Masatoshi Horiuchi

Immunological and virological study of sudden deafness.

Thirty-three patients with sudden deafness and 11 controls were selected from the patients admitted to the Department of Otolaryngology, Tokai University Hospital from November 1990 to October 1991. Viral titers were measured for mumps, adenovirus, rubella, measles, herpes simplex virus (HSV), varicella zoster virus (VZV), rhinosyncytial virus, cytomegalo-virus (CMV), and mycoplasma pneumoniae in 33 sudden deafness patients and 11 controls at a 2-week interval. In 20 of 33 sudden deafness patients and 5 of 11 controls, autoantibodies of rheumatoid factor (RF), anti-mitochondrial antibody (AMA), anti-nuclear antibody (ANA), anti-parietal cell antibody (APA), anti-smooth muscle antibody (ASA), and anti-type II collagen antibody were studied. Viral titer study did not reveal any significant change either in the patients or in the controls, whereas autoantibody study revealed a relatively high incidence for ASA in the patients as compared with the controls. The relatively high incidence for ASA suggests that immune-mediated processes may be involved in the etiology of sudden deafness.

Survival Benefit of Screening for Early Esophageal Carcinoma in Head and Neck Cancer Patients

Abstract: Primary cancer of the head and neck was diagnosed in 676 cases. Systematic endoscopic screening of the upper gastrointestinal tract (including iodine staining of the esophagus) was performed within 1 month of diagnosing head and neck cancer in order to determine the possible presence of a second malignancy‐ We divided cases in which esophageal cancer was detected into a group in which the initially diagnosed head and neck cancer had been treated curatively and those in which the treatment had been non‐curative. A pathological diagnosis of primary esophageal cancer was obtained in 37 cases (5.5%). The incidence of esophageal cancer associated with cancer of the oral cavity or pharynx was significantly higher (10.9%) than in cases with an associated cancer of the larynx or paranasal sinus (1.9%, p<0.05). All but one of the 37 cases detected by screening were asymptomatic and had superficial carcinoma. Of these lesions, 19 Were mucosal carcinomas, 17 submucosal carcinomas and only one an advanced cancer. Twenty‐four of these 37 cases had died. The cause of death was head and neck cancer in 17, esophageal cancer in two and other causes in five. The 5‐year survival rate of cases in whom the initial head and neck cancer had been treated curatively was 46.7%.

Schwannoma of the trachea; a new resection technique

Tumors of the trachea are rare, especially schwannoma. We diagnosed a 27-year-old man with schwannoma of the trachea after he was admitted to our hospital with complaints of progressive dyspnea and wheezing. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with conventional therapy. Flexible fiberscopy revealed the presence of a submucosal tumor in the subglottic area. Tracheal tomography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a mass in the trachea that extended from the cricoid cartilage level to the second tracheal ring. After tracheostomy, we removed the tumor from a tracheostoma upwards to the larynx without a laryngofissure, using forceps and scissors usually used for laryngomicrosurgery and endoscopes usually used for sinus surgery. No complications developed during or after the procedure. To our knowledge, this is the first report of the removal of a tracheal schwannoma by this technique.

Basaloid squamous carcinoma of the larynx: Report of a case

Basaloid squamous carcinoma (BSC) is a rare neoplasm. We present a case of basaloid squamous carcinoma of the larynx in a 57-year-old male patient. The diagnosis before treatment was supraglottic carcinoma (T3N1MO) and biopsy of the larynx revealed a poorly differentiated squamous cell carcinoma. Total laryngectomy and right radical neck dissection were performed, and pathological studies of a specimen removed from the larynx revealed BSC of the larynx. The patients postoperative progress was uneventful, however, 12 months later he developed lung metastasis of the left side. The patient underwent partial resection of the lung. He developed recurrence of lung metastasis 6 months later. Chemotherapy with cisplatin (CDDP) and vindesine sulfate (VSD) was administered in two courses, but the efficacy was evaluated as no change (NC). At present, 26 months after the first visit, he has been asymptomatic with lung metastasis, and there was no evidence of recurrence in the neck.

Neuroendocrine Differentiation in a Case of Acinic Cell Carcinoma of the Parotid Gland

We report a case of acinic cell carcinoma of the parotid gland with neuroendocrine differentiation. Light microscopically, the tumor appeared as clear cell‐type acinic cell carcinoma. In addition, the tumor showed neurosecretory features such as Grimelius positivity and the presence of neurosecretory granules by electron microscopy. We suggest that a tumor cell arising from a stem cell can show simultaneous differentiation to both neuroendocrine and acinic cells.

A Case Report: Steroid Induced Hypersensitivity Reaction in a Patient with Bell's Palsy

Glucocorticoids are effective medications and have been used for a multitude of indications. However, adverse effects and intolerance reactions have been reported since 1974.We report a steroid-induced hypersensitivity reaction in a case with Bells palsy. A 40-year-old male consulted our out-patient clinic due to right peripheral facial palsy.As soon as he was injected with the hydrocortisone sodium succinate, he developed erythema all over his body, moderate itchiness and respiratory distress. His condition was improved immediately after the cessation of infusion.The medication for facial palsy was altered from infusion to oral prednisolone. Thereafter, he showed no hypersensitivity reaction. Intradermal reaction was positive for three steroids with succinate-ester and negative for two steroids with phosphate-ester. We speculated that the succinate-ester component of hydrocortisone played a pivotal role in the anaphylactoid reaction in this case.

13 Cases Who Underwent Simultaneous UPPP and Nasal Surgery.

We performed uvulopalatopharyngoplasty (UPPP) and nasal surgery simultaneously for 13 patients with sleep-disordered breathing.Comparing these patients with 21 cases who underwent UPPP and nasal surgery, respectively, for age, body mass index (BMI), nasal cavity resistance, quantity of bleeding, operation duration, post-operative course and hospitalization period, there were no statistically significant differences except hospitalization period. (p<0.05).No major complications such as airway loss, near-fatal hemorrhage, or arrythmia occurred.We performed simultaneous operations under patient selection standards as follows: 1) aged under 45, 2) BMI less than 30kg/m2, 3) no cardiopulmonary diseases, 4) the subject has simple snoring or obstructive sleep apnea with an apnea index of less than 20times/hour, 5) no indications for the type of tongue base.We consider that maintaining these standards and careful respiratory management will lead to good results.

The Correlation between Obstructive Sleep Apnea Syndrome and Obesity.

To investigate the correlation between obstructive sleep apnea syndrome (OSAS) and obesity, 71 OSAS patients whose sites of obstruction were diagnosed based on sleep nasendoscopy findings were studied. The patients were subdivided into three groups by body mass index (BMI) as follows: Group A, 24 patients with BMI less than 25 (kg/m2); Group B, 19patients with BMI between 25 and 28; and Group C, 28 patients with BMI more than 28. Variables examined include the apnea index (AI), 4% O2 desaturation index (DI), nadir SpO2, and cephalometric data (SNA, SNB, PNS-U, MP-H, PAS). AT and cephalometric data were not correlated with BMI, but DI and nadir SpO2 were mutually correlated with BMI. These data suggest that OSAS may be worsened by obesity. Of the 71 patients, 45 were treated with surgery based on sleep nasendoscopy findings, and 33 patients, AI, DI, and nadir SpO2 were evaluated after surgery. There was a 77.4% and 72.7% improvement in the AT and DI respectively, but neither were correlated with BMI. The response rates were slightly better than previous reports. We believe that careful patient selection using sleep nasendoscopy data as well as avoiding surgery for extremely obese patients when possible may contribute to good results of surgical treatments.

Primary radiotherapy for tongue cancers with a tumor thickness exceeding 1 cm

AbstractBackground. In tongue cancers with a tumor thickness exceeding 1 cm, the validity of radiotherapy as an initial treatment remains controversial. Methods. Between 1979 and 1991, 26 patients with tongue cancer that was 1 cm or more in tumor thickness, and who were without clinical adenopathy underwent interstitial radiotherapy (mean dose, 64 Gy) following external irradiation (mean dose, 35 Gy). Results. In 16 (62%) of the 26 patients control was achieved at the primary site (i.e., no local recurrence till the last follow-up of 41–120 months). In 5 of the 10 patients with recurrence rescue was achieved with a salvage operation. All 3 patients who developed nodal metastases were salvaged. One patient with osteonecrosis and 2 patients with tongue ulcers were operated upon. The whole tongue remained in 13 of the 26 patients and the cumulative 5-year survival was 80%. Conclusion. Radiotherapy is a suitable initial treatment for patients with tongue cancers exceeding 1 cm tumor thickness except for T4 tumors.

An Autopsy Case of So‐called Midline Malignant Reticulosis Followed by Extensive Dissemination with Immunohisto‐chemical Evidence for Its T Cell Malignancy

An autopsy case of malignant midline reticulosis (MMR) is reported. The patient, a 42 year old Japanese male, died after a clinical course of 22 months. Autopsy revealed extensive infiltration of generalized organs by the tumor cells, suggesting that the disease was highly malignant in nature. Staining with monoclonal antibodies against T cell surface antigens Leu 4 on frozen sections and UCHL1 on paraffin embedded sections enabled us to examine the phenotype of the tumor cells with good morphological preservation and to verify the T cell nature of the tumor. Acta Pathol Jpn 39: 446 450, 1989.