Akinori Kida

A Morphological Study of Age Changes in Adult Human Auricular Cartilage With Special Emphasis on Elastic Fibers

Objective It is well known that the size of the human auricle increases after it has finished development. The reason why the size of the human auricle continues to enlarge until advanced age after reaching adulthood was investigated by observation of the ultrastructure of elastic fibers in human auricular cartilage.

Phase I/II trial of weekly docetaxel and concomitant radiotherapy for squamous cell carcinoma of the head and neck

BackgroundA phase I/II trial of concurrent docetaxel and radiation for head and neck cancer was conducted to estimate the recommended dose schedule of docetaxel, and then to evaluate the therapeutic benefit.MethodsPatients received radiation in 2.0-Gy single daily fractions to a total dose of 60 Gy. Docetaxel was administered weekly for 6 consecutive weeks.ResultsDocetaxel 15 mg/m2 was considered the maximum tolerated dose (MTD). The recommended dose was decided as 10 mg/m2. The phase II study was conducted using docetaxel at 10 mg/m2. Thirty-nine patients were enrolled. The overall response rate was 96.9%. The prognosis of the complete response (CR) patients was significantly better than that of the partial response (PR) patients. Grade 3 or 4 adverse events consisted of lymphopenia, stomatitis, and anorexia. Thirty-two of the 35 eligible patients showed high compliance, of over 90%, and their toxicities were manageable.ConclusionEven low-dose docetaxel shows a strong effect in combination with radiation, with a high survival rate in CR patients. The effect on survival will be assessed by further follow-up.

Experimental investigation of battery-induced esophageal burn injury in rabbits

OBJECTIVE In recent years, small high-performance batteries have become very popular. With this increasing miniaturization of batteries, clinicians have noted an increasing frequency rate of esophageal injury due to battery ingestion by infants. The situation is associated with severe injury to the esophagus due to the electrical current produced, particularly in the case of high-performance batteries producing high currents. The pathophysiologic features and complications of esophageal battery burns have not been thoroughly investigated. Our study intended to investigate the pathophysiologic features and complications of esophageal battery burn. DESIGN Open, randomized, controlled study. SETTING Experimental animal laboratory in a university hospital. SUBJECTS Male adult mixed-breed rabbits, 22 wks old and weighing 3 to 3.5 kg. INTERVENTIONS The experimental rabbit model of esophageal injury due to battery ingestion described herein was designed to study not only the direct influence of contact with the battery but also damage to neighboring tissues and the biochemical and pathologic mechanisms of injury. We investigated the relationship between the direction of the inserted battery and the mechanism underlying these complications. Esophageal burn injury was created by placing a 3-V battery into the esophagus for 9 hrs. MEASUREMENTS AND MAIN RESULTS The cathode side of the esophagus became increasingly alkaline, while the anode side was acidic. Low-voltage battery burns are likely to be due to secondary chemical reactions caused by the electric current because of acid generated at the anode and alkali at the cathode using a micro pH meter. Injury was significantly more severe on the alkaline side when a battery was placed with its cathode directed toward the trachea. Alkaline complications affecting neighboring tissues were more severe than acid complications. These results indicate that as well as the esophageal mucosa itself being injured, deleterious effects are exerted on surrounding tissues, the severity of which vary depending on the orientation and duration of the battery being lodged in the esophagus. CONCLUSIONS The direction of the battery cathode, which produces alkali, is important in determining the severity of complications. Based on our investigation of the underlying mechanisms of these complications, we advocate the establishment of treatment guidelines for battery swallowing accidents.

Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention

Conclusions. The clinical and surgical findings of this study indicated advanced cholesteatoma in many patients with facial paralysis. The outcome of facial paralysis was good. Poor outcomes were observed in cases with petrosal cholesteatoma and in those who underwent surgery ≥2 months after the onset of paralysis. Objective. To investigate clinical features of cholesteatoma associated with facial paralysis. Material and methods. Sixteen patients with facial paralysis due to middle ear cholesteatoma were reviewed. After removal of the cholesteatoma lesion, a limited area of the fallopian canal, that in which facial nerve edema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. Results. Initial paralysis was incomplete in 11 patients (69%). The onset of paralysis was sudden in 12 patients (75%). Labyrinthine fistulae (n=9; 56%) and bone destruction in the cranial fossa (n=10; 63%) were frequently observed. Six patients (38%) were totally deaf due to labyrinthitis. The outcome of facial paralysis was good in 13 patients (81%). Patients who underwent surgery ≥2 months after the onset of paralysis frequently had a poor outcome. Paralysis was not improved in two cases with petrosal cholesteatoma.

Demonstration of the Nasal Septal Branches of the Sphenopalatine Artery by Use of a New Intravascular Injection Method

We injected a new injection material into the external carotid artery using a new method, which led to the successful demonstration of the nasal septal branches of the sphenopalatine artery in human cadavers. The result shows the trunk of the artery divided into three main branches, the upper two of which run toward Littles area. We believe that the knowledge of septal branches, shown in a photograph, is very useful, not only for nasal treatment, but also for anatomic demonstration to students.

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children

OBJECTIVES Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

The role of adjustment of expiratory effort in the control of vocal intensity: Clinical assessment of phonatory function

OBJECTIVE: To determine the role of the adjustment of expiratory effort in the control of vocal intensity. STUDY DESIGN: An intensity-loading test was performed by using the airway interruption method. Three groups of subjects were used: a control group thought to resemble normal vocal fold closure, a group of patients with Reinkes edema thought to represent increased mass at the level of the vocal folds, and a group with vocal fold paralysis that was thought to represent a group with lack of adequate vocal fold closure. RESULTS: In the control group, expiratory lung pressure and airway resistance slightly increased. In the patients with Reinkes edema, expiratory lung pressure, and airway resistance significantly increased. In this group, the voice intensity was controlled by laryngeal adjustment, but a greater expiratory effort was needed because of a greater increase in glottal resistance. In the patients with vocal cord paralysis, airway resistance did not increase even with a high-intensity voice. Vocal intensity was controlled by expiratory effort. CONCLUSIONS: If there is sufficient ability for laryngeal adjustment, vocal intensity is controlled primarily by laryngeal adjustment and by expiratory adjustment in response to increased glottal resistance. However, vocal intensity is controlled by expiratory effort when laryngeal adjustment ability is poor.

Evaluation of Expiratory Effort on Dysphonic Patients on Increasing Vocal Intensity

It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinkes edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinkes edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer. (Otolaryngol Head Neck Surg 1998;118:723–7.)

Clinical Assessment of Squamous Cell Carcinoma of the Nasal Cavity Proper

The subjects were 14 patients with squamous cell carcinoma or undifferentiated carcinoma of the nasal cavity treated at Nihon University Hospital between October 1984 and November 1991, who were followed for at least 3 years. The site of the tumor origin within the nasal cavity was the lateral wall in 8 patients, the nasal septum in three patients, and unknown in three patients. Histologically, there were 13 squamous cell carcinomas in (3 well differentiated, 7 moderately differentiated, and 3 poorly differentiated) and 1 undifferentiated carcinoma. Treatment was by a combination of radiotherapy, chemotherapy, and surgery in 8 cases, a combination of radiotherapy and surgery in 5 cases, and surgery alone in 1 case. The 3-year and 5-year Kaplan-Meier survival rates were 86 and 69%, respectively. A total of 6 patients suffered a recurrence, with local recurrence occurring in 4 patients and pulmonary metastasis in 2 patients. Tumor control was achieved in 3 of the 4 cases of local recurrence by reoperation, and by surgery in 1 of the 2 cases of pulmonary metastasis. The duration of the recurrence-free interval in the patients who developed local recurrences, 18 to 46 months after the completion of the initial course of therapy, was of considerable interest.

COMBINATION CHEMOTHERAPY WITH CDDP AND 5-FU IN HEAD AND NECK CANCER .

Combination chemotherapy with CDDP and 5-FU was performed in 19 patients with evaluable head and neck cancer and 2 CR patients and 7 PR patients were obtained; thus the response rate was 47.4%. Histologically, the present therapy is considered to be especially effective against well differentiated squamous cell carcinoma (83.3%). The present therapy is considered to be useful as a neo-adjuvant chemotherapy (75.0%), but it is desirable to perform at least 2 courses of treatment. The side effects observed were nausea, vomiting, anemia, leukocytopenia and alopecia, etc., and most of them were reversible. However, there were 2 patients in which the continuation of chemotherapy was impossible due to renal disorders.