Gota Tsuda

Sclerosing polycystic adenosis of the left parotid gland: report of a case with fine needle aspiration cytology.

BACKGROUND Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.

OTOTOXICITY OF CARBOPLATIN IN GUINEA PIGS

Since carboplatin (CBDCA) is a platinum compound of second generation, its ototoxicity was investigated. In order to assess the ototoxicity, hearing acuity was measured based on the compound action potential (AP), and the organ of Corti was morphologically studied using scanning electron microscopy (SEM) and succinate dehydrogenase (SDH) staining in guinea pigs treated with CBDCA. CBDCA induced morphological changes in the organ of Corti when the guinea pigs received 50 mg/kg daily for 2 or 3 days. The threshold value of AP was elevated 10 to 25 dB in treated animals, as compared with the control value. The SEM study and SDH staining revealed that the administration caused scattered degeneration of the outer hair cells (OHCs), and the inner hair cells remained intact. These lesions were milder than those of OHCs treated with cisplatin (CDDP). The rapid elimination of CBDCA from the kidney and the inner ear seems to account for the low ototoxicity of this compound. Although CBDCA is less toxic than CDDP, it may affect hearing function if patients suffer from renal dysfunction or if the organ of Corti is vulnerable.

Timing for removal of tympanic ventilation tube in children

The medical records of 220 ears of 137 pediatric patients (85 male and 52 female) in which three kinds of ventilation tubes were inserted for treating otitis media with effusion (OME) were reviewed. The tubes selected were the Shepard grommet (75 ears), Goode-T (39 ears), and Paparella type II tube (106 ears). The criteria for tube placement were as follows: (1) continuous conductive hearing loss with over 25 dB air-bone gap, (2) resistance to conservative therapy for over 6 months, and (3) retracted and glue-colored tympanic membrane with type B tympanogram. The tubes that remained in place for over 18-24 months were removed intentionally in combination with a freshening of the perforation edge and tape-patch technique using Steri-Strip tape (3M) for preventing permanent eardrum perforation, because the incidence of persistent perforation became higher after long-term intubation. Shepard grommets tended to be extruded earlier, while Paparella type II tubes tended to stay longer. The OME recurrence rate decreased 12 months or more after tubal insertion. There was a tendency for the recurrence rate to decrease the longer the tube stayed in the eardrum. The number of recurrences decreased when the patients age at the tube removal or extrusion was 7-8 years old. Adenoidectomy did not influence the recurrence rate of OME. Although the Goode-T and Paparella tube II tubes showed high perforation rates, the perforation rate after extrusion or removal of the tube was decreased by the use of the tape patch technique in combination with a freshening of the perforation edge. From these findings, it was concluded that the appropriate intubation period for the treatment of OME in children is over 12 months with the use of a long-term tube, and that if the patients age at the time of tube insertion was below 6 years, it might be better that the removal of the tube is postponed until the patient is 8 years of age.

Platysma Myocutaneous Flap Including the External Jugular Vein with Special Reference to Neck Dissection

Although platysma myocutaneous flap (PTMCF) is suitable for a small intraoral defect, combination with neck dissection (ND) decreases the viability. Therefore, a version of PTMCF was devised to increase the viability. This version consists of three points: preservation of the external jugular vein (EJV), preservation of the facial artery after skeletonization from the submandibular gland, and a new incision around the flap. This procedure was applied to 21 patients with intraoral cancer. All 21 patients underwent some kind of ND. The average viable area of transferred skin was 80%. This rate was significantly better than that for 46 previous cases using Farr’s modification with ND, in which the facial artery was divided. Viability of the flaps was analyzed by the vessels preserved, especially by EJV. ND is not a contraindication with this version.

Free peroneal and its composite flap: a distant donor for head and neck reconstruction.

Free peroneal or its composite flap from the leg has been transferred in four patients for oro-mandibular and hypopharyngeal defects following surgery for malignancy. These flaps were successfully transplanted in all patients: two cases of free peroneal flap and two of free fibular graft with skin with no resulting problems with the leg. The peroneal osteocutaneous flap offers the following advantages: The axial vessels are preferable for microvascular surgery. Two flaps can be used with two cutaneous branches. A flap measuring up to 16 x 4.5 cm can be utilized with primary closure at the donor site. A long bone can be obtained together with skin. Surgery on the neck and harvesting of the flap can be done at the same time. The donor site is not conspicuous.

FREE PERONEAL SKIN FLAP FOR OROPHARYNGEAL RECONSTRUCTION

The thicknesses of three dermal flaps, platysma, forearm, and fibula, which are often used for oropharyngeal reconstruction, were measured in 21 subjects using 15 MHz Doppler ultrasonography. The mean (SD) thicknesses were 2.2 (0.3), 3.1 (0.5), and 3.8 (0.6) mm, respectively. The free peroneal skin flap from the leg was used in 14 patients with head and neck cancer. These flaps were successfully transplanted in 13 of 14 patients (93%) with no problems at the donor site. This flap offers many advantages, including its distance from the head and neck, its cosmetic superiority to a forearm flap, it allows two flaps with two cutaneous branches, it is possible to close the donor site primarily without a skin graft, and it has thin subcutaneous tissue. We found that the free peroneal skin flap is particularly useful for oropharyngeal reconstruction.

A case of sinonasal teratocarcinosarcoma treated with surgery and post-operative intensity-modulated radiotherapy (IMRT).

Sinonasal teratocarcinosarcoma (SNTCS) is a rare and aggressive malignant neoplasm, which has poor prognosis. SNTCS is histologically characterized by the combination of one or more epithelial elements and mesenchymal components. We report a 59-year-old man with SNTCS involving right maxillary and ethmoid sinuses. He complained of numbness of the right cheek for 1 month. Computed tomography and magnetic resonance imaging revealed soft tissue filling the right maxillary and ethmoid sinuses, protruding into the nasal cavity. Tumor was removed with Denker rhinotomy, and post-operative intensity-modulated radiation therapy (IMRT: 64Gy in 32 fractions) was performed. Follow-up examination for 2 years after the IMRT has shown no evidence of recurrence or metastasis. IMRT is a new type of conformal radiotherapy that is based on the use of non-uniform radiation beam intensities. IMRT can achieve optimal dose distributions and may improve the clinical outcomes dramatically with minimal complications. This report describes this patients clinical course, etiology, diagnosis and management of SNTCS, and the advantage of IMRT in the treatment of SNTCS.

A Study on Nebulizer Therapy with a High Concentration of Antibiotics for Chronic Sinusitis

Nebulizer therapy is an important conservative therapy for chronic sinusitis. Therefore, we report favorable results obtained with high dose antibiotic nebulizer therapy for chronic sinusitis. We chose aminoglycoside Astromicin sulfate (ASTM) as an antibiotic and used it at individual dosages of 40 mg. Subjective improvement was seen in 81% of cases. Even radiological improvement measured by densitometer revealed an efficiacy of 68%.

A New Version of Platysma Myocutaneous Flap Including the External Jugular Vein; A Comparison with Farr's Modified Method with Special References to the Viability of Flaps and Combinations with Neck Dissection

A new version of the platysma myocutaneous flap, which includes the external jugular vein and the preserved facial artery, was utilized in eight patients. The viable area of transferred skin was 64% on average. This rate was statistically better than that in 46 cases using Farrs modification with conservative or radical neck dissection, and was almost the same viability rate as that in cases without neck dissection. It was, therefore, concluded that this new version is a useful local flap especially for intra-oral defects measuring 30-40 cm2.