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Many patients with head and neck cancer (HNC) suffer from psychological distress associated with dysfunction and/or disfigurement. Our aim was to evaluate the ratio of patients with persistence of psychological distress during hospitalization and identify the predictors of persistence or change in psychological distress among HNC patients.
Method:
We conducted a single-center longitudinal study with self-completed questionnaires. We evaluated psychological distress (the Hospital Anxiety and Depression Scale; HADS) and functional level (the Functional Assessment of Cancer Therapy–Head and Neck Scale; FACT–H&N) among patients during hospitalization at the Medical Hospital of Tokyo Medical and Dental University.
Results:
Of 160 patients, 117 (73.1%) completed the questionnaire at both admission and discharge. Some 42 (52.5%) patients reported persistent psychological distress. The physical well-being of patients with continued distress was significantly lower than that of other patients (21.7 ± 4.7, 19.4 ± 6.1, 19.5 ± 5.4; p < 0.01), and the emotional well-being of patients with continued distress was significantly lower than that in patients with no distress and reduced distress (22.3 ± 3.5, 20.5 ± 2.5; p < 0.01).
Significant of results:
Impaired physical and emotional function appears to be associated with persistent psychological distress among HNC patients. Psychological interventions focused on relaxation, cognition, or behavior may be efficacious in preventing such persistent distress.
This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument.
Method:
Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test–retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy–Head and Neck (FACT–H&N) scales.
Results:
Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT–H&N demonstrated significant correlations (Spearman's ρ = 0.47–0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test–retest reliability showed an intraclass correlation coefficient (ICC) of 0.62–0.79.
Significance of Results:
The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.
Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.
We report on a rare case of angiolymphoid hyperplasia with eosinophilia (ALHE) arising from the facial artery, which was pre-operatively diagnosed as an aneurysm. ALHE is a rare lesion, the precise nature of which remains controversial: it is still unclear whether ALHE is a tumour or an inflammatory disease or whether it can be separated from Kimura’s disease based on its pathological characteristics. ALHE rarely occurs in muscular arteries, and this is the first description of ALHE arising from the facial artery. Angiography vividly revealed the pathological structure of the lesion in this case, which prompted us to advocate angiography for diagnosing ALHE arising from muscular arteries. Complete dissection and cryotherapy proved to be effective treatment, although complete management of any therapeutic protocol should avoid recurrence of the lesion, whatever specific treatments are selected.
The histopathological and imaging findings of a rhabdomyoma of the base of the tongue were studied. An immunohistochemical examination of the tumour cells showed positiveimmunostaining for myoglobin, desmin, and striated muscle actin, but negative immunostaining for smooth muscle actin. Electron microscopy showed many glycogen granules and mitochondria in the tumour cells. The T2-weighted and contrast-enhanced magnetic resonance images (MRI) clearly delineated morphological features of this tumour, but T1-weighted MRI and computed tomography (CT) images showed no important features. These findings are typical for an adult extracardiac rhabdomyoma located in the head and neck region, and they will be useful for diagnosis of this tumour.
The present paper describes the first reported case, to our knowledge, of a myoepithelioma arising in an accessory parotid gland. Because pre-operative fine-needle aspiration cytological findings and operative findings suggested that this tumour was malignant, the decision was made to remove the tumour surgically along with the buccal branches of the facial nerve. The resected nerve was reconstructed by nerve transplantation, using the great auricular nerve. Subsequently the tumour was found to be benign. One year after surgery, the patient had excellent facial nerve function and so far there has been no evidence of recurrence.
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