A 62-year-old woman, who had dysesthesia in the throat, and polyposia the previous year, was admitted in a coma because of respiratory failure. Computed tomography scans demonstrated dilatation of the esophagus and steno...A 62-year-old woman, who had dysesthesia in the throat, and polyposia the previous year, was admitted in a coma because of respiratory failure. Computed tomography scans demonstrated dilatation of the esophagus and stenosis of the trachea. After emergency intubation, extubation was not possible due to a collapsed trachea, so we performed a tracheostomy. The tracheoscopy from the stoma showed an esophagus-like trachea due to disappearance of the tracheal cartilage and the straight pattern on the membranous portion, and the lumen deformed with coughing. With the continuous dyspnea episode, the patient was diagnosed as having tracheomalacia. Anti-type II collagen antibody and pathological findings of the trachea led us to the diagnosis of Relapsing Polychondritis.
The large cell neuroendocrine carcinoma (LCNEC) of the lung was first reported in detail by Travis et al. in 1991. Extrapulmonary LCNEC rarely occurs, and only 22 cases have been reported in the head and neck mucosal reg...The large cell neuroendocrine carcinoma (LCNEC) of the lung was first reported in detail by Travis et al. in 1991. Extrapulmonary LCNEC rarely occurs, and only 22 cases have been reported in the head and neck mucosal regions. Today LCNEC of the larynx is contained in the moderately differentiated/Grade 2 category. However some authors advocate that LCNEC of the larynx should be separated from this category because of the difference in the clinical manifestations and pathological features. Standard treatment for head and neck mucosal LCNEC (M-LCNEC) has not been confirmed. However we suggested the efficacy of postoperative chemotherapy for M-LCNEC. This report describes a case of an LCNEC of the oropharynx. The patient was a 64-year-old man. We treated him with surgery and chemoradiotherapy. He has been disease-free for 36 months after adjuvant-chemotherapy.
Otitis media related with ANCA associated vasculitis is an intractable condition conditions that is resistant to conventional conservative treatment or surgical treatments. The name "otitis media with ANCA associated vas...Otitis media related with ANCA associated vasculitis is an intractable condition conditions that is resistant to conventional conservative treatment or surgical treatments. The name "otitis media with ANCA associated vasculitis (OMAAV)" has been proposed as a new concept for this disease. In the present study, we examined the clinical feature of 14 cases of OMAAV. We also investigated the usefulness of combined tests for ANCA detection. There were 11 females and 3 males, with a median age of 68.5 years. PR3-ANCA was positively detected in 4 (28.6%) patients, MPO-ANCA was detected in 6 (42.9%), and 4 (28.6%) were both ANCAs negative. During the course 6 patients developed pachymeningitis and 5 patients developed facial palsy. Plasma samples from 14 OMAAV patients were tested for the presence of ANCAs with five detection methods (3 PR 3-ANCA kits (direct ELISA, capture ELISA, anchor ELISA), 2 MPO-ANCA kits (direct ELISA, capture ELISA)) and the indirect immunofluorescence (II) technique. Six patients (42.9%) were positive for ANCA in clinical examination (single EIA method), while ANCA was positively detected in 9 patients (64.3%) with combined methods. In ANCA negative cases, ANCA should also be tested with a different technique such as new generation ELISA and IIF.
BACKGROUND: Persons allergic to birch pollen often report oral and pharyngeal hypersensitivity to fruit and vegetables, due to immunological cross-reactivity between pollen and foods. This phenomenon is referred to as th...BACKGROUND: Persons allergic to birch pollen often report oral and pharyngeal hypersensitivity to fruit and vegetables, due to immunological cross-reactivity between pollen and foods. This phenomenon is referred to as the oral allergy syndrome (GAS). Such cross-reactive antigen reactions mainly involve Bet v 1, which is the major birch-pollen allergen, and partially involve birch-pollen profilin Bet v 2. Soybean contains Bet v 1-related antigen (Gly m 4), and soy milk often causes the OAS with severe symptoms such as precordial and abdominal burning sensation because soy milk undergoes little denaturation, and this water-soluble liquid is consumed by most people rather quickly. We evaluated the frequency of the oAS after ingestion of soymilk and examined IgE antibodies to various allergens. METHODS: A total of 167 patients [122 women, 45 men; age range, 4-72 years (mean age, 32 years)], who had experienced GAS episodes and had IgE birch--pollen antibodies, were interviewed. Using the CAP system, we examined IgE antibodies to birch pollen and other allergens. Of 167 patients, 161 were examined for IgE antibodies to Bet v 1, Bet v 2, Gly m 4, and soybean. We evaluated the frequency of the GAS after soy milk ingestion based on reports by GAS patients with birch pollen allergy, and evaluated the positive rates of some of the IgE antibodies. RESULTS: Among the 167 patients with birch-pollen allergy and GAS on ingestion of any of the foods, there were 16 cases (10%) with OAS following soy milk ingestion. In addition, the foods that caused OAS most often were apples (123 cases, 74%), peaches (67%), and cherries (55%), followed by pears (37%) and kiwi (37%). A higher CAP class for birch pollen, Bet v 1, Gly m 4, and soybean was associated with a higher prevalence of OAS to soy milk. Of 15 patients who had GAS on ingestion of soy milk and had birch-pollen allergy, 47% (7cases) were CAP class 1 for soybean and only 7% (case) was CAP class c2, whereas 93% (14cases) were CAP class 1 for Gly m 4, and 87% (3cases) were CAP class ≥ 2 for Gly m 4. CONCLUSION: Among the birch-pollen allergic OAS patients, 10% had the OAS on ingestion of soy milk, and among these with birch-pollen allergy and the OAS on ingestion of soy milk, the positive rate for soy milk CAP was low, whereas that for Gly m 4 CAP was high.
We have performed transoral surgical resection for patients with T1/T2 hypopharyngeal cancer and induction chemotherapy with docetaxel for patients with T2/T3 disease. The patients were analyzed in order to determine the...We have performed transoral surgical resection for patients with T1/T2 hypopharyngeal cancer and induction chemotherapy with docetaxel for patients with T2/T3 disease. The patients were analyzed in order to determine the current situation of larynx preservation in patients with hypopharyngeal cancer. The data of a total of 83 patients with hypopharyngeal cancer were analyzed retrospectively. The primary subsites were : pyriform sinus (PS) in 61 patients, posterior wall (PW) in 13 patients, and postcricoid (PC) in 9 patients. The number of patients classified as having T1, T2, T3 and T4 disease were 14, 29, 23 and 17, respectively. The main therapies employed in the patients were as follows: transoral surgical resection plus radiation therapy for T1 disease, radiation therapy, induction chemotherapy, and partial resection for T2 disease, induction chemotherapy, radiation therapy, and pharyngo-laryngoesophagectomy for T3 disease, and pharyngo-laryngoesophagectomy plus induction chemotherapy for T4 disease. The 5-year larynx preservation rates in the patients with T1, T2, T3 and T4 disease were 100%, 73%, 39% and 35%, respectively. Our method was able to improve the larynx preservation rate without having any adverse effect on the survival rate. However, the strength of treatment for T 3 disease needs to be improved, because a large number of recurrences and deaths due to the primary disease were encountered in this patient group.