Ray Motohashi

Effects of age and sex on the expression of estrogen receptor α and β in the mouse inner ear

Abstract Conclusion: Estrogen receptor (ER) α and β were expressed in the inner ear, and expression decreased with increasing age. ERα may alter cochlear and vestibular sensory transduction, and ERβ may have a neuroprotective function in the inner ear. Objective: Expression of ERα and ERβ in the mouse inner ear and its alterations with sex and aging were analyzed. Materials and methods: Male and female CBA/J mice aged 8 weeks and 24 months were used. The localization and the intensity of ERα and ERβ immunoreactivity in the inner ear of young and old mice of both sexes were investigated by immunohistochemistry. Results: ERα and ERβ were co-expressed in the inner ear, i.e. in the nuclei of stria vascularis, outer and inner hair cells, spiral ganglion cells and vestibular ganglion cells, vestibular dark cells and endolymphatic sac. Strial marginal cells, outer hair cells and type II ganglion cells showed less expression of ERα. No gender- or age-related difference was noted in the expression pattern of ERα or ERβ, but fluorescence intensity of ERα was stronger in young female mice than in young male mice. In contrast, ERβ revealed no significant difference. In the old mice, fluorescence intensities of both ERα and ERβ were significantly decreased in both sexes.

Analysis of High-Pitched Phonation Using Three-Dimensional Computed Tomography

OBJECTIVES/HYPOTHESIS Our aim was to use three-dimensional computed tomography (3DCT) to examine arytenoid cartilage movement during a high-pitched tone task. STUDY DESIGN This was a prospective study. METHODS This study included 14 patients with male-to-female gender identity disorder who had undergone 3DCT imaging for surgical simulation between January 2007 and May 2008. First, to prove that the phonation condition was indeed one of the high-pitched phonation, we confirmed the rotational movement of the thyroid cartilage, horizontal gliding movement of the inferior horn, and vocal fold elongation on a high-pitched tone task. Next, we detected the arytenoid cartilage positions of the joint during a comparison of comfortable and high-pitched phonations. We measured the movement direction and movement distance of the arytenoid cartilage. RESULTS In all cases, the cricothyroid space became narrower (rotation movement), and we observed anterior gliding movement of the inferior horn. In all cases, elongation of the vocal folds by the high-pitched phonation was confirmed and the arytenoid cartilages were displaced both anteriorly and caudally from the position during comfortable phonation by the high-pitched tone task. CONCLUSIONS The arytenoid cartilages did not move posteriorly to elongate the vocal folds during high-pitched phonation. The arytenoid cartilages were pulled anteriorly and moved caudally because of tension associated with vocal fold elongation because of the task of high-pitched phonation. These results suggest that there are no movements at the cricoarytenoid joint that directly control the length of the vocal folds in accordance with pitch.

Analysis of pitch range after arytenoid adduction by fenestration approach combined with type I thyroplasty for unilateral vocal fold paralysis.

OBJECTIVE The purpose of this study was to determine the postoperative pitch range acquired in cases of unilateral vocal fold paralysis, as well as factors affecting outcomes. SUBJECTS AND METHODS We analyzed 39 cases of unilateral vocal fold paralysis for which surgery was performed between January 2006 and January 2009 and for which pitch ranges and the items listed below were measured preoperatively and 1 year postoperatively. Arytenoid adduction (AA) and type I thyroplasty were performed simultaneously in all cases regardless of preoperative severity. AA was performed by the fenestration approach as previously reported. In this procedure, the cricoarytenoid and cricothyroid joints are not released. Correlations between pitch range acquired postoperatively and the following items were examined: (1) pre- and postoperative maximum phonation time (MPT), (2) pre- and postoperative mean airflow rate (MFR), and (3) preoperative pitch range. Furthermore, patients were surveyed regarding their ability to sing after surgery, and the pitch range cutoff value dividing ability and inability to sing was calculated. RESULTS Pitch range increased significantly from 3±4.47 halftones (mean ± standard deviation) preoperatively to 17.5±5.80 halftones postoperatively. Preoperative MPT, MFR, and pitch range did not correlate with postoperative pitch range. Postoperatively, only MPT correlated with the width of postoperative pitch range. Twenty-three of 39 subjects (59%) responded that they were able to sing, and the pitch range cutoff value dividing the two groups was 22 halftones. CONCLUSION AA and type I thyroplasty significantly expanded postoperative pitch range. There was no correlation between preoperative severity and width of pitch range acquired postoperatively.

Two Cases of Small Cell Cancer of the Maxillary Sinus Treated with Cisplatin plus Irinotecan and Radiotherapy.

Background. Small cell carcinoma (SmCC) in the nasal cavity and paranasal sinuses is very rare, and definitive therapies have not yet been established. Methods. Chemoradiotherapy comprised 60 Gy of external radiation, with the administration of irinotecan intravenously at 60 mg/m2 on days 1, 8, and 15 and cisplatin at 60 mg/m2 on day 1. Results. Case 1 involved a 66-year-old woman with stage III cancer. Adverse events included decreased white blood cells, anemia, and oral mucositis, all Grade 2. The patient remained free of cancer as of 3 years and 6 months after completing the treatment. Case 2 involved a 60-year-old man with stage IV cancer. He also experienced adverse events of decreased white blood cells, anemia, and oral mucositis, all Grade 2. He died after 11 months due to metastases throughout the body. Conclusions. The results suggest that this regimen may be tolerable as a therapy for this type of carcinoma.

Detection of passive movement of the arytenoid cartilage in unilateral vocal-fold paralysis by laryngoscopic observation: useful diagnostic findings

In a previous study of patients with unilateral vocal-fold paralysis (UVFP), three-dimensional computed tomography (3DCT) revealed passive movement during phonation, with the arytenoid cartilage on the paralyzed side pushed to the unaffected side and deviated upwards. The present work compares the 3DCT findings with those obtained by 2-dimensional endoscopy to visualize the vertical passive movement of the arytenoid cartilage. The study population consisted of 23 patients with UVFP and two with laryngeal deviation but normal movement of the vocal folds. Two endoscopic findings represented cranial deviation during phonation: posterior deviation of the arytenoid hump and lateral deviation of the muscular process. These two findings were classified into four grades, ranging from 0 (normal) to 3 (severe). Cranial displacement detected by 3DCT was also classified into four grades. Significant correlations were found between the 3DCT-determined grade of cranial displacement of the arytenoid cartilage and the grade assigned based on the two endoscopic findings. Moreover, lateral deviation of the muscular process was more significantly correlated with 3DCT grade than with endoscopic grade. Thus, endoscopic findings may be useful in the diagnosis of vocal-fold paralysis, and passive lateral deviation of the muscular process as an indicator of UVFP.

Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty.

OBJECTIVE To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP. STUDY DESIGN This is a retrospective review of clinical records METHODS Four cases of AdBP, in which surgical treatment was performed, are presented. AdBP shows disorders of vocal fold adduction because of paralysis of the thyroarytenoid and lateral cricoarytenoid muscles. The PCA muscle, dominated by the recurrent nerve PCA muscle branch, does not show paralysis. Thus, this type of partial recurrent nerve paresis retains the abductive function and is difficult to distinguish from arytenoid cartilage dislocation because of their similar endoscopic findings. The features include acute onset, and all cases were idiopathic etiology. Thyroarytenoid muscle paralysis was determined by electromyography and stroboscopic findings. The adduction and abduction of paralytic arytenoids were evaluated from 3 dimensional computed tomography (3DCT). RESULTS In all cases, surgical treatments were arytenoid adduction combined with thyroplasty. When we adducted the arytenoid cartilage during inspiration, strong resistance was observed. In the two cases where we could cut the PCA muscle sufficiently, the maximum phonation time was improved to ≥30 seconds after surgery, from 2 to 3 seconds preoperatively, providing good postoperative voices. In contrast, in the two cases of insufficient resection, the surgical outcomes were poorer. CONCLUSIONS Because the preoperative voice in AdBP patients is typically very coarse, surgical treatment is needed, as well as ordinary recurrent nerve paralysis. In our experience, adequate PCA muscle resection might be helpful in surgical treatment of AdBP.

Antiemetic therapy of fosaprepitant, palonosetron, and dexamethasone combined with cisplatin-based chemotherapy for head and neck carcinomas

Abstract Conclusion: Concomitant antiemetic therapy comprising fosaprepitant, palonosetron, and dexamethasone is effective for head and neck carcinoma. Objective: A patient diary was constructed to determine the effectiveness of concomitant antiemetic therapy with a neurokinin-1 receptor antagonist (fosaprepitant), 5-hydroxytryptamine receptor antagonist (palonosetron), and dexamethasone in accordance with guidelines. Methods: Subjects comprised 41 patients who received 71 courses of chemotherapy, along with fosaprepitant, palonosetron, and dexamethasone. A patient diary was compiled concerning the presence/absence of vomiting, vomiting episodes, presence/absence of rescue therapy, food intake, presence/absence of nausea, and general condition. Results: The frequency of the primary end point of complete response in the overall phase was 69.0%. The proportion of patients with no vomiting in the overall phase was 90.1%. In the acute phase, the proportion of no nausea and slight nausea together was 91.5%, no change in and slightly reduced food intake together was 87.3%, and the proportion of good general condition and relatively good general condition was 85.9%. In the delayed phase, the proportion of no nausea and slight nausea together was 56.3%, no change in and slightly reduced food intake together was 43.7%, and the proportion of good general condition and relatively good general condition together was 53.5%.

A Case of Giant Osteoma in the Middle Turbinate of a Child

Only seven cases of osteoma arising in the middle turbinate have been reported to date. We report the eighth case, involving osteoma in the middle turbinate of a child. This young boy was initially examined at the age of nine for the main complaint of nasal obstruction. Although a large osteoma with a maximum diameter of 30 mm was observed on computed tomography (CT), the patient was only observed because of the wishes of the family. At 13 years, he was again examined, as a result of worsening of the nasal obstruction. CT revealed that the osteoma had enlarged to a maximum diameter of 41 mm. Endoscopic surgery was attempted, but because of difficulties, the osteoma instead had to be removed under direct vision via a gingival incision. The final pathological diagnosis was osteoid osteoma. The nasal obstruction disappeared following surgery, with no recurrence after more than 12 months postoperatively.

A case report of malignant melanoma of the sphenoid sinus.

Malignant melanoma of the sphenoid sinus is a very rare disease, and only 6 cases have previously been reported. The present case involved a 74-year-old woman who was examined for visual disturbance of the left eye. Computed tomography revealed a soft tissue shadow, but only mucosal hypertrophy was found on opening the sphenoid sinus under general anesthesia. One month postoperatively, visual disturbance of the right eye and paresis of cranial nerve III appeared. Malignant melanoma was diagnosed from biopsy. Multiple bone metastases were identified, but the patient declined active treatment. As a result, palliative care was provided and she died 3 months later. When there is no improvement in postoperative visual acuity as in this case, in consideration of the possibility of neoplastic lesions, rigorous followup including monitoring for neurological symptoms is warranted.

The efficiency and adverse events of radiotherapy with cetuximab for Japanese head and neck cancer patients

OBJECTIVES Radiotherapy with cisplatin (Chemoradiotherapy, CRT) has long been one of the standard treatments for head and neck squamous cell cancer (HNSCC). Approval of cetuximab for the treatment of HNSCC has made radiotherapy with cetuximab (Bioradiotherapy, BRT) a new treatment option for HNSCC. Reports of BRT in the Japanese written in English up to now is only the phase II study, though it includes only 22 patients. Also on the nature of the clinical Phase II trial, sampling bias of cases may exist. Here we report the treatment completion rate, response rate and frequency of adverse events of BRT in Japanese patients with HNSCC in English for the first time. In association with this, we examine the issues related to BRT in Japanese patients. PATIENTS AND METHODS The subjects consisted of patients with HNSCC who underwent BRT as the first curative treatment (45 cases). Their treatment completion rate, response rate and frequency of adverse events were examined. RESULTS Of the 45patients, 42 were male and 3 were female. The mean age of the patients was 64 (range from 40 to 86). Adverse events of Grade3 or more were 12 cases (27%) of dermatitis, 31 cases (69%) of mucositis/stomatitis, 6 cases (13%) of interstitial pneumonia. The complication rate of pulmonary emphysema in those who developed interstitial pneumonia and those who did not were 83% and 21%, respectively. The BRT completion rate was 78%, and the response rate was 84%. CONCLUSION BRT is sufficiently tolerable and have high response rate even for the Japanese, but we should recognize that BRT is not a minimally invasive and easily manageable treatment.