Implant placement in oral squamous cells carcinoma patients treated with chemoradiotherapy: "Sapienza Head and Neck Unit" clinical recommendations.

OBJECTIVE: To date, the treatment of patients affected by head and neck squamous cell carcinoma (HNSCC) is highly challenging for clinicians. Possible therapies are surgical resection of the tumor mass, radiotherapy, chemotherapy or, more often, a combined treatment that inevitably affects both normal and tumor cells. Consequently, patients' anatomy and functions become reduced or altered. Nowadays the functional restoration is significantly improved thanks to the innovation in prosthetic rehabilitation and in radiotherapy. The current IMRT (Intensity Modulated Radiation Therapy) allows planning adequate treatments evaluating different tissues' involvement and radiation dosage. It is possible to define the most suitable sites for implant insertion, using data provided by dose-volume histogram (DVH). This study aims to illustrate the idea of obtaining a unique CT image by blending radiation-planning CT and Cone Beam CT. PATIENTS AND METHODS: Five patients among 54 candidates were selected for this study. Selection criteria were: good general health (PS0-1), age between 18 and 72 years, absence of metastatic disease or local recurrence, disease-free interval of at least 18 months. Radiation planning CT scan and maxillo-facial CT Cone Beam of every patient were overlapped and merged. Only one CT for every evaluated patient was obtained in order to plan the most suitable areas for implant placement. RESULTS: The placement of 10 implants in 5 patients was programmed using the explained method. Patients (all male) were aged between 48 and 72 years old, with a median age of 64.4 years. In every case of this study, a modification of the initial program of implant placement was necessary. The new imaging method we are proposing was able to provide information about radiation isodoses received in the planned osseointegrated implants' positions. CONCLUSIONS: This new method allows operators to correct their own therapy plans and choices, customizing the treatment plan on the actual condition of the patient. Moreover, it makes all the rehabilitation process safer and can reduce the risk of failure, side effects and inconveniences for the patients.

Advances in the Management of HPV-Related Oropharyngeal Cancer.

Patients with human papillomavirus- (HPV-) related oropharyngeal squamous cell carcinoma (OPSCC) have a better prognosis than HPV-negative OPSCC when treated with standard high-dose cisplatin-based chemoradiotherapy. Consistent with this assertion and due to younger age at diagnosis, novel approaches to minimize treatment sequelae while preserving survival outcomes become of paramount importance. Here, we critically reviewed the evidence-based literature supporting the deintensification strategies in HPV-related OPSCC management, including radiotherapy dose and/or volume reduction, replacement of cisplatin radiosensitising chemotherapy, and the use of transoral surgery. Undoubtedly, further researches are needed before changing the standard of care in this setting of patients.

Aesthetic satisfaction in lip and palate clefts: a comparative study between secondary and tertiary bone grafting.

Lip and palate cleft represent one of the most frequently occurring congenital deformity, which includes dental anomalies, such as variation in tooth number and position. In case of hypodontia implant-prosthetic rehabilitation offers significant advantages in terms of function, aesthetics and quality of life and bone graft is usually needed. Secondary bone grafting, generally performed in the mixed dentition phase (years 8-11) seems to be the most successful method to allow for rehabilitation. It's often necessary to perform a tertiary bone grafting in adult age in order to achieve better bone quantity and quality before implant placement. Aim of this retrospective study was to evaluate the aesthetic perception that patients had of themselves comparing dental implants placed in tertiary grafted alveolar cleft sites with a previous secondary grafting to only secondary grafting. Between 2009 and 2012, fourteen alveolar cleft were treated with implant rehabilitation and eleven of them received tertiary bone grafting six months prior to implant placement. All patients were questioned to give a score from 1 to 10 their aesthetic satisfaction of their smile before and after implant rehabilitation and during pre-surgery provisional rehabilitation. At the end of their prosthesis rehabilitation patients who received tertiary bone grafting resulted more satisfied than those who had secondary bone grafting only (9.5 vs 8).

[Changes in the organization of the extracellular matrix at the skin level during diabetes]. / Alterazione dell'organizzazione della matrice extracellulare a livello cutaneo in corso di diabete.

The ultrastructural study of cutaneous biopsies in diabetic patients highlighted in different phases of disease a progressive alteration of extracellular matrix (E.M.). In the initial phase of disease the morphologic aspect showed an increased accumulation of proteoglycan biglycan, laminin, fibronectin and type IV collagen. These components are responsible for the lamina lucida expansion and are induced by TGF-beta. In the last phase of the disease, an accumulation and a defective organization of E.M. component arises. Type V collagen, normally not present in the skin, is observed. In patients with over ten years of diabetic history, the morphological aspect is defined by a progressive disorganization of E.M. The formation of a vicious circle is responsible for the progressive remodeling of E.M. This process may be linked to the not enzymatic glycosylation of E.M., due to several episodes of hyperglycemia, and to autoinductive mechanisms of TGF-beta. These mechanisms are responsible for the cytokine synthesis and for the E.M. inhibition of degradation.

[The intracystic concentration of MCA in the fluid from large breast cysts]. / Concentrazione intracistica dell'MCA nel fluido di grosse cisti della mammella.

75 patients with breast gross cystic disease and no cancer have been included in the study. For each patients serous and intracystic concentrations of MCA have been measured. The aim of the study is to assess whether if a relation between intracystic concentration of the marker and resistance and capability of cellular reproduction exists (confirmed by the release of the cyst). The analysis of intracystic values shows that synthesis of MCA is an intrinsic peculiarity of cytologic kind. It is apparently independent from inflammatory or hemorrhagic contemporary processes.

99m Tc MIBI prone scintimammography in breast Paget's disease: a case report.

A 99m Tc MIBI prone scintimammography (PSM) was performed in a case of underlying Paget's disease of the breast. 99m Tc MIBI PSM showed a diffuse scintigraphic image like a spread of uptake from the deeply located zones of the breast toward epidermis. In vivo, 99m Tc MIBI PSM represents the spread of neoplastic Paget's cells probably attracted by chemotactic factors released by keratinocytes. This spread in Paget's disease is correlated to neu oncogene overexpression which increases the metastatic activity as a consequence of motility enhancement and growth stimulation effect. These scintigraphic images suggest that 99m Tc MIBI PSM could be relevant in management of Paget's disease of the breast.

[Production of PSA by breast adenocarcinoma cells: preliminary results]. / Produzione del PSA da parte di cellule di adenocarcinoma della mammella: risultati preliminari.

PSA has been measured out with highly sensitive method both in liquid of mammary cysts and in cytosol of neoplastic cells. Our data point out that dysplastic, metaplastic and anaplastic breast epithelial cells produce PSA. Such production is, probably, related to expression of hormonal receptors.

99mTc MIBI prone scintimammography in patients with suspicious breast cancer: relationship with mammography and tumor size.

99mTc MIBI prone scintimammography (PSM) is reported to be a specific examination in order to assess the nature of breast lesions. Fifty-three patients whose mammography was stratified according to the breast imaging reporting and data system (BI-RADS), the five category classification of mammography approved by the American college of radiology, were studied with prone scintimammography, with the aim of assessing the accuracy of this exam and its usefulness in clinical practice. Thirty-five out of forty-one patients with BI-RADS category V (high probability of cancer) showed cancer at histology. Thirty-one of them had positive PSM. Three out of the six patients with mammo-graphic features of category IV indicated malignancy. PSM was positive in all of them and negative in the three benign lesions. One of the five patients with category III mammography showed cancer and positive PSM. The PSM was negative in 12/13 patients with benign patology (specificity 92.3%). When the cancers were stratified for T-category significant differences were found between the sensitivity for tumors larger or smaller than 1 cm. The sensitivity was 50% for the cancers smaller than 1 cm and 96.9% for those larger than 1 cm. PSM is a very specific method to determine the nature of breast lesions. Its sensitivity is also high but has to be improved when tumors smaller than 1 cm have to be detected. From a clinical point of view PSM can at the moment be considered as an accurate method for the study of borderline lesions of IV and also of III BI-RADS category. In this case a positive PSM indicates an impact in clinical decision making.

[Immunoradiometric assay of Ca 125 in breast cystic fluid]. / Dosaggio immunoradiometrico del Ca 125 nel liquido di grosse cisti della mammella.

Ca 125 was assayed in serum and in breast cyst fluid of 78 patients with GCD. Levels of the marker in cyst fluid are generally < 30 U/ml. More significative results were found in relation to cysts relapse. In apocrine cysts relapse levels were higher than 270 U/ml, in serum cysts not relapsed levels were between 31-270 U/ml. Ca 125 could have a significative role in cell differentiation and its control.

[Levels of Cathepsin D in breast cyst fluid]. / Dosaggio della Catepsina-D nel fluido di macrocisti della mammella.

Cathepsin-D was assayed in serum and in breast cyst fluid of 60 non neoplastic patients with GCD. The results are independent from cytological type or possible cyst relapse. Although the study confirms the high levels of Cat-D in breast cyst fluid no predictive value has been demonstrated. Its expression may be related to systemic endocrine factors.

99mTc-MIBI prone scintimammography in patients with high and intermediate risk mammography.

Mammographic lesions can be classified into categories of high (HR), intermediate (IR) and low risk of breast cancer. We have performed 99mTc MIBI scintimammography on 85 patients with high or intermediate risk lesions in order to verify its ability to diagnose cancer before biopsy. The scintimammography was performed in prone lateral view; all the patients were submitted to excisional biopsy. HR lesions showed 86% of cancers and scintigraphic accuracy of 0.81. The accuracy of scintimammography was 0.97 in lesions larger than 1 cm. IR lesions showed 47% of cancer with scintigraphic accuracy of 0.95. The scintigraphic sensitivity was 0.97 lesions larger than and 0.50 in lesion smaller than 1 cm, whereas the specificity was always about 90%. Our results suggest that scintimammography can substantially decrease the need of biopsy for breast cancer diagnosis.

[Prognostic significance of desmoplasia in breast carcinoma. A preliminary clinical study]. / Significato prognostico della desmoplasia nel carcinoma della mammella. Studio clinico preliminare.

This study carried on 61 patients with breast cancer confirmed the biological assumption of a higher malignancy in tumors with strong desmoplastic reaction. Patients in stage II A, II B and III presenting a marked desmoplastic reaction have a shorter DFS (disease free survival). Therefore, desmoplastic reaction may be considered a marker of local malignancy and metastatic process.

[Level of immunosuppressive acidic protein in the fluid of breast cysts]. / Dosaggio della proteina acida immunosoppressiva nel liquido di cisti mammarie.

IAP marker was detected by radio-immunodiffusion in breast gross cyst fluid and in serum. No correlation was found between this antigen and cyst' cytological type, serum concentrations and acute phlogosis. In most cysts IAP was not valuable; on the other hand, high levels of glycoprotein were found only in the subgroup on relapsed class of apocrine cysts.

[The prognostic significance of the measurement of Ca 15-3 in the fluid of large breast cysts]. / Significato prognostico del dosaggio del Ca 15-3 nel liquido di grosse cisti della mammella.

Ca 15-3 was assayed in serum and in breast cysts fluid of 78 non neoplastic patients presenting Gross Cysts (GCD). In apocrine cysts and in the mixed type (serous and apocrine, class III) relapse was indicated by high serum and intracystic levels of the marker. Ca 15-3, therefore, may discriminate in a group of cysts a higher cellular resistance as well as an increased cell proliferation. Results suggest an important role of the marker in the follow up of patients with GCD and for the early detection of cyst relapse.

[The biological effects of the CO2 laser studied in experimental intestinal resections]. / Studio degli effetti biologici del laser CO2 nelle resezioni intestinali sperimentali.

An histological and E.M. study has been performed on rat's intestinal tract resection to evaluate CO2 laser effects. Necrotic effect of laser is evident up to 120 micron. While the intestinal tissue results normal at 480 micron from resection line. Muscular and fibrous components appear more resistant to damage while E.M. presents a new organization of its components forming a new compact and continue tissue. This new organization may be involved in the protection of the subepithelial spaces, and may have an important role in intestinal anastomosis scar process.

[A histological and ultrastructural study of the effects of the argon laser scalpel on the kidney]. / Studio istologico ed ultrastrutturale degli effetti del bisturi laser ad argon sul rene.

The authors carried an histological and ultrastructural study on rat kidney following polar excision by argon laser. The involvement of the remainder portion of the kidney was evaluated analysing the depth of the damage induced by the laser radiation. Restitution ad integrum was found below 360 micron thickness with a different involvement of the various kidney components. Glomeruli showed a deep damage caused by intravascular photocoagulation. On the contrary, tubular and extracellular damage was less serious and the damaged area extended for only 240 micron from the section, probably for a lack of absorbance of the argon radiation by clear and water-rich tissues.

[The role of echography in the determination and monitoring of ductal ectasia in nipple discharge]. / II ruolo dell'ecografia nell'individuazione e nel monitoraggio delle ectasie duttali nella mammella secernente.

In this study a good sensibility of ultrasound in identifying ductal disease was demonstrated. We evaluated the relationship between nipple discharge and ductal ectasia and the importance of the ectasia in maintaining nipple discharge. From our data the hypothesis of a possible role of oestroprogestinic hormones in the genesis or maintaining of ductal ectasia emerged.

[Diagnosis, prognosis and therapy of phyllodes tumor of the breast]. / Diagnosi, prognosi e terapia del tumore filloide della mammella.

The Authors report 4 cases very interesting for the differential diagnosis of phyllodes tumor, a breast tumor with a mainly local malignant potential. Such tumor, although presenting histologic, clinical and instrumental features which allow for a presumptive pre-surgical diagnosis, often has characteristics comparable to other breast pathologies with a different natural history. The Authors, after analyzing clinical, mammographic, echographic and histologic features of the tumor, suggest the most appropriate therapy for the local control of the lesion. Surgical excision should be carried at least 1 cm deep into the normal tissue to prevent local relapse related to an incomplete enucleation: in fact, the tumor is only apparently capsulated. Furthermore, the Authors believe a patients must undergo, after primary surgery, an adequate instrumental and clinical follow up for the early diagnosis of commonly occurring relapses.

[The use of mammary echotomography in the diagnosis and monitoring of the pregnant and puerperal breast. 3 cases of galactocele]. / Utilizzazione dell'E.T.G. mammaria nella diagnostica e nel monitoraggio della mammella gravidica e puerperale. Tre casi di galattocele.

Three cases of galactocele appeared as breast nodule during lactation are reported. From our experience and the recent literature, ultrasound shows a good reliability for the diagnosis of breast diseases during pregnancy and lactation in spite of oedema and breast turgidity, distinctive of these periods.

[Use of ultrasound-guided needle aspiration in the diagnosis and treatment of breast cysts]. / Utilizzazione dell'agoaspirazione ecoguidata nella diagnosi e nel trattamento delle cisti della mammella.

The authors evaluated the advantages obtained utilizing FNAB with ultrasound in the needle aspiration of breast cysts. Echography can guide the aspiration up to its end in an effective and localized way. Cytologic examination of the cystic fluid confirmed the benign nature of the cyst. The association of needle aspiration and guided echography was related to a low number of relapses (19.8%). Among these relapses some risk factors have been found as well as a correlation between cystic fluid cytologic examination and relapses incidence has been determined.