Sudden out-of-hospital cardiac arrest in pediatric patients in Kyushu area in Japan.

BACKGROUND: It is well-known that a neurologically favorable outcome of out-of-hospital cardiac arrest (OHCA) is associated with the presence of bystander-initiated cardiopulmonary resuscitation (bystander CPR) and use of an automated external defibrillator. However, little is known about the effect of the presence of pre-existing conditions, prior activity, and locations on the outcome of pediatric OHCA. METHODS: We analyzed the data from questionnaires about pediatric patients with OHCA aged from 3 days to 19 years in the Kyushu area in Japan between 2012 and 2016. RESULTS: A total of 594 OHCA cases were collected. The numbers of OHCA cases and the rate of 1 month survival with a favorable neurological outcome during sleeping, swimming / bathing, and exercise were 192 (1.0%), 83 (32.5%), and 44 (65.9%), respectively. When an OHCA occurred at school (n = 56), 88% of children / adolescents received bystander CPR, but when it occurred at home (n = 390), 15% received bystander CPR. Cardiovascular (n = 61), suicide (n = 61), and neurological / neuromuscular (n = 44) diseases were three major pre-existing conditions. The OHCA of cardiovascular disease was associated with exercise (24/61) and mainly occurred at school (22/61). The OHCA of neurological / neuromuscular disease was associated with swimming/bathing (15/44) and mainly occurred during bathing at home (12/44). Multivariate regression analysis showed that the presence of bystander CPR (P < 0.001) and occurrence of OHCA at school (P < 0.001) were independently predictive of a favorable outcome in pediatric OHCA. CONCLUSION: The outcome was different among pre-existing conditions, prior activity, and location of OHCA. These findings might be useful for preventing OHCA and improving the outcome of pediatric OHCA.

[Fat injection to treat widening of a tracheoesophageal fistula with a voice prosthesis].

In the field of otolaryngology, fat injection is mainly performed for glottic insufficiency. We encountered a patient of tracheoesophageal fistula with a voice prosthesis after total laryngectomy, in whom the fistula grew too wide. This condition was difficult to treat by conservative therapy. We performed fat injection around the tracheoesophageal fistula, achieving sufficient reduction in the size of to prevent leakage. This treatment allowed continuous use of the voice the prosthesis by the patient.

[Isolated sphenoid sinus lesions: a clinical analysis of 44 cases].

OBJECTIVE: We reviewed isolated sphenoid sinus lesion (ISL), a relatively uncommon entity found mostly in departments other than otolaryngology. STUDY DESIGN: We retrospectively studied 44 cases of ISL at the Department of Otolaryngology, Kagoshima City Hospital, Kagoshima, Japan, for the 5 years between 1999 and 2003. METHODS: Data was obtained for each patient regarding age, present symptoms, first department visit, pathological classification, and therapy. RESULTS: Eighty percent of patients first visited departments other than otolaryngology. Of these, 32 had inflammatory disease, 8 mucocele, 1 a benign tumor, and 3 malignant tumors. The most common symptoms were headache at 59% followed by ocular symptoms at 27%. Ocular symptoms included ocular pain in 60% of those with inflammatory disease, visual disturbance in 63% of those with mucocele, and diplopia in all of those with neoplasms. CONCLUSION: The type of ocular symptom largely depends on ISL pathology. Patients with headaches and diplopia have a high ratio of malignant neoplasms. Endoscopic sinus surgery was useful in diagnosing and treating ISL in cases in which conservative therapy was ineffective. It is most important to differentiate pathological disease that requires early diagnosis and therapy such as acute inflammatory disease, mucocele with visual disturbance, and malignant tumors.

[Ectopic thyroid carcinoma lacking a thyroglossal duct cyst in the submental portion: a case report].

Ectopic thyroid carcinomas in the submental portion arise usually from a thyroglossal duct cyst. We report a rare case of that lacking a thyroglossal duct cyst. The patient, a 32 year-old man, had two submental tumors with good mobility. CT, MRI, and US revealed two solid tumors. Fine needle aspiration cytology (FNAC) suggested thyroid papillary carcinoma metastasis. The thyroid gland itself showed normal morphology. The submental tumors were extirpated. Pathological examination revealed ectopic normal thyroid tissue and papillary carcinoma. As the edge of the extirpated tumor showed positive papillary carcinoma cells, reoperation was performed to remove the residual tumor using Sistrunk's technique. To the best of our knowledge, this is the 45th case of ectopic thyroid carcinoma with no thyroglossal duct cyst and second case of that in the submental portion in the English and Japanese literature. FNAC was the most important to diagnose and differentiate the submental tumors.

[Juvenile nasopharyngeal angiofibroma: stage and surgical approach].

Juvenile nasopharyngeal angiofibromas (JNAs) are benign tumors that occasionally invade the pterygopalatine fossa, infratemporal fossa, or middle cranial fossa. Several surgical approaches have been used based on the location of the tumor, including transpalatal, transmaxillary, and lateral rhinotomy, midfacial degloving, and Le Fort type I osteotomy. We reviewed 4 cases of JNA that had been treated by resection in the Department of Otolaryngology of Kagoshima City Hospital and 31 cases of JNA reported in the Japanese literature between 1990 and 2003. We analyzed the outcome of the surgical treatment of JNA in these cases to identify the surgical approaches that were most effective in removing tumors at several different stages. Radkowski staging showed that 17 (48.6%), 2 (5.7%), 4 (11.4%), 9 (25.7%) and 3 (8.6%) patients had stage IA, IB, IIA, IIC, and IIIA tumors, respectively. A transpalatal approach was employed in 11 cases (31.4%), a transmaxillary approach in 9 cases (25.7%), a transnasal approach in 6 cases (17.1%), and other approaches, (25.7%). The recurrence rate was, 5% in the stage I cases, 38% in the stage II cases, and 33% in the stage III cases. The transpalatal approach was followed by a high recurrence rate in the cases of stage II and higher stage. Several factors are critical when choosing the surgical approach to JNA: adequate exposure of the tumor, ability to control bleeding, prevention of postoperative facial deformity, and avoidance of interference with growth of the face.

Effect of sugar alcohols on gut function and body composition in normal and cecectomized rats.

The effects of two sugar alcohols on feed utilization, digesta retention, gut fermentation and serum lipid profiles were compared in normal and cecectomized rats to examine the possibility of the cecectomized rat as an experimental animal with relevance to humans. Semi-purified diets containing no sugar alcohol, 7% sorbitol or 7% lactitol were fed to normal and cecectomized rats for 16 days. The digestibility of the crude fat and the compositions of the carcass dry matter and crude fat were significantly decreased by feeding sugar alcohols in both groups, but the effects were relatively higher in the cecectomized rats than in the normal rats. Diarrhea, faster transit times and shorter retention times of digesta were noted in the cecectomized rats fed sugar alcohols, while the inverse results were observed in the normal rats fed similar diets. The concentration of cecal organic acids was increased in the normal rats, whereas the concentration of colonic organic acids was decreased in the cecectomized rats fed sugar alcohols, compared with their corresponding control groups. The concentration of serum total cholesterol was decreased in both the normal and cecectomized rats fed diets containing sugar alcohols. The tendencies for diarrhea, faster digesta transit and reduced body fat induced by the fermentable materials in the cecectomized rat have good relevance to the parallel effects of fermentable materials in humans, suggesting the possibility of using the cecectomized rat as a model to study some of the physiological effects of sugar alcohols in humans.

[Verrucous carcinoma of the nasal cavity: a case report].

We report a rare case of verrucous carcinoma occurring in the nasal cavity. A 53-year-old man reporting left-sided nasal obstruction and awareness of a left intranasal lesion--a whitish polypoid lesion--was found in CT to have an expansive lesion of the left nasal cavity and maxillary sinus. The tumor was completely removed by Denker's operation. Verrucous carcinoma is a rare variant of squamous cell carcinoma most commonly seen in the oral cavity. In some cases, conventional squamous cell carcinoma components may be observed focally in verrucous carcinoma, called a hybrid tumor. In our case, the tumor showed typical features of a hybrid tumor. To the best of our knowledge, this is the first case of hybrid verrucous squamous cell carcinoma originating in the nose in the Japanese literature.