[Clinical Features of the Pediatric Acquired Cholesteatoma Based on the Staging Criteria for Cholesteatoma 2010 Japan].

In this study, we retrospectively evaluated the clinical features of the pediatric acquired cholesteatoma based on the staging criteria for cholesteatoma 2010 Japan. Between 2001 and 2012, total of 36 pediatric patients underwent otologic surgery at our hospital, 29 patients (29 ears) with pars flaccida cholesteatoma and 7 patients (7 ears) with pars tensa cholesteatoma. The age range was 4 to 15 years, (median was 10.5 years). Stage 11 was the most common for both the pars flaccida and pars tensa. A staged operation was performed in 24 ears with pars flaccida cholesteatoma, and 4 ears with pars tensa cholesteatoma. The success rate of hearing improvement was 72% (21/29) in pars flaccida cholesteatoma and 57% (4/7) in pars tensa cholesteatoma. Hearing improvement decreased in advanced cases. In staged operations, residual cholesteatoma was found in 11 ears (46%) with pars flaccida cholesteatoma and 2 ears (50%) with pars tensa cholesteatoma. These results suggest that the residual rate of cholesteatoma in the pediatric population is high. In conclusion, a high rate of residual cholesteatoma in the pediatric population was observed in our study. Thus a staged operation would be the recommended treatment approach in pediatric acquired cholesteatoma.

A Comparison of Analgesic Effect between Loxoprofen and Celecoxib and the Frequency of the Hemorrhage Following Tonsillectomy.

Hemorrhage following tonsillectomy is still a major complication despite the progress in medical technology. Celecoxib is a selective COX-2 inhibitor and has a lower effect of platelet aggregation compared with conventional non-steroidal anti-inflammatory drugs (NSAIDs). We investigated whether or not the selection of celecoxib would reduce the risk of hemorrhage and provide a good analgesic effect following tonsillectomy in comparison with the use of loxoprofen (a conventional NSAID). 　We divided 107 cases of tonsillectomy into two groups by the kind of analgesic prescribed; the celecoxib group (n=55) and the loxoprofen group (n=52). Regarding the effective rate of the analgesic effect, the loxoprofen group scored 93.3% and the celecoxib group scored 68.6%. There was a significant difference between them (p=0.0003). Regarding side effects, the celecoxib group showed no side effects, whereas 8.0% of the loxoprofen group developed abdominal pain. There were no statistically significant differences between the changes in the VAS scale regarding the pain (p=0.834), the prescription periods of analgesic (p=0.485), the amount of food intake during the hospitalization (p=0.579), the rescue dosage rate (p=0.585), periods of usage (p=0.198) and the last dosage day. As for the tendency and the grade of postoperative hemorrhage, there were no statistically differences between the two groups (p=0.220). The rates of occurrence of late-onset hemorrhage (i.e. after the postoperative eleventh day) were 0.0% (0/11) in the the celecoxib group (n=11) and 31.2% (5/16) in the the loxoprofen group showing a statistically differences between them (p=0.049). 　Our results suggest that Celecoxib might reduce the risk of late-onset hemorrhage after the postoperative eleventh day with few side effects, so it could be a useful analgesic drug following tonsillectomy. However, it might be necessary to consider administration in combination with acetaminophen because Celecoxib has insufficient analgesic effect following tonsillectomy.

[Submucosal Partial-turbinectomy (SPT) Preceding an Endoscopic Sinus Surgery (ESS) Procedure].

Preceding a endoscopic sinus surgery (ESS), we have proposed performing a submucosal partial-turbinectomy (SPT) which removes a part of the inferior nasal concha bone attached to maxillary sinus with an antrostomy. By this method, we could not only make a large antrostomy but also obtain good maneuverability by opening the middle nasal meatus in ESS. We performed SPT preceding ESS in 140 cases (261 sides) between January 2012 and June 2014. The stenosis rates of the middle nasal meatus were 14.2% (37 sides from 261 sides) in one month, 7.4% (18 sides from 243 sides) in three months and 3.7% (6 sides from 163 sides) in 6 months after surgery. The closing rates of the antrostomy were 1.5% (4 sides from 261 sides) in one month, 2.9% (7 sides from 243 sides) in three months and 6.7% (11 sides from 163 sides) in 6 months after surgery. We considered that the SPT method would contribute to secure sufficient ventilation routes for wound healing of sinusitis following surgery on the mucous membrane. In addition, the SPT method has merit from the point of deceasing risks of atrophic rhinitis and empty nose syndrome by preserving most of the inferior nasal concha.

[The Significance of Resection of the Cricoid Cartilage as a Surgical Procedure in Laryngotracheal Surgery].

The cricoid cartilage has been regarded as an extremely important organ because it plays important role in both of phonation and breathing. We herein report on two different types of surgical procedure for laryngotracheal diseases with aggressive resection of the cricoid cartilage. The first procedure is a tracheostomaplasty by partial resection of the cricoid cartilage. A tracheostoma is made by resection of the cricoid cartilage in the range of approximately a one-third front. This method is effective for such cases having difficulty in tracheostomy owing their backgrounds with such condition as neck stiffness, obesity, higher displacement of the brachiocephalic artery, short neck, thyroid disease and so on. We applied this procedure for eight cases with such difficult backgrounds. In all cases, we were able to make a good tracheostoma and the postoperative courses were uneventful. The second procedure is a glottic closure with resection of the cricoid cartilage and thyroid cartilage. We applied this procedure for six cases with intractable dysphagia. One case had a postoperative bleeding. We were able to make good conditions in all cases with a large tracheostoma and no pharyngeal-tracheal leakage. In conclusion, the surgical procedure involving resection of the cricoid cartilage can be applied to some laryngotracheal diseases.

[Clinical study of secondary cholesteatoma].

Acquired middle ear cholesteatoma is considered to be formed by retraction of the tympanic membrane. There are rare cases in which the tympanic membrane epidermis extends into the medial surface of the tympanic membrane from the margin of its perforation, namely so-called secondary cholesteatoma. We studied the cases of secondary cholesteatoma clinically. These cases were found in 13 of 419 ears (3.1%) with acquired middle ear cholesteatoma operated on in our hospital from March 2001 to October 2010. The average age of all the cases was 51.5 years old, with a range of 11-65 years. We adopted the canal wall down tympanoplasty procedure with canal reconstruction in all cases. The postoperative hearing improvement rate was 84.6%. There were no cases of recurrence of the cholesteatoma.

[A case of epiglottic NK/T cell malignant lymphoma].

We report a case of malignant epiglottic natural killer (NK)/T cell lymphoma. A 33-year-old man seen 1-month period for throat pain was found in endoscopic larynx examination to have inflammation with plaques and redness epiglottic. The 4 month period, right epiglottic inflammation showed progressive necrosis. The diagnosis of malignant lymphoma was confirmed by 3 biopsies. Laryngomicrosurgery specimens histologicalily showed moderate leukocytic infiltration mainly of atypical lymphocytes. Neoplastic cells were UHCL1+, CD3+, L26-, CD79a, and EBER-ISHW. Despite 4 units of DeVIC chemotherapy and regional irradiation, the man died of metastatis 1 year and 9 months after initial treatment. Among malignant laryngeal tumors, malignant epiglottic NK/T cell lymphoma is extremely rare, with only one case reported in the literature.

[Evaluation of soft diets using freeze infusion in videofluorography].

A food developed at the Hiroshima Prefectural Food Technology Research Center, Hiroshima, Japan, has proved to be a boon in videofluorography. The food features decreased hardness with retained their shape due to being impregnated with macerating enzymes under reduced pressure after vegetables are defrosted. Samples were removed immediately from the enzyme solution after freeze infusion. All foods tested raging from carrots to chicken contasted well in videofluorography in an evaluation of swallowing in 107 subjects with dysphagia, results for carrots compared well with those for 33% iopamidol, jelly, and yogurt. Only a subjects showed silent aspiration with carrots, compared to 19 with 33% iopamidol. Among 70 subjects showing no residual jelly and/or yogurt, just 12-8 severe and 4 moderate-showed residual carrots in the pharyngeal space. In contrast, among 67 subjects showing no residual carrots in the pharyngeal spase, 9 moderate subjects showing no residual jelly and/or yogurt. We concluded foods such as carrots treated as stated following jelly and/or yogurt as new nutrition sources for subjects with dysphagia.

Head and neck infections caused by Streptococcus milleri group: an analysis of 17 cases.

BACKGROUND: Streptococcus milleri group (SMG) is a common inhabitant of the mouth and gastrointestinal tract, and can be an aggressive pathogen causing abscess formation at various sites in the body. However, it has rarely been listed as a cause of head and neck infections. OBJECTIVES: The present study was performed to evaluate the clinical significance of SMG by reviewing the microbiology and clinical records of patients with SMG in head and neck infections retrospectively. STUDY DESIGN: A retrospective review of all patients diagnosed as having SMG bacterial infections at Onomichi General Hospital, Hiroshima, between the years 2001 and 2002 was performed; 17 patients developed head and neck infections with SMG. Here, we describe the clinical features and management of SMG in head and neck infection. RESULTS: The patient population consisted of 12 males and 5 females with a median age of 62 years (age range, 8-78 years). The sites of infection were as follows: maxillary sinus (n=6), peritonsillar region (n=4), subcutaneous (n=3), submandibular space-retropharyngeal space (n=1), deep neck-mediastinum (n=1), parapharyngeal space (n=1), submandibular space (n=1), tonsil (n=1), parotid gland (n=1), and masseter muscle (n=1). Ten cases (59%) were of suppurative diseases. Six cases (35%) had mixed SMG with anaerobe infection. Three cases showed deteriorating clinical courses, and all three of these cases were culture-positive for SMG with anaerobes. In addition, one deteriorating case showed gas gangrene regardless of repeated surgical debridement and intravenous antibiotic therapy; hyperbaric oxygen therapy improved this patient's condition. CONCLUSION: It is important to recognize SMG as a pathogen in head and neck infection. In addition, the care should be taken with infectious diseases caused by SMG with anaerobes as the patient's clinical course can deteriorate rapidly.

Reduced expression of p27 is correlated with progression in precancerous lesions of the larynx.

OBJECTIVES: Factors related to malignant transformation of laryngeal precancerous lesions remain largely unknown, so we investigated the relationship between the expression of p27 and precancerous laryngeal lesion. STUDY DESIGN: In this study we investigated the expressions of p27 and p53 protein in 56 cases with laryngeal precancerous or cancer lesions (20 cases of hyperplasia, 19 of dysplasia, and 17 of squamous cell carcinoma), and went on to evaluate the relationship between immunoreactivity of each of them and the histological findings. We also evaluated the correlation between immunoreactivity and proliferative activity with the aid of Ki-67 nuclear antigen staining. METHODS: A retrospective study was performed in 56 cases (20 with epithelial hyperplasia, 19 with epithelial dysplasia and 17 with laryngeal cancer). Immunohistochemistry was performed to investigate expression of p27, p53 protein and Ki-67 nuclear antigen staining, using the avidian-biotin-peroxidase complex technique. RESULTS: p27 immunostaining was observed in 12 out of 20 cases of hyperplasia (60%), six out of 19 cases of dysplasia (31%), and 2/17 (12%) of carcinoma. We found significant association between p27 immunostaining and the histological findings. On the other hand, p53 immunostaining was observed in 6/20 (30%) of hyperplasia, 3/19 (16%) of dysplasia, and 7/17 (41%) of carcinoma. No significant association was found between p53 and the histological findings. CONCLUSIONS: Our results revealed that immunohistochemical assessment of p27 in bioptic samples of laryngeal precancerous lesions might be useful in selective patients who should undergo a more specific follow-up evaluation.

Role of perivascular sympathetic nerves and regional differences in the features of sympathetic innervation of the vascular system.

Maintenance of blood pressure is mostly dependent on sympathetic "tone", and the sympathetic nerve innervates the entire vascular bed, excepting the capillaries. Although norepinephrine (NE) is the principal neurotransmitter released upon sympathetic nerve stimulation, neuropeptide Y and ATP are cotransmitters in various vascular tissues. In addition, dopamine and epinephrine, as well as acetylcholine, have been shown to be sympathetic neurotransmitters in specific vasculatures. Transmitter NE release is modified by a number of endogenous substances including the transmitter itself. Chronic denervation of the preganglionic fiber induces an increase in NE release per pulse, indicating postganglionic neuronal supersensitivity. So far, three main adrenoceptor types have been shown, alpha1, alpha2 and beta, each of which is further divided into at least three subtypes, as well as the alpha1L-adrenoceptor, a phenotype of the cloned alpha1a-adrenoceptor, in the blood vessel. Thus, the response of vessels with different receptor types to a transmitter varies quantitatively and even qualitatively from one vessel to another. The remarkable diversity in the sympathetic innervation mechanism in the vascular system may play an important role in regional variations in the regulation of blood flow. The sympathetic nerve also exerts long-term trophic action on the blood vessel. In conclusion, the sympathetic nervous system plays an important role not only in the regulation of cardiovascular dynamics but in the maintenance of the vessel structure, as well.