記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To examine the role of autofluorescence (AF) monitoring with near-infrared fluorescence imaging (NIFI) in identifying parathyroid lesions in primary or secondary hyperparathyroidism (P-HPT or S-HPT) surgeries. STUDY DESIGN: Prospective study. METHODS: Twelve lesions each were resected from 12 and 3 patients with P-HPT and S-HPT, respectively. The mean and maximum AF intensities of the lesions normalized to that of the thyroid tissue for in situ and ex vivo preparations were compared between P-HPT and S-HPT. Subjective visual classifications of AF intensity were compared with postoperative quantitative assessments. The unevenness of AF distribution inside the lesions was assessed by determining the ratio of maximum to mean AF intensity and comparing them with the corresponding ratio for normal parathyroid glands (PGs). RESULTS: In all quantitative comparisons (in situ/ex vivo, mean, and maximum AF), AF intensities of P-HPT were stronger than those of S-PHT. The AF-positive rate in in situ subjective visual classification was higher for P-HPT (100% vs. 33%). Subjective visual classifications showed a positive correlation with AF intensities. The ratio of maximum to mean AF was higher in P-HPT and S-HPT than in normal PGs. CONCLUSIONS: For P-HPT, AF intensity in both in situ and ex vivo preparations was sufficiently high and correlated with the subjective visual classification, suggesting that NIFI may be useful for confirming P-HPT lesions. In contrast, NIFI may have only a minor role in S-HPT surgeries owing to the weak-AF of S-HPT lesions. HPT lesions show an uneven AF intensity distribution compared with normal PGs. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2097-E2104, 2021.

DOI： 10.1002/lary.29310

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記述言語：英語  

DOI： 10.1002/lary.29425

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

末梢挿入型中心静脈カテーテル(peripherally inserted central catheter、PICC)は安全性が高く頭頸部癌の薬物療法でも用いられるが、留置側の左右差に着目した報告は少ない。PICC留置後の先端位置移動と合併症発生率の左右差について検討した。PICC留置を行った頭頸部癌145例172件を対象とし後方視的な調査を行った。留置側は右36件、左136件で、留置期間中央値は65日であった。121例137件でX線による留置時・留置後の先端位置評価が可能であった。先端位置をZone A:上大静脈下半分と右心房上部、Zone B:上大静脈上半分と左腕頭静脈合流部、Zone C:左腕頭静脈に分類し、Zone A・Bを適正位置とした。右側では留置時33件(100%)、留置後30件(91%)が適正位置であったのに対し、左側では留置時97件(93%)、留置後82件(79%)が適正位置で、留置時と留置後では有意な変化を認めた(p=0.001)。そのほかの合併症発生率に左右差は認めなかった。左側からのPICC留置では上大静脈右側壁にカテーテル先端が当たり、Zone Aへの留置率が低い。さらに留置後の体位・肢位の変化により先端が移動し、適正位置であるZone A・Bに留まりにくい。不適正な先端位置は遅発性の上大静脈壁損傷や血栓症を招くため、右側からのPICC留置が望ましいと考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01099&link_issn=&doc_id=20210226330006&doc_link_id=10.3950%2Fjibiinkoka.124.122&url=https%3A%2F%2Fdoi.org%2F10.3950%2Fjibiinkoka.124.122&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the role of lateral temporal bone resection (LTBR) in the treatment of external ear canal (EAC) carcinoma between 2007 and 2018. The estimated 3-year disease-free survival (DFS) and disease-specific survival (DSS) according to the tumor stage and treatments were investigated in 36 patients with EAC squamous cell carcinoma. T stage classification according to the University of Pittsburgh staging system was as follows: 14 patients in T1, four patients in T2, nine patients in T3, and nine patients in T4. The 3-year DFS rate was 77.4% for T1 tumors, 100% for T2, 44.4% for T3 tumors, and 11.1% for T4 tumors (p < 001). The 3-year DSS rate was 100% for T1/T2 tumors, 87.5% for T3 tumors, and 11.1% for T4 tumors (p < 0.01). T1/T2 patients received mostly LTBR. Among nine T3 tumors, five patients (56%) received LTBR combined with preoperative chemotherapy and/or postoperative radiation (RT). Four of them had negative surgical margin and survived with no evidence of disease. The DFS of T3 patients who underwent concurrent chemoradiotherapy and LTBR was 0 and 80%, respectively (p = 0.048). For T1/T2 tumors, surgery achieved an excellent outcome. For T3 tumors, LTBR achieved negative surgical margin and showed good survival when combined with preoperative chemotherapy and/or postoperative RT. In contrast, the prognosis of T3 patients who could not undergo surgery was as poor as that of T4 patients. Therefore, in addition to subtotal temporal bone resection, LTBR-based treatment strategy may be a treatment option for limited cases of T3 patients.

DOI： 10.3389/fsurg.2021.708245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: We aimed to compare the outcomes and safety of chemoradiotherapy (CRT) between elderly and non-elderly patients with head and neck squamous cell carcinoma (HNSCC). It is difficult to assess the causal effect of age because of possible differences in general conditions among individuals. Therefore, we adjusted the background factors of elderly and non-elderly patients using propensity score matching (PSM). Methods: A total of 146 patients with HNSCC who received CRT were divided into an elderly (≥70 years, n = 35) and non-elderly group (<70 years, n = 111). Pre-treatment characteristics, including the performance status, Charlson comorbidity index, body mass index, primary site, and TNM stage were adjusted by PSM. We compared the outcomes and safety of CRT with high-dose single-agent cisplatin (CDDP) as well as outcomes following recurrence between the groups, before and after PSM. Results: The total dose of CDDP administered during CRT was significantly lower in the elderly group before PSM. However, it became comparable to the non-elderly group and adverse events did not differ between the groups following PSM, resulting in a comparable CRT completion rate. Overall-, disease specific-, and progression-free survivals of elderly patients were comparable to those of non-elderly patients following PSM. In contrast, elderly patients with recurrence could receive fewer salvage treatments than their non-elderly counterparts, resulting in worse survival. Conclusions: CRT with high-dose CDDP is safe and effective for the treatment of elderly patients with HNSCC. However, salvage treatments can be rarely conducted for elderly patients with a recurrence, considering a deterioration of their general condition.

DOI： 10.3389/fsurg.2021.753049

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early detection of head and neck carcinoma (HNC) as superficial HNC (SHNC) identified using recently developed optical techniques, such as magnifying endoscopy and narrow-band imaging (NBI), in combination with endoscopic surgeries enables minimally invasive treatment with favorable outcomes for HNC. This study aimed to identify the predictive factors for the rare but important clinical issue of SHNC, namely cervical lymph node metastasis (CLNM), following endoscopic resection. METHODS: Sixty-nine patients with SHNC who underwent endoscopic resection were enrolled in the study. Clinical data, preoperative endoscopic findings, pathological findings, and treatment outcomes were retrospectively reviewed. Because the pharyngeal mucosa lacks the muscularis mucosa, we measured tumor thickness in permanent pathology as an alternative to the depth of invasion. Correlations with the occurrence of CLNM were statistically examined. RESULTS: The 5-year disease-specific survival rate was 100%. Of 69 patients, 3 (4.3%) developed CLNM. All had subepithelial but not epithelial tumors. The 0-IIa type in the macroscopic findings, type B2/B3 vessels in narrow-band imaging, tumors ≥ pathological stage T2, lymphatic invasion, positive surgical margins, and tumor thickness >1,000 μm showed significant correlations with CLNM following endoscopic resection. Furthermore, the classification of type B vessels was significantly associated with tumor thickness. CONCLUSION: The treatment outcomes following endoscopic resection for SHNC were favorable. The risk of CLNM following endoscopic resection in SHNC can be predicted by several preoperative endoscopic and postoperative pathological findings. Among them, the classification of type B vessels, which correlated with both tumor thickness and CLNM, might be a useful predictive factor.

DOI： 10.3389/fsurg.2021.813260

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although immune-checkpoint inhibitors (ICIs) are effective against various cancers, little is known regarding their role in salivary gland carcinoma (SGC) treatment. Therefore, we evaluated the efficacy and safety of nivolumab monotherapy in patients with recurrent and/or metastatic SGC. In this multicentre retrospective study, nivolumab (240 mg) was administered every 2 weeks. The overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety were examined; the correlation between treatment outcomes and clinicopathological factors was analysed. Twenty-four patients were enrolled; the most common histopathology was salivary duct carcinoma. Eleven tumours were PD-L1-positive; no tumour was microsatellite instability-high. The ORR was 4.2%, and the median PFS and OS were 1.6 and 10.7 months, respectively. One patient continued nivolumab for 28 months without disease progression. One patient showed grade 4 increase in creatine phosphokinase levels and grade 3 myositis. Biomarker analysis revealed significantly increased OS in patients with performance status of 0; modified Glasgow prognostic score of 0; low neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and C-reactive protein; and high lymphocyte-to-monocyte ratio and in patients who received systemic therapy following nivolumab. Although nivolumab's efficacy against SGC was limited, some patients achieved long-term disease control. Further studies are warranted on ICI use for SGC.

DOI： 10.1038/s41598-020-73965-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES/HYPOTHESIS: To assess the ability of near-infrared fluorescence imaging (NIFI) to identify parathyroid glands (PGs) among histologically proven PG/non-PG specimens compared with a surgeon's visual acumen, and to determine NIFI sensitivity in detecting incidentally resected PGs from thyroidectomy specimens, compared to the surgeon's visual inspection. STUDY DESIGN: Prospective study. METHODS: With mean age of 61 years, 36 patients with various thyroid diseases were enrolled. Possible PGs (n = 28) and lymph nodes (n = 32) were identified by the experienced surgeon's visual inspection. Using NIFI, 15 PGs were further identified from thyroidectomy specimens. For these 75 specimens, the surgeon's judgments (PG vs. non-PG) were recorded. Histological evaluation was performed after examining the NIFI auto-fluorescence of each specimen. RESULTS: There were no significant differences in sensitivity, specificity, positive predictive value, and negative predictive value between the surgeon's visual inspection and NIFI in identifying PGs, with values of 100%/97.1%, 85.0%/87.5%, 85.4%/87.2%, and 100%/97.2%, respectively. The sensitivity of NIFI (82.9%) for detection of PGs from thyroidectomy specimens was significantly higher than that of the surgeon's visual inspection (61.0%). False negative specimens contained bleeding/congestion and/or encapsulation by thick tissues, whereas false positive specimens contained electrocoagulated tissues. CONCLUSIONS: NIFI showed results comparable to the experienced surgeon's visual inspection in identifying PGs. This could benefit novice surgeons. NIFI may be useful for experienced surgeons to locate incidentally resected PGs within thyroidectomy specimens for auto-transplantation. Prevention of intra-gland bleeding and congestion, careful removal of thick capsules, and bloodless surgeries without electrocoagulation are important for reducing false positive and false negative results. Laryngoscope, 2020.

DOI： 10.1002/lary.29163

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endoscopic submucosal dissection (ESD) has gained wide acceptance as a minimally invasive and curative surgery for superficial head and neck carcinoma. However, the safety of ESD for superficial pharyngeal carcinoma after radiotherapy has not been elucidated. Superficial hypopharyngeal carcinoma of the left pyriform sinus developed in a 76-year-old man who had undergone concurrent chemoradiotherapy for T2N2bM0 pyriform sinus carcinoma on the opposite side 12 months before. He underwent ESD without complications. Because tumor invasion into the muscular layer was a concern, the muscular layer was partially resected with the tumor. Twelve days after discharge, he presented with a sore throat and difficulty in swallowing. Endoscopy and computed tomography revealed necrosis due to wound infection with abscess formation around the left carotid artery. The common carotid artery subsequently ruptured. Although the surgical intervention was performed, he passed away 46 days after ESD due to carotid blowout. ESD is a minimally invasive treatment for superficial head and neck carcinoma, but carotid blowout can occur in cases after radiation. Prior radiotherapy and deeper dissection into the muscular layer may hamper wound epithelization, resulting in infection-induced necrosis and carotid blowout. Diligent monitoring of wound healing is essential in patients who have previously undergone irradiation.

DOI： 10.1016/j.anl.2020.08.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Sarcopenia, defined as a decrease in the skeletal muscle mass and its function, is associated with a poor clinical outcome in several malignancies. We aimed to examine whether sarcopenia can be a predictor of incompletion of concurrent chemoradiotherapy (CCRT) and survival for head and neck cancer (HNC) patients. METHODS: Forty-one male HNC patients who received CCRT were enrolled in the study. Cross-sectional muscle areas at the third lumbar vertebral level were normalized by the squared height of the patients and were termed the lumbar skeletal muscle index (LSMI, cm2/m2), a marker of sarcopenia. Patients were divided into high (30/41, 73%) and low (11/41, 27%) LSMI groups. The LSMI cut-off value was set at 39.7 cm2/m2 based on a receiver operating characteristic curve for incompletion of CCRT. The groups were compared for survival rate by the Kaplan-Meier method. Factors predicting incompletion of CCRT were investigated among several variables. RESULTS: Multivariate analysis showed that a pre-treatment low LSMI (P = 0.033) and age over 70 years (P = 0.023) were the only significant predictors for incompletion of CCRT. The 2-year disease-specific survival (DSS) rate was significantly lower in the low LSMI group (61%) than in the high LSMI group (97%, P = 0.012), whereas there were no differences in the DSS rate between the low and high body mass index groups. CONCLUSION: The prevalence of sarcopenia in HNC patients receiving CCRT was 27%. Its presence before treatment was a significant predictor of incomplete CCRT and poor DSS rate in HNC patients.

DOI： 10.1007/s00405-020-06273-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The importance of nivolumab for recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) is rapidly increasing. However, prognostic factors have not been determined for predicting treatment outcome. We aimed to investigate the prognostic factors in R/M HNSCC patients treated with nivolumab. METHODS: This retrospective study included 42 patients with R/M HNSCC who received nivolumab therapy. Correlations of overall survival (OS) with various patient characteristics including age, recurrent/metastatic site, performance status (PS), programmed death-ligand 1 positivity, body mass index, neutrophil-to-lymphocyte ratio, modified Glasgow prognostic score (mGPS), previous cetuximab administration, and immune-related adverse events were investigated. RESULTS: The overall response rate and disease control rate were 16.7% and 45.2%, respectively. Estimated 1-year OS and progression-free survival (PFS) were 56.4% and 24.5%, respectively. Multivariate analysis revealed that PS = 2 (hazard ratio 0.147; 95% CI 0.041-0.527; p = 0.003) and mGPS = 2 (hazard ratio 0.188; 95% CI, 0.057-0.620; p = 0.006) were independent predictors of poor OS. Given that the PS and mGPS were independent prognostic factors, we classified patients into three groups according to PS and mGPS: Group 1, both PS and mGPS were 0 or 1 (n = 30); Group 2, either PS or mGPS was 2 (n = 9); Group 3, both PS and mGPS were 2 (n = 3). The OS curves were significantly stratified among the three groups. CONCLUSION: The combination of PS and mGPS accurately predicted OS after nivolumab therapy. Preventive intervention to maintain general condition without simultaneously exceeding level 2 of PS and mGPS might be important for improving treatment outcomes of nivolumab.

DOI： 10.1007/s00405-020-05945-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It was reported that treatment outcomes of the salvage chemotherapy (SCT) following nivolumab are fairly good compared with those of nivolumab itself. However, predictive factors of SCT for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) were not determined. METHODS: Twenty-one R/M HNSCC patients received SCT following nivolumab. The treatment outcome and predictive factors for the favorable response to SCT were investigated. RESULTS: The objective response rate (ORR) and the disease control rate of SCT were 52.4% and 81.0%, respectively. The median progression-free survival and the median overall survival time were 5.4 and 12.9 months, respectively. Patients with positive programmed death-ligand 1 (PD-L1) expression showed greater tumor shrinkage evaluated by the response evaluation criteria in solid tumors and higher ORR than those with negative PD-L1 expression. CONCLUSIONS: Treatment outcome of SCT following nivolumab in R/M HNSCC was favorable. PD-L1 expression may be a predictive factor of SCT.

DOI： 10.1002/hed.26374

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and purpose: Concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients. Patients and methods: We retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC. Results: We identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22-6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029). Conclusion: Candida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.

DOI： 10.1016/j.ctro.2019.10.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The present study aimed to clarify the incidence and clinical outcomes of nasopharyngeal carcinoma (NPC) in the Chubu region of Japan from 2006 to 2015, compared with previous reports. A retrospective analysis was conducted based on medical records from 40 hospitals located in the Chubu region in the central Japanese main island, with a population of around 22.66 million individuals. This study was designed in line with to two previous clinical studies into NPC conducted in the same area of Japan. We recruited NPC patients diagnosed in hospitals across this area over a 10-year period (2006-2015) using a questionnaire about sex, age, primary site, clinical symptoms, pathology, Union for International Cancer Control (UICC) staging, serological exam, treatment, and survival. A total of 620 NPC patients were identified. The age-standardized incidence of NPC from 2006 to 2015 was 0.27 per 100,000 individuals per year. There were no significant differences between this study and the previous two studies conducted in the same area of Japan. The five-year overall survival rate for all patients was 75.9%, while those for patients with stages I, II, III, and IVA were 97%, 91%, 79%, and 68%, respectively. The age-standardized annual incidence of NPC in the present study was 0.27 per 100,000 individuals per year, which was relatively low and stable. The five-year overall survival rate for all NPC patients was significantly improved in this decade compared with previous studies. The smoking rates in male and female NPC patients were 64.5% and 18.8%, respectively, thereby suggesting the involvement of smoking in the incidence of NPC.

DOI： 10.3390/cancers11081180

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS: Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS: A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION: The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).

DOI： 10.1016/j.anl.2018.02.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hematogenous metastasis is the most common form of metastasis in head and neck cancer, and reports have described successful resection of pulmonary metastases of such cancers. We report treatment outcomes after surgical resection of pulmonary metastases of head and neck cancer and identify prognostic factors. This clinicopathologic study investigated the clinical records of 16 patients with pulmonary metastases of head and neck cancer (excepting cases of thyroid cancer) who had undergone metastasectomy at our center during the period 2001-2012. The mean age of the 16 patients (11 men and 5 women) was 62.1 years. The mean interval between completion of successful treatment of the primary tumor and detection of pulmonary metastasis was 21 months (range, 6-56 months). All patients underwent pulmonary resection. The overall 1-year survival rate was 79.4 %, and the 2- to 5-year survival rate was 63.2 %. These rates compare favorably to those in previous reports on resection of pulmonary metastases. When prognostic factors for survival rates were compared, the factors associated with a negative prognosis were a disease-free interval of <12 months and partial resection of pulmonary metastases. Multivariate analysis did not reveal any prognostic factors associated with negative outcomes. Surgical resection of pulmonary metastases of head and neck cancer might improve outcomes.

DOI： 10.1007/s12070-014-0799-y

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Clinical outcomes of 53 patients with oropharyngeal and hypopharyngeal squamous cell carcinoma, treated from January, 2000 to December, 2008 by concurrent chemoradiotherapy of either CDDP or CDGP, plus 5-FU were investigated. Patients were treated with either CDDP (70 mg/m2) or CDGP (100 mg/m2) on day 1 of the chemotherapy regime, with 5-FU (700 mg/m2/day) as a continuous infusion for 5 days. Each regimen was administered as two courses in the first and final weeks of radiotherapy. Radiotherapy was administered at a daily dose of 2 Gy for five days a week, with patients receiving a total of 70 Gy by the end of seven weeks. The primary cancer was located in the oropharynx and hypopharynx in 21 and 32 patients, respectively. Twenty-six patients (49.1%) had stage IVA disease and 10 patients (18.9%) had overall stage I to II disease. Acute adverse events such as pharyngeal mucositis and leucopenia occurred in 49.1% and 43.4% of patients, respectively, and second round chemotherapy was not commenced in 56.6% of patients (n=30) due to significant adverse events. Mean weight loss following treatment was 4.1 kg. After a median follow-up of 30.0 months, 3-year overall survival was 53.0% for advanced carcinoma of the oropharynx and hypopharynx. Five-year overall survival was 46.4%. Patients receiving two courses of chemotherapy had an improved 5-year survival compared to patients receiving one course (67.0% vs 32.8%). Results indicate a significant benefit from two courses of chemotherapy. As such, minimizing the incidence of adverse effects and thereby reducing treatment discontinuation will likely improve overall treatment outcomes.

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記述言語：日本語   出版者・発行元：(一社)日本内分泌外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

Nivolumab(Nivo)が再発・転移頭頸部癌の全生存期間を有意に延長することが報告され、本邦では2017年3月から保険収載となった。本研究では2017年6〜10月に当院でNivoを投与した再発・転移頭頸部癌10例の臨床像に関して検討した。年齢は44〜75歳で中央値62.5歳、PSは0が7例、2が3例、Cetuximab(Cetu)暴露例は8例であった。観察期間の中央値6ヵ月における効果判定はPR3例、SD2例、PD5例であり、PS不良例や急速進行例では治療効果不良、Cetu暴露の有無やPD-L1染色の陽性・陰性と治療効果の間には相関がなかった。有害事象は許容範囲内であった。CheckMate-141試験と比較すると本研究の方がPS0の患者の割合が多く、Nivo投与期間が長い傾向にあった。今後、Nivoの適応決定や投与のタイミングに関して検討する必要があると思われた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J04210&link_issn=&doc_id=20190312410012&doc_link_id=10.5106%2Fjjshns.28.313&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.28.313&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本内分泌外科学会・日本甲状腺外科学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：日本音声言語医学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

新潟県には県内の癌治療施設が一堂に会する新潟県頭頸部癌悪性腫瘍登録委員会があり、県内の頭頸部悪性腫瘍症例のデータを四半世紀にわたって登録してきた。癌登録に関しては有用なデータではあるが、放射線療法や化学療法の進歩とともに施設間の治療内容および治療成績の格差が目立ってきて、全体の予後調査という点において信頼性が低下してしまった。そこでわれわれは県内の癌治療施設が一堂に会する利点を利用して「頭頸部扁平上皮癌に対する高用量CDDP+RTの県内多施設共同研究phase I/II study」を立ち上げた。phase Iにおいては12例が登録され、最大耐用量や用量限界毒性、化学療法減量・中止基準、phase IIにおけるCDDP推奨投与量などが検討され、その結果CDDP推奨投与量は80mg/m2となった。今後はCCRT完遂率などをendpointとしたphase IIを開始する予定である。地方における治療の一つのモデルケースとして、現状の経過を報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J04195&link_issn=&doc_id=20160518480012&doc_link_id=10.5981%2Fjjhnc.42.70&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.42.70&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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記述言語：日本語   出版者・発行元：金原出版(株)  

2013年2月〜2014年6月の8例(男7例、女1例、48〜85歳)を対象とした。セツキシマブは初回400mg/m2、2回目以降は放射線治療とともに週1回250mg/m2を投与した。放射線治療には三次元放射線治療計画を用い、病変部の総線量は70Gyを基本とした。セツキシマブ・放射線治療とも完遂できたのは6例であり、治療の1次効果は完全寛解(CR)が5例、部分寛解(PR)が3例であった。CRの5例中4例が再発なく生存し(観察期間21〜26ヵ月)、1例は治療後4ヵ月で肺転移を認めたが、観察期間29ヵ月で担癌生存中である。PRの3例のうち1例は原病死、1例は治療に関連する肺障害により死亡、1例は、17ヵ月間、担癌生存中である。有害事象はGrade 5の肺障害を1例、Grade 3の嚥下障害を5例に認めた。粘膜炎による疼痛に対し全例にオピオイド鎮痛薬の使用を要した。全例に皮膚障害を認めたが、治療完遂に影響を及ぼさなかった。

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記述言語：日本語   出版者・発行元：新潟市民病院  

梅毒は近年増加に転じている。当院でも過去7年間に、第二期梅毒3例(うち梅毒性肝炎2例)、潜伏期梅毒1例、第四期梅毒2例(心血管梅毒・梅毒性大動脈瘤1例、神経梅毒・脊髄癆1例)の6例を経験した。いずれもヒト免疫不全ウイルス(HIV)感染合併ではなかった。6例の病期と臨床像は多彩であり、診療科も複数にまたがっていた。個々の症状や身体所見、一般検査は非特異的であった。性的活動性がある年代で、発熱、皮疹、リンパ節腫脹、肝機能障害、進行性の神経障害などをみた場合には、常に梅毒を考慮する必要があると考えられた。性感染症リスク行動の病歴聴取や検査前または術前の感染症検査が診断のきっかけとなることもあるため、これらの情報にも注意を払う必要があると考えられた。これらの症例を提示しながら、先天梅毒以外のHIV感染合併のない梅毒の臨床像について概説した。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟市民病院  

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記述言語：日本語   出版者・発行元：日本内分泌外科学会・日本甲状腺外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

頭頸部領域に再発を繰り返した類上皮血管内皮腫の1例を報告する。症例は40歳女性で、過去12年間に頭蓋骨左側、下顎骨左側、左耳下腺、鼻中隔左側の類上皮血管内皮腫に対して複数の医療機関で摘出術を施行され、経過観察目的に当科紹介となった。初診時は頭頸部領域に腫瘍性病変を認めなかったが、経過中に鼻中隔左側に腫瘤が出現した。生検にて類上皮血管内皮腫再発の診断となり、腫瘍切除術を施行した。腫瘍径と病理組織像から低危険度群に分類されたため、追加治療をせず経過観察を行っており、術後18ヵ月再発を認めていない。本症例では頭頸部領域の片側性再発を繰り返しており、今後も慎重な経過観察が必要と思われた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J04210&link_issn=&doc_id=20150721380009&doc_link_id=10.5106%2Fjjshns.25.55&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.25.55&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

当科にて2007年から2013年までの7年間に、原発性副甲状腺機能亢進症と診断され、手術を施行した20例について検討した。内訳は男性6例、女性14例で、年齢は41〜84歳(平均年齢60.6歳)、病理診断は、腺腫18例、副甲状腺癌1例、不明1例であった。ほぼ全例に超音波、CT、99mTcMIBI(methoxyisobutylisonitrile)シンチグラフィを行い、局在診断に有用であった。19例に血清Ca値の正常化を認め、1例は正常化しなかった。この症例では甲状腺結節を合併していたため、局在診断が困難であった。局在診断技術が向上しても1腺摘出だけでは対応できない場合もあり、両側検索の対応も常に念頭におく必要があると思われた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J04210&link_issn=&doc_id=20150312410014&doc_link_id=10.5106%2Fjjshns.24.323&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.24.323&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：新潟市民病院  

症例は84歳の女性で、右側胸部痛を主訴に当院救急外来を受診し、高カルシウム血症、腎機能低下を認め内分泌内科に緊急入院となった。原因検索のため、血液検査、超音波検査、単純CTを施行、甲状腺左葉下極に接した石灰化を伴う20mm大の腫瘤と、i-PTHの高値を認めた。さらに副甲状腺シンチグラムで異常集積がみられ、原発性副甲状腺機能亢進症と診断した。保存的治療をおこなったが、高カルシウム血症及び腎機能が徐々に増悪したため、手術目的に当科紹介となった。全身麻酔下に副甲状腺腫瘍摘出術を施行し、術中所見で周囲への浸潤は認めず、迅速病理診断は腺腫であったが、最終的な永久病理診断は副甲状腺癌となった。副甲状腺癌は非常に稀な疾患であり、術前診断が困難な事も多い。本例も手術後に診断が確定したが、術前から副甲状腺癌に特徴的な症状を念頭に置き治療にあたる必要があると思われた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

頭頸部領域に生じた高分化型脂肪肉腫の3例を経験したので報告する。症例1は78歳男性、頸縦隔脂肪肉腫。他院で縦隔病変の開胸切除後に当科紹介となり、頸部病変を全摘した。症例2は41歳男性、中下咽頭脂肪肉腫。経口切除後に再増大したため、頸部外切開により腫瘍を全摘した。永久病理診断にて一部粘液型部分を認めたため、術後照射を行った。症例3は62歳男性、頸縦隔脂肪肉腫。経頸部的に腫瘍を全摘した。脂肪肉腫は悪性軟部組織腫瘍の中では発生頻度が高いが、頭頸部領域では稀である。一般に悪性軟部組織腫瘍の治療には十分な安全域をつけた広範囲切除術が原則とされるが、脂肪肉腫の中でも良悪性中間腫瘍に位置する高分化型脂肪肉腫においては切除縁に関する統一見解はない。本報告では全例に辺縁切除術を行い、現在まで明らかな再発を認めていない。浸潤傾向のない頭頸部高分化型脂肪肉腫に対しては隣接臓器を温存した辺縁切除術で対応可能と思われた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04195&link_issn=&doc_id=20140512480014&doc_link_id=10.5981%2Fjjhnc.40.75&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.40.75&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

声門下狭窄を伴った先天性喉頭横隔膜症に対し、良好な治療経過を経た1例を報告する。症例は39週、2,320gで出生、直後から喘鳴を認めた。ファイバースコピーにて喉頭横隔膜症と診断され、呼吸状態が安定しないため気管切開術を施行した。1歳10ヵ月で直達喉頭鏡を施行し、喉頭横隔膜症に声門下狭窄を合併していることが分かった。2歳5ヵ月で喉頭截開を用いて根治術を施行、3ヵ月間ステントを留置し、ステント抜去後は再び気管カニューレを装用して経過観察とした。喉頭の再狭窄は生じず、3歳9ヵ月で会話が可能となり、5歳で気管孔閉鎖術を行った。現在6歳で、軽度の嗄声はあるが日常生活に支障を認めていない。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J04210&link_issn=&doc_id=20130311410011&doc_link_id=10.5106%2Fjjshns.22.311&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.22.311&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00990&link_issn=&doc_id=20130222020016&doc_link_id=%2Fdg3nigta%2F2012%2Fs12609%2F007%2F0505-0505%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2012%2Fs12609%2F007%2F0505-0505%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

喉頭癌に対する放射線治療の重篤な晩期障害の1つとして喉頭壊死がある。喉頭壊死は晩期障害の中では比較的早期に発症することが多いが、今回われわれは放射線治療32年後に発症した遅発性喉頭壊死症例を経験したので報告する。症例は91歳男性、1977年に喉頭癌T2の診断でγ線(60Co)の放射線治療を施行された。32年後に慢性炎症を契機に喀血と、これによる気道閉塞による呼吸停止が生じ、緊急対応後の精査で遅発性の喉頭壊死と診断した。気道確保と保存的治療の結果、音声機能は温存可能であったが、嚥下機能は喪失し経口摂取は困難となった。放射線治療の長期経過後の喉頭壊死症例では、保存的治療での対応も可能であるが、喉頭が温存できても機能喪失の可能性が大きいと思われた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J04210&link_issn=&doc_id=20120706420016&doc_link_id=10.5106%2Fjjshns.22.81&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.22.81&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

2000年1月〜2008年12月までの9年間に、中下咽頭扁平上皮癌に対し化学放射線同時併用療法(CRT)を行った53症例の治療成績について検討した。原発巣は中咽頭21例と下咽頭32例で、放射線治療は1例を除く52例で休止なく70Gyを完遂した。グレード3以上の有害事象発生率は、粘膜炎49.1%、白血球減少43.4%であり、治療前後で平均4.1kgの体重減少を認めた。2コース目の化学療法は、30例で有害事象のため施行不能であった。観察期間中央値30.0ヵ月での進行中下咽頭癌全症例の粗生存率は、3年で53.0%、5年で46.4%であった。2コース目の化学療法が可能であった群で、5年生存率は67.0%と未施行群の32.8%に比べ高かった。有害事象の発生を最小限に抑え、2コース目の化学療法の施行率を上げることが本治療の成績向上に重要と考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00296&link_issn=&doc_id=20120620480013&doc_link_id=%2Fab8gtkrc%2F2012%2F003906%2F014%2F0921-0925%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2012%2F003906%2F014%2F0921-0925%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：耳鼻咽喉科臨床学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例は49歳女性で、布団を押し入れに詰め込むとき、左頸部腫脹、圧迫感が出現した。視診、ファイバースコープで口腔・咽喉・喉頭に異常を認めなかったが、左鎖骨上〜左頸部に瀰漫性腫脹を認めた。触診で圧痛は認めず、境界は不明瞭であった。左頸部の組織内出血またはリンパ液漏出を疑ったが腫瘍性病変除外のため細胞診を施行した。乳糜を疑うような液体成分は引けなかった。バイタルサインに問題なく、気道狭窄がないことを確認し左頸部圧迫固定とした。4日後、左頸部腫脹は消失し、細胞診の結果はフィブリン塊、好中球、リンパ球が認められるのみで悪性所見は認めなかった。原因検索のため再度CTを施行したが異常は指摘できなかった。その後、同部位に腫脹を認めたため緊急でMRI、核医学検査を施行した。MRI、T2強調画像脂肪抑制で左鎖骨上〜左頸部にかけ、軟部組織間への液体成分貯留を認め、水とほぼ同様の信号を呈した。核医学検査で両足の皮下にラジオアイソトープ(RI)を注入し、リンパ管シンチグラフィーを施行し、左鎖骨上に著明なRI集積を認め、特発性リンパ漏と診断した。再診時には腫脹は消失した。

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)インターメルク  

症例は60歳男性で、病悩2ヵ月の嗄声を主訴に受診し、右反回神経麻痺、甲状腺右葉腫瘍を指摘された。甲状腺機能は正常で、サイログロブリン値は36ng/mlと若干の上昇を認めた。副甲状腺機能は正常、自己抗体は陰性、白血球増多などは認めず全身状態は良好であった。頸部超音波上、右葉下部に2cm大の石灰化を伴わない分葉状、不整形低エコー結節を認めた。超音波、頸胸部CT、骨シンチグラフィで明らかな頸部リンパ節転移、肺・骨転移は認めなかった。穿刺吸引細胞診のPapanicolaou染色標本では小型核小体の目立つ、小〜中型の大小不同差のある核をもつN/C比大の悪性細胞が集塊状及び孤立性に出現していた。術前にCASTLE(carcinoma showing thymus-like differentiation)の可能性を疑い、甲状腺右葉切除、中心領域リンパ節郭清、右反回神経合併切除術を施行した。甲状腺CASTLEと診断し、右気管傍リンパ節に転移を認めた。

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

頭頸部再建手術においては、切除側と再建側がお互いの要望するところを熟知し、協調性をもって計画的にチーム医療を実施することが大事である。切除側の注意点には、特に原発巣切除断端の良好な血流ならびに健常組織の保存、血管吻合の候補となる血管の愛護的操作と保存がある。一方再建側の注意点には、最適なvolumeを持ち血流の安定した皮弁の採取、術後機能を最大限に引き出し、かつ合併症を回避すべく工夫を施した再建が挙げられる。実際の手術が時間の点でも、人員配置の点でも継ぎ目なく有効に行われるためには、切除、再建の両者が要求する細かい部分までをよく熟知し、お互いが協調していく体制が必須である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J04195&link_issn=&doc_id=20090511370001&doc_link_id=10.5981%2Fjjhnc.35.1&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.35.1&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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