1/4. Pulmonary lymphangitic carcinomatosis from an oropharyngeal squamous cell carcinoma: a case report.Pulmonary lymphangitic carcinomatosis (PLC), a form of lymphatic spread of cancer cells, from head and neck cancers is extremely rare. We report here a case of PLC from an oropharyngeal squamous cell carcinoma in a 68-year-old man. The patient underwent inductive chemoradioimmunotherapy which resulted in complete tumor remission. The tumor, however, recurred 6 months later and was resected. Late metastasis occurred in the ipsilateral cervical lymph nodes 13 months post surgery and these lymph nodes were dissected. Three months later, the patient suffered from a fever, cough and dyspnea and a chest radiograph revealed an interstitial linear pattern from the right hilum to the right upper lung field. Without diagnosis of the pulmonary lesion, swelling of the bilateral lymph nodes followed after a few months and dyspnea worsened with spread of the reticular shadow and appearance of Kerley's B line on the roentgenogram, suggesting PLC. The patient gradually became more distressed and finally died 6 months after the onset of dyspnea. The microscopy of the autopsied pulmonary tissue revealed tumor cell nests in the lymph vessels in the septa and the pulmonary lesion was histopathologically diagnosed as PLC. The present case indicates that we should consider PLC when cough and dyspnea with reticular shadows and Kerley's B line are observed in patients with head and neck carcinoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/4. Prolonged right ventricular failure after relief of cardiac tamponade.PURPOSE: To report a case of severe and fatal cardiac complication following pericardiotomy to relieve a malignant tamponade. Right ventricular (RV) failure was responsible for major hypoxemia and for a persistent shunt through a patent foramen ovale. In the absence of pulmonary embolism and coronary occlusion, possible pathophysiologic mechanisms are discussed. CLINICAL FEATURES: This 53-yr-old patient presented with oropharyngeal carcinoma previously treated by chemotherapy. One month later, he showed clinical and echocardiographic signs of cardiac tamponade. He had a circumferential pericardial effusion with complete end-diastolic collapse of the right cavities. After an emergent pericardiotomy, he rapidly presented severe hypoxemia. Transesophageal echocardiography showed an akinetic and dilated right ventricle, paradoxical septal wall motion and a normal left ventricular function. A contrast study revealed a right-to-left shunt. No residual pericardial effusion was detectable. Pulmonary angiography excluded a pulmonary embolism and the coronary angiogram was normal. troponin Ic was elevated postoperatively and peaked on day two (3.78 micro g x L(-1)). The patient died of refractory shock with persistent intracardiac shunt and RV akinesia on day nine. CONCLUSION: Although pulmonary embolism or thrombus of a coronary vessel are the most common causes of prolonged RV failure after pericardiotomy, other mechanisms may be invoked. The possibility is raised that a rapid increase in RV tension may induce the development of muscular injury and impair coronary blood flow, despite a normal coronary angiogram. These could result in a stunned myocardium and opening of a patent foramen ovale. We hypothesize that gradual decompression of a chronic pericardial effusion might be beneficial in patients at risk.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/4. Uncommon torticollis in children.We report on one case of uncommon torticollis in children caused by a pencil cap lodged in the neck. diagnosis had been established two months after the trauma, during a screening for oro-pharyngeal cancer. The foreign body had pierced the posterior wall of pharynx without damaging the spine and large vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/4. MRI-guided laser interstitial thermal therapy (LITT) of head and neck tumors: progress with a new method.A less invasive method for treatment of tumors is being tested based on interstitial photothermal ablation via infrared Nd:YAG laser fiber optics. The technique can be applied safely and effectively for therapy of common tumors in humans. In the current study five patients were treated by interstitial laser palliation with the Nd:YAG laser using special fiberoptic applicator tips, which distribute laser energy efficiently throughout the tumor volume. magnetic resonance imaging (MRI) scanning was employed to locate the tumor, position the fibers correctly, and monitor the development of thermal necrosis in the tumors. Two patients were diagnosed with adenoid cystic carcinoma of the paranasal sinuses, one with a recurrent carcinoma of the tongue and oropharynx, one with a recurrent carcinoma limited to the oropharynx, and one patient with a carcinoma of the epi- and oropharynx. The maximum follow-up without recurrence was 2 years in a patient with an adenoid cystic carcinoma tumor of the paranasal sinuses. There were no immediate or delayed complications. Anatomical structures including eyes, brain, and important vessels were recognized by MRI during laser therapy. MRI-guided interstitial laser photothermal ablation appears to be a safe and effective method for treatment of selected tumors of the head and neck region with particular applications in palliation of inoperable tumor recurrences.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |