[in Japanese]

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[in Japanese]

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　Oblique reconstruction CT images of frontal sinus drainage pathways were created with ONIS which is free DICOM viewer software. By placing the slice line of the cross sectional image on the drainage pathway of the frontal sinus in the sagittal view, the key oblique CT image could be generated in 96.9% of 65 normal paranasal sinuses that showed the frontal sinus and its drainage pathway simultaneously in one slice. The route of the drainage pathway was divided by the line of the uncinate process, and three variations were defined as follows: (1) inside, (2) outside to inside, and (3) outside. Additionally, three variations of the upper attachment site of the uncinate process were defined as follows: (1) outside: orbital wall, (2) upside: skull base or intersinus septum of the frontal sinus, and (3) inside: middle turbinate. The uncinate process was attached to the “outside” in 66.7%, and all of them had the “inside” pathway of drainage. The rest of them in whom the uncinate process was attached to the “upside” or “inside” had a drainage pathway of “outside to inside” or “outside.” The anatomical relations between the frontal sinus and the anterior ethmoid cells such as agger nasi cell, frontal ethmoidal cell and intersinus septal cell were reasonably explained with these variations in the drainage pathway. The key oblique CT image showing the frontal sinus drainage pathway is the imaginary plane of the surgical pathway of instruments while they are inserted into the frontal sinus. Therefore, using the oblique CT image together with the sagittal CT image, we can get valuable information about the three dimensional anatomy of the frontal sinus before and during frontal sinusotomy.

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　The aim of this study was to investigate distinctive change in the hearing impaired elderly listeners, especially about speech recognition. Subjects were 525 patients (235 males, 290 females), from 60 to 98 years of age who had visited the Hearing Aid Clinic of Otorhinolaryngology, National Center for Geriatrics and Gerontology Hospital, between June 2001 and December 2012. Pure-tone air conduction threshold determination was administered to each subject. The speech audiometry materials used to define speech discrimination ability were Japanese monosyllabic word lists, 67S word lists. Sex- and age-specific trends in maximum discrimination score (MDS) and rollover index (RI) were shown in this study. RI was computed by the formula (PBmax-PBmin)/PBmax. PBmax has almost the same meaning as MDS in Japan. PBmin represented the lowest PB score above the test intensity level of PBmax. Mean MDSs were 80.8% in their sixties, 75.3% in their seventies, 60.7% in their eighties, and 45.5% in their nineties. The rate of decrease in mean MDS per decade accelerated in the older generation. Mean RIs were 0.18 in patients in their sixties, 0.24 in their seventies, 0.30 in their eighties, and 0.30 in their nineties. It increased until the age of eighties. In the model 1, multiple logistic analyses were performed to examine the effect of age (in 10-year increments), sex and mean hearing levels in pure tone average of values at 500, 1000, 2000, 4000 Hz (in 10 dB increments) on the MDS<60%. Significant associations were observed between MDS<60% and age (odds ratio, 3.03; 95% confidence interval, 2.38 to 3.85), and mean hearing levels in pure tone average of values at 500, 1000, 2000, 4000 Hz (2.33; 2.03 to 2.68). Sex was not associated with MDS<60%. In the model 2, multiple logistic analyses adjusted for age and sex were performed to examine the effect of hearing level at test frequencies of 125, 250, 500, 1000, 2000, 4000, and 8000 Hz(in 10 dB increments)on the MDS<60%. Significant associations were observed between MDS<60% and hearing level at 250 Hz(2.04; 1.44 to 2.89), and 2000 Hz(1.46; 1.16 to 1.83), and 4000 Hz(1.24; 1.02 to 1.50). These outcomes suggest that the important point in qualifying the fitting of hearing aid is to present the list words at an adequate sound pressure level for evaluation of speech understanding especially in the hearing impaired elderly listeners.

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　It is often difficult to decide whether to restart an oral diet during acute hospitalization. We investigated retrospectively the predictive factors for successful oral intake after discharge from an acute care hospital or transfer to a recovery rehabilitation hospital.
A total of 45 inpatients were enrolled, presenting with dysphagia due to various diseases during hospitalization in an acute care hospital. Between October 2011 and December 2012 the patients were examined with a videoendoscopic examination of swallowing (VE). We classified the feeding procedure after discharge from the hospital into three groups-the first group (group 1) had no oral intake limitation, the second group(group 2) had limited oral intake, and the third group (group 3) had no oral intake ability. We then assessed the factors of age, sex, VE score, and functional independence measure (FIM) score to compare the activities of daily living (ADL) between group 1 and group 2+3. FIM score consists of motor and cognitive scores.
We observed a statistically significant difference in age, VE score, motor FIM score and cognitive FIM score in a univariate analysis (p=0.03, p=0.0036, p=0.0019, p=0.0125). The VE score also showed a statistically significant difference in a multivariate analysis (p=0.0396), indicating that the VE score was an independent variable related to prediction of the feeding procedure. A VE score of 4 as the cut-off point between group1 and group 2+3 provided a specificity of 0.944 and a positive predictive value of 0.923. On the other hand, a VE score of 9 as the cut-off point between group 3 and group 1+2 provided a specificity of 0.969 and a positive predictive value of 0.857.
These results indicate that the VE score is a useful tool for the prediction of successful oral intake after discharge from an acute care hospital. In addition, age and ADL are also useful predictive factors for the feeding procedure.

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　In a taste disorder, an agreement between patients' complaints and gustatory function test results is not necessarily found both at the initial hospital visit and during the course of treatment; therefore, it is difficult to assess treatment responses and review treatment strategies based on the assessed treatment responses. The present study investigated the time course of changes in disc gustometry results and subjective symptom scores measured at 4-week intervals in 44 patients with a taste disorder who were considered eligible for zinc replacement treatment and who received polaprezinc at a dose of 150mg/day (equivalent to a 34mg/day dose of zinc) for up to 24 weeks. The study also examined the potential differences in treatment outcomes according to the predictive factors for response such as patient background and assessed disc gustometry results during the course of treatment. Results indicated that disc gustometry results and subjective symptom scores showed different time courses of changes. The response rate as measured by disc gustometry was 47.7% at week 12 of treatment, and showed a subsequent slow increase to 56.8% at week 24. On the other hand, subjective symptom scores showed a time-proportional improvement up to week 24. Among the patients included in the present study, a clear difference was found according to the presence or absence of an improving trend as determined by disc gustometry at week 12 of treatment, although there were no differences in ultimate treatment responses, including categories of taste disorder, according to patient background. Patients showing a trend toward improvement had significantly better treatment responses in terms of both ultimate response rates and subjective symptom scores, whereas patients showing no trend toward improvement were less likely to respond to the subsequent 12-week continued treatment.

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　We encountered a 38-years-old female patient who was complaining of an unpleasant sensation of the left cervical area due to a recurrent tumor originating from the middle pharynx. She had a history of surgically resected neurofibroma and lipoma from the anterior oropharyngeal wall respectively 5 years and 11 years previously. The preoperative diagnosis of a benign, non-epithelial neoplasm was made based on the imaging studies and surgical treatment was scheduled. An extended surgical resection of the middle pharynx including normal mucosa and a part of the tongue base was successfully accomplished. To cover the pharyngeal defect, a right antero-lateral thigh musculo-cutaneous flap was used for reconstruction. Microscopically, the surgically resected tissue showed a mixed condition of mature cartilaginous, bony and fibroadipose tissue without atypia. The final diagnosis was a benign mesenchymoma which was thought to have developed from pluripotential mesenchymal cells. We considered that the past tumorous lesions had possibly originated in those cells. Because pluripotential mesenchymal cells cannot easily be identified with ordinary histopathological examination, the determination of optimal surgical margins is difficult. In the case of mesenchymoma, substantial marginal tissue should be resected in order to prevent recurrence even in the case of a pathologically-proven benign tumor.

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　Salivary duct carcinoma is a malignant salivary neoplasm with a poor prognosis. Effective treatment for remote metastases has not been recognized. We report herein on a case of this tumor overexpressing HER2 successfully treated with trastuzumab-based molecular targeted therapy. The patient was a 69-year-old man, who developed remote metastases into the liver and the thoracic vertebra six months after surgery and postoperative irradiation for the primary and nodal lesions. After targeted therapy including paclitaxel and trastuzumab, these metastatic lesions showed rapid and continued regression. After paclitaxel was discontinued due to peripheral neuropathy in the extremities, trastuzumab monotherapy followed without resulting in cardiotoxicity. After three years since development of remote metastases, the patient is doing well without re-progression of the disease.

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　Cervical major blood vessel injuries often produce acute ingravescence of the circulatory dynamics. Therefore, if immediate treatment is not given, fatal complications can occur, resulting in death. Common carotid artery (CCA) injuries in particular are often associated with fatal outcomes. Moreover, most CCA injuries with hemorrhage producing hematoma are the result penetrating trauma, and there are few reports of blunt injuries. We report herein on a case of blunt CCA injury producing acute hematoma due to minor trauma. A 35-year-old man who was gently punched on his jaw when he was training with his child visited emergency room in our hospital complaining of swelling and pain of his neck soon after that. When we examined his neck, the larynx was displaced to the left by right neck swelling. Flexible transnasal laryngoscopic examination revealed constriction of the suffocating airway by a hematoma, so an emergency tracheotomy was performed. Enhanced CT of the neck showed active bleeding, so emergency surgical removal of the hematoma and hemostasis was carried out. We found a laceration (approximately 2cm) of the CCA, and arrested hemorrhage with sutures. No postoperative neurologic deficit occurred. His postoperative course was good, and discharged 22 days after the operation.

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　The use of drug-eluting stents (DES) has been spreading worldwide to treat coronary heart disease. Patients treated with DES need long-term dual antiplatelet therapy with aspirin and thienopyridine to prevent stent thrombosis. Perioperative management is important to prevent postoperative complications in thyroid surgery if thyroid surgery is considered in patients who have been treated with DES. However, no evidence exists regarding the safety of perioperative management in patients treated with DES. We reviewed two cases of patients undergoing thyroid surgery after DES implantation. In the two cases, our protocol was adopted for perioperative management, and postoperative complications were assessed. Our thyroid surgeries were performed safely and free from serious complications such as stent thrombosis and postoperative bleeding. Under our protocol, patients after DES implantation were safely treated without severe complications. We believe that our protocol for perioperative management is useful for thyroid surgery.

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　The presence of hearing impairment deteriorates patients' quality of life by affecting their daily-life communication. Several self-report assessments are available to evaluate the subjective outcome of hearing aids, however, the procedures to evaluate the impairment of communication induced by hearing impairment has not been well established.
A PC-recorded audio file prepared to evaluate the communication ability of hearing aid users, by extracting fifteen spoken language items from the Communication ADL Test: sp-CADL. A before and after study was performed among the hearing aid users who were attending Okayama University Hospital to evaluate the improvement in each of the 15 sp-CADL scores. Twenty-one adults were included in this study whose age ranged from 22 to 83 years old (mean: 56.7 years old). The total and individual scores of the sp-CADL improved significantly after the use of the hearing aids (p<0.05). The total sp-CADL score of the patients with hearing aids showed a good correlation with the best scores of the speech discrimination test measured before wearing hearing aids. CADL may be used for measuring communicative outcomes in patients using hearing aids.

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