Objective: To examine whether microdebrider intracapsular tonsillotomy (MT) results in less postoperative pain compared with electrosurgical extracapsular tonsillectomy (ET).Design: Prospective, randomized, double-blind, matched pair, clinical trial.Setting: Specialty care hospital.Patients: Twelve male (48%) and 13 female (52%) children aged 5 to 15 years, with obstructive tonsillar hyperplasia were randomized to have one tonsil removed by MT and the other by ET.Interventions: An angled endoscopic microdebrider was used to perform MT, and ET was performed by standard monopolar cautery technique. Parents and children were blinded to the side of MT and ET. Children rated the pain 0 to 5 by side using the Faces Pain Scale-Revised. Blinded data collection was via telephone daily for 2 weeks by a study nurse.Main Outcome Measures: Primary: postoperative pain as recorded by Faces Pain Scale-Revised; secondary, presence or absence of otalgia and postoperative bleeding.Results: Twenty-two children (88%) had tonsillectomy and adenoidectomy, while 3 children (12%) had tonsillectomy alone. On postoperative days 1 to 9, children reported significantly less pain on the MT side compared with the ET side (paired t test; PϽ.01). By postoperative days 10 to 14, the difference between sides disappeared. Twenty children (80%) reported otalgia, and it was always unilateral. For those children reporting otalgia, there was a 100% correlation between the side of otalgia and the side of ET. There was no posttonsillectomy bleeding among the 25 children.Conclusion: Microdebrider intracapsular tonsillotomy is significantly less painful compared with electrosurgical ET in children undergoing surgical intervention for obstructive tonsillar hypertrophy.
OBJECTIVES: To assess the correlation between cortaction overexpression, the clinicopathological characteristics, and tumor behavior in oral squamous cell carcinoma (OSCC). METHODS: Some 122 OSCC patients subjected to surgical resection of primary tumor and neck dissection between January 2001 to September 2004 were enrolled in the study. Cortactin expression of tumor tissue by immunohistochemical stain, tumor size, lymph node numbers, differentiation status, lymphvascular invasion, local-regional recurrence, and distant metastasis were evaluated. The outcome measurement was schematic with Kaplan-Meire survival method. The Fisher exact test and Chi-square test were used for statistical analysis. RESULTS: Statistical analysis indicates no correlation between cortactin overexpression with pathologic grade (P ϭ 0.960), or tumor site (P ϭ 0.377). Nevertheless, statistical differences were found with respect to pT stage of primary tumor (P ϭ 0.037), pN stage of lymph node metastasis (P ϭ 0.007), disease stage (P ϭ 0.01), disease status (P ϭ 0.00034), and tumor recurrence (P ϭ 0.00123). The cumulative survival after surgery is typically correlated with disease stage, regardless of cortactin expression (P ϭ 0.001). Also, there is a statistically significant difference in cortactin levels between stages I/II or III/IV OSCC patients (P ϭ 0.048, and P ϭ 0.006). CONCLUSIONS: EMS1 gene amplification and the concomitant overexpression of cortactin have been shown to correlate with poor prognosis and tumor metastasis in OSCC.
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