Relationship between perioperative cardiopulmonary bypass time, platelet count, fibrinogen level, rotational thromboelastometry data, antithrombin level, and blood loss volume and the effects of deep hypothermic circulatory arrest: An observational study

INTRODUCTION

We hypothesized that perioperative fibrinogen level, platelet count, and rotational thromboelastometry (ROTEM) data values decrease in proportion to cardiopulmonary bypass (CPB) time, particularly in patients who underwent deep hypothermic circulatory arrest (DHCA).

METHODS

A total of 160 patients were enrolled and divided into the following three groups depending on CPB time: <2-h, 2- 3-h, and >3-h groups. Blood samples were obtained during CPB weaning. Platelet count, ROTEM data, fibrinogen level, and antithrombin level were determined. For propensity matching, we selected 15 patients who underwent DHCA and 15 patients who did not undergo DHCA and used propensity scores to match CPB time and other characteristics.

RESULTS

The <2-h, 2-3-h, and >3-h groups included 74, 63, and 23 patients, respectively. No significant differences in platelet count and fibrinogen level were observed between the groups. Antithrombin level and amplitude of clot firmness at 10 min in the EXTEM and FIBTEM tests were lowest in the >3-h group. Similarly, blood loss volume and transfusion volume were highest in the >3-h group. Significant differences in platelet count, ROTEM data, lowest esophageal and bladder temperatures, and transfusion volume were observed between patients who underwent DHCA and patients who did not undergo DHCA.

CONCLUSIONS

The longer the CPB time, the greater the perioperative blood loss volume and transfusion volume, particularly if CPB time is greater than 3 hours. Sub-group analysis revealed that DHCA affects perioperative platelet count and function as well as blood loss volume.

Influence of doctor-patient relationships and health-related factors on the medical satisfaction of patients with Sjögren's disease

OBJECTIVES

Patients with chronic, incurable conditions rely on their providers to help relieve their symptoms. Dissatisfaction with their care can erode the doctor-patient relationship and reduce the effectiveness of treatment. We investigated the relationships between satisfaction and symptoms, the doctor-patient relationship, and health-related factors in patients with Sjögren's disease (SjD) in Japan.

METHODS

Using a questionnaire survey, we evaluated via multinomial logistic regression associations between satisfaction [satisfied, neither (neither satisfied nor dissatisfied), dissatisfied] and symptoms, prescribed medications, anxiety, distress, expectations from treatments, and doctor-patient relationships.

RESULTS

Of 259 patients, 101 (39%) were satisfied, 111 (42.9%) were neither, and 47 (18.2%) were dissatisfied. Patients who were neither or dissatisfied with their current treatment wanted their systemic pain to disappear (adjusted relative risk ratio [aRRR] 3.38, 95% CI 1.66-6.91; aRRR 3.04, 95% CI 1.30-7.15, respectively). Patients who used artificial saliva only were significantly more dissatisfied (aRRR 3.52, 95% CI 1.03-2.04). Both the neither and dissatisfied patients dissatisfied with their doctor's limited understanding of SiD (aRRR 12.69, 95% CI 4.21-38.24; aRRR 32.76, 95% CI 10.09-106.34, respectively) and with the limited opportunities to ask their doctor about their disease (aRRR 0.19, 95% CI 0.06-0.59; aRRR 0.08, 95% CI 0.02-0.24, respectively).

CONCLUSIONS

Pain and the use of artificial saliva alone markedly affected medical satisfaction and we expected the future advance in these two areas, pain and dryness, will improve satisfaction. It is most important for doctors to better understand SjD.

Surgical results of 29 ears with congenital middle ear anomalies; Microscopic vs. endoscopic ear surgery

OBJECTIVE

Although congenital middle ear anomalies include various types of ossicular anomalies, all of these can be treated by ossiculoplasty or stapes surgery. Transcanal endoscopic ear surgery (TEES) is a minimally invasive surgical method for middle ear disease with an excellent surgical view that has been widely adopted worldwide. To determine the efficacy of TEES for middle ear anomalies, we describe the surgical results and compare the hearing outcomes between patients treated by TEES and microscopic ear surgery (MES).

METHODS

A total of 39 ears with congenital middle ear anomalies were treated surgically at the University Hospital of Kochi Medical School between January 2011 and December 2021. In total, 29 ears of 23 patients were included in the study. Demographics, type of anomaly, surgical methods, pre- and postoperative hearing thresholds, and surgical complications were investigated by retrospective chart review.

RESULTS

Of the 29 ears, 11 were treated by MES and 18 were treated by TEES. There were no differences in sex, age, preoperative hearing thresholds, or rate of stapes surgery between the two groups. The mean air-bone gap improvement was 20.6 dB in the MES group and 28.8 dB in the TEES group; these values were not significantly different. The median operation time was not significantly different between the MES and TEES groups (125 and 130 min, respectively). The improvements of air conduction in class 1 and 2 (stapes surgery) and class 3 (ossiculoplasty) cases were also not different between the groups.

CONCLUSIONS

TEES achieved comparable hearing outcomes to MES without postauricular or endaural incisions. Further, class 1 and 2 anomalies demonstrated hearing improvement similar to class 3 without major complications. Since the surgical field limited around the ossicular chain, coupled with the fact that the middle ear anomaly itself does not exhibit inflammation leading to unfavorable bleeding, TEES is a feasible surgical procedure for all types of congenital ossicular anomalies.

Hypopituitarism due to CNS Aspergillus Infection

A 59-year-old man was admitted to our hospital with hyponatremia. An endocrine examination indicated panhypopituitarism, and magnetic resonance imaging revealed a mass-like lesion in the pituitary gland. Sinus endoscopy revealed a fungal mass in the sphenoid sinus, and the patient was diagnosed with hypopituitarism due to aspergillosis of the central nervous system (CNS). The patient's hyponatremia resolved with hydrocortisone replacement. Although the right internal carotid artery was eventually occluded, antifungal medications were administered for the aspergillosis, and the patient's general condition improved. The patient's CNS lesions have remained under control since discharge. This is the first case to suggest that ACTH secretion may be relatively preserved in Aspergillus-induced hypopituitarism.

Hypereosinophilic syndrome presenting as eosinophilic gastroenteritis exacerbated by clopidogrel bisulphate

Clopidogrel is a widely prescribed prodrug with antithrombotic activity that functions by irreversibly inhibiting the P2Y12 receptors on platelets; nevertheless, drug-induced eosinophilia from this drug is rarely reported. An 81-year-old man was diagnosed with cerebral infarction 2 months earlier and was admitted to our hospital with rash, fever, wheezing, and stomach discomfort after being initiated with clopidogrel treatment. Based on his medical history, chest CT, and gastroscopy, we diagnosed him with clopidogrel-induced hypereosinophilic syndrome. After discontinuation of clopidogrel, the eosinophilia and symptoms improved. In cases of drug-induced eosinophilia, it is important to obtain a detailed medical history.

Denileukin diftitox-induced systemic capillary leak syndrome with acute kidney injury

Systemic capillary leak syndrome is a rare and life-threatening disorder, characterized by recurrent episodes of unexplained hypotension, hemoconcentration, and hypoalbuminemia. This condition is caused by leakage of plasma and proteins into the extravascular space and can be classified as either idiopathic or secondary. Secondary systemic capillary leak syndrome can result from cancer, infections, medications, or surgery. Systemic capillary leak syndrome frequently develops as a side effect of denileukin diftitox treatment of refractory cutaneous T-cell lymphoma. However, the pathophysiology of this disease is not well understood. Herein, we report a case of denileukin diftitox-induced systemic capillary leak syndrome.

SOCS1 Gene Therapy for Head and Neck Cancers: An Experimental Study

BACKGROUND/AIM

Head and neck squamous cell carcinoma (HNSCC) is a fatal and debilitating disease, which is characterized by steady, poor survival rates despite advances in treatment. Suppressor of cytokine signaling (SOCS) 1 is up-regulated following cytokine-induced Janus kinase - signal transducer and activator of transcription (JAK-STAT) pathway activation, and inhibitors of cytokine signaling play roles in regulating cell growth and differentiation. We investigated the therapeutic potential of SOCS1 for HNSCC.

MATERIALS AND METHODS

We used cell lines of oropharyngeal and tongue cancers (Detroit-562 and SCC-9, respectively) and a recombinant adenovirus vector expressing SOCS1 (AdSOCS1).

RESULTS

AdSOCS1-induced SOCS1 overexpression significantly decreased cell proliferation through G₂M phase cell cycle arrest and apoptosis. AdSOCS1 inhibited cell growth more strongly in SCC-9 cells than in Detroit-562 cells. JAK inhibitor I induced cell cycle arrest at the G₀/G₁ and GfM phases in Detroit-562 and SCC-9 cells, respectively. AdSOCS1 also decreased the activity of phosph-STAT3 (pSTAT3) and phosphop44/42 mitogen-activated protein kinase (p-p44/42 MAPK), as well as the expression of the anti-apoptotic protein B-cell lymphoma-extra large (Bcl-xL). JAK inhibitor I decreased the expression of pSTAT3, but not p-p44/42 or Bcl-xL. The MAPK/extracellular signal-regulated kinase (MEK) inhibitor, U0126, decreased the expression of Bcl-xL in SCC-9 cells, but not in Detroit-562 cells. AdSOCS1 treatment inhibited tumor growth in mouse xenograft models.

CONCLUSION

Overexpression of SOCS1 has a potent antitumor effect on HNSCC, suggesting the potential for clinical use. The varying effectiveness among cancer cells by over expression of SOCS1 may contribute to efficacy of SOCS 1 gene therapy for clinical use.

Factors Influencing the Purchase Rate of Cartilage Conduction Hearing Aids

BACKGROUND

 Innovated hearing aids (HAs), termed cartilage conduction hearing aids (CC-HAs), show good performance in patients with closed ears and continuous otorrhea. However, factors other than the ear condition that influence the purchase rate of CC-HAs remain unclear.

PURPOSE

 To identify the factors that influence the purchase rate of CC-HAs.

RESEARCH DESIGN

 A correlational study.

STUDY SAMPLE

 A total of 249 patients were enrolled.

DATA COLLECTION AND ANALYSIS

 The patients' demographics, clinical characteristics, outcomes, and CC-HA transducer types were compared. The data were analyzed for six groups classified based on the ear condition.

RESULTS

 In the unilateral closed-ear group, the purchase cases were significantly younger than the nonpurchase cases (p < 0.05). Regarding the outcomes in the bilateral closed-ear group, the purchase cases showed significantly better-aided thresholds at 0.25 and 0.5 kHz than the nonpurchase cases. No significant differences in the functional gains and speech recognition scores were found between purchase and nonpurchase cases in all six groups. Regarding the transducer type, the continued-use rate of the simple transducer type was significantly lower in the bilateral chronic continuous otorrhea, bilateral open, and unilateral open groups.

CONCLUSION

 In the closed ears, no remarkable negative factors were found. Transducer type had a significant influence on the continued-use rate in the nonclosed ears including the ears with chronic continuous otorrhea, although the purchase rate of CC-HAs in the bilateral chronic continuous otorrhea group was comparable to the closed ears.

Staphylococcus aureus nasal colonization increases the risk of cedar pollinosis

Background

One‐third of the people in Japan are colonized with Staphylococcus aureus (S. aureus) and suffer from virulence factor‐mediated subclinical inflammation of the nares. We investigated whether subclinical inflammation contributed to cedar pollinosis affecting 20 million people annually.

Methods

The study participants were 814 inhabitants of the A or B prefectures. We compared the colonization rate and population structure of S. aureus, in association with the prevalence of cedar pollinosis, between participants in these two areas.

Results

A prefecture had twice the annual amount of airborne cedar pollen compared with B. The prevalence of cedar pollinosis was significantly higher in A (23.5%) than in B (13.1%) (p = 0.0004). Moreover, the prevalence of cedar pollinosis was higher in female participants (23.3%) than in male participants (14.7%) (p = 0.003). In addition, the prevalence of cedar pollinosis was higher in S. aureus carriers (24.2%) than in S. aureus noncarriers (17.9%) (p = 0.03). The isolation rate of clonal complex (CC) 508 was higher in the A group (21%) than in the B group (7%) (p = 0.015).

Conclusion

Nasal colonization of S. aureus is a major risk factor for cedar pollinosis. However, the direct mechanism of this risk is currently unknown.

The prevalence of cedar pollinosis in the research area was proportional to the amount of cedar pollen. The prevalence of cedar pollinosis was higher in S. aureus carriers (24.2%) than in S. aureus noncarriers (17.9%) (p = 0.03). The prevalence of cedar pollinosis was higher in female participants (23.3%) than in male participants (14.7%) (p = 0.003).

Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea

OBJECTIVES

The severity of pediatric obstructive sleep apnea (OSA) can vary from mild to very severe (AHI ≥ 30 events/h) with the seasons. The efficacy of medical treatment has been investigated in cases of mild and moderate pediatric OSA, but not in severe cases thoroughly.

METHODS

Our prospective cohort study involved 205 children who visited our outpatient clinic between December 2014 and May 2020. We performed home sleep tests after the initial visit, and then polysomnography after optimizing the control of rhinitis, sinusitis, adenoid hypertrophy, and tonsillitis by using medical treatments.

RESULTS

The respective proportions of patients who improved to obstructive AHI (O-AHI) < 1/h or who proceeded to surgery were 43.4% and 62.3% in mild cases; 43.3% and 52.2% in moderate cases; 30.2% and 68.4% in severe cases; and 0.0% and 100% in very severe cases. Additionally, nadir SaO₂ improved significantly between before and after medical treatment in both O-AHI < 1/h and O-AHI ≥ 1/h patients (respectively p < 0.0001, p = 0.0009). The lowest nadir SaO₂ before medical treatment was 74% in patients in whom O-AHI was normalized after medical treatments.

CONCLUSION

Medical treatment instituted before a surgical decision is made can provide substantial benefits and avoid unnecessary surgery if there is time for such treatments. In contrast, it may be difficult to normalize the O-AHI in pediatric patients with very severe OSA or a nadir SaO₂ of less than 74% by medical treatment.

MEASUREMENT OF HALF-VALUE LAYER IN COMPUTED TOMOGRAPHY SCANNERS USING LUMINESCENCE OF POLYETHERSULFONE RESIN BY X-RAY IRRADIATION

In this study, a method for estimating the half-value layer (HVL) and effective energy (Eeff) by imaging the luminescence from a polyethersulfone (PES) resin with rotating irradiation of X-rays in a computed tomography scanner was developed. The luminescence of the PES resin was imaged using a charge-coupled device camera. The PES-HVL was determined from the luminance attenuation profile corresponding to the X-ray attenuation within the resin. The PES-HVLs for tube potentials of 80-135 kVp were converted into Eeff values and were compared to those of a conventional lead-covered case method. The Eeff obtained using the proposed luminescence imaging method agreed within ~3.9% of that obtained using the conventional method. Moreover, dose simulations based on the X-ray spectrum calculated from the HVLs were performed using a poly(methyl methacrylate) phantom with a diameter of 16 cm. The simulated doses based on the luminescence imaging method agreed with the in-phantom dosimetry within ~9%.

Laryngeal malignant peripheral nerve sheath tumor mixed with high- and low-grade malignancies

Malignant peripheral nerve sheath tumors (MPNSTs), as defined by immunohistochemical evaluation, are identified along a spectrum ranging from atypical neurofibroma to high-grade MPNST because these tumors are similar in terms of cell shape and tissue components on hematoxylin–eosin (HE) staining. The patient was a 57-year-old male referred to our hospital, with a recurrent red tumor at the anterior commissure of the larynx and submucosal swelling of the right vocal fold. A surgical specimen from a right horizontal partial laryngectomy was evaluated immunohistochemically. A high-grade MPNST lesion was included in the submucosal white tumor, whereas a low-grade MPNST lesion was encountered around the high-grade MPNST lesion. This tumor may involve different malignancies even when it is small. Although intra-tumor heterogeneity in cancers has been reported recently, careful immunohistochemical examination can be important and beneficial for eradicating the tumor while preserving vocal function.

Cartilage tympanoplasty for recurrent cholesteatoma using a single sliced cartilage graft: Our experience in 14 ears

Our procedure may provide a useful alternative in cases where previous surgeries have failed to eradicate the cholesteatoma.

Cartilage Conduction Hearing Aid Fitting in Clinical Practice

BACKGROUND

 Cartilage conduction hearing aids (CCHAs) were newly devised and spread fast in Japan since their launch in 2017. However, little knowledge is available for this new device.

PURPOSE

 The aim of this study was to establish the knowledge of CCHAs and suggest their indication.

RESEARCH DESIGN

 Correlational study.

STUDY SAMPLE

 A total 256 patients were registered.

DATA COLLECTION AND ANALYSIS

 The fitting of CCHAs was surveyed in nine institutions. The outcomes were assessed by audiometric tests. The patients were classified into seven groups, depending on the ear conditions. The clinical characteristics, assessment results, and purchase rates were compared among the groups. The assessment results of CCHAs were also compared with those of previously used hearing aids.

RESULTS

 Most patients who used CCHAs were classified into the bilateral closed (aural atresia or severe stenosis) ear (n = 65) or unilateral closed ear (n = 124) groups. The patients in these groups achieved good benefits that resulted in a high purchase rate. The bilateral continuous otorrhea group also supported a high purchase rate, although the benefits of CCHAs were not always excellent. In contrast, the purchase rate was poor in the patients who could use air conduction hearing aids (ACHAs) without absolute problems. As for using a CCHA as a contralateral routing of signals hearing aid, the benefits depended on the patients.

CONCLUSIONS

 CCHAs are considered as a great option not only to the patients with closed ears but also to those who had difficulties in ACHAs usage.

A case of maxillary cancer treated by intra-arterial therapy using a steerable microcatheter

We report on a 69-year-old man with locally-advanced left maxillary sinus cancer who underwent treatment with intra-arterial chemoradiotherapy. Angiography showed that the main feeding arteries were the left maxillary artery and the ophthalmic artery, arising from the internal carotid artery. Due to acute branching of the ophthalmic artery, conventional microcatheters could not be inserted. Using a steerable microcatheter, we were able to repeatedly administer chemoradiotherapy via the ophthalmic artery. The tumor has mostly disappeared after intra-arterial chemoradiotherapy, and the patient is still alive two years after treatment. A steerable microcatheter is very useful for acute-angled vascular branches.

Leak-free million-fold DNA amplification with locked nucleic acid and targeted hybridization in one pot

An isothermal cascade reaction that exponentially amplifies pre-designed, single-stranded DNA as a sensor and signal amplifier module for DNA-based computing and molecular robotics was developed. Taking advantage of the finding that locked nucleic acid can suppress problematic ab initio DNA synthesis, up to million-fold amplification rates and concurrent hybridization were achieved at a physiological temperature in a single reactor. Although the effect of locked nucleic acid introduction to the templates was complicated, undesired leak DNA amplification was generally suppressed in the amplification reaction for distinct DNA sequences. The present reaction that senses one DNA as an input and generates a large amount of another DNA as an output, exhibiting a high correlation between the molecular concentration and the amplification time, is applicable for nucleic acid quantification.

Verbal abuse during pregnancy increases frequency of newborn hearing screening referral: The Japan Environment and Children's Study

BACKGROUND

Verbal abuse during pregnancy has a greater impact than physical and sexual violence on the incidence of postnatal depression and maternal abuse behavior towards their children. In addition, exposure of children (aged 12 months to adolescence) to verbal abuse from their parents exerts an adverse impact to the children's auditory function. However, the effect of verbal abuse during pregnancy on fetal auditory function has not yet been thoroughly investigated.

OBJECTIVE

The objective of the study was to examine the relationship between intimate partner verbal abuse during pregnancy and newborn hearing screening (NHS) referral, which indicates immature or impaired auditory function.

PARTICIPANTS AND SETTING

The Japan Environment and Children's Study is an ongoing nationwide population-based birth-cohort study designed to determine environmental factors during and after pregnancy that affect the development, health, or wellbeing of children. Pregnant women living in 15 areas of Japan were recruited between January 2011 and March 2014.

METHODS

Multiple imputation for missing data was performed, followed by multiple logistic regression using 16 confounding variables.

RESULTS

Of 104,102 records in the dataset, 79,985 mother-infant pairs submitted complete data for questions related to verbal and physical abuse and the results of NHS. Of 79,985 pregnant women, 10,786 (13.5%) experienced verbal abuse and 978 (1.2%) experienced physical abuse. Of 79,985 newborns, 787 (0.98%) received a NHS referral. Verbal abuse was significantly associated with NHS referral (adjusted odds ratio: 1.44; 95% confidence interval: 1.05-1.98).

CONCLUSIONS

Verbal abuse should be avoided during pregnancy to preserve the newborn's auditory function.

MEASUREMENT OF INTERNAL RADIATION DOSE DISTRIBUTION IN CT EXAMINATIONS USING POLYETHYLENE TEREPHTHALATE RESIN

This study proposes a new dosimetry method for the estimation of the internal radiation dose distribution of a subject undergoing computed tomography (CT) examinations. In this novel method, dose distribution of a subject by CT scans was estimated based on radiophotoluminance distribution with polyethylene terephthalate (PET) resin which was cut to the average head size of a Japanese 1-year-old child. The difference in dose distribution depending on the type of bowtie filter was visualized by imaging luminance distribution with the PET phantom using a charge-coupled device camera. Dose distribution images simulated from a water phantom of the same size as the PET phantom were compared with the luminance distribution images. The linear correlation was demonstrated between luminance of the PET phantom and the simulated water dose. In comparison with the simulated water doses and the converted water doses from luminance of the PET phantom, the relative differences were within 20%.

The gray scale value of ear tissues undergoing volume-rendering high-resolution cone-beam computed tomography

OBJECTIVE

When the thresholds for VR reconstruction from multi-slice CT images are changed, problems develop when assessing pathologies in the absence of standardized thresholds. The advantages of CBCT include lower radiation exposure compared with other techniques and better visualization of small ear structures. However, a disadvantage is that the scanner provides unstandardized gray scale values, thus not CT numbers (Hounsfield units, HU).

METHODS

We analyzed 88 sets of volume data obtained from temporal bones. The gray scale values were measured in aerated areas (two sites), along the ossicular chain (four sites) and in a bone area (one site) in the external and middle ears, and in soft tissue areas (five sites) and bone areas (two sites) in the inner ear.

RESULTS

The standard male and female gray scale values were 2448-2970 and 2585-3091 for the aerated areas, 3248-4945 and 3359-5223 for the ossicular chains, 3368-4109 and 3371-4147 for soft tissues, and 4790-5776 and 5044-5959 for bone, respectively. Sex significantly affected the values (p<0.05). Significant differences between aerated areas and ossicular chains, and between soft tissues and bone, were evident (all p<0.0001).

CONCLUSION

Volume-rendering (VR) images obtained by cone-beam computed tomography (CBCT) can be standardized simply by using fixed thresholds.

Five-year postoperative outcomes of modified staged canal wall up tympanoplasty for primary acquired cholesteatoma

OBJECTIVE

For successful canal wall up tympanoplasty (CWUT) for the treatment of cholesteatoma, the restoration of stable middle ear aeration is also important; however, little is known about the dynamics of such aeration or the optimal surgical procedure. In this study, alternative additional surgical procedure was selected based on the grade of middle ear aeration during the second-stage operation.

SUBJECTS AND METHODS

Patients included in this study underwent staged CWUT surgeries with mastoid cortex plasty (MCP) for well-aerated ears (grade 3) and bony mastoid obliteration (BMO) for poorly aerated ears (grade 2-0). Of the 115 ears included in this study, 62 were followed for more than 5 years. Recurrence rates with deep retraction pocket formation were assessed using the Kaplan-Meier survival analysis. The aeration was graded as: 0, no aeration; 1, aeration of only the mesotympanum; 2, aeration of the entire tympanic cavity; and 3, aeration of both the tympanic and mastoid cavities.

RESULTS

No recurrence was observed in ears associated with grade 3 aeration that underwent MCP or in ears with grade 2 aeration that underwent BMO during second-stage surgery. For grades 0 and 1 aeration ears, the recurrence rates were 8.1% after 5 years and 12.5% after 10 years (p < 0.05), and the aeration of recurrent ears deteriorated to grade 0.

CONCLUSION

Aeration during second-stage surgery predicts the final outcome.

Polyglycolic acid sheet attached with fibrin glue can facilitate faster epithelialization of the mastoid cavity after canal wall-down tympanoplasty

OBJECTIVE

This study retrospectively investigated whether polyglycolic acid (PGA) sheet attached to the bone surface using fibrin glue facilitate faster epithelialization of the mastoid bowl after canal wall-down (CWD) tympanoplasty compared to a simple dressing using poly-N-acetyl-glucosamine (Kichin) sheet.

MATERIALS AND METHODS

After completion of the CWD tympanoplasty, PGA sheet (n=16, PGA group) with fibrin glue or Kichin sheet (n=38, Kichin group) were placed on the bone surface of the mastoid bowl.

RESULTS

Postoperative epithelialization of the mastoid cavity was significantly (p<0.05) faster in the PGA group than in the Kichin group (mean 135 versus 244 days, respectively). Use of the Kaplan-Meier method showed that only the short-term epithelialization rate (up to 100 days after operation) was significantly higher. No major adverse effects related to either procedure were seen.

CONCLUSION

Epithelialization of the mastoid bowl after CWD tympanoplasty was faster in the postoperative short term when it was dressed with PGA sheet using fibrin glue compared with Kichin sheet.

A dramatic enhancing effect of InBr3 towards the oxidative Sonogashira cross-coupling reaction of 2-ethynylanilines

The addition of InBr3 to the oxidative Sonogashira cross-coupling reaction of 2-ethynylaniline with (E)-trimethyl(3,3,3-trifluoroprop-1-enyl)silane led to a dramatic increase in the reactivity to afford the corresponding 1,3-enynes bearing a trifluoromethyl group on their terminal sp(2) carbon. The subsequent cyclization of these 1,3-enynes under palladium catalysis provides access to the corresponding indoles bearing a 3,3,3-trifluoroprop-1-enyl group at their 2-position.

A modified combined transseptal/transnasal binostril approach for pituitary lesions in patients with a narrow nasal space: technical note

We describe a modification of the combined transseptal/transnasal binostril approach using a two-surgeon, four-handed technique (modified Stamm's approach) for pituitary lesions in patients with narrow nasal spaces. This approach comprises of a transseptal route through one nostril and a transnasal route without harvesting a pedicled nasoseptal flap (NSF) through the other. On the transseptal side, the nasal septum was removed using an endoscopic septoplasty technique. On the transnasal side, the mucosa containing the septal branch of the sphenopalatine artery over the face of the sphenoid and nasal septum was preserved for harvesting the NSF if an intraoperative cerebrospinal fluid leak was encountered. This approach was performed in six patients with pituitary lesions, including four non-functioning macroadenomas, one growth hormone-producing macroadenoma, and one Rathke's cleft cyst, all of which were associated with a severe deviation of the nasal septum and/or narrow nasal space. The meticulous and comfortable manipulation of an endoscope and instruments were achieved in all six patients without surgical complications. Our findings, although obtained in a limited number of cases, suggest that the modified Stamm's approach may be useful for selected patients, particularly those with a severe deviation of the nasal septum, without considerable damage to the nasal passages.

Modified hemostatic technique using microfibrillar collagen hemostat in endoscopic endonasal transsphenoidal surgery: technical note

Microfibrillar collagen hemostat (MCH) is accepted as an effective topical hemostatic agent during endoscopic endonasal transsphenoidal surgery (EETS), particularly to achieve venous hemostasis; however, handling MCH may be troublesome because of its adherence to gloves and instruments. We describe here a method of “injection” of MCH suspension using a syringe applicator. This technique allows a rapid and precise delivery of MCH to the bleeding points and thereby results in effective hemostasis; in addition, it is easy to prepare and it is also inexpensive.

[Endoscopic ear surgery for traumatic ossicular disruptions]

Although endoscopic ear surgery (EES) has been used to perform middle ear surgery since 1993, it has not become as common in otologic surgery as it is in endoscopic sinus surgery. This report discusses the problems and the indications for EES in traumatic ossicular disruptions in two cases. Case 1 was a 33-year-old man with a left longitudinal temporal bone fracture who presented with mixed hearing loss, with an average hearing level of 45.0 dB in the left ear. He underwent EES, which revealed incudostapedial joint disrutption. Repositioning of the incus resulted in an improvement in hearing to 18.3 dB postoperatively. Case 2 was a 30-year-old man with a right mixed hearing loss of 56.7 dB. Computed tomography showed a right longitudinal temporal bone fracture and dislocation of the incus. EES revealed dislocation of the incus and fracture of the anterior crus of the stapes. A type IV tympanoplasty was performed, interpositioning the autologous incus between the footplate and the malleus handle. Postoperatively, the average hearing level was 18.3 dB, with a 1.7-dB air-bone gap. Traumatic ossicular disruptions are considered to be a good indication for EES.

Role of barium esophagography in patients with locally advanced esophageal cancer: evaluation of response to neoadjuvant chemoradiotherapy

Purpose. This retrospective study examined the usefulness of barium esophagography, focusing on the luminal stenosis, in the response evaluation of neoadjuvant chemoradiotherapy (NACRT) in patients with esophageal cancer. Materials and Methods. Thirty-four patients with primary advanced esophageal cancer (≥T2) who were treated with NACRT before surgical resection were analyzed. All patients underwent barium esophagography before and after NACRT. The tumor length, volume, and percent esophageal stenosis (PES) before and after NACRT were measured. These values and their changes were compared between histopathologic responders (n = 22) and nonresponders (n = 12). Results. Posttreatment tumor length and PES in responders (4.5 cm ± 1.1 and 33.0% ± 18.5) were significantly smaller than those in nonresponders (5.8 cm ± 1.9 and 48.0% ± 12.9) (P = 0.018). Regarding posttherapeutic changes, the decrease in PES in responders (31.5% ± 13.9) was significantly greater than that in nonresponders (14.4% ± 10.7) (P < 0.001). The best decrease in PES cutoff with which to differentiate between responders and nonresponders was 18.8%, which yielded a sensitivity of 91% and a specificity of 75%. Conclusions. Decrease in PES is a good parameter to differentiate responders from nonresponders for NACRT. Barium esophagography is useful in response evaluation to NACRT in patients with locally advanced esophageal cancer.

Width of the normal facial canal measured by high-resolution cone-beam computed tomography

CONCLUSIONS

In the facial canal, discrepancies between left and right side measurements at each point may be useful in the assessment and diagnosis of facial canal-related pathologies.

OBJECTIVES

This study was performed to obtain accurate and high-resolution images of the normal facial canal and measure its widths on cross-sections of the canal at anatomically and clinically important sites using high-resolution cone-beam computed tomography (CBCT).

METHODS

CBCT volume data of bilateral temporal bones were obtained from 28 healthy adult volunteers. The widths of the bony facial canals were measured at the meatal foramen, the cochleariform process, the stapes, the pyramidal eminence, and the point of emergence of the chorda tympani in the vertical segment.

RESULTS

The widths of the facial canal at each point were similar bilaterally (r = 0.54-0.85, p < 0.01), but showed regional differences and site-specific variations. The narrowest of the five sites was the level of the meatal foramen (p < 0.05), as reported previously. The second narrowest site was the level of the stapes (p < 0.01) followed in order by the level of the cochleariform process, the pyramidal eminence, and the point of emergence of the chorda tympanis (p < 0.01).

Genotype of Staphylococcus aureus Isolated from Otorrhea of Chronic Otitis Media

Objectives:

Staphylococcus aureus (SA) causes about 50% of cases of chronic otitis media (COM). Specific characteristics of a geographical region and diseases such as impetigo and atopic dermatitis were identified as factors in the molecular epidemiology of SA. We compared the genotype of SA isolated from otorrhea of patients with COM with the genotype isolated from the nasal inhabitants of healthy subjects.

Methods:

Forty SA isolates, including 11 methicillin-resistant SA (MRSA) isolates, were collected from patients with COM who underwent tympanoplasty between April 2009 and July 2012. Multilocus sequence typing was performed on these isolates. First, PCR and DNA sequencing were performed on seven housekeeping genes of SA. A clonal complex (CC) was defined as the coincidence of a gene among five of the seven genes. In patients with MRSA, the period until the ears became dry postoperatively was investigated.

Results:

The proportion of CC8 and CC5 SA strains of COM were greater than that of nasal inhabitants, possibly because the CCs included MRSA stains. The proportion of CC188 and CC508 SA strains, which are major strains in nasal inhabitants, was smaller. The proportion of CC121, CC509, and CC59 SA strains, which are minor strains in nasal inhabitants, was greater. The periods were 207 days for the CC8 MRSA strain (n=4), 189 days for the CC5 MRSA strain (n = 4), and 95 days for the CC 95 MRSA strain (n=1); no significant difference was found.

Conclusions:

This study revealed discrepancies in CCs between SA from COM and SA from nasal inhabitants.

Scattered radiation from dental metallic crowns in head and neck radiotherapy

We aimed to estimate the scattered radiation from dental metallic crowns during head and neck radiotherapy by irradiating a jaw phantom with external photon beams. The phantom was composed of a dental metallic plate and hydroxyapatite embedded in polymethyl methacrylate. We used radiochromic film measurement and Monte Carlo simulation to calculate the radiation dose and dose distribution inside the phantom. To estimate dose variations in scattered radiation under different clinical situations, we altered the incident energy, field size, plate thickness, plate depth and plate material. The simulation results indicated that the dose at the incident side of the metallic dental plate was approximately 140% of that without the plate. The differences between dose distributions calculated with the radiation treatment-planning system (TPS) algorithms and the data simulation, except around the dental metallic plate, were 3% for a 4 MV photon beam. Therefore, we should carefully consider the dose distribution around dental metallic crowns determined by a TPS.