Iatrogenic rhinopharyngeal isolated argyria induced by silver-containing nasal drug.

Localized nasal argyria has been reported in 3 published articles as secondary to occupational exposure and involving the anterior part of the nose. No previous cases of such pathology involving the rhinopharynx were described. Here we report the first case of localized argyria of the roof and of the posterior wall of the rhinopharynx secondary to prolonged use of nasal drops containing colloidal silver protein. The recognition of such pathology can be useful to increase the number of conditions that must be considered in the differential diagnosis of rhinopharyngeal mucosa alterations.

Major bleeding of the upper aerodigestive tract due to oral anticoagulant/antibiotic interactions.

INTRODUCTION: Although a well-known complication in certain medical specialties, major bleeding due to the interaction between oral anticoagulants and antibiotics has been rarely reported concerning the upper aerodigestive tract. We report three cases of life-threatening bleeding of the upper aerodigestive tract in a context of antibiotic therapy in patients treated with oral anticoagulants. CASE SERIES: Three male patients under coumadin anticoagulation therapy presented major bleeding in three different contexts (epistaxis, peritonsillar abscess and postoperative course after total laryngectomy). Surgical intervention for hemostasis was required in all cases, with coagulation correction in two. Complications were severe anemia (2/3) and chronic heart failure (1/3). DISCUSSION/CONCLUSIONS: Interactions between two drugs commonly used in otolaryngology can result in major bleeding. The goal of this article is to raise practitioners' awareness of a potentially fatal, although rare, complication. We also review the main preventive strategies.

Wasabi nose: an underreported complication of cyclophosphamide infusions.

Wasabi nose, a term used to describe the nasopharyngeal discomfort experienced during cyclophosphamide infusions, is a rare phenomenon, previously described in case reports of adult oncology patients typically receiving high-dose chemotherapy regimens. The underlying mechanism by which this phenomenon occurs is unknown. We report four cases of children with rheumatic diseases afflicted by profound nasopharyngeal discomfort secondary to low-dose cyclophosphamide infusions. We additionally review the literature regarding potential medical management of these complications and describe our experience using these interventions.

Lymphoproliferative disorder of nasopharynx after long-standing cyclosporin therapy for psoriatic arthritis.

BACKGROUND: The increased risk of developing lymphoproliferative disorders, mainly linked with Epstein-Barr virus infection, is well documented in patients with cyclosporin-induced immunosuppression following organ transplantation. Lymphoproliferative disease is extremely rare in the non-transplant setting. METHODS: We present the first published case of non-Epstein-Barr virus associated lymphoproliferative disease in a patient receiving long-standing cyclosporin therapy for psoriatic arthritis, which presented as a recurrent nasopharyngeal mass. RESULTS: Histological examination showed lymphoid hyperplasia in repeated biopsies. Macroscopic clearance was persistently followed by aggressive recurrence. Spontaneous regression occurred upon cyclosporin withdrawal. CONCLUSION: This rare complication of cyclosporin therapy in non-transplant patients is highlighted from an otolaryngological perspective, as the sole presentation may be a recurrent nasopharyngeal mass. Repeated biopsies showing lymphoid hyperplasia, together with aggressive recurrence, should prompt immediate drug withdrawal to reduce immunosuppression and promote spontaneous regression.

Mannheimiose pulmonar experimental em bezerros: swab nasal e nasofaringeano como auxílio diagnóstico: [revisão] / Experimental pneumonic mannheimiosis in calves: nasal and nasopharingeal swabs for diagnostic: [revision]

Um modelo experimental de mannheimiosepneumônica bovina (MPB) foi utilizado com o objetivo de avaliar as espécies bacterianas das cavidades nasais e nasofaringeanas em diferentes momentos do curso da doença, bem como verificar a eficiência diagnóstica do exame microbiológico dos swabs nasais (SN) e nasofaringeanos (SNF). Um total de 28 bezerros foi distribuído aleatoriamente em quatro grupos experimentais (G1 a G4). SN e SNF foram colhidos sete dias antes e 12 (G1), 24 (G2), 48 (G3) e 72 (G4) horas após a inoculação intrabronquial de Mannheimia haemolytica. Após a indução da MPB, a bactéria M. haemolytica biotipo A foi predominante nos SN e SNF, sendo isolada em todos os momentos avaliados, com exceção de um SN colhido 24 horas após a indução da infecção. Não houve diferença significativa nas taxas de isolamento de Pasteurella multocida nos SN ou SNF, colhidos antes e após a indução da MPB. Contudo, esta bactéria passou a ser isolada mais freqüentemente após a indução da MPB, principalmente no SNF. Portanto, pode-se concluir que o exame microbiológico de SN e SNF é um teste auxiliar no diagnóstico da MPB.

An experimental model of bovine pneumonic mannheimiosis (BPM) was used to evaluate the nasal and nasopharynx bacterial species of calves during the course of the disease and for checking the diagnostic efficiency of nasal swab (NS) and nasopharingeal swab (NPS) microbiological exams. A total of 28 calves were randomized into four experimental groups (G1-G4). NS and NPS were obtained 7 days before and 12 (G1), 24 (G2), 48 (G3) e 72 (G4) hours after intrabronchial inoculation of Mannheimia haemolytica. After the induction of BPM, M. haemolytica biotype A was the predominant isolated bacterium in NS and NPS in all evaluated sampling times, except for one NS (harvested 24 hours). There were no significant statistical differences for the rates of Pasteurella multocida isolation in NS and NPS, harvested before and after the induction of BPM. However, this bacterium was isolated more frequently after the induction of BPM, mainly in NPS. Therefore, the microbiological NS and NPS exams were important auxiliary tests for diagnosing BPM.

Airflow, gas deposition, and lesion distribution in the nasal passages.

The nasal passages of laboratory animals and man are complex, and lesions induced in the delicate nasal lining by inhaled air pollutants vary considerably in location and nature. The distribution of nasal lesions is generally a consequence of regional deposition of the inhaled material, local tissue susceptibility, or a combination of these factors. Nasal uptake and regional deposition are are influenced by numerous factors including the physical and chemical properties of the inhaled material, such as water solubility and reactivity; airborne concentration and length of exposure; the presence of other air contaminants such as particulate matter; nasal metabolism, and blood and mucus flow. For certain highly water-soluble or reactive gases, nasal airflow patterns play a major role in determining lesion distribution. Studies of nasal airflow in rats and monkeys, using casting and molding techniques combined with a water-dye model, indicate that nasal airflow patterns are responsible for characteristic differences in the distribution of nasal lesions induced by formaldehyde in these species. Local tissue susceptibility is also a complex issue that may be a consequence of many factors, including physiologic and metabolic characteristics of the diverse cell populations that comprise each of the major epithelial types lining the airways. Identification of the principal factors that influence the distribution and nature of nasal lesions is important when attempting the difficult process of determining potential human risks using data derived from laboratory animals. Toxicologic pathologists can contribute to this process by carefully identifying the site and nature of nasal lesions induced by inhaled materials.

The effect of 3-methylfuran inhalation exposure on the rat nasal cavity.

The acute inhalation toxicity of 3-methylfuran (3MF) was investigated in female CD/CR rats. Animals were killed 1, 3, 6, 9, 12, 15 and 30 days following a 1-h exposure to 148 mumol 3MF/1. Relatively selective 3MF-induced necrosis of the olfactory epithelium was seen at day 1 post exposure. Subsequent resolution of the acute olfactory necrosis was not complete and resulted in partial occlusive fibrosis of the nasal cavity as seen at 30 days. Pretreatment of the animals with piperonyl butoxide (PB) did not block 3MF-induced olfactory epithelial necrosis although it prevented Clara cell necrosis when given at a dose of 800 mg/kg intraperitoneally 1 h before exposure to 3MF.

[Study of a group of subjects occupationally exposed to tartaric acid]. / Indagine su un gruppo di soggetti con esposizione professionale ad acido tartarico.

The Authors report the results of an investigation carried out in a factory producing tartaric acid in order to evaluate the effects of occupational exposure to this substance. A group of 44 subjects exposed to the acid and a group of 30 subjects not exposed, as a means of control, were submitted to anamnestic questionnaire, othorinolaringoyatric examination, spirometry, bronchodilatation test with salbutamol. Our data show a higher prevalence of oropharyngeal and cutaneous lesions in the exposed subjects, while no difference between the two groups was found for dental, bronchial and gastric lesions.

[Drug side-effects in ORL practice (author's transl)]. / Nebenwirkungen von Medikamenten im Hals-Nasen-Ohrenbereich.

Drug side-effects as opposed to toxic effects are defined and the specific side-effects of drugs used in otorhinolaryngology are then discussed. Drug induced changes in the ear, nose, throat, mouth, salivary glands and thyroid are listed. Only the most common and most important effects are discussed in detail. Some of the less commonly encountered side-effects have only been reported in a single patient and the mechanism involved is therefore uncertain. A good history is often valuable for reaching the correct diagnosis. It is also important for the physician to know the exact mechanism of a drug's action before prescribing it and to also inform the patient of the possible side-effects when these are relatively common.