A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma.

Background: There is no standard first-line chemotherapy for recurrent/metastatic (RM) or unresectable locally advanced (LA) salivary gland carcinoma (SGC). Patients and methods: We conducted a single institution, open-label, single arm, phase II trial of combined androgen blockade (CAB) for androgen receptor (AR)-positive SGC. Leuprorelin acetate was administered subcutaneously at a dose of 3.75 mg every 4 weeks. Bicalutamide was administered orally at a daily dose of 80 mg. Patients were treated until progressive disease or unacceptable toxicities. Results: Thirty-six eligible patients were enrolled. Thirty-three patients had RM disease and three patients had LA disease. The pathological diagnoses were salivary duct carcinoma (34 patients, 94%) and adenocarcinoma, NOS (two patients, 6%). The best overall response rate was 41.7% [n = 15, 95% confidence interval (CI), 25.5%-59.2%], the clinical benefit rate was 75.0% (n = 27, 95% CI, 57.8%-87.9%). The median progression-free survival was 8.8 months (95% CI, 6.3-12.3 months) and the median overall survival was 30.5 months (95% CI, 16.8 months to not reached). Additional analyses between treatment outcomes and clinicopathological factors or biomarkers including AR positivity, human epidermal growth factor receptor 2 status, and its complex downstream signaling pathway gene mutations showed no statistically significant differences. Elevated grade 3 liver transaminases and increased serum creatinine were reported in two patients, respectively. Discontinuation of leuprorelin acetate or bicalutamide due to adverse event occurred in one patient. Conclusion: This study suggests that CAB has equivalent efficacy and less toxicity for patients with AR-positive RM or unresectable LA SGC compared with conventional chemotherapy, which warrants further study. Clinical Trial Registration: UMIN-CTR (http://www.umin.ac.jp/ctr/index-j.htm), identification number: UMIN000005703.

The foramen of Huschke: age and gender specific features after childhood.

The foramen of Huschke (FH) is an aperture that is formed in the tympanic plate of the temporal bone at the age of about 1 year. The FH usually closes before the age of 5 years; but it occasionally persists throughout life. A persistent FH may result in complications such as temporomandibular joint (TMJ) herniation and salivary fistula formation, and facilitate ear injury during TMJ arthroscopy. In this study, the authors examined 1994 temporal bones from 997 Japanese dry skulls, in order to define age and gender specific features of the persistent FH after childhood. A persistent FH was found in 12% of men and in 20% of women, representing a female predominance (P<0.0001). The incidence of a persistent FH decreased with age in both genders, suggesting that a persistent FH can close over time.

Potentially distinctive features of sinonasal inverted papilloma on MR imaging.

OBJECTIVE: The objective of this study is to describe potentially distinctive MR features of sinonasal inverted papilloma and those of coexisting squamous cell carcinoma. CONCLUSION: A sinonasal mass with a convoluted cerebriform pattern on T2- or enhanced T1-weighted images suggests inverted papilloma as a histologic diagnosis. Necrosis in a mass with such an appearance strongly suggests coexistent carcinoma.

Appearance of the inferior phrenic artery and vein on CT scans of the chest: a CT and cadaveric study.

OBJECTIVE: Central linear densities are often seen at the level of the diaphragm on CT scans of the chest. To determine the cause of these densities, we evaluated helical CT scans and correlated the results with the findings from a study of cadavers. SUBJECTS AND METHODS: Forty patients who had normal findings on conventional CT scans had helical CT of the entire chest. For the cadaveric study, we examined the lung bases and extrapleural spaces on the diaphragmatic surface in 22 formalinized cadavers. RESULTS: On helical CT scans, linear densities extending laterally from the mid-part of the right side of the inferior vena cava and from the posterior margin of the left ventricle were seen on the right side of the chest in 12 subjects (30%) and on the left side in 17 subjects (42%). In the cadavers, the inferior phrenic artery and the accompanying vein ran over the diaphragmatic dome in the extrapleural space from the region of the inferior vena cava on the right and from the posterior margin of the left ventricle on the left. These supradiaphragmatic vessels were seen on the right side in 10 cadavers (45%) and on the left side in four cadavers (18%). CONCLUSION: We conclude that these linear densities at the level of the diaphragm on CT scans of the chest represent the inferior phrenic artery and vein.

[Relationship between oral food intake and nausea caused by intravenous injection of iodinated contrast material].

From December, 1990 to July, 1992 we investigated the relationship between the time after oral food intake and nausea and vomiting caused by the intravenous injection of iodinated contrast media in 2,414 patients who underwent contrast enhanced CT. The contrast media used were as follows: amidotrizoic acid (high-osmolality contrast medium, HOCM, iodine 292 mg/ml) in 1173 patients, iopamidol (low-osmolality contrast medium, LOCM, iodine 300m g/ml) in 641 patients, and iohexol (LOCM, iodine 300 mg/ml) in 600 patients. All the patients had an intravenous injection of 100ml in volume. The overall incidence of nausea and vomiting was 3.8% (96/2412 patients). The incidence was 6. 7% (79/1173 patients) in the HOCM group and 1.4% (17/1241 patients) in the LOCM group. The incidence of nausea and vomiting increased with the interval between the oral intake of food and the intravenous injection of contrast medium. It is concluded that fasting before contrast-enhanced CT enhances the adverse effect of nausea and vomiting.

Infrahyoid spread of deep neck abscess: anatomical consideration.

The aim of this study was to determine the pathway of infrahyoid extension of the oropharyngeal abscess considering the anatomy of the fascial spaces by cross-sectional imaging. CT scans and MR images were retrospectively reviewed in ten patients with known infrahyoid extension of oropharyngeal abscesses (eight with acute tonsillitis, two with acute phlegmonous oropharyngitis). In seven of eight patients tonsillar abscesses descended along the deep cervical fascia converging on the hyoid bone and further accumulated in the anterior cervical space through which extension to the mediastinum took place in four patients. In seven patients the abscesses involved the retropharyngeal space at the infrahyoid neck. In two of these seven patients the abscesses directly extended down into the upper mediastinum through the retropharyngeal space. In one patients of the seven mediastinal spread of an abscess occurred through the posterior cervical space, not through the retropharyngeal space. Cross-sectional imaging is valuable in the evaluation of deep neck abscesses and the pathway of spread. The anterior cervical space in the infrahyoid neck is important for mediastinal extension of pharyngeal abscesses.