Olanzapine for The Prevention of Nausea and Vomiting Caused by Chemoradiotherapy with High-Dose Cisplatin for Head and Neck Cancer.

Background: Chemotherapy-induced nausea and vomiting (CINV) are the most common and distressing adverse events in patients receiving anticancer therapy. Radiotherapy also induces nausea and vomiting, so concurrent chemoradiotherapy-induced nausea and vomiting (CRINV) are significant problems for patients undergoing chemoradiotherapy. Conventionally, three-drug combination therapy with dexamethasone, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, and neurokinin-1 (NK1) receptor antagonist has been used to prevent CRINV induced by concurrent chemoradiotherapy with cisplatin for patients with head and neck cancer (HNC). Nonetheless, CRINV still remains a problem. The effectiveness of adding olanzapine to prevent CINV has been reported, suggesting the efficacy of four-drug combination therapy for CRINV. However, its effectiveness has hardly been reported in patient receiving chemoradiotherapy for HNC. Methods: A total of 109 patients with HNC who received concurrent chemoradiotherapy with cisplatin from April 2014 to March 2021 were included and divided into the following two groups according to antiemetic treatment regimen: the conventional group (Con group; n = 78) who received three-drug combination therapy and the olanzapine group (Olz group; Olz group, n = 31) who received four-drug combination therapy with olanzapine. Acute (0 to 24 h from cisplatin) and delayed (25 to 120 h from cisplatin) CRINV were then compared using the Common Terminology Criteria for Adverse Events. Results: No significant difference in acute CRINV were observed between both groups (P = 0.5761, Fisher's exact test). However, the Olz group had a significantly lower incidence rate of delayed CRINV over Grade 3 compared to the Con group (P = 0.0318, Fisher's exact test). Conclusion: Four-drug combination therapy with olanzapine was effective in suppressing delayed CRINV due to chemoradiotherapy with cisplatin for HNC.

Photoimmunotherapy with surgical navigation and computed tomography guidance for recurrent maxillary sinus carcinoma.

Photoimmunotherapy (PIT) using lasers to target treatment areas is effective for unresectable locally advanced or unresectable locoregionally recurrent head and neck cancer; however, there are only two devices to target the treatment area. One illuminates tumour tissue through a needle, and the other illuminates tumour tissue superficially. Treating lesions surrounded by bone, such as in maxillary sinus cancer, is difficult. We report the first case of PIT for unresectable recurrent maxillary sinus cancer employing surgical navigation and computed tomography guidance in a 56-year-old man. Although he underwent concurrent chemoradiotherapy for cT4bN0M0 maxillary sinus cancer, the tumour recurred at the primary site 6 months post treatment. Chemotherapy was performed for approximately 1 year; however, the tumour progressed. The tumour involved the anterior wall of the maxillary sinus and caused bone destruction; thus, we believed that PIT with a needle device was possible if the puncture was carefully performed. We used a surgical navigation system for neurosurgery and computed tomography guidance to ensure that intraoperative punctures were accurately performed. The operation time was 1 h 52 min and the treatment was completed as planned. Tumour necrosis and volume reduction were obtained with no severe adverse events, which reduced the patient's pain.

A Novel Concept for Surgical Management of a Traumatic Comminuted Cricoid Fracture.

The cricoid plays 2 key roles: phonation and maintenance of the airway frame, both of which are lost in cases of comminuted cricoid fractures. The management of these 2 functions becomes a challenge in planning surgical treatment. We report the treatment course in a case of traumatic comminuted cricoid fracture that was resolved with good airway and phonatory functions. A 25-year-old man fell down the stairs and complained of respiratory discomfort and hoarseness of voice. A computed tomography scan showed comminuted cricoid fracture; therefore, surgery was performed to restore the patient's airway and phonation functions. We found that the airway was maintained by the anterior part and that the phonation depended on the posterior part of the cricoid. This novel concept helped clarify the treatment goal in this case of comminuted cricoid fractures. Furthermore, it is important that the anterior part of the cricoid is reconstructed with sufficient internal diameter, while the posterior part of the cricoid is reconstructed in the correct position.

Successful transoral videolaryngoscopic surgery for leiomyoma in the base of the tongue.

Leiomyomas are benign tumors with smooth muscle differentiation that occur most frequently in the uterine myometrium. They are uncommon in the head and neck region. We report a rare case of tongue base leiomyoma successfully resected with transoral endoscopic surgery. A 14-year-old male was found to have a tongue base tumor. The tumor located in the right tongue base. It had a smooth surface and no deep invasion. The tumor was resected with transoral videolaryngoscopic surgery. There were no serious adverse events requiring further intervention. Histologically, the tumor was composed of densely cellular fascicles of spindle-shaped cells with smooth muscle differentiation with diffuse and intense reactivity for α-smooth muscle actin, desmin, calponin, and anaplastic lymphoma kinase on immunohistochemistry. After careful consideration of the differential diagnosis, the tumor was diagnosed a smooth muscle tumor, mostly consistent with leiomyoma. This is the first report of leiomyoma arising from the tongue base that was completely resected by transoral videolaryngoscopic surgery without adverse events. For tongue base tumors, endoscopic transoral surgery can be considered as an option for complete resection without impairment of postoperative function.

Usefulness of ultrasound for assessing the primary tumor of hypopharyngeal carcinoma.

Objectives: To clarify the usefulness of ultrasonography for detecting hypopharyngeal cancer. Study Design: Cross-sectional study. Methods: The study included 95 patients who underwent pre-treatment ultrasonography. We evaluated the usefulness of ultrasonography for detecting primary hypopharyngeal carcinoma of each T stage and subsite, and for assessing extrahypopharyngeal invasion. Additionally, we determined the efficacy of color Doppler for evaluating primary hypopharyngeal carcinoma. Results: The patients comprised 93 men and 2 women with a mean age of 67.5 years. The T stage (primary tumors) was T1 in 29 patients, T2 in 22, T3 in 9, and T4 in 35. Primary sites with a T stage over T3 were detected using ultrasonography in 17 patients.Regarding primary subsites, postcricoid tumors were assessed most easily (64%), while posterior wall tumors were the most difficult to assess (25%). In 15 of 17 patients, the evaluation of extrahypopharyngeal invasion by ultrasonography matched up precisely with computed tomography findings. In addition, abnormally increased blood flow in primary hypopharyngeal cancers was recognized by color Doppler, and could be used to predict subsites. Conclusions: Cancers at T3 and T4 hypopharyngeal primary tumors and their extrahypopharyngeal invasion were detectable using ultrasonography. Furthermore, ultrasonography was useful for assessing postcricoid tumors that were difficult to observe by flexible laryngoscopy. Level of Evidence: 4.

Benign and malignant tumors in Down syndrome: analysis of the 1514 autopsied cases in Japan.

BACKGROUND: Down syndrome is known for its association with neoplasms. The aim of this study was to examine this association. METHODS: We surveyed the association with benign and malignant neoplasms in Down syndrome patients registered in the Annual of Pathological Autopsy Cases of Japan (1974-2000), a database of autopsied cases operated by the Japanese Society of Pathology. RESULTS: In a total of 1514 cases with Down syndrome, there were eight cases with 10 benign tumors (four male and four female) and 104 cases with malignant disorders (61 male, 42 female and one case with unrecorded sex), in which 87 cases with hematopoietic malignancies (83.7%) and 17 cases with solid tumors (16.3%), were identified. The association of gallbladder adenocarcinoma with a benign tumor of the colon was noted in one case, while a further two cases with double benign tumors were confirmed as well. No case with a double malignancy was found. Hematopoietic malignancies (87 cases) included 31 cases (35.6%) with acute myelocytic leukemia, 10 (11.4%) with acute lymphocytic leukemia and two (2.3%) with chronic myelocytic leukemia. The ratio of acute myelocytic leukemia to acute lymphocytic leukemia was 3.1 in the present study. A peak in the age distribution was at 0 years in our data in contrast to the previous data (at 1 year) for myelocytic leukemia. The 17 solid tumors identified included three hepatocellular carcinomas, three extrahepatic cholangiocarcinomas, two gallbladder adenocarcinomas, three brain tumors, and three seminomas. CONCLUSION: We present new associations of benign and malignant tumors with Down syndrome.

Live birth prevalence of Down syndrome in Tottori, Japan, 1980-1999.

One hundred sixty-four patients with Down syndrome (DS) were confirmed in Tottori Prefecture, Japan, from 1980 to 1999. The sex ratio of 1.52 (99 males and 65 females) was comparable to that reported in previous studies. The live birth prevalence per 1,000 was 1.52 (95% CI: 1.29-1.75) from 1980 to 1999, with a prevalence of 1.34 (95% CI: 1.05-1.63) recorded between 1980 and 1989, and 1.74 (95% CI: 1.37-2.11) between 1990 and 1999. There was no statistically significant change between these two decades (chi(2)-test). Live birth prevalence in these two decades showed a significant increase (chi(2)-test, P < 0.005) compared with that recorded in 1969-1978 in Tottori Prefecture (0.803, 95% CI: 0.677-0.929). Mean ages of mothers at the birth of a DS patient were 31.0 years in 1980-1989 and 32.4 years in 1990-1999 (t-test, no significant difference). Dispersion analysis on the mean age of mothers at birth for patients born between 1969-1978, 1980-1989, and 1990-1999 showed a significant difference (t-test, P < 0.005), while comparing the mean age of mothers in 1969-1978 to those in 1990-1999 also revealed a significant difference (t-test, P < 0.001). Live birth prevalence has increased due to the rise in fertility rates among older women, although maternal age-specific risk rates remain unchanged. The widespread introduction of induced abortion following prenatal diagnosis decreased live birth prevalence of DS largely in European (and a few Asian) countries after 1990, or kept prevalence steady, despite increasing fertility rates among women aged 30 and over. In contrast, all published studies have reported an increase in live birth prevalence of this syndrome in Japan, probably resulting from the fact that prenatal diagnoses are used only exceptionally in this country (due to the negative attitude toward selection of life in Japanese culture).

Martsolf syndrome in Japanese siblings.

We describe a Japanese brother and sister with Martsolf syndrome. They had short stature, severe mental retardation, cataract, hypogonadism, craniofacial dysmorphism, and bone and joint symptoms including scoliosis, lax finger joints, and talipes valgus. Previously undescribed findings included proximal femoral epiphyseal dysplasia reminiscent of Legg-Calve-Perthes disease in both patients, and Klippel-Feil malformation and osteopathia striata in one patient. Brain MRI showed mild frontal and temporal lobe atrophy, and mild ventricular enlargement. Severe GH deficiency was demonstrated after insulin tolerance and glucagon/propranolol tolerance tests. No responses to serum LH and FSH after a gonadotropin-releasing hormone (GnRH) test suggested secondary hypogonadism, that is, hypogonadotropic hypogonadism, due to hypothalamus-pituitary axis insufficiency in both patients.