Small cell carcinoma (SCC) occurs mostly in the lung, and in some patients is accompanied by production of ectopic hormones. Small cell carcinoma of the head and neck is very rare. We report 4 patients with SCC of the head and neck (larynx, tonsil, maxillary sinus, and parotid gland). The patient with SCC of the maxillary sinus demonstrated a high level of plasma serotonin and overexpression of parathyroid hormone; however, he did not show any related symptoms. The patient with SCC of the tonsil showed the syndrome of inappropriate secretion of antidiuretic hormone associated with antidiuretic hormone hyperproduction at the terminal stage. In the literature, 16 patients with SCC of the head and neck with ectopic hormone production have been reported. Antidiuretic hormone and adrenocorticotropic hormone were the hormones that caused clinical symptoms (paraneoplastic syndromes). We believe that the evaluation of hormonal syndromes is valuable for diagnosis and treatment.
Acoustic neuroma sometimes presents with sudden-onset sensorineural hearing loss as a primary symptom. We investigated 848 untreated cases that included 20 cases with acoustic neuroma with sudden-onset sensorineural hearing loss and 828 cases without acoustic neuroma. Fourteen of the 20 acoustic neuroma and 90 of the 828 cases of sudden-onset sensorineural hearing loss showed a trough-shaped audiogram with the greatest amount of hearing loss in the mid-frequency range. The incidence of a trough-shaped audiogram was significantly higher in patients with acoustic neuroma than in those without (<i>p</i> < 0.01). This study suggests that a trough audiogram is a significant finding in patients with sudden-onset sensorineural hearing loss and indicates the presence of acoustic neuroma.
<div>Abstract<p><b>Purpose:</b> One copy of the galanin receptor 1 (<i>GALR1</i>) locus on 18q is often deleted and expression is absent in some head and neck squamous cell carcinoma (HNSCC) cell lines. To determine if loss of heterozygosity and hypermethylation might silence the <i>GALR1</i> gene, promoter methylation status and gene expression were assessed in a large panel of HNSCC cell lines and tumors.</p><p><b>Experimental Design:</b> Promoter methylation of <i>GALR1</i> in 72 cell lines and 100 primary tumor samples was analyzed using methylation-specific PCR. GALR1 expression and methylation status were analyzed further by real-time PCR and bisulfite sequencing analysis.</p><p><b>Results:</b> The <i>GALR1</i> promoter was fully or partially methylated in 38 of 72 (52.7%) HNSCC cell lines but not in the majority 18 of 20 (90.0%) of nonmalignant lines. <i>GALR1</i> methylation was also found in 38 of 100 (38%) primary tumor specimens. Methylation correlated with decreased <i>GALR1</i> expression. In tumors, methylation was significantly correlated with increased tumor size (<i>P</i> = 0.0036), lymph node status (<i>P</i> = 0.0414), tumor stage (<i>P</i> = 0.0037), <i>cyclin D1</i> expression (<i>P</i> = 0.0420), and <i>p16</i> methylation (<i>P</i> = 0.0494) and survival (<i>P</i> = 0.045). Bisulfite sequencing of 36 CpG sites upstream of the transcription start site revealed that CpG methylation within transcription factor binding sites correlated with complete suppression of <i>GALR1</i> mRNA. Treatment with trichostatin A and 5-azacytidine restored <i>GALR1</i> expression. In UM-SCC-23 cells that have total silencing of <i>GALR1</i>, exogenous <i>GALR1</i> expression and stimulation with galanin suppressed cell proliferation.</p><p><b>Conclusions:</b> Frequent promoter hypermethylation, gene silencing, association with prognosis, and growth suppression after reexpression support the hypothesis that <i>GALR1</i> is a tumor suppressor gene in HNSCC.</p></div>
Loss of heterozygosity (LOH) on 18q predicts poor survival in head and neck squamous cell carcinomas (HNSCCs). Several putative tumor suppressor genes, such as DCC, DPC4/Smad4, and MADR2/Smad2, are mapped to 18q, but thus far, the important gene locus in HNSCC is not known. To identify possible gene loci on 18q, we performed LOH studies using tumor DNA from 57 HNSCC primary tumor cell lines and DNA isolated from fibroblasts or lymphoblastoid cells from the same patients. Forty-two highly polymorphic microsatellite markers spaced not more than 5 cM apart (mean distance, 1.82 cM) spanning the region from D18S44 in 18q11.1 to D18S1141 in 18q23 were used. D18S71 in 18p11.21 on 18p was also used to determine whether the short arm was retained. Forty-three of 57 (75%) HNSCC lines showed LOH or isolated allelic imbalance (AI) for at least one locus on 18q. Although many of the cell lines had large distal 18q deletions with a breakpoint between 18q11.1 and 18q12.2 to qter, three loci were identified that were lost in 70% or more of the cases. The minimally lost regions (MLRs) range in size from 1.5-15.79 cM. The most proximal is centered on D18S39 (1.56 cM) in band 18q21.1, with LOH or isolated AI in 28 of 38 (74%) of informative cases. The largest (15.8 cM) begins at D18S61 (28 of 40; 70%) in band 18q22.2 and extends through D18S50 in 18q23. The third is centered on D18S70 (30 of 40; 75%) in band 18q23 (3.67 cM). Of these MLRs, only the one centered on D18S39 has been implicated previously in HNSCC. D18S70, the most frequently lost marker, was the only marker consistently lost in three tumor cell lines with very minimal losses, UM-SCC-19, UM-SCC-67, and UM-SCC-73A. In addition, UM-SCC-91 exhibited AI only at this locus, and UT-SCC-4 had AI at D18S70 and D18S39 only. Close physical mapping of these three regions may pinpoint one or more previously unidentified tumor suppressor genes.
Octylcyanoacrylate is a tissue adhesive that has been approved for closure of surgical incisions. Since 2002 to 2003, we have used this tissue adhesive (marketed as DERMABOND®) for skin closure following cochlear implant surgery in 16 adults and 16 children. Infants aged 2-3 years old comprised 37.5% of the patients. The post-auricle incision was J-shaped, the wound was 6cm in length, and there were no major problems of wound dehiscence or infection. Minor problems arose in 5 patients (15.6%), including partial dehiscence in two patients, partial infection in two patients and partial post-auricle edema in one patient, but all of these resolved spontaneously. A drainage tube was inserted into the wound in five patients, but there were no problems in these cases. Using an octylcyanoacrylate tissue adhesive has many advantages. It eliminates the need for suture removal and disinfection, and allows wounds to get wet briefly during showering or bathing, because a barrier function against microbial penetration or moisture is present. This is especially advantageous in young patients. Our current experience with this approach demonstrates that DERMABOND® can be used successfully and appropriately for wound closure after a variety of ear surgeries.
Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep neck infection and has a high mortality rate. Therefore, we need rapid diagnosis and treatment. The reported strategies for DNM treatment have stressed the need for surgical management and adequate antibiotic administration. We experienced one case of DNM with a deep neck abscess. The patient was a 52-year-old male with acute epiglottitis, so we started antibiotic administration, and although the epiglottitis and inflammatory response were getting better, chest pain and dyspnea gradually occurred. We therefore performed CT scan imaging which showed signs of a gas forming abscess in both the neck and anterior mediastinum. Transcervical mediastinal drainage was performed by otolaryngologists and thoracic surgeons. In spite of the operation, the patient’s respiratory condition was getting worse, and a second operation was required via thoracotomic drainage. We should take account of gas-forming abscess as a severe case, therefore we considered a more extended drainage area and performed an additional operation. CT imaging is very useful for determining whether to perform surgery, including transcervical, mediastinal, or thoracotomic drainage.
In the present study, we examined 109 patients operated on by open and reconstruction tympanoplasty and review and discuss postsurgical problems of residual and recurrent cholesteatomas. Sixty four patients (59%) were treated by one-stage operation, and 45 (41%) required two-stage procedures. Residual cholesteatoma was found in four patients at the second look and recurrent cholesteatoma in two after the first operation. However, in all patients who have been followed for one to four years after one- or two-stage operations, there has been no evidence of residual or recurrent cholesteatoma.
We studied the clinical effects of LipoPGE1 in 23 patients with sudden deafness who also received methylprednisolone (LipoPGE1 group). Twenty one patients were treated with methylprednisolone without LipoPGE1 (non-LipoPGE1 group).Complete recovery was noted in 10 patients, marked improvement in 4, improvement in 8, and no change in 1 in the LipoPGE1 group. The corresponding figures were 6, 2, 5 and 8 in the non-LipoPGE1 group.The differences were statistically significant. No serious side effects were observed in the LipoPGE1 group.These results suggest that LipoPGE1 therapy combined with steroid is effective in patients with sudden deafness.
We investigated 974 patients with sudden sensorineural hearing loss who consulted the otolaryngological service of Hamamatsu University Hospital and four affiliated hospitals from 1984 to 1992. Among them, we selected 569 new cases showing a pure tone average of 31 dB or more at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz on the affected side in the initial audiometry performed within 14 days after the onset of sudden sensorineural hearing loss. The 569 patients consisted of 13 with acoustic neuromas (SHLANs), 493 with idiopathic sudden sensorineural hearing loss (ISHLs) and 63 others. Ten of the 13 SHLANs and 40 of the 493 ISHLs showed the trough type audiogram on the initial examination. We defined the 10 cases as the Trough AN group and the 40 as the Trough ISHL group. Statistical analysis of the difference in pure tone averages at 5 frequencies between the 2 groups demonstrated that the mean hearing losses at 125, 250 and 500 Hz of Trough AN were significantly less than those of Trough ISHL. This study demonstrates that the trough type audiogram, especially a slight low tone loss, shown in patients with sudden sensorineural hearing loss was a significant finding suggesting the presence of acoustic neuroma.
