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Biomedical subjects

L W DeSanto

Publications and source records attributed to L W DeSanto.

At least 19 recordsLinked to original sources
PubMed1992

Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy.

The records of patients with pathologically confirmed metastatic squamous cell carcinoma involving cervical lymph nodes who were treated at the Mayo Clinic between January 1965 and December 1987 were reviewed. In 117 patients a primary tumor could not be discovered. Of these, 24 patients underwent curative resection of all gross disease by neck dissection or excisional biopsy. All 24 patients presented with unilateral adenopathy. Their median age was 63 years. Eighteen patients were men. Fourteen patients were in clinical stage N1; six, N2a; three, N2b; and one, N3. Six patients had grade 1 or 2 nodal metastases; 14, grade 3; and 4, grade 4. Gross or microscopic evidence of extracapsular tumor extension was noted in eight patients. All patients were followed until death or for a median of 8.5 years (range, 3.3-20.4 years). A squamous cell carcinoma of the upper aerodigestive tract subsequently developed in only one patient (4%) within 5 years of operation. In six patients (25%), a recurrence developed in the dissected neck a median of 3 months (2.4 months-6.6 years) after operation. Five of these patients had extracapsular extension, and four had pathologic Stage N2a or higher neck disease. Both patients with pathologic Stage N1 disease who had recurrences in the dissected neck had extracapsular extension. Delayed, contralateral neck metastases in an undissected neck developed in two patients. The 5-year overall and cause-specific survivals for all 24 patients were 66% and 74%, respectively. Extracapsular extension was a predictor of neck recurrence, control of disease above the clavicles, cause-specific survival, and overall survival. Patients with pathologic Stage N1 neck disease with no extracapsular extension can be managed by surgery alone. Patients with pathologic Stage N2 or higher neck disease or extracapsular extension should be considered for postoperative, adjuvant radiation therapy.

Adult↗
PubMed1979

Reconstruction after total laryngopharyngectomy.

After resection of a hypopharyngeal cancer, utilization of the remaining pharyngeal mucosa in restoring pharyngoesophageal continuity is the procedure of choice. This is possible in most patients. However, a few patients have cancers that involve the posterior pharyngeal wall and esophageal introitus. Resection in this group involves complete removal of a segment of the laryngopharynx and reconstruction with the use of tissue from the adjacent side of the neck, chest, or alimentary canal. Between 1965 and 1974, 44 patients required reconstruction of a pharyngeal defect with the use of adjacent skin flaps or visceral interposition. Pharyngeal reconstruction with the use of these techniques involved multiple operative procedures, a greater morbidity, and a large time investment by the patient and surgeon. Survival of these patients was shorter than survival of patients who had repair by primary closure of the pharyngeal mucosa because of the extent of the primary lesions.

Adult↗
PubMed1979

Squamous cell carcinoma of the tonsil and tongue-base region.

From 1969 through 1975, 145 patients were treated for squamous cell carcinoma of the tonsil and tongue-base region; 119 received initial treatment, and salvage operations were done in 26. The overall five-year survival rate was 42%. Cervical metastasis was the most important determinant of survival. Pathologic stage I or II disease was controlled by surgical treatment. In patients with stage III or IV disease, operation alone controlled the primary lesion better than radiation alone or combined preoperative radiation and surgical treatment. With operation alone, however the rate of neck recurrence was higher than with the other two methods of treatment. In advanced disease, surgical treatment combined with postoperative radiation should be considered. Mandibular osteotomy and excision of the primary lesion are as effective in local tumor control as composite resection. In patients with a tumor-free margin, osteotomy can be used to preserve the mandible.

Aged↗
PubMed1979

No morphometric abnormality recurrent laryngeal nerve in spastic dysphonia.

Spastic dysphonia is a disorder of phonation that is usually markedly improved by surgical resection of one recurrent laryngeal nerve (RLN). In this study, biopsies of the RLN were obtained at surgery from nine patients with spastic dysphonia (disease group) and eight patients with laryngeal cancer (control group). The RLN was found to be composed of several nerve regions having characteristic fiber compositions. For the various nerve regions and for the whole nerve, we evaluated morphology, median fiber diameter, density, and size distribution of fibers. The morphologies of teased fibers were also evaluated. We found no significant differences between the nerves of the disease and control groups. Therefore, we were unable to verify previous reports of neuropathic abnormality of the RLN in spastic dysphonia.

Adult↗
PubMed1979

Osteoma: an unusual cause of amaurosis fugax.

A 16-year-old white boy presented with a history of amaurosis fugax associated with an afferent pupillary defect, proptosis, discomfort of the left eye. Tomograms of the skull and of the orbit revealed a lobulated 4-cm ivory osteoma arising from the left ethmoid sinus and extending into the maxillary sinus and left orbit. After surgical extirpation, visual acuity returned to normal and the papilledema resolved after 4 months. This patient is 1 of 37 patients with osteoma of the paranasal sinuses or of the orbit (or of both) who underwent surgical treatment at the Mayo Clinic between the years 1948 and 1977. Twelve of these patients had orbital involvement, and only these patients had ocular signs and symptoms.

Adolescent↗
PubMed1979

Nasolacrimal duct obstruction following transantral-ethmoidal orbital decompression.

Of 200 patients undergoing bilateral transantral-ethmoidal orbital decompression for Graves' ophthalmopathy, nine suffered symptomatic postoperative obstruction of the lower nasolacrimal excretory system. Five of the nine patients had persistent symptoms of epiphora or repeated episodes of dacryocystitis that necessitated dacryocystorhinostomy. Dacryocystorhinostomy relieved symptoms and objective evidence of obstruction in these five patients. We believe that nasolacrimal duct obstruction occurred in these patients as a complication of nasoantral window construction.

Dacryocystitis↗
PubMed1978

Congenital deafness and spontaneous CSF otorrhea.

Two patients with congenital deafness had spontaneous CSF otorrhea and recurrent bacterial meningitis. A careful workup, including tomograms, is especially important in the treatment of the closed type of CSF otorrhea. At operation of our patients, the leak was found to be at or near the oval window. The stapes was removed, and muscle was packed into the defect. The profuse flow of CSF was believed to be secondary to a wide-open cochlear aqueduct in the first case, and to an abnormal communication between the internal auditory meatus and the vestibule in the second case. These findings were the bases for the recurrent bacterial meningitis.

Adolescent↗
PubMed1978

Cellular mixed tumors of the salivary glands.

Mixed tumors are unusual in that they possess both epithelial and mesenchymal elements. The proportions of the two elements vary greatly; the lesions with a pronounced preponderance of epithelial tissue have been called cellular mixed tumors. This increase in epithelial cellularity often results in misdiagnosis or in concern that the tumor may be more aggressive than the ordinary mixed tumor--possibly even malignant. We have reviewed 1,095 consecutive parotid tumors that were removed at the Mayo Clinic, Rochester, Minn, from 1950 through 1970. Ninety-three of the lesions were diagnosed initially as cellular mixed tumors, and slides were available for review. Of these 93, 43 fulfilled our criteria of having greater than 80% of each tumor composed of the packed epithelial cells. All tumors had a corresponding reduction in the mesenchymal portion. The records of the 43 patients were studied to determine the clinical behavior of these neoplasms, particularly with regard to recurrence, metastasis, and malignant transformation. Our findings confirmed our clinical suspicions that some of these cellular mixed tumors, notably those that showed histopathologic evidence of an increased rate of mitotic activity, can and do act in a more aggressive manner.

Adenoma, Pleomorphic↗
PubMed1977

Verrucous carcinoma of the larynx.

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow-growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.

Adult↗
PubMed1976

Carcinoma of the supraglottic larynx. A review of 221 cases.

Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.

Aged↗