Kenji Suzuki

Bilateral middle ear squamous cell carcinoma and clinical review of an additional 5 cases of middle ear carcinomas.

We reported a retrospective review of the clinical records for a 64 year old male patient with bilateral middle ear squamous cell carcinoma (MESCC), and for the five other patients with MESCC treated at our institution during the last 20 years. The patient with bilateral MESCC has survived and remained tumor free for more than 1.5 years after extended radical resection of the secondary tumor combined with intra-arterial and systemic chemotherapy, radiotherapy and immunotherapy. Four patients with unilateral MESCC were treated with multidisciplinary treatment (induction chemotherapy, surgery and radiotherapy), and the remaining patient was treated with radiotherapy and mastoidectomy. Five of the six patients are alive with no evidence of disease. The patient treated with radiotherapy and radical mastoidectomy died of local recurrence 3 years after diagnosis. We suggest that MESCC should be considered when refractory granulation, long-standing otorrhea, otalgia and facial paralysis are observed. Multidisciplinary treatment, including intra-arterial chemotherapy and en bloc resection of the temporal tumor is useful for the treatment of MESCC and will improve the prognosis of patients with this disease.

Pleomorphic adenoma of the external auditory canal in Japan, with a case report.

A rare case of a 51-year-old female with a pleomorphic adenoma, measuring 0.9 x 0.7 x 0.6 (cm3), originating from the right external auditory canal (EAC), was reported. The authors discussed the 7 reported cases of EAC pleomorphic adenoma in Japan, comparing them with pleomorphic adenomas occurring in the nasal cavity and the parotid gland. It is currently too early to conclude that pleomorphic adenoma in the EAC does not tend to recur or shows a marked tendency toward canceration. The best possible treatment for EAC pleomorphic adenoma at present seems to be, as in cases of tumors in other sites, surgical resection together with removal of a sufficient range of surrounding normal tissue, followed by careful long-term postoperative observation of the clinical course.

Four-Barrel Aortic Dissection Involving the Ascending Aorta: A Case Report

A fifty-four-year-old woman was evaluated at the authors hospital for symptoms of repeated chest and back pain. The symptoms had recurred for five months prior to admission. A dynamic computed tomographic scan was performed on admission and demonstrated an enlarged ascending aorta with four barrels secondary to split intimal flaps. This case is an extremely rare example of a patient with a four-barrel aortic dissec tion involving the ascending aorta.

Experimental and Clinical Studies of Causative Bacteria in Tonsillitis

To study the pathogenesis of upper respiratory tract infections, we focused on acute tonsillitis and performed three experimental and clinical studies. From these studies, we found out that there seemed to be an intimate relationship between anatomical structure and adherence of S. pyogenes, and we confirmed that the M protein of S. pyogenes played an important role in adherence to the epithelium and the normal bacterial flora was actively involved in the bodys defense against infections. We also identified that nearly half of causative bacteria in tonsillitis in Japan were the genus streptococcus, especially S. pyogenes with 23.4%. The incidence of Methicillin (DMPPC)-resistant Staphylococcus aureus (MRSA) was 27% in middle ear exudate and 14.3% in nasal discharge, but no MRSA was isolated from tonsillitis.

The Antibiotic Susceptibilities and Betalactamase Production of Clinical Isolated Branhamella catarrhalis from Acute Otitis Media in Children

Branhamella catarrhalis has been misconsidered as a normal resident in human respiratory tract for a long time. However, many authors recently have reported its pathogenecity and isolated it from the otolaryngological region. In our study, this organism can be isolated from the ear and nasal discharge in the child with acute otitis media by the rate of 7.5% and 21.4% respectively. Out of this 107 isolated strains, 97 strains (90.7%) were found to be beta-lactamase producing organisms. The MIC measurement of penicillins and cephems (except CEX) for inhibition of all these strains in our study is 6.25 micrograms/ml or less and because of the unreliability of the ABPCs susceptibility test by disk method, it is necessary to check the beta-lactamase production in each strain. Becoming of the high emergence rate of beta-lactamase producing strains, B. catarrhalis should be considered to be as important pathogen as Streptococcus pneumoniae and Haemophilus influenzae in upper respiratory tract infections in children.