A definitive diagnosis of salivary gland tumors is extremely difficult to make without evaluating the entire tumor and conducting immunohistochemical examinations. In this study, we aimed to examine and compare the expression patterns of the tumor protein （TP） D52 family, including TPD52, TPD53, and TPD54, in salivary gland tumor cells by using immunohistochemical staining. Among over 30 benign and malignant salivary gland tumors with extensive and diverse morphological features and overlapping histological similarities, we selected Warthin’s tumor and pleomorphic adenoma to represent benign salivary gland tumors and mucoepidermoid carcinoma to represent malignant ones. Tumor samples were fixed in 10％ buffered formalin and embedded in paraffin. Then, immunohistochemical staining was performed using antibodies against TPD52, TPD53, and TPD54. Neither the benign salivary gland tumors nor mucoepidermoid carcinoma stained for TPD52. However, the intensity of TPD53 and TPD54 staining was found to be low in the benign salivary gland tumors and high in mucoepidermoid carcinoma. TPD54 may serve as a pathological indicator of benign salivary gland tumors and mucoepidermoid carcinoma.

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Understanding respiratory motion is necessary for accurate dose administration during stereotactic body radiation therapy. Although four-dimensional （4D） computed tomography （4DCT） is useful for understanding respiratory movements, 4D radiotherapy with a time axis is required. However, reports on the evaluation of 4DCT remain lacking. Therefore, this study was designed to evaluate the basic physical characteristics of a respiratory-gated 4DCT helical scanning system （4D-HS） using MATLAB^Ⓡ. In this study, the physical characteristics were evaluated by examining the body-axis direction resolution, slice sensitivity profile （SSP）, and volume change due to respiratory phase change and comparing multiplanar reconstruction profiles （MPRs） of slit phantoms. These characteristics were compared using normal helical scanning （N-HS）. A 31％ overestimation was observed in the volume fluctuation of 4D-HS based on the volume of N-HS. Furthermore, SSP with full width at half maximum （FWHM） and modulation transfer function （MTF） showed a similar resolution between 4D-HS and N-HS. The difference in FWHM is considered an offset by the voxel effect. In the MPR comparison, both 4D-HS and N-HS were visually identifiable up to a 0.5-mm slit. 4D-HS is a reconstruction system with excellent temporal resolution. Furthermore, its resolution follows respiratory dynamics and can continuously collect respiratory dynamics components. Our findings suggest the usefulness of 4D-HS in clinical practice.

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To identify the risk factors and clinical results for acute cholecystitis after covered self-expandable metal stent （SEMS） placement for distal malignant biliary obstruction （MBO）, we have retrospectively examined the clinical outcomes in patients with acute cholecystitis after endoscopic biliary SEMS placement for distal MBO. This was a retrospective study. Between January 2014 and June 2017, 90 patients who were identified to have underwent endoscopic covered SEMS placement for distal MBO at our institution were included in this analysis. Patients with benign biliary strictures after cholecystectomy were excluded. After covered SEMS placement, we followed up with physical examination and laboratory data and continued with the follow-up for as long as possible. The risk factors for acute cholecystitis after covered SEMS placement were then evaluated. Acute cholecystitis was observed in 15 patients （17％） after covered SEMS placement. The median time to the onset of acute cholecystitis after covered SEMS placement was 19 days （interquartile range, 5-127 days）. Cholecystitis was initially treated with percutaneous gallbladder aspiration （PTGBA） in 11 patients, percutaneous gallbladder drainage （PTGBD） in 2 patients, and antimicrobial therapy alone in 2 patients. Five patients （including four patients treated with PTGBA and one patient treated with antimicrobial therapy alone） had cholecystitis recurrence. In a multivariate analysis of the risk factors for cholecystitis after covered SEMS placement, bile duct cancer （odds ratio （OR）, 12; P＝0.028）, thin bile duct diameter （≤8mm） （OR, 5.2; P＝0.048）, and chemotherapy （OR, 12.6; P＝0.008） were identified as the significant risk factors. Bile duct cancer, thin bile duct diameter, and chemotherapy were identified as risk factors for acute cholecystitis after endoscopic covered SEMS placement for distal MBO. PTGBA is useful as the initial treatment for acute cholecystitis after covered SEMS placement for distal MBO; however, cholecystitis recurrence should be taken into consideration.

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The combination drug S-1, which contains tegafur, gimeracil, and oteracil potassium, is a fluoropyrimidine-based oral antineoplastic agent in which the principal drug tegafur is a prodrug of fluorouracil （5-FU）. In recent years, many studies have reported eye problems, especially corneal damage, as an adverse effect of S-1 treatment. In this study, we investigated the cytotoxic effects of each of the constituents of S-1 on corneal epithelial cells by measuring viable cell counts and lactate dehydrogenase （LDH） release. Experimental chemosensitivity study for 5-FU and the constituents of S-1 （i.e., tegafur, gimeracil, and oteracil） using a human cell line. We used immortalized human corneal epithelial （HCE-T） cells to estimate viable cell counts （expressed as a percentage of the control cells） and the activity of LDH in a culture medium （expressed as a percentage of the total LDH activity）. Decreases in viable cell counts were noted with 5-FU and tegafur, but a significant elevation in LDH activity was noted only with tegafur. The incidence of damage in cells exposed to tegafur significantly decreased on adding tranylcypromine, an inhibitor of CYP2A6 that metabolizes tegafur to 5-FU. In addition, 5-FU did not elevate LDH activity, which is an indicator of cell membrane disruption, and concentration-dependence was not observed when cells were treated with 5-FU doses of up to 1,000ng/ml. These findings suggest that the disruption of the metabolic activity of the corneal epithelium by 5-FU is involved in the corneal injury mechanism of S-1.

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The Onodi cell is a pneumatized posterior ethmoid cell that lies on the sphenoid sinus and is closely related to the optic canal. A rare case of a patient who was relieved from long-term severe visual impairment caused by mucocele in the Onodi cell is presented herein. An 80-year-old man was referred to the hospital by an ophthalmologist with a complaint of blurred vision in the right eye for a couple of months. A computed tomography scan demonstrated a cystic lesion occupying the right posterior ethmoid sinus, which suggested the Onodi cell. In addition, a bone defect of the optic canal was present. Ophthalmologic examination showed no papilledema. However, severe visual impairment and narrowing of the visual field in the right eye were noted. Surgical treatment using the endoscopic endonasal approach was performed under general anesthesia. Purulent discharge oozed out when the cystic lesion in the right posterior ethmoid sinus was opened. His visual impairment and severe visual field contraction gradually improved after surgery. In this case, the patient’s severe visual impairment improved although a couple of months had passed before treatment. Preoperative fundus examination showed no optic nerve atrophy or inflammatory optic neuropathy in the right eye, counting fingers and visual acuity was considered to have improved.

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Children with Netherton syndrome are likely to be sensitized to multiple allergens due to skin barrier dysfunction. Owing to substantial increases in total and food allergen-specific IgE levels, some children with Netherton syndrome are diagnosed with food allergies （FAs） and advised to avoid particular foods. However, it is unclear whether such children actually have FAs. We report a child with Netherton syndrome without atopic dermatitis （AD） who was able to stop avoiding certain foods （hens’ eggs and peanuts） after undergoing oral food challenge （OFC）. A 5-year-old Japanese boy with Netherton syndrome without AD consulted at our hospital to evaluate the possibility of allergies to hens’ eggs and peanuts. Netherton syndrome had been diagnosed at birth. At 1 year old, the levels of specific IgE for egg white and peanuts were ＞100 and 14.6kU/l, respectively. He had not consumed or experienced allergic symptoms to these foods. However, he was instructed to completely avoid these foods in his diet. At 5 years old, he still completely avoided these foods. The levels of specific IgE for egg white, ovomucoid, and peanuts were 34.5, 9.4, and 17.4kU/l, respectively. Since the serum-specific IgE levels and the serum-specific IgE/total IgE ratio decreased, we performed OFCs for hens’ eggs and peanuts. The results of the OFCs using half a baked egg and 10g of peanuts were all negative. The same dosing schedule was repeated at home, again with negative results. Therefore, the avoidance could be stopped. This report suggests that we should identify whether patients have AD or not, and OFCs should be performed before requesting food restriction in patients with Netherton syndrome.

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An extremely rare case of an isolated fracture of the orbital roof caused only by an eye contusion and a simultaneous blowout fracture, trapdoor type, which was operated on using the transpalpebral supraorbital rim approach was reported herein. The patient was a 35-year-old male who fell off the surfboard into the sea with the fin hitting hard the patient’s right eye. The patient had right ptosis, pain on looking upwards, and forehead paralysis. No bruises on the head or face other than the lower eyelid were noted. The orbital computed tomography scan showed that only the orbital roof was fractured, the bone fragments cranially deviated, and the orbital fat was incarcerated in the fracture site. The patient underwent surgery using the transpalpebral supraorbital rim approach on day 14 postinjury. The fracture was of the trapdoor type, and the orbital fat, levator palpebrae superioris muscle, and supraorbital nerve were strangulated at the fracture site. Ptosis and eye movement disorder quickly improved postoperatively. Isolated orbital roof blowout fracture, trapdoor type, is a rare condition, and the fracture can be repaired using the transpalpebral approach in the absence of intracranial lesions and extensive bony deviation.

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