Novel pre-therapeutic scoring system using patient and haematological data to predict facial palsy prognosis.

OBJECTIVES: We describe a novel scoring system, the facial Palsy Prognosis Prediction score (PPP score), which we test for reliability in predicting pre-therapeutic prognosis of facial palsy. We aimed to use readily available patient data that all clinicians have access to before starting treatment. DESIGN: Multicenter case series with chart review. SETTING: Three tertiary care hospitals. PARTICIPANTS: We obtained haematological and demographic data from 468 facial palsy patients who were treated between 2010 and 2014 in three tertiary care hospitals. Patients were categorised as having Bell's palsy or Ramsey Hunt's palsy. MAIN OUTCOME MEASURES: We compared the data of recovered and unrecovered patients. PPP scores consisted of combinatorial threshold values of continuous patient data (eg platelet count) and categorical variables (eg gender) that best predicted recovery. We created separate PPP scores for Bell's palsy patients (PPP-B) and for Ramsey Hunt's palsy patients (PPP-H). RESULTS: The PPP-B score included age (≥65 years), gender (male) and neutrophil-to-lymphocyte ratio (≥2.9). The PPP-H score included age (≥50 years), monocyte rate (≥6.0%), mean corpuscular volume (≥95 fl) and platelet count (≤200 000 /µL). Patient recovery rate significantly decreased with increasing PPP scores (both PPP-B and PPP-H) in a step-wise manner. PPP scores (ie PPP-B score and PPP-H score) ≥2 were associated with worse than average prognosis. CONCLUSIONS: Palsy Prognosis Prediction scores are useful for predicting prognosis of facial palsy before beginning treatment.

[Pathogenesis mechanism in ear fullness in otosclerosis].

To clarify the mechanism underlying ear fullness in otosclerosis, we studied the relationship between clinical features and examinations. Subjects were 116 otosclerosis patients (140 ears). The presence or absence of ear fullness was judged from a questionnaire in initial diagnosis or a chart description. Ear fullness was observed in 44 ears (31%) and absent in 96. The averaged air and bone conduction hearing levels (500 Hz-4 k Hz) in initial diagnosis were significantly lower in the group with ear fullness. The difference in averaged hearing was mainly apparent at 2 k Hz and 4 k Hz. The difference in hearing at lower frequencies (125 Hz, 250 Hz, and 500 Hz) and higher frequencies (2 k Hz, 4 k Hz, and 8 k Hz) was significantly larger in the group of ear fullness. From these results, we postulated that ear fullness in otosclerosis is caused by fixation of the stapes. The psychoacoustic abnormal sensation caused by lower input of lower-frequency sound or incomplete fixation of the stapes may cause ear fullness. Further study is needed to clarify the pathogenesis of ear fullness in different ear pathologies.

[Clinical examination to screen for laryngeal cancer: results, problems and prospects].

The Yokohama Municipal Cancer Detection Center, established as an affiliate of the Yokohama Municipal Citizen's Hospital in June, 1981, has performed clinical examinations to screen for laryngeal cancer in a total of 26,377 patients (12,205 men and 14,172 women) 40 years of age or older, in the past 15 years. Approximately 9.3% (2,398) of the patients required further examination, surgery, or observation. Thirty-one cases of malignant tumor were found, 26 of laryngeal cancer, 2 of hypopharyngeal cancer, and 1 each of thyroid cancer, tonsillar cancer and acute lymphoid leukemia. In addition, 51 cases of vocal fold leukoplakia and approximately 700 cases of vocal fold polyp and polypoid vocal fold were diagnosed. As mentioned in previous reports, examinations of this type present both definite benefits and deficiencies. Many problems still remain. Examples of these are the small absolute numbers of examinees, the rather heavy burden placed upon the examining doctor, and the low incidence of laryngeal cancer in female patients. Laryngeal cancer is predominantly a male disease, but female patients should not be excluded from receiving screening examinations. In recent years, many thyroid tumors have been detected in female patients. In the future, laryngeal cancer examination may develop into a head and neck cancer examination that includes screening for thyroid cancer.

[Fine-needle aspiration cytology of tumors of major salivary glands].

Between 1986 and 1997, 124 patients with tumors of major salivary glands (93 parotid tumors, 31 submandibular gland tumors) were assessed by fine-needle aspiration cytology (FNAC). The 124 cases included 28 cases of primary malignant tumors and 96 cases of benign lesions. The preoperative fine-needle diagnoses were compared with postoperative pathologic findings. Sensitivity for malignancy was 64%, and specificity was 99%. Overall accuracy was 91%, and the predictive value for malignancy was 95%. FNAC allowed determination of histogenesis in 13 (68%) of the 19 cases cytologically diagnosed as malignant, and in 72 (71%) of the 105 cases cytologically diagnosed as benign. The diagnostic accuracy for histologic diagnosis of malignant neoplasms, pleomorphic adenoma, and Warthin's tumor was 46%, 73%, and 82%, respectively. The predictive value for specific histologic diagnosis of malignancy, pleomorphic adenoma, and Warthin's tumor was 100%, 91%, and 100%, respectively. The diagnostic accuracy and the predictive value for histologic diagnoses were relatively high (> 70%) for squamous cell carcinoma, adenocarcinoma, malignant lymphoma, pleomorphic adenoma, and Warthin's tumor. Adenoid cystic carcinoma and low-grade malignancies such as mucoepidermiod carcinoma and acinic cell carcinoma were the lesions most frequently misdiagnosed.

Palliative radiotherapy for lingual metastasis of renal cell carcinoma.

The report is of a 50-year-old man with renal cell carcinoma (RCC) who had rapidly progressing metastasis to the tongue at 10 months after the left radical nephrectomy. The metastatic lingual tumor was not resectable, therefore treated with radiation (50 Gy). The tumor disappeared macroscopically after the radiation therapy, but enlarged again 4 months later. The patient died of respiratory failure due to multiple lung metastases 12 months after the appearance of the lingual metastasis. Radiation therapy is an acceptable palliative strategy for advanced lingual metastasis of RCC.