The relationship between scapular position and glenohumeral rotational range of motion in high school baseball players.

BACKGROUND: Past research indicated that scapular malposition is related to the glenohumeral internal rotation deficit (GIRD). However, there is no research examining the effect of throwing-related pain on this relationship. This study investigated the relationship between scapular position and range of motion (ROM) and compared the difference in this relationship between with and without throwing-related pain. METHODS: Forty male baseball players in high school were recruited for this study. The existence and degree of throwing-related pain were obtained from a questionnaire. Participants were divided into 2 groups according to the presence or absence of the pain. Glenohumeral internal and external rotation ROM (abduction internal rotation angle and abduction external rotation angle [ABER], respectively) were measured using a digital inclinometer. The pectoralis minor muscle length was measured using a vernier caliper and scapula index, which indicated the scapular position, measured using a measuring tape. All these measurements were taken on both dominant and nondominant sides. The GIRD and total motion arc (TMA) deficit were calculated from the ROM measurements. Groups were compared using a mixed-model analysis of variance. RESULTS: There was a significant interaction between group and ABER dominance. Other variables were not seen as the interaction effect. There was a significant positive correlation between the scapula index and TMA (r = 0.47, P = .02) and a negative correlation between the scapula index and GIRD (r = -0.65, P < .01) in the dominant side of the pain group. In addition, in the nondominant side of the pain group, the scapula index and ABER were significantly correlated (r = 0.43, P = .04). CONCLUSIONS: The results of this study indicate that the scapular position is associated with the glenohumeral ROM in high school baseball players. In addition, this study demonstrated that the scapular internally rotated position was correlated with the GIRD and TMA deficit in high school baseball players who had throwing-related pain. On the other hand, the scapular externally rotated position was correlated with increased ABER, mainly in the pain-free baseball players or on the nondominant side. These results indicated that the scapular position might affect the glenohumeral rotational ROM in high school baseball players.

Advantage of a higher position of the tracheostoma with glottic closure for preventing complications related to tracheostomy tube: a retrospective cohort study.

BACKGROUND: Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes tracheostoma at a position higher than the first ring of the trachea and theoretically has a potential to prevent such complications owing to a longer distance between the tip of tracheostomy tube and the tracheal membrane adjacent to the brachiocephalic artery. Our aim is to evaluate the safety of glottic closure in neurologically impaired patients by comparing outcomes with laryngotracheal separation. METHODS: This study is a single-center retrospective study from 2004 to 2019, using data of 15 and 12 patients who underwent glottic closure (GC) and laryngotracheal separation (LTS). The primary outcome was the incidence of postoperative complications induced by tracheostomy tube placement and adjustment of the tracheostomy tube position to prevent these complications, such as by converting to a length-adjustable tube and/or placing gauze between the skin and tube flange. Additionally, we analyzed the anatomical relationship between the tracheostomy tube tip and brachiocephalic artery and measured the distance between them using postoperative CT images. RESULTS: No patients in either group had trachea-brachiocephalic artery fistula. Erosion or granuloma formation occurred in 1 patient (7%) and 4 patients (33%) in the GC and LTS groups, respectively. Adjustment of the tracheostomy tube was needed in 2 patients (13%) and 6 patients (50%) in the GC and LTS groups. CT revealed a higher proportion of patients with the tracheostomy tube tip superior to the brachiocephalic artery in GC than LTS group. The mean tracheostoma-brachiocephalic artery distance was 40.8 and 32.4 mm in the GC and LTS groups. CONCLUSIONS: Glottic closure reduces the risk of postoperative complications related to a tracheostomy tube. This may be due to the higher position of the tracheostoma at the level of the cricoid cartilage, increasing the distance between the tracheostoma and brachiocephalic artery.

Outcomes of Aspiration Prevention Surgery: A Retrospective Cohort Study Using a Japanese Claims Database.

Aspiration prevention surgeries, such as laryngotracheal separation and total laryngectomy are performed to prevent aspiration pneumonia. We aimed to investigate the outcomes of surgery for intractable aspiration and relevant factors. This retrospective cohort study used a nationwide insurance claims database that included company employees and their family members aged < 75 years in Japan. We extracted the data of patients who underwent aspiration prevention surgeries between January 2005 and March 2019. We identified 127 patients (males, 55.9%), of whom 59.8% were aged < 18 years at the surgery. The most common comorbidity was neurological disease (99.2%). The frequency of pneumonia episodes decreased by 1.5 per year after surgery compared with before surgery (p < 0.001). Among patients who received parenteral and enteral nutrition before surgery (n = 92), the adjusted hazard ratio (aHR) for oral intake without parenteral and enteral nutrition was lower in the longer preoperative duration (≥ 14.7 months) for the parenteral and enteral nutrition. However, the difference was not statistically significant (aHR 0.55; 95% confidence interval: 0.15-2.08, p = 0.38). The aHR for oral intake was higher in the ≥ 30 years group than in the < 30 years group (aHR 13.76; 95% confidence intervals: 4.18-42.24; p < 0.001). This study demonstrated that postoperative oral intake was achieved more frequently in patients aged ≤ 30 years than in those aged > 30 years, and supported the effectiveness of aspiration prevention surgery for reducing aspiration pneumonia. Further research is necessary to investigate factors related to postoperative oral intake.

Effects of aging on basement membrane-related gene expression of the skeletal muscle in rats.

The basement membrane (BM), with collagen IV as a major component, plays an important role in the maintenance of muscle structure and its robustness. To investigate the effects of aging on factors related to BM construction, we compared the expression status of these factors in 3- and 20-month-old male Wistar rats. The expression levels of Col4a1 and Col4a2 (encoding collagen IV), Sparc (involved in collagen IV functionalization), and Mmp14 (a collagen IV degradation factor) were decreased. These results suggest that aging suppresses collagen IV synthetic and degradative factors and affects BM-related factors in the steady state.

Indications and postoperative outcomes of surgery for laryngotracheal stenosis: A descriptive study.

OBJECTIVE: Tracheal reconstruction is a rare surgical procedure and the actual incidence of or indications for this procedure have not been thoroughly elucidated. We performed the nationwide database analysis to clarify the real-world situation of laryngotracheal surgery requiring cervical tracheal reconstruction. METHODS: Patients who underwent surgical treatment for laryngotracheal stenosis or defect from 2008 to 2016 were identified from the Diagnosis Procedure Combination inpatient database, collected from 270 acute care hospitals in Japan. Patients were divided into two groups based on presence/absence of malignancy, and T-tube or tracheotomy dependence at 6 months after surgery was compared between the two groups. RESULTS: One hundred and thirty-four patients (75 males) were identified. The median age at surgery was 65.5 years. The most common indication for surgery was malignancy (n = 60, 44.8%), followed by iatrogenic (n = 25, 18.6%), trauma (n = 6, 4.5%), malformation of the larynx and trachea (n = 6, 4.5%), and chronic inflammatory disease (n = 4, 2.8%). Thyroid cancer was the most common malignancy (n = 38). Thirty patients (22.4%) failed to decannulate within 6 months and malignancy was associated with a lower dependence on T-tube or tracheotomy at 6 months after surgery (adjusted odds ratio: 0.25, 95% confidence interval: 0.08-0.79). CONCLUSION: A Japanese health insurance claims database provided a useful overview of the clinical features and outcomes of patients who underwent cervical tracheal reconstruction surgery for laryngotracheal stenosis or defect.

Successful Treatment of a Mixed Neuroendocrine-Nonneuroendocrine Neoplasm of the Colon with Metastases to the Thyroid Gland and Liver.

Patients with mixed neuroendocrine-nonneuroendocrine neoplasms (MiNENs) of the colon have poor prognosis. Herein, we report a patient with MiNEN of the colon with metastases to the liver and the thyroid gland, with long-term survival. A 45-year-old man presented with anterior neck swelling. Histopathological examination of the thyroid tumor revealed neuroendocrine carcinoma (NEC), suggesting that a primary NEC in another organ had metastasized to the thyroid gland. Computed tomography to identify a primary NEC revealed two tumors: one in the liver and one in the transverse colon. A biopsy revealed that the histopathology of the liver and colon tumors was NEC and adenocarcinoma, respectively. Thereafter, the patient underwent surgical resection of the colon tumor and was finally diagnosed as colon MiNEN with metastases to the thyroid and liver. The surgical resection of the metastatic liver tumor was performed after several courses of systemic chemotherapy, and the patient survives presently without any recurrence for approximately seven years after the diagnosis. Surgical resection of each metastatic lesion combined with systematic chemotherapy apparently improved the prognosis of MiNEN of the colon with distant metastases.

Use of preoperative haemostasis and ABO blood typing tests in children: a retrospective observational study using a nationwide claims database in Japan.

OBJECTIVES: To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. DESIGN: A retrospective observational study. SETTING: Nationwide insurance claims database in Japan. PARTICIPANTS: Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). MAIN OUTCOME MEASURES: We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. RESULTS: We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). CONCLUSIONS: In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.

Slow shift of dead zone after an abrupt shift of the light-dark cycle.

The suprachiasmatic nucleus (SCN) is the center of the mammalian circadian system. Environmental photic signals shifts the phase of the circadian rhythm in the SCN except during the dead zone, when the photic signal is gated somewhere on the way from the retina to the neurons in the SCN. Here we examined the phase of the dead zone after an abrupt delay of the LD cycles for several days by observing the mc-Fos induction in the SCN by light pulses. After an abrupt shift of the LD cycles, the dead zone showed a slow phase shift, about two hours per day, which was well corresponded with the slow phase shift of the rest-activity cycles. In our previous study we demonstrated that, after an abrupt shift of the LD cycles, the SCN showed transient endogenous desynchronization between shell and core regions that showed a slow and a rapid shift of the circadian rhythms, respectively. Therefore, the present findings on the phase shift of the dead zone after the LD cycles shift suggest that the phase of the dead zone is under the control of the timing signals from the shell region of the SCN.

Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring.

OBJECTIVES/HYPOTHESIS: This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery. STUDY DESIGN: Retrospective cohort study. METHODS: This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared. RESULTS: The study included 5,804 patients. Multivariable logistic regression analysis revealed that use of IONM was not associated with increased RLNP risk (odds ratio: 1.15; 95% confidence interval: 0.67-1.96). There was no significant effect on RLNP prevention when stratified by tumor or nodal classification. Rather, the patients who had T4 or N1b classifications who received IONM had higher incidences of RLNP. CONCLUSIONS: Use of IONM did not significantly reduce the risk of RLNP. The results for the T4 and N1b populations may be explained by indication bias or unmeasured confounders. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1954-1960, 2019.

Exposure to tobacco smoke prenatally and during infancy and risk of hearing impairment among children in Japan: A retrospective cohort study.

BACKGROUND: Previous studies of the association between tobacco smoke and hearing loss in children are limited, involve small samples and are cross-sectional. We investigated the association of maternal smoking during pregnancy and exposure to tobacco smoke at age 4 months with hearing impairment at age 3 years in children. METHODS: This population-based retrospective cohort study included 50 734 children born between 2004 and 2010 in Kobe City, Japan. Smoking during pregnancy and exposure to tobacco smoke at 4 months was measured using parent-reported questionnaires. Hearing impairment was determined by the whispered voice test. RESULTS: Of the included children, 3.8% were exposed to smoking only during pregnancy; 3.9% were exposed only to second-hand smoke at 4 months; and 0.9% were exposed to tobacco smoke during pregnancy and at 4 months. The prevalence of hearing impairment at age 3 years was 4.6%. Compared with children not exposed to tobacco smoke prenatally and at 4 months, the risk of hearing impairment was elevated in children exposed to only maternal past smoking during pregnancy (RR 1.26, 95% CI 1.13, 1.40), only second-hand smoke at 4 months (RR 1.30, 95% CI 1.07, 1.56), only smoking during pregnancy (RR 1.68, 95% CI 1.42, 2.00) and smoking during pregnancy and second-hand smoke at 4 months (RR 2.35, 95% CI 1.79, 3.10). CONCLUSIONS: Exposure to tobacco smoke prenatally and postnatally was associated with hearing impairment in children. A prevention of smoking before and during pregnancy and exposure to second-hand smoke postnatally may reduce hearing impairment risk in children.

Clinical epidemiology of tracheal invasion from thyroid cancer in Japanese population: Functional outcomes and effect of aging.

BACKGROUND: Although tracheal invasion from thyroid cancer is life-threatening, the epidemiology of its development remains unclear. This study aimed to determine the epidemiology (prevalence, incidence, and risk factors) and functional outcomes of tracheal invasion from thyroid cancer among Japanese patients who were eligible for full-layer tracheal resection. METHODS: Patients with thyroid cancer and with or without tracheal invasion were identified based on procedure codes using a large inpatient database that is maintained by a data vendor. The prevalence and incidence were estimated for each age and sex using Japanese volume of thyroidectomies and Japanese population data. We also explored whether a tumor-related tracheal defect was successfully reconstructed after full-layer tracheal resection. RESULTS: Among the 8482 patients with thyroid cancer, the overall prevalence of tracheal invasion was 0.4-0.7%. The overall incidence of thyroid cancer was 12.0/100,000 persons, and the incidence of tracheal invasion was estimated to be 0.05-0.09/100,000 persons. The age distributions were noticeably different between thyroid cancer cases with and without tracheal invasion. The highest incidence was observed at ages of 70-79 years for thyroid cancer with tracheal invasion and 60-69 years for thyroid cancer without invasion. Approximately one-half of patients experienced long-term use of a tracheal tube and/or multiple operations for tracheal reconstruction. CONCLUSION: The peak incidence of tracheal invasion from thyroid cancer was observed at ages of >70years. In addition, conventional surgical management appears to be limited in its ability to reconstruct tracheal defects.

Effects of aging on basement membrane of the soleus muscle during recovery following disuse atrophy in rats.

Aging is known to lead to the impaired recovery of muscle after disuse as well as the increased susceptibility of the muscle to damage. Here, we show that, in the older rats, reloading after disuse atrophy, causes the damage of the muscle fibers and the basement membrane (BM) that structurally support the muscle fibers. Male Wistar rats of 3-(young) and 20-(older) months of age were subjected to hindlimb-unloading for 2weeks followed by reloading for a week. In the older rats, the soleus muscles showed necrosis and central nuclei fiber indicating the regeneration of muscle fibers. Furthermore, ectopic immunoreactivity of collagen IV, a major component of the BM, remained mostly associated with the necrotic appearance, suggesting that the older rats were impaired with the ability of repairing the damaged BM. Further, after unloading and reloading, the older rats did not show a significant alteration, although the young rats showed clear response of Col4a1 and Col4a2 genes, both coding for collagen IV. In addition, during the recovery phase, the young rats showed increase in the amount of Hsp47 and Sparc mRNA, which are protein folding-related factor genes, while the older rats did not show any significant variation. Taken together, our findings suggest that the atrophic muscle fibers of the older rats induced by unloading were vulnerable to the weight loading, and that attenuated reactivity of the BM-synthesizing fibroblast to gravity contributes to the fragility of muscle fibers in the older animals.

A case of angiosarcoma arising from internal jugular vein.

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 (66Gy) 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.

Prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status.

BACKGROUND: The purpose of this study was to determine whether pretreatment 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG PET/CT) volume-based parameters, such as metabolic tumor volume and total lesion glycolysis, add more prognostic information in patients with oropharyngeal squamous cell carcinoma (SCC). METHODS: The subjects were 47 patients with oropharyngeal SCC who underwent 18F-FDG PET/CT before any treatment and followed by definitive therapy. PET parameters (metabolic tumor volume and total lesion glycolysis) and tumor p16/p53 status were evaluated retrospectively. Univariate and multivariate analyses were performed for disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). RESULTS: All volume-based PET parameters were found to be significant prognostic factors for DFS, DSS, and OS in univariate analysis. In multivariate analysis, only metabolic tumor volume for total tumor lesions (cutoff 65) retained an independent association with DFS, DSS, and OS. CONCLUSION: Metabolic tumor volume for total tumor lesions may be a predictive marker for survival outcomes in patients with oropharyngeal SCC with known p16/p53 status.

Prognostic impact of p16 and p53 expression in oropharyngeal squamous cell carcinomas.

BACKGROUNDS: A p16 protein is known to be overexpressed in human papillomavirus-positive head and neck squamous cell carcinoma specimens. p53 is a tumor suppressor protein detectable by immunohistochemistry in carcinogen-associated head and neck squamous cell carcinoma as a result of gene mutations. The purpose of this study is to investigate the prognostic impact of p16 and p53 expression in oropharyngeal squamous cell carcinomas. METHODS: We retrospectively examined the relationship between prognosis, and p16 and p53 expression levels of oropharyngeal squamous cell carcinoma specimens in 53 patients using immunohistochemistry. RESULTS: Overall, 55% of patients were p16 positive and 45% p16 negative, while 28% were p53 positive and 72% p53 negative. The p16 status showed an inverse relationship with the p53 status. A survival analysis by p16 status, p53 status, Union for International Cancer Control stage and main treatment modality demonstrated that only p16 status was related to better prognosis in terms of overall survival and disease-specific survival (3-year overall survival, 87 vs. 62%, P = 0.02; 3-year disease-specific survival, 90 vs. 62%, P = 0.02). To evaluate the practical prognostic factors in oropharyngeal squamous cell carcinoma patients, we classified patients as either p16-positive or p53-negative oropharyngeal squamous cell carcinomas, representing human papillomavirus-related oropharyngeal squamous cell carcinoma with wild-type p53 or the remaining patients with p16-negative or p53-positive OPSCCs, respectively. The former group showed survival advantages in terms of overall survival and disease-specific survival by log-tank test compared with the latter group (3-year overall survival, 96 vs. 58%, P = 0.005; 3-year disease-specific survival, 96 vs. 63%, P = 0.02). CONCLUSIONS: A group of patients who were p16 positive/p53 negative had better prognoses in terms of overall survival and disease-specific survival than that who were p16-positive alone.

Intra-arterial administration of antibiotics for refractory skull base osteomyelitis.

We report two cases of elderly diabetic men with skull base osteomyelitis (SBO) originating from malignant external otitis (MEO). In both, a devastating infection and neural paralysis deteriorated after conventional therapy, including long-term intravenous administration of culture-directed antibiotics with strict control of blood sugar levels and surgical debridement of infectious granulation tissue. Since poor perfusion of antibiotics in the lesion may be associated with serious nature of MEO/SBO, we administered antibiotics intra-arterially via a retrograde catheter with the tip set at the proximal point of the external carotid artery to increase the tissue drug concentration in the maxillary artery (MA) and ascending pharyngeal artery (APA) supply areas, in which intense inflammation was observed. This intra-arterial administration of antibiotics (IA therapy) followed by long-term intravenous and oral antibiotic treatments eliminated their infection and no recurrence was observed in 2 years follow-up period. Interestingly, CT images of angiography via the catheter demonstrated stronger enhancement in the MA supply area compared to the APA supply area and IA therapy was more effective in the former. These results suggest that IA therapy, which might achieve high antibiotic concentration at the site of infection, is effective in patients with MEO/SBO refractory to conventional treatments.

Clinical features of rapidly progressive bilateral sensorineural hearing loss.

CONCLUSION: Rapidly progressive bilateral sensorineural hearing loss (SNHL) often develops as a symptom of intracranial diseases or systemic vasculitis. For early diagnosis and treatment of these potentially fatal diseases, a history of hearing deterioration within 2 months and associated symptoms may be important. OBJECTIVES: To reveal clinical features and causative diseases for rapidly progressive bilateral SNHL. METHODS: The inclusion criterion was patients with bilateral progressive SNHL, who had experienced difficulty in daily conversation within 4 days to 1 year after the onset of hearing loss awareness. This study was a retrospective evaluation of 12 patients with rapidly progressive bilateral SNHL who visited our hospital between 2007 and 2011. RESULTS: The causative disease for hearing loss was identified in 11 of 12 patients; intracranial lesions including nonbacterial meningitis, meningeal metastasis of lymphoma, and superficial siderosis in 4 patients, systemic vasculitis in 2, auditory neuropathy spectrum disorder in 1, and an isolated inner ear disorder in 4. Relatively rapid hearing deterioration within 2 months showed a significant association in six patients with an intracranial lesion or systemic vasculitis. Moreover, all these six patients complained of dizziness and/or non-cochleovestibular symptoms such as fever, headache, and/or altered mental state in addition to hearing loss.

Predictive value of middle ear aeration before second-stage operation in staged tympanoplasty with soft-wall reconstruction.

CONCLUSION: The extent of middle ear aeration before second-stage canal wall-down (CWD) tympanoplasty was correlated with postoperative middle ear stability. OBJECTIVE: 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). METHODS: 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. RESULTS: 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.

[A case of intraorbital solitary fibrous tumor resected successfully with preoperative arterial embolization].

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.

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.