John D. Piro

Combined modality treatment of Ewing's sarcoma of the maxilla

Primary bone sarcomas arising in osseous structures of the head and neck are rare. These tumors are often incompletely resected and treated with radiotherapy for local control.

Implant brachytherapy: A novel treatment for recurrent orbital rhabdomyosarcoma☆

BACKGROUND Orbital rhabdomyosarcoma is the most common primary malignancy of the orbit in childhood. Tumor resection and exenteration were the preferred treatment modalities for rhabdomyosarcoma. In the past 20 years, however, combined local radiation and systemic chemotherapy have shown excellent survival results. Tumor recurrence after any of the aforementioned therapies is almost always fatal. We have developed a novel treatment for recurrent disease that has resulted in long-term survival for three patients. METHODS Three patients with recurrent orbital rhabdomyosarcoma were previously treated with primary radiation and chemotherapy. At the time of recurrence, exenteration and localized brachytherapy were performed. An individually molded poly(methylmethacrylate) (Lucite; E. I. du Pont de Nemours & Co., Wilmington, Del.) device loaded with radioactive iodine seeds delivered localized high-dose radiation, 6000 cGy over 6 days, to the orbit without irradiating the brain. RESULTS All patients are alive and free of disease with follow-up ranging from 4 years and 4 months to 8 years and 4 months. CONCLUSION A novel technique of delivering localized radiation to the orbit of three children with recurrent orbital rhabdomyosarcoma appears curative.

Impression procedure for creating a partial auricular prosthesis.

Severe anatomic undercuts associated with tissue remnants or a defect site can often be an obstacle in achieving an accurate impression for a facial prosthesis. This article describes a procedure that overcomes the problems encountered in achieving an accurate impression. The distinct properties of 2 impression materials are applied to create a 3-piece impression that can be reassembled to develop an accurate stone master cast.

Chondrosarcoma metastatic to the oral cavity

Metastases to the oral cavity from nonoral malignant lesions occur rarely. We report the case of a woman with chondrosarcoma of the pelvis in whom gingival metastases, in addition to pulmonary, skin, and brain metastases, developed. Clinical course, x-ray correlation, histopathologic review, and treatment modalities are described. The six previously reported cases of chondrosarcoma metastatic to the oral cavity are tabulated and analyzed. Metastases should be included in the differential diagnosis of gingival lesions in patients with prior or current nonoral malignant tumors.

Comparative clinical evaluation of radiographs exposed with films of different emulsion speed

Abstract In order to investigate the effect of the use of faster emulsion speed x-ray film on radiograph quality (a study directed ultimately at decreasing the exposure of the patient and/or operator to x-radition), individual and comparative evaluations of the quality of x-ray images resulting from the exposure of the same areas of the mouth using x-ray film of three different emulsion speeds were made. One film of each of four different areas in the mouth was exposed with each of the three x-ray films (DuPont standard slow, S-1, moderately fast, D-1, and very fast, “Lightning Fast”) in each of thirty-five patients. All films were processed under conditions standard for all three films. Blind study and evaluation of the resulting roentgenograms revealed that, in terms of both individual excellence and comparative performance, use of both the moderately fast and slow standard speed films was found to result in roentgenograms superior to the very fast films in a greater percentage of instances. There was relatively little to choose in terms of over-all clarity, variations in density, and visibility of detail between the moderately fast and slow speed standard films. However, many films exposed with the very fast x-ray film were judged excellent and many were judged to be best in performance when compared with the two slower films. This suggests that it is possible to obtain radiographs of the highest quality using the very fast speed film and indicates that further study of some of the critical factors in exposure time, target-film distance, and processing may result in a technique productive of very fast films of uniformly highgrade excellence. Although at present the routine use of very fast film with the short-cone technique is not indicated on the basis of this investigation, increased study of the use and performance of x-ray films with faster emulsion speeds seems highly desirable. Since the exposure of the slow and the moderately fast speed films was found productive of relatively equally excellent films, in terms of both individual quality and comparative performance, increased use of the moderately fast speed film is definitely indicated, due to decreased radiation exposure of the patient and the operator. Where maximum excellence of films is essential, as in the study of difficult to diagnose lesions or when magnification of radiographs is anticipated, the use of the standard slow speed film is still indicated.

Clinical laboratory studies on a new topical corticosteroid—Triamcinolone acetonide

Abstract Triamcinolone acetonide, a new corticosteroid which has been suggested as a highly active topical agent in the treatment of certain acute and chronic lesions of the oral mucous membranes, was studied with respect to its possible systemic actions. In order to determine any undesirable effects incident to topical therapy, we undertook detailed blood chemistry, hematologic, and urine studies in eleven patients treated with this corticosteroid. A comparative study of the before- and after-treatment blood and urine test values following the five-day period of drug therapy (including 1 mg. per day of the active agent, triamcinolone acetonide) did not reveal any discernible or noteworthy deviations. All test findings remained within the accepted normal range. Where posttherapy deviations within the normal range were found, no consistent pattern was evident.

Intensification of intraoral roentgenograms by toning

Abstract In order to evaluate the effectiveness of a toning solution for the intensification of roentgenograms, three roentgenograms in duplicate were taken for each of twenty areas of the mouth (in twenty patients). These films were exposed, developed, and intensified according to various experimental and normal specifications. Evaluation of these films by a panel from the Department of Stomatology suggested that, under various conditions in which it may be impossible to obtain other than an underdeveloped or underexposed radiograph, the subsequent use of a toner intensifier is indicated to improve the quality of the available films. In many instances, the image produced will be superior to that in the unintensified state. The intensification process, an inexpensive, readily available, simply performed procedure, is carried out in room light and hence the roentgenogram may be toned to exactly the desired density and contrast. The technique may also prove to be of value in restoring age-faded roentgenograms and as a new specific differential diagnostic aid for hard-tissue lesions. Consideration should be given particularly to the use of such an intensifier to permit decreased exposure times of standard x-ray films in order to minimize both operator and patient exposure to radiation.

An atlas of oral lesions observed in the syndrome of oral melanosis with associated intestinal polyposis (Peutz-Jeghers syndrome)

In order to depict the variations in oral melanin pigmentation seen in patients with the syndrome of oral melanosis and intestinal polyposis known as Peutz-Jeghers Syndrome, an atlas of clinical photographs representing 20 patients, gathered from 14 authors reporting on this disease, has been presented. The pigmentations are relatively indistinguishable, except for the usually large numbers of areas involved, from melanin deposits commonly appearing in and about the oral cavity. It is emphasized, therefore, that the findings of oral melanin pigmentation should demand further study of the patient for the possible presence of intestinal polyposis on the basis of such signs and/or symptoms as intussusception, abdominal pain, melena, and anemia. The oral signs in this disease may not be accompanied by intestinal disease in all hereditarily afflicted patients. Such patients and their descendants should be followed carefully to permit prompt diagnosis should intestinal signs appear.

Gelfoam sponge biopsy in the diagnosis of oral carcinoma.

Abstract One or more Gelfoam sponge biopsy specimens were taken in eleven consecutive cases of carcinoma (proved positive by surgical biopsy) of the oral cavity. One each of these Gelfoam biopsies was performed, processed, and studied according to the technique of Gladstone, while additional specimens were studied by a slightly modified technique. In our hands, fixed, mounted, and stained sections of these Gelfoam biopsy specimens were negative for cancer in eight of the eleven cases.