Extranodal lymphoma of the tongue, a very rare entity-report of two cases with literature review.

BACKGROUND: Lymphomas are malignant neoplasms of the lymphocyte cell lines affecting the lymph nodes, spleen and other nonhemopoietic tissues. Of the extranodal lymphomas found in the head and neck region, 3-5% of malignant lymphomas arise in the oral and paraoral region, mainly from Waldeyer's ring. The involvement of the base of the tongue is extremely rare. SUMMARISED CASE: Case 1: 64 year old female who presented initially with an enlarged occipital lymph node which gradually became generalized cervical lymphadenopathy with initial histology confirmed reactive lymphoid hyperplasia. Biopsy of left postero-lateral tongue lesion eventually showed high grade T cell lymphoma. Case 2: 85 year old male presented with history of dysphagia for one year who was found to have a lesion extending from his base of tongue into the nasopharynx. Histology showed a diffuse B cell lymphoma. DISCUSSION: Both patients were noted to have lesion of the tongue, but tongue lesions are noted in the literature to be extremely rare. When tongue lymphomas do occur, most are of B-cell origin; the diffuse large-cell variety is the most common. Extranodal lymphomas of the T cell phenotype tend more to be sinonasal in origin than of the tongue, with T cell lymphomas of the tongue being even rarer than B cell lymphomas. CONCLUSION: With regards to tumours arising in the tongue, squamous cell carcinomas are still classified as the most common. Lymphomas however, should still be kept in consideration as a differential diagnosis with regards to lesions arising from this site.

The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm.

OBJECTIVES: Conservative management for retropharyngeal abscesses <2 cm is now a first line option. It is unclear if conservative management can be used to manage larger abscesses without increased morbidity and mortality. STUDY DESIGN: A prospective case series was performed from 2012 to 2015 by the Otolaryngology department of the San Fernando General Hospital involving pediatric patients who presented with retropharyngeal abscesses. All patients were initially treated with antibiotics alone. METHODS: Patients with clinical features and CT scan confirmation of a retropharyngeal abscess were included in the study. Those who improved clinically and biochemically within 48 h continued to be treated conservatively and those who deteriorated had surgical intervention. RESULTS: Sixteen patients fulfilled the inclusion criteria. Most patients were Afro Trinidadian males between the ages of two and five who were also found to be iron deficient. Drooling was a sensitive predictor for the presence of an abscess but did not indicate the need for drainage. Hoarseness was the clinical feature that prompted surgical intervention. Sixty three percent of patients had an abscess >2 cm of which 90% improved within 48 h. One patient required surgical drainage with no increase in morbidity or mortality. CONCLUSION: Conservative management of retropharyngeal abscesses >2 cm can be offered to patients during the first 48 h. If the patient demonstrates clinical and biochemical improvement, antibiotics alone can be continued. If the patient deteriorates, surgical drainage can be subsequently performed with no increase in morbidity and mortality.

Ethnicity, violent offending, and vulnerability to schizophrenia: a pilot study.

Previous research has highlighted increased risk for schizophrenia in Afro-Caribbeans as well as over-representation in the prison population. This small-scale study examined the relationship between criminality, ethnicity, and psychosis-proneness in a male prison sample. Twenty British Caucasian and 20 Afro-Caribbean prisoners were divided into equal sub-groups of violent and non-violent offenders. Participants completed measures of schizotypy, delusional ideation, and hostility. Afro-Caribbean offenders scored more highly on negative schizotypy and delusional ideation than their Caucasian counterparts. Violent offenders scored more highly on the positive symptoms of schizotypy than non-violent prisoners. Both ethnicity and violent offending may be relevant factors when considering vulnerability to psychosis in the offending population.

Ethnic differences in otitis media [abstract]

The comparative incidence of Otitis Media (OM) has long been difficult to ascertain as almost all previous epidemiological studies were performed in comparatively homogenous populations. In an attempt to question the racial variation of OM, a study was done in Trinidad, with a population of 1.2 million people. About 40 percent of the population is of African ancestry, 40 percent of East-Indian ancestry and 20 percent includes persons of mixed ethnicity, Caucasian, Chinese and middle-Eastern descent. All patients who presented with acute otitis media (AOM), middle ear effusion (MEE), or chronic suppurative otitis media (CSOM) either of the tubo-tympanic (TT) or attico-antral (AA) types, during the period November 1998 to May 1999, were included in the study. The three national otolaryngology Departments participated in the study suggesting that patients were representative of the whole population. A questionnaire was devised with documented ethnic and other demographic factors. This was completed once an experienced physician diagnosed the patient with one of the above conditions. Two hundred and fifty-two patients enrolled in the study. There were 128 males and 124 females and the age range was 4 months to 83 years. Sixty patients presented with AOM, 88 with MEE and 104 with CSOM. The most interesting result was the ethnic distribution of the patients. One hundred and thirty-eight were of East-Indian descent and 71 were of African origin, a ratio of nearly 2:1. In conclusion, in a national population containing nearly equal numbers of two major ethnic groups, the East Indians presented twice as commonly as the Africans with otitis media. Various proposed reasons for this will be discussed. (AU)