Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
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Volume 117, Issue 12
Displaying 1-18 of 18 articles from this issue
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Review article
Original article
  • A Middle to Long Term Clinical Study on Pars Flaccida and Pars Tensa Cholesteatoma Using Survival Analysis
    Yukihiro Somekawa, Tsutomu Nagashima, Tomoyuki Masaki, Katsuji Asano, ...
    2014 Volume 117 Issue 12 Pages 1448-1456
    Published: December 20, 2014
    Released on J-STAGE: January 19, 2015
    DOIhttps://doi.org/10.3950/jibiinkoka.117.1448
    JOURNAL FREE ACCESS
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    　The current clinical study was performed on 311 cases of pars flaccida and 89 cases of pars tensa cholesteatoma which were treated with canal wall reconstructed tympanoplasty between 1991 and 2012. The average follow-up time of these patients was 5.3 years.
    　Since follow-up periods were different in each case and some censored patients were involved, we used survival analysis on this study to discuss the cumulative rates of disease-free successful cases and the rates of recurrent cholesteatoma throughout the postoperative course.
    　The disease-free successful cases were defined as those cases in which patients were both out of re-operation with recurrent and residual cholesteatoma and out of revision operation with another problem, furthermore, maintained good hearing outcome. Based on the criteria set by the Japan Otological Society (2010), the cases that satisfied the following were evaluated as good hearing results; (a) a successful case in which preoperative bone conduction was used, and (b) a case in which the postoperative air-bone gap was within 20dB after tympanoplasty for chronic otitis media. The analysis results were shown for each of (a) and (b).
    　1. In pars flaccida cholesteatoma, the 5-year survival rate of successful case was (a) 76.1% and (b) 83.9%, the 10-year survival rate was (a) 58.9% and (b) 73.0%. In pars tensa cholesteatoma, the 5-year survival rate of successful cases was (a) 57.7% and (b) 63.5%, the 10-year rate was (a) 42.1% and (b) 56.9%. A significant difference was seen between pars flaccida and pars tensa cholesteatoma (p<0.001).
    　2. In pars flaccida cholesteatoma, the 5-year recurrence rate was 7.6% and the 10-year rate was 15.3%, and the recurrence rate increased gradually throughout the follow-up period. On the other hand, in pars tensa cholesteatoma, the increase in the recurrence rate reached a peak 15.8% at 5.5 years after the surgery.
    　A long term follow-up is necessary when evaluating the clinical results after tympanoplasty.
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  • Preoperative Evaluation of Surgery for Intractable Aspiration Based on the Prognostic Nutritional Index
    Masaya Uchida, Keiko Hashimoto, Shigeyuki Mukudai, Chihisa Ushijima, K ...
    2014 Volume 117 Issue 12 Pages 1457-1462
    Published: December 20, 2014
    Released on J-STAGE: January 19, 2015
    DOIhttps://doi.org/10.3950/jibiinkoka.117.1457
    JOURNAL FREE ACCESS
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    　Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patient's preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients.
    　In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI.
    　Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01.
    　A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower.
    　Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable aspiration. Based on the O-PNI score, it was possible to evaluate the survival benefit associated with this operative procedure. We showed a treatment algorithm based on the preoperative O-PNI value. We believe there is a necessity to develop preoperative effective nutritional therapy as a future issue.
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  • A Clinical Study of Cases Diagnosed as Being Oropharyngeal Carcinoma after Cervical Mass Extirpation/Biopsy
    Takatsugu Mizumachi, Satoshi Kano, Tomohiro Sakashita, Hiromitsu Hatak ...
    2014 Volume 117 Issue 12 Pages 1463-1470
    Published: December 20, 2014
    Released on J-STAGE: January 19, 2015
    DOIhttps://doi.org/10.3950/jibiinkoka.117.1463
    JOURNAL FREE ACCESS
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    　In the case of oropharyngeal carcinoma, patients may present with symptoms similar to cervical lymphadenopathy, and the primary lesion may only be diagnosed after cervical mass extirpation/biopsy. We retrospectively analyzed the clinical course in 11 oropharyngeal carcinoma patients that were diagnosed after cervical mass extirpation/biopsy between 1998 and 2013. Before the diagnosis was made of oropharyngeal carcinoma, a cervical lymph node biopsy was performed in six patients; the lymph node was extirpated due to an initial diagnosis of lateral cervical cyst in four patients; and neck dissection was performed due to an initial diagnosis of primary unknown carcinoma in one patient. The primary tumor site in the oropharynx was the palatine tonsil in six patients and the lingual tonsil in five patients. Five of six patients with palatine tonsil carcinoma and three of five patients with lingual tonsil carcinoma were found to be positive for human papillomavirus (HPV). The duration from cervical lymph node extirpation/biopsy to final diagnosis was 1 to 13 months. All patients finally underwent radiation therapy or chemoradiotherapy, and they had no recurrence or metastasis. As the incidence of HPV-related oropharyngeal carcinoma increases, the number of oropharyngeal carcinomas assumed to be cervical lymphadenopathy due to the presenting symptoms may increase. It is important to investigate the oropharynx thoroughly so as to adequately differentiate the possibility of oropharyngeal carcinoma from that of cervical lymphadenopathy. Metastatic lymph nodes might present as cysts in cases of oropharyngeal carcinoma, it is therefore necessary to take the potential for metastatic lymph nodes in the oropharyngeal cancer into consideration when differentiating this disease from cervical cyst-shaped lesions.
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  • A Case Report: Primary Nasal Tuberculosis
    Hiroko Koda, Nao Makino, Masatoki Takahashi, Natsuko Kurata
    2014 Volume 117 Issue 12 Pages 1471-1476
    Published: December 20, 2014
    Released on J-STAGE: January 19, 2015
    DOIhttps://doi.org/10.3950/jibiinkoka.117.1471
    JOURNAL FREE ACCESS
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    　A 62-year-old female visited us complaining of lacrimination and the swelling of the left side of the nasal dorsum. Granulation tissues were seen on the anterior-lateral wall of the left nasal cavity, and an imaging study revealed a mass occupying both the left nasal cavity and the anterior ethmoid sinuses invading the face with erosion of the nasal bone. Histological examination showed an epithelioid granuloma without caseous necrosis which mostly suggested sarcoidosis. The affected lesions became larger 11 months after the initial examination, and a biopsy was performed again, which revealed the same pathological findings. Although the biopsy specimen was negative based on the PCR findings, tubercle bacillus was detected in the culture 7 weeks later. The patient was finally diagnosed as having primary tuberculosis of the nose and paranasal sinuses because systemic examination showed no evidence of tuberculosis in other areas. She was treated with antituberculosis medication, and the affected nasal lesions disappeared. It is important to perform a biopsy and tissue culture repeatedly when we encounter an intractable and undiagnosed disease in the nasal cavity.
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  • A Case of Intraorbital Solitary Fibrous Tumor Resected Successfully with Preoperative Arterial Embolization
    Ippei Kishimoto, Shogo Shinohara, Keizo Fujiwara, Masahiro Kikuchi, Ri ...
    2014 Volume 117 Issue 12 Pages 1477-1482
    Published: December 20, 2014
    Released on J-STAGE: January 19, 2015
    DOIhttps://doi.org/10.3950/jibiinkoka.117.1477
    JOURNAL FREE ACCESS
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    　The solitary fibrous tumor (SFT) is a rare spindle cell neoplasm derived from mesenchymal cells. It sometimes recurs clinically, and is categorized as an‘intermediate malignancy’ tumor under the WHO (World Health Organization) classification of soft tissue tumors. Several studies have reported on intraorbital SFTs, but none of them has pointed out the utility of preoperative arterial embolization in the case of an intraorbital SFT. A 75-year-old man, who had received a dacryocystectomy for a benign tumor in the right lacrimal sac 30 years previously, visited our hospital complaining of lower eyelid swelling and lachrymation that had persisted for a year. CT and MRI revealed an intraorbital lesion, and the open biopsy specimen showed dense growth of spindle cells, which turned out to be an SFT by immunohistochemistry based on the findings. After preoperative embolization of the infraorbital artery, we removed the tumor with a skin incision on the lower rim of the orbit with little bleeding. The surgical specimen revealed that the tumor was close to a lacrimal canaliculus, which suggested the tumor originated from the lacrimal apparatus considering the patient's past history. He was followed up for three months without recurrences.
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