Revisione critica dei risultati e nuovi algoritmi decisionali sulla chirurgia dell'OSAS

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the periodic reduction or cessation of airflow during sleep. The syndrome is associated whit loud snoring, disrupted sleep and observed apnoeas. Surgery aims to alleviate symptoms of daytime sleepiness, improve quality of life and reduce the signs of sleep apnoea recordered by polysomnography. Surgical intervention for snoring and OSAHS includes several procedures, each designed to increase the patency of the upper airway. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty with or without tonsillectomy, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include tongue-base suspension, genioglossal advancement, hyoid suspension, lingualplasty, and maxillomandibular advancement. We reviewed 269 patients undergoing to osas surgery at the ENT Department of Forlì Hospital in the last decade. Surgery was considered a success if the postoperative apnea/hypopnea index (AHI) was less than 20/h. According to the results, we have developed surgical decisional algorithms with the aims to optimize the success of these procedures by identifying proper candidates for surgery and the most appropriate surgical techniques. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. The intended purpose of medical algorithms is to improve and standardize decisions made in the delivery of medical care, assist in standardizing selection and application of treatment regimens, to reduce potential introduction of errors. Nasal Continuous Positive Airway Pressure (nCPAP) is the recommended therapy for patients with moderate to severe OSAS. Unfortunately this treatment is not accepted by some patient, appears to be poorly tolerated in a not neglible number of subjects, and the compliance may be critical, especially in the long term if correctly evaluated with interview as well with CPAP smart cards analysis. Among the alternative options in Literature, surgery is a long time honoured solution. However until now no clear scientific evidence exists that surgery can be considered a really effective option in OSAHS management. We have design a randomized prospective study comparing MMA and a ventilatory device (Autotitrating Positive Airways Pressure – APAP) in order to understand the real effectiveness of surgery in the management of moderate to severe OSAS. Fifty consecutive previously full informed patients suffering from severe OSAHS were enrolled and randomised into a conservative (APAP) or surgical (MMA) arm. Demographic, biometric, PSG and ESS profiles of the two group were statistically not significantly different. One year after surgery or continuous APAP treatment both groups showed a remarkable improvement of mean AHI and ESS; the degree of improvement was not statistically different. Provided the relatively small sample of studied subjects and the relatively short time of follow up, MMA proved to be in our adult and severe OSAHS patients group a valuable alternative therapeutical tool with a success rate not inferior to APAP.

Stratigraphy and Palaeontology of the Late Cretaceous Wapiti Formation, west-central Alberta, Canada

A complete stratigraphic assessment and revision of the middle Campanian to upper Maastrichtian Wapiti Formation in north-western Alberta and north-eastern British Columbia is the main aim of this research project. The study area encompasses an area of approximately 200X180 km in the Grande Prairie County (west-central Alberta) and easternmost British Columbia, Canada. Results presented here indicate that the 1300m thick succession currently reported in the literature as “undifferentiated lithostratigraphic unit”, consists of five lithostratigraphic units and four unconformity-bounded depositional sequences; their study and description have been documented integrating several geological disciplines, including sequence stratigraphic methods, well-log signatures, facies analysis, and fossil associations. On the whole, particular attention has been given to 1) age and nature of both basal and upper contacts of the Wapiti Formation, 2) effective mappability of lithostratigraphic units and depositional sequences in western Alberta, and 3) the identification of previously undetermined maximum flooding surface of the Bearpaw seaway and Drumheller Marine Tongue, which are reference marine unit in central and southern Alberta. A second, but not less important, guideline for the project has been the rich paleontological record of the Wapiti deposits. Detailed paleoenvironmental and taxonomical information on old and new finds have been the base for correlation with well known associations of Alaska, southern Alberta, and Montana. Newly discovered rich fossil localities documented an extraordinarily diverse fauna during the latest Cretaceous, including dinosaurs, squamates, and fresh-water fishes and reptiles. Lastly, in order to better characterize the Wapiti Formation, major marker beds were described: these include several bentonites (altered volcanic ash deposits) which have been documented over an area of almost 30.000 km2, as well as four major coal zones, characterized by tabular coal seams with an overall thickness of 2 meters. Such marker beds represent a formidable tool for high-resolution chronology and regional correlations within the Late Cretaceous Alberta foreland basin.

Manifestazioni Cranio-facciali delle Neurofibromatosi

The term neurofibromatosis (NF) subsumes at least seven different genetic disorders associated by the presence of neurofibromas located in the skin, oral cavity, visceral and skeletal level. As NF1 (Von Recklinghausen disease), one of the most common genetic diseases, can have oral manifestations, dentists have to be aware about pathognomonic features. The thesis’ target is the literature’s review on the NF1 manifestations either systemic or cefalic area and these features’ research in a specimen of 30 patients NF1 affected. NF1 is manifested in the cefalic area locating either in the jaws (isolated neurofibromas, ipoplasia or bone structures absence) or soft tissues (fibromas and neurofibromas located in: cheeck, lips, oral mucosa, tongue, mouth’s floor, gingiva and palate). Frequently, NF1 patients are affected by dental anomalies of position, number and eruption, that determinates the possibility of orthopaedic-orthodontic problems. An increased prevalence of the caries risk and a possible pulpar involvement of neurofibromas is reported. Clinical and radiographical typical signs of the disease and specific indications for the differential diagnosis with other oral pathologies are described (cysts and odontogenic tumors, periapical lesions of endodontic origin and severe parodontitis). The importance of screening programs and periodical follow-ups (biannual dental visits from the age of four years, annual X-ray checks from the age of six) is supported by the high frequency of manifestations at hard and soft tissues level of the cefalic area and by the documented risk of malignant transformation.

Interferometria SAR per lo studio di movimenti e generazione di modelli digitali del terreno in Antartide

Satellite SAR (Synthetic Aperture Radar) interferometry represents a valid technique for digital elevation models (DEM) generation, providing metric accuracy even without ancillary data of good quality. Depending on the situations the interferometric phase could be interpreted both as topography and as a displacement eventually occurred between the two acquisitions. Once that these two components have been separated it is possible to produce a DEM from the first one or a displacement map from the second one. InSAR DEM (Digital Elevation Model) generation in the cryosphere is not a straightforward operation because almost every interferometric pair contains also a displacement component, which, even if small, when interpreted as topography during the phase to height conversion step could introduce huge errors in the final product. Considering a glacier, assuming the linearity of its velocity flux, it is therefore necessary to differentiate at least two pairs in order to isolate the topographic residue only. In case of an ice shelf the displacement component in the interferometric phase is determined not only by the flux of the glacier but also by the different heights of the two tides. As a matter of fact even if the two scenes of the interferometric pair are acquired at the same time of the day only the main terms of the tide disappear in the interferogram, while the other ones, smaller, do not elide themselves completely and so correspond to displacement fringes. Allowing for the availability of tidal gauges (or as an alternative of an accurate tidal model) it is possible to calculate a tidal correction to be applied to the differential interferogram. It is important to be aware that the tidal correction is applicable only knowing the position of the grounding line, which is often a controversial matter. In this thesis it is described the methodology applied for the generation of the DEM of the Drygalski ice tongue in Northern Victoria Land, Antarctica. The displacement has been determined both in an interferometric way and considering the coregistration offsets of the two scenes. A particular attention has been devoted to investigate the importance of the role of some parameters, such as timing annotations and orbits reliability. Results have been validated in a GIS environment by comparison with GPS displacement vectors (displacement map and InSAR DEM) and ICEsat GLAS points (InSAR DEM).