Pyriform sinus haemangioma: an unusual presentation of an unusual condition.

OBJECTIVE: We present a rare case of an unusual presentation of a pyriform sinus haemangioma in a normally healthy, Caucasian woman, including our management and a review of the literature. CASE REPORT: A 44-year-old woman presented complaining of bringing up fresh blood whilst brushing her teeth, dysphonia, food sticking in her throat, and epigastric pain for the preceding 12 months, accompanied by a 17.5 kg weight loss. She underwent pre-operative computed tomography and subsequent complete excision of a pyriform sinus haemangioma using CO2 laser. DISCUSSION: Haemangiomas are congenital vascular malformations and can affect any part of the body. They are not prevalent in adults and are rarely found in the pyriform sinus. Their common presenting symptoms and management have been previously documented; however, the presented case is unusual in both its presentation and management.

An unusual presentation of inverted papilloma: case report and literature review.

OBJECTIVE: Inverted papilloma is a rare but locally aggressive tumour with the potential for malignant transformation. Intracranial extension or complications secondary to inverted papilloma are extremely rare. We report a case of inverted papilloma with a large frontal sinus mucocele eroding the frontal sinus, which presented with sudden neurological compromise. A literature review on intracranial extension of such tumours is also included. METHODS: A Medline search of articles, using the terms 'inverted papilloma', 'Ringertz tumour', 'intracranial extension' and 'complication'. Suitable references from the collected articles were also reviewed. Articles published in English were selected and reviewed. RESULTS: A total of 10 cases was identified. Intracranial spread was more commonly seen in recurrent cases, especially if the recurrence involved the cribriform plate, fovea ethmoidalis or orbits. Cases with extradural disease seemed to have a better prognosis than those with intradural spread. CONCLUSIONS: Intracranial involvement of inverted papilloma is extremely rare, and is usually seen in recurrent cases. This case report highlights an unusual but serious case of inverted papilloma presenting with acute neurological deterioration secondary to a large frontal sinus mucocele eroding the frontal sinus. A literature review on intracranial extension of inverted papilloma indicated that common sites of intracranial spread include the cribriform plate, fovea ethmoidalis and orbits. The prognosis for patients with such tumours depends on the type of dural involvement, with intradural extension carrying a poorer prognosis.

Paediatric neck abscesses: microbiology and management.

INTRODUCTION: Paediatric neck abscesses remain common problems which are sometimes difficult to manage. METHODS AND MATERIALS: We conducted a retrospective study of 64 children who underwent incision and drainage of neck abscesses at Leeds General Infirmary from 1 February 2002 to 31 July 2006. The aim of this study was to identify the presenting symptoms in children, the appropriateness of prescribed antibiotics and the role of atypical mycobacteria in neck infections. The outcome measure was clinical resolution of the abscess. RESULTS: The mean presenting age was 44.2 months (3.68 years). The commonest sign and symptom was neck mass (96.9 per cent). The mean period of hospitalisation was 3.7 (+/- standard deviation of 1.9) days. Staphylococcus aureus (48.4 per cent) was the commonest organism cultured. Atypical mycobacteria were found in only 4.7 per cent of the specimens. Flucloxacillin was the most common antibiotic used (57.8 per cent), often in combination with other antimicrobials. The abscess recurrence rate was 4.7 per cent. No fatalities occurred in this series of patients. CONCLUSION: Appropriately prescribed intravenous antibiotics and surgical drainage remain the central core of treatment. Atypical mycobacterial infection is an important differential diagnosis of a painless, cervico-facial mass. An algorithm for the management of paediatric neck abscesses is proposed.

Paediatric granular cell tumour of the larynx: case report of laser resection with frozen section.

Granular cell tumours of the larynx are a very rare cause of persistent hoarse or husky voice in children. We report the case of a 13-year-old girl who presented with a three-year history of progressively huskier voice. We discuss the presentation, location and diagnosis of the tumour. In addition, we present a method of surgical treatment of the tumour, involving the hitherto unreported technique of laser excision and frozen section of the lesion.

Airway intervention in adult supraglottitis.

BACKGROUND: The timing of aggressive airway intervention in adult epiglottitis is controversial. AIMS: To correlate Friedman's staging of epiglottitis on admission with the airway interventions undertaken. METHODS: A retrospective study of 23 adult patients, mean age 51 years (range 29-81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. RESULTS: Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. CONCLUSIONS: Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage Ill (moderate respiratory distress, stridor, respiratory rate > 30 per minute, pCO2 > 45mmHg) disease.

Paediatric acute mastoiditis: the Alder Hey experience.

Acute mastoiditis was a common condition in the pre-antibiotic era, but has become rare now with the widespread use of antibiotics. A retrospective study was carried out of patients with acute mastoiditis who were seen at Alder Hey Children's Hospital, Liverpool over a five-year period. Their case records were identified and details of gender, age at presentation, symptoms, signs and clinical management were noted and analysed. Twenty-one patients who presented with acute mastoiditis were identified. The patients' age at presentation ranged from three months to 14 years. Five cases out of 21 (23.8 per cent) were under one year of age. Eighteen cases (85.7 per cent) presented with post-aural swelling while 12 (57.1 per cent) had aural discharge. All patients were treated with intravenous antibiotics and only five patients (23.8 per cent) required surgical intervention in the form of a cortical mastoidectomy with, or without, myringotomy. A significant number of cases can be treated conservatively with intravenous antibiotics. Surgery in the form of cortical mastoidectomy can be reserved for complicated cases and in those in whom conservative treatment has failed.