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Human papillomavirus (HPV) infection at the cervix, anus and oropharynx has been rarely concurrently estimated among HIV-infected women. Using multiplex polymerase chain reaction testing, we prospectively evaluated HPV genotype distribution across three anatomic sites among 50 eligible HIV-infected women from Chennai, India, who provided biological specimens and answered a sexual behaviour questionnaire. We also assessed clinical and behavioural factors related to HPV prevalence. Oncogenic HPV prevalence was comparable between the anus and cervix at 52.2% and 52.0% and lower at the oropharynx at 13.2%; 78% of women with a cervical HPV infection had the same type in the anus. Newly acquired oncogenic HPV infections were lower at cervix (24%) than anus (35%) at three months. 'Any type' cervical HPV prevalence was higher among women with low education and less than five years since HIV diagnosis. CD4+ count and antiretroviral therapy status were not associated with HPV prevalence at the three anatomic sites; however, enrolment cervical HPV16 prevalence was elevated among women with nadir CD4+ <200 cells/µL and enrolment CD4+ <350 cells/µL. Regular cervical screening is essential in HIV-infected Indian women irrespective of CD4+ count and antiretroviral therapy status. Additional research clarifying the natural history of anal HPV infection is also needed in this population., (© The Author(s) 2015.)

Objectives: There has been a reemergence of syphilis among men who have sex with men over the past decade, especially in patients infected with human immunodeficiency virus (HIV). This study was aimed at describing the oropharyngeal manifestations of secondary syphilis in HIV-infected patients. We also sought to determine the clinical risk factors for the development of oropharyngeal syphilitic lesions in patients with secondary syphilis., Methods: We performed an observational, comparative, retrospective study of HIV-infected patients who were admitted to a tertiary referral center in Mexico City and who had syphilis according to the criteria of the US Centers for Disease Control and Prevention., Results: We identified 44 patients with syphilis, 31 of whom had secondary syphilis and 9 of whom had oropharyngeal manifestations. Lesions involving the anterior tonsillar pillar were the most common, observed in 5 patients; and tongue lesions were observed in 3 patients. In the patients with secondary syphilis, multivariate analysis showed that the development of oropharyngeal lesions was not associated with age, CD4 and CD8 cell counts, or HIV RNA viral load., Conclusions: The present work shows that oropharyngeal manifestations of secondary syphilis and overlapping stages of syphilis are frequent in HIV-infected patients. To the best of our knowledge, this is the first comparative study of the oropharyngeal manifestations of syphilis in HIV-infected patients.

Objectives: We performed an electron microscopic ultrastructural study of oropharyngeal epithelium in patients with laryngopharyngeal reflux (LPR) and sore throat to evaluate whether dilatation of intercellular spaces could be traced at this level., Methods: The study included 20 patients with LPR and sore throat and 5 control subjects. The patients were subjected to upper gastrointestinal tract endoscopy and flexible pharyngolaryngoscopy. Oropharyngeal biopsy specimens were taken from the patients and controls for ultrastructural study by transmission electron microscopy., Results: The entire group of patients with LPR showed dilatation of intercellular spaces essentially at the squamous basal and suprabasal levels in their oropharyngeal biopsy specimens, whereas none of the control subjects showed such a morphological marker., Conclusions: Dilatation of intercellular spaces as a morphological marker can be traced in patients with LPR and sore throat at the level of the oropharynx. This contributes to a better understanding of the pathophysiology of LPR. If this finding is confirmed in a large series, it will represent a cost-effective, relatively noninvasive method for diagnosis of LPR.

Objectives: We compared the ability of an oropharyngeal (OP) aerosol-detecting pH probe and a standard dual pH probe in measuring laryngopharyngeal reflux (LPR)., Methods: Fifteen subjects with LPR symptoms had 24-hour simultaneous placement of the OP probe and a standard dual pH probe. Acid exposure was defined as a 10% pH decrease below baseline for the OP probe or a pH of less than 4 at the upper esophageal sphincter (UES) probe of the dual pH probe., Results: The mean duration of acid exposure was 650 seconds (SD, 619) or 0.75% of the total time for the OP probe and 438 seconds (SD, 511) or 0.51% of the total time for the UES probe. When we excluded meals and sleep, the mean duration of acid exposure was 271 seconds (SD, 356) or 0.31% of the total time for the OP probe and 271 seconds (SD, 359) or 0.31% of the total time for the UES probe. The correlation coefficient (R) between the two probes for measurement of the duration of acid exposure was 0.50 (p < 0.05). When we excluded meals and the supine position, the R was notably higher, at 0.95 (p < 0.0001)., Conclusions: The OP probe reliably documented LPR events when meals and sleep were eliminated and was better tolerated than the standard dual probe.

Objectives: This pilot study was designed to 1) identify predictors of difficult laryngeal exposure in obese patients, 2) develop strategies for efficient intubation and intraoperative visualization of the glottis, and 3) devise perioperative protocols for difficult laryngoscopies., Methods: We undertook a retrospective study over a 1-year period of 14 consecutive patients with a body mass index of more than 30 kg/M2 who underwent elective direct laryngoscopy under general anesthesia. Measurements of height, weight, neck circumference, Mallampati score, and Cormack-Lehane classification of the airway were recorded. Problems encountered during anesthesia induction and emergence were also noted. The laryngologist recorded on a visual analog scale the degree of difficulty encountered in obtaining a binocular stereoscopic view and magnification, illumination, and suspension., Results: Anatomic challenges during difficult laryngoscopy included decreased neck extension, redundant folds of tissue in the oropharynx and hypopharynx, and upper airway collapsibility. Overall, there was an association between the incidence of difficult laryngeal exposure and the Cormack-Lehane score (r = .57; p = .03), but the Mallampati score was of limited utility to the laryngologist. Neck size in female patients correlated with the Cormack-Lehane score (p = .02). Neither weight nor body mass index were predictive of a difficult laryngeal exposure. Straight blade laryngoscopes with a distal flange allowed greater depth of insertion and provided the best visualization of the glottis., Conclusions: An appropriate clinical examination may help predict a difficult airway. However, further studies are warranted to fully characterize the anatomic predictors of a difficult laryngeal exposure.

Pharyngeal wall inspiratory collapse (PWIC) is a dynamic obstruction of the air column proximal to the glottis during inspiration. Our objectives were to assess PWIC's incidence and its contribution to the symptoms of upper airway obstruction (UAO), and to propose indications for intervention. In a retrospective review of consecutive endoscopic evaluations and clinical data of 108 infants with UAO, PWIC was diagnosed in 50 infants (46%). The most common presenting symptom was apnea (52%). The PWIC was accompanied by 2 to 7 synchronous airway abnormalities, most frequently laryngomalacia (78%). Generalized hypotonia was the most common associated systemic finding (80%). Severe PWIC cases required bi-level positive airway pressure (BiPAP). The severity of PWIC, measured by a newly developed classification, was positively correlated to apnea (p < .05) and the need for BiPAP (p < .054). Spontaneous recovery occurred within 36 months. The incidence of PWIC among infants with UAO is high, and its role in UAO deserves greater recognition. Better diagnosis of PWIC will improve the treatment of UAO.

Mucosal melanomas of the head and neck, as a group, are rapidly lethal neoplasms with site-specific differences in survival. They are preponderantly thick melanomas and as a consequence can present with cervical lymph node metastasis with or without distant spread. Long-term survival is unusual to rare; 5-year survival is poor, and 10-year survival, dismal. Whether this life-consuming nature is due to a biologic characteristic or related to late discovery is unknown. Because of the accelerated course and obvious differences in epidemiology, mucosal melanomas should be considered separate from melanomas of the skin.

The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.

Persistent oropharyngeal membrane was found in a 6-day-old Hereford calf. The calf was unable to nurse and had not passed feces since birth. Physical examination revealed a fold of tissue spanning the caudal oral cavity, and a barium study demonstrated that food remained within the oral cavity despite a swallowing reflex. A thickened epiglottis was demonstrated radiographically but was not confirmed on necropsy. Necropsy revealed a complete soft-tissue partition between oral cavity and oropharynx with a central blind-ended diverticulum. Only a few cases of persistent oropharyngeal membrane have been reported previously, all in humans. This is the first report of this defect in domestic animals. Possible similarities to the more common persistent anal membrane are discussed.

Uvulopalatopharyngoplasty (UPPP) is currently the preferred method for treatment of the obstructive sleep apnea syndrome (OSAS). However, only 50 per cent of the patients operated upon are cured by this surgical procedure, and there is a demand for better and more objective selection criteria. Computed tomography (CT) of the oropharynx was obtained in 32 consecutive adult patients with proven OSAS. An additional 15 patients with the same complaints, but without objective evidence of OSAS, were used as a control group, together with 20 normal subjects. The axial widths of the tongue and the genioglossus and hyoglossus muscles were measured by CT. Both the tongue and genioglossus widths were significantly larger in the OSAS patients than in the two control groups (p less than 0.001). The increased tongue width will cause encroachment of the oropharyngeal airway below the level of the soft palate. Thus, CT can be used to measure the tongue size in order to evaluate its predictive value for the outcome of the UPPP procedure.

Both muscular hypotonia and anatomic abnormalities have been implicated in the pathogenesis of the obstructive sleep apnea syndrome (OSAS). The upper airways of 25 patients with OSAS were evaluated to determine potential sites of obstruction. Significant airway compromise was found in all patients with some patients having multiple sites of airway narrowing.