Search

We report the case of a 42-year-old male with Harada's disease who showed impairment of bilateral, vestibular and cochlear function. He showed bilateral sensorineural hearing loss on an audiogram and canal paresis in Caloric response. The systemic administration of betamethasone was effective: his visual acuity and hearing level normalized and vertigo subsided.

Metastatic tumors to the head and neck from distant primary tumors are rare. Very few cases of metastatic tonsillar tumor have been reported in the literature, and most of them originated in the lung, kidney, skin, or stomach. We treated a patient with pancreatic cancer which had metastasized to the palatine and lingual tonsils. A 57-year-old male complained of sore throat and a feeling of foreign body in the pharynx after treatment for a lung tumor. The right palatine and lingual tonsils were coated with a dirty furlike covering. Biopsy showed an undifferentiated carcinoma. The tumor disappeared completely after radiation treatment, but he developed liver damage and obstructive jaundice caused by para-aortic lymph node swelling. Jaundice disappeared after PTCD (percutaneous transhepatic cholangio drainage) and radiation to the abdomen, but he died 2 months later of peritonitis carcinomatosa. Autopsy revealed primary pancreatic undifferentiated carcinoma which had metastasized to the lung and tonsils.As far as we are aware, this is the first report in Japan of metastasis to the tonsils from a primary pancreatic tumor. The clinical aspects of metastatic tonsillar tumor and a possible mechanism of the metastatic processes are discussed.

23-year-old female had sensorineural hearing loss due to acute carbon monoxide intoxication after exposure to cooking-gas for about 33 hours.The audiogram showed marked hearing loss, especially in the high frequency range.L-V therapy for sensorineural hearing impairment had been reported to be effective in several other cases.We used L-V therapy, and her hearing was restored.

The therapeutic effect of sulpiride was studied in 33 patients with vertigo, dizziness, and a tendency of depression.They were given oral sulpiride, 150 mg daily, and the subjective symptoms and objective findings were recorded before and two and four weeks after the start of treatment. The efficacy of the drug was evaluated; 7.4% showed marked improvement, 51.9% marked or moderate improvement, and 100% more than slignt improvement was seen in the fourth week. Many subjective symptoms, such as nausea and vomiting, headache, loss of appetite, stiff shoulders, general fatigue, obstructive sense of ear, as well as vertigo and dizziness, were also reduced.Righting reflex and gaze and positional nystagmus were significantly improved.The scores of SDS and CMI decreased markedly at the second and fourth week.Only four patients complained of side effects, which were liver dysfunction, and galactorrhea.In conclusion, sulpiride is useful in the treatment of vertiginous patients who have a tendency of depression.

A 63-year-old man complained of dysphagia. He had had tongue cancer treated by resection of the left half of the tongue and surgical repair with a greater pectoral muscle flap . This time, hypopharyngeal carcinoma was diagnosed and chemotherapy was attempted, but it was not successful. After resection of the hypopharynx, larynx and cervical esophagus, reconstitution was carried out with a left anterolateral thigh flap (AL-T flap). On day 14 after surgery, he was able to eat. The benefits of anterolateral thigh flap are reported, and the literature is reviewed.

A 40-year-old female was operated on for nasal polyps, but the tumor had extended already into the cranial space. Olfactory neuroblastoma was diagnosed. After chemotherapy we conducted transnasal dissection for the skull base lesion and performed craniotomy for the intracranial one. Postoperative irradiation of 50 Gy was given. Although no local recurrence or distal metastasis has been continuing found during the four years since treatment, careful follow up is necessary because of the high rate of local recurrence.

A 70-year-old man was admitted to the hospital because of a large left submandibular mass, 7×5×5cm. The tumor but it had been growing slowly for 50 years, enlarged suddenly, so we removed it together with adjacent lymph nodes. The pathohistological examination showed adenosquamous cell carcinoma accompanied by specific hyalinization. The hyalinization was considered to be related to the enlargement of the tumor and to the development of squamous cell carcinoma. Three years after the first operation, squamous cell carcinoma recurred. The adenosquamous cell carcinoma should be treated more vigorously at the initial stage.