Publications by authors named "Taiji Kawasaki"

11 Publications

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Sudden sensorineural hearing loss in patients with vestibular schwannoma.

Sci Rep 2021 01 21;11(1):1624. Epub 2021 Jan 21.

Department of Otolaryngology-Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.

Clinical features of sudden sensorineural hearing loss (SSNHL) associated with vestibular schwannoma (VS) are not fully understood. Determining a treatment plan and explaining it to patients requires clinicians to clearly understand the clinical features related to the tumor, including SSNHL. To identify the full range of clinical features of VS-associated SSNHL, especially recovery of hearing following multiple episodes of SSNHL and what factors predict recovery and recurrence. A multicenter retrospective chart review was conducted in seven tertiary care hospitals between April 1, 2011, and March 31, 2020. We collected and analyzed dose of administered steroid, pure-tone audiometry results, and brain MRIs of patients diagnosed with VS-associated SSNHL. Seventy-seven patients were included. They experienced 109 episodes of audiogram-confirmed SSNHL. The highest proportion of complete recoveries occurred in patients with U-shaped audiograms. The recovery rates for the first, second, and third and subsequent episodes of SSNHL were 53.5%, 28.0%, and 9.1%, respectively. Recovery rate decreased significantly with increasing number of SSNHL episodes (P =0 .0011; Cochran-Armitage test). After the first episode of SSNHL, the recurrence-free rate was 69.9% over 1 year and 57.7% over 2 years; the median recurrence time was 32 months. Logarithmic approximation revealed that there is a 25% probability that SSNHL would recur within a year. SSNHL in patients with VS is likely to recur within one year in 25% of cases. Also, recovery rate decreases as a patient experiences increasing episodes of SSNHL.
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http://dx.doi.org/10.1038/s41598-020-80366-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820278PMC
January 2021

Thyroid lobe size predicts risk of postoperative temporary recurrent laryngeal nerve paralysis.

Laryngoscope Investig Otolaryngol 2019 Dec 6;4(6):708-713. Epub 2019 Nov 6.

Department of Otolaryngology Head and Neck Surgery, Keio University School of Medicine Tokyo Japan.

Objectives: In patients who had undergone thyroidectomy in Japan for benign tumor, we determined whether thyroid lobe size correlates with temporary recurrent laryngeal nerve paralysis (T-RLNP).

Methods: We retrospectively collected medical record data on usage of intraoperative neuromonitoring, laterality of thyroidectomy, amount of bleeding during surgery, duration of surgery, and whether the surgeon was a board certified otorhinolaryngologist as determined by the Oto-Rhino-Laryngological Society of Japan. Thyroid size was measured in preoperative axial computed tomography (CT) images. Receiver operating characteristic (ROC) curve analysis was used to determine the thyroid size that predicted a high risk of T-RLNP or permanent recurrent laryngeal nerve paralysis (P-RLNP).

Results: Of the 146 eligible patients identified, 9 (6.2%) developed T-RLNP and 2 (1.4%) developed P-RLNP. The amount of bleeding during thyroidectomy was significantly greater in T-RLNP patients than in P-RLNP patients. Thyroid sizes in CT images were significantly larger in T-RLNP patients compared to patients who did not develop RLNP (referred to hereafter as N-RLNP). ROC analysis revealed that 1.3% of thyroid lobes with an area of less than 1000.0 mm, and 9.9% of thyroid lobes with an area of greater than 1000.0 mm were at risk for T-RLNP.

Conclusion: We presented evidence that thyroid sizes, as measured on preoperative axial CT images, were larger in T-RLNP patients than in N-RLNP patients. Our results indicate a connection between benign thyroid tumor stretch injuries and T-RLNP.

Level Of Evidence: IV.
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http://dx.doi.org/10.1002/lio2.321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929579PMC
December 2019

Acquisition of resistance to androgen deprivation therapy in salivary duct carcinoma: A case report.

Rare Tumors 2018 19;10:2036361318798867. Epub 2018 Sep 19.

Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

Salivary duct carcinoma is a relatively rare salivary cancer, and most cases are androgen receptor -positive. Salivary duct carcinoma growth is suggested to be androgen dependent, which can reportedly be controlled by androgen deprivation therapy. However, the effectiveness and underlying molecular mechanisms of androgen deprivation therapy for salivary duct carcinoma remain unknown. We report a salivary duct carcinoma case (65-year-old man) arising from the parotid gland with metastasis to the neck lymph nodes and lungs. Androgen deprivation therapy was performed according to the same protocol for prostate cancer treatment. Expression levels of androgen receptor and FOXA1 (forkhead box A1) were immunohistochemically analyzed before and after androgen deprivation therapy. Although the tumor volume was partially diminished during the first 3 months, acquired resistance to androgen deprivation therapy occurred. FOXA1 was not detected in parotid gland after androgen deprivation therapy, whereas androgen receptor expression was positive. FOXA1 expression might be related to acquired androgen deprivation therapy resistance in salivary duct carcinoma.
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http://dx.doi.org/10.1177/2036361318798867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149030PMC
September 2018

Utility of clinico-biological data for long-term prognosis of head and neck terminal cancer.

Acta Otolaryngol 2017 Aug 16;137(8):895-898. Epub 2017 Mar 16.

b Department of Otorhinolaryngology, Head and Neck Surgery , Keio University, School of Medicine , Tokyo , Japan.

Objective: The prognosis of terminal head and neck cancer is traditionally determined using indices such as the palliative prognosis index. We aimed to develop an alternative prognosis index using clinico-biological data.

Methods: This retrospective case-series study included 33 head and neck cancer patients whose cancer recurred despite receiving radiation therapy between April 2010 and April 2014. Clinico-biological data were collected the day patients were diagnosed as terminal. Bivariate correlation analyses were performed on survival times and clinico-biological data. For multivariate regression analyses, patients were divided into two groups: (1) patients who survived >120 days, and (2) those who survived <120 days. Group clinico-biological data were used to determine survival-time cutoff points for the prognosis index.

Results: Bivariate analyses revealed significant correlations between survival time and BMI, hemoglobin, albumin, C-reactive protein (CRP), Onodera's Prognostic Nutritional Index (O-PNI), modified Glasgow Prognostic Score (mGPS), and Performance Status (PS). Multivariate analyses showed a strong correlation between survival time and BMI. The two groups differed significantly in BMI, albumin, CRP, O-PNI, and mGPS. In multivariate analyses BMI, CRP, and O-PNI differed significantly in the two groups.

Conclusion: BMI ≤16.4, CRP ≥1.01, and O-PNI ≤33.4 are significant predictors of long-term survival in terminal cancer patients.
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http://dx.doi.org/10.1080/00016489.2017.1299940DOI Listing
August 2017

Successful continual intratympanic steroid injection therapy in a patient with refractory sensorineural hearing loss accompanied by relapsing polychondritis.

Auris Nasus Larynx 2017 Aug 20;44(4):489-492. Epub 2016 Aug 20.

Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

Objective: To report the treatment efficacy of continual intratympanic steroid injection (ITSI) therapy in a patient with refractory sensorineural hearing loss accompanied by relapsing polychondritis.

Patient: A 49-year-old female diagnosed with relapsing polychondritis at the age of 45 years and who had been treated with corticosteroids and immunosuppressants developed sensorineural hearing loss in the left ear.

Intervention: Her unilateral hearing loss did not recover despite receiving one cyclophosphamide pulse treatment, one methylprednisolone pulse treatment, and weekly leukapheresis. Thus, we decided to initiate weekly ITSI therapy.

Main Outcome Measure: Pure tone audiometry.

Results: A week after the first ITSI treatment, the patient's hearing improved. We continued ITSI therapy and attempted to extend the interval between treatments, but her hearing worsened when ITSI therapy was delivered at 2- to 3-week intervals. Thus, we returned ITSI therapy to once per week for 21 months (total of 71 treatments). She experienced no adverse events, like tympanic perforation, and 1 year after terminating the therapy, her hearing remained stable and did not worsen.

Conclusions: Continual, weekly ITSI therapy was effective in treating sensorineural hearing loss accompanied by relapsing polychondritis. ITSI therapy may be a promising treatment option for sensorineural hearing loss caused by autoimmune disease.
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http://dx.doi.org/10.1016/j.anl.2016.07.019DOI Listing
August 2017

Pretreatment Hematologic Findings as Novel Predictive Markers for Facial Palsy Prognosis.

Otolaryngol Head Neck Surg 2016 10 10;155(4):581-7. Epub 2016 May 10.

Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

Objective: To examine the relationship between prognosis of 2 different facial palsies and pretreatment hematologic laboratory values.

Study Design: Multicenter case series with chart review.

Setting: Three tertiary care hospitals.

Subjects And Methods: We examined the clinical records of 468 facial palsy patients who were treated with an antiviral drug in combination with either oral or intravenous corticosteroids in participating hospitals between 2010 and 2014. Patients were divided into a Bell's palsy group or a Hunt's palsy group. We used the Yanagihara facial nerve grading system to grade the severity of facial palsy. "Recovery" from facial palsy was defined as achieving a Yanagihara score ≥36 points within 6 months of onset and having no accompanying facial contracture or synkinesis. We collected information about pretreatment hematologic findings, demographic data, and electrophysiologic test results of the Bell and Hunt group patients who recovered and those who did not. We then compared these data across the 2 palsy groups.

Results: In the Bell's palsy group, recovered and unrecovered patients differed significantly in age, sex, electroneuronography score, stapedial muscle reflex, neutrophil rate, lymphocyte rate, neutrophil-to-lymphocyte ratio, and initial Yanagihara score. In the Hunt's palsy group, recovered and unrecovered patients differed in age, electroneuronography score, stapedial muscle reflex, monocyte rate, platelet count, mean corpuscular volume, and initial Yanagihara score.

Conclusions: Pretreatment hematologic findings, which reflect the severity of inflammation and bone marrow dysfunction caused by a virus infection, are useful for predicting the prognosis of facial palsy.
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http://dx.doi.org/10.1177/0194599816646552DOI Listing
October 2016

Modified endoscopic transnasal-transmaxillary-transpterygoid approach to parapharyngeal space tumor resection.

Head Neck 2016 06 8;38(6):933-8. Epub 2016 Feb 8.

Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

Background: Conventional approaches for removing parapharyngeal space tumors require a cervical skin incision and resection of soft tissues between the skin and parapharyngeal space. The surgical visual field for this conventional approach is limited.

Methods: To decrease invasiveness during removal of benign parapharyngeal space tumors and to enhance the visual field, we devised a new approach called the modified endoscopic transnasal-transmaxillary-transpterygoid approach (MENMAP). The "surgical corridor" to the parapharyngeal space consists of the maxillary sinus, submucous tunnel under the lateral nasal wall, and the space created by removing the pterygoid process.

Results: We successfully performed en bloc removal of a parapharyngeal space tumor using the MENMAP approach. The only surgical complication was hypoesthesia of the right hard palate and maxillary gingiva, which gradually improved.

Conclusion: The MENMAP approach is a viable alternative for removing parapharyngeal space tumors, as it is safe, feasible, and less invasive. © 2016 Wiley Periodicals, Inc. Head Neck 38: 933-938, 2016.
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http://dx.doi.org/10.1002/hed.24399DOI Listing
June 2016

[Usefulness of Clinicobiological Data Obtained Prior to Cervical Lymph Node Biopsy].

Nihon Jibiinkoka Gakkai Kaiho 2015 Mar;118(3):206-12

Introduction: We commonly use data obtained prior to cervical lymph node biopsy for the diagnosis of malignant lymphoma. Based on such data, we can confirm whether a biopsy should be performed in some cases. Currently, the parameters used to indicate a presurgery examination prior to biopsy have been very few. So, we retrospectively analyzed cases of cervical lymph node biopsy. Moreover, we examined the usefulness of clinicobiological data obtained prior to cervical lymph node biopsy to evaluate various factors related to the diagnosis of malignant lymphoma.

Methods: This study included 77 patients for whom the initial diagnostic impression was malignant lymphoma before surgery. Of the 77 cases, 40 were diagnosed as having malignant lymphoma and 37 were diagnosed as having non-malignant lymphoma. We performed a case-controlled study to evaluate the differences in clinicobiological data between malignant and non-malignant lymphoma in terms of the following parameters: (1) age, (2) sex, (3) number of white blood cells, (4) white blood cell lymphocyte count, (5) percentage of white blood cell lymphocytes, (6) percentage of eosinophils (%), (7) percentage of monocytes (%), (8) atypical lymphocytes (%), (9) hemoglobin level, (10) lactate dehydrogenase level, (11) C-reactive protein level, (12) soluble interleukin-2 receptor (IL-2R) level, and (13) cytological findings. We used multivariate and univariate analyses to study the data statistically.

Results: The following 5 factors were found to be significant in a Wilcoxon t-test for malignant lymphoma: percentage of white blood cell lymphocytes, sIL-2R level, age, white blood cell lymphocyte count, and cytological findings; these factors were also significant when examined using a Pearson χ2 test. The other factors did not differ significantly between the malignant and non-malignant lymphomas. The percentage of white blood cell lymphocytes and the cytological findings were identified as significant independent factors for the diagnosis of malignant lymphoma in a multivariate analysis, whereas the other factors were not found to be significant.

Conclusion: Based on the results of the univariate and multivariate analyses performed in the present study, the decline in the percentage of white blood cell lymphocytes and the cytological findings obtained prior to cervical lymph node biopsy are significant indicators of malignant lymphoma.
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http://dx.doi.org/10.3950/jibiinkoka.118.206DOI Listing
March 2015

Closure of tracheoesophageal puncture with pedicled fascia flap of the sternocleidomastoid muscle.

Auris Nasus Larynx 2015 Aug 21;42(4):318-21. Epub 2015 Feb 21.

Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.

Objective: Closure of a tracheoesophageal puncture (TEP) formed during voice prosthesis implantation may sometimes be required. We report a new method of closure that we have termed the RESET method.

Methods: We used the RESET method for four patients. An initial incision was made at the mucocutaneous junction of the tracheostoma, and the trachea and esophagus were separated. The TEP was sectioned, and the tracheal and esophageal sides were sutured into separate layers. A pedicled fascia flap lifted from the sternocleidomastoid muscle was sandwiched between the trachea and the esophagus, and subsequently secured.

Results: The TEP was closed in all patients, and no complications were observed.

Conclusion: The RESET method, using a pedicled fascia flap with stable perfusion, is a simple, reliable method of TEP closure.
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http://dx.doi.org/10.1016/j.anl.2015.02.004DOI Listing
August 2015

Transoral closure of pharyngeal perforation caused by gastrointestinal endoscopy.

Auris Nasus Larynx 2014 Feb 1;41(1):113-7. Epub 2013 Aug 1.

Department of Otolaryngology, Head, and Neck Surgery Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.

Objective: We present a case of pharyngeal perforation caused by gastrointestinal endoscopy that was successfully repaired with transoral mucosal sutures. This is the first report of a transoral surgical closure of a perforation caused by an endoscope. We describe the repair procedure, the necessary equipment, and the effectiveness of suturing pharyngeal perforations.

Patient: An 87-year-old woman brought to our emergency department by ambulance because of hematemesis and endoscopic hemostasis was successfully performed. But after hemostasis, CT scan showed emphysema extending from the right lower jaw to the superior mediastinum and pharyngeal perforation was observed by laryngeal fiberscope.

Intervention: Even though she had received conservative treatment, exacerbation of inflammation was observed and therefore we performed transoral surgery for closing the pharyngeal perforation.

Main Outcome Measure: We followed up with CT scans, blood test and vital signs.

Results: The pharyngeal perforation smoothly closed and exacerbation of inflammation was not observed, even after oral ingestion began.

Conclusion: Transoral closure of a pharyngeal perforation is less invasive and performing this procedure at an early stage can lead to a favorable outcome.
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http://dx.doi.org/10.1016/j.anl.2013.07.005DOI Listing
February 2014

Spindle cell carcinoma of the nasal cavity.

Int J Clin Oncol 2011 Apr 14;16(2):165-8. Epub 2010 Sep 14.

Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku, Shizuoka 424-8636, Japan.

We report an extremely rare case of spindle cell carcinoma of the sinonasal cavity. A 75-year-old man was admitted to our hospital because of right nasal obstruction. Nasal endoscopy showed a polypoid tumor measuring 3 × 3 cm at the nasal septum in the right nasal cavity, and an excisional biopsy was performed. Computed tomography (CT) demonstrated the nasal tumor extended to the maxillary sinus. Histologically, the tumor consisted of malignant spindle cells with hyperchromatic nuclei. Mitotic figures and necrosis were recognized. In some areas, edematous changes were recognized. No apparent differentiation was noted. The tumor cells were free of keratinization and intercellular bridge formations; therefore, there were no squamous cell components. Immunohistochemically, the tumor cells were positive for pancytokeratin, cytokeratin (CK)5/6, CK18, CK19, high molecular weight CK, p63, and vimentin. The tumor cells were negative for epithelial membrane antigen, CK7, CK14, p53 protein, S100 protein, HMB45, chromogranin, synaptophysin, CD34, CD56, glial fibrillary acidic protein, neuron-specific enolase, neurofilaments, α-smooth muscle actin, neuroblastoma, myoglobin, carcinoembryonic antigen (CEA), carbohydrate antigen (CA)19-9, CD3, CD20, CD30, CD45RO, and CD45. A pathological diagnosis of spindle cell carcinoma of sinonasal lesion was made. The patient underwent resection of right maxilla followed by chemotherapy and radiation and was alive without metastasis 5 years after initial presentation.
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http://dx.doi.org/10.1007/s10147-010-0121-2DOI Listing
April 2011
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