Tomonori Terada

Taste function in elderly patients with unilateral middle ear disease.

Objective It is generally said that taste function deteriorates naturally with age. Taste function after middle ear surgery in elderly patients has not been clarified. Material and Methods The taste function of the chorda tympani nerve on the normal and diseased sides was examined before and after middle ear surgery using electrogustometry in 79 patients aged>60 years, and the findings were compared with those in 228 young and middle-aged patients. Results The threshold of electrogustometry on the normal side increased significantly with increasing age (p<0.0001). The rate of thresholds that were off the scale was highest in the>70 years age group. The preoperative threshold on the diseased side increased significantly with increasing age in patients with chronic otitis media (p=0.0029) and cholesteatoma (p<0.0001). In patients with chronic otitis media, the postoperative threshold of the>60 years age group tended to be higher than that of the<60 years age group. Conclusions These findings suggest that the taste function of the chorda tympani nerve deteriorated on the diseased side as much as on the normal side in elderly patients. Therefore, in most cases, we do not have to pay as much attention to the chorda tymapani nerve when performing surgery in elderly patients compared to young and middle-aged patients.

Randomized Phase III Trial of Adjuvant Chemotherapy with S-1 after Curative Treatment in Patients with Squamous-Cell Carcinoma of the Head and Neck (ACTS-HNC)

Background We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN). Patients and Methods Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety. Results A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group. Conclusions Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN. Trial Registration ClinicalTrials.gov NCT00336947 http://clinicaltrials.gov/show/NCT00336947

CD44 expression is related to poor prognosis of hypopharyngeal squamous cell carcinoma

Abstract Conclusions: CD44 expression in hypopharyngeal squamous cell carcinomas (SCCs) is closely associated with poor prognosis for patients. CD44 may serve as a prognostic marker for hypopharyngeal SCCs. Objectives: CD44, an adhesion molecule binding to extracellular matrix, is believed to participate in the progression of malignancies. To clarify the role of CD44 in the progression of hypopharyngeal SCCs, we examined CD44 expression in relation to clinical parameters in hypopharyngeal SCCs. Methods: Biopsy specimens of hypopharyngeal SCCs were collected from 40 untreated patients, and their CD44 expression was examined immunohistochemically. Hypopharyngeal SCCs were classified into two groups: CD44-low SCCs comprising < 50% CD44-positive tumor cells and CD44-high SCCs comprising ≥ 50% CD44-positive tumor cells. The relation between CD44 expression and various parameters (clinical T and N stages, distant metastasis, and pathological T and N stages) was analyzed by Fishers exact test. The relation between CD44 expression and the 5-year disease-free survival (DFS) rate was also analyzed by log rank test. Results: The CD44 expression in hypopharyngeal SCCs was related to pathological N stage, but not to clinical T and N stages and pathological T stage, of the patients. Distant metastasis during the follow-up occurred more frequently in patients with CD44-high SCCs than those with CD44-low SCCs. The 5-year DFS was significantly lower in the former than in the latter.

Three cases of cochleosaccular endolymphatic hydrops without vertigo revealed by furosemide-loading vestibular evoked myogenic potential test

Objective To describe possible cases of cochleosaccular endolymphatic hydrops without vertigo. Study Design Retrospective case report. Setting University hospital. Patients Three patients with possible cochleosaccular hydrops without vertigo were studied. The basis of diagnosis was positive result of the furosemide-loading vestibular evoked myogenic potential test, no canal paresis in the caloric test, and recurrent cochlear symptoms or fluctuating low-tone hearing loss. Case Report In case 1, a 47-year-old woman had recurrent left aural fullness and tinnitus and a few weeks later complained of a floating sensation and could not stand up. The furosemide-loading vestibular evoked myogenic potential test showed a positive result in the left ear. In case 2, a 24-year-old woman complained of a backward falling sensation lasting several seconds; subsequently, a severe floating sensation persisted and she could not stand up for several days. Audiography showed fluctuating low-tone hearing loss in the left ear, and the furosemide-loading vestibular evoked myogenic potential test showed a positive result. In case 3, a 41-year-old woman had a floating sensation while walking and subsequently complained of tinnitus in the left ear. She could not stand up because of a severe floating sensation and, moreover, complained of a sudden falling sensation lasting for several seconds. The furosemide-loading vestibular evoked myogenic potential test indicated a positive result in the left ear. Conclusions The patients in cases 2 and 3 complained of a short-lasting sensation of falling down. Severe disequilibrium that prohibited standing up was noted in all cases. It was suggested that these symptoms were caused by saccular hydrops.

The threshold of hypothyroidism after radiation therapy for head and neck cancer: a retrospective analysis of 116 cases

The purpose of the present study was to determine the risk factors for developing thyroid disorders based on a dose–volume histograms (DVHs) analysis. Data from a total of 116 consecutive patients undergoing 3D conformal radiation therapy for head and neck cancers was retrospectively evaluated. Radiation therapy was performed between April 2007 and December 2010. There were 108 males and 8 females included in the study. The median follow-up term was 24 months (range, 1–62 months). The thyroid function was evaluated by measuring thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels. The mean thyroid dose, and the volume of thyroid gland spared from doses ≥10, 20, 30 and 40 Gy (VS10, VS20, VS30 and VS40) were calculated for all patients. The thyroid dose and volume were calculated by the radiotherapy planning system (RTPS). The cumulative incidences of hypothyroidism were 21.1% and 36.4% at one year and two years, respectively, after the end of radiation therapy. In the DVH analyses, the patients who received a mean thyroid dose <30 Gy had a significantly lower incidence of hypothyroidism. The univariate analyses showed that the VS10, VS20, VS30 and VS40 were associated with the risk of hypothyroidism. Hypothyroidism was a relatively common type of late radiation-induced toxicity. A mean thyroid dose of 30 Gy may be a useful threshold for predicting the development of hypothyroidism after radiation therapy for head and neck cancers.

Clinical features of 5 patients with descending necrotizing mediastinitis originating from deep neck infection.

Descending necrotizing mediastinitis originating from deep neck infection is one of the most serious diseases in the head and neck region. Delayed diagnosis leads to death. We examined 5 cases of descending necrotizing mediastinitis, successfully treated with antibiotics and surgical drainage. Abscess was found in the lower part of the anterior mediastinum in 3 cases and the posterior mediastinum in 2 cases. We first conducted transcervical mediastinal drainage for 3 cases, however, thoracotomy was eventually required in all cases. For cases of abscess in the lower part of the anterior mediastinum, early and aggressive surgical drainage in collaboration with thoracic surgeons is very important and can improve survival.

Arterial chemoradiotherapy for carcinomas of the external auditory canal and middle ear

The purpose of this study was to estimate the efficacy of superselective arterial chemoradiotherapy for locally advanced carcinomas of the external auditory canal and middle ear.

Combined small cell carcinoma of the hypopharynx.

We report an extremely rare case of combined small cell carcinoma (combined SmCC) of the hypopharynx. A 73-year-old male presented with multiple left neck swellings for 1 month. A tumorous lesion was found in the left pyriform sinus, and biopsy revealed that the lesion was squamous cell carcinoma (SqCC). Surgery was performed and pathological examination led to a diagnosis as combined SmCC, composed of SqCC and small cell carcinoma (SmCC). One month after surgery, a contrast-CT indicated metastases to the cervical lymph node (LN), mediastinum and liver. We performed 5 courses of chemotherapy with the use of cisplatin (CDDP) and irinotecan (CPT-11). The patient temporarily showed a favorable response to the chemotherapy; however, eventually he died of regrowth of the tumor. Combined SmCC is a disease with a poor prognosis. Although biopsy sometimes fails to detect the SmCC component, intensive diagnosis and treatment are necessary.

Utility of real-time diagnosis using contact endoscopy for oral and lingual diseases.

OBJECTIVE In this study, we prospectively investigated the diagnostic accuracy of CE findings in oral and lingual diseases. METHODS Between January 2004 and December 2009, CE was used to examine 66 patients with oral and lingual diseases at Hyogo College of Medicine Hospital. Blood vessel networks and superficial cell layers in the mucosal epithelium of normal and lesion sites were observed after staining with 1% methylene blue. Endoscopic diagnoses (CE diagnosis) were compared with subsequent definitive diagnoses based on pathological findings. The sensitivity and specificity for CE diagnosis were calculated. RESULTS On CE findings, SCC showed the characteristics of absent and tortuous blood vessels, heterogeneous distribution, and increased nucleus/cytoplasm (N/C) ratio. Leukoplakia showed no atypical cells, abundant cornified layers, or cytoplasm without nuclei. Lesions were pathologically classified into three groups: 46 squamous cell carcinomas (SCC), 10 leukoplakias, and 10 other benign lesions (n=66). In 4 patients with SCC, malignancy was underestimated by CE findings. The overall diagnostic rate of the CE was 93.9% (62/66 patients). The sensitivity and specificity of SCC were 0.913 (42/46 patients) and 1.0 (20/20 patients), respectively. CONCLUSION The usefulness of contact endoscopy (CE) as an in vivo real-time diagnostic instrument that can deliver results prior to pathological confirmation was suggested.

A case of idiopathic tracheal stenosis

Idiopathic tracheal stenosis (ITS) is an extremely rare disease. We report the case of a 32-year-old woman with ITS. She had no history of previous surgery, endotracheal intubation, neck trauma, granulomatous disease, or any other severe respiratory tract infections. She presented with progressive dyspnea on effort and had been treated for bronchial asthma for 3 years. Chest radiography and laboratory examinations revealed no abnormalities. Bronchoscopy demonstrated almost circumferential tracheal stenosis extending for 10 mm from about 20 mm below the vocal cords. Luminal diameter was about 4 mm at the narrowest. Bronchoscopic biopsy revealed increased fibrous tissue and chronic inflammatory cell infiltration (nonspecific inflammatory tissue). These finding are compatible with idiopathic stenosis as reported by Grillo et al. After tracheostomy, the patient was treated by tracheal segmental resection (two rings) with end-to-end anastomosis of the cartilaginous trachea. Symptoms of tracheal stenosis were completely relieved and no recurrence has been observed as of 3 years postoperatively.