Candidemia in patients with head and neck cancer: mortality and a novel risk factor.

PURPOSE: Candidemia is a bloodstream infection (BSI) by Candida spp. and is associated with high mortality. However, there have been few reports about BSI in head and neck cancer (HNC). We aimed to evaluate the impact of candidemia in patients with HNC and compared it with bacteremia. STUDY DESIGN: A multicenter retrospective study. METHODS: We retrospectively analyzed 83 BSI episodes in HNC (2011 to 2020) and divided them into the candidemia and bacteremia groups. We then compared the survival rate and risk factors for candidemia between the groups. RESULTS: The overall cumulative incidence (risk) of candidemia in BSI was 12 out of 83 episodes (14.5%). The 1-year mortality for the bacteremia and candidemia groups was 33.3% and 58.3%, respectively (log-rank p = 0.041). Broad-spectrum antibiotics (odds ratio [OR]: 29.5; 95% confidence interval [CI], 2.49-350), mucositis (OR 11.0; 95% CI, 1.52-80.1), and malignant wounds (OR 79.5; 95% CI 1.33-4737) were significant risk factors for candidemia in HNC. CONCLUSIONS: Candidemia causes high mortality in patients with HNC. To our knowledge, malignant wounds have not been previously reported as a risk factor for candidemia. For early diagnosis and treatment of candidemia, risk factors should be considered, and antifungal therapy started earlier.

An autopsy case of Trousseau's syndrome with tumor thrombosis in unknown primary squamous cell carcinoma of the head and neck.

Trousseau's syndrome (TS) and tumor thrombosis (TT) are known as cancer-associated thrombosis with poor prognosis. TS is extremely rare in patients with squamous cell carcinoma. In this study, we report an unknown primary squamous cell carcinoma of the head and neck (SCCHN) patient with TS and TT in pulmonary artery definitely diagnosed by autopsy. A 73-year-old man had a past surgical history for unknown primary SCCHN and lung metastases. Three years after the initial surgery, the patient had multiple cerebral infarction, deep venous thrombosis in the legs and mediastinum metastases. Our diagnosis was TS and treatment with chemotherapy and unfractionated molecular heparin started. It could help control the hypercoagulative state and cancer progression, but finally, he died from progressive disease (mediastinum metastases and pulmonary embolism) five years after the initial surgery. An autopsy revealed multiple metastases and thrombosis in the pulmonary artery with squamous cell carcinoma microscopically. Although there is no established treatment for managing TS, intensive therapy such as a combination of chemotherapy and anticoagulant therapy can be effective in improving hypercoagulation therapy. In addition, an autopsy should be considered for patients with thrombosis to distinguish between TS and TT.

A case of rhinocerebral mucormycosis with brain abscess drained by endoscopic endonasal skull base surgery.

A 70-year-old Japanese man undergoing remission induction therapy for acute monocytic leukemia (AML-M5b) developed fever and headache, and was started on antibiotics and liposomal amphotericin B (L-AMB). There was no improvement, and computed tomography and contrast-enhanced magnetic resonance imaging revealed acute rhinosinusitis and brain abscess. Successful endoscopic endonasal surgery was performed at this point, providing drainage for the rhinosinusitis and abscess. Histopathological findings showed the mucormycosis.

The facial nerve canal in patients with Bell's palsy: an investigation by high-resolution computed tomography with multiplanar reconstruction.

Facial nerve edema is an important finding in Bell's palsy patients. Inflammation may cause facial nerve edema, and mechanical compression and ischemic change of the facial nerve may occur in the facial nerve canal. A few studies have reported the dimensions of the facial nerve canal using conventional computed tomography or human temporal bone sections. However, the cross-sectional area of the facial nerve canal has not been fully understood. Therefore, the cross-sectional area of the facial nerve canal was measured in patients with unilateral Bell's palsy by computer tomography with multiplanar reconstruction. Sixteen patients with unilateral Bell's palsy were enrolled. Computed tomography of the temporal bone was performed, and perpendicular images to the facial nerve canal were reconstructed by the multiplanar reconstruction technique. The cross-sectional area of the facial nerve canal on the affected and unaffected sides was measured at the labyrinthine segment, the horizontal segment, and the mastoid segment. Both in the labyrinthine and horizontal segments, the mean cross-sectional area of the facial nerve canal was significantly smaller on the affected side than on the unaffected side. There was no significant difference between the affected and unaffected sides in the cross-sectional area of the facial nerve canal in the mastoid segment. The labyrinthine segment was the narrowest segment in the facial nerve canal. These findings suggest that the facial nerve is vulnerable, especially in the labyrinthine segment of the facial nerve canal, and a narrow facial nerve canal may be one of the risk factors for Bell's palsy.

Modification of surgical procedures of type 1 tympanoplasty for non-cholesteatomatous chronic otitis media.

OBJECTIVE: To introduce our modified procedures of type 1 tympanoplasty and to assess their efficacy. METHODS: We modified the surgical procedures of type 1 tympanoplasty and have used these procedures since September 1999. The modified points are enlargement of the facial recess approach, no elevation of the posterior meatal skin and the tympanic annulus, and endoaural repair of tympanic membrane perforation. 51 patients with simple chronic otitis media have undergone this modified type 1 tympanoplasty. Postoperative hearing was evaluated according to the criteria proposed by the Otological Society of Japan. RESULTS: The average follow-up period was 15 months (range 6-35). The hearing result was considered successful when the postoperative hearing level satisfied with at least one of three conditions as follows: (1) air-bone gap <15 dB, (2) hearing gain >15 dB, or (3) hearing level >30 dB. The success rate was 94.1%. The average postoperative air-bone gap, hearing gain and hearing level were 3.9, 10.0 and 29.3 dB, respectively. CONCLUSION: Our modified tympanoplasty is useful to achieve better postoperative hearing results.

Evidence for Purinergic Receptors in Vestibular Dark Cell and Strial Marginal Cell Epithelia of Gerbil.

Purinergic receptors have been found to modulate ion transport in several types of epithelial cells as well as excitable cells. It was of interest to determine whether vestibular dark cells and strial marginal cells contain purinergic receptors in either the apicalor basolateral membrane which modulate transepithelial ion transport. Vestibular dark cell and strial marginal cell epithelia were mounted in a micro-Ussing chamber for the measurement of the transepithelial voltage and resistance from which the equivalent short circuit current (I(sc)) was obtained. The apical and basolateral sides were independently perfused with adenosine and adenosine 5'-triphosphate (ATP). Adenosine (10(-5) M) had no effect on I(sc) at either the apical or basolateral side of vestibular dark cells and strial marginal cells, suggesting either the absence of P(1) receptors or the absence of coupling of P(1) receptors to vectorial ion transport by these epithelia. Apical perfusion of ATP (10(-8) to 10(-4) M) caused a decrease in I(sc) of both vestibular dark cells and strial marginal cells. Apical perfusion of the nucleotides uridine 5'-triphosphate (UTP), 2-methylthioadenosine triphosphate (2-meS-ATP), adenosine 5'-O-(3-thiotriphosphate) (ATPγS) and α,ß-methylene adenosine 5'-triphosphate (α,ß-meth-ATP) caused qualitatively similar responses with different magnitudes of response. The sequence of the magnitude of response of each compound at 10(-6) or 10(-5) M was assessed from the fractional change of I(sc). The sequence for vestibular dark cells was UTP = ATP = ATPγS ≫ 2-meS-ATP > α,ß-meth-ATP, and for strial marginal cells it was UTP = ATP ≫ 2-meS-ATP, corresponding to the sequence for the P(2U) receptor. The effect of agonist on the apical membrane was reduced by the antagonist 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) but not cibacron blue or suramin. DIDS in the absence of exogenous purinergic agonist caused a sustained increase in I(sc). The effect of ATP on the apical membrane was greater in the absence of divalent cations. Basolateral perfusion of ATP led to a biphasic response of I(sc) in vestibular dark cell and strial marginal cell epithelia, consisting of an initial rapid increase followed by a slower decrease. Perfusion of the perilymphatic surface of the stria vascularis (basal cell layer) with ATP had no acute effect on I(sc). The initial increase of I(sc) in vestibular dark cell epithelium during basolateral perfusion had a sequence of 2-meS-ATP > ATP ≫ UTP = α,ß-meth-ATP = ATPγS, corresponding to the sequence for the P(2Y) receptor. Subsequently, the agonists caused a sustained decrease in I(sc) with a sequence of ATPγS > 2-meS-ATP > ATP > UTP >α,ß-meth-ATP. This sequence is most simply interpreted as the result of the coexistence of P(2U) and P(2Y) receptors in the basolateral membrane. Both the increase and decrease of I(sc) by ATP at the basolateral membrane were reduced by the antagonist suramin. These findings provide evidence for the regulation of transepithelial ion transport by P(2U) receptors in the apical membrane and by coexisting P(2U) and P(2Y) receptors in the basolateral membrane of K(+)-secretory epithelial cells in the inner ear and are consistent with the hypothesis that the apical receptors are part of an autocrine negative feedback system in these cells.