac arteries. The diagnosis was confirmed by imaging techniques (3D Cone Beam Scan) and by histology.

Conclusions: This case confirms that atherosclerosis is also a disease of ancient times. The presence of atherosclerosis in pre-contemporary individuals could suggest that the disease may not only be uniquely characteristic of a specific diet or lifestyle, but it could be also an inherent component of human ageing.
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http://dx.doi.org/10.1016/j.atherosclerosis.2018.11.028DOI Listing
January 2019

Feasibility of a combination of intraoral UHFUS and CBCT in the study of peri-implantitis.

Oral Surg Oral Med Oral Pathol Oral Radiol 2019 Mar 31;127(3):e89-e94. Epub 2018 Aug 31.

Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.

Objectives: The aim of this study was to investigate the combination of intraoral ultra-high-frequency ultrasonography (UHFUS) and cone beam computed tomography (CBCT) in the evaluation of hard and soft tissues in a case of peri-implantitis.

Study Design: A 57-year-old patient was referred for pain and numbness of the chin after implant placement and the subsequent guided bone regeneration (GBR) procedure. Clinical examination revealed hard tumefaction of the mandibular mucosa, with mild mobility of the implants. Assessment with UHFUS was undertaken for the study of the width, degree of tissue alteration, and vascularity of the swollen mucosa, and CBCT was used to evaluate the bone surrounding the implants and the possible impingement of the inferior alveolar nerve.

Results: A combination of CBCT and UHFUS was effective in the evaluation of GBR complications in peri-implantitis, revealing alterations in the periosteum secondary to suboptimal GBR treatment. This was the first study to use UHFUS to evaluate the characteristics of oral soft tissues.

Conclusions: UHFUS is a promising tool for the diagnosis of complicated soft tissue diseases. When used with CBCT, it can provide useful information on oral and maxillofacial diseases involving hard and soft tissue in a noninvasive way, with reduced radiation dose exposure.
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http://dx.doi.org/10.1016/j.oooo.2018.08.014DOI Listing
March 2019

Feasibility of intraoral ultrasonography in the diagnosis of oral soft tissue lesions: a preclinical assessment on an ex vivo specimen.

Radiol Med 2018 Feb 25;123(2):135-142. Epub 2017 Sep 25.

Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.

Objectives: The early detection of oral soft tissue lesions is an important prognostic factor, and the possibility of using ultrasonography (US) as a diagnostic tool may improve the diagnosis and characterization of tissue alterations at an early stage. This study aims to evaluate the feasibility of intraoral US by performing a preclinical assessment of an ex vivo specimen in which focal lesions were simulated.

Materials And Methods: Fourteen lesions were simulated on a freshly extracted calf tongue, by introducing in the tongue different materials mimicking the appearance of various focal lesions. The specimen was scanned with a 8 MHz US probe and computed tomography (CT) was performed to compare the two imaging techniques. Later, the specimen was dissected to set a benchmark for size assessment.

Results: US was able to identify all the simulated lesions within the tongue, resulting in one case more accurate than CT. Statistical analysis demonstrated high correlation between the measurements of the simulated lesions performed on the US images and the real size of the materials introduced in the tongue (p < 0.05).

Conclusions: This preclinical study proves that US performs well in the detection and characterization of simulated lesions of the tongue. These findings suggest that US could be effectively used in clinical applications. However, further research is mandatory to assess the reliability of in vivo US in the detection and characterization of tongue lesions as well as of other oral soft tissue alterations.
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http://dx.doi.org/10.1007/s11547-017-0817-8DOI Listing
February 2018
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