Patients allergic to birch-pollen (BP) often report oral and pharyngeal hypersensitivity to fruits and vegetables such as apples (oral allergy syndrome, OAS), because of immunological cross-reactivity between pollen and food. The cross-reactive antigens causing OAS in BP allergic patients are mainly Bet v 1, which is the major allergen of birch, and partially Bet v 2, which is a profilin of birch. Besides BP, patients allergic to mugwort-pollen (MP) and grass-pollen (GP) occasionally report hypersensitivity to foods such as melons and watermelons because of the shared profilin. We evaluated the relationship between each pollen IgE and Bet v 2 IgE. We assumed Bet v 2 as a marker of profilin, because profilin is homologous among various vegetations.

　We included 429 patients who showed oral and pharyngeal hypersensitivity to fruits and vegetables (133 males, 296 females, aged 4-79 [mean age, 34.5 years]) and had IgE to BP. The foods most often causing symptoms were apples (314 cases), peaches (283 cases) and cherries (231 cases). We examined the IgE to inhalant allergens (BP, orchard GP, MP, and mite) and to Bet v 2 using the CAP system, and evaluated the relationship between each pollen CAP and Bet v 2 CAP. We considered pollen CAP class two or more as positive, and Bet v 2CAP class one or more as positive.

　Of the 429 patients, 429 (100%), 165 (38.5%), 115 (26.8%), 253 (59.0%) were positive for BP, GP, MP, and mite CAP, and 60 (14.0%) were positive for Bet v 2CAP. The positive rate of Bet v 2CAP was 5.3% (12/228 cases) in patients who were negative for both GP CAP and MP CAP, 8.1% (7/86 cases) in patients who were positive for GP CAP but negative for MP CAP, 11.1% (4/36 cases) in patients who were negative for GP CAP and positive MP CAP, and 46.8% (37/79 cases) in patients who were positive for both GP CAP and MP CAP. Of 193 patients with GP CAP class zero and MP CAP class zero, only three (1.6%) were positive for Bet v 2CAP. Using multiple logistic-regression analysis adjusted for gender, age-class, and four CAP classes, factors associated with positivity for Bet v 2CAP were mainly positivity for MP CAP (odds ratio 2.16, ｐ<0.0001) and partially that for GP CAP (odds ratio 1.25, p=0.025).

　Profilin allergy was mainly associated with MP allergy, partially with GP allergy, and seldom affected by BP allergy.

　Negative pressure wound therapy (NPWT) is a treatment that accelerates healing by continuously sucking fluids out of a wound while allowing a moist environment to be maintained at the wound surface by sealing the wound surface. In Japan, health insurance coverage for NPWT became available in 2010 as topical negative pressure therapy in refractory wound management. We undertook NPWT in 6 patients (4 males and 2 females; age range 39-75 years; mean age, 63.0 years; median age: 66.0 years) who underwent surgery for head and neck cancer between October 2014 and November 2017. The primary diseases were tongue cancer (n=4), lower gingival cancer (n=1), and unknown primary cancer (n=1). Although finding a better way to use NPWT is necessary due to the complexity of the head and neck anatomy, all 6 patients were successfully treated for their surgical wounds by NPWT. In this paper, we present a report of the 6 cases of NPWT performed at our medical center, with a review of the relevant literature.

　Dysphagia frequently occurs in patients undergoing lateral retropharyngeal lymph node (LRPN) dissection via the transcervical approach. As the cause of dysphagia was considered to be injury of the pharyngeal nerve plexus (PNP) branching from the vagal nerve at its intracranial portion, we developed a surgical technique for preservation of the PNP during LRPN dissection using a nerve stimulator and a video monitoring system with rigid endoscopy. After making an incision on the submandibular skin, the hypoglossal nerve is exposed until the intracranial level by transection of the digastric and stylohyoid muscles. At that level, the pharyngeal branches of the vagal nerve are detected by a nerve stimulator. As LRPN exists deeply beneath the pharyngeal branches, the lymph nodes are carefully excised under endoscopic monitoring. This surgical technique was adopted in two patients with metastasis to the LRPN from papillary thyroid carcinoma. In the first patient, the swallowing function was normal immediately after the surgery. In the second case, although the lower part of the PNP was sacrificed, oral intake was possible a week after the surgery due to preservation of the upper part of PNP. Preservation of the PNP during LRPN dissection is useful for preventing postoperative dysphagia.