Kengo Nishimoto

Venous thrombosis after microvascular free-tissue transfer in head and neck cancer reconstruction.

OBJECTIVE Microvascular free-tissue transfer is essential for functional reconstruction in head and neck cancer surgery. The risk of free flap failure depends on venous thrombosis rather than arterial thrombosis, and any type of failure caused by venous thrombosis is often diagnosed late. In this study, we studied the flap survival rate achieved by this technique depending on the recipient vein. Further, the risk factor was analyzed for venous thrombosis with regard to preservation of recipient vein during neck dissection. METHODS This study is a retrospective review of 102 consecutive free flaps performed by a single head and neck surgical team from 2000 to 2006 at the Department of Otolaryngology, Head and Neck Surgery at Kagoshima University Hospital. The recipient vessels such as the external jugular (EJ) vein and internal jugular (IJ) system were carefully preserved during neck dissection. All patients received 80 microg of prostaglandin E1 (Alprostadil) for 5 days after surgery. RESULTS The overall success rate was 94.1%. All the six cases of unsuccessful free flap transfer were caused by venous thrombosis. Microvascular free flaps anastomosed to the EJ vein failed at a significantly higher rate (13.3%) than those anastomosed to the IJ system (2.8%) (p<0.05). On studying the failed cases after IJ system anastomosis, we found that all complications were caused by internal jugular vein thrombosis (IJVT) and not by microvascular anastomotic thrombosis. In all the three cases of flap failure with IJVT, the dissected IJ vein was patently ballooning because of the remaining connective tissue, including the adventitia around the IJ vein in the supraclavicular lesion. CONCLUSIONS Although the IJ system is the ideal recipient vessel when compared with EJ vein, there is another risk of flap failure due to IJVT. To improve the survival rate, IJVT should be prevented by a careful manipulation of IJ system during neck dissection to avoid ballooning of the IJ vein in head and neck cancer surgery.

Inhibition of Vascular Endothelial Growth Factor by Macrolides in Cultured Fibroblasts from Nasal Polyps

Objective: In order to study a new mechanism of efficacy of 14‐membered ring macrolides in treating chronic rhinosinusitis, inhibitory effects of macrolides on vascular endothelial growth factor production were examined in vitro.

The Role of Nuclear Factor-κB in Interleukin-8 Expression by Human Adenoidal Fibroblasts†

Objectives/Hypothesis The production of cytokines by adenoids is known to be associated with inflammation of nasopharynx and the pathogenesis of otitis media with effusion. However, the role of adenoids in producing inflammatory cytokines such as interleukin‐8 (IL‐8) is not yet clear. In the present study, expression of IL‐8 in adenoidal fibroblasts was investigated at the level of transcription factors. Further, the effects of clarithromycin, a 14‐member ring macrolide, on IL‐8 gene expression and nuclear factor‐κB (NF‐κB) activation in adenoidal fibroblasts were evaluated.

Clinical evaluation of taste dysfunction using a salt-impregnated taste strip

We have used special tests to investigate taste function in detail. To evaluate acuity for a salty taste, we used a paper with salt crystals, Salsave. The procedure is simple and takes only a few minutes. We analyzed the relationships between the magnitude of the threshold of response to this test and the results of other taste function tests in 126 patients who visited our clinic. The mean magnitude of the response to Salsave significantly correlated with the results of other taste tests. Thus, this is a useful method for screening the detection and recognition threshold of a salty taste.

Olfactory Dysfunction in Patients with Minamata Disease

We studied the olfactory functions of organic mercury poisoning (Minamata disease) by using both the smell identification test and the olfactory detection threshold test (with phenyl ethyl alcohol). The subjects were 19 patients with Minamata disease who were treated in Meisuien, Minamata, Kumamoto, Japan and include cases that developed the disease in utero. The mean age was 78.7 ± 14.3 years old. Both smell identification and olfactory detection tests in the majority of patients decreased significantly compared with those of healthy elder subjects. A few cases showed normal olfactory identification and detection functions. The olfactory identification function deceased with advancing age. Correlation existed between detection threshold and background factors such as age and duration after documented Minamata disease was found. No significant relationship was identified between olfactory function and the typical symptoms of Minamata disease.

Relationship between Abnormal Sensation in the Throat and Menopause

Abnormal sensations in the throat (AST) are commonly encountered in general and otolaryngological practice, especially among middle aged women. These sensation may occur alone, or more often, in combination with the systemic symptoms, including those of menopause. We analyzed 26 Japanese women with a complaint of an abnormal sensation in the throat who were taking a synthetic sex hormone (Methermon-F). Multianalysis of variance (MANOVA) was used to evaluate the efficacy of the treatment using the quantitative scores of Kuppermans climacteric symptoms. The presence of the excessive perspiration and vertigo, insomnia, and the absence of fatigue were associated with clinical efficacy of the hormone, while the presence of hyposthenia and tingling sensation were associated with a poor response. Results suggested that the clinical efficacy of this hormone in treating middle-aged menopausal women with AST was related to the menopausal symptoms.

The Role of Thymidine Phosphorylase in the Pathogenesis of Allergic Rhinitis

The activity and distribution of thymidine phosphorylase (TP) in the nasal mucosa of patients with nasal allergy was examined and compared with those in healthy subjects. TP activity was analyzed by spectrophotometry and expression was examined by immunoblotting and immunohistochemical staining using a monoclonal antibody specific to TP. The expression level of TP detected by immunoblotting showed a correlation with the activity detected by spectrophotometry. In nasal mucosa obtained from patients with nasal allergy, the level of TP was significantly higher than that from normal subjects. Eosinophils, basal cells in mucosal epithelium and fibroblasts in nasal mucosa obtained from patients with nasal allergy were stained with anti-TP monoclonal antibody. Strong staining of eosinophils present in nasal discharge was observed. The present results indicate that an increased number of TP-expressing cells, especially eosinophils in nasal mucosa, might be associated with the pathogenesis of nasal allergy.The activity and distribution of thymidine phosphorylase (TP) in the nasal mucosa of patients with nasal allergy was examined and compared with those in healthy subjects. TP activity was analyzed by spectrophotometry and expression was examined by immunoblotting and immunohistochemical staining using a monoclonal antibody specific to TP. The expression level of TP detected by immunoblotting showed a correlation with the activity detected by spectrophotometry. In nasal mucosa obtained from patients with nasal allergy, the level of TP was significantly higher than that from normal subjects. Eosinophils, basal cells in mucosal epithelium and fibroblasts in nasal mucosa obtained from patients with nasal allergy were stained with anti-TP monoclonal antibody. Strong staining of eosinophils present in nasal discharge was observed. The present results indicate that an increased number of TP-expressing cells, especially eosinophils in nasal mucosa, might be associated with the pathogenesis of nasal allergy.

[Operative field limited by in the case of a tonsillectomy due to temporomandibular arthrosis--a case report].

We report herein on a patient with unexpected trismus after the induction of general anesthesia due to temporomandibular arthrosis. A 30 year old man visited our hospital complaining of hematuria, and he was scheduled for bil tonsillectomy under general anesthesia. Preoperative examination revealed no evidence of difficult airway and no sign of trismus. Despite the administration of muscle relaxants, it was impossible to expand the operative field due to by trismus after the introduction of general anesthesia. Malignant hyperthermia was excluded, and the trismus was judged to be due to temporomandibular arthrosis. Manual repositioning was performed, trismus was improved and expansion of the surgical field became possible. During any head and neck surgical procedure, if an otolaryngologist should encounter trismus after the induction of general anesthesia, temporomandibular arthrosis should be borne in mind if temporomandibular arthrosis is diagnosed as the cause, manual repositioning should be employed as soon as possible.

Evaluation of the Usefulness of FDG-PET for the Diagnosis of Laryngeal Cancer

Masaki Kawabata, Kengo Nishimoto, Yukari Sagara, Tatuya Fukuiwa and Yuichi Kurono Recently, many investigators have reported the usefulness of fluorodeoxyglucose-positron emission tomography (FDG-PET) for the diagnosis of malignant head and neck tumors. Little is known, however, about its application for the diagnosis of laryngeal carcinoma. In this study, we investigated the specificity and sensitivity of FDG-PET for detecting laryngeal squamous cell carcinoma before treatment. Thirty-two patients (31 male and 1 female) with laryngeal carcinoma who had visited the Kagoshima University Hospital between Jan. 2003 and Nov. 2005 were retrospectively investigated. All patients at stages T2, T3 and T4, showed FDG standardized uptake value (SUV) greater than 4.0 in the primary sites, except for one patient of T2. In contrast, 6 out of 10 cases diagnosed as Ti showed FDG SUV readings lower than 4.0. Four patients, in Ti and T2 stages, who had remarkably elevated FDG SUV levels in their primary tumors underwent surgical treatment such as partial laryngectomy and total laryngectomy followed by concurrent chemo-radio-therapy. Those findings suggest that PET is useful for the diagnosis of laryngeal carcinoma and that an elevated level of FDG SUV in the primary tumor might indicate higher biological activity of the carcinoma.

A Case of Suspected Laryngeal Tuberculosis Accompanied by Lung Tuberculosis

A case of suspected laryngeal tuberculosis accompanied by lung tuberculosis was reported in this paper. The patient was a 72 year-old male. He had developed hoarseness, sore throat and pain on swallowing, and consulted our clinic. Laryngoscopic examination showed swelling of the left arytenoid as well as laryngeal palsy. Pulmonary tuberculosis was diagnosed by microbiological identification of tubercle bacillus in the sputum. Although there was no evidence indicating laryngeal tuberculosis, local areas in the larynx were markedly improved after treating the patient with anti-tuberculosis chemotherapy. Consequently the patient was diagnosed as having laryngeal tuberculosis. Laryngeal tuberculosis is now rare in Japan, but it was suggested that careful attention should still be paid to the differential diagnosis of laryngeal inflammatory diseases.