Hisaaki Ikoma

Hepatocellular carcinoma metastatic to the oral cavity including the maxilla and the mandible: report of two cases and review of the literature

SummaryTwo cases of hepatocellular carcinoma metastatic to the oral cavity are presented. One patient had metastases to the maxilla and finally, to the mandible, and the other patient, to the mandible. Both cases histologically showed highly-differentiated trabecular hepatocellular carcinoma which had vascularized stroma, explaining the frequently observed oral hemorrhage. The clinical signs and symptoms described here suggested the existence of a tumor metastatic to the oral cavity, and might indicate an unusual manifestation of hepatocellular carcinoma. Reports of metastatic lesions of hepatocellular carcinoma to the oral cavity, including the mandible, maxilla and gingiva proper, are reviewed.

Endoscopic classification of pharyngeal stenosis pattern in obstructive sleep apnea hypopnea syndrome

Abstract Twenty‐one patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) were classified into three categories according to their pharyngeal stenosis patterns during sleep, as determined from endoscopic findings: (i) a falling type (n = 6); (ii) an all‐round type (n = 11); and (iii) a bilateral type (n = 4). In all patients with the bilateral type, the palatine tonsils were hypertrophied, and the apnea–hypopnea indexes (AHI) were improved markedly by surgery. Conversely, the AHI of patients with the falling and all‐round types were reduced by a smaller percentage. Surgical therapy is only to be recommended to patients with OSAHS whose pharynx is bilaterally stenotic.

Posterior canal-activated vestibulocortical pathways in cats

This study was undertaken to investigate vestibulothalamocortical pathways in anesthetized cats. Synaptic connections of posterior canal-activated excitatory vestibuloocular relay (PC) neurons to thalamic neurons were examined by a spike-triggered averaging technique. The averaged potentials evoked in the ventrobasal complex of the thalamus revealed a negative wave with latencies from 0.8 to 1.5 ms. Thirty-six thalamic neurons, which were activated by nose-up head rotation and by contralateral labyrinth stimulation, were mainly located in the ventrobasal complex. Thirteen of these neurons were antidromically activated from the anterior suprasylvian sulcus or postcruciate dimple of the cortex. These results suggest that the PC neurons participate, at least in part, in the vestibulocortical pathways contributing to spatial orientation.

Posterior Canal-Activated Excitatory Vestibuloocular Relay Neurons Participate in the Vestibulocortical Pathways in Cats

We have previously reported that axon collaterals of posterior canal-activated excitatory vestibular (PC) neurons project to the contralateral oculomotor nucleus, and rostrally to the thalamus. To elucidate the vestibulothalamocortical pathways we investigated the synaptic connections of the PC neurons with the thalamic neurons by post-spike averaging of compound potentials triggered by spikes of the PC neuron in anesthetized cats. The averaged field potential evoked in the ventrobasal complex (VBC) revealed a spike followed by a negative wave. Latencies of the wave ranged from 0.8 to 1.5 ms. Next, we examined the location and axonal projection of 36 thalamic neurons which were activated by nose-up head rotation and by contralateral labyrinth stimulation. Most of them were located in the VBC and some in the medial geniculate body. Thirteen of the 36 neurons were antidromically activated from the anterior suprasylvian sulcus or postcruciate dimple of the cortex. These results suggest that the PC neurons participate, at least in part, in the vestibulocortical pathways contributing to spatial orientation.

Clinical significance of negative esophageal pressure in sleep apnea syndrome

The authors investigated the relationship between esophageal pressure fluctuation (DPes) during sleep and the following parameters: respiratory disorder variables and daytime sleepiness manifested as the Epworth sleepiness scale (ESS). In the younger patient group under 60 years of age (n = 33), DPes was correlative to both the apnea‐hypopnea index and ESS. However, in the elderly group of 60 years and over (n = 16), the variables showed smaller values than did those in the younger group. These results suggest that DPes may be associated with the aggravating process of sleep apnea syndrome (SAS) in the younger patient.

Four cases of neonatal acute maxillary osteomyelitis.

Acute maxillary osteomyelitis was diagnosed in 4 neonates. Three of them were born in the same hospital: a 10-day-old female, a 12-day-old male and a 17-day-old female. Staphlococcus aureus was cultured from all 4, so it was suspected that the infections were hospital-acquired. It is important to inform the hospital where in-fants were born when such infections are diagnosed. Each infant of the patients was treated surgically and with antibiotics. Three responded well, but one developed a brain abscess. CT scanning was very useful in evaluating complications at an early stage. In a patient treated surgically 10 years ago, well-developed sinuses were observed on X-ray examination. Aggressive treatment with both surgery and antibiotics should be pursued for patients with this disease.

Five Cases of Multiple Primary Malignant Tumors

Five cases of multiple primary malignant tumors were examined in this clinic in last 5 years. Case 1 (64-year-old man) had adenocarcinoma of the rectum and squamous cell carcinoma of the larynx. Case 2 (72-year-old man) was with squamous cell carcinoma of the larynx and adenocarcinoma of the stomach. Case 3 (53-year-old man) had adenocarcinoma of the rectum and squamous cell carcinoma of the maxilla. Case 4 (69 year-old man) was affected by squamous cell carcinoma of the maxilla and malignant lymphoma of the testes. Case 5 (72-year-old man) had squamous cell carcinoma of the larynx and malignant lymphoma of the inguinal lymph node. Literary speculations on multiple tumors have been made also, especially on incidence, age at onset, sex difference, affected organs and interval of cancerous pathogenity.