Secretory immunity is crucial for the primary defence of nasal and pharyngeal mucosa. B cells with a potential for J-chain expression are initially stimulated in mucosa-associ-ated lymphoid tissue, including tonsils and adenoids, and thereafter migrate to the secre-tory effector sites where they become immunoglobulin (Ig)-producing plasma cells. Locally produced Ig consists mainly of dimers and larger polymers of IgA (poly-IgA) that is selectively transported through glandular cells by an epithelial receptor called secretory component (SC). Secretory antibodies perform surface protection by immune exclusion of live and dead antigens. IgG can also participate in this primary defence; like IgE it reaches the secretions by passive diffusion. The inflammatory properties of antibodies belonging to these two classes explain their involvement in mucosal immuno-pathology when elimination of penetrating antigens is unsuccessful. T cells activated in this process may, by a T_H2 profile of cytokines, promote persistent inflammation with extravasation and priming of eosinophils. This appears to occur in the late-phase allergic reaction, perhaps driven mainly by interleukin-4 (IL-4) released from mast cells subjected to IgE-mediated degranulation. Eosinophils are potentially tissue-destructive cells, particularly after priming with IL-5. Cytokines also upregulate adhesion molecu-les on vascular endothelium and nasal epithelium, thereby enhancing migration of eosinophils and other leukocytes into the mucosae. Intercellular adhesion molecule-1 (ICA M-1), which is readily upregulated by interferon-γ on nasal epithelium, is of par-ticular importance for further migration of leukocytes onto the mucosal surface. How-ever, epithelial ICAM-1 might also provide a cosignal for overstimulation of CD4⁺ T lymphocytes by antigen-presenting HLA-R⁺ epithelium; this could partly explain that upper airway mucosae appear less able than gut mucosa to engage CD8⁺ suppressor cells for downregulation of hypersensitivity reactions against environmental antigens. Ther-apeutic control of adhesion molecules may become an adjunct in future treatment of allergic disease.

抄録全体を表示

The oral and pharyngeal mucosa is an active, immunological microenvironment quite different from other mucosal surfaces between the body and the external environment, such as the gastrointestinal mucosa. It has scant mucous coat and is covered by a thick stratified squamous epithelial cell layer, which expresses neither cell adhesion molecules nor class II MHC antigens. Thus, it has been speculated that the defense mechanism in the oral cavity and pharynx depends mainly on a nonimmunological mechanism which resists mechanical stimuli. Recently, however, squamous cells are identified as producers of a wide variety of cytokines in response to nonspecific stimulation in certain inflammatory diseases of the oral cavity and in vitro experiments, and intraepithelial Langerhans cells have been in considered to be a unique subpopulation of antigenpresenting dendritic cells, which express class II MHC antigens and cell adhesion molecules such as ICAM-1 (CD54). The submucosal vascular unit, consisting of venule-like blood vessels, continuoresly expresses various cell adhesion molecules, including ICAM-1, E-selectin and P-selectin (CD62), regardless of the presence or absence of inflammatory infiltration. Cytokines released by squamous epithelial cells activated by external antigens upregulate the expression of these cell adhesion molecules. These events promote adhesion of circulating leucocytes, especially memory T cells and neutrophils, to the submucosal interstitium.
In contrast to the oral and pharyngeal mucosa, the intestinal mucosa is covered by a thick mucous coat containing immunoglobulins, such as secretory IgA (sIgA), which may con-tribute to the prevention of adhesion and uptake of microorganisms and dietary antigens in the intestinal tract, thereby forming a mucosal defense mechanism is its preferential utiliza-tion of IgA for its B cell response to antigenic challenge through the mucosa. The intestinal mucosa is equipped with a lymphoid apparatus consisting of organized lymphoid tissues, a diffuse collection of lymphocytes and plasma cells in the lamina propria and lymphocytes within villous epithelial cells which express class II MHC antigens whether or not inflamma-tion is present.
These findings indicate that microenvironmental diversity caused by differences of cover-ing epithelial cells leads changes in the pattern of mucosal defense mechanisms and immune-inflammatory responses.

抄録全体を表示

A palatine tonsil, removed by tonsillectomy, from a patient with PPP and slight fever, was cut into two pieces. One was treated with Ultra-micro Waves, and lymphocytes were isolated from both pieces.
We investigated the immune responses of tonsillar lymphocytes against the streptococci, PHA, and PWM. Blastoid transformation was measured by ³H-Tdr uptake, and IgG and Interleukin-1 (IL-1) by ELISA.
Blastoid transformation and production of IgG and IL-1 were not effected by ultra-microwave stimulation, but Streptoccocal antigens stimulated IL-1 production in tonsillar lymphocytes from the patient.

抄録全体を表示

Free jejunum graft reconstruction, a technique for reconstructing the digestive tract following radical surgery to treat hypopharyngeal cancer, is advantageous because it causes relatively few complications such as necrosis, insufficient anastomosis, stenosis, etc. This technique has one disadvantage: it is difficult to provide a voice substitute through esophage-al speech.
After radical surgery for hypopharyngeal cancer in a 60-year-old woman and free jejunum graft reconstruction, we attempted a direct T-J shunt operation by applying the direct T-E shunt technique that we have recently been using in our department in cases of advanced laryngeal cancer. The attempt was a succces, and the patient achieved agood voice substitute. This shunt operation is technically easy, and it takes only 20 minutes to secure a sufficient voice substitute. Therefore, we intend to continue this type of operation in the furture.

抄録全体を表示

We report a case of parotid cancer with severe granulocytosis, considered to be caused by G-SF (granulocyte colony-stimulating factor) derived from tumor cells. A 72-year-old male had marked leukocytosis with up to 57, 800 WBC/mm³. The serum concentration of G-CSF was also high, 42.2pg/dl. We performed total parotidectomy, and the number of WBC and the serum concentration of G-SF decreased considerably (WBC: 17, 700mm³, G-SF: 20. 7pg/dl).The tumor was diagnosed pathologically as undifferentiated carcinoma. A higher level of G-SF was detected in the conditioned medium of tumor cells and serum than in control medium and normal serum. The existence of G-SF in the tumor cells was demonstrated by avidin-biotin-peroxidase staing anti-G-CSF antibody. These findings convinced us that these tumor cells produced and secreted G-SF.

抄録全体を表示

A rare case of nerve sheath myxoma of the oropharynx in a 54-year-old-woman is reported. Her complaint was slight pain upon swallowing. At the left arcus palatoglossus, a flat, edematous, ulcerated tumor was found and excised surgically. The tumor was well encapsulated, measuring ca. 1.5-1-1cm. The cut surface was yellowish and gelatinous. Histopathologically it consisted of distinct lobules surrounded by fibrous septa. Each lobule was composed of spindle-shaped cells with elongated nuclei surrounded by a myxoid matrix, which stained prominently with Alcian blue. Immunohistochemically the tumor cells stained specifically positive for S-100 protein, neuronspecific enolase, and vimentin. They stained negative for myoglobin, and Factor XIIIa. The staining pattern suggested a neoplasm arising from neuroectodermal cells in the endoneurium of the peripheral nerve. The tumor was diagnosed as nerve sheath myxoma, which is considered to be a specific clinicopathological entity. After three years there has been no recurrence.
Myxomatous tumors in the oropharyngeal region, require a differential diagnosis among nerve sheath myxoma, odontogenic myxoma, soft tissue myxoma, neuroma and schwannoma. They can usually be differentiated easily by histological and immunohistochemical studies. Nerve sheath myxomas are rare; only eight cases in the oral and oropharynx region have been reported in Europe and America and only one case in Japan.

抄録全体を表示

Profunda Mycosis of the head and neck is a rare disease whose chief complaint was an enlarging cervical mass, which was diagnosed as chromoblastomycosis.
Our patient was a 33-year-old man. When he first visited our hospital the cervical mass had been present for six months and was increasing in size. He later developed motor paralysis. An MRI scan of the brain revealed a mass lesion in the parietal region and in the parietopontine tract.
A biopsy of cervical lymph nodes showed mycotic lymphadenitis. A craniotomy was performed to biopsy the lesions in the brain. The brain biopsy revealedblack fungi. The enlarging mass of the neck was diagnosed as chromoblastomycosis.
Antifungal medications were administered, and the mass in the neck diminished. However, the lesion in the brain were not significantry improved by antimycotic agents.

抄録全体を表示

Acute suppurative thyroiditis is a comparatively rare thyroid inflammatory disease.The pathogenesis was usually uncertain until Miyauchi et al. emphasized the significance ofthe internal fistula originating from the apex of the left piriform sinus as the route of infectionto the thyroid.
We treated two adult patients with suppurative thyroiditis due to infection through apiriform sinus fistula and observed a good response to surgical treatment.
Case 1 was a 31-year-old man, Case 2 a 37-year-old woman. Both patients had redness, swelling, and pain in the peripheral region of the left thyroid gland. After resolution ofthese symptoms, pharyngoesophageal angiography and esophageal endoscopy were performed, and a piriform sinus stoma and opening of the fistula were demonstrated. During surgery, asoft probe was inserted into the fistula and left in place to provide easy detection of thisfistula. The left lobe of the thyroid was removed together with the fistula tract.
The two patients have had norecurrence of the disorder, and their thyroid function hasbeen normal, So, the prognosis is good.
We believe that complete removal of the fistula with careful operative technique is essentialfor a permanent cure.

抄録全体を表示

In this paper, the term “pharyngeal surgery” is used as an inclusive term for plasticsurgeries at the faucial level for sleep related breathing disorders (SRBD): uvulectomy, palatoplasty, UPPP, and etc. It does not include midline glossectomy, mandibular hyoidadvancement surgery, etc.
The long term (6-24 months) and short term (14-28 days) effects of the pharyngealsurgery on SRBD were studied.
The long term effect was studied by a questionnaire answered by 97 patients. Improvementof snoring was noted by 84.5%, and of apnea by 94.5%. The results of surgery wererated as satisfactory by 93.8%.
The short term effect was studied by nocturnal polysomnography in 22 patients. Criteriawere established to define pharyngeal surgery responders as those who showed a 50% or morereduction in the apnea index and a postoperative index of less than 20. Improvement wasdocumented in 81.0%.
The sites of obstruction were observed by nasendoscopic diurnal polysomnography undersedation with diazepam to be the soft palate, base of tongue or both. Pharyngeal surgerywas most effective in treating soft palate obstruction.
The discrepancy in past reports of the effects of pharyngeal surgery seems to be due todifferences in the accuracy of diagnosis of the site of obstruction.
In order to increase the effectiveness of pharyngeal surgery for SRBD, exact diagnosis ofthe site obstruction is important.

抄録全体を表示

During the past 10 years, 18 patients with palatine tonsil cancer (all squamous cell carcinomas) were treated in the Department of Otorhinolaryngology of Mie University Hospital. Seven patients (39%) had stage II or III, and 11 (61%) had stage IV carcinoma. The cumulative 5-year survival rate was 50%. All patients were treated with irradiation therapy with or without simultaneous chemotherapy. Salvage operations were performed in 5 patients with residual cancer and radical neck dissection in 10 patients with a cervical mass. Six patients received intra-arterial chemotherapy simultaneously. The original tumors of the 6 patients were controlled by the combination of irradiation and simultaneous intra-arterial chemo-therapy. The 5-year cumulative survival rate was 82% for the patients treated with the combination therapy, and 36% for those who did not receive intra-arterial chemotherapy. We conclude that combination therapy is effective in the treatment of the original tumor of palatine tonsil cancer.

抄録全体を表示

We treated two patients with food allergy who had lesions in the oral cavity and throat. The first had adverse reactions to cuttlefish, shrimp, and crab in the oral cavity and throat. The second case had adverse reactions to some cereals with oral cavity and throat lesions associated with a systemic reaction.

抄録全体を表示

Intractable recurrent ulcer of the oral cavity and pharynx is defined as irregular ulcerating lesions limited to the oral cavity and pharynx with no specific clinical or hematological abnormalities, which recur easily and are resistant to various treatments for at least one month.
Twenty-two patients with intractable recurrent ulcers were examined histologically with the use of anti-human immunoglobulin (IgG, IgA and IgM) and HLA-DR. Of the subepithelial cells which expressed immunoglobulin those expressing IgG were the most numerous, and those expressing IgM were the fewest. NLE type (neutrophil cells, lymphocytes and eosinophil cells infiltrated type) cells expressed IgA and IgG equally, and LPE type (lymphocytes, plasma cells and eosinophil cells infiltrated type) cells had the highest expression of IgG. However no NL type (neutrophil cells and lymphocytes infiltrated type) cells expressed immunoglobulin. Epithelial expression of IgG was found in 19 patients, that of IgA in 19 patients, and that of IgM in 17 patients. Immunoglobulins were located in the spinous and granular layers. Epithelial expression of HLA-DR was present in 80% of patients-with epithelial immunoglobulins.
These results suggest that some form of celluar immunity is involved in the occurrence and advance of intractable recurrent ulcer. However, it could not be determined whether the epithelial expression of immunoglobulin is caused by autoimmunization or is a reaction to the plasma stored in and between epithelial cells.

抄録全体を表示

A66-year-old male with sialodochitis fibrinosa of the submandibular gland is described. He had no history of allergy, and skin tests and RAST were negative. Histopathologlcal study revealed a mucous plug with many eosinophils in the lumen of the duct, marked eosinophilia and formation of lymphoid follicles in the periductal interstitial tissues.
Immunohistochemical staining showed predominant infiltration of EG2 positive eosinophils and CD4 positive T cells. An Extract of the submandibular gland with sialodochitis fibrinosa showed chemotactic activity against eosinophils from both a healthy donor and the patient. It is conceivable that soluble factors derived from CD4 positive T cells contributed partly to the eosinophilic infiltration.

抄録全体を表示

Department of Otolaryngology, Otemae Hospital;Department of Otolaryngology, The Center for Adult Diseases, Osaka;Department of Otolaryngology, Kinki Central Hospital;Department of Otolaryngology, Izumisano City Hospital;Department of Otolaryngology, Suita Municipal City Hospital;Department of Otolaryngology, Hyogo Prefectural Nishinomiya Hospital;Department of Otolaryngology, Osaka Prefectural Hospital;Department of Otolaryngology, Osaka University, Medical SchoolA clinical trial of Tsumura Saibokuto (a Chinese medicine) as therapy for abnormal sensation in the throat was conducted at 8 institutions: 146 patients were given Saibokuto (7.5g/day) for 2 weeks. After the exclusion of 2 patients, one with side effect and the other with inadequate administration, the clinical effect was evaluated in 144 patients
.The rates for marked and moderate effectiveness at 2 weeks were 27.8% and 22.9%, respectively. Saiboiuto was especially effective in patients with neurotic personality or redness of the throat. Slight side effects were observed in 2 patients (1.4%); one had abdominal discomfort and the other had GOT and GPT elevation.
We conclude that Saibokuto is a useful first choice medicine for patients with abnormal sensation in the throat.

抄録全体を表示

From January 1985 to June 1993, 33 patients with deep neck abscess were treated in our department. Patients were 24 males and 9 females with ages ranging from 1 to 77 years (average age 41.9 years). In 18 patients (55%) the abscess was secondary to pharyngiti s and tonsillitis. Other causes were toothbrushing, endoscopy or intubation.
All 33 patients were examined by CT scan. The abscess was located in the parapharyngeal space in 13 patients, in the retropharyngeal space in 7, in the floor of the mouth in 4, in multiple areas in 5 and in other spaces in 4. Five of the 33 patients were treated with intravenous antibiotics and 27 with surgical incisions, punctures or abscess-tonsillectomy. CT scan proved to be very useful in the diagnosis and treatment of deep neck abscess.
The bacteria isolated were a-streptococcus in 7 patients, anaerobic bacilli in 3, and Salmonella in 1.
Four patients had diabetes mellitus, and its control was critical in the treatment of deep neck abscess.

抄録全体を表示

In the surgical treatment of OSAS, it is important to identify the precies location of the obstruction in order to select appropriate surgical procedures.
In the surgical treatment of OSAS, it is important to identify the precies location of the obstruction in order to select appropriate surgical procedures.

抄録全体を表示

A 40-year-old male developed a deep neck abscess (parapharyngeal and retropharyngeal abscess) after tonsillectomy under general anesthesia. Peptostreptococcus and Bacteroides intermedius were found in the pus from the abscess . He was treated with antibiotics and draining incision through the pharynx under the guide of ultrasonic scanning on external cervical region.
We conclude that endotracheal intubation or tonsillectomy can cause a deep neck abscess, so adequate post operative antibiotic administration is nescessary to prevent infection. We also noted that ultrasonic scanning is useful in the performance of incision and drainage of deep neck abscesses.

抄録全体を表示

Sixty-eight adult patients with obstructive sleep dyspnea (59 males and 9 females with a mean age of 47.1 years) were studied by polysomnography and simultaneous analysis of snoring and variation of upper airway pressure with breathing . Forty-seven patients were classified into three groups according to the site of obstruction determined by pressure changes between the esophagus and mesopharynx. Twenty-one of them were tested before and after uvulopalatopharyngoplasty (UPPP). Soft palate obstruction was diagnosed in 23 patients whose pressure fluctuations in the mesopharynx (Pmeso) and esophagus (Peso) were equally high and above the normal range. Base of the tongue obstruction was diagnosed in 13 patients whose Pmeso was within the normal range, but whose Peso was abnormally high. The diagnosis was combined type in 11 patients, since both pressures were abnormally high and Peso was significantly higher than Pmeso.
An acoustic analysis of snoring showed that the average value of fundamental frequency in those with obstruction at the base of the tongue was significantly higher than that in those with soft palate obstruction. After UPPP, the fundamental frequency increased significantly (preoperative, 185.7±129.7Hz; postoperative, 308.0±122.9Hz; p<0.001). Those whose preoperative fundamental frequency was equal to or less than 150Hz responded well to UPPP. We conclude that the analysis of snoring may be useful in determining the site of upper airway obstruction in patients with obstructive sleep dyspnea.

抄録全体を表示

A 4-year-old girl had severe progressive respiratory obstruction during sleep.The preoperative examination revealed cor pulmonale due to upper airway obstruction. Adenotonsillectomy was efficient in relieving the obstruction, and cardiorespiratory function was greatly improved.

抄録全体を表示