[in Japanese]

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Objectives : Bilateral vocal cord paralysis caused by central nervous system dysfunction results from such diverse causes as cerebrovascular disorder and neurodegenerative disease. Otolaryngologists are often consulted about indications of tracheostomy for such cases, but if their recognition of causative disease is insufficient, it is difficult to judge indications of tracheostomy. We reviewed tracheostomy cases due to bilateral vocal cord paralysis caused by multiple system atrophy (MSA) and considered points to keep in mind in such cases.
Materials and methods : We diagnosed 9 cases of vocal cord midline fixation due to central bilateral vocal cord paralysis caused by MSA and treated by tracheostomy. We reviewed clinical conditions and suitable time for tracheostomy because it presents a specific clinical course.
Results : 7 cases were MSA-P and 2 cases were MSA-C. Inspiratory stridor in awaking and dysphasia was aggravated at the almost same time in 7 cases.
Discussion : Vocal cord abductor paralysis in MSA may cause sudden death, but when an otolaryngologist not familiar with this disease is asked for air way evaluation, it is possible to be diagnosed as no vocal cord paralysis because there is no an adductor disorder, so clinical course of MSA should be clarified more.
In vocal cord midline fixation, it was expected that intervention by hypermyotony in the progress of Parkinsonism was a main factor, as was vocal cord abductor disorder due to a neurogenic change in the posterior cricoarytenoid muscle in MSA. The aggravation of dysphasia is an important index in judging the indication of tracheostomy.

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Arytenoid cartilage dislocation is a known complication of tracheal intubation and is also a type of laryngeal injury. Although spontaneous recovery has been reported, most patients require reduction via pharyngoscopy under general or neuroleptic anesthesia, and some must be treated by open reduction such as laryngoplasty.
We report 8 cases of arytenoid cartilage dislocation between August 2003 and August 2004. Excluding 3 patients who recovered spontaneously, we conducted reduction under local anesthesia as an ambulatory procedure in the other 5 with anterior dislocation, i.e., 2 men and 3 women aged 53 to 75 years old. Of these 5, dislocation occurred after tracheal intubation in 4, and in 1 after wearing a laryngeal mask. The outcome was favorable in all 5.
Surgery was conducteded after a fiberscope was inserted nasally and a urethral balloon catheter was inserted via the other nasal cavity under topical anesthesia with 4% lidocaine for both nasal cavities and the larynx. While monitoring the larynx, we expanded the balloon and pulled it away from the glottis. The expanded balloon was then placed at the arytenoid region for a few seconds. This procedure was repeated several times to achieve reduction.
Three patients recovered well within 1 to 2 weeks of the first reduction, while 2 requierd a second reduction because of insufficient improvement after the first. These two both showed improved vocal cord movement and recovery from hoarseness within 1 to 2 weeks after the second reduction. We conducted 7 reductions without complications in any patient.
Our approach is usable in the ambulatory setting, and is simple, minimally invasive, and effective. We consider it to be useful treatment for anterior arytenoid cartilage dislocation.

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We report a case of follicular carcinoma of the thyroid gland with concurrent tuberculous lymphadenitises as neck lymph node metastases of thyroid carcinoma. A 71-year-old woman presented with multiple painless masses in the thyroid gland and painless lymphadenopathies in the right neck. She and her family had no previous history of tuberculosis. A diagnosis of thyroid cancer with lymph node metastases was made, and the patient underwent total thyroidectomy with neck dissection. Lymph nodes were hard and severely adhered to the internal jugular vein. The histopathological diagnosis was follicular carcinoma and multiple nodes of adenomatous goiter of the thyroid gland, and tuberculous lymphadenitises of lymph nodes in the right neck. There was no findings of coexisting pulmonary tuberculosis. The possibility of coexisting tuberculous lymphadenitis must thus be ruled out when we find painless lymph node swelling in aged patients with head and neck cancer including thyroid cancer.

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Epstein-Barr virus (EBV) is associated with the development of a variety of highly metastatic carcinomas, including nasopharyngeal carcinoma (NPC). EBV-encoded latent membrane protein 1 (LMP1) is essential for B-cell transformation. In this study, we used two-dimensional differential gel electrophoresis (2D-DIGE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS) to study the mechanism behind tumor invasion and metastasis. Eight proteins, including Vimentin and Ezrin, were identified from the alteration of expressed proteins in HEK-293 cells responding to LMP1 gene transfection. Vimentin is a major protein of the mesenchymal intermediate filament, which maintains the cytoskeleton conformation. Ezrin is also an essential protein that links the cell membrane to the actin cytoskeleton. The up-regulation of Vimentin and Ezrin in the LMP1 gene-transfected cells suggests that EBV LMP1 is involved in the progression and metastasis of NPC.

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