Dyspnea is a warning sign of impending airway collapse during an episode of acute epiglottitis. Adult patients with more systemic comorbidities might bear higher risk of airway compromise; the role of diabetes mellitus can't be overlooked.

No abstract

Background Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Early detection is the best way to improve survival for this disease. A prospective study was designed to assess the feasibility of a new screening method for NPC by use of polymerase chain reaction (PCR) based on the close association of NPC and Epstein‐Barr virus (EBV). Methods One hundred thirty‐three different tissues from nasopharynx, nose, and sinus were investigated by use of PCR to check for the presence of EBV genome. Subsequently, from April 1996 to March 1997, 55 patients were enrolled in a prospective screening study. All patients underwent nasopharyngeal swabs before biopsy. Polymerase chain reaction detection of EBV genome was conducted on swab samples. Anti‐EBV viral capsid antigen (VCA) in IgA and IgG class were checked at the same visit. Results The EBV genome was present in 91.4% (85/93) of NPC tissues and in 25.0% (10/40) of non‐NPC tissues (p< .001, χ2 test). Of the 55 swabs, 49 (89.1%) specimens obtained enough cells for PCR examination. Thirty of these 49 patients were pathologically proved NPC. The presence of EBV were 86.7% (26/30) in NPC group and 42.1% (8/19) in non‐NPC group. The sensitivity and specificity were 86.7% and 57.9%, respectively, which were similar to those of serologic method (87.5% and 43.5%) when the cut‐off point was set at anti‐VCA IgG ≥ 160 and IgA ≥ 10. Combining both methods elevates the specificity to 84.2%. Conclusions The sensitivity of this PCR screening method is similar to that of the serologic method. Combining both methods can greatly increase the specificity, indicating this new method is a good supplement to the serologic screening of this endemic disease. © 1998 John Wiley & Sons, Inc. Head Neck 20: 732–738, 1998.

The aim of the present study is to review the recurrence patterns and incidence of second primary tumors (SPTs) in patients with oral squamous cell carcinoma (OSCC) who underwent surgery alone without postoperative adjuvant therapy. Data on patients recorded in the head and neck cancer registry of Cathay General Hospital were reviewed. A total of 72 patients with T1-3N0 OSCC who underwent surgery alone were included. Among the 72 patients, 44 had T1 tumors, 22 had T2 tumors, and 6 had T3 tumors. The 5-year overall survival (OS) rate was 77.3%, the recurrence-free survival rate was 74.1%, and the SPT-free survival rate was 73%. Eighteen (25%) patients had disease recurrence (regional recurrence in nine patients, local recurrence in seven patients, and locoregional recurrence in two patients). Most patients with local recurrence alone (6/7 patients, 85.7%) could be salvaged with treatment. However, locoregional control was obtained in only five (45.5%) of 11 patients with neck recurrence after surgical salvage therapy. At the time of analysis, 20 patients developed SPTs, and 15 (75%) of the SPTs were in the oral cavity. The annual incidence of SPT was 5%. Neck recurrence and SPT were associated with 48.4% and 24.4% lower 5-year OS rates, respectively. Multivariate analysis revealed that neck recurrence was a significant risk factor for low OS (p = 0.008). Neck recurrence was the most important prognostic factor for OS. The incidence of SPT development was high. Regular and long-term monitoring for recurrence and development of SPTs is necessary to improve the survival rate.

The prevalence of IL-17-producing FOXP3(+) CD4(+) tumor infiltrating lymphocytes is increased in oral squamous cell carcinoma.

Plasmacytoma is an extremely rare and discrete solitary mass of neoplastic monoclonal plasma cells. Extramedullary plasmacytoma (EMP) tends to occur during the fifth and seventh decades of life and is rarely diagnosed in younger patients. Only four cases of EMP have been previously reported in relatively young patients. Here we report a 15-year-old patient presenting with long-term nasal obstruction, who was found to have EMP of the nasopharynx. The patient was treated with surgery followed by radiotherapy with a satisfactory outcome. To the best of our knowledge, this study describes the the youngest individual with nasopharyngeal EMP to be reported in the literature.

The features of head and neck CD in Taiwan are similar to those reported in western studies. Although CD is not a common disease, it should be considered as a differential diagnosis in patients with a neck mass, especially when the patient is suffering from long-term inflammation. Multicentric CD is also likely to be initially misdiagnosed as unicentric CD. It is important to remember that all patients diagnosed with CD should receive a systemic survey to exclude the possibility of ignored lesions.

Five serological tests were assessed for their sensitivity for screening and early detection of nasopharyngeal carcinoma (NPC). The tests included the detection of antibodies to various gene products of EBV: viral capsid antigen (VCA) using an indirect immunofluorescence assay (FA), DNase using an activity neutralisation test (NT), Dnase using an enzyme-linked immunosorbent assay (ELISA), DNA polymerase (DP) using NT, and major DNA binding protein (MDBP) by ELISA. Sera from 100 NPC outpatients and 20 NPC patients, who were detected in a prospective study, were examined. The results showed that levels of antibody to DNase detected by ELISA and to DP detected by NT and the positivity rate for VCA by FA increased with NPC stage. More species of EBV antibody became detectable as NPC progressed. The detection of anti-MDBP antibody by ELISA was suitable for screening for NPC. Anti-DP antibody detected by NT was a valuable marker both for early detection and prognosis of NPC. Detection of anti-DNase antibody by ELISA was the most sensitive method for detection of NPC. No single test was sufficient to detect all the NPC patients and a combination of anti-DNase by ELISA with other tests are recommended to identify NPC patients.