Open penetrating external laryngotracheal injury and abdominal trauma by suicide attempt successfully treated with immediate intervention: A case report.

An open penetrating external laryngotracheal injury (PE-LTI) is a rare life-threatening injury requiring immediate intervention. Penetrating injuries may cause tissue loss, which makes wound closure difficult sometimes. Here, we report the case of an open PE-LTI and abdominal trauma by suicide attempt. A 38-year-old Asian man with depression was found in his home after having cut his own neck and abdomen. He was transported to a regional trauma center and immediately intubated. On arrival, his blood pressure was 120/90 mmHg and heart rate was 120 beats/min. Physical examination revealed three cuts each on the neck and abdomen and no dysphonia. The patient's condition was diagnosed as an open PE-LTI, classified as group 5 on the Schaefer classification system and zone II on the Roon and Christensen classification system. He was also evaluated for possible mesenteric injury. We performed an emergency primary laryngotracheal repair and exploratory laparotomy. There was no obvious blood vessel injury, but soft and cartilage tissues were crushed and disconnected completely. On day 8, he underwent wound closure and tracheostomy on the caudal side of the wound. He was successfully weaned from mechanical ventilation on day 9, transferred to the general ward on day 13, decannulated on day 63, and discharged from the hospital thereafter for subacute care. In this case of severe neck injury with complete laryngotracheal separation, tissue losses were relatively minimal. Wound closure presumably occurred early in the absence of blood vessel injury.

Hearing loss is associated with hippocampal atrophy and high cortisol/dehydroepiandrosterone sulphate ratio in older adults.

OBJECTIVES: Hearing loss (HL) has been recognised as a prodromal symptom of cognitive disorder with aging. It is still uncertain if HL leads to cognitive impairment directly or through an indirect mechanism. DESIGN: Participants of this study underwent an auditory test, blood tests, and brain MRI. The atrophy rate of the hippocampus (HP) was calculated using voxel-based specific areas. A partial correlation analysis whilst controlling for the effect of age was performed to analyse the factors affecting hearing levels and HP atrophy rate (HP%). STUDY SAMPLE: Thirty-six older adults with hearing impairment. RESULTS: The group of participants with moderate or severe HL (n = 22) had higher cortisol/dehydroepiandrosterone sulphate (C/D) ratio, geriatric depression score (GDS) and HP% than the mild HL or normal hearing group (n = 14, p < 0.05). The HP% showed a significant positive correlation with the C/D ratio, GDS and the hearing level of high frequency (HF) (p < 0.05). The C/D ratio was positively correlated with the HP% and the hearing level of the HF (p < 0.05). CONCLUSIONS: Our results suggest that the HL is associated with the atrophy of HP and high C/D ratios in older adults; however, HL may not be causally related to hippocampal atrophy.

[Eight Cases of Small Cell Neuroendocrine Carcinoma of the Head and Neck].

Small cell neuroendocrine carcinoma of the head and neck is a rarely occurring poorly differentiated and high-grade malignant neoplasm characterized by highly active proliferation of neuroendocrine tumor cells. There are no established therapies for this disease. To clarify the clinical course and develop effective treatment(s) for the carcinoma, we reviewed the data of 8 patients of small cell neuroendocrine carcinoma of the head and neck treated by us between 2006 and 2014 at the Department of Otolaryngology, Gifu University School of Medicine and our affiliated hospitals. The patients consisted of 3 men and 5 women, ranging in age from 38 to 84 years old (mean : 60.9 years). The tumor arose from the nasal cavity or the paranasal sinuses in 3 cases, from the parotid grand in 2 cases, from the oropharynx in 2 cases, and from the hypopharynx in 1 case. The tumor that arose from the hypopharynx was a combined small-cell carcinoma with squamous cell carcinomas, and the one that arose from the oropharynx had already metastasized to the brain. Most of the patients were treated by chemotherapy and radiotherapy based on the treatment employed for small cell carcinoma of the lung. Only the patient in whom the tumor arose from a paranasal sinus was treated by surgery despite the definitive diagnosis of small cell carcinoma. We selected CPT-11 and a platinum agent for 4 patients, and VP-16 and a platinum agent for 3 patients as the first-line chemotherapy. Although two patients showed carcinoma-free survival, one died of recurrence of the regional lymph node metastases and five died of distant metastases despite the absence of locoregional recurrence. The 5-year survival rate was a dismal 25%, suggesting that we need to establish effective treatment(s) for the control of distant metastases in cases of the small cell neuroendocrine carcinoma of the head and neck.

[A case of idiopathic neck bleeding from a parathyroid cyst].

Bleeding from parathyroid cysts is rare. The retropharyngeal space has a very soft structure and if bleeding spreads to this space, airway obstruction can easily occur. We report on a 50-year-old female case with idiopathic neck bleeding from a left parathyroid cyst without any episode of injury. The patient complained of neck swelling after exercise and went to a nearby hospital. At the hospital, the doctor thought this swelling was caused by retropharyngeal bleeding from a tumor behind the left thyroid gland. Embolization of the left thyroid artery was performed. However, the next day, airway obstruction.was occurred and she was brought to our hospital. An emergency operation was performed to open the left neck swelling region. The operation findings and pathological examination showed that the bleeding was caused by a parathyroid cyst and airway obstruction had occurred because of retropharyngeal edema. In this case, the bleeding may have been caused by torsion of the neck when the patient exercised. The retropharyngeal edema probably resulted from the delay of delivery of the lymphatic and venous return and the arterial embolization. 1 year after the operation, the patient is very well and there has been no recurrence.

Damping control of balance in the medial/lateral direction and the risk of falling in the elderly.

AIMS: A proportional-integral-derivative (PID) control has recently been used as a control algorithm of body balance. The purpose of this study was to elucidate an association of the proportional and derivative gain based on the PID control gain for balance for quiet standing with the risk factor for falls in the elderly. METHODS: The movement of a marker on the back of 23 elderly participants (age 75.6±6.6 years) was measured by our developed device with a complementary metal oxide semiconductor video camera and the trunk sway speed in the medial/lateral (M/L) direction (TSSX) was calculated as absolute values of the whole time series. The PID control gain (proportional gain: K(P), integral gain: K(I), derivative gain: K(D)) was identified using the trunk sway data, and normalized by individual height and weight (K(P)n, K(D)n and K(I)n). Individual risk factor for falls was additionally assessed with the Tinetti Performance Oriented Mobility Assessment (POMA) and the fall risk questionnaire. RESULTS: The score in the POMA and the K(D)n significantly decreased with age (P<0.01). The score in the POMA showed a positive correlation with the K(D)n, and negative correlations with the TSSX and K(P)/K(D) ratios (P<0.01). The average K(D)n and the score in the POMA of fallers were significantly lower than those of non-fallers (P<0.05). CONCLUSION: These results suggest that the decreased damping control by derivative gain for balance in the M/L direction is one of the risk factors for falls in the elderly.