Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell , Leukemic Infiltration , Skin Neoplasms , Skin/pathology , Aged , Biopsy/methods , Humans , Immunohistochemistry , Immunologic Tests/methods , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Leukemic Infiltration/etiology , Leukemic Infiltration/pathology , Male , Mohs Surgery/methods , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
Hemostasis is a critical component of otologic and neurotologic surgery. In these surgeries the surgical field is small; thus, even a small amount of bleeding can obstruct the view of critical and extremely small structures. Additionally, relatively large vascular structures traverse the area; if they are encroached on by trauma or disease, bleeding must be controlled within a very small space in a meticulous fashion that does not encroach on structures of the middle ear and mastoid. The authors discuss several hemostatic agents in the middle ear, mastoid, and lateral skull base, highlighting their origins, mechanisms, advantages, and complications.
Subject(s)
Blood Loss, Surgical/prevention & control , Ear Diseases/surgery , Hemostasis, Surgical/methods , Hemostatic Techniques , Hemostatics/pharmacology , Neurosurgical Procedures , Otologic Surgical Procedures , Ear, Middle/surgery , Humans , Mastoid/surgery , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Otologic Surgical Procedures/adverse effects , Otologic Surgical Procedures/methods , Skull Base/surgeryABSTRACT
BACKGROUND: A number of factors other than those identified by the American Joint Committee on Cancer (AJCC) may have prognostic significance in the evaluation of melanoma. OBJECTIVE: We sought to evaluate commonly recorded clinical features potentially associated with aggressive melanoma. METHODS: We conducted a retrospective case-control study. We included patients given a diagnosis of cutaneous melanoma with at least 5 years of follow-up or documented metastases. Patients were divided into nonaggressive and aggressive groups. Univariate and multivariate statistical analyses were performed to evaluate the association of multiple clinical and histologic parameters and metastases. RESULTS: We included 141 patients. Significant prognostic factors in univariate analysis associated with nonaggressive disease included history of dysplastic nevus syndrome and ABCDE criteria. Significant factors in univariate analysis associated with aggressive disease included age and immunosuppression. Only age and immunosuppression remained significant in multivariate analysis when controlled across statistically significant histologic variables from AJCC. LIMITATIONS: The study is retrospective and has a small sample size. CONCLUSION: Older patients and those with a history of immunosuppression may be at higher risk for aggressive disease and should be closely monitored after an initial diagnosis of melanoma.
