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PURPOSE: The clinical and radiologic results of bone substitute application in the sinus elevation procedure were evaluated for up to 4 years after a grafting procedure followed by implant placement. MATERIALS AND METHODS: Between 1997 and 2001, augmentation of the maxillary sinus floor with alloplastic or xenogenic materials was performed in 34 nonsmoking patients with generally good health. However, only 18 patients attended all of the required annual clinical and radiographic examinations and thus were included in the study. Mean follow-up after implantation was 29 months. RESULTS: At the second-stage surgery all the implants were osseointegrated, except for 1 Frialit-2, which was removed. Following prosthetic rehabilitation no implant was lost after 4 years of function, for a prosthetic success rate of 100%. The cumulative implant survival rate after 48 months was 97% (36 of 37 implants). DISCUSSION: Osseointegrated implants are a reliable treatment option for restoring the posterior maxilla, and final predictability was not influenced by their placement in augmented areas after sinus elevation with bone substitutes. CONCLUSIONS: The survival rate obtained with this study is similar to that expected for implants placed in nongrafted areas. This study showed that alloplasts and xenogenic materials are reliable for bone regeneration in the subantral cavities, as they showed very low resorption in the present study. [ABSTRACT FROM AUTHOR]

PURPOSE: The long-term results of endosseous implants depend on the maintenance of bone support. The aim of this study was to evaluate radiologically bone resorption around dental implants placed in grafted sinuses after up to 4 years of function. MATERIALS AND METHODS: Between 1997 and 2001, augmentation of the maxillary sinus floor with alloplastic (Biostite) or xenogenic (Bio-Oss) materials was performed in 34 patients. RESULTS: Eighteen patients participated in the study. Twenty-six sinus augmentations were performed on these 18 patients, and they received 37 implants. The change in marginal bone level around the implants at the mesial side was 1 mm during the first year after the abutment connection, followed by an annual loss of 0.1 mm. The change in marginal bone level around the implants at the distal side was 1.1 mm during the first year after the abutment connection followed by an annual loss of 0.2 mm. DISCUSSION: The implant survival rate observed in this study is in line with data previously reported for patients treated with implants in the posterior maxilla without bone atrophy. The results for implants placed into sinuses grafted with Bio-Oss were similar to the results for implants placed in sinuses grafted with Biostite. CONCLUSION: Although this study involved a limited number of procedures, it confirmed that alloplastic and xenogenic materials can be reliable for bone regeneration in subantral cavities. The angular defects present both at the distal and mesial sides of the implants were comparable to those observed at implants placed in native bone. [ABSTRACT FROM AUTHOR]

Purpose: Over the last few years, particular attention has been paid to the implant surface and its influence on the formation and maintenance of surrounding bone. The surface of Osseotite implants (Implant Innovations) is produced by a process of thermal etching, which produces a surface with an average roughness that is twice that of machined implants produced by the same manufacturer. In addition to reducing osseointegration time, this factor appears to favor its maintenance over time. This study presents the results of a clinical trial of Osseotite implants., Materials and Methods: Five hundred fifty-five Osseotite implants were placed in 244 patients over 5 years, between September 1996 and September 2001. The average follow-up period from implant placement was 26 months (SD 13.1)., Results: After the first surgical stage, 8 failures were noted in 6 patients. Life table analysis showed a cumulative survival rate of 98.5%, but no implant was lost after prosthetic loading, with a 100% survival rate both for the mandible and for the maxilla. For the prosthetic loading time, only the implants with more than 12 months of loading were considered, obtaining an average prosthetic loading time of 34 months (SD 9.2). DISCUS SION: The implant survival rate after loading was 100% both in the anterior and posterior regions, and no difference was noted in relation to the different types of prostheses, or length and width of implants., Conclusion: The results obtained in this retrospective study population revealed an acceptable survival rate for these implant-supported restorations.

The present article introduces preliminary clinical and histologic evidence on the combination of a platelet-rich plasma and anorganic bovine bone in maxillary sinus augmentation procedures. The clinical and histologic results from 10 patients underline the different clinical and biologic advantages offered by the combined use of a well-known osteoconductive material, anorganic bovine bone, and a new technique that consists of stimulating bone regeneration using the local increase of growth factors contained in autologous platelet-rich plasma.

Herein we report the retrospective survey of 48 consecutive unselected cases of vaginal carcinoma, mainly treated with radiotherapy in our Institute from 1959 to 1970. In this series irradiation was delivered almost always with a single and continuous application of sources of radium 226. Radiumtherapy treatment varied according to the extension in surface of the neoplasm, the clinical stage and especially the vaginal step involvement, considering the length of the organ. Despite the very good immediate response, failures of treatment locally or in paravaginal and pelvic areas were frequently observed, and success of the treatment after a brief follow-up was poor. The actuarial survival was 41.6% and 33.3% at 3 and 5 years, respectively. Stage I cases showed at the follow-up better therapeutic results (48.6% survival at 5 years) than stage II and III cases (28.3%). The poorest results were observed in neoplasms extended to the whole vagina, and all these patients died within 4 years of the beginning of treatment. This report stresses that radiotherapy of vaginal carcinomas demands individualization and a properly planned therapeutic program that combines external irradiation with renewed techniques of low dose rate and continuous irradiation with radioactive sources.

51 variously edentolous patients have been treated by placing 143 Core-Vent and Screw-Vent osteointegrated implants. The follow-up ranges from 8 to 20 months. Just one implant was removed. The Authors explain their surgical method and their considerations about the two different kinds of implants. Some clinical cases are reported.

The clinical classification of oral carcinomas presents some points still under discussion. In other respects the main questions about the treatment of these cancers could be resolved by cooperative clinical trials which impose the definition of a common clinical language. With a system based on an original computer program for the compiling, store and process essential data on cancer diseases we analyzed 736 consecutive and unselected oral carcinomas and we studied the prognostic value of main clinical factors. In our series, the main prognostic factors are tumor size, clinical appearance of the primary and clinical status of neck nodes. Sex, age and histological grade are unimportant. From our study we propose to complete the TN classification with two useful clinical criteria distinguishing the exophytic or minimally infiltrating tumors from the deeply infiltrating (greater than 1 cm) and the large metastatic omolateral nodes from the small ones (phi less than 3 cm).

During a preliminary clinical experience (1973-1977) we experimented three different sequences in associating 6 MOPP cycles (CT) with radiotherapy (RT) for the treatment of stage II and III Hodgkin's disease. A total of 55 consecutive previously untreated patients can be estimated to contribute in defining feasibility, immediate results and toxicity of the combined treatment. In this group of patients RT preceded CT in 20 cases (RT-6 MOPP), the opposite sequence (6 MOPP-RT) was preferred in 16 cases, whilst a split-course CT fitting in the RT (3 MOPP-RT-3 MOPP) was employed in 19 cases. Except for the sequence used with respect to irradiation, the CT was carried out in all the cases according to the classical scheme proposed by De Vita et al. (11). RT was effected with 60Co-teletherapy and a wide field or segmental sequential fields, having variable extension depending on the stage ("extended nodal irradiation" for stage II and III cases with lymph node involvement not below L3; "total nodal irradiation" for the remaining cases in stage III). The programmed doses were 45.0 Gy to the involved areas and 40.0 Gy to the clinically uninvolved regions for the RT-6 MOPP and 6 MOPP-RT groups. Doses of 35.0/30.0 Gy were planned for the 3 MOPP-RT-3 MOPP group. The three different groups are not homogeneous with regard to certain important clinical and pathological characteristics; in fact, a higher quota of stage III patients, with systemic symptoms and spleen positivity is present in the 6 MOPP-RT and 3 MOPP-RT-3 MOPP groups. The combined treatment has achieved a complete clinical remission in 18/20 patients in the RT-6 MOPP group (90.0%), in 12/16 patients of the 6 MOPP-RT group (75.0%), and in 17/19 cases in the 3 MOPP-RT-3 MOPP "sandwich" combination (89.5%). The average overall duration of the treatment was 48 weeks for the sandwich combination, 50 weeks for the RT-6 MOPP group, and 56 weeks for the 6 MOPP-RT association. As regards the sandwich combination, both CT and RT took a reasonable length of time to complete. On the contrary, both the medical treatment and irradiation required an excessively long time and were not well tolerated when preceded by either RT or CT in full doses. In particular, myelosuppression was less acute and prolonged in the 3 MOPP-RT-3 MOPP group, whereas the actual doses of CT and RT were higher than those which can be reached with respect to other groups. Three preliminary cycles of CT considerably reduce the target volumes and complications arising from RT. The first CT time gave an objective response greater than 50% in 9/9 cases of the 3 MOPP-RT-3-MOPP group with mediastinal involvement. In this group, rather considerable pulmonary complications were observed in 3/9 patients (33.3%) with respect to the 40% found for the 6 MOPP-RT group (2/5 cases) and the 67.7% for the RT-6 MOPP group (6/9 cases).

Our study reports 282 oral cancer cases treated with 60Co-teletherapy (TCT), taken from 736 oral carcinomas treated with radiotherapy on the primary tumor from January 1959 to December 1970. They were mainly locally advanced cases which often had regional node involvement. In fact, during that period, the more advanced cases were submitted to TCT. There were only 9 (3.2%) patients with T1 lesions, while there were 134 (47.5%) T2 and 139 (49.3%) T3, T4 cases; there were respectively 106 (37.6%) and 44 (15.6%) N1 or N2 and N3 cases. Almost half of the patients were greater than or equal to 66 years old at onset of the treatment (138/282 cases, or 47.2%); the women were a small minority (18/282, or 6.4%). There were 58 (20.6%) carcinomas of the mucosal surface of the cheeks, 60 cases arising from the retromolar areas, the upper-lower alveolar processes and the hard palate (21.3%), 72 carcinomas of the mobile portion of the tongue (25.5%) and 92 arising from the floor of the mouth (32.6%). All the patients considered in the study were treated with conventional techniques by doses, field dimensions and fractionation. The overall results were objectively disappointing, even though they should be evaluated keeping in mind the nature and the gravity of oral carcinomas submitted to TCT. Actuarial survival at 5 and 10 years from the onset of treatment was respectively 11.6% and 6.4%. None of the N1, N3 cases survived beyond the fourth year from onset of the treatment. Long-term survival differs very little in relation to the site of origin in the oral cavity. Nowadays, TCT alone may have only a palliative role in the treatment of oral cancer, reserving it for those cases which, due to their extreme gravity or the various contraindications, do not permit more aggressive treatments. In a combined therapeutic approach the aim of TCT today is to control the minimum disease foci. Its association with surgery appears to be most effective.

According to previous personal experience with conventional 226-Ra sources, in T2 oral carcinomas treated with curietherapy alone the incidence of local failures was 23%. Moreover, 50% of the local relapses were marginal with respect to the treated volume. From May 1980 to November 1981, 29 T2 oral carcinomas suitable for correct curietherapy received 3 weekly courses of VBM chemotherapy: i.e., vincristine, 1 mg i.v.; bleomycin, 15 mg i.m. after 6 and 24 h; and methotrexate, 30 mg p.o. after 48 h. A full dose curietherapy was performed 2 weeks after the completion of VBM. Twenty-seven patients have had a minimum follow-up of 12 months. The overall treatment was well tolerated and immediate results were encouraging. However, the local failure rate does not seem to have decreased by the combined treatment in comparison with curietherapy alone in historical series.

In this paper we analyze overall patients affected by inoperable adenocarcinoma of the endometrium, observed and treated with radiotherapy alone at the Milan Cancer Institute from January 1959 to December 1973. A total of 82 cases were collected for this study. Only the Stage IV cases have been excluded, as well as those treated for relapse. Inoperability were derived from various medical contra-indications in 70 patients (F85.4%) and from extrauterine spreading of the tumor in 12 (14.6%). The results achieved by the radiotherapy alone are not to be disregarded. The overall 5-years survival was 38.8% for the total number treated and 40.6% for Stage I and II cases. The most useful irradiation technique for the treatment of the primary tumor proved to be the uterine packing with cobalt-60 radioactive pearls and a 5-years survival of 45.7% was observed in 41 Stage I patients treated in this way. The most disappointing results were registered in Stage III cases (28.6% of 5-years survival). This paper confirms the interest of radiotherapy for the treatment of inoperable endometrial adenocarcinoma.

For this study we have reviewed 186 carcinomas of the tonsillar region, i.e., the lateral wall of the oropharynx, treated from January 1959 to December 1973 at this Institute. In 148 patients (79.6%) the primary tumor and the lymphatic areas were treated with 60Co-teletherapy (TCT). In 15 cases (8.1%) the primary lesion was removed by transoral surgery, followed by irradiation of the tonsillar region and lymphatic areas with TCT. In 23 patients (12.3%) the primary tumor was treated with interstitial curietherapy, after which a radical homolateral neck dissection was performed on 10 of them; the neck was not treated in the remaining 13 cases, initially N0. As far as the case initially treated with TCT alone are concerned, disease-free survival at 5 years was 42.5% for T1 cases and under 30% for T2, T3, whereas it was only 6.5% for T4. The most frequent failure cause of TCT was local relapse, isolated or associated with a nodal relapse. Local failures were nearly always central. On the contrary, if the field extension was adequate, there were very few nodal failures, at least in initially N0 or N1 cases. Our study recommends a revision of the current attitude towards the treatment of carcinomas of the tonsillar region.

In a retrospective and not randomized clinical study we have selected 175 cases of squamous carcinoma of the anterior 2/3 of the tongue treated by interstitial radium therapy on the primary from January 1959 to December 1970. At the end of the treatment 64 patients (36.6%) were operated by radical neck dissection in homolateral lymphatic areas and 111 underwent no operation on the neck. The incidence of false negative is 25% (16/64 cases operated) and 3 patients showed lymph nodal and perilymph nodal metastasis (4.7% of the whole number of operated cases). In the following evolution the homolateral lymph nodal relapse are 2 among the 64 operated patients (3.1%) (both were N+) and 36 among the 101 non operated ones of whom a sufficient follow-up is available (greater than or equal to 3 years) (35.6%); in this last group 9 patients initially were T1, 24 were T2, 3 were T3. The data about the clinical evolution and the analysis of survival curves, in the two groups that underwent or not the neck dissection, permit to draw useful parameters for therapeutic planning.

The purpose of this study was to realize a computer system for cancer data automatic processing. A clinical research in oncological practice is usually time consuming and often not reliable or deceiving because of a number of various errors. Until now, only a few information systems have been specifically designed for cancer data processing, and these have a limited capacity of autonomous data elaboration. Our system, based on an original computer program, can compile, store and process essential data on cancer diseases, with a high degree of reliability and high speed of elaboration. Input and output of this system are simplified and user oriented, without limitations for the subject at study on clinical research, and no particular training of the physicians involved is necessary.

From January 1961 to June 1978, 417 patients with cervical cancer were submitted to lymphangiography as part of the initial diagnostic work-up. As regards the distribution by clinical stage of the cases under consideration, there were 187 cases in Stage Ib (44.8%) 99 in Stage II (23.7%) and 131 in Stage III plus IV (31.5%). For the early stages preference was given to a radical surgery plus pre- or postoperative radiotherapy combination (154/417 patients, or 36.9%). On the contrary, the cases which were more developed locally or which presented contra-indications to surgery received radiological treatment alone (263/417 cases, or 63.1%). The overall incidence of positive examinations was 29.9% (10.7% in Stage Ib; 28.3% in Stage II; 58.7% in Stage III and 60.0% in Stage IV). The histologic type on its own did not seem to influence the incidence of lymph node metastases detectable by lymphography. In the 145 patients who had surgical exploration, the overall diagnostic accuracy of lymphography was 82.8% with 3 false positive and 22 false negative reports. The para-aortic chains were involved in 28/417 patients (6.7%). For the negative cases, with all the stages mixed together, a 74.7% 5-year survival rate free of disease was recorded, as compared with the 34.5% found for the positive cases (P less than 0.0001). Similar differences was recorded stage by stage.

The authors set out the technical innovations which are being used to comply with the three classical aims of endocavitary curietherapy for cervical cancer: the personalization of the irradiation device, protection of staff against exposure risks due to ionizing radiations, planning and control of the irradiation conditions. The personalization of the irradiation device is achieved by preparing a specially shaped vaginal applicator for each patient, and staff protection is ensured by the use of remote-loading techniques and closed circuit television control for in-patients. The planning of the treatments answers to the logic of reproducing the usual curie therapy method with conventional radium-226 sources. In order to control the irradiation conditions, at least the essential part of the treatments must be recognized and expressed: equivalent radium milligrams per hour (MRA h), dose rate (Gy h-1), dimensions of the treated volume and space distribution of the dose.

Automatic treatment planning for calculation of absorbed dose in curietherapy has been performed at the Istituto Nazionale Tumori of Milano on a routine for some years. The radioactive implant is reconstructed from orthogonal or stereo-roentgenograms, a tabular listing of doses or dose rates can be obtained on the grid of points and the isodose curves are automatically drawn with the projection of sources onto the selected planes of calculation by an interactive plotter.

The results are presented of a retrospective clinical study carried out on 341 patients affected with cancer of the uterine cervix, with lymphography in the pretreatment diagnostic work-up, treated in our Institute from January 1961 to December 1976. The clinical classification of the patients studied was: 157 cases in Stage I (46.0%), 95 cases in Stage II (27.9%), and 89 cases in Stages III and IV (26.1%). During the period considered, the therapeutic approach for carcinoma of the cervix was practically constant and in line with the therapeutic policy most frequently followed for these neoplasms. For the early stages (9/341 patients or 27.6%) preference was given to a radical surgery and postoperative radiotherapy combination; for borderline cases and "bulky" and "barrel-shaped" lesions, radiotherapy usually preceded surgical treatment to enlarge its indications and improve its results (36/341 patients or 10.5%). The cases that were more developed locally or that presented contraindications to surgery received radiological treatment alone (211/341 patients or 61.9%). Radiotherapy treatment consisted of radium therapy performed with a single application of 226Ra conventional sources, followed by percutaneous irradiation with 60Co-teletherapy in the more developed cases and/or in the presence of lymph node metastases. All the patients were submitted to diagnostic lymphography at the onset of the treatment and 92 (26.9%) had lymph node metastases. In the framework of this clinical review, the 5-year disease-free survival from onset of the treatment varied from 88.2% for the cases at Stage Ib occult, 72.5% for the cases at Stage Ib, 63.8% for the Stage II cases, to 40.5% for the cases at Stage III and IV. The presence of a pathologic report at lymphography makes a considerable difference in terms of disease-free, long-term survival after treatment