1/17. paracoccidioidomycosis and larynx carcinoma.Report of a case of paracoccidioidomycosis associated with a carcinoma: both located in the larynx in a patient whose therapeutic response to antifungal treatment produced a recovery of physical conditions. This case shows the importance of taking into account the diagnosis of paracoccidioidomycosis in all patients with problems in the larynx, especially those who inhabit or inhabited endemic areas of paracoccidioides brasiliensis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. Epiglottic histoplasmosis presenting in a nonendemic region: a clinical mimic of laryngeal carcinoma.histoplasma capsulatum is a dimorphic fungus endemic to north america. histoplasmosis is primarily an inhalation-acquired mycosis that is encountered rarely outside of endemic regions. In nonendemic regions, histoplasmosis may present a diagnostic challenge and both clinical and laboratory vigilance are required to accurately identify infection. Unusual clinical presentations with limited physical findings may compound the difficulty in diagnosis. We describe a 78-year-old retired soil science professor who presented with an eroded epiglottic mass secondary to disseminated histoplasmosis in a nonendemic region (alberta). Clinically, this mass was thought to represent a primary laryngeal carcinoma, as no other buccal or oropharyngeal ulcers were identified. histoplasmosis was confirmed by tissue biopsy and a positive immunodiffusion test for immunoglobulin g. Disseminated histoplasmosis is often associated with laryngeal and oropharyngeal disease; however, isolated epiglottic histoplasmosis is rare. histoplasmosis should be included in the differential diagnosis of neoplasms and chronic ulcers of the upper aerodigestive tract.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/17. Cricoid chondrosarcoma presenting as arytenoid hypertelorism.BACKGROUND: Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for voice disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid hypertelorism caused by cricoid chondrosarcoma may be aphonic even though the anterior membranous vocal folds make contact during attempted phonation. methods: Between 1991 and 2002, nine patients were diagnosed with cricoid chondrosarcoma. patients' charts and video examinations were retrospectively evaluated for symptoms and the presence of arytenoid hypertelorism on endoscopic evaluation. Two were women, and seven were men, with a mean age of 70 (range 53-72) years at diagnosis. RESULTS: Eight (88%) patients had aphonia or dysphonia caused by arytenoid hypertelorism as their presenting symptom. Six were diagnosed after failed medialization laryngoplasty or other laryngeal rehabilitation surgery. All nine patients had a low-grade tumor. The initial treatment in eight patients was hemicricoidectomy, and one patient had a total laryngectomy. In four cases, a second procedure was needed 1 to 6 years later because of recurrence. Seven patients are alive without clinically significant disease; one is alive with moderate disease, and one has died from an unrelated cause. CONCLUSIONS: Severely dysphonic, elderly patients presenting with arytenoid hypertelorism of unknown cause should be evaluated by fiberoptic laryngoscopy and by computed tomography scan to rule out cricoid chondrosarcoma. Because these tumors behave so benignly, the authors recommend conservative surgery (unilateral hemicricoidectomy) as the diagnostic/treatment modality of choice.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/17. Molecular cloning and characterization of a new subtype of human papillomavirus 6 DNA.A new subtype of human papillomavirus (HPV) 6 was molecularly cloned from a laryngeal papilloma specimen. The DNA of this isolate showed a strong hybridization signal with HPV 6b DNA under stringent conditions. Comparison of restriction enzyme fragment patterns of this HPV DNA with HPV 6b DNA revealed that this DNA is not identical to HPV 6b DNA. Thus, it represents a new subtype of HPV 6 DNA, which we have tentatively designated as HPV 6e DNA. A map of the physical structure of HPV 6e was also established.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/17. Juvenile laryngeal papillomatosis.Always ask about hoarseness and quality of voice in a history of any child presenting with cough or asthma-like symptoms. Children presenting with what appears to be an acute onset of hoarseness, without any physical signs of airways obstruction, should be reviewed after two weeks. If there is chronic hoarseness, referral to an ENT specialist should be considered with a view to laryngoscopy. If the child develops clinical signs of acute airway obstruction such as stridor or respiratory distress, prompt paediatric review is indicated. When referring, it is important to emphasise whether or not there is chronic hoarseness in order to differentiate the diagnosis from croup. Juvenile Laryngeal Papillomatosis may present with cough, pneumonia, dysphagia, or stridor, as well as hoarseness. These patients are often misdiagnosed as having asthma or allergies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/17. Otolaryngologic manifestations of child abuse.The number of reported cases of child abuse has increased dramatically over the past several years. Maltreatment of children can take several forms including neglect, sexual abuse, physical assault and psychological trauma. Five cases of child abuse presenting initially to the otolaryngology Service are outlined: bilateral auricular hematomas, recurrent tympanic membrane lacerations, a pharyngeal laceration with retropharyngeal abscess and medical neglect of a patient with a parotid malignancy and one with laryngeal papillomatosis. Characteristic presentations and risk factors in family background are discussed toward the goal of early recognition and appropriate intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/17. Human papillomavirus type 11 DNA in squamous cell carcinomas and pre-existing multiple laryngeal papillomas.The case histories of 4 patients are presented, who developed an invasive squamous cell carcinoma from pre-existing multiple laryngeal papillomatosis (two juvenile-onset and two adult-onset) during a long latency period. A series of 14 routinely processed, paraffin-embedded biopsies obtained from these patients (including both benign papillomas and carcinomas) were analysed using in situ DNA-hybridization technique with 35S-labelled Human papillomavirus (HPV) dna probes of HPV types, 6, 11, 16, 18 and 30. The lesions were also assessed by indirect immunoperoxidase (IP-PAP) technique to demonstrate the expression of HPV structural proteins. On light microscopy, morphology was consistent with HPV infection in all 14 biopsies. HPV antigen expression could not be demonstrated in any of the papillomas or carcinomas, however. HPV 11 DNA was present in high copy numbers in both the benign and malignant lesions of 2 patients, both presenting with the juvenile-onset disease. The present findings provide support for the role of HPV as an etiological agent in laryngeal squamous cell carcinoma, most probably acting synergistically with chemical or physical carcinogens (one patient received irradiation and 2 others were smokers). It seems clear that an infection by the 'low risk' HPV types 6 and 11 by no means excludes the possibility of developing a laryngeal malignancy, so far ascribed to the 'high risk' type HPV 16 only.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. pain-inducing laryngeal paraganglioma: report of the ninth case and review of the literature.There are two distinct forms of laryngeal paraganglioma. The patient with the rare Type II has exquisite throat pain that is often clinically confusing. The small size or submucosal location of the lesion often results in a delay in correct diagnosis and treatment. The lesion is very aggressive, even if tiny, generally with widespread metastasis. This tumor should be considered in the differential diagnosis of severe persistent throat pain, especially in the absence of abnormalities on physical or radiologic examination.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/17. Functional recovery from cancer surgery: estimation of expectations.Level of expected functional recovery from colostomy, laryngectomy and mastectomy was established by the delphi technique. One hundred fifteen cancer rehabilitation experts responded to 2 rounds of questionnaires and provided their judgments regarding degrees and timing of recovery in 14 functional, physical and psychological areas. feedback of first round judgments was provided in the second round and 85% agreement was set as the standard for consensus. The mastectomy patient is expected to have the quickest recovery with former level of functioning reached in most areas by 3 months postdischarge. The colostomy patient is expected to be functioning normally in most areas by 6 months postdischarge. The laryngectomy patient is expected to be functioning normally in most areas by 12 months postdischarge. Some functions were judged to have the same rate of recovery for all 3 patient types; for example, the experts agreed that for the 55-year-old patients described in the case abstracts, sexual activities would not reach the preoperative frequency until 12 months postdischarge.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/17. Elusive head and neck carcinomas beneath intact mucosa.This study presents 19 patients who had mucosally inapparent carcinomas of the upper aerodigestive tract demonstrated by computed tomography (CT). This group contains subpopulations that were identified both retrospectively and prospectively. During the same period 40 nasopharyngeal, 20 oropharyngeal-tongue base, and over 100 laryngeal and hypopharyngeal carcinomas were studied; all had clinically obvious mucosal components. Nine of our 19 patients had strictly submucosal tumors and a variety of clinical presentations; 5 patients had strictly submucosal recurrence of treated carcinomas and 5 had mucosal lesions which were not identified on examinations by more than one practicing head and neck surgeon. Sixteen of the 19 tumors were confirmed histologically; in 3 others confirmation was by a combination of CT and clinical course. CT can demonstrate the deep extent of aerodigestive tract carcinomas more accurately than physical examination and it can show mucosally inapparent disease. CT should be part of the staging work-up in nearly all upper aerodigestive tract carcinomas and in patients suspected of harboring an unknown primary within this region.- - - - - - - - - - ranking = 7.550314850296keywords = physical examination, physical (Clic here for more details about this article) |
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