Efficacy of stress management program for depressive patients with advanced head and neck cancer: A single-center pilot study / Eficacia de un programa de control del estrés para pacientes depresivos con cáncer avanzado de cabeza y cuello: estudio de un solo centro

BACKGROUND/OBJECTIVE: Patients with head and neck cancer (HNC) have some problems such as dysfunction of breathing, eating, and/or speaking. The aim of this study was to examine efficacy of the stress management program for HNC patients (SMAP-HNC) compared with usual care (UC). METHOD: We conducted a pilot study of SMAP-HNC for depressive HNC patients between January 2016 and March 2018. The program contains psychoeducation, stress coping training, and operant reinforcement. The outcome measure was the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT), and Brief Coping Inventory (COPE). RESULTS: Twenty patients were randomly assigned to SMAP-HNC and UC group. Although a small sample sizes, there was no significant difference of depression score change between SMAP-HNC and UC group (Hedges’d g -0.83; 95% CI -1.80 to 0.13). CONCLUSIONS: It was the first study to conduct stress management program for HNC patients. Unfortunately, our trial designed as a randomized controlled trial is underpowered to make conclusion as to the efficacy of SMAP-HNC. However, there are some valuable suggestions to modify the stress management program in future

ANTECEDENTES/OBJETIVO: Los pacientes con cáncer de cabeza y cuello (CCC) tienen algunos problemas como trastornos de la respiración, la alimentación y/o el habla. El objetivo de este estudio fue examinar la eficacia de un programa de control del estrés para pacientes con CCC (SMAP-HNC) en comparación con la atención habitual (AH). MÉTODO: Llevamos a cabo un estudio piloto de SMAP-HNC para pacientes depresivos con CCC entre enero de 2016 y marzo de 2018. El programa contiene psicoeducación, entrenamiento para afrontar el estrés y refuerzo operante. Las medidas de los resultado fueron la Hospital Anxiety and Depression Scale (HADS), la Functional Assessment of Cancer Therapy (FACT) y el Brief Coping Inventory (COPE). RESULTADOS: Veinte pacientes fueron asignados aleatoriamente al grupo SMAP-HNC y AH. Aunque los tamaños de las muestras son pequeños, no hubo diferencias significativas en el cambio en el puntaje de depresión entre el grupo SMAP-HNC y el grupo AH (g de Heges's -0,83; IC del 95%: -1,80 a 0,13). CONCLUSIONES: Es el primer estudio en emplera un programa de control del estrés para pacientes con CCC. Desafortunadamente, nuestro ensayo diseñado como un ensayo controlado aleatorio tiene poco poder para llegar a una conclusión sobre la eficacia de SMAP-HNC. Sin embargo, hay algunas sugerencias valiosas para modificar el programa de control del estrés en el futuro

Efficacy of stress management program for depressive patients with advanced head and neck cancer: A single-center pilot study.

BACKGROUND/OBJECTIVE: Patients with head and neck cancer (HNC) have some problems such as dysfunction of breathing, eating, and/or speaking. The aim of this study was to examine efficacy of the stress management program for HNC patients (SMAP-HNC) compared with usual care (UC). METHOD: We conducted a pilot study of SMAP-HNC for depressive HNC patients between January 2016 and March 2018. The program contains psychoeducation, stress coping training, and operant reinforcement. The outcome measure was the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy (FACT), and Brief Coping Inventory (COPE). RESULTS: Twenty patients were randomly assigned to SMAP-HNC and UC group. Although a small sample sizes, there was no significant difference of depression score change between SMAP-HNC and UC group (Hedges'd g -0.83; 95% CI -1.80 to 0.13). CONCLUSIONS: It was the first study to conduct stress management program for HNC patients. Unfortunately, our trial designed as a randomized controlled trial is underpowered to make conclusion as to the efficacy of SMAP-HNC. However, there are some valuable suggestions to modify the stress management program in future.

ANTECEDENTES/OBJETIVO: Los pacientes con cáncer de cabeza y cuello (CCC) tienen algunos problemas como trastornos de la respiración, la alimentación y/o el habla. El objetivo de este estudio fue examinar la eficacia de un programa de control del estrés para pacientes con CCC (SMAP-HNC) en comparación con la atención habitual (AH). MÉTODO: Llevamos a cabo un estudio piloto de SMAP-HNC para pacientes depresivos con CCC entre enero de 2016 y marzo de 2018. El programa contiene psicoeducación, entrenamiento para afrontar el estrés y refuerzo operante. Las medidas de los resultado fueron la Hospital Anxiety and Depression Scale (HADS), la Functional Assessment of Cancer Therapy (FACT) y el Brief Coping Inventory (COPE). RESULTADOS: Veinte pacientes fueron asignados aleatoriamente al grupo SMAP-HNC y AH. Aunque los tamaños de las muestras son pequeños, no hubo diferencias significativas en el cambio en el puntaje de depresión entre el grupo SMAP-HNC y el grupo AH (g de Heges's -0,83; IC del 95%: -1,80 a 0,13). CONCLUSIONES: Es el primer estudio en emplera un programa de control del estrés para pacientes con CCC. Desafortunadamente, nuestro ensayo diseñado como un ensayo controlado aleatorio tiene poco poder para llegar a una conclusión sobre la eficacia de SMAP-HNC. Sin embargo, hay algunas sugerencias valiosas para modificar el programa de control del estrés en el futuro.

Improving the Quality of Life of Patients With Severe Dysphagia by Surgically Closing the Larynx.

OBJECTIVES:: The aim of this study was to elucidate the utility of the Kano method with surgical closure of the larynx by cricoid cartilage removal in improving quality of life in patients with severe dysphagia and their caregivers. METHODS:: Nine patients with severe dysphagia who underwent the Kano method were evaluated for oral intake and activities of daily living using the functional oral intake scale and the Barthel index, respectively, as indices of quality of life. Additionally, nutritional status, inflammation, and postoperative complications were assessed. Furthermore, 7 family caregivers were queried regarding frequency of sputum suction, mood of family caregivers, and postoperative satisfaction. RESULTS:: Functional oral intake scale and Barthel index scores as well as inflammation improved significantly after surgery ( P < .05). There were no severe complications or other complications requiring surgical intervention. The frequency of sputum suction was reduced postoperatively ( P < .05). The mood of family caregivers was significantly improved and satisfaction level was high postoperatively. CONCLUSIONS:: Surgical closure of the larynx is an appropriate choice for patients with irreversible severe dysphagia and impaired articulation or vocal function because quality of life is improved for both patients and family caregivers and the satisfaction of family caregivers is sufficient.

Right dominance in the incidence of external auditory canal squamous cell carcinoma in the Japanese population: Does handedness affect carcinogenesis?

OBJECTIVES/HYPOTHESIS: To investigate the relationship between handedness and the incidence of squamous cell carcinoma in the external auditory canal (EACSCC). MATERIALS AND METHODS: Sixty-eight cases of EACSCC were enrolled in this study, and their affected side was checked. Handedness and ear-picking habits were also investigated in 34 EACSCC cases. Handedness was judged based on self-categorization, and the relationship between handedness and the affected side was investigated. RESULTS: Fifty-two cases occurred on the right side, and 16 cases occurred on the left side of patients with EACSCC. The incidence of laterality in EACSCC showed a statistically significant right dominance. Concerning handedness, 29 cases were right-handed, 4 cases were left-handed, and 1 case was ambidextrous. Twenty-seven out of the 29 right-handed cases and 1 ambidextrous case suffered from carcinoma on the right side, whereas 3 left-handed cases suffered from carcinoma on the left side. That is, most of the cases suffered from EACSCC on the same side as their handedness, and this tendency showed a statistically significant difference. Most of the patients with EACSCC experienced itching and habitual ear-picking in the affected side. CONCLUSION: Mechanical stimulations to the EAC, such as ear picking, may plausibly cause EACSCC. In Japan, ear picking, also called "mimikaki," is a popular habit and an established unique culture. Because ear picking requires delicate handling and manipulation, this tends to occur on the same side as the handedness in the Japanese population. This is the first report about the relationship between handedness and carcinogenesis. LEVEL OF EVIDENCE: N/A.

[Combined Anterior Craniofacial Resection for Locally Advanced Ethmoid Carcinomas].

OBJECTIVE: Carcinoma of the ethmoid sinus is very rare, and treatment for locally advanced tumors remains as a formidable challenge to the clinician. We reviewed cases of ethmoid carcinoma in which anterior craniofacial resection had been undertaken and evaluated the safety and validity of the operative methods. METHODS: We retrospectively reviewed 13 patients with ethmoid carcinoma who underwent combined anterior craniofacial resection. We evaluated the surgical procedures, complications, outcomes, local recurrence, and the survival rate. RESULTS: Coronal incision and anterior craniotomy were performed in all cases. Four out of 13 cases underwent ipsilateral orbital exenteration due to involvement of the orbital contents. There were no potentially fatal complications, except for two cases of epidural abscesses which were successfully cured. Positive surgical margins were observed in 6 patients, and they received postoperative radiotherapy and/or chemotherapy. Local recurrences occurred in 4 cases, and 3 died at 9, 11, and 49 months after the surgery. Distant metastasis was not observed during the observation period. The overall 5-year survival rate was 75.2% (Kaplan-Meier method). CONCLUSION: These tumors were safely removed without severe complications and postoperative mortality. Combined anterior craniofacial resection is an effective and safe option for treatment of locally advanced ethmoid carcinomas after various preoperative treatments.

[Treatments for otorhinolaryngological patients with psychiatric disorders].

There are few systems in place for patients with psychiatric disorders who need treatments for physical complications. In Tokyo, "The Tokyo metropolitan psychiatric emergency system" was established in 1981, and Ome Municipal General Hospital participated in it. Under this system, fifteen patients with psychiatric disorders were treated for otorhinolaryngological diseases in our department from April 2005 to March 2011. We reviewed the fifteen patients. The coexisting psychiatric disorders were schizophrenia in twelve patients, and mental retardation, Korsakoff's syndrome, and Alzheimer's dementia in one patient each, respectively. All the patients had been receiving psychiatric treatment. The otorhinolaryngological diseases were head and neck cancer in nine patients, chronic sinusitis in three patients, and benign salivary gland tumor, cholesteatoma, and epistaxis in one patient each, respectively. Among the fifteen patients, thirteen could complete their treatment, but two dropped out due to exacerbation of their psychiatric symptoms. The therapeutic course is uncertain in otorhinolaryngological diseases occurring concomitantly with psychiatric disorders, especially in head and neck cancer, because it may be difficult to prioritize the problem when determining the treatment options and delivering the treatment. Thus, we should treat patients with psychiatric disorders carefully on a case-by-case basis depending on their psychiatric symptoms. It is also important to cooperate with psychiatrists and patients' families.

Longitudinal study of 29 patients with Meniere's disease with follow-up of 10 years or more (In commemoration of Professor Emeritus Isamu Watanabe).

CONCLUSIONS: A final incidence of bilateral involvement was 20.7%. Episodic spells of vertigo were completely controlled in 23 of 29 patients, while 11 of 29 patients demonstrated over 70 dB hearing loss. OBJECTIVE: To analyze the clinical course of 29 patients with Meniere's disease during follow-up of 10 years or more. METHODS: The subjects were 29 patients with a mean follow-up of 18.3 years. The hearing level was measured by the pure tone average (PTA) of four frequencies at the initial and the final examination, and it was classified into four categories according to the American Academy of Otolaryngology-Head and Neck Society (AAO-HNS) criteria. The control of vertigo was evaluated by the modified AAO-HNS criteria. RESULTS: At enrolment two patients had bilateral involvement. In the period of follow-up, bilateral involvement emerged in four more patients. The hearing levels at the final examinations were as follows: 3 patients, <25 dB; 6 patients, 26-40 dB; 9 patients, 41-70 dB; and 11 patients, >70 dB. The control of vertigo according to the modified AAO-HNS guideline was class A in 23 patients, class B in 2 patients, and class C in 1 patient; the remaining 3 patients could not be evaluated.

Parapharyngeal space tumors: anatomical and image analysis findings.

OBJECTIVE: The parapharyngeal space (PS) is defined as the deepest space in the neck and it consists of the pre- and post-styloid regions. PS tumors originating in these regions are thought to dislocate the carotid artery (CA) in either the posterior or anterior direction. To determine the precise anatomy of the PS and its relationship with the CA in diagnostic images, we conducted cadaveric and imagining analysis. MATERIALS AND METHODS: We examined the posterior and lateral aspects of the PS in three cadavers. We also examined 17 patients who suffered from PS tumors, in which the carotid artery was dislocated (CA), then compared the results with surgical and pathological findings. RESULTS: The anterior part of the PS was mainly composed of fatty tissue and is generally referred to as the pre-styloid region of the PS. In the posterior of this fatty region, blood vessels and nerves were tightly covered with muscles and adjacent fascias to form a compact musculo-fascial structure containing the CA, jugular vein, vagal, glossopharyngeal, accessory and sympathetic nerves, and a portion of the hypoglossal nerves. The hypoglossal nerves emerged from the hypoglossal canal posterior to this structure and coursed behind it, entering it at the upper third of the PS. These anatomical findings indicated that the PS was actually comprises of three regions. Image analysis showed that the CA was dislocated in the postero-lateral direction by a pleomorphic adenoma originating from the parotid gland and by a trigeminal schwannoma, both of which were pre-styloid tumors. On the other hand, the post-styloid tumors did not always dislocate the CA in the anterior direction. Tumors that developed within the musculo-fascial structure such as those of the carotid body tumor or sympathetic nerve schwannoma dislocated the CA from both the antero- to the postero-lateral directions. A hypoglossal nerve schwannoma originating from the most posterior part of the PS, which was behind the musculo-fascial structure dislocated the CA in the anterior direction. CONCLUSION: The present findings indicated that the post-styloid region of the PS is considered to consist of two regions. As the CA is a component of this musculo-fascial structure, tumors originating from it that are defined as post-styloid did not always displace the CA in the anterior direction. Such anatomical recognition is helpful for diagnostic imaging of PS tumors.

The effect of 3,4-diaminopyridine on the patients with hereditary pure cerebellar ataxia.

BACKGROUND: Downbeat nystagmus (DBN) is often seen in patients with pure cerebellar type of spinocerebellar ataxia (SCA) like spinocerebellar ataxia type 6 (SCA6). DBN frequently presents with other cerebellar symptoms such as postural imbalance or ataxia. A potassium channel blocker 3,4-diaminopyridine (3,4-DAP) has been reported to reduce DBN by increasing the excitability of Purkinje cells. OBJECTIVE: The objective of this study is to determine whether 3,4-DAP has a beneficial effect on DBN along with postural imbalance and ataxic symptoms in 10 patients with SCA6 and five patients with chromosome 16q22.1-linked autosomal dominant cerebellar ataxia (16q-ADCA). RESULTS: The patients took 20mg of 3,4-DAP twice a day for a week. DBN was observed in seven patients with SCA6 and two with 16q-ADCA. Although 3,4-DAP significantly reduced DBN (P<0.05), other ataxic symptoms did not improved. However, 3,4-DAP showed benefit in two patients with oscillopsia. CONCLUSION: 3,4-DAP may be effective on DBN and oscillopsia, although it was not proved to be effective on other symptoms of ataxia in SCA patients.

A novel permanent tracheostomy technique for prevention of stomal stenosis (triangular tracheostomy).

OBJECTIVE: Stenosis of a permanent tracheostoma after total laryngectomy lowers postoperative quality of life (QOL), and its prevention is clinically important. METHODS: From April 2003 to March 2009, the authors performed 87 permanent tracheostomies. For the purpose of prevention of tracheostomal stenosis, we had applied new technique from October 2005. RESULTS: The incidence of the tracheostomal stenosis was retrospectively reviewed. Until September 2005, conventional permanent tracheostomy was applied for 33 cases and tracheostomal stenosis developed in 6 cases (18.2%). On the other hand, stenosis did not develop in any of the 54 cases in which the new technique was used. The triangular method was significantly superior to the conventional method in preventing stenosis. Stomal recurrence did not develop in either technique. CONCLUSION: The key point of the new technique is as follows: at the upper end of trachea, the posterior part of tracheal cartilage is preserved and the anterior edge of the tracheostoma is made much lower. The shape of the tracheostoma approximates a triangle, and the area is greater than with other methods. From our experience, this technique is safe and effective for the prevention of tracheostomal stenosis.

Partial maxillary swing approach for removal of the tumors in the retromaxillary area.

OBJECTIVE: Removal of tumors around the pterygoid process poses difficult challenges. Our method for removal of tumors in this area using a modification of the maxillary swing approach is reported. METHODS: A retrospective study of five cases was performed using the partial maxillary swing approach. Like the "maxillary swing approach", the maxilla is swung laterally with the facial skin; however, only two-thirds of the anterior maxillary bone is swung. RESULTS: All tumors were safely removed using the partial maxillary swing approach alone, with the exception of one patient who needed an additional mandibular swing. No facial palsy, masticatory problems or necrosis of the maxilla were observed in any cases. CONCLUSIONS: The partial maxillary swing approach offers a wide surgical field of the lesion around the posterior part of the maxilla and pterygoid process without severe complications and is useful for removal of tumors in these areas.

First-bite syndrome: a review of 29 patients with parapharyngeal space tumor.

OBJECTIVE: The aim of this study is to clarify the etiology of first-bite syndrome. METHODS: A total of 29 consecutive patients treated with a surgical resection for parapharyngeal space tumor between April 1999 and April 2005 were retrospectively reviewed. RESULTS: Nine cases of first-bite syndrome were developed. Eight of those patients had undergone surgical ablation of the cervical sympathetic chain and/or external carotid artery. In two patients who underwent ablation of the sympathetic chain but in whom first-bite syndrome did not develop, the superior cervical ganglion was probably preserved. CONCLUSION: The present findings strongly indicate that loss of sympathetic innervation to the parotid gland from the superior cervical ganglion causes first-bite syndrome. They also suggest that some residual or autonomous activity of the superior cervical ganglion could prevent development of first-bite syndrome even if the lower sympathetic trunk was ablated.

Mechanical obstruction of the eustachian tube by the benign tumor of the parapharyngeal space does not cause otitis media with effusion.

OBJECTIVE: We are reporting on eustachian tube and middle ear pathologic findings in patients with parapharyngeal tumors. PATIENTS: Eleven cases of eustachian tube involvement as indicated by obstruction due to compression of the tumor were assessed in this study. MAIN OUTCOME MEASURES: Each patient underwent otoscopy, nasopharyngoscopy, a pure-tone hearing test, impedance audiometry, and sonotubometry. RESULTS: All of the tumors were diagnosed benign according to the histologic examination. In 9 of the 11 patients, the pharyngeal opening of the eustachian tube narrowed or was blocked by the tumor. None of the patients showed any response on the tumor side in the sonotubometry. Therefore, gas exchange was prevented through the eustachian tube by the tumor; however, they also showed an intact tympanic membrane and normal hearing tests. CONCLUSION: According to our data, if there is drainage of middle ear fluid through the eustachian tube and the exchange of gas in the middle ear is preserved, otitis media with effusion will not occur even in cases such as these.

Bony eminence on the middle cranial fossa corresponding to the temporomandibular joint.

We report a nameless bony eminence over the temporomandibular joint (TMJ) and its possible clinical significance. Forty-two half heads of 21 UK Caucasian cadavers (61-95 years old, mean 84.3 +/- 8.2 years, male:female = 11:10) were used to investigate the surface of the middle cranial fossa (MCF) over the TMJ. The thickness of the bony roof of the glenoid fossa was also measured. A bony eminence over the glenoid fossa was observed in half of the specimens. Some showed a complete oval bulge, which completely reflected the contour of the glenoid fossa. The others showed a bony bulge, which partially reflected that contour. The mean (+/-SD) thickness of the bone in the roof of glenoid fossa was 1.5 +/- 1.2 mm. The mean bony thickness of specimens showing the eminence was 0.8 +/- 0.5 mm, whereas it was 2.3 +/- 1.2 mm in specimens without an eminence. These differences were statistically significant (P < 0.01). The osteological features we describe may be relevant to certain clinical problems. Traumatic dislocation of mandibular condyle, for example, might relate to a weakness of the glenoid fossa.

Audiovestibular findings in patients with mitochondrial A1555G mutation.

OBJECTIVE: The aims of this study were to explore the prevalence of the A1555G mutation among a group of Japanese patients and to assess the pathophysiology of the hearing impairment associated with the mutation. STUDY DESIGN: Genetic study and retrospective chart review. METHODS: We screened for the mitochondrial DNA A1555G mutation in 138 unrelated Japanese deaf patients, including 63 sporadic cases and 75 familial cases with different patterns of inheritance. When available, patients carrying the mutation received audiovestibular examinations, including speech audiometry, distortion-product otoacoustic emission (DPOAE) testing, electrocochleography (ECochG), and electronystagmography. RESULTS: One of 63 sporadic cases (1.6%) and 6 of 75 familial cases (8.0%) carried the A1555G mutation. Patients with the mutation and a familial history included two with autosomal recessive inheritance and four with maternal inheritance. In addition, two of six patients (33.3%) presenting with aminoglycoside-induced sensorineural hearing loss (SNHL) were associated with the A1555G mutation. All but one of the patients carrying the mutation showed high-frequency SNHL. Distortion-product levels of DPOAE were reduced to the noise levels, suggesting the A1555G mutation caused cochlear deafness. Cochlear microphonics in ECochG showed elevation of the detection thresholds and corresponding audiometric thresholds. The ECochG data implied that patients with high-frequency SNHL had impairment of the cochlear hair cells that was most severe toward the basal turn. The electronystagmographic findings indicated no apparent vestibular dysfunction. CONCLUSIONS: Screening for the A1555G mutation, even in patients with idiopathic bilateral SNHL, likely would be useful for preventing further development and/or acceleration of the deafness.