Persistent Sore Throat Research Articles

へん桃周囲膿ようによるｔｏｘｉｃ ｓｈｏｃｋ ｓｙｎｄｒｏｍｅ例

We describe a patient hospitalized for peritonsillar abscess who developed toxic shock syndrome. A 38-year-old male sought medical advice because of persistent high fever and sore throat with severe pain during swallowing. Physical examination found gross unilateral swelling of the palate and anterior pillar with medial displacement of the right tonsil. We diagnosed peritonsillar abscess and performed surgical drainage under antibiotic coverage. By the third hospital day the patient became afebrile and was gradually able to eat. However, he had a spiking temperature up to 40°C and his blood pressure was 80/50mmHg on the sixth day. He complained of nausea, vomiting and diarrhea. Laboratory data demonstrated a WBC count of 31, 800/μl, CRP level of 19.5mg/dl, BUN level of 27mg/dl, GOT and GPT level of 59 and 40IU/I. A stool culture revealed toxic shock syndrome toxin-1 (TSST-1) producing Methicillin Resistant Staphylococcus aureus (MRSA).

Group A streptococcal pharyngitis

The group A Streptococcus is the most common bacterial cause of pharyngitis. Although most cases of streptococcal pharyngitis are managed by primary care providers, the otolaryngologist is often consulted to assist in the management of patients with persistent sore throat, chronic streptococcal carriage, recurrent streptococcal pharyngitis, or complications of streptococcal infection. This article reviews recent advances in diagnosis and management of individual episodes of streptococcal pharyngitis, the clinical approach to the streptococcal carrier, and the role of tonsillectomy in the management of recurrent pharyngotonsillitis.

A 35-Year-Old Man With Persistent Cough, Fever, and Sore Throat

A 35-year-old white Belgian man with an uneventful medical history was referred from Port Said, Egypt, for fever of unknown origin. As a civil engineer, he was working on a tunnel project with 50% of his day spent underground in caissons. About 6 months before referral, he developed a sore throat, hoarseness, nasal congestion, cough, and slightly enlarged submandibular glands, with a temperature up to 39.5°C. Within a few days, slight-to-moderate sternal and anterior chest pains were noted. An initial clinical evaluation included a chest radiograph and CT scan that were interpreted as normal.

Traumatic Esophageal Perforation Resulting from Endotracheal Intubation

Traumatic Esophageal Perforation Resulting from Endotracheal Intubation

Practitioner-Based Nutrition Advice for Chronic Fatigue Syndrome Varies

Chronic fatigue syndrome (CFS) is a vaguely identified disorder characterized by various persistent symptoms, including fatigue, sore throat, mild fever, muscle pain and weakness, depression, and lack of mental clarity. Nutritional aspects related to CFS have received little attention despite the fact that the syndrome is associated with a number of characteristics which may increase nutritional risk. A questionnaire was mailed to health care practitioners: 200 medical doctors (MDs), 200 doctors of osteopathic medicine (DOs), and 200 doctors of chiropractic (DCs) to determine whether nutrition was among recommendations given to CFS patients and whether these practitioners perceived these recommendations as beneficial. Response rate was 33% of subjects receiving the survey instrument: 72 MDs (39%), 55 DOs (30%), and 58 DCs (31%). Fifty-seven percent of 139 respondents (38% of MDs, 58% of DOs, and 69% of DCs) replied that they used nutrition therapies when treating CFS patients. Nutrition advice varied widely. Recommendations included low sugar, low caffeine, low fat, yeast-free, hypoallergenic, and low sodium diets and supplements of multivitamin/mineral, single vitamin, herbal remedy, single mineral, and homeopathy. Use of yeast-free diets varied by practice group, with DCs most likely and MDs least likely to report it (p<0.01). No MDs used homeopathy. DCs were most likely (64%) and MDs least likely (24%) to perceive improvement due to nutrition therapy (p<0.05); this difference may be confounded by other variables that differ between these types of practice. Due to the wide array of advice reported and the very small numbers of CFS patients per subject, no conclusions could be drawn regarding promising therapies, using this empirical approach.

GASTROESOPHAGEAL REFLUX AND ASTHMA IN THE ELDERLY PATIENT: Pathogenesis, Diagnosis, and Treatment

The prevalence of gastroesophageal reflux (GER) in the elderly population may be as high as 20%. There is little information, however, about elderly patients with GER-associated asthma. The exact relationship between GER and asthma is unclear, although the association is well recognized. This article reviews the data that link GER to clinical presentations, diagnostic tools, and treatment options.

GRANULOMA ANNULARE AND DISSEMINATED HERPES ZOSTER

A 71-year-old man was admitted to the Wake Forest University/Baptist Hospital Medical Center on February 1, 1989, with pharyngitis and a cutaneous eruption that began that day. The past history was significant for a diagnosis of chronic lymphocytic leukemia (CLL) made in 1984, and for longstanding hypertension, severe coronary artery disease, and prostatic hypertrophy. The patient had required no therapy for his CLL until August, 1988, when he developed hemolytic anemia and was treated with oral chlorambucil, 4 mg/day, and a tapering course of prednisone. By December, 1988, the prednisone therapy had been discontinued, but the patient required hospital admission for pneumococcal pneumonia, which responded well to intravenous antibiotic therapy. One day prior to the current admission the patient complained of persistent fevers, sore throat, productive cough, and headache. He noted a new cutaneous eruption on the day of admission in February, 1989. The past history was positive for occasional herpes stomatitis. The patient did not know if he had previously been infected with varicella. Skin examination revealed multiple (greater than 20), single, and grouped vesicles in a generalized distribution involving the bilateral trunk, head, neck, arms, and legs. The heaviest involvement was on the right posterior auricular area and on the neck. A Tzanck preparation obtained from an early lesion was positive for multinucleated giant cells. Viral culture was negative at 24 hours and at 1 week. A skin biopsy of an early vesicular lesion was performed and revealed intraepidermal vesicles with acantholysis and giant cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of Persistent Cough During Long-term Enalapril Treatment: Controlled Study Versus Nifedipine

The prevalence and severity of cough during long-term enalapril treatment were examined by comparing a cohort of 136 hypertensive patients who started treatment with enalapril with consecutive age and sex-matched patients who commenced nifedipine therapy during the same period. Cough and other symptoms were assessed by a questionnaire designed to avoid bias towards reporting cough. After a mean of 27 months' treatment patients on enalapril had an excess of persistent cough (16 per cent, 95 per cent CI 7-25, p less than 0.01), voice change (14 per cent, 95 per cent CI 2-27, p less than 0.05) and sore throat (10 per cent, 95 per cent CI -0.1 to 20.3 per cent, p less than 0.01) when compared to nifedipine-treated patients. The cough was usually dry, moderate or severe, paroxysmal, and troublesome at night. Cough tended to be more common in women (23 per cent vs. 7.2 per cent), non-smokers, and at higher doses of enalapril, but was not related to age, duration of treatment, or chronic respiratory disease. Dry cough commonly persists as a troublesome side-effect during long-term enalapril treatment, and is often associated with voice change and sore throat.

Parapertussis: Report of a case and a review of the literature

Whooping cough is endemic in Brisbane with laboratory confirmed epidemics occurring at intervals of two to four years in the spring and summer of 1980/81, 1983/84, 1985/86 and 1989/90. Between January 1975 and June 1990, nine of 356 (2.5%) Bordetella isolates from patients at the Royal Brisbane Hospital were identified as Bordetella parapertussis . One child had dual infections with B. pertussis and B. parapertussis isolated from the same specimen. B. parapertussis was isolated from the mother of this child and from another adult, a young resident, who presented with persistent sore throat and cough. This paper reports the latest case and reviews the clinical spectrum and laboratory diagnosis of parapertussis. The generally low rate of detection of B. parapertussis may be the result of the lack of cultures taken from children and adults with mild whooping cough and the failure to distinguish this species from B. pertussis .

Diarrhea, Fever, Hypoxia, and Rash in a House Officer

DR. LEE COHEN. A 26-year-old male physician was in good health until August 1989, when he had five episodes of watery diarrhea over 24 hours after eating in a Mexican restaurant. Six days later he developed fever to 39.7?C that was associated with chills, malaise, myalgias, headache, and sore throat. The fever persisted for 72 hours, at which time he presented to the emergency room at UCLA Medical Center and was given erythromycin for possible streptococcal pharyngitis. He subsequently developed profuse, watery diarrhea, which occurred as frequently as every 15 minutes. He returned to the emergency room on the following day because of persistent diarrhea, sore throat, exertional dyspnea, and nonproductive cough. He denied a history of rash, stiff neck, chest pain, or abdominal pain. He was admitted to the hospital. The patient was a house officer in the department of internal medicine on rotation at a local county hospital. He denied known exposure to patients with communicable diseases, and no member of his household had a similar illness. The patient asserted that he had not traveled recently, gone camping, ingested raw foods or milk, been exposed to animals, or been bitten by arthropods. He had received routine childhood immunizations, and the result of a test for purified protein derivative within the preceding year was negative. He had not been hospitalized recently. Physical examination showed a well-developed,

Effects of adding nedocromil sodium (Tilade®) to the routine therapy of patients with bronchial asthma

In a 12-week double-blind, group comparative trial, preceded by a 2-week baseline period, 38 asthmatic subjects of mixed aetiology and varying severity received either 4 mg nedocromil sodium by metered dose inhaler twice a day or a matching placebo preparation, in addition to their existing maintenance therapy of inhaled corticosteroids plus inhaled bronchodilators. Asthma severity and lung function were assessed at 4-weekly clinic visits, and symptomatology (morning tightness, daytime asthma, cough, night-time asthma), morning, afternoon and evening PEFR, and the use of inhaled bronchodilators were recorded on daily diary cards. Treatment with nedocromil sodium led to significant (P less than 0.05) improvements in clinic assessment of FEV1 and PEFR both before and after an inhaled bronchodilator from at least the eighth week onwards. Mid-study FVC was also significantly (P less than 0.05) improved. Daily PEFR increased throughout the study in the nedocromil sodium-treated subjects and the diurnal variation was reduced. Daily symptom severity was also reduced and these improvements occurred despite the similar or slightly reduced use of inhaled bronchodilators. However, none of these improvements in diary card parameters reached statistical significance. By the final week of the study subjects treated with nedocromil sodium predominantly had a mild form of asthma or no symptoms at all, and both patients and clinicians reported the effectiveness of nedocromil sodium; the subjects but not the clinicians finding it significantly more effective (P less than 0.05) than placebo. Nedocromil sodium was well tolerated although one patient was withdrawn owing to a persistent sore throat after 7 weeks of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

A case presenting symptoms of subacute necrotizing lymphadenitis following infectious mononucleosis

We treated a Japanese woman who presented symptoms of subacute necrotizing lymphadenitis (SNL), which occurred following an EB virus infection, i.e., infectious mononucleosis (IM). No such cases have been reported and the possibility that SNL may be induced by an EB virus infection has to be given attention.The patient was a 26 year-old Japanese woman who admitted to Kyushu University Hospital because of persistent fever and sore throat. Systemic lymphadenopathy, hepatomegaly, leukocytosis, an increased number of atypical lymphocytes and the elevation of serum EB VCA-IgM titer were evident and the diagnosis of IM was made. Two months after the onset of IM, she again had a high fever and marked swelling of the left submandibular lymph nodes accompanied by marked tenderness. Serum markers of EB virus showed evidence of the convalescent stage of IM. Leukocytopenia was present and she recovered 40 days later with no specific treatment. Though SNL was not histologically proven, the diagnosis of SNL was made. Immunological investigations showed that the ratio of OKT 4+ to OKT 8+ lymphocytes was decreased and the natural killer cell activity had deteriorated.

Rapid detection of neonatal hypoglycaemia. Evaluation of Dextrostix Reflectance Meter system.

<h3>Introduction</h3> Oesophageal high resolution manometry (OHRM) is a fast developing area of medicine. Whilst seemingly being at the “cutting edge” of technological advancement, it is a relatively simple procedure to perform and interpret. Its ability to demonstrate functional as well as anatomical abnormalities, has led to a range of new diagnoses and shed light on areas of previous clinical and management dilemma. Despite this, few hospitals outside of the large central teaching hospitals, have embraced this new technology. <h3>Objective</h3> To assess the demand for OHRM within a district general hospital (DGH). To assess the reasons for referral and the general outcomes from the procedure. <h3>Methods</h3> The Luton &amp; Dunstable Hospital set up a new OHRM service in July 2009. Prospective procedure related information was stored on a HRM database. This database was analysed to assess total number of procedures performed, the reasons for referral and the diagnostic outcome of those procedures. <h3>Results</h3> Over the course of the first 2 years, a total of 162 procedures were performed. Patients were referred in with a range of symptoms, often in combinations. Of these 162 patient 9 suffered dental problems, 31 had globus, 32 had persistent sore throat, 27 had chronic cough, 13 had nocturnal cough, 118 had endoscopic negative reflux-like symptoms, 40 had endoscopy negative dysphagia, 30 had atypical chest pains, 1 had persistent nausea, 24 had dysphonia and 2 were for reflux assessment. A wide range of diagnoses were made often in combination, including; - 52 with reduced LOS pressures, 18 with a small LOS, 58 with a hiatus hernia, 52 with acid reflux, 40 with non-acid reflux, 75 with oesophageal dysmotility, 23 with oesophageal spasm, 6 with hypertonic contractions, 19 with hypotonic dysmotility, 5 with achalasia type 2, 4 with achalasia type 3, 15 with a wide transition zone, 17 with transient LOS relaxation, 3 with poor pharyngeal co-ordination, 1 with food bolus, and 20 who were normal. <h3>Conclusion</h3> OHRM is relatively simple procedure to perform and interpret. With its ability to diagnose both functional and anatomic abnormalities it has become an invaluable part of our DGH gastroenterology unit. Given the clear benefits over standard manometry, we believe that all patients throughout UK should have access to an OHRM service. <h3>Disclosure of Interest</h3> None Declared.

Tuberculosis of the tonsil: Case report and review

Tuberculosis tends to be forgotten in the present epidemiological situation, which inevitably leads to a delay in diagnosis. We report a patient who presented with a persistent sore throat due to tuberculosis of the tonsil which was undiagnosed for for 10 months, and who was subsequently found to have pulmonary tuberculosis. The literature is reviewed. It is emphasised that a persistent sore throat warrants thorough investigation, and the possibility of tuberculosis should be included in the differential diagnosis.

TUMORS OF THE NASOPHARYNX

Tumors of the nasopharynx present a perplexing problem from the standpoints of both diagnosis and management. The anatomical peculiarities of the nasopharynx make adequate clinical examination and early diagnosis difficult. When the symptoms develop, the tumor may have reached such an advanced stage that the results of treatment will be unsatisfactory. Diagnosis is rarely made clinically because the complaints are seldom related to the nasopharynx. The difficulties encountered in the recognition of these lesions have been shown by New. 42 In his series of 194 patients with malignant tumors of the nasopharynx, 185 different types of operations had been performed for relief of symptoms prior to admission to the Mayo Clinic. For practical purposes, any patient with unexplained otological complaints should have a thorough examination of the nasopharynx. When a patient complains of nasal obstruction, epistaxis, persistent sore throat, or other nasopharyngeal symptoms, one should suspect the possibility of a tumor of the nasopharynx with extension to the oropharynx. Cranial nerve paralysis, particularly of the sixth to third nerves, should lead to a suspicion of a nasopharyngeal tumor. Any enlargement of the cervical lymph nodes should merit a nasopharyngeal examination. A palpable deep node under the sternocleidomastoid muscle is almost pathognomonic of a malignant tumor of the nasopharynx. 15 Roentgen examination is a valuable adjunct in the diagnosis of these tumors. In interpreting roentgenograms of the nasopharynx, a knowledge of regional anatomy of the head and neck and of the routes of spread of the disease is imperative. For a presumptive diagnosis, demonstration of a soft tissue mass is essential; bony sclerosis of the base of the skull is highly suggestive of a malignant process, and destruction of the base of the skull is reliable evidence of neoplastic disease. For the final diagnosis of tumors of the nasopharynx, the clinical and roentgen findings must be confirmed by tissue biopsy. Once the diagnosis is established, the gross limits of disease as demonstrated roentgenologically provide a firm basis for treatment planning.

NEISSERIA CATARRHALIS BACTEREMIA WITH MENINGITIS.

NEISSERIA GONORRHOEAE and N meningitidis have a well-established pattern of pathogenicity in man. Aerobic nonpathogenic neisseriae, on the other hand, are found normally in the nasopharynx and in the upper respiratory tract. The following report describes a case in which, despite a clinical picture of meningococcemia, a culture of N catarrhalis was developed from blood, spinal-fluid, and throat specimens. Report of a Case A 2 1/2-year-old boy was brought to the hospital 18 hours after he developed lethargy, fever, and anorexia, and four hours after petechiae were first noticed on his arms. The physician who saw him did not institute therapy but referred him for immediate admission. The patient's history included persistent rhinorrhea and sore throat during the previous winter. He had also experienced frequent earaches, but not within the six months previous to admission. The patient weighed 28.6 lb (13 kg). He was comatose and had a rectal temperature

MALIGNANT GRANULOMA OF THE FACE

FOR MANY years cases of destructive, usually fatal, idiopathic granulomatous ulcerating lesions of the facial structures have been encountered. These have been reported in the medical literature under a variety of titles. Although not common, this entity must be of much more frequent occurrence than seems indicated by the number of cases hitherto reported. In this country, reviews, some of them extensive, have appeared in the otorhinolaryngologic literature only, and it is therefore probable that numerous instances of the syndrome have been overlooked or classified as some other condition by those not aware of its existence. It is my purpose at this time to present a review and two additional instances of this little-known but important entity. REPORT OF CASES Case1.—A 27-year-old white woman was admitted to the Los Angeles General Hospital in December, 1949, because of a persistent sore throat of six weeks' duration, which had not

HORMONE EXCRETION AND BIOASSAY OF EXTIRPATED TUMOR IN TERATOMA OF THE TESTIS

FROM A LABORATORY aspect of the case reported herein, one is impressed with the value of the biological method of testing in teratoma of the testes. In the light of the results obtained from serial examinations, it must be recognized as a valuable diagnostic procedure and as an assay of the effectiveness of treatment. This case is presented because it afforded such correlation of the bioassays and its clinical course, and assay of the extirpated tumor has suggested an interrelationship between hormone excretion and existing neoplasm. L.S., a male, age 32, who was admitted to the hospital on 3/20/39, complained of persistent cough, joint pains and sore throat of 3 months duration. Hospitalization was advised for investigation, as there were remissions during that period of illness. Swelling of the right testicle had occurred 3 days prior to admission.

RELATION OF ALLERGY AND TONSILLECTOMY IN CHILDREN: INCIDENCE OF RESPIRATORY ALLERGY IN CASES OF ROUTINE TONSILLECTOMY

The otolaryngologist, the pediatrician and the general practitioner are frequently confronted with the problem of diagnosis and treatment in cases of recurrent colds, sinusitis, bronchitis and recurrent pneumonia in children. These conditions are generally considered as infectious, and the treatment usually consists of the administration of cold "shots," drainage of sinuses or the removal of the tonsils and adenoids. That these symptoms and signs may be of allergic instead of infectious origin has been emphasized by Piness and Miller, Cohen and Rudolph and Hansel. The allergic nature of these complaints is often not recognized until frank bronchial asthma develops. Piness and Miller¹pointed out that allergy alone may produce chronic nasal obstruction without sneezing, unassociated with enlarged adenoids, and may cause frequent attacks of rhinorrhea and nasal obstruction in no way related to infection, although often designated as colds or sinusitis. Allergy may also cause persistent sore throat unrelated to