ABSTRACT
Three male patients aged 29, 30 and 34 years and a 36-year-old female are reported with nasal septum perforation and a history of cocaine abuse. Two of the patients also had a perforation of the hard palate. In all four, antineutrophil cytoplasmic antibodies (ANCA) were found. One had a cytoplasmic immunofluorescence-staining pattern (c-ANCA), the other three showed a perinuclear staining pattern (p-ANCA). Furthermore, all patients were found to be nasal carriers of S. aureus. We hypothesise that tissue damage to the nasal and palatal area in patients using cocaine may partly be mediated by the presence of ANCA antibodies. Furthermore, we speculate that S. aureus facilitates the development of these ANCA antibodies.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/analysis , Cocaine-Related Disorders/complications , Maxillary Sinus/pathology , Nasal Septum/pathology , Nose Diseases/etiology , Staphylococcal Infections/pathology , Staphylococcus aureus , Adult , Cocaine-Related Disorders/microbiology , Female , Fluorescent Antibody Technique , Humans , Male , Maxillary Sinus/microbiology , Nasal Mucosa/pathology , Nasal Septum/microbiology , Nose Diseases/immunology , Nose Diseases/microbiology , Staphylococcal Infections/immunology , Staphylococcal Infections/microbiologyABSTRACT
AIMS: To investigate the results of our treatment policy, we present our institutional experience in the management of regional neck node metastases of cutaneous head and neck squamous cell carcinoma (CHNSCC). METHODS: Between 1977 and 1997, 343 patients presented with CHNSCC, of whom 41 were treated for regional metastases, with parotidectomy and/or (selective) neck dissection. Histological analysis was performed on all operation specimens. Patients with multiple nodes and/or extra capsular rupture, at risk for recurrence, received adjuvant radiotherapy. RESULTS: Seventy-six percent of the regional metastases occurred within the first 2 years, but a delay of more than 5 years was also observed. Parotid gland (56%), neck levels II (39%) and V (22%) were most frequently involved. Twenty-four percent of patients treated with curative intent failed at the regional site. Five years overall survival was 46%, with a median survival of 49 months. No survival differences emerged between patients treated by surgery alone and patients receiving adjuvant radiotherapy (P=0.14). Five patients died of disease, of whom three with distant metastases. CONCLUSION: Regionally metastasized CHNSCC is a serious disease with a high risk of regional recurrence, calling for combined surgery and adjuvant radiotherapy. A small subset of patients with a long interval between completion of primary treatment and presence of regional nodes justifies a long follow-up.
Subject(s)
Carcinoma, Squamous Cell/secondary , Head and Neck Neoplasms/pathology , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/therapy , Cheek , Combined Modality Therapy , Female , Forehead , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Neck Dissection , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/secondary , Neoplasm Recurrence, Local/therapy , Neoplasm Staging , Netherlands , Palliative Care , Radiotherapy, Adjuvant , Skin Neoplasms/mortality , Skin Neoplasms/therapy , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
Vocal fold palsy is a cause of dysphonia. Due to incomplete glottic closure during phonation, patients with a unilateral vocal fold palsy present with a weak and breathy voice and recurrent aspiration. To lessen the clinical manifestations of unilateral vocal fold palsy, polytetrafluoroethylene (Teflon) paste is one agent which has been injected into the paraglottic region, thus causing the vocal fold to move more medially. One of the complications associated with Teflon paste injection is migration of the paste into the surrounding tissues. We present a patient with idiopathic left vocal fold palsy who underwent Teflon injection to the vocal fold and subsequently developed a precricoid nodule, mimicking a cartilaginous swelling.
Subject(s)
Foreign-Body Migration/diagnostic imaging , Polytetrafluoroethylene/administration & dosage , Vocal Cord Paralysis/therapy , Aged , Cricoid Cartilage , Female , Humans , Injections, Intralesional , Tomography, X-Ray ComputedABSTRACT
In two patients with chronic rheumatoid arthritis, a woman aged 65 and a man aged 56 years, cricoarytenoid arthritis was diagnosed. The symptoms were hoarseness, sore throat and stridor. In both patients a narrowed glottic fissure was found. In one patient tracheostomy was necessary to guarantee a free airway; in the other, therapy with local corticosteroid injections (triamcinolone), combined with immunosuppressive therapy (prednisone), was effective. Early detection through anamnesis and laryngoscopy allows early therapy with a good prognosis.
