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Biomedical subjects

N J Cassisi

Publications and source records attributed to N J Cassisi.

At least 91 records · Page 5Linked to original sources
PubMed1985

The influence of excisional or incisional biopsy of metastatic neck nodes on the management of head and neck cancer.

Between November 1964 and December 1981, 80 patients who had undergone an open biopsy of a cervical lymph node containing squamous cell carcinoma were treated with curative intent in the University of Florida Division of Radiation Therapy. Irradiation was the initial step in the definitive treatment of all patients, followed by neck dissection and/or primary resection, as indicated. The patients were divided into two groups. (a) NX (no gross residual neck disease) (25 patients): According to the referring surgeons' and pathologists' reports, a single, clinically positive lymph node was totally excised in 25 patients. No other clinically positive lymph nodes were appreciated upon referral. No neck dissections were added following irradiation in this group of patients. The absolute 5 year disease-free survival in the NX group was 79%, and the rate of neck disease control was 96%. (b) Gross residual neck disease (55 patients): Gross residual disease remained in the neck in 55 patients following biopsy. In some patients, only an incisional biopsy of a large mass had been performed; in others, only one of several involved nodes was removed. The absolute 5 year disease-free survival in this group of patients was 31%, and the rate of neck disease control was 64%. The more consistent addition of a neck dissection in recent years has resulted in improved neck control rates in this group: 13/20 (65%) for N1-N2 disease and 2/7 (29%) for N3A disease following irradiation alone versus 6/7 (86%) for N2 disease and 5/8 (63%) for N3A disease when a neck dissection was added following irradiation. There are some differences in the rates of neck control, control above the clavicles, survival, distant metastasis, and complications between this series and other reported series in which open neck-node biopsy preceded definitive treatment. Possible reasons for these differences are discussed.

Adolescent↗
PubMed1985

Effects of hyperbaric oxygen and irradiation on experimental skin flaps in rats.

This study investigated the effects of hyperbaric oxygen (HBO) and irradiation (RT) on experimental skin flaps in rats under varying conditions. Animals were assigned at random to 1 of 15 groups that represented all possible ordering effects of HBO, RT, and flap, as well as controls that included flap-only, RT-only, and HBO-only groups. Cranially based skin flaps measuring 3 x 9 cm were elevated on the dorsum. The surviving length was evaluated with fluorescein dye 7 days after the operation. Rats receiving HBO were subjected to four consecutive 2-hour treatments of 100% oxygen at 2.5 atmospheres with half-hour intervals of room air. Depending on the treatment condition, HBO was given either 48 hours or 24 hours before flap elevation, or within 4 hours or 48 hours after flap elevation. Rats receiving RT (60Co) were given a single dose of 1000 rads to the dorsum. Results showed that all groups receiving HBO within 4 hours after flap elevation had significantly greater flap survival length (P less than .05), with as much as a 22% greater length of surviving flap. HBO given 48 hours before flap elevation also significantly improved flap survival over controls (P less than .05). RT appeared to have no immediate significant effect on flap survival. However, rats receiving RT, regardless of other factors, gained significantly less weight than did controls (P less than .001). Findings clearly indicate that, to be effective, HBO needs to be given as soon after surgery as possible.

Animals↗
PubMed1985

Biologically aggressive papillomas of the nasal cavity: the role of radiation therapy.

Five patients were irradiated at the University of Florida for advanced and/or recurrent papillomas of the nasal cavity and paranasal sinuses from December 1969 through December 1981. Three patients were irradiated either before or after resection and two patients were treated with radiation therapy alone. Two patients had pure inverted papilloma, one patient had inverted papilloma associated with a focus of squamous cell carcinoma, and two patients had cylindrical cell papillomas. Four patients are alive and continuously disease free at 3, 3, 4, and 11 years following treatment. One patient died of intercurrent disease nine years following treatment without evidence of recurrent tumor.

Aged↗
PubMed1984

Stage T3 squamous cell carcinoma of the glottic larynx treated with surgery and/or radiation therapy.

This is a retrospective analysis of 68 patients with Stage T3 squamous cell carcinoma of the glottic larynx treated with surgery and/or irradiation from March 1965 to April 1981 at the University of Florida. Follow-up ranged from 2 to 17.5 years. Initial local-regional control of disease above the clavicles (i.e., prior to salvage attempts) by treatment technique for patients at risk for greater than or equal to 2 years was 11/19 (58%) with irradiation alone, 5/7 (71%) with preoperative irradiation and surgery, 8/9 (89%) with surgery and postoperative irradiation, and 18/23 (78%) with surgery alone. Initial control of disease at the primary site was accomplished in 11/18 (61%) treated with radiation therapy alone, and ultimate control of the primary was obtained in 15/18 (83%) after surgical salvage. Analysis of complications and survival is included, and treatment recommendations are discussed.

Carcinoma, Squamous Cell↗
PubMed1984

Results of twice-a-day irradiation of squamous cell carcinomas of the head and neck.

The results of twice-a-day irradiation for moderately advanced and advanced squamous cell carcinomas of the head and neck in 57 patients, treated at the University of Florida between March 1978 and July 1981, are reviewed. Fifty patients received irradiation alone to the primary site with or without neck dissection; 7 patients received preoperative irradiation (5040-6000 rad) followed in 4-6 weeks by resection of the primary tumor and neck dissection(s). Two 120 rad treatments were administered daily, with a 4-6 hour interval between fractions. External beam tumor doses were usually 7440-7680 rad when irradiation alone was used for the primary lesion; 2 of 3 T2 and 11 of 13 (85%) T3 lesions that received greater than or equal to 7440 rad remain locally controlled at 2-5 years' follow-up. External beam doses of 7440 rad controlled only 1 of 10 T4 cancers; higher doses controlled 3 of 8 T4 lesions. One severe complication of irradiation and 2 severe complications of salvage surgery have occurred in the group that received irradiation alone to the primary lesion. Five of the 7 patients who received planned combined preoperative irradiation plus surgery to the primary tumor were alive and free of disease at 2 years. Absolute disease-free survival at 2 years for the entire patient group was 23/57 (40%).

Adult↗
PubMed1984

Squamous cell carcinoma of the supraglottic larynx treated with radical irradiation: analysis of treatment parameters and results.

Eighty-one patients were treated with radical radiation therapy, with or without immediate neck dissection(s), for squamous cell carcinoma of the supraglottic larynx from October 1964 through May 1981. There is a 2-year minimum follow-up on all patients; 75/81 (93%) have a minimum 3-year follow-up, and 58/81 (72%) have at least a 5-year follow-up. Patients were staged according to the 1983 AJCC staging system. Patients were excluded from the local control analysis if they died less than 2 years from treatment with the primary site controlled. The initial local control rates and ultimate local control rates after surgical salvage of irradiation failures were as follows: T1, 11/12 (92%) and 12/12 (100%); T2, 20/26 (77%) and 23/26 (88%); T3, 9/14 (64%) and 11/14 (79%); and T4, 2/11 (18%) and 5/11 (45%). The incidence of severe complications was 3/81 (3.7%). The 5-year absolute and determinate survival rates by AJCC stage were as follows: I, 6/12 (50%) and 6/6 (100%); II, 5/6 (83%) and 5/5 (100%); III, 4/8 (50%) and 4/5 (80%); and IV, 6/32 (19%) and 6/26 (23%).

Carcinoma, Squamous Cell↗
PubMed1984

Carcinoma of the nasal vestibule.

Squamous cell carcinomas of the nasal vestibule are essentially skin cancers that require special therapeutic considerations because of the regional anatomy. They have sometimes been considered poorly suited for treatment by irradiation because of potential or actual cartilage and/or bone invasion and therefore have been treated by surgical resection, sometimes producing defects that are difficult to reconstruct satisfactorily. From 1966 to April 1980, 13 patients with squamous cell carcinoma of the nasal vestibule were treated with radiotherapy at the University of Florida. Eight lesions were de novo; 5 were recurrent after 1 or more surgical procedures. Treatment consisted of radium needle implantation and/or external beam therapy. Neck management was individualized. All de novo and 4 of 5 recurrent lesions were controlled locally. Cosmetic results were good in patients with de novo lesions. There were no instances of significant cartilage or soft tissue necrosis despite cartilage involvement by tumor in 6 cases.

Adult↗
PubMed1983

Treatment of early vocal cord carcinoma: a comparison of apples and apples.

Radiation therapy, hemilaryngectomy, and even cordectomy will cure a very large percentage of patients with early vocal cord cancer and preserve the voice. However, hemilaryngectomy and cordectomy are conceded by most surgeons to usually produce a poorer voice, compared to radiation therapy, and the operations are restricted to certain anatomical distributions. Those surgeons advocating hemilaryngectomy or cordectomy have compared their results with radiation therapy series which include a proportion of patients with lesions not suitable for voice-sparing operations. One hundred and thirty-nine patients with T 1-2 carcinoma of the vocal cords with a 2-15 year follow-up, who were treated initially by radiation therapy, were analyzed in detail by initial extent of disease. Patients were identified whose lesions were anatomically suitable for hemilaryngectomy or cordectomy, and results for these patients compared to operative results. Since the curative results with voice sparing by irradiation were at least equal, and since the quality of the voice is thought to be much better, there is little justification for recommending a major operation except in specific situations. Lesions initially suitable for voice-sparing operations which subsequently recur after irradiation can usually be treated by a voice-sparing operation.

Carcinoma↗
PubMed1982

Chemodectomas arising in temporal bone structures.

Eighteen patients with chemodectomas arising in temporal bone structures were evaluated and treated at the University of Florida. Seventeen patients have each been followed a minimum of 3 years. Patients were retrospectively staged as having "local" or "advanced" disease, depending on the presence or absence of bone destruction and/or cranial nerve involvement. Fourteen of the patients received radiation therapy as all or part of their therapy; 6 patients were treated with radiation therapy alone, 3 patients were irradiated immediately postoperatively for residual disease, and 5 patients had radiation therapy for recurrence after operation. They were treated with cobalt-60 radiation with doses ranging from 3760 to 5640 rad. All irradiated patients demonstrated evidence of tumor regression, and none have had tumor recurrence with followup of 3-12 years. Of the 8 patients with cranial nerve paralysis prior to therapy, 5 had return of function of 1 or more cranial nerves. One of 6 patients treated initially with radiation therapy had a complication, while 6 of 8 patients irradiated postoperatively had complications. None of the complications were fatal. Three patients treated by operation for early disease limited to the hypotympanum had the disease controlled for 11-12 years. Guidelines for the selection of initial therapy are discussed.

Humans↗
PubMed1982

Carcinoma of the base of the tongue: results of radical irradiation with surgery reserved for irradiation failure.

Between 1964 and 1977, 95 previously untreated patients with squamous cell carcinoma of the base of the tongue received treatment with curative intent at the University of Florida. Eighty-six of the 95 patients (91%) had Stage III or IV disease at presentation. Eighty-nine patients received radical courses of irradiation to the primary with or without neck dissection(s), with surgery reserved for salvage of irradiation failure. Six patients underwent planned combined treatment of the primary lesion. Of the 89 patients whose primary lesions were radically irradiated, failure at the primary site occurred in 24% of those with T1-3 lesions and 78% with T4 lesions. Control results were related to irradiation treatment technique. None of the 9 patients with Stage I-II disease died of the cancer. Actuarial survival at 5 years for Stage III patients was 46%. Within the Stage IV population there is a subgroup of patients with highly treatable and curable disease. The addition of a neck dissection following irradiation of N2-N3 neck disease decreased the incidence of failure in the neck. No patient developed severe soft tissue necrosis or required mandibulectomy for bone exposure following irradiation.

Carcinoma, Squamous Cell↗
PubMed1981

Radical irradiation for carcinoma of the pyriform sinus.

Radiation therapy is sometimes prescribed as an alternative to partial or total laryngopharyngectomy in the initial management of carcinoma of the pyriform sinus. Forty-two patients were irradiated for cure and have a follow-up period of 2-14 years. Local control by irradiation alone was 11 of 14 for T1, 6 of 10 for T2, 3 of 6 for T3, and 1 of 7 T4. Three T2 failures were salvaged by laryngopharyngectomy for an ultimate control of 9 of 10 for T2. Management of the neck is critical since 79% of the patients presented with clinically positive necks, and many had substantial neck disease. Complete or partial neck dissection was added after irradiation on an individualized basis. In spite of the extensive degree of neck disease, only three patients died of uncontrolled neck disease with the primary controlled. The two-year absolute survival for Stages I and II was 83%, Stage III 62% and Stage and Stage IV 52%. The five-year absolute survival for Stages I and II was 66%, Stage III 38%, and Stage IV 10%. Complications of irradiation, neck dissection, and surgical salvage procedures are reviewed.

Head and Neck Neoplasms↗
PubMed1979

Fractures of the zygoma. A geometric, biomechanical, and surgical analysis.

We present a four-part study of the cosmetic results of common zygomatic fracture reduction techniques: (1) a geometric analysis of an idealized paper and clay model; (2) a topographic analysis of zygomatic fractures in the dry skull; (3) a biomechanical analysis of fixation techniques in the fresh cadaver; and (4) a retrospective and prospective review of our clinical experience. The following are concluded: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Masseteric contraction may cause late displacement in poorly fixed fractures. Two-point interosseous fixation at the "buttress" fracture and the frontozygomatic fracture is suitable for routine surgery. The infraorbital rim may be aligned through the gingivobuccal sulcus incision. Transcutaneous incisions may be limited to the brow incision. The transconjunctival approach is suitable for orbital floor repair.

Biomechanical Phenomena↗
PubMed1979

Upper airway obstruction during sleep in children.

Cinefluoroscopic findings are described in nine children with sleep-related upper airway obstruction who are asymptomatic while awake. Asleep, these patients show strikingly similar changes in the region of the hypopharynx. During inspiration, the tongue and hypopharyngeal soft tissues are approximate, obliterating the hypopharyngeal air space causing intermittent and almost complete obstruction to air flow. The value of cinefluoroscopic studies on sleeping children with clinical symptoms of airway obstruction during sleep is emphasized.

Airway Obstruction↗
PubMed1978

Squamous cell carcinoma of the skin metastatic to parotid nodes.

Preauricular masses may represent metastases to parotid nodes from carcinoma of the skin of the face, scalp, and neck. At the University of Florida from January 1966 to March 1977, a total of 20 patients were treated whose first evidence of metastasis was a preauricular mass ranging in size from 1 to 6 cm. All had been treated from two weeks to five years previously for at least one ipsilateral squamous cell carcinoma of the face or scalp. In no patient has a mucosal primary site of the head and neck subsequently developed. Treatment consisted of surgery or irradiation of both. The results suggest that superficial parotidectomy is usually inadequate for complete removal of these nodes, since the nodes lie lateral to the posterior facial vein and not the facial nerve. Surgery followed by irradiation appears to result in better survival than either modality alone.

Carcinoma, Squamous Cell↗