Backgrounds: Salivary dysphagia due to digestive tract obstruction from pharyngeal and cervical esophageal cancer is a major cause of drooling, and the retention of saliva in the mouth is annoying to patients. Case report: An 87-year-old woman with recurrent hypopharyngeal cancer after radiation therapy complained that she could not sleep at night because of continuous sputa accumulation, and that she had to repeatedly eliminate saliva throughout day. Intravenous betamethasone at dose of 8 mg per day provided symptom relief the day after its administration. Her score on the Support Team Assessment Schedule, Japanese version (STAS-J) for salivary dysphagia decreased from 4 before treatment to 1 within two days after the initial administration. The dose was decreased to 2 mg per day six days after the start of administration, but the symptom relief continued. No symptom recurrence was seen for the two months that steroids were administered. Discussion: Our STAS-J finding indicates that the anti-inflammatory effect of betamethasone produces a rapid response that is maintained for months in cases of stenosis due to malignancy. Conclusions: Treatment with high dose steroid has the possibility of the relief of suffering caused by difficulty swallowing saliva.

OBJECTIVESOur objectives were (1) to evaluate whether single spot urine is suitable media for longer-term phthalate esters exposure assessment, and (2) to estimate intake level of phthalate esters of Japanese pregnant women using urinary metabolites as an indicator of prenatal exposure level in their offspring.

METHODSWe analyzed nine metabolites (MMP, MEP, MnBP, MBzP, MEHP, MEOHP, MEHHP, MINP, MnOP) of seven phthalate esters in spot urine samples from 50 pregnant women by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Using four urine samples collected from each of 12 subjects from 50 pregnant women within 5-12 weeks, we compared intra- and interindividual variation in urinary metabolites by calculation of intraclass correlation coefficient (ICC). We estimated daily intakes of 50 pregnant women from their urinary metabolite concentrations.

RESULTSICCs for seven phthalate metabolite concentrations in single spot urine samples were: MMP (0.57), MEP (0.47), MnBP (0.69), MBzP (0.28), MEHP (0.51), MEHHP (0.43), and MEOHP (0.41) in 12 pregnant women. Phthalate ester metabolites had high detection rates in 50 subjects. The mean daily intake ranged from 0.01 to 2 mug/kg per day. The daily intake levels in all subjects were lower than corresponding tolerable daily intake (TDI) set by the European Food Safety Authority (EFSA), though maximum value for DnBP of 6.91 mug/kg per day accounted for 70% of TDI value.

CONCLUSIONSHigher ICCs indicated that phthalate metabolite levels in single spot urine could reflect longer-term exposure to the corresponding diesters of subjects. Although the current exposure level was less than TDIs, further studies and exposure monitoring are needed to reveal the toxicity of phthalate esters to sensitive subpopulation.