Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
Volume 121, Issue 12
Displaying 1-19 of 19 articles from this issue
Review article
Original article
  • ―Usefulness of Preoperative CT Evaluation―
    Minako Hisamitsu, Yuichiro Otsuka, Urara Funakoshi, Akiko Shimada, Toy ...
    2018 Volume 121 Issue 12 Pages 1479-1485
    Published: December 20, 2018
    Released on J-STAGE: January 16, 2019
    JOURNAL FREE ACCESS

     Recently, endoscopic modified medial maxillectomy (EMMM) has been performed as treatment for tumors of the maxillary sinus. In EMMM, when the anterior wall of the maxillary sinus is preserved, injury to the anterior superior alveolar nerve (ASAN) is unlikely, in contrast to the case during the Caldwell-Luc and Denker's operations, which have been the conventionally adopted procedures. We encountered a case in which injury of the ASAN was confirmed during EMMM. The ASAN is located in a bony canal or sulcus structure in the anterior wall of the maxillary sinus, called the canalis sinuosus (CS). In many cases, the CS is detectable on high-resolution CT images. We performed CT image analysis of 40 maxillary sinuses in 20 patients (10 males, 10 females), to examine the CS structure and risk of ASAN injury during EMMM. In 10 sinuses, the total canal structure of the CS was identified, and in these cases, the canal was considered to be fully covered by the bone: such cases are considered to be at a lower risk for ASAN injury during EMMM. However, in 5 of these 10 sinuses, the CS was located in the septa of the maxillary sinus, which are usually removed during sinus surgery; therefore, the risk of injury to the ASAN is considered to be higher in such cases. In 25 sinuses, the canal structure of the CS was partially defective, and in 5 sinuses, the CS was undetectable. In the latter 30 sinuses, the ASAN is considered to be more exposed in the maxillary sinus, with a greater risk of injury to the nerve during EMMM.

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  • Akihisa Tasaki, Taro Sugimoto, Takuro Sumi, Yusuke Kiyokawa, Fuminori ...
    2018 Volume 121 Issue 12 Pages 1486-1492
    Published: December 20, 2018
    Released on J-STAGE: January 16, 2019
    JOURNAL FREE ACCESS

     The objective of this study was to evaluate the adverse events and efficacy of treatment with the combination regimen of docetaxel, cisplatin, and 5-fluorouracil (TPF) in patients with head and neck cancer.

     We retrospectively analyzed the data of 82 patients with locally advanced head and neck cancer who underwent treatment with TPF between January 2012 and December 2014. We investigated the early and late toxicities and efficacy of the treatment. The 3-year overall survival rate was 70.7%, the locoregional control rate was 64%, and the disease-free survival rate was 62.8%. Grade≧3 neutropenia was observed in 82.9% of the patients (n=68) and febrile neutropenia (FN) was observed in 51.2% of the patients (n=42). The late toxicity rate may be lower than that reported previously.

     TPF-CCRT treatment compared rather favorably with CDDP-CCRT treatment. The incidence of FN was higher than 20%, and the prophylactic use of granulocyte-colony stimulating factor (G-CSF) was necessary. Serious adverse events are commonly observed in patients undergoing treatment with TPF; hence, this treatment should be provided in experience-rich facilities.

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  • Atsushi Yuta, Yukiko Ogawa, Hitomi Ogihara, Hideaki Kozaki, Takeshi Sh ...
    2018 Volume 121 Issue 12 Pages 1493-1498
    Published: December 20, 2018
    Released on J-STAGE: January 16, 2019
    JOURNAL FREE ACCESS

     Cross reactivity has been observed between Japanese cedar pollen (JCP) and tomato extract, because of the presence of common epitopes. Because the oral mucosa is directly exposed to the allergen during sublingual immunotherapy (SLIT), we considered that SLIT with Japanese cedar pollen might have some influence on the allergic reactions to tomato antigens in patients with tomato oral allergy syndrome (OAS).

     We studied the influence of JCP SLIT in subjects with tomato OAS.

     The adverse events in 220 cases of JCP SLIT during the first year were recorded. In 107 of these cases, changes in the s-IgE in 107 were followed up for 2 years. We clinically identified two patients of tomato OAS among our 455 JCP SLIT experiences.

     No increase in the frequency of adverse events was observed in the groups with class 2 (20 cases of SLIT) and 1 (18 cases of SLIT) immuno-CAP scores, as compared to that in those with class 0 (182 cases of SLIT) scores. On average, the serum tomato s-IgE level was 0.16±0.16 in the pre-SLIT phase, 0.18±0.19 at 1 year after the treatment, and 0.16±0.16 UA/mL at 2 years after the treatment. Among the 92 class 0 cases, class 0 increased to class 1 in 10 cases, and to class 2 in 4 cases after 1 year. Furthermore, the s-IgE level in 12 class 0 cases increased from under the detectable range (<0.1UA/mL) to over the detectable range. In all, the s-IgE increased in 37% the cases after 1 year, if cases with only a slight increase were included. The two patients with tomato OAS who underwent SLIT were maintained without any trouble. The cross-reactivity of epitopes between JCP and tomato may cause increase in the serum levels of tomato s-IgE during JCP SLIT, because similar changes of the the tomato and JCP s-IgE levels were observed.

     JCP SLIT can be performed safely in patients positive for tomato s-IgE, based on our experience.

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  • Naoko Momiyama, Kohtaro Eguchi, Taro Sugimoto, Akiko Tamiya, Hiroaki N ...
    2018 Volume 121 Issue 12 Pages 1499-1505
    Published: December 20, 2018
    Released on J-STAGE: January 16, 2019
    JOURNAL FREE ACCESS

     Radiation-induced hypopituitarism (RIH) is a late adverse effect of intracranial irradiation. Recently, reports of cases of RIH after radiation therapy for head and neck cancer have increased, owing to improvements in the survival rates of the patients. In this paper, we report the case of a patient in whom RIH developed 13 years after radiation therapy for nasopharyngeal cancer.

     A 53-year-old man who had received chemoradiation therapy for nasopharyngeal carcinoma (T4N1M0, squamous cell carcinoma) at the age of 40 years visited our department 9 years after completion of the therapy for the purpose of follow-up. At the end of 4 years of follow-up, the patient developed a right infratemporal fossa abscess secondary to radiation-induced osteonecrosis of the right greater wing of the sphenoid. Even after surgical drainage and antibiotic therapy, the patient remained in shock, failing to respond to even pressor therapy with noradrenaline. Since the patient was abnormally inertia from the first visit, hormone deficiency was suspected and the patient was eventually diagnosed as having adrenal and thyroid insufficiency. Hormone supplementation was started, and not only did the patient recover from the shock state, but also his mental state and intelligence were restored. The patient was discharged on oral hydrocortisone and levothyroxine after 149 days of hospitalization.

     Since RIH is a progressive and irreversible condition, long-term follow up and timely hormone supplementation are recommended after irradiation of the skull base. Further accumulation of evidence is needed.

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  • Yujiro Fukuda, Hirotaka Hara
    2018 Volume 121 Issue 12 Pages 1506-1510
    Published: December 20, 2018
    Released on J-STAGE: January 16, 2019
    JOURNAL FREE ACCESS

     Doping is banned throughout the world, as opposed to the spirit of fair play. It is also a problem that is attracting worldwide attention, as it leads to loss of social credibility of the athletes themselves, but also harms the overall value of sports.

     Prohibited substances and methods of prohibition are specified in the World Anti-Doping Code, and are updated once a year, but they are diverse. It is very difficult for a person who does not have expertise in medicine to determine whether a particular drug is included in the anti-doping code. Also, it is a problem that the contents of the anti-doping code are not well known to many doctors.

     Cold medicines, drugs for pollinosis, and herbal medicines for therapeutic purposes, sometimes contain banned substances. It is necessary to recognize the fact that there is no punishment for the doctor who prescribes prohibited substances, but the doctor should be fully aware of the importance of the athlete's life.

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