Koichiro Nishiyama

Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future.

Objectives: Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long‐term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future.

Sudden deafness accompanied by asymptomatic mumps

In this study we investigated asymptomatic mumps as a possible cause of sudden deafness. We studied 131 sudden deafness patients by measuring their serum mumps antibody values. Positive IgM antibody results, which strongly suggest recent mumps infection, were revealed in 9 of the 130 patients tested (6.9%). Asymptomatic mumps infections are apparently closely related to sudden deafness. Further studies will provide more definite diagnoses of mumps deafness and might be applicable to the treatment of such hearing loss.

Long-term result of the new endoscopic vocal fold medialization surgical technique for laryngeal palsy

Objective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.

Autologous transplantation of fascia into the vocal fold as a treatment for recurrent nerve paralysis

Objectives To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure.

Chemosurgery with trichloroacetic acid for allergic rhinitis: Evaluation of the efficacy in terms of inhibition of Th2 cell infiltration

OBJECTIVE To examine local inhibition of Th2 cell infiltration as the basis for demonstrating the superior clinical effect of trichloroacetic acid (TCA) treatment for allergic rhinitis. METHODS Mirror-image sections of the inferior turbinate mucosae of both sides were obtained from 26 patients who underwent TCA treatment on one side because of the nasal anatomy status and who eventually underwent bilateral inferior turbinectomy because of failure of the TCA treatment. Th2 cell counts, defined as counts of cells positive for anti-CD4 antibody and anti-CKR4 antibody (double-positive cells) were obtained for comparison. The differences between the TCA-treated and non-TCA-treated mucosae were analyzed by Mann-Whitneys U test. RESULTS Th2 cell infiltration was characteristically found just beneath the epithelium and in the periglandular areas. The mean count+/-standard deviation of Th2 cells was 4.96+/-2.72 cells/mm(2) in the TCA-treated mucosae and 12.03+/-7.19 cells/mm(2) in the non-treated mucosae, the difference being significant (p<0.01). CONCLUSION TCA treatment induces inhibition of Th2 cell infiltration. This corroborates the suggestion that TCA treatment can inhibit local type I allergic reactions.

Endoscopic vocal cord medialization: A new surgical technique without neck incision for laryngeal palsy

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.

Reduction by a kallikrein inhibitor of the increased nasal airway resistance of allergic patients after antigen challenge.

Kallikrein activity in nasal lavage fluid, which was measured with a synthetic substrate, Pro-Phe-Arg-methylcoumarilamide, was increased in accordance with the severity of the symptoms of house-dust-mite allergic rhinitis. Antigen challenge was applied to patients with allergic rhinitis by placing a disk containing allergen on the nasal mucosa of the right inferior turbinate. Kallikrein activities and kinin levels in the nasal lavage fluid had increased significantly 15 min after the antigen challenge. These increases were accompanied by a marked increase in nasal airway resistance 15 min after antigen challenge. Pretreatment of the patients with camostat mesilate (60 mg/kg, p.o), a non-peptide serine proteinase inhibitor clinically used in Japan, inhibited the kallikrein activity in the nasal lavage fluid. The increase in nasal airway resistance after antigen challenge was also markedly reduced by oral administration of the inhibitor, indicating involvement of the kallikrein-kinin system in induction of the nasal symptoms.

Hypopharyngeal neurinoma: report of two cases.

Hypopharyngeal neurinoma is a very rare disease and we found reports of only seven cases in the literature. Laryngomicrosurgery (LMS) and lateral neck exploration are two operating methods for hypopharyngeal neurinoma. Of the seven reported cases, the operating method was mentioned in six: two were operated on using LMS and four using the neck exploration method. It is necessary to select the operating method based on the size of the tumor, the existence of a stem, the risk of bleeding, etc. It is difficult to trace the original nerve of the tumor and this could not be done conclusively in the previous reports.

Change in tissue kallikrein level in nasal wash after the administration of oxatomide in patients with nasal allergy.

The tissue kallikrein level in the nasal wash was measured before and after 4-week administration of oxatomide (30 mg per day) in 9 patients with perennial allergy. It was found that tissue kallikrein level in the nasal wash obtained following provocation tests significantly decreased from 6.05 ± 4.43 (10-10 mol/hour/L)to 1.84 ± 0.93 (10-10 mol/hour/L) after the administration of oxatomide. Improvement in subjective symptoms was also observed in all patients after the administration. These results would indicate that kinin in the system is actively involved in the pathogenesis of nasal allergy.

Combined Chemotherapy and Radiation Therapy in Head and Neck Cancer

A combination chemotherapy (PT treatment) with cisplatin and tetrahydropyranyl-adriamycin (THP-ADM) was performed in 17 patients with head and neck squamous cell carcinoma. Chemotherapy treatment began with an intravenous dose of 50 mg/body cisplatin and an intravenous dose of 20 mg/body THP-ADM. Administration of THP-adriamycin was performed on the first day only, while cisplatin treatment was repeated once a day until the third day. Five of the 17 cases achieved complete response (29.4%) and seven achieved partial response. Response rate was 70.6%. Toxicity was mild and controlled with symptomatic treatment. Leukopenia was observed in 71.4% thrombocytopenia 14.3% (due to myelosuppression), appetite loss 38.1%, general fatigue 28.6% and nausea and vomiting 23.8%. No electrocardiographic abnormality was noted.