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L O Redaelli de Zinis

Publications and source records attributed to L O Redaelli de Zinis.

13 recordsLinked to original sources
PubMed2006

Vascular anomalies of the tympanic membrane.

Benign vascular lesions include various forms whose classification has created some controversies in the literature. The observation of a rare case of vascular bulge of the eardrum in a 57-year-old man prompted us to analyse the essential features of these lesions. This was an incidental finding and the mass was removed by a transcanal approach. The patient is free of disease four years later. Vascular malformations can be differentiated from vascular tumours since they are present at birth, are generally stable, do not involute, and do not necessitate treatment unless symptoms occur.

Arteriovenous Malformations↗
PubMed2001

Oncological results of endoscopic resections of Tis and T1 glottic carcinomas by carbon dioxide laser.

A cohort of 88 patients with glottic cancer (13 Tis, 75 T1) who underwent endoscopic CO2 laser excision between January 1995 and June 1997 was prospectively studied. The mean follow-up was 43 months (range, 30 to 60 months). The depth and extent of the excision (graded according to the European Laryngological Society Classification, which includes 5 types of resection) were based on the results of a preoperative and intraoperative diagnostic test battery. Five patients died of other diseases, and none of glottic cancer. Of the 12 patients who developed a local recurrence, 5 underwent a second endoscopic procedure, 5 a total laryngectomy, and 1 a supracricoid laryngectomy, and 1 was treated with radiotherapy. The 5-year local control rate with endoscopic surgery alone, according to the Kaplan-Meier method, was 91%. None of the variables (8 related to the tumor and 2 to the treatment) tested in a univariate analysis by the log-rank test was found to have a significant impact on disease-free survival rates. The present study confirmed that endoscopic partial cordectomy for Tis and T1 glottic cancers can be regarded as a valid alternative to radiotherapy in terms of oncological results.

Adult↗
PubMed1999

Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy.

BACKGROUND: Pharyngocutaneous fistula is the most common complication following total laryngectomy. The present study was designed to determine the incidence and predisposing factors and to describe the management of the complication. METHODS: The records of 246 consecutive patients who underwent total laryngectomy for squamous cell carcinoma were reviewed. We evaluated 23 factors potentially predisposing to fistula formation (age, sex, smoking and drinking habits, hypertension, diabetes, chronic bronchitis, chronic congestive heart failure, anesthesiologic risk, cholinesterase level, pre- and postoperative hemoglobin and albumin levels, previous treatment, previous tracheotomy, site of origin of the tumor, surgical procedure, concurrent neck dissection, suture material, status of surgical margins, clinical stage, and histologic grade) using the chi-squared test and logistic regression analysis. RESULTS: A pharyngocutaneous fistula developed in 16% of patients within a mean time of 11 days from surgery. Spontaneous closure with local wound care was achieved in 70% of cases. Ten patients required surgical closure by direct suture of the pharyngeal mucosa; a deltopectoral flap and a pectoralis major myocutaneous flap were used in one case each. The mean healing time was 39+/-46 days in the group of patients requiring surgical closure, compared with 19+/-12 days in the group in which spontaneous closure occurred. The definitive model of logistic regression analysis showed that pharyngolaryngectomy, chronic congestive heart failure, and postoperative hemoglobin level lower than 12.5 g/dL carried respectively a two-, five-, and ninefold increase in the risk of fistula development. The model, with a specificity of 81%, is fairly good in identifying patients with a low risk of fistula. CONCLUSIONS: The results observed in the group of patients under analysis corroborated the relevance of factors such as the extension of laryngectomy and postoperative hemoglobin level on fistula occurrence. However, chronic congestive heart failure, which is an expression of disturbance of the organism, emerged for the first time as an additional statistically significant risk factor for pharyngocutaneous fistula formation. Our experience confirmed that most fistulas can be successfully managed with conservative treatment. Except for the rare cases in which large defects are present, direct suture is appropriate when conservative treatment has failed.

Adult↗
PubMed1998

Regional and distant metastases in laryngeal and hypopharyngeal sarcomas.

Cervical node and distant metastases are the most important prognostic factors in malignant laryngeal neoplasms. Owing to the unusual occurrence of laryngeal sarcomas, the prevalence of their metastases has never been analyzed in detail. We reviewed the laryngeal sarcomas reported in the literature and noticed that both regional and distant metastases are rare events and variable for different histotypes. These observations have obvious therapeutic and prognostic implications.

Humans↗
PubMed1998

[Indications for elective neck dissection in malignant epithelial parotid tumors].

The purpose of the present study was to define the indications and extension for the treatment of lymph nodes in clinically NO patients with primary malignant epithelial parotid tumors. A retrospective analysis was performed on 46 cases with such tumor out of 307 parotid neoplasms (246 benign, 61 malignant) consecutively treated from 1985 to 1994. Lymph node metastases were present only in the histotypes with a high degree of malignancy (overall incidence, 24%). Two patients (5%) showed occult metastases. No correlation was found between the size of the neoplasm and the incidence of lymph node metastases. However, the latter were significantly more common in locally highly aggressive neoplasms (class "a"), 8%; class "b" 43%; P = 0.006). Due to the small number of cases, it was not possible to correlate the incidence of occult metastases with neoplasm size or local extension. As regards topographic distribution of lymph node metastases, level II was always involved, level V was never involved, and level i.v was involved only when metastases were found in the upper levels. Occult metastases were found only at level II. Over a follow-up period of 2 to 10 years, no cases were seen with cervical recurrences. Although drawn from a limited series, the results are similar to the data generally reported in the literature, showing that lymph node metastases are rare in neoplasms with a low grade of malignancy whereas there is a significant increase in the incidence of metastatic lymph nodes and occult metastases when the grade of malignancy is high. In conclusion, in clinically NO patients, a suprahomohyoid neck dissection (levels I-II-III) is indicated only when the neoplasm shows a high grade of malignancy or when it is a class "b" malignancy. In the other cases, neck dissection is determined by the clinical evidence of metastasis and can be extended to the lower levels. Neck dissection can be avoided in NO patients whenever ultrasound and fine needle biopsy are both routinely used in the preoperative evaluation of the cervical lymph nodes.

Epithelial Cells↗
PubMed1998

[Endoscopic treatment of sphenoid aspergilloma].

In recent years there has been an increase in fungal infections of the nose and paranasal sinuses, even though it is difficult to ascertain the incidence and prevalence of such disorders. The only information which can be drawn from the literature is that such infections are diagnosed in 6% to 13% of surgically treated chronic sinusitis. Aspergillus is the etiologic agent in approximately 80% of cases. Fungal infections are classified into two groups: non-invasive and invasive. The former includes mycetoma and allergic fungal sinusitis. The latter comprises the chronic indolent form, which presents slowly progressive bone erosion, and the fulminant form, which almost invariably carries a dismal prognosis. The maxillary sinus is involved in 80% of mycetomas, followed, in order of frequency, by the ethmoid and frontal sinus. Localization in the sphenoid sinus is exceedingly rare, with only 71 cases reported in the literature. Diagnosis of mycetoma is based on fungal cultures of nasal secretion (which are indeed of limited sensitivity, around 40%) and histological examination of the material removed from the sinus, which identifies the fungus in 80% of cases. CT and MR are highly sensitive diagnostic tools because of their ability to detect the presence of ferromagnetic substances (i.e. iron, magnesium and manganese) and calcium deposits in the diseased sinus. Four new cases of sphenoid mycetoma, treated with endoscopic surgery, are described. The advantages of the endoscopic approach compared to traditional techniques and the role of anti mycotic agents are also discussed.

Aspergillosis↗
PubMed1997

Prognostic determinants in supraglottic carcinoma: univariate and Cox regression analysis.

BACKGROUND: A series of 281 consecutive patients affected by supraglottic cancer and treated with surgery alone or with surgery followed by radiotherapy between 1983 and 1989 was reviewed to identify significant prognostic determinants. METHODS: Fifty-one variables (related to host, tumor, and treatment) were tested by univariate and multivariate analysis performed on absolute and determinate survival. RESULTS: The final model of the multivariate analysis for absolute survival included the following covariates listed in order of higher relative risk of death: extracapsular spread, involvement of the medial wall of the pyriform sinus, thyroid cartilage invasion, metachronous tumor, anesthesiologic risk according to the American Society of Anesthesiologists classification (chi 2 = 71.28 with 6 d.f., p < .00001). The definitive model for determinate survival included: extracapsular spread, involvement of the medial wall of the pyriform sinus, extralaryngeal soft tissue invasion, and thyroid cartilage invasion (chi 2 = 82.74 with 5 d.f., p < .0001). CONCLUSIONS: Extracapsular spread was the most important factor affecting the prognosis of patients with supraglottic carcinoma. A second important finding was that T and N category did not emerge as a significant independent prognostic predictor at multivariate analysis. The negative impact on absolute survival of physical status and metachronous tumor could be the expression of the influence of concomitant diseases on survival. These observations concur to reinforce the concept that the current TNM classification is rather inadequate in predicting the prognosis of patients with supraglottic carcinoma when the aforementioned variables are considered.

Adult↗
PubMed1994

[Incidence and distribution of lymph node metastases in supraglottic squamous cell carcinoma: therapeutic implications].

This retrospective study was designed to establish some guidelines for the treatment of the neck in the case of supraglottic cancer. The patient population included a series of 264 patients, from 39 to 76 years old (mean age 58.3), who had undergone monolateral (76) or bilateral (188) neck dissection for a total of 452 neck dissections. The distribution of the patients, according to pT category, was the following: 17 T1 (6.4%), 88 T2 (33.3%), 107 T3 (40.5%) and 52 T4 (19.7%). In 121 patients the tumor was central (45.8%), whereas in 143 (54.2%) the neoplasm did not extend beyond the midline and was therefore defined as lateralized. The overall incidence of lymph node metastases was 43.4% (39 N1, 32 N2b, 28 N2c), and the rate of occult metastases was 24.7%. The distribution of metastases according to pT category was as follows: 6.2% T1, 30.7% T2, 38.3% T3 and 57.7% T4 (p < 0.001). Occult metastases distribution was: 0% T1, 19.6% T2, 26.7% T3 and 44.4% T4 (0.001 < p < 0.01). The incidence of bilateral metastases was significantly different (p < 0.001) in central (45.8%) and lateralized tumors (7.8%). The distribution of metastases according to level was 0.8% I, 82.4% II, 35.2% III, 13.6% IV and 0% V (p < 0.001). When level I or IV was involved, lymph node metastases were also present in level II and/or III. These results suggest that contralateral elective neck dissection is not required in lateralized tumors and elective neck dissection is not indicated in T1 lesions. Since no occult metastases were detected in level I or V, the management of choice for the clinically negative neck might well be a selective dissection limited to levels II, III and IV ("lateral neck dissection"). Levels I and V should be dissected only when metastatic nodes are found.

Adult↗
PubMedDate not supplied

Sphenoid mucocele with intracranial invasion secondary to nasopharyngeal acinic cell carcinoma.

We present a case of sphenoid mucocele with large invasion of the middle cranial fossa, secondary to a nasopharyngeal acinic cell carcinoma, occurring in a 52-year-old man. To the best of our knowledge, this association has not been reported so far. We discuss the importance of imaging techniques in delineating the relationship between the two lesions, as long as the clinical and therapeutic problems related both to sphenoid mucocele and acinic cell carcinoma.

Carcinoma↗