Biomedical subjects
G Motta
Publications and source records attributed to G Motta.
Chondroid chordoma of the lateral skull base.
A rare case of chondroid chordoma of the lateral skull base with laterocervical extension is reported. Clinical, radiological and pathological features of the tumor are described. This unusual location of chondroid chordoma enabled total resection of the neoplastic tissue through a combined laterocervical and far lateral transjugular approach.
An ecologic study of geographical variation in multiple sclerosis risk in central Sardinia, Italy.
We carried out an ecological study in the most archaic area of Sardinia to obtain a reliable estimate of the prevalence of multiple sclerosis (MS) and to investigate the geographical variation in the prevalence across the 100 administrative communes. To estimate the area-specific prevalence rate, we adopted a Bayesian approach that makes it possible to filter out the random variation from the estimates and to obtain a map that reflects the true geographical variation in MS prevalence. 428 resident cases were identified by the case register, including 69 multiplex families. The overall prevalence was 157 per 100,000 inhabitants. The Bayesian area-specific prevalence ranged from 143 to 262/100,000. The high prevalence and its moderate geographical variation in a genetically homogeneous population, as well as the high number of multiplex families observed in the communes with the highest prevalence, could be interpreted as representing a high susceptibility of the population to MS.
CO2 laser treatment of bilateral vocal cord paralysis in adduction.
This study presents results obtained from 83 patients with bilateral vocal cord paralysis in adduction treated between 1982 to 2001, with CO(2) laser microlaryngoscopy. In relation to the different types of surgery followed, three distinct treatment groups were included: group 1 (1982-1984) included 5 patients treated with vaporization of the vocal process of the arytenoid and the homolateral posterior third of the true vocal cord. Group 2 (1983-1990) contained 19 patients who were treated with arytenoidectomy and removal of the homolateral posterior half of the true vocal cord and group 3 (1990-2001), including 59 patients who were treated with arytenoidectomy and removal of the homolateral posterior half or two thirds of both the true and false vocal cord. Functional results were assessed by means of spirometry, spectrography and aerophonic examinations performed at 5, 90, 180, and 240 days postoperatively. The results show that removal of the posterior third of the true vocal cord and false vocal cord, combined with arytenoidectomy, is the surgical treatment of choice to resolve respiratory insufficiency in these patients.
Carcinosarcoma of the lung: a case report.
The clinical and pathological data of a single case of carcinosarcoma of the lung observed in the period from 1978 to 1998 were reviewed. The diagnosis was based on immunohistochemical examination of the surgical specimen after a lower left lobectomy. The patient was given adjuvant chemotherapy. The local recurrence showed only sarcomatous features. The characteristics of this rare tumor are discussed in this case report.
The new international staging system for lung cancer. Evolution of the system and concerned remarks.
The rationale of the Staging System of Lung Cancer is discussed from his presentation (Mountain, 1985) to the recent revision and proposals of new classifications. Survival rates offered a strong statistical support to the latest revision in 1997. Stage Group have become 7 out of Stage 0 (Tis). In the New Lymph Node Map, station 4 is confirmed as mediastinal (N2). The improved definition of Stage Grouping requires a golden standard of staging and a worldwide consensus on the surgical approach to mediastinal lymphadenectomy. IASLC, the International Association for the Study of Lung Cancer, is now moving to collect a new largest database with the aim to offer the next expected Revision.
The "Will Rogers effect" on stage grading.
Will Rogers phenomenon affects survival statistics applied to clinical research and could determine a misreading of results. Stage migration due to new methods of diagnostic imaging and staging invasive procedures could improve actuarial survival in each stage. TNM System is impaired when survival rates come from different inhomogeneous countries, regions and eras. Randomized trials suffer this fallacious phenomenon when staging depends on the different treatments which are to be evaluated.
The invasive staging and the role of complete resection in the surgical treatment of NSCLC.
Years of debates couldn't solve the discussion between the NSCLC assessment founded on CT scan and mediastinoscopy as in the Western countries and the refined extensive bronchoscopy, CT imaging and exploratory thoracotomy as practiced in Japan. Recently, the clinical onset of combined therapy protocols, the recognised value of the intrathoracic staging (also in the West) and survival rates in the earlier N2 disease moved towards change this steady situation. The role of complete resection in N2 NSCLC is therefore debated from the preoperative assessment to survival results in resected cases. Accuracy of CT scan and cervical mediastinoscopy is discussed also in the light of neoadjuvant therapy. The clinical value of intrathoracic staging is improved by Japanese experiences while a rationale assessment of Complete/Incomplete Resections is defined. Moreover, technical details of intraoperative recognition are cleared.
Considerations about tumor size as a factor of prognosis in NSCLC.
A literature review of the initial attempt to correlate tumor size in NSCLC with the expectancy of survival is presented starting from the 60s. The larger size was connected with an increased risk of metastatic diffusion. In the 70s resulted evident the relationship between tumor size and lymph node involvement so affecting survival. In the context of the TNM Staging System (Mountain 1986) size appeared a well assessed factor of prognosis and is recognised to play a major role in Stage I where the subsets T1N0 and T2N0 showed a consistent difference in survival across the 3 cm cut-off. The peculiar relation between largest size and mediastinal lymph node metastases is discussed as well as the proposal to allocate T2 descriptor within the range 3-5 cm. Finally, series of clinical observations from Japanese experience about small sized T1N0 tumors are presented and discussed.
Considerations about the complete resection in NSCLC surgery. Review.
The complete resection for NSCLC is analyzed through the study of a series of retrospective surgical reports upon the incomplete resection, due to a microscopic residual tumor at the resection margin. Following Shields' statement in 1974, the incomplete resection represents, in fact, the basic study protocol for the local recurrence following the resection of primary NSCLC. First of all, the obligation for a careful intraoperative pathologic assessment upon the resection margins, clearly emerges from this study. Secondly, two main aspects featuring the incomplete resection have also been pointed out. The first is represented by the historical microscopic residual tumor at the bronchial resection margin, while the second, more recently recognized, is represented by the critical resection margin within the involved ipsilateral mediastinal lymphatic area. The analysis of such different figures leads to different considerations when dealing with the basic matter of the local-regional completeness of resection and the oncological result in terms of cure. In fact, while the problem of the bronchial remnant appears amenable to further improvement by activating the surgical attention, the second, instead, is to be considered unmodifiable by the surgery alone. It basically depends on the extended microvascularity of the large lymphatic mediastinal network which appears to be the crucial factor of risk for such a "lymphatic" resection margin. In conclusion, the matter of complete resection is still open to further research provided that the design is strictly prospective. As a matter of fact, so far the expectation for cure in any apparently completely resected NSCLC is ruled by other well-known factors of prognosis which do not consider the quality of the resected margin at all.
[The use of Phonagel in glottic insufficiency].
The authors describe their experience concerning collagen implantation in case of glottic insufficiency after cordectomy by the CO2 Laser. Three different kinds of injection are indicated as follows: injection of 3/4 of collagen in the site responding to vocal fold removal on 1/4 in the survival fold after cordectomy with conservation of the thyroarytenoid muscle; implantation of 1/2 in the new fold and 1/2 in the surviving one after cordectomy with removing of the cricoarytenoid muscle; infiltration of the whole material in the residual vocal fold after cordectomy enlarged to the false vocal fold and the ventricule as well. Video laryngoscopic and spectrographic examinations documented good phonatory results after collagen implantation in 19 cases over 21; two cases had a persisting insufficiency depending on the fact they had been previously operated of enlarged cordectomy and the scar tissue was not sufficient for measures and consistency to obtain a satisfactory injection of collagen.
[Tracheoesophageal prostheses].
The AA. report their own experience in the field of tracheoesophageal speech rehabilitation of laryngectomees. In order to get a high rate of successful results, (an accurate selection of patients is of fundamental importance) mainly to identify the physical requirements and the motivational aspects potentially favouring vocal, rehabilitation. The personal technique of tracheoesophageal fistula creation under local anesthesia is illustrated, the procedure generally last 5-10 minutes with minimal tissue trauma and blood loss and is also suitable for outpatients. For the above-mentioned reasons, the AA. prefer to perform the tracheoesophageal puncture as a secondary procedure, i.e., after total laryngectomy, taking into account the many inconveniences related to primary rehabilitation, as reported in literature. Finally, advantages and inconveniences of the various types of prosthetic devices employed are illustrated and the causes of failure are discusses.
[Diagnosis of sensorineural hearing loss by ipsilateral masking of brain stem auditory evoked potentials].
The Authors show their original technique for the differential diagnosis of cochlear and retrocochlear hearing loss which employs ipsilateral masking of the A.B.R. in order to define the difference in V wave latency between a standard technique (clicks at 21 pps without noise) and a sensitized technique (clicks at 21 pps with noise at S/N of +40). This difference in latency has been named Sensitizing Latency Difference (SLD). Sixty normal subjects, 85 patients with cochlear hearing loss and 6 with retrocochlear hearing loss, were studied. The obtained data showed a SLD value: in normal hearing of: a) 0.31 msec. (+/- 0.14 SD) from 18 to 40 years old; b) 0.36 msec. (+/- 0.26 SD) from 41 to 60 years old; c) 0.48 msec. (+/- 0.21 SD) over 60 years old; in patients with cochlear hearing loss 0.12 msec. (+/- 0.14 SD) in 2 subjects affected by retrocochlear hearing loss a value superior to 1.5 msec. in the other 4 cases the V waves disappeared during recording of the sensitized test. A differential value of 1 msec. between cochlear and retrocochlear hearing loss was established by the Authors who with this value correctly identified all the patients with retrocochlear hearing loss and 97.8% of the subjects with cochlear hearing loss. An incorrect diagnosis of the hearing loss origin (false positives) was made in 2.2% of the patients with cochlear hearing loss. In conclusion, the Authors feel that the SLD evaluation, in consideration of its large clinical utility and of the high reliability of obtained data, is a particularly useful test in making a differential diagnosis between cochlear and retrocochlear hearing loss.
[Use of CO2 laser in conservative surgery of glottic tumors].
The present work evaluates the results obtained in a group of 360 patients with laryngeal-glottic tumors (classification T1/T2-N0-M0) who, in the last 10 years, have undergone direct microlaryngoscopy surgery employing a CO2 Laser. In the T1 glottic carcinomas the neoplasm was limited to the vocal cord on one side or it involved the anterior commissure and, most likely, the vocal cord on the opposite side; in T2 glottic tumors the extension reached the hypoglottic region and/or the Morgagni ventricle and the false vocal cords on one or both sides but without compromising laryngeal motility. The five year healing rate for the T1 tumors proved to be 84.7% while it was 74% for the T2 forms. In 36 cases complications were found which can be broken down as follows: - limited local recurrences (13 patients) requiring subsequent direct microlaryngoscopy; - regional lymph node metastases (6 patients) without reproduction of the primary neoplasm; in general (5 of the 6 cases) these patients underwent lateral neck dissection; - spreading of the neoplastic process (17 cases) which made total laryngectomy with lateral neck dissection necessary; this procedure was performed in 15 cases. When these subsequent surgical procedures are also taken into account the percentage healing rises to 94.3% for T1 glottic tumors and to 84.9% for T2. Detailed analysis of the case study, comparison with the data found in the relative literature regarding patients treated with traditional techniques, a series of observations on the advantages and disadvantages inherent to the techniques employed have all led to the conclusion that the use of a CO2 laser in the treatment of laryngeal tumors gives excellent results in terms of prognosis. Moreover, this technique offers significant advantages over the traditional methods and constitutes a reliable technique for partial laryngectomies as long as the indications are accurately applied and the proper techniques used.
Complications of surgery in the treatment of lung cancer: their relationship with the extent of resection and preoperative respiratory function tests.
We reviewed our experience with the surgical treatment of lung cancer, in order to investigate if the extent of the pulmonary resection and preoperative respiratory function tests correlate with the frequency of postoperative complications. The records of 292 patients who underwent lobectomy and of 64 who had pneumonectomy were analyzed. Postoperative complications developed in 148 patients. The incidence of bronchopleural fistula and cardiac rhythm disturbances was significantly higher after pneumonectomy than after lobectomy. A significant relationship was found between the preoperative ventilatory function tests and the postoperative frequency of intrapleural air spaces or atelectasis. The 30 day operative mortality was significantly related to the extent of the resection; postoperative deaths due to cardiorespiratory insufficiency were also associated to the severity of the obstructive pulmonary disease.
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Multiple aneurysmal dilatations in a knitted dacron velour graft.
The formation of multiple aneurysms in the midportion of Dacron grafts has been reported only twice in the surgical literature. In the present case, three aneurysmal dilatations developed 6 years following an orto-femoral Dacron graft implantation. Multiple structural defects in the Dacron prosthesis appear to be the most likely cause of the graft failure.