Risa Tona

Prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status

The purpose of this study was to determine whether pretreatment 18F‐fluorodeoxyglucose‐positron emission tomography (18F‐FDG PET/CT) volume‐based parameters, such as metabolic tumor volume and total lesion glycolysis, add more prognostic information in patients with oropharyngeal squamous cell carcinoma (SCC).

Prognostic Impact of p16 and p53 Expression in Oropharyngeal Squamous Cell Carcinomas

BACKGROUNDS A p16 protein is known to be overexpressed in human papillomavirus-positive head and neck squamous cell carcinoma specimens. p53 is a tumor suppressor protein detectable by immunohistochemistry in carcinogen-associated head and neck squamous cell carcinoma as a result of gene mutations. The purpose of this study is to investigate the prognostic impact of p16 and p53 expression in oropharyngeal squamous cell carcinomas. METHODS We retrospectively examined the relationship between prognosis, and p16 and p53 expression levels of oropharyngeal squamous cell carcinoma specimens in 53 patients using immunohistochemistry. RESULTS Overall, 55% of patients were p16 positive and 45% p16 negative, while 28% were p53 positive and 72% p53 negative. The p16 status showed an inverse relationship with the p53 status. A survival analysis by p16 status, p53 status, Union for International Cancer Control stage and main treatment modality demonstrated that only p16 status was related to better prognosis in terms of overall survival and disease-specific survival (3-year overall survival, 87 vs. 62%, P = 0.02; 3-year disease-specific survival, 90 vs. 62%, P = 0.02). To evaluate the practical prognostic factors in oropharyngeal squamous cell carcinoma patients, we classified patients as either p16-positive or p53-negative oropharyngeal squamous cell carcinomas, representing human papillomavirus-related oropharyngeal squamous cell carcinoma with wild-type p53 or the remaining patients with p16-negative or p53-positive OPSCCs, respectively. The former group showed survival advantages in terms of overall survival and disease-specific survival by log-tank test compared with the latter group (3-year overall survival, 96 vs. 58%, P = 0.005; 3-year disease-specific survival, 96 vs. 63%, P = 0.02). CONCLUSIONS A group of patients who were p16 positive/p53 negative had better prognoses in terms of overall survival and disease-specific survival than that who were p16-positive alone.

Risk factors for retropharyngeal cellulitis in Kawasaki disease

OBJECTIVE Kawasaki disease (KD) is an acute multisystemic vasculitis of unknown etiology that occurs in infants and children. Retropharyngeal cellulitis has been reported as a rare manifestation of KD. This study investigated the frequency and characteristics of patients with KD manifesting as retropharyngeal soft-tissue swelling. METHODS We retrospectively reviewed 277 patients, with a mean age of 1 year and an age range of 7 months to 12 years, in whom KD had been diagnosed between 2005 and 2011. RESULTS In 10 patients (3.6%), contrast-enhanced computed tomography (CECT) showed low-density lesions without ring enhancement in the retropharyngeal spaces. These patients presented initially with fever and cervical lymphadenopathy, and were initially treated by their pediatricians for suppurative lymphadenitis (seven patients) or retropharyngeal abscess (three patients). KD was finally diagnosed either after antibiotics had been ineffective or when other symptoms characteristic of KD emerged. CONCLUSION Low-density lesions in the retropharyngeal space were identified by CECT in 3.6% of the KD patients. Early diagnosis of KD is essential because coronary artery lesions develop in 50% of untreated patients. If a child presents with fever, cervical lymphadenopathy, and swelling of the retropharyngeal space, KD should be included in the differential diagnoses.

Predictive value of middle ear aeration before second-stage operation in staged tympanoplasty with soft-wall reconstruction

Abstract Conclusion: The extent of middle ear aeration before second-stage canal wall-down (CWD) tympanoplasty was correlated with postoperative middle ear stability. Objective: To evaluate middle ear aeration before second-stage CWD tympanoplasty as a predictor of postoperative re-aeration potential and external auditory canal (EAC) stability in staged CWD tympanoplasty with soft-wall reconstruction (SWR). Methods: Middle ear aeration was evaluated before and at 1 year after the second-stage operation in patients who underwent staged CWD tympanoplasty with SWR for middle ear cholesteatoma. Based on the computed tomography (CT) findings, middle ear aeration was graded as A when the mastoid and tympanic cavities were aerated, B when only the tympanic cavity was aerated, and C in cases with no aeration in the tympanic cavity. We also examined postoperative EAC stability. Results: Forty-one ears were included. In all, 17 of 19 ears (89.5%) with grade A aeration preoperatively maintained grade A aeration postoperatively, while 5 of 18 ears (27.8%) with grade B aeration had grade A aeration, and no ear with grade C aeration had recovered grade A aeration. All ears with grade A aeration preoperatively maintained smooth EACs. EAC retraction requiring additional treatment occurred in five ears with grade B aeration and all ears with grade C aeration.

Detection of subclinical recurrence or second primary cancer using (18) F-FDG PET/CT in patients treated curatively for head and neck squamous cell carcinoma.

The efficacy of posttreatment surveillance 18F‐fluorodeoxyglucose positron emission tomography (18F‐FDG PET)/CT was evaluated in patients with head and neck squamous cell carcinoma (HNSCC).

Audio–visual integration during speech perception in prelingually deafened Japanese children revealed by the McGurk effect

OBJECTIVE To investigate the McGurk effect in profoundly deafened Japanese children with cochlear implants (CI) and in normal-hearing children. This was done to identify how children with profound deafness using CI established audiovisual integration during the speech acquisition period. METHODS Twenty-four prelingually deafened children with CI and 12 age-matched normal-hearing children participated in this study. Responses to audiovisual stimuli were compared between deafened and normal-hearing controls. Additionally, responses of the children with CI younger than 6 years of age were compared with those of the children with CI at least 6 years of age at the time of the test. RESULTS Responses to stimuli combining auditory labials and visual non-labials were significantly different between deafened children with CI and normal-hearing controls (p<0.05). Additionally, the McGurk effect tended to be more induced in deafened children older than 6 years of age than in their younger counterparts. CONCLUSIONS The McGurk effect was more significantly induced in prelingually deafened Japanese children with CI than in normal-hearing, age-matched Japanese children. Despite having good speech-perception skills and auditory input through their CI, from early childhood, deafened children may use more visual information in speech perception than normal-hearing children. As children using CI need to communicate based on insufficient speech signals coded by CI, additional activities of higher-order brain function may be necessary to compensate for the incomplete auditory input. This study provided information on the influence of deafness on the development of audiovisual integration related to speech, which could contribute to our further understanding of the strategies used in spoken language communication by prelingually deafened children.

Intra-arterial administration of antibiotics for refractory skull base osteomyelitis

We report two cases of elderly diabetic men with skull base osteomyelitis (SBO) originating from malignant external otitis (MEO). In both, a devastating infection and neural paralysis deteriorated after conventional therapy, including long-term intravenous administration of culture-directed antibiotics with strict control of blood sugar levels and surgical debridement of infectious granulation tissue. Since poor perfusion of antibiotics in the lesion may be associated with serious nature of MEO/SBO, we administered antibiotics intra-arterially via a retrograde catheter with the tip set at the proximal point of the external carotid artery to increase the tissue drug concentration in the maxillary artery (MA) and ascending pharyngeal artery (APA) supply areas, in which intense inflammation was observed. This intra-arterial administration of antibiotics (IA therapy) followed by long-term intravenous and oral antibiotic treatments eliminated their infection and no recurrence was observed in 2 years follow-up period. Interestingly, CT images of angiography via the catheter demonstrated stronger enhancement in the MA supply area compared to the APA supply area and IA therapy was more effective in the former. These results suggest that IA therapy, which might achieve high antibiotic concentration at the site of infection, is effective in patients with MEO/SBO refractory to conventional treatments.

Clinical features of rapidly progressive bilateral sensorineural hearing loss.

Abstract Conclusion: Rapidly progressive bilateral sensorineural hearing loss (SNHL) often develops as a symptom of intracranial diseases or systemic vasculitis. For early diagnosis and treatment of these potentially fatal diseases, a history of hearing deterioration within 2 months and associated symptoms may be important. Objectives: To reveal clinical features and causative diseases for rapidly progressive bilateral SNHL. Methods: The inclusion criterion was patients with bilateral progressive SNHL, who had experienced difficulty in daily conversation within 4 days to 1 year after the onset of hearing loss awareness. This study was a retrospective evaluation of 12 patients with rapidly progressive bilateral SNHL who visited our hospital between 2007 and 2011. Results: The causative disease for hearing loss was identified in 11 of 12 patients; intracranial lesions including nonbacterial meningitis, meningeal metastasis of lymphoma, and superficial siderosis in 4 patients, systemic vasculitis in 2, auditory neuropathy spectrum disorder in 1, and an isolated inner ear disorder in 4. Relatively rapid hearing deterioration within 2 months showed a significant association in six patients with an intracranial lesion or systemic vasculitis. Moreover, all these six patients complained of dizziness and/or non-cochleovestibular symptoms such as fever, headache, and/or altered mental state in addition to hearing loss.

A case of angiosarcoma arising from internal jugular vein.

Primary angiosarcoma is a rare disease with a poor prognosis. It most commonly arises in the head and neck region; localization in the deep soft tissue of the neck is extremely rare. We herein present a case of angiosarcoma derived from the right internal jugular vein. A 79-year-old man presented with a 1-month history of a growing right neck mass. Computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, and fine-needle aspiration cytology revealed a malignant tumor of unknown origin. Right neck dissection was performed for both diagnosis and therapy. Immunostaining of the resected tumor cells revealed positivity for CD31, CD34, factor VIII-related antigen, and D2-40, which allowed for a definitive diagnosis of angiosarcoma. Postoperative radiotherapy (66Gy) was performed on the right neck, including the surgical bed and upper mediastinum. The patient was followed up for 10 months with no recurrence. Only six cases of angiosarcoma arising in the deep soft tissue of the neck have been reported in the English-language literature. The present report is the first to describe angiosarcoma arising from the internal jugular vein.