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Hypopharyngeal squamous cell carcinoma (HPSCC) is an aggressive disease with poor prognosis; but has no established biomarkers on the order of human papilloma virus and p16 in oropharyngeal carcinoma. This study investigated pre-treatment serum markers, including the combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) as a prognosis predictor in patients with HPSCC treated in our hospital. We retrospectively reviewed electronic medical records of 118 consecutive patients treated with curative intent at our hospital between 2007 and 2013. Of these 118 patients, we enrolled 100 patients for whom we had sufficient data to analyze relationships between clinico-laboratory characteristics and survival, including the prognostic significance of pre-treatment serum markers and previous reported clinical factors. Multivariate analysis of clinico-laboratory characteristics associated COP-NLR with cancer-specific survival, as were lymph node metastases. Kaplan-Meier analysis and log-rank tests showed that the COP-NLR could stratify those patients into three independent groups (P = 0.003). COP-NLR might be a useful predictor of survival in patients with HPSCC.

Although identification of human papilloma virus (HPV) status in oropharyngeal squamous cell carcinoma (OPSCC) is essential in predicting treatment response, no imaging modality can currently determine whether a tumor is HPV-related. In this retrospective study, 26 patients with OPSCC confined to the lateral wall or the base of tongue underwent neck magnetic resonance imaging, using T1-, T2- and diffusion-weighted imaging (DWI). Apparent diffusion coefficients (ADCs) in a region of interest covering the largest available primary tumor area of OPSCC on a single slice of the ADC map were calculated using two b values (0 and 1,000 s/mm(2)). Mean and minimum ADCs were compared with HPV status, using p16 immunohistochemistry as a surrogate marker for HPV infection. Mean and minimum ADCs for HPV(+) OPSCC were significantly lower than those for HPV(-) OPSCC. A cut-off value of mean ADC for HPV(+) OPSCC of 1.027 × 10(-3) mm(2)/s yielded sensitivity and specificity of 83.33 and 78.57%, respectively. In conclusion, the present study indicates that ADC could be used to predict HPV status in patients with OPSCC.

Oral cancer patients who undergo mandibular bone partial resection often exhibit swallowing disturbance after surgery. We examined the usefulness of manometry in obtaining quantitative data on swallowing function in patients after mandibular bone partial resection. Postsurgical swallowing function was investigated, using a combination of videofluorography (VF) and manometry, in five patients with oral cancer, who underwent mandibular bone partial resection. Three patients underwent reconstruction of soft tissue defects only, while the remaining two patients underwent reconstruction of both soft tissue defects and a bony segment using a reconstruction plate or vascularized fibula with a skin paddle. Oropharyngeal swallowing pressure ranged from 61 to 82 mmHg compared to the normal range of 109 ± 31 mmHg (mean ± SD). Partial resection of the mandible without reconstruction of the bony segment defect had a negative effect upon oropharyngeal swallowing pressure. Four of the five patients exhibited normal function in the oral stage. Elevation of the larynx was disturbed in 80% of the patients. None of the patients in this study experienced aspiration after surgery. In conclusion, a combination of VF and manometry revealed that mandibular bone partial resection resulted in disturbed elevation of the larynx while pharyngeal swallowing pressure decreases in those patients who do not undergo bony segment reconstruction. Our results suggested that the tongue, including the base of the tongue, should be set in a closed space so that pharyngeal swallowing pressure does not release.

Our aim was to evaluate the efficacy of ultrasonographic (US) examination in the pre-operative diagnosis of biliary atresia (BA) with special reference to the presence or absence of extrahepatic bile duct. Thirty consecutive neonates and infants aged 8 to 169 days (mean: 62 days) suspected of having biliary atresia were examined pre-operatively in real time B-mode ultrasonography. We used a 5 or 7.5 MHz probe of micro convex type. Patients were fasted and sedatives administered. When the common bile duct was absent, we considered it a positive finding for BA diagnosis; if not, it was considered a negative finding. A definitive diagnosis of BA was confirmed at surgery by gross morphology or intra-operative cholangiography. US findings had a sensitivity of 83% (19 of 23 BA patients), a specificity of 71% (5% of 7 non BA patients) and an accuracy rate of 80%. The positive predictive value was 90% (19 of 21), while the negative predictive value was 56% (5 of 9). There were four false-negative cases. Two were BA cases with patent distal common bile duct, one was BA in which the hepatic artery was determined to be the common bile duct, and the other was a subtype of extrahepatic bile duct dilatation (the so-called, "correctable type"). We employed US criteria for visualization of the extrahepatic bile duct for pre-operative diagnosis of BA. US examination referring to the presence or absence of the extrahepatic bile duct is an effective and useful method for clinical survey.

Purpose: We examined the surgical indications for funnel chest, taking psychological factors into consideration., Methods: We assessed 36 young people with funnel chest who were seen as outpatients, including 31 boys and 5 girls aged from 1 to 22 years old. Respondents were asked whether they suffered psychological distress, and if they wanted surgery. The severity of the deformity was evaluated using the Vertebral Index (VI) and the Frontosagittal Index (FSI) calculated from chest roentgenograms., Results: The VI in 11 patients without distress (23.7 +/- 4.1) was lower than that in 25 patients with distress (32.8 +/- 8.2), and the FSI in the patients without distress (33.5 +/- 5.3) was higher than that in the patients with distress (23.6 +/- 8.6). The VI in 19 patients who did not want surgery (26.9 +/- 7.9) was lower than that in 17 patients who did (33.5 +/- 7.5), and the FSI in the patients who did not want surgery (30.4 +/- 8.1) was higher than that in the patients who did (22.4 +/- 8.1). The distressed patients suffered many psychological problems, such as being the object of bullying., Conclusion: The severity of the deformity affected the patient's psychological state. We consider that a VI >28 or an FSI <28 are indications for surgery, based on the mean VI + SD and the mean FSI-SD of patients not suffering distress.

Forty-seven children with funnel chest (FC) who underwent sternal elevation and 210 normal children were examined to determine the indications for surgical treatment using the vertebral index (VI) and frontosagittal index (FSI). In normal children VI gradually increased and FSI gradually decreased with age. Both indices changed significantly at 3 years of age. Although the VI of FC patients decreased significantly from 33.8 +/- 7.6 (n=40) to 24.4 +/- 3.9 (n=38) postoperatively (P < 0.0001), it was significantly larger than that of normal children over 3 years of age (20.2 +/- 2.2, n=150) (P < 0.0001), and although the FSI of FC patients increased significantly from 22.0 +/- 7.0 (n=40) to 34.5 +/- 6.5 (n=38) postoperatively (P < 0.0001), it was significantly smaller than that of normal children over 3 years of age (41.1 +/- 4.0, n=150) (P < 0.0001). Since many patients had a thin and flat chest despite excellent correction, their postoperative indices were not normal. There was a correlation between VI and FSI in normal children and a high degree of correlation between VI and FSI both before and after operation in FC patients. We conclude that a VI of more than 27 and/or a FSI of less than 29 are indications for surgical treatment based on the mean VI + 3SD and FSI - 3SD of normal children over 3 years of age. These values are almost equal to the mean VI - SD and FSI + SD of patients with physical, cosmetic, and/or psychological disturbances. However, it is not necessary to measure both indices simultaneously. Postoperative VI and FSI did not always reflect the degree of chest-wall depression in FC patients because of their flat chests.