Noriyuki Sakihama

Investigation of Pharyngeal Swallowing Function Using High-Resolution Manometry

Objectives/Hypothesis: This study aimed to demonstrate the feasibility of a novel high‐resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.

MR Imaging Criteria for the Prediction of Extranodal Spread of Metastatic Cancer in the Neck

BACKGROUND AND PURPOSE: The presence of extranodal spread in metastatic nodes significantly affects treatment planning and prognosis of the patient with head and neck cancer. We attempted to evaluate the predictive capability of MR imaging for the extranodal spread in the neck. MATERIALS AND METHODS: We retrospectively studied MR images from 109 patients with histologically proved metastatic nodes, of which 39 were positive for extranodal spread. We assessed 47 extranodal spread–positive and 130 extranodal spread–negative metastatic nodes by using the following MR imaging findings as the possible criteria for extranodal spread: 1) nodal size (short-axis diameter); 2) obliterated fat spaces between the metastatic node and adjacent tissues, such as the muscles and skin on T1-weighted images (“vanishing border” sign); 3) the presence of high-intensity signals in the interstitial tissues around and extending from a metastatic node on fat-suppressed T2-weighted images (“flare” sign); and 4) an irregular nodal margin on gadolinium-enhanced T1-weighted images (“shaggy margin”). Multivariate logistic regression analysis was conducted to identify independent predictive criteria for extranodal spread. RESULTS: Nodal size, shaggy margin, and flare sign criteria were independent and significant MR imaging findings suggestive of extranodal spread in the metastatic nodes. We obtained 77% sensitivity and 93% specificity with the flare sign, 65% sensitivity and 99% specificity with the shaggy margin, and 80% sensitivity and 85% specificity with the size criterion (cutoff point = 16 mm). CONCLUSION: Fat-suppressed T2-weighted and gadolinium-enhanced T1-weighted images are useful for the detection of extranodal spread in metastatic nodes in the neck.

Vascular permeability to sodium fluorescein in the rabbit cranial nerve root: possible correlation with normal cranial nerve enhancement on gadolinium-enhanced magnetic resonance imaging

Vascular permeability in cranial nerve roots was examined after intravenous injection of sodium fluorescein in the adult rabbit. Fluorescence was observed in the distal nerves through the following portions: intracavernous portion of the oculomotor nerve, distal internal auditory camal segment of the facial nerve, and ganglionic portions of the trigeminal, glossopharyngeal and vagus nerves. In the acoustic nerve, the vestibular ganglion showed fluorescence. No fluorescence was observed in the olfactory or optic nerves. During in vivo gadolinium-enhanced magnetic resonance imaging (Gd-MRI) of two separate animals, trigeminal nerve enhancement was observed in the region showing fluorescence. Histologically, intense fluorescence was observed in ganglia and external nerve sheaths of the cranial nerves showing macroscopic fluorescence. A slight fluorescence was also seen in endoneurial connective tissue but not observed within the nerve fibers. The results of this study suggest that the physiological enhancement of human cranial nerves seen on Gd-MRI may correlate with vascular permeability.

Vascular permeability changes associated with experimentally induced facial nerve lesions in the rabbit

Changes in vascular permeability to sodium fluorescein following experimentally induced nerve lesions were examined in the rabbit facial nerve. Sodium fluorescein was injected intravenously as a permeability tracer and then localized by fluorescence microscopy. In control nerves, endoneurium showed only slight fluorescence while intense fluorescence was observed in the epineurium and perineurium. In nerves demonstrating edema and Wallerian degeneration, endoneurium was found to have an increased accumulation of tracer. This increased endoneurial vascular permeability in facial nerve lesions may explain nerve enhancement seen in gadolinium-enhanced magnetic resonance imaging in patients with facial nerve paralysis.

Metachronous Manifestation of Carcinoma Ex Pleomorphic Adenoma in a Buccal Minor Salivary Gland and the Contralateral Parotid Gland: A Case Report and Review of the Literature

0 Carcinoma ex pleomorphic adenoma (Ca-ex-PA) has been defined as a pleomorphic adenoma from which an epithelial malignancy is derived. It is also known s carcinoma arising in a benign mixed tumor, carcioma ex benign pleomorphic adenoma, carcinoma rising in a pleomorphic adenoma, and malignant ixed tumor. In files of the Armed Forces Institute of athology reviewed since 1970, Ca-ex-PA accounted or 9.5% of all pleomorphic adenomas and 6% of all alignant salivary gland tumors. Most salivary gland neoplasms present as a single mass involving only one gland, and multiple salivary gland tumors occur rarely. In 1989, Gnepp et al reported multiple salivary gland tumors of various combinations. Among these, the occurrence of multiple malignant salivary gland tumors was quite unusual. In 2008, Whitt et al reviewed 31 cases of

Extracellular Fluid Pathway inside the Facial Nerve Fascicles

The extracellular fluid pathway in the facial nerve and the diffusion of a tracer from the facial nerve to other cranial nerves was examined in the rabbit. Sodium fluorescein solution was injected into either the facial nerve fascicles or the epineurial connective tissue as a tracer at the stylomastoid foramen and then localized by fluorescence microscopy. In the facial nerve, fluorescence was observed in the endoneurium and external nerve sheath (epineurium and perineurium) through the geniculate ganglion following injection into the nerve fascicles. The vestibular, trigeminal, and glossopharyngeal ganglia also showed fluorescence on the injection side in ganglion cells and intercellular connective tissues. The results suggested that the endoneurial connective tissue constitutes a diffusion pathway inside the facial nerve fascicles and that the extracellular fluid pathway from the facial nerve to these cranial ganglia may be related to the neural spread of inflammation or neoplastic metastasis.

Vascular permeability to fluorescent substance in human cranial nerves.

It has recently been reported that in the facial canal, the facial nerve shows enhancement on gadolinium-enhanced magnetic resonance imaging in patients with clinically normal facial nerves. However, the mechanism of this enhancement has not yet been sufficiently clarified. The present study investigated the permeability of blood vessels in human cranial nerves that were obtained from surgically treated patients. The patients received an intravenous injection of sodium fluorescein 45 minutes before nerve resection. For histologic observation, the nerves were removed and frozen at −70°C, and the sections were then cut at 4-μm thickness with a freezing microtome. The localization of the tracers was examined with a fluorescence microscope. Fluorescence was observed in the external nerve sheath and slightly in the endoneurium of these nerves, but was not observed within nerve fibers. These findings indicate that the vascular barrier in human peripheral nerves is incomplete.

THE PROBLEM OF NEWLY PROPOSED TNM CLASSIFICATION ABOUT HYPOPHARYNGEAL CARCINOMA

1997年UICCによる悪性腫瘍の臨床病期分類 (新分類) が改訂された。新分類への変更状況とその問題点について下咽頭扁平上皮癌229例を対象に検討した。亜部位の改訂により, 1987年UICC分類 (旧分類) にて輪状後部に分類されていた38例中7例が後壁となった。T分類の変更は229例中31例 (13.5%) に要した。旧分類T1, T2症例について下咽頭頸部食道造影による再分類を行った結果, 81例中27例 (34%) は分類不能であり, その理由として下方進展の把握が困難とした症例が11例と最も多かった。N0症例での原発巣治療はT2に占める放射線治療の割合が増加し, 下咽頭部分切除はT3にも適応とされることになった。下咽頭癌は Stage IV症例が多く, 予後の不良なN3, 遠隔転移陽性症例を分離したことは妥当と考えられた。今後は正確な病期分類のため, 下咽頭造影, CTに加えMRIの撮影が必要である。