Ikuo Nagayama

Prognostic Value of EGFR and TGF-α in Early Laryngeal Cancer Treated With Radiotherapy

The purpose of this study was to determine the overexpression of both epidermal growth factor receptor (EGFR) and transforming growth factoralpha(TGF‐α) (a ligand of EGFR) in early laryngeal squamous cell carcinoma. In addition, we attempted to evaluate the prognostic values of our findings.

Importance of pre-operative recognition of the nonrecurrent laryngeal nerve

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

View from beneath: pathology in focus. Renal cell carcinoma metastasis to the tongue.

: Metastases to the tongue from distant primaries are very rare. A case of renal cell carcinoma metastasis to the tongue, occurring in a 58-year-old man, is presented and previously reported cases are reviewed.

Malignant schwannoma arising in a paranasal sinus

A case of malignant schwannoma arising in a paranasal sinus is reported. In this case, histological hallmarks were lost because of the poorly differentiated nature of the tumour. Immunohistological techniques were applied to the diagnosis, confirming the neural origin of this tumour. Malignant schwannoma is a relatively rare disease in the nasal cavity and paranasal sinuses. For the treatment of this tumour, wide resection is recommended. In this patient, radical resection of the maxilla with orbital and ethmoid exenteration was performed. The patient recovered uneventfully with no evidence of disease three years after surgery.

Intratemporal Facial Nerve Neurinoma Without Facial Paralysis

A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.

Patient with primary tonsillar and gastric syphilis

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

Development of High Frequency Vestibulo-Ocular Responses to Active Head Shaking

Computer aided active head shaking test has several advantages because it can be used clinical at frequencies higher than 2 Hz. In this study, VOR gain and phase were examined over age. For this experiment, we designed an original measurement system composed of EOG, an angular velocity sensor and a microcomputer. VOR gain was expressed by transfer function. Forty normal subjects ranging from 10 to 75 were examined for high frequency VOR responses to active head shaking. VOR gain at frequencies higher than 2 Hz attained the same value as that seen in children below the age of 10 years. The VOR gain was nearly 1 within 2 Hz, decreasing with frequencies above 4 Hz. The effect of aging was shown at frequencies of more than 4 Hz, and appeared in patients above 50 years of age. No obvious phase lag was observed within 5 Hz.

Subdural hematoma associated with dural metastasis from paranasal sinus cancer: a case report and review of the literature.

We report a 72-year-old woman who developed a subdural hematoma following dural metastasis from paranasal sinus carcinoma. Subdural hematoma with malignant neoplasm is a serious condition seen only in advanced stages. The prognosis is poor, but appropriate measures can help the patient. Head and neck surgeons should note this unusual clinical entity.

Squamous cell carcinoma of the nasal septum with Wegener's granulomatosis treated with cyclophosphamide and corticosteroids

Well differentiated squamous cell carcinoma of the nasal septum developed in a 55-year old man with Wegeners granulomatosis. It is suggested that the malignancy was induced by immunosuppressive state from an increased and prolonged use of cyclophosphamide and corticosteroids. Although the efficacy of the therapeutic concept using cyclophosphamide and corticosteroids is well established, there have been some few reports that cyclophosphamide could be implicated in the genesis of malignancies. The pathophysiology of Wegeners granulomatosis should be better understood, and effective and less toxic alternative protocol should be established.

A Case of Cervical Thymic Cyst.

A case of a thymic cyst is reported, and the literature from 1952 to 1998 was reviewed. A 19-year-old female was found to have a frontal neck mass. MRI demonstrated a cystic mass laterally to the right lobe of the thyroid gland, and pharyngography did not show a pyrif orm sinus fistula. At surgery, the cyst was found to be connected to the thymus, and was diagnosed pathologically as a cervical thymic cyst. Cervical thymic cysts are rare and clinically asymptomatic. The distributions of the age and sex of the patients are different between Japanese and Caucasian at this time.