Treatment of Malignant Tumor in the Head and Neck: --Interdisciplinary Collaboration of Surgery and Radiotherapy--

Although the prime importance in treatment of head and neckcancer is eradication of tumors, due attention should be paidto the conservation of many important structures and functionsin the region. Just to mention a few of these important humanfunctions, there are phonation, digestion and facial expression.Simple surgical procedures specialized by otolaryngologistsare no longer satisfactory. Recently, radiotherapy of head and neck cancer has developedto a superlative degree and chemotherapy to a practical degreealthough much still remains to be satisfied. Our aim was toorganize an interdisciplinary group of specialists in surgery,radiotherapy and regional chemotherapy into a composite attackforce. We aimed at most effective treatment with the least ofside effects. Since 1961, our combined approach to cancer of the head andneck in close collaboration with radiotherapists has yieldedmuch improved results. This has led to an increasing numberof patients with satisfactory rehabilitation.

1. 1. Cancer of the maxilla: Even in the advanced cases combinedsurgery, radiotherapy and regional chemotherapy has led to thepreservation of important structures and functions. Many patientsare now allowed to return to social life and to their previousjobs.
2. 2. Cancer of the nasopharynx: Radiotherapy is the firstchoice.When the effect is less satisfactory, chemotherapy anda window-operationof the palate are performed.
3. 3. Tumorsof the tonsils: The majority of patients suffer fromthe reticulumcell sarcoma. Radiotherapy is the first choice.
4. 4. Cancerof the larynx: A full dose of radiotherapy is thefirst choice.Partial resections are done when indicated.
5. 5. Cancer of thetongue, hypopharynx and esophagus: Radiotherapyis the firstchoice in the majority of cases. Some need plasticsurgery.

     

Malignant transformation of renal angiomyolipoma

In the present paper, two cases of malignant transformation of renal angiomyolipoma without tuberous sclerosis are reported. Pathological examination revealed that, in both cases, in addition to the areas affected by typical angiomyolipoma, there were areas that contained elevated numbers of perivascular epithelioid cells with prominent nuclear pleomorphism. Immunohistochemical examination revealed that both cases were negative for keratin and epithelial membrane antigen, but were positive for the melanogenesis-related marker HMB-45. Metastatic diseases appeared 40 months after radical nephrectomy in the first case and 18 months in the second case.     

RESPIRATORY FUNCTION DURING CERVICAL AND THORACIC EXTRADURAL ANALGESIA IN PATIENTS WITH NORMAL LUNGS

Lung volumes, expired gas volumes, tests of ventilatory capacityand blood-gas tensions were measured in women before and afterinduction of cervical or thoracic extradural analgesia using2% mepivacaine. Inspiratory capacity, vital capacity, totallung capacity and FEV₁, all decreased significantly 30 min afterboth cervical and thoracic extradural blocks. The changes observedduring cervical block were significantly greater than thoseobserved during thoracic extradural analgesia. Expiratory reservevolume and functional residual capacity decreased significantlyafter thoracic cxtradural block, but did not change after cervicalextradural block. Reduction in expired minute volume was observedin the two groups. Pa_co2 and alveolar-arterial oxygen tensiondifference increased, and Pa_co2 decreased significantly 25 minafter both blocks. These results demonstrate that pulmonaryventilation is slightly impaired by the two blocks and to thesame degree, but ventilatory reserve and capacity are markedlyimpaired by cervical extradural block. ^* Present address: Department of Anesthesiology, Shimane MedicalCollege and Hospital, Izumo City, Shimane-Ken, Japan.     

Case of Spontaneous Gastrojejunal Fistula Due to Gastric Cancer

A rare case of gastrojejunul fistula secondary to gastric cancer is presented. Fluoroscopic examination visualized the passage of contrast medium from the stomach to the small intestine. Gastric fiberscopy revealed cancer on the greater curvature of the corpus perforation into the jejunum. The scope could be inserted readily into jejunum through this perforation. Laparotomy showed that the cancer infiltrated and perforated from the stomach to the jejunum at about 10 cm. from the ligament of Treitz. Distal gastrectomy and resection of 10 cm. of the perforated jejunum were performed. The resected specimen revealed a Borrmann III gastric cancer of the greater curvature perforating the jejunum.     

Supravital observation of in vitro basophils in immunological reactions

The migration velocity and morphology of basophils in vitro were examined after the addition of anti-immunoglobulin (anti-lgE or anti-IgG). In atopic asthma patients with high serum IgE levels (more than 1000 i.u./ml) basophils showed increased migration velocity and showed pear-shaped and palmate processes after the addition of anti-lgE, but on the addition of anti-IgG, these basophils did not show increased migration velocity or morphological changes. In intractable asthma patients with low serum IgE levels, these changes occurred with anti-IgG but not with anti-IgE. These in vitro findings suggest a basophil reactivity to anti-IgE and anti-IgG in individual patients and support our previous differentiation of asthma patients according to basophil reaction.     

Defective Ultraviolet-Induced DNA Repair in Bone Marrow Cells and Peripheral Lymphocytes of Patients with Refractory Anemia with Excess of Blasts

The extent of ultraviolet (UV) irradiation-induced DNA repairwas measured in bone marrow cells and peripheral lymphocytesof patients with refractory anemia with excess of blasts (RAEB).Bone marrow cells from RAEB, when exposed to a 2 J/m dose ofUV, exhibited 50% lower incorporation of tritiated thymidinethan those of control subjects. A similar finding was observedin the peripheral lymphocytes. These data suggest that bonemarrow cells and peripheral lymphocytes from RAEB are deficientin repair of UV-induced lesions by DNA. Furthermore, this impairedDNA repair efficiency in RAEB was not related to the presenceor absence of a karyotype abnormality.     

A Case Report of Lethal Multiple Pterygium Syndrome

We report a patient with a lethal multiple pterygium syndrome. The patient was the first child born to a 28-year old mother. The family history was unremarkable; no consanguinity was reported. The patient was the product of a 37-week gestation by cesarian section, and admitted to our intensive care unit after resuscitation. He weighed 2,158 g, and measured 33cm (CHL). The patient had hydrops, cystic hygroma on the back of the neck, hypertelorism, a flat upturned nose, a highly arched cleft palate, micrognathia, low set ears and multiple pterygia. In addition, the finger showed slender and hypoplastic ridges and creases. The feet showed rocker-bottom deformities. Furthermore, the genitalia was normally formed male with bilateral cryptorchism. The spine showed scoliosis and lordosis with vertebral bony fusions, separations and reduced intervertebral spaces. The ribs were 11 pairs and gracile. The lung was hypoplastic, and the heart was small but normal in structure. Chromosomal examination revealed a normal male karyotype (46, XY). The infant died within two hours after birth.
Gillin and Pryse-Davis (1976) described three female siblings with this early lethal disorder. This disorder was separated from other conditions associated with pterygia by Hall et al. (1982). At least 30 cases have been reported. However, this type of case seems to have not been reported in Japan. This disorder is considered autosomal-recessive, but in other report, X-linked recessive inheritance is proposed. Therefore, further studies are necessary in order to make a more precise etiology of this disorder.