Analysis of Risk Factors for High-dose Cisplatin-induced Renal Impairment in Head and Neck Cancer Patients.

BACKGROUND/AIM: Concurrent chemoradiotherapy with high-dose cisplatin (CDDP-RT) is the standard therapy for advanced head and neck cancer; however, due to CDDP-induced renal impairment, dose reduction or discontinuation is frequently required. Therefore, the identification of risk factors for renal impairment is of importance to improve the efficacy and safety of CDDP-RT. PATIENTS AND METHODS: We retrospectively investigated risk factors for renal impairment in advanced head and neck cancer patients receiving CDDP-RT. Renal impairment was defined as a >25% decrease from baseline in estimated glomerular filtration rate within 14 days after CDDP administration in the first cycle. RESULTS: Of the 82 patients analyzed in this study, 21 (26%) patients developed renal impairment. Multivariate logistic regression analysis showed that concomitant use of a calcium channel blocker or lower hemoglobin levels significantly contributed to the increased risk of CDDP-induced renal impairment (odds ratio=3.60, 95% confidence interval=1.04-12.40; odds ratio=0.71, 95% confidence interval=0.50-0.99, respectively), while concomitant use of proton pump inhibitors was a factor associated with a decreased risk of CDDP-induced renal impairment (odds ratio=0.20, 95% confidence interval=0.04-0.86). CONCLUSION: Renal function of patients receiving calcium channel blocker or patients with lower hemoglobin levels should be monitored cautiously when receiving CDDP-RT.

True aneurysm of the facial artery.

True aneurysm of the facial artery is extremely rare. We describe a case of true facial aneurysm of the submandibular lesion in a 73-years-old man. A color Doppler ultrasonography and computed tomography (CT) revealed a 2.1 cm x 1.5 cm aneurysm with turbulent arterial flow and some thrombus inside the lumen. At the operation, the aneurysm was excised and proximal and distal ends of the facial artery were ligated. The histopathologic examination confirmed a true aneurysm of the facial artery with degenerative changes of the wall and some thrombus in the lumen. The postoperative course was uneventful, and no recurrence has been noted in more than 1-year follow-up.

Relationship between transglottal pressure and fundamental frequency of phonation--study using a rubber model.

The relationship between the change in fundamental frequency of phonation (F0) per unit change of transglottal pressure (dF/dP) was studied using a rubber model of the vocal folds that allows the stiffness and elongation of the vibrating part to be varied flexibly. Changes in elongation and stiffness successfully reproduced the negative relationship between dF/dP and F0 at low F0 seen in humans. The thyroarytenoid muscle appears to work concomitantly with the cricothyroid (CT) muscle to regulate F0, raising F0 by increasing the stiffness of the vibrating part at low F0, that is, when the CT muscle is relaxed.

Role of platelet-derived growth factor in airway remodeling in rhinosinusitis.

BACKGROUND: The purpose of this study was to elucidate the role of platelet-derived growth factor (PDGF) in the pathogenesis of rhinosinusitis. METHODS: Nasal mucosa and polyps were obtained during surgery in patients with allergic rhinitis, chronic rhinosinusitis (CRS) without asthma, and CRS with asthma. PDGF concentrations in nasal discharge were measured, and the histological distribution and expression levels of mRNA for PDGF and PDGF receptors were examined. PDGF-producing cells were determined by double-staining for PDGF and CD68 or major basic protein. RESULTS: The concentration of PDGF was significantly higher in CRS with asthma. An immunohistochemical study showed that PDGF was localized in epithelial cells, gland cells, vascular endothelial cells, and inflammatory cells. Expression of PDGF increased in epithelial cells in all three diseases, in macrophages in CRS without asthma, and eosinophils in CRS with asthma, and PDGF receptors were detected in epithelial cells and submucosal fibroblasts. Increased expression of PDGF mRNA was found in CRS with asthma. CONCLUSION: The results indicate that PDGF is produced by macrophages, eosinophils, and epithelial cells in rhinosinusitis and that it acts on receptors in epithelial cells and fibroblasts. PGDF may be an important cytokine in the pathogenesis of rhinosinusitis by promoting tissue fibrosis and formation of nasal polyps.

Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis.

BACKGROUND: Intractable posterior epistaxis sometimes requires intensive treatment, such as surgery or embolization. Maxillary artery ligation has been widely used for the treatment of intractable posterior epistaxis. It is highly effective, but significant complications may occur, including an oroantral fistula and damage to the infraorbital nerve. Embolization is less invasive and can be performed in poor surgical candidates. However, it has more serious complications, such as facial nerve paralysis and hemiplegia. This investigation evaluates the effectiveness and complications of endoscopic ligation of the sphenopalatine or maxillary artery for the treatment of intractable posterior epistaxis. METHODS: Between April 2003 and March 2007, 46 patients were hospitalized for the treatment of severe posterior epistaxis in our University Hospital. Thirty patients were successfully treated by anterior and/or posterior nasal packing, and five patients were treated by electrocoagulation. Endoscopic ligation was performed under general anesthesia in 11 patients (6 men and 5 women; age range, 50-80 years). RESULTS: Eight patients underwent endoscopic ligation of the sphenopalatine artery, and three patients underwent endoscopic ligation of the maxillary artery through the middle meatus and posterior antral wall opening. There were no complications, and the patients' postoperative courses were uneventful. Recurrent epistaxis occurred in one patient on oral anticoagulants 15 months after ligation of the sphenopalatine artery, and it was successfully treated by anterior nasal packing. CONCLUSION: Endoscopic ligation of the sphenopalatine or maxillary artery is safer than arterial embolization and is less invasive than transantral ligation of the maxillary artery. This technique appears to be a simple and highly effective surgical treatment for patients with intractable posterior epistaxis.

[Image-guided endoscopic sinus surgery: a comparison of two navigation systems].

We evaluated the effectiveness of two navigation systems with optical tracking in endoscopic sinus surgery (ESS). The Signa SP/i Intraoperative navigation system (General Electric Co., Intraoperative NS) is advantageous in acquiring both real time and high-resolution images during surgery, compared to conventional image-guided navigation (Stealth Station TREON, Medtronic Inc., IGNS) that rely entirely on preoperative three-dimensional images. We studied the following in 14 patients treated with intraoperative NS and 19 treated with IGNS: 1) additional time for navigation system implementation, 2) available instrumentations in ESS, and 3) navigation system accuracy. Navigation systems required additional time to prepare ESS. The time lapse from admittance to the operating room to ESS onset was measured in patients under both systems and controls undergoing ESS without any image guidance. Preparation of the intraoperative NS required an additional 52 min and IGNS required 17 min compared to the control group. Based on operative instruments, the intraoperative NS has some limitations arising from the application of a high magnetic field. Surgical instruments must not be attracted by the magnetic field in the operating room. So those used in our study were thoroughly examined and some remanufactured using MR safe materials. All instruments in ESS could be used in surgical guidance during surgery in the IGNS. Anatomic landmarks were accurately visualized using intraoperative NS and IGNS. Intraoperative NS renews the image during surgery, so surgeons could confirm the surgical outcome during ESS. Since the average distant error in both systems was between 1 mm and 2.5 mm, we confirmed that accuracy obtained with both navigation system was suitable for ESS completion. The intraoperative NS renewed the image during navigation. In conclusion, both navigation systems are sufficient for accurate image navigation in ESS, but navigation systems must be selected based on the individual case.

Carcinosarcoma of the submandibular gland: an autopsy case.

Malignant mixed tumors of salivary glands are classified as three types:carcinoma arising in a pleomorphic adenoma, the most common; benign metastasizing pleomorphic adenoma; and carcinosarcoma (true malignant mixed tumor), which is very rare [Ann. Otol. Rhinol. Laryngol. (1982) 91 342]. In carcinoma, both epithelial and soft tissue elements are malignant. In the context of previous reports, we discuss a case of carcinosarcoma of the submandibular gland including the results of postmortem examination.