Search PubMed⌕ Search

Biomedical subjects

L W DeSanto

Publications and source records attributed to L W DeSanto.

At least 37 records · Page 2Linked to original sources
PubMed1989

Utility of near-total laryngectomy for supraglottic, pharyngeal, base-of-tongue, and other cancers.

This report emphasizes the utility of the near-total laryngectomy for those patients in whom conventional conservation surgery is an option but may be oncologically or physiologically unsafe. The near-total operation can be offered for supraglottic cancer, pharyngeal cancer, and, more commonly, primary glottic cancer with cord fixation. Its application is described for patients who are candidates for conventional conservation surgery but are compromised physiologically by age or poor general health and for patients in whom tumor extent would not permit safe conventional conservation surgery.

Adult↗
PubMed1989

Space-occupying orbital lesions: can critical increases in intraorbital pressure be predicted clinically?

Thirteen cadaver orbits were studied to determine whether noninvasive clinical measurements of globe excursion could be used to predict intraorbital pressure. Intraorbital pressure measurements, exophthalmometry, and orbitonometry (which measures resistance to globe retrodisplacement) were performed at 1-ml increments to 12 ml of added orbital volume. Orbitonometry, performed with forces of 100, 200, and 300 g, yielded both E (global position) and Y (retrodisplacement) values. Plots of orbital pressure against percentage of excursion, a function of orbital retrodisplacement (that is, orbital pressure versus [(E0 - E300)/E0] x 100), for 131 paired values over all orbits yielded a function with low percentage of excursion values associated with high intraorbital pressures. This relationship reflected both the proptosis and the increased orbital tension produced by added volumes. Comparison of clinical orbitonometry data with such experimental data may allow predictions about which patients are threatened by critical intraorbital pressure levels and may benefit from orbital decompression surgery to preserve vision.

Adult↗
PubMed1988

Facial paralysis and occult parotid cancer. A characteristic syndrome.

Extratemporal involvement of the seventh cranial nerve is often secondary to a tumor of the parotid gland. We describe six patients who had facial paralysis associated with an occult malignant neoplasm of the parotid gland. Initial evaluations in these patients, including computed tomography and magnetic resonance imaging, provided no evidence of a parotid tumor. Four of the six patients had a progressive triad of ear pain, facial paralysis, and sensory loss in the second and third divisions of the trigeminal nerve. This pattern indicates a high probability of a malignant lesion of the parotid gland, even in the presence of normal findings on noninvasive studies.

Adenocarcinoma↗
PubMed1988

Neoplasms of the vagus nerve.

A tumor of the vagus nerve often is discovered unexpectedly at operation. We report 36 of these rare neoplasms in 35 patients. The majority of the tumors presented as a mass in the upper cervical or parapharyngeal region. Usually the mass was asymptomatic. The following types and frequencies of neoplasms of the vagus nerve were noted: paragangliomas, 50%; neurilemmomas, 31%; neurofibromas, 14%; and neurofibrosarcomas, 6%. Surgical resection, with preservation of the vagus nerve when possible, is the treatment of choice. The clinical features, diagnosis, management, and prognosis of the tumors are presented. Special problems that occur with vagal neoplasms include postoperative dysfunction, catecholamine secretion, and intracranial or skull-base extension.

Adolescent↗
PubMed1988

Total pharyngolaryngectomy and cervical esophagectomy with jejunal autotransplant reconstruction: complications and results.

Eighteen patients underwent pharyngoesophageal reconstruction with a free jejunal autotransplant in a one-stage procedure after circumferential resection for cancer of the pharynx and cervical esophagus. Of these, six had minor complications (fistulas) and six had major complications including abdominal bleeding, cervical bleeding, graft failure, and one surgical death. The mean survival was 427 days after resection and reconstruction (range, 120 to 866 days). Ten patients died of their disease, and four died of other causes. The site of failure was local in five and distant in five. In view of this high complication rate and unimpressive survival rate, the use of other lower-morbidity reconstructive options or staged procedures may need to be considered in poor surgical candidates.

Adult↗
PubMed1988

Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck.

The relative merits and indications for complete or modified dissection of the neck are straightforward. Which operation is selected centers on the perception of the value of the preservation or the risk with the loss of one or more of three structures: the spinal accessory nerve, the internal jugular vein and the sternocleidomastoid muscle. If these were the only issues, the choice of operation would be easy. Unfortunately, some of the most contentious issues in treatment of metastasis to the neck have been linked with the concept of the modified neck dissection. Such issues as combined multimodality therapy, preoperative and postoperative radiation therapy or surgical treatment alone, prophylactic dissection and bilateral simultaneous dissection of the neck are rightly or wrongly tied in with the type of dissection of the neck. More information, such as the certainty of the real risk factors in the neck with metastatic disease, the real value, if any, of adjunctive combined therapy and basic information about the role of the nodes in the neck, is necessary before the debate on the modified versus the radical dissection of the neck will end.

Carcinoma, Squamous Cell↗
PubMed1987

Migration of Teflon after vocal cord injection.

Each of eight mongrel dogs received a 0.5 ml injection of polytef paste into the right vocal fold. These dogs were killed at 1 week, 1 month, 3 months, and 6 months after injection, and a number of organs were examined. Polarizing microscopy was used to examine the upper cervical lymph nodes, lower cervical lymph nodes, mediastinal lymph nodes, abdominal lymph nodes, cerebral cortex, brainstem, lung, liver, spleen, and kidney to determine if migration of polytef had occurred. Examination of these organs revealed that there was consistent migration of polytef particles into the cervical lymph nodes, with the highest incidence occurring in upper cervical lymph nodes on the side of injection. There was no evidence of migration of polytef particles to distant sites. The study shows that polytef particles may migrate to cervical lymph nodes after injection into the larynx; however, there is no evidence of distant migration.

Animals↗
PubMed1987

Positive Delphian lymph node: clinical significance in laryngeal cancer.

The significance of metastatic cancer in the Delphian lymph node in patients with laryngeal carcinoma has not been thoroughly discussed. Between 1960 and 1985, we identified 20 cases of histologically proven metastasis to the Delphian node. In 12 of these patients with glottic cancer (T1-T3), the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy; in 6 patients, ipsilateral neck metastasis developed. Eleven of the 20 patients have died from their laryngeal cancer. The frequency of neck metastasis or death, or both, from cancer is unusually high in patients with a positive Delphian node.

Aged↗
PubMed1986

Oncocytic and oncocytoid carcinoid tumors (well-differentiated neuroendocrine carcinomas) of the larynx.

Carcinoid tumors of the larynx are exceedingly rare neoplasms. With the inclusion of the five neoplasms we report herein, the total number reported in the English-language literature is 16. These five neoplasms all showed light microscopic features of oncocytic (or oncocytoid) cells. Ultrastructurally, all lesions contained dense-core granules of the neurosecretory type. One case further met the ultrastructural criteria for true oncocytoma (that is, an oncocytic carcinoid). The lesion did not metastasize, and the patient was successfully treated surgically. In the other four cases, the lesions were considered to be oncocytoid carcinoids, since they failed to meet the ultrastructural requirements of a true oncocytoma. Each of these four lesions metastasized, although one patient did have a long, indolent course.

Aged↗
PubMed1986

Juvenile angiofibromas. Behavior and treatment of extensive and residual tumors.

In a 15-year period, 40 juvenile angiofibromas were treated surgically (lateral or extended rhinotomy) at the Mayo Clinic, Rochester, Minn. Tumors were staged according to size and extension by using the Sessions classification. Stage III tumors involved the middle fossa or cavernous sinus or both structures, with or without extension into the orbit. Seven patients had stage I, ten had stage IIA, and six had stage IIB disease. Five tumors extended to the skull base (stage IIC). There were 12 cases that included intracranial extension (stage III), none of which involved the sella. There were eight cases with residual tumor: four (stages IIB [one], IIC [one], and III [two]) were not treated again, and four (stage III) were treated with various methods, including operation, embolization, and irradiation. No patient died. No complications or morbidity was experienced by the four patients who were not treated for residual tumor.

Follow-Up Studies↗
PubMed1986

Angiofibroma: treatment trends in 150 patients during 40 years.

A series of 150 patients with histologically confirmed angiofibroma examined from 1945 through 1983 was studied to contrast treatment methods and surgical approaches. From 1945 to 1955, treatment consisted primarily of radiation. From 1955 through 1971, the primary method of treatment was surgical removal; the lateral rhinotomy approach was used to expose the tumor and its extensions in most cases. From 1971 through 1983, all tumors were removed surgically. Trends in diagnosis, treatment, and adjunctive therapy at a single institution were evaluated. Specifically, the trends considered were operative approaches, blood replacement with and without hypotensive anesthesia, adjunctive measures such as hormonal therapy or tumor embolization, mortality, and morbidity. Lateral rhinotomy provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, elements of the skull base, temporal fossa, and infratemporal fossa. Surgical treatment, specifically the lateral rhinotomy approach and its extensions, is recommended as the best method of managing angiofibroma in most patients.

Adolescent↗
PubMed1986

Tumefactive fibroinflammatory lesions of the head and neck.

We use the term "tumefactive fibroinflammatory lesion" to describe an unusual fibrosclerosing disorder that appears to be malignant clinically, yet it actually is a benign but destructive tumor. In 12 patients (6 men and 6 women; age at diagnosis, 33 to 71 years), the lesion sites were neck in 4 patients, parotid gland in 4, antrum in 2, nasal cavity in 1, tongue in 1, nasopharynx in 1, and buccal space in 1. Although the biologic behavior and the surgical findings suggest that this lesion is an invasive, aggressive malignancy, the histologic appearance is a benign lesion consisting of an admixture of fibrous tissue and inflammatory cells. Treatment has included surgical removal and radiation therapy. Dramatic resolution of these lesions has occurred with the use of steroids.

Adult↗
PubMed1985

Neck dissection and combined therapy. Study of effectiveness.

Data on 1,385 neck dissections in 1,192 patients were studied to evaluate the effectiveness of treatment with operation alone and with various forms of combined therapy in controlling cervical metastasis. Of the 1,192 patients, 837 were treated by operation (neck dissection) alone, and the remainder had preoperative or postoperative radiation to the primary site and to the entire side of the neck that was dissected. In no stage of neck disease was either form of combined therapy superior to operation alone in decreasing the rates of recurrence. In an attempt to simulate a randomized, prospective study in a clinical situation for which the end results were already known, we used a separate statistical analysis--a case-control technique to specifically address the issue of the effectiveness of postoperative radiation in decreasing the frequency of recurrences after dissection in the various stages of disease. No evidence of a relationship between recurrence and the administration of planned postoperative radiation was found.

Carcinoma, Squamous Cell↗
PubMed1985

Cancer of the supraglottic larynx: a review of 260 patients.

The treatment of supraglottic larynx cancer is still unsettled. The current concerns are the place of conservation surgery, the use of radiation for cure with surgery for salvage, and the management of neck metastasis. In 1976, we reported our experience with treatment of 221 patients with supraglottic cancer. At that time, the issue was the oncologic safety of the conservation operations. That review affirmed that these operations were safe and effective in properly selected patients. This article is on the study of an additional 260 patients treated in a subsequent period. The principal issues addressed in this review are (1) the frequency of recurrence at the primary site in all stages of supraglottic cancer treated surgically and (2) radical radiation with surgery for salvage. This study documents the oncologic effectiveness of the treatment of primary disease with surgery alone for stages I and II supraglottic cancer. For all stages of supraglottic cancer, this study further documents that the control of neck metastasis remains an unsolved problem.

Adult↗
PubMed1985

Lymphoepithelioma (undifferentiated carcinoma) of the laryngohypopharynx.

Lymphoepithelioma (World Health Organization type 3, undifferentiated carcinoma of the nasopharyngeal type) is an extremely rare cancer in the laryngohypopharyngeal regions. We found reports of only 6 such tumors in the English language medical literature; 1 of the 6 was from our institution. We report four additional cases seen at the Mayo Clinic. Radiotherapy controlled disease at the primary site in three of the four cases. The neoplasm has a propensity for early, widespread dissemination. Three of our four patients died of extensive visceral and nodal metastases. One patient has survived eight years without a recurrence.

Carcinoma, Squamous Cell↗