To pursuit the only-one research subject is very important for ENT doctors. We do not have enough time or money to compete with basic scientists. To find the only-one subject is recommended for young ENT doctors who begin the basic or clinical research. How to find the only-one subject will be also discussed.

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Myeloid-derived suppressor cells (MDSC) represent a heterogeneous population and have the potential to suppress immune responses via diverse mechanisms including the production of immunosuppressive cytokines, arginase I, reactive oxygen species, and nitric oxide. Due to the lack of specific markers, human MDSC are still poorly defined. Recent studies suggest that in head and neck cancer, abnormal accumulation of MDSC in peripheral blood and tumor sites might contribute as an important mechanism of tumor immune evasion. This article reviews the characterization and immune suppressive mechanisms mediated by MDSC. Moreover, clinical implications in patients with head and neck cancer, as well as the development of novel strategies to efficiently overcome immune suppression by MDSC are also discussed.

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This study involved 21 patients who were treated for eosinophilic sinusitis from July 2009 to June 2010 at the Department of Otorhinolaryngology, Japanese Red Cross Medical Center. We investigated the causes, treatment approaches, and outcomes of acute exacerbation of sinus symptoms, such as impaired sense of smell, rhinorrhea, and nasal obstruction. The relationship between seasonal factors and acute exacerbation of sinusitis were also assessed. Eleven of the 21 patients with eosinophilic sinusitis had a total of 23 episodes of acute exacerbation. The most frequent symptom was impaired sense of smell (22 episodes), followed by exacerbated rhinorrhea (14 episodes) and nasal obstruction (12 episoeds). Sinus symptoms improved in 19 of the 23 episodes for a fair outcome. Although acute exacerbation was most frequently caused by cold and asthma, it also resulted from temporary discontinuation of steroid therapy, such as oral steroid administration or betametasone nasal drops, for the prevention of adverse effects. Acute exacerbation of eosinophilic sinusitis was distributed almost throughout the year, with the highest frequency seen at the change of the seasons, such as in March and June. The survey results showed that sinus symptoms are generally exacerbated during winter through early spring when cold, asthma, and hay fever are prevalent.

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We report the clinical course of a 74 year-old man with extranodal NK/T cell lymphoma, nasal type (ENKL). He developed gradual right visual loss for several months. At the referral to our clinic, he presented swelling of the eyelid, but endoscopic observation of nasal cavity revealed no signs of nasal cavity tumor. Together with computed tomographic scan, we initially assumed his case as invasive sinus aspergillosis, that we immediately performed endoscopic sinus surgery. The paranasal sinus biopsy in the surgery showed diffuse infiltrates of lymphoma cells and inflammatory cells accompanied with wide spread ischemic necrosis, and he was diagnosed of ENKL. Finally, with positive cytology of cerebrospinal fluid and aqueous humor from both eyes, this case was classified into Ann Arbor IV B stage. Radiation therapy was performed and primary lesion was controlled, but his general condition gradually deteriorated, and he died in about three months after diagnosis. ENKL, an uncommon lymphoproliferative disorder, usually involve the nasal cavity or paranasal sinuses, and rarely occurs in the orbit. But in this case, we suppose the origin of ENKL to be the orbit. Early diagnosis of ENKL is important, because ENKL of advanced clinical stages shows poor prognosis. To make early diagnosis, biopsy of several tissues and immunostaining are desirable because of necrotic tissue contained in tumor. It is also important to inform pathologist about possibility of ENKL for immunostaining.

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Forty-five patients with Japanese cedar/cypress pollinosis were divided into 3 groups, dexamethasone cipecilate (DX-CP) group, fexofenadine hydrochloride (FEX) group, and the combination group (15 patients each) to examine irritability of dry powder-type steroid nasal spray (DX-CP) and the combination effect with a second-generation antihistamine (FEX). The respective drugs were administered for at least 10 days. The patients rated nasal symptoms and troubles with daily life on a 5-point scale and ocular symptoms on the visual analogue scale; further, a questionnaire survey concerning the impression of the drug, with respect to irritability, was performed in the DX-CP group. Changes in nasal symptom scores and troubles with daily life in the DX-CP and combination groups showed no significant differences for some of the categories, but the values in these groups were higher than those in the FEX group for all categories; the therapeutic effects (resolution to aggravation) were significantly better compared to the FEX group. Changes in the VAS scores for eye itching did not differ significantly in all groups. Comparison between the DX-CP group and the combination group showed no significant difference for all categories. Concerning the impression of use of DX-CP, irritability at the time of spraying was “totally absent” or “negligible” at 90%; moreover, other impressions of use were generally favorable. While no obvious difference was noted in the effect between DX-CP monotherapy and combination with FEX, DX-CP was less irritable and could be useful for the treatment of Japanese cedar/cypress pollinosis as monotherapy.

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