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Hyperhomocysteinemia causes various diseases including cardiovascular disease, osteoporotic fracture and dementia. Although there have been reports that hyperhomocysteinemia decreases physical performance, findings are inconsistent on the association of homocysteine, folate, vitamin B12 and physical performance. Considering that lower physical performance increases the risk of fall and fracture in the elderly, the effect of nutritional status on physical function must be clarified. This is a cross-sectional study conducted from April 2015 to November 2016. Eighty-six residents and users in five care facilities were evaluated for their blood homocysteine, folate and vitamin B12 concentrations and indices for physical performance; lower limb muscle strength, handgrip strength and gait speed. Analyses of physical performance were done in women only, considering the high proportion of women in the study population and the muscular gender difference. In the third tertile of plasma homocysteine concentration, handgrip strength was significantly lower than in the first tertile (p=0.027). In the first tertile of serum folate concentration, handgrip strength was significantly lower than in the third tertile (p=0.002). Although not statistically significant, lower limb muscle strength in the third tertile of folate was higher than in the first (p=0.061) and second (p=0.057) tertile. In the multiple regression analysis, however, only serum folate concentration was a significant contributor except for age. In subjects with their serum folate and vitamin B12 concentrations both exceeding the median, lower limb muscle strength was higher. Low serum folate concentration is a risk factor for lower physical performance independent of homocysteine in elderly women.

Objective Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma. Methods The study included 65 patients with submandibular gland carcinoma who underwent initial surgical treatment at the Kyoto University and its affiliated hospitals. Results The 3-year overall survival (OS), disease specific survival, locoregional control (LRC), and no distant metastasis (NDM) rates were 74.2%, 74.2%, 90.0%, and 64.8%, respectively. In the current follow-up study, 16 patients died of the disease, 5 patients were alive with recurrence, 43 patients were alive without disease, and 1 patient died of unrelated disease without recurrence. All patients who died of the disease had developed distant metastasis. Based on univariate analysis, tumor grade (high grade) and lymph node metastases (≥N2) were significant prognostic factors for OS and LRC. It also revealed tumor grade (high grade), T classification (≥T3), and lymph node metastases (≥N2) were significant for distant metastasis. Multivariate analysis showed the following significant prognostic factors: lymph node metastases (≥N2) for OS, LRC, and NDM, and high tumor grade for NDM. Conclusion Our study suggested death of submandibular gland carcinoma occurred mainly due to distant metastasis. The significant predictors of distant metastasis were lymph node metastases (≥N2) and tumor grade (high grade).

The management of patients with cervical metastasis in head and neck cancer of unknown primary (HNCUP) remains controversial. This current multicenter retrospective study investigated the treatment outcomes of patients with HNCUP.The study included patients who were treated curatively at 12 institutions in Japan from January 2006 to December 2015.Eighty patients with HNCUP were included. The median follow-up period was 34 months. The three-year overall survival (OS), disease-specific survival (DSS), regional relapse-free survival (RRFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) rates were 72.5%, 80.3%, 74.0%, 89.7%, and 86.9%, respectively. Nodal status was a significant factor for OS, DSS, RRFS, and DMFS; and extracapsular extension (ECE) was significant for OS and DSS. There was a distinct difference between the survival rates of patients with N1-2a and N2b-3 disease. RT was a significant positive factor for LPFS (3-year LPFS, RT 93.0% vs. no RT 83.0%, p = .043).For N2a as well as N1 disease without ECE, a single treatment modality, including ND or RT alone is acceptable. When ND alone is performed, thorough monitoring should be continued during follow-up to identify the emergence of the primary lesion.

Objectives/hypothesis In 2013, we introduced a modified technique for mucosal/muscle layer defect coverage with fibrin glue and polyglycolic acid (PGA) sheets (mMCFP technique) in patients undergoing endoscopic transoral surgeries for laryngopharyngeal cancers. This technique allows easy and convenient coverage of the wound surface, even when it involves the laryngopharyngeal lumen. To our knowledge, use of the MCFP technique for coverage of postoperative mucosal and/or muscle layer defects involving the laryngopharyngeal lumen has not been reported. The aim of the present study was to retrospectively evaluate the safety of our mMCFP technique used simultaneously with endoscopic transoral resection of Tis, T1, T2, and select T3 pharyngeal and supraglottic cancers. Study design A single centre retrospective study. Methods Between June 2013 and February 2019, 102 patients underwent simultaneous end-flexible-rigidscopic transoral surgery and wound coverage using our mMCFP technique. All patients required mucosal and/or muscle layer resection. For all patients, we recorded the incidence of postoperative complications and the time period for which the PGA sheets could be observed after surgery. Results In 41%, 35%, and 8% patients, the PGA sheets could be observed on the wound surface for 2, 3, and 4 weeks, respectively. Other than postoperative bleeding in two patients (2%), no postoperative complications were recorded. Conclusions The findings of this study suggest that our mMCFP technique is a safe and simple method for the repair of mucosal and/or muscle layer defects after endoscopic transoral surgery for laryngopharyngeal cancers. Level of evidence 4 Laryngoscope, 130:1740-1745, 2020.

Hyperhomocysteinemia causes various diseases including cardiovascular disease, osteoporotic fracture and dementia. Although there have been reports that hyperhomocysteinemia decreases physical performance, findings are inconsistent on the association of homocysteine, folate, vitamin B

Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope.To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers.In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method.Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively.E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function.

Objective Salivary gland carcinoma is rare among head and neck cancers. Sublingual gland carcinoma, a type of salivary gland carcinoma, is even rarer; therefore, the number of cases at a single institute is too small for sufficient evaluation of tumor characteristics. We conducted a multicenter, retrospective analysis of sublingual gland carcinomas in patients who visited 12 institutions associated with the Kyoto Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group. Methods Thirteen previously untreated patients who visited the institutions between 2006 and 2015 were enrolled. The overall survival (OS) and disease-free survival (DFS) rates for all patients and by disease stage were analyzed. Statistical analyses were performed for all patients with respect to disease stage. Results Eight of thirteen patients were diagnosed with adenoid cystic carcinoma on pathological study. A significant difference in OS rate was observed between patients with Stage I–III and Stage IV disease; however, the difference in DFS rate by disease stage was not significant. Conclusion Stage IV disease was identified as a poor prognostic factor in patients with sublingual gland carcinoma. However, even patients with Stage I–III disease experienced relatively short DFS. Distant metastasis is a serious problem among patients with sublingual gland carcinoma.

Heart failure is a major manifestation of thiamine deficiency; beriberi. Even thiamine insufficiency, milder than deficiency, may be associated with increased heart failure risk. In this cross-sectional study, the relationship between thiamine insufficiency and heart failure was investigated in the Japanese institutionalized elderly from April to November 2017. Fifty-five subjects in four care facilities were evaluated for their whole blood thiamine and plasma brain natriuretic peptide concentrations. Mean whole blood thiamine concentration was 88.7 ± 22.3 nmol/L in men and 92.0 ± 16.5 nmol/L in women, and significantly and negatively correlated with plasma brain natriuretic peptide concentrations (r = -0.378, p = 0.007). In the multiple regression analysis adjusted by age, sex, body mass index, and eGFR, whole blood thiamine concentration was a significant negative contributor (standardized coefficient β = -0.488, p = 0.001) to plasma brain natriuretic peptide. In the logistic regression analysis adjusted by the same variables, whole blood thiamine concentration significantly contributed to plasma brain natriuretic peptide concentration higher than over 40 pg/ml (OR: 0.898, 95%CI: 0.838-0.962). Whole blood thiamine concentration in subjects with diuretics was significantly lower than those without it (p = 0.023). Thiamine insufficiency was related to increased plasma brain natriuretic peptide concentration and may increase the risk of heart failure.

Adenoid cystic carcinoma of the head and neck (ACCHN) is rare and difficult to study effective treatment at one institute. Our aim is to identify prognostic factors for this disease by conducting a multicenter study at 11 institutions in Japan.A retrospective multicenter study of ACCHN was performed. One hundred and three patients were identified between 2006 and 2015. The overall survival (OS) rate for all patients was calculated, and OS, locoregional control (LRC) rate, or no distant metastasis (NDM) rate was calculated for patients in that the surgery was performed without distant metastasis (DM). Statistical analyses were performed.A significant difference with multivariate analysis was observed in patients in sublingual glands, stage IV and the use of radiation therapy ≥60Gy (sufficient RT) in OS for all patients. A significant difference was observed in the use of sufficient postoperative RT in the OS and the LRC rate, and in pathological surgical margins in the NDM rate.Sublingual glands or stage IV was a poorer, and sufficient RT was a better prognostic factor for ACCHN. Sufficient RT was effective to prevent local recurrence after surgical resection. Positive surgical margins caused an increase in DM.

Intramusucular hemangioma is a benign neoplasm frequently arising from the skeletal muscles of the trunk and extremities. Involvement of the head and neck by this tumor is rare, even though the majority of such tumors originate from the masseter and the trapezius. Preoperative diagnosis is very difficult because of the rarity and the distribution of these tumors in the deep space. We report on a rare case of intramuscular hemangioma, involving the posterior cricoarytenoid muscle. A 82-year-old female patient with an abnormal sensation in her throat, was found to have a tumor in the left piriform sinus. Thus we performed biopsies twice, but the pathology was not confirmed, with a report of just normal mucosa. However we speculated that the tumor was benign and so performed a lateral neck exploration. The tumor was completely removed. Histological examination revealed it to be an intramuscular hemangioma of the skeletal muscle. Based on the intraoperative findings of the tumor, we diagnosed it as an intramuscular hemanginoma originating from the posterior cricoarytenoid muscle. As the posterior cricoarytenoid muscle opens the glottal space, the left vocal cord was fixed medially after the surgery. Nevertheless its tonus appeared fine and phonetic function remained normal.

Primary tracheal cancer is very rare and a tumor obstructing the airway is an emergency difficult to manage. We report a case of primary tracheal cancer requiring surgery using percutaneous cardiopulmonary support (PCPS). A 68-year-old man was referred of severe dyspnea and squamous cell carcinoma obstructing the subglottic laryx found in bronchoscopy. Computed tomography (CT) showed a tumor extending from the cricoid cartilage to the third tracheal ring. We diagnosed tracheal cancer because most of the lesion was in the tracheal wall. Because dyspnea was getting worse, we performed emergency surgery. PCPS was established before tracheostomy for airway management. We performed total wide-field laryngectomy with the inferior margin located at the seventh tracheal ring. Using PCPS helps keep the operation uneventful and successful. Despite postoperative chemoradiotherapy, mediastinal lymph node and lung metastases 8 months post-operatively led to the man's death 15 months later. PCPS is very simple and easy to control, and has proven very effective in cases of severe airway stenosis.

近年，PET/CTが頭頸部扁平上皮癌の頸部リンパ節転移診断に有用との報告が散見され，当科でも治療前のN分類の決定にPET/CTを用いている。今回，当科で頸部郭清術を行った症例の術前PET/CTと術後病理診断を比較し，頸部リンパ節転移診断におけるPET/CTの有用性を検討した。対象は，PET/CT施行後1ヶ月以内に頸部郭清術を行い，なおかつ導入化学療法などの術前治療を行わなかった42例59側で，術前PET/CTで転移陽性と診断した23側のうち術後病理で転移リンパ節を認めたのは19側，PET/CTで転移陰性と診断した36側のうち術後病理で転移リンパ節を認めなかったのは33側であった。感度は86%，特異度は89%であり，頸部リンパ節転移診断においてPET/CTは有用であると考えられたが，偽陽性や偽陰性例の存在に留意する必要がある。

In hypopharyngeal carcinoma, even partial laryngopharyngectomy, results in functional disorders involving swallowing and speaking. We reconstructed partial defects following partial laryngopharyngectomy using a combined flap of a hyoid bone flap and radial forearm free flap. Before ablative surgery, we prepared an ipsilateral hyoid bone as a bone flap with sternohyoidal muscle. Then a radial forearm free flap was prepared simultaneously with tumor surgery. Thereafter, we reconstructed the epiglottis and pyriform recess using the combined flap. We successfully reconstructed 7 patients suffering from squamous cell carcinoma of the hypopharynx. The tracheostoma in all patients could be closed. Six patients could swallow without dysphagia within 48 days. This is the first report of the successful combined use of a hyoid bone flap and radial forearm free flap for hypopharyngeal carcinoma.

It is important to suppress lymph node recurrence and distant metastasis to achieve better survival of advanced laryngeal cancer, especially supraglottic cancer.The therapeutic outcomes of 33 cases with advanced laryngeal cancer treated at Kyoto University Hospital between 2000 and 2008 were reviewed.Thirty-one males and two females were involved. Their ages ranged from 49 to 81 years (average 65.6 years). All tumors were squamous cell carcinoma, arising at the glottis in 21 cases and the supraglottis in 12 cases. Most glottic cancers (90.5%) and supraglottic cancers (83.3%) were classified as T3 or T4. Total laryngectomy with neck dissection was performed in the treatment of T3 or T4 cases. Two cases of T2 cancers were treated by radiotherapy (66-72 Gy) with neck dissection, and one case of T2 cancer was treated by radiotherapy (66 Gy). Partial laryngectomy with neck dissection was performed in one T3 case.Five-year overall survival rates for stage III of glottic cancer, stage IV of glottic cancer, stage III of supraglottic cancer, and stage IV of supraglottic cancer were 100%, 40.9%, 100%, and 24.2%, respectively. Five-year disease-specific survival rates for stage III of glottic cancer, stage IV of glottic cancer, stage III of supraglottic cancer, and stage IV of supraglottic cancer were 100%, 56.3%, 100%, and 28.1%, respectively. No local recurrence occurred. Regional lymph node recurrence occurred in two cases- one patient with glottic cancer and one with supraglottic cancer. Both of them died of disease despite undergoing chemotherapy. One case initially had lung metastasis, and post-treatment distant metastasis occurred in the lung in four cases, in the skin in one, and in multiple organs in one case.

Once-daily radiotherapy for stage I glottic cancer and hyperfractionated radiotherapy for stage II glottic cancer achieved satisfactory results in terms of prognosis and laryngeal preservation. The treatment strategy for stage II glottal cancer with subglottal invasion needs to be reconsidered to further improve the outcome.Although early glottic carcinomas are highly curable by radiation therapy, the laryngeal preservation rate is not always sufficient. We reviewed the stage I/II glottal cancer treated in our institute during a recent 15-year period to improve the outcome and prognosis.In all, 113 cases of stage I/II glottic cancer (81 stage I cases and 32 stage II cases) were treated in Kyoto University hospital from 1994 to 2008. In 81 cases with stage I glottic cancer, radiation was performed for 66 cases, transoral laser excision (TLE) was performed for 14 cases, and hyperfractionated radiotherapy was done for one case. Among 32 cases with stage II glottic cancer, 24 cases were treated with hyperfractionated radiotherapy, 6 cases were treated with radiation, and one case with partial laryngectomy. Total laryngectomy was performed for one patient who suffered mixed connective tissue disease. Kaplan-Meier estimates were used for the analysis of survival rate and laryngeal preservation rate.The 5-year overall survival rates were 88.4% in stage I cases and 89.1% in stage II cases. The 5-year disease-specific survival rates were 100% in stage I cases and 93% in stage II cases. The 5-year laryngeal preservation rates were 99% in stage I cases and 90% in stage II cases. Two cases of stage II glottal cancer with subglottal invasion failed to be controlled and the patients died from local recurrence and mediastinum lymph node metastasis, respectively.

Treatment of advanced hypopharyngeal cancer has become more conservative and more multidisciplinary, and the prognosis has been improved. Induction chemotherapy has the potential to extend organ preservation therapy even in cases with locally advanced primary lesion. It is also important to develop a strategy to reduce distant metastasis and to keep track of second primary cancers.To update the therapeutic outcome of advanced hypopharyngeal cancer.A total of 72 cases with stage III/IV hypopharyngeal cancer were treated at Kyoto University Hospital during 2000-2008. Surgery was performed in 56 cases; total pharyngolaryngoesophagectomy (TPLE) in 39 cases and partial pharyngectomy (PPX) preserving the larynx in 17 cases. Radiotherapy (RT) with or without concurrent chemotherapy was applied in 16 cases. Induction chemotherapy (ICT) has been applied for 14 cases since 2006 to achieve organ preservation and reduction of distant metastasis. The follow-up period varied from 12 months to 96 months (mean 32 months). Therapeutic outcomes were chart reviewed.Five years cumulative overall and disease-specific survival (DSS) rates were 52.1% and 63.8%, respectively. DSS rates in cases treated with surgery and those with RT were 65.1% and 56.1%, respectively. N2c status showed the worst prognosis according to nodal disease classification. Local control rates for cases treated with TPLE, PPX, and RT were 97.3%, 100%, and 80.4%, respectively. The effective rate of ICT was 79%, and laryngeal preservation was achieved in 79% of the cases with ICT. Recurrence occurred in 20 cases. Approximately half of the recurrence was distant disease. In the end, 17 cases died of the primary disease, while 10 cases died of other causes, mainly second primary cancers.

耳下腺手術後のFrey症候群の発症を予防するために，胸鎖乳突筋弁などで露出された耳下腺実質を被覆する方法が従来から行われてきたが，それでも一定の発症は見られる。今回われわれは，Frey症候群予防のために，新しい概念である被膜下耳下腺手術を行った。被膜下耳下腺手術とは，皮膚と耳下腺浅葉被膜の間を剥離せずに被膜下のレベルで皮弁を挙上することにより，汗腺に分布する交感神経を温存して術後の神経の過誤支配を予防する術式である。対象は2008年1年間に当科で手術を施行した耳下腺良性腫瘍新鮮例27例のうち，被膜下耳下腺手術を行い術後6ヶ月以上の経過を観察できた23例である。病理組織別では，ワルチン腫瘍が12例，多形腺腫が10例，嚢胞が1例であった。術後にFrey症候群を発症した症例は1例も認めず，予防率は100%と非常に良好な結果であった。

To present the clinical results of closing chronic tympanic membrane (TM) perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane patch.Closure of TM perforations in 87 patients was attempted using bFGF, which is thought to promote the regeneration of TM tissues by facilitating the growth of fibroblasts and collagen fibers.Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane was placed in the perforation with the silicon layer facing outward and then infiltrated with 0.1 ml of trafermin. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete TM closure.The mean perforation size before treatment was 14.4%. Complete closure of the TM perforation was achieved in 80 patients (92.0%), whereas pinholes remained in 5 patients (8.7%), and small perforations were observed in 2 patients (2.3%). In the patients with complete closure, the TM perforations closed after an average 1.8 treatments, and hearing improved by 13.6 dB.This study demonstrated that bFGF combined with atelocollagen is effective for the conservative treatment of TM perforation.

The incidence of tuberculosis in Japan, including tuberculous otitis media, has increased alarmingly. Predisposing factors remain, however, to be clarified—particularly in view of how clinical features have changed—with the use of effective antitubercular therapy and improved economic and social conditions. Otolaryngologists must thus be aware of tuberculous in chronic otitis media and its varied manifestations. We report the two cases of tuberculous otitis media and its presentation and clinical manifestation. Tuberculous otitis media diagnosis was corroborated by pathohistological, microbiological, and molecular biological tests.

Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.

We report a rare case of giant cell tumor of bone arising in the 1st thoracic vertebra, which was successfully resected by a lower cervical approach. The patient was a 16-year-old female who presented with a cervical mass and dyspnea. Imaging study revealed a mediastinal mass arising in the 1st thoracic vertebra, extending upward into the lower neck. After repeated open biopsies, a diagnosis of giant cell tumor of bone was made. Curative surgery was performed by orthopedic and head and neck surgeons. Surgical exposure of the tumor was performed mainly by head and neck surgeons using a lower surgical approach without a median sternotomy. The postoperative course was uneventful and the patient is doing well without recurrence.

Conclusion: The results suggest that early diagnosis and treatment are the most important factors to improve the prognosis in oral cancer patients. Objective: In this retrospective study we analyzed the therapeutic outcome of oral cancers at out institute. Patients and methods: Thirty-one patients with oral cancers were treated between January 2000 and December 2004 at the Department of Otolaryngology–Head and Neck Surgery, Kyoto University Hospital. Transoral resection of tumor with or without neck dissection was performed for early oral cancers (stage I and II), while more extensive resection and radical neck dissection followed by postoperative radiotherapy was performed for advanced cases (stage IIII and IV). In the treatment of early tongue cancer, either partial glossectomy or brachytherapy was selected. The 3-year disease-specific survival rates of all patients, early-staged, and advanced-staged patients were 82.2%, 92.9%, and 63.5%, respectively. The prognosis was significantly related to the clin...

OBJECTIVE The aim of this study was to detect prognostic factors in patients with locally advanced papillary thyroid carcinoma. PATIENTS The study included 72 patients (T4a/T4b 72/0, N0/N1a/N1b 25/15/32, M0/M1 68/4, mean follow-up 8.1 4.4 years) who underwent initial surgical treatment at Osaka Red Cross Hospital between April 1993 and April 2011. RESULTS Eleven patients died of PTC, 3 patients with recurrence died of unrelated disease and 10 patients are alive with recurrence. The overall 5-year survival rate was 88.3%, and the 10-year survival rate was 73.4%. The disease-specific 5-year survival rate was 91.4%, and the 10-year survival rate was 88.6%. The 5-year local control rate was 94.1%, and the 10-year local control rate was 85.4%. Patients with distant metastasis (M1), tracheal invasion and/or multiple organs invasion showed a significantly worse disease-specific survival rate based on a univariate analysis, which also revealed that tracheal invasion, laryngeal invasion, esophageal invasion and multiple organs invasion were risk factors linked to the development of distant metastasis during follow-up (recurrence as distant metastasis). The following were found to be clinically significant risk factors, based on the multivariate analysis among tracheal invasion, laryngeal invasion, esophageal invasion and recurrent laryngeal nerve invasion : Tracheal invasion was a risk factor for disease-specific survival, and tracheal invasion and laryngeal invasion were risk factors for recurrence as distant metastasis. CONCLUSIONS In this study, distant metastasis, multiple organs invasion, tracheal invasion and/or laryngeal invasion were shown to be higher risk factors.

We report a case of maxillary cancer that caused a marked systemic inflammatory reaction including leukocytosis and high blood levels of C-reactive protein. The production of Granulocyte-colony stimulating factor (G-CSF) by tumor cells was demonstrated by immunohistochemical staining. Despite the reported poor prognosis of G-CSF producing tumors, chemoradiotherapy was highly effective and all of the inflammatory indexes settled to within normal limits. The patient is under close follow-up and has been in complete remission for eleven months after the completion of chemoradiotherapy.

Change and its significance in the treatment of the hypopharyngeal carcinoma (HPC) are discussed, chiefly based on the author's experiences. In the nineteen-seventies and eighties, the prognosis of HPC was poor, and the 5-year over-all survival was only 24% in 173 patients. Locoregional recurrence was the most serious problem. To improve locoregional control, we introduced extended surgery with reconstruction using a free jejunal graft, in which a safety margin of 3cm or more was secured at the primary site while bilateral retropharyngeal and paratracheal dissections were added to bilateral radical neck dissections. This treatment achieved a disease-specific 3-year survival of 64% for patients with advanced (stage III, IV) HPC, which was significantly better than that of patients treated by previous methods. Furthermore, postoperative radiotherapy was introduced for advanced HPC treatment, in which a 50Gy dose was basically used to irradiate the bilateral neck and a 10Gy dose was locally added when a retropharyngeal lymphnode metastasis was histopathologically identified or the number of lymphnode metastasis was three or more. In the recent five years, the disease-specific 3-year survival reached 81% in 39 advanced HPC patients. During this period, we endeavored to conserve in laryngeal functions for patients with early (stage I, II) HPC by performing a radiotherapy or partial pharyngectomy. In 14 early HPC patients, there was no recurrence and the larynx was well conserved in eleven. We also developed a new method of reconstruction after partial laryngopharyngectomy, in which aspiration was well prevented by reconsfructing the supraglottis and hypopharynx using hyoid bone attached to sternohyoid muscle and free forearm flap. Progress in surgical reconstruction techniques and radiotherapy changed the treatment of HPC, providing a better prognosis for advanced HPC patients and a better life quality for early HPC patients.

Objectives: The objective of the present study was to demonstrate regenerative medicine of the tracheal tissue by using an in situ tissue engineering technique for airway reconstruction. Methods: Based on the previous successful experimental animal studies, the current regenerative technique was applied to repair of the trachea of a 78-year-old woman with thyroid cancer. A Marlex mesh tube covered by collagen sponge was used as a tissue scaffold. The operative intervention included right hemithyroidectomy, resection of the trachea, and tracheoplasty using the scaffold. The right half of three rings of the trachea was resected, and the scaffold material was sutured to the defect of the trachea. Results: After 2 weeks, the mesh collagen structure of the artificial material could be seen with endoscopy in most of the implanted area. The artificial material was covered with epithelial growth after 2 months. Epithelialization continued to cover the artificial material completely for 2 years without any complications. Conclusions: The current regenerative technique avoided tracheotomy, a second operation, and deformity. Good epithelialization has been observed on the tracheal luminal surface without any complications for 2 years. Although long-term observation is required, regenerative medicine of the tracheal tissue appears feasible for airway reconstruction.

最近5年間に当科で初治療を行った下咽頭癌49例のうち食道癌との重複例16例について検討した。食道癌治療後に下咽頭癌が見つかった9例中6例は当院で経過観察されており，そのほとんどは早期癌で発見され喉頭保存治療が可能であった。3年累積生存率は62%で，死亡例5例中3例が食道癌死であった。下咽頭癌による死亡例はなかった。生存者11例中，発声機能が喪失したもの7例，気管カニューレ装着中1例，重篤な嚥下障害が残ったもの6例であった。予後には食道癌の治療が最も関与し，両癌の治療で嚥下障害が増大する傾向が示された。