Although on-the-job training is widely used for training in surgical procedures, due consideration must be paid to medical safety and medical ethics. We conduct an animal laboratory training program using live pigs for the purpose of improving surgical techniques. Here, we investigated the usefulness of this system for total laryngectomy. The subjects were 56 surgeons who performed a total laryngectomy and self-evaluated after training. Eight evaluation factors were considered: identification of the hyoid bone, identification of the thyroid cartilage, identification and cutting of the pharyngeal contractile muscle, identification and cutting of the superior laryngeal nerve, intraoperative tracheostomy and replacement of the intubation tube, preservation of the pharyngeal mucosa and laryngectomy, pharyngeal suture, and creation of a permanent tracheostomy. A comparison was made between physicians with 10 years or less of experience after graduation and those with 11 or more years in practice. There were 39 trainees in the former group and 17 in the latter. Physicians with 11 or more years of experience scored higher in all items, with significant differences especially in the factors of superior laryngeal nerve, laryngectomy, pharyngeal suture, and permanent tracheostomy. Because a pig's larynx is similar to the human larynx, a laryngectomy can be performed in the same manner as with human surgery. Scoring enabled extraction of those factors that younger doctors are relatively less skilled at. We concluded that animal laboratory training offers effective guidance and can make a positive contribution to safer operations in human patients.

Total pharyngolaryngectomy (TPL) is one of the standard treatments for locally advanced hypopharyngeal carcinoma. With TPL, postoperative hypoparathyroidism may occur depending on the extent of the concurrent thyroidectomy and paratracheal dissection. However, postoperative parathyroid function has not been studied in detail. We performed a retrospective study of 53 patients with hypopharyngeal carcinoma who underwent TPL between April 2008 and September 2018. We investigated the effect of thyroidectomy and paratracheal dissection on parathyroid function 3 months after TPL. Occurrence of postoperative hypoparathyroidism was 0% for thyroid lobectomy＋unilateral VI dissection (0 of 4 cases), 36% for thyroid lobectomy＋bilateral VI dissection (5 of 14 cases), and 97% for total thyroidectomy＋bilateral dissection (34 of 35 cases), indicating that the frequency of hypoparathyroidism tended to increase as the range of resection increased. In addition, hypercalcemia and renal dysfunction were observed in 20% of cases with parathyroid correction. Adjustment of the correction drug improved the hypercalcemia in all 8 cases, but renal dysfunction remained in 2 cases. Because patients with corrected parathyroid function may have hypercalcemia and renal dysfunction, it is necessary to continue to control oral administration by blood and urine tests.

We reviewed 22 cases with spontaneous pneumomediastinum in our institution from January 2009 to January 2019. The cases included 17 men and 5 women. The mean age was 20.5 (11-57), and mean BMI was 19 (16-24) kg/m². Five cases had a history of smoking. There was no clear cause in 11 cases, whereas 8 occurred during sports, 2 when coughing, 1 when singing, and 1 while drinking water. The chief complaint was chest pain in 17 cases, pain in the throat in 9, and respiratory discomfort in 1. The mean white blood cell level was 9710±2800/μl, and the CRP level was 0.46±0.86 mg/dl. All cases were diagnosed by CT examination. The mean hospital stay was 3 days, and mean follow-up length was 9.6 days. All cases recovered by conservation without intervention. Cases of spontaneous pneumomediastinum require careful management.

A foreign body caught in the pharynx and esophagus is a relatively common occurrence encountered in ambulatory practice. It can normally be extracted orally or endoscopically, but removal of some types of foreign bodies requires an external incision. For example, while a partial denture with sharp clasp is difficult to remove, removal of a complete denture with no sharp clasp is typically safe. We encountered a patient with a cervical esophageal foreign body consisting of a complete denture with no sharp clasp that required an external incision for its extraction. The patient was reported to have lost her complete denture, which was confirmed by esophageal fiberscopic examination. The denture could not be removed by fiberscopy, however, and trans-oral removal was attempted under general anesthesia. But as the complete denture was cutting into the esophageal mucosa, it would not move. To extract it, an external incision was required. This case confirmed that with a complete denture having no sharp clasp but cutting into the mucosa, removal requires an external incision.

In esophageal cancer cases, there are many cases involving multiple primary cancers, and treatment is often difficult. Cases of synchronous esophageal and renal cancers are rare, however, and there is no consensus on how to treat them. Here, we report a case of unresectable advanced esophageal cancer, oropharyngeal cancer, and renal cancer which was successfully treated with multidisciplinary treatment. A 66-year-old male was diagnosed with advanced esophageal cancer with tracheal invasion. Further examination also revealed oropharyngeal cancer and left renal cancer. As nephrectomy was considered necessary to treat the renal cancer, chemoradiotherapy including 5-FU and cisplatin was performed first to treat the esophageal cancer. After chemoradiotherapy, the esophageal cancer decreased in size-and might be curable with additional therapies; then left nephrectomy was performed. After additional chemotherapies, salvage surgery was performed for the esophageal cancer. To treat the oropharyngeal cancer, chemotherapy markedly reduced its size and a complete response was achieved by additional radiotherapy. Now, 17 months after the initial treatment, the patient is alive and well without recurrence of any cancers. In patients with synchronous renal cancer, it is necessary to conduct well-balanced multidisciplinary treatment, considering the timing of using cisplatin, a key drug in esophageal or head and neck cancers.

Esophageal pulmonary fistula concomitant with advanced esophageal cancer often causes lung abscess and deterioration of respiratory status, and shows poor prognosis. Herein we report a case of esophageal cancer with esophago-pulmonary fistula, and discuss the treatment strategies. The case was initially diagnosed as a lung abscess due to esophago-pulmonary fistula, and was treated with antibiotics. In addition, a nasal drainage tube was inserted into the lung abscess through the fistula. After control of infection, chemoradiotherapy was performed. In this case, the tumor remained unresectable after the treatments, however; there was no fever or recurrence of inflammation due to the esophago-pulmonary fistula. Esophago-pulmonary fistula is a difficult condition with poor prognosis, but radical resection could be possible in some cases with advanced esophageal cancer who responded to chemoradiotherapy and are in good general condition. Treatment strategies for advanced esophageal cancer with esophago-pulmonary fistula should be tailor-made based on the detailed patient conditions.

We report the case of a 65-year-old male who was admitted to our hospital for COVID-19 pneumonia in the early stage of the epidemic. He was treated with tracheal intubation and mechanical ventilation on the 4th day in hospital. His respiratory function did not improve, however, and a tracheostomy was performed in the hospital's negative pressure room on the 16th day in hospital. A dual cannula tube was used for the tracheostomy tube. Management after surgery was performed with the appropriate standard precautions and additional precautions against aerosol infections in consultation with an infection control team. After surgery, the patient's respiratory condition improved and he was removed from the ventilator on the 35th day in hospital. The tracheostomy tube was changed to the speech type on the 38th day, and the tube was removed on the 45th day. In addition, after the tracheostomy a comprehensive evaluation was performed using the Kuchi-kara Taberu (KT) index to assess dysphagia rehabilitation, and on the 22nd day in hospital a small amount of food intake was started. After undergoing swallowing rehabilitation based on a plan, the nasal tube was removed on the 40th day. No nosocomial infections were observed in our medical staff or hospitalized patients during the course. For infection risk management after tracheostomy in patients with COVID-19 pneumonia, it is important to prevent contact infection, droplet infection and aerosol infection as the routes of infection. A dual cannula tube is considered useful for reducing aerosol generation during procedures such as tube replacement.