Tuvia Hadar

Endoscopic Transnasal Transsphenoidal Microsurgery Versus the Sublabial Approach for the Treatment of Pituitary Tumors: Endonasal Complications

Objective: To evaluate the nasal complications after transnasal transsphenoidal operations for pituitary tumors, comparing two surgical techniques: traditional sublabial transseptal and endoscopic transseptal techniques.

Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy

Hurthle cell carcinoma is a rare thyroid cancer histologically related to the well‐differentiated malignancies of the thyroid gland. This report presents the evaluation of 30 years experience in treating 17 patients (out of 549 thyroid cancer patients) with Hurthle cell carcinoma. All 17 patients were treated surgically. Six patients (35.3%) died of their thyroid disease. Survival rates for 10 and 15 years were 63.7% and 25%, respectively. These rates are above those of high‐grade malignancies and below those of low‐grade malignancies of the thyroid gland. Nonsurgical treatment, including radioactive iodine therapy, is disappointing; thus, initial radical surgery is recommended as the treatment of choice. Cancer 57:1613–1617, 1986.

Antiestrogen therapy for hereditary hemorrhagic telangiectasia: A double-blind placebo-controlled clinical trial

Hereditary hemorrhagic telangiectasia (HHT) is associated with recurrent epistaxis in 90% of cases. Good response to hormone treatment has been documented, although its use remains controversial. The aim of this study was to examine the efficacy of an antiestrogenic agent, Tamoxifen, in the treatment of HHT‐associated epistaxis.

Anaplastic thyroid carcinoma. A clinical, histologic, and immunohistochemical study.

Twenty‐six cases of anaplastic thyroid tumor were investigated and reclassified using immunoperoxidase techniques. Sections of the neoplasms were stained immunohistologically for the following thyroid associated antigens: (1) thyroglobulin, which shows a positive reaction with follicular cells of the thyroid; (2) calcitonin, which is positive in medullary carcinoma of the thyroid; and (3) leucocyte common antigen (LC), which identifies lymphomata and Factor VIII‐related antigen for hemangioendothelioma. Using these methods, five cases were reclassified. Three cases were identified as lymphomata, one case was reclassified as medullary carcinoma of the thyroid, and one case was identified as hemangioendothelioma. Eleven cases were confirmed to be anaplastic carcinoma of the thyroid and ten cases were negative for all the antigens tested. There was a significant difference in the survival of the groups of patients mentioned above. Prognostic data support the suggestion that immunohistochemical methods should be used for the precise classification of anaplastic thyroid carcinoma. In this way, tumors such as malignant lymphoma and medullary carcinoma, which resemble anaplastic carcinoma histologically but have a better prognosis, can be identified. This is important for planning surgical procedures and chosing chemotherapy and/or radiotherapy.

Outcome of oral tongue squamous cell carcinoma in patients with and without known risk factors.

BACKGROUND Tobacco smoking and high alcohol consumption are considered major risk factors of oral tongue squamous cell carcinoma. This study compared disease outcome between patients with and without known risk factors. METHODS Patients with oral tongue squamous cell carcinoma treated at two major medical centers from 1994 to 2008 were identified by cancer registry search. The medical files were reviewed for background-and-disease-related data, risk factors, and outcome. RESULTS The study sample consisted of 291 patients: 175 had a history of heavy tobacco smoking and alcohol abuse and 116 did not. Comparison of the patients without risk factors between the two centers yielded no differences in background features. Men accounted for 74% of the total patients with risk factors and comprised 77% of the risk-factor group. The risk-factor group was characterized by a significantly higher mean tumor grade (p=0.0001) and greater tumor depth of invasion (p=0.022) than the non-risk-factor group. The 5-year local and regional control rates were 85.3% and 74%, respectively, with no significant difference between the groups. The 5-year overall survival rate was 68% in the risk-factor group and 64% in the non-risk-factor group (p=NS). Separate analysis of patients aged <40 years at diagnosis revealed a worse overall (p=0.015) and disease-free survival (p=0.038) in those without risk factors. CONCLUSIONS The outcome of oral tongue carcinoma is similar in patients with and without risk factors. The worse prognosis in younger patients (<40 years) without risk factors suggests that the pathogenesis in these cases involves factors other than smoking and alcohol.

Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome.

Clin. Otolaryngol. 2010, 35, 307–312

Hemostatic effect of tranexamic acid in elective nasal surgery.

Background Bleeding is the most frequent complication of nasal surgery. The aim of this prospective study was to evaluate the effectiveness of tranexamic acid (TA), an antifibrinolytic agent, in reducing bleeding during and after nasal surgery. Methods The study sample included 400 patients aged 18–60 years who underwent combination functional endoscopic sinus surgery with septoplasty and conchotomy. Two hundred patients were not given a hemostatic agent (control group) and 200 patients were administered 1 g of oral TA three times daily starting 2 hours before surgery, for 5 days. Bleeding was monitored during surgery and for 2 weeks postoperatively. Results Patients given oral TA showed significantly less operative and postoperative bleeding compared with controls. No patients required additional packing, compared with five patients in the control group. Adverse reactions to TA were minimal, and they disappeared when the treatment stopped. Conclusion TA is a safe and effective drug for the reduction of bleeding in nasal surgery. It may be recommended for routine use.

ORIGINAL ARTICLE: Squamous cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features and outcome

Clin. Otolaryngol. 2010, 35, 307–312

Laryngeal carcinoma in patients 40 years of age and younger.

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1NOMO) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1NOMO) and seven patients (35%) had laryngeal carcinoma in Stage II (T2NOMO) and III (T3NOMO). Patients with T1NOMO received only radiotherapy. Three patients with T2NOMO underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3NOMO received pre‐operative and postoperative radiotherapy in addition to total laryngectomy. The 5‐year survival rate for T1NOMO and T2NOMO was 100% and for T3NOMO 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.

Stapedotomy technique and results: Ten years' experience and comparative study with stapedectomy

Fifty of the 810 patients who underwent stapedotomy for otosclerosis from 1969 through 1988 were randomly chosen for follow‐up of at least 5 years. Most of the patients (65%) had follow‐ups of 10 years after stapedotomy, but another 50 patients who underwent stapedectomy had follow‐ups of longer than 10 years.