Postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx.

OBJECTIVE: Assessment of incidence, risk factors, management, and outcome of postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. METHODS: Retrospective review of a cohort of 514 cancers of the lateral oropharynx consecutively resected. RESULTS: Incidence of postoperative hemorrhage was 3.6%. In 31.5% of cases, onset was after hospital discharge. No hemorrhages occurred after the end of the fourth postoperative week. Variables associated with increased risk of hemorrhage were advanced age (P=.004), antithrombotic treatment (P=.012), and robotic assistance (P=.009). When the source of hemorrhage could be identified, hemostasis, performed transorally in most cases, was highly effective; no patients in this subgroup showed recurrence. In spontaneously resolved hemorrhage under observation or when no active site of bleeding was found on exploration under general anesthesia, the recurrence rate was 18.1%. Overall, hemorrhage resulted in death in 2 patients. CONCLUSION: Exploration under general anesthesia in case of active bleeding and observation with discussion of arterial exploration of the ipsilateral external carotid system in patients in whom no source of bleeding can be identified are the keys to successful management of this potentially lethal complication.

[Analysis of the variables affecting patients' memorization and interpretation of information on thyroidectomy-related risks]. / Analyse des facteurs qui influent sur la mémorisation et l'interprétation par le malade de l'information concernant les risques de la thyroïdectomie.

We prospectively analyzed patients' memorisation and interpretation of preoperative information on the risks of thyroidectomy. This study was conducted in an academic tertiary care referral center, based on an inception cohort of 280 patients who were consecutively informed of the risks of thyroidectomy (unilateral laryngeal immobility, bilateral laryngeal immobility, hypocalcemia, common surgical complications, and perioperative death) by the same surgeon during the period 2003-2006. Univariate analysis was used to identify factors affecting memorisation and interpretation of the information delivered. After being informed of the risks, 14.6% of patients declined surgery, and 5% decided to postpone the operation for a few months. Among the 215 patients who underwent thyroidectomy, 0.9% remembered all five risks, 17.2% three or four, 61.4% one or two, and 20.4% none. The number of risks remembered did not vary over time. Age, occupation, and the year of the analysis influenced memorisation. In the immediate post-operative period, 85.5% of the patients had a positive opinion and 45.1% a negative opinion of the preoperative information, and 35.3% simultaneously expressed positive and negative opinions. The number of preoperative visits and the interval between the final preoperative visit and surgery both affected the patients' interpretation of the information. Patient memorisation of information on surgical risks is poor, and this results in major stress for the patient. After receiving this information, a significant proportion of patients decide to forego surgery.

Sternocleidomastoid myofascial flap for reconstruction after composite resection of invasive squamous cell carcinoma of the tonsillar region: technique and outcome.

OBJECTIVE: To present the surgical technique and determine the efficacy of sternocleidomastoid myofascial (SCMF) flap reconstruction after composite resection with intent to cure. STUDY DESIGN: Retrospective review of 73 consecutive patients with a previously isolated and untreated moderately to well-differentiated invasive squamous cell carcinoma of the tonsillar region and a minimum of 3 years follow-up, managed at a tertiary referral care center during the years 1970 to 2002, with an ipsilateral superiorly based SCMF flap after composite resection. METHODS: The surgical procedure is presented in detail. Potential technical pitfalls are highlighted. Survival, mortality, and morbidity are documented. Univariate analysis for potential correlation between the incidence for postoperative flap complications and various variables is also performed. RESULTS: The 1, 3, and 5 year Kaplan-Meier actuarial survival estimates were 82.2%, 64.4%, and 49.3%, respectively. Death never appeared to be related to the completion of the SCMF flap. Thirty-three (45.2%) patients had some kind of significant postoperative surgical complication, and nine (12.3%) patients had some kind of significant postoperative medical complication. The most common significant postoperative complication was partial SCMF flap necrosis and pharyngocutaneous fistula noted in 30.1% and 10.9% of patients, respectively. Complete SCMF flap necrosis was never encountered. No patient developed carotid artery rupture or died as a result of the SCMF flap, and none required additional surgery. In univariate analysis, no significant statistical relation was noted between the significant postoperative surgical complications related to the use of the SCMF flap and the variables under analysis. CONCLUSIONS: The superiorly based SCMF flap appears to be simple to perform and useful for reconstruction of defects after composite resection.

[The impact of fusafungine on the prescription of antibiotics in the treatment of rhinopharyngitis]. / Impact de la fusafungine sur la prescription d'antibiotiques dans le traitement de la rhinopharyngite en France.

OBJECTIVE: The analysis in France, during the period 01/12/99 to 30/11/2000, of the prescription of systemic antibiotics in patients with rhinopharyngitis and of the variables statistically related to such prescriptions and the potential role of fusafungine in the form of a rhinopharyngeal spray. METHODS: A retrospective study, based on a panel of 1,010 general practitioners, in a cohort of 30,568 patients presenting with rhinopharyngitis. The fusafungine group consisted of 16,076 patients who had rhinopharyngitis and in whom fusafungine was prescribed. The control group consisted of 14,492 patients with rhinopharyngitis without prescription of fusafungine. The overall rate of antibiotic prescription was documented. A stepwise statistical analysis was conducted to specify the variables statistically associated with the prescription of a systemic antibiotic. The rate of prescription of a systemic antibiotic and the cost of the treatment were also compared within both groups. RESULTS: The overall rate of systemic antibiotic prescription was 52.9%, falling from 60.4% in the group without fusafungine down to 46.2% in the group with fusafungine (p<0.01) whichever the systemic antibiotic prescribed. The stepwise analysis documented various variables that appear to be related to the systemic antibiotic prescription. A saving of 0.7 euros per prescription was noted in the fusafungine group. CONCLUSION: Although various variables appear to influence systemic antibiotic prescription in patients with rhinopharyngitis, our study shows that prescription of fusafungine in spray from led to statistically significant reduction in systemic antibiotic prescription.