To enhance the treatment effects for intractable Meniere's disease, we tried to expose the opened endolymphatic sac to high concentrations of steroids. This technique - endolymphatic sac drainage and steroid-instillation surgery (EDSS)-involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into the sac lumen opened and expanded with a bundle of absorbable gelatin films. The long-term results of vertigo control and hearing improvement treated with the above techniques were excellent. However, some cases suffered from revisited vertigo even years after EDSS, because endolymphatic sac surgery including EDSS was not ablative but conservative surgery. We experienced a revision surgery of EDSS and obtained a good result. Here, we descride surgical observation of the first and second operations and discuss the significance of revision surgery.

View full abstract

In cholesteatoma surgery, we use open tympanoplasty and expose the matrix to the open cavity in cases with adhesion of matrix in which the dura is too tight to exfoliate. We applied this method to four patients with firm adhesion of matrix and dura. All four exhibited poor mastoid development. Three exhibited adhesion to the dura of the middle fossa, while two exhibited adhesion to the dura of the posterior fossa. Labyrinthine fistula in the posterior semicircular canal was found in two of these patients. Our findings suggest that firm adhesion of matrix and dura may be caused by isolation of cholesteatoma and continuous inflammation. Our patients experienced no complications, and we therefore recommend this method for patients with firm adhesion of matrix and dura.

View full abstract

The patient was an 86-year-old female with unilateral recurrent nerve paralysis with chief complaints of hoarseness and aspiration, who underwent percutaneous BIOPEX® injection under local anesthesia. After surgery, the hoarseness and aspiration improved, and improvement of the arcuate vocal fold and adduction of the vocal fold were observed by laryngeal fiberscopy. The patient died of another disease 123 days after injection, and autopsy was performed. CT of the excised larynx demonstrated that there were no changes, such as absorption and movement, from CT images taken on the day after surgery. Macroscopically, the BIOPEX® was hardened in a mass between the vocal fold and thyroid cartilage. Adduction of the affected arytenoid cartilage was observed. Pathohistologically, the foreign-body reaction around the injected BIOPEX® was very mild.

View full abstract

We encountered a case of multiple liposarcoma of the neck. The patient was a 79-year-old woman, who had undergone two operations for lipoma of the neck in 1996 and 1999. Recurrence of the lesions resulted in her being referred to our department as malignancy was suspected. A bilateral neck dissection was carried out in December 2002. This showed multiple tumors in both sides of the neck with parts of these tumors having a solid consistency. Histological examination confirmed the diagnosis of a well-differentiated liposarcoma. Subsequent healing of the wound was good, but due to the development of aspiration pneumonia, the patient's discharge from hospital was prolonged. In our paper, we discuss this case and review the literature of similar cases.

View full abstract

Although in recent years there have been a tendency to choose partial hypopharyngectomy with laryngeal preservation in some cases of early stage hypopharyngeal cancer, the standard operation for advanced stage is still considered to consist primarily of total pharyngolaryngectomy. In this article, we report a case of an advanced T3 hypopharyngeal cancer with laryngeal preservation. The field of resection ranged from most of the piriform sinus to the epiglottis, aryepiglottic fold, paraglottic space, false vocal cord, and a part of the arytenoids. Although the resected area encompassed such a large area as described above, we succeeded in the reconstruction with several devices and attained good swallowing function by making the bulky rectus abdominal myocutaneous flap over-hang the supraglottic space and occupying the piriform sinus of the affected side with it. In conclusion, we believe that there is a possibility to perform partial hypopharyngectomy with laryngeal preservation even in T3 cases when movement of bilateral arytenoids and vocal cords are both intact.

View full abstract

A clinical analysis was performed on 158 patients with papillary thyroid carcinomas initially treated at Saga University Hospital between 1983 and 2005. We analyzed 7 prognostic factors. Age, gender, pT4, N1b, and clinical stage showed significant differences in univariate analyses. Diameter of primary tumors (≥4 cm) and distant metastasis were significant poor prognostic factors by both univariate and multivariate analyses. Based on the risk ratio of the distant metastasis, we scored the prognostic factors as follows: age and gender were 1 respectively, diameter of primary tumors (≥4 cm) was 2, T4 was 3, and N1b was 4. The prognostic factor score was defined as the sum of these points for each case. The prognostic factor score was correlated with the incidence rate of distant metastasis as follows, score 0-3 : 0%, 4-6 : 5%, 7-9 : 21%, and 10-11 : 43%. We consider the prognstic factor score to be useful for determination of treatment and estimation of the incidence of distant metastasis.

View full abstract