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ObjectiveThis study aimed to clarify whether circulating miR-21 represents a predictive biomarker in patients with head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy, and to investigate the effect of miR-21 inhibitor for chemoradiation in human SCC cells.MethodsPlasma samples were obtained from 22 patients with HNSCC and 25 non-cancer volunteers. Plasma miR-21 expression was measured using real-time quantitative reverse transcription polymerase chain reaction. The effects of miR-21 inhibitor in human SCC cells were investigated by performing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, flow cytometry, and Western blot analysis.ResultsPlasma miR-21 expression was higher in HNSCC patients than in control patients (p< 0.001). Seven patients with recurrence showed significantly higher plasma miR-21 than the 15 patients without recurrence. Moreover, miR-21 inhibition significantly enhanced cisplatin- or radiation-induced apoptosis. Western blot analysis suggested the programmed cell death 4 (PDCD4) protein as a potential target of miR-21 in relation to apoptosis. Adding miR-21 inhibition to radiation or cisplatin treatment provided clear and potent suppression of tumor cell proliferation.ConclusionThis study provides new insights into the role of miR-21 as a predictive biomarker for HNSCC treated with chemoradiotherapy, and suggests a potential target to improve the effects of chemoradiotherapy against HNSCC.

Background To assess the effects of Epstein–Barr virus (EBV) and human papillomavirus (HPV) infection on the tumor microenvironment, we examined the relationship between viral infection status, macrophage migration inhibitory factor (MIF), and tumor-associated macrophages in nasopharyngeal carcinoma (NPC). Methods A tissue microarray containing 150 cores from 90 patients with NPC and six with chronic inflammation was used. EBV and HPV status were detected using in situ hybridization with commercial EBER1 and HPV16/18 probes. Immunofluorescence double staining of MIF, pan-macrophage marker CD68, M1 macrophage marker CD11c, and M2 macrophage marker CD163 were analyzed using the same tissue microarray. The levels of these markers between NPC and inflammation cases and between tumor nests and stroma were compared. Correlations among these markers were analyzed. Results We found EBER1(+) cases in 90% of NPC patients, including 10% EBV/HPV co-infection. M1 macrophages mainly infiltrated the tumor nest, while M2 macrophages infiltrated the tumor stroma. We found a significant positive correlation between EBER1 levels and MIF levels in tumor nests and a significant positive correlation between HPV16/18 and CD11c(+) cell levels in NPC tissues. Conclusions It is suggested that MIF is associated with EBV, and M1 macrophage infiltration is affected by HPV status in NPC.

To elucidate the molecular mechanisms underlying the progression of head and neck squamous cell carcinoma (HNSCC), we investigated the function of let-7c as a tumor suppressor. Let-7c expression was significantly down-regulated in HNSCC tumor tissues and cell lines. In vitro and in vivo studies revealed that let-7c negatively regulated HNSCC proliferation, migration and epithelial-mesenchymal transition (EMT). To explore the underlying mechanisms that affect these molecular events achieved by let-7c, we predicted its target genes. We performed luciferase assay and confirmed that insulin-like growth factor 1 receptor (IGF1R) and high mobility group AT-hook 2 (HMGA2) were the direct targets of let-7c. Knocking down of IGF1R and HMGA2 inhibited HNSCC progression, including proliferation, migration and EMT in HNSCC cells. Re-expression of these genes overcame let-7c-mediated inhibition. Taken together, our finding suggests that let-7c inhibits HNSCC progression by targeting IGF1R and HMGA2 and might be a novel target for HNSCC treatment.

To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5-96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

The present study aimed to clarify the incidence and clinical outcomes of nasopharyngeal carcinoma (NPC) in the Chubu region of Japan from 2006 to 2015, compared with previous reports. A retrospective analysis was conducted based on medical records from 40 hospitals located in the Chubu region in the central Japanese main island, with a population of around 22.66 million individuals. This study was designed in line with to two previous clinical studies into NPC conducted in the same area of Japan. We recruited NPC patients diagnosed in hospitals across this area over a 10-year period (2006&ndash, 2015) using a questionnaire about sex, age, primary site, clinical symptoms, pathology, Union for International Cancer Control (UICC) staging, serological exam, treatment, and survival. A total of 620 NPC patients were identified. The age-standardized incidence of NPC from 2006 to 2015 was 0.27 per 100,000 individuals per year. There were no significant differences between this study and the previous two studies conducted in the same area of Japan. The five-year overall survival rate for all patients was 75.9%, while those for patients with stages I, II, III, and IVA were 97%, 91%, 79%, and 68%, respectively. The age-standardized annual incidence of NPC in the present study was 0.27 per 100,000 individuals per year, which was relatively low and stable. The five-year overall survival rate for all NPC patients was significantly improved in this decade compared with previous studies. The smoking rates in male and female NPC patients were 64.5% and 18.8%, respectively, thereby suggesting the involvement of smoking in the incidence of NPC.

The aim of the study is to investigate plasma miR-21 for a possible therapeutic effect determination marker in head and neck squamous cell carcinoma (HNSCC). Plasma samples are obtained from 86 HNSCC patients and 29 non-cancer volunteers who had been treated at Mie University Hospital between May 2015 and December 2016, and plasma miR-21 expression was measured using real-time quantitative reverse transcription polymerase chain reaction. In addition, plasma miR-21 level of advanced HNSCC patients including 22 non-recurrent cases and 11 recurrent cases before and after treatment was analyzed using a longitudinal design. Plasma miR-21 expression in 86 HNSCC patients was obviously higher than in 29 control patients (P < 0.0001). The area under the curve (AUC) for plasma miR-21 was 0.756 (95% confidence interval: 0.661-0.851). Furthermore, our longitudinal study of plasma miR-21 showed that the expression level of plasma miR-21 was significantly reduced at the time point of 2 months after treatment in case of no recurrence. On the other hand, plasma miR-21 was not decreased after treatment in case of 10 patients who had developed recurrences during the follow-up period. This study may provide new insights into the role of plasma miR-21 as a biomarker for HNSCC, and plasma miR-21 would be useful for early detection of tumor recurrence after operation or chemoradiotherapy.

Primary ciliary dyskinesia (PCD) is a genetic disease inherited in an autosomal recessive manner. The prevalence of PCD is estimated to be 1 in 20,000 live births. Congenital abnormality of the primary cilia results in situs inversus in 50% of patients. Decreased function of motile cilia causes chronic rhinosinusitis, otitis media with effusion, bronchiectasis and infertility. Cases with situs inversus are considered to show "Kartagener's syndrome", and diagnosis is not difficult. However, in cases without situs inversus, the diagnosis is much more troublesome. PCD without situs inversus is thus probably underdiagnosed. Prolonged chronic cough represents an important symptom that is seen in most patients. The diagnosis of PCD requires the presence of the characteristic clinical phenotypes and either: (1) specific ciliary ultrastructural defects identified by transmission electron microscopy in biopsy samples of respiratory epithelium; or (2) identification of mutation in one of the genes known to be associated with PCD. Nasal nitric oxide concentration is extremely low in PCD, and this could be useful for screening of the disease. At present, no fundamental therapies are available for PCD. Diagnosis in the early stages is important to prevent progression of bronchiectasis and deterioration of lung function by guidance for daily life, immunization, cessation of smoking and prompt therapy at the time of respiratory tract infection. Since PCD is inherited in an autosomal-recessive manner, genetic counseling is necessary after definite diagnosis.

Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Physical examination revealed swollen areas in the posterolateral pharyngeal wall and on the external left side of the neck. Computed tomography imaging showed a left-sided mass that was filled with air and fluid. Eventually, the pyriform sinus cyst and the entire fistulous tract were excised. The postoperative course was uneventful. Follow-up after 18 months showed no recurrence.

Circulating microRNAs (miRNAs) are emerging as promising non-invasive biomarkers for human cancer. Head and neck squamous cell carcinoma (HNSCC) is a prevalent malignancy worldwide, but its overall survival has remained unchanged in the past 3 decades. Biomarkers for evaluating efficacy of cancer therapy are urgently needed. To explore circulating miRNAs as cancer therapy biomarkers, we initially identified that 8 miRNAs were distinctly dysregulated in cancerous tissues compared with adjacent non-cancerous counterparts from 16 patients, using microarray and real-time PCR. Based on this discovery, the comparison study was performed between pre- and 6 months post-operative paired plasma samples on 9 patients. MiR-99a, which was down-regulated in cancerous tissues, was significantly increased in plasma after operation. Meanwhile, oncomiR miR-21 and miR-223 that were up-regulated in cancerous tissues, were significantly reduced in post-operative plasma samples. We firstly report the significant changes of miR-99a in plasma of HNSCC patients after surgery. Furthermore, plasma miR-223 was inversely increased in a patient whose cancer relapsed within 6 months after operation. We conclude that these circulating miRNAs may serve as biomarkers to evaluate the efficacy of therapy and the prognosis of HNSCC.

We report a case of papillary carcinoma of the thyroid gland and cervical lymph node metastases with concurrent tuberculous lymphadenitis that was diagnosed preoperatively. A 35-year-old woman presented with multiple lymph node swellings and an anterior neck mass. No findings suggesting the coexistence of pulmonary tuberculosis were present. The patient underwent a total thyroidectomy with bilateral neck dissection together with medication. Measures to prevent tuberculosis were undertaken during the perioperative period. The histopathological diagnosis was papillary carcinoma with both metastatic and tuberculous lymphadenitis of the lymph nodes in the neck. The possible coexistence of tuberculous lymphadenitis must be ruled out when lymph node swellings are observed in patients with head and neck cancer, including thyroid carcinoma.

We investigated whether IL-33 is involved in mucus overproduction and goblet cell hyperplasia in eosinophilic chronic rhinosinusitis (ECRS). IL-33 mRNA was significantly higher in the eosinophilic CRS group than in the non-eosinophilic CRS group from human nasal polyps. IL-33 induced MUC5AC mRNA and MUC5AC protein, and also goblet cell hyperplasia at air liquid interface culture in human nasal epithelial cells. In addition to that, IL-33 induced MUC5B and FOXA3, and reduces FOXJmRNA. In conclusion, our present study demonstrated that the direct evidence of IL-33 which lead to increase mucin gene and protein expression, as well as goblet cell hyperplasia. This study provides novel insights into the role of IL-33 on mucus overproduction in eosinophilic inflammation of human airways.

Cetuximab is remarkable for the relatively high rate and severity of hypersensitivity reactions (HR) being reported in the literature. Screening for cetuximab‐specific IgE in serum via immunoassay has been found to be useful in preventing HR; however, these tests are known to have a low positive predictive rate. In an attempt to remedy this, we evaluated the interaction between cetuximab and IgE on basophils for predicting severe cetuximab‐induced HR. Twelve head and neck cancer patients were enrolled in this single‐institution study: four with a history of cetuximab‐induced HR and eight with no such history. Cetuximab‐specific and galactose‐α‐1,3‐galactose (α‐gal) specific IgEs in serum were measured in vitro using an enzyme‐linked immunosorbent assay (ELISA). IgE‐cetuximab binding on basophils was also analyzed to evaluate the decrease in cetuximab molecules on basophils after dissociation of IgE from FcεRI. The positive predictive value associated with the presence of cetuximab‐ or α‐gal‐specific IgE in serum was found to be only 0.67, whereas the negative predictive value was 1.00. On the other hand, in all four patients who developed HR, the cetuximab molecules on basophils were decreased significantly due to the dissociation of IgE from basophils (P

重度誤嚥で苦しむ2症例に対し，鹿野らにより修正された声門閉鎖術を行った。甲状軟骨ならびに輪状軟骨を鉗除した後に正中にて喉頭内腔に侵入し視野を展開した。その後，上下声帯粘膜弁ならびに胸骨舌骨筋弁を用いて声門閉鎖を行った。この術式はこの2症例に対し成功し，かつ術後経過も良好であった。結論として，成人の嚥下性肺炎の治療としては，本術式は効果的でリスクも少ないと思われた。

Background/Aims: Long-term macrolide therapy is an effective treatment for chronic sinusitis and diffuse panbronchiolitis. However, long-term use of macrolides may promote the growth of drug-resistant bacteria; therefore, development of macrolides with no antibacterial action is desirable. A new erythromycin (EM) derivative, (8R,9S)- 8,9-dihydro-6,9-epoxy-8,9-anhydropseudoerythromycin A (EM900), does not possess antibacterial action. Methods: To determine whether EM900 induced a clinically relevant anti-inflammatory response and repressed mucin gene expression in cells derived from human airway epithelia, we assessed the effects of EM900 on IL-1β-induced inflammatory cytokines in A549 cells and MUC5AC gene expression in HM3-MUC5AC cells. We also investigated the effects of EM900 on IL-1β-induced NF-ĸB activation. We performed reporter gene assays and quantitative PCR in A549 and HM3-MUC5AC cells. Results: Both EM and EM900 suppressed IL-1β-induced IL-8 expression in A549 cells. EM900 also suppressed IL-1β-induced IL-1β and TNF-α expression in A549 cells. EM900 inhibited IL-1β-induced MUC5AC expression in HM3-MUC5AC cells. Both EM and EM900 suppressed IL-1β-induced NF-ĸB activation in A549 cells. Conclusion: This study demonstrated that EM900 suppressed the induction of inflammatory cytokines and MUC5AC gene expression in cells derived from human airway epithelia, and our findings indicate that these effects may be mediated by the suppression of NF-ĸB activation.

Head and neck cancer is frequently accompanied with other primary cancers, especially esophageal cancer. Among 337 cases with head and neck cancers treated at Mie University Hospital from January 2001 to December 2005, 31 cases (9.2%) had multiple cancers. Oropharyngeal cancer and hypopharyngeal cancer cases showed esophageal cancer significantly more frequently than other head and neck cancer cases (25.0-26.7%). Brinkman's index was significantly higher in the group with cancer of the oropharynx associated with esophageal cancer than in the group without any other primary cancer. Sake index was significantly higher in the group with cancer of the oropharynx or hypopharinx associated with esophageal cancer than in the group without any other primary cancer. Endoscopic examinations should be routinely performed after the treatment of head and neck cancer.

A retrospective clinical study was conducted involving 143 patients with laryngeal cancer treated in our department between 1998 and 2006. The subjects consisted of 138 males and 5 females, with a ratio of 28:1. The mean age was 68.1 years old. The subsite of origin comprised 78 (54.5%) in the glottis, 61 (42.7%) in the supraglottis, and 4 (2.8%) in the subglottis. The clinical stage according to the 1997 UICC TMN classification system was I in 53 cases (37.1%), II in 34 (23.8%), III in 20 (14.0%), and IV in 36 (25.2%). The 5-year overall survival rate was 71.2% in the total cases, 84.4% in stage I, 89.6% in stage II, 51.2% in stage III, and 38.9% in stage IV. The disease-specific 5-year survival rate was 88.3% in the total cases, 75.5% in the supraglottic type, 98.1% in the glottic type, and 100% in the subglottic type. The preservation rate of the larynx at 5 years was 83.3% in T1, 56.5% in T2, and 0% in T3 and T4.

Fish bones as a foreign body are often present in the palatine tonsil and the base of the tongue. Such foreign bodies can often be diagnosed with inspection only. However, it is difficult to diagnose and extirpate a foreign body when it is buried in the oral/pharyngeal mucosa. We experienced a case of a fish bone foreign body buried in the tongue muscle layer. We report herein on the case of a 49-year-old man with a fish bone foreign body buried in his tongue. The patient had noticed a sore throat since eating a sea bream and was referred to our department. Visual inspection revealed no foreign body, but CT imaging revealed a fish bone in the tongue. We performed an emergency surgical exploration of tongue to locate the fish bone. Because the fish bone as a foreign body was unable to be confirmed by palpation, we identified the location of the fish bone by intraoperative CT. This is a rare case of a fish bone buried in the tongue muscle layer, and intraoperative CT was useful in identifying the positon of the foreign body.

甲状腺癌手術において反回神経麻痺は可及的に避けねばならない合併症であるが, 時に, 癌の浸潤のために反回神経を犠牲にせざるをえない場合がある。一側の反回神経麻痺は致命的ではないが, 患者の苦痛は深刻である。正常な声帯の可動性が再獲得できないことから, 従来から神経の再建は必要ないとされてきたが, 声帯の萎縮防止と発声時に声帯が緊張するため, 音声は良好である。今回, 反回神経の即時再建を13例に施行した。神経間移植が5例, 頸神経ワナ-反回神経吻合が8例に行われた。声帯の可動性は全例で認められなかった。MPTが9例において正常に, 呼気流量 (VC/MPT) が11例において正常範囲に復帰した。一方で, 非再建群では, MPT, VC/MPTとも正常化したものはなかった。MPT, VC/MPTによる音声機能評価では, 神経の即時再建は有用であると言える。

Background Pendred's syndrome (PS) is an autosomal recessive disorder characterized by goiter and congenital sensorineural hearing loss. Recent advances in molecular biology revealed the gene responsible for PS (PDS) and provided an important aid for the diagnosis of this condition. Methods A case of PS with huge goiter and congenital hearing impairment was diagnosed by mutational analysis of the PDS gene. Results Physical examination and computer tomography CT revealed a diffuse swelling of the thyroid gland. Thyroid function tests were normal, and the perchlorate discharge test was negative. Audiologic examination confirmed sensorineural hearing loss, and temporal bone CT revealed bilateral enlarged vestibular aqueducts. The mutational analysis revealed that the patient was homozygous for His 723 Arg (2168AG) in exon 19, a missense mutation. Conclusions The results of thyroid function tests in PS patients are usually normal, and the positive perchlorate discharge test has been used for the diagnosis. However, this is a nonspecific test and is not sensitive enough for PS. In our case, despite a negative perchlorate test, the patient was diagnosed by mutational analysis and received total thyroidectomy to relieve respiratory distress caused by thyroid enlargement. This is the first report of a mutation detected in the thyroid tissue and clearly shows that the mutation caused histopathologic change in that gland. © 2002 Wiley Periodicals, Inc.

1989年から1999年の早期頭頸部癌に対する根治照射後に, 遅発性気道狭窄をきたした7例を検討した。対象は54歳から77歳の男性6例, 女性1例であった。内訳は喉頭癌声門型T1a, T1b各1例, T2; 3例, 声門下T2; 1例, 原発不明癌1例であった。照射終了からの期間は3ケ月から3年11ケ月 (中央値7ケ月) であった。線源はすべて60Coで, ライナックは1例もなかった。照射線量は60Gy3例, 70Gy4例であった。1例は1側の声帯運動障害を伴い計4回の再燃を来たした。3例で気管切開を行い, 両側声帯運動障害が主因であった。同期間に根治照射をした喉頭癌90例をコントロールとして, 背景, 治療方法, 粘膜反応性を比較した。その結果, 照射線源 (60Co), 線量, 頸部手術, 使用鎮痛薬と使用時期, 粘膜炎の出現時期, 照射中の喉頭浮腫が危険因子としてあげられ, 特に照射中の粘膜炎の出現時期と程度が重要と考えられた。

最近24年間に当科にて治療を行った頭頸部腺様嚢胞癌40例を対象として, 累積生存率, 病期別, 原発部位別, 組織型別, 放射線治療の有無, 遠隔転移の有無についてそれぞれ検討を加えた。結果は5年及び10年生存率はそれぞれ74.8%と47.4%であった。病期別では stage III-IVは stage I-IIに比して有意に予後不良であった。原発部位別では上顎・鼻副鼻腔が他部位にして予後不良であった。放射線治療併用の有無, 遠隔転移の有無で予後については統計学的に有意差は認められなかった。遠隔転移例で手術可能例はその他の群に比して有意に予後が改善された。結論は1) 上顎や鼻副鼻腔は手術時に十分な切除がされていない場合が多く, より拡大切除が望まれた。2) 放射線による予後改善までは認められなかった。3) 遠隔転移例でも可能であれば手術を考慮すべきである。

The patient was an 82-year-old female with a swelling at the left side of the soft palate. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large cystic tumor in the left parapharyngeal space. The cystic tumor was removed via a cervical approach with mandibulotomy (mandibular swing approach). Postoperative histological examination revealed a pleomorphic adenoma with cystic formation.Pleomorphic adenoma with large cystic formation is rare in the parapharyngeal space and a differential diagnosis includes branchial cleft cyst, abcess, cystic hygroma, metastatic lymph node with central necrosis and aneurysm. CT and MRI are essential for diagnosis and provide information on the size and location of the tumor. There are several possible approaches to tumors in the parapharyngeal space: transoral excision, cervical approach with or without mandibulotomy and transparotid approach. It is preferable to perform a mandibular swing approach for the removal of the large tumor in the parapharyngeal space.

One hundred fifty patients have been tracheostomised in the past five years at Yamada Red Cross Hospital. Of these 150 patients, 90 were proposed for tracheostomy by other departments, and such cases are on the increase. Thirty-two patients showed indications for tracheostomy in the stenosis of the aero-tract caused by the tumors or mucosal swelling. Prophylactic tracheostomy was performed in 23 cases due to a delayed stenosis of the aero-tract. Emergent tracheostomy was performed in 31 cases, and, of these cases, an incision of the cricothyroid membrane was performed in one case. Though tracheostomies have been performed in many departments, the determination of accurate indications and safe operative techniques for different cases are best assisted when performed by head and neck surgeons.

Frequently, double cancer and distant metastases have been detected by means of therapeutic techniques for head and neck cancers. Between January 1997 and February 1999, we experienced 59 cases of head and neck Squamous cell carcinoma in the department of otolaryngology at the Yamada Red Cross Hospital. Eight patients of 59 (13.6%) had pulmonary metastases and/or primary lung cancers, detected by chest CT scans. However, such lesions in 4 patients of 59 (6.8%) were detected by normal Chest X-rays. Positive correlations were observed between T stage and positive CT scans.CT scanning of the chest is more effective than chest X-ray, and is now used routinely in our department prior to undertaking major head and neck surgery.

Recurrent laryngeal nerve (RLN) paralysis is a major complication after thyroidectomy. Immediate reconstruction of the RLN is proposed in such cases.Four cases underwent concurrent recurrent laryngeal nerve reconstruction at our department between 1997 and 1998.Nerve transfer was performed in three cases and the great auricular nerve and the ansa cervicalis were chosen as nerve grafts. Direct anastomosis of the ansa cervicalis to the peripheral end of the RLN was conducted in one case. Both procedures resulted in a good post-operative status, and hoarseness and mis-swallowing in no cases were observed.The operated-side vocal cords in all cases were observed to be fixated at the paramedian portion, without atrophy. The average maximum phonation time (MPT) was 14.5 seconds, and this was longer than that in cases who had not undergone reconstruction of the recurrent laryngeal nerve (their average MPT was 8.9 seconds).We concluded that an immediate reconstruction of the RLN should be disirable for cases who need a nerve resection in a thyroid operation.

From 1990 through 1998, 143 patients with laryngeal cancer were treated in our department. Of the 143 patients, 94 had glottal, 43 had supraglottal, and 6 had subglottal cancer. The 5-year survival rate in patients with laryngeal cancer was 90.0% for stage I, 81.3% for stage II, 77.9% for stage III, and 42.6% for stage IV. The 5-year survival rate was 86.5% for glottal, 55.9% for supraglottal and 66.7% for subglottal cancer patients. The laryngeal preservation rate was 90.4% for stage I, 60.5% for stage II, 21.4% for stage III and 28.1% for stage IV.A loco-regional recurrence occurred in 24 of 143 patients (16.8%). The salvage rate for these patients was 45.8% (11/24). Six of 11 patients who died of primary disease and nodal failure (including 2 stomal recurrences) had supraglottic stage N carcinoma.In conclusion, laryngeal preservation surgery should be recommended in the early stages of cancer after radiation failure and local recurrence. It is recommended to dissect the anterior compartment including the delphian lymph node, pretracheal, and parathyroidal nodes bilaterally for patients with laryngeal tumors that have significant anterior subglottic extension, tumors arising in the subglottic region, or advanced tumors arising in any region, especially the supraglottis.

The development of preoperative diagnosis for thyroid cancer has restricted the surgical indication for benign thyroid disease, but surgical management should still be performed for hyperthyroidism, enlarged thyroid tumors and so on. Also, it is possible to diagnose for thyroid papillary carcinoma preoperatively, but it is difficult to do so for follicular carcinoma. Therefore, we must operate for some solitary tumor cases in order to rule out the latter type of cancer. In this study, we evaluated the thyroid patients treated in our department and proposed indications for benign solitary thyroid tumor.Between 1989 and 1998, 555 patients with thyroid disease were treated in our department. 204 cases were benign, and 351 showed thyroid malignancy. 185 cases were benign thyroid nodules, and 17 were follicular carcinoma. In this study, the tumors that were large in size were found to be follicular carcinoma more frequently. We concluded that a case with a solitary tumor≥40-50mm should undergo a thyroid operation for the purpose of ruling out follicular carcinoma.

Since we use fine-needle aspiration cytology under ultrasonographic imaging for the diagnosis of thyroid tumors, we can easily detect small thyroid cancers.However, there is a question whether to operate on the small well-differentiated thyroid cancers or not, because the majority of the thyroid cancer have a good prognosis.Therefore, we studied 95 patients with pre-operative T1NO thyroid cancer who had been treated in our department from 1986 to 1996. 35 patients of the 95 had positive nodes (38.9%), 21 had intrathyroidal metastases (22.1%) ; and 7 had extra-thyroidal invasions (7.4%) . Two patients out of these 7 showed an invasion of the trachea that might have had an influence on survival.We feel that surgical treatment is indicated for small thyroid cancer based on.

In the past 4 years, middle ear surgery has been performed on 166 ears. A total of 42 ears operated on by modified type III tympanoplasties, and 19 ears operated on by type IV tympanoplasties were reviewed. The type III tympanoplasty group included 12 ears with cholesteatoma and 20 with chronic otitis media. The type IV tympanoplasty group included 9 cases of cholesteatoma and 5 cases of chronic otitis media. Postoperative hearing results were evaluated, and success rates in hearing results were 81.6% of type III patients, and 66.7% of type IV tympanoplasty patients. Second surgeries were performed on 7 ears previously operated on at other hospitals, and success was observed in 6 ears. In 18 ears, artificial columella (hydroxyapatite) was used for reconstruction of the ossicular chain, and discharge of the columella was observed in only 1 ear. In 21 ears with cholesteatoma and reconstruction of the ossicular chain, residual recurrence of cholesteatoma was observed in 3, but true recurrence of cholesteatoma was not experienced.

Seventy-nine patients with head and neck abscesses were treated at our clinic between 1995 and 1997. Sixty-three cases had a peritonsillar abscess, seven were cases of deep neck infection and nine cases were other sorts of abscesses.Of the seven patients with deep neck infection, two were treated only with chemotherapy and steroids. Surgical drainage was performed in the remaining five patients.For the effective treatment of head and neck abscess, enhanced CT scanning is useful, in addi-tion, prompt surgical drainage of the abscess and therapy with antibiotics for anaerobic pathogens and with steroids for a short period are required.

Malignant lymphoma is a systematic disease which frequently manifests itself first in the head and neck region.Although the diagnosis of a malignant lymphoma is not difficult, the addition of infection in the affected lymphoid tissues makes the histological diagnosis complicated. A prudent evaluation and repeated biopsies are required in cases complicated by infected lymphoid tissues. On the other hand, the administration of antibiotics, drainage and debridement of the affected region are essential for the severe inflammation of the deep neck. We recently experienced a 60-year-old male patient with a malignant lymphoma and severe infection of the neck.Debridement of the infected neck region and subsequent reconstruction of the defect in the neck were performed in this case.A pectoralis major musculocutaneous flap was elevated, passing through the retro-clavicular space, and the defect in the neck was then covered by this flap without any complication.Combined chemotherapy was performed by the medical department, and achieved a complete response.This reconstructive procedure enabled the satisfactory covering of defects in the upper neck region.

Metastasis of thyroid cancer to the sternum is rare. Ablation is the therapy of choice for patients with metastasizing differentiated thyroid cancer, while surgical resection is an option for those with resectable bony metastasis. This report describes a case of a 65-year-old woman with a sternal tumor. The patient was treated by partial sternal resection and sternal reconstruction with new material polypropylene/expanded polytetrafluoroethylene (ePTFE) composite. The postoperative course was uneventful, and she was free of recurrence after 1 year of follow-up. We conclude that surgery should be used to manage solid bony metastasis from thyroid papillary carcinoma. Further more, a polypropylene/ePTFE composite may be useful for sternal reconstruction after thoracotomy.

Osteosarcoma arising from the maxilla is a rare tumor of the head and neck region, accounting for only 6% to 7% of all osteosarcomas. Although therapy for maxillary cancer is well established, that for sarcoma of the maxilla, especially osteosarcoma is less clearly defined. In our department, a case of osteosarcoma arising from the maxilla was treated with surgery and chemo-radiotherapy. Surgery preceded postoperative irradiation with adjuvant intra-arterial chemotherapy. In the literature, surgery is the most readily available form of therapy, whereas radiotherapy and chemotherapy are not commonly used in the treatment of osteosarcoma. The Japanese literature suggests that a combination of chemotherapy and surgery might improve the outcome in cases of osteosarcoma of the maxilla.In cases of osteosarcoma, recurrence at the primary site is common, and the prognosis in these cases is generally poor. Therefore, precise evaluation of the extent of the osteosarcoma is more essential. In our patient, 3-dimension CT was used preoperatively, and proved useful for the evaluation of the extent of disease and the determination of suitable operative procedures.

To clarify long-term outcome of benign paroxysmal positional vertigo (BPPV), 50 patients were followed up for a mean of 52 months. Overall recurrence rate by Kaplan-Meier estimation was 37% at 60 months. The patients with horizontal canal BPPV (n = 19) had a significantly higher recurrence rate (50%) at 60 months than those with posterior canal BPPV (n = 28; 26%). There was no significant association between recurrence rates and sex or age.

This study aims to identify predisposing characteristics of descending necrotizing mediastinitis (DNM) arising from deep neck infection (DNI) and to determine appropriate therapeutic intervention strategies. We retrospectively reviewed 54 patients (male, n = 34; female, n = 20; mean age, 64.5 years) who had been treated at Mie University Hospital for DNI between April 2001 and October 2011. Eight of nine patients who developed DNM confirmed by computed tomography of the neck and chest, underwent mediastinal drainage (video-assisted thoracic surgical drainage, n = 6; mediastinoscopy-assisted drainage, n = 2). A patient developed uncontrolled acute respiratory distress syndrome after aggressive surgery, resulting in a mortality rate of 12 %. High blood CRP values, and the pharynx and tonsils as origins of infection were factors involved in the development of DNM arising from DNI. In conclusion, DNM remains a destructive and fatal disease that requires aggressive treatment including mediastinal exploration.

Summary Streptococcus pneumoniae ( S. pneumoniae ) causes high early mortality in pneumococcal pneumonia, which is characterized by acute lung injury (ALI). The molecular mechanisms underlying ALI and the high early mortality remain unknown. Despite recent studies that identify deubiquitinating enzyme cylindromatosis (CYLD) as a key regulator for T cell development, tumor cell proliferation, and NF-κB transcription factor signaling, its role in regulating bacteria-induced lethality, however, is unknown. Here, we showed that CYLD deficiency protected mice from S. pneumoniae pneumolysin (PLY)-induced ALI and lethality. CYLD was highly induced by PLY, and it inhibited MKK3-p38 kinase-dependent expression of plasminogen activator inhibitor-1 (PAI-1) in lung, thereby potentiating ALI and mortality. Thus, CYLD is detrimental for host survival, thereby indicating a mechanism underlying the high early mortality of pneumococcal pneumonia.

We reported a case of thyroglossal duct cancer, which metastasized to the bilateral cervical lymph nodes. The cervical lymph node metastases were detected in the upper portion of the neck. According to the results obtained in the preoperative fine needle aspiration cytology, the lymph node metastases were classified as group V and a diagnosis of papillary carcinoma was made. The preoperative studies with 123 I revealed no concentration in the submittal tumor. In our surgical procedure, bilateral supraomohyoid neck dissection was added to excision of the tumor. Conclusion: In view of the fact that thyroglossal duct cancer metastasized bilaterally to cervical lymph nodes in the present case, we experienced an extremely rare case.

In our hospital, ultrasonography is performed for patients who come for thyroid cancer screening. Seventy-eight patients with thyroid cancer which was found by such screening were operated on from 1989 to 1998, while 287 patients with thyroid cancer found by other methods were operated on during the same period in our department. The age of the patients at surgery in the screening group was younger than that of the contrast group. In the screening group, 41 (52.6%) patients had small thyroid cancer, a higher rate that in the contrast group. Invasion of surrounding organs by the primary cancer was observed in only one patient (1.3%) in the screening group, a rate of invasion that was statistically lower than that in the contrast group. Twenty-six patients with benign thyroid disease detected in our screening were operated on during the same period. Careful selection of patients who need fine-needle aspiration cytology is demanded of head and neck surgeons, and careful evaluation of indicators is necessary to avoid surgery in the case of benign thyroid disease.

Eosinophilic chronic rhinosinusitis (ECRS) is considered a refractory and intractable disease. Patients with ECRS present with thick mucus production, long-term nasal congestion, loss of sense of smell, and intermittent acute exacerbations secondary to bacterial infections. Despite medical and surgical interventions, there is a high rate of recurrence with significant impairment to quality of life. The recent increasing prevalence of ECRS in south Asian countries and the strong tendency of ECRS to reoccur after surgery should be considered. The majority of cases need repeat surgery, and histological examinations of these cases show eosinophilic-dominant inflammation. The degradation and accumulation of eosinophils, release of cytokines, and mucus secretion have important roles in the pathogenesis of ECRS. ECRS differs from non-ECRS, in which eosinophils are not involved in the pathogenesis of the disease, and also in terms of many clinical characteristics, blood examination and nasal polyp histological findings, clinical features of the disease after surgery, efficacy of medications, and computed tomography findings. This review describes the clinical course, diagnosis, and treatment of ECRS as well as its pathophysiology and the role of eosinophils, mucus, cytokines, and other mediators in the pathogenesis of ECRS.

Anterior craniofacial resection is now recognized as one of the best treatment for nasal and paranasal tumors involving the cribriform plate. This approach allows for a more oncologically sound en bloc tumor removal. Here we report 6 cases of anterior skull base surgery for malignant neoplasms. The mean age was 54.0 years ranging from 30 to 70. There were 5 men and 1 woman. The pathological diagnoses were as follows: squamous cell carcinoma (4), adenocarcinoma (1), and malignant melanoma (1). Three patients required free tissue transfer and anterior skull base was reconstructed using a pericranial flap in 3 patients. Four patients are alive without disease, and two died. Major complications occurred in 1 of 6 patients and that patient developed a cerebellar hemorrhage. Infectious complications occurred in 2 patients. There were no perioperative deaths. We concluded that craniofacial resection is an effective surgical treatment for nasal and paranasal tumors.