Morphological and functional changes of the geniohyoid muscle in elderly patients after hip fracture surgery: Comparison of ultrasound images with a focus on swallowing function.

OBJECTIVE: The purpose of this study was to clarify, using ultrasound imaging, (1) whether the area and contraction of GH change in elderly patients after hip fracture surgery and (2) whether the changes in the area and contraction of GH are related to decline in swallowing function. METHODS: The participants were 21 female patients over 65 years of age who underwent hip fracture surgery. The patients were divided into two groups based on the results of swallowing assessment by water drinking: One with normal swallowing function (NSF) and the other with suspected decline in swallowing function (DSF). Sagittal cross-sectional area (SA) of GH at rest and the shortening rate (SR) of GH upon contraction during swallowing were compared at two time points: immediately and 2 weeks after surgery. Wilcoxon signed-rank test was used for intra-group comparisons, and Mann-Whitney U-test was used for between-group comparisons. RESULT: SA of GH decreased significantly at 2 weeks after surgery in both groups, regardless of their swallowing function. In the intra-group comparison, SR significantly decreased (worsened) only in DSF group. SR at 2 weeks after surgery was significantly higher in NSF than in the DSF. In the inter-group comparison, DSF showed a significantly smaller (worse) change of SR than NSF in 2 weeks after surgery. CONCLUSION: Decrease in muscle mass, or atrophy, of GH observed in both NSF and DSF, did not coincide with the post-operative change in GH contraction of the two groups. The results suggest the importance of continuous swallowing assessment in the elderly individuals during their perioperative period.

A case of sinonasal teratocarcinosarcoma treated with surgery and post-operative intensity-modulated radiotherapy (IMRT).

Sinonasal teratocarcinosarcoma (SNTCS) is a rare and aggressive malignant neoplasm, which has poor prognosis. SNTCS is histologically characterized by the combination of one or more epithelial elements and mesenchymal components. We report a 59-year-old man with SNTCS involving right maxillary and ethmoid sinuses. He complained of numbness of the right cheek for 1 month. Computed tomography and magnetic resonance imaging revealed soft tissue filling the right maxillary and ethmoid sinuses, protruding into the nasal cavity. Tumor was removed with Denker rhinotomy, and post-operative intensity-modulated radiation therapy (IMRT: 64Gy in 32 fractions) was performed. Follow-up examination for 2 years after the IMRT has shown no evidence of recurrence or metastasis. IMRT is a new type of conformal radiotherapy that is based on the use of non-uniform radiation beam intensities. IMRT can achieve optimal dose distributions and may improve the clinical outcomes dramatically with minimal complications. This report describes this patient's clinical course, etiology, diagnosis and management of SNTCS, and the advantage of IMRT in the treatment of SNTCS.

Usefulness of C-arm CT during superselective infusion chemotherapy for advanced head and neck carcinoma.

PURPOSE OF THE STUDY: To evaluate the usefulness of C-arm computed tomography (CT) during superselective intra-arterial infusion chemotherapy for advanced head and neck carcinoma. METHODS: C-arm CT was performed during superselective intra-arterial infusion chemotherapy for 11 patients with advanced head and neck carcinoma located in the hypopharynx (n = 3), maxillary sinus (n = 3), oropharynx (n = 1), larynx (n = 1), extra-auditory canal (n = 1), tonsil (n = 1) and tongue (n = 1). The usefulness of C-arm CT during superselective catheterisation was evaluated. RESULTS: On arteriography, nine tumours showed tumour stains and two in the oropharynx or tonsil showed no obvious tumour stains. C-arm CT was performed one to four times (mean ± standard deviation, 2.5 ± 0.8) in each patient during a single procedure. C-arm CT clearly showed not only the vascular territory of the selected branch but also the tumour itself in all patients. Intra-arterial infusion chemotherapy was performed through one to three branches (mean, 1.7 ± 0.9) according to C-arm CT findings without any complications. CONCLUSION: C-arm CT during superselective intra-arterial infusion chemotherapy was useful to determine the arterial supply of head and neck carcinoma. C-arm CT may replace conventional CT during superselective arteriography in this procedure.

Sclerosing polycystic adenosis of the left parotid gland: report of a case with fine needle aspiration cytology.

BACKGROUND: Sclerosing polycystic adenosis (SPCA) of major salivary glands is a rare recently described entity. We report a case of SPCA of the left parotid gland, including the cytologic and histopathologic findings. CASE: A 20-year-old man presented with a left parotid mass that had been growing slowly for 3 years. Fine needle aspiration cytology showed many syncytial cell clusters of variable size and some ductal structures with an inflammatory background. The cells forming syncytial clusters were large and polygonal, with abundant, eosinophilic, granular or lacelike cytoplasm. Apocrine differentiation with decapitation secretion was commonly seen. The ductal cells had a relatively high nuclear/cytoplasmic ratio, with granular cytoplasm. Grossly, the 5-cm lesion was a discrete, pale, cystic nodule embedded within the parotid gland parenchyma. Microscopically, the lesion was a nonencapsulated, circumscribed mass of sclerotic and hyalinized, collagenous tissue with lymphoplasmacytic infiltration. Sclerosing adenosis and cystic ducts with frequent apocrinelike cells were commonly seen. Some acinar cells contained eosinophilic, intracytoplasmic granules of various sizes. CONCLUSION: The presence of syncytial clusters with apocrine metaplasia and ductal structures in a lymphoplasmacytic background should suggest a diagnosis of SPCA of a major salivary gland.

Tracheoesophageal shunt method with omohyoid muscle loop for voice restoration.

OBJECTIVE: To decrease the aspiration rate of the previously reported simple mucodermal tracheoesophageal (TE) shunt method for voice restoration after total laryngectomy with the use of omohyoid muscle loop. DESIGN: Retrospective clinical analysis. SETTING: Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan. PATIENTS: Ten male patients underwent total laryngectomy and received TE shunt by the omohyoid muscle loop method for voice restoration. There were 5 patients with glottic laryngeal cancer, 2 with supraglottic laryngeal cancer, and 3 with hypopharyngeal cancer. Patients' age ranged from 46 to 66 years. INTERVENTION: The dermal incision on the neck was U-shaped with a superiorly pedicled, small U-shaped dermal flap. This small flap was used to form the anterior wall of the shunt. Bilateral omohyoid muscles were preserved at the total laryngectomy site with or without neck dissection. After creating a TE shunt directly on the posterior wall of the tracheal stump, the bilateral omohyoid muscles were looped through each other beneath the TE shunt. MAIN OUTCOME MEASUREMENTS: Maximum phonation time, maximum phonation intensity, and rating scales of shunt voice, aspiration rate, and survival time. RESULTS: Mean maximum phonation time was 20 seconds, while mean maximum phonation intensity was 83 dB. The first voice was obtained on postoperative day 29 on average. Of the 10 patients, 9 could phonate, with 1 case (10%) of slight aspiration 3 months after the surgery. CONCLUSIONS: Although this omohyoid muscle loop method needs to preserve the hyoid bone with those muscles, aspiration was prevented more effectively compared with the former, direct mucodermal TE shunt method. The indication for this method is preferably glottic laryngeal cancer.