Cases reported "Lymphadenitis"

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1/36. Surgery for cervicofacial nontuberculous mycobacterial adenitis in children: an update.

    OBJECTIVE: To assess optimal surgical treatment with excision or curettage techniques in children with cervicofacial nontuberculous mycobacterial (NTM) adenitis. DESIGN: Retrospective case series. SETTING: Tertiary university-based pediatric referral center. patients: patients younger than 18 years diagnosed as having cervicofacial NTM adenitis by positive mycobacterial cultures or stains, or by histopathologic evaluation. INTERVENTIONS: Fine-needle aspiration biopsy for diagnosis, surgical excision and/or curettage of head and neck lesions for treatment. MAIN OUTCOME MEASURES: Number of procedures per patient, complications, resolution of mass. RESULTS: A total of 32 surgical procedures were performed in 25 children with cervicofacial NTM adenitis (mean, 1.3 procedures per patient; range, 1-3): 19 excisional and 13 curettage procedures. The 14 children who had excision as an initial procedure required no additional surgery. Of 11 children who had curettage as an initial procedure, 6 (55%) required additional procedures. Three of these children had additional surgery as planned staged procedures. Excisional surgery after initial curettage (5 patients) was simplified by initial debridement and secondary healing. No complications of curettage were noted. Transient marginal mandibular nerve weakness was seen in 4 patients who had excision. Fourteen of 16 fine-needle aspiration biopsy specimens were diagnostic for NTM adenitis. CONCLUSIONS: Cervicofacial NTM adenitis can be treated with excision or curettage. Excision remains the treatment of choice because of the high cure rate with a single procedure. We now consider curettage as a staged procedure for lesions in proximity to the facial nerve or with extensive skin necrosis, with initial curettage simplifying subsequent excision and wound closure. Preoperative counseling should include discussion of planned or unplanned revision surgery after curettage. Fine-needle aspiration biopsy allows early diagnosis of NTM adenitis.
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2/36. Demonstration of parasites in toxoplasma lymphadenitis by fine-needle aspiration cytology: report of two cases.

    Two cases of toxoplasma lymphadenitis diagnosed by fine-needle aspiration (FNA) cytology, in which the microorganisms were identified in the cytologic preparations, are presented. The first case was that of an 8-yr-old boy with bilateral cervical lymphadenopathy of 2-mo duration, in which an FNA specimen of one of the lymph nodes in a Papanicolaou-stained smear disclosed a toxoplasma cyst, and in Wright-Giemsa preparation, dispersed tachyzoites and a pseudocyst. The second case was that of a 52-yr-old man with enlargement of a single lymph node in the neck, of 3-mo duration, FNA of which in Wright-Giemsa preparation disclosed numerous tachyzoites dispersed free in exudate, and also within cells, forming pseudocysts. In both cases, immunocytochemistry by the peroxidase method for toxoplasma gondii antigen was positive. The tachyzoites seen in Wright-Giemsa preparations, when subjected to fluorescence microscopy, emitted autofluorescence, facilitating their identification. While the presence of parasites in toxoplasma lymphadenitis is quite unusual, having been reported occasionally in histologic preparations and only rarely in cytologic FNA materials, our 2 cases suggest that in active disease, tachyzoites may not be so uncommon in FNA specimens. Besides the use of immunocytochemistry in the diagnosis of the disease, air-dried preparations stained by the Wright-Giemsa method are valuable for the demonstration of such parasites through careful search, along with the possible use of fluorescence microscopy.
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3/36. The radiographic evaluation of infants with stridor.

    In the elective evaluation of infant stridor, inspiratory plain radiographs of the neck and chest are routinely obtained with fluoroscopy and a barium swallow when indicated. Several factors, including patient positioning, roentgenographic technique, and the phase of respiration, may significantly alter the appearance of the airway, reducing the diagnostic accuracy of this modality and leading to misinterpretation of the pathologic changes.
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4/36. Cervical lymphadenitis and cat scratch disease (CSD): an overlooked disease?

    Cat Scratch disease (CSD) is a benign disease characterized by regional lymphadenopathy affecting most frequently the head and neck region in children and young adults. In the present paper, the authors describe four cases of CSD focusing on clinical history, diagnostic management and therapy. The main germ responsible for this lymph node disease is bartonella henselae. Diagnosis is based on history, serology and histological findings. Clinical evolution is generally favorable despite the fact that complications occur in about 5% to 13% of patients including encephalitis, hepatitis and Parinaud's oculoglandular syndrome. Antibiotic treatment is only considered for highly symptomatic patients. Surgical excision of the lymphadenopathy is useful to establish the diagnosis when serology is not available and/or when the adenopathy become fluctuating. The authors emphasize the increasing incidence of patients with CSD in the ENT population and the algorithm for CSD disease affecting the cervical lymph nodes.
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5/36. Staphylococcal submandibular lymphadentitis of childhood.

    The presentation of two patients with the condition is described. The difficulty of finding an underlying cause of the infection is discussed, and the importance of a history of recent head and neck infection emphasised. Recommendations are made for appropriate antibiotic therapy to cover Staphylococci as well as the more common Streptococci.
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6/36. Preoperative histologic assessment of head and neck lesions using cutting needle biopsy.

    OBJECTIVE: This study assessed the clinical utility of cutting needle biopsy in which a newly developed Monopty biopsy instrument (MBI) (Monopty, Bard Urologic Division; Covington, Ga) was used in the preoperative assessment of head and neck lesions. STUDY DESIGN: Needle biopsies were performed with the MBI in 16 cases of head and neck lesions that included lesions in lymph nodes, salivary glands, palate, and soft tissue. RESULTS: High-quality histopathologic specimens were obtained without complications in all biopsies performed, and the diagnostic target tissue was obtained in 15 of 16 cases. Diagnoses made from MBI needle biopsy specimens were consistent with the final diagnoses made from subsequent surgical materials in 14 cases, and the accuracy rate was 88%. None of the samples demonstrated significant rush artifacts or obscuring blood, both of which are problems commonly associated with manual biopsy techniques. CONCLUSIONS: This technique offers a safe and effective means of obtaining adequate tissue for the histological assessment of head and neck lesions.
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7/36. Diagnosis, management and surgical treatment of non-tuberculous mycobacterial head and neck infection in children.

    The aim of this study was to present our experience with the clinical characteristics of non-tuberculous mycobacterial (NTM) head and neck lymph node infections, the use of modern diagnostic tools and the appropriate therapeutic measures. We have reviewed the cases of 14 Caucasian children with NTM head and neck lymphadenitis who were treated in our clinic in the last 5 years. Three of the patients were male and 11 were female. Their age ranged from 15 to 98 months (mean age 45.7 /- 21.76 months). Cervical lymph nodes were involved in all of our cases, while the submandibular region was found to be the area mostly affected. Overlying skin was involved in 7 cases. Diagnosis was based on intradermal skin testing with specific antigens for atypical mycobacteria, histological examination and specimen culture. skin tests were positive for NTM in all of the patients with a predilection for mycobacterium avium complex. The diagnosis was confirmed by histological examination in 13 cases. Specimen culture was positive in 9 cases, most of them growing M. avium-intracellulare complex. Treatment included complete surgical excision of the affected lymph nodes and the overlying skin, as well as functional neck dissection when required. A second procedure was performed in 2 patients. Successful evaluation of NTM infections of the head and neck lymph nodes should include a detailed history, thorough physical examination and specific laboratory investigations. The treatment of choice is complete surgical excision of all affected tissue.
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8/36. Abnormal radionuclide angiogram in cervical lymphadenitis: case report.

    We have observed increased activity over the neck on radionuclide angiograms of two patients with cervical lymphadenitis. This incidental findings should not be confused with other causes of locally increased perfusion.
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9/36. A rare case of Crohn's disease in head and neck surgery.

    oral manifestations of Crohn's disease may present to the Otolaryngologist in the form of ulceration, glossitis and odynophagia, but rarer examples of presentation are also recognized. In this case a 24-year-old lady presented with cervical lymphadenopathy, the subsequent investigation of which resulted in the identification of the disease both in this node and in the tonsils. It is noted that these lesions may precede the classical intestinal manifestations and so the Otolaryngologist could aid in the initial diagnosis of the disease. The pathogenic possibilities of how Crohn's disease might have arisen in these and other extra-intestinal regions, are discussed.
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keywords = neck
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10/36. Update on treatment of Marshall's syndrome (PFAPA syndrome): report of five cases with review of the literature.

    Marshall's syndrome or PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is a recently described pediatric periodic disease characterized by recurrent febrile episodes associated with head and neck symptoms. The origin of this syndrome is unknown, and it can last for several years. During healthy periods, patients grow normally. The differential diagnosis includes other diseases characterized by periodic fevers, such as familial mediterranean fever, familial Hibernian fever, hyperglobulinemia D syndrome, Behcet's disease, cyclic neutropenia, juvenile rheumatoid arthritis, and several infectious diseases. Many treatments have been used, with various results, including antibiotics, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, colchicine, antiviral medicines, steroids, cimetidine, and tonsillectomy. We describe 5 new patients affected by PFAPA syndrome who were observed at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, italy, from November 2000 to August 2001. All children underwent physical examination, bacterial, fungal, and viral cultures, chest radiography, and several laboratory studies. The patients were treated by successful tonsillectomy, and after a mean follow-up of 10 months, no recurrence was observed. An analysis of the literature is also presented with particular emphasis on the differential diagnosis of this rare illness and the results of the different therapeutic options.
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