Nobuo Takagi

Clinical Analysis of Tracheostomy in Infant

Tracheostomy was performed in 7 patients during a 3-year period (2002-2004) at our hospital. The causative diseases were central nervous system disorders (3 cases), laryngo-tracheal stenosis (1 case), Edwards syndrome (trisomy 18) (1 case), werdnig-Hoffmann disease (1 case), Trauma (1 case). Five cases were neonates less than one day old. A vertical incision is made in the midline of the trachea. A 4-0 nylon suture is then placed through the tracheal wall on either side of the vertical incision. Complications after surgery included 3 cases of stomal granulation. Staphylococcus aureus (MRSA) was detected in the peristomal region in 2 of these three. Therefore, MRSA infection seemed to be one of the factors precipitating the development of granulation.

Two Cases of Schwannoma Arising from the Vagus Nerve in the Neck.

A schwannoma arising from the vagus nerve is relatively uncommon in the neck. In 3 years, 2 patients with a vagus nerve schwannoma were at the Kyoto First Red Cross Hospital. The two patients were 50 and 59-year-old-males. A CT scan showed the tumor between the common carotid artery and the internal jugular vein, and between the internal carotid artery and the internal jugular vein, respectively resulting in an increase in the distance between the artery and the vein (separation). Both patients underwent complete removal of the tumor using an external approach following a CT preoperative diagnosis of a neurilemmoma of the vagus nerve.A discussion was then made on clinical problems related to the diagnosis including FNA (fine needle aspiration cytology).

The Utility and the Limitations of Ultrasonography for Lymph Node Metastases.

Ultrasonography (US) is a very useful examination tool to evaluate cervical lymph node swelling in cases of head and neck cancer. Many reports have demonstrated that US is more reliable than palpation, CT or MRI for evaluating lymph nodes. Cervical lymph nodes removed by radical neck dissection from 19 cases with head and neck carcinomas were examined histopathologically, and observations were compared with preoperative US findings. Metastatic lymph nodes were diagnosed by size on US. Lymph nodes exceeding 7mm in Level 1 and 6mm in other cervical regions were diagnosed as metastases. A total of 457 lymph nodes were removed by radical neck dissection and 58 lymph nodes were positive for metastasis histopathologically. Twenty-nine of 58 lymph nodes were determined to be positive for metastases by preoperative US and they were all positive in histopathological examinations after operation. Since it is often difficult to detect the number of positive lymph nodes by US, there is a high possibility of multiple metastatic lymph nodes when one metastatic lymph node is detected by US findings. The prognosis of head and neck carcinomas is thought to depend on the number of metastatic lymph nodes, therefore, radical neck dissection should be performed in cases of positive lymph nodes detected by US findings.