[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Objective: To evaluate the objective and subjective improvement after multilevel surgery, genioglossus advancement (GA) plus uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea syndrome (OSAS).
Methods: GA and UPPP were undertaken in 24 patients with moderate and severe OSAS between January 2006 and December 2011. Epworth Sleepiness Scale (ESS) score, snoring, the feeling of having slept well and polysomnography were used for the evaluation of surgical outcomes. In addition, we determined whether baseline polysomnography, cephalometry, and authropometry data could predict GA and UPPP success or failure.
Results: The mean ESS score decreased significantly from 12.96 to 7.08. The mean apnea-hypopnea index (AHI) improved from 37.3 to 19.33. Objective success as evaluated by a 50% reduction in AHI or by AHI<15 was obtained in 16 of 24 patients. The lowest oxygen saturation and stage 1 and stage 2 were also improved significantly. There were no major postoperative complications. There were significant differences in SNA, SNB, FX and PNS-P between the success and failure of GA and UPPP. The indication of GA and UPPP were SNA>79.11 degrees, SNB>75.69 degrees, FX>78.67 degrees, and 36.79 mm<PNS-P<42.29 mm.
Conclusion: GA and UPPP surgeries are effective and safe for patients with moderate and severe OSAS. However, further studies are necessary to decide definitively if GA and UPPP are appropriate treatments for OSAS.

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Occurrence of airborne pollen in Sapporo has been studied for 19 years during the period between 1995 and 2013. There are wide year-to-year variations in the quantities of birch pollens. A simple linear regression with the least squares method was used for studying correlations between the annual quantities of birch pollens and the meteorological factors. A significant positive correlation was found between the hours of sunlight in June of the preceding year and the annual birch pollen concentrations with the correlation coefficient, R = 0.667. Also, we found the significant positive correlation between the hours of sunlight in March and the annual birch pollen concentrations with the correlation coefficient, R = 0.684. These results suggest that the atmospheric birch pollen counts can be predicted from meteorological factors.

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We retrospectively reviewed the records of the 30 patients with adenoid cystic carcinoma of the head and neck (ACCHN) who had undergone initial treatment in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1988 and 2007. The primary tumor site was the parotid gland in 10 patients and the submandibular gland in 4 patients, which account for about a half of the subjects. Thirty patients underwent surgical resection with curative intent as the primary treatment, of which 10 patients had post-operative radiotherapy. The 5-and 10-year disease-specific survival (DSS) was 73.9% and 62.4%, respectively, whereas the 5-and 10-year disease-free survival (DFS) was 64.3% and 59.7%, respectively. A univariate analysis revealed that DSS was significantly correlated with perineural invasion (p = 0.010) and lymphatic invasion (p = 0.036), while DFS was significantly correlated with higher T-stage (p = 0.044), a positive surgical margin (p = 0.012) and perineural invasion (p = 0.019). A multivariate analysis demonstrated that perineural invasion (p = 0.034, risk ratio = 9.530) was the independent prognostic factor for DSS, whereas for DFS it was a positive surgical margin (p = 0.038, risk ratio = 8.897). The histological grade classification, defined specifically for ACC, showed no correlation with the survival. Extended resection with wider margin and additional resection in cases with positive margin may improve treatment results, however, surgical resection alone can prevent neither the development of local recurrence mainly attributed to undetectable perineural invasion, nor that of delayed distant metastasis. Therefore, the roles of adjuvant radiotherapy and effective systemic therapies are also significant in ACCHN, although a reliable regimen for the latter has not yet been established. Development of a personalized strategy for the adjuvant therapy, which should be based on the accurate prediction of the long-term prognosis in combination with dependable molecular biomarkers, would be indispensable in the future to improve the clinical outcome of the patients with ACCHN.

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The olfactory neuroblastoma, first described in 1924, is a rare tumor arising from the olfactory epithelium. Because of its rarity, it is difficult to accrue a large individual series. To elucidate the characteristics of olfactory neuroblastomas in Japan, we report herein on our institutional experience of 14 cases and reviewed 104 cases reported from Japan. In our cases, one out of nine surgically treated patients died during treatment and the remaining 8 patients are alive without disease. Among the five non-surgically treated patients, four patients experienced local treatment failure and the other one patient died of metastasis. In the 104 Japanese cases, 54 patients were treated with multimodality treatment including surgery and radiation. The 3-year overall survival rates for surgically treated patients and non-surgically treated patients were 85% and 73%, respectively. The prognostic factors for survival were modified Kadish stage, Hyams' grade and surgical treatment. Further investigation is required for the validation of endoscopic resection.

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OBJECTIVE: The purpose of this study was to comparatively assess the diagnostic accuracy between ¹³¹I SPECT/CT and ¹³¹I whole-body scintigraphy (WBS) in differentiated thyroid carcinoma outpatients following radioablation.
METHODS: a retrospective cohort study was performed in eleven patients with differentiated thyroid carcinoma (fourteen studies), who underwent both ¹³¹I WBS and ¹³¹I SPECT/CT, 7-10 days after administration of 1,110 MBq of ¹³¹I for radioablation, following a total thyroidectomy. A head and neck surgeon and two nuclear medicine specialists first interpreted the WBS images, followed by SPECT/CT images.
RESULTS: SPECT/CT led to accurate revisions of the first diagnoses in 13 of 24 cervical foci of ¹³¹I uptake on WBS. Out of the 5 distant lesions, which were diagnosed as metastases by WBS alone, 5 (100%) were found out to be benign lesions by SPECT/CT. Thus, WBS was prone to be false-positive both in detecting cervical node metastases (13/28, 46.4%) and distant metastases (5/17, 29.4%). Eventually, SPECT/CT after ¹³¹I radioablation altered postoperative patients' management in 42.8% of patients with thyroid carcinoma by upstaging or down-staging their disease.
CONCLUSION: SPECT/CT after ¹³¹I radioablation for differentiated thyroid cancer patients determines more accurately cervical lymph node metastasis, thyroid remnants and distant metastasis than does WBS alone. Both WBS and SPECT/CT after ¹³¹I radioablation are highly recommended for appropriate management of differentiated thyroid cancer patients who have undergone a total thyroidectomy.

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Background: Pollinosis caused by the pollen of Sugi (Cryptopmeria japonica) trees is the most significant allergic disease occurring in the spring in Japan. For pollinosis patients and medical staff, it is important to know when the pollen dispersion would reach maximum or when the pollen count would decrease as well as knowing what would the total density of pollen grains be. These sorts of information could be useful for the purpose of disease prevention and deciding on the therapeutic regimen. In this study, we presented the sugi-dispersal patterns and cited several examples of the dispersal pattern.
Methods: Airborne pollen grains were collected using a Durham sampler. Total annual pollen counts/cm² were examined. The sugi-dispersal patterns were classified into several groups by cluster analysis using variables of ten days pollen counts distribution from February to April for the past 26 years. (1987-2012).
Result: The annual pollen count revealed an alternate rhythm consisting of an “on” year (high pollen count) and an “off” year (low pollen count). The results of the cluster analysis showed eleven off-years classified as one group (group 1), and fifteen on-years classified into three groups (groups 2A, 2B, and 2C).
The dispersal pattern in group 1 was almost symmetrical with the pollen count rapidly decreasing until late-March. On the other hand, the patterns in group 2 were asymmetrical. In group 2A and 2B a high rate of dispersion was indicated after maximum dispersion, whereas in group 2C the high rate of dispersion was indicated before maximum dispersion. In group 2A, a major dispersion of almost 3000 grains was noted in late-March, and immediately proceeded to the cypress (Chamaecyparis) pollen season without any decrease seen in pollen dispersion.
The periods of dispersion of over 10 pollen grains/cm² per day were 38, 47, 47 and 51 days in groups 1, 2A, 2B and 2C, respectively. That in group 2 was significantly longer than that in group 1, but there was no significant differences between groups 2A, 2B and 2C.
Conclusion: In conclusion, in the dispersal pattern whereby a major dispersion was seen in late-March and proceeded to the cypress pollen season such as in group 2A, patients' symptoms might be prolonged or be more serious. This new concept of dispersal pattern could very well be useful for clinical management of pollinosis.

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