Cases reported "Pharyngeal Diseases"

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1/24. The use of granulocyte colony stimulating factor to promote wound healing in a neutropenic patient after head and neck surgery.

    BACKGROUND: neutropenia and neutrophil dysfunction, in association with a variety of diseases, has been shown to play a role in poor wound healing. Wound breakdown with fistula formation in patients undergoing total laryngectomy results in significant morbidity and increased hospital stay. Although malnutrition, prior radiation, diabetes, and other diseases are recognized as factors predisposing patients with head and neck cancer to developing fistulas, neutrophil dysfunction should also be considered. Granulocyte colony stimulating factor (G-CSF) has been used successfully to treat neutropenia and neutrophil dysfunction. methods: This study was conducted as a case report. RESULTS: We present the first report of a neutropenic head and neck cancer patient with a persistent wound of 6 months' duration who showed dramatic improvement after treatment with G-CSF. CONCLUSION: We conclude that G-CSF may represent a useful adjunct in patients with persistent wound healing problems and neutropenia despite adequate treatment by conventional means. Further clinical experience with G-CSF in patients with delayed healing is indicated.
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ranking = 1
keywords = cancer
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2/24. Candida dubliniensis in radiation-induced oropharyngeal candidiasis.

    Candida dubliniensis is a recently described species that has been shown to cause oropharyngeal candidiasis in patients with hiv. We present a detailed evaluation of a patient undergoing head and neck radiation for oral cancer who developed oropharyngeal candidiasis from a mixed infection of C dubliniensis and candida albicans. To our knowledge, this is the first described case of C dubliniensis contributing to oropharyngeal candidiasis in this patient population.
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ranking = 295.56897400215
keywords = radiation-induced, cancer
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3/24. The causes of dysphagia in carcinoma of the lung.

    Dysphagia occurs in only a small percentage of patients with lung cancer, but the frequency of this cancer means that large numbers are affected. Non-quantitative analysis of a large Scottish series of lung cancer cases indicates the following eight broad categories of dysphagia according to underlying mechanisms: mediastinal disease; cervical lymphadenopathy; brainstem lesions; gastrointestinal tract metastases; associated systemic disorders; second primaries; oropharyngeal and oesophageal infections; and radiation-induced oesophageal toxicity.
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ranking = 75.267243500538
keywords = radiation-induced, cancer
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4/24. Delayed carotid artery rupture in advanced cervical cancer--a dilemma in emergency management.

    Carotid artery rupture in the setting of advanced carcinoma of the head and neck constitutes a surgical emergency. This report details three such patients, two of whom presented with profuse bleeding, the other with imminent rupture. Notably, our first patient ruptured 27 years after having had radiotherapy for carcinoma of the larynx. This patient had had no previous surgery and at operation no recurrent tumor was evident. In the other two patients, previous surgery had demonstrated tumor invasion of the carotid artery. The choice of therapy in this calamitous condition is controversial, the question being whether to resect and reconstruct or ligate the ruptured artery. Our three patients underwent ligation with no recurrence of bleeding and no neurological sequelae for a follow-up period of 5-36 months. Of paramount importance is the hemodynamic stabilization of the patient prior to being submitted to surgery. Our results favor ligation rather than resection and reconstruction as the procedure of choice in this difficult predicament.
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ranking = 2
keywords = cancer
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5/24. candida glabrata oropharyngeal candidiasis in patients receiving radiation treatment for head and neck cancer.

    candida glabrata colonization is common in patients receiving radiation treatment for head and neck cancer, but to our knowledge has never been described as the infecting organism with oropharyngeal candidiasis (OPC). This study presents the first three patients described with C. glabrata OPC in this patient population. Patient 1 developed C. glabrata OPC and required fluconazole, 800 mg/day, for clinical resolution. Antifungal susceptibility testing revealed a MIC of fluconazole of >64 microg/ml. Elapsed time from initial culturing to treatment decision was 7 days. patients 2 and 3 developed C. glabrata OPC. They were patients in a study evaluating OPC infections, and cultures were taken immediately. CHROMagar Candida plates with 0, 8, and 16 microg of fluconazole/ml were employed for these cultures. Lavender colonies, consistent with C. glabrata, grew on the 0- and 8-microg plates but not on the 16-microg plate from patient 2 and grew on all three plates from patient 3. Based on these data, a fluconazole dose of 200 mg/day was chosen for patient 2 and a dose of 400 mg/day was chosen for patient 3, with clinical resolution in both. Elapsed time from initial culturing to treatment decision was 2 days. C. glabrata does cause OPC in head and neck radiation treatment patients, and the use of fluconazole-impregnated chromogenic agar may significantly reduce treatment decision time compared to that with conventional culturing and antifungal susceptibility testing.
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ranking = 2.5
keywords = cancer
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6/24. candida glabrata is an emerging cause of oropharyngeal candidiasis in patients receiving radiation for head and neck cancer.

    Oropharyngeal candidiasis (OPC) is relatively common in patients receiving radiation for head and neck cancer occurring in approximately 25% of patients. candida albicans has been described as the primary infecting organism. Recently, other organisms, particularly candida glabrata, have emerged as causative agents of OPC among immunocompromised patients. This study describes the characteristics of 6 patients with head and neck cancer treated with radiotherapy at our institution, who were found to have candida glabrata-associated OPC and their responses to oral fluconazole. All 6 patients were successfully treated with oral fluconazole. However, most did not respond to the usual dose of 100 mg/day necessitating doses ranging from 200 to 800 mg/day to achieve clinical cure. All 3 patients receiving radiation only were successfully treated with up to 200 mg/day; 2 of 3 patients receiving concomitant chemoradiation required doses ranging from 400 to 800 mg/day. As with systemic infection, previous fluconazole use appears to be a risk factor for this infection, but not with all patients.
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ranking = 3
keywords = cancer
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7/24. Use of becaplermin in the closure of pharyngocutaneous fistulas.

    BACKGROUND: We report on the contribution of recombinant platelet-derived growth factor-BB (becaplermin) in treating recalcitrant postlaryngectomy fistulas in two patients with head and neck cancer. methods: Topical becaplermin was applied daily, with periodic wound assessment and photodocumentation. RESULTS: The two patients with persistent fistula refractory to conventional management have demonstrated rapid improvement after topical application of becaplermin. Each wound exhibited an exuberant granulation response, with a 50% decrease in the size of wound at 1 week. The patients experienced eventual closure, with none having local recurrence of their cancer at 2 years' follow-up. CONCLUSIONS: Becaplermin seems to be a promising addition to traditional methods of treatment for postlaryngectomy fistulas. In patients with delayed healing, future studies will be required to determine the overall efficacy of such biologic response modifiers in the treatment of pharyngocutaneous fistulas and other chronic wounds of the head and neck.
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ranking = 1
keywords = cancer
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8/24. Surgical approach to submucosal lesions of the supraglottic larynx: the supero-lateral thyrotomy.

    The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy. Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.
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ranking = 0.097721651139794
keywords = neoplasm
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9/24. Fat hypertrophy in a pharyngeal reconstruction flap presenting as an enlarging neck mass: demonstration of benign changes with PET/CT.

    The patient is a 73-year-old man with a history of radioresistant recurrent squamous cell carcinoma of the larynx, treated with total laryngectomy/pharyngectomy and rectus abdominis deep inferior epigastric perforator flap reconstruction, who presented with a painless enlarging neck mass. physical examination revealed increased neck bulk and fiberoptic nasopharyngolaryngoscopy was negative. The clinician was concerned about underlying recurrent neoplasm or adenopathy displacing the flap outward and referred the patient for PET/CT.
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ranking = 0.097721651139794
keywords = neoplasm
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10/24. Heterotopic neuroglial tissue causing upper airway obstruction in a newborn.

    Heterotopic neuroglial tissue, composed of differentiated neuroectodermal tissue, represents developmental heterotopia of neuroglial tissue rather than true neoplasm. Herein, we present a patient with nasopharyngeal heterotopic neuroglial tissue who presented with respiratory distress and feeding difficulty in early days after birth. magnetic resonance imaging showed a cystic lesion measuring about 3 x 1.5 cm in the nasopharynx near the uvula. The lesion was resected and confirmed histologically as a heterotopic neuroglial tissue.
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ranking = 0.097721651139794
keywords = neoplasm
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