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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab.We conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery.The median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutions CONCLUSIONS: Our results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.

Introduction Papillary thyroid carcinoma has a relatively good prognosis among malignant tumors of the thyroid. Therefore, a “wait and see” strategy is often adopted for patients with micropapillary thyroid carcinoma. On the other hand, patients with papillary thyroid carcinoma with N1b or M1 disease are known to show a poor prognosis. Here, we investigated the differences in the characteristics between patients with papillary thyroid microcarcinoma with and without N1b metastatic nodes/distant metastases to identify the risk factors for metastasis. Methods The retrospective study was performed in patients with thyroid microcarcinoma who were treated at the Kobe City Medical Center General Hospital from 2007 to 2017. The characteristics of the patients with thyroid microcarcinoma who were classified as having N1b or M1 disease (N1b/M1 group) were compared with those of patients with the same cancer classified as having N0, N1a, or M0 disease (N0/N1a group). Results A total of 65 patients were enrolled in this study; 12 were classified into the N1b/M1 group and 53 were classified into the N0/N1a group. The proportion of males was significantly higher in the N1b/M1 group than in the N0/N1a group. There were no statistically significant differences in the distribution of the tumor sites, the ultrasonographic findings, or the frequency of the presence of multiple carcinomas. Although three patients died due to other causes, there were no patients who died due to papillary thyroid carcinoma. Conclusion No significant predictors were identified for classifying patients with papillary thyroid microcarcinoma into the N1b/M1 group in this study. However, our findings suggested that male patients with papillary thyroid microcarcinoma require more careful follow-up in comparison to female patients with this cancer.

Background In Japan, there has been a lot of reports showing an association between facial flushing after light alcohol consumption and heterozygosity for inactive aldehyde dehydrogenase-2 (ALDH2). Persons with inactive ALDH2 may have a higher risk of alcohol-related oral, pharyngeal and esophageal cancers, compared with those with wild-type ALDH2. The purpose of this study was to examine whether flushers with oral or pharyngeal squamous cell carcinoma have an increased risk of synchronous or metachronous cancer of the upper gastrointestinal (UGI) tract. Methods A retrospective study was performed by medical chart review and through a questionnaire sent to 285 patients treated for oral and pharyngeal cancer. Responses were obtained from 150 patients (52.6%), who were classified as flushers or non-flushers, smokers (≥20 pack-year; 1 pack-years = number of cigarettes/20 per day) or non-smokers, and drinkers (≥14 units of alcohol consumption per week; 1 unit = 22 g) or non-drinkers. Relationships of these factors with occurrence of second primary cancers (SPCs) in the UGI tract were investigated. Results In Kaplan-Meier analysis, there was a significantly higher rate of SPC at 5 years in flushers and drinkers, but no relationship with smoking. In multivariate analyses, a history of flushing was significantly associated with SPC in the UGI tract (HR 2.64, 95% CI 1.25-5.52, P = 0.0109), but not with smoking or alcohol consumption. Conclusions A simple interview on history of facial flushing after alcohol intake can be useful for identifying patients at high risk for synchronous or metachronous cancers of the UGI tract.

Objectives An effect of audio-visual (AV) integration is observed when the auditory and visual stimuli are incongruent (the McGurk effect). In general, AV integration is helpful especially in subjects wearing hearing aids or cochlear implants (CIs). However, the influence of AV integration on spoken word recognition in individuals with bilateral CIs (Bi-CIs) has not been fully investigated so far. In this study, we investigated AV integration in children with Bi-CIs. Methods The study sample included thirty one prelingually deafened children who underwent sequential bilateral cochlear implantation. We assessed their responses to congruent and incongruent AV stimuli with three CI-listening modes: only the 1st CI, only the 2nd CI, and Bi-CIs. The responses were assessed in the whole group as well as in two sub-groups: a proficient group (syllable intelligibility ≥80% with the 1st CI) and a non-proficient group (syllable intelligibility Results We found evidence of the McGurk effect in each of the three CI-listening modes. AV integration responses were observed in a subset of incongruent AV stimuli, and the patterns observed with the 1st CI and with Bi-CIs were similar. In the proficient group, the responses with the 2nd CI were not significantly different from those with the 1st CI whereas in the non-proficient group the responses with the 2nd CI were driven by visual stimuli more than those with the 1st CI. Conclusion Our results suggested that prelingually deafened Japanese children who underwent sequential bilateral cochlear implantation exhibit AV integration abilities, both in monaural listening as well as in binaural listening. We also observed a higher influence of visual stimuli on speech perception with the 2nd CI in the non-proficient group, suggesting that Bi-CIs listeners with poorer speech recognition rely on visual information more compared to the proficient subjects to compensate for poorer auditory input. Nevertheless, poorer quality auditory input with the 2nd CI did not interfere with AV integration with binaural listening (with Bi-CIs). Overall, the findings of this study might be used to inform future research to identify the best strategies for speech training using AV integration effectively in prelingually deafened children.

The aging Japanese population has led to an increase in the number of accidentally swallowed dentures. Therefore, we report the case of an elderly Japanese woman with dementia who accidentally and sequentially swallowed two dentures. The patient presented to our hospital with a diagnosis of a single impacted denture in her hypopharynx although we subsequently identified a second impacted denture in her rectum after taking a careful clinical history. Open surgery was required to remove the second denture from her rectum. This case highlights the importance of carefully considering the patient’s history if there is a possibility of latent swallowed dentures.

Intersinus septal cells (ISSC) are defined as cells confined to the thin septum separating the frontal sinuses. In 2008, Som et al. first described four cases with a mucocele proved to have arisen in ISSC. Here, we report two cases with a mucocele in ISSC, representing the second report to appear in the English literature. Case 1 involved a mucocele in the center of the frontal lesion with rudimentary bilateral frontal sinuses, which suggested that the ISSC mucocele occurred during very early development of the frontal sinuses. Case 2 concerned a mucocele in the unilocular frontal sinus invading the left orbit. The frontal sinus septum was destroyed with partial ‘Y’-shaped remnants, which implied the ballooning and bursting of the ISSC mucocele into both sides of the frontal sinus. The two different mechanisms of development of the ISSC mucoceles may vary in relation to the time of onset.

To determine the prognostic factors for hearing recovery in patients with sudden sensorineural hearing loss (SSHL) refractory to systemic corticosteroids following salvage treatment.This is a retrospective observational study at nine tertiary referral hospitals. A total of 120 patients with sudden deafness refractory to systemic corticosteroids were enrolled. The patients were randomly assigned to receive topical application of recombinant human IGF-1 or intratympanic injection of dexamethasone as salvage treatment. Multiple regression analysis was performed to identify determinants of hearing recovery using pure tone audiometry results at 8 weeks after treatment. Clinical predictors that were evaluated included age, sex, pretreatment hearing level, presence of vertiginous symptoms, days to study entry from symptom onset and salvage treatment assignment (IGF-1 vs. dexamethasone).The linear regression model identified age (P=0.001), pretreatment hearing level (P0.001), days to study entry from symptom onset (P=0.011) and treatment assignment (P=0.033) at 8 weeks after treatment as significant variables influencing the recovery of pure tone audiometry average thresholds. Younger age (60 years), early initiation of salvage treatment and treatment with topical IGF-1 therapy had significant effects on hearing recovery.The results indicate that early initiation and choice of treatment modalities for salvage treatment may be important for the prognosis of patients with refractory SSHL. The positive effect of topical IGF-1 therapy on hearing recovery indicates its utility as salvage treatment.

To investigate the McGurk effect in profoundly deafened Japanese children with cochlear implants (CI) and in normal-hearing children. This was done to identify how children with profound deafness using CI established audiovisual integration during the speech acquisition period.Twenty-four prelingually deafened children with CI and 12 age-matched normal-hearing children participated in this study. Responses to audiovisual stimuli were compared between deafened and normal-hearing controls. Additionally, responses of the children with CI younger than 6 years of age were compared with those of the children with CI at least 6 years of age at the time of the test.Responses to stimuli combining auditory labials and visual non-labials were significantly different between deafened children with CI and normal-hearing controls (p0.05). Additionally, the McGurk effect tended to be more induced in deafened children older than 6 years of age than in their younger counterparts.The McGurk effect was more significantly induced in prelingually deafened Japanese children with CI than in normal-hearing, age-matched Japanese children. Despite having good speech-perception skills and auditory input through their CI, from early childhood, deafened children may use more visual information in speech perception than normal-hearing children. As children using CI need to communicate based on insufficient speech signals coded by CI, additional activities of higher-order brain function may be necessary to compensate for the incomplete auditory input. This study provided information on the influence of deafness on the development of audiovisual integration related to speech, which could contribute to our further understanding of the strategies used in spoken language communication by prelingually deafened children.

Background The efficacy of posttreatment surveillance 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT was evaluated in patients with head and neck squamous cell carcinoma (HNSCC). Methods The subjects were 158 patients with HNSCC who underwent PET/CT after definitive treatment. PET/CT detection of subclinical recurrence or a second primary cancer and the effect of timing of PET/CT scans on survival were analyzed. Results Recurrence or a second primary cancer occurred in 70 patients, and 67% of these cases were detected by PET/CT. Detection rates were 17%, 9%, 5%, and 5% in the first, second, third, and fourth scans at 4, 9, 15, and 21 months, respectively. In multivariate analysis, patients who underwent early first scans had significantly better disease-specific (hazard ratio [HR] = 0.37; p = .031) and overall (HR = 0.45; p = .040) survival compared with those who underwent late first scans. Conclusion Earlier detection of subclinical lesions by surveillance PET/CT within 4 months after treatment may improve survival in patients with HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E511–E518, 2016

Primary angiosarcoma is a rare disease with a poor prognosis. It most commonly arises in the head and neck region; localization in the deep soft tissue of the neck is extremely rare. We herein present a case of angiosarcoma derived from the right internal jugular vein. A 79-year-old man presented with a 1-month history of a growing right neck mass. Computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, and fine-needle aspiration cytology revealed a malignant tumor of unknown origin. Right neck dissection was performed for both diagnosis and therapy. Immunostaining of the resected tumor cells revealed positivity for CD31, CD34, factor VIII-related antigen, and D2–40, which allowed for a definitive diagnosis of angiosarcoma. Postoperative radiotherapy (66 Gy) was performed on the right neck, including the surgical bed and upper mediastinum. The patient was followed up for 10 months with no recurrence. Only six cases of angiosarcoma arising in the deep soft tissue of the neck have been reported in the English-language literature. The present report is the first to describe angiosarcoma arising from the internal jugular vein.

Mutations of SLC26A4 are associated with incomplete partition type II (IP-II) and isolated enlargement of the vestibular aqueduct (EVA). We experienced a congenitally deaf 6-year-old boy with a rare p.Thr410Met homozygous mutation in SLC26A4 who underwent bilateral cochlear implantation. He had bilateral inner ear malformation, in which the dilated vestibule and EVA were identical to those in IP-II, but the cochlea lacking a bony modiolus resembled that in incomplete partition type I. These results suggest that homozygous mutations in SLC26A4 are always associated with EVA, while the severity of cochlear malformation may vary depending on the type of SLC26A4 mutation.

[Objective]: In a common cavity (CC) deformity, the cochlea and vestibule are confluent to form a single cavity without internal architecture, and distribution of auditory neuronal tissue is unclear. The purposes of this study are to reveal the spatial distribution of auditory neuronal tissue in CC deformity using electrically evoked auditory brainstem response (EABR) during cochlear implantation. [Study Design]: Retrospective case review. [Setting]: Cochlear implant (CI) center at a tertiary referral hospital. [Patients]: Five patients with CC deformity who underwent cochlear implantation and intraoperative EABR testing. [Main Outcome Measures]: Spatial distribution of electrodes that elicited an evoked wave V (eV) in EABR testing was evaluated in each CC deformity. [Results]: Electrically evoked auditory brainstem response testing demonstrated that electrodes attached on the inner wall of the anteroinferior cavity of the CC deformity successfully elicited a reproducible eV in all cases, and the latency of each eV was an approximately 4 ms, which is similar to those reported in patients without an inner ear malformation. Interestingly, in Case 1 with the lowest percentage of eV-positive electrodes (31.8%), CI-aided audiometric thresholds were changed, depending on the frequency allocation to eV-positive electrodes in the programming. Cochlear implant–mediated facial nerve stimulation was observed in 3 of 5 cases, and results of EABR testing were useful for optimizing the device program to decrease facial nerve stimulation without sacrificing CI-mediated auditory performance. [Conclusion]: The results of EABR testing suggested that auditory neuronal elements are distributed to the anteroinferior part of CC deformity, mainly around or near the inner wall of the cavity. In cases with CC deformity, EABR testing is useful to achieve the optimal electrode array placement and to adjust programming parameters of the implanted device, which might be essential to maximize CI outcomes and to decrease facial nerve stimulation.

The solitary fibrous tumor (SFT) is a rare spindle cell neoplasm derived from mesenchymal cells. It sometimes recurs clinically, and is categorized as an 'intermediate malignancy' tumor under the WHO (World Health Organization) classification of soft tissue tumors. Several studies have reported on intraorbital SFTs, but none of them has pointed out the utility of preoperative arterial embolization in the case of an intraorbital SFT. A 75-year-old man, who had received a dacryocystectomy for a benign tumor in the right lacrimal sac 30 years previously, visited our hospital complaining of lower eyelid swelling and lachrymation that had persisted for a year. CT and MRI revealed an intraorbital lesion, and the open biopsy specimen showed dense growth of spindle cells, which turned out to be an SFT by immunohistochemistry based on the findings. After preoperative embolization of the infraorbital artery, we removed the tumor with a skin incision on the lower rim of the orbit with little bleeding. The surgical specimen revealed that the tumor was close to a lacrimal canaliculus, which suggested the tumor originated from the lacrimal apparatus considering the patient's past history. He was followed up for three months without recurrences.

The extent of middle ear aeration before second-stage canal wall-down (CWD) tympanoplasty was correlated with postoperative middle ear stability.To evaluate middle ear aeration before second-stage CWD tympanoplasty as a predictor of postoperative re-aeration potential and external auditory canal (EAC) stability in staged CWD tympanoplasty with soft-wall reconstruction (SWR).Middle ear aeration was evaluated before and at 1 year after the second-stage operation in patients who underwent staged CWD tympanoplasty with SWR for middle ear cholesteatoma. Based on the computed tomography (CT) findings, middle ear aeration was graded as A when the mastoid and tympanic cavities were aerated, B when only the tympanic cavity was aerated, and C in cases with no aeration in the tympanic cavity. We also examined postoperative EAC stability.Forty-one ears were included. In all, 17 of 19 ears (89.5%) with grade A aeration preoperatively maintained grade A aeration postoperatively, while 5 of 18 ears (27.8%) with grade B aeration had grade A aeration, and no ear with grade C aeration had recovered grade A aeration. All ears with grade A aeration preoperatively maintained smooth EACs. EAC retraction requiring additional treatment occurred in five ears with grade B aeration and all ears with grade C aeration.

Patients with Wegener's granulomatosis (WG) often suffer from hearing loss, but its precise mechanisms have not been well understood. We experienced 3 WG cases whose initial symptoms were bilateral progressive mixed (both conductive and sensorineural) hearing loss, followed by systemic symptoms one year later. They were diagnosed as WG based on positive serology of anti-neutrophil cytoplasmic antibodies (ANCAs) and pathologic findings of affected lesions in addition to systemic symptoms. Although they were different in the type of ANCAs and systemic lesions, all showed considerably reversible cochlear disorders with normal vestibular functions. Moreover, their initial otologic manifestations shared same characteristic features, (1) thick ear drums with pulsatile serous intratympanic effusion, (2) poor speech discrimination ability, and (3) steroid-dependent changes of hearing levels (HLs). They exhibited no significant vestibular abnormalities in chair vestibule-ocular reflex (VOR) testing and cold air caloric tests even when they had severe hearing loss. On the basis of these results, we hypothesized that vasculitis of stria vascularis which generates endocochlear potential might cause these reversible cochlear-specific dysfunctions.

Cochlear implantation was effective for deaf children with congenital cytomegalovirus (CMV) infection, but their cochlear implant (CI) outcomes were often impaired, depending on the types of CMV-associated psycho-neurological disorders. Evaluation of cognitive development and autistic tendency of implantees might be useful to predict their CI outcomes.To reveal the influence of CMV-associated psycho-neurological disorders on CI outcomes.This was a retrospective evaluation of 11 implantees with congenital CMV infection (CMV-CIs) and 14 implantees with autosomal recessive hearing loss (genetic-CIs).Nine of 11 CMV-CIs suffered from psycho-neurological disorders; one from attention deficit hyperactivity disorder, two from pervasive developmental disorder, and six from mental retardation. Aided hearing thresholds with CIs in the two groups did not differ, but two autistic and two mentally retarded CMV-CIs showed significantly low scores in speech discrimination tests. Language-Social (L-S) developmental quotients (DQs) evaluated by the Kyoto Scale of Psychological development were improved after the implantation in both groups, but the postoperative increase of L-S DQs was significantly smaller in the CMV-CIs than that of genetic-CIs. Interestingly, the postoperative L-S and Cognitive-Adaptive (C-A) DQs showed statistically significant correlation in all cases except for two autistic CMV-CIs whose L-S DQs were much lower than those expected from their C-A DQs.

We retrospectively analyzed 26 ears of 21 subjects having auditory ossicular malformation and who had undergone auditory reconstruction between April 2004 and December 2010 at our clinic. We checked preoperative condition, pathological classification, surgical procedure, and hearing improvement. We could predict pathological conditions precisely from preoperative computed tomography (CT), including incudostapedial disconnection (9/12, 75%) and malleus and/or incus fixation (7/12, 58%), which tended to be present in external ear malformation, and stapes footplate fixation (0/12, 0%). We could not, however, predict complex malformation (0/8, 0%). Overall success was 90% (18/20) in the 20 ears observed for at least 1 year. In the 2 ears without improved hearing, the first had congenital cholesteatoma and no stapes superstructure, was treated with type IV tympanoplasty. The second had malleus, incus, and stapes fixation and discontinuity between the incus and stapes, and was treated with type III tympanoplasty and stapes mobilization. Preoperative diagnosis is difficult in mixed congenital auditory ossicular malformation, especially stapes footplate fixation, possibly requiring unexpected procedures, with a poor hearing outcome. Preoperative status must thus be evaluated precisely using hearing, tympanometry, acoustic reflex test, and CT. Temporal bone CT and external ear findings are useful in diagnosing middle-ear malformation. Subjects' informed consent should also be obtained due to the possible need for changing procedure based on findings during surgery.

当科で人工内耳手術を行った小児内耳奇形例11例をSennaroglu分類による奇形の型と人工内耳使用マップ, 術前聴力と術後人工内耳装用域値, 術前後の語音聴取や言語発達の成績, 発話明瞭度との関連を評価し, この分類法の臨床的妥当性について検討した。内耳奇形の内訳は2例がcommon cavity (CC), 2例がincomplete partition type I (IP-I), 5例がincomplete partition type II (IP-II), 1例がcochleovestibular hypoplasiaとcochlear nerve deficiencyの合併例 (CVH/CND), 1例が内耳道狭窄とCNDの合併例であった。11例中8例において人工内耳で音感を得るのに通常より大きな電荷量を必要とした。嚢胞状の蝸牛を呈するCCとIP-Iの4例中2例は術後語音聴取成績, 言語発達は良好であったが2例は不良でばらつきがあった。IP-II5例はすべての検討項目で術後成績が良好で言語メディアに聴覚-音声を使用していた。CND合併例2例は術後も語音聴取や言語発達の成績が不良で視覚言語の併用を必要とした。IP-IとIP-IIを峻別するSennaroglu分類とMRIによる蝸牛神経の評価の臨床的意義が確認された。

Conclusion. We have demonstrated differences in cortical activation with language-related visual stimuli in patients who were profoundly deafened due to genetic mutations in GJB2 and SLC26A4. The differences in cortical processing patterns between these two cases may have been influenced by the differing clinical courses and pathogenesis of hearing loss due to genetic mutations. Our results suggest the importance of hearing during early childhood for the development of a normal cortical language network. Objectives. To investigate the cortical activation with language-related visual stimuli in patients who were profoundly deafened due to genetic mutations in GJB2 and SLC26A4. Methods: The cortical activity of two adult patients with known genetic mutations (GJB2, SLC26A4) was evaluated with fluorodeoxyglucose-positron emission tomography (FDG-PET) with a visual language task and compared with that of normal-hearing controls. Results: A patient with a GJB2 mutation showed activation in the right auditory association area [BA21, BA22], and the left auditory association area [BA42] even with visual language task; in contrast, a patient with an SLC26A4 mutation showed no significant activation in the corresponding area., Article, ACTA OTO-LARYNGOLOGICA. 131(11):1232-1236 (2011)

Although many patients visit the emergency room (ER) with disequilibrium, the epidemiology of these cases has not been well delineated. In this single institutional study, 650 patients presenting to the ER with a complaint of disequilibrium from April 1, 2008, to March 31, 2009 were analyzed from chart review by classifying the symptom into 3 subtypes; dizziness, vertigo and presyncope. Age, gender, neurological findings, resource uses, diagnosis, and the results of specialist consultation were assessed. Patients with dizziness were associated with greater neurological disorders than vertigo patients (p

A 65-year-old man admitted for a left parotid tumor and high fever unresponsive to peroral antibiotics was found in gallium scintigraphy to have “hot” spots in the left parotid gland and left maxillary sinus. The ineffectiveness of intravenous antibiotics necessitated open biopsy to histologically diagnose the man’s condition. Surgical parotid gland and maxillary sinus specimens showed necrotizing granulomas with giant cells. Elevated proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) comfirmed a clinical diagnosis of Wegener’s granulomatosis. Treatment with prednisolone and cyclophosphamide led to clinical improvement. Major salivary gland involvement is rarely a presenting symptom in Wegener’s granulomatosis and correctly diagnosing this condition may increase morbidity due to disease progression.

Multiple endocrine neoplasia type 2B (MEN 2B), an autosomal dominant syndrome, involves endocrine tumors caused by RET protooncogene germ-line mutations in chromosome 10. The case we report, initially suspected in jaw deformity surgery, was a 19-year-old man whose malocclusion was found in a school health checkup. In surgery, his somewhat abnormal buccal mucosa and mandible were biopsied and pathological findings indicated multiple mandibular and buccal mucosal neuromas suggesting de novo MEN 2B. Whole-body examination confirmed diagnosis, showing medullary thyroid carcinoma, megacolon, prominent corneal nerves, and mucosal tongue and lips neuromas. Gene examination showed germ-line mutations of the RET protooncogene affecting codon 918 in exon 16. Medullary thyroid carcinoma was treated by total thyroidectomy with central compartment and bilateral neck dissection. Pathological analysis revealed multiple bilateral lobe cancer foci and one central-compartment lymph-node metastasis were detected pathologically. Normal calcitonin and CEA serum levels proved the biochemical cure for medullary thyroid carcinoma 7 months postoperatively. MEN 2B-associated medullary thyroid carcinoma is more aggressive than that without known gene mutations, necessitating early diagnosis and close follow-up. Findings of multiple oral-cavity neuromas thus mandate examination for MEN 2B.

口腔白板症は“他のいかなる疾患としても特徴づけられない著明な白色の口腔粘膜病変”をさす症候名で，病理組織学的に過形成，異形成，上皮内癌，浸潤癌に分類される。舌白板症が，多段階発癌という悪性転化の過程を考えると，一つの舌白板症病変に過形成・異形成と癌が混在し，局所生検のみでは正しい診断が得られない可能性がある。本論文では，舌白板症で切除した標本を評価し，病理組織学的診断において局所生検を施行せず，全病変を切除することの必要性の検討を目的としている。対象は過去13年間に舌白板症と診断した28例で以下の2点につき後ろ向きに検討した。（1）局所生検後に全病変を切除した例に関して，それぞれの診断が異なった例の割合と原因。（2）全病変の切除生検を施行した例において，病理組織学的混在例と非混在例がどの程度存在するか。検討（1）で，局所生検における正診率は6割であり，診断が異なった原因は，病理組織学的混在例および，病変採取部位が浅いためであった。検討（2）で，病理組織学的混在例は33%にみられた。舌白板症の診断において局所生検のみでは正しい診断が得られない可能性があり，全病変の切除生検が望ましいことを示した。

Objectives We evaluated differential diagnoses of cystic parotid gland lesions and the efficacy of preoperative diagnosis. Materials and methods Of 191 parotid gland nodules resected between January 2003 and October 2008, 167 (87%) were benign and 24 (13%) malignant. Thirty-five parotid gland nodules whose components were almost cystic were enrolled in this study. All cystic lesions were retrospectively evaluated with respect to preoperative diagnostic examinations and histopathological confirmed diagnosis. Cystic components in surgical specimens were also evaluated histopathologically. The relationships with magnetic resonance imaging (MRI) findings and histopathological confirmed diagnosis were studied. Results Of 35 cystic lesions, 11 were complete cystic masses and had no mural nodules, while remaining 24 were incomplete and had mural nodules. Histopathological examinations showed that 5 were nonneoplastic, 27 were cystic degenerations of benign tumors, and 3 were cystic degenerations of malignant tumors. In the 11 complete cysts, preoperative diagnosis could not be made using any modality, whether with FNAC, salivary scintigraphy, or 67-gallium citrate scintigraphy. Of 24 incomplete cysts, only 9 cystic Warthin tumors were diagnosed correctly before surgery. Studies of cystic components in MRI and histopathology suggested that hemorrhagic degeneration of malignant tumors should be kept in mind for cystic lesions showing hemorrhagic portions. Conclusions Cystic parotid gland lesions are difficult to diagnose correctly before surgery, but the evaluation of cystic components by MRI and FNAC is helpful in differentiating between benign and malignant tumors.

The authors report a case of anaplastic thyroid carcinoma which was treated with chemotherapy and radiotherapy and proved to achieve pathological CR (complete response) after a radical operation. A 53-year-old female presented with a mass of about 4 cm in diameter arising from the left lobe of her thyroid and surrounding her cervical esophagus. Pre-operative aspiration cytology and open biopsy revealed the tumor was a giant cell anaplastic carcinoma. There was no sign of distant metastasis. Two cycles of chemotherapy were very effective in treating the tumor but regrowth appeared to occur during hyperfractionated radiotherapy. A radical operation, including a resection of the larynx, cervical trachea and esophagus, was successfully performed and no living cancer cells, only granulation and necrosis, were observed in the operation specimen. The patient has been alive for over 2 years since without any evidence of recurrence.

この論文は手術中のフライ症候群の予防効果を調べること，特に胸鎖乳突筋弁と耳下腺被膜を縫合する方法との比較を目的としている。2002年から2007年までの間の耳下腺切除後術後患者86名にフライ症候群の症状，運動制限，局所の痛みにつきアンケートを用いて質問した。質問に答えた58名を胸鎖乳突筋弁群（筋弁群）（29例），耳下腺被膜縫合群（縫合群）（29例）にグループ分けした。全て術後12ヶ月以上経過した症例であった。これらの群間の比較にはカイ2乗検定を使用した。食事時の発汗については「自覚しない」あるいは「わずかに自覚」の症例が筋弁群で各々66%，28%（計93%），縫合群で82%，11%（計93%）であった。また発赤については各々75%，17%（計93%），縫合群で85%，11%（計96%）であった。これらの症状に対し2つのグループ間で有意差はなかった。運動制限や局所の痛みについても患者の割合にこの2群間で有意な差はなかった。手術部の変形については筋弁群でわずかに多く自覚されたが，有意差はなかった（7%に対し22%）。胸鎖乳突筋弁群は被膜縫合と同様の効果があるうえに，より広い欠損部にも応用できて有用な方法であると結論した。