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Analysis of students difficulties to complete the story problem of sequence and series in class xi sma/ma

Author: 
Francesco Asprea , Gregorio Micali , Annunziata Maceri and Francesco Carfi

Background: The authors exhibit a rare case of false positive for paraglottic neoplasia caused by an intense localized inflammatory episode, in cardiac transplanted patient in anti-rejection immunosuppressive therapy.
Material and method: A 62-year-old male patient who had undergone cardiac transplantation and accused a sense of a hypopharyngeal foreign body came to our observation. The laryngoscopic examination revealed edema of the left true vocal cord and of the left false vocal cord and tumefaction of the left arytenoid cartilage. A CT was prescribed which showed a probably heteroplasic mass of about 3 centimeters located in the left paraglottic space and extended to the left arytenoid cartilage. We performed operative microlaryngoscopy with biopsy of the left artenoid region and the left vocal cord on which the edema was treated by a cordal lifting, following the principles of modern phonosurgery
Results: Laryngoscopic control one month after surgery highlighted the total resolution of the left vocal chord edema and the previously visible arytenoid tumefaction. In consideration of the normal laryngoscopic picture and of the negative histological findings for neoplasia, it was decided to wait for a further 40 days, at the end of which CT, MRI and PET were repeated which were completely normal with disappearance of the paraglottic neoplasia previously highlighted, even wondering the radiologists.
Conclusions: Systemic and localized infections and neoplasms are among the main consequences of anti-rejection therapies and the main causes of morbidity and mortality in transplant patients.

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