Makito Okamoto

Narrow band imaging for detecting superficial oral squamous cell carcinoma: a report of two cases.

We present two cases of superficial squamous cell carcinoma of the floor of the mouth, which were coincidentally detected by narrow band imaging (NBI) combined with magnifying gastrointestinal endoscopy (GIE) during gastrointestinal evaluation. We successfully removed the lesions using laser assisted with NBI combined with magnifying GIE. Because NBI combined with magnifying GIE shows a well‐demarcated brownish area and scattered foci of microvascular proliferation, it may play an important role in the management of superficial squamous cell carcinoma in the oral cavity.

Effect of single-drug treatment on idiopathic sudden sensorineural hearing loss

OBJECTIVES In order to evaluate the effect of a medical administration for the sudden deafness patients, single-drug treatment for idiopathic sudden sensorineural hearing loss (ISSHL) was assessed at multi-centers participating in the Acute Severe Hearing Loss Study Group sponsored by the Ministry of Health, Labor and Welfare of Japan. METHODS The subjects consisted of ISSHL patients who were (1) 20 years of age or older, (2) diagnosed within 2 weeks after the onset of hearing loss, (3) showing a mean hearing level of 40-90 dB at five frequencies from 250 to 4000 Hz, (4) previously untreated, and (5) with normal for age in hearing of the opposite ear. The drugs used in this study were ATP, alprostadil, hydrocortisone and amidotrizoate, which were administered intravenously, and beraprost sodium and betamethasone, which were given orally. Two drugs were assigned to each center, one of which was selected according to the code hidden in envelopes and administered for 1 week. The treatment after the single-drug administration was conducted at the discretion of each center. The hearing gain and recovery rate at 1 week after the initiation of single-drug treatment and at 1 month or over when the hearing level was fixed, were evaluated based on the criteria for hearing recovery prepared by the Acute Severe Hearing Loss Study Group. RESULTS There was no statistically significant difference in the recovery rate among drugs either at 1 week after the initiation of single-drug treatment or at the time of fixed hearing level. At the time when the hearing level was fixed, a statistically significant difference in the complete recovery rate was detected only between amidotrizoate and beraprost sodium. CONCLUSION From these results, we could not find any specific drugs recommended for ISSNHL. In evaluating the effect of the drugs, however, several problems in the clinical trial for ISSHL should be considered.

Water May Cure Patients With Meniere Disease

Objectives/Hypothesis: We examined whether sufficient water intake is effective in the long‐term control of vertigo and hearing activity in patients with Meniere disease (MD) for whom conventional therapy has proven unsuccessful.

Treatment Effects in Patients with Squamous Cell Carcinoma of the Oral Cavity

A total of 221 patients (155 males, 66 females; stage I, n ¾ 55; stage II, n ¾ 58; stage III, n ¾ 57; stage IV, n ¾ 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n ¾ 161; cancer of the oral floor, n =28; cancer of the hard palate, n ¾ 12; cancer of the buccal mucosa, n ¾ 11; and cancer of the gingiva, n ¾ 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I=91%, stage II=73%, stage III=63%, stage IV=47%; p <0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher ( p <0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher ( p <0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% ( n ¾ 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% ( n ¾ 14) but no significant difference was observed between these 2 groups.rate .

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.

Multiple primary malignancies in the head and neck: a clinical review of 121 patients.

A total of 121 multiple primary malignancies (quadruple, n ¾ 2; triple, n ¾ 11; and double, n ¾ 108) were treated at the Department of Otorhinolaryngology, Kitasato University Hospital between July 1972 and December 1998. Of the 108 patients with double primary malignancies, 18 had synchronous double primary malignancies (SDPM), which were defined as occurrence of the index tumor and second malignancy within 6 months of each other, and 90 had metachronous double primary malignancies (MDPM), which were defined as occurrence of the index tumor and the second malignancy separated by a period of >7 months. MDPM was subdivided into MDPM-F (head and neck malignancy occurred as the first tumor; n ¾ 55) and MDPM-S (head and neck malignancy occurred as the second tumor; n ¾ 35). Of the 55 patients with MDPM-F, 27 (49.1%) of the second malignancies were found in the digestive tract, 12 in the stomach (21.8%), 8 in the esophagus (14.5%) and 7 in lower digestive tract tumors (12.7%). The 3- and 5-year survival rates of MDPM-F were 79.2% and 62.3%, respectively. Differential diagnosis between multiple primary malignancy (MPM) and multicentric tumors is often difficult when the lesions involve the oral cavity, pharynx and esophagus. We suggest that it is beneficial to follow patients for as long as possible in order to facilitate diagnosis of tumor recurrence, metastasis and MPM.

Narrow band imaging for detecting metachronous superficial oropharyngeal and hypopharyngeal squamous cell carcinomas after chemoradiotherapy for head and neck cancers.

We present two cases of metachronous superficial squamous cell carcinomas at oropharyngeal and hypopharyngeal mucosal sites after chemoradiotherapy for head and neck cancers. These were detected by narrow band imaging combined with a magnifying gastrointestinal endoscopy. In one case, we successfully removed the tumor using endoscopic submucosal dissection. Narrow band imaging combined with magnifying gastrointestinal endoscopy illustrated well‐demarcated brownish area and scattered foci of microvascular proliferation. Thus, it may serve as an ideal surveillance mode after chemoradiotherapy for head and neck cancers

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.

Risk of superficial squamous cell carcinoma developing in the head and neck region in patients with esophageal squamous cell carcinoma

Multicentric squamous dysplasia in the esophagus can be visualized by Lugol chromoendoscopy as multiple Lugol‐voiding lesions (LVLs). Narrow‐band imaging combined with magnifying endoscopy (NBI‐ME) facilitates the detection of superficial squamous cell carcinoma within the head and neck region (HNSCC). We investigated risk factors for superficial HNSCC in patients with esophageal squamous cell carcinoma (ESCC).

Cephalometric Analysis in Patients with Obstructive Sleep Apnea Syndrome

Cephalometry is useful as a screening test for anatomical abnormalities in patients having obstructive sleep apnea syndrome. In this study, various conventional parameters in cephalometry, such as the distance and angles determining the oropharyngeal space, and the areas of the soft palate, oral cavity, tongue and pharynx in both posterior-anterior and lateral view X-ray films, were measured before and after surgery in order to evaluate the preoperative predictability and usefulness of uvulopalato-pharyngoplasty and/or midline laser glossectomy (MLG) for the purpose of preoperative assessment and evaluation of surgical treatment. As test subjects, American adult patients with disturbed respiration in sleep observed at Oakland Otology and Apnea Clinic during 1989-1992 and Japanese patients with the same problems observed at Kitasato Univ. Hospital during 1992-1994 were used. The results were as follows: i) cephalometry revealed morphological abnormalities in the skull, and the measurement of soft tissue in the oropharynx provided useful anatomical data to assess the space of the upper airway in each patient before operation; ii) the areas of the soft palate, the whole tongue and the lower half of the tongue were significantly enlarged, and the lengths of MPH, SPL and PNS-H were longer in the apnea group than in the snoring group; iii) in MLG patients, increases in the area of the oral cavity and pharyngeal cavities and a decrease in the area of the upper half of the tongue were observed.