1,720,996 research outputs found
An economic analysis of plea bargaining: The incentives of the parties in a mixed penal system
No full textIn 1989 the Italian Government enacted a new Code of Penal Procedure which represents one of the most prominent attempts to introduce plea bargaining proceedings into a basically inquisitorial system as alternative institutions to dispose of legal cases. The paper outlines some of the central features of the 1989 Italian reform and compares the incentives of the parties involved in the Italian and in the U.S. plea bargaining institutions with specific reference to the objective function of the prosecutors and the incentives for the defendants to plea in view of the expected sanctions and the recurrence of amnesties. The most relevant theoretical implications are tested, with several variables related to the demand and the supply of penal justice, and estimates are provided of their impact on the number of plea bargaining procedures concluded in Italy after the 1989 reform
Solitary nonchordomatous lesions of the clival bone: differential diagnosis and current therapeutic strategies.
No full text"A nonchordomatous solitary lesion of the clival bone is an exceptionally rare pathological entity, which represents a diagnostic and a therapeutic challenge. Many diseases with extremely different biological behavior, and requiring a dedicated treatment strategy, may result in similar clinical patterns. The approach to a correct differential diagnosis has to consider the specific epidemiological, radiological, and histopathological characteristics of each pathology to minimize the diagnostic bias and to allow the planning of the best treatment strategy. Because of the rarity of these diseases, a systematical review of nonchordomatous lesions of the clival bone still lack in the literature. The purposes of this study are to provide an overview of the epidemiological, clinical, radiological, and histopathological characteristics of nonchordomatous clival lesions, with particular emphasis on diagnostic and therapeutic strategies and related clinical outcome. © 2013 Springer-Verlag Berlin Heidelberg.. .
Submental orotracheal intubation: An alternative to tracheotomy in transfacial cranial base surgery
No full textThis retrospective study evaluated the safety and efficacy of submental intubation not only for trauma treatment but also for oncological cranial base surgery. The medical records of 24 patients who underwent submental intubation from 1996 to 2002 were reviewed. There were 6 procedures for craniofacial trauma, 12 transmaxillary approaches to the clivus for clivus chordomas, and 6 transmaxillary approaches to the cranial base for chondrosarcomas. Time required for intubation, accidental extubation, postoperative complications, and the healing of intraoral and submental scars were evaluated. The submental orotracheal intubation was completed successfully in all patients. No accidental extubations or tube injuries occurred. The mean time required for intubation was 5 minutes. The only complication was one case of superficial infection of the submental wound. The intraoral and submental accesses healed with minimal scarring in all patients. Submental orotracheal intubation is a useful and safe technique for airway management of craniomaxillofacial traumas and during transfacial approaches to the cranial base. It avoids the complications associated with tracheostomy. It also permits considerable downward retraction of the maxilla after a Le Fort I osteotomy and is associated with good clival exposure. Furthermore, it does not interfere with maxillomandibular fixation at the end of the surgery
Microsurgical treatment of frontal mucocele sequelae
No full textSkull base surgery has undergone a revolution in recent decades with the introduction and development of new surgical approaches correlated with many modifications in this anatomically and functionally complex area. The most important progress has been possible with the advent of microsurgical flaps, which allow for the movement of large masses and different tissue components, providing effective separation and coverage of the endocranial content, replacement of the composite craniofacial defects, and reconstruction of poorly vascularized areas. To reduce the incidence of complications in the treatment of frontal recurrent mucoceles, accurate planning of reconstruction is mandatory.
We introduce 2 cases involving anterior cranial base repair after radical resection of chronically infected tissues in patients affected by frontal recurrent mucoceles. Reconstruction was accomplished through a forearm flap and a frontal bone reconstruction with custommade prosthesis
The combined interhemispheric sub-commissural translaminaterminalis approach for large craniopharyngiomas
No full text"Objective: We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique. Methods: Four cadaveric specimens fixed with gluteraldehyde and injected with latex were dissected to illustrate the approach. Results: The surgical steps of the approach are reported. The ACoA anatomy was studied. In particular, the surgical route in-between and lateral to the first and second segments of the anterior cerebral artery and the ACoA complex were examined. The approach was adopted in a clinical setting; two illustrative cases regarding the removal of large craniopharyngiomas with suprasellar extension through this route are described. Conclusions: The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas. © 2013 Elsevier Inc. All rights reserved.. .
Current therapeutic options and novel molecular markers in skull base chordomas
No full text"Chordomas are extremely rare tumours. They arise in the spheno-occipital region in 35% of cases. Chordomas usually present benign histopathological features but often exhibit a malignant clinical behaviour. Radical surgical removal and high-dose radiation therapy seem to be effective in tumour control and to improve survival rate. Despite the advancements in microsurgical techniques and the development of radiation therapies, clival chordomas still represent a challenge. Nevertheless it appears that chordomas that have been resected to the same extent and that received post-operative radiotherapy might exhibit different rates of regrowth. This result supports the hypothesis that the recurrence rate of chordomas might be dependent on biological variables other than the extent of resection and the post-operative radiotherapy. Genetic and molecular studies on oncogenesis of chordomas are still limited, but they represent the basis for the development of molecular targeted therapies. We present a review of the current knowledge about skull base chordomas biology, therapeutic options and related clinical outcome.
Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients
No full text"The aim of this study is to assess the efficacy and safety of surgical treatment of orbital cavernomas in terms of clinical and functional results. Twenty consecutive patients underwent surgical removal of a unilateral orbital cavernoma between 1999 and 2009. Indications for surgical treatment were: visual impairment, diplopia due to ocular movement impairment, progressive and disfiguring unilateral proptosis, severe retroorbital pain clearly related to the orbital cavernoma. We used a topographic classification of the lesions within the orbit. The orbit has been divided into an anterior and a posterior compartment on the axial plane and into three sectors on the coronal plane. The proptosis was quantified on MRI scans. The location of the cavernoma determined the choice of the surgical approach. We performed eight lateral orbitotomies and 12 fronto-orbito-zygomatic approaches. All the tumors were completely removed as assessed at follow-up MRI. We did not record any intraoperative or major postoperative complication requiring a reoperation. The postoperative visual acuity improved in four of five patients with visual impairment, it worsened in the other case. Proptosis improved in all the patients. Diplopia improved in four patients, and did not recover in another case. Surgical treatment of symptomatic orbital cavernomas is safe and effective. Tumor location dictates the choice of surgical approach. Visual function and cosmetic result are the main parameters to evaluate the clinical outcome. Surgical approach and dissection technique are crucial in determining the visual outcome.
Surgical treatment of giant pituitary adenomas: Strategies and results in a series of 95 consecutive patients
No full textObjective: Giant pituitary adenomas, defined as those measuring at least 4 cm in maximum diameter, are a therapeutic challenge. We report our experience in a large, consecutive series of patients with giant adenomas. Methods: Between 1990 and 2004, 95 patients with a giant pituitary adenomas underwent surgery at our department. Nonfunctioning pituitary adenoma was the most frequent type (n = 70; 73.7%), whereas hormone-secreting adenomas numbered only 25 (26.3%). The mean age at the time of surgery (+/- standard error of the mean) was 48.4 +/- 1.5 years; there were 66 men (69.5%) and 29 women (20.5%). Results: In total, 111 surgical procedures were performed. Of these, 85 approaches (76.6%) were transsphenoidal and 26 (23.4%) were transcranial. Visual improvement occurred in 59 of the 79 patients with preoperative defect who could be evaluated after surgery (74.7%). Radical tumor excision was obtained in 14 patients (14.7%). Adjuvant medical and radiation therapies led to 74.5% (95% confidence interval, 62.7-86.4%) control of tumor growth at 5 years. This was not different in patients with nonfunctioning pituitary adenomas compared with patients with hormone-secreting tumors. In the subgroup of patients with nonfunctioning pituitary adenomas, radiation therapy had a protective role against tumor growth (P < 0.01). Conclusion: Maximal surgical removal of giant adenomas through the transsphenoidal or transcranial approach, or both, aimed to relieve compression of the optic pathway and reduce tumor volume as much as possible, offers the best chances to control the tumor when followed with adjuvant medical and radiation therapies
Solitary lesions of the clivus: what else besides chordomas? An extensive clinical outlook on rare pathologies
No full textBackground: Solitary non-chordomatous lesions of the clivus are rare pathologies, which represent a diagnostic challenge. This study provides an overview of the clinical, radiological and prognostic characteristics of non-chordomatous clival lesions, highlighting current therapeutic options. Methods: Twenty-two non-chordomatous lesions of the clivus were collected. A retrospective analysis of clinical and radiological patterns as well as survival data was conducted. Results: Clinical presentation was a result of local mass effect. Imaging features, although mainly specific, were not always diagnostic. Extent of surgery was gross total in 45.5 % of cases. Depending on the histology, biological behaviour and presence of seeding, adjuvant treatment was performed, tailoring the treatment strategy to the single patient. Conclusions: Solitary non-chordomatous lesions of the clival bone are more prevalent than expected. They should be approached with a correct differential diagnosis, considering specific epidemiological, radiological, and histopathological characteristics, to minimise diagnostic bias and allow the planning of the best treatment strategy. © 2015, Springer-Verlag Wien
Surgical strategies and modern therapeutic options in the treatment of craniopharyngiomas
No full text"The optimal treatment of patients with craniopharyngioma remains controversial. In particular, the role of aggressive treatment compared to less aggressive therapeutic options is poorly understood.Radical resection is the therapy of choice at any age, because it is associated with the best outcome in terms of survival.Nevertheless, aggressive behaviour, location, involvement of critical structures, tumour size, calcifications, and patient age may limit the extent of resection. Surgery can also carry significant morbidity in terms of visual, hypothalamic, and endocrinological disturbances. Long term sequelae reduce the quality of life in 50% of long-term survivors, notably obesity and neurobehavioral impairment due to hypthalamic involvement and iatrogenic induced lesions. The quality of life should be considered as a clinically important endpoint in patients, who currently experience good overall survival rates, regardless of the degree of surgical resection.Tendency to recur despite negative postoperative imaging led many authors to advocate a less aggressive surgical treatment followed by radiation therapy.We review the data reported in the literature, especially early outcome after surgical treatment and factors affecting the risk of tumour recurrence, to elucidate the role of attempted radical resection in the treatment of craniopharyngioma and to identify the clinical and morphological characteristics predictive for the best surgical prognosis. © 2013 Elsevier Ireland Ltd.. .
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