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Objectives: In recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital., Methods: We retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses., Results: Our hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments., Conclusion: Diagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Anaplastic thyroid cancer (ATC) is an aggressive malignancy with a poor prognosis and limited treatment options. Herein, we report two cases of unresectable ATC treated with a combination of BRAF and MEK inhibitors. The patients were initially treated with other therapies but were switched to BRAF and MEK inhibitors after testing positive for BRAF mutations. This resulted in a partial response, tumor shrinkage, and conversion to resectability in one case. The patient experienced manageable adverse events. BRAF mutations are common in thyroid cancers, and studies have demonstrated the efficacy of combining BRAF and MEK inhibitors for treating advanced or recurrent differentiated thyroid cancer or ATC with BRAF mutations. These cases emphasize the importance of BRAF gene testing at the initial diagnosis and the potential of BRAF and MEK inhibitors as treatment options for unresectable ATC with BRAF mutations. The oral administration and manageable adverse event profiles of these medications make them suitable for outpatient treatment. In conclusion, BRAF gene testing should be performed at the initial diagnosis, and the use of BRAF and MEK inhibitors should be considered in patients with ATC., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: This study aimed to investigate the association among swallowing function, hand grip strength, and peak expiratory flow in elderly patients with dysphagia., Methods: A total of 35 patients (26 men and 9 women, 80.7 ± 8.1 years) were included in the final analysis. They underwent videoendoscopy (VE) for the assessment of swallowing function, hand grip strength test, and peak expiratory flow test. We used the Hyodo score, the objective scale of VE developed by Hyodo et al. (2010), which consists of the following 4 parameters: salivary pooling degree at the vallecula and pyriform sinuses, glottal closure reflex induced by touching of the endoscope to the epiglottis or arytenoid, swallowing reflex initiation assessed by "white-out" timing, and pharyngeal clearance after blue-dyed water is swallowed., Results: The Hyodo score significantly correlated to hand grip strength and peak expiratory flow, and hand grip strength was significantly correlated to peak expiratory flow. Although a significant correlation was noted between the Hyodo score and hand grip strength after adjustment for peak expiratory flow, no significant correlation was found between the Hyodo score and peak expiratory flow after adjustment for hand grip strength., Conclusions: This study indicated that unlike peak expiratory flow, hand grip strength is associated with swallowing function, which was evaluated by an objective scale, and can be used as an indicator for whole body muscle strength. This result may contribute to the investigation of the effect of muscle training on dysphagia., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Chondrosarcoma is a rare malignant tumor occurring in the trunk and long bones. We present an extremely rare case of chondrosarcoma of the hyoid bone with clinical and pathological correlation and a literature review. We searched all cases of the hyoid chondrosarcoma in PubMed (MEDLINE) between 1990 and 2015. Eighteen cases were analyzed, including the present case. Most of them were low grade type. In 12 cases where intraoperative findings were recorded, no adhesion to the surrounding tissue was observed. Chondrosarcoma of the hyoid bone is usually low grade type, and there may be no invasion to the adjacent structures even if invasion is suspected by imaging findings. In order to preserve swallowing and laryngeal function, total hyoidectomy without laryngectomy should be indicated according to the intraoperative findings. Needle biopsy is an effective diagnostic technique, but open biopsy should be avoided to prevent the dissemination. To the best of our knowledge, this is the first presentation of hyoid bone chondrosarcoma with the investigation of intraoperative findings and pre-operative diagnostic modality., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The Japan Society for Head and Neck Surgery (JSHNS) started a board certification system for head and neck surgeons in 2010. To become certified, the following qualification and experiences are required: (1) board certification as otorhinolaryngologist, (2) 2 years of clinical experience in a board-certified training facility, (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty and (4) surgical experience in 50 major head and neck surgical procedures, including 20 neck dissections, under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings, (2) one clinical paper on head and neck cancer published in a major journal, (3) attendance at two annual meetings of JSHNS and (4) enrolment in three educational programs approved by JSHNS. The qualifying examination consists of multiple choice tests and oral examinations. A total of 151 head and neck surgeons were certified in 2010 followed by 43 in 2011 and 34 in 2012, while the membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013. Although the board certification system for head and neck surgeons was started only recently, it has encouraged many residents and fellows as well as established head and neck surgeons. We believe that this system will contribute to further advancement in the clinical practice for head and neck cancers in Japan., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Recent remarkable progress in endoscopic technology has enabled the detection of superficial cancers that were undetectable in the past. However, even though advanced endoscopic technology can detect early lesions, it is useless unless it can provide wide exposure of an area. By modifying the Killian position, it is possible to observe a wider range of the hypopharyngeal space than is possible with conventional head positions. We report a revolutionary method that uses a new head position to widely open the hypopharynx. The technique is named "the Modified Killian's method.", Methods: The patient is initially placed in the Killian position and then bent further forward from the original position (i.e., the modified Killian position). While in this position, the patient's head is turned and the Valsalva maneuver is applied. These additional maneuvers constitute the Modified Killian's method and widely expands the hypopharyngeal space., Results: The conventional head position cannot open the hypopharyngeal space sufficiently; however, the Modified Killian's method opens the hypopharyngeal space very widely., Conclusion: The Modified Killian's method enables observation of the entire circumference of the hypopharyngeal space and the cervical esophageal entry. The Modified Killian's method may become an indispensable technique for observing the hypopharynx and detecting hypopharyngeal cancers., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)