Yoshiyuki Tamura

Cochlear implant after reconstruction of the external bony canal wall and tympanic cavity in radically mastoidectomized patients with cholesteatoma

One of the postoperative complications of cochlear implants in patients, who previously received radical mastoidectomy, is an exposure of electrode by breakdown of thin epithelium in the open mastoid cavity. To avoid such complications, in the first stage, radical mastoidectomy with the reconstruction of the posterior bony canal wall and mastoid obliteration with bone chips and plates and the creation of the new tympanic cavity, were performed. One or 3 years later, implantation of a 22-channel cochlear implant, as the second stage procedure, was successfully performed in three patients with profound sensorineural hearing loss, due to cholesteatoma in the side of the ear in which cochlear implantation was indicated. The advantages of this technique are as follows: (1) Electrode is protected from the cavity problems, such as chronic infection or erosion of the epithelium in the open mastoid cavity; and (2) reconstruction of the new tympanic cavity and tympanic membrane is beneficial for avoidance of electrode exposure in the mastoid and tympanic cavity.

Survival Benefit of Screening for Early Esophageal Carcinoma in Head and Neck Cancer Patients

Abstract: Primary cancer of the head and neck was diagnosed in 676 cases. Systematic endoscopic screening of the upper gastrointestinal tract (including iodine staining of the esophagus) was performed within 1 month of diagnosing head and neck cancer in order to determine the possible presence of a second malignancy‐ We divided cases in which esophageal cancer was detected into a group in which the initially diagnosed head and neck cancer had been treated curatively and those in which the treatment had been non‐curative. A pathological diagnosis of primary esophageal cancer was obtained in 37 cases (5.5%). The incidence of esophageal cancer associated with cancer of the oral cavity or pharynx was significantly higher (10.9%) than in cases with an associated cancer of the larynx or paranasal sinus (1.9%, p<0.05). All but one of the 37 cases detected by screening were asymptomatic and had superficial carcinoma. Of these lesions, 19 Were mucosal carcinomas, 17 submucosal carcinomas and only one an advanced cancer. Twenty‐four of these 37 cases had died. The cause of death was head and neck cancer in 17, esophageal cancer in two and other causes in five. The 5‐year survival rate of cases in whom the initial head and neck cancer had been treated curatively was 46.7%.

Mixed tumor of the external auditory canal

A mixed tumor with apocrine differentiation seen in the r external auditory canal of a 39 year old male is reported. The i well demarcated polypoid tumor showed proliferation of elongated gland‐like or duct‐like structures lined by two rows of epithelial cells, occasionally accompanied by foci of kera‐tinization. There were fat cells in the myxoid stroma, in which no chondroid elements were seen. This neoplasm is considered to have arisen from the ceruminous gland, the modified apocrine gland of the skin.

Physicians' perspectives on "do-not-resuscitate" (DNR) orders

AbstractBackground. The purpose of this study was to investigate physicians perspectives on do-not-resuscitate (DNR) orders at Tokai University hospital, where a euthanasia-like accident occurred several years ago.nMethods. A questionnaire on DNR orders survey was administered to physicians and the anonymous answers were collected 2 weeks later.nResults. Answers were received from 150 of the 400 physicians (37.5%) (surveyed from every department), and revealed that more than 90% of the physicians felt that DNRs were occasionally necessary and that more than 60% of the physicians stated that they had performed DNR. Only 14% of the physicians answered that the patients consent would be indispensable, and 78% stated that the patients family and the physician could decide on DNR without the patients consent being given. Only half of the physicians stated that they regarded it as necessary that DNR order sheets be established hospital policy, and more than 20% of the physicians stated that such an order sheet would not be necessary.nConclusion. There is, in fact, a tacit understanding regarding DNR between physicians and patients/families in medical practice in Japan. However, DNR orders constitute definite medical decisions and procedures. Therefore, such orders should be clearly stated in a standardized format, although such procedures do not seem to be acceptable in the context of the Japanese traditional value system.