A study was conducted of various aspects of 160 cases of hypopharyngeal and cervicalesophageal squamous cell carcinomas treated at the Department of Head and Neck Surgery of the Cancer Institute Hospital during the 14-year period from 1969 through 1982, The carcinomas consisted of 64 cases of pyriform sinus, 54 cases of postcricoid, 14 cases of the posterior wall and 28 cases of cervical esophagus. Surgical treatment was administered to 83 patients (51, 9%). Of these, 3 underwent surgical treatment alone, 53 were administered with radiological treatment prior to the surgery, and 27 underwent a salvage operation for the treatment of recurrence after radical radiotherapy. The depth of invasion to the adventitia was determined for each resected specimen in accordance with the General Rules for Clinical & Pathological Studies on Esophageal Cancers “. No cancer cells were detected in some specimens due to preoperative therapy, and these cases were designated as ” Ca (-). The histological depth of invasion to the adventitia (a) was determined as “Ca (-)” in 5 cases, “a0”in 34 cases, “a1” in 4 cases, “a2” in 15 cases and “a3” in 25 cases. The deeper the histological invasion to the adventitia was, the greater were the number of pathological metastases to the lymph nodes, the number of postoperative metastases to the lymph nodes and the number of distant metastases. The prognosis in relation to the histological depth of invasion to the adventitia was good in the group consisting of “a0” and “Ca (-), ” while it was poor in the other groups, and the difference in prognosis between the “a0” + “Ca (-)” group and the “a1” + “a2”, “a3” group was statistically significant (P<0.05). With regard to invasion of other organs in “a3”, laryngeal invasion was seen at a high incidence in the pyriform cancer cases, while thyroidal invasion was detected at a high incidence in the postcricoid cancer cases and cervical escphagus cancer cases. The depth of invasion was diagnosed using CT. The diagnoses consisted of 22 cases of CTA0, 3 cases of CTA1, 9 cases of CTA2 and 25 cases of CTA3. Comparison of the histological depth of invasion to the adventitia and the CT-diagnosed depth of invasion (CTA) revealed that the accuracy of diagnosis by CT was about 67%. This difference was surmised to be due to reduction or disappearance of cancers achieved by preoperative therapy. In the CT diagnosis of invasion of other organs in CTA3 specimens of laryngeal invasion the specificity was about 90%, the sensitivity was about 70%, and the accuracy was about 90%. In CTA3 specimens of thyroid invasion the specificity, sensitivity and accuracy of the CT diagnoses were about 85%, 71% and 86%, respectively. Thus, CT was found to be an excellent technique in the diagnosis of invasion of other organs. The survival rate was high in patients whose CTA had been diagnosed as CTAO or CTA1, while it was low in patients whose CTA had been diagnosed as CTA2 or CTA3. However, the difference in the survival rate between these twopatient groups was not statistically significant.
We used a combined chemotherapy with CDDP and 5-FU as a induction chemotherapy for various head and neck cancers since Jan. 1967. Ten cases were statiscally evaluated so far, in which 3 tongue cancer, 2 nasophraynx cancer, 2 ear cancer, 1 ethmoid cancer, 1 hypopharynx cancer and 1 larynx cancer were included. The therapeutic result showed 100% response rate to the therapy eventualy with 4 cases of CR and 6 cases of PR. There were a decreare in the numbers of leucocyte, and paltelet. Nausea, vomitting and stomatitis frequenthy accompanied by this use. Despite these side effects, it was all posible to conclude the combined chemotherapy to be a good treatment of choice for head and neck cancer except one case.
The results of rhinomanometry in 245 schoolchildren, 245 members of a swimming club, and 285 examinee of entrance examination to an university, done in conjunction with physical examination are reported. We measured unilateral nasal resistance at the point of “Radius 1”, and the total nasal resistance at the of “P =1.0 cmH20” by the anterior method with nozzle, Firstly, according to the result of questionnaire and anamnasis, we classified the objects into the two groups, one is the group complained of nasal obstruction and the other is the group with no such complaint. Then we compared the average values of the nasal resistance of the two groups. There was a significant difference between the total nasal resistance of the two groups in schoolchildren and members of the swimming club. And there was significant difference between the unilateral nasal resistance of the two groups in the examinees of the entrance examination. Secondly, according to the view through the nasal scope, we classified the objects into groups, one with disease of the nose or sinus and the other without. There was a significant difference between the total nasal resistance of the two groups. The rhinomanometry was found to be useful in physical examination.
We performed 20 operation of stapedectomy during March 1984-February 1988 sixteen cases were on the small fenestra stapedectomy (SFS) and 4 cases were total stapedectomy. We studied the hearing level in both the pre and post operative situations and complications, etc, on 16 cases of small fenestra stapedectomy. In our results, we concluded that SFS is safe and effective surgical procedure to increase hearing efficiency with little dizziness and few complications. We feel this will be a standard surgical procedure in near future in Japan.
We report a case (73-year-old, male) of a foreign body, a bullet received during action in the war, that had been retained as long as 48 years in the ethmoidal sinus. The majority of foreign bodies in the paranasal sinuses are removed in a relatively short time after their occurrence. We reviewed documented cases of long-standing foreign bodies in the paranasal sinuses, with the following interesting results: (1) Patients were dominantly male. (2) Frequent cases were war, work-related accidents, traffic accidents, falls and fights. (3) Many foreign bodies were the relics of combat wounds. Metallic foreign bodies were common, a large proportion of which were medical instruments, particularly those in dentistry. (4) Nearly all the foreign bodies were lodged in the maxillary or ethmoidal sinus. Foreign bodies are usually discovered by careful history taking and observation of the chronic sinusitis-like symptoms, but sometimes found accidentally during an X-ray examination. We emphasize that it is imperative to remove the foreign bodies as early as possible to prevent infections and lead poisoning, to allay the patient's anxiety and to avoid difficulties in operation.
Triad of allergic rhinitis are nasal obstruction, watery discharge and sneeze. We studied the change of nasal respiratory resistance both before and after sneeze in the nasal provocation test using antigen disks. We also studied the effect of sneeze in the nasal provocation test with Rhinograph. In patients with known antigen responce, the nasal provocation test was perfor-med with the appropriate antigen disk while nasal respiratory resistance was continuously measured by Rhinograph. The dose-responce curve obtained by Rhinograph (Rhinogram) was analyzed in the case with sneeze. The values of the stable nasal respiratory resistance within one minute before and after sneeze were measured by rhinograph. Comparisons have been made between the two values. The result is as follows. 1) The nasal respiratory resistance before sneeze is higher than that after sneeze. 2) The nasal respiratory resistances are about equal both before and after sneeze. 3) The nasal respiratory resistance after sneeze is higher than that before sneeze. About half number of 1) and 2) were negative cases of the nasal provocation test. Rhinogram with sneeze is not continuous. It is difficult to analyze the uncontinuous Rhinogram. The cases with sneeze are not adequate for the nasal provocation test with Rhinograph.
Reconstruction of the tracheal wall after removal of the tracheal cartilage has been a difficult problem. We were used to apply autograft cartilage for tracheal wall reconstruction. However, to remove the cartilage tissue need extra surgical works. Moreover, cartilage tissue is too fragile to keep the tracheal wall in position. Since the bio-compatibility of the ceramics tissue has been proved in various medical fields, we used the ceramics tissue to reconstruct the tracheal wall instead of autograft cartilage tissue. As a result, not only the easiness to manuplate, but also the rigidity of this tissue have been proved to be the advantageous point. In this case, after resection of thyroid carcinoma, tracheal defect was anterior and lateral walls in the 1st and 2nd tracheal rings, and anterior wall in the 3rd and 4th tracheal rings. We used two pieces of the hydroxyl apatite in the subcutaneous space in place of the tracheal cartilage. At least after one year observation, post operative course has been uneventful and the result has been encouraging. We recommend to use the ceramics tissue as an artificial cartilage wall instead of the autograft cartilage tissue.