Management of advanced carcinoma of the base of tongue.

BACKGROUND AND OBJECTIVE: Base-of-tongue carcinoma is a relatively rare disease with aggressive behavior and poor prognosis. Up to date no consensus exists regarding the ideal management strategy for each stage of the disease. This study aims to evaluate the experience of a single head and neck oncology center in the management of advanced stage base-of-tongue cancer. METHODS: A retrospective evaluation of cases primarily treated for stage III/IV(A-B) base-of-tongue carcinoma, between 1980 and 2007, at a tertiary referral center. RESULTS: A total of 366 cases were studied. Five-year disease specific survival (DSS) was 42% and local control (LC) 80%. Regional and distal control estimates were 91.3 and 84%, respectively. Prognosis was significantly superior for cases receiving surgery plus adjuvant treatment compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease significantly worsened prognosis. Satisfactory retention of pharyngeal function and no fatal complications were noted in surgical cases. CONCLUSION: Although no consensus exists regarding ideal therapy for advanced base-of-tongue carcinoma, combined strategies with the use of surgery and adjuvant chemoradiotherapy (CRT) seem to offer the best possibility for a positive outcome.

Potential impact of the financial crisis on outpatient hospital visits due to otorhinolaryngologic disorders in Crete, Greece.

The public health effect of financial crises has been emphasized in previous studies. In addition, a series of otorhinolaryngologic disorders and manifestations has been related to psychological factors in the literature. Such conditions include temporomandibular joint disorders, laryngopharyngeal reflux, chronic tinnitus, and vertigo. Focusing on the outpatient database records of a large hospital in Crete, Greece, the objective of this retrospective study was to explore possible occurrence variations within the prementioned otorhinolaryngologic morbidity which may be potentially attributed to increased levels of socioeconomic stress. Results revealed that although the total number of visits between two periods - before and after the beginning of the financial crisis in Greece - was comparable, a significant increase in the diagnosis of two disorders, namely vertigo and tinnitus was found. In addition, a trend toward increased rate of diagnosis for reflux and temporomandibular joint disorders was noted. Potential implications of these findings are discussed. In conclusion, health care providers in this as well as in other countries facing similar socio-economic conditions should be aware of potential changes in the epidemiologic figures regarding specific medical conditions.

Auditory brainstem response changes during exposure to GSM-900 radiation: an experimental study.

The objective of the present study was to investigate the possible electrophysiological time-related changes in auditory pathway during mobile phone electromagnetic field exposure. Thirty healthy rabbits were enrolled in an experimental study of exposure to GSM-900 radiation for 60 min and auditory brainstem responses (ABRs) were recorded at regular time-intervals during exposure. The study subjects were radiated via an adjustable power and frequency radio transmitter for GSM-900 mobile phone emission simulation, designed and manufactured according to the needs of the experiment. The mean absolute latency of waves III-V showed a statistically significant delay (p < 0.05) after 60, 45 and 15 min of exposure to electromagnetic radiation of 900 MHz, respectively. Interwave latency I-III was found to be prolonged after 60 min of radiation exposure in correspondence to wave III absolute latency delay. Interwave latencies I-V and III-V were found with a statistically significant delay (p < 0.05) after 30 min of radiation. No statistically significant delay was found for the same ABR parameters in recordings from the ear contralateral to the radiation source at 60 min radiation exposure compared with baseline ABR. The ABR measurements returned to baseline recordings 24 h after the exposure to electromagnetic radiation of 900 MHz. The prolongation of interval latencies I-V and III-V indicates that exposure to electromagnetic fields emitted by mobile phone can affect the normal electrophysiological activity of the auditory system, and these findings fit the pattern of general responses to a stressor.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas.

BACKGROUND AND OBJECTIVES: This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions. METHODS: A retrospective case-series study was conducted at an academic tertiary referral center. The files of 1,314 cases that underwent primary surgical treatment for glottic cancer were studied. Various prognostic factors, including age, surgical procedure, T classification, N classification, histological grade, and status of margins were assessed in univariate and multivariate analyses. All variables were investigated for their association with local and regional disease control as well as disease specific and overall survival. RESULTS: Status of margins significantly affected disease specific survival and local control regardless of tumor stage in this series. All other variables assessed in the univariate analysis for their association with survival were also found to be significant. However, status of surgical margins and N classification were the only significant variables in multivariate analysis. CONCLUSION: The prognostic value of negative surgical margins for the treatment of glottic cancer cannot be overestimated. Responsibility of the surgeon during primary surgical treatment of glottic carcinomas is emphasized.

T1 and T2 hypopharyngeal cancer treatment with laser microsurgery.

BACKGROUND AND OBJECTIVE: To assess the oncologic results and functional outcomes of CO(2) laser microsurgery in T1 and T2 hypopharyngeal cancer. METHODS: The files of 119 T1 and T2 hypopharyngeal carcinoma cases primarily managed with laser surgery were reviewed. Cases were assessed for 5-year disease-specific survival (DSS) as well as local control (LC) rates, with respect to T and N classification, status of surgical margins, and decision on neck management and adjuvant therapy. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function. RESULTS: DSS and LC rates of 72.6% and 85.4%, respectively, were noted overall in this series. Survival rates were found to be significantly better for cases with negative surgical margins. The presence of regional metastases was also found to significantly affect prognosis. Satisfactory retention of function and a low rate of major complications were noted. CONCLUSION: Laser surgery appears to be very effective for T1 and T2 hypopharyngeal cancer treatment as long as clear surgical margins can be achieved. Oncologic results are acceptable with low incidence of complications and satisfactory retention of function. The neck must always be included in the primary treatment plan of hypopharyngeal lesions.

The Hellenic Voice Handicap Index of Different Laryngeal Mass Lesions: A Receiver-Operating Characteristic Analysis.

BACKGROUND: Voice disorders influence the quality of people's life. When the type of disorder is determined then the clinicians are capable of finding their patients' needs and address their complaints concerning their vocal problems. One of the most used tools, for assessing the patients' quality of life (in accordance with their vocal status), is the Voice Handicap Index. In this study, we determined the cut-off scores of Voice Handicap Index for population with laryngeal mass lesions such as vocal polyps and nodules. The calculated cut-off points further guide clinicians toward applying a needed interventional method/therapy even in the cases where the condition of a person could not be easily estimated. METHODS: The study involved 130 participants (aged 19-74). Specifically, 90 nondysphonic people served as the control group, while 40 participants had already been diagnosed with voice disorders due to laryngeal mass lesions. Participants who were diagnosed with a laryngeal inflammation or had undergone a surgery were excluded from the study. The cut-off scores were determined through a receiver-operating characteristic (ROC) analysis. RESULTS: The calculated cut-off points were 19.50 for the total score of VHI, 7.50 for the functional domain, and 8.50 for the physical and the emotional domain. CONCLUSIONS: The aforementioned cut-off points could be used in empowering the everyday clinical practice. Moreover, their knowledge could help the construction of an individualized therapy plan, as well as monitoring-biofeedback tool for the populations with vocal fold lesions.

Cross-cultural Adaptation and Validation of the Greek Voice Handicap Index-10 (GVHI-10) With Additional Receiver Operating Characteristic Analysis.

OBJECTIVE(S): The use of subjective evaluation tools are proven useful and of high clinical value in the case of voice disordered population. For that type of evaluation, self-assessment questionnaires about the severity of the voice like Voice Handicap Index-30 (VHI-30) have been developed. The VHI-30 is the most studied tool which includes psychometrically robustness while guiding physician's therapeutic decision making. Additionally, a valid abbreviated version of VHI-30 was developed for the first time in the Greek Language which is named as Greek Voice Handicap Index-10 (GVHI-10). Consequently, the aim of our study was to validate the proposed version of the VHI-10. METHODS: Ninety nondysphonic individuals and 90 dysphonic patients were classified by Otolaryngologists and Speech Language Pathologists. The study's subjects were evaluated with endoscopy and stroboscopy. Also, they were administrated the GVHI-30 and the translated version of the Voice Evaluation Template (VEF). The GVHI-10 was extracted by the Greek version of VHI-30. RESULTS: The group with voice disorders exhibited higher statistical significance in all GVHI-10 scores compared to those of the control group. The GVHI-10 showed a high internal consistency (Cronbach's a = 0.915 and split-half reliability coefficient equal to 0.86), good sensitivity compared to Greek VHI-30 (r = 0.764, P = 0.000) and intraclass correlation. A total cut-off point equal to 6.50 (AUC: 0.964; P < 0.001) was also calculated. CONCLUSIONS: The proposed version of GVHI-10 distinguished the perceived levels of voice between dysphonic and nondysphonic groups and between different voice disordered populations. The GVHI-10 is shown to be clinically valid and sensitive exhibiting high reliability.

Molecular pathways and genetic factors in the pathogenesis of laryngopharyngeal reflux.

The prevalence of laryngopharyngeal reflux (LPR) has been constantly rising in the western world and affects today an alarmingly high percentage of the general population. Even though LPR and gastroesophageal reflux disease (GERD) are both the product of gastroesophageal reflux and seem to be sibling disorders, they constitute largely different pathological entities. While GERD has been for a long time identified as a source of esophageal disease, LPR has only recently been associated with head and neck disorders. Despite the high incidence of LPR and its great impact on patients' quality of life, little is known regarding its pathogenesis. On the other hand, studying the molecular and genetic basis of a disease is of fundamental importance in medicine as it offers better insight into the pathogenesis and opens new, disease-specific therapeutic trends. The aim of this study is to enlighten any known or suspected molecular mechanisms that contribute to the pathogenesis of LPR, and to suggest new trends for future research.

Long-term results of endonasal dacryocystorhinostomy.

The aim of this study is to review the long-term results of endonasal endoscopic dacryocystorhinostomy (DCR) according to our experience as well as to evaluate potential prognostic factors for long-term outcomes. The files of 165 patients who underwent endonasal DCR at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Furthermore, these cases were clinically evaluated at least 5 years after surgery and completed a subjective result evaluation questionnaire. A cure was reported by a total of 112 (67.9%) subjects and significant improvement without need for further treatment was noted in 23 cases (13.9%). Thirty (18.2%) cases were considered as failures. The overall successful outcome according to the subjective symptom evaluation was 81.8%. Poor correlation between clinical findings and subjective report of symptoms was found. None of the prognostic factors that were assessed affected outcomes significantly. In conclusion, long-term success rates for endonasal DCR seem to be comparable to previously published short-term results.

Septoplasty outcome in patients with and without allergic rhinitis.

OBJECTIVE: To assess the effect of allergic rhinitis (AR) on septoplasty outcome in terms of subjective and objective measurements and clarify whether patients with nasal septum deviation (NSD) and allergic rhinitis (AR) benefit from septoplasty to the same extent as patients who do not have allergic rhinitis. STUDY DESIGN: A prospective study, with consecutive sampling of all patients undergoing septoplasty from June 2005 to February 2007, conducted in a tertiary care otorhinolaryngologic clinic. METHODS: One hundred and seventy-six patients underwent septoplasty over the study period. Follow-up data were obtained from one hundred and forty-nine subjects. All participants underwent active anterior rhinomanometry (AAR) and assessed the severity of their symptoms based on a Nasal Obstruction Symptom Evaluation (NOSE) Scale prior to and following septo- plasty. Patients were divided into two groups according to AR status. Comparisons were made between symptoms and rhinomanometry data. RESULTS: Following septoplasty, subjective improvement in breathing (decreased NOSE scores) was observed for both groups, the decrease being significantly more substantial in the NSD group. Airflow, as measured during active anterior rhinomanometry, increased in the deviated side following septoplasty in both groups. In the NSD group the increase was significantly high- er than in the NSD and AR group. CONCLUSION: The surgeon should proceed with caution when managing patients with allergic rhinitis and nasal septum deviation. These patients are more likely to be less satisfied after septoplasty compared to patients without allergy. Adequate medical management of allergic rhinitis should be the first priority for these cases.

Checking for voice disorders without clinical intervention: The Greek and global VHI thresholds for voice disordered patients.

Voice disorders often remain undiagnosed. Many self-perceived questionnaires exist for various medical conditions. Here, we used the Greek Voice Handicap Index (VHI) to address the aforementioned problem. Everyone can fill in the VHI questionnaire and rate their symptoms easily. The innovative feature of this research is the global cut-off score calculated for the VHI. Therefore, the VHI is now capable of helping clinicians establish a more customizable treatment plan with the cut-off point identifying patients without normal phonation. For the purpose of finding the global cut-off point, a group of 180 participants was recruited in Greece (90 non-dysphonic participants and 90 with different types of dysphonia). The voice disordered group had higher VHI scores than those of the control group. In contrast to previous studies, we provided and validated for the first time the cut-off points for all VHI domains and, finally, a global cut-off point through ROC and precision-recall analysis in a voice disordered population. In practice, a score higher than the well-estimated global score indicates (without intervention) a possible voice disorder. Nevertheless, if the score is near the threshold, then the patient should definitely follow preventive measures.

Relationship between BMD, dental panoramic radiographic findings and biochemical markers of bone turnover in diagnosis of osteoporosis.

OBJECTIVE: Mandibular indices, measured on panoramic radiographs, may be useful screening implements for low skeletal bone mass density (BMD). Recent studies suggest that radiographic examination of mandible may constitute an effective process for the early diagnosis of osteoporosis. Biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women. In contrast to the vast information available on dental radiographic findings and BMD only scarce data exist on the relationship between panoramic mandibular indices and biochemical markers. The aim of this study was to examine the diagnostic performance of dental panoramic radiography and biochemical markers of bone turnover in relation to BMD at the spine in a group of postmenopausal women. SUBJECTS AND METHODS: An assessment of the number of lost teeth, mandibular cortical width (MCW) at the mental region and morphologic classification of mandibular inferior cortex (MIC grade) was performed on dental panoramic radiographs in a group of 141 postmenopausal women 38-81 years of age. BMD at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than 1.0), and as indicative of osteopenia (T-score -1.0 to -2.5) or osteoporosis (T-score less than -2.5) according to the World Health Organization classification. Serum bone alkaline phosphatase (BAP) was measured with an enzyme immunoassay. Cross-linked N-telopeptides of type I collagen (NTx) corrected for creatinine secretion, was measured with a competitive-inhibition enzyme-linked immunosorbent assay ELISA. RESULTS: In our study, a decrease in MCW by 1mm increases the likelihood of osteopenia or osteoporosis to 47% (p-value<0.05), having taken into consideration the effect of the years elapsed since menopause. The increase of alkaline phosphatase (ALP) per unit increase the likelihood of osteopenia or osteoporosis to 14% (p-value<0.05), having checked the effect of the years since menopause. A decrease in MCW by 1mm increases the likelihood of moderately or severely eroded cortex to 97% (p-value<0.001). The increase in ALP per 1 unit increases the likelihood of moderate or severe erosion per 10% (p-value<0.05), taking into account the years since menopause. CONCLUSIONS: Our results suggest that dentists have sufficient clinical and radiographic information that enables them to play a significant role in early diagnosis of osteoporosis in postmenopausal women. Panoramic radiographs and biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women.

Septal cartilage reshaping with the use of an Erbium doped glass fiber laser. Preliminary results.

STATEMENT OF PROBLEM: To evaluate the efficacy of Erbium doped glass fiber laser in patients undergoing nasal septal cartilage reshaping. METHOD OF STUDY: A prospective study was conducted in patients undergoing laser nasal septal cartilage reshaping. Microsurgical sponges soaked in a tetracaine solution plus adrenaline were applied in each side of the nose for ten minutes before the procedure. The cartilage of nasal septum was straightened and fixed in the median position using a modified nasal speculum. An optothermomechanical contactor with transparent indenter and thermocouple sensor was placed on septal regions of maximum mechanical stress. Patients were asked to evaluate the severity of pain during the procedure on a visual analog scale. A rhinomanometric evaluation was conducted preoperatively and postoperatively. All patients were asked to evaluate the improvement of their symptoms. All patients' data and potential complications were entered in a database and were statistically assessed. MAIN RESULTS: Our series consisted of 64 patients. Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes. PRINCIPAL CONCLUSION: Septal cartilage reshaping is an easy painless and bloodless method using en Erbium doped glass fiber Laser. Laser device LSC-701 (Arcuo Medical Inc.) is effective, safe and inexpensive medical equipment.

Recurrent Desmoid Tumor of the Neck: A Case Report of a Benign Disease with Aggressive Behavior.

We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases.

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy.

BACKGROUND: Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia. METHODS: One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH. RESULTS: A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%. CONCLUSION: Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy.

Microsatellite DNA instability in nasal cytology of COPD patients.

Genetic alterations in the microsatellite DNA level have been successfully detected in sputum samples of patients with COPD and have been shown to be disease specific. Furthermore, previous studies have shown that inflammation coexists in the nasal mucosa of patients with COPD. The aim of this study was to assess the presence of MSI in nasal cytological samples of patients with COPD comparing the results with sputum samples of the same individuals. Nasal brush samples, sputum samples obtained by induction, and peripheral blood from 20 patients with COPD were analyzed. DNA was extracted and analyzed for MSI using the following microsatellite markers: RH70958, D5S207, D6S344, D6S263, G29802, D13S71, D14S588, D14S292 and D17S250. Microsatellite analysis was also performed in 8 healthy non-smokers. MSI was detected in the sputum samples of 7 patients with COPD (35%). In contrast, no microsatellite DNA instability was noted in the nasal cytological samples of the same COPD patients. In addition, no genetic alteration was detected in the control group. These results suggest that MSI is a specific finding for the target organ of COPD, i.e. the lungs, despite the fact that inflammation coexists in the nasal mucosa of COPD patients. Our study supports the hypothesis that MSI could be an index of the somatic-acquired genetic alterations in the lungs of COPD patients.

Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women.

OBJECTIVE: The use of mandibular anatomic indicators on panoramic radiographs, i.e. the number of lost teeth, mandibular cortical width at the mental region (MCW), panoramic mandibular index (PMI), alveolar crest resorption degree (M/M ratio) and morphologic classification of the mandibular inferior cortex (MIC grade) can be useful in the evaluation of bone resorption in different age groups of women to determine the presence of osteoporosis. The purpose of this study was to assess the validity of mandibular radiomorphometric measurements and to determine the frequency of tooth loss in postmenopausal women. SUBJECTS AND METHODS: An assessment of the number of lost teeth, MCW, PMI, M/M ratio and MIC grade was performed on dental panoramic radiographs in a group of 133 postmenopausal women 38-80 years-of-age. BMD at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than 1.0), and as indicative of osteopenia (T-score -1.0 to -2.5) or osteoporosis (T-score less than -2.5) according to the World Health Organization classification. RESULTS: In our study when the T-score at the lumbar spine is decreased, the age of menopause is increased, and the MCW is decreased to a point of statistical significance. A decrease in MCW by 1mm increases the likelihood of osteopenia or osteoporosis to 43%, having taken into consideration the effect of the years elapsed since menopause. It was also shown that age, years since menopause, MCW value, and the number of teeth lost have a statistically important effect on the incidence of moderate or severe cortical erosion. Moreover, when the MCI is C2 or C3 (mild or severe erosions) the age is increased, the years since menopause are increased and the MCW is decreased to a point of statistical significance. As far as tooth loss is concerned, an increase by 1 unit in the number of teeth lost, increase the likelihood of moderate or severe erosion to 6%, having taken into account the years elapsed since menopause. Our study also demonstrated that postmenopausal women tend to lose their teeth at an age older than 50 years. They usually lose the 1st and 2nd mandibular molars and the 1st and 2nd maxillary premolars. Loss of front teeth and canines occurs at an age older than 60 years (except for the lateral maxillary incisors). At a younger age they tend to lose the 2nd maxillary premolars more frequently than their mandibular counterparts. CONCLUSIONS: In conclusion, panoramic radiographs constitute an integral part of almost every routine dental evaluation and can be useful for the early diagnosis of osteoporosis in postmenopausal women. Dentists have sufficient clinical and radiographic information that enables them to play a significant role in patient screening for osteoporosis.

Increased incidence of papillary thyroid cancer among total thyroidectomies in Crete.

OBJECTIVE: To investigate the increased incidence of papillary thyroid cancer as found in specimens of total thyroidectomies and potential correlation with etiological factors. STUDY DESIGN AND SETTING: A retrospective study on patients who underwent total thyroidectomy, from 1990 to 2004, in an academic tertiary referral medical center. Patients' records were placed in a database, which included medical condition, history, and demographics. Histopathological slides were reviewed with special focus on papillary cancer. RESULTS: Our series consisted of 2379 patients. Thyroid cancer was confirmed in 354 patients (14.88%). Papillary carcinoma represented the most frequent type (316 patients, 89.26%). Increased incidence of papillary carcinomas was noticed after 1995, reaching the maximum value in the year 2000. After 2000, there was a descending trend and then a plateau. CONCLUSION: The increased incidence of papillary thyroid cannot be attributed to dietary patterns or increased diagnostic and therapeutic activity. It is likely to be associated with increased radiation and may be associated with the Chernobyl fallout.

Tonsillectomy with thermal welding technology using the TLS(2) thermal ligating shear.

OBJECTIVE: To introduce and assess a new method of tonsillectomy with thermal welding technology (TWT) using the thermal ligating shear (TLS(2)), in pediatric population. METHOD: TWT provides a new surgical instrument that combines heat and pressure to simultaneously coagulate and divide tissue. Among the headpieces available for the TWT generator, the TLS(2) handpiece was selected. A prospective study was conducted in our Department, on 60 children who underwent tonsillectomy with the use of TWT. Inclusion criteria were obstructive sleep apnea syndrome, peritonsilar abscess history and chronic tonsillitis. Patients undergoing adenoidectomy, or any other procedure together with tonsillectomy were excluded from this study. All patients' data, including intraoperative blood loss, operation time and complication rates were recorded in a database. RESULTS: Our series consisted of 60 patients (39 male and 21 female). There was no measurable bleeding during surgery in any of the cases. The mean operative time was 20 min. Only one case of postoperative hemorrhage occurred. Mild uvula edema was noticed in 25 patients. CONCLUSION: TWT is a safe method for tonsillectomy. Among the several handpieces available for the TWT generator, the TLS(2) is very effective and easy to use in tonsillectomy procedures, providing sufficient heamostasis and diminished operative time.

Angiotensin-converting enzyme inhibitor (ACE-I)- and angiotensin receptor blocker (ARB)-related angioedema: a neglected issue in daily practice in Greece.

Several reports on angioedema (AE) related to the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) have been published recently. This study reports on the experience gained at the Ear, Nose, and Throat (ENT) Clinic of the University Hospital of Heraklion, Crete. A retrospective chart review of the patients admitted to this clinic, in a 42-month period (1999-2003), and discharged with a diagnosis ENT code for AE was performed (14 eligible patients). A complementary telephone survey was conducted during January 2005. Ten patients responded to our invitation. Of those patients, five were under ACE-I and one was under ARB treatment during the AE episode. The mean length of time between the onset of symptoms and presentation to the hospital was 4.5 hours (range 0.5-12 hours). The mean duration between the initiation of antihypertensive treatment and AE episode was 26.2 months (range 1-60 months). Patients reported that no information was provided about the possible adverse effects of these drugs. Although AE introduced by ACE-I and ARBs is an uncommon side effect, this case series conveys a key message to primary care physicians.