Zenker Diverticulum

Zenker Diverticulum is a multifactorial disorder of the Killian’s triangle in thehypopharynx characterized by the main symptoms of dysphagia affecting theseventh and eighth decades of age and rarely under 40 years of age. The existenceof factors that cause an increase in the intraluminal pressure of the pharynx willlead to the formation of a pocket located in the Killian’s triangle, an area with weakertone of the hypopharyngeal wall and a decrease in relative pressure in theretropharyngeal space. Zenker Diverticulum was first described by Ludlow in 1769,who reported abnormal dilatation of the posterior pharyngeal wall on postmortemexamination of a patient who complained a lifelong dysphagia. Zenker Diverticulumis thought to be associated with increasing age in relation to motor musclecoordination for swallowing functions and GERD (gastroesophageal reflux disease).Symptoms include dysphagia, regurgitation, malnutrition, and recurrent aspirationpneumonia. Management includes invasive surgery and non-invasive endoscopy.

Microbiological features of Pseudomonas aeruginosa in children with Cystic Fibrosis

The purpose of the study was to determine the frequency rate of Pseudomonas aeruginosa infection among children with cystic fibrosis (CF) in Dnipro region and to provide microbiological characteristics of the obtained isolates. The study was conducting from January 2019 to December 2020. Children with genetically confirmed CF diagnosis were enrolled. The main research method was bacteriological with identification of microorganisms by biochemical properties; antimicrobial susceptibility was determined by disk-diffusion method. Biological material: mucus from a deep smear from the posterior pharyngeal wall, sputum and tracheobronchial lavage waters. The Leeds criteria were used to define persons with chronic infection. The study involved 21 children. We collected 183 respiratory samples with 49 isolates of P. aeruginosa. The most important co-existing pathogens were Staphylococcus aureus, Aspergillus spp. and Candida spp. In our study, P. aeruginosa was associated with Aspergillus spp. (χ2=20.952; df=1; p˂0.001). Mucoid isolates were found in 24.49% of cases. P. aeruginosa showed variable sensitivity to different groups of antimicrobial agents, but the highest resistance was to penicillins. Mucoid P. aeruginosa was more resistant to penicillins (p˂0.001) and cephalosporins (p=0.036). Infection P. aeruginosa is frequent among children with CF; there were three children with chronic bronchopulmonary infection P. aeruginosa in Dnipro region in the end of 2020. The likelihood of Aspergillus spp. infection was higher in the case of current P. aeruginosa infection. P. aeruginosa showed variable susceptibility to different groups of antimicrobial agents, but mucoid isolates were more resistant.

Pharyngo-laryngeal histoplasmosis in an immunocompromised child—a case report

Background Histoplasmosis is an endemic granulomatous fungal infection which rarely infects the larynx; less than 100 cases have been reported in medical literature till date. Case presentation A 6-year-old female child, a diagnosed case of B cell acute lymphoblastic leukemia since past 2 years and on chemotherapy, presented with hoarseness and dysphagia since past 2 months. Direct laryngoscopy revealed granular appearance of posterior pharyngeal wall and the supra-glottic larynx. Histopathological examination and bone marrow aspiration confirmed the diagnosis of disseminated histoplasmosis. Conclusions Pharyngo-laryngeal histoplasmosis should be considered in the differential diagnosis of an immunocompromised patient presenting with persistent hoarseness.

Image guided biopsy/FNAC in head and neck cancers in covid 19 pandemic

Suspected growth in the region of base of tongue, pharynx, and larynx need direct/indirect laryngoscopy for establishing Diagnosis and for Staging of the disease. The Covid 19 Pandemic has severely affected these modes of examination because they are Aerosol Generating Procedures and carry very high risk of transmission of the Virus. The Department of Head And Neck Oncosurgery at KCHRC is one of the busiest department at our Institute with an average annual footfall of around 20,000 new patients. The main objective of our study is to know the role of Image Guided Biopsy/FNAC for primary diagnosis in Head and Neck Cancers. Retrospective analysis of prospectively collected data of 35 patients was done from April to September 2020. Histopathological records along with patient’s clinical records were reviewed. Of the 35 patients, 23 patients underwent CT Guided biopsies, 11 patients had CT Guided FNA and one patient had USG guided biopsy. In 23 patients (CT Guided Biopsy), the biopsy was taken from tongue in 16 patients, Larynx in two patient, Pyriform sinus(PFS), posterior pharyngeal wall, RMT (retromolar trigone), lower GBS and Tonsil sites had one patient each. Of the 11 CT Guided FNAC patients, the site of FNA was from PFS in 7 patients, Tongue in 2 patients RMT and soft palate had one patient each. One patient had undergone USG Guided biopsy for PFS lesion. Out of 35 patients, tissue specimen taken was adequate in 33 patients and inadequate in two patients. The results were supported both histologically and clinically. The histological confirmation was found in 88.6% cases (31/35), squamous cell carcinoma was found in 74.3% cases (26/35), no malignancy in 8.5% cases(3/35), no specific lesion in 5.7% cases(2/35), no definitive diagnosis in 2.8% cases(1/35) and in inadequate in 8.5% cases(3/35). Repeat biopsy in one patient revealed no malignancy. There were no post procedure complications noted. Image guided biopsy/FNAC is a safe, reliable minimally invasive technique and can be used for primary diagnosis of Head and Neck cancers without the risk of Aerosol generation in the current Covid -19 Pandemic.

Rare giant zenker’s diverticulum with mediastinal extension

Zenker’s Diverticulum (ZD) is a herniation of the posterior pharyngeal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle through a natural weakness [1]. The main clinical presentation is progressive solid food and pill dysphagia, with subsequent weight loss, halitosis, and regurgitation, complicated by the occurrence of several aspiration and recurrent pneumonia when extended into the chest [2,3]. Indeed, only rare few cases of massive mediastinal extension were reported in the literature [3].

Rare Case of a Schwannoma of the Posterior Pharyngeal Wall in a Child

We present a rare case of a schwannoma which is localized on the posterior pharyngeal wall. It caused severe difficulty in swallowing and breathing in a 3-year-old child. Schwannomas of the posterior pharyngeal wall have been rarely reported in children. To our knowledge, only 7 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, but none of them is associated with a child. The tumor was removed with plasma radiofrequency excision via a transoral route. Computed tomography or magnetic resonance imaging examination showed no recurrence of the tumor up to 2 years. To our knowledge, for the first time, a case of posterior pharyngeal wall schwannoma has been reported in a 3-year-old child, and the schwannoma was removed via plasma radiofrequency transoral excision. This case study illustrates that schwannoma may occur in children, and it is safe to treat this disease through plasma radiofrequency transoral excision route.

Comparative characteristics of typical and atypical (Mycoplasma) pneumonia in children

Aim: To compare the features of clinical-anamnestic and laboratory-instrumental data and treatment of children with typical and atypical (Mycoplasma) forms of pneumonia.Materials and methods. A comparative analysis was carried out of 1 70 case histories of children in hospital with a verified diagnosis of pneumonia in 2020. The basis for the diagnosis of Mycoplasma pneumonia was a positive PCR result of a smear of the posterior pharyngeal wall. The resulting data was constructed using Microsoft Excel 2007.Results. Mycoplasma pneumonia is specific for older schoolchildren; characterized by: prolonged course (73.5%), long-term preservation of an unproductive cough (75.7%), mild intoxication (68.6%) and catarrhal syndromes (54.3%), gradual onset (76.6%), severe lymphocytosis up to 55%, segmental or polysegmental damage to the lung tissue (92.7%).