Postoperative hemorrhage after tonsillectomy: use of ketorolac tromethamine.

Recent reports have associated an increased incidence of bleeding after tonsillectomy with the perioperative use of ketorolac tromethamine. To review this association, we examined the hospital and office records of 310 pediatric patients who underwent tonsillectomy with or without adenoidectomy at our institution during a 2-year period. Of these patients, 213 received ketorolac administered as a single dose at the conclusion of the procedure. The remaining 97 patients did not receive ketorolac. The frequency of postoperative hemorrhage was not found to differ significantly between these 2 groups (2.3% vs. 3.1% respectively, P = 0.71). Furthermore, the average time to discharge after surgery was significantly shorter in those patients who received ketorolac than in those who did not (8.5 hours vs. 12.5 hours, respectively, P < 0.0001). The frequency of overnight hospital stays was also significantly lower in those patients who received ketorolac (16.0% vs. 31.6%, respectively, P < 0.01). Concern over the potential for increased hemorrhage after tonsillectomy has led several authors to caution against the use of ketorolac in this setting. In our study, however, the use of ketorolac was not found to increase the incidence of posttonsillectomy hemorrhage and furthermore was associated with a significant decrease in the length of hospital stay as well as a decreased likelihood of overnight hospital stay after surgery.

The role of IgE-mediated hypersensitivity in otitis media with effusion.

INTRODUCTION: The role of immunoglobin (Ig) E-mediated hypersensitivity in otitis media with effusion (OME) has been the subject of much controversy and personal bias. Uncontrolled studies report the incidence of respiratory allergy in children with OME to range from 4% to over 90%. MATERIALS AND METHODS: Children 1 to 18 years old who had OME requiring a myringotomy and tubes from January 1, 1987, through July 1, 1988, were the subjects of this study. The history of allergic and radioallergosorbent test (RAST) analysis of specific serum IgE levels was undertaken for 26 allergens on 89 children in the study group and 59 children in the control group. RESULT: The incidence of allergen as diagnosed by RAST score was higher in children with OME than children in the control group (P > .05). There was no correlation between positive RAST scores and the number of polyethylene-ventilating (PE) tubes previously placed, history of tonsillectomy, history of adenoidectomy, or the character of the effusion (mucous v serous). CONCLUSION: Respiratory allergy is a factor involved in the pathogenesis of OME.

Otolaryngology problems in the immune compromised patient--an evolving natural history.

As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent--including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis--thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Kaposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses.

Living cytology--revisited. In vitro demonstration of intraabdominal adenocarcinomatosis.

An in vitro culture technique, "living cytology", was used in a single-blind study to study 36 paracentesis and 7 intracystic fluid specimens for possible adenocarcinomatosis. Islets of epithelial cells were demonstrated only in the 20 patients who were ultimately shown to have intraabdominal adenocarcinomatosis. Ten patients with nonmalignant conditions and 6 patients with nonmetastatic malignancies did not exhibit a comparable pattern. One of the 7 intracystic fluid specimens grew out epithelial islets similar to those observed in patients with intraabdominal adenocarcinomatosis.

Hormonal control of morphogenetic cell death of the wing hypodermis in Lucilia cuprina.

1. Cytoplasmic fragments in the haemolymph of newly emerged flies derive from the degenerating wing hypodermis. 2. At the time of eclosion, dorsal and ventral cell layers of the wing are connected by processes containing bundles of microtubules and microfilaments. Cytoplasmic fragments contain similar bundles of microtubules but few microfilaments. 3. Extensive vacuolation marks the onset of hormonally initiated fragmentation of the wing hypodermal cells. Haemocytes containing lysosomes are present in the wing at this time, but do not invade the fragmenting hypodermis.