西野 宏

OBJECTIVE: There has been little progress in examination of the oropharynx with a light source such as electric light, a penlight, or a forehead mirror over the past 100 years. It is therefore necessary to develop methods to display and record oropharyngeal observations. METHOD: Since the aim of this study was to assess the safeness to use from the perspective of physicians, medical staffs, patients, and patients' families and usefulness of pharyngeal scope, the number of devices was limited, the number of patients was not set based on hypothetical statistical tests. RESULTS: A total of 150 volunteers were enrolled in this study. Among them, 96 underwent examination alone and the remaining 28 underwent treatment procedures. The study was done without any complications in all 150 cases. Most (91.3%) physicians hoped to continue using the new device if available. When comparing the use of the device for observation alone and for treatment procedures, there was no significant difference for evaluation items (p > .05) except convenience factor which received a significantly different (p = .0154) evaluation from physicians for observation alone and for treatment procedures. A positive evaluation was received about examination, recording/display and explanation from the patients and patients' families. CONCLUSIONS: Our new device received positive evaluations by who underwent examination of the oral cavity and pharynx, recording of the results, and treatment procedures.

In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital. A computed tomography scan showed a tumor lesion in the brain that was diagnosed as a brain abscess by magnetic resonance imaging. Neurosurgeons performed burr hole drainage of the abscess, followed by administration of antibiotics. Although impaired fine movements of the left hand remain, progress has been relatively favorable with no recurrence of osteomyelitis or brain abscess post-surgery.

BACKGROUND: The aim of this study was to compare the therapeutic outcomes of total pharyngolaryngectomy with those of concomitant chemoradiotherapy in advanced hypopharyngeal cancer. METHODS: This is a retrospective multi-institutional study. The medical records of 979 patients with hypopharyngeal cancer, who were initially treated between 2006 and 2008, were reviewed. In this study, we matched a group of total pharyngolaryngectomy patients with a second group of chemoradiotherapy patients, according to age, gender, subsite, arytenoid fixation, cartilage invasion, and N classification, and analyzed overall survival, disease-specific survival, and locoregional control rates. RESULTS: The matched-pair analysis included 254 patients. The 5-year overall survival, disease-specific survival, and locoregional control rates were 58.5% and 53.5% (P = 0.30), 68.9% and 68.0% (P = 0.80), and 82.2% and 63.6% (P < 0.01), respectively, for patients in the total pharyngolaryngectomy and chemoradiotherapy groups. For T4a patients with cartilage invasion, the matched-pair analysis included 46 patients. The 5-year overall survival, disease-specific, and locoregional control rates were 56.5% and 26.0% (P = 0.092), 56.5% and 41.3% (P = 0.629), and 43.0% and 42.5% (P = 0.779), respectively, for patients in the total pharyngolaryngectomy and chemoradiotherapy groups. CONCLUSIONS: The data from this large-scale multi-institutional joint research program of hypopharyngeal cancer in Japan suggest that chemoradiotherapy may provide adequate survival benefit for hypopharyngeal cancer patients with the distinct advantage of larynx preservation. Our data also suggest that chemoradiotherapy is as beneficial as total pharyngolaryngectomy for the local control of locally advanced hypopharyngeal cancer.

BACKGROUND: Little is known about quality of life and functional status of patients with terminally ill head and neck cancers. METHODS: We conducted a multicenter, prospective, observational study to examine quality of life and functional status in terminally ill head and neck cancer patients. RESULTS: Of the 100 patients meeting inclusion criteria, 72 were observed until death. There was no significant difference in the quality of life score between baseline and Week 3. Forty patients (54.9%) could speak and 22 patients (30.5%) could have oral intake upon study entry. Fifty-three patients (74.6%) received enteral nutrition. Twenty-six patients (36.6%) required dressing changes for fungating tumors. The route of nutritional intake (nasogastric tube vs. percutaneous gastric tube) might be predictive for the duration of hospital stay (64 vs. 21 days, P = 0.0372). CONCLUSION: There was no significant relationship between quality of life and functional status seen in this study. Feeding tube type could have the most impact on quality of life.

:Immediate reconstruction of orbitomaxillary defects is challenging for head and neck reconstructive surgeons. The primary goals of orbitomaxillary reconstruction are to cover the skin and mucosal defects, fill the defect space, and reconstruct the natural facial contour. This report describes 2 patients who underwent extended orbitomaxillectomy and immediate reconstruction using a combined latiss

Interleukin-6（IL-6）は代表的な炎症性サイトカインである。IL-6は炎症のみならず癌細胞の生物学的活性に影響を与える。細胞増殖，細胞死抵抗性，浸潤，血管新生，転移，免疫，幹細胞，悪液質に関与していることがわかってきた。IL-6は多くの癌細胞において癌細胞活性を高め，腫瘍形成と転移に関与する重要なサイトカインである。この総説では簡潔にその働きを述べる。

日本は高齢化社会を迎えつつある。本論文は1970年1月から2014年9月までの間に自治医科大学附属病院で治療を受けた75歳以上のstage III/IV 頭頸部癌患者（甲状腺癌を除く）125人を後方視的に検討した。放射線治療は46人に行われ，3人が嚥下性肺炎とせん妄で治療が中断となった。放射線治療終了1か月以内に6人が合併症を生じた。嚥下性肺炎，せん妄，脳梗塞，急性腎不全であった。34人に手術が行われた。喉頭全摘出術が11人，咽頭喉頭食道切除・再建術が10人，舌切除・再建術が3人，切除術が10人であった。舌切除・再建術3人のうち2人は嚥下性肺炎を認めた。緩和治療は28人に選択された。Performance status 2以上の場合には治療関連合併症出現の割合が多かった。

We retrospectively assessed the utility of the LigaSure^TM Vessel Sealing System compared with conventional surgery in 40 cases of free osseous flap harvest comprising 17 fibula flaps ( LigaSure : conventional, 11 : 6 ), 13 scapula flaps ( 4 : 9 ), and 10 iliac crest flaps ( 8 : 2 ). Postoperative duration of suction drain, total fluid collection volume by drain, and avascularized time during fibula flap harvest with a tourniquet did not differ significantly between the LigaSure^TM and conventional techniques. In one case, additional surgery due to hematoma was required 23 days postoperatively in a donor site following scapular tip flap harvest without LigaSure^TM. Reconstructive surgery with free flap transfer is performed with recipient surgery, such as tumor ablation or contracture release; therefore, intraoperative blood loss and total surgical time, which are reportedly significantly decreased by LigaSure^TM, could not be evaluated in this study. LigaSure^TM enables complete hemostasis to be easily accomplished, and the results of hemostasis are at least as favorable as those with the conventional technique.

病気の治療を標準化するためには，何よりもその治療の目的，エンド・ポイントを明確にしなければ議論が不可能である。下顎切除・再建においては，新しい高度な技術が導入されている一方で，多くの症例で大きな機能障害が残存しないため，さまざまな治療法が選択可能となる。これらの多くは治療法として問題ないものなので，優先順位をつけた具体的な治療目標を達成できるかどうかを基準にして選択できるようにするのがこの論文の目的である。具体的には目標を絶対的，標準的，努力目標の3段階に設定し，それぞれに達成率を併記した。

放射線性頭蓋底骨壊死は，局所病変であるが，不快な症状を呈し，内頸動脈破裂など重篤な合併症をきたすことがある。疾患の認知と，積極的な対応が望まれる。症例は，61歳男性。上咽頭癌化学放射線治療後再発癌に再照射を行い，局所的な頭蓋底骨壊死を生じた症例の治療を経験した。鼻内内視鏡下手術による腐骨除去が，治療効果においても内頸動脈破裂予防においても有効な治療法と考えられる。しかし，手術操作で内頸動脈露出が懸念される場合は，むしろ内頸動脈破裂を誘発してしまう可能性があり，適応は慎重にすべきである。また，手術に際しては，頭蓋底の構造を理解し，内視鏡手術の技量や技術を駆使した慎重な操作を要すると考えられた。

今回われわれは2000年から10年間に当科で入院，手術を行った鼻副鼻腔乳頭腫62 例について検討を行った。年齢は平均56歳，男性47人，女性15人，主訴は一側性の鼻閉，発症部位は上顎洞内側壁，病理組織診断はinverted papillomaが最も多かった。Krouseの分類ではT1 4例，T2 27例，T3 28例，T4 3例であった。治療は全例手術（Denker 29例，ESS 34例（うちEMM 6例））を施行した。再発は11例にみられた。鼻副鼻腔乳頭腫は完全摘出が必要な腫瘍だが，その手術方法は，近年内視鏡手術を中心とした低侵襲な手術法が選択されるようになってきている。しかし再発する例もみられ，適切な手術法の選択と術後の厳重な経過観察が必要と考えられた。

上顎洞癌に対する集学治療の主たる治療は切除手術と考える。当科で施行されている分割切除による腫瘍全摘出術を呈示する。手術は顔面皮膚切開をおかずに上顎歯肉部を切開しおこなう。腫瘍組織を覆う被膜様線維組織を確認し,剥離操作を行うことが手術操作のポイントである。可能なかぎり腫瘍組織に切り込まずに腫瘍組織を周囲より剥離摘出する。広範囲に眼窩底骨や骨膜が切除された場合には残存骨膜を絹糸でできるだけよせ,眼球の下方への偏位を少なくする。頭蓋底の骨欠損を認め硬膜に腫瘍組織が接する場合には,手術用顕微鏡下に硬膜と腫瘍組織を剥離する。