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Granulomatous sialadenitis
311
CURRENT LITERATURE
this phenomenon, little has been reported in dentistry to confirm or deny that diffusion hypoxia truly occurs and what the clinical consequences may be. In spite of this lack of information, current dental practice requires the administration of 100% oxygen for 3 to 5 minutes following treatment for prevention. In this study, 104 healthy adult patients undergoing routine dental treatment with N20 were studied. At the conclusion of treatment, the patient was allowed to breath room air without supplemental oxygen. Pulse oximetry was used to measure oxygen saturation (Sao,) during the perioperative period. Average length of treatment was 21 minutes, and average NzO concentration was 35.6%. Mean pretreatment Sao, was 97%, and mean SaoZ following discontinuation of N20 was 98%. Over the first 4 minutes following N20 discontinuation, mean SaoZ decreased 2% and stabilized. Because no patient had a Sao, less than 92%, it was concluded that no patient in this sample developed diffusion hypoxia. Using this sample of patients, the probability of diffusion hypoxia ranges statistically from 0% to 2.84%, with 95% confidence limits. The authors conclude that administration of oxygen is unnecessary following nitrous oxide in healthy patients. They suggest that further studies are needed to confirm the lack of clinical evidence for this phenomenon.-J. DEMBO Reprint requests to Dr Milgrom: Department of Dental Public Health Sciences, SM-35, University of Washington, Seattle, WA 98185.
Oral Monomorphic Adenomas. Bat&is JG. Ann Otol Rhino1 100:348, 1991 Two of the least familiar monomorphic
adenomas of salivary glands, the inverted ductal papilloma and canalicular adenoma, have a predilection for the anterior mouth, particularly the upper lip. They are biologically benign, but unfamiliarity with their histopathology can lead to misdiagnosis of malignancy. The clinical and pathological features and differential diagnosis from mucoepidennoid carcinoma are presented.-G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 1515 Holcomhe Blvd,
Houston. TX 77030. Terminal Duct Adenocarcinomas of Salivary Tissues. Batsakis JG, El-Naggar AK. Ann Otol Rhino1 Laryngol 100:25 1, 199 1 Terminal duct adenocarcinoma is recommended as an encompassing diagnostic designation for a preponderantly intraoral salivary gland carcinoma that has also been termed polymorphous low-grade adenocarcinoma, lobular carcinoma, and low-grade papillary adenocarcinoma. The carcinoma is biologically of low grade, with its papillary phenotype manifesting a more aggressive behavior than nonpapillary forms--G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd, Houston. TX 77030.
Granulomatous Sialadenitis. Batsakis JG. Ann Otol Rhino1 Laryngol 100: 166, 199 1 Granulomatous inflammation in salivary tissues is most often a response to liberated ductal contents, particularly mucin, in various degrees of obstructive sialadenopathy. Less frequent is a granulomatous sialadenitis resulting from specific infective granulomas or systemic granuloma-forming diseases.
In these instances, salivary parenchymal involvement is usually secondary to disease localization in regional lymph nodes.-G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd,
Houston, TX 77030. Undifferentiated Carcinomas of Salivary Glands. Batsakis JG, Luna MA. Ann Otol Rhino1 Laryngol 100:82, 1991 Undifferentiated carcinomas of salivary glands are those epithelial malignancies with light-microscopy histopathological features not sufficient to place them in other defined classes of carcinoma. They are ultrastructurally heterogeneous and can manifest neuroendocrine differentiation. With or without the latter, the carcinomas are biologically of high grade and rank with salivary duct and high-grade mucoepidermoid carcinomas in terms of morbidity and mortality.G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, IJniversity of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd,
Houston, TX 77030. Head and Neck Cancer: An Analysis of the Incidence, Patterns of Treatment and Survival at the University of Iowa. Hussey DH, Latourette HB, Panje WR. Ann Otol Rhino1 Laryngol 1OO:l. 1991 (suppl 152) A retrospective study on 4,506 patients with head and neck cancer at the University of Iowa Hospitals between 1960 and 1985 evaluated tumor population characteristics, care patterns, and patient survival. The number of patients per year and distribution of cancer by anatomic site remained relatively stable over the 26-year period, with a general trend toward more advanced stages in later years. Treatment modalities correlated well with the site and stage of the disease and with patient survival rates. There was a gradual improvement in 5-year survival rates over the 26-year period, from +39% in 1960 to ?47% in 1984, principally due to improvement in “regional stage” disease survival, from 22% in 1960 to t41% in 1985.-G. H. SPERBER Reprint requests to Dr Hussey: Division of Radiation Oncology, University of Iowa Hospitals, Iowa City, IA 52242-1059.
Reversal of Central Benzodiazepine Effects by Intravenous Flumazenil. Clark MS, Lindenmuth JE, Jafek BW, et al. Anesth Prog 38: 12, 199 1 Flumazenil, a benzodiazepine antagonist, may be useful in reversing the effects of benzodiazepines in cases of oversedation. Thirty adult patients undergoing surgical extractions participated in this randomized, double-blind study. Midazolam was titrated intravenously to a clinical endpoint of sedation prior to commencement of surgery. At the completion of surgery, patients received either flumazenil (0.1 mg/ mL) or placebo intravenously. The drug or placebo was titrated in 2-mL increments until reversal of sedation or to a total of 10 mL. Baseline and postsedation testing included tests of cognitive ability, motor function, memory, and subjective and objective assessments of sedation. The reversal effects appeared to be immediate and profound, with significant differences from placebo at 5 and 15 minute times in all areas except memory. The authors conclude that flumazenil was efficacious in reversing the effects of midazolam
CURRENT LITERATURE
this phenomenon, little has been reported in dentistry to confirm or deny that diffusion hypoxia truly occurs and what the clinical consequences may be. In spite of this lack of information, current dental practice requires the administration of 100% oxygen for 3 to 5 minutes following treatment for prevention. In this study, 104 healthy adult patients undergoing routine dental treatment with N20 were studied. At the conclusion of treatment, the patient was allowed to breath room air without supplemental oxygen. Pulse oximetry was used to measure oxygen saturation (Sao,) during the perioperative period. Average length of treatment was 21 minutes, and average NzO concentration was 35.6%. Mean pretreatment Sao, was 97%, and mean SaoZ following discontinuation of N20 was 98%. Over the first 4 minutes following N20 discontinuation, mean SaoZ decreased 2% and stabilized. Because no patient had a Sao, less than 92%, it was concluded that no patient in this sample developed diffusion hypoxia. Using this sample of patients, the probability of diffusion hypoxia ranges statistically from 0% to 2.84%, with 95% confidence limits. The authors conclude that administration of oxygen is unnecessary following nitrous oxide in healthy patients. They suggest that further studies are needed to confirm the lack of clinical evidence for this phenomenon.-J. DEMBO Reprint requests to Dr Milgrom: Department of Dental Public Health Sciences, SM-35, University of Washington, Seattle, WA 98185.
Oral Monomorphic Adenomas. Bat&is JG. Ann Otol Rhino1 100:348, 1991 Two of the least familiar monomorphic
adenomas of salivary glands, the inverted ductal papilloma and canalicular adenoma, have a predilection for the anterior mouth, particularly the upper lip. They are biologically benign, but unfamiliarity with their histopathology can lead to misdiagnosis of malignancy. The clinical and pathological features and differential diagnosis from mucoepidennoid carcinoma are presented.-G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 1515 Holcomhe Blvd,
Houston. TX 77030. Terminal Duct Adenocarcinomas of Salivary Tissues. Batsakis JG, El-Naggar AK. Ann Otol Rhino1 Laryngol 100:25 1, 199 1 Terminal duct adenocarcinoma is recommended as an encompassing diagnostic designation for a preponderantly intraoral salivary gland carcinoma that has also been termed polymorphous low-grade adenocarcinoma, lobular carcinoma, and low-grade papillary adenocarcinoma. The carcinoma is biologically of low grade, with its papillary phenotype manifesting a more aggressive behavior than nonpapillary forms--G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd, Houston. TX 77030.
Granulomatous Sialadenitis. Batsakis JG. Ann Otol Rhino1 Laryngol 100: 166, 199 1 Granulomatous inflammation in salivary tissues is most often a response to liberated ductal contents, particularly mucin, in various degrees of obstructive sialadenopathy. Less frequent is a granulomatous sialadenitis resulting from specific infective granulomas or systemic granuloma-forming diseases.
In these instances, salivary parenchymal involvement is usually secondary to disease localization in regional lymph nodes.-G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, University of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd,
Houston, TX 77030. Undifferentiated Carcinomas of Salivary Glands. Batsakis JG, Luna MA. Ann Otol Rhino1 Laryngol 100:82, 1991 Undifferentiated carcinomas of salivary glands are those epithelial malignancies with light-microscopy histopathological features not sufficient to place them in other defined classes of carcinoma. They are ultrastructurally heterogeneous and can manifest neuroendocrine differentiation. With or without the latter, the carcinomas are biologically of high grade and rank with salivary duct and high-grade mucoepidermoid carcinomas in terms of morbidity and mortality.G. H. SPERBER Reprint requests to Dr Bat&is: Department of Pathology, IJniversity of Texas, M.D. Anderson Cancer Center, 15 15 Holcomhe Blvd,
Houston, TX 77030. Head and Neck Cancer: An Analysis of the Incidence, Patterns of Treatment and Survival at the University of Iowa. Hussey DH, Latourette HB, Panje WR. Ann Otol Rhino1 Laryngol 1OO:l. 1991 (suppl 152) A retrospective study on 4,506 patients with head and neck cancer at the University of Iowa Hospitals between 1960 and 1985 evaluated tumor population characteristics, care patterns, and patient survival. The number of patients per year and distribution of cancer by anatomic site remained relatively stable over the 26-year period, with a general trend toward more advanced stages in later years. Treatment modalities correlated well with the site and stage of the disease and with patient survival rates. There was a gradual improvement in 5-year survival rates over the 26-year period, from +39% in 1960 to ?47% in 1984, principally due to improvement in “regional stage” disease survival, from 22% in 1960 to t41% in 1985.-G. H. SPERBER Reprint requests to Dr Hussey: Division of Radiation Oncology, University of Iowa Hospitals, Iowa City, IA 52242-1059.
Reversal of Central Benzodiazepine Effects by Intravenous Flumazenil. Clark MS, Lindenmuth JE, Jafek BW, et al. Anesth Prog 38: 12, 199 1 Flumazenil, a benzodiazepine antagonist, may be useful in reversing the effects of benzodiazepines in cases of oversedation. Thirty adult patients undergoing surgical extractions participated in this randomized, double-blind study. Midazolam was titrated intravenously to a clinical endpoint of sedation prior to commencement of surgery. At the completion of surgery, patients received either flumazenil (0.1 mg/ mL) or placebo intravenously. The drug or placebo was titrated in 2-mL increments until reversal of sedation or to a total of 10 mL. Baseline and postsedation testing included tests of cognitive ability, motor function, memory, and subjective and objective assessments of sedation. The reversal effects appeared to be immediate and profound, with significant differences from placebo at 5 and 15 minute times in all areas except memory. The authors conclude that flumazenil was efficacious in reversing the effects of midazolam