Publisher：耳鼻咽喉科展望会  

DOI： 10.11453/orltokyo.62.1_48

Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

DOI： 10.3950/jibiinkoka.122.77

Scopus

Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

<p>　Relapsing polychondritis is a rare and potentially fatal autoimmune disease of unknown etiology, characterized by inflammation and destruction of different cartilaginous structures, including the ear, nose, larynx, trachea, bronchi, peripheral joints, eyes, heart and skin, with a high risk of misdiagnosis.</p><p></p><p>　Data of nine patients with this condition were analyzed. The average age at diagnosis of the nine patients (four male and five female) was 56.4 years (33-84 years). The interval from onset to diagnosis varied from three months to two years. Auricular chondritis was detected in six patients, polyarthritis in three patients, nasal chondritis in four patients, inflammation of the eyes in two patients, laryngotracheal chondritis in six patients, and labyrinthine dysfunction in two patients.</p><p></p><p>　Underlying autoimmune diseases included Behçet's disease, polymyalgia rheumatica, and Vogt-Koyanagi-Harada disease. No biopsy findings are pathognomonic for the diagnosis of RP. Histopathological examination of an involved cartilage can be a valuable tool when accurate diagnosis proves difficult. However, steroid treatment, as in patients with autoimmune diseases can affect the results of histopathological examination and modify the clinical manifestations.</p><p></p><p>　Until date, therapy for RP is still empiric, due to the lack of standardized guidelines for the treatment, and depends on the basis of the disease activity and severity of organ involvement. Mild forms, such as auricular chondritis alone, are treated with NSAIDs and low-dose corticosteroids. Laryngotracheal complications require high-dose corticosteroids and immunosuppressants. As for convalescence, eight cases survived, and one died of other diseases.</p>

DOI： 10.3950/jibiinkoka.122.1322

Scopus

Publisher：(一社)日本頭頸部癌学会  

頭頸部領域に発生する小細胞癌はまれであるが、悪性度が高く早期にリンパ節転移・遠隔転移をきたし予後不良である。またその発生頻度の低さから標準的な治療法は確立されていない。症例は63歳男性。主訴は左咽頭痛。CT、MRI検査では左中咽頭に限局した腫瘍を認めた。生検の病理組織像、および免疫染色でCD56とシナプトフィジンが陽性で、クロモグラニンAが一部陽性であったことから、小細胞癌と診断された。治療は放射線療法とPI(シスプラチン+イリノテカン)療法を併用し施行した。治療後5年経過したが再発は認めていない。(著者抄録)

Publisher：Laryngoscope  

DOI： 10.1002/lary.27030

Scopus

PubMed

Publisher：Auris Nasus Larynx  

DOI： 10.1016/j.anl.2017.04.009

Scopus

PubMed

Publisher：(一社)日本耳鼻咽喉科学会  

舌下投与または経鼻投与によるホスホリルコリン(PC)免疫付与の有効性と安全性を、マウスを用いて検討した。7〜10週齢のBALB/cマウスを、PC-キーホールリンペットヘモシアニン(KLH)+コレラ毒素(CT)の舌下投与群、CTの舌下投与群、PC-KLH+CTの経鼻投与群、CTの経鼻投与群の4群に振り分け、免疫反応の評価にはPC特異的抗体価、IFN-γ産生CD4陽性T細胞、IL-4産生CD4陽性T細胞などを測定した。その結果、舌下投与と経鼻投与のいずれでも、PC-KLH+CTの免疫付与によって唾液中、鼻洗浄液中、腟洗浄液中のPC特異的IgA抗体価は著明に増加しており、腟洗浄液では舌下投与の方が抗体価の増加が顕著であった。また、PC特異的IgGサブクラスも両投与法により著明に増加していた。IFN-γとIL-4によるCD4陽性T細胞の産生はPC-KLH+CTの方がCTのみ投与より高まっており、IL-4値は舌下投与の方が経鼻投与より有意に低値であった。なお、中枢神経系障害に伴う異常行動や麻痺、局所炎症反応に伴う浮腫や腫脹の発現は認められなかった。舌下免疫付与は経鼻免疫付与と同等の有効性を有することが示された。

Publisher：Laryngoscope  

DOI： 10.1002/lary.26971

Scopus

PubMed

Publisher：日本耳鼻咽喉科感染症・エアロゾル学会  

扁桃周囲膿瘍症例のうち、ガレノキサシン(GRNX)を術前内服後に即時膿瘍扁摘を施行した19歳以上の患者10症例を対象に、臨床検査成績ならびにCT所見とGRNXの膿汁および患側扁桃組織内濃度を比較した。また、抗菌薬の組織移行性が不良となる要因について検討した。その結果、CRP値や白血球数が高値になるほどGRNXの組織移行性が低下することが判明した。膿瘍径が大きい症例や造影CTでring enhancementが認められず病悩期間が短い症例では、CRP値や白血球数が高値を示し、GRNXの組織移行性も低いことが示された。

Publisher：Japan Society for Head and Neck Cancer  

Small cell carcinoma is rarely seen in the head and neck area and high-grade malignant neoplasm is characterized by highly active proliferation of neuroendocrine tumor cells. There are no established therapies for this disease. The patient was a 63-year-old man, who visited our clinic complaining of sore throat on the left side. The presence of tumor was confirmed by CT imaging on which a mass limited to the left oropharynx was observed. The pathological diagnosis of a biopsy specimen taken from the oropharynx was small cell carcinoma. Immunohistochemical studies showed positive staining for CD56 and synaptophysin, and partial positivity for chromogranin. The patient received concurrent chemoradiotherapy using cisplatin and irinotecan. There has been no clinical evidence of recurrence or metastasis 5 years after treatment.

DOI： 10.5981/jjhnc.44.300

Scopus

Publisher：Japan Society for Infection and Aerosol in Otorhinolaryngology  

<p>Clinical findings of patients with peritonsillar abscesses were compared to the penetration of garenoxacin (GRNX) into the serum, abscesses, and palatine tonsil to determine the factors that reduce the efficacy of antibiotics toward this disease. Ten patients who underwent abscess tonsillectomies were enrolled in the study. After the oral administration of GRNX, general anesthesia was induced and samples of blood, pus from the abscess, and a part of the palatine tonsil were obtained prior to surgery for the measurement of GRNX concentration. Correlations between the concentrations of GRNX in the samples and the levels of C-reactive protein (CRP), white blood cell (WBC) count, size of the abscess and presence of ring enhancement estimated using computed tomography (CT), and the duration of the illness before surgery (in days) were examined. The data showed that the concentrations of GRNX in the abscess and serum were significantly decreased in patients with high levels of CRP (≥11 mg/dL). In patients with high WBC (≥19,000 cells/μL) counts, the concentrations were significantly decreased in the tonsil and serum. The concentrations of GRNX in the abscess were significantly lowered in patients with large abscesses (≥25 mm). The concentrations of GRNX in the abscess and tonsils were lowered when the abscess was without ring enhancement and when the illness persisted for longer than 7 days before surgery. These results indicate that severe inflammation reduces the penetration of antibiotics into the abscess and tonsils. In addition to the high levels of CRP and the high WBC count, a large abscess without ring enhancement and a short duration of illness might be indications for surgical drainage. Moreover, it is suggested that antibiotics with good tissue penetration should be used for the treatment of a peritonsillar abscess. </p>

DOI： 10.24805/jjsiao.6.1_15

Publisher：(一社)日本耳鼻咽喉科学会  

マウスを用いてホスホリルコリン(PC)による経皮免疫(TCI)が血清および膜表面の粘膜免疫反応に及ぼす影響を調べた。BALB/cマウスの背中および耳介の皮膚におけるTCIについてはPC・キーホールリンペットヘモシアニン(KLH)およびコレラ菌由来毒素(CT)を用いて評価した。試験期間は6週間で、週に1回植菌が実施された。免疫原性の評価のため、ELISAを用いてPC特異的IgG1およびIgG2a、IgM、IgA、分泌IgA抗体を測定した。さらに、IL-4、IL-5、IL-10、IL-12、IL-13についてもELISAを用いて評価した。TCI後の耳介皮膚における血清IgGは、背中の皮膚および対照と比較して有意に多かった。TCI後の耳介皮膚における分泌IgA抗体は、背中の皮膚のTCI後および対照の鼻、気管支肺胞洗浄液、腟、糞便検体と比べて有意に多いことが示された。耳介皮膚のTCI後、IL-4、IL-10、CD4+細胞産生は背中皮膚のTCI後および対照と比べて有意に亢進された。

Publisher：Auris Nasus Larynx  

DOI： 10.1016/j.anl.2016.08.006

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PubMed

Publisher：日本口腔・咽頭科学会  

光学機器の進歩から早期の下咽頭癌が発見される機会は多くなり、生存率の向上のみならず機能温存に寄与している。ただ、すべての住民が医療技術の恩恵を受けているかは不明であり、鹿児島県における地域格差の有無に関して検討する。当院を受診した下咽頭癌を鹿児島市、鹿児島市以外の本土症例、離島症例に分けて病期分類や受診までの経緯を中心に検討した。離島からの症例は、鹿児島市内の症例と比較して統計学的有意に進行癌が多く、地域格差を認めた。紹介診療科に関しては早期癌ほど他科が多く、IV期のみが耳鼻咽喉科からの紹介が他科を上回っていた。(著者抄録)

Publisher：日本口腔・咽頭科学会  

今回我々は、中咽頭側壁から前壁にかけて潰瘍性病変を認めたEBウイルス陽性MTX-LPDの1例を経験したので若干の文献的考察を踏まえて報告する。症例は80歳女性。受診の約6-7年前から慢性関節リウマチと診断され、同時期よりMTXの服用を開始した。受診の約1ヵ月前から咽頭違和感を自覚したため近医耳鼻咽喉科受診し、舌根部の潰瘍性病変を指摘された。内視鏡では、中咽頭前壁右側に潰瘍を伴う隆起性病変を認めた。一度は経過観察で症状は消失したが、約1年後に再燃認めた。再燃時のPET/CT検査では、中咽頭右側壁に最大SUV値10.5の異常集積を認めた。免疫染色で腫瘍細胞は、CD20・CD79aに陽性で、CD3・CD4・CD5・CD8には介在する小型リンパ球が陽性、CD56は陰性であった。異型リンパ球はEBV encoded small RNAs in situ hybridization陽性で、EBウイルスの関与が示唆された。以上のRAに伴うMTXの服用歴、血液生化学所見、病理組織学的検査所見よりEBV陽性MTX-LPDと診断した。MTX休止で腫瘤は認められなくなったが、今後再発の可能性もあり、経過観察中である。(著者抄録)

Publisher：耳鼻咽喉科臨床学会  

頭部・顔面皮膚悪性腫瘍の頸部リンパ節転移と診断され、耳下腺全摘術および頸部廓清術を施行した患者の診療録を解析し、頭部・顔面皮膚悪性腫瘍患者の耳下腺リンパ節郭清の妥当性を検討した。対象は4例(男女各2名、平均72歳)で、原発巣は側頭部皮膚が3例、上瞼が1例であった。リンパ節郭清範囲として、CT、MRI、PET/CT、頸部超音波検査にて全例が耳下腺部リンパ節転移陽性と診断され、全例に顔面神経温存耳下腺全摘術が選択されていた。症例1(77歳男)では原発病変の病理診断が脂腺癌で、転移リンパ節は耳下腺リンパ節のみであったが、予防的に上頸部郭清を追加した。深頸部リンパ節転移陽性であった症例2(81歳女)では、上頸部郭清を追加していた。症例3(69歳男)では、全頸部郭清を追加していた。症例4(60歳女)では、耳下腺全摘術のみを施行していた。各症例の病理学的リンパ節転移部位診断結果にて、症例1では耳下腺浅葉・深葉、症例2では耳下腺深葉に潜在的リンパ節転移を認めた。術後は全例に一過性の顔面神経麻痺を認めたが、経過とともに全例、改善を認め、治療追加は認めず、5年間再発・転移を認めず、無病生存であった。

Publisher：耳鼻咽喉科臨床学会  

<p>The optimal method for parotidectomy in patients with non-melanoma cutaneous carcinoma of the head and face region has still not been clarified. To clarify the optimal procedure for therapeutic parotidectomy, we reviewed the medical records of patients with non-melanoma cutaneous carcinoma. Between 2006 and 2010, we treated four cases of cutaneous carcinoma with metastasis to the parotid area. The site of origin of the cutaneous carcinoma was the temporal region of the head in three of these patients and the eyelid in the fourth patient. All four patients had metastatic lymph nodes in the parotid area. Two of the four patients had lymph node metastasis in both the parotid and cervical areas. None of the patients had facial palsy before the surgery. Facial nerve-preserving total parotidectomy (FNP-TP) with or without neck dissection was performed in all patients. Postoperative histopathological examination revealed occult metastasis of the lymph nodes in the deep and superficial lobes of the parotid gland in two of the patients. None of the patients received postoperative adjuvant radiation therapy or chemotherapy and all survived for more than five years without recurrence. From these results, it is considered that FNP-TP (elective dissection of the deep lobe of the parotid gland) may be the appropriate choice of procedure for therapeutic parotidectomy in patients with cutaneous carcinoma of the temporal area of the face and neck with metastatic lymph nodes in the parotid area. Furthermore, this procedure may allow avoidance of postoperative adjuvant radiotherapy in some cases.</p>

DOI： 10.5631/jibirinsuppl.151.72

Publisher：Japan Society of Stomato-pharyngology  

<p>　<i>Objective</i>: In recent years, the opportunities to detect hypopharyngeal cancer in the early stage have increased thanks to advances in optical instruments. In this report, we discuss regional differences and the process of recent hospital visits in patients with hypopharyngeal cancer who visited our hospital.<br>　<i>Methods</i>: The subjects were patients with hypopharyngeal cancer who were referred to the department of Otolaryngology, Kagoshima University Medical and Dental Hospital during the period from January 2009 to December 2015.<br>　<i>Results</i>: Among 45 hypopharyngeal cancer patients from Kagoshima City, 4 (8.8%), 3 (6.6%), 13 (28.8%), 5 (11.1%), and 20 patients (44.4%) were diagnosed as having phase 0, I, II, III and IV, respectively. Among 75 patients from the mainland, other than Kagoshima, 6 (8.0%), 5 (6.6%), 12 (16.0%), 12 (16.0%), and 40 patients (53.3%) were diagnosed as having phase 0, I, II, III and IV, respectively. Among 23 patients from isolated islands, 0 (0%), 3 (13.0%), 2 (8.7%), 3 (13.0%) and 15 patients (65.2%) were diagnosed as having phase 0, I, II, III and IV, respectively. In the comparison between the groups, a statistically significant difference (<i>p</i>=0.04) was confirmed between the patients from Kagoshima City vs. those from the isolated islands.<br>　In the phase IV group alone, the number of patients who were referred by a department of otolaryngology was higher, while many patients with phase 0 to III were referred by other departments.<br>　<i>Conclusion</i>: In a statistical comparison, the number of patients with advanced cancer from the isolated islands was significantly higher than that of patients from Kagoshima City, suggesting a regional difference. Regarding the department that referred patients to our hospital, in the phase IV group alone, the number of patients referred by the department of otolaryngology was higher, while many patients in earlier stages were referred from other departments.</p>

DOI： 10.14821/stomatopharyngology.30.85

Publisher：Japan Society of Stomato-pharyngology  

<p>　Patients with rheumatoid arthritis (RA) are known to develop lymphoproliferative disorders (LPDs) during the course of their illness, particularly in cases treated with methotrexate (MTX) for long periods. We describe herein a case of an MTX-related Epstein-Barr-virus associated lymphoproliferative disorder.<br>　A 80-year-old woman presented to the ENT service with a one-month history of a pain in the oropharynx. The patient had a history of RA and had been treated with MTX. On endoscopic examination, a tumorous lesion was observed in the oropharynx. A positron emission tomography/computed tomography (PET/CT) scan showed abnormal accumulation in the same area. Histological analysis showed variant cells, which stained positive for CD3, CD4, CD5, CD8, CD20, and CD79 and negative for CD56. The variant cells also stained positive for EBER-ISH.<br>　Taking those findings together, we diagnosed the patient as having methotrexate associated diffuse large B-cell lymphoma related to Epstein-Barr virus infection.</p>

DOI： 10.14821/stomatopharyngology.30.67

Publisher：The Society of Practical Otolaryngology  

<p>The optimal method for parotidectomy in patients with non-melanoma cutaneous carcinoma of the head and face region has still not been clarified. To clarify the optimal procedure for therapeutic parotidectomy, we reviewed the medical records of patients with non-melanoma cutaneous carcinoma. Between 2006 and 2010, we treated four cases of cutaneous carcinoma with metastasis to the parotid area. The site of origin of the cutaneous carcinoma was the temporal region of the head in three of these patients and the eyelid in the fourth patient. All four patients had metastatic lymph nodes in the parotid area. Two of the four patients had lymph node metastasis in both the parotid and cervical areas. None of the patients had facial palsy before the surgery. Facial nerve-preserving total parotidectomy (FNP-TP) with or without neck dissection was performed in all patients. Postoperative histopathological examination revealed occult metastasis of the lymph nodes in the deep and superficial lobes of the parotid gland in two of the patients. None of the patients received postoperative adjuvant radiation therapy or chemotherapy and all survived for more than five years without recurrence. From these results, it is considered that FNP-TP (elective dissection of the deep lobe of the parotid gland) may be the appropriate choice of procedure for therapeutic parotidectomy in patients with cutaneous carcinoma of the temporal area of the face and neck with metastatic lymph nodes in the parotid area. Furthermore, this procedure may allow avoidance of postoperative adjuvant radiotherapy in some cases.</p>

DOI： 10.5631/jibirin.110.31

Scopus