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We describe a case of an 87-year-old Japanese woman with left maxillary gingival cancer and Warthin tumor in the right submandibular gland. Warthin tumors originating from the submandibular gland are uncommon, and such a case complicated with oral cancer is extremely rare. Warthin tumors generally produce positive results on 18 F-fluorodeoxyglucose positron-emission tomography, which can present challenges in differential diagnoses including metastatic malignancies or lymph node metastases. Both Warthin tumor and oral, head, and neck cancers are strongly associated with smoking. Therefore, it is noteworthy that Warthin tumor also may present in patients with oral cancer. [ABSTRACT FROM AUTHOR]

The rate of implant removal and the factors influencing its indication in patients with distal radius fracture (DRF) in Japan are unclear. We retrospectively evaluated the incidence rate of implant removal in a large cohort of DRF patients obtained from the Diagnosis Procedure Combination database in Japan between April 2014 and March 2019. Patient- and hospital-related factors possibly affecting removal rate, including age, sex, annual number of open reduction and internal fixation (ORIF) for DRF procedures per hospital, number of hospital beds, advanced or general care hospital, and hospital location were analyzed as well. Hospital location was classified into three types based on population and population density as 1) large city, 2) local city, and 3) sparse area. Implant removal was performed in 3242 (26.3%) of 12,328 DRF patients receiving ORIF. According to multivariate analysis, the significant factors related to a decreased probability of removal were older patients, male, large annual number of ORIF for DRF procedures per hospital, large number of hospital beds, advanced care hospital, and hospital in large city. This study clarified the current implant removal rate and trends following ORIF for DRF in Japan. Both patient- and hospital-related factors significantly impacted the decision for implant removal. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab. We conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery. The median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutions Our results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19. [ABSTRACT FROM AUTHOR]

Objective: Axenfeld-Rieger syndrome (ARS) type 3 is a rare autosomal dominant disease, characterized by anterior segment dysgenesis of the eye, hearing loss, and cardiac defects. ARS type 3 is highly associated with FOXC1 mutations, which induces developmental disorders of neural crest cells. Most studies about ARS patients focused on ophthalmologic findings, but details in their hearing loss have not yet been revealed. In this report, we investigated audiological and otological manifestations in the ARS type 3 patient who had the novel heterozygous FOXC1 mutation leading deletion at the forkhead DNA-binding domain.Methods and Results: Pure tone audiometry showed bilateral sensorineural hearing loss (SNHL) and audiological examinations confirmed that major dysfunctions existed in the cochlea, rather than the spiral ganglion neurons and the cochlear nerve. CT and MRI revealed the hypoplastic cochlea at both sides. Given that the 6p25 deletion syndrome, lacking one allele of the FOXC1 gene, shows similar, but more severe cochlear malformations than the present case, the FOXC1 mutations might contribute to the hypoplasia and dysfunctions in the cochlea.Conclusion: To our knowledge, this is the first report demonstrating that the ARS type 3 patient with the FOXC1 mutation has the hypoplasia and dysfunctions in the cochlea, which results in bilateral SNHL. [ABSTRACT FROM AUTHOR]

In patients with vascular diseases, heparinization is necessary for surgery. Here, we report the case of a 77-year-old man who presented with heparin-induced thrombocytopenia (HIT) during the postoperative management of tongue cancer. The patient was already on warfarin owing to arteriosclerosis obliterans, and was perioperatively administered heparin by a cardiologist. The prothrombin time-international normalized ratio (PT-INR) was stabilized, and heparin administration was terminated on postoperative day 23. However, on postoperative day 41, the PT-INR was prolonged; warfarin was discontinued, and heparin was re-administered. On day 6 after heparin re-administration (postoperative day 47), the patient developed sudden fever. Contrast-enhanced computed tomography (CT) imaging was performed to evaluate the fever and showed a thrombus at the L5 level of the inferior vena cava. Blood examination showed a platelet count of 108,000 /μL; however, the next day, the count was 87,000 /μL. On day 10 after heparin re-administration (postoperative day 51), contrast-enhanced CT imaging showed an increase in thrombus formation. Therefore, inferior vena cava filter insertion surgery was performed on day 13 of heparin re-administration (postoperative day 54). The patient was diagnosed with HIT because of thrombocytopenia and increased thrombin after the re-administration of heparin, which was discontinued on postoperative day 64; argatroban (an anti-thrombin drug) was administered for HIT treatment. The patient was discharged with an indwelling inferior vena cava filter and intestinal fistula. [ABSTRACT FROM AUTHOR]

To examine the stability of the articular reduction 12 weeks after intra-articular distal radius fracture (DRF) fixation with a volar locking plate (VLP). We prospectively assessed for losses in articular reduction, including gap and step, during the 12 weeks following surgery for intra-articular DRF treated with a VLP in 68 wrists. The mean patient age was 62 years (range, 16–88 years). Frontal and lateral digital tomosynthesis, a recently developed form of digital tomography, was employed to measure articular gap and step in the lunate and scaphoid fossa of the radius. The average time between surgery and imaging was 1.2 days (range, 0–2 days) for the first evaluation and 87.0 days (range, 74–105 days) for the second examination. The mean gap and step were similar at the first and second examinations: 0.4 mm (SD, 0.8) and 0.3 mm (SD, 0.6) and 0.3 mm (SD, 0.7) and 0.3 mm (SD, 0.5), respectively. There was no change in the alignment of the fragments in cases treated with VLP. Therapeutic II. [ABSTRACT FROM AUTHOR]

Background: While limb elevation and other methods for reducing hand edema are commonly used in clinical practice, alternative methods, such as compression and venous perfusion assist system (VPAS), have emerged. This study compared the efficacy of VPAS to limb elevation in decreasing hand edema after surgery for distal radial fracture (DRF) treated by a volar locking plate (VLP).Methods: A randomized controlled trial was conducted in 102 patients to compare VPAS and elevation methods for edema reduction following VLP fixation for DRF. Changes in edema were measured using the tape measure method along with other parameters on the next day and at one, three, six, and 12 weeks postoperatively.Results: There were no significant differences in edema reduction or other factors between the VPAS and elevation groups at any measurement point.Conclusions: VPAS appears to confer no measurable advantage over management with elevation for edema reduction after VLP fixation of DRF.Trials Registry: This study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000015640). [ABSTRACT FROM AUTHOR]

Silver nanowire (AgNW)/photosensitive polymer composite film fabricated by roll-to-roll die coating exhibits optical and electrical anisotropy, depending on the coating conditions. To clarify the relation between the optical anisotropy, the electrical anisotropy and the orientation of AgNWs, the orthogonal optical constants of the composite films were determined by Mueller matrix spectroscopic ellipsometry. Multiple-sample analysis of reflection mode Mueller matrix and polarized transmission data was performed assuming a three-layer model consisting of substrate/polymer layer/conductive layer. The effective optical constants of the conductive layer revealed that the localized surface plasmon resonances, which arise from electric oscillation of along the short axis of AgNW, are large in the crosswise direction where the sheet resistance is large. On the other hand, the surface plasmon resonance associated with the electric oscillation along the long axis of the AgNW is large in the lengthwise direction where the sheet resistance is small. It seems the optical and electrical anisotropy reflects the morphology of the composite film, where the long axis of AgNW is preferably oriented in the direction lengthwise to the coated film. [ABSTRACT FROM AUTHOR]

Advanced-stage trapeziometacarpal (TMC) osteoarthritis of the thumb often presents with concomitant hyperextension deformity of the metacarpophalangeal (MCP) joint. Although several studies have reported simultaneous procedures to correct this deformity, the indication for these procedures remains controversial. The purpose of this study was to evaluate changes in the range of motion (ROM) of the thumb MCP joint before and after TMC arthrodesis. We evaluated the functional flexion and extension and functional ROM of the MCP joints during the performance of 10 activities of daily living tasks before and after TMC arthrodesis in 10 thumbs of 9 patients with Eaton stage III TMC osteoarthritis and hyperextension deformity of the MCP joint. The mean functional flexion of the MCP joint increased from 26° to 38°, and the mean functional extension of the MCP joint decreased from 16° to 5° of hyperextension. There was no change in the mean total arc of functional ROM of the MCP joint. The MCP joint motion shifted from extension to flexion after TMC arthrodesis, and the total arc of functional ROM of the MCP joint was similar before and after arthrodesis. Therapeutic V. [ABSTRACT FROM AUTHOR]

A 53-year-old man presented with the chief complaint of oral noises. No lesion could be observed in the oral cavity. Ultrasound detected several high-echogenicity areas inside the bilateral parotid ducts, and the initial stage of pneumoparotid was diagnosed. It was considered that air had entered each duct in retrograde fashion through the parotid papilla because of repeated compression of the bilateral parotid glands by the patient who had the habit of compressing the buccal region. This case suggests that ultrasound is effective for diagnosing the initial stage of pneumoparotid. [ABSTRACT FROM AUTHOR]

Purpose To identify risk factors for tendon attrition after volar locking plate fixation of distal radius fractures. Methods We prospectively assessed attrition of the flexor pollicis longus tendon at volar plate removal in 127 hands in 126 patients. We also evaluated preoperative lateral wrist radiographs, sonographs, and crepitus with flexor pollicis longus tendon motion and compared the demographic and radiographic characteristics of patients with and without tendon attrition. Multivariate logistic regression analysis was employed to identify the factors independently associated with tendon attrition. Results We found 12 cases of tendon attrition (10%) and 1 that presented with tendon rupture in our cohort. Crepitus was recognized in 14 patients (11%): 6 cases (50%) were among the 12 hands in 12 patients with tendon attrition whereas 8 (7%) were detected in the remaining 114 hands in 113 patients. Logistic regression examination revealed that audible crepitus and volar placement of the plate in lateral radiographs were independent predictors of tendon attrition. Conclusions Crepitus and volar placement of hardware in lateral radiographs were independent risk factors for flexor tendon attrition after volar plating for distal radius fracture. These results may facilitate surgical decisions regarding early plate removal to prevent possible tendon rupture. Type of study/level of evidence Diagnostic II. [ABSTRACT FROM AUTHOR]

Purpose To evaluate retrospectively whether prophylactic embolization of pseudoaneurysms detected on early postoperative screening with computed tomography (CT) after partial nephrectomy can prevent delayed hemorrhage. Materials and Methods Between January 2012 and May 2014, early postoperative contrast-enhanced CT was performed 3–5 days after partial nephrectomy in 312 patients (group A); CT was not performed in 65 patients (group B) because of renal insufficiency or contrast medium allergy. If pseudoaneurysms were detected on CT in group A, prophylactic embolization was performed. The frequency of delayed hemorrhage occurring more than 3 days after surgery in group A was compared with group B and with 212 patients (group C) who underwent partial nephrectomy between January 2010 and December 2011 without early postoperative CT. Changes in estimated glomerular filtration rate at discharge were compared among the groups. Results Prophylactic embolization of pseudoaneurysms was performed in 26 patients (8%) in group A. Frequency of delayed hemorrhage in group A (0.6%) was significantly lower than in groups B (4.6%; P = .038) and C (4.7%; P = .005). No major complications attributable to prophylactic embolization were observed. The decrease in estimated glomerular filtration rate in group A (−2% ± 13%) was smaller than that in group B (−8% ± 13%; P < .001) and not worse than that in group C (−4% ± 14%; P = .108). Conclusions Prophylactic embolization of pseudoaneurysms detected on early postoperative CT can prevent delayed hemorrhage after partial nephrectomy, without major complications. [ABSTRACT FROM AUTHOR]

Locations of Lewis acid sites (LASs) on three MWW -type zeolites, the conventional Al-containing MWW zeolite (Al-MWW), acid-treated Al-containing MWW zeolite (Al-MWW-AT) and interlayer-expanded Al-containing MWW zeolite (Al-IEZ-MWW), were clarified by IR method using hexamethyleneimine (HMI), pivalonitrile (PN) and CO as probe molecules. No significant difference was found for Brønsted acid sites (BASs) in the strength and positions, while the locations of LASs were distinguished. LASs existed only on the external surfaces of Al-MWW, and in the expanded interlayer micropores (12-membered ring, 12-MR) of Al-IEZ-MWW. The simple acid treatment with nitric acid was found to generate LASs in the interlayer 10-MR micropores of Al-MWW-AT. The reactivity of the three zeolites depending on the positions of the active LASs was further confirmed in the Meerwein–Ponndorf–Verley (MPV) reduction of different ketones in size; 4-methylcyclohexanone and 2-butanone. Al-IEZ-MWW was superior for the reduction of 4-methylcyclohexanone over LASs in the interlayer 12-MR micropores, and Al-MWW-AT also showed fair reactivity for the reduction of smaller 2-butanone over LASs in the interlayer 10-MR micropores. [ABSTRACT FROM AUTHOR]

Mutations of SLC26A4 are associated with incomplete partition type II (IP-II) and isolated enlargement of the vestibular aqueduct (EVA). We experienced a congenitally deaf 6-year-old boy with a rare p.Thr410Met homozygous mutation in SLC26A4 who underwent bilateral cochlear implantation. He had bilateral inner ear malformation, in which the dilated vestibule and EVA were identical to those in IP-II, but the cochlea lacking a bony modiolus resembled that in incomplete partition type I. These results suggest that homozygous mutations in SLC26A4 are always associated with EVA, while the severity of cochlear malformation may vary depending on the type of SLC26A4 mutation. [ABSTRACT FROM AUTHOR]

Abstract: We report two cases of elderly diabetic men with skull base osteomyelitis (SBO) originating from malignant external otitis (MEO). In both, a devastating infection and neural paralysis deteriorated after conventional therapy, including long-term intravenous administration of culture-directed antibiotics with strict control of blood sugar levels and surgical debridement of infectious granulation tissue. Since poor perfusion of antibiotics in the lesion may be associated with serious nature of MEO/SBO, we administered antibiotics intra-arterially via a retrograde catheter with the tip set at the proximal point of the external carotid artery to increase the tissue drug concentration in the maxillary artery (MA) and ascending pharyngeal artery (APA) supply areas, in which intense inflammation was observed. This intra-arterial administration of antibiotics (IA therapy) followed by long-term intravenous and oral antibiotic treatments eliminated their infection and no recurrence was observed in 2 years follow-up period. Interestingly, CT images of angiography via the catheter demonstrated stronger enhancement in the MA supply area compared to the APA supply area and IA therapy was more effective in the former. These results suggest that IA therapy, which might achieve high antibiotic concentration at the site of infection, is effective in patients with MEO/SBO refractory to conventional treatments. [Copyright &y& Elsevier]

Abstract: Human flavin-containing monooxygenase 3 (FMO3, EC 1.14.13.8) in liver catalyzes a variety of oxygenations of nitrogen- and sulfur-containing medicines and xenobiotic substances. Loss-of-function mutations of the FMO3 gene, the enzyme responsible for trimethylamine N-oxygenation, cause the inherited disorder trimethylaminuria (also known as fish odor syndrome). In this mini-review, mutations of the FMO3 gene reported in the literature and in the National Center for Biotechnology Information single nucleotide polymorphism database were surveyed. Then, the activities of FMO3 variants in human liver microsomes and the activities of recombinantly expressed FMO3 variant proteins with respect to the oxygenation of nitrogen- and sulfur-containing drugs were summarized and the potential for drug interactions was demonstrated. Individual differences in FMO3 function were seen in subjects genotyped for homozygous FMO3 variants. Specific regions of the FMO3 C-terminus are required for functional activity. Naturally truncated FMO3 is believed to have barely detectable function, thereby explaining the relationship with severe impaired phenotypes. The present article provides fundamental, up-to-date information on the importance of human FMO3 in individual xenobiotic oxygenations, including those of new medicines and dietary-derived trimethylamine. [Copyright &y& Elsevier]

Abstract: Intralesional steroid injections were administered in two patients with central giant cell granuloma of the jaw (CGCG). In these patients, intralesional corticosteroid injections resulted in disappearance of the lesions and callus formation at the sites of bone resorption on radiographs during follow-up. Surgical curettage or excision and radiation therapy have been reported as treatments for CGCG, in addition to intralesional steroid injection. However, CGCG occurs predominantly in young adults. Considering the tissue defects caused by surgical treatments and side effects of drugs, intralesional steroid injection appears to be the most minimally invasive procedure and to yield favorable results. In treatment of CGCG, intralesional corticosteroid injection, a minimally invasive procedure, could be considered the first choice for treatment of CGCG, while surgery should be performed for recurrence. [Copyright &y& Elsevier]

Abstract: Patients with Wegener''s granulomatosis (WG) often suffer from hearing loss, but its precise mechanisms have not been well understood. We experienced 3 WG cases whose initial symptoms were bilateral progressive mixed (both conductive and sensorineural) hearing loss, followed by systemic symptoms one year later. They were diagnosed as WG based on positive serology of anti-neutrophil cytoplasmic antibodies (ANCAs) and pathologic findings of affected lesions in addition to systemic symptoms. Although they were different in the type of ANCAs and systemic lesions, all showed considerably reversible cochlear disorders with normal vestibular functions. Moreover, their initial otologic manifestations shared same characteristic features, (1) thick ear drums with pulsatile serous intratympanic effusion, (2) poor speech discrimination ability, and (3) steroid-dependent changes of hearing levels (HLs). They exhibited no significant vestibular abnormalities in chair vestibule-ocular reflex (VOR) testing and cold air caloric tests even when they had severe hearing loss. On the basis of these results, we hypothesized that vasculitis of stria vascularis which generates endocochlear potential might cause these reversible cochlear-specific dysfunctions. [Copyright &y& Elsevier]

We report a rare case of snapping in the dorsal wrist that was caused by extensor carpi radialis longus tenosynovitis occurring after rupture of the muscle in the middle forearm. After resection of the tendon at the wrist, the snapping disappeared. [ABSTRACT FROM AUTHOR]

Calcium pyrophosphate dihydrate crystal deposition disease can cause extra-articular pathology including nerve compression syndrome. We report a rare case of this complication in a 79-year-old woman. [Copyright &y& Elsevier]