Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies.

PURPOSE OF THE INVESTIGATION: Tonsillectomy and adenoidectomy are the most common surgical procedures in otorhinolaryngology. The most serious complication is postoperative hemorrhage, with a 2-4% risk of substantial bleeding. The aim of this study was to evaluate the incidence of and possible predictive factors for postoperative hemorrhage requiring surgical revision in patients undergoing cold dissection tonsillectomy/adenoidectomy. BASIC PROCEDURES: We performed a single-institution retrospective study of 8388 patients who underwent tonsillectomy and/or adenoidectomy between 1994 and 2006. Tonsillectomy was performed using only cold-steel dissection with bipolar diathermy for hemostasis. MAIN FINDINGS: Hemorrhage occurred in 114 patients (1.78%) after tonsillectomy and in seven patients (0.35%) after adenoidectomy. After tonsillectomy 85.09% of the hemorrhages were secondary, occurring between the postoperative days 1 and 15, whereas in the adenoidectomy group 85.71% of the bleeding episodes were primary. Two patients (0.03%) required blood transfusions, none of the patients required an external carotid artery ligation, and there were no cases of death in our series. On the basis of logistic regression analysis, patient age was found to be a statistically significant risk factor (P = 0.007): the highest incidence was found in patients over 16 years of age (2.19%). At warmer times of year the incidence was higher (1.98%) than at colder times (1.63%). The resident surgeons caused a hemorrhage incidence of 1.75% and the consultant surgeons one of 1.84%. The incidence was significantly higher in male patients (2.2%) than in female patients (1.4%; P = 0.016). PRINCIPAL CONCLUSIONS: Our data show that whereas adenoidectomy can be safely performed as a one-day procedure, tonsillectomy complications due to postoperative hemorrhages might be avoided only if patients were to stay in hospital until postoperative day 15, which would clearly be impractical for economic, organizational and social reasons. A crucial factor for increasing the safety of this procedure is the provision of meticulous education and information for the patient and/or parents.

Mcl-1, vascular endothelial growth factor-R2, and 14-3-3sigma expression might predict primary response against radiotherapy and chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck.

PURPOSE: This study was done to explore whether the expression of a selected set of proteins could predict primary response to radiotherapy or concomitant radiotherapy and chemotherapy in patients with advanced head and neck cancer. EXPERIMENTAL DESIGN: Forty-three pretreatment tumor biopsies were taken during diagnostic panendoscopy and examined for Mcl-1, vascular endothelial growth factor (VEGF)-R2, CD9, and 14-3-3sigma expression by immunohistochemistry. Forty-three patients underwent primary radiotherapy, of which, 29 patients received concomitant chemotherapy (low dose daily cisplatin, mitomycin C bolus). The primary end-point was locoregional tumor control 6 months after completion of radiotherapy. Mcl-1, VEGF-R2, CD9, and 14-3-3sigma expression were correlated with patients' primary response to radiotherapy and chemotherapy and with established clinicopathologic variables. RESULTS: Thirty complete and 13 partial responses were observed in our patient group. High expression levels of Mcl-1 (P=0.021), VEGF-R2 (P=0.032), and 14-3-3sigma (P=0.013), but not of CD9, in tumor biopsies was correlated with complete response. Overexpression of at least two of the three aforementioned proteins in pretreatment biopsies predicted-with a likelihood of 80%-whether a patient would achieve complete response to radiotherapy and chemotherapy. However, if only one of these proteins is overexpressed, there is a likelihood of 84.6% that this patient would not completely respond to therapy. CONCLUSION: Determining the expression levels of Mcl-1, VEGF-R2, and 14-3-3sigma may be helpful in predicting the early clinical response in head and neck tumor patients receiving primary radiotherapy and chemotherapy and may further allow a pretherapeutic selection of patients.

Differential expression pattern of cyclooxygenase-1 and -2 in head and neck squamous cell carcinoma.

OBJECTIVE: The enzyme cyclooxygenase catalyzes the first step of the synthesis of prostanoids Cyclooxygenase has been shown to exist in two distinct isoforms: cyclooxygenase-1 is constitutively expressed as a housekeeping enzyme in most tissues whereas the inducible cyclooxygenase-2 has been reported to be involved in inflammatory processes and in the carcinogenesis of squamous cell carcinoma. The aim of this study was to investigate the distribution patterns of cyclooxygenase-1 and -2 in peritumoral lymphocytic infiltrates and tumor cells of head and neck carcinoma. MATERIAL AND METHODS: Immunohistochemical analysis was performed using paraffin-embedded tumor specimens from 24 patients suffering from oropharyngeal, hypopharyngeal and oral squamous cell carcinomas. RESULTS: We observed that cyclooxygenase-2 immunoreactivity, compared to that of cyclooxygenase-1, was significantly increased in peritumoral lymphocytic infiltrates as well as in tumor cells. CONCLUSION: The expression of cyclooxygenase-2 in both tumor specimens and the surrounding peritumoral lymphocytic infiltrates supports the hypothesis that cyclooxygenase may be one of several important links between chronic inflammation and carcinogenesis.