Use of preoperative erythropoietin in head and neck surgery.

OBJECTIVE: To determine whether preoperative erythropoietin can raise the hemoglobin levels of head and neck cancer patients prior to major ablative surgery. STUDY DESIGN: Prospective, consecutive series. METHODS: Ten patients who were to undergo major head and neck surgery were scheduled to receive subcutaneous doses of erythropoietin (600 IU/kg) on days 21, 14, 7, and 1 prior to surgery. Serial hemoglobin levels and reticulocyte counts were obtained throughout the course of treatment. RESULTS: Eight patients experienced a significant increase in hemoglobin. There were two nonresponders. The mean preoperative hemoglobin level for all 10 patients increased 12.6 g/L, from 135.5 +/- 16.2 g/L (baseline) to 148.1 +/- 23.7 g/L (1 day preoperatively, p < .0001). CONCLUSIONS: Erythropoietin significantly increases hemoglobin levels in patients awaiting major head and neck oncologic surgery. It can be viewed as an important adjunct to other well-established blood conservation techniques aimed at reducing perioperative transfusion rates.

Effect of nasal continuous positive airway pressure on esophageal function.

OBJECTIVE: The purpose of this study was to conduct a prospective investigation of the mechanism(s) of nasal continuous positive airway pressure (CPAP) upon the reduction of recumbent gastroesophageal reflux. DESIGN: Prospective assessment. SETTING: Health Sciences Center and St. Boniface General Hospital, Winnipeg, Manitoba. METHODS: An esophageal motility examination was conducted on 16 patients during the application of nasal CPAP set at 0 cm, 4 cm, and 8 cm water pressure. Esophageal parameters studied were wave amplitude and velocity, midesophageal resting pressure, and upper and lower esophageal sphincter resting pressure. RESULTS: The midesophageal resting pressure increased significantly from a baseline of -3.5 +/- 1.4 mm Hg to -1.6 +/- 1.8 mm Hg at 4 cm CPAP (p < .01) and -0.9 +/- 1.2 mm Hg at 8 cm CPAP (p < .01). CONCLUSIONS: The known reduction of nocturnal reflux that occurs when patients use an application of nasal CPAP appears to be related to direct mechanical compression of the esophagus. Results of an earlier report suggesting a reflex response by the lower sphincter were not reproduced.

In situ infrared histopathology of keratinization in human oral/oropharyngeal squamous cell carcinoma.

Fourier transform infrared (FTIR) microspectroscopy is emerging as a promising new tool for histopathological investigations of tissue histochemistry. This study was designed to assess whether changes in tissue biochemistry induced by well-differentiated and poorly differentiated oral/oropharyngeal squamous cell carcinoma (SCC) can be detected by infrared spectroscopy. The biopsies analyzed were each proven SCC positive and compared with tissue taken from the contralateral normal site. Individual infrared spectra, recorded from specific tissue areas, were correlated with histopathological structures normally found in the oral mucosa. Infrared mapping of these areas allows the generation of biochemical images of molecular structures such as lipids, sugars, and proteins. The visualization of DNA and tissue structures containing keratin (well expressed in all epithelia) reveals distinct differences between normal and SCC-positive biopsies. Bivariate histogram analysis of cell components (e.g., DNA and keratin) indicated that cancer cells produce a relatively homogeneous and clearly abnormal cell biochemistry, whereas differentiated epithelial cells present a very heterogeneous distribution of cellular components. Using these features, tissue containing abnormal or cancer cells can easily be distinguished from normal epithelial structures. The abnormal keratin distribution in poorly differentiated SCC and in keratin pearls (present only in well-differentiated SCC) offers insight into the process of malignant tissue transformation in squamous epithelium. Applying infrared microspectroscopy in combination with bivariate statistics to histopathological tissue thin sections provides a potential diagnostic tool for detection of cell changes in epithelial cancers.

Primary extramedullary plasmacytoma of the salivary glands.

Primary extramedullary plasmacytomas (PEMP) are uncommon plasma cell neoplasms that generally occur in the submucosal tissue of the upper airway. Salivary gland PEMP is an extremely rare condition. This report describes a unique case of PEMP in the parotid gland associated with pulmonary amyloidosis. A review of all salivary gland PEMP's suggests that they behave similarly to PEMP's in other locations. The treatment of choice for localized disease is radiotherapy which should include regional lymphatics. Local control can be achieved in the majority of cases. The minority of patients develop systemic metastases and die from their disease. Chemotherapy can control disseminated disease and may induce remission.