Toru Handa

Superselective cisplatin (CDDP)-carboplatin (CBDCA) combined infusion for head and neck cancers.

A group of 26 patients with carcinoma of the head and neck region was treated by superselective intra-arterial infusion of cisplatin (CDDP)-carboplatin (CBDCA). The tumor locations included the tongue (n = 4), oral base (n = 2), nasopharynx (n = 2), oropharynx (n = 8), hypopharynx (n = 4) and larynx (n = 4). Using the coaxial technique, a microcatheter was placed in the lingual, ascending pharyngeal, facial and superior thyroidal arteries according to the location of the tumor. Under imaging studies, CDDP (50 mg/m2)-CBDCA (300 mg/m2) was infused into the vessel, via injectors at the rate of 12.5 ml/min. One to five injections were given every 4 weeks. During and following the chemotherapy the patients received radiotherapy (n = 22), surgery (n = 4) or both (n = 3). Sixty-six sessions of intra-arterial chemotherapy were given with no major complications. Drug-related systemic side effects were mild. The overall response rate was 96% (complete response (CR) 50% and partial response (PR) 46%). Superselective CDDP-CBDCA combined infusion is feasible, relatively non-toxic, and important as multimodality therapy.

Gap Junction Change in Supporting Cells of the Organ of Corti with Ryanodine and Caffeine

It has been demonstrated that the gap junctions of the supporting cells of the organ of Corti are controlled by H+ and Ca2+. Inside these cells there is a tubular structure. It is supposed that this network is endoplasmic reticulum. Calcium release from inside the cells, and the effect of calcium on the gap junctions of these cells, were investigated under whole cell clamping application of ryanodine and caffeine. Membrane capacitance and membrane resistance were calculated, with corrections for changes in whole cell parameters. Ryanodine-treated cells (1 microM-10 mM), caffeine-treated cells (5 mM 500 nM) and A23187-treated cells were uncoupled at their gap junctions. Therefore, Ca2+ plays a role in the uncoupling of the gap junctions in supporting cells of the organ of Corti from inside the cells.

a Full-thickness Chondrocutaneous Flap from the Auricular Concha for Repair of Tracheal Defects

&NA; A free full‐thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft. (Plast. Reconstr. Surg. 99: 1887, 1997.)

Arterial embolization for control of bleeding in advanced head and neck malignancy

BackgroundThis study was undertaken to assess the efficacy and suitability of an arterial embolization technique for the control of bleeding in advanced head and neck malignancies.MethodsEmbolization was performed on 6 patients with advanced head and neck malignancy using various embolic materials for the control of bleeding. The primary tumors were located in the nasopharynx, hypopharynx (n=2), oral base, face, and external auditory canal. All of these patients had severe anemia and 5 had massive regional hemorrhages.All bleeding was well controlled by the arterial embolization; 2 patients were cured of hypovolemic shock. None of the patients died as a direct result of tumor bleeding, and there were no massive rebleeding cases in our series.ConclusionArterial embolization offers an effective, safe, and fast method for controlling bleeding from advanced head and neck malignancies. A good working relationship between the surgeon and the interventional radiologist provides the greatest chance for sucess in such cases.

Maxillary Hemangioma; A Case Report and Review of the Japanese Literature.

An 81-year-old woman was admitted to our hospital because of right maxillary swelling, pain and nasal obstruction. The medial wall of the right maxillary sinus protruded to the nasal septum. Plain X-ray films showed destruction of the lateral bony wall, and plain CT scans showed destruction of the posterior bony wall of the right maxillary sinus. The tumor was invading the parapharyngeal space. These findings suggested a malignant tumor of the right maxillary sinus.When needle biopsy was attempted intranasally, the needle could be inserted into the right maxillary sinus without any resistance. The pathological report was no malignancy, only coagulation.The right cheeck and gingiva showed swelling abruptly. Emergency CT showed an osteolytic lesion of the alveolar bone. Right maxillary sinectomy was done. The pathological report was fibrosis, hyalinization and capillary dilatation, these finding are compatible with hemangioma of the right maxillary sinus. The authors review the Japanese literature and discuss the ethiology of hemangiomas of the nose and paranasal sinuses.

Tofisopam Treatment of Patients with Vertigo and Dizziness

The therapeutic effect of Tofisopam (150 mg/ day p.o) was evaluated in 39 patients with vertigo or dizziness. The subjective symptoms and objective findings were recorded before and four and eight, weeks after the start of treatment. After eight weeks there was marked improvement in 30.6%, moderate improvement in 19.4%, slight improvement in 41.7%, and no change in 8.3%. Clinical improvement was not quite so high after four weeks of treatment. There was no significant difference in response between peripheral vertigo and autonomic dysfunction. Clinical improvement tended to be slightly lower in patients over 50 years old than in younger patients and higher in females than in males.Many subjective symptoms, as well as vertigo and dizziness, were also reduced, such as stiff shoulder, stiff neck, headache, paresthesia and feverish sensation. The objective signs which were greatly improved were : righting reflex and gaze and positional and positioning nys-tagmus. Schellongs test, which had been positive in ten patients, became nagative in eight of them. Only one patient had any side effects : abnormal liver function tests. Tofisopam is con-siderd to be useful in the treatment of vertigo and dizziness.

EFFECTS OF HEAVY METAL IONS IN ENDOCOCHLEAR DC POTENTIAL AND COCHLEAR MICROPHONICS IN THE GUINEA PIG

Endocochlear DC potential (EP) and cochlear microphonics (CM) in the guinea pig under the influence of the divalent heavy metal cations of manganese, nickel, cobalt and cadmium, and the trivalent cation of lanthanum were investigated. The area from the scala tympani to the scala vestibuli was perfused with control and test solutions. CM decreased gradually to 50-80%, but EP showed no change after perfusion with a solution containing 1 mM of metal ions. At a concentration of 10 mM, EP decreased from 80 mV to 10-20 mV and CM decreased to 15-55%. At 100 mM, EP increased by about 10 mV at the beginning of perfusion, remained steady for 1 min, and then rapidly decreased to 0-10 mV. Meanwhile, CM continued to decrease, finally sustaining a 10-56% reduction. The decrease in EP and CM were irreversible, and perfusion of the area with the standard solution for 20 min had no effect. The osmolarity of the artificial perilymph containing 100 mM of metal ions was twice as high as that of the normal physiological solution. The effects of osmolarity, however, were excluded because perfusion with an artificial perilymphatic solution made hypertonic by either NaCl or sucrose changed neither EP nor CM. The application of 100 mM of metal ions topically to the round window membrane caused no change in EP. The alkali metal ions are known to inhibit inward Ca2+ current. Therefore, the present results suggest that Ca2+ ions play a role in maintaining EP generation in the stria vascularis and CM generation in the organ of Corti.

A Case of Recurrent Ulcers of the Oral Cavity, Pharynx and Larynx

This is a report of an 81-year-old man with recurrent aphthosis of the oral cavity and uncontrolled diabetes mellitus (Type II). When he was 71 and 76 years old, he entered the Department of Oral Surgery of our hospital due to recurrent aphthosis of the oral cavity. It was suspected that the case was Behgets disease, but no specific findings were obtained. When he was 80 and 81 years old, he entered our department three times because of acute epiglottitis, chondritis of the epiglottis and pharyngeal ulcer, respectively. Although the patient was given Cepharanthin, no remarkable change was noted. Some treatment to control the blood glucose was performed, and his ulcers healed gradually.

Bacteriological Study and Observation by the Scanning Electron Microscope of the Tips of the Intraarterial Catheters

Bacteriological studies and observation by the scanning electron microscope of the tips of the intraarterial catheters were made on patients with malignancies of the head and neck who were treated by intraarterial injection. Seven of the 28 samples (25 %) were positive bacterial contamination, but no clinical symptoms of infection developed at all. There were two achromobacter xylosoxidans, 2 staphylococcus epidermidis, 2 propionibacterium acnes and one pseudomonas cepacia. Positive bacterial contamination (Pseudomonas cepacia) was seen in ony 1 of the 9 patients who were compelled to remove the intraarteral catheters. Scanning electron microscopic findings of the tips, and the inside catheters showed granular and fern-like materials, but none showed bacteria. Predominant peaks of Na, Cl, P, S levels were detected by an X-ray microanalyzer. In conclusion, no relationship was observed between the trouble of tubing and the bacterial contamination, but care should be paid to avoid the contamination.