Nansei Yamada

Subclinical deviation of the subjective visual vertical in patients affected by a primary headache

Conclusion. Our results suggest that patients with migraine or tension-type headache have subclinical deviations of the subjective visual vertical, which may be associated with their subjective imbalance Objectives. Patients affected by migraine or tension-type headache often complain of unsteadiness. However, they rarely show a clinical significance in the objective examinations of their equilibrium. We investigated the equilibrium functions in patients affected by migraine or tension-type headache Subjects and methods. We investigated the neurotological findings of 17 patients with migraine, 20 patients with tension-type headaches, and 16 patients without headache. All patients in this study experienced vertigo or dizziness before they underwent the examination; however, they never had vertigo attacks for more than 1 month before the examination. All patients in this study were tested during headache-free intervals Results. There was no significant difference in the hearing levels of pure tone audiometry, the canal palsy percentage of bithermal caloric test, and the body sway in posturography among the three groups (p>0.05, Mann-Whitney U test). The average values in absolute deviations of subjective visual vertical (SVV) in patients with tension-type headache (1.3±1.1°) and patients with migraine (1.5±1.2°) were significantly larger in comparison with those of patients without headache (0.6±0.4) (p<0.05, Mann-Whitney U test). Intra-individual varaiances of the SVV in patients with primary headache were significantly larger than those in patients without headache (p<0.05, Mann-Whitney U test).

Epidemiological analysis of nasopharyngeal carcinoma in the central region of Japan during the period from 1996 to 2005

OBJECTIVE It has become clear through epidemiological analysis that the incidence of cancers of the lung, liver, colon, and rectum are increasing in Japan every year. However, there have been few epidemiological analyses of nasopharyngeal carcinoma (NPC) in Japan. The aim of this study was to analyze the epidemiology and current incidence of NPC in the Chubu region of Japan during the period from 1996 to 2005. METHODS Takeshita et al. conducted a similar investigation in the Chubu region 10 years ago, and, as a result, this is a comparative study. The Chubu region is the central region of Japanese main island. We researched NPC patients treated in hospitals in each prefecture over a 10-year period (1996-2005) using a questionnaire. RESULTS A total of 525 cases (male:385, female:134, unknown:6) were analyzed epidemiologically, histologically, serologically, and clinically in this study. The incidence per 10(5) population per year was 0.29. For the period of 1986-1995, the age-standardized incidence of NPC was 0.28 per 10(5) persons per year in Takeshitas report. There was no significant difference between the two periods. The ages of the patients ranged from 13 to 90 years. The mean age of was 55.2 years. On the basis of the World Health Organization (WHO) histological criteria, 36% of the patients were classified as WHO I, 27% as WHO II, and 37% as WHO III. Carcinoma was located in the posterosuperior region in 56%, lateral in 41%, and inferior in 3%. Tumor staging showed that 6% to belonged to stage I, 25% to stage II, 31% to stage III, and 38% to stage IV. A neck mass was present in 52% of the patients, ear symptoms in 48%, nasal symptoms in 27%, headaches in 10%, pharyngeal symptoms in 9%, ophthalmologic symptoms in 9%, and cranial neurological symptoms in 9%. The positive rates of serum titers of the antibodies to Epstein-Barr virus (EBV)-related antigens were calculated. The positive rate of anti-EBV-viral capsid antigen (VCA) immunoglobulin (Ig) G titers was 58.6%, that of anti-EBV-VCA IgA titers was 53.6%, and that of EBNA was 81%. The five-year survival rate for all patients was 67.6%, and that for those in stage I, II, III, and IV was 75%, 84%, 69%, and 53%, respectively. The five-year survival rate for stage IV was significantly lower than those for the other stages (P<0.05). CONCLUSION The age-standardized annual incidence of NPC in our survey was 0.29 per 10(5) persons per year, being relatively low and stable.

Surgical Treatment by Partial Petrosectomy for a Middle-Ear Carcinoid with Progressive Extension: A Case Report and Review of the Literature

We herein report a 59-year-old male patient with a recurrent carcinoid tumor of the middle ear 7 years after a tympanomastoidectomy. The CT and dynamic MRI demonstrated an extensive tumor close to the carotid artery canal and the jugular bulb, and the tumor was removed by a partial petrosectomy with a transmastoid approach. The histopathological findings revealed a solid and trabecular tumor with cells positive for cytokeratin, chromogranin A, synaptophysin, and CD56. The MIB-1 antibody for the Ki-67 antigen was positive in 6.6% of the tumor cells. The relevant literature is reviewed in regard to the present case.

A new route for passing a free flap vascular pedicle using contralateral facial vessels as recipient vessels in skull base reconstruction.

tion of the cranial base (Fig. 2). We report a combined application of intraoperative three-dimensional image guidance and piezoelectric surgery to more safely perform osteotomies in Le Fort III advancement. Nasofrontal and pterygomaxillary osteotomies, which were historically performed blindly and with instrumentation capable of neural and vascular injury, can be more controlled with these adjunctive tools. We suggest that real-time image guidance and ultrasonic bone saws minimize the potential morbidity and mortality of this procedure, reduce the need for immediate postoperative imaging, and do not extend operative time. DOI: 10.1097/PRS.0b013e31825500ce

Gas Gangrene in the Neck caused by Peritonsillar Abscess; A Case Report

The patient was 89-year-old male who complained of sore throat and swallowing pain. X-ray and CT showed gas formation in the neck. We performed an emergency operation, found necrotic tissues and diagnosed gas gangrene. In our earlier experiences with gas gangrene, there were many bacteria in the pathological specimen. In this case, anaerobic bacteria were detected in the necrotic tissues, contributing to the pathological diagnosis. Furthermore, we paid attention to the change in LDH based on past experiences. In the blood test, LDH rose simultaneously as his condition got worse. Findings of necrotic tissues in the pathological investigation was useful to the detection of bacteria and LDH showed the degree of gas gangrene.