Prevalence of human papillomavirus in oropharyngeal cancer: a multicenter study in Japan.

BACKGROUND: The incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) have risen steadily in the USA and in northern Europe. These increases are thought to be a consequence of persistent infection with high-risk human papillomavirus (HPV) in OPSCC patients. HPV is an emerging etiologic factor in OPSCC. In Japan, the incidence of OPSCC has significantly increased over the last three decades. However, the population of HPV-positive OPSCC patients is currently unknown. We examined the nationwide trends with regard to HPV incidence in OPSCC patients at 21 specific sites, and examined the relationship between the presence of HPV and survival in OPSCC patients in Japan. METHODS: Tumor samples were obtained from patients with OPSCC prior to treatment, and HPV infection was investigated by polymerase chain reaction (PCR). Hybrid Capture 2 (HC2) was also adopted for swab examination on the surface of fresh tumors. RESULTS: HPV was detected by PCR in 79 (50.3%) out of 157 OPSCC patients. The clinical features of HPV-positive OPSCC were low differentiation, a tendency to involve the lateral wall, and high nodal staging. The sensitivity and specificity of HC2 were 93.7 and 96.2%, respectively, indicating its utility as a screening test. HPV-positive patients had significantly better overall survival and disease-free survival than HPV-negative patients.

Investigation of pharyngeal swallowing function using high-resolution manometry.

OBJECTIVES/HYPOTHESIS: This study aimed to demonstrate the feasibility of a novel high-resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. STUDY DESIGN: Prospective study. METHODS: Thirty-three asymptomatic adult Japanese controls were studied. A solid-state high-resolution manometry assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 mL of water) pressures at velopharynx, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above-mentioned points of pressure measurement were also measured. RESULTS: The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point in men were 141.1 +/- 73.5 (mm Hg, mean +/- standard deviation) and 162.7 +/- 94.9, 175.3 +/- 59.7 and 182.9 +/- 83.6, 172.7 +/- 73.8 and 236.1 +/- 78.9, and 10.0 +/- 1.3 (cm) and 10.1 +/- 1.4, 14.1 +/- 1.5 and 14.4 +/- 1.3, 17.9 +/- 1.7 and 18.0 +/- 1.4, respectively. Those in women were 118.9 +/- 38.0 (mm Hg) and 124.7 +/- 43.4, 165.9 +/- 41.5 and 167.3 +/- 65.0, 149.2 +/- 68.7 and 243.7 +/- 87.4, and 9.5 +/- 1.2 (cm) and 9.4 +/- 1.2, 13.0 +/- 1.5 and 12.8 +/- 1.4, 15.8 +/- 1.5 and 16.0 +/- 1.3, respectively. The maximum value of resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure and the distance from the nostril to the mid-point of the width of the resting UES pressure in men and in women were 70.2 +/- 30.0 mm Hg, 4.0 +/- 0.7 cm, 19.1 +/- 1.3 cm, and 61.8 +/- 26.7 mm Hg, 3.6 +/- 0.6 cm, 17.0 +/- 1.2 cm, respectively. CONCLUSION: The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies.

A case with sinonasal teratocarcinosarcoma in the nasal cavity and ethmoid sinus.

Sinonasal teratocarcinosarcoma (SNTCS) is a rare and aggressive malignant neoplasm histologically characterized by the combination of one or more epithelial elements and mesenchymal components. We report a 61-year-old man with SNTCS involving left nasal cavity and ethmoid sinus. He complained of left epistaxis for 1 week. Computed tomography and magnetic resonance imaging revealed a soft tissue filling the left middle meatus and ethmoid sinus, and effusion in the left sphenoid sinus but no invasion to the orbit or skull base. Tumor was completely removed with lateral rhinotomy, and post-operative radiation therapy (Liniac 60 Gy) was performed. Follow-up examination for 3 years and 5 months after the radiation therapy has shown no evidence of recurrence or metastasis. This report describes his clinical course, etiology, diagnosis and management of SNTCS with a review of literature.

[Toxic shock-like syndrome presenting as phlegmon of the neck: a case report].

Toxic shock-like syndrome (TSLS) is known to progress rapidly into septic shock and multiple organ failure with necrotizing soft tissue infection and high mortality. We report a rare case of TSLS of the head and neck. A 55-year-old man reporting redness and swelling of the neck and suspected of a deep neck abscess was found in computed tomography and magnetic resonance imaging to have no abscess. Infection spread rapidly and CRP rose while platelets and blood pressure decreased leading us to suspect TSLS. Pus culture yielded Streptcoccus pyogenes, Group A. We administered high-dose penicillin, clindamycin, and gabexate mesilate with intensive supporting care, leading to a successful outcome. TSLS is a life-threatening infection, but early diagnosis and appropriate therapy may reverse this threat.

Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer.

BACKGROUND AND PURPOSE: Metastasis to the regional cervical lymph nodes may be associated with alterations in water diffusivity and microcirculation of the node. We tested whether diffusion-weighted MR imaging could discriminate metastatic nodes. METHODS: Diffusion-weighted echo-planar and T1- and T2-weighted MR imaging sequences were performed on histologically proved metastatic cervical lymph nodes (25 nodes), benign lymphadenopathy (25 nodes), and nodal lymphomas (five nodes). The apparent diffusion coefficient (ADC) was calculated by using two b factors (500 and 1000 s/mm(2)). RESULTS: The ADC was significantly greater in metastatic lymph nodes (0.410 +/- 0.105 x 10(-3) mm(2)/s, P <.01) than in benign lymphadenopathy (0.302 +/- 0.062 x 10(-3) mm(2)/s). Nodal lymphomas showed even lower levels of the ADC (0.223 +/- 0.056 x 10(-3) mm(2)/s). ADC criteria for metastatic nodes (>/= 0.400 x 10(-3) mm(2)/s) yielded a moderate negative predictive value (71%) and high positive predictive value (93%). Receiver operating characteristic analysis demonstrated that the criteria of abnormal signal intensity on T1- or T2-weighted images (A(z) = 0.8437 +/- 0.0230) and ADC (A(z) = 0.8440 +/- 0.0538) provided similar levels of diagnostic ability in differentiating metastatic nodes. The ADC from metastatic nodes from highly or moderately differentiated cancers (0.440 +/- 0.020 x 10(-3) mm(2)/s, P <.01) was significantly greater than that from poorly differentiated cancers (0.356 +/- 0.042 x 10(-3) mm(2)/s). CONCLUSION: Diffusion-weighted imaging is useful in discriminating metastatic nodes.

Vascular permeability to fluorescent substance in human cranial nerves.

It has recently been reported that in the facial canal, the facial nerve shows enhancement on gadolinium-enhanced magnetic resonance imaging in patients with clinically normal facial nerves. However, the mechanism of this enhancement has not yet been sufficiently clarified. The present study investigated the permeability of blood vessels in human cranial nerves that were obtained from surgically treated patients. The patients received an intravenous injection of sodium fluorescein 45 minutes before nerve resection. For histologic observation, the nerves were removed and frozen at -70 degrees C, and the sections were then cut at 4-microm thickness with a freezing microtome. The localization of the tracers was examined with a fluorescence microscope. Fluorescence was observed in the external nerve sheath and slightly in the endoneurium of these nerves, but was not observed within nerve fibers. These findings indicate that the vascular barrier in human peripheral nerves is incomplete.