Inflammatory factors and oxidative stress play a major role in the pathogenesis of postoperative AF. This review provides an analysis of current evidence in support of efforts directed at antiinflammatory and antioxidant agents as interventions.

This is the first reported Australian case of synovial sarcoma of the pharynx. A 29-yearold man had a large hypopharyngeal mass excised and received radiotherapy and chemotherapy. No recurrence was seen 12 months later. Clinical record A 29-year-old man presented to the emergency department with stridor and a background of progressive globus sensation, loud snoring and worsening dysphagia over 2 years. He had not suffered weight loss, and past medical history was otherwise unremarkable. Flexible endoscopy examination revealed a well circumscribed, encapsulated tumour arising from the left lower lateral wall of the oropharynx and hypopharynx, and from the left arytenoid on its posterior aspect (Box 1). Computed tomography (CT) scanning revealed a 3  4.1 cm soft tissue mass arising from the left pharyngeal wall just inferior to the tonsillar fossa (Box 2). Endoscopic laser resection (microlaryngoscopy) was carried out with several scopes, including a bivalved speculum and a Boyle-Davis gag to gain full exposure. The capsule was broken at its deep aspect; however, macroscopic clearance was achieved with dissection down to healthy muscle. The patient made an uneventful recovery and was discharged on Day 3. Histopathological analysis revealed a well circumscribed tumour that measured 8  4  3 cm and was composed of relatively uniform spindle cells showing frequent mitotic activity. The tumour showed focal necrosis and focal calcification. The posterior surface was raw, suggesting incomplete margins. The cells stained positively for vimentin and CD99, and occasional cells stained positively for cytokeratin AE1/AE3 and epithelial membrane antigen (EMA).

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We illustrate a case involving a 51-year-old man who presented to a tertiary hospital with sepsis secondary to an abscess of the nasal vestibule and pustular eruptions of the nasal mucosa. Associated cellulitis extended across the face to the eye, and mucosal thickening of the sinuses was seen on computed tomography. The patient underwent incision and drainage and endoscopic sinus surgery. Blood cultures and swabs were positive for a gram-negative bacillus, Burkholderia pseudomallei. He had multiple risk factors including travel to an endemic area. The patient received extended antibiotic therapy in keeping with published national guidelines. Melioidosis is caused by Burkholderia pseudomallei, found in the soil in Northern Australia and Asia. It is transmitted via cutaneous or inhaled routes, leading to pneumonia, skin or soft tissue abscesses, and genitourinary infections. Risk factors include diabetes, chronic lung disease, and alcohol abuse. It can exist as a latent, active, or reactivated infection. A high mortality rate has been identified in patients with sepsis. Melioidosis is endemic in tropical Northern Australia and northeastern Thailand where it is the most common cause of severe community-acquired sepsis. There is one other report of melioidosis in the literature involving orbital cellulitis and sinusitis.

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