[Perioperative management of coagulation in otorhinolaryngologic surgery]. / Perioperatives Gerinnungsmanagement in der HNO-Heilkunde.

Considering the increasing number of patients suffering from drug-induced coagulation disorders caused by antiplatelet or anticoagulant therapy, the right balance between minimizing the risk of bleeding and the risk of a venous thrombosis or embolism during otorhinolaryngologic (ORL) surgery is becoming increasingly important. According to a recent study, the highest risk of intraoperative bleeding in ORL surgery is associated with transoral tumor surgery, tonsillectomy, thyroidectomy, and glomus tumor surgery. The risk of venous thrombosis or embolism during ORL surgery is estimated to be 1%, and increases to 6% among tumor patients. Currently, there is no general recommendation for perioperative hemostatic management because of the limited available data. In the majority of patients who continue antiplatelet therapy with acetylsalicylic acid (ASS) to prevent thromboembolic events, the perioperative bleeding risk is considered to be acceptable. For patients with dual antiplatelet therapy, surgical procedures should be only performed after adaption of the medication.

Transnasal devascularisation of a sinonasal hypervascular tumour (glomangiopericytoma) with direct injection of liquid polymer agent (Squid®).

The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity. A primary attempt at trans-arterial embolisation through selective ophthalmic artery catheterisation was unsuccessful due to unfavourable anatomy. An extensive devascularisation of the nasal fossa lesion was obtained using a single injection of low-density polymeric embolic agent (SQUID®). Post-operative eradication was uneventful. Final histopathology exam revealed vascular tumour consistent with a rare sinonasal glomangiopericytoma. To our knowledge, this is the first reported case of a rare sinonasal glomangiopericytoma treated by direct TN injection, utilising the liquid polymer agent SQUID®.

Somatostatin receptor scintigraphy and therapy of neuroendocrine (APUD) tumors of the head and neck.

Through the development of somatostatin scintigraphy with the labeled somatostatin analog Indium111-Octreotide, it has recently become possible to accurately diagnose primary tumors of the APUD system as well as their metastases, since these tumors usually have somatostatin receptors. Experience with this method is already available for endocrine and exocrine tumors of the gastrointestinal tract, neuroendocrine and breast tumors, small cell bronchial carcinomas and certain lymphomas. In the present study, this new diagnostic technique was used for the first time in various head and neck tumors (carcinoid of the larynx, Merkel cell tumor, glomus tumor of the carotid and glomus jugulare tumor). Concurrently, some of these tumors shown by this diagnostic method to be somatostatin receptor positive were treated using the somatostatin analog Octreotide, a therapeutic approach new for the ENT-specialty. Our initial results prove that the detection of the ENT tumors which we studied by means of receptor scintigraphy is reliable. The preliminary results of this Octreotide therapy show a growth inhibitory effect, especially for those tumors of the head and neck which are inoperable or are difficult to approach surgically.

Subungual glomus tumors: an algorithmic approach.

Glomus tumors of the hand are benign lesions that historically have often eluded a timely diagnosis and effective therapy. The reason for this difficulty in diagnosis lies partially in the rarity of these lesions. A certain degree of suspicion as well as a knowledge of the appropriate workup are necessary. In this article we submit an algorithmic approach to the diagnosis and treatment of these lesions as a guideline for clinical management. A description of our preferred method of extirpation is provided.

[Detection of somatostatin receptors in tumors in the area of the head and neck and their clinical importance]. / Nachweis von Somatostatinrezeptoren in Tumoren des Kopf-Hals-Bereiches und ihre klinische Bedeutung.

The development of a radiolabelled somatostatin analogue Indium-111-Pentetreotide makes the detection of somatostatin receptor-bearing tumours by scintigraphic techniques possible. The existence of high-affinity binding sites for somatostatin has been described previously for most endocrine active tumours of the gastroenteropancreatic system (GEP), malignant lymphomas, small cell lung carcinomas, a subgroup of breast tumours and several types of neuroendocrine related human tumours. Using this new diagnostic tool we investigated some head and neck tumours of neuroendocrine origin (carcinoid of larynx, Merkel cell carcinoma, paragangliomas) with the newly developed radiolabelled somatostatin analogue Indium-111-Pentetreotide whether in vivo visualisation of somatostatin receptors might be possible. In cases not accessible for surgery but with a positive receptor status we started a specific therapy with the somatostatin analogue octreotide. The preliminary results suggest that this new isotopic scanning technique in a diagnostic tool and a predictive method for an effective therapy of those head and neck tumours which revealed highly specifically a positive receptor status. The therapeutical results using the somatostatin analogue octreotide indicate that this new concept is an ideal therapeutic strategy for those neuroendocrine head and neck tumours which cannot be controlled by surgical procedures.