Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head a...Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P;range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.展开更多
Objective: To evaluate the incidence of cervical angiopathy caused by radiation therapy for head and neck cancer. Methods: Segments of 57 cervical arteries were obtained during surgery for head and neck malignant tumo...Objective: To evaluate the incidence of cervical angiopathy caused by radiation therapy for head and neck cancer. Methods: Segments of 57 cervical arteries were obtained during surgery for head and neck malignant tumors and divided into two groups (irradiated group and non-irradiated group) based on the treatment prior to vascular resection. In order to evaluate vascular injury after radiation therapy, we examined the degree of medial atrophy, medial fibrosis, smooth muscle cell (SMC) differentiation in the media and intima, intimal hyperplasia and endothelial cell (EC) injury. Sections of arterial segments were stained with hematoxylin-eosin, Elastica van Gieson and Masson’s trichrome, and immunohistochemistry for α-smooth muscle actin (α-SMA), smoothelin, S100A4 and CD31 in the resected vessels was conducted. Results: The median interval between the completion of radiation therapy and vascular resection was nine months. No significant differences were observed between the two groups in terms of medial atrophy, medial fibrosis and intimal hyperplasia. The ratio of the smoothelin-positive area per α-SMA-positive area in the media and the S100A4-positive proportion in the intima, indicating the degree of differentiation of the medial SMC and dedifferentiation of the intimal SMC, respectively, showed no significant differences, despite the tendency toward a lower smoothelin-positive area per α-SMA-positive area in the media of the irradiated arteries. The EC coverage revealed on CD31 immunohistochemistry was significantly decreased, with mural thrombus adhesion, in the irradiated group. Conclusions: The ECs of small arteries are damaged by irradiation. Although we did not confirm the statistical significance of medial SMC dedifferentiation, a decreased expression of smoothelin tended to be observed in the media of the irradiated arteries. Our findings provide histopathological evidence of irradiation angiopathy in head and neck cancer and may help to improve the surgical safety of microvascular anastomosis and determine the treatment strategy for head and neck tumors.展开更多
Objective: To investigate the cumulative recurrence rate of pars tensa retraction cholesteatoma on the new staging system established by Japan Otological Society (JOS). Materials and Methods: It is a retrospective stu...Objective: To investigate the cumulative recurrence rate of pars tensa retraction cholesteatoma on the new staging system established by Japan Otological Society (JOS). Materials and Methods: It is a retrospective study and performed in a tertiary and academic center. The series comprised 71 patients with pars tensa retraction cholesteatoma who underwent surgical treatment by a single surgeon between 1994 and 2007. Results: The 10-year cumulative recurrence rate of pars tensa retraction cholesteatoma was 12.1% overall, 20.0% in Stage I, 14.4% in Stage II and 6.2% in Stage III. Conclusions: The JOS staging system for pars tensa retraction cholesteatoma did not reflect the prognosis. The development of a common international staging system for cholesteatoma in the future is desirable.展开更多
Objective: To evaluate factors affecting the perforation closure rate for perforated otitis media. Methods: Between 2008 and 2012, a total of 118 patients with perforated chronic otitis media underwent tympanoplasty a...Objective: To evaluate factors affecting the perforation closure rate for perforated otitis media. Methods: Between 2008 and 2012, a total of 118 patients with perforated chronic otitis media underwent tympanoplasty at Hyogo College of Medicine Hospital by a single surgeon. Prognostic factors were analyzed using multivariate analysis with logistic regression. Results: The success rate for tympanic perforation was 93.2%. Factors showing significance on multivariate analysis were dryness of perforation and patient age at the time of surgery. Conclusion: The results suggest that pre-surgical treatment is a key factor influencing the closure rate.展开更多
文摘Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P;range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.
文摘Objective: To evaluate the incidence of cervical angiopathy caused by radiation therapy for head and neck cancer. Methods: Segments of 57 cervical arteries were obtained during surgery for head and neck malignant tumors and divided into two groups (irradiated group and non-irradiated group) based on the treatment prior to vascular resection. In order to evaluate vascular injury after radiation therapy, we examined the degree of medial atrophy, medial fibrosis, smooth muscle cell (SMC) differentiation in the media and intima, intimal hyperplasia and endothelial cell (EC) injury. Sections of arterial segments were stained with hematoxylin-eosin, Elastica van Gieson and Masson’s trichrome, and immunohistochemistry for α-smooth muscle actin (α-SMA), smoothelin, S100A4 and CD31 in the resected vessels was conducted. Results: The median interval between the completion of radiation therapy and vascular resection was nine months. No significant differences were observed between the two groups in terms of medial atrophy, medial fibrosis and intimal hyperplasia. The ratio of the smoothelin-positive area per α-SMA-positive area in the media and the S100A4-positive proportion in the intima, indicating the degree of differentiation of the medial SMC and dedifferentiation of the intimal SMC, respectively, showed no significant differences, despite the tendency toward a lower smoothelin-positive area per α-SMA-positive area in the media of the irradiated arteries. The EC coverage revealed on CD31 immunohistochemistry was significantly decreased, with mural thrombus adhesion, in the irradiated group. Conclusions: The ECs of small arteries are damaged by irradiation. Although we did not confirm the statistical significance of medial SMC dedifferentiation, a decreased expression of smoothelin tended to be observed in the media of the irradiated arteries. Our findings provide histopathological evidence of irradiation angiopathy in head and neck cancer and may help to improve the surgical safety of microvascular anastomosis and determine the treatment strategy for head and neck tumors.
文摘Objective: To investigate the cumulative recurrence rate of pars tensa retraction cholesteatoma on the new staging system established by Japan Otological Society (JOS). Materials and Methods: It is a retrospective study and performed in a tertiary and academic center. The series comprised 71 patients with pars tensa retraction cholesteatoma who underwent surgical treatment by a single surgeon between 1994 and 2007. Results: The 10-year cumulative recurrence rate of pars tensa retraction cholesteatoma was 12.1% overall, 20.0% in Stage I, 14.4% in Stage II and 6.2% in Stage III. Conclusions: The JOS staging system for pars tensa retraction cholesteatoma did not reflect the prognosis. The development of a common international staging system for cholesteatoma in the future is desirable.
文摘Objective: To evaluate factors affecting the perforation closure rate for perforated otitis media. Methods: Between 2008 and 2012, a total of 118 patients with perforated chronic otitis media underwent tympanoplasty at Hyogo College of Medicine Hospital by a single surgeon. Prognostic factors were analyzed using multivariate analysis with logistic regression. Results: The success rate for tympanic perforation was 93.2%. Factors showing significance on multivariate analysis were dryness of perforation and patient age at the time of surgery. Conclusion: The results suggest that pre-surgical treatment is a key factor influencing the closure rate.
