Biomedical subjects
Publications and source records attributed to V Agostini.
The authors describe a rare complication of radical neck dissection, a 'pseudotumor' with fracture of the medial portion of the clavicle. Out of 899 radical neck procedures carried out in the ENT Department of Florence University, there were four such cases.
The postoperative course was evaluated for 458 consecutive patients, all over the age of 56 years, who had undergone laryngeal conservation surgery in the last 10 years. One hundred seventy-one patients aged 66 and over made up the "elderly" group and 287 patients, aged between 56 and 65 years formed the control group. It was confirmed that cordectomy and frontolateral laryngectomy are feasible even in elderly patients. Bronchopneumonia is the most frequent and serious complication after supraglottic laryngectomy. Therefore this operation should be performed in the elderly patient only after a thorough evaluation of cardiac and respiratory function. Prophylactic neck dissection should not be done for N0 necks and the second therapeutic neck dissection in N2 cancers should be staged 6 or more weeks later. Hemilaryngopharyngectomy and subtotal reconstructive laryngectomy with cricohyoidpexis are not advisable in elderly patients.
Frequency and importance of secondary pauses (SP) following termination of high rate artrial pacing were evaluated in 64 patients. The maximal values of the first 10 post-pacing cycles, resulting from series of pacing between 70/min--160/min, were compared with the normal post-pacing values of Benditt. SP were present in 1 case (4%) of 23 patients without electrocardiographic signs of sinus node dysfunction (SDF), but in 21 cases (51%) of 41 patients with SDF (p less than 0.01). SP were more frequent in patients with SA-Block and/or sinus pauses (64%) and with bradycardia-tachycardia-syndrome (60%), whereas were more rare (35%) in patients with sinus bradycardia only. Patients with SDF and SP did not significantly differ from patients with SDF without SP concerning absolute and corrected sinus node recovery time, basal heart rate, reduction of cycle length after atropine, abnormal reactions to carotid sinus pressure and frequency of syncopes. In 1 patient SP, present in basal conditions, were not evident after atropine. SP could be interpreted as indication of SDF and should always be searched for because it may be the only evidence of SDF after atrial pacing; therefore SP may reduce the frequency of false negative tests after rapid atrial pacing. Possibly, vagal mechanisms are involved.
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A retrospective study has been performed on 155 cases of surgically treated hypopharyngeal carcinomas in order to bring to light what effect the type of surgery has on survival and the reasons for failure. The following operations were performed: 103 hemipharyngectomies with total laryngectomy (HPTL); 28 total circular pharyngectomies with total laryngectomy (CPTL); 16 hemipharyngectomies with partial laryngectomy (HPPL); 4 exereses in lateral pharyngectomy; 2 total laryngectomies and 2 hemipharyngectomies in lateral pharyngotomy. Analysis of the results is only performed on the three most numerous groups of patients. The overall neoplastic mortality rate at 5 years was 79% for the HPTL group while it was 50% and 61% in the CPTL and HPPL groups, respectively. The actuarial survival curves show a higher, statistically significant, cumulative 5-year survival rate for the CPTL group (55.9%) than for the HPTL group (30.5%). The authors conclude that, considering the particular submucosa spreading to which hypopharyngeal carcinoma is subject and the good functional recovery which can be obtained with modern reconstructive surgery of the alimentary tract, CPTL should be the treatment of choice, even in the less advanced cases, in order to significantly reduce the risk of local recurrences.
Carcinoma of the lip is a common lesion which is not always acknowledged as as a potentially lethal disease. The risk of cancer occurs most commonly among aging white men. The risk factors normally associated with lip cancer are rural residence and outdoor occupation. In addition, both actinic radiation and tobacco smoking have been considered casually related to lip cancer. The present study is based on a retrospective review of 86 patients (82 males, 4 females, mean age 65) affected by carcinoma of the lip, treated in Florence from 1970 to 1988. The most frequent site for carcinoma of the lip proved to be the lower lip (71 cases); other sites included the upper lip (7) and the commissure (8). The lip tumor was a squamous cell carcinoma in 82 patients and a basal cell carcinoma in the remaining four. Good prognosis was found for all those with relatively small lesions (T1-T2). On the contrary, the prognosis proved quite poor for those who exhibited tumor fixation to the mandible or erosion of the mandible (23.5%, 5 year survival). Primary radiotherapy may be used for the smaller lesions as cure rates proved equivalent to those achieved surgically although the authors found surgery is always preferable as a primary method of treatment. Surgical excision of the tumor is a relatively minor procedure with a minimum of morbidity as compared with radiation therapy which may lead to local tissue reaction and may disturb function. Surgical management is also recommended as it bears the advantage of being to give a histologically accurate tumor margin assessment. Moreover, with surgery, functional results are good.(ABSTRACT TRUNCATED AT 250 WORDS)
During the surgical treatment of head and neck cancers the surgeon may have to face the problem of deciding what measures to adopt when the tissue at the margin of the surgical sections proves histologically to be cancerous. Many factors may influence the decision for supplementary therapy; among these, of primary importance are stage and site of the tumor, the effectiveness of non surgical therapy, and the psychophysical status of the patient. In order to better consider this problem a retrospective study, limited to laryngeal surgery, and a review of the literature have been carried out. Review of the patients undergoing surgery from 1972 to 1988 has revealed that histological examination of section margins during or after laryngeal surgery was performed in 56 cases: 10 stripping vocal cords, 11 cordectomies, 2 frontolateral laryngectomies, 2 hemilaryngectomies, 20 horizontal supraglottic laryngectomies, 10 total laryngectomies and 1 subtotal laryngectomy with cricohyoidopexis. The margin was negative in 35 cases while tumor lesions of various types were present in 21 cases. An invasive tumor was present in 14 patients and in 7 an 'in situ' tumor or premalignant diskeratosis was found. A policy of abstention was adopted in all but one of the cases. All cases of 'in situ' cancer and of invasive premalignant change were grouped together as they have in common base membrane integrity and the fact that the second lesion is to be considered precancerous. The following results were obtained: in 14 cases of invasive cancer at the section margin there were 8 recurrences (57.1%) 4 after total laryngectomy; 6 patients showed no evidence of disease (NED) after from 3 to 7 years. In the 7 cases of 'in situ' cancer and premalignant lesions at the surgical margin, 4 showed recurrence (57%) and of these 2 underwent surgery. The 3 other cases have been NED for 3 to 5 years. On the other hand, even in the group of 35 margin free patients 8 developed recurrences (22.3%) and of these 3 underwent surgery and 1 radiotherapy. It appears evident that in conservative surgery of the larynx the presence of tumor cells at the surgical margin does not necessarily lead to a recurrence; such recurrences vary from 18% to 60% depending on the study. Nonetheless, it is certain that a real possibility of recovery exists in 50% of these patients. It is, however, impossible to specify which patient manifesting a positive margin actually runs the risk of developing a recurrence.(ABSTRACT TRUNCATED AT 400 WORDS)
The authors present the developments made in the use of cutaneous cervical flaps in the reconstruction of the hypopharyngo-cervical esophagus since Mikulicz first introduced the technique in 1886. Mention is made of the most recent, valid reconstructive possibilities which have resulted in a progressive reduction in the use of cervical flaps. The advantages and disadvantages of the Wookey-operation are enumerated and considerations are made regarding the validity of this technique. The authors conclude that the use of cutaneous cervical flaps remains an effective method, particularly when more limited extirpation and/or further reconstructive stages are required or when a patient's poor general state contraindicates more stressing procedures.
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