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Objective: Gallbladder cancer (GBC) typically follows an aggressive course with the standard of care for advanced disease; complete responses are rarely encountered. We report a case in which tumor disappearance on positron emission tomography computed tomography (PET-CT) was treated with S-1 as the second-line treatment for local recurrence of GBC after gemcitabine (GEM) plus cisplatin (CDDP) (GC) combination therapy. Case Presentation: A 69-year-old woman was referred to our hospital with complaints of right hypochondrial pain. Based on ultrasound, CT, and magnetic resonance imaging (MRI) findings, we diagnosed patient with suspected GBC. Results: We performed the resection of the gallbladder base, partial resection of the transverse colon, and partial resection of the stomach for GBC. At four months after the surgery, PET-CT showed local recurrence. First-line chemotherapy with GC therapy was initiated. After 9 courses, PET-CT showed increased local recurrence. We concluded that GC treatment was ineffective. Second-line chemotherapy with S-1 was initiated for two weeks, followed by a 7-day rest period. PET-CT in September 2019 showed the markedly reduction of the local recurrence, and PET-CT in October 2021 showed the complete disappearance of the local recurrence. At 20 months after the discontinuation of S-1, PET-CT showed the complete disappearance of the local recurrence. Conclusions: Chemotherapy with S-1 can be managed safely and was demonstrated to be effective in treating the local recurrence of GBC recurrence.

Objective: Small bowel adenocarcinoma (SBA) is a rare disease but its clinical features have been clearly elucidated. The present study clarified the clinicopathological characteristics, the effectiveness of the surgical procedure, neoadjuvant chemotherapy, and adjuvant chemotherapy of the patients with SBA. Patients and Methods: The clinicopathological characteristics of 9 cases of SBA resected at our hospital were reviewed between 2004 and 2017. Results: The mean age of the 9 patients (4 men, 5 women) was 69.6 (57-83) years. The sites included the duodenum (n=3), jejunum (n=3), and ileum (n=3). As neoadjuvant chemotherapy, S-1 was administered to a patient with a large duodenal adenocarcinoma invading the portal vein. The surgical procedures included partial resection of jejunum (n=3); partial resection of ileum (n=3); pylorus-preserved pancreatoduodenectomy (PD) (PPPD) with right hemicolectomy due to invasion of ascending colon (n=1); subtotal stomach-preserving PD (SSPPD) (n=1); and wedge resection of the duodenum (n=1). The stage was classified as follows: stage I (n=1), stage IIA (n=1), stage IIB (n=3), stage IIIA (n=1), stage IIIB (n=2), and unknown, (n=1). As adjuvant chemotherapy, S-1 was administered to three stage IIB patients, one IIIA patient, and one IIIB patient. Tegafur uracil (UFT) + calcium folinate (LV) was administered to one stage IIIB patient. The cumulative five-year survival rate was 77.8%. Conclusions: Aggressive esophagogastroduodenoscopy, double-balloon endoscopy, and colonoscopy for symptoms such as anemia and abdominal pain, as well as intraoperative during abdominal surgery, would improve the prognosis of SBA.

Objective: Primary appendiceal adenocarcinoma accounts for 1% of colorectal tumors and is a rare malignancy. Peritoneal dissemination commonly occurs as part of the natural course of disease, following the sequence of luminal wall invasion, obstruction, and perforation. Patients and Methods: Twenty patients with appendiceal adenocarcinoma were surgically treated in our hospital between 1990 and 2021. The clinicopathological features, preoperative diagnosis, intraoperative diagnosis, surgical techniques, postoperative adjuvant chemotherapy, chemotherapy, outcome, and prognostic factors for survival of patients with primary appendiceal adenocarcinoma were reviewed. Results: Patients (8 males, 12 females), with an age from 35 to 94 years (mean: 72.8 years), were involved in the study. Before surgery, 7 (35%) patients were diagnosed with primary appendiceal adenocarcinoma and 13 were diagnosed with other conditions. 10 patients had stage I or II disease and 10 patients had stage III or IV disease. Sixteen patients received curative resection, while 4 received non-curative resection. The cumulative five-year survival rate was 62.1%. The preoperative and intraoperative diagnoses, pathological stage, and curative resection had a significant impact on survival. Conclusions: The preoperative and intraoperative diagnoses, pathological stage, and curative resection had an important impact on survival of patients with primary appendiceal adenocarcinoma.

Objective: Gastrointestinal stromal tumors (GISTs) present with different clinical and immunohistochemical characteristics depending on the anatomic site. The present study clarified the clinicopathological characteristics of small bowel (SB) GISTs, which are relatively infrequent. Patients and Methods: The clinicopathological characteristics of 15 cases of small intestinal GISTs resected at our hospital were reviewed. SBGISTs were divided into duodenal (d) GISTs and jejunal/ ileal (ji) GISTs for the comparison. Results: The tumors included six cases in the duodenum, six in the jejunum, and three in ileum. All patients underwent duodenal wedge resection for dGIST and partial SB resection for jiGIST. The stage was I in seven patients, II in two patients, IIIB in five patients, and IV in one patient. The median postoperative observation period was 67 (11-175) months. Ten patients had no recurrence, two had hepatic and peritoneal recurrence, one had multiple hepatic recurrence, one had peritoneal recurrence, and one had lymph node recurrence. On comparing dGISTs and jiGISTs, recurrence was significantly more frequent in jiGISTs than in dGISTs. Conclusions: In five cases of recurrence, chemotherapy and surgery at the appropriate time seemed effective for achieving a long-term survival. Recurrence was significantly more frequent in jiGISTs than in dGISTs.

Objective: The prognosis of patients with advanced gastric cancer (GC) with multiple lymph-node metastasis is poor. The present study evaluated a neoadjuvant S-1 and oxaliplatin regimen (SOX) followed by D2 gastrectomy for advanced GC with lymph-node metastasis. Patients and Methods: Ten patients with resectable clinical advanced gastric cancer with multiple lymph-node metastasis who received preoperative SOX therapy were included in this study from 2015 to 2021. Results: A clinical evaluation by RECIST version 1.1 criteria after SOX therapy showed 8 cases of partial response (PR), 2 cases of stable disease (SD), and no progress disease (PD). The histopathological stages were IB in 3 patients, IIA in 2, IIB in 2, IIIA in 2, and IIIB in 1, and downstaging was observed in 8 of 10 patients (80%). Histopathological effects were Grade 1a in 4 patients, Grade 1b in 3 patients, Grade 2a in 2 patients, and Grade 2b in 1 patient; there were no Grade 3 patients. Adverse events of neoadjuvant chemotherapy (NAC) according to the CTCAE criteria were Grade 1 anemia, nausea, dysgeusia, and peripheral neuropathy in one patient each; Grade 2 anemia in two patients; and diarrhea in one patient. No grade ≧3 adverse events were observed. The surgical techniques were distal gastrectomy in four cases, total gastrectomy in five cases, and total gastrectomy and caudal pancreatectomy in one case; all patients underwent D2 dissection, and all received R0 surgery. One patient had local recurrence, and one patient had peritoneal recurrence and is on chemotherapy. The remaining eight patients are alive without recurrence. Conclusions: In the future, neoadjuvant chemotherapy with SOX therapy may become a treatment option for advanced resectable GC with multiple lymph-node metastasis.

Objective: Even after surgery and intensive postoperative treatment, the mortality rate of patients with perforated colorectal cancer (CRC) is high. The purpose of this retrospective study was to evaluate risk factors for postoperative recurrence and hospital mortality in patients with perforated CRC. Patients and Methods: We experienced a total of 142 patients who were diagnosed with colorectal perforation and who underwent emergency surgery from 2008 to 2021. First, we performed a clinicopathological study of patients with perforated CRC. Next, we examined the clinicopathological characteristics of the CRC and non-CRC groups. We investigated the histopathological characteristics and risk factors for postoperative recurrence and hospital mortality in 32 patients with perforated CRC. Results: The Hinchey stage of the CRC group was significantly higher than that of the non-CRC group (p=0.00619), and that in the proximal site group was significantly higher than that of the cancer site group (p=0.00489). The rate of recurrence in the proximal site perforation group was significantly higher than that in the cancer site perforation group (p=0.0135). Patients with T4 disease showed a significantly higher rate of recurrence than those with T3 disease (p=0.0443). The number of dissected lymph nodes in the recurrence-free group was significantly higher than that in the recurrence group (p=0.0377). There was a tendency for more patients in the recurrence-free group to receive postoperative adjuvant chemotherapy; however, this difference was not statistically significant. The preoperative shock rate in the hospital mortality group was significantly higher than that in the alive at discharge group (p=0.0169). Conclusions: The proximal site perforation, T4 disease, and the small number of dissected lymph nodes were the risk of the recurrence. The large number of preoperative shocks was the risk of the hospital mortality.

Atypical Teratoid Rhabdoid Tumor (ATRT) is a rare malignant intracranial neoplasm more commonly diagnosed in young children. The authors report the case of an 11-year-old boy with a long standing history of slowly progressive weight loss, fatigue, and weakness over 1.5 years whose magnetic resonance imaging revealed a large heterogeneous enhancing dorsally exophytic lower brainstem mass. Examination revealed extreme cachexia, gaze-evoked nystagmus, dysphagia, dysarthria, bilateral dysmetria, and global weakness without ambulation. The protracted history and neuroimaging features were most suggestive of a low grade glioma. However, pathology revealed a hypercellular tumor with large hyperchromatic nucleoli and loss of INI-1 staining on immunohistochemistry consistent with a diagnosis of an ATRT. The child died shortly after surgery due to complications from his brainstem infiltrative disease. This case illustrates the diverse presentation of ATRT in childhood that can clinically and radiographically mimic that of low grade glioma.

We report a rare case of myxofibrosarcoma arising in the neck. A 55-year-old man presented with a two-year history of left-sided, painless, submandibular swelling. Computed tomography and magnetic resonance imaging (MRI) revealed an 80 × 35 mm, well defined, lobulated, submandibular tumour extending to the parapharyngeal space. The tumour showed uniformly low intensity and marked hyperintensity in T1- and T2-weighted MRI scans, respectively, and was scarcely enhanced by gadolinium. A tentative diagnosis of lymphangioma or plunging ranula was made, and the patient underwent local injection of OK-432, which proved to be ineffective. Resection of the tumour was then performed via a transcervical approach. The tumour was histopathologically and immunohistochemically diagnosed as a low-grade myxofibrosarcoma. The patient's post-operative clinical course was uneventful, and the patient was free of disease 27 months after surgery. The pathology, clinical characteristics and treatment of myxofibrosarcoma are bibliographically reviewed. [ABSTRACT FROM AUTHOR]

Background: Chondroblastoma is classified as a benign bone tumor. However, postoperative local recurrence remains a concern. We analyzed the factors contributing to chondroblastoma local recurrence and the clinical challenges associated with treating these patients., Methods: This retrospective study examined 59 patients followed up at our hospitals for ≥ 1 year after surgery during 1990-2020. The most common lesion site was the epiphyses of long bones (42 cases, 71%), including the femur, tibia, and humerus. Curettage was performed in 57 cases; 2 cases with an iliac lesion underwent resection. The median postoperative follow-up period was 47 months. Clinical features of chondroblastoma were retrospectively investigated, and local recurrence and postoperative functional outcomes were assessed., Results: Local recurrence occurred in 9% (5/57) of patients after curettage but not in the resected cases. The median time to local recurrence was 14 months. The local recurrence-free survival (LRFS) rate for all patients was 92.7% at 2 years and 88.3% at 5 years. All patients with local recurrence were aged < 17 years at the time of surgery. Local recurrence was observed in the proximal humerus in two cases and the calcaneus, acetabulum, and distal femur in one case each. None of the adjuvant procedures (high-speed burr, ablation, bone replacement materials, and preoperative denosumab) helped reduce local recurrence risk (P > 0.05). Trends toward fewer local recurrences were observed in the group treated using the high-speed burr and in the group not treated using bone replacement materials. Among the groups treated with bone replacement materials, artificial bone achieved the best LRFS rate, followed by allograft and autograft. At the final follow-up, the mean Musculoskeletal Tumor Society score was 29.8 (range: 25-30), indicating excellent postoperative functional outcomes. Joint degeneration was observed in five patients. Patients with local recurrence had a high degree of disability and joint deformity (P < 0.05). Two patients received preoperative denosumab and neither experienced local recurrence nor functional impairments., Conclusions: Good oncological and functional outcomes were achieved. Age < 17 years was associated with a high risk of local recurrence after curettage (P = 0.0198). Patients with local recurrence exhibited poorer functional outcomes. High-speed burr may help reduce the recurrence risk. If bone grafts are necessary, materials with low biocompatibility, including artificial bone, may be optimal. Managing patients with chondroblastoma should encompass curative and functional aspects., Competing Interests: Declarations. Consent for participation: Informed consent was obtained from all participants, or from their legal guardians if the participants were under 20 years old. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

A 20-year-old woman presented to our hospital with abdominal pain. Abdominal computed tomography revealed multiple masses in the upper jejunum, which were suspected as lipomas. Partial resection of the small intestine, including the masses, was performed on the same day due to intussusception secondary to the masses. Pathological examination revealed that the masses consisted of mucosa and edematous submucosa with multiple dilated blood vessels and lymphatic ducts without muscularis propria. The masses were diagnosed as multiple muco-submucosal elongated polyps (MSEP), a type of non-neoplastic polyp. MSEP was originally named colonic MSEP, but with the development of endoscopic techniques and imaging tests, similar polyps have been reported to occur not only in the colon but also in the entire intestinal tract. In this case, multiple MSEPs in the upper jejunum caused intussusception. As reported cases of multiple lesions causing intussusception are few, our case may help to clarify the pathogenesis of this disease., (© 2023. Japanese Society of Gastroenterology.)

Background: Dedifferentiated liposarcoma occurs predominantly in the retroperitoneum. Given the paucity of cases, information on the clinical characteristics of this entity in the extremities and trunk wall is quite limited. In particular, the significance of preoperative evaluation and principles of intraoperative management of the different components, i.e., well-differentiated and dedifferentiated areas, are still to be defined., Methods: Clinical characteristics, treatment outcomes, and risk factors for poor oncological outcomes in cases of dedifferentiated liposarcoma in the extremity or trunk wall were analyzed by a retrospective, multicentric study., Results: A total of 132 patients were included. The mean duration from the initial presentation to dedifferentiation was 101 months in dedifferentiation-type cases. The 5-year local recurrence-free survival, metastasis-free survival, and disease-specific survival rates were 71.6%, 75.7%, and 84.7%, respectively. Among 32 patients with metastasis, 15 presented with extrapulmonary metastasis. A percentage of dedifferentiated area over 87.5%, marginal/intralesional margin, and R1/2 resection in the dedifferentiated area were independent risk factors for local recurrence. Dedifferentiated areas over 36 cm 2 , French Federation of Cancer Centers Sarcoma Group grade III, and intralesional or marginal resection were independent risk factors for metastasis. A dedifferentiated area over 77 cm 2 and lung metastasis were independent risk factors for disease-specific mortality., Conclusions: The typical clinical characteristics of dedifferentiated liposarcoma in the extremity and trunk wall were reconfirmed in the largest cohort ever. The evaluation of the dedifferentiated area in terms of grade, extension, and pathological margin, together with securing adequate surgical margins, was critical in the management of this entity., Competing Interests: Declaration of competing interest No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors declare that they have no conflicts of interests., (Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

We analyzed the clinicopathological characteristics of six patients with duodenal gastrointestinal stromal tumor (dGIST) resected in our hospital between 2005 and 2020. The patients (5 males, 1 female) were aged from 43 to 83 years old (mean: 63.7 years old). With respect to the preoperative diagnosis, one patient was diagnosed with dGIST by a biopsy, and five patients were diagnosed with suspected dGIST by esophagogastroduodenoscopy (EGD). The tumor locations were the third portion in four cases, second portion in one, and fourth portion in one. The pathological stages were I in four patients, II in one, and IIIB in one. All patients were discharged 12.8 days (10-15 days) postoperatively without complications, such as pancreatic fistula or suture deficiency. Regarding the prognosis, all patients are alive without recurrence. The wedge resection is a reasonable option for resection of dGIST and should be routinely considered if technically feasible., Competing Interests: None, (Copyright © Japan Medical Association.)

Background: Considering the invasiveness of standard multidisciplinary approaches used for the treatment of soft tissue sarcoma, including surgery with wide margins, intensive chemotherapy, and radiotherapy, evaluation of comorbidities in high-grade soft tissue sarcoma patients is essential. Several previous studies have reported the impact of comorbidities on the survival of soft tissue sarcoma patients. Patient health status differs between nationalities or ethnic groups and only limited data has been reported with respect to the impact of comorbidities on Japanese soft tissue sarcoma patients., Methods: The incidence of each comorbidity, relationship between comorbidities and underlying clinicopathological factors, relationship between treatment status and comorbidities, and impact of comorbidities on disease-specific death in 136 patients with high-grade soft tissue sarcoma at the authors' institution were analyzed. For the evaluation of comorbidities, the updated Charlson comorbidity index was applied., Results: Of the patients, 25% presented with more than one comorbidity. Elderly patients showed a significantly higher incidence of comorbidities (p < 0.0001). Patients with congestive heart failure (p = 0.004), dementia (p < 0.0001), hemiplegia/paraplegia (p < 0.0001), and renal disease (p < 0.0001) showed worse prognosis. Tumor grade (p = 0.01) and updated Charlson comorbidity index (p < 0.0001) were independent risk factors for disease-specific death., Conclusions: Comorbidity status was a significant risk factor for disease-specific death in Japanese patients with high-grade soft tissue sarcoma. Innovations in comorbidity management may be a means for the improvement of oncological outcomes in soft tissue sarcoma. Given the difficulties in conducting standard randomized control studies in this field, data accumulation from real-world cases appears to be the most practical approach in establishing and applying strategies for the treatment of patients with comorbidities or elderly patients., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Aims: There have been some reports about the efficacy of trauma team activation. In November 2015, we implemented a trauma call system, wherein a general surgeon, neurosurgeon, and orthopedic surgeon are called to the emergency department when severe trauma patients are transferred to our emergency department. In this study, we evaluated the efficacy of this trauma call system., Methods: The purpose of the present study was to evaluate the efficacy of a trauma call system for trauma cases with an Injury Severity Score ≥16. We compared the mortality of trauma cases and the time from arrival to the start of the examination and intervention before and after implementing this trauma call system., Results: There was no significant difference in the mortality rates before and after the implementation of the trauma call system. The median time from arrival to the start of contrast-enhanced computed tomography or transcatheter arterial embolization improved from 54 to 19 min ( P  = 0.015) and 171 to 84 min ( P  = 0.030), respectively, after the implementation of the trauma call system., Conclusion: Our trauma call system did not significantly improve the mortality of trauma patients with an Injury Severity Score ≥16. However, it was effective for reducing the time from the arrival to the start of contrast-enhanced computed tomography or transcatheter arterial embolization.

We analyzed the clinicopathological characteristics, preoperative diagnosis, surgical operations, chemotherapy regimens, and prognoses of 6 patients with primary small intestinal carcinomas that were resected at our hospital between January 2004 and December 2014. The patients(3 men and 3 women)were 65 to 77 years old(mean: 70 years old). We were able to diagnose 3 patients pathologically before surgery via double balloon endoscopy and endoscopy of the large intestine. We performed partial resection of the jejunum in 3 patients, partial resection of the ileum in 1 patient, laparoscopic ileocecal resection in 1 patient, and right hemicolectomy in 1 patient. The histological type was well-differentiated adenocarcinoma in 2 patients, moderately differentiated adenocarcinoma in 2 patients, papillary adenocarcinoma in 1 patient, and poorly differentiated adenocarcinoma in 1 patient. The tumor depth was T2 in 1 patient, T3 in 2 patients, and T4 in 3 patients. The pathological stage was I in 1 patient, II A in 1 patients, II B in 2 patient, III A in 1 patient, and III B in 1 patient. The postoperative median duration of follow-up was 44 months(range: 10-127). Regarding prognosis, 5 patients are alive without recurrence, and 1 patient died of peritoneal dissemination. The overall 5-year survival rate was 75%. We suggest that it is very important to perform radical resection with lymph node dissection for patients without distant metastases.

We investigated the clinicopathological findings of 90 patients with colorectal perforation who underwent emergency surgery between January 2008 and July 2015.T he patients were divided into 2 groups, namely those with perforation due to colorectal cancer(colorectal cancer group, n=20)and those with perforation due to benign colorectal disease(non-colorectal cancer group, n=70).We investigated the clinicopathological findings of the 2 groups.The SOFA score was significantly lower in the colorectal cancer group than in the non-colorectal cancer group.Of the 20 cases of primary cancer, 11 were located in the sigmoid colon; 5, in the rectum; 2, in the transverse colon; 1, in the ascending colon; and 1, in the cecum.The perforation occurred at the tumor site in 8 patients and at the oral site of cancer in 12.Eleven patients had stage II cancer, 1 had stage IIIa, and 8 had stage IV.Ten patients underwent curability A resection; 1, curability B resection; and 8, curability C resection.Recurrence was observed in 6 of the 10 patients who had undergone curability A resection and in 1 patient who had undergone curability B resection.The initial recurrence site was the liver in 3 cases, the peritoneum in 2 cases, and a local site in 2 cases.Even if the patents underwent curative operation, the recurrence rate was high.Therefore, we conclude that adjuvant chemotherapy is required along with careful follow-up.

The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7-14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy recovery after colorectal resection.

Langerhans cell histiocytosis (LCH) usually occurs in children under the age of 10 years with a predilection for the skull, spine, rib and humerus. Solitary LCH occurring in an adult clavicle is uncommon with limited reports to date. The lesion in our patient was curetted with the intent to make a diagnosis, which subsequently lead to the remission of the symptom and the disease. At the final follow-up after 1 year, no local recurrence or metastasis is observed.

Objective: To investigate whether distortion product otoacoustic emissions (DPOAEs) can be a prognostic indicator of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL)., Methods: Seventy-eight consecutive patients with ISSNHL were enrolled. DPOAEs were measured at the first hospital visit. Two primary pure tones with a frequency ratio (f2/f1) of 1.2 were used at non-equal sound pressure levels (L1/L2=80/70dB SPL). The DPOAE amplitude was measured at the 11 frequencies of 2f1-f2 with f2 varying from 593 to 6031Hz. All the patients received steroid administration in combination with hyperbaric oxygen (HBO) therapy. Hearing recovery was evaluated by the improvement in hearing compared to the unaffected contralateral ear. Correlations between the hearing improvement rate and five potential prognostic factors (the DPOAE amplitude, patient's age, days from onset to the start of treatment, initial hearing level, and presence of vertigo) were examined by simple and multiple regression analyses., Results: The net DPOAE amplitude in patients with hearing improvement rate ≥50% was significantly larger than that with hearing improvement rate <50% at f2 frequencies of 3031 and 4812Hz (unpaired Student's t-test, p<0.05). A simple regression analysis showed that the hearing improvement rate significantly correlated with the net DPOAE amplitude at f2 frequencies of 3031 and 4812Hz, but not with that at the other f2 frequencies tested. The correlation coefficients were 0.528 and 0.522 for 3031 and 4812Hz, respectively, with p values <1×10(-6). In a multiple regression analysis, the partial correlation coefficients of the net DPOAE amplitude were 0.308 and 0.246 with p values of 0.008 and 0.036 for 3031 and 4812Hz, respectively., Conclusion: The significant correlation between hearing recovery and DPOAEs measured before treatment indicates that DPOAEs are a potentially useful means of predicting hearing prognosis in ISSNHL., (Published by Elsevier Ireland Ltd.)

A 75-year-old woman was referred to our hospital because of locally advanced gastric cancer. Gastrointestinal fiberscopy revealed type 3 advanced gastric cancer in the posterior wall of the gastric cardia extending to the middle body. Abdominal CT scan revealed direct invasion of pancreas and regional lymph node metastases, indicating clinical stage IV (cT4N2H0P0M0). After two courses of S-1/CDDP, neoadjuvant chemotherapy was administered, and total gastrectomy with D2 lymphadectomy was performed. Histological examination revealed no residual cancer cells in the surgically obtained stomach and lymph nodes, suggesting a complete pathological response (Grade 3). She was treated with S-1 for one year after operation and presently, 16 months after operation, she is in good health without recurrence.

Polysomnography (PSG) has been the gold standard for the diagnosis of sleep apnea syndrome (SAS). However, PSG is not generally available since it is technically demanding, and cost and labour are necessary. Currently, there is growing demand for its diagnosis. Thus, simplified portable equipments have been increasingly utilized. Sleeprecorder SD-101 (Suzuken, Nagoya, Japan) is a pad-shaped and novel device for SAS analysis. A total of 162 sitting-sensor tips are 1.6 inch apart, embeded in the 55 x 22 inch pad, and capable of detecting load with precision of one gram. Sleeprecorder SD-101 placed beneath the chest can recognize respiratory pattern and record thoracic movement during sleep. SASLyzer (Suzuken, Nagoya, Japan), a software installed in a compatible PC, analyzes the data and indicates apnea-hypopnea index (AHI). We present a case of SAS in a 40-year-old man (181 cm, 98 kg) with peritonsillitis. We used Sleeprecorder SD-101 since he complained of severe snoring and excessive daytime sleepiness. He had severe SAS with AHI 50.7. Subsequently, conventional PSG also indicated AHI 77. In the present case with severe SAS, these two methods showed equivalent severity. Sleeprecorder SD-101 could be a useful device for screening of SAS patients.

Objective: To investigate the relationships among nasal obstruction (NO), snoring, and excessive daytime sleepiness (EDS) in working people with or without allergic rhinitis (AR)., Design: Prospective study using questionnaires., Setting: An industrial company in Japan., Participants: We asked 1878 daytime workers to complete questionnaires; data from 1459 respondents were analyzed. Participants were divided into 3 groups: those with NO plus AR, those with NO without AR, and those with AR without NO. Individuals without NO or AR served as controls., Main Outcome Measures: Allergic rhinitis and daytime sleepiness were evaluated using the European Community Respiratory Health Survey questionnaire and the Epworth Sleepiness Scale, respectively., Results: The percentage of snorers, the Epworth Sleepiness Scale score, and the percentage of participants with EDS were higher in the NO-AR and NO groups but were not significantly different in the AR group compared with the control group. These variables did not differ between the NO-AR and NO groups. Patients in the NO-AR and NO groups had higher odds of snoring and of having EDS, whereas the odds of snoring or of having EDS were not statistically significant in the AR group compared with the control group (P = .67 and P = .3, respectively)., Conclusions: Nasal obstruction is associated with snoring and EDS in individuals with or without AR. Allergic rhinitis without NO is not associated with sleep-disordered breathing or EDS.

We studied the usefulness of cephalometry and pharyngeal findings in determining efficient primary diagnosis of obstructive sleep apnea syndrome (OSAS). Subjects were 171 adult men with sleep-disordered breathing, who underwent cephalometry and polysomnography (PSG) and had pharyngeal findings evaluated by modified Mallampati grade (MMP) and palatine tonsil size. An apnea-hypopnea index (AHI) of > or = 15 in PSG was considered to indicate OSAS. We analyzed the correlation between AHI and other parameters and conducted stepwise multiple regression analysis to predict AHI, and studied the screening performance of prediction equations using a receiver operating characteristic (ROC) curve. Of the 8 cephalometric parameters examined, the length of the soft palate (PNS-P; p = 0.011) and the distance from the mandibular plane to the hyoid bone (MP-H; p < 0.001) correlated significantly with AHI. Two indices of the pharyngeal finding and body mass index (BMI) also significantly correlated with the AHI (MMP; p < 0.001, tonsil size; p = 0.005, BMI; p < 0.001). We next set up three prediction equations including (a) two significant cephalometric parameters (PNS-P and MP-H), (b) two pharyngeal indices (MMP and tonsil size), or (c) both. BMI was included in all three. ROC curve analysis showed that the screening performance of prediction equations was (c) > (a) > (b). Sensitivity and of equation (c) with a cutoff of 15 were 0.95 and specificity 0.25. These results indicate that both cephalometric parameters and pharyngeal indices should be included in conducting an efficient primary diagnosis for OSAS.

Objectives: We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers., Methods: Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity., Results: The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level., Conclusions: We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.

Dark-skinned people are known to be more tolerant of ototraumatic noise than are light-skinned people, and pigmented animals are more tolerant of ototraumatic noise and aminoglycoside ototoxicity than are albino animals. Such tolerance may be dependent on the local ability of detoxification and antioxidant enzymes, including glutathione S-transferase (GST) and glutathione peroxidase (GSPx). In the present study, we examined the difference in GST/GSPx expression in the lateral wall of the cochlea between pigmented and albino guinea pigs. Eight-week-old male pigmented and albino guinea pigs were killed by transcardiac perfusion with 2% paraformaldehyde. The cochlear ducts were isolated, further fixed with 4% paraformaldehyde, decalcified, and then embedded in paraffin. Sections prepared at 5-microm thickness were incubated with anti-GST-alpha,-mu,-pi, or anti-GSPx antibody, reacted with Alexa Fluorconjugated secondary antibody, and examined under a Carl Zeiss Axioskop 2 plus fluorescence microscope. The cochlea ducts were also subjected to immunoelectron microscopy for GST-pi by the postembedment method. The stria vascularis of pigmented guinea pigs was strongly immunoreactive for GST-alpha,-mu,-pi, and GSPx, whereas no or only weak immunoreactivities were seen in the stria vascularis of albino guinea pigs. The spiral ligament showed positive but different immunoreactivities for these enzymes between the strains. Double-stained immunofluorescence micrographs for GST-pi and GSPx showed a close resemblance of localization between the two enzymes in both pigmented and albino guinea pigs. At the ultrastructural level, immunoreactivity for GST-pi was localized preferentially in the melanin cells of pigmented guinea pigs. These results suggest that correlation between pigmentation and inner ear susceptibility is, at least partially, attributed to the different distribution of GST/GSPx in the stria vascularis.

Background: Our aim was to evaluate the efficacy and toxicity of chemoradiotherapy (CRT) with transoral debulking microsurgery for T2N0 glottic cancer., Methods: Thirty patients with T2N0 glottic cancer treated with concurrent hyperfractionated radiotherapy (RT) and carboplatin were retrospectively analyzed. Median total dose of RT was 72 Gy. Nineteen of 30 patients also received transoral debulking microsurgery during or before CRT. The remaining 11 patients who demonstrated complete response or good partial response at 36 to 45.6 Gy were not treated with transoral debulking microsurgery., Results: Local recurrence developed in 5 patients; 4 of these patients did not undergo transoral debulking microsurgery. The 3-year local control rate was significantly better for CRT with transoral debulking microsurgery (95%) than for CRT alone (61%) (p = .02)., Conclusion: CRT with transoral debulking microsurgery may have a positive impact on the local control of T2N0 glottic cancer, which justifies further evaluation to confirm its definite benefit.

Objective: We conducted a controlled retrospective analysis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in order to investigate the effect of prostaglandin E1 (PGE1) plus hyperbaric oxygen (HBO) therapy in comparison with that of steroid plus HBO therapy., Methods: One hundred and ninety-six consecutive patients with ISSNHL (hearing levels > or ==40dB; time from the onset of hearing loss to the start of treatment < or ==30 days) were enrolled. Ninety-five patients underwent PGE1 plus HBO therapy (PG group) and 101 underwent steroid administration plus HBO therapy (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear., Results: The hearing levels after treatment were 52.2+/-3.0 and 47.5+/-2.8dB, the hearing gains were 31.3+/-2.2 and 27.2+/-2.3dB, the cure rates were 28.4% and 28.7%, the recovery rates were 54.7% and 53.5%, and the hearing improvement rates were 48.4+/-5.1% and 53.9+/-4.2% in the PG and steroid groups, respectively. There were no significant differences between the two groups., Conclusion: We concluded that PGE1 and a steroid are equally effective in the treatment of ISSNHL when used together with HBO therapy. PGE1 plus HBO therapy can be one of the potential alternative treatments for ISSNHL, particularly in steroid-intolerant patients such as those with severe diabetes mellitus, an active peptic ulcer, or viral hepatitis.

The feasibility and anti-tumor activity of gemcitabine (GEM) as postoperative adjuvant chemotherapy were evaluated retrospectively. Between September 1998 and June 2007, patients with resected invasive pancreatic cancer (stage III, IVa, IVb) were given adjuvant chemotherapy with GEM (GEM group, n=10) or did not receive chemotherapy (n=11). Started the administration of GEM 38.5 days after surgery, and the mean duration was 15.4 months. Grade 3 or 4 adverse event was not observed in the GEM group. There was a significant difference in overall survival between the GEM group and the no-chemotherapy group (p=0.037), but there was no significant difference in disease-free survival between the two groups. Adjuvant chemotherapy with GEM was feasible and showed a benefit in patients with invasive pancreatic cancer.

We conducted a prospective bacteriological survey to investigate antibiotic resistance-related genetic characteristics and the turnover of nasopharyngeal Haemophilus influenzae carriage in healthy children in day-care centers (DCCs). A total of 363 nasopharyngeal mucus samples were collected from children aged 0 to 6 years attending two DCCs in the summer of 2004 (n = 184) and the following winter (n = 179). We obtained 172 H. influenzae isolates and analyzed them by antimicrobial susceptibility testing, PCR for bla(TEM-1) and the penicillin-binding protein (PBP) gene, and pulsed-field gel electrophoresis (PFGE). The overall carriage rate was 47.4% (172/363), and 37.2% of the isolates (64/172) were ampicillin (AMP) resistant. All the resistant isolates had a PBP mutation(s), while only three isolates had TEM-1. The carriage rate was significantly higher in the winter than in the summer (56.4% and 38.6%, respectively), owing to the increase in the numbers of AMP-susceptible H. influenzae isolates in the winter. Children aged < or = 3 years showed a higher rate of carriage of H. influenzae isolates with an AMP resistance gene(s) than those aged > or = 4 years (21.9% and 12.6%, respectively). Forty-two strains with different PFGE patterns were obtained from among the 172 isolates. Only five strains were observed in both seasons. None of the strains isolated in the summer was isolated from the same carrier in the winter. Twenty-seven strains (64.3%) were isolated from two or more children, and 25 of these were each isolated from children belonging to the same DCC. These results indicate the spread of H. influenzae, particularly those with a PBP mutation(s), and the highly vigorous genetic turnover and substantial horizontal transmission of this pathogen in healthy children attending DCCs in Japan.

Organized hematoma is a benign and non-neoplastic lesion, however, differential diagnosis from neoplastic diseases is always problematic, and patients are often forced to sustain excessive surgical invasion. We retrospectively studied the characteristics of imaging findings of organized hematoma of the maxillary sinus, and estimated the validity and effectiveness of endoscopic sinus surgery for the treatment of this disease. Three patients (2 men and a woman, ranging in age from 50 to 62 years) with organized hematoma of the maxillary sinus who underwent endoscopic sinus surgery were retrospectively analyzed. The diagnosis was provisionally made based on the findings of preoperative computed tomography (CT) and magnetic resonance imaging (MRI), and was confirmed by histopathological examinations of surgical specimens. CT revealed a well-defined expansile mass in the unilateral sinus associated with thinning and expansion of the medial sinus wall in all the cases. On contrast-enhanced images, patchy heterogeneous enhancement was observed. Intermingled low/intermediate/high signal intensity was seen on both T1- and T2-weighted MRI. The lesions were curetted via an endoscopic middle meatal antrostomy with the assistance of a microdebrider. None of the patients received arterial embolization or blood transfusion. Histopathological findings were consistent with those of organized hematoma. Their postoperative courses were uneventful, and all the patients are currently free from disease. We conclude that organized hematoma of the maxillary sinus can be successfully treated by endoscopic sinus surgery under accurate preoperative diagnosis and careful surgical planning.