Nasopharyngeal tuberculosis.

Nasopharyngeal tuberculosis used to be a common disease in the upper aerodigestive system. Before 1920, 1.4 and 6.5 per cent of all adenoids and tonsils removed from asymptomatic patients were infected by tuberculosis. After the introduction of antituberculous chemotherapy and BCG vaccination, this disease was considered uncommon and sporadic cases were reported in the medical literature. Recently, tuberculosis has begun to increase again due to the high global HIV-infected rate and antituberculous drug resistance among these people. To describe and highlight the clinical features of this condition, fifteen Thai patients (7 males and 8 females) from the Department of Otolaryngology, Siriraj Hospital, Bangkok, Thailand were reviewed. Cervical lymphadenopathy was the most common presenting symptom in our series (93.34%), 11 of them were classified as primary nasopharyngeal tuberculosis and most had abnormal nasopharyngeal findings by mirror examination except 2 cases. Although all had histopathological confirmation of nasopharyngeal tuberculosis, sometimes problems occur in the diagnosis between this disease and nasopharyngeal carcinoma, which are also common among Oriental people in many of their clinical similarities. Therefore routine nasopharyngeal biopsy is considered justified and diagnostic.

Detection of Epstein-Barr virus DNA and HHV-6 DNA in tissue biopsies from patients with nasopharyngeal carcinoma by polymerase chain reaction.

A total of 34 tissue biopsies were collected from nasopharyngeal carcinoma (NPC) patients and 5 controls with non-NPC. Extracted DNA from tissue biopsies were analyzed for presence of specific gene sequences to EBV type A and type B, and HHV-6 by polymerase chain reaction (PCR). The different sequences of EBV type A and B were parts from the highly divergent forms of the EBV nuclear antigen 2 (EBNA 2). The PCR amplified products for EBNA 2A and EBNA 2B were 115 and 119 base pairs respectively whereas that of HHV-6 DNA was 776 base pairs. The results demonstrated that EBV DNA was detected in 32 of 34 cases (94.1%): 28 (82.3%) with type A, 2 (5.9%) with type B, and 2 (5.9%) with both types. EBV DNA of type A could be detected 1 (20%) of 5 controls. HHV-6 DNA was in 5 of 34 samples (14.7%) whereas HHV-6 DNA was not detectable in biopsy tissues from controls. The results show that in the NPC patient group, A type of EBV is predominant. Detection of HHV-6 DNA in patients group only might be resulted from reactivation of a latent infection or association with EBV-induction of NPC.

Prevalence of IgA specific antibodies to Epstein-Barr virus capsid and early antigens in nasopharyngeal carcinoma.

Ninety-one patients with nasopharyngeal carcinoma (NPC), and 164 age-matched healthy controls were tested for presence of IgA antibodies to Epstein-Barr virus capsid antigen (VCA) and early antigen (EA) in their sera by indirect ELISA using "EBViral DETECT" commercial test kit. IgA anti-VCA was found in 76 (83.5%) of NPC patients and 16 (9.8%) of the controls. Meanwhile, IgA anti-EA was found in 72 (79.1%) of NPC patients and 21 (12.8%) of the controls. In a parallel study by indirect immunofluorescence test (IIF), IgA anti-VCA was found in 77 of 91 (84.6%) NPC patients and 22 of 142 (15.5%) controls. The prevalence rates of anti-VCA as screened by ELISA and IIF were very similar suggesting that neither one of the two tests can be used alternatively depending on the purpose and facilities in each individual laboratory. IgA antibodies to VCA and EA were more prevalence in NPC patients than those in the controls, the finding which again supported the association between EBV and NPC as was suggested in many other reports.

Platysma myocutaneous flap for hypopharyngeal reconstruction.

Ten male patients with hypopharyngeal and/or laryngeal cancer underwent hypopharyngeal reconstruction after tumor ablation, using platysma myocutaneous flaps. Their age ranged from 41-82 years, (mean age of 62.7 years). All were examined by barium swallowing before and 2 weeks after operation in order to compare the size and function of hypopharynx. The immediate postoperative period was uneventful and satisfactory except one patient (10%) who suffered from the separation of suture lines on the flap leading to the development of saliva fistula and neck infection. The surgical technique, minor complications and long-term postoperative results were fully described in the report.