RESUMEN
A retrospective study was conducted on patients with upper aerodigestive tract foreign bodies requiring operative intervention over a 12-year period to aid in the recognition and management of foreign body associated complications. Oesophagoscopies were performed for the removal of foreign bodies in 37 patients, age one to 82 years with a male to female ratio of 1.2:1. Retropharyngeal abscesses accounted for eight of 11 foreign body-associated complications. Fish bones were the cause in six cases, chicken bone and a pen refill in one case each. An abscess was already present at the time of initial procedure in six cases and developed in two cases after successful removal of the foreign body. A high level of suspicion for a retropharyngeal abscess should be maintained in cases with perforation, and in patients with immunodeficiency.
Asunto(s)
Cuerpos Extraños/complicaciones , Procedimientos Quirúrgicos Orales/métodos , Absceso Retrofaríngeo/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Esofagoscopía , Femenino , Cuerpos Extraños/cirugía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Absceso Retrofaríngeo/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Determination of the genetic composition of papillary thyroid cancers may help explain differences in observed clinical behavior. Comparative genomic hybridization (CGH) is a novel molecular cytogenetic assay that allows simultaneous detection of gains, losses, and amplification of genetic information, making it an ideal screening tool. The aim of this study was to identify genetic aberrations occurring in papillary thyroid cancers by using CGH analysis. METHODS: CGH analysis was performed on 21 individual cases of papillary thyroid cancers. Nonparametric statistical comparisons were performed with the Fisher exact test. RESULTS: Genetic abnormalities were identified by CGH in 10 of 21 cases (48%). A recurrent pattern of aberrations was seen in cases where genetic changes were detected, involving losses at chromosome arms 1p and 9q and chromosomes 17, 19, and 22, and gains at chromosome 4 and chromosome arms 5q, 6q, 9q, and 13q. The loss of chromosome 22 was unique to younger patients (P =.05) and was associated with a higher rate of regional lymphatic metastasis (19% vs 80%, P =.02). CONCLUSIONS: Two genetically unique groups of patients were identified by using CGH analysis. One group had no detectable aberrations; the other had a recurrent pattern of aberrations, localizing to the identical chromosomal loci. This pattern of aberrations suggests that the involved loci may contain genes important in thyroid carcinogenesis. The clinical significance of the presence of copy number changes detected by CGH needs to be determined. In addition, molecular cloning of involved genes in each of the aberrations is warranted.
Asunto(s)
Carcinoma Papilar/genética , Aberraciones Cromosómicas , Análisis Citogenético , Neoplasias de la Tiroides/genética , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: Younger or older age has a significant impact on the outcome of patients with head and neck cancer. However, the data regarding outcomes based on age are conflicting. The aim of this article is to determine the impact of age on the outcome of laryngeal cancer. MATERIALS AND METHODS: A retrospective study was performed including all patients with squamous cell carcinoma of the larynx for over a 9-year period. The patients were divided into 3 groups based on age. The younger age group included patients 40 years of age and younger, the older group included patients over 80 years of age, and the remaining patients served as the control group. Descriptive statistics were used to summarize study data. Nonparametric quantitative and qualitative analyses were performed using the Mann-Whitney U test and Fisher's exact test, respectively. Survival analysis was performed using the generalized Wilcoxon test. The Cox proportional hazards model was used for multivariate analysis. RESULTS: Of the 209 patients with laryngeal carcinoma presenting to our institution over a 9-year period, 20 (10%) were < or =40 years and 15 (7%) were > or =80 years of age. No differences in TNM stage at presentation, treatment, or treatment-associated complications were observed based on age. However, younger patients were less likely to report tobacco (50%; P < .001) or alcohol (57%; P = .03) use and more likely to have human immunodeficiency virus infection (50%; P< .001). Older patients showed a trend toward having a worse baseline medical status. Recurrence was significantly more common in older patients (P = .02) and cause-specific survival significantly poorer for both younger and older patients (P = .002). CONCLUSIONS: The presentation and outcome of laryngeal cancer is influenced by the age at presentation. The differences may be related exact reason for the observed survival differences needs to be determined.
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Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/terapia , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/terapia , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Estudios de Casos y Controles , Femenino , Humanos , Neoplasias Laríngeas/diagnóstico , Masculino , Persona de Mediana Edad , Probabilidad , Estudios Retrospectivos , Estadísticas no Paramétricas , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: Non-Hodgkin's lymphoma is the 2nd most common malignancy in human immunodeficiency virus (HIV)-infected patients. However, limited information regarding head and neck manifestations of non-Hodgkin's lymphoma is present in the literature. The aim of this article is to describe the head and neck manifestations of non-Hodgkin's lymphoma in HIV-infected patients and compare it with that seen in noninfected patients. PATIENTS AND METHODS: A case-control study was performed including 124 patients with non-Hodgkin's lymphoma presenting over a 5.5-year period to tertiary care center in a metropolitan location. RESULTS: Overall, the anatomic distribution of non-Hodgkin's lymphoma is not altered in the presence of HIV infection with the head and neck region (63%) most often involved overall. However, within the head and neck region, extralymphatic disease is significantly more common in HIV-infected patients (59%) than noninfected patients (33%; P = .001). Central nervous system (CNS) involvement accounts for 41% of head and neck non-Hodgkin's lymphoma in HIV-infected patients, in contrast to only 12% of noninfected patients. High-grade lymphoma (68%) are more common than intermediate (30%) or low-grade disease (2%) in the HIV-infected population, whereas low (24%) and intermediate (60%) grades are more common than high-grade lymphoma (16%) in noninfected patients (P < .001). The large cell immunoblastic type (48%) is the most common subtype in HIV-infected patients, whereas diffuse large-cell type (32%) was most common in HIV-negative patients (P < .05). Survival is significantly poor for HIV-infected patients (P < .05). The impact of HIV infection on survival remain significant even after controlling for the effects of confounding factors. CONCLUSIONS: Head and neck involvement with non-Hodgkin's lymphoma occurs in a significant number of HIV-infected patients. Our data show that the distribution and course of non-Hodgkin's lymphoma is unique in HIV-infected patients. A high level of suspicion for non-Hodgkin's lymphoma is required in all cases of head and neck lesions in patients with HIV infection to facilitate management.
Asunto(s)
Neoplasias de Cabeza y Cuello/inmunología , Linfoma Relacionado con SIDA/inmunología , Linfoma no Hodgkin/inmunología , Adulto , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Humanos , Linfoma Relacionado con SIDA/epidemiología , Linfoma no Hodgkin/epidemiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
BACKGROUND: This study was performed to assess the relationship between Hashimoto's thyroiditis and the development, presentation, management, and outcome of papillary thyroid carcinoma. METHODS: Two complementary analytic methods were used. The clinical study was a retrospective case-control study, including patients seen with papillary thyroid carcinoma presenting during a 12-year period. We also used a systematic literature review to identify suitable reports and meta-analysis to statistically combine published results. RESULTS: The prevalence of Hashimoto's thyroiditis is significantly higher in patients with papillary thyroid cancer (odds ratio, 1.89; 95% CI, 1.02-3.50). These patients typically have a dominant nodule, 44% of which are discovered incidentally on routine examinations. Fine-needle aspiration has a sensitivity of 91% for the identification of papillary cancer. The prognostic variables at the time of a diagnosis of papillary cancer and the approach to management are not altered by the presence of coexistent Hashimoto's thyroiditis. In addition, the rate of surgical complications was not higher in patients with coexistent Hashimoto's disease. Meta-analysis suggested a positive correlation between Hashimoto's disease and disease-free survival (r = 0.09; 95% CI, 0.05-0.12) and overall survival (r = 0.11; 95% CI, 0.07-0.15). CONCLUSIONS: There is an increased prevalence of Hashimoto's thyroiditis in patients with papillary thyroid carcinoma. The presence of coexistent Hashimoto's thyroiditis does not affect the diagnostic evaluation or management of papillary thyroid cancers. The survival of patients who have papillary thyroid cancers may be superior in coexistent Hashimoto's thyroiditis.