Tatsuya Fukuiwa

Venous thrombosis after microvascular free-tissue transfer in head and neck cancer reconstruction.

OBJECTIVE Microvascular free-tissue transfer is essential for functional reconstruction in head and neck cancer surgery. The risk of free flap failure depends on venous thrombosis rather than arterial thrombosis, and any type of failure caused by venous thrombosis is often diagnosed late. In this study, we studied the flap survival rate achieved by this technique depending on the recipient vein. Further, the risk factor was analyzed for venous thrombosis with regard to preservation of recipient vein during neck dissection. METHODS This study is a retrospective review of 102 consecutive free flaps performed by a single head and neck surgical team from 2000 to 2006 at the Department of Otolaryngology, Head and Neck Surgery at Kagoshima University Hospital. The recipient vessels such as the external jugular (EJ) vein and internal jugular (IJ) system were carefully preserved during neck dissection. All patients received 80 microg of prostaglandin E1 (Alprostadil) for 5 days after surgery. RESULTS The overall success rate was 94.1%. All the six cases of unsuccessful free flap transfer were caused by venous thrombosis. Microvascular free flaps anastomosed to the EJ vein failed at a significantly higher rate (13.3%) than those anastomosed to the IJ system (2.8%) (p<0.05). On studying the failed cases after IJ system anastomosis, we found that all complications were caused by internal jugular vein thrombosis (IJVT) and not by microvascular anastomotic thrombosis. In all the three cases of flap failure with IJVT, the dissected IJ vein was patently ballooning because of the remaining connective tissue, including the adventitia around the IJ vein in the supraclavicular lesion. CONCLUSIONS Although the IJ system is the ideal recipient vessel when compared with EJ vein, there is another risk of flap failure due to IJVT. To improve the survival rate, IJVT should be prevented by a careful manipulation of IJ system during neck dissection to avoid ballooning of the IJ vein in head and neck cancer surgery.

Inhibition of Vascular Endothelial Growth Factor by Macrolides in Cultured Fibroblasts from Nasal Polyps

Objective: In order to study a new mechanism of efficacy of 14‐membered ring macrolides in treating chronic rhinosinusitis, inhibitory effects of macrolides on vascular endothelial growth factor production were examined in vitro.

Application of cyberknife for the treatment of juvenile nasopharyngeal angiofibroma: a case report.

Juvenile nasopharyngeal angiofibroma (JNA) tumors can be locally destructive when they spread submucosally. The purpose of this study was to present an image-guided, robotic radiotherapy (Cyberknife) to successfully treat a 12-year-old boy with Juvenile nasopharyngeal angiofibroma (JNA). He complained of progressive right nasal obstruction, intermittent epistaxis. Computed tomography (CT), and magnetic resonance imaging (MRI) revealed the presence of a tumor in the right nasal cavity and nasopharynx with significant hypervascularization from the right maxillary artery. Pathological findings confirmed the diagnosis of JNA. Surgical treatment was recommended but refused by religious reasons. We initially treated the patient with external-beam radiation therapy (total treatments, 12; total dose, 2400 cGy), which, after 7 months, failed to reduce the size of the tumor or relieve the patients symptoms. We subsequently treated the patient with Cyberknife therapy (total treatments, 3; total dose, 4512 cGy) and observed almost complete disappearance of the tumor after 7 months. After 2 years of observation, there has been no tumor recurrence. Cyberknife therapy is compared with other therapeutic options for JNA, and its benefits are discussed in the context of the findings in the literature.

Vascular endothelial growth factor produced in nasal glands of perennial allergic rhinitis.

Background Vascular endothelial growth factor (VEGF), a pleiotropic polypeptide that mediates endothelial cell-specific responses such as induction of angiogenesis and vascular leakage, is hyperproduced in a variety of inflammatory disorders. In asthma, VEGF hyperproduction promotes mucosal edema by enhancing vascular leakage. However, in allergic rhinitis, details of the pathophysiological importance remain unclear. This study was designed to investigate and discuss the pathophysiological significance of VEGF in nasal secretions from perennial allergic rhinitis sufferers. Methods Seven allergic rhinitis patients sensitized with house-dust mites and 12 chronic rhinosinusitis patients were enrolled. Nasal secretion VEGF was quantified and compared between groups. In allergic rhinitis cases, nasal lavage VEGF was estimated before and after the antigen provocation. Nasal gland VEGF was immunohistochemically investigated. VEGF messenger RNA (mRNA) levels in serous and mucous acini were analyzed by laser microdissection and light cycler-polymerase chain reaction. Results VEGF levels in nasal secretions and nasal lavage from allergic rhinitis were higher than in nonallergic rhinosinusitis, after rather than before antigen provocation. VEGF mRNA expression was higher in serous versus mucous acini. These results are consistent with the immunohistochemistry results. Conclusion In allergic rhinitis, there was significant VEGF production in serous acini, which was hypersecreted after antigen provocation. VEGF may play an important role in pathophysiology of allergic rhinitis.

A Case of Suspected Laryngeal Tuberculosis Accompanied by Lung Tuberculosis

A case of suspected laryngeal tuberculosis accompanied by lung tuberculosis was reported in this paper. The patient was a 72 year-old male. He had developed hoarseness, sore throat and pain on swallowing, and consulted our clinic. Laryngoscopic examination showed swelling of the left arytenoid as well as laryngeal palsy. Pulmonary tuberculosis was diagnosed by microbiological identification of tubercle bacillus in the sputum. Although there was no evidence indicating laryngeal tuberculosis, local areas in the larynx were markedly improved after treating the patient with anti-tuberculosis chemotherapy. Consequently the patient was diagnosed as having laryngeal tuberculosis. Laryngeal tuberculosis is now rare in Japan, but it was suggested that careful attention should still be paid to the differential diagnosis of laryngeal inflammatory diseases.