The impact of cidofovir treatment on viral loads in adult recurrent respiratory papillomatosis.

Cidofovir is an antiviral agent used in the therapy of recurrent respiratory papillomatosis (RRP). In this study, we hypothesized that cidofovir is effective in decreasing the viral load of human papillomavirus (HPV). We established a type specific real-time PCR and measured HPV DNA loads. The course of viral load of HPV types 6 and 11 after repeated applications of cidofovir intralesionally was compared to the clinical outcome using a modified Derkay score. In 6 of the 8 (75 %) patients, we detected HPV 6. In 2 (25 %) patients, we detected HPV 11. In all of the patients, the viral load and the modified Derkay score decreased significantly during the treatment. We conclude that viral load of HPV can be monitored using the technique described here. Cidofovir in combination with surgical debulking reduces the viral load in patients with RRP. Relapses of the symptoms cannot be avoided but might be delayed.

[Dysphagia as a presenting symptom of a cervical neurofibroma]. / Zervikales Neurofibrom als Ursache von Globusgefühl.

A 33-year-old, otherwise healthy female nursing student presented to the ear-, nose-, and throat- (ENT) outpatient clinic with a globus sensation that had been progressing for 6 months. Tomographic imaging revealed a neck mass extending from the 4th vertebrum to the subclavicular region and apex of the left lung. A surgical resection with histopathological examination exposed a neurofibroma. Management and differential diagnoses of globus sensation are herein discussed. This case underlines the importance of tomographic imaging, even in common but persisting symptoms such as globus sensation.

Post-infectious olfactory dysfunction exhibits a seasonal pattern.

HYPOTHESIS: We investigated whether olfactory dysfunction following infections of the upper respiratory tract (post-URTI) has an incidence matching the seasonality of URTIs. STUDY DESIGN: Retrospective study. METHODS: In total, 457 patients (126 male, 331 female) with post-URTI olfactory loss were examined during a 6-year-period (1999-2004). Their records were assessed for age, sex, and time of onset of the disease. The severity of olfactory dysfunction was assessed using the "Sniffin' Sticks" (odour threshold, odour discrimination, and odour identification). RESULTS: Incidence of post-URTI olfactory dysfunction exhibited seasonal fluctuations with deviations from the winter seasonality of URTIs. The overall incidence of the disease differed significantly between months. March (12.7%) and May (12.6%) were the months with the highest incidence of the disease throughout the year. The lowest incidence was observed in September (5.6%). Significant differences were found between these months and months with a high incidence of URTIs. DISCUSSION: The peak incidence of post-URTI olfactory loss in March may be explained by the high incidence of influenza at this time. However, it is unclear why the incidence of the disease presents a second peak in May, when the incidence of respiratory viruses is relatively low. Climate conditions at this time might play a role in the susceptibility of the nasal epithelia towards certain viral infections, e.g. parainfluenza type III. CONCLUSION: Post-URTI olfactory dysfunction exhibits spring seasonality with peaks in March and May and possible causative factors being influenza and parainfluenza viruses (type III), respectively.

[Vallecular cyst as a rare cause of progressive inspiratory stridor]. / Progredienter inspiratorischer Stridor durch eine gestielte Valleculazyste.

BACKGROUND: Vallecular cysts are frequently observed, benign masses of the upper aerodigestiv tract. Usually they appear as harmless and asymptomatic and go unnoticed by the patient. In rare cases, obstructions of the upper airway due to monstrous vallecular cysts may become life threatening. CASE: We report on a 69-year-old otherwise healthy woman with a rapidly progressive history of dyspnea caused by a pedicled vallecular cyst. Increasing stridor prompted emergency surgical resection. CONCLUSION: Vallecular cysts that increase in size can cause dyspnea due to obstruction of the aditus of the larynx. This case demonstrates the need for surgical treatment at an early stage of pedicled vallecular cysts.

[An accessory retropharyngeal bone as a rare cause of dysphagia]. / Akzessorischer retropharyngealer Knochen. Seltene Ursache einer Dysphagie.

A 77-year-old woman had a history of several-years of dysphagia. On presentation, a submucosal mass impinging on the left oropharynx was present. CT-scans showed a bony structure isolated from the cervical column. The patient underwent complete surgical resection using a transoral approach. Histological examination confirmed the radiological finding; a new formation of bone surrounded by cartilage with hematopoieses in the bone marrow. Recovery was complete within 2 weeks. Dysphagia due to cervical spine osteophytes, Forestier's disease or progressive ossifying fibrodysplasia is well known. This case adds an isolated retropharyngeal bone formation as a rare cause of dysphagia to the literature.