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Sexually Transmitted Diseases May 2015The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in...
BACKGROUND
The Centers for Disease Control and Prevention recommends pharyngeal screening of Neisseria gonorrhoeae (GC) and rectal screening of GC and Chlamydia trachomatis (CT) in HIV-infected and at-risk men who have sex with men (MSM). There are currently no recommendations to routinely screen women at extragenital sites. We define the prevalence of extragenital GC and CT in women attending 2 urban sexually transmitted disease clinics in Baltimore City and compare it with the prevalence of extragenital infections in MSM and men who have sex with women.
METHODS
All patients who reported extragenital exposures in the preceding 3 months, who presented for care between June 1, 2011, and May 31, 2013, and who were tested for GC and CT using nucleic acid amplification tests at all sites of exposure were included in the analyses. We used logistic regression models to identify risk factors for extragenital infections.
RESULTS
A total of 10,389 patients were included in this analysis (88% African American; mean age, 29 years; 42% women; 7% MSM; 2.5% HIV infected). The prevalence estimates of any extragenital GC and CT were as follows: 2.4% GC and 3.7% CT in women, 2.6% GC and 1.6% CT in men who have sex with women, and 18.9% GC and 11.8% CT in MSM. Among women, 30.3% of GC infections and 13.8% of CT infections would have been missed with urogenital-only testing. Unlike MSM, age ≤ 18 years was the strongest predictor of extragenital infections in women.
CONCLUSIONS
Although the prevalence of extragenital gonorrhea and chlamydia is highest in MSM, a significant number of GC and CT infections in young women would be missed with genital-only testing. Cost-effectiveness analyses are needed to help inform national guidelines on extragenital screening in young women.
Topics: Adolescent; Adult; Baltimore; Chlamydia Infections; Chlamydia trachomatis; Cost-Benefit Analysis; Female; Gonorrhea; Humans; Mass Screening; Middle Aged; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pharyngeal Diseases; Pharynx; Prevalence; Rectal Diseases; Rectum; Sexual Behavior; United States
PubMed: 25868133
DOI: 10.1097/OLQ.0000000000000248 -
Dysphagia Oct 2016Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study...
Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study reports characterizes oral and pharyngeal phase dysphagia and diet modifications on videofluoroscopic swallow studies (VFSS) in a large cohort of children with Down syndrome. A total of 158 pediatric patients (male = 95; female = 63; mean age 2.10 years, SD 3.17 years) received an initial VFSS at a pediatric teaching hospital as part of their medical care. A total of 56.3 % (n = 89) children had pharyngeal phase dysphagia with aspiration and deep laryngeal penetration occurring most frequently. Of the 61 patients who aspirated, 90.2 % (n = 55) did so silently with no cough or overt clinical symptoms. In 76.7 % of cases of pharyngeal phase dysphagia, a functional feeding plan, with use of thickened liquids or change in feeding system to control flow rate and/or bolus size, was able to be established, which allowed children to continue eating by mouth. Thickened liquids (76.7 %, n = 46) were the most effective adaptation, with change in feeding system alone effective in only 8.3 % (n = 5) cases. Oral phase dysphagia was reported in the majority of patients (63.8 %, n = 88/138); however, this was not predictive of pharyngeal phase dysphagia. Age, sex, and reason for referral, including prior clinical symptoms, did not have a statistically significant impact on the presence of dysphagia. This comprehensive review has application to clinical understanding and management of dysphagia in children with Down syndrome.
Topics: Child, Preschool; Deglutition; Deglutition Disorders; Down Syndrome; Female; Fluoroscopy; Humans; Infant; Larynx; Male; Pharyngeal Diseases; Pharynx; Respiratory Aspiration; Retrospective Studies; Video Recording
PubMed: 27405422
DOI: 10.1007/s00455-016-9725-7 -
European Annals of Otorhinolaryngology,... Dec 2014Necrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and... (Review)
Review
OBJECTIVE
Necrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and fascial planes, with high mortality and morbidity rates. The origin is generally odontogenic or pharyngeal, involving a mixed flora of microorganisms. Descending infection and mediastinal involvement are usually associated and are the main complications. The aim of the present study was to review the cases treated in our department and analyze diagnosis and treatment, supplementing the understanding of the disease.
METHODS
A retrospective study was performed on the clinical records of patients admitted to our center between January 2005 and June 2010 with diagnosis of necrotizing cervical fasciitis.
RESULTS
Six clinical records were reviewed. The origin of the infection was mainly oropharyngeal and odontogenic, with a mixed flora of Prevotella, Peptostreptococcus and coagulase-negative Staphylococcus. All patients presented mediastinal involvement: superior mediastinitis in 4 patients and superior and postero-inferior mediastinitis in 2 cases. All patients underwent early drainage by bilateral cervicotomy with mediastinal drainage by a cervical approach in those with superior mediastinal affection, and associated thoracotomy, in a single surgical step, for postero-inferior mediastinitis. Temporary tracheotomy was performed in all cases. All received broad spectrum antibiotics, with a medium hospital stay of 37 days. There were no deaths reported.
CONCLUSION
Concerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome.
Topics: Adult; Aged; Anti-Bacterial Agents; Bacteroidaceae Infections; Drainage; Fasciitis, Necrotizing; Female; Gram-Positive Bacterial Infections; Humans; Length of Stay; Male; Mediastinitis; Middle Aged; Mouth Diseases; Peptostreptococcus; Pharyngeal Diseases; Prevotella; Retrospective Studies; Staphylococcal Infections; Thoracotomy; Tracheotomy
PubMed: 25002374
DOI: 10.1016/j.anorl.2013.08.006 -
Ear, Nose, & Throat Journal Jun 2024A pharyngeal recess cyst is a benign lesion, located at the nasopharyngeal recess with limited development. Pharyngeal recess cysts rarely occur. This case report...
A pharyngeal recess cyst is a benign lesion, located at the nasopharyngeal recess with limited development. Pharyngeal recess cysts rarely occur. This case report describes a young male patient presenting with a foreign body sensation in the pharynx. Electronic nasopharyngoscope examination revealed a large nasopharyngeal cyst, whose root was located in the left pharyngeal recess. Complete surgical resection was performed, and the patient successfully recovered.Pharyngeal recess cysts are rare lesions that can be diagnosed based on imaging and endoscopy findings. It is treated surgically and has a favorable prognosis.
Topics: Humans; Male; Cysts; Pharyngeal Diseases; Adult
PubMed: 34753325
DOI: 10.1177/01455613211056549 -
Head & Neck Nov 2015Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pharyngocutaneous fistula (PCF) is the most common surgical complication after total laryngectomy. Controversy still remains regarding the multiple risk factors implicated. The purpose of this study was to evaluate the potential risk factors for PCF.
METHODS
The strategy for our literature survey included research in MEDLINE up to December 2013. The risk factors analyzed were age, sex, smoking habit, alcohol use, comorbidity, preoperative hemoglobin level, blood transfusion, preoperative tracheotomy, previous radiotherapy and chemoradiotherapy, primary tumor site, T classification, cartilage invasion, tumor grade, surgical margins, suture material, second layer of suture, reconstruction, tracheoesophageal prosthesis, and neck dissection.
RESULTS
The electronic search resulted in 311 studies from which 63 met the inclusion criteria.
CONCLUSION
Chronic obstructive pulmonary disease (COPD), previous hemoglobin <12.5g/dL, blood transfusion, previous radiotherapy or chemoradiotherapy, advanced primary tumors, supraglottic subsite, hypopharyngeal tumor site, positive surgical margins, and the performance of neck dissection were risk factors for PCF.
Topics: Age Factors; Aged; Comorbidity; Cutaneous Fistula; Female; Humans; Incidence; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Neck Dissection; Pharyngeal Diseases; Postoperative Complications; Prognosis; Risk Assessment; Sex Factors
PubMed: 24958209
DOI: 10.1002/hed.23804 -
European Archives of... Jan 2019To evaluate the efficacy and safety of Chinese medicine in the treatment of adenoid hypertrophy in children. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the efficacy and safety of Chinese medicine in the treatment of adenoid hypertrophy in children.
METHOD
Screening standard articles, extracting relevant data from meta-analysis, were analyzed by Revman5.1 software, by searching PubMed, Medline, VIP, Wan Fang and Chinese HowNet database 2006-2016 in traditional Chinese medicine treatment of children with adenoid literature.
RESULTS
206 articles met the inclusion criteria, of which ten were selected and included in the meta-analysis, and there were 803 patients. The results showed that the remission rate of the Chinese medicine treatment group was better than that of the Western medicine group. The combined effect of the amount of OR 2.06, 95% Cl (1.45, 2.96) and the combined effect of the amount of the test Z = 4.12, P < 0.00001 showed the recurrence of the disease was lower in traditional Chinese medicine treatment group than the Western medicine group. The combined effect of the amount of OR 3.05, 95% Cl (2.11, 4.56) and the combined effect of the amount of the test Z = 5.86, P < 0.00001 showed the total effective rate is high in the traditional Chinese medicine treatment group than the Western medicine group. The difference between the combined effect of the amount of OR 2.79, 95% Cl (1.78, 5.03) and the combined effect of the amount of the test of Z = 4.54, P < 0.00001 was statistically significant, which showed the treatment effect of Chinese medicine group is obviously better than the Western medicine group.
CONCLUSION
The use of Chinese medicine for the treatment of children with adenoid hypertrophy has good clinical efficacy.
Topics: Adenoids; Child; Drugs, Chinese Herbal; Humans; Hypertrophy; Medicine, Chinese Traditional; Pharyngeal Diseases; Treatment Outcome
PubMed: 30361788
DOI: 10.1007/s00405-018-5113-2 -
BMC Infectious Diseases Mar 2021Cytomegalovirus (CMV) is an important pathogen among immunocompromised hosts. Typically, CMV in human immunodeficiency virus (HIV) infection causes diseases of the... (Review)
Review
BACKGROUND
Cytomegalovirus (CMV) is an important pathogen among immunocompromised hosts. Typically, CMV in human immunodeficiency virus (HIV) infection causes diseases of the retina, digestive tract, lungs and liver, but there are few cases of CMV infection of the pharynx and larynx.
CASE PRESENTATION
A 57-year-old man with HIV infection was admitted because of pharyngeal pain. Before and after admission, pharyngeal biopsies guided by laryngeal endoscopy were performed four times, but pathological examination showed nonspecific inflammation, and the cause of pharyngeal ulceration was unclear. Additionally, the ulceration deteriorated after initiation of retroviral therapy. Laryngomicrosurgery was conducted under general anesthesia to remove tissue, and pathological diagnosis confirmed CMV infection. Pathological features included enlargement of the cytoplasm and nucleus in infected cells, and intranuclear bodies called owl's eye inclusions. Ganciclovir dramatically improved the symptoms and laryngoscopic findings.
CONCLUSIONS
This case was diagnosed as pharyngitis and pharyngeal ulceration caused by CMV infection, related to immune reconstitution inflammatory syndrome. In previous reports of CMV-induced pharyngeal or laryngeal ulceration in HIV infection, we found six cases similar to our present case. All cases were diagnosed by biopsy. The present case indicates the importance of biopsy for definitive diagnosis. CMV infection should be considered as a differential diagnosis of pharyngeal ulceration in patients with HIV infection.
Topics: Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Pharyngeal Diseases; Ulcer
PubMed: 33691621
DOI: 10.1186/s12879-021-05943-w -
European Archives of... Sep 2023Pharyngeal leak (PL) and pharyngocutaneous fistula (PCF) are serious complications following total laryngectomy and their incidence is higher in the salvage setting. The...
AIM
Pharyngeal leak (PL) and pharyngocutaneous fistula (PCF) are serious complications following total laryngectomy and their incidence is higher in the salvage setting. The aim of this study is to describe the accuracy of water soluble swallow (WSS) to rule out salivary postoperative leak after salvage total laryngectomy (STL) to expedite start of oral intake.
MATERIAL AND METHODS
Retrospective study including patients undergoing STL between 2008 and 2021 at Guy's Hospital. WSS was routinely performed within 15 days post operation.
RESULTS
Sixty-six patients underwent STL. Nine developed clinically diagnosed PCF; one died before having WSS. Fifty-six patients underwent WSS post STL. WSS was performed within 15 days after STL when no postoperative complications occurred (76.8%). Among patients undergoing WSS with no clinical suspicion for fistula (56), PL was identified in 15 cases (26.8%). They were managed conservatively; PCF was avoided in 7(46.7%) cases. Three patients (7.3%) developed PCF after having started oral intake with a negative WSS. These three cases were further analysed, 2 cases where recorded at the beginning of the studied period when less experience was available possibly leading to incorrect results. Sensitivity and negative predictive value (NPV) for fistula prediction were 72.7% and 92.7%, respectively.
CONCLUSION
Taking into account the high NPV of WSS, it is safe to start oral intake after negative WSS. Further studies to evaluate its accuracy earlier on after SLT are justified taking into account the results and the impact that delayed feeding has on patient's quality of life.
Topics: Humans; Laryngectomy; Retrospective Studies; Quality of Life; Laryngeal Neoplasms; Cutaneous Fistula; Pharyngeal Diseases; Salvage Therapy
PubMed: 37210463
DOI: 10.1007/s00405-023-08016-7 -
The Laryngoscope Mar 2020In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS-assisted workup, we have adopted a pharyngeal-sparing radiation therapy (PSRT)...
OBJECTIVE
In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS-assisted workup, we have adopted a pharyngeal-sparing radiation therapy (PSRT) approach targeting only the at-risk neck and omitting treatment of the pharynx. We report outcomes following PSRT, and compare to institutional historical control subjects who received pharyngeal-targeted RT (PRT).
METHODS
Between 2009 and 2018, 172 patients underwent TORS-assisted endoscopy as part of their workup for HNCUP. Following TORS, 54 patients had pT0 disease, of which 45 received RT. Forty-nine percent received PSRT and 51% received PRT.
RESULTS
No statistically significant differences existed between the PSRT and PRT groups with respect to overall nodal distribution, p16 positivity (55% vs. 43%, P = .12), neck dissection rates (77% vs. 65%, P = .51), and administration of chemotherapy (55% vs. 65%, P = .55). Median follow-up for PSRT and PRT groups were 24 and 28 months, respectively (P = .04). Two-year RFS was 86% and 74% for PSRT and PRT patients, respectively (log-rank P = .30). Three and six patients recurred after PSRT and PRT, respectively. Two-year OS for PSRT and PRT patients was 91% and 74%, respectively (log-rank P = .31). Compared to PRT, PSRT was associated with statistically significantly less: grade 2+ mucositis (18% vs. 91%, P < .01), new opioid requirement (27% vs. 91%, P < .01), mean weight loss during RT (6.2 lbs vs. 17.4 lbs, P < .01), feeding tube placement during RT (5% vs. 43%, P < .01), and treatment-related unplanned hospitalizations (9% vs. 39%, P = .04).
CONCLUSION
Following TORS-assisted management of patients with pT0 HNCUP, we observed reduced toxicity following PSRT compared to PRT without apparent compromise of disease cure.
LEVEL OF EVIDENCE
Level 3 evidence, retrospective review comparing cases and controls Laryngoscope, 130:691-697, 2020.
Topics: Carcinoma; Case-Control Studies; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck; Neoplasms, Unknown Primary; Organ Sparing Treatments; Organs at Risk; Pharyngeal Diseases; Pharynx; Postoperative Period; Radiation Injuries; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 31411747
DOI: 10.1002/lary.28200 -
Journal of the Pediatric Infectious... Sep 2016The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level...
INTRODUCTION
The epidemiology and hospital course of children with retropharyngeal abscess (RPA) or parapharyngeal abscess (PPA) have not been fully described at the national level in the United States.
METHODS
Pediatric discharges for PPA and RPA were evaluated by using the Kids' Inpatient Database from 2003, 2006, 2009, and 2012. Cases were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes 478.22 and 478.24 for PPA and RPA, respectively. Nationally representative incidence data were calculated by using weighted case estimates and US census data. Demographic and cost analyses were conducted by using unweighted analyses.
RESULTS
There were 2685 hospital discharges for PPA and 6233 hospital discharges for RPA during the 4 study years combined. The incidence of RPA increased from 2.98 per 100 000 population among children <20 years old in 2003 to 4.10 per 100 000 in 2012. The incidence of PPA peaked at 1.49 per 100 000 in 2006. Incidences were highest among children <5 years old and boys in all age groups for PPA and RPA. Winter-to-spring seasonality also was evident for both. PPA was managed surgically in 58.1% of the cases, and RPA was managed surgically in 46.7%. Surgery was performed most often on the day of admission or the following day, was more frequent at teaching hospitals, and was associated with higher hospital charges. The mean hospital length of stay was longer for children who had surgery versus those who did not (4.4 vs 3.1 days [for PPA] and 4.8 vs 3.2 days [for RPA], respectively; both P < .001). The median charges for RPA and PPA were similar. The proportions of children with RPA or PPA covered by Medicaid increased during the study period.
CONCLUSION
PPA and RPA represent relatively common male-predominant childhood infections with similar epidemiologies. The incidence of hospital discharges with a diagnosis of RPA increased during the study period. Substantial proportions of children with PPA or RPA are now managed without surgery. Surgical drainage was associated with higher hospital charges and longer lengths of stay.
Topics: Adolescent; Child; Child, Preschool; Female; Hospital Charges; Hospitalization; Humans; Incidence; Infant; Length of Stay; Male; Pharyngeal Diseases; Retropharyngeal Abscess; Retrospective Studies; United States
PubMed: 26407249
DOI: 10.1093/jpids/piv010