Howard B. Lampe

Frey’s syndrome and parotidectomy flaps: A retrospective cohort study ☆ ☆☆

Gustatory sweating, also known as Freys syndrome, is a recognized phenomenon after parotidectomy. The incidence of clinically significant gustatory sweating may be dependent on the thickness of the skin flap that is elevated at the time of surgery. Dissection in the subcutaneous level or the deeper sub-superficial musculoaponeurotic system level are 2 commonly used techniques in the operation. Twenty-eight patients were prospectively evaluated for Freys syndrome after superficial parotidectomy. Thirteen patients underwent subcutaneous and 15 patients sub-superficial musculoaponeurotic system flap elevation. The overall incidence of gustatory sweating was determined, and a comparison of the two surgical techniques was assessed subjectively by patient interview-questionnaire and objectively evaluated with starch-iodine testing.

A triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery.

In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.

Head and Neck Squamous Cell Carcinoma Cell Line-Induced Suppression of in vitro Lymphocyte Proliferative Responses

Tumour-infiltrating lymphocytes (TILS) are often difficult to expand in vitro. In some cases this has been attributable to immunosuppression mediated by the elaboration of prostaglandins by either tumor cells or tumor-infiltrating monocytes. In this laboratory, freshly prepared TILs containing single-cell suspensions of head and neck tumors displayed both poor proliferation as well as minimal responsiveness to indomethacin-mediated reversal of immunosuppression. In order to investigate tumor-mediated immunosuppression further, a system was developed whereby a new cell line of head and neck squamous cell carcinoma was used to suppress allogeneic peripheral blood mononuclear cell proliferation in response to phytohemagglutinin (PHA) and interieukin-2 (IL-2). Tumor cells were able to suppress peripheral blood mononuclear cell (PBMNC) proliferation up to 95%. This suppressive effect was dependent on tumor cell number and was reversible by the use of higher concentrations of PHA, but not by increased concentrations of IL-2. Suppression was immediate when IL-2 was used as the stimulus for proliferation, but required extended lymphocyte/tumor cell contact when PHA was used. Flow cytometric analysis of tumor-exposed and PHA-stimulated PBMNCs revealed a decrease in both the number of cells expressing IL-2 receptors as well as the density of IL-2 receptors per cell. This pattern of suppression, as well as the reversibility of suppression by indomethacin, implicates prostaglandins in the mechanisms by which these tumor cells mediate immunosuppression.

DNA analysis of head and neck squamous cell carcinoma by flow cytometry.

The use of flow cytometry to measure the DNA content from tumors has evolved over the years. In squamous cell carcinoma arising in the head and neck, there has not been uniform agreement in the literature, and decisions regarding patient treatment cannot be made using this parameter. The use of proliferating cell nuclear antigen (PCNA), a newly available marker of a cells proliferative activity (S-phase fraction) is also discussed. In a prospective series of patients, the findings of diploidy, aneuploidy, low (PCNA) positivity, and high PCNA positivity are compared to known biological parameters. Strong trends are shown demonstrating biological aggressiveness associated with aneuploidy, high PCNA fraction, and the combination of aneuploidy and high PCNA fraction. The potential use of whole-cell preparation to determine ploidy and PCNA fraction as a predictor of metastatic potential are discussed. The whole-cell preparation technique allows accurate DNA ploidy measurements and, with the use of PCNA, a measure of proliferative activity. These parameters combined with known TNM staging may 1. allow alteration in treatment and ultimately affect patient survival, and 2. allow comparison of treatment modalities between biologically similar tumors.

Laryngectomy clinical pathway: development and review.

OBJECTIVE The goal of the study is to determine if the implementation of a protocol for the preoperative and postoperative care of patients receiving a laryngectomy for cancer of the larynx or hypopharynx (i.e., laryngectomy clinical pathway) reduced length and cost of hospital stay without increasing complication rates. DESIGN This study is a comparison of the perioperative course of two groups of laryngectomy patients. Data were collected retrospectively from the records of patients operated on before the implementation of the clinical pathway as the institutional historical control. Comparison was made with data collected prospectively on patients operated on after the implementation of the clinical pathway. SETTING The study was performed at a mid-sized teaching hospital associated with two regional cancer centres. All surgeries were performed by one of two otolaryngology-head and neck surgeons and residents under their supervision. METHODS The demographic, patient, tumour, treatment, dietary, and complication data were analyzed. Fishers exact (two-tailed) statistical test was used for parametric data and Wilcoxon scores for nonparametric data. MAIN OUTCOME MEASURE The principal outcome measure was the length of postoperative inpatient stay. Secondary outcome measures were readmissions and postoperative complications. RESULTS There was a statistically significant decrease of 6.7 days in the mean length of hospitalization in the clinical pathway group even when taking postoperative readmissions into account. There was no concomitant increase in surgical complications. The mean reduction in hospital cost per case was calculated to be

Evaluation of postoperative drainage with application of platelet-rich and platelet-poor plasma following hemithyroidectomy: a randomized controlled clinical trial.

3,420 (Can). CONCLUSIONS Application of a clinical pathway for patients receiving laryngectomy is both feasible and effective.

Carcinoma of the ethmoid sinus

Platelet‐rich plasma (PRP) and platelet‐poor plasma (PPP) have been used to improve hemostasis and wound healing after surgery; however, randomized controlled trials proving their efficacy are lacking.

Whole Cell Preparation of Squamous Cell Carcinoma for Cytometric Analysis of DNA

Cancer of the ethmoid sinus is a rare tumor in the head and neck, accounting for less than 1 per cent of all such malignancies. This paper examines squamous cell carcinoma arising in the ethmoid sinus, the most common form of ethmoidal malignancy in a series reviewed at the University of Michigan. Sixteen cases diagnosed between 1964 and 1974 (inclusive) were included in this study. Peak incidence of the disease occurred in the seventh decade of life. All patients had a minimum follow-up of at least five years. The patients had relatively common nasal complaints that unfortunately represented an unusual and frequently fatal disease. The symptoms of ethmoid sinus cancer are reviewed, and the many modalities of treatment that can be used are discussed. The problems of staging ethmoid sinus cancer are elucidated, and difficulties with the suggested classification systems are discussed. Ultimately, only 29 per cent of the patients survived five years.

Radioprotective effect of free radical scavenging enzymes.

To date, analysis of the DNA content of head and neck squamous cell carcinomas has relied on the homogenation of the entire tissue specimen and subsequent staining and quantitation of the naked nuclei. This methodology does not make allowance for the extremely variable nature of these tumors with respect to their cellular composition. Further, by destroying the cytoplasm and cell membranes, this methodology makes it impossible to distinguish the DNA content of the tumor cells from that of the background stromal and inflammatory cells. The authors present a methodology for the selective exclusion of inflammatory cell infiltrates from the DNA analysis of these tumors. Using this technique, it has been found that exclusion of the inflammatory cells allows the investigator to look more specifically at the malignant cell population. This has been most helpful in those samples in which the tumor cells have been diploid or near-diploid. With this technical refinement, the relationship between DNA ploidy and clinical prognosis may be more acurately asessed.