1/26. rhabdomyoma of the hypopharynx and larynx. Report of two cases and a review of the literature.Two cases of extracardiac rhabdomyoma are reported in a 54-year-old man with unexplained difficulty in breathing and in a 39-year-old man with a prolonged history of hoarseness. attention is drawn to the necessity of doing hypopharyngo-and laryngoscopy in such cases. One tumour was found in the left vallecula in the hypopharynx and the other on the left vocal cord. The literature and the histological findings in 53 cases are reviewed. It appears that this rare tumour is most frequently found in muscles derived from the pharyngeal arches. A total of 40 cases have been diagnosed during the last decade, and this increase is likely to continue in the future. It may turn out that extra-cardiac rhabdomyoma is not so rare as was first presumed.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
2/26. Primary cancer of the larynx associated with primary lung cancer. Report of 21 cases, 14 with autopsy findings and 7 biopsies.The present paper reports 21 cases (14 autopsies and 7 biopsies) of associated primary cancers of the larynx and the lung. This association is by no means uncommon, the laryngeal lesion being usually the first to appear. Mulitple primary cancers--of the same or of a different histologic type--tend to occur in the same organ or organ system, either simultaneously or after a time interval. In case of synchronous primary malignant tumour of the larynx and lung the most lethal cancer (the lung cancer) must be managed first. Cancer patients are more likely than other individuals to develop a second primary malignant tumour. Laryngectomized patients should be followed-up possibly by means of cytologic examinations of bronchial secretions and chest x-rays at short intervals for early detection of a possible second primary malignant pulmonary lesion.- - - - - - - - - - ranking = 0.023528189558538keywords = chest (Clic here for more details about this article) |
3/26. Fine-needle aspiration of dedifferentiated chondrosarcoma of the larynx.We present a case of dedifferentiated chondrosarcoma of the larynx in which the dedifferentiated component was initially diagnosed by fine-needle aspiration (FNA). The patient was a 74-yr-old man who presented with difficulty breathing and an anterior neck mass. A CT scan demonstrated a 4.5-cm cartilaginous lesion involving the left thyroid cartilage, with an anterior soft-tissue component. Nine years prior, the patient had an incomplete resection of a low-grade chondrosarcoma at the same site. FNA was performed on the current lesion, demonstrating a high-grade spindle-cell sarcoma with a storiform pattern. The cytomorphology together with immunocytochemistry and electron microscopy were diagnostic of malignant fibrous histiocytoma (MFH), and synthesis of the clinical, radiographic, and cytomorphologic features resulted in a diagnosis of dedifferentiated chondrosarcoma. The cytologic diagnosis was histologically confirmed by laryngectomy. Although rare, dedifferentiated chondrosarcoma should be included in the differential diagnosis of high-grade sarcomas of bone and cartilage assessed by FNA.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
4/26. Successful treatment of severe respiratory papillomatosis with intravenous cidofovir and interferon alpha-2b.In contrast to uncomplicated juvenile laryngeal papillomas which may regress spontaneously, papillomatosis involving pulmonary parenchyma is associated with a poor outcome. This report represents the case of a 34 yr-old female in whom respiratory papillomatosis resulted in voice problems and recurrent pneumonias due to bronchial obstruction. A computed tomographic scan of the chest showed worsening bilateral round cavitating consolidations. bronchoscopy revealed polypoid lesions of the right vocal cord and the midtrachea which were confirmed as squamous papillomatosis by histology. Interferon (IFN)alpha-2b treatment was inefficient as was cidofovir monotherapy on a maintenance basis. Six months of IFN-alpha-2b and cidofovir in combination led to a complete macroscopic disappearance of the laryngeal lesions and to an impressive regression of the tracheal papillomas and of the intrapulmonary consolidations. These data provide support that severe respiratory papillomatosis can be safely treated by interferon alpha-2b and cidofovir in combination. Probably the same mechanisms as in ribavirin plus interferon alpha-2b, in the treatment of patients with chronic hepatitis c, are responsible for the therapeutic success in this case.- - - - - - - - - - ranking = 0.023528189558538keywords = chest (Clic here for more details about this article) |
5/26. Malignancy of the larynx in a child.Squamous cell carcinoma of the larynx in children is rare. The management of laryngeal malignancy is more difficult in children than adults for several reasons: the aggressive nature of a tumor that is often diagnosed late in children; the delicacy of pediatric anatomic structures; intraoperative blood loss; long-term post-treatment complications; and psychological factors particular to children. A tracheostomized 13-year-old boy came to us with a 4-month history of hoarseness, breathing difficulty, and swelling in the neck. A detailed examination revealed that a transglottic tumor had infiltrated the thyroid and cricoid cartilage, the upper two tracheal rings, and the thyroid gland. Such an infiltration has not been previously reported. The lesion proved to be a well-differentiated squamous cell carcinoma. We performed a wide-field total laryngectomy, which was followed by radiotherapy. Unfortunately, the child survived only 3 years postoperatively.- - - - - - - - - - ranking = 1keywords = breathing (Clic here for more details about this article) |
6/26. Coronary artery spasm induced by carotid sinus stimulation during neck surgery.We observed four transient episodes of marked ST-segment elevation in a 58-yr-old man with no history of coronary artery disease undergoing resection of a metastatic neck mass under general anaesthesia. Elevations of the ST segment were abrupt, with no change in arterial pressure or heart rate, and resolved spontaneously. When the carotid sinus was compressed directly, ST-segment elevation was noted 1 min after the onset of stimulation. After surgery, coronary angiography showed diffuse, slight narrowing of the distal bed of the posterolateral branch of the right coronary artery. ergonovine caused total occlusion of the posterolateral branch of the right coronary artery with chest pain and ST-segment elevation, confirming the diagnosis of variant angina. The coronary artery spasm seems to have been provoked by vagal activation from carotid sinus stimulation during general anaesthesia.- - - - - - - - - - ranking = 0.023528189558538keywords = chest (Clic here for more details about this article) |
7/26. Lower airway papillomatosis in children.Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest x-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.- - - - - - - - - - ranking = 0.047056379117075keywords = chest (Clic here for more details about this article) |
8/26. A subglottic mass mimicking near-fatal asthma: a challenge of diagnosis.Upper airway obstruction due to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report on a 50-year-old woman who was ultimately diagnosed with subglottic tumor, but who presented with near-fatal asthma. According to her medical history she had been treated with high doses of prednisolone and bronchodilators for the past year for difficult asthma. The patient presented to the Emergency Department (ED) in severe respiratory distress. The chest X-ray study revealed bilateral hyperinflation. The flow-volume curve suggested a fixed airway obstruction. After performing a laryngoscopic examination, a subglottic mass was discovered and an urgent tracheotomy was performed. After the operation, all symptoms and respiratory distress disappeared. This case report emphasizes the fact that not all wheezes are attributable to asthma. Upper airway obstructions can lead to asthma-like symptoms in which establishment of the correct diagnosis may be challenging.- - - - - - - - - - ranking = 0.023528189558538keywords = chest (Clic here for more details about this article) |
9/26. Management of patients with persistent chest pain and ST-segment elevation during 5-fluorouracil treatment: report about two cases.5-fluorouracil, a widely used drug in cancer treatment, is known to have cardiotoxic effects: chest pain with ECG changes, arrhythmias, arterial hypertension or hypotension, myocardial infarction, cardiogenic shock and sudden death have been described in the literature. Coronary artery vasospasm is the pathogenetic mechanism hypothesized in most cases, but mechanisms other than myocardial ischemia had been advocated in some patients. The approach to the patient with persistent chest pain, despite therapy and persistent ST-segment elevation mimicking an acute myocardial infarction, has not been well addressed, and the appropriate diagnostic and therapeutic pathways have not yet been defined. We present our experience regarding 2 patients treated with 5-fluorouracil and referred to our coronary care unit because of prolonged chest pain (in one case with clinical evidence of hemodynamic impairment) and persistent ST-segment elevation, in whom an acute myocardial infarction was suspected. One patient was treated with systemic fibrinolysis, and coronary angiography was performed 6 days later; the other was submitted to urgent coronary angiography shortly after admission. In both cases the ECG and echocardiographic abnormalities were transient and normalized within a few days, the serum markers of myocardial necrosis were persistently in the normal range and the coronary artery trees were normal. The diagnostic and therapeutic approach to patients with this unusual clinical presentation is also discussed.- - - - - - - - - - ranking = 0.16469732690976keywords = chest (Clic here for more details about this article) |
10/26. Subglottic and tracheal malignancies.Subglottic and tracheal malignancies are the least frequently encountered laryngeal cancers. When these tumors are encountered, they have often reached advanced size prior to producing symptoms. Once symptoms are brought to the attention of the otolaryngologist, rapid and accurate diagnosis is essential to effect the earliest possible treatment and to minimize morbidity and mortality associated with this problem. Illustrative cases are presented including a highly unusual case that presented with cardiac-like chest pain. A review of the literature including the pertinent anatomy, pathophysiology, and methods of diagnosis and treatment is presented. Increased familiarity with this disease process and a high index of suspicion on the part of the otolaryngologist may lead to improved survival patterns in patients with these malignancies.- - - - - - - - - - ranking = 0.023528189558538keywords = chest (Clic here for more details about this article) |
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