Objective: Thrombocytopenia correlates with heavy alcohol use, liver disease, preoperative treatment, and hematological disorder, and can adversely affect surgical outcomes. However, to the best of our knowledge, the effect of thrombocytopenia on short-term and long-term outcomes after esophagectomy has never been discussed. Methods: A total of 570 esophagectomies for esophageal cancer performed between April 2005 and September 2017 at Kumamoto University were included in this study. According to the number of platelets pretreatment, patients were divided into three groups: ＜130,000, 130,000 to 350,000, and ＞350,000. Short-term and long-term outcomes were retrospectively compared among the groups. Results: The low platelet count group was significantly associated with frequent liver comorbidity, greater intraoperative bleeding, and poor overall survival. Multivariate analysis suggested that thrombocytopenia is one of the independent prognostic factors for unfavorable overall survival (Hazard ratio 2.41, 95% confidence interval (1.370-4.219), p=0.002). Conclusions: Thrombocytopenia is associated with poor physical status and can be a cause of unfavorable prognosis after esophagectomy for esophageal cancer.

Background: Allergy to house dust mites (HDMs) is a major cause of asthma, and reducing HDMs may effectively control asthma. This study examined the effectiveness of using professional cleaning on management of childhood asthma. Methods: A total of 24 asthmatic children sensitized to HDMs were randomly placed into either a professional-intervention group (professional group; n=13) or parent-intervention group (parent group; n=11). In the professional group, cleaners removed HDMs and educated the residents on the best method. In the parent group, parents cleaned their homes in their usual fashion. For both groups, measurements were taken pre- and post-intervention using a childhood asthma control test (cACT), blood eosinophil count, and serum total IgE level. Results: cACT scores improved in the professionally cleaned group, whereas the eosinophil count (p<0.05) and IgE level (p<0.01) significantly increased in the parent-cleaned group. Conclusions: Reducing allergens professionally may improve childhood asthma control.

Among phonosurgeries for unilateral vocal cord paralysis, arytenoid adduction (AA) is theoretically nearest to physiological vocal cord adduction. Posterior glottic gap and vocal cord level difference can be corrected by AA; however, because AA is not very effective for vocal fold bowing, in many cases it is combined with thyroplasty type I (TPI). We have normally treated unilateral vocal cord paralysis by vocal fold injection laryngoplasty with calcium phosphate paste (BIOPEX^®). This surgery was considered to have similar effect to TPI via transoral approach. But in cases of patients with a large posterior glottal gap or vocal cord level difference, this surgery may be insufficient for full phonetic improvement. In this article we reported two cases of severe dysphonia caused by unilateral vocal cord paralysis treated by a combination of injection laryngoplasty with BIOPEX^® and AA. Both patients had a large posterior glottic gap, vocal cord level difference, and short maximum phonation time (MPT) of less than 3 seconds. After this surgical procedure, MPT improved to 12 seconds in both patients. In cases of severe dysphonia caused by unilateral vocal fold paralysis, AA with TPI under local anesthesia is one treatment of choice. However, when patients want surgery under general anesthesia, it is difficult to adjust vocal cord medialization by TPI due to poor visualization. In cases of BIOPEX^® injection under general anesthesia and suspension laryngoscopy, vocal cords were extended and fully visualized. This surgical approach is therefore suitable in combination with AA under general anesthesia. For patients who are indicated for AA and want general anesthesia, vocal fold injection with BIOPEX^® may be one viable choice as combination surgery.

We encountered two cases of herpes zoster laryngitis presenting with persistent hiccups accompanied by dysphagia. Case 1 was a 59-year-old male patient complaining of sore throat and dysphagia. On laryngeal endoscopy, a laryngeal lesion which manifested itself as white mucosal plaque was attached on the right side of the laryngeal aspect of the epiglottis and right arytenoid. His right vocal cord was fixed at the paramedial position. Case 2 was a 69-year-old male patient manifesting left facial weakness after onset of sore throat and dysphagia. He showed severe facial paralysis accompanied with herpetic eruption on the left auricular skin. On laryngeal endoscopy, a laryngeal lesion which manifested itself as white mucosal plaque spread over the left side of the laryngeal aspect of the epiglottis and arytenoid. The left vocal cord was fixed at the paramedial position. After dysphagia was improved in both patients, persistent hiccups were observed. Videofluorographic examination was performed to assess their swallow function, and stagnation of the contrast media was clearly observed near the esophagogastric junction. Although the hiccups were resistant to several drugs, this symptom went away on its own after 11 days in Case 1, and after 18 days in Case 2. We reexamined problems in primary care of herpes zoster laryngitis based on knowledge in the literature. In addition, we examined the pathophysiology of the lower esophagus in cases of varicella zoster virus infection, along with anatomical and physiological aspects of the developmental mechanism of persistent hiccups.

When conducting laryngeal preservation surgery for advanced cervical esophageal carcinoma extending to the high region (i.e., adjacent to the larynx), it is important to make a comprehensive assessment of the social background of the patient in addition to the clinical factors. Here we report our treatment experience with a complicated case for which preservation of vocal function was feasible. The patient was in her early twenties and demonstrated several serious issues: ①her aim was to become a singer and, presently in a hikikomori state, singing was her only perceived reason to live; ②height 162 cm, body weight 115 kg, and BMI 43.8; ③from just beneath the cricoid cartilage to the thoracic esophagus, a circumferential tumor with high-grade stenosis and involvement of the membranous part of the trachea was observed (cT4) and water intake was not possible; ④synchronous right tonsillar cancer (T1); and⑤the patient strongly wanted to preserve vocal function. Radiation to esophagus 45 Gy and pharynx 70 Gy was administered concomitantly with chemotherapy (5-FU+cis-platinum×3). For surgery, 30 kg of body weight reduction was achieved and the oropharyngeal and esophageal tumors shrank respectively to PR and CR. After confirming a mental support system on our multi-disciplinary cancer board, we conducted the surgery. Fortunately, vocal function was preserved without paralysis of the recurrent nerve. We deeply realized the difficulty of pursuing functional preservation and survival at the same time.

Granulation and edema in the trachea sometimes occur after head and neck surgery. They usually cause airway stenosis and pneumonia. We treated three cases of granulation and edema in the trachea with local injections of triamcinolone acetonide. Case 1 was a 50-year-old female with thyroid cancer. Her thyroid and part of the trachea were surgically removed. After that, granulation in the trachea was observed. It disappeared with local injections administered three times. Case 2 was a 71-year-old male with laryngeal cancer. He underwent a total laryngectomy and tracheoesophageal (TE) shunt insertion. Afterwards, granulation around the voice prosthesis appeared. We changed the length of the voice prosthesis several times but these adjustments failed to make the granulation disappear. We therefore treated it with local injections three times, which resulted in disappearance of the granulation. Case 3 was an 81-year-old male with recurrent aspiration pneumonia caused by multiple system atrophy. He could take some food orally after TE diversion performed twice and closure of the TE fistula. Subsequently, the rear wall of the trachea appeared edematous and airway stenosis was revealed. It disappeared after two treatments with local injections.