Left Vocal Cord Palsy Immediately After COVID-19 Despite No Tracheal Intubation.

The cases of coronavirus disease 2019 (COVID-19) typically present with pulmonary and upper respiratory tract symptoms, but may also present with neurologic complications. Because severe cases are often intubated or ventilated, there are some reports of vocal cord palsy associated with intubation; however, there are few reports of recurrent nerve palsy without intubation management. We experienced a case of left vocal cord palsy following COVID-19 in a healthy young male patient with no previous medical history. The patient became aware of hoarseness symptoms three days after he was found to be COVID-19 positive, and an endoscopic examination of the larynx revealed left vocal cord palsy. Since the patient had no previous medical history and there were no lesions that could cause recurrent nerve palsy on neck-thorax imaging, it was considered likely that the patient had unilateral recurrent nerve palsy due to acute inflammation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Medication was started and his hoarseness became relieved. In vocal cord palsy occurring after COVID-19 illness, it is necessary to consider the presence of both vocal cord palsy related to tracheal intubation and recurrent nerve palsy associated with SARS-CoV-2 infection.

Recurrence 14 Years After Initial Treatment of Extranodal NK/T Cell Lymphoma, Nasal Type.

Extranodal NK/T cell lymphoma, nasal type (ENKL) primarily involves the nasal cavity. Although patients might visit an otorhinolaryngologist with nasal symptoms, such as nasal obstruction and epistaxis, it would be difficult to make a diagnosis correctly. We present a case of ENKL in which the patient had been in remission after initial treatment and relapsed 14 years after treatment. The patient had a worsening of nasal symptoms before the recurrence, but on this occasion, treatment such as sinusitis was successful in alleviating the symptoms. Although recurrence of lymphoma 10 years after treatment is rare, the possibility of recurrence should always be considered in post-malignant lymphoma cases as with any malignant tumor.

A Case Found to Be Severe Acute Respiratory Syndrome Coronavirus 2 Positive Immediately Before Hospitalization for Infectious Mononucleosis.

The cases of coronavirus disease 2019 (COVID-19) mainly present with symptoms such as persistent fever, cough, and general malaise, which may become severe or fatal; while young people do not show these typical symptoms and are asymptomatic, some cases are infected with minor symptoms or none. Herein, we report a case of a 20-year-old woman who was hospitalized for infectious mononucleosis (IM). Initially, fever and sore throat were observed without typical COVID-19 symptoms, but polymerase chain reaction (PCR) tests performed before admission confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity. Fortunately, she was discharged without any serious symptoms as IM and COVID-19. Virological examination suggested a primary infection with the Epstein-Barr virus. In the COVID-19 pandemic, we should also pay attention to the possibility of SARS-CoV-2 coinfection in mild and asymptomatic young cases, even if the symptoms suggesting IM are preceded.

Unilateral Isolated Hypoglossal Nerve Palsy Secondary to Tonsillitis.

Hypoglossal nerve palsy is usually associated with glossopharyngeal nerve, vagus nerve, and accessory nerve palsy, and the occurrence of hypoglossal nerve palsy alone is rare. We report a case of a 41-year-old man with unilateral isolated hypoglossal nerve palsy. The patient was aware of a leftward deviation of the tongue along with pharyngeal pain. The pharyngeal pain was quickly relieved by antibiotic treatment, but the deviation of the tongue did not improve, and the patient was referred to our hospital. As a result of the medical examination, a single paralysis of the left hypoglossal nerve and mild swelling of the left lingual tonsil up to the left palatine tonsil were observed. Various tests were performed, but there were no significant abnormal findings other than a suggestion of mild tonsillitis. We diagnosed the patient as idiopathic or tonsillitis-induced unilateral hypoglossal nerve palsy and started medical treatment with corticosteroids and methylcobalamin. The hypoglossal nerve palsy showed a tendency to improve after one month of onset and was almost cured by two months of onset.

Long-term efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell carcinoma.

OBJECTIVE: The present study aimed to retrospectively analyze the long-term efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell carcinoma. METHODS: The study enrolled 53 patients (23 with stage II disease, 13 with stage III disease, and 17 with stage IV disease). S-1 was administered orally twice a day for 14 days, followed by a two-week rest period. Nedaplatin was intravenously administered on day 4. Where possible, two courses of chemotherapy were performed. Radiotherapy was started with the administration of S-1. We analyzed the clinical response, survival rate, acute adverse events, and late swallowing toxicity. RESULTS: The complete response rates for the primary tumor and neck lymph node metastases were 94.3% and 79.3%, respectively. The five-year overall survival rate was 79.5%, the five-year disease-specific survival rate was 84.8%, and the five-year relapse-free survival rate was 73.7%. The main acute adverse events were leukopenia, neutropenia, mucositis, and dermatitis. No patient had severe nephrotoxicity. Late swallowing toxicity was observed in 13 patients. CONCLUSIONS: The low toxicity, and low nephrotoxicity of chemoradiotherapy with nedaplatin and S-1 have a positive impact on long-term survival. The combination of nedaplatin and S-1 can be used instead of cisplatin and 5-fluorouracil as a safer regimen, especially in patients with some complications and those requiring treatment in an outpatient setting.

[Medical Assistance Based on Interviews Conducted before Physician Examination by a Pharmacist for Outpatients with Thyroid Cancer Treated with Lenvatinib].

In municipal hospitals, there are few cases of thyroid cancer for which the multi-kinase inhibitor lenvatinib is used. Moreover, there are very few reports of lenvatinib use. We examined interventions related to the use of lenvatinib made at the pharmaceutical outpatient clinic in our facility. Seven patients received lenvatinib. The prescription proposals from the pharmacist( 45 cases)provided advice on dosage(15.6%), discontinuation of medication(11.1%), supportive care(64.4%), and other advice(9.0%). The prescription acceptance rate was 84.4%. Among the prescription proposals of supportive care, there were suggestions regarding blood pressure(26.7%), diarrhea(8.9%), nausea(8.9%), and oral hemorrhage(6.7%). Some patients also experienced side effects, such as abnormalities in equilibrioception and visual field defects; however, the relationship between such abnormalities and lenvatinib is unclear. In addition, we asked physicians to confirm if the outpatient pharmacists contributed to the examination process. We believe that lenvatinib administration can be continued safely with pharmaceutical outpatient clinic support for patients, even in municipal hospitals.

Efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck cancer.

OBJECTIVE: We investigated the efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck cancer, as an alternative to cisplatin and 5-fluorouracil. METHODS: A total of 31 patients were enrolled in this study. S-1 was administered orally twice a day for 14 days followed by a 2-week rest. Nedaplatin was intravenously administered on day 4. If possible, two courses of chemotherapy were performed. The radiotherapy was started concurrently with the administration of S-1. RESULTS: The overall complete response rate was 81%. The 2-year overall survival rate was 96%. The 2-year relapse-free survival rate was 94%. The main adverse events were hematological toxicity, mucositis and dermatitis. CONCLUSIONS: Our findings suggest that this therapeutic regimen has either an equal or lower toxicity than the conventional cisplatin and 5-fluorouracil, and that it has equal efficacy with regard to the clinical response and short-term outcome. Moreover, it is possible to successfully perform this treatment in an outpatient setting.

Effect of alpha-naphthyl isothiocyanate on 2-amino-3-methylimidazo[4,5-b]pyridine (PhIP)-induced mammary carcinogenesis in rats.

The modifying effects of alpha-naphthyl isothiocyanate (ANIT) on 2-amino-3-methylimidazo[4,5-b]pyridine (PhIP)-induced mammary carcinogenesis were investigated in female Sprague-Dawley (SD) rats, and the hepatic activities of the phase II detoxifying enzymes glutathione S-transferase (GST) and quinone reductase (QR) were also assayed. Ninety-eight rats were divided into 4 groups. Starting at 6 weeks of age, rats were fed the high-fat diet without ANIT (Groups 1 and 4) or the experimental diet (high-fat diet mixed with 400 ppm ANIT, Groups 2 and 3). At 7 weeks of age, Groups 1 and 2 were given PhIP in corn oil (85 mg/kg body weight, 8 times for 11 days) by intragastric intubation. One week after the last PhIP injection, 5 rats in each group were sacrificed to assay GST and QR activities, and the experimental diets for Groups 2 and 3 were switched to the high-fat diet without ANIT until termination of the experiment. Group 4 served as the vehicle control. All rats were sacrificed at 24 weeks after the start of the experiment. At termination of the experiment, mammary tumours were detected in Groups 1 (PhIP alone) and 2 (PhIP + ANIT) and were shown histologically to be adenocarcinomas; their incidences (multiplicities) were 56.3% (1.66 +/- 2.31/rat) in Group 1 and 6.7% (0.07 +/- 0.25/rat) in Group 2 (p < 0.001). Mean sizes of the tumours were 10.6 +/- 5.3 mm in Group 1 and 6.5 mm in Group 2. No mammary tumours were observed in rats of Groups 3 and 4. In addition, ANIT treatment significantly increased the activities of GST and QR in the livers of rats in Groups 2 and 3 as compared to Groups 1 and 4. These results imply that the isothiocyanate compound ANIT shows potent inhibitory effects on mammary carcinogenesis induced by PhIP in female SD rats when administered during the initiation stage.