Katsuyuki Kawamoto

Capsule of parotid gland tumor: evaluation by 3.0 T magnetic resonance imaging using surface coils

Background: Magnetic resonance (MR) imaging of parotid gland tumors has been widely reported, although few reports have evaluated the capsule of parotid gland tumors in detail. Purpose: To evaluate the diagnostic usefulness of 3.0 T MR imaging with surface coils for detection of the parotid gland tumor capsule, and to clarify the characteristics of the capsules. Material and Methods: Seventy-eight patients with parotid gland tumors (63 benign and 15 malignant) were evaluated. Axial and coronal T2-weighted and contrast-enhanced T1-weighted images were obtained using a 3.0 T MR scanner with 70 mm surface coils. It was retrospectively assessed whether each parotid gland tumor was completely surrounded by a capsule. The capsule was classified as regular or irregular in terms of capsular thickness, and as none, mildly, or strongly enhancing in terms of contrast enhancement. Visual interpretations were compared with histopathological findings to evaluate the diagnostic ability of MR imaging to detect parotid gland tumor capsules. Statistical evaluation was conducted concerning the presence of capsules, capsular irregularity, and the difference in contrast enhancement between benign and malignant tumors, and that between pleomorphic adenomas and Warthins tumors. Results: Capsules completely surrounding the tumor on MR imaging yielded a sensitivity of 87.7% (50/57), specificity of 90.5% (19/21), and accuracy of 88.5% (69/78). Benign tumors had a capsule completely surrounding the tumor significantly more often than malignant tumors (P = 0.009). Concerning capsular irregularity, malignant tumors tended to have more irregular capsules than benign tumors, although there were no significant differences. The capsules of malignant tumors enhanced significantly more strongly than those of benign tumors (P = 0.018). Conclusion: 3.0 T MR imaging using surface coils could correctly depict parotid gland tumor capsules in most cases. Most benign and some malignant tumors had capsules completely surrounding the tumors. Malignancy should be considered in tumors with irregular and strongly enhancing capsules.

Subglottic laryngeal closure: a unique modified method of laryngotracheal separation to prevent aspiration.

Objectives: Laryngotracheal separation (LTS) is an ideal surgical method for intractable aspiration; however, the oral side of the tracheal stump can easily disintegrate. Therefore, we developed a modified LTS method. We performed subglottic laryngeal closure (SGLC) as a new surgical method and evaluated the outcomes. Methods: We retrospectively analyzed the medical records of 36 patients (28 male and 8 female; 15 to 91 years of age) who underwent SGLC between 2007 and 2011 at Tottori University Hospital, Japan. Operative data (operative time, intraoperative bleeding, and time to drain removal), outcomes (aspiration and changes in nutritional status), and complications with regard to the surgical method were examined. The occurrence of a subcutaneous proximal laryngeal stump fistula was evaluated by videofluoroscopy. Results: The SGLC was performed safely in all patients. Fistulization was observed in only 1 of the patients (2.8%), and major bleeding after surgery was observed in 1 patient (2.8%). The procedure relieved aspiration pneumonia in all patients. Conclusions: We conclude that SGLC is effective for treating and preventing pulmonary aspiration. The incidence of postoperative complications, particularly that of subcutaneous fistulas, was very low. Therefore, this method may be useful for patients in poor condition.

Lower brainstem dysfunction in an infant with persistent primitive trigeminal artery

A 6-month-old boy with persistent primitive trigeminal artery (PPTA) presented with stridor, dysphagia, delayed motor development and postural neck and shoulder dystonia. Magnetic resonance imaging/angiography and ultrasonography revealed PPTA, with flow from the dilated basilar artery to the right internal carotid artery, lower brainstem compression by the dilated basilar artery, and cerebellar vermis hypoplasia. Evoked potentials showed lower pons and medulla oblongata functional disruption. These lesions may be related to vascular etiology in the lower brainstem or to congenital malformation syndrome involving infratentorial structures. The relationship of this condition to Möbius syndrome is discussed.

Submucosal Abscess of the Esophagus Caused by Piriform Sinus Fistula Treated with Transoral Video Laryngoscopic Surgery

Piriform sinus fistula (PSF) is a rare branchial anomaly that causes repetitive acute suppurative thyroiditis or deep neck abscess. The definitive treatment of PSF is open neck surgery. However, such surgery has a cosmetic problem and a high risk of recurrence. Furthermore, identifying the fistula is difficult due to previous repetitive infections. We report a case of esophageal submucosal abscess caused by PSF treated with endoscopic mucosal incision. The patient underwent transoral video laryngoscopic surgery (TOVS), and endoscopy as well as fluoroscopy revealed complete closure of PSF without any complication. TOVS is a novel surgical technique for the definitive treatment of PSF with esophageal submucosal abscess.

A Case of Deep Cervical Abscess Caused Perforation at Gastroenterological Endoscopy

We reported a rare case of perforation of the piriform sinus caused by gastroenterological endoscopy examination, leding to deep cervical abscess. The patient was a 56-year-old man who complained of dyspnea, high-grade fever and neck pain after gastroenterological endoscopy examination. Computed tomography revealed a deep cervical abscess and obstruction of the airway. We immediately, performed drain-age under general anesthesia, and found a perforation at the piriform sinus. He was treated with frequent wound washing and the daily intravenously instillation of antibiotics for anaerobic bacteria, and was discharged 31 days after the operation. Early diagnosis and operation are important for the management of deep cervical abscess.

Laryngeal Carcinosarcoma Recurring with Innominate Artery Fistula: A Case Report

Innominate artery fistulas require a surgical procedure, although the prognosis is usually very poor because of complications such as re-bleeding and infection. A 50-year-old man presented with laryngeal carcinosarcoma (T1a, N0, M0). Partial laryngectomy was performed but there was a recurrence; therefore, total laryngectomy, total thyroidectomy, right radical neck dissection, left functional neck dissection, skin-combined resection and D-P flap were performed. On postoperative day 6, after intense coughing, copious hemorrhage from the tracheostoma was demonstrated. Immediately, bleeding was arrested by pressing the tracheostoma. Fistula of the innominate artery was then repaired using left great saphenous vein, but recurrent perforation of the innominate artery developed. Therefore, innominate artery transection and omentopexy were performed. These results demonstrate that in cases of trachea-innominate artery fistula, innominate artery transection should be performed first.

R143: Immunohistochemical Study of pChAT in the Rat Larynx

0 seconds. The mean estimated blood loss was 38.1 41.2 ml per side. Mucosal regeneration was achieved fully or partially for all operative sides at 30 days. One patient reported a mild re-bleed that resolved with packing. No serious adverse events or complications such as synechia, adhesion, or infection were reported in this study. CONCLUSION: Surgiflo® Hemostatic Matrix with Thrombin-JMI® is clinically successful for use following ESS. SIGNIFICANCE: Although Surgiflo® Hemostatic Matrix with Thrombin-JMI® was effective in controlling 96.7% of bleeding in this study, further randomized, controlled trials are indicated. SUPPORT: This study was supported by a grant from Johnson&Johnson wound management.

Three cases of acute hearing loss due to mumps infection

Hearing loss is a rare complication of mumps infection, however improvement of mumps-related deafness is difficult. In Japan, immunization against mumps is not required and mumps-related deafness is thought to have increased.We encountered three cases of unilateral sensorineural hearing loss due to mumps infection. The diagnosis was based on criteria determined by the Acute Profound Deafness Committee in Japan. All cases were treated for sudden deafness with routine steroid therapy.Case 1 was a 5-year-old boy. He was diagnosed as having mumps-associated hearing loss and his hearing improved. Case 2 was a 27-year-old woman, diagnosed as having mumps-related deafness and her hearing was not improved by therapy. Case 3 was a 43-year-old man, diagnosed as having mumps-associated deafness, but his hearing was not improved with therapy.Sensorineural hearing loss due to mumps infection is considered difficult to recover. However, some cases showing improvement have been reported such as our case 1. Early diagnosis and therapy are thought to be needed. Immunization against mumps should be required from the perspective of preserving hearing.

Evaluation of cervical lymph node tuberculosis

From January 1990 to December 1999, we treated twelve patients with cervical lymph node tuberculosis. The diagnosis was confirmed by histopathological findings of biopsy, 10 cases by resection of lymph node, 1 case by fine needle aspiration biopsy and 1 case was diagnosed following resection of lymph node at another hospital. After diagnosis, all patients received antituberculous chemotherapy and one patient with pocket formation underwent total resection of neck masses with infectious skin. Four cases were lost to follow-up, but the others showed good response and had no recurrence.Tuberculosis is an important infectious disease demanding constant attention because of the possibility of herd infection. We should consider tuberculosis when cervical lymph node swelling is seen, and early diagnosis and treatment are needed to prevent the spread of infection to others. Antituberculous chemotherapy is effective, however, when pocket and abscess formation occur, combination therapy of chemotherapy and operation such as neck dissection are needed in early course.