Soji Suzuki

Multiple primary cancer risk in patients with squamous cell carcinoma of the oral cavity

During 6375 patient‐years of observation, 136 new cancers developed in 117 of 1429 patients with squamous cell carcinoma of the oral cavity. The risk of multiple cancers was excessive in the upper digestive or respiratory tract in patients with squamous cell carcinoma of the oral cavity, accounting for 87 (64%) of the 136 later cancers. In addition, multiplicity of cancers was site‐specific, being common in the oral cavity–esophagus–lung axis and uncommon in sites such as the maxillary sinus and epipharynx. In addition, the observed‐to‐expected ratio was different in each site of the oral cavity–esophagus–lung axis, i.e., 57.5 for the oral cavity and pharynx, 12.0 for the esophagus, 7.3 for the larynx, and 2.0 for lung cancers.

Leukoplakia‐associated multiple carcinomas in patients with tongue carcinoma

A series of 522 patients with a diagnosis of squamous cell carcinoma or carcinoma in situ of the tongue were reviewed and followed. Leukoplakia was found in 88 of these patients before and after the diagnosis of tongue carcinoma. A high incidence of multiple carcinomas in the oral cavity and pharynx (116 times greater than expected) was encountered in tongue carcinoma patients. The observed incidence of multiple oral carcinomas in the group with tongue carcinoma with leukoplakia was five times greater than that of the subjects without leukoplakia. The incidence of secondary esophageal carcinomas was also high, 12 times greater than the statistical expection. However, there was no increased occurrence of secondary esophageal carcinomas in the patients with leukoplakia.

The efficacy of radiation therapy for a malignant melanoma in the mucosa of the upper jaw: an analytic study

An analysis has been made of the effect of radiation therapy in 28 patients with a malignant melanoma (Stage I: 18 cases; Stage II: 10 cases) in the mucosa of the upper jaw. Treatment had been provided by one of the following methods: intraoral mold (10 cases), interstitial brachytherapy (two cases), intraoral electron therapy (nine cases), or external irradiation (seven cases). The results have shown that the survival rate for all 28 patients was 25%, and that the survival rate for stage I patients treated by intraoral electron or brachytherapy was 47%. The primary tumor control rate in percentages was 79% (22/28) in all 28 radiotherapy patients; 92% (11/12) for tumors treated by a mold or an interstitial implant; 67% (6/9) for tumors treated by an intraoral cone; and 71% (5/7) for tumors treated by external irradiation with or without surgery. A neck metastasis that was found in 19 patients was treated by surgery, radiotherapy, and/or immunochemotherapy, and the result was successful in nine patients. The major factor in the failure of treatment was a distant, metastatic dissemination. This analysis revealed that radiotherapy has achieved similar or better results than surgery and may be advocated for the management of a localized malignant melanoma in the mucosa of the upper jaw.

Childhood moyamoya disease before and after encephalo-duro-arterio-synangiosis: an angiographic study

SummaryEncephalo-duro-arterio-synangiosis (EDAS) is a new surgical operation for childhood moyamoya disease, and its effects have been studied by comparing pre-and postoperative angiograms in 27 patients. The development of collaterals from the external carotid arterial system into the territory of the middle cerebral artery was excellent in 16 of 54 cerebral hemispheres after EDAS, good in 25, and poor in 13. The development of collaterals after EDAS increased as the stenotic process in the internal carotid artery on preoperative angiograms increased except in the most advanced cases, where it seemed to decrease in comparison with the group with middle grade stenosis. After EDAS, not only the superficial temporal artery, but also the adjacent middle meningeal artery participated in forming collateral pathways. Furthermore, decrease of abnormal net-like vessels was observed when there was good to excellent development of collateral vessels. Stenotic lesions in the internal carotid and posterior cerebral arteries were often seen to progress, indicative of the rapidly progressive nature of childhood moyamoya disease. These results appear to suggest that EDAS should be performed as early as possible in childhood moyamoya disease before the occurrence of an irreversible ischaemic state and/or permanent neurological defects.

Analysis of the angiographic findings in cases of childhood moyamoya disease

SummaryCerebral angiograms of 34 patients with childhood moyamoya disease have been analysed, this analysis having revealed the following findings. The blood flow to abnormal net-like vessels (ANV) in the base of the brain is mainly supplied from the internal carotid artery (ICA) in the early stage of this disease. In a later stage, however, the blood supply is mainly from the posterior cerebral artery (PCA). Though, no remarkable change was found in the volumes of ANV from the early to later stages of the disease, the leptomeningeal collaterals, the most prominent anastomoses in moyamoya disease, had a tendency to decrease during the later stage with the development of PCA stenosis. Eighteen occlusive PCA lesions were found in the proximal portion of the PCA in eight cases (44%), and in the distal in nine cases (50%). The incidence of aneurysm (1.5%) and intracranial bleeding was low as compared to cases of adult moyamoya disease.

Maxillary sinus carcinoma: Result of radiation therapy

Four hundred and sixteen patients with carcinoma of the maxillary sinus received primary therapy consisting of external beam irradiation alone or in combination with surgery and/or chemotherapy at the Department of Radiology, Tokyo Medical and Dental University Hospital, between 1953 and 1982. In our institution, methods of treating cancer of the maxillary sinus have been changed from time to time and showed different control rates and clinical courses. An actuarial 10-year survival rate of 21% has been obtained by megavoltage irradiation alone as well as 34% actuarial 10-year survival rate by megavoltage irradiation with surgery. After the introduction of conservative surgery followed by conventional trimodal combination therapy (antrotomy: intraoral partial maxillectomy + radiation + intra-arterial infusion), the local control rate has been improved. The amount of functional, cosmetic, and brain damages have been remarkably decreased by this mode of therapy. The actuarial five year survival rate was 67%. In addition, along with the improvement of the local control rate, the control of nodal and distant organ metastases have been emerging as one of the important contributions to the prognosis of this disease.

Duplicate origin of left vertebral artery.

SummaryA verified case of duplicate origin of the left vertebral artery in association with a large aneurysm arising from the aortic arch immediately distal to the left subclavian artery is presented. An anomalous left vertebral artery arises directly from the aortic arch between the left common carotid and subclavian arteries, and joins with the normal left vertebral artery in the transverse foramen of the fifth cervical vertebra.

Ultrasonically guided staging splenic tissue core biopsy in patients with non-Hodgkin's lymphoma.

Ultrasonically guided tissue core biopsy of the spleen was undertaken in eight patients with previously untreated non‐Hodgkins lymphoma in the staging procedure. In all cases, the tissue core specimens that were biopsied were sufficient to diagnose the presence of involvement of non‐Hodgkins lymphoma, and two of the eight were found to have histologic involvement. There was no complication in this series. It was concluded that this is a safe and reliable technique for the staging of malignant lymphoma.

Reappraisal of trimodal combination therapy for maxillary sinus carcinoma

The introduction of trimodal combination therapy (surgery + radiation + intraarterial infusion) for maxillary carcinoma resulted in a change in the sites of recurrence and no satisfactory improvement in the local control rate. To examine the cause of these phenomena, external carotid angiography was performed on 51 patients prior to the start of the therapy and the results of the treatment were studied. Angiographic findings indicated that maxillary carcinoma is fed not only by the maxillary artery, but also by the internal carotid, facial, transvers facial and other arteries from the external carotid artery. The multiplicity of feeders causes irregular distribution of the intraarterially infused antimetabolites. Irregular and local low distribution of antimetabolites may well bring about the high rate of recurrence. The results of intraarterial transcatheter Tc‐99m‐MAA injection were also in accord with the angiographic findings.

Moyamoya disease: diagnostic accuracy of MRI

Our purpose was to evaluate the diagnostic accuracy of MRI in moyamoya disease. We studied 30 patients with this disease, comparing MRI and angiographic findings. The diagnostic value of MRI was evaluated for occlusive lesions, collateral vessels, and parenchymal lesions. In all patients bilateral occlusion or stenosis of the supraclinoid internal carotid artery and proximal anterior and middle cerebral arteries was clearly shown by MRI, and staging of the extent of occlusion agreed with angiographic staging in 44 (73%) of 60 arteries. MRI, particularly coronal images, clearly showed basal cerebral moyamoya vessels in 54 hemispheres, and 45 of a total of 71 large leptomeningeal and transdural collateral vessels were identified. MRI also showed parenchymal lesions in 48 (80%) hemispheres, and the extent of occlusion in the anterior and posterior circulations respectively correlated with white matter and cortical and/or subcortical infarcts.