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PubMed2003

Persistent primary hyperparathyroidism caused by adenomas identified in pharyngeal or adjacent structures.

Abnormalities in the normal migration of the parathyroid glands during embryological development of the head and neck may result in considerable variability in the location of parathyroid tissue. Ectopic parathyroid adenomas present diagnostic and technical challenges and are frequently the cause of persistent primary hyperparathyroidism (HPT) after unsuccessful initial parathyroid surgery. We report a series of eight patients with persistent primary HPT who had adenomas in rare and unusual locations associated with various pharyngeal structures. Four were located within the epineurium of the vagus nerve at or above the level of the carotid bifurcation, and four were located within the paranasopharyngeal space or oropharynx. Noninvasive and invasive preoperative imaging studies were crucial in localizing the neoplasms in these patients and permitted the use of a direct surgical approach, resulting in cure in all patients and a low complication rate. The location of parathyroid glands in high pharyngeal and cervical structures is a consequence of anomalous or arrested descent through developing pharyngeal structures and illustrates the remarkable spectrum of ectopic parathyroid adenomas that occur secondary to this phenomenon.

Adenoma↗

PubMed1999

Factors related to the prescription of antibiotics for young children with viral pharyngitis by general practitioners and paediatricians in southeastern France.

This study evaluates the antibiotic-prescribing practices of physicians as well as other related issues in the context of viral pharyngitis. In a telephone interview, 535 physicians practising in southeastern France were submitted a clinical case description of an episode of acute pharyngitis in a 2-year-old child. Questions concerned antibiotic treatment and physicians' reasons for their treatment decision. The viral origin of the pharyngitis was more likely to be suspected by paediatricians than by general practitioners (92% vs. 78%, P<0.01); 57% of allopaths (compared with 26% of homeopaths/acupuncturists and 14% of paediatricians, P<0.001) declared they would prescribe an antibiotic in this situation (amoxicillin only in 42% of cases). This difference between allopaths and other physicians was still significant after controlling for knowledge regarding antibiotic therapy. In order to limit the risk of emerging resistant bacteria, it is urgent that training be upgraded for physicians, especially for allopaths.

Anti-Bacterial Agents↗

PubMed2006

Multiple doses of cefodizime are necessary for the treatment of Neisseria gonorrhoeae pharyngeal infection.

A single dose of cefodizime (CDZM), ceftriaxone (CTRX), or spectinomycin (SPCM) is recommended for the treatment of gonococcal urethritis or uterine cervicitis in the era of multidrug-resistant Neisseria gonorrhoeae; namely, cefozopran-resistant N. gonorrhoeae (CZRNG). N. gonorrhoeae pharyngeal infection is not so rare in Japan; however, the proper treatment regimen for this infection is not clear. We previously found that a single dose of CDZM completely eradicated multidrug-resistant N. gonorrhoeae in patients with urethritis and uterine cervicitis, so we tried a single 1.0-g dose of CDZM for the treatment of N. gonorrhoeae pharyngeal infection, including infections with CZRNG. The eradication rate of N. gonorrhoeae from the pharynx was 63.0% with a single 1.0-g dose of CDZM, while the rate for CZRNG with the same dose of CDZM was 38.5%. N. gonorrhoeae was completely eradicated from the pharynx when patients received one or two additional doses of CDZM. Therefore, we concluded that two to three doses of CDZM were necessary for the treatment of N. gonorrhoeae pharyngeal infection including infection with CZRNG.

Anti-Bacterial Agents↗

PubMed2006

The ionic dependence of voltage-activated inward currents in the pharyngeal muscle of Caenorhabditis elegans.

The pharynx of Caenorhabditis elegans consists of a syncytium of radially orientated muscle cells that contract synchronously and rhythmically to ingest and crush bacteria and pump them into the intestine of the animal. The action potentials that support this activity are superficially similar to vertebrate cardiac action potentials in appearance with a long, calcium-dependent plateau phase. Although the pharyngeal muscle can generate action potentials in the absence of external calcium ions, action potentials are absent when sodium is removed from the extracellullar solution (Franks et al. 2002). Here we have used whole cell patch clamp recordings from the pharynx and show low voltage-activated inward currents that are present in zero external calcium and reduced in zero external sodium ions. Whilst the lack of effect of zero calcium when sodium ions are present is not surprising in view of the known permeability of voltage-gated calcium channels to sodium ions, the reduction in current in zero sodium when calcium ions are present is harder to explain in terms of a conventional voltage-gated calcium channel. Inward currents were also recorded from egl-19 (n582) which has a loss of function mutation in the pharyngeal L-type calcium channel and these were also markedly reduced in zero external sodium. Despite this apparent dependence on external sodium ions, the current was partially blocked by the divalent cations, cadmium, barium and nickel. Using single-channel recordings we identified a cation channel for which the open-time duration was increased by depolarisation. In inside-out patches, the single-channel conductance was highest in symmetrical sodium solution. Further studies are required to determine the contribution of these channels to the pharyngeal action potential.

Animals↗

PubMed1987

Family outbreak of fatal Yersinia enterocolitica pharyngitis.

A family outbreak of fatal Yersinia enterocolitica pharyngitis is reported. Two members of a family were hospitalized for pharyngitis and posed a diagnostic dilemma until cultures of throat, blood, and stool revealed Y. enterocolitica. Neither patient responded to erythromycin therapy. The first patient died, and her husband's life-threatening illness seemed to respond to aminoglycoside and trimethoprim/sulfamethoxazole therapy. Y. enterocolitica should be considered as an etiologic agent in the differential diagnosis of a patient with pharyngitis whose condition deteriorates during erythromycin or penicillin therapy.

Female↗

PubMed1986

Pharyngeal carcinoma and natural killer cell activity.

An evaluation of natural killer cell activity was performed in 42 patients with pharyngeal carcinoma. Compared with age- and sex-matched control subjects, the cancer patients expressed significantly lower cytotoxicity against K562 target cells (68 +/- 8 lytic units versus 99 +/- 8 lytic units, p less than 0.01), with 52 percent of the patients expressing deficient activity (below 1 standard deviation of the mean activity of the control population). The probability of deficient activity was greater in these patients than observed in patients with cancer of other head and neck sites. Although natural killer cell activity was lower in patients who drank alcohol or had nodal metastases, no single clinical factor was predictive of deficient cytotoxic response. Prospective longitudinal evaluation (mean = 12 months) of these pharyngeal cancer patients demonstrated that deficient natural killer cell activity measured before treatment identified a population with a significantly increased risk for the development of distant metastases. Distant metastases developed in 7 of 18 patients (39 percent) with deficient natural killer cell activity. In contrast, none of the 16 patients with normal natural killer cell function had evidence of distant disease at last follow-up (p less than 0.01). Deficient natural killer cell activity exists in patients with pharyngeal cancer and is an independent marker for the subsequent development of distant metastases.

Adult↗

PubMed1989

Natural killer cells and metastases from pharyngeal carcinoma.

Natural killer cell activity was assessed in 100 previously untreated pharyngeal carcinoma patients. Diminished natural killer cell function in these patients was associated with an increased risk of death from uncontrolled regional and distant metastases. During the assessment, the cell line MDA686-Ln was established from a metastatic pharyngeal carcinoma of a patient with low natural killer cell cytotoxicity. The initially cytotoxicity-resistant cell line could be lysed when natural killer cell cytotoxicity was enhanced in vitro either through enrichment of a Leu 19+ natural killer cell population by fluorescent-activated cell sorting or by interleukin-2 activation. Additionally, increased circulating immune complexes were identified in these patients, subsequently isolated, and found to block natural killer cell reactivity against MDA686-Ln. In light of this negative interaction, 38 patients were randomly evaluated for both circulating immune complex levels and natural killer cell function. Both parameters examined together were complementary in defining the risk of death with disease; four of five deaths occurred in patients with both high circulating immune complex levels and low natural killer cell function. Results support the biologic modification of natural killer cell activity for controlling metastatic pharyngeal carcinoma and point to the potential confounding influence of circulating immune complex.

Adult↗

PubMed1986

Respiratory functions of the inferior pharyngeal constrictor and sternohyoid muscles during sleep.

We studied the respiratory activity of the inferior pharyngeal constrictor and sternohyoid muscles of the rat during non-rapid eye movement (non-REM) and REM sleep. Each animal carried chronically implanted electrodes for recording the integrated EMG activity of respiratory muscles as well as the electrocorticogram (ECoG) and postural tone (dorsal neck EMG). The latter permitted polygraphic identification of sleep states. Curled up postures enhanced inspiratory activity of both upper airway muscles during non-REM sleep, an effect which CO2 breathing failed to augment except in the well curled up position. Hypoxia reduced their activity. During REM sleep, the inferior pharyngeal constrictor and sternohyoid muscles retained their inspiratory activity. No tonic activity could be detected in either muscle. We conclude that the inferior pharyngeal constrictor and sternohyoid muscles safeguard upper airway patency in the two main sleep states.

Animals↗

PubMed1996

Metabolic profiles of cat and rat pharyngeal and diaphragm muscles.

Pharyngeal muscles play important roles in the maintenance of upper airway patency during sleep. The present study determined the extent of heterogeneity among pharyngeal muscles and the diaphragm in their metabolic profiles, and examined whether differences among muscles may account for previously described differences in their fatigue resistance. Cat and rat sternohyoid, geniohyoid, genioglossus (cat only) and diaphragm muscle were assayed for activities of the mitochondrial enzyme citrate synthase (CS), the glycolytic enzyme phosphofructokinase (PFK) and the cytosolic enzyme lactate dehydrogenase (LDH). CS activity varied among muscles in both species, being highest for genioglossus in cat and highest for diaphragm in rat. PFK activity was highest for genioglossus in cat, but did not differ among muscles in rat. LDH activity was lower for the genioglossus than the sternohyoid and diaphragm in cat. CS and PFK activities correlated positively, and LDH activity correlated negatively, with in vitro fatigue resistance assessed after 5 min of repetitive stimulation in cat. These data indicate close relationships between metabolic profiles, particularly oxidative capacity, and fatigue resistance of pharyngeal muscles in relationship to each other and to the diaphragm.

Animals↗

PubMed1991

Screening for pharyngeal gonorrhea in adolescents. A reexamination.

The cost-effectiveness of screening for pharyngeal gonorrhea (PG) in an adolescent clinic population was examined in the context of dramatically decreasing prevalence. Chart review revealed that the apparent PG prevalence had decreased from 15/555 (2.7%) 8 years ago to 0/319 (0.0%) recently in the clinic population studied. The earlier high prevalence of PG probably represented poor laboratory test specificity. Cost analysis showed that only at very high prevalence of PG (greater than 8%) would pharyngeal screening be cost-effective unless PG can be shown to be an important source of genital infection. We concluded that continued pharyngeal screening is not justified in our clinic because prevalence is so low.

Adolescent↗

PubMed1986

Group A streptococcal pharyngitis and bacteremia associated with a Ludwig's angina-like syndrome.

Ludwig's Angina (LA) is an infection of the submandibular and sublingual spaces usually initiated by abscesses of the inferior molars due to mixed oral flora. Pharyngitis due to group A beta-hemolytic streptococci (GABHS) rarely results in bacteremia. A patient presented with the classical findings of LA, and had no odontogenic focus but had GABHS pharyngitis and bacteremia. Attempts to isolate other microbiological organisms from the submandibular and sublingual spaces were unsuccessful. The patient required emergent tracheostomy and was treated with penicillin G for 4 wk with complete resolution of his clinical illness. The case demonstrates a previously unreported association between GABHS pharyngitis and the development of LA.

Arthritis, Infectious↗

PubMedDate not supplied

Adult and pediatric pharyngitis: a review.

Acute pharyngitis is frequently encountered in the ambulatory care setting. Although usually of viral etiology, streptococcal disease is the focus of diagnostic efforts, in light of significant suppurative and nonsuppurative sequelae. The traditional symptoms of fever, adenopathy, and pharyngeal exudate are suggestive, but not diagnostic of streptococcal pharyngitis. Thus, the importance of diagnostic testing, including Group A beta hemolytic strep antigen screen and culture, is emphasized. Recent innovations in therapy include modification of antibiotic dosing regimens and use of cephalosporins to improve patient compliance.

Adolescent↗

PubMed2006

An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow.

OBJECTIVE: To evaluate the influence of tongue-to-palate pressures on submental muscle contraction and oral and pharyngeal pressure dynamics during effortful swallowing maneuver. DESIGN: Comparative analysis of 2 task strategies on biomechanic measures of swallowing. SETTING: Research laboratory in a free-standing research facility. PARTICIPANTS: Consecutive volunteer sample of 20 healthy participants (age range, 20-35 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak amplitude of submental surface electromyography and orolingual and pharyngeal manometric pressure at 4 locations. RESULTS: General linear model analysis of variance revealed statistically significant greater amplitudes for the tongue emphasis condition of effortful swallow at all measured sensors (P<.004). CONCLUSIONS: Tongue-to-palate emphasis during execution of effortful swallowing increases amplitudes of submental surface electromyography, orolingual pressure, and upper pharyngeal pressure to a greater degree than a strategy of inhibiting tongue-to-palate emphasis.

Adult↗

PubMed2005

Caenorhabditis elegans neprilysin NEP-1: an effector of locomotion and pharyngeal pumping.

The control of signal peptide activity by cell surface proteases is one of the main factors that regulate the development and behaviour of organisms. In mammals, neprilysins (NEPs) are known to play a key role in these processes and their inactivation can initiate cellular disorganisation, which in turn may lead to prostate cancer or Hirschsprung disease. Although the proteome of the nematode Caenorhabditis elegans has been intensively studied, very little is known about the function of neprilysins. ZK20.6 (NEP-1), the C.elegans protein with highest identity to mammalian neprilysins, is a 753 amino acid residue protein that displays all neprilysin-typical characteristics, including a short intracellular domain, a transmembrane domain and a long extracellular active domain. Here we show that the expression pattern of nep-1 is limited to pharyngeal cells and a single head neuron. Compared to wild-type, the locomotion of nep-1 knockout animals is significantly impaired, a phenotype that can be rescued by the extrachromosomal re-introduction of nep-1. This suggests that this enzyme plays an important role in the regulation of nematode locomotion. Finally, electrophysiological recording of the pharyngeal activity showed a high sensitivity of the nep-1 pharynx to serotonin (5-HT) and to the neuropeptide AF1 (C.elegans FLP-8), indicating that NEP-1 is a central component that controls the neuronal innervation of pharyngeal pumping in C.elegans.

Amino Acid Sequence↗

PubMed2004

Proton pump inhibitor therapy for chronic laryngo-pharyngitis: a randomized placebo-control trial.

OBJECTIVE: To determine the efficacy of proton-pump inhibitor (PPI) therapy for chronic laryngo-pharyngitis treated with lifestyle modification. STUDY DESIGN AND METHODS: Double-blind, randomized trial comparing two-month Rabeprazole (20 mg b.i.d.) to placebo control. RESULTS: Compared to baseline, both PPI and control patients had significant improvement in total reflux symptoms (P = 0.002 and P = 0.03 respectively), with significant improvement in "laryngo-pharyngeal" but not "typical" reflux symptoms. No significant difference was noted for change in reflux symptoms between PPI-treated and control patients (P = 0.44). Significant global improvement was noted by 50% of control and 53% of PPI-treated patients (P = 1.0). No significant differences were noted within or between treatment groups for change in health status or videostrobolaryngoscopy grade. Lifestyle modification compliance correlated significantly with global improvement. CONCLUSION: Compared to baseline, lifestyle modification for 2 months significantly improved chronic laryngo-pharyngitis symptoms. When compared to control, treatment with a PPI failed to demonstrate significantly greater improvement in reflux symptoms, health status, or laryngeal appearance.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMedDate not supplied

[Analysis of the relationship between chronic pharyngitis and tonsillectomy with the microbiologic study of the cavum].

Chronic pharyngitis is an usual process with difficult treatment. It has been related to tonsillectomy. This study collected 224 patients suffering from chronic pharyngitis, 55 tonsillectomies and 169 without operation. Bacteriological culture was done from nasopharynx in the different seasons. Microorganisms more frequent were Staphylococcus aureus, Corynebacterium sp and Aspergillus. The time between the tonsillectomy and this study has been of more than 17 years. No relationship has been found between chronic pharyngitis and tonsillectomy, considering types of microorganisms, seasons, numbers of microorganisms isolated per culture, Gram stain, and age of the patients.

Adult↗

PubMedDate not supplied

[Chronic pharyngitis and macrolides].

We have noticed that macrolides can improve the main symptoms of many patients with chronic pharyngitis. We feel that the efficacy of macrolides for chronic pharyngitis can be due to the anti-inflammatory effect of this group of antibiotics. However, we think that at present the use of macrolides is not the therapy of choice for chronic pharyngitis.

Anti-Bacterial Agents↗

PubMed1996

Cervical necrotising fasciitis with pharyngeal perforation: treatment and reconstruction.

We present a case of life-threatening necrotising fasciitis of the neck with acute pharyngeal perforation following a parapharyngeal abscess caused by tonsillitis. The joint occurrence of cervical necrotising fasciitis and acute pharyngeal perforation has not been previously reported. A new way of reconstructing the pharyngeal defect using an islanded submental perforator flap is presented.

Acute Disease↗