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Papillary thyroid carcinoma (PTC) is a relatively indolent disease, despite the high incidence of lymph node metastases. Although less frequent, some upper mediastinal metastases of PTC cannot be removed without sternal resection. In this study, we investigated the prognostic impact of upper mediastinal dissection (UMD) by sternotomy on patients with mediastinal metastases of PTC. Charts of patients with PTC who underwent surgical treatment at our institution between 2006 and 2018 were retrospectively reviewed. Fifty-eight patients with upper mediastinal metastases were enrolled. Kaplan-Meier survival curves were compared, and Cox hazard regression models were used for analyses. Of the 58 patients with mediastinal metastasis, 12 (20.7%) underwent dissection of the prevascular nodes, 51 (87.9%) underwent dissection of the upper paratracheal nodes, and 14 (24.1%) underwent dissection of the lower paratracheal node. The preferred site of mediastinal metastasis was the upper paratracheal nodes. The 5 and 10-year disease-specific survival rates for patients after UMD were 74.6% and 58.7%, respectively. Among 25 patients (43.1%) with locoregional recurrence, 12 (20.7%) had mediastinal recurrence and 7 were eligible for additional UMD. Although distant metastasis was the predominant poor prognostic factor, mediastinal recurrences were more frequently unresectable than cervical recurrences, suggesting that mediastinal recurrence is a poor prognostic factor. Mediastinal metastases larger than 30 mm or metastases to the lower paratracheal nodes are considered a risk factor for mediastinal recurrence. UMD by sternotomy for patient with upper mediastinal metastases which are difficult to resect via transcervical approach is an effective treatment option to improve patient prognosis.

Primary hyperparathyroidism is usually caused by parathyroid adenoma; however, parathyroid carcinoma is a rare cause. We report a rare case of 74-year-old female of primary hyperparathyroidism caused by parathyroid carcinoma (PC) and coexisting multiple parathyroid adenomas. She was referred to our hospital for primary hyperparathyroidism and a suspected thyroid tumor. She had no family history of malignant tumor. Computed tomography (CT) and ultrasonography of the neck revealed some masses posterior to both thyroid lobes. Those masses were believed to be parathyroid lesions. However, another mass located posterior to the right upper thyroid lobe seemed to be heterogeneous, which indicated a malignant thyroid tumor as well as parathyroid tumor. The preoperative diagnosis was multiple parathyroid adenoma and suspicious incidental thyroid carcinoma. Therefore, the patient underwent total parathyroidectomy and thyroidectomy. The histopathological diagnosis was parathyroid carcinoma coexisting with multiple parathyroid adenomas. There was no evidence of recurrence at 1 year after the surgery. It was difficult to diagnose PC preoperatively. Few rare cases of PC coexisting with parathyroid adenoma in multiple endocrine neoplasia type 1 (MEN1) have been reported. Therefore, careful follow-up was necessary considering the possibility of MEN1, though she did not wish for a genetic examination.

Piriform sinus fistula (PSF) is a rare branchial anomaly that causes repetitive acute suppurative thyroiditis or deep neck abscess. The definitive treatment of PSF is open neck surgery. However, such surgery has a cosmetic problem and a high risk of recurrence. Furthermore, identifying the fistula is difficult due to previous repetitive infections. We report a case of esophageal submucosal abscess caused by PSF treated with endoscopic mucosal incision. The patient underwent transoral video laryngoscopic surgery (TOVS), and endoscopy as well as fluoroscopy revealed complete closure of PSF without any complication. TOVS is a novel surgical technique for the definitive treatment of PSF with esophageal submucosal abscess.

A 49-year-old man noticed a resting tremor in his right hand and was diagnosed with Parkinson's disease (PD) at the age of 43. Soon thereafter, he noticed a right neck mass that only appeared when he swallowed and was accompanied by an uncomfortable sensation. At the age of 49, he was admitted to our hospital to adjust his medication for PD and to examine the neck mass. The subcutaneous mass was round, soft, and approximately 3 cm in diameter. The symptoms in his neck showed no progression. Resting tremors and rigidity due to his PD were predominantly observed on his right side, but his postural reflex was intact. Cervical echogram revealed that the mass was the belly of the OM itself. Thus, the patient was diagnosed with omohyoid muscle syndrome (OMS). It can be surmised that some susceptibility of the OM itself and/or structural fragility in the surrounding tissues would be involved in the pathogenesis of OMS. In this case, considering that OMS occurred soon after symptoms of PD appeared, we speculated that muscle tone abnormalities due to PD played a role in the development of OMS.

A case of transitional cell carcinoma (TCC) of the frontal sinus is reported. An 83-year-old man complained of left exophthalmos and nasal obstruction. On examination, the nasal cavity was blocked with a polypoid swelling. Computed tomography and magnetic resonance imaging demonstrated tumor in the frontal sinus and mucocele in the paranasal sinus. The mass in the left frontal sinus was excised and diagnosed as TCC. The treatment was performed by a linear accelerator. The prescribed dose was 70Gy. Irradiation was performed without effect, and the patient died 1 year later. Previous reports of TCC in the paranasal sinus are reviewed and discussed.

Innominate artery fistulas require a surgical procedure, although the prognosis is usually very poor because of complications such as re-bleeding and infection. A 50-year-old man presented with laryngeal carcinosarcoma (T1a, N0, M0). Partial laryngectomy was performed but there was a recurrence; therefore, total laryngectomy, total thyroidectomy, right radical neck dissection, left functional neck dissection, skin-combined resection and D-P flap were performed. On postoperative day 6, after intense coughing, copious hemorrhage from the tracheostoma was demonstrated. Immediately, bleeding was arrested by pressing the tracheostoma. Fistula of the innominate artery was then repaired using left great saphenous vein, but recurrent perforation of the innominate artery developed. Therefore, innominate artery transection and omentopexy were performed. These results demonstrate that in cases of trachea-innominate artery fistula, innominate artery transection should be performed first.

We reported a rare case of perforation of the piriform sinus caused by gastroenterological endoscopy examination, leding to deep cervical abscess. The patient was a 56-year-old man who complained of dyspnea, high-grade fever and neck pain after gastroenterological endoscopy examination. Computed tomography revealed a deep cervical abscess and obstruction of the airway. We immediately, performed drain-age under general anesthesia, and found a perforation at the piriform sinus. He was treated with frequent wound washing and the daily intravenously instillation of antibiotics for anaerobic bacteria, and was discharged 31 days after the operation. Early diagnosis and operation are important for the management of deep cervical abscess.

From January 1990 to December 1999, we treated twelve patients with cervical lymph node tuberculosis. The diagnosis was confirmed by histopathological findings of biopsy, 10 cases by resection of lymph node, 1 case by fine needle aspiration biopsy and 1 case was diagnosed following resection of lymph node at another hospital. After diagnosis, all patients received antituberculous chemotherapy and one patient with pocket formation underwent total resection of neck masses with infectious skin. Four cases were lost to follow-up, but the others showed good response and had no recurrence.Tuberculosis is an important infectious disease demanding constant attention because of the possibility of herd infection. We should consider tuberculosis when cervical lymph node swelling is seen, and early diagnosis and treatment are needed to prevent the spread of infection to others. Antituberculous chemotherapy is effective, however, when pocket and abscess formation occur, combination therapy of chemotherapy and operation such as neck dissection are needed in early course.

Hearing loss is a rare complication of mumps infection, however improvement of mumps-related deafness is difficult. In Japan, immunization against mumps is not required and mumps-related deafness is thought to have increased.We encountered three cases of unilateral sensorineural hearing loss due to mumps infection. The diagnosis was based on criteria determined by the Acute Profound Deafness Committee in Japan. All cases were treated for sudden deafness with routine steroid therapy.Case 1 was a 5-year-old boy. He was diagnosed as having mumps-associated hearing loss and his hearing improved. Case 2 was a 27-year-old woman, diagnosed as having mumps-related deafness and her hearing was not improved by therapy. Case 3 was a 43-year-old man, diagnosed as having mumps-associated deafness, but his hearing was not improved with therapy.Sensorineural hearing loss due to mumps infection is considered difficult to recover. However, some cases showing improvement have been reported such as our case 1. Early diagnosis and therapy are thought to be needed. Immunization against mumps should be required from the perspective of preserving hearing.

We previously reported that dietary glucosylceramides show cancer-prevention activity in a mouse xenograft model of human head and neck cancer cells (SCCKN). However, the mechanism was unclear. Ceramides, metabolites of glucosylceramides, induce apoptotic cell death in various malignancies. Here, we investigated the inhibitory effects of dietary glucosylceramides on tumor growth in vivo and in vitro. SCCKN were subcutaneously inoculated into the right flanks of NOD/SCID mice. Mice were treated with or without dietary glucosylceramides (300 mg/kg) daily for 14 consecutive days after confirmation of tumor progression. Microvessel areas around the tumor were assessed by hematoxylin–eosin staining and immunohistochemistry of CD31, and, as markers for angiogenesis, protein levels of VEGF, VEGF receptor-2, and HIF-1α were assessed by Western blotting. Mass spectrometry was performed to measure the levels of sphingolipids in mouse serum after treatment with dietary glucosylceramides. Oral administration of glucosylceramides significantly decreased SCCKN growth in the xenograft model with inhibition of angioinvasion. In tumor-invasive areas, VEGF and HIF-1α in the tumor cells, and VEGF receptor-2 in endothelial cells decreased after treatment with dietary glucosylceramides. Dietary glucosylceramides increased serum levels of sphingosine-based ceramides as compared to the control. In SCCKN and UV♀2 cells, C6-ceramide suppressed the expressions of VEGF, VEGF receptor-2, and HIF-1α in vitro. These results suggest that dietary glucosylceramides trigger the de novo pathway of ceramide synthesis, indicating that sphingosine-based ceramide suppresses the growth of head and neck tumors through the inhibition of pro-angiogenic signals such as VEGF, VEGF receptor-2, and HIF-1α.

It is important to know whether a parotid gland lesion is in the superficial or deep lobe for preoperative planning. We aimed to investigate the ability of 3.0 T magnetic resonance (MR) imaging with surface coils to identify the intraparotid facial nerve and locate parotid gland lesions, in comparison to other indirect landmark methods.We retrospectively evaluated 50 consecutive patients with primary parotid gland lesions. The position of the facial nerve was determined by tracing the nerve in the stylomastoid foramen and then following it on sequential MR sections through the parotid gland. The retromandibular vein and the facial nerve line (FN line) were also identified. For each radiologist and each method, we determined the diagnostic ability for deep lobe lesions and superficial lobe lesions, as well as accuracy. These abilities were compared among the three methods using the Chi-square test with Yates' correction.Mean diagnostic ability for deep lobe lesions, the diagnostic ability for superficial lobe lesions, and accuracy were 92%, 86%, 87%, respectively, for the direct identification method; 67%, 89%, 86%, respectively, for the retromandibular vein method; and 25%, 99%, 90% , respectively, for the FN line method. The direct identification method had significantly higher diagnostic ability for deep lesions than the FN line method (P 0.01), but significantly lower diagnostic ability for superficial lobe lesions than the FN line method (P 0.01).Direct identification of the intraparotid facial nerve enables parotid gland lesions to be correctly located, particularly those in the deep lobes.

Background The reflex cough test is useful for detecting silent aspiration, a risk factor for aspiration pneumonia. However, assessing the risk of aspiration pneumonia requires measuring not only the cough reflex but also cough strength. Currently, no reflex cough testing device is available that can directly measure reflex cough strength. We therefore developed a new testing device that can easily and simultaneously measure cough strength and the time until the cough reflex, and verified whether screening with this new instrument is feasible for evaluating the risk of aspiration pneumonia. Methods This device consists of a special pipe with a double lumen, a nebulizer, and an electronic spirometer. We used a solution of prescription-grade L-tartaric acid to initiate the cough reflex. The solution was inhaled through a mouthpiece as a microaerosol produced by an ultrasonic nebulizer. The peak cough flow (PCF) of the induced cough was measured with the spirometer. The 70 patients who participated in this study comprised 49 patients without a history of pneumonia (group A), 21 patients with a history of pneumonia (group B), and 10 healthy volunteers (control group). Results With the novel device, PCF and time until cough reflex could be measured without adverse effects. The PCF values were 118.3 ± 64.0 L/min, 47.7 ± 38.5 L/min, and 254.9 ± 83.8 L/min in group A, group B, and the control group, respectively. The PCF of group B was significantly lower than that of group A and the control group (p