[A site of origin histopathological study on parapharyngeal space tumors. A review of 76 cases].

Tumors of the parapharyngeal space are said to account for 0.5% of all head and neck tumors, and are thus relatively rare. We performed histopathological examination of 76 tumors of the parapharyngeal space in patients hospitalized at the International University of Health and Welfare, Mita Hospital Head and Neck Oncology and Surgery center for 6 years from July 2005 to June 2011. There were 35 men and 41 women; the patients ranged in age from 15 to 78 years with a median age of 44. We performed preoperative CT and MRI, aspiration biopsy cytology (fine needle aspiration [FNA]) and postoperative histopathology diagnosis. There were 69 benign tumors (90.8%), and 7 malignant tumors (11.8%). Among the benign tumors were 32 schwannomas (42.1%) and 28 pleomorphic adenomas (36.8%). A total of 26 tumors of prestyloid origin were pleomorphic adenomas (93.8%), and 28 tumors of poststyloid origin were schwannomas (87.5%); all 7 malignant tumors (100%) were of prestyloid origin. There were 55 patients who underwent preoperative FNA, and the proper diagnosis rate was 70.9% (39/55 case). Preoperative imaging seemed to be very useful for predicting the histopathology. Furthermore, it would be desirable for FNA to be performed preoperatively for tumors of prestyloid origin, in consideration of the likelihood of such tumors being malignant. We think that there is room for improvement in the accurate FNA diagnosis rate.

An investigation on pharmacy functions and services affecting satisfaction of patients with prescriptions in community pharmacies.

Various functions expected by patient expects are needed with progress in the system for separation of dispensing and prescribing functions. In this investigation, the relationship between patient satisfaction and pharmacy function were analyzed quantitatively. A questionnaire survey was conducted in 178 community pharmacies. Questions on pharmacy functions and services totaled 87 items concerning information service, amenities, safety, personnel training, etc. The questionnaires for patients had five-grade scales and composed 11 items (observed variables). Based on the results, "the percentage of satisfied patients" was determined. Multivariate analysis was performed to investigate the relationship between patient satisfaction and pharmacy functions or services provided, to confirm patient's evaluation of the pharmacy, and how factors affected comprehensive satisfaction. In correlation analysis, "the number of pharmacists" and "comprehensive satisfaction" had a negative correlation. Other interesting results were obtained. As a results of factor analysis, three latent factors were obtained: the "human factor," "patients' convenience," and "environmental factor," Multiple regression analysis showed that the "human factor" affected "comprehensive satisfaction" the most. Various pharmacy functions and services influence patient satisfaction, and improvement in their quality increases patient satisfaction. This will result in the practice of patient-centered medicine.

[Prophylactic neck dissection for submandibular gland cancer].

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in T1, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma, 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomyohoid neck dissection is suitable for N0 cases of submandibular gland cancer because of four reasons: 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in N0 cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.