Two new homoisoflavonoids from the bulbs of Bessera elegans.

A further chemical investigation of the bulbs of Bessera elegans (Liliaceae) led to the isolation of a new homoisoflavonoid (1), a new scillascillin-type homoisoflavonoid (2), three known flavonoids (3-5), and two known norlignans (6 and 7). The structures of the new homoisoflavonoids (1 and 2) were determined based on the results of extensive spectroscopic analysis, including two-dimensional NMR data. The isolated compounds (1-7) were evaluated for cytotoxicity against HL-60 human promyelocytic leukemia cells and TIG-3 normal human diploid fibroblasts. Compound 1 exhibited potent tumor-selective cytotoxic activity against HL-60 cells.

Early evaluation of neoadjuvant chemotherapy response using FDG-PET/CT predicts survival prognosis in patients with head and neck squamous cell carcinoma.

BACKGROUND: The purpose of this study was to investigate the possibility of early survival prediction after completion of one cycle of neoadjuvant chemotherapy (NAC) by positron emission tomography (PET)/computed tomography (CT) with (18)F-fluorodeoxyglucose (FDG). METHODS: Fifty-seven patients with advanced head and neck squamous cell carcinoma (HNSCC) underwent FDG-PET/CT scans twice, before and after one cycle of NAC. We calculated the maximal standardized uptake value (SUV(max)) for a primary tumor and/or metastatic lymph nodes and defined %decrease as the %difference in SUV(max) between the two scans divided by that of the initial scan. Patients were classified as responders by PET (%decrease ≥55.5% or post-NAC SUV(max) ≤3.5) and by RECIST (≥30% decrease in size). The local control (LC) rate and the disease-specific survival (DSS) rate were assessed between the responders and non-responders. Multivariate analysis was also performed using the Cox proportional hazards model. RESULTS: In univariate analysis, the PET finding of a primary site was a significant risk factor for LC and DSS rates at 2 years after completion of NAC (P = 0.03 and 0.02, respectively), but there was no difference between responders and non-responders by the RECIST criteria. In a multivariate regression analysis, the PET finding in the primary site and the definitive therapy choice were independent prognostic factors in LC, while the PET finding in the primary site was the only independent prognostic factor in DSS. CONCLUSION: Our preliminary data indicate that the PET finding in the primary lesion after one cycle of NAC was an independent prognostic factor in LC and DSS in patients with HNSCC.

[Preoperative diagnosis and surgical strategy in congenital auditory ossicular malformation of 26 ears].

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.

Suture granuloma showing false-positive finding on PET/CT after head and neck cancer surgery.

We report herein two cases of suture granuloma showing focal intense 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG)-uptake in positron emission tomography (PET). Follow-up FDG-PET after surgical intervention for head and neck cancer revealed lesions with high FDG-uptake, which were highly suspected of being a recurrent tumor. The lesions were subjected to excisional biopsy for definitive diagnosis. Histopathological examination proved them to be suture granulomas caused by non-absorbable silk sutures. It should be emphasized that suture granulomas can show false-positive findings on FDG-PET, thus requiring differential diagnosis from recurrent tumors.

Reversible cochlear disorders with normal vestibular functions in three cases with Wegener's granulomatosis.

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.

Neural hyperplasia in maxillary bone of multiple endocrine neoplasia type 2B patient.

Multiple endocrine neoplasia (MEN) type 2B is the rarest and most aggressive form of MEN syndrome. MEN 2B patients manifest characteristic oral and facial features besides the neural crest cell-derived tumors, including medullary carcinoma, pheochromocytoma, mucosal neuroma, and ganglioneuromatosis of the gut. We report a case of MEN 2B diagnosed on the basis of the warning signs of mucosal neuroma and multiple neural hyperplasias in the maxillary bone resected during orthognathic surgery. A subsequent systemic examination under the pathologic diagnosis of neural lesions revealed medullary thyroid carcinoma, megacolon, thickened corneal nerves, and RET gene mutation, thus verifying the diagnosis of MEN 2B. An immunohistochemical study revealed an increased number of unmyelinated Schwann cells in the hyperplastic nerves. We suggest that intraosseous neural hyperplasia is a specific finding of the MEN 2B syndrome in addition to the known oral and facial manifestations.

[A case of relapsing polychondritis with respiratory symptom manifestation alone].

Relapsing polychondritis, a comparatively rare condition systemically affecting organs containing collagen, such as cartilage tissue, is diagnosed based on clinical manifestations and pathological findings. Our case report involves a respiratory symptom alone. A 65-year-old man seen for fever and dyspnea was found in computed tomography and endoscopy to have subglottic and tracheal stenosis, necessitating tracheostomy and tracheal cartilage biopsy. Pathologically bony cartilage change was seen but no definite auricular inflammation findings. Additional auricular cartilage biopsy, showed no inflammation. Residual auricular cartilage scarring, however, indicated cartilage destruction by previous inflammation or trauma, yielding a final diagnosis of relapsing polychondritis. Steroid therapy quickly relieved symptoms. Auricular cartilage biopsy thus proved useful in definitively diagnosing this condition.

[Clinical evaluation of 24 cases of primary thyroid malignant lymphoma].

OBJECTIVES: We analyzed open biopsy in diagnosing primary thyroid lymphoma (PTL) and tumor management with compression symptoms and therapy. METHODS: We retrospectively studied 24 subjects diagnosed with PTL from December 1997 to June 2010. RESULTS: Open biopsy was done in 23 of 24 subjects. Incisional biopsy was done in 14, 13 of whom yielded sufficient materials in the first biopsy. Excisional biopsy was done in the remaining 9, 2 of whom developed permanent recurrent laryngeal nerve palsy after biopsy. The five with airway obstruction underwent incisional biopsy followed by immediate steroid administration of dexamethasone or methylprednisolone. All had histopathologically confirmed diagnosis and airway symptoms were resolved within a few days. Multidisciplinary therapy including chemotherapy, radiotherapy, and surgery was applied in 20 of 24 subjects. Single therapy was done in 4-chemotherapy in 2 and radiotherapy and surgery in 1 each. Overall results were satisfactory, with a 92% 10-year disease-free survival rate and an 86% 10-year overall survival rate based on the Kaplan-Meier method with 46-month median follow up. CONCLUSION: When diagnosing PTL, especially large tumors spreading into extrathyroid tissue, incisional biopsy is more advantageous in histopathological diagnosis than excisional biopsy due to the lower risk of surgical complications. In a case involving a small intrathyroidal nodule, excisional biopsy is safer and more diagnostically accurate. In an airway obstruction emergency, once a definitive diagnosis is made, steroid administration plus endotracheal intubation, if necessary, for airway management is optimal management. Subjects with stage IE mucosa-associated lymphoid tissue (MALT) lymphomas can be treated with radiotherapy or surgery alone. Those with diffuse large B-cell lymphoma (DLBCL) or greater than stage IE MALT lymphoma, however, should be treated with multidisciplinary therapy because they have a potentially poor outcome.

[Two cases of intractable malignant external otitis with skull base osteomyelitis alleviated by intraarterial antibiotic administration].

Malignant external otitis (MEO) is a devastating external auditory canal infection usually occurring in the elderly with diabetes. MEO often progresses to potentially lethal skull base osteomyelitis (SBO) complications such as meningitis or multiple cranial nerve palsies. Poor vascularity in affected tissue due to diabetic microangiopathy and Pseudomonal infection is thought responsible for refractory infection. We conducted intraarterial antibiotic infusion (IA) in the external carotid artery of two subjects with intractable MEO deteriorating after long-term intravenous antibiotic administration with surgical debridement. IA raised the antibiotic concentration in infectious tissue. Clinical MEO manifestation was relieved just after starting IA, and IA therapy was followed by additional long-term intravenous and oral antibiotic administration, dramatically improving MEO while leaving only minimal infection at the skull base. These results demonstrate IA effectiveness in treating refractory MEO.

[Cystic parotid gland lesion evaluation].

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.

Molecular epidemiology of hospital-acquired vancomycin-resistant enterococci.

Vancomycin-resistant Enterococcus faecium strains are a significant cause of nosocomial infections in predisposed patients. Multiple-locus variable-number tandem repeat analysis (MLVA) has been validated recently by use of a global strain collection. In this report, we applied MLVA together with multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) to type 14 isolates from three clusters of patients colonized or infected with vancomycin-resistant Enterococcus faecium and another 10 epidemiologically unrelated isolates from the same hospital. The clusters could be distinguished by all three typing methods, which proved to be concordant. PFGE patterns provided the highest resolution. We observed seven sequence types (ST), six MLVA types (MT), and nine distinct ST/MT combinations. The combination of MLST and MLVA may be an alternative to PFGE in hospital epidemiology, providing the benefits of high accuracy, reproducibility, and portability.