losartan-potassium and Tongue-Neoplasms

Despite its primary hematopoietic function, erythropoietin (Epo) is a pleiotropic cytokine that exerts various biological functions in many different non-hematopoietic cells and cancers, and its stimulatory effects are mediated through activation of its receptor (EpoR). Recent studies have shown that Epo and EpoR may be involved in carcinogenesis, angiogenesis, and invasion. We have investigated the expression of Epo and EpoR in a series of 65 resected squamous cell carcinomas (SCC) of the tongue using immunohistochemical staining. The proportion of Epo and EpoR changes in them was greater than those in normal squamous epithelium (P<0.05). Epo expression was associated with age, density of microvessels, and the stage of the tumour (P<0.05). EpoR expression was associated with microvascular density alone (P<0.05). After adjusting for other clinicopathological factors, Epo and EpoR expression remained independent adverse prognosticators for postoperative survival (P<0.05). Our findings support the hypothesis that the Epo and EpoR systems influence the prognosis of carcinogenesis, angiogenesis, and malignant progression of SCC of the tongue, and confirm that Epo and EpoR are independent prognostic markers.

Topics: Adult; Age Factors; Aged; Carcinoma, Squamous Cell; Erythropoietin; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Neovascularization, Pathologic; Prognosis; Proportional Hazards Models; Receptors, Erythropoietin; Tongue Neoplasms

A giant hemangioma of the tongue was resected in a 16-year-old otherwise healthy young man (ASA I). Despite a total blood loss of 4,300 ml, corresponding to 105% of the patients intravascular blood volume, no allogeneic red blood cells had to be transfused intraoperatively. Besides minimization of intraoperative blood loss with preoperative alcohol injections into the tumor, ligation of large tumor-perfusing arteries, application of fibrin glue, skillful surgical technique, positioning of the surgical field above the level of the heart, controlled hypotension and maintenance of normothermia, acute normovolemic hemodilution (augmented by preoperative administration of recombinant human erythropoetin - rhEpo) and autotransfusion of lost blood were used for recovery of autologous blood. Under the protection of hyperoxia, a decrease of the hemoglobin (Hb) concentration to 4.2 g/dl was bridged by extreme normovolemic hemodilution. No signs of immanent or manifest tissue hypoxia were encountered. Retransfusion of autologous red blood cells was only started when surgical control of bleeding was achieved. Additionally a total of 4 units of fresh frozen plasma were infused for stabilization of plasma coagulation. After a 9-hour surgical duration, the patient was transferred to the intensive care unit, normotensive (with low-dose infusion of norepinephrin) and normothermic with a Hb concentration of 5.6 g/dl. In the face of an increasing lactacidosis 2 units of packed red blood cells were transfused on post surgical day 1.

Topics: Adolescent; Anesthesia, General; Blood Loss, Surgical; Blood Preservation; Blood Transfusion, Autologous; Erythrocyte Transfusion; Erythropoietin; Fibrin Tissue Adhesive; Hemangioma; Hemodilution; Humans; Male; Plasma; Recombinant Proteins; Tissue Adhesives; Tongue Neoplasms