Visualization of horizontal canal benign paroxysmal positional vertigo using 3DCT imaging and its assessment.

BACKGROUND: There have been no useful imaging methods to diagnose benign paroxysmal positional vertigo (BPPV), a common cause of vertigo, depending on the characteristic symptom. OBJECTIVE: To visualize horizontal canal (HC) BPPV using 3DCT and assess its clinical usefulness. SUBJECTS AND METHODS: Ten BPPV patients were diagnosed with distinct BPPV, canalolithiasis, and cupulolithiasis of the HC (hc-BPPV, hc-BPPV-cu), which were definitely diagnosed on the basis of criteria of BPPV by the Barany Society and 10 healthy subjects without a history of dizziness were investigated using 3DCT with several different CT window values (CTWVs). RESULTS: The HCs of BPPV patients were clearly visualized and the luminal aspects showed differences among ears with cupulolithiasis, canalolithiasis and no symptoms healthy subjects. CONCLUSIONS AND SIGNIFICANCE: 3DCT images visualized the characteristic changes of the HC of patients with BPPV compared to healthy subjects. The HC images were coincident with the clinical condition of cupulolithiasis and canalolithiasis. This imaging technique is clinically useful for diagnosing, treating and assessing the prognosis of HC BPPV.

Practical 3DCT imaging of the vestibular aqueduct for Meniere's disease.

CONCLUSION: Radiographic visualization of the vestibular aqueduct (VA) from a lateral inside view was effective in assessing patients with Meniere's disease (MD). There were no VA shapes specific to MD on radiography, except for an obliterated VA. This technique could yield more accurate images and functional assessment of the VA for MD evaluation in a clinically useful and convenient manner, without requiring morphologic measurement. OBJECTIVE: To visualize the detailed images of the VA using three-dimensional (3D) computed tomography (CT) and discuss its clinical utility in assessing MD. SUBJECTS AND METHODS: The VAs in 13 healthy subjects and 25 MD patients, who were definitely diagnosed according to criteria described by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were imaged from the medial and lateral sides using 3DCT and compared to conventional CT images. RESULTS: Examination of the VA from both the lateral outside and inside views on 3DCT yielded more precise images than generated by conventional CT and could be useful to estimate the VA function. The estimated VA function in the MD ears was significantly abnormal compared to the function in healthy ears. An obliterated VA was characteristic of affected MD ears.

A clinical study of malignant tumors of Stensen's duct.

CONCLUSION: Malignant tumors of Stensen's duct are often squamous cell carcinomas. Surgery is the treatment of choice, and maintaining an adequate safety margin and performing parotidectomy may help to reduce postoperative recurrence. OBJECTIVES: Since malignant tumors of Stensen's duct are extremely rare, the number of cases is limited in single-facility studies, making it difficult to perform a sufficient number of clinical examinations. Therefore, we reviewed 26 cases with Stensen's duct malignancies to examine their clinical features. METHODS: We conducted a retrospective study of 26 cases with Stensen's duct malignancies, including 1 patient whom we treated and 25 cases previously reported in the English literature, and analyzed their clinical parameters, including age, sex, affected side, chief complaint, tumor size, histopathology, treatment method, and treatment outcome. RESULTS: Most cases were diagnosed in patients between 40 and 69 years of age. The chief complaint was swelling in the cheek in 24 patients, in 14 of whom the swelling was painful. The most common tumor diameter range was 10-19 mm. Squamous cell carcinoma was the most frequent histopathology. The recurrence rate in surgical patients who did not undergo parotidectomy was 60%, whereas in patients who underwent parotidectomy, the recurrence rate was only 7%.

Three-dimensional cone beam computed tomography imaging of the membranous labyrinth in patients with Meniere's disease.

CONCLUSION: Three-dimensional cone beam computed tomography (3DCT) images revealed characteristic malformations of the membranous labyrinth of the inner ear in Meniere's disease (MD). The morphology of the membranous region between the vestibular cecum of the cochlea and the saccule of ears with MD was compared to that of healthy ears. The present study supports the hypothesis proposed earlier that reuniting duct blockade is a result of the dislodgement of saccular otoconia. OBJECTIVE: To visualize the membranous labyrinth using 3DCT and to investigate the pathology of MD. METHODS: A preparatory study was conducted to determine the optimal 3DCT window settings for the detection of water, muscle, calcium carbonate (CaCO3), and bone. Based on this preparatory study, the ears of 13 healthy volunteers and 25 MD patients definitely diagnosed according to the criteria issued by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were visualized. RESULTS: The differences in the membranous labyrinth between MD ears and healthy ears could be visualized using 3DCT. The images were classified into three types based on their morphological pattern. The ears of patients with MD were different from normal ears in terms of this classification.

Epithelioid myoepithelioma of the accessory parotid gland: pathological and magnetic resonance imaging findings.

Tumors of the accessory parotid gland (APG) are rare, and pleomorphic adenoma (PA) is the most common benign APG tumor subtype. Myoepithelioma of the APG is much rarer than PA, and to date, only 5 cases have been sporadically reported in the English literature. We describe the clinicopathological and MRI findings of an epithelioid myoepithelioma of the APG that was treated in our hospital. The patient's only clinical symptom was a slow-growing and painless mid-cheek mass. The tumor was suspected to be PA before surgery based on the following MRI findings: (1) a well-circumscribed and lobulated contour, (2) isointensity and hyperintensity relative to the muscle on T1- and T2-weighted images (WIs), respectively, (3) good enhancement on contrast-enhanced T1-WIs, (4) peripheral hypointensity on T2-WIs, and (5) a gradual time-signal intensity curve enhancement pattern on gadolinium-enhanced dynamic MRI. The tumor was completely resected via a standard parotidectomy approach, and the postoperative pathological examination of the tumor, including immunohistochemistry, confirmed the diagnosis of epithelioid myoepithelioma. As it is hardly possible to distinguish myoepithelioma from PA and low-grade malignant tumors preoperatively, a pathological examination using frozen sections is helpful for surgical strategy-related decisions.

Evaluation of usefulness of fine-needle aspiration cytology in the diagnosis of tumours of the accessory parotid gland: a preliminary analysis of a case series in Japan.

CONCLUSION: The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign. OBJECTIVES: Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours. METHODS: We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours. RESULTS: There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

RBM10 regulates alternative splicing.

RBM10, originally called S1-1, is a nuclear RNA-binding protein with domains characteristic of RNA processing proteins. It has been reported that RBM10 constitutes spliceosome complexes and that RBM5, a close homologue of RBM10, regulates alternative splicing of apoptosis-related genes, Fas and cFLIP. In this study, we examined whether RBM10 has a regulatory function in splicing similar to RBM5, and determined that it indeed regulates alternative splicing of Fas and Bcl-x genes. RBM10 promotes exon skipping of Fas pre-mRNA as well as selection of an internal 5'-splice site in Bcl-x pre-mRNA. We propose a consensus RBM10-binding sequence at 5'-splice sites of target exons and a mechanistic model of RBM10 action in the alternative splicing.

Neural mechanisms of phonemic restoration for speech comprehension revealed by magnetoencephalography.

In daily communication, we can usually still hear the spoken words as if they had not been masked and can comprehend the speech when spoken words are masked by background noise. This phenomenon is known as phonemic restoration. Since little is known about the neural mechanisms underlying phonemic restoration for speech comprehension, we aimed to identify the neural mechanisms using magnetoencephalography (MEG). Twelve healthy male volunteers with normal hearing participated in the study. Participants were requested to carefully listen to and understand recorded spoken Japanese stories, which were either played forward (forward condition) or in reverse (reverse condition), with their eyes closed. Several syllables of spoken words were replaced by 300-ms white-noise stimuli with an inter-stimulus interval of 1.6-20.3s. We compared MEG responses to white-noise stimuli during the forward condition with those during the reverse condition using time-frequency analyses. Increased 3-5 Hz band power in the forward condition compared with the reverse condition was continuously observed in the left inferior frontal gyrus [Brodmann's areas (BAs) 45, 46, and 47] and decreased 18-22 Hz band powers caused by white-noise stimuli were seen in the left transverse temporal gyrus (BA 42) and superior temporal gyrus (BA 22). These results suggest that the left inferior frontal gyrus and left transverse and superior temporal gyri are involved in phonemic restoration for speech comprehension. Our findings may help clarify the neural mechanisms of phonemic restoration as well as develop innovative treatment methods for individuals suffering from impaired speech comprehension, particularly in noisy environments.

Clinical analysis of 21 cases of cervical tuberculous lymphadenitis without active pulmonary lesion.

CONCLUSION: The necessity of considering cervical tuberculous lymphadenitis (CTL) should be emphasized even today for the differential diagnosis of cervical lymphadenopathy, particularly when it is located in the posterior triangle and supraclavicular regions even in patients without active pulmonary tuberculosis (PTB). OBJECTIVE: This study was conducted to highlight the characteristics of patients with CTL without active PTB who were treated in our department. METHODS: Between 2004 and 2011, 21 cases of CTL without active PTB were included in this retrospective study. Histological examination after excisional biopsy of the affected lymph node was performed in 18 patients using hematoxylin and eosin staining and Ziehl-Neelsen (Z-N) staining for acid-fast bacilli (AFB) identification. Growth of Mycobacterium tuberculosis was detected by culturing and/or nucleic acid amplification tests including polymerase chain reaction (PCR) and transcription-mediated amplification (Mycobacterium Tuberculosis Direct: MTD). RESULTS: The male to female ratio was 1:1.3. Patient ages ranged from 22 to 89 years. Eighteen patients (85.7%) complained of indolent unilateral cervical lymphadenopathy in the posterior triangle (26.5%), internal jugular (24.5%), or supraclavicular nodes (18.4%). Positive rates of AFB according to Z-N staining and culturing of M. tuberculosis and/or PCR or MTD were 33.3% (6/18) and 72.2% (13/18), respectively.

Blockage pattern of longitudinal flow in Meniere's disease.

CONCLUSION: In the present study, classification of the patterns of 3D CT images of the ductus reuniens (reuniting duct) (RD), saccular duct (SD), and endolymphatic sinus (ES) gave more precise information for assessing the pathological condition of Meniere's disease (MD) than our previous study. OBJECTIVE: This study attempted to provide more detailed information on MD by classifying the patterns of 3D CT images of the RD, SD, and ES in patients with MD. METHODS: We examined the ears of 62 patients with definitely diagnosed unilateral MD based on the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using 3D CT. The 3D CT images of bony grooves of RD, SD, and ES (BRD, BSD, and BES) were classified into patterns according to aspects of their patency. RESULTS: BRD could be classified into six types by assessing their patency defined using the criteria in this study. In the ears on the affected side of patients with MD, the BRD, BSD, and BES lost continuity in 3D CT images along their bony routes and were significantly different from normal healthy ears (p < 0.01). There were no significant differences among each stage of MD in the distributions of BRD and BES except for BSD.

S1-1/RBM10: multiplicity and cooperativity of nuclear localisation domains.

BACKGROUND INFORMATION: S1-1, also called RBM10, is an RNA-binding protein of 852 residues. An alteration of its activity causes TARP syndrome, a severe X-linked disorder with pre- or post-natal lethality in affected males. Its molecular function, although still largely unknown, has been suggested to be transcription and alternative splicing. In fact, S1-1 localises in the nucleus in tissue cells and cultured cells. RESULTS: By deletion and substitution mutagenesis, a classical 17-amino-acid (aa) nuclear localisation sequence (NLS1) was identified at aa 743-759 in the C-terminal region of S1-1. NLS1 was bipartite, with its N-terminal basic cluster weakly contributing to the NLS activity. S1-1 contained two additional NLSs. One was in the aa 60-136 RNA recognition motif region (NLS2), and the other was a novel NLS motif sequence in the aa 481-540 octamer-repeat (OCRE) region (NLS3). The OCRE is a domain known to be critical in splicing regulation, as shown with RBM5, a close homologue of RBM10 [Bonnal et al. (2008) Mol. Cell 32, 81-95]. The NLS activities were verified by expressing each DNA sequence linked to EGFP or a FLAG tag. These multiple NLSs acted cooperatively, and S1-1 became completely cytoplasmic after the concomitant removal of all NLS domains. In some cell types, however, S1-1 was partly cytoplasmic, suggesting that cellular localisation of S1-1 is subjected to regulation. CONCLUSIONS: The present results indicate that S1-1 contains multiple NLSs that act cooperatively. Among them, the OCRE is a hitherto unreported NLS. The nuclear localisation of S1-1 appears to be regulated under certain circumstances. We discuss these NLSs in relation to the biochemical processes they are involved in.

[Clinical features of accessory parotid gland tumors].

Accessory parotid gland tumors are relatively rare; hence, adequately detailed clinical analyses of these tumors are difficult to perform at a single institution. In this report, we describe the findings for 65 patients [29 men, 36 women; median age, 51 (9-81) years] with accessory parotid gland tumors, consisting of 4 cases documented by us and 61 cases previously reported by other Japanese authors. Approximately 50% of the patients were treated in an otolaryngology department, while the remaining patients were treated in plastic surgery, oral surgery, or dermatology departments. In 4 patients, the results of preoperative fine-needle aspiration cytology indicated that the tumor was benign; however, the postoperative histopathology results revealed malignant tumors. The frequencies of malignant and benign tumors were 44.6% (n = 29) and 55.4% (n = 36), respectively. Mucoepidermoid carcinoma and pleomorphic adenoma were the most frequent types of malignant and benign accessory parotid gland tumors, respectively. Among the various surgical methods that were used, such as direct cheek and intraoral incisions, a standard parotidectomy incision was the most preferred treatment approach for these tumors. Recently, an endoscopic approach has also been found to yield satisfactory results. An optimal approach should be selected after evaluating the advantages and disadvantages of these methods. No definite guidelines are available regarding the choice of elective neck dissection and postoperative radiation therapy for malignant accessory parotid gland tumors. Although tumor resection (plus elective neck dissection) and postoperative radiation therapy have been frequently performed for various kinds of malignant accessory parotid gland tumors to date, additional studies are needed regarding the criteria for selecting elective neck dissection and postoperative radiation therapy. Since the malignancy rate for accessory parotid gland tumors is higher than that for parotid gland tumors, the possibility of malignancy (especially mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma) should be considered when resecting accessory parotid gland tumors, even if the results of preoperative fine-needle aspiration cytology indicate that the tumor is benign.

Anatomic distribution of hematolymphoid malignancies in the head and neck: 7 years of experience with 122 patients in a single institution.

CONCLUSION: Most hematolymphoid malignancies in the head and neck were malignant lymphomas that most often occurred in sexagenarian men. Approximately 80% of them were B-cell lymphomas with a predominance of diffuse large B-cell lymphoma (DLBCL) in both nodal and extranodal sites. Our results were compatible with those in a previous study that was conducted in the central part of Japan. OBJECTIVES: This analysis was performed to describe the anatomic distribution of hematolymphoid malignancies that were diagnosed by biopsy in our department. METHODS: Clinical medical records of 122 patients with hematolymphoid malignancies in the head and neck from January 2004 to December 2010 were retrospectively reviewed. The anatomic site of origin according to the histopathology of each malignancy was analyzed. RESULTS: The incidence ratio of hematolymphoid malignancies was 15.1%. The male:female ratio was 2.3:1. Ages ranged from 17 to 89 years (median, 66). Of the 122 cases, 121 were lymphoid neoplasms (4 cases of Hodgkin lymphoma and 117 cases of non-Hodgkin lymphoma) and the remaining 1 was myeloid. The most common histopathology was DLBCL (54.9%), followed by follicular lymphoma (8.2%), and peripheral T-cell lymphoma (8.2%). Most commonly, the oropharynx (36.1%) and the cervical lymph node (34.4%) were affected.

[Solitary hyoid bone metastasis from hepatocellular carcinoma treated with surgery].

The incidence of bone metastasis in patients with hepatocellular carcinoma (HCC) has reportedly been increasing. The hyoid bone is rarely a target of metastatic HCC. We present a unique case of HCC which showed a single distant metastasis to the hyoid bone. An 81-year-old Japanese man was referred to us from the Department of Gastroenterology complaining of a 1-month history of a painful left neck mass when swallowing. He had a serial history of non-surgical treatments for HCC in the previous six years. Ultrasonography-guided fine needle aspiration cytology yielded a diagnosis of poorly differentiated carcinoma. PET-CT demonstrated a mass (SUV 3.8) which had destroyed the left side of the hyoid body. Based on these cytological and radiological findings of the mass in addition to his medical history of having recurrent HCC, we strongly suspected that the mass was a solitary metastatic HCC of the hyoid bone. The mass was completely resected combined with the hyoid bone under general anesthesia. Postoperative pathologic findings were consistent with metastatic HCC. The patient was relieved from pain in swallowing just after surgery. Minimally invasive surgery can be an effective treatment modality for pain relief even in patients with bone metastasis from HCC.

Assessment of Meniere's disease from a radiological aspect - saccular otoconia as a cause of Meniere's disease?

CONCLUSION: Significant reduced visualization of the reuniting duct (ductus reuniens; RD), saccular duct (SD) and endolymphatic sinus (ES) in Meniere's disease (MD) compared with normal control ears on three-dimensional (3D) CT imaging suggests the blockage of endolymphatic flow there with radiodense substances, which may be explained by dislodged otoconia from the saccule. These structures could be involved in the pathogenesis of MD. OBJECTIVE: This study was designed to visualize and assess the RD, SD and ES in patients with MD using 3D CT. METHODS: Sixty-two patients with a definite diagnose of unilateral MD, based on criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), were compared with contralateral ears and normal controls (26 ears) using 3D CT. The RD, SD and ES were scrutinized for patency on 3D CT images. RESULTS: MD ears showed loss of continuity of the RD, SD and ES based on evaluation of 3D CT images, and differed significantly from normal healthy control ears (p < 0.01).

Visualization and assessment of saccular duct and endolymphatic sinus.

CONCLUSION: The saccular duct and endolymphatic sinus run in the bony groove, before reaching the orifice of the vestibular aqueduct. We first clinically visualized this sulciform groove using three-dimensional (3D) cone beam CT images. This strategy can be useful to assess the condition of the saccular duct and endolymphatic sinus concerning the longitudinal flow system of endolymph. OBJECTIVE: To assess the saccular duct and endolymphatic sinus in the endolymphatic system in order to advance clinical studies on inner ear dysfunction. METHODS: The sulciform groove of the saccular duct and endolymphatic sinus of human subjects was analyzed by cone beam CT and compared with that of a cadaver. RESULTS: We could obtain reconstructed 3D CT images of the sulciform groove of the saccular duct and endolymphatic sinus using several CT window levels.

[A case of bilateral aplasia of the submandibular glands associated with a unilateral submandibular hemangioma].

Congenital aplasia of the major salivary gland is a rare condition. We report on a case of bilateral aplasia of the submandibular glands associated with a left submandibular hemangioma. A 62-year-old woman came to our department complaining of a 3-year history of left submandibular swelling. She had no notable family or personal medical history. On physical examination of the head and neck region, a 30 mm, non-tender mass was palpated in the left submandibular area. On imaging examinations including ultrasonography and CT, lack of the right submandibular gland and a left submandibular mass with calcification were demonstrated. Fine needle aspiration cytology resulted in blood elements only. Functioning tissue could not be observed in the bilateral submandibular glands on technetium pertechnetate scintigraphy. We performed a left submandibular tumor extirpation. Intraoperatively, the left submandibular gland and duct were missing. On pathologic examination, the tumor was found to be a hemangioma. The parotid and sublingual glands were recognized bilaterally on postoperative MRI. Her postoperative condition was satisfactory. This condition may be due to the dysfunction of several factors, such as fibroblast growth factors, related to gland differentiation.

Phase I/II study of s-1 plus cisplatin combination chemotherapy in patients with advanced/recurrent head and neck cancer.

OBJECTIVE: The objectives of this study were to determine the maximum tolerated dose (MTD) and recommended dose (RD) of S-1 plus cisplatin (CDDP) and to evaluate safety and efficacy using the defined RD in advanced/recurrent head and neck cancer (HNC). METHODS: S-1 was administered orally at 40 mg/m(2) twice daily for 14 consecutive days, and CDDP was infused on day 8 at a dose of 60 and 70 mg/m(2). Each course was repeated every 4 weeks. RESULTS: A total of 38 patients were registered, 10 patients for the Phase I study and an additional 28 patients for the Phase II study. Although no dose-limiting toxicity (DLT) was observed in the CDDP 60 mg/m(2) (Level 1) group, two of six patients in the CDDP 70 mg/m(2) (Level 2) group exhibited DLT (fatigue/diarrhea). The MTD was not achieved in the Phase I study. Level 2 was therefore determined as the RD. In the Phase II study, 34 patients, including 6 patients from the Phase I study, were evaluated. At the termination of treatment, the confirmed response rate was 44.1% (15/34, 95% CI: 27.4-60.8). The best response rate without an adequate duration time was 67.6% (95% CI: 51.9-83.4). The median survival period was 16.7 months, and the 1-year survival rate was 60.1%. The main toxicities of Grade 3 or above were anorexia (26.5%), nausea (14.7%), neutropenia/thrombocytopenia (11.8%) and anemia/fatigue (8.8%). CONCLUSIONS: This is considered to be an effective regimen with acceptable toxicities for HNC.

Blockage of reuniting duct in Meniere's disease.

CONCLUSION: The bony saccular orifice to the bony groove of the ductus reuniens (reuniting duct) could not be visualized in the Meniere's ear with significantly greater frequency compared with normal subjects, which suggests that the reuniting duct is affected by radio-opaque substances in CT findings. OBJECTIVE: This study investigated a more specific, objective, and simpler strategy to diagnose Meniere's disease by assessing the reuniting duct. SUBJECTS AND METHODS: We examined the ears of 12 patients with definitely diagnosed unilateral Meniere's disease in stage 3 based on Meniere's disease criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), and the ears of 12 normal control subjects using three-dimensional (3D) cone beam CT. RESULTS: The bony groove of the reuniting duct between the saccule and cochlea was visualized in all control subjects. However, the bony saccular orifice to the bony groove could not be visualized in the lesional ear of Meniere's patients with significantly greater frequency compared with those of the contralateral non-lesional ears and control ears (p < 0.01). This orifice was not patent in 66.7% (8 of 12 ears) on the lesional side but all contralateral non-lesional ears of the patients and normal control ears were patent.