The association of lymph node volume with cervical metastatic lesions in head and neck cancer patients.

The aim of this study was to determine if volume of cervical lymph node measured via computed tomography (CT) could differentiate metastatic from benign lesions in head and neck cancer patients. We conducted a retrospective review of chart and images in a tertiary referring center in Taiwan. Patients with head and neck cancers underwent radical, modified radical or functional neck dissection were enrolled. The CT images before operation were reassessed by a radiologist and were compared with the results of pathological examination. A total of 102 patients were included for final analyses. Most patients were male (n = 96, 94%) and average age was 50.1 years. Although the average nodal volume in patients with cervical metastases was higher than those of patients without cervical metastases, it was not an independent factor associated with cervical metastasis after controlling for other variables; however, central nodal necrosis on enhanced CT image [odds ratio (OR) 18.95, P = 0.008) and minimal axial diameter >7.5 mm (OR 6.868, P = 0.001) were independent factors correlated with cervical metastasis. Therefore, the volume of cervical lymph node measured from CT images cannot predict cervical metastases in head and neck cancer patients. Measurement of minimal axial diameter of the largest lymph node is a simple and more accurate way to predict cervical metastasis instead.

Prospective, randomized, controlled trial of tranexamic acid in patients who undergo head and neck procedures.

OBJECTIVES: To determine if tranexamic acid could reduce the drainage duration after head and neck procedures. STUDY DESIGN: Prospective, randomized, controlled trial. METHODS: Patients who underwent head and neck operations were included. The study group was treated with tranexamic acid during the perioperative period whereas the control group received normal saline solution. Blood samples were also collected. RESULTS: The study and control groups consisted of 26 and 29 patients, respectively. Although there was a significant difference in the drainage amount between the two groups, (49.7 vs 88.8 mL, P = 0.041), no significant difference could be found in the drainage duration between the two groups (2.69 vs 3.07 days, P = 0.146). There was also no significant difference in the coagulation profiles between the two groups. CONCLUSION: We did not find a meaningful effect in reducing the drainage duration after head and neck procedures with the use of prophylactic tranexamic acid.

The association of smoking, alcoholic consumption, betel quid chewing and oral cavity cancer: a cohort study.

We aimed to analyze the relationship between smoking, alcoholic consumption and betel quid chewing with oral cavity cancer. All male patients age > or =18 years who visited our clinic received an oral mucosal inspection. Basic data including personal habits were also obtained. A multivariate logistic regression model was utilized to determine relevant risk factors for developing oral cavity cancer. A total of 8,356 patients were enrolled in this study. Abnormal findings were found in 382 patients (4.6%). Two hundred and ninety-seven patients received biopsy and 191 patients were proven to have oral cavity cancer. The results of multivariate logistic regression showed that those who smoked, consumed alcohol and chewed betel quid on a regular basis were most likely to contract oral cancer (odds ratio: 39.66, 95% confidence interval: 26.04-60.38). Therefore, habitual cigarette smokers, alcohol consumers, and betel quid chewers have a higher risk of contracting oral cavity cancer and should receive oral mucosal screening regularly so potential oral cavity cancer can be detected as early as possible, which may result in better and improved survival of oral cancer patients.

Using information technology to reduce the inappropriate use of surgical prophylactic antibiotic.

Despite implementation of practical guidelines, continuing education programs in our hospital, the percentage of inappropriate prophylactic antibiotic usage remains high. The aim of this study was to investigate whether information technology can reduce the misuse of surgical prophylactic antibiotic. We started physician continuing education programs in January 2005 and initiated feedback system in July 2005. The computerized reminder system was implemented in April 2006. Relevant data about the surgical prophylactic antibiotic usage were collected and was separated into three groups. Group 1 consisted of data from January 2005 to June 2005, while group 2 and group 3 consisted of data from July 2005 to March 2006 and April 2006 to December 2006, respectively. The percentage of no prophylactic antibiotic in clean procedures and the duration of prophylactic antibiotic in clean-contaminated procedures were recorded and analyzed. Furthermore, the surgical wound infection rates were also collected. In clean procedures, the percentage of no prophylactic antibiotic after surgery decreased in the long run. In parotidectomy, submandibular gland surgery and thyroidectomy patients, the percentage even reached 100% at the end of this study. In clean-contaminated procedures, the duration of prophylactic antibiotic after surgery was also reduced except in laryngectomized patients at the end of this study. Information technology such as feedback and reminder systems is an effective method to reduce inappropriate usage of surgical prophylactic antibiotic.