Biomedical subjects

G Spriano

Publications and source records attributed to G Spriano.

At least 19 recordsLinked to original sources

PubMed1999

[Radiation treatment of early stage supraglottic cancer].

The management of early-stage squamous cell carcinoma (SCC) of the supraglottic larynx is still controversial. Supraglottic laryngectomy as well as irradiation alone is correlated with good oncological and functional results. In order to evaluate the results and prognostic factors influencing the successful using radiotherapy (RT), the authors performed a retrospective study of 100 consecutive T1-T2 N0 M0 cases of SCC of the supraglottic larynx, treated at a single institution between 1983 and 1992. RT was delivered with 60Co or 6 MeV photons through two lateral parallel opposed portals encompassing the primary laryngeal tumor and the upper and mid-neck nodes (Robbins' levels II, III and V). Supraclavicular nodes (level IV) were electively irradiated in 54 patients with T2 N0 tumors only, using an anterior field with midline block. Sixty-three patients received conventional fractionation (2 Gy/fraction, once-a-day, five times a week), while 37 patients were irradiated according to a twice-a-day fractionation regimen (1.5 Gy/fraction, twice a day with six-hour interval, five days a week). The median total tumor dose delivered was 67 Gy. A multivariate analysis showed that performance status, tumor grade and fractionation modality were the only statistically significant variables influencing disease-free survival. Acute and late radiation reactions were relatively low. This retrospective study confirms that conservative management of T1-T2 N0 supraglottic cancer using RT can achieve good cure rates with the possibility of larynx preservation for the majority of the patients. The decision between different conservative treatment modalities may be influenced by several factors correlated to the patient's conditions, tumor characteristics, but especially treatment modalities.

Adult↗

PubMed1998

Subtemporal suboccipital transpetrosal transsigmoidal approach to aneurysm of the basilar artery fenestration.

The aneurysm arising from the lower third of a basilar artery fenestration is a rare event. The traditional suboccipital or subtentorial transtentorial or transoral approach to this vascular malformation can be problematic. We report the case of a 52-year-old woman who suffered a Grade 4 subarachnoid hemorrhage from an aneurysm located at a fenestration of the proximal third of the basilar artery. This aneurysm was successfully clipped through a left subtemporal suboccipital translabyrinthine transsigmoidal approach. In the aneurysms of the proximal third of the basilar artery the transpetrosal approach with its variants (translabyrinthine and transsigmoidal) related to patient's clinical condition can be useful with undoubted advantages.

Basilar Artery↗

PubMed1998

[Basaloid-squamous cell carcinoma of the larynx: a new morphologic entity. Case report].

Basaloid-Squamous Cell Carcinoma (BSCC) is considered a biologically aggressive variation of squamous cell carcinoma (SCC). Wain et al. first reported BSCC as an independent neoplasm in 1986. In the past, it was most likely misinterpreted as atypical SCC. To date approximately one hundred cases have been reported in the literature. The pathognomonic characteristic of BSCC is an intimate association between basaloid and squamous patterns: for this reason a small biopsy specimen may be insufficient for correct diagnosis. In such cases, knowledge of the biological behavior of these tumors (i.e. local aggressiveness and tendency to spread both regionally and at a distance) may prove useful. Prognosis and survival rates are certainly worse than in SCC. Within the upper aero-digestive tract, BSCC is most likely to arise in the supraglottic larynx, the pyriform sinus and the base of the tongue. Treatment should include surgery of the primary tumor and of the neck lymph nodes, followed by radiotherapy. The authors present a new case report indicating the typical feature of this tumor (aggressiveness, synchronous basaloid and squamous histology, supraglottic involvement.

Aged↗

PubMed1997

[Solitary fibrous tumor of the nasopharynx. Apropos of a case].

Solitary fibrous tumor (SFT) is a rare neoplasm, arising in the adult and more commonly in the pleura. For many years it has been referred to the serous surfaces of the body, namely pleura, peritoneum and pericardium; recently cases arising in mesenchymal organs such as lung, mediastinum, liver and paranasal sinuses were reported. We present a SFT of the nasopharynx, observed in a 41 year-old patient complaining a 6 months history of aural fullness at the right ear. Clinical examination revealed the presence of secretory otitis media and swelling of the lateral wall of the nasopharynx. CT scan and MR showed the presence of a solid mass, with scarce vascularization, extending from the right side of the nasopharynx to the infratemporal and pterigoid fossae. The surgical approach consisted in a facial translocation by the rotation of a maxillary-check flap through different osteotomies; a firm whitish mass not invading the surrounding tissues was identified and enucleated. A definitive diagnosis cannot be made at frozen sections, requiring more accurate processing and immunohistochemical staining. Literature reports fourteen cases of SFT of the upper aero-digestive tracts (nasopharynx, paranasal sinuses, larynx) and some 8 more cases in the head and neck area (thyroid, salivary glands and parapharyngeal spaces). This case report adds a further contribution to support the mesenchymal origin of the SFT.

Adult↗

PubMed1997

[Idiopathic thrombosis of the internal jugular vein].

The venous thrombosis represents a vascular disorder usually involving the low limbs. The manifestation at the level of the upper limbs and the neck is much more rare, particularly as a consequence of a central venous catheterization of an infectious disease or of a trauma. The authors report an unusual case of spontaneous thrombosis of the internal jugular vein and analyze the most salient nosologic, diagnostic and therapeutic aspects.

Anticoagulants↗

PubMed1997

[A free radial forearm flap in oral cavity reconstruction].

A relatively recent method for reconstruction of the oral cavity after tumor removal employs the use of revascularized free flaps. In particular, the Radial Forearm Flap has gained significant international recognition. After a review of the history of this procedure, the authors describe the essential aspects of the technique including what is involved in removal as well as in microanastomosis and reconstruction. In addition, the paper also deals with operative patient monitoring, prevention and treatment of any complications. Finally, a series of 10 cases is presented all of which underwent surgery at the E.N.T. Division of the Varese Hospital. The case study presents the oncological and functional results and emphasizes the technical details of the entire sampling. The purpose of this work has been to demonstrate that this procedure can be used by an E.N.T. surgical staff without requiring input from an outside team of specialists. Although this technique is difficult and somewhat limited, it must be considered one of the most innovative proposals in the field of plastic, reconstructive surgery of the head and neck.

Adult↗

PubMed1997

[Surgical treatment of otosclerosis in the aged. Results of retrospective analysis].

Otosclerosis is, per se, a disease which rarely occurs after the age of 50. This is why stapes surgery is seldom performed in advanced age and there are few reports on the topic in the literature. The authors have performed a retrospective analysis of patients over the age of 65 who had undergone surgery for otosclerosis in the last 27 years. Out of a total of 3585 surgical procedures, 106 patients were analyzed. Most of the cases were in the advanced stages. Assessment of the outcome included pre- and post-operative audiometry, one year after surgery. Inner ear performance was established by evaluating air and bone conduction at 0.5, 1, 2, 3 and 4 kHz. The results showed that performing otosclerosis surgery is worthwhile even in the elderly with mixed auditory impairment, as long as the air-bone gap is limited to 20-30 dB and the surgical procedure is through. In this light, stapedotomy appears to be the most adequate technique. When evaluating the results the possibility of adopting a less powerful hearing aid should also be considered a success.

Age Factors↗

PubMed1995

[Lymph node problem in cutaneous head and neck carcinomas].

Skin carcinomas of the head and neck can produce lymphatic metastases: the main lymphatic station of drainage is in the lymph nodes of the parotid region, especially for tumours of the upper 2/3 of the face. The analysis of the prognostic factors (site of origin, etiology, immunodepression, previous treatment, size, thickness, grading, perineural invasion, rapid growth) identifies a group of patient at risk, for local recurrence and for lymphatic metastases. In those cases, representing less than 10% of these tumours, the prophylactic treatment of lymph nodes-parotid and neck nodes-can be reasonable. The cases N positive have a severe prognosis, in these patients an aggressive surgical treatment, extended to both parotid and neck nodes, followed by radiotherapy, is justified. Only prospective studies and statistical evaluation of results, could define the real prognostic importance of different factors and the best treatment for the lymph nodes.

Head and Neck Neoplasms↗

PubMedDate not supplied

Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy.

PURPOSE: This study was performed to investigate factors associated with laryngeal morbidity when postoperative radiation therapy (RT) is added to supraglottic laryngectomy. MATERIALS AND METHODS: From 1980 to 1994, 56 patients affected with T1 to 4 N0 to 2c supraglottic squamous cell carcinoma selected for standard (59%) or extended (41%) supraglottic laryngectomy at 2 different institutions were retrospectively analyzed. Most of the patients (91%) also underwent neck dissection. Approximately 80% of the patients had stage T4 primary lesions or N2 neck disease. Postoperative RT was added for presumed microscopic disease at the primary site (13 patients), regional nodes (23 patients), or both (20 patients). Median delivered doses to the larynx and to the neck were 50 Gy (range, 40 to 64 Gy) and 46 Gy (range, 40 to 64 Gy), respectively. Median follow-up for living patients is 11 years (range, 2.8 to 16.9 years). Laryngeal complication was defined as the appearance of grade 2 or higher toxicity according to the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) scoring systems. RESULTS: Two- and 5-year actuarial locoregional control rates were 85+/-5% and 83+/-5%, respectively. Thirty patients (54%) developed laryngeal complications. However, just one patient experienced grade 4 laryngeal oedema requiring permanent tracheostomy. Estimated actuarial survival without laryngeal complications were 50+/-7%, 43+/-7%, and 39+/-7% at 2, 5, and 10 years, respectively. At univariate analysis, treated volumes (P = .03) and total dose to the larynx (P = .03) were significantly associated with local toxicity. A trend was observed also for the maximum dose to the neck (P = .06) and dose per fraction (P = .09). A multivariate Cox proportional hazards model showed total dose to the larynx to be the only independent predictor of toxicity (P = .03). The hazard ratio of laryngeal toxicity was 2.2 (95% confidence interval: 1.1/4.6), for a total dose to the larynx greater than 50 Gy. CONCLUSION: After supraglottic laryngectomy, postoperative RT to the neck does not affect local morbidity, but careful RT treatment planning is necessary to avoid delivering a total dose to the larynx greater than 50 Gy.

Actuarial Analysis↗

PubMedDate not supplied

Conservative management of T1-T2N0 supraglottic cancer: a retrospective study.

PURPOSE: Evaluate the results of conservative management of early-stage supraglottic cancer. PATIENTS AND METHODS: A retrospective analysis of 166 consecutive T1-T2N0 cases of squamous cell carcinoma of the supraglottic larynx, treated conservatively between 1983 and 1992, was performed. Sixty-six patients received conservative surgery (CS), whereas 100 patients received definitive radiation therapy (RT). Surgical procedures included horizontal supraglottic laryngectomy in 38 patients, extended supraglottic laryngectomy in 16 patients, and reconstructive laryngectomy with cricohyoidopexy in 12 patients. Elective bilateral neck dissection was always performed. Radiotherapy was delivered with 60Co or 6 MV photons to the primary laryngeal tumor and the upper and mid neck nodes (level II and III), whereas supraclavicular nodes (level IV) were electively irradiated only in 54 patients with T2N0 tumors. Fifty-two patients received conventional fractionation, whereas 31 patients were irradiated according to a twice-a-day fractionation regimen. The median total tumor dose was 67 Gy (range, 64 to 72 Gy). RESULTS: The 5-year overall survival of the whole series was 72.7% +/- 4.5. In patients treated with CS, the 5-year disease-free survival was 88.4% +/- 4.5 versus 76.4% +/- 6.1 for patients who received RT. Salvage surgery was effective in rescuing 2 of 3 CS failures and 12 of 25 RT failures. The overall incidence of secondary tumors (11%) and distant metastases (5%) was relatively low, although together they account for 15% of all deaths. Complications of CS were significantly correlated to the extent of surgical procedure. A multivariate analysis performed in the RT group showed that performance status, tumor grade, and fractionation regimen significantly influenced disease-free survival. CONCLUSION: Conservative management of T1-T2N0 supraglottic cancer, either by CS or RT, can achieve good cure rates with larynx preservation for the majority of the patients (82% overall; 95% in the CS group and 72% in the RT group). The decision between different conservative treatment modalities may be influenced by the patient's conditions, tumor characteristics, treatment modalities, and also economic costs.

Adult↗

PubMedDate not supplied

[Prospective, cohort, epidemiologic studies of laryngeal neoplasms in Italy].

Recent epidemiological studies show, quite surprisingly, a regression in mortality rates for lung cancer in some of the most industrialized countries of the world. Aetiopathogenetic analogies are made by the Authors in order to verify future trends concerning the incidence of laryngeal cancer in Italy. In this study a particular study model, which furnishes incidence rate expectations for the disease, is elaborated. Comparison of relative risks according to birth dates demonstrates that people born around 1930 are in the higher risk range while younger generations seem to show an effective incidence reduction. Evaluations include that of estimating the period in which the world-wide incidence of the disease will be maximum. With the addition of 70 years (main incidence in the seventh decade) to the year 1930 (the worst year) the study predicts that the end of this century will see the most consistent accumulation of new cases. After the year 2010 a trend towards a gradual regression in incidence will appear. The reasons are probably related to the social and cultural transformations of the last twenty years, particularly the progressive abandoning of the smoking habit.

Adult↗

PubMedDate not supplied

[Temporal bone metastasis of adenocarcinoma of the breast: personal observations and a review of the literature].

A single case of temporal bone metastases from breast carcinoma is reported and its clinical features and main instrumental diagnostic characteristics are described. Although this is quite rare the possibility cannot be neglected when making diagnosis should the clinical features and test results suggest such an expansive process of the temporal bone. In fact, although extremely limited, treatment is strictly linked to proper and early diagnosis.

Breast Neoplasms↗

PubMedDate not supplied

[Salvage surgery after unsuccessful radiotherapy of cancer of the larynx].

The problem of the surgical management of irradiation failures in laryngeal carcinoma is taken into consideration. A series of 60 consecutive laryngectomies performed at the E.N.T. Department of the Regional Hospital of Varese from 1982-1987 is presented. All patients had previously undergone curative radiotherapy for squamous cell carcinoma of the larynx with subsequent local recurrence. The postoperative course is examined in relation to the observed 11 cases of complications (18.3%) taking them into consideration individually. A statistical analysis is also presented for the incidence of complications in relation to the most significant parameters. No significant difference was found in regard to timer elapsed since termination of radiotherapy (more or less than 6 months), irradiation field extension (limited to the larynx or extended to the neck nodes), type of surgical salvage (including neck dissection or not) and pre-operative hemoglobin and blood proteins values. In those patients who had previously undergone irradiation, total laryngectomy is quite a safe procedure in terms of potential local-regional complications. The choice of primary radiotherapy should not be influenced by the fear of such complications arising if salvage surgery is required after local recurrence.

Adult↗

PubMedDate not supplied