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Between 1986–2004, 13 patients (11 males and 2 females; mean age, 63.9 years) underwent microsurgical reconstruction after total maxillectomy in our hospital. Reconstructions using a rectus abdominis musculocutaneous flap were primarily carried out in our hospital by emphasizing soft-tissue filling. No postoperative complication related to a vascular anastomosis (such as thrombosis) was noted (success rate, 100%). In 3 cases, fistula formation was observed postoperatively (23.0%). In one case reconstructed with a scapular flap with a vascularized scapula, atelectasis followed by serious pneumonia was observed, and the patient temporarily fell into a life-threatening condition. Five patients died after 1–2 years due to recurrence of maxillary sinus carcinoma, and 2 died after 3–4 years due to another tumor (lung and esophageal). The disease-specific 5-year survival rate of all 40 patients with maxillary sinus carcinoma treated in our hospital by the Kaplan-Meier method was 54.6%, and the overall survival rate was 45.8%. As the prognosis of maxillary sinus carcinoma is poor, we consider that priority should be given to filling of defects with soft tissues, and we also consider that this study is significant to reevaluate strategies for maxillary reconstruction. © 2006 Wiley-Liss, Inc. Microsurgery, 2006.

Aim The presence of simultaneous primary tumours in other regions affects the prognosis and management decisions of head and neck cancer patients. Therefore, early detection of these tumours is necessary. Recent improvements in positron emission tomography (PET) have made it possible to examine the patient's whole body. The present study was undertaken to evaluate the clinical contribution of whole-body PET using fluorodeoxyglucose (FDG) for head and neck cancer patients. Methods Fifty-three consecutive patients with previously untreated head and neck cancer were examined. Whole-body FDG PET imaging was performed at 1 h after injection of 1 8 F-FDG. A 3-D acquisition was undertaken and iterative reconstruction was performed. The final diagnosis of simultaneous primary tumour was established by histological findings or clinical follow-up. Results Of 53 patients, six (11%) had evidence of simultaneous primary tumour. In five of these six patients, simultaneous primary tumours (two gastric cancer; one colon cancer; one pancreatic cancer; one thyroid cancer) were found by FDG PET. One more patient was found to have prostate cancer on the basis of blood test but this was not detected by FDG PET. In none of the remaining 47 patients, were additional simultaneous primary tumours found by FDG PET or any of the other routine examinations or during follow-up. Conclusions The results of this study show a high rate of simultaneous primary tumour in patients with primary head and neck cancer. FDG PET appears to be a promising imaging modality for the detection of simultaneous tumours in head and neck cancer patients.

Paranasal mycosis is divided into non-invasive and invasive types. The invasive type is rare, but sometimes fatal; it can extend up to the skull base and affect the orbital cavity with bone destruction. We encountered a case of invasive paranasal-skull base mycosis resistant to surgical and pharmacological treatments. A 78-year-old man developed persistent headache and retro-ocular pain in June, 2004, and consulted the Department of Neurosurgery and Otorhinolaryngology, Ritsurin Hospital on July 20. CT scan demonstrated a soft tissue shadow in the ethmoid and sphenoid sinus with bone destruction of the skull base. We performed endonasal endoscopic biopsy on July 30, but we could not open the sphenoid sinus because of bleeding. Therefore, we only opened the bilateral ethmoid sinuses. The result of biopsy showed granulation tissue. On August 11, endonasal endoscopic surgery was performed to obtain biopsy and culture as well as to drain the sphenoid sinus. The second histopathological examination demonstrated a fungus ball. Culture of this fungus ball demonstrated Aspergillus fumigatus. Post-operative CT scan showed the persistent residue of a soft tissue shadow and expansion of a bone defect of the skull base. The patient was referred to Kagawa University for further treatment. Endonasal endoscopic surgery was performed again to remove residual fungus on August 20. Antifungal drug therapies had been administered throughout the treatment period, but we failed to control the fungal disease. The patient died on September 21.

1983年10月から1999年1月の間に当科で治療を行った外耳道癌7例, 中耳癌7例について, 臨床像, 治療法, 予後等について検討した。男性2例, 女性12例と女性に多く, 扁平上皮癌が11例, 腺様嚢胞癌が2例, 腺癌が1例だった。Stell らの分類では外耳道癌7例中T14例, T21例, T32例で, 中耳癌は7例中T11例, T22例, T33例, Tx1例であった。外耳道癌症例は手術を主体とした治療が行われ, 初回治療で手術を併用しなかった症例は1例のみだった。中耳癌症例はT1, T2症例は手術主体の治療が行われたが, T3以上の症例では放射線中心の治療法が行われ, 担癌生存の1例を除いていずれも治療早期に原病死していた。今後の治療成績の向上のためには, 腫瘍の進展範囲の的確な診断と, より安全な拡大手術法の確立, 早期発見が必要と思われる。

The use of long-term middle ear ventilation tubes (Paparella type II) was retrospectively analyzed in 66 ears with otitis media with effusion, in children treated at Kagawa Medical University Hospital between January 1990 and March 1998. The average intubation period was 23.9 months. The average pure tone air conduction threshold showed a remarkable improvement of between 32.7dBHL and 16.9dBHL. Otorrhea was observed in 25 ears (37.8%), obstruction in 2 ears (3.0%), granulation in 3 ears (4.5%) and permanent ear drum perforation in 11 ears (19.6%). No cholesteatma or adhesion of the ear drum was seen. Recurrence of otitis media with effusion was found in 9 of 45 ears (20.0%). In conclusion, Paparella type II tube can be placed for a long-term period and have a low rate of reccurence, but have a high rate of otorrhea and permanent ear drum perforation.

Thermal burns of the larynx after swallowing hot beverages are extremely rare among adults. Most reported cases have occurred among young children. We report the case of a male adult who, upon swallowing hot milk from a bottle, experienced a burn of the larynx affecting the epiglottis and surrounding supraglottic structures. Since dyspnea usually occurs within hours of a burn of the larynx, the importance of airway management in this case is emphasized.

The effects of granulocyte colony stimulating factor (G-CSF) were evaluated in 9 patients with malignant lymphoma of the head and neck. The effects of 31 cycles of cytotoxic chemotherapy were treated with G-CSF. G-CSF was given by one of the following three routes: 1) administration before or with cytotoxic chemotherapy, 2) administration after cytotoxic chemotherapy with leukocyte counts of more than 2000/mm3, and 3) administration after leukocyte counts had dropped to less than 2000/mm3. The first group consisted of one cycle of CHOP therapy and 2 cycles of VAMA therapy. The second group consisted of 10 cycles of CHOP therapy. The third group consisted of 13 cycles of CHOP therapy and 5 cycles of VAMA therapy.Leukocyte nadirs occurred on around day 14 for CHOP therapy and around day 21 for VAMA therapy without G-CSF treatment. In the first group, the leukocyte nadirs occurred earlier with G-CSF treatment. Additional G-CSF treatments were given in two of the three cycles. In the second group, the leukocyte counts did not drop below 2000/mm3 in three of the ten cycles. Additional G-CSF treatments were given in five of the remaining seven cycles. The two other cycles went without additional treatment. The mean volume of G-CSF was 305±86μg. In the third group, the leukocyte counts increased to more than 2000/mm3 immediately after G-CSF administration in CHOP therapy. The mean volume was 227±78μg, significantly less than that of the second group. The leukocyte counts also exceeded 2000/mm3 3-5 days after G-CSF administration in 5 cycles of VAMA therapy. These data indicate that the most appropriate administration of G-CSF is 50-75μg/body/day×3-5 days after leukocyte counts fall below 2000/mm3.

Cartilage invasion in laryngohypopharyngeal cancer has a significant impact on the choice of treatment modality and outcome of the disease. We examined invasion of cartilage in laryngohypopharyngeal cancer by simultaneous bone and tumor dual-isotope SPECT using99mTc-hydroxymethylene diphosphonate and20lTl-chloride. Early and delayed simultaneous bone and tumor dual-isotope SPECT were performed on 19 patients with laryngohypopharyngeal cancer. Dual-isotope SPECT images were superimposed to project tumor location from tumor SPECT onto the osseous structures shown by bone SPECT. The presence or absence of cartilage invasion was evaluated histopathologically or by radiological studies such as CT and/or MRI. Histopathological or radiological examination of the cartilage revealed invasion in 5 patients and no invasion in 14 patients. The results of both early and delayed dual-isotope SPECT were exactly the same. Using dual-isotope SPECT, the sensitivity, specificity, and accuracy in detecting cartilage invasion by laryngohypopharyngeal cancer were: 80% (4/5), 92.9% (13/14), and 89.5% (17/19), respectively. Results of the present study suggest that superimposed early bone and tumor dual-isotope SPECT images may be sufficient for the diagnostic evaluation of cartilage invasion by laryngohypopharyngeal cancer. Superimposed dual-isotope SPECT imaging is a useful technique in the evaluation of cartilage invasion in laryngohypopharyngeal cancer.

Introduction: Platelets enhance leukocytic phagocytosis via the action of ATP and ADP in platelet release products (PRPr). The present study was designed to clarify the type of complements and complement receptors that are involved in phagocytosis activation by PRPr, ATP and ADP. Materials and Methods: Human peripheral blood was used as the source of neutrophils and platelets. The supernatant of the platelet suspension after simulation was used as PRPr. The effects of PRPr, ATP, ADP, and other substances on neutrophilic phagocytosis, rosette formation and expression of several antigens were investigated. For the markers of neutrophilic phagocytosis and rosette formation, IgM-sensitized sheep red blood cells (SRBC) were treated with diluted human serum (EAC) or purified complements (C1, C4, C2 and C3) (EAC3b) followed by C3 inactivation (EAC3bi). The expressions of CD11b, CD11c, CD18, and CD35 were evaluated using a flow cytometer. Results: Neutrophilic phagocytosis of EAC and EAC3bi was enhanced by PRPr, ATP, and ADP, whereas this phagocytosis activation was abolished by antibodies against CD11b and CD18. Neutrophil rosette formation with EAC3bi was increased by ATP and ADP. Flow cytometry revealed that the expressions of CD11b and CD35 on neutrophils were increased by PRPr, but not by ATP and ADP. The component in PRPr, responsible for the increase in expressions of these antigens, could not be identified. Conclusion: PRPr increases the neutrophilic phagocytosis of complement-coated particles through the action of ATP and ADP by increasing the binding avidity with iC3b, but not the number of Mac-1 (CD11b/CD18).

Subjects were 51 patients undergoing folded pharyngeal flap surgery for velopharyngeal incompetence at the Department of Otolaryngology of Kagawa Medical University between August 1985 and July 2001. Causal diseases were cleft palate in 27 (53%), submucous cleft palate in 8 (16%), and congenital velopharyngeal incompetence in 16 (31%). In history, 31% with congenital velopharyngeal incompetence, 25% with submucous cleft palate, and 11% with cleft palate had congenital abnormalities. In addition, 56% with congenital velopharyngeal incompetence, 38% with submucous cleft palate, and 15% with cleft palate had mental retardation, indicating that it occurred with high frequency in patients with congenital velopharyngeal incompetence. The postoperative improvement of nasality was investigated in 48 patients whose progress could be observed for more than 1 year. Of 39 preoperatively diagnosed with advanced velopharyngeal dysfunction, 34 (87%) showed improved nasality. Of 9 with preoperatively slight deficiency, 8 (89%) improved nasality. The blowing test showed no difference in results between patients who had advanced and slight deficiency. Articulation on speech level improved to be normal in 78% of patients with slight deficiency, but only in 46% of those with advanced deficiency. Improvement of articulation on a speech level was high (86%) in patients with submucous cleft palate, but low in patients with congenital velopharyngeal incompetence who had mental retardation. Further study is required to detail postoperative prognosis factors.

We examined mandibular invasion of intraoral squamous cell carcinoma by simultaneous bone and tumor dual-isotope SPECT using (99m)Tc-hydroxymethylene diphosphonate ((99m)Tc-HMDP) and (201)Tl-chloride ((201)Tl) and by CT.Early and delayed simultaneous bone and tumor dual-isotope SPECT and CT were performed on 39 patients suspected of having tumor invasion of the mandible by intraoral squamous cell carcinoma. SPECT images were superimposed to project tumor location from tumor SPECT onto the osseous structures shown by bone SPECT. The CT imaging protocol consisted of 5-mm contiguous axial images.Histopathologic examination revealed invasion of the mandible in 13 patients and no tumor invasion in 26 patients. The results of delayed dual-isotope SPECT were exactly the same as those of early dual-isotope SPECT. On early and delayed dual-isotope SPECT, the sensitivity, specificity, and accuracy in detecting mandibular invasion by intraoral squamous cell carcinoma were 100% (13/13), 88.5% (23/26), and 92.3% (36/39), respectively. The corresponding values using CT were 45.5% (5/11), 94.7% (18/19), and 76.7% (23/30), respectively, when 9 patients were excluded because of dental artifacts.Our results suggest that superimposed early bone and tumor dual-isotope SPECT images alone may be sufficient in the diagnostic evaluation of mandibular invasion by intraoral squamous cell carcinoma.

Production of macromolecular activators of phagocytosis from platelets (MAPPs) was observed when the lysate of fresh platelets was incubated with MAPP precursors and thrombin. An 800-Da MAPP activator (PMA-II) was obtained by Superdex peptide gel filtration of the lysate after thrombin treatment. The necessity of thrombin in MAPP production in fresh platelets was confirmed by the action of anti-thrombin monoclonal antibody or anti-thrombin III and heparin. To specify the thrombin receptor on which the thrombin forming PMA-II binds, the effects of thrombin-receptor-derived peptides and anti-thrombin receptor antibodies on MAPP production by stored platelets which have lost their thrombin content were investigated. DYYPEEDTEGD involved in glycoprotein Ibalpha and anti-glycoprotein Ibalpha antibody prevented stored platelets from producing MAPP. These observations suggest that thrombin bound to glycoprotein Ibalpha functions as a serine protease in MAPP formation.