論文

Background: There have been inconsistent results regarding the contribution of the connexin family of genes to tumor cell proliferation. Materials and Methods: We aimed to clarify the role of connexin 30 (Cx30), by transfecting three kinds of vectors that express either full length Cx30 (Cx30-Full), Cx30 devoid of C-terminal region (Cx30-DelC) or Cx30 C-terminal region (Cx30-CT), in HSC-4, a head-and-neck cancer cell line. Results: Transfected Cx30-Full was localized on the plasma membrane, while Cx30-DelC and Cx30-CT was expressed in the cytoplasm or circumnuclear sites. We studied the effect on the growth rate followed by immunostaining with anti-Ki-67 (MIB-1). The MIB indices of HSC-4 cells transfected with Cx30-Full and Cx30-DelC, but not Cx30-CT were shown to be significantly higher than that of the controls. Conclusion: Our results demonstrated that Cx30 enhanced the proliferation of HSC-4 cells and the proliferating activity was considered to be achieved without the transport of the protein onto the plasma membrane.

Conclusions. Cervical sympathetic chain schwannoma (CSCS) sometimes mimics carotid body tumor (CBT). Differential diagnosis between these tumors is sometimes difficult using MRI alone. MRA, color Doppler ultrasonography, and fine needle aspiration (FNA) after imaging may be helpful to rule out CBT. Surgical resection of CSCS is relatively effortless, and Horner's syndrome is an expected but acceptable postoperative complication. Intratumoral hemorrhage and vasodilation may be the main reasons for significant enhancement on MRI. Objectives. CSCSs are rare and known to mimic carotid body tumors. We report 9 cases of CSCS with an emphasis on imaging, surgical management, and pathological findings. Moreover, we describe the differential diagnosis of CSCS and CBT, and speculate the reasons behind significant enhancement on MRI. Patients and methods. Nine cases of CSCS treated at a tertiary referral center between 1996 and 2008 were reviewed. Results. MRI revealed 3 of 9 cases (33%) splayed the carotid bifurcation and displayed marked contrast enhancement with gadolinium. All patients underwent surgical excision of the mass with minimal blood loss. Postoperative Horner's syndrome was encountered in all patients, which required no treatment. Marked gadolinium enhancement tended to be associated with histological findings such as intratumoral hemorrhage and vasodilation. © 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As).

Objective: It is well known that mucoepidermoid carcinoma (MEC) displays a variety of biological behaviors. While the high-grade type is a highly aggressive tumor, its low-grade counterpart usually demonstrates a more benign nature and several systems have, therefore, been proposed to grade this neoplasm. Methods: This report analyzes 43 patients suffering from head and neck MEC, who were treated in our department during the period from 1989 to 2005. The relationship between clinical and pathologic characteristics and survival rate was investigated. Results: The 5-year overall and disease-free survival rate was 62.3 and 57.2%. Multivariate analysis demonstrated that the parameters that significantly affected survival were the patient's age (P = 0.040) and treatment method (P = 0.011). Conclusions: The patient's age and treatment method is the prognostic parameter in this study. Although complete surgical resection is the standard treatment for MEC, we should aggressively consider adjunctive radiotherapy in those cases that have a high risk of recurrence and poor prognosis. © The Author 2008. Published by Oxford University Press. All rights reserved.

A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide. © 2005 Taylor & Francis.

We have developed a new recording system for endoscope images with the popular mini digital video (mini DV) camera. A special adaptor screws onto the lens top, and either a flexible or rigid endoscope can be attached to the camera. Using this system, we can monitor not only the endoscopic images but also the patient's condition. Satisfactory images can be obtained even with the finest fiberscope. Nevertheless, our new system costs only $1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casual setting or for house calls for the purpose of patient education. © 2005 The American Laryngological, Rhinological and Otological Society, Inc.

Intramuscular myxoma is a benign mesenchymal tumor that commonly occurs in the larger skeletal muscles, and is rare in the head and neck. A case of intramuscular myxoma in the scalene muscle is described. This is the first report of this tumor arising in that muscle. It is difficult to diagnose pre-operatively from clinical features, CT scan and ultrasonography of the neck because of the lack of characteristic manifestation or radiographic features. Intramuscular myxoma has an infiltrative tendency, so there are several reports of recurrence because of incomplete excision or enucleation. In our case no recurrence was observed for 4 years, since the tumor was removed with the muscle adherent to it. © 2004 Elsevier Ireland Ltd. All rights reserved.

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean, 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thalium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathyroidectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n = 16; hyperplasia group, n = 6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery. In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands are not injured by the biopsy procedures.

We evaluated the diagnostic value of pulse oximetry during sleep in pediatric obstructive sleep apnea syndrome (OSAS) caused by adenoid-tonsil hypertrophy. Subjects were 22 healthy children free of symptoms such as snoring, sleep apnea and oral breathing and 163 children suspected of OSAS with snoring or sleep apnea. Subjects were measured for percutaneous oxygen saturation (SpO2) during sleep. Of those with suspected OSAS, 69 underwent adenotonsillectomy and were measured for SpO2 both pre- and postoperatively, then pre- and postoperative measurements were compared. After measurement, we analyzed three parameters: lowest saturation (LSpO2), the desaturation index, and total desaturation duration under 95% (TDD95). Few abnormal findings were seen in healthy children. We calculated the mean and standard deviation (SD) of each parameter and set borderlines of mean-2SD for LSpO2 and mean + 2SD for ODI and TDD95. With these borderlines, 105 children for LSpO2, 75 for ODI and 76 for TDD 95 were judged to be normal among the 163 with suspected OSAS. Histograms showed that the mode of each parameter was situated near the borderline. Comparison between pre- and postoperative measurements showed that the effect of the surgery strongly correlated with preoperative measurement in patients undergoing surgery. Assuming that a patient with postoperative improvement is positive, we calculated sensitivity and specificity for each borderline measurement. We found that if success is 100%, the borderline should be 87% for LSpO 2, 3.5 for ODI, and 30.0 for TDD95. If success exceeds 90%, the borderline should be 90% for LSpO2, 2.0 for ODI, and 7.0 for TDD95. We therefore conclude that measurement of SpO2 during sleep is useful in screening for pediatric OSAS.

2 cases of suspected Wegener's granulomatosis showing inflammation in the middle ear and progressive sensorineural hearing loss (SNHL) are reported. The first patient was a 73-year-old female who visited our hospital with a complaint of sudden onset of hearing loss. She had SNHL and administration of steroid hormone improved her hearing acuity temporarily, but then her hearing deteriorated. Subsequently she showed subglottic stenosis, pneumonia and saddle nose. The second patient was a 55-year-old male with otalgia and hearing loss. He had progressive SNHL and ear polyp, and then showed saddle nose. His hearing loss was almost fully recovered after treatment with cyclophosphamide and predonisolone. It was considered in these cases that sensorineural hearing loss had an autoimmune origin. Otitis media is well known as an otological manifestation of Wegener's granulomatosis, but SNHL is comparatively rare. Diagnosis of Wegener's granulomatosis was made by clinical symptoms because c-ANCA titers of our cases were negative, and histopathological studies were not typical. In these cases, they took predonisolone before diagnosis. We suggest that steroid hormones may suppress disease activity and make diagnosis difficult. It is important to look for this disease among SNHL patients and perform general examination in the early stage, because early therapy can lead to an improvement in the morbidity and survival of this disease.

We report two cases of cranial nerve palsy due to varicella-zoster virus infection. One patient, a 53-year-old woman, was admitted to our hospital complaining of a sore throat, right otalgia and painful vesicle on the right auricle. Herpetic vesicles were present on the right soft palate and arytenoid. She also reported loss of hearing in the right ear but there was no facial palsy. The serum antibody titer for herpes zoster was significantly elevated, and the cerebrospinal fluid showed pleocytosis. She was diagnosed as having herpes zoster involving the vestibulocochlear nerve and glossopharyngeal nerve. She was treated with intravenous acyclovir and satellite ganglion block. She did not have any residual signs. The other patient, a 44-year-old woman, complained of a sore throat, hoarseness and difficulty in swallowing. She had no skin rash, but there was a single vesicle on the left arytenoid. Physical examination revealed poor elevation of soft palate on the left side, but gag reflex was preserved. The serum antibody titer for herpes zoster was significantly elevated. She was diagnosed as having herpes zoster involving vagus nerve. She was treated with intravenous acyclovir for 7 days. She did not have any residual sign. In cases of unilateral cranial nerve palsy with pain, herpes zoster should be considered, and serum antibody titer for herpes zoster should be evaluated.

A case of orbital tumor is reported. A 52-year-old man consulted our hospital with left exopthalmus and impaired vision. On opthalmologic exmination, left exopthalmos in Hertel statometer, left impaired visual acuity and degeneration of retina in superolateral region of the optic disk of his left eye were noted. Magnetic resonance imaging (MRI) demonstrated a tumor with clear margin in the retro bulbar space. He was referred to our oto-rhino- laryngological section for surgery. At surgery, coronal incision was made and the extended lateral orbitotomy was made with fenestration of the frontal sinus. The tumor was easily removed without any complication on visual acuity and eye-ocular movement. We conclude that the approach with coronal incision and frontal sinus fenestration is useful for resection of orbital tumor.