Gunji Nagatani

Clinical features of head and neck cancer patients with methicillin-resistant Staphylococcus aureus

Conclusions. The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens. Objectives. To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA). Patients and methods. Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method. Results. MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.

Prostaglandin E1 in combination with hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss.

Conclusions. Prostaglandin E1 (PGE1) is less effective than stellate ganglion block (SGB) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with severe hearing losses when used together with hyperbaric oxygen (HBO) therapy. In contrast with the systemic action of intravenous PGE1, SGBs localized vasodilating action may explain its advantage over intravenous PGE1. Objectives. To investigate the effect of PGE1 plus HBO therapy on ISSNHL in comparison with that of SGB plus HBO therapy. Patients and methods. We retrospectively analyzed 205 consecutive patients with ISSNHL (hearing levels≥40 dB; time from the onset of hearing loss to the start of treatment≤30 days). Ninety-five patients underwent intravenous PGE1 plus HBO therapy (PG group) and 110 underwent SGB plus HBO therapy (SGB group). Hearing recovery was evaluated by grade assessment and by hearing improvement compared to that in the unaffected contralateral ear. Results. The overall hearing outcome was not statistically different between the two groups. For patients with initial hearing levels<80 dB, the groups had roughly equivalent hearing outcomes, whereas in patients with initial hearing levels≥80 dB, the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0±5.0% vs 35.3±6.8%; p<0.05).

Digastric Muscle Sew-up Procedure for the Repair of the Floor of the Mouth following Pull-through Operation for Oral Cancers

Objectives: We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers. Methods: Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity. Results: The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level. Conclusions: We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.

Sclerosing Mucoepidermoid Carcinoma in the Parotid Gland With CRTC1-MAML2 Fusion: A Case Report:

In this article, we report a case of sclerosing mucoepidermoid carcinoma (MEC) arising in the parotid gland, with CRTC1-MAML2 gene fusion. A 73-year-old woman with a mass in the right parotid region was referred to our hospital. Radiological imaging tests revealed a well-defined mass, measuring 25 mm in diameter, with foci of calcification in the deep lobe of the parotid gland, extending to the parapharyngeal space. Microscopically, the tumor was composed of a proliferation of atypical glandular epithelial cells having intracytoplasmic mucin, squamoid cells, and intermediate cells arranged in nests embedded in a fibrosclerotic stroma, associated with a dense chronic inflammatory infiltrate containing immunoglobulin G4-immunoreactive plasma cells. Reverse transcription-polymerase chain reaction analysis using a formalin-fixed, paraffin-embedded tumor tissue specimen revealed the CRTC1-MAML2 fusion gene transcript. This is the first report of sclerosing MEC with the detection of the MEC-associated fusion gene, reinforcing a common genetic association between MEC and sclerosing MEC.

Hyperbaric Oxygen in Combination with Other Therapies for Idiopathic Sudden Sensorineural Hearing Loss

Hyperbaric oxygen (HBO) therapy combined with steroid administration is an effective treatment for idiopathic sudden sensorineural hearing loss (ISSNHL), but is sometimes unfeasible for patients with underlying diseases, particularly for those with steroid-intolerance. We conducted a controlled retrospective analysis of patients with ISSNHL who received HBO in combination with stellate ganglion block (SGB), prostaglandin (PG) E1, or steroid therapy in order to identify possible alternative regimens.Three hundred and six consecutive patients with ISSNHL (average hearing levels of 5 frequencies (250-4000Hz)≥40dB; time from the onset of hearing loss to the start of treatment ≤30 days) were enrolled. One hundred and ten, 95, and 101 patients underwent SGB+HBO (SGB group), PGE1+HBO (PG group), and steroid+HBO therapy (steroid group), respectively. Hearing recovery was evaluated by grade assessment, by hearing gain, and by hearing improvement rate compared to the unaffected contralateral ear.The overall hearing outcome did not differ among the three groups. In patients with initial hearing levels <80dB, the PG group tended to show a higher cure rate, recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups. In contrast, in patients with initial hearing levels ≥80dB, the SGB group tended to show a higher recovery rate, hearing gain, and hearing improvement rate compared to those of the other groups, and the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0±5.0% vs. 35.3±6.8%; p<0.05).We concluded that both SGB+HBO and PGE1+HBO are promising alternative regimens for ISSNHL, and that SGB+HBO and PGE1+HBO are recommended for patients with initial hearing levels≥80dB and <80dB, respectively.