Practica Oto-Rhino-Laryngologica

Pathogenesis of Nasal Mucus Hypersecretion in Chronic Sinusitis

Yuichi MAJIMA

2001 Volume 94 Issue 5 Pages 393-401
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.393

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Nasal mucus hypersecretion is a feature of chronic sinusitis (CS). Bacterial infection, which initiates neutrophil accumulation in the nose and sinuses is an initial cause of CS. The specific neutrophil products to stimulate mucus glycoprotein (MGP) secretion are neutrophil elastase, cathepsin G and platelet-activating factor. Eicoanoids are a group of lipids derived from arachidonic acid that is released from the cell membranes of inflammatory and epithelial cells, and also contribute to MGP production. Bacterial products, such as lipopolysaccharide and elastase from some bacteria, are potent secretagogues. Such products derived from inflammatory cells and bacterias are retained in sinuses for a long time because of obstruction of the sinus ostium and mucociliary dysfunction of the nose and sinuses. Submucosal gland cells are hyperplastic and hypertrophic but goblet cells are not, and the major source of MGP hypersecretion is submucosal gland cells rather than goblet cells. The role of neural innervation of submucosal glands on MGP overproduction has not yet to be elucidated.
The rheologic properties of nasal mucus from CS patients are much higher than the optimal viscoelasticity for mucociliary transport. Since MGP mainly determines the high viscosity and the high elasticity of nasal mucus, a control of MGP production could contribute to the normalization of abnormal viscoelasticity, and result in the improvement of mucociliary clearance. This is accomplished by removing the sinus retention that contains many secretagogues. Although current pharmacological approaches to airway mucus production are limited, glucocorticoid appears to be the most effective among the few useful drugs. The effect of 14-membered macrolide antibiotics on MGP production is still controversial. Some mucolytic agents change the conformations of MGP and lead to the reduction of viscoelasticity when they are administered topically or systemically.
The mechanisms of nasal mucus hypersecretion are also discussed in relation to the etiology of CS.

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Laparoscopic Harvest of Omental Free Flap for Head and Neck Reconstruction

[in Japanese], [in Japanese]

2001 Volume 94 Issue 5 Pages 402-403
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.402

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Otogenic Cerebellar Abscess Secondary to Middle Ear Cholesteatoma

Kojiro TSUJI, Mieko SONE, Masafumi SAKAGAMI

2001 Volume 94 Issue 5 Pages 405-410
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.405

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We report a case of cerebellar abscess and sigmoid sinus thrombophlebitis secondary to middle ear cholesteatoma. A 77-year-old female was referred to our clinic with right otorrhea, earache, headache, fever and gate disturbance. CT revealed bony destruction in the posterior fossa of the temporal bone and a cerebellar abscess in the right cerebellum. Emergency abscess drainage via a posterior fossa approach was performed by neurosurgeons, followed by total removal of the cholesteatoma 47 days later. Eight months after the surgery, she recovered her previous mental and physical level and showed no complications.
The mortality of intracranial complications such as cerebellar abscess, brain abscess, meningitis and sigmoid sinus thrombosis has decreased recently due to the availability of the preantibiotic treatment. However, typical symptoms are often masked by proceeding antibiotic therapy and it is important to reduce mortality from otogenic complications by early diagnosis and precise treatment in the early stage.

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Otogenic Intracranial Abscess due to Cholesteatoma; Report of a Case

Yoshiaki IGUCHI, Masatoshi HIRAYAMA, Kazuhiro YAMAMOTO, Atsushi OCHIAI ...

2001 Volume 94 Issue 5 Pages 411-416
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.411

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A 55-year-old female presented with headache and aphasia of the department of neurosurgery in our hospital. On CT examination, the patient had an enhanced ring in the temporal lobe, and inflammation reaction was higher than normal levels, and the neurosurgeon diagnosed an intracranial abscess. Chemotherapy was begun on admission together with the administration of an anti-convulsant. After one month, aural discharge was noted, and we diagnosed intracranial abscess due to middle ear inflammation. The aural CT scan was revealed bone destruction and we noted cholesteatoma in the mastoid. We performed mastoidectomy and neurosurgeons removed an abscess capsule by craniotomy. The patient was discharged on the 26th postoperative day. Recently, otologic treatment for an otogenic intracranial abscess is often delayed because of the initial treatment by other specialists. In the present case, we speculated that the initial absence of aural discharge was due to the intensive chemotherapy.

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Congenital Cholesteatoma Revealed by Myringotomy; Two Case Reports

Kuniyuki Takahashi, Yutaka YAMAMOTO, Shigehisa HASHIMOTO, Sugata Takah ...

2001 Volume 94 Issue 5 Pages 417-420
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.417

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Two cases of congenital cholesteatoma incidentally found by myringotomy are reported. The first case (3-year-old male) had been suffering from repetitive acute otitis media. When a myringotomy was performed in the follow-up period, white debris was also observed in the tympanic cavity. The second case (8-year-old male) had been treated under the diagnosis of otitis media with effusion. In the follow-up period, conductive hearing loss had continued, but his middle ear effusion disappeared. Therefore, an exploratory myringotomy was carried out, and white debris was found in the tympanic cavity. Finally, both patients were diagnosed as having congenital cholesteatoma by intraoperative findings. Myringotomy is a common procedure for patients with otitis media. Close observation of the tympanic cavity is very important at the time of the myringotomy to rule out congenital cholesteatoma.

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A Case Report of Facial Nerve Palsy in an Infant Associated with Chickenpox

Takeshi Tanaka, Kouji IWAI, Masaharu SUDO

2001 Volume 94 Issue 5 Pages 421-425
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.421

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Facial palsy is a rare neurological complication of chickenpox. We report a 4-month-old girl with facial palsy on the right side followed by the appearance of the chickenpox rash. There were no other neurological abnormalities and brain MRI was normal. Her facial palsy had recovered completely after 6 weeks of therapy with acyclovir and vitamin B12.
A survey of the literature (1950-2001) showed that to date only 22 cases including this case of facial palsy due to the Varicella-zoster virus that causes chickenpox have been reported. To our knowledge this patient is the youngest of the 22 reported cases.

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Angioleiomyoma of the Inferior Turbinate; A Case Report

Shin-ichiro KITAJIRI, Keisaku TABUCHI, Harukazu HIRAUMI

2001 Volume 94 Issue 5 Pages 427-430
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.427

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A rare case of angioleiomyoma of the inferior turbinate is presented. A 72-year-old female who visited our outpatient clinic had a pedunculated mass in her right inferior turbinate. The patient showed no symptoms of the mass. The mass was removed by an endonasal approach. A histopathological examination revealed an angioleiomyoma.

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Two Cases of Pierre Robin Sequence

Eiji TAKEUCHI, Hiroya KITANO, Kazutomo KITAJIMA

2001 Volume 94 Issue 5 Pages 431-435
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.431

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Two cases of Pierre Robin sequence are reported. The Pierre Robin sequence is a grouping of abnormalities that includes micrognathia, glossoptosis, upper airway obstruction, and cleft palate. It is suggested that micrognathia is the primary anormaly that causes glossoptosis, upper airway obstruction, and cleft palate, and that mandibular abnormality may have many different causes. The etiology is complex, and it has been suggested that it may be a nonspecific symptom complex rather than a specific syndrome. Problems in the postoperative course are the same as those in the neonatal period; children with the Pierre Robin sequence may present with respiratory obstruction and feeding difficulties shortly after birth and operation. The management of this condition includes prone positioning, tongue traction, glossopexy, nasopharyngeal tubes, intubation, and tracheostomy. The obstruction in our cases was well controlled with prone positioning.

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Pleomorphic Adenomas in Parotid Gland and Submandibular Gland of the Other Side; A Case Report

Masakatsu TAKI, Kazuhiro SYOGAKI, Taketoshi SHIMADA, Yasuo HISA, Takas ...

2001 Volume 94 Issue 5 Pages 437-441
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.437

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Pleomorphic adenomas in several salivary glands are rare. We report a patient with pleomorphic adenomas in the right parotid gland and the left submandibular gland. Preoperative MRI and neck echography revealed masses in the right parotid gland and the left submandibular gland. Right superficial parotidectomy and left submandibular sialoadenectomy were performed and the histopathologic diagnosis was Pleomorphic adenoma, with no suggestion of malignancy and metastasis. To our knowledge, there have been no previous reports of pleomorphic adenoma both in the parotid gland and in the submandibular gland of the other side.

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Sleep Apnea Syndrome with Consciousness Disorder; A Case Report

Keizo Fujiwara, Makoto MIURA, Ken ISHIJIMA

2001 Volume 94 Issue 5 Pages 443-446
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.443

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A 55-year-old male suffering from general edema with dyspnea visited our hospital. The results of cardiac catheterization and monitoring SpO₂ suggested congestive heart failure occurring with sleep apnea syndrome (SAS) with pulmonary hypertension. A polysomnography confirmed severe obstructive sleep (apnea index; 37.1). Although we strongly recommended the use of nasal CPAP or a surgical treatment (uvulopalatopharyngoplasty; UPPP), the patient refused therapy. Six months later, his respiratory status had deteriorated and he was readmitted to our hospital. He had marked hypoxia (PaO₂ 61.7mmHg) with hypercapnia (PaCO₂ 101.9mmHg) on admission. Since his consciousness level deteriorated after admission, he underwent endtracheal intubation and tracheostomy. After these treatments sufficiently improved pulmonary hypertension and congestive heart failure, he underwent further UPPP to make closure of the tracheostoma possible. Even after the closure, he showed no sign of dyspnea or congestive heart failure. We discuss the clinical course in this patient with referrence to the literature.

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A Case of Extramedullary Plasmacytoma from Right Frontal Sinus

Kenichiro FUJITA, Hiroyuki YAMADA, Hajime ISHINAGA, Ryoji ISHIDA, Akih ...

2001 Volume 94 Issue 5 Pages 447-452
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.447

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A 72-year-old man with a history of nasal obstruction and swelling of the forehead area was referred to our department. CT revealed a mass in the right frontal sinus, extending into the ethmoid sinus and orbital fossa. Nasal biopsy showed sheets of plasma cell, and further investigation led to the diagnosis of IgG-type extramedullary plasmacytoma. Radiotherapy and an operation were performed and the tumor dissapeared. Since recurrence of the tumor was observed in the left maxillary sinus at 14 months after the initial treatment, we employed left partial maxillectomy in addition to radiation with intra-arterial chemotherapy. MCNU-VMD chemotherapy, consisting of MCNU, vincristine sulfate, melphalan and dexamethasone was performed when the tumor disseminated in the left humerus at four months after the second treatment.
In a case of advanced plasmacytoma the prognosis is often poor and chemotherapy should be used to achieve a better prognosis.

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The Basaloid Squamous Cell Carcinoma of the Base of the Tongue

Tomoko TSUJI, Kaoru SHINOHARA, Kimio HASHIMOTO, Hideyuki FUKUSHIMA, Ko ...

2001 Volume 94 Issue 5 Pages 453-463
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.453

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Basaloid squamous cell carcinoma is very rare and has a poor prognosis. Head and neck basaloid carcinomas were first reported by Wain1 in 1986, and to date only 200 cases of head and neck basaloid carcinomas have been reported, and most of these were investigated by retrospective examination of the patient's charts. Before Wain's report, these cases were classified as adenoid cystic carcinoma, small cell undifferentiated carcinoma, and poorly differentiated squamous carcinoma and were treated on a case by case basis ; thus, the prognosis of these patients should improve by accurate diagnosis and appropriate treatment.
We report a case of the basaloid squamous cell carcinoma of the base of the tongue that was diagnosed by preoperative biopsy. In this patient we were able to plan preoperative chemotherapy, radical resection of the tumor with a wider safety zone than usually used for ordinary squamous carcinoma, bilateral neck dissections, and post operative radiation. The patient has been free from tumor for 21 months. It is important for ENT doctors to be aware of this new category of malignant tumor to improve the prognosis of this malignancy.

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High Dose Morphine for Oropharyngeal Cancer Pain

Harukazu HIRAUMI, Keisaku TABUCHI, Shin-ichiro KITAJIRI

2001 Volume 94 Issue 5 Pages 465-467
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.465

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A case of severe oropharyngeal cancer pain controlled with intravenous high dose morphine is reported.
The patient was treated with enteral morphine at first, but as the tumor increased in size, pain between the administration of morphine occurred. With the continuous intravenous high dose morphine up to 3, 360 mg/day, good pain relief was achieved. Seizure occurred during the continuous intravenous morphine administration, but no other severe side effects occurred.

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A Case of Hemophagocytic Syndrome with Cervical Lymphadenopathy

Hideaki KOUZAKI, Hiroshi Tanaka, Kazuhiro TANIGUCHI, Tetsuy OKUDA, Kaz ...

2001 Volume 94 Issue 5 Pages 469-474
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.469

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A 16-year-old male was admitted to our hospital in July 23, 1999, because of high fever and cervical lymphadenopathy. Although he was treated with antibiotics, his fever persisted and his laboratory data revealed leukopenia and thrombocytopenia. Bone marrow puncture was perfomed and showed increased numbers of mature histiocytosis with hemophagocytosis and diagnosis of hemophagocytic syndrome was made. He was given pulse therapy with methylprednisolone and completely recovered after the treatment and was discharged 34 days after admission.
Hemophagocytic syndrome presents with symptoms of fever, cytopenia, liver dysfunction and coagulopathy and it is characterized by systemic proliferation of benign hemophagocytic histiocytosis in the bone marrow, lymph nodes, liver and spleen.
Hemophagocytosis is induced by cytokines due to activated T-lymphocytes and macrophages. The prognosis in hemophagocytic syndrome varies from good to poor; thus, early diagnosis and early treatment are important.

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Influence of Inflammatory Cells in Paranasal Mucosa on Cultured Human Sinus Ciliated Cells

-The Influence of Eosinophil Infiltration-

Kyosuke FURUKIDO, Sachio TAKENO, Takashi ISHONO, Hiroko KAWAMOTO, Koji ...

2001 Volume 94 Issue 5 Pages 475-480
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.475

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Although recently there have been an increasing number of reports of chronic sinusitis acompanied with a high level of eosinophils, there is little evidence that eosinophils influence epithelial cells in the paranasal sinus. In this study, we focused on the difference in infiltration cells, especially eosinophil infiltration, on the ciliary beat frequency (CBF) of cultured human sinus epithelial cells. Sinus mucosal explants were successfully cultured on poly-L-lysine coated dishes with an abundant outgrowth of ciliated cells. CBF measurement was carried out by photoelectric method at specific predetermined sites on 7 to 10 day cultured specimens. In this study, CBF in eosinophil infiltration (more than 51 cells/ 100 pmt) was significantly higher (p < 0.05) than CBF in eosinophil infiltration (less than 50 cells/100 pm2). On the other hand, CBF was not significantly different among the groups of mononuclear cell infiltration (more than 51 cells/100 pmt and less than 50 cells/100 pm2). Moreover, CBF in less than 0.3 (eosinophils/mononuclear cells) was significantly higher (p <0.05) than CBF in more than 0.3 (eosinophils/mononuclear cells). Thus we suggest that eosinophil infiltration in human sinus mucosa is influenced by the level of CBF.

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Surgery of Oropharynx

[in Japanese]

2001 Volume 94 Issue 5 Pages 482-483
Published: May 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.482

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