Between January 1, 1973, and December 31, 1988, the authors or their associates performed 552 fine-needle aspiration biopsies on patients with clinically significant masses of the salivary glands. All patients presented at the Medical College of Virginia Hospitals or Clinics of Virginia Commonwealth University; they were followed for periods ranging from 1 to 16 years. When available, the fine-needle aspiration diagnoses were correlated with histologic diagnoses and long-term patient outcomes. The sensitivity for a neoplasm was 93.3%; the specificity for the absence of a neoplasm was 99%. Diagnostic efficiency was 96.4%, and predictive value of a positive aspiration for a neoplasm was 98.3%. With fine-needle aspiration, surgical excision of salivary gland masses is often unnecessary. In patients with primary and metastatic neoplasms involving the salivary glands, fine-needle aspiration aids the surgeon in mapping the extent of the surgical procedure and in preoperatively preparing the patient. The procedure is cost-effective.

Results of 567 thin-needle aspiration biopsies of head and neck lesions are reviewed. Cases included lymph nodes, salivary glands, thyroid, soft tissue and bone lesions. For the entire series, 17 patients had unsatisfactory aspirations. There were 12 false negative reports and 4 false positive reports, rates of 2.1% and 0.7%, respectively. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative reports. In the case of benign and malignant tumors, reports were histologically specific in more than 98% of the cases. This technique is simple to perform and saves time and hospital costs. Thin-needle aspiration biopsy can be effectively used in the management and diagnosis of head and neck tumor patients where close cooperation of the clinician and cytopathologist exists.Cancer 43:1541-1548, 1979.N JULY 1974, the authors presented a pre-

Between November 1972 and December 1981, 1303 fine needle aspiration biopsies were performed on patients with head and neck masses at the Medical College of Virginia, Virginia Commonwealth University. The results of 649 lymph node, 227 salivary gland, 286 thyroid, and 41 miscellaneous aspiration biopsies are reviewed. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative results. Techniques for performing the procedure are briefly reviewed. Cost containment is stressed, particularly the savings that occur when the diagnosis is not neoplastic. Future developments and uses of the procedure are discussed.

Few drug reactions are more life threatening than the sudden development of edema involving the mucosal and submucosal layers of the upper aerodigestive tract. Drug-induced angioedema is a recognized entity of angiotensin-converting enzyme (ACE) inhibitors, and despite reports in medical journals and drug insert warnings, captopril and enalapril continue to be widely prescribed. As these drugs are efficacious and usually well-tolerated in the treatment of mild forms of hypertension, their popularity is rising. From June 1, 1984 to August 1, 1991, 36 patients with angioedema secondary to ACE inhibitors presented at the Medical College of Virginia Hospitals. Thirty were successfully managed with medical therapy. Two were intubated, 1 had placement of a nasal trumpet, and 3 required tracheostomies. Of extreme importance is the recognition that angioedema resulting from ACE inhibitors is probably not immunoglobulin E (IgE) mediated and that antihistaminics and steroids may not alleviate the airway obstruction. The otolaryngologist must be prepared for the need of possible early surgical intervention.

Between 1973 and December 1978, the authors performed 133 thin needle aspiration biopsies of the thyroid gland. Thin needle aspiration biopsy has proved valuable in this series and may save some patients the necessity of thyroid surgery. The procedure, performed quickly, results in a diagnosis usually available minutes later, and a definite patient disposition can be made promptly. At a time of medical cost containment, this procedure will become more important in patient care. Review of our aspirations through 1977 revealed three false negative biopsies and two false positive reports. Important differential characteristics between follicular neoplasm and nodular or ade‐nomatous goiter will be discussed. Neoplasms appear to represent a smaller percentage of cold thyroid nodules than reported elsewhere.