[Giant-cell epulis. II. Histological aspects].
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Biomedical subjects
Publications and source records attributed to S Gandolfo.
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Eighty-four previously untreated patients (69 males, 15 females) with squamous carcinoma of the tongue (30 patients), floor of the mouth (30), cheek (16), and retromolar region (8) were treated using a protocol comprising cryosurgery + chemotherapy, followed by external 60Co radiotherapy. The follow-up period was at least 6 months (median, 50 months). Cryosurgery (1-2 sessions in 49 T1-2 cases; 2-4 in 35 T3-4 cases) was accompanied by a CMF (cyclophosphamide, methotrexate, 5-fluorouracil) schedule (T1-2, two courses; T3-4, three courses). Radiotherapy was given 15 to 20 days after combined cryochemotherapy (T1, 50 Gy on tumor and lymph nodes; T2-3-4, same with an extra dose of 10 to 15 Gy on the primary lesion). Complete remission was reached 4 months after treatment in 76 of 84 patients (90.5%). Survival with no evidence of disease (NED) in the 57 patients (27 T1-2, 30 T3-4) with a follow-up of more than 3 years was 59.6% for the series as a whole, 70.3% for T1-2, and 50.0% for T3-4; 78.2% for the tongue, 52.6% for the floor, 66.6% for the cheek, and 0% for the retromolar region. The picture was much the same after 5 years. Actuarial survival at 6 years was 66% in the series as a whole, 75.5% in T1-2, and 57.5% in T3-4 (tongue 86.9%, floor 56.1%, cheek 68.4%, and retromolar region 0%). It is believed that the results obtained in tumors of the tongue, floor and cheek, coupled with the conservative aspects of the protocol, make it a suitable subject for a controlled trial.
UNLABELLED: Eighty-five patients (74 males, 11 females) with untreated squamous-cell carcinoma of the tongue (40 patients) and the floor of the mouth (45 patients) underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 52 months). T1-4N0M0 lesions (tongue; 32 patients; floor of mouth, 32 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with CMF (cyclophosphamide, methotrexate, fluorouracil) (T1-2: 2 courses; T3-4: 3 courses). 15-20 days after the end of cryo-chemotherapy the patients underwent TCT (T1: 50 Gy to the tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy to the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor of mouth: 13) received the same cryotherapy and chemotherapy, followed by surgery (13 extended suprahyoid dissections, 8 conservative laterocervical dissections, 1 RND). The actuarial survival rate of patients with tongue tumours after 6 years was 81.4% (N0 87.1%; N+ 60.0%). Four months after treatment, 35 patients had reached complete remission (CR). The probability of remaining in CR for 6 years was 53.6% (N0 56.1%; N+ 50.0%). For tumours of the floor of the mouth the actuarial survival rate was 55.2% (N0 56.5%; N+ 48.6%). Four months after treatment, 38 patients had reached CR. The probability of remaining in CR for 6 years was 59.9% (N0 61.5%; N+ 59.3%). A controlled study is recommended in the light of these results and the conservative nature of the protocol.
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UNLABELLED: One hundred and twelve patients (95 males, 17 females) with untreated squamous-cell carcinoma of the oral cavity underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 51 months). T1-4N0M0 lesions (tongue, 31 patients; floor, 31 patients; cheek, 17 patients; retromolar, 9 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with (cyclophosphamide, methotrexate, fluorouracil)(CMF) (T1-2:2 courses; T3-4: 3 courses). The patients, 15-20 days after the end of cryo-chemotherapy, underwent TCT (T1: 50 Gy on tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy on the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor: 13, cheek: 2, retromolar: 1) received the same cryotherapy and chemotherapy, followed by surgery (16 widened suprahyoid dissections, 8 conservative laterocervical dissections, 1 radical neck dissection). Overall actuarial survival at six years was 61.9%: T1-4N0M0 (88 patients) 66.6% (T1-2 76.0%; T3-4 56.9%); T1-4N1-3M0 (24 patients) 44.4% (T1-2 66.6%; T3-4 33.3%). Six-year actuarial survival by site was: tongue (39 patients) 79.2% (N0 85.9%); floor (44 patients) 55.2% (N0 57.1%); cheek (19 patients) 74.2% (N0 68.9%); retromolar (10 patients) 0% (N0 0%). Complete remission was reached four months after treatment by 97 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in 4/7 patients with benign oral lesion and in 9/10 patients with oral cancer. All 4 oral leukoplakias were positive for CEA. The histologic presence of CEA in oral cancer was related mainly to the formation of well differentiated tissue. The anaplastic carcinoma was negative. These findings indicate that CEA is a product of differentiated cells and should not be considered exclusively an oncofetal antigen or a marker of undifferentiated cells.
Following earlier personal studies indicating that cryosurgery stimulates several non-specific immunological parameters, mainly those of the cell-mediated component, in patients with squamous-cell carcinoma of the oral cavity, inhibition of leukocyte migration (evaluated by means of the LIF test) was investigated, using a heterologous squamous-cell tumour extract, before and 7 and 14 days after a single cryotherapy session in 14 patients (11 in stages I and II, 3 in stages III and IV). Increased inhibition was observed after 7 days in 8 subjects (57.2%)-72.7% in stage I-II patients. In two cases, reactivity appeared for the first time. In 7/8 cases, this increase persisted, though at lower levels, until the 14th day. The conclusion is drawn that cryosurgery can stimulate specific delayed hypersensitivity in stage I-II squamous-cell carcinoma of mouth.
Five-year results in 60 oral and pharyngeal cancer patients treated with combined approach chemoradiotherapy (39 patients) and chemoradiotherapy plus lymph node surgery (21 patients) are reported. Complete remission (CR) was achieved in 16/39 (41%) patients treated with chemoradiotherapy alone, and in 16/21 (76%) patients who had chemoradiotherapy plus surgery. The number of CR was statistically (chi-square test) higher (p less than 0.025) in the second group. The 5-year actuarial survival was 39.7% in the group of patients treated with chemoradiotherapy plus surgery. After 5 years 53% of the patients who reached CR are living free of disease in the first group and 76% in the second group.
In previous works the Authors have shown that cryosurgical treatment of oral squamous cell cancer modifies numerous aspecific immunological parameters mostly concerning the cell-mediated component. In the present work the Authors have studied the leukocyte migration inhibition (LMI) response in vitro of peripheral blood leukocytes from patients affected by oral squamous cancer to oral tumor antigens using the leukocyte migration agarose test. The LMI was evaluated immediately before cryosurgical treatment of oral squamous cell carcinoma and 7 and 14 days after. The results suggest that cryosurgery is able to stimulate the specific cell-mediated response of patients affected by early stage carcinoma of oral cavity.
The authors have evaluated general immunocompetence after cryosurgical treatment of 11 patients affected by benign oral lesions and of 17 patients affected by oral squamous carcinoma. Serum immunoglobulin levels, C3-C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analyzed before a single cryotreatment and 7 and 14 days after. In the patients affected by benign lesions the observed variations seem to suggest that in these cases cryosurgery has a merely mechanical action of extirpation of the lesion and the consequent extinction of the phenomena reactive to the same lesion. In cancer patients, cryosurgery modifies numerous immunological parameters mostly concerning the cell-mediate components.
The authors have evaluated general immunocompetence of 10 pts. after a cryosurgery treatment for oral squamous cell carcinoma. Serum immunoglobulin levels, C3 - C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analized before and after 7 and 14 days a single cryotreatment. Humoral immunity was scarcely modified by the cryosurgery; on the contrary a statistically significant augment of peripheral large lymphocytes (p < 0,0001), T-lymphocytes (p < 0,025) and lymphocyte response to PHA (p < 0,001) was found both after 7 and 14 days.
The results of two studies on tolerability and efficacy of mezlocillin/oxacillin are reported. The pain caused by i.m. injection of 1 g (20% solution) of the fixed antibiotics combination mezlocillin/oxacillin is compared with that caused by 1 g ampicillin. The injection volume was 5 ml. The statistical analysis of the patients' statements indicates a better tolerance of the fixed antibiotics combination mezlocillin/oxacillin than of ampicillin. The second study was determined the clinical efficacy and tolerability of mezlocillin/oxacillin in the treatment of wound infections, biliary tract infections, urinary tract infections, appendicitis and peritonitis. 19/20 patients were clinically cured after about 7 days o treatment with i.m. injections of 1.5 g mezlocillin/oxacillin in 6 ml of a 25% aqueous solution t.i.d. Treatment had to be discontinued after 3 days in one case because of a generalized exanthema. No other side effects were reported. These studies show that both the i.m. injection o the 20% solution of 1 g mezlocillin/oxacillin combination and the 25% solution of 1.5 g of this combination are tolerated without problems.
To evaluate the intensity of the localized pain caused by intramuscular administration of 6-[(R)-2-[3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido]-2-phenyl-acetamido]-penicillanic acid sodium salt (mezlocillin, Baypen), the pain was compared to that caused by ampicillin in a blind test. Ampicillin served as reference because of its extensive use. 50 patients were given 1 g of mezlocillin and 1 g of ampicillin successively, in both gluteal regions. Ampicillin is significantly more painful than mezlocillin. However, substantial pain is produced by both drugs. In a second study, to reduce the pain, 50 patients were given 1 g of mezlocillin twice, one injection was given in a period of 5-7 s, and the other in a 12-15 s period. The slower injection is significantly less painful than the faster one. In conclusion, i.m. administration of mezlocillin is less painful than that of ampicillin, and the slow injection reduces the pain of mezlocillin administration.
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