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1.
J Radiat Res ; 61(2): 243-248, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32030428

RESUMO

The identification of thyroid cancers among children after the Chernobyl nuclear power plant accident propelled concerns regarding long-term radiation effects on thyroid cancer in children affected by the Fukushima Daiichi nuclear power plant accident in Fukushima, Japan. Herein we consider the potential association between absorbed dose in the thyroid and the risk of developing thyroid cancer as detected by ultrasonography on 300 473 children and adolescents aged 0-18 years in Fukushima. The absorbed dose mentioned in the present study indicates the sum of that from external exposure and that from internally deposited radionuclides. We grouped participants according to estimated absorbed doses in each of 59 municipalities in Fukushima Prefecture, based on The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2013 report. The 59 municipalities were assigned to quartiles by dose. We limited our analyses to participants aged ≥6 years because only one case of thyroid cancer was observed in participants aged ≤5 years; 164 299 participants were included in the final analysis. Compared with the lowest dose quartile, the age- and sex-adjusted rate ratios (95% confidence intervals) for the low-middle, high-middle and highest quartiles were 2.00 (0.84-4.80), 1.34 (0.50-3.59) and 1.42 (0.55-3.67) for the 6-14-year-old groups and 1.99 (0.70-5.70), 0.54 (0.13-2.31) and 0.51 (0.12-2.15) for the >15-year-old group, respectively. No dose-dependent pattern emerged from the geographical distribution of absorbed doses by municipality, as estimated by UNSCEAR, and the detection of thyroid cancer among participants within 4-6 years after the accident. Ongoing surveillance might further clarify the effects of low-dose radiation exposure on thyroid cancer in Fukushima.

2.
Auris Nasus Larynx ; 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32088014

RESUMO

OBJECTIVES: The risk of aspiration pneumonia has been reported to increase with age, especially in elderly residents of nursing homes. However, the characteristics of those with swallowing impairments at elderly care facilities have not yet been evaluated using reliable instrumental examinations. The aims of the current study were to investigate the frequency of swallowing impairment and determine the characteristics of the elderly with swallowing disorders residing at care facilities. METHODS: To reveal the characteristics of the elderly with swallowing disorders, questionnaires for dysphagia screening and flexible endoscopic evaluation of swallowing (FEES) were used. Regarding the dysphagia screening, two types of questionnaires were sent to 451 elderly persons aged 65 years and older who were living in facilities for the elderly in Japan. FEES was performed to assess swallowing impairment at each facility for those who were found to be positive for dysphagia by the questionnaires. The frequency of swallowing impairment and the characteristics of elderly subjects with swallowing disorders were investigated. RESULTS: Among 413 subjects who completed both questionnaires, 229 were screened positive for dysphagia, 160 of whom underwent FEES. Swallowing impairment was observed in 93 subjects. The subjects with swallowing impairment had a significantly high prevalence of fever, sputum, and/or history of aspiration pneumonia. Their oral intake ability and activities of daily living were significantly low. CONCLUSION: We demonstrated the frequency of swallowing disorders and the characteristics of elderly subjects with swallowing disorders living in care facilities using FEES. Our results suggest the importance of screening all elderly care facility residents for dysphagia.

3.
Fukushima J Med Sci ; 65(3): 122-127, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31839647

RESUMO

The Great East Japan Earthquake, which occurred on March 11, 2011, and its subsequent Fukushima Daiichi Nuclear Power Plant accident, prompted implementation of the Thyroid Ultrasound Examination (TUE) program as a part of the Fukushima Health Management Survey. The purpose of this program is to support residents of Fukushima Prefecture, and to analyze the health effects of the released radionuclides. Regardless of relatively high participation rates and a well-planned diagnostic flow, it is conceivable that not all thyroid cancer cases can be detected by the TUE program. The aims of the present study were to identify and characterize these "outside" cases, targeting patients at Fukushima Medical University (FMU) Hospital. As of June 30, 2017, we have successfully identified 11 outside cases. These corresponded to 5.7% of the 194 subjects who were identified as having thyroid cancer or suspected thyroid cancer in the TUE program. Although the outside subjects of other institutes were not investigated, the present study may have identified the majority of outside subjects in Japan, considering that FMU Hospital treats a large number of thyroid cancer subjects. Furthermore, the characteristics of the 11 subjects were not different from those of the subjects identified in the TUE program. These findings confirm that the TUE program was able to identify subjects of thyroid cancer adequately and sufficiently.

4.
Epidemiology ; 30(6): 853-860, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31259849

RESUMO

BACKGROUND: The 2011 Great East Japan Earthquake led to a nuclear accident at Fukushima Daiichi Nuclear Power Plant. This study examines the associations of radiation dose and lifestyle factors with incidence of thyroid cancer in Fukushima. METHODS: We designed a prospective study with 300,473 participants aged 18 years or younger, who underwent thyroid examinations from October 2011. Follow-up surveys were conducted through June 2017, and 245,530 participants (123,480 men and 122,050 women, 82% follow-up) received follow-up examinations. Fukushima Prefecture was divided into five areas based on individual external radiation dose. We calculated relative risks and 95% confidence intervals (CIs) for thyroid cancer in each area, with area of lowest dose as reference, using age-adjusted Poisson regression models. We also calculated risks associated with overweight and obesity. RESULTS: The incidence per 100,000 for Groups A (highest dose), B, C, D, and E (lowest dose) were 13.5, 19.2, 17.3, 9.0, and 8.3, respectively. Compared with Group E, the age-adjusted risks (95% CIs) were 1.62 (0.59, 4.47) for group A, 2.32 (0.86, 6.24) for group B, 2.21 (0.82, 5.94) for group C, and 1.02 (0.36, 2.86) for group D. Obesity was positively associated with thyroid cancer incidence; the multivariable-adjusted risk of thyroid cancer was 2.23 (1.01, 4.90) for obese individuals compared with nonobese individuals. CONCLUSION: Regional differences in radiation dose were not associated with increased risk of thyroid cancer among children in Fukushima within 4 to 6 years after the nuclear power plant accident. Obesity may be an important factor for further follow-up in Fukushima.

5.
Laryngoscope ; 129(10): 2249-2252, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31099422

RESUMO

OBJECTIVES/HYPOTHESIS: Flexible endoscopic evaluation of swallowing (FEES) is a relatively safe procedure to determine the safety of oral feeding, and consists of the introduction of food and liquid as well as a sensitivity test. However, the introduction of food and liquid can cause pneumonia or suffocation secondary to aspiration. To solve this problem, we investigated the possibility of performing FEES without introduction of food or liquid (referred to hereafter as FEES screen) to assess swallowing impairment severity. STUDY DESIGN: Retrospective study. METHODS: A total of 106 subjects with swallowing impairment underwent conventional FEES, and both their salivary pooling degree and larynx sensitivity were analyzed to detect swallowing impairment without the introduction of food or liquid. The subjects were divided into two groups: an undetectable swallowing impairment (USI) group and a detectable swallowing impairment (DSI) group. The general characteristics, functional impairment status, and clinical assistance requirements of the two groups were investigated and compared. RESULTS: The numbers of subjects in the USI and DSI groups were 64 and 42, respectively. The DSI group showed a significantly higher prevalence of aspiration during FEES, and their required levels of care were also significantly higher. Additionally, their levels of consciousness, oral intake ability, and activities of daily living were significantly low compared to the USI group. CONCLUSIONS: This study demonstrated the feasibility of FEES screen for assessment of swallowing impairment severity. Using our low-risk assessment, we were able to identify subjects with low oral intake ability as well as those who required intervention. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2249-2252, 2019.


Assuntos
Transtornos de Deglutição/diagnóstico , Endoscopia/métodos , Adulto , Idoso , Deglutição , Ingestão de Alimentos , Endoscópios , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Índice de Gravidade de Doença
6.
Jpn J Clin Oncol ; 49(1): 37-41, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30364985

RESUMO

Objectives: To evaluate the clinical impact of cachexia, defined by the combination of albumin and C-reactive protein levels, in patients with unresectable locally advanced head and neck squamous cell carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706. Methods: Forty-five patients received radiation for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. The present analysis was conducted in 44 patients with available data. The association between treatment efficacy and cachexia was investigated. Pretreatment cachexia was defined as a serum albumin level of less than 3.5 mg/dl and C-reactive protein level of more than 0.5 mg/dl. Results: Among the 44 patients, 5 patients had cachexia. On comparison with the cachexic and non-cachexic patients, the percentage of clinical complete remission (20% vs 72%), time to treatment failure at 3 years, (20% vs 53%) and proportion of treatment completion (20% vs 79%) were statistically worse in the cachexic patients, while overall survival, progression-free survival and local progression-free survival at 3 years tended to be worse in cachexic patients. Conclusions: This supplementary analysis from a prospective study suggests that a pretreatment status of cancer cachexia is a prognostic factor for treatment outcomes and compliance in patients with locally advanced head and neck squamous cell carcinomas treated with chemoradiotherapy, and a candidate stratification factor in future prospective trials in this population.


Assuntos
Caquexia/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/complicações , Idoso , Caquexia/patologia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
7.
JAMA Otolaryngol Head Neck Surg ; 145(1): 4-11, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30489622

RESUMO

Importance: Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed. Objectives: To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations. Design, Setting, and Participants: In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry. Main Outcomes and Measures: Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round. Results: Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years. Conclusions and Relevance: Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.


Assuntos
Carcinoma/diagnóstico por imagem , Detecção Precoce de Câncer/métodos , Acidente Nuclear de Fukushima , Programas de Rastreamento/métodos , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Adolescente , Carcinoma/epidemiologia , Carcinoma/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Japão/epidemiologia , Masculino , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/etiologia , Ultrassonografia , Adulto Jovem
8.
Photomed Laser Surg ; 36(9): 468-471, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30096265

RESUMO

OBJECTIVE: To develop a treatment for tinnitus called xenon phototherapy of the stellate ganglion (XPSG) and analyze its effect on tinnitus. METHODS: Patients with chronic tinnitus received XPSG. Symptoms were assessed subjectively with tinnitus handicap inventory (THI) and numerical rating scale (NRS). THI and NRS scores were analyzed in XPSG (n = 43) and sham treatment (non-XPSG) (n = 18) groups. RESULTS: THI and NRS scores improved significantly after 3 months of XPSG. Severe cases with high THI or NRS score showed greater improvement. No significant difference was observed between before and after sham treatment in non-XPSG groups. CONCLUSIONS: XPSG significantly improved THI and NRS scores with high patient satisfaction.


Assuntos
Lasers de Gás/uso terapêutico , Fototerapia , Gânglio Estrelado , Zumbido/terapia , Xenônio , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Auris Nasus Larynx ; 45(2): 384-387, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28624427

RESUMO

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job. Under local anesthesia, resection was performed, and PGA sheet grafting were used to shield the skin defect. After resection, she was relieved from pain, and could stay home without daily wound treatment. One and half months after resection, the wound was almost epithelialized. The PGA sheets consist of soft, elastic, nonwoven fabric made of PGA. In recent years, PGA sheet grafting has been widely used in the reconstruction and was chosen to shield the skin defect for this case. PGA sheet grafting after resection of cervical skin tumor can be an acceptable method for palliative care to relieve pain, bleeding, offensive smell, and ugly appearance.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Neoplasias de Cabeça e Pescoço/cirurgia , Ácido Poliglicólico/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Adesivos Teciduais/uso terapêutico , Adenocarcinoma Papilar/patologia , Feminino , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Pessoa de Meia-Idade , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Ovarianas/patologia , Neoplasias Cutâneas/secundário , Técnicas de Fechamento de Ferimentos
11.
JAMA Otolaryngol Head Neck Surg ; 144(1): 57-63, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29145557

RESUMO

Importance: Thyroid cancer generally grows at a very slow rate in adults, and overdiagnosis is a global issue. However, the detection of early-stage thyroid cancer by screening is not well described in young patients. To prevent overdiagnosis, it is essential to understand the natural course of thyroid cancer growth detection by ultrasonography screening in young patients. Objective: To evaluate the natural progression of thyroid cancer in young patients. Design, Setting, and Participants: An observational study evaluated changes in the diameter of malignant or suspected malignant thyroid tumors on 2 occasions. Changes in malignant thyroid tumor diameter were estimated during the observation period between the screening and confirmatory examinations in the first-round thyroid ultrasonography examination of the Fukushima Health Management Survey in patients younger than 21 years after a nuclear accident at a power plant in Fukushima, Japan. In total, 116 patients cytologically diagnosed with or suspected to have thyroid cancer were classified into 3 groups based on a greater than 10% reduction, a change of -10% to +10% in diameter, and a greater than 10% increase in tumor diameter. The association between tumor growth rate and tumor diameter was analyzed. The study was conducted from March 1, 2016, to August 6, 2017. Main Outcomes and Measures: Tumor volume changes, the coefficient of growth of thyroid cancer in young patients, and the association between the observation period or tumor diameter and them. Results: Of 116 patients, 77 were female; the mean age was 16.9 years (median, 17.5 years). The mean observation period was 0.488 (range, 0.077-1.632) years. No significant differences in age, sex, tumor diameter, observation period, or serum levels of thyrotropin and thyroglobulin were observed among the groups. Whereas tumor volume changes were not linearly correlated with the observation period (Pearson R = 0.121; 95% CI, -0.062 to 0.297), the coefficient of growth was significantly and negatively correlated with the tumor diameter in the screening examination (Spearman ρ = -0.183; 95% CI, -0.354 to -0.001), suggesting growth arrest after the initial proliferation phase. Conclusions and Relevance: Ultrasonography screening could reveal asymptomatic thyroid cancer that is falling into a growth arrest pattern in many young patients. Considering the long life expectancy, prevention of overdiagnosis necessitates careful long-term monitoring without immediate diagnosis for suspected noninvasive thyroid cancer.

12.
Fukushima J Med Sci ; 63(2): 106-111, 2017 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-28680008

RESUMO

Angiosarcomas are rare malignant tumors derived from endothelial cells and occur most commonly in the scalp and the face. The prognosis is poor. Therefore, spontaneous regression of angiosarcoma is a rare phenomenon.We describe a case of a 73-year-old man with multiple metastatic angiosarcoma.In the present case, weekly paclitaxel therapy had an effect, but could not be continued because of interstitial pneumonia (IP). Weekly docetaxel therapy did not have an effect, but further chemotherapy was not carried out because aggravation of the IP was a concern.The primary lesion and other metastatic lesions were inconspicuous on the positron emission tomography/computed tomography scan performed in one year and two months after best supportive care.We reported an extremely rare case of spontaneous regression of therapy-resistant metastases of angiosarcoma that has remained controlled for 40 months since the initial diagnosis.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Hemangiossarcoma/patologia , Couro Cabeludo/patologia , Neoplasias Cutâneas/patologia , Idoso , Resistencia a Medicamentos Antineoplásicos , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Hemangiossarcoma/tratamento farmacológico , Humanos , Masculino , Neoplasias Cutâneas/tratamento farmacológico
13.
Thyroid ; 27(8): 1011-1016, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28657504

RESUMO

BACKGROUND: Thyroid hemiagenesis is a rare congenital variant characterized by the lack of development of one thyroid lobe with no clinical manifestations. METHODS: This study was performed to determine the prevalence and characteristics of thyroid hemiagenesis in a normal Japanese population. This cross-sectional study was performed from October 9, 2011, to April 30, 2015. In total, 299,908 children and young adults in the Fukushima Health Management Survey were examined to determine the presence of thyroid agenesis or hemiagenesis. Thyroid width, thickness, and length were measured in 292,452 of these subjects. RESULTS: Thyroid agenesis was diagnosed in 13 subjects, and hemiagenesis was detected in 67 subjects (0.02%; 22.3/100,000 individuals). Although there was no significant sex-related difference (p = 0.067), the female:male ratio was 1.67:1.00. Females were significantly dominant in right hemiagenesis, while there was no difference in left hemiagenesis between males and females. The thyroid volumes at the 2.5th and 97.5th percentiles for age and body surface area were determined for each sex. Multivariate regression analysis showed that a large hemithyroid volume was independently associated with the presence of contralateral hemiagenesis (p < 0.001). CONCLUSION: The prevalence of thyroid hemiagenesis in the present study is in agreement with that reported in other countries. The prevalence of right hemiagenesis was higher in females, and the larger contralateral lobe in patients with rather than without hemiagenesis may have been caused by a compensatory feedback mechanism to prevent hypothyroidism. In addition, the prevalence of hemiagenesis, especially right hemiagenesis, may be affected by sex-related factors similar to those in patients with an ectopic thyroid gland.


Assuntos
Anormalidades Induzidas por Radiação/etiologia , Acidente Nuclear de Fukushima , Disgenesia da Tireoide/etiologia , Glândula Tireoide/efeitos da radiação , Anormalidades Induzidas por Radiação/diagnóstico por imagem , Anormalidades Induzidas por Radiação/epidemiologia , Anormalidades Induzidas por Radiação/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Japão/epidemiologia , Masculino , Programas de Rastreamento , Tamanho do Órgão/efeitos da radiação , Prevalência , Índice de Gravidade de Doença , Fatores Sexuais , Disgenesia da Tireoide/diagnóstico por imagem , Disgenesia da Tireoide/epidemiologia , Disgenesia da Tireoide/fisiopatologia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/fisiopatologia , Ultrassonografia , Adulto Jovem
14.
Acta Otolaryngol ; 136(11): 1154-1158, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27295405

RESUMO

CONCLUSION: The 3-year progression-free survival rate of non-invasive salivary duct carcinoma (SDC) or adenocarcinoma not otherwise specified (NOS) was significantly better than that of invasive SDC or adenocarcinoma NOS in Carcinoma ex pleomorphic adenoma (CXPA). The presence of invasion is an important prognostic factor for SDC and adenocarcinoma NOS in CXPA. OBJECTIVES: CXPA is a rare parotid gland malignant tumor for which therapy is not yet standardized. The purpose of this study was to review the characteristics of CXPA patients and to analyze their outcomes in the Northern Japan Head and Neck Cancer Society. METHOD: The medical records of 33 patients who had been provided initial treatment in 12 institutes of northern Japan from 2002-2011 were reviewed as a multi-institutional retrospective study. RESULTS: The 3-year overall and progression-free survival rate of all patients was 79.9% and 76.8%, respectively. Both the 3-year overall and progression-free survival rates were 87.5% for patients with non-invasive SDC or adenocarcinoma NOS. The 3-year overall and progression-free survival rates for patients with invasive SDC or adenocarcinoma NOS were 60.4% and 30.5%, respectively. The progression-free survival rates for patients with invasive SDC or adenocarcinoma NOS was significantly poor (p < 0.05).


Assuntos
Adenoma Pleomorfo/patologia , Carcinoma/patologia , Glândula Parótida/patologia , Neoplasias Parotídeas/patologia , Adenoma Pleomorfo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/mortalidade , Estudos Retrospectivos
15.
Nihon Jibiinkoka Gakkai Kaiho ; 119(2): 125-8, 2016 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-27149710

RESUMO

We retrospectively analyzed 54 patients who died of head and neck squamous cell caricinoma regarding the process and duration of cachexia using the modified Glasgow Prognostic Score (mGPS). The patients were classified as having cachexia when the serum albumin level was less than 3.5 mg/dL and the C-reactive protein (CRP) level was more than 0.5 mg/dL. The number of patients with cachexia was eight (8%) at the first visit and 50 (93%) at the time of death. In the 50 patients, the median and average time of having cachexia was 59 and 95 days, respectively. Thirty-two of the 50 patients (64%) died within three months after the presence of cachexia was confirmed. In this study, the time of having cachexia was so short, then the policy of care should be converted from aggressive into supportive in patients classified as having cachexia. mGPS would be an accurate assessment tool for cachexia and ascertain the end stage of head and neck cancer patients.


Assuntos
Caquexia/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Proteína C-Reativa/análise , Caquexia/terapia , Feminino , Escala de Resultado de Glasgow , Neoplasias de Cabeça e Pescoço/química , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Prognóstico , Estudos Retrospectivos , Assistência Terminal , Adulto Jovem
16.
Thyroid ; 26(6): 843-51, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27098220

RESUMO

BACKGROUND: Thyroid nodules and cancers are rare in children compared with adults. However, after the 1986 Chernobyl Nuclear Power Plant accident, a rapid increase in childhood thyroid cancer was observed. To avoid any confusion and misunderstanding of data obtained in Fukushima after the 2011 nuclear accident, baseline prevalence of thyroid nodules and cancers should be carefully assessed with standardized criteria systematically, and comprehensively applied to the population perceived to be at risk. AIMS: Under the official framework of the Fukushima Health Management Survey, the thyroids of children in Fukushima were examined using ultrasound, and the results collected in the first four years after the nuclear accident were analyzed in order to establish a baseline prevalence of childhood thyroid abnormalities, especially cancer. SUBJECTS AND METHODS: Of 367,685 people aged 18 years or younger as of April 1, 2011, who were living in Fukushima Prefecture at the time of the accident, 300,476 underwent thyroid ultrasound screening. Of those, 2108 subjects with thyroid nodules were further examined using an advanced ultrasound instrument, with standardized criteria applied to determine the need for fine-needle aspiration cytology (FNAC). FNAC results determined the need for surgery and histological confirmation of the cytological diagnosis. RESULTS: Of the 2108 rescreened subjects, 543 underwent FNAC, of whom 113 were diagnosed with malignancy or suspected malignancy. Subsequently, 99 patients underwent surgical resection, revealing 95 cases of papillary thyroid cancer, three poorly differentiated cancers, and one benign nodule. The overall prevalence of childhood thyroid cancer in Fukushima was determined to be 37.3 per 100,000 with no significant differences between evacuated and non-evacuated areas. Thyroid cancer patients had external exposure estimates of <2.2 mSv during the first four months. CONCLUSIONS: The high prevalence of childhood thyroid cancer detected in this four-year study in Fukushima can be attributed to mass screening. It clearly exceeds what is found incidentally anywhere else. Direct comparisons with any other results, even those from cancer registries, are not meaningful because of differences in methodology.


Assuntos
Acidente Nuclear de Fukushima , Inquéritos Epidemiológicos , Neoplasias Induzidas por Radiação/epidemiologia , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologia , Adolescente , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Japão/epidemiologia , Masculino , Programas de Rastreamento , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Prevalência , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia
17.
Thyroid ; 26(5): 717-25, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26971545

RESUMO

BACKGROUND: Serum thyroid hormone concentration is regulated through the hypothalamic-pituitary-thyroid axis. This study aimed to clarify the relationships between thyroid hormone regulation and ultrasonographic findings in subjects with thyroid nodules detected during thyroid ultrasound examination for the Fukushima Health Management Survey. METHODS: As of October 31, 2014, a total of 296,253 subjects, who had been living in Fukushima Prefecture at the time of the Fukushima nuclear power plant accident and were aged ≤18 years on March 11, 2011, participated in two concurrent screening programs. In the primary screening, thyroid nodules were detected in 2241 subjects. A secondary confirmatory thyroid ultrasound examination and blood sampling for thyroid function tests were performed on 2004 subjects. The subjects were reassessed and classified into disease-free subjects (Group 1), subjects with cysts only (Group 2), subjects with nodules (Group 3), and subjects with malignancy or suspected malignancy (Group 4). Serum concentrations of free triiodothyronine (fT3), free thyroxine (fT4), thyrotropin (TSH), thyroglobulin, and the fT3/fT4 ratio were classified according to the diagnoses. RESULTS: Inverse relationships between age and log TSH values (Spearman's correlation r = -0.311, p = 0.015), serum fT3 concentration (r = -0.688, p < 0.001), and the fT3/fT4 ratio (r = -0.520, p < 0.001) were observed in Group 1. When analysis of covariance with Bonferroni post hoc comparisons was used in the four groups, the log TSH values were significantly lower in both Group 3 and Group 4 compared with Group 1 and Group 2 after correcting for age (p < 0.001; Group 1 vs. Group 3, p = 0.016; Group 1 vs. Group 4, p = 0.022; Group 2 vs. Group 3, p = 0.001; Group 2 vs. Group 4, p = 0.008). However, no significant differences were observed between the four groups regarding levels of fT3, fT4, fT3/fT4 ratio, and thyroglobulin (p = 0.304, 0.340, 0.208, and 0.583, respectively). CONCLUSION: TSH suppression can be present in response to illness, including thyroid nodules, in young subjects. Low TSH levels may be associated with the finding of papillary thyroid cancer as well as with thyroid nodules in children and adolescents.


Assuntos
Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/sangue , Tireotropina/sangue , Adolescente , Fatores Etários , Criança , Pré-Escolar , Humanos , Testes de Função Tireóidea , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tiroxina/sangue , Tri-Iodotironina/sangue , Ultrassonografia , Adulto Jovem
18.
Head Neck ; 38 Suppl 1: E239-45, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-25546403

RESUMO

BACKGROUND: The purpose of this study was to investigate the effects of CK19 expression in the primary lesions of head and neck squamous cell carcinoma on the diagnosis of the cervical lymph node (CLN) metastasis using the 1-step nucleic acid amplification assay. METHODS: Primary lesions and 54 CLNs were resected from 21 patients with head and neck squamous cell carcinoma between 2009 and 2011. Each CLN was tested by the 1-step nucleic acid amplification assay, and the CK19 mRNA copy number obtained was compared to the corresponding histopathological results. RESULTS: In the primary lesion CK19-positive group, the sensitivity and specificity of the 1-step nucleic acid amplification assay against hematoxylin-eosin staining were 86% and 100%, respectively. The p value by Fisher's exact test was < .0001, indicating statistical significance. CONCLUSION: These results suggest that 1-step nucleic acid amplification offers similar diagnostic potential to that of histopathological diagnosis of CLN biopsy in patients with a CK19-positive primary lesion. © 2015 Wiley Periodicals, Inc. Head Neck 38: E239-E245, 2016.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Queratina-19/genética , Técnicas de Amplificação de Ácido Nucleico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/patologia , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade
19.
Laryngoscope ; 126(6): 1349-53, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26536058

RESUMO

OBJECTIVES/HYPOTHESIS: In order to make possible organ preservation, since 2007 our hospital has performed induction chemotherapy (ICT) with cisplatin and 5-fluorouracil (PF) for hypopharyngeal cancer as chemoselection, followed by alternating chemoradiotherapy (ACRT) with docetaxel, cisplatin, and 5-fluorouracil in (TPF) good responders and curative surgery was used in poor responders. METHODS: Twenty-six patients with stage III to stage IVB hypopharyngeal cancer received ICT. Eleven of the patients were classified as poor responders and received curative surgery. The remaining 15 patients were classified as good responders. Three of these patients underwent curative surgery, and the remaining 12 underwent ACRT. RESULTS: The primary lesions in the 12 ACRT patients responded completely to treatment without severe late toxicities. The estimated 3-year laryngectomy-free rate for all 26 patients was 23%. The estimated 3-year overall survival rates for all 26 patients, 12 patients treated with ACRT, and 14 patients who underwent curative surgery, were 79%, 75%, and 84%, respectively. CONCLUSION: The patients who underwent ACRT showed no significant difference in overall survival compared with the patients who underwent curative surgery. All the patients were able to proceed with this series of therapy, indicating that ICT with PF could be a feasible tool for choosing good responders. Because ACRT with TPF had a high response rate and fewer severe toxicities, this treatment could be safe and have enough impact to control hypopharyngeal cancer in good responders. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1349-1353, 2016.


Assuntos
Antineoplásicos/administração & dosagem , Quimiorradioterapia/métodos , Neoplasias Hipofaríngeas/terapia , Quimioterapia de Indução/mortalidade , Faringectomia/mortalidade , Adulto , Idoso , Protocolos Antineoplásicos , Cisplatino/administração & dosagem , Terapia Combinada , Intervalo Livre de Doença , Docetaxel , Feminino , Fluoruracila/administração & dosagem , Humanos , Neoplasias Hipofaríngeas/patologia , Quimioterapia de Indução/métodos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Faringectomia/métodos , Taxoides/administração & dosagem , Resultado do Tratamento
20.
Auris Nasus Larynx ; 42(2): 128-33, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25262550

RESUMO

OBJECTIVE: To evaluate normal salivary gland stiffness and compare the diagnostic performance of virtual touch quantification (VTQ) and virtual touch imaging quantification (VTIQ) for head and neck tumor. METHODS: A total of 92 measurements were examined, comprising 77 normal salivary glands, 11 benign tumors and four malignant tumors. Examinations were made to evaluate normal salivary gland stiffness and compare the diagnostic performances of new ultrasonic techniques regarding head and neck tumor. RESULTS: The mean values of VTQ and VTIQ for the normal salivary group (NSG) were 1.92 and 2.06m/s, respectively. The VTQ and VTIQ values were correlative, and there were no statistical differences in each mean value between the normal parotid glands and submandibular glands. For the benign tumor group (BTG), four of the 11 values were non-numeric and were considered above the measurable range. The mean VTIQ value for the BTG was 4.24m/s. For the malignant tumor group (MTG), all four VTQ values were non-numeric. The mean VTIQ value for the MTG was 6.52m/s. For the mean VTIQ values, significant differences were observed among the three groups. The optimum VTQ cutoff value to detect malignant tumors was above the measurable range, and that of VTIQ was 4.83m/s. CONCLUSION: The VTQ and VTIQ values were correlative for the salivary glands, and the stiffnesses of normal parotid glands were almost same as those of submandibular glands. VTQ and VTIQ values could be applied for the preoperative diagnosis in salivary gland lesions.


Assuntos
Adenolinfoma/diagnóstico por imagem , Adenoma Pleomorfo/diagnóstico por imagem , Carcinoma de Células Acinares/diagnóstico por imagem , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Glândulas Salivares/diagnóstico por imagem , Neoplasias da Glândula Submandibular/diagnóstico por imagem , Adenolinfoma/diagnóstico , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma Pleomorfo/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Acinares/diagnóstico , Carcinoma Adenoide Cístico/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Estudos de Casos e Controles , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Parotídeas/diagnóstico , Sensibilidade e Especificidade , Carcinoma de Células Escamosas de Cabeça e Pescoço , Neoplasias da Glândula Submandibular/diagnóstico , Ultrassonografia
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