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(Background) We investigated the effect of dietary supplementation with monosodium glutamate (MSG) on chemotherapy-induced downregulation of the T1R3 taste receptor subunit expression in the tongue of patients with advanced head and neck cancer. (Methods) Patients undergoing two rounds of chemoradiotherapy were randomly allocated to a control or intervention group (dietary supplementation with MSG at 2.7 g/day during the second round of chemotherapy). The relative expression of T1R3, a subunit of both umami and sweet taste receptors, in the tongue was assessed by quantitative polymerase chain reaction analysis. Dysgeusia was assessed with a visual analog scale and daily energy intake was evaluated. (Results) T1R3 expression levels in the tongue, taste sensitivity, and daily energy intake were significantly reduced after the first round of chemotherapy compared with before treatment. Furthermore, these parameters significantly decreased after the second round of chemotherapy, but the extent of decrease was significantly attenuated in the MSG group compared with the control group. (Conclusions) MSG supplementation suppresses chemotherapy-induced dysgeusia, possibly due to the inhibition of the T1R3-containing taste receptor downregulation in the tongue, thereby increasing energy intake in patients with advanced head and neck cancer.

Descending necrotizing mediastinitis (DNM) requires an early and aggressive surgical approach. We report herein on a case of DNM in which continuous saline irrigation with a pleated drain was found to be useful. A 71-year-old man presented with a sore throat and a peritonsillar abscess, CT imaging showed that an abscess with gas had spread widely over the mediastinum. The pus culture showed Streptococcus milleri group, and anaerobic bacteria were not identified in this case, The CT imaging findings on the other hand revealed suspected anaerobic infection and so the conditions in this case had caused serious mixed infection. We performed aggressive therapies such as cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, but the abscess was not cleared. We therefore added transcervical continuous saline irrigation with a pleated drain. The patient responded well to this treatment and was discharged on the 62 nd postoperative day. We found that continuous saline irrigation with a pleated drain was useful in this case.

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