Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Candidiasis: Oral Carcinoid 273

management

■rule out xerostomia, hyperglycemia, anemia, immunosuppression,

antibiotic use

specific therapy

■stabilize patients and frequent mouth rinses (water and/or antisep-

tic)

■systemic antifungals

■topical antifungals

■sialogogues if necessary

follow-up

■watch for recurrence; search for causative factor(s)

complications and prognosis

■prognosis depends upon eliminating or controlling causative factors

■complications include discomfort, halitosis, dysgeusia, transmis-

sion to partners,

■genital/anal/skin spread

Carcinoid..........................................

MAY CHEN, MD and GEORGE A. FISHER, MD, PhD

history & physical

History

■Carcinoid (“cancer-like”) neoplasms least aggressive of neuroen-

docrine tumors

■Incidence 0.5–1.5 per 100,000

■Median age at presentation∼60 years of age

■Female predominance in younger age groups

■Familial association with MEN type I

Signs & Symptoms

■Local symptoms: depend on site of disease

■Gastric carcinoids: dyspepsia, nausea or anemia

■Midgut carcinoids: 40–60% asymptomatic (e.g. found in 1 of 200

appendectomy specimens)

■Most frequent symptoms those of carcinoid syndrome

■Carcinoid syndrome most common with liver metastases; occasion-

ally crampy abdominal pain due to obstruction