Regulatory implementation of the occupational equivalent dose limit for the lens of the eye and underlying relevant efforts in Japan.

In April 2011, the International Commission on Radiological Protection recommended reducing the occupational equivalent dose limit for the lens. Such a new occupational lens dose limit has thus far been implemented in many countries, and there are extensive discussions toward its regulatory implementation in other countries. In Japan, discussions in the Japan Health Physics Society (JHPS) began in April 2013 and in Radiation Council in July 2017, and the new occupational lens dose limit was implemented into regulation in April 2021. To share our experience, we have published a series of papers summarizing situations in Japan: the first paper based on information available by early 2017, and the second paper by early 2019. This paper (our third paper of this series) aims to review updated information available by mid-2022, such as regarding regulatory implementation of the new occupational lens dose limit, recent discussions by relevant ministries based on the opinion from the council, establishment process of safety and health management systems, the JHPS guidelines on lens dose monitoring and radiation safety, voluntary countermeasures of the licensees, development of lens dose calibration method, and recent studies on exposure of the lens in nuclear workers and biological effect on the lens.

Modified combination of platelet count and neutrophil "to" lymphocyte ratio as a prognostic factor in patients with advanced head and neck cancer.

BACKGROUND: We evaluated the prognostic potential of the combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) in patients with advanced head and neck cancer. METHODS: We proposed a modified COP-NLR scoring system defined as follows: score 0 (platelet count level <300 × 109 /L and NLR <3); score 1 (platelet count level ≥300 × 109 /L and NLR <3); and score 2 (NLR ≥3). We assessed whether the modified scoring system had better performance as an indicator of prognosis than the existing COP-NLR scoring system (original and 4-group scores). RESULTS: A total of 248 patients were enrolled. The Akaike Information Criterion value with the modified COP-NLR score was the smallest among the 3 models. The 3-year survival rates according to the modified COP-NLR scores of 0, 1, and 2 were 80.6%, 59.9%, and 23.8%, respectively. CONCLUSION: The modified COP-NLR score is a useful prognostic marker in patients with advanced head and neck cancer.

Thrombophlebitis of the head and neck: report of two cases.

Septic thrombophlebitis caused by head and neck infection has become a rare disorder due to the development of antibiotics. We report herein two cases of septic thrombophlebitis of the head and neck. Case 1 was a 7-year-old girl, who presented with fever, otalgia, and headache. Acute otitis media was diagnosed in another hospital. A computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated mastoiditis with thrombophlebitis of the right lateral and sigmoid sinuses. Case 2 was a 39-year-old woman, who presented with left neck pain, fever chills and severe pharyngalacia. Peritonsillar abscess was diagnosed. A CT scan demonstrated a left internal jugular vein thrombus in addition to multiple pulmonary nodules with emboli. A diagnosis of Lemierre's syndrome was made based on these findings. Both cases were successfully treated by intravenous antibiotics. A lack of awareness of these conditions and a delayed diagnosis may lead to potentially fatal consequences. A clinical suspicion of septic thrombophlebitis seems to be essential to make an accurate diagnosis during the early stage of the disease and archive a successful outcome.

Synchronous unilateral parotid gland neoplasms of three different histological types.

A 67-year-old male with three synchronous tumors in the unilateral parotid gland is reported. Postoperative histological examinations confirmed the presence of three synchronous primary tumors, specifically pleomorphic adenoma, Warthin's tumor and salivary duct carcinoma, in the right parotid gland. To our knowledge, this is the first case report describing three different histological types in the unilateral parotid gland.

Basaloid squamous cell carcinoma of the maxillary sinus: a report of two cases.

Basaloid squamous cell carcinoma (BSCC) is a highly aggressive neoplasm and a histologically distinctive variant of squamous cell carcinoma. Since the first description by Wain et al. in 1986, only 18 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We report herein two cases of BSCC of the maxillary sinus. Case 1 was 78-year-old man, who received preoperative radiotherapy and operation. He was alive without disease for 25 months after the operation. Case 2 was a 60-year-old man who received radiotherapy without operation. He died of lung metastasis 6 months after the initial diagnosis. We reviewed the clinical features of BSCC from the literature.

Successful treatment of eosinophilic otitis media using ramatroban: report of two cases.

OBJECTIVE: The pathogenesis of eosinophilic otitis media is not yet fully understood. The purpose of this paper is to describe the clinical course of our two patients with eosinophilic otitis media and to discuss the pathogenesis and treatment of this intractable condition. METHODS: Two cases of eosinophilic otitis media were treated with ramatroban. RESULTS: The middle ear effusion has been well controlled in both patients for more than 1 year with minimal corticosteroid therapy. CONCLUSIONS: Our experience suggests that the pathogenesis of eosinophilic otitis media is related to the pharmaceutical effects of ramatroban, i.e., inhibition of the thromboxane A2 receptor (TP) and the chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2).

Coexistence of pemphigus vulgaris and bullous pemphigoid in the upper aerodigestive tract.

Pemphigus vulgaris and bullous pemphigoid are autoimmune blistering diseases of the skin and the mucosa characterized by circulating autoantibodies. Coexistence of these lesions is extremely uncommon. We report herein a case of both pemphigus vulgaris and bullous pemphigoid which occurred in the upper aerodigestive tract. The diagnosis was made based on the circulating autoantibodies and direct immunofluorescent studies. The literature on this subject is reviewed.

Preoperative evaluation of ossicular chain abnormality in patients with conductive deafness without perforation of the tympanic membrane.

OBJECTIVE: To evaluate the usefulness of pure-tone audiometry, tympanometry, and liquid and acoustic reflex (AR) tests in the differential diagnosis of ossicular fixation and discontinuity. DESIGN: A prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: Thirty-nine patients (46 ears) undergoing operations at University of Tsukuba Hospital, Tsukuba, Japan, from 1990 through 2003 for conductive deafness without perforation of the tympanic membrane. Clinical examinations for the preoperative diagnosis included pure-tone audiometry, tympanometry, and liquid and AR tests. We compared the preoperative diagnosis with the surgical findings. RESULTS: Although neither pure-tone audiometry nor tympanometry contributed to the differential diagnosis of ossicular chain abnormality, liquid and AR test results showed a significant difference between fixation and discontinuity of the ossicular chain. With the liquid test, bone conduction at lower frequencies was improved by filling the external auditory canal with water at lower frequencies in cases of ossicular fixation. In contrast to the findings observed in ossicular fixation, no improvement of the threshold of bone conduction was recognized at any frequency in the ears with ossicular discontinuity. In ipsilaterally stimulated AR, the reversed pattern was the most marked at 2000 and 500 Hz in ossicular fixation and discontinuity, respectively. CONCLUSION: Liquid and AR tests are reliable examinations for the differential diagnosis of ossicular fixation and discontinuity.

Primary osteogenic sarcoma of the ethmoid sinus: a case report.

Primary osteogenic sarcoma arising from the ethmoid sinus is an extremely rare condition. We report herein a 50-year-old female presenting with lacrimation. Computed tomography (CT) scan showed tumor calcification, which is a common feature of osteogenic sarcoma. Exploratory ethmoidectomy was performed, and histological examination confirmed the diagnosis of osteogenic sarcoma. Radiation therapy and chemotherapy failed to reduce the tumor size. The patient was finally treated by anterior craniofacial resection and orbital exenteration. Although primary osteogenic sarcoma of the ethmoid sinus is uncommon, the authors emphasize that osteogenic sarcoma should be suspected when tumor calcification was observed on CT scan and that adequate surgical resection with negative surgical margins remains the mainstay of treatment of this lesion.

Life-threatening vocal cord paralysis in a patient with group A xeroderma pigmentosum.

We report a 19-year-old male with group A xeroderma pigmentosum who presented life-threatening vocal cord paralysis. At 3 months of age, he became sensitive to sunlight, and at the age of 4 years he was diagnosed with group A xeroderma pigmentosum. The neurologic symptoms progressed slowly thereafter. From the age of 18 years, he reported the development of occasional episodic inspiratory stridor and dyspnea, but the cause remained unknown. At the age of 19, he had a common cold and became severely dyspneic and cyanotic. Immediate examination of the glottis upon arrival by an otorhinolaryngologist using a fibroscope indicated complete paralysis of both vocal cords, and tracheal intubation resulted in marked improvement of respiration. Tracheostomy was performed thereafter. Inspiratory stridor and dyspnea are the common symptoms in this disease, and some patients with group A xeroderma pigmentosum undergo a tracheostomy, but the pathogenesis remains unknown. To our knowledge, vocal cord paralysis has never been reported in patients with group A xeroderma pigmentosum. This case is presented to illustrate the importance of fibroscopy in the examination of vocal cords in patients with group A xeroderma pigmentosum before the development of life-threatening events.

Nevoid basal cell carcinoma syndrome: report of an aggressive case with ethmoid sinus invasion.

Nevoid basal cell carcinoma syndrome, also referred to as Gorlin-Goltz syndrome, is a rare autosomal dominant disorder characterized by multiple basal cell carcinomas, jaw cysts, palmar or plantar pits, ectopic calcification of the falx cerebri, and various skeletal developmental abnormalities. A minority of basal cell carcinomas demonstrate aggressive behavior and involve the craniofacial bones in nevoid basal cell carcinoma syndrome. A non-familial case of nevoid basal cell carcinoma syndrome with a basal cell carcinoma of the eyelid invading to the ethmoid sinus is reported.