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1.
Psychooncology ; 27(2): 556-562, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28857394

RESUMO

OBJECTIVE: Patients with head and neck cancer (HNC) experience many stressful problems with breathing, eating, swallowing, and/or speaking. The aim of this study was to (a) identify the clusters of HNC patients based on their stress coping strategies and (b) evaluate the differences in clinical data and depression among the identified HNC patients' coping clusters. METHODS: We conducted a single-center, cross-sectional study with self-completed questionnaires for patients with HNC between April and August 2013. We measured stress coping (an abbreviated version of the COPE Inventory: Brief COPE) and depression (the Japanese version of the Beck Depression Inventory-II: BDI-II). RESULTS: Of the 116 patients who completed all the questionnaires, 81 (69.8%) participants were 60 to 79 years old and 105 (90.5%) were men. Cluster analysis based on the standardized z score of Brief COPE showed that patients were classified into 3 clusters, labeled "dependent coping," "problem-focused coping," and "resigned coping." The ANOVA revealed that depression (BDI score) was significantly higher in the dependent-coping cluster compared with the problem-focused coping. CONCLUSIONS: This study indicates that patients with a dependent-coping pattern may account for the largest HNC population and are likely to suffer from depression. Dependent coping includes smoking, drinking, seeking support, or engaging self-distraction. In the future, we should develop psychological intervention programs focused on coping strategies and enhancement of the support system for patients with HNC.


Assuntos
Adaptação Psicológica , Depressão/psicologia , Neoplasias de Cabeça e Pescoço/psicologia , Qualidade de Vida/psicologia , Estresse Psicológico/psicologia , Idoso , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Estresse Psicológico/etiologia , Inquéritos e Questionários
2.
Palliat Support Care ; 14(1): 42-51, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26089108

RESUMO

OBJECTIVE: Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients. METHOD: We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy-Head and Neck Scale; FACT-H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University. RESULTS: Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4; p < 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01). Significant of results: Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.


Assuntos
Neoplasias de Cabeça e Pescoço/psicologia , Qualidade de Vida/psicologia , Estresse Psicológico/psicologia , Idoso , Idoso de 80 Anos ou mais , Imagem Corporal/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários
3.
Palliat Support Care ; 13(5): 1373-80, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25620032

RESUMO

OBJECTIVE: This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument. METHOD: Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test-retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scales. RESULTS: Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT-H&N demonstrated significant correlations (Spearman's ρ = 0.47-0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.62-0.79. SIGNIFICANCE OF RESULTS: The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço/psicologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Sobreviventes/psicologia , Idoso , Análise de Variância , Análise Fatorial , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Traduções
4.
Nihon Jibiinkoka Gakkai Kaiho ; 118(8): 1037-45, 2015 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-26548097

RESUMO

OBJECTIVE: Carcinoma of the ethmoid sinus is very rare, and treatment for locally advanced tumors remains as a formidable challenge to the clinician. We reviewed cases of ethmoid carcinoma in which anterior craniofacial resection had been undertaken and evaluated the safety and validity of the operative methods. METHODS: We retrospectively reviewed 13 patients with ethmoid carcinoma who underwent combined anterior craniofacial resection. We evaluated the surgical procedures, complications, outcomes, local recurrence, and the survival rate. RESULTS: Coronal incision and anterior craniotomy were performed in all cases. Four out of 13 cases underwent ipsilateral orbital exenteration due to involvement of the orbital contents. There were no potentially fatal complications, except for two cases of epidural abscesses which were successfully cured. Positive surgical margins were observed in 6 patients, and they received postoperative radiotherapy and/or chemotherapy. Local recurrences occurred in 4 cases, and 3 died at 9, 11, and 49 months after the surgery. Distant metastasis was not observed during the observation period. The overall 5-year survival rate was 75.2% (Kaplan-Meier method). CONCLUSION: These tumors were safely removed without severe complications and postoperative mortality. Combined anterior craniofacial resection is an effective and safe option for treatment of locally advanced ethmoid carcinomas after various preoperative treatments.


Assuntos
Seio Etmoidal/cirurgia , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Adulto , Idoso , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/tratamento farmacológico , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida
5.
Oncology ; 87(3): 173-82, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25033838

RESUMO

BACKGROUND: The incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) have risen steadily in the USA and in northern Europe. These increases are thought to be a consequence of persistent infection with high-risk human papillomavirus (HPV) in OPSCC patients. HPV is an emerging etiologic factor in OPSCC. In Japan, the incidence of OPSCC has significantly increased over the last three decades. However, the population of HPV-positive OPSCC patients is currently unknown. We examined the nationwide trends with regard to HPV incidence in OPSCC patients at 21 specific sites, and examined the relationship between the presence of HPV and survival in OPSCC patients in Japan. METHODS: Tumor samples were obtained from patients with OPSCC prior to treatment, and HPV infection was investigated by polymerase chain reaction (PCR). Hybrid Capture 2 (HC2) was also adopted for swab examination on the surface of fresh tumors. RESULTS: HPV was detected by PCR in 79 (50.3%) out of 157 OPSCC patients. The clinical features of HPV-positive OPSCC were low differentiation, a tendency to involve the lateral wall, and high nodal staging. The sensitivity and specificity of HC2 were 93.7 and 96.2%, respectively, indicating its utility as a screening test. HPV-positive patients had significantly better overall survival and disease-free survival than HPV-negative patients.


Assuntos
Carcinoma de Células Escamosas/virologia , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/epidemiologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/secundário , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/patologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/mortalidade , Infecções por Papillomavirus/virologia , Prevalência , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
6.
J Vet Med Sci ; 86(6): 656-659, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38658334

RESUMO

We devised a method to detect the classical swine fever virus (CSFV) in tail-wiped swabs from wild boars. The CSFV gene in swabs was detected with high sensitivity using nested real-time polymerase chain reaction (PCR), which is a combination of reverse transcription-PCR (RT-PCR) and real-time PCR. We compared CSFV gene detection from boar tissue using the conventional and our tail-wiped swab method. The tail-wiped swab method showed sensitivity and specificity of 100% (26/26) and 98.8% (172/174), respectively compared to the conventional method. Thus, the swab-based CSFV detection method was considered to have detection sensitivity comparable to that of conventional methods. Additionally, we conducted surveillance for CSFV in wild boars on Awaji Island. CSFV was detected in 10.7% (45/420) of samples.


Assuntos
Vírus da Febre Suína Clássica , Peste Suína Clássica , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Sus scrofa , Animais , Vírus da Febre Suína Clássica/isolamento & purificação , Vírus da Febre Suína Clássica/genética , Suínos , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sus scrofa/virologia , Peste Suína Clássica/diagnóstico , Peste Suína Clássica/virologia , Cauda/virologia , Japão , Reação em Cadeia da Polimerase Via Transcriptase Reversa/veterinária , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos
8.
Auris Nasus Larynx ; 48(6): 1162-1166, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33892989

RESUMO

OBJECTIVE: ndoscopic laryngopharyngeal surgery (ELPS) is a useful surgery for superficial cancers of the head and neck region, but it has not yet been well evaluated for synchronous multiple primary cancers (multiple primaries). The purpose of this study was to clarify the safety and usefulness of ELPS for patients with multiple superficial primary cancers in the head and neck region. METHODS: rom December 2009 to December 2016, 145patients with superficial head and neck cancers underwent ELPS. The patients were divided into two groups; a group consisting of patients with a single primary cancer (single primary) and another group consisting of patients with synchronous multiple primaries, and the incidences of postoperative complications and lymph node metastasis were retrospectively compared between the two groups. RESULTS: f the 145 patients, 107 had a single primary cancer and 38 had multiple primaries. There was no significant difference in the age, sex, or rate of intraepithelial cancer between the two groups. Postoperative complications included dysphagia in 6 (5.6%) patients with a single primary and 2 (5.3%) patients with multiple primaries. One patient with multiple primaries required gastrostomy because of aspiration pneumonia. In addition, the following complications were also observed. Laryngeal paralysis occurred in 2 (1.9%) patients with a single primary, and 1 (2.6%) patient with multiple primaries; tracheostomy because of postoperative bleeding in 1 (0.9%) patient with a single primary; infection occurred in 2 (5.3%) patients with multiple primaries. Postoperative lymph node metastasis was found in 7 (6.5%) patients with a single primary and 6 (15.8%) patients with multiple primaries. Lymphatic invasion of the primary cancer was noted in 3 (2.8%) patients with a single primary and 5 (13.2%) patients with multiple primaries, being significantly higher in the latter group. CONCLUSION: ELPS is also a safe surgery for patients with multiple primaries. However, the incidence of lymphatic invasion of the primary cancer was significantly higher in patients with multiple primaries.


Assuntos
Endoscopia , Neoplasias Laríngeas/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Faríngeas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/cirurgia , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
9.
Auris Nasus Larynx ; 48(3): 525-529, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33446370

RESUMO

OBJECTIVE: Involvement in the tracheostomy procedure for COVID-19 patients can lead to a feeling of fear in medical staff. To address concerns over infection, we gathered and analyzed experiences with tracheostomy in the COVID-19 patient population from all over Japan. METHODS: The data for health-care workers involved in tracheostomies for COVID-19-infected patients were gathered from academic medical centers or their affiliated hospitals from all over Japan. RESULTS: Tracheostomies have been performed in 35 COVID-19 patients with a total of 91 surgeons, 49 anesthesiologists, and 49 surgical staff members involved. Twenty-eight (80%) patients underwent surgery more than 22 days after the development of COVID-19-related symptoms (11: 22-28 days and 17: ≥29 days). Thirty (85.7%) patients underwent surgery ≥ 15 days after intubation (14: 15-21 days, 6: 22-28 days, and 10: ≥29 days). Among the total of 189 health-care workers involved in the tracheostomy procedures, 25 used a powered air-purifying respirator (PAPR) and 164 used a N95 mask and eye protection. As a result, no transmission to staff occurred during the 2 weeks of follow-up after surgery. CONCLUSION: No one involved in tracheostomy procedures were found to have been infected with COVID-19 in this Japanese study. The reason is thought to be that the timing of the surgery was quite late after the infections, and the surgery was performed using appropriate PPE and surgical procedure. The indications for and timing of tracheostomy for severe COVID-19 patients should be decided through multidisciplinary discussion.


Assuntos
COVID-19/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Insuficiência Respiratória/terapia , Traqueostomia/métodos , Oxigenação por Membrana Extracorpórea , Dispositivos de Proteção dos Olhos , Pessoal de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Japão , Respiradores N95 , Isoladores de Pacientes , Equipamento de Proteção Individual , Respiração Artificial/métodos , Dispositivos de Proteção Respiratória , SARS-CoV-2
10.
Auris Nasus Larynx ; 47(1): 158-162, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30929928

RESUMO

Lingual lymph node metastases are rarely seen in carcinoma of the tongue, and these nodes are not removed during neck dissection. Lingual lymph nodes are classified into medial and lateral groups, and metastasis to the former is extremely rare. A 55-year-old male with squamous cell carcinoma of the tongue, (stage T4aN0M0), underwent hemiglossectomy with neck dissection and free flap reconstruction. The lingual septum had a mass, 8 mm in size, which was diagnosed as medial lingual lymph node metastasis on histopathology. The patient developed multiple distant metastases and died of disease 18 months after the initial surgery. The presence of medial lymph node metastasis could result in contralateral neck metastases and worsen prognosis. Such cases may warrant more intensive therapy than recommended by current guidelines.


Assuntos
Linfonodos/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Neoplasias da Língua/patologia , Progressão da Doença , Retalhos de Tecido Biológico , Glossectomia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia/patologia , Procedimentos de Cirurgia Plástica , Neoplasias da Coluna Vertebral/secundário , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Tomografia Computadorizada por Raios X , Língua , Neoplasias da Língua/diagnóstico por imagem , Neoplasias da Língua/cirurgia , Ultrassonografia
11.
Int J Clin Health Psychol ; 20(3): 213-221, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32994794

RESUMO

BACKGROUND/OBJECTIVE: Patients with head and neck cancer (HNC) have some problems such as dysfunction of breathing, eating, and/or speaking. The aim of this study was to examine efficacy of the stress management program for HNC patients (SMAP-HNC) compared with usual care (UC). METHOD: We conducted a pilot study of SMAP-HNC for depressive HNC patients between January 2016 and March 2018. The program contains psychoeducation, stress coping training, and operant reinforcement. The outcome measure was the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT), and Brief Coping Inventory (COPE). RESULTS: Twenty patients were randomly assigned to SMAP-HNC and UC group. Although a small sample sizes, there was no significant difference of depression score change between SMAP-HNC and UC group (Hedges'd g -0.83; 95% CI -1.80 to 0.13). CONCLUSIONS: It was the first study to conduct stress management program for HNC patients. Unfortunately, our trial designed as a randomized controlled trial is underpowered to make conclusion as to the efficacy of SMAP-HNC. However, there are some valuable suggestions to modify the stress management program in future.


ANTECEDENTES/OBJETIVO: Los pacientes con cáncer de cabeza y cuello (CCC) tienen algunos problemas como trastornos de la respiración, la alimentación y/o el habla. El objetivo de este estudio fue examinar la eficacia de un programa de control del estrés para pacientes con CCC (SMAP-HNC) en comparación con la atención habitual (AH). MÉTODO: Llevamos a cabo un estudio piloto de SMAP-HNC para pacientes depresivos con CCC entre enero de 2016 y marzo de 2018. El programa contiene psicoeducación, entrenamiento para afrontar el estrés y refuerzo operante. Las medidas de los resultado fueron la Hospital Anxiety and Depression Scale (HADS), la Functional Assessment of Cancer Therapy (FACT) y el Brief Coping Inventory (COPE). RESULTADOS: Veinte pacientes fueron asignados aleatoriamente al grupo SMAP-HNC y AH. Aunque los tamaños de las muestras son pequeños, no hubo diferencias significativas en el cambio en el puntaje de depresión entre el grupo SMAP-HNC y el grupo AH (g de Heges's -0,83; IC del 95%: -1,80 a 0,13). CONCLUSIONES: Es el primer estudio en emplera un programa de control del estrés para pacientes con CCC. Desafortunadamente, nuestro ensayo diseñado como un ensayo controlado aleatorio tiene poco poder para llegar a una conclusión sobre la eficacia de SMAP-HNC. Sin embargo, hay algunas sugerencias valiosas para modificar el programa de control del estrés en el futuro.

13.
Acta Med Okayama ; 63(1): 35-42, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19247421

RESUMO

We investigated the impact of olmesartan and temocapril on pancreatic islet beta-cells during the development of diabetes mellitus using Otsuka-Long-Evans-Tokushima Fatty (OLETF) rats. Four-week-old male OLETF rats were fed standard chow (untreated:n5), or chow containing either 0.005% olmesartan(n5) or 0.01% temocapril (n5) until being sacrificed at 35 weeks of age. Pancreas sections were double-stained with anti-insulin and anti-glucagon antibodies. The percent areas of beta-cells, alpha-cells and non-alpha-non-beta-cells were compared among groups. In untreated OLETF rats, the fasting plasma glucose (FPG) level was elevated at the 18th week and remained elevated until the 35th week. On the other hand, no significant elevation in FPG levels was observed in olmesartan- or temocapril-treated rats. Pancreatic islets from olmesartan-treated rats were significantly smaller in size as compared with those from untreated OLETF rats. Furthermore, the average area occupied by beta-cells as a fraction of the total area of an individual islet was significantly higher in olmesartan- or temocapril-treated rats than that in untreated OLETF rats. Olmesartan and temocapril both prevented the development of hyperglycemia, possibly through the prevention of islet beta-cell loss in spontaneously diabetic OLETF rats.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hiperglicemia/prevenção & controle , Imidazóis/uso terapêutico , Células Secretoras de Insulina/efeitos dos fármacos , Tetrazóis/uso terapêutico , Tiazepinas/uso terapêutico , Animais , Peptídeo C/urina , Frutosamina/sangue , Insulina/sangue , Células Secretoras de Insulina/patologia , Masculino , Ratos , Ratos Endogâmicos OLETF , Receptor Tipo 1 de Angiotensina/análise
14.
Head Neck ; 41(11): 3970-3975, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31469469

RESUMO

BACKGROUND: Magnifying endoscopy with narrowband imaging (ME-NBI) is useful in predicting the invasion depth by examining the microvascular status of tumor surfaces. This retrospective study aimed to determine its efficacy in pharyngeal cancer. METHODS: Between April 2016 and March 2018, 59 lesions from 46 patients who underwent transoral resection were retrospectively analyzed. Using ME-NBI, microvascular status was classified into B1, B2, or B3, based on the classification of the Japan Esophageal Society. RESULTS: A significant correlation was observed between microvascular status and invasion depth (P = .011). Mean thickness of lesions with B1, B2, and B3 vessels were 563, 1364, and 2825 µm, respectively (P = .006). In previously treated lesions, a significant correlation was observed between microvascular status and invasion depth (P = .012). CONCLUSIONS: ME-NBI is useful in predicting the invasion depth and thickness of pharyngeal tumors, even in patients with previously treated lesions.


Assuntos
Endoscopia , Microvasos/diagnóstico por imagem , Microvasos/patologia , Imagem de Banda Estreita , Neoplasias Faríngeas/diagnóstico por imagem , Neoplasias Faríngeas/patologia , Idoso , Epitélio/diagnóstico por imagem , Epitélio/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa/diagnóstico por imagem , Mucosa/patologia , Invasividade Neoplásica , Valor Preditivo dos Testes , Estudos Retrospectivos
15.
Ann Otol Rhinol Laryngol ; 128(11): 1023-1029, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31220916

RESUMO

OBJECTIVES: The indication of transoral robotic surgery for hypopharyngeal cancer is limited because of poor accessibility. The aim of this study was to explore the efficacy of a curved laryngopharyngoscope used in combination with a next-generation flexible robotic surgical system for accessing and resecting the hypopharynx. METHODS: A comparative evaluation of the curved laryngopharyngoscope versus standard straight-blade retractors using the flexible robotic surgical system was conducted on 2 cadavers. End points measured included visualization, accessibility, and ease of dissection for accessing and resecting the hypopharynx. RESULTS: Visualization, accessibility, and dissection were superior with the curved laryngopharyngoscope in all subareas of the hypopharynx. The advantages of accessibility and visualization were much more evident in the cadaver with a high body mass index. CONCLUSIONS: These preclinical data suggest that using a curved laryngopharyngoscope in combination with a flexible robotic surgical system may lead to technical innovations concerning transoral surgery of the hypopharynx.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Laringoscópios , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Idoso , Cadáver , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Boca
16.
Auris Nasus Larynx ; 35(1): 109-13, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17851003

RESUMO

OBJECTIVE: The aim of this study is to clarify the etiology of first-bite syndrome. METHODS: A total of 29 consecutive patients treated with a surgical resection for parapharyngeal space tumor between April 1999 and April 2005 were retrospectively reviewed. RESULTS: Nine cases of first-bite syndrome were developed. Eight of those patients had undergone surgical ablation of the cervical sympathetic chain and/or external carotid artery. In two patients who underwent ablation of the sympathetic chain but in whom first-bite syndrome did not develop, the superior cervical ganglion was probably preserved. CONCLUSION: The present findings strongly indicate that loss of sympathetic innervation to the parotid gland from the superior cervical ganglion causes first-bite syndrome. They also suggest that some residual or autonomous activity of the superior cervical ganglion could prevent development of first-bite syndrome even if the lower sympathetic trunk was ablated.


Assuntos
Transtornos de Deglutição/fisiopatologia , Hiperalgesia/fisiopatologia , Glândula Parótida/inervação , Neoplasias Faríngeas/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Gânglio Cervical Superior/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/complicações , Neoplasias Faríngeas/fisiopatologia , Estudos Retrospectivos , Gânglio Cervical Superior/fisiopatologia , Simpatectomia/efeitos adversos , Síndrome
17.
Head Neck ; 40(1): 16-23, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29130568

RESUMO

BACKGROUND: The purpose of this cadaveric study was to determine the efficacy of a flexible, next-generation robotic surgical system for transoral robotic hypopharyngectomy. METHODS: A comparative evaluation study of the flexible versus rigid robotic surgical systems for the hypopharynx was conducted using 3 cadavers. Endpoints for assessment were visualization of the hypopharynx, access to the hypopharynx, and difficulty of dissection. Hypopharyngectomy was performed on 3 other cadavers using the da Vinci Sp surgical system. RESULTS: Access to the apex of the pyriform sinus and the esophageal inlet was easier with the da Vinci Sp than with the da Vinci Si. Dissection with the da Vinci Sp was easier in all areas of the hypopharynx than with the da Vinci Si. Robotic hypopharyngectomy was successfully completed on all cadavers using the da Vinci Sp surgical system. CONCLUSION: Preclinical testing in human cadavers suggests that flexible robotic surgery may facilitate successful transoral hypopharyngectomy.


Assuntos
Hipofaringe/cirurgia , Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Robótica , Adulto , Ácido Ascórbico , Cadáver , Desenho de Equipamento , Segurança de Equipamentos , Flavonoides , Humanos , Boca , Maleabilidade , Sensibilidade e Especificidade
18.
Adv Med Sci ; 62(2): 393-397, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28575786

RESUMO

PURPOSE: IgG4-related disease is a systemic disease that affects various organs of the body. Aim of this study is to elucidate the clinical characteristics of IgG4-related rhinosinusitis. MATERIAL AND METHODS: Clinical features, laboratory findings, radiological and endoscopic findings, associated disease, treatment and prognosis were retrospectively examined in 10 patients with IgG4-related rhinosinusitis. RESULTS: The age was 59.1±11.3 years old and male-to-female ratio was 1:1. The chief nasal complaints were hyposmia (n=4), nasal obstruction (n=3), and nothing (n=3). Serum IgG4 levels were elevated in all patients and the value was 740.4±472.4mg/dl. Other IgG4-related diseases were associated in all 10 patients, including IgG4-related sialadenitis (n=6), IgG4-related dacryoadenitis (n=5), and autoimmune pancreatitis (n=5). Imaging findings on CT/MRI were obstruction of the way of elimination (n=10), thickening of the sinus mucous membrane (n=10), and fluid in the sinus (n=6). All of the cases had bilateral findings. Nasal endoscopic findings were chiefly deviated nasal septum (n=5), polyps (n=4), edema of the mucous membrane (n=3). Histologically, abundant infiltration of IgG4 positive plasma cell and lymphocyte and an elevated IgG4+/IgG+ cell ration was detected in all 8 patients and 5 patients, respectively. Endoscopic sinus surgery was performed in 8 patients. Eight patients were treated with steroid therapy for other associated IgG4-related diseases. Symptoms improved in all 6 patients after an initial treatment (endoscopic surgery (n=5) and steroids (n=1)), but one patient suffered relapse. CONCLUSIONS: IgG4-related rhinosinusitis is a distinct entity of IgG4-related disease, and is associated in patients with multiple IgG4-related diseases.


Assuntos
Imunoglobulina G/sangue , Rinite/imunologia , Rinite/patologia , Sinusite/imunologia , Sinusite/patologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Rinite/sangue , Sinusite/sangue
19.
Case Rep Otolaryngol ; 2017: 1341059, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28154766

RESUMO

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

20.
Hypertens Res ; 27(8): 545-50, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15492473

RESUMO

The current guideline-recommended blood pressure values are difficult to maintain in general practice, partly due to the lack of ideal anti-hypertensive agents. Since morning hypertension has a high correlation with cardiovascular events, expectations that telmisartan, a long-acting angiotensin-II type-1 receptor blocker (ARB), can improve cardiovascular mortality are high. In this study, the efficiency of telmisartan in reducing morning hypertension and pulse wave velocity (PWV) as a practical surrogate endpoint was investigated. Seventeen unsupervised and 7 untreated hypertensive patients were prescribed telmisartan 40 mg/day for 3 months. Medication already prescribed upon enrollment in this study was continued, with the exception of ARBs (all of which turned out to be losartan 50 mg/day), which were discontinued and replaced with telmisartan. Morning home blood pressure (MHBP), office blood pressure (OBP), and brachial-ankle PWV (baPWV) were investigated in a prospective fashion. A stratified analysis was performed regarding previous use (group L) or non-use (group N) of losartan. Over a 3-month period, telmisartan was found to significantly reduce both OBP (from 153+/-13/85+/-9 to 141+/-17/80+/-7 mmHg (p <0.01)) and MHBP (from 153+/-23/93+/-11 to 137+/-22/82+/-10 mmHg (p <0.001)). Surprisingly, 7 patients (70%) from group L achieved an OBP of less than 140/90 mmHg by simply changing their medication to telmisartan. Furthermore, baPWV fell significantly from 1,892+/-334 cm/s to 1,672+/-324 cm/s (p <0.01), which was greater than the change in baPWV estimated by OBP reduction. Here it must be mentioned that there were no significant differences between group L and group N in the courses of blood pressures and baPWV. In conclusion, telmisartan 40 mg/day was found to be effective for reducing MHBP and arterial wall stiffness in patients with mild-to-moderate hypertension, and thus may also be effective for improving cerebrocardiovascular mortality.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Benzimidazóis/administração & dosagem , Benzoatos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Benzimidazóis/efeitos adversos , Benzoatos/efeitos adversos , Ritmo Circadiano , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Telmisartan
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