Radiation therapy is an important treatment option for laryngeal cancer; however, it could cause serious complications, including laryngeal necrosis. This necrosis is considered to be caused by circulatory disturbance in the laryngeal tissues. Bevacizumab is one of the antiangiogenic drugs that is widely used for various kinds of cancer. Meanwhile, bevacizumab induces variable complications, and medication-related osteonecrosis of the jaw is one of these adverse events. Moreover, an association between antiangiogenic drugs and appendicular skeleton has been described in a few case reports. The present case developed severe cricoid cartilage necrosis that occurred after the administration of bevacizumab. It was used to treat newly occurring adenocarcinoma of the lung five years after radiation therapy for laryngeal cancer. In this case, apparent exacerbation of the laryngeal necrosis occurred 9 weeks after the initiation of chemotherapy. Bevacizumab was approved in 2007 as a treatment for unresectable, advanced or recurrent colorectal cancer, and its indications have since been expanded to various carcinomas. In addition, drugs targeting angiogenesis-related molecules, such as VEGF, have been increasing in recent years. It is assumed that there are a number of cases in which antiangiogenic drugs are used for metachronous double cancer after treatment for head and neck cancer. Careful attention needs to be paid to patients undergoing chemotherapy, including bevacizumab, after radiation therapy for head and neck cancer.

Ingested foreign bodies are not rare occurrences in daily clinical practice and it is said that about 90% of foreign bodies are fishbones. Herein, we report a case of an ingested fishbone that migrated to the extrapharyngeal space and had to be removed through a skin incision on the neck. A 69-year-old woman who had eaten sea bream the previous day visited a doctor complaining of discomfort swallowing. At the initial examination, there are no significant findings and a fishbone could not be identified. However, upon re-examination three days later, we noticed mild swelling in the posterior pharyngeal wall using a laryngeal fiberscope. A CT examination revealed a fishbone foreign body in the posterior pharyngeal wall. We then removed the fishbone from the inferior pharyngeal constrictor muscle through a skin incision on the neck. The long axis of the extracted fishbone was 23 mm.

After the surgery, the patient recovered with the administration of antibiotics and nutritional management through a nasogastric tube. In this case, a fishbone migrated to the extrapharyngeal space through a rare route of insertion. It is likely for this reason that no significant findings were observed at the initial examination. Even in cases there are no significant findings, if it is suspected that a foreign body has migrated to the extrapharyngeal space, a proactive CT examination is necessary.

Hereditary angioedema (HAE) is an autosomal dominant disorder that causes sudden onset of edema in various parts of the body, including the face, extremities, and gastrointestinal tract. HAE is a chronic, recurrent disorder that causes swelling of the limbs, severe abdominal pain, and facial edema, especially edema of the upper respiratory tract, and can be fatal. HAE is not well recognized, but it is an extremely urgent disease. In this report, we describe a case of severe HAE in a 20-year-old man who had three episodes of laryngeal edema over a short period of time and underwent a total of three tracheotomies. We report this case with some discussion of the literature and with the aim of educating the public.

(Introduction) Even if the results of medical interview and rhinoscopic findings are suspicious for allergic rhinitis, all serum antibody titers and skin tests may be negative. In Europe and the United States, such cases are described as Local Allergic Rhinitis (LAR). We investigated the possibility of mite-LAR using a nasal provocation test with a commercially available HD disc, that can be performed in daily practice. Since cedar discs are not commercially available, we only examined the response to mite. The histopathological features of LAR in the nasal mucosa were compared with those of allergic and non-allergic rhinitis to aid in the investigation of the pathogenesis of LAR.

(Subjects, Methods) Twenty-one patients with symptoms of rhinitis who underwent surgical treatment at our department were included in the study. Endpoints included: (1) preoperative measurement of mite-specific IgE antibody titer in peripheral blood, (2) preoperative nasal provocation test (HD disc), (3) measurement of mite-specific IgE antibody titer in the mucosa of the inferior turbinate, and (4) HE staining and immunostaining with anti-CD40 antibody in specimens of the mucosa of the inferior turbinate.

(Results and discussion) 13 of the 21 cases were negative for mite-specific IgE antibody titer in peripheral blood, and 5 of the 13 cases were considered to have mite-LAR. In all groups, CD40-positive cell clusters were observed in the inferior turbinate mucosa. We describe the pathogenetic hypothesis of LAR and indicate that the establishment and standardization of a nasal provocation test is of great importance in the diagnosis of allergic rhinitis.

Many patients are suspected of having vertebrobasilar insufficiency (VBI). Specifically, these include elderly patients with vertigo who have complications that suggest progressive atherosclerosis or deformity of the cervical vertebrae. However, it is surprisingly difficult to make a definitive diagnosis of VBI. In particular, we focused on the fact that the search for and presentation of the organic abnormality site of VBI has not been clarified.

We have previously reported that CT scans (CT) can be used to search for and demonstrate calcified lesions in the vertebral and subclavian arteries and deformed lesions in the cervical vertebra, which can cause VBI. In this study, we have improved the CT imaging method for more efficient retrieval and presentation of lesions. This method is tentatively called Pseudo-CTangiography (P-CTA), meaning CT angiography without contrast agent, and is a diagnostic imaging method for VBI.

We discuss a theoretical comparison of angiography, cervical ultrasound, MRA, and CT used to diagnose VBI. In addition, the pathological significance of the lesions shown on CT, i.e., arterial calcification, cervical deformity, and arterial bending and tortuosity, is also discussed.

If VBI is properly diagnosed, early detection and treatment can be implemented for patients with VBI vertigo, and stroke prevention can be achieved.