Hideharu Aruga

Endoscopic Examination of the Upper Gastrointestinal Tract for the Presence of Second Primary Cancers in Head and Neck Cancer Patients

Endoscopic examination of the upper gastro-intestinal tract with Lugols solution staining was performed on 150 patients with head and neck cancer treated at the Departments of Otolaryngology and Radiology, Osaka University Hospital, between June 1987 and December 1991. Thirteen second primary cancers (11 esophageal and 2 gastric cancers) were found endoscopically, although prior fluoroscopy had found only 4 (3 esophageal and one gastric cancer). All of the 9 second primary cancers which were not detected by fluoroscopy were in the early stage. Both Brinkmans and Alcohol indices of double primary cancer cases were significantly higher than those of single head and neck cancer cases. These results indicate that head and neck cancer patients who smoke and/or drink heavily require thorough examination of their upper gastro-intestinal tract with endoscopy, using Lugols solution staining, as well as with fluoroscopy.

A case with candida albicans of the neck.

Candidasis of the paraphryngeal space is very rare. We report a case of neck and phanyngeal abscess due to candida albicans.A 73-year-old woman came to our hospital complaining of a sore throat, hoarsness. Prulenta plugs were seen on left tonsillar swelling. She had a very tumorlike swelling on the left side of the neck. At first, she was treated with an incision from the molar and soft palatine. We recognized about 50 ml yellow, whitish pus with a bad smelling gas. The first bacteriological examination showed abundant streptococcus and a small amount of candida albicans. Finding its test results, she was treated with broadspectrum antibiotics. Though antibiotic treatment, the neck tumor grew gradually up and massive pus was discharged from the incision wound. As streptococcus decreased, candida albicans increased. After detective bacteriological findings, we treated with antifungal antibiotics and the patient rapidly recovered. X-ray film and. CT revealed gas-like in the soft tissue in the so called bubble shadow.