Horseshoe osteotomy maintains the nasal cavity and function after superior repositioning.

The aim of this prospective cohort study was to compare changes in nasal cavity and function between Le Fort I with and without horseshoe osteotomy after superior repositioning of the maxilla. The patients were divided into 2 groups, a Le Fort I alone (LF alone) group and a combination Le Fort I and horseshoe osteotomy (HS) group. The nasal cavity volume was measured using 3-dimensional computed tomographic images, and nasal resistance was assessed by anterior active mask rhinomanometry. The HS group consisted of 17 patients, and the LF alone group consisted of 15 patients. The magnitude of change in nasal cavity volume was significantly smaller in the HS group than in the LF alone group (p < 0.001), even though the mean amount of superior maxillary movement was considerably larger in the HS group than in the LF alone group (p < 0.001). Mean nasal resistance was significantly smaller postoperatively than preoperatively in the HS group (p < 0.05). Furthermore, the change in nasal resistance was smaller in the HS group than in the LF alone group (p < 0.001). Within the limitations of this study, it seems that horseshoe osteotomy is useful for maintaining the nasal cavity and function after superior repositioning of the maxilla.

[Clinical study of cervical lymph node metastasis in maxillary cancer patients].

The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.

Expression of Myc target gene mina53 in subtypes of human lymphoma.

Mina53 (mina) was identified as a gene, which is directly induced by the oncogene c-myc. Elevated expression of Mina53 protein was found in >80% of colon cancer and esophageal squamous cell carcinoma (ESCC). Patients with high expression of Mina53 had shorter survival, suggesting the prognostic usefulness of Mina53. We studied Mina53 expression in lymphoma subtypes to examine its diagnostic significance and its possible role in lymphoma-genesis. Surgical cases of 28 lymphoma and 4 non-neoplastic tissues were stained immunochemically using anti-Mina53 monoclonal antibody. Mina53 expression correlated well with c-Myc expression in lymphoma, suggesting that c-Myc is a controlling factor for mina53 expression also in lymphomas. Although the expression of Mina53 as well as c-Myc was less frequent in lymphoma compared with those of colon and ESCC, increased expression of Mina53 was found in Burkitt-like lymphoma (1/1), Hodgkin's lymphoma (3/5), diffuse large B cell lymphoma (DLBCL) (5/13), lymphomas with a transition from follicular to DLBCL (1/2), with none in follicular (0/4) and T cell lymphoma (0/3). Analyses of the data suggested that Mina53 was frequently expressed in aggressive types of B cell lymphoma. To get more information about the expression of Mina53 in DLBCL, which most frequently occurs among lymphomas, we analyzed the expression of Mina53 in another 21 DLBCL specimens, which were in more advanced stages than those described above. The expression level of Mina53 correlated to the international prognostic index (IPI) values with statistical significance (r=0.477, P=0.0275). Notably, in this group, Mina53 expression did not correlate with c-Myc expression, suggesting that other factor(s) besides c-Myc largely affect the expression of Mina53 in advanced DLBCL. These results suggest that although Mina53 expression is not prominent in lymphoma in general, it may be related to tumor progression of B cell lymphoma.

[Clinical study of neck dissection for lymph node metastasis in patients with malignant skin tumors of the forehead and face].

We reviewed the records of 10 patients with malignant skin tumors of the forehead and face who underwent neck lymph node dissection at Kurume University Hospital between 2000 and 2004. Two patients underwent selective neck dissection (SND), 5 patients underwent SND and superficial parotidectomy (SP) and 3 patients underwent modified radical neck dissection and SP. Lymph node metastasis to the upper jugular group was found in 3 patients, and metastasis to lymph nodes of the parotid region was found in 3 patients. In a patient with malignant melanoma of the forehead, the patent blue dye was injected intradermally around the tumor and blue-stained lymph nodes were identified in the upper jugular group and parotid region. From these results, we consider that the sentinel lymph nodes of frontal and facial malignant tumors are located in the upper jugular group and parotid region. Thus, in malignant skin tumor patients, SND and SP might be mandatory.

[Autologous tumor-specific immunotherapy for recurrent malignant melanoma of the nasal cavity].

Malignant melanoma usually occurs in tissues containing large numbers of melanocytes, such as the skin, mucosa and eye, and is one of the most highly malignant tumors known. No satisfactory treatment results have ever been reported. We report here an effective course of immunotherapy consisting of the local injection and intra-venous administration of autologous tumor-cell-stimulated cytotoxic T lymphocytes in a patient with recurrent malignant melanoma. The patient was a 45-year-old woman. She had been diagnosed as having malignant melanoma in 1996 and under went radio-chemotherapy at our hospital. Seven years later, recurrences were recognized in bilateral nasal cavities. Following systematic chemotherapy, 23 local injections of cytotoxic T lymphocytes were performed. Mediastinal lymphonode metastasis was recognized in March, 2004, so 15 additional intravenous administrations of cytotoxic T lymphocytes were performed. At present, no obvious regrowth has been recognized. Immunotherapy using cytotoxic T lymphocytes may be a useful strategy for controlling recurrent malignant melanoma.

Expression and distribution of CD44 and hyaluronic acid in human vocal fold mucosa.

OBJECTIVES: Expression of CD44 (a cell surface receptor for hyaluronic acid) and the distribution of hyaluronic acid were examined in the human vocal fold mucosa. METHODS: Light microscopic investigation was carried out on 10 normal larynges of newborn, infant, younger adult, and older adults with Alcian blue staining, a hyaluronidase digestion study, and immunohistochemistry for CD44. RESULTS: Before the appearance of hyaluronic acid in the newborn vocal fold mucosa, CD44 was expressed on the stellate cells in the macula flava and on the fibroblasts in Reinke's space. During infancy, hyaluronic acid appeared and was distributed in the vocal fold mucosa. Many more stellate cells in the macula flava showed CD44 expression, and a large amount of hyaluronic acid was present around the infant stellate cells; however, the fibroblasts in Reinke's space expressed little CD44. During adulthood, hyaluronic acid was distributed in the vocal fold mucosa. Almost all of the stellate cells in the macula flava showed CD44 expression, and much hyaluronic acid existed around the stellate cells in the adult macula flava. However, fibroblasts in the adult Reinke's space expressed little CD44, and hyaluronic acid density in that space was lower than that in the macula flava. CONCLUSIONS: Stellate cells in the macula flava and CD44 cooperatively play important roles in maintaining hyaluronic acid in the human vocal fold mucosa as a vibrating tissue.

Comparison of preoperative fine-needle aspiration cytology diagnosis and histopathological diagnosis of salivary gland tumors.

We investigated 115 patients with salivary gland epithelial tumors who had undergone preoperative fine needle aspiration cytology (FNAC) of salivary glands and had been diagnosed by postoperative histopathological examination. We compared the findings of preoperative FNAC with their histopathological types in salivary gland tumors, and discuss the results and problems. The diagnostic accuracy, sensitivity, and specificity of preoperative FNAC of salivary glands were 98.2%, 88.2%, and 100%, respectively. The percentage of inadequate specimens was 6.1%. The rates of agreement in the diagnosis of pleomorphic adenoma, Warthin tumor, and basal cell adenoma were 96%, 92.9%, and 55.5%, respectively. The rate of agreement of histopathological types in the malignant tumors was 30%. We realized again not only that the diagnostic accuracy of preoperative FNAC for salivary gland tumors was high, but also that it was a safe, easy-to-perform, clinically very useful diagnostic procedure. However, this study exposed several problems which are the inadequate sampling rate and the difficulty in diagnosing malignant tumors. We have been making efforts to take appropriate specimens by writing comments on the cytological report indicating a re-examination, or by the presence of the clinical laboratory technician at the FNAC procedure. We consider it necessary to adequately re-aspirate the solid portion after cyst fluid aspiration, or to re-perform FNAC at a later date, and to improve the diagnostic accuracy by further experience with more patients.

[Indications for pharyngeal surgery in adult with sleep-disordered breathing patients].

We assessed the indications for pharyngeal surgery, including tonsillectomy and uvulopalatopharyngoplasty (UPPP) for patients with sleep-disordered breathing (SDB). The indications for surgery can be divided into two groups. In the first group, the indicated surgery is a radical treatment of SDB. The characteristics of this group were (1) grade 1 tonsillar hypertrophy, (2) bilateral (side to side type) oropharyngeal stenosis, as determined using a snoring sound test, and (3) no risk of facial disfiguration. In this group, the improvement in AHI (Apnea Hypopnea Index) was 76.2%, while the improvement in AI (Apnea Index) was 95.7%. In the second group, the treatment was designated as supplemental. The characteristics of this group were (1) bilateral oropharyngeal stenosis, (2) tonsillar hypertrophy larger than grade 2, and (3) unsuccessful treatment with NCPAP (Nasal Continuous Positive Airway Pressure) or oral appliances. In this group, the improvement in AHI was 50.7%, but, surgery remained an effective means of treating SDB.

[A retrospective study of malignant parotid tumors].

The clinical features of 74 patients (39 men, 35 women; mean age, 62 years) with malignant parotid tumors were retrospectively investigated. According to the TNM Classification, 4 patients were classified as T1, 9 as T2, 6 as T3, and 55 as T4. Fifty cases were staged as N0, 9 as N1, 14 as N2 and 1 as N3. Tumors located in both lobes of the parotid gland were the most frequent type of tumor (49%). Twenty-four percent of the 74 patients exhibited facial nerve palsy before treatment. Facial palsy was found predominantly in cases with a higher T classification or with deep lobe occupation. Histopathologically, sixteen tumor types were observed; mucoepidermoid carcinoma was the most common. The overall five-year and ten-year survival rates determined using the Kaplan-Meier method were 65% and 61%. The factors influencing a poor outcome were T4 classification (p=0.0189), an N+ stage (p<0.0001), and facial palsy (p<0.0001). As for the major histopathologic types, the five-year survival rates were 69% for mucoepidermoid carcinoma, 48% for adenocarcinoma, 71% for adenoid cystic carcinoma, and 100% for acinic cell carcinoma and malignant mixed tumor. With respect to the treatment modality, patients who were classified as T1 or T2 and whose tumors were located in the superficial lobe without facial nerve invasion could be satisfactorily treated with only a superficial lobectomy conserving the facial nerve. A total parotidectomy with total removal of the facial nerve seemed necessary for T3 and T4 cases, especially those with adenocarcinoma or mucoepidermoid carcinoma. Modified neck dissection may be necessary for N0 cases, especially those with adenocarcinoma, adenoid cystic carcinoma or undifferentiated carcinoma. Nerve grafting after total nerve resection is recommended for a better quality of life.

Antitumor effects of systemic and local immunization with a CTL-directed peptide in combination with a local injection of OK-432.

PURPOSE: The accumulation of T cells into the tumor site is crucial for the elicitation of in vivo antitumor effects after cancer vaccination. In this study, we investigated the antitumor effects and associated mechanisms of action that were induced by systemic and local immunization with a CTL-directed peptide in combination with a peritumoral injection of a streptococcal preparation, OK-432. EXPERIMENTAL DESIGN AND RESULTS: The human SART3(315-323) peptide, which has the potential to induce human leukocyte antigen-A24-restricted CTLs, not only has the same amino acid sequence as the mouse SART3, but also has the capacity for binding to H-2K(d) molecules. Therefore, the SART3(315-323) peptide could be used as a tumor antigen-derived peptide in H-2(d) mice. Systemic immunization with the SART3(315-323) peptide and the subsequent peritumoral injection of both the SART3(315-323) peptide and OK-432 effectively induced peptide-specific and colon26 carcinoma-reactive CTLs in BALB/c mice. The combination therapy suppressed the growth of s.c. established colon26 carcinoma. The accumulation of both CD8(+) and CD4(+) T cells into the tumor site was more apparent in mice treated with the combination therapy than in those treated with other protocols. In addition, the level of IgG reactive to the administered SART3(315-323) peptide increased in mice that were treated with the combination therapy. CONCLUSION: These results indicate that antitumor effects could be efficiently induced by a combination therapy that included systemic and local immunization with a CTL-directed peptide together with a local injection of OK-432.

Immunohistochemical expression of Mina53 and Ki67 proteins in human primary gingival squamous cell carcinoma.

Studies have reported the presence of relationships between the Myc target gene Mina53 and poor prognostic factors in several cancers including esophageal cancer. In this study, we investigated the relationships between Mina53 expression in gingival squamous cell carcinoma and clinicopathological factors. Seven samples of normal and dysplastic gingival tissues and 15 samples of gingival squamous cell carcinoma were immunostained for Mina53 and Ki67, and examined for the relationships between their expression and differentiation degree, lymph node metastasis, stage, tumor diameter, and prognosis. In normal and dysplastic gingival tissues, the localization of the expression of Mina53 and Ki67 was similar, but that in gingival squamous cell carcinoma tissue varied depending on the degree of differentiation. In well-differentiated GSCC with pearl formation, Mina53 was negative at the center of the clearly keratinized cancer nest, but positive in the nuclei of cells in the periphery and adjacent area of the cancer nest. In diffusely proliferating undifferentiated and moderately-differentiated GSCC showing no pearl formation, both Mina53 tended to be positive in the nuclei of cancer cells in the entire cancer nest. A significant correlation was found between the expression of Mina53 and that of Ki67 in patients with gingival squamous cell carcinoma or dysplastic gingiva. No significant correlation was noted between the expression of Mina53 or Ki67 and prognostic factors such as the degree of differentiation, lymph node metastasis, stage, and tumor diameter. In gingival squamous cell carcinoma, Mina53 expression was correlated with the proliferation of tumor cells, but unlike esophageal and other squamous cell carcinomas, not with the prognosis. The absence of correlations with prognostic factors suggests that may differ gingival squamous cell carcinoma differs biologically from esophageal squamous cell carcinoma which is correlated with Mina53 in terms of the biological expression of Mina53.

[Combination therapy for severe sleep apnea syndrome].

We assessed the treatment of severe SAS (sleep apnea syndrome) patients who had an AHI (apnea hypopnea index) over 100. Eleven (3.3%) of the 374 patients who came to our hospital between May 2002 and December 2003 had an AHI over 100. They received CPAP (continuous positive airway pressure) therapy as initial therapy, and the AHI recovered within normal limit in the five patients who did not have tonsillar hypertrophy. The other six patients had tonsillar hypertrophy, and the effect of CPAP was poor. Two of the six patients with tonsillar hypertrophy, underwent UPPP (uvuropalatopharyngoplasty), and CPAP become effective postoperatively. These results indicate that combined treatment by CPAP and surgery is an effective means of treating severe SAS with tonsillar hypertrophy.

[Toxic shock-like syndrome of the neck, a case report].

Streptococcal toxic shock-like syndrome (TSLS) is known to progress rapidly into septic shock and have a high mortality of 40%. We report a rare case of neck infectious disease caused by Group A hemolytic streptococcus pyogenes. A 65-year-old man, hospitalized for eyelid swelling and dyspnea suffered shock, dyspnea, and pressure reduction on the day he was hospitalized and died of multiple organ failure 18 days later. Despite treatment with antibiotics, tracheostomy, immunoglobulin, etc. We suspected that he had been infected via a laceration of the external auditory meatus. Accurate diagnosis followed by prompt, radical treatment is essential if TSLS is to be treated successfully.

[Clinical review of mucoepidermoid carcinomas].

Mucoepidermoid carcinoma is a rare head and neck cancer tumor, composed of both mucous and epidermoid cells. We retrospectively reviewed the case of 36 such patients hospitalized in the last 24 years (between 1978 and 2002) at Kurume University Hospital, focusing on origin, treatment, and treatment outcome. In this study, 33 patients undergoing currative treatment were studied in detail. Tumors originated in major salivary glands in 24 and in the oral cavity, paranasal cavity, and oropharynx in 3 each. Salivary gland carcinomas were graded, clinically and histopathologically based on the criteria of Goode et al. as follows: low (n = 3), intermediate (n = 3), and high (n = 18). All patients underwent radical surgery. Lymphnode metastasis was detected in 9, distant metastasis in 6 (lung: 4; liver: 1; bone: 1), and local recurrence in 5 patients. Lymphnode recurrence was detected in 3. Survival was calculated with Kaplan-Meier's methods. Five-year overall survival was 64%, i.e., 56% in salivary gland malignancy, 67% in oral cavity malignancy, 100% in paranasal cavity malignancy and 100% in oropharynx malignancy. Five-year survival was 76% in T2, 75% in T3, 51% in T4. Five-year survival in NO was 80% and 22% in N+ cases, with a statictically significant difference (p < 0.05). Five-year survival was 71% in stage I, 83% in stage II, and 54% in stage IV. Five-year survival in low and intermediate grade was 100%, whereas that in high grade was 43%. The 21 patients undergoing modified neck dissection has a 5-year survival of 52%. In 20 patients undergoing postoperative radiotherapy, 4 died of local recurrence. In 31 patients not undergoing chemotherapy, 6 died of distant metastasis. These results emphasize the necessity of radiotherapy and chemotherapy after surgical treatment for head and neck mucoepidermoid carcinoma.

[Clinical investigation of squamous cell carcinoma of the posterior oropharyngeal wall].

Clinical features of 33 patients with squamous cell carcinoma of the posterior oropharyngeal wall treated at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital from 1973 to 2003 were analysed. Of these, 23 (21 men and 2 women, mean age: 66 years) underwent radical treatment, and 10 (8 men and 2 women, mean age: 78 years) did not. In those treated radically, 2 were stage I, 5 stage II, 6 stage III, and 10 stage IV. The primary disease was surgically treated in 16, and reconstruction added in 5, using the free jejunum in 4 and a forearm flap. Radical radiotherapy was done in 7. Five-year local control in the 23 was 35.3%. Disease-specific 5-year survival was 32.0%. Seven died of primary oropharyngeal cancer. After treatment, 78.3% were able to eat orally. In conclusion, squamous cell carcinoma of the posterior oropharyngeal wall is relatively rare and has a poorer prognosis than other types of oropharyngeal cancer.

Immunohistochemical distribution of CD9 in parotid gland tumors.

OBJECTIVE: CD9 is a member of the tetra-membrane-spanning glycoprotein family called tetraspanin. CD9 suppresses breeding and motion in some types of cancer cells. At present, the expression of CD9 in the salivary gland has not yet been elucidated. METHODS: We examined the expression of CD9 not only in the normal salivary glands of human embryo and adults but also in the parotid gland tumors using immunohistochemical staining. RESULTS: CD9 was not detected in embryos at 18 weeks of gestation, but was observed at 24 weeks in the salivary gland. CD9 was constantly detected in the adult normal parotid gland. In benign parotid gland tumors, CD9 was present in the 11 of 16 pleomorphic adenomas, every Warthin tumors (18/18) and basal cell adenoma (1/1). In contrast, positive staining for CD9 in malignant parotid tumors was observed in only the case of mucoepidermoid carcinomas. Neither acinic cell carcinomas or adenoid cystic carcinomas did show positive reaction in examined cases. The localization of CD9 was also observed in intercalated duct cells. CONCLUSION: There was a statistically significant reduced expression of CD9 in malignant parotid gland tumors as compared to benign parotid gland tumors (P = 0.003).

[A case of neurinoma of the nasal septum].

Neurinoma grows in the modulated nerve with Schwann cells, and is observed for all positions of the body. It is comparatively rare for neurinoma to grow in the nasal cavity and paranasal sinuses, however. We report a case of neurinoma of the nasal septum. A 24-year-old man seen for nasal obstruction was found in anterior rhinoscopy to have a tumor of the bilateral nasal cavity. Computed tomography (CT) showed a soft tissue density mass in the anterior part of the nasal cavity. Because we suspected neurinoma from biopsy, we resected the tumor by Denker's operation under general anesthesia. We found that it originated from the nasal septum. Histopathological findings of the tumor indicated an Antoni A type neurinoma. After surgery, cartilago costalis was transplanted the plastic surgery to correct the defect in the nasal septum. The post operative course was good and no signs of recurrence were seen. This is the 19th case found in the literature.

Antiepiligrin cicatricial pemphigoid of the larynx successfully treated with a combination of tetracycline and niacinamide.

A case of antiepiligrin cicatricial pemphigoid that primarily involved the larynx and required a tracheostomy was studied. The diagnosis was based on the direct immunofluorescence findings of a biopsy specimen from the glottis, immunofluorescence using normal and 1M sodium chloride-split normal human skin as substrates, and immunoprecipitation. A dramatic clinical improvement was observed after the combined administration of tetracycline hydrochloride and niacinamide. The tracheal stoma could be shut after the narrow segment was cut by means of carbon dioxide laser therapy. The patient showed no respiratory difficulty during the 2-year follow-up period. The combined therapy of tetracycline and niacinamide is thus considered to be an effective treatment for various types of cicatricial pemphigoid.