Kei Fukushima

The Endoscopically Measured Effects of Airway Maneuvers and the Lateral Position on Airway Patency in Anesthetized Children with Adenotonsillar Hypertrophy

Obstruction of the upper airway is a major challenge for anesthesiologists administering general anesthesia in spontaneously breathing children with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea. In this study, we examined the effects of body position shifting and common airway maneuvers such as chin lift and jaw thrust on airway patency (stridor score and upper airway dimensions by endoscopy) in anesthetized children scheduled for adenotonsillectomy. Eighteen children aged 1–11 yr were anesthetized with sevoflurane. During spontaneous breathing with 5% sevoflurane and 100% oxygen, upper airway dimensions and stridor score were recorded. After baseline recording, chin lift and jaw thrust were performed in both the supine and the lateral decubitus position. Chin lift, jaw thrust, and lateral position increased the airway dimensions and improved the stridor score. Moreover, lateral positioning enhanced the effects of these airway maneuvers on airway patency. We concluded that lateral positioning combined with airway maneuvers provided better airway patency for anesthetized children with adenotonsillar hypertrophy.

Effects of lithium on endolymph homeostasis and experimentally induced endolymphatic hydrops

There is evidence to suggest that water homeostasis in the inner ear is regulated via the vasopressin (VP)-aquaporin 2 (AQP2) system in the same fashion as in the kidney. The VP-AQP2 system in the kidney is well known to be inhibited by lithium, resulting in polyuria due to a decrease in reabsorption of water in the collecting duct of the kidney. Therefore, lithium is also likely to inhibit the VP-AQP2 system in the inner ear, and consequently exert some influence on inner ear fluid homeostasis. In this study, we investigated the effects of lithium on AQP2 expression in the rat inner ear, and on the cochlear fluid volume in hydropic ears of guinea pigs. A quantitative PCR study revealed that lithium reduced AQP2 mRNA expression in the cochlea and endolymphatic sac. Lithium application also decreased the immunoreactivity of AQP2 in the cochlea and endolymphatic sac. In a morphological study, lithium intake significantly reduced endolymphatic hydrops dose-dependently. These results indicate that lithium acts on the VP-AQP2 system in the inner ear, consequently producing a dehydratic effect on the endolymphatic compartment.

Modification of surgical procedures of type 1 tympanoplasty for non-cholesteatomatous chronic otitis media.

Objective: To introduce our modified procedures of type 1 tympanoplasty and to assess their efficacy. Methods: We modified the surgical procedures of type 1 tympanoplasty and have used these procedures since September 1999. The modified points are enlargement of the facial recess approach, no elevation of the posterior meatal skin and the tympanic annulus, and endoaural repair of tympanic membrane perforation. 51 patients with simple chronic otitis media have undergone this modified type 1 tympanoplasty. Postoperative hearing was evaluated according to the criteria proposed by the Otological Society of Japan. Results: The average follow-up period was 15 months (range 6–35). The hearing result was considered successful when the postoperative hearing level satisfied with at least one of three conditions as follows: (1) air-bone gap <15 dB, (2) hearing gain >15 dB, or (3) hearing level >30 dB. The success rate was 94.1%. The average postoperative air-bone gap, hearing gain and hearing level were 3.9, 10.0 and 29.3 dB, respectively. Conclusion: Our modified tympanoplasty is useful to achieve better postoperative hearing results.

Bilateral plunging ranula: a case report

Abstract Background : Since the etiology of ranula is unknown, treatment is still controversial. However, ranula has recently been speculated due to mucous extravasation into the ambient tissues from a traumatized sublingual gland or duct. Plunging ranula is far less frequently encountered than sublingual type. Furthermore, bilateral presentation was very unusual. We encountered a case of bilateral plunging ranula, which occurred asynchronously, and treated via different surgical approach. Case report : A 5-year-old girl, who had undergone the removal of a median cervical cyst by Sistrunk method at the age of 2, had swelling in the left submandibular region 9 months before. Magnetic resonance imaging (MRI) revealed a plunging ranula. Excision of ranula and removal of the sublingual gland were performed via a cervical approach and the cyst lining had no epithelium. Contralateral ranula was found by follow-up MRI 6 months after the surgery. Following the previous result, incision of ranula and removal of the sublingual gland were undergone via an intraoral approach. Follow-up at 9 months shows no evidence of recurrence. Conclusion : As treatment of plunging ranula, excision of the sublingual gland appears to be essential for cure, regardless of whether via intraoral or cervical approach. Intraoral excision is more advisable because of its less invasiveness.

Pathological findings of gray-zone papillary thyroid carcinoma

In the 2010 Japanese guidelines for the management of thyroid tumor, patients with papillary thyroid carcinoma excluding those in the low-risk and high-risk groups were classified into the gray-zone risk group, and the committee of the Japanese guidelines left the extent of surgery for this group to the discretion of each surgeon. In this study, we histologically examined extirpated thyroids in 20 patients with grayzone carcinoma to determine their pathological findings. Intraglandular cancer foci in the affected side were observed in 9 patients and those in the opposite side were identified in 7 of 8 patients who received operations over subtotal thyroidectomy. Vascular invasion was observed in 15 patients in spite of all patients being M0. Lymphatic invasion and lymph node metastases were observed in 6 patients and 9 patients, respectively. These results showed that gray-zone carcinoma had a relatively high incidence of intraglandular cancer focus, vascular invasion and lymph node metastasis.