Modified Lothrop (Draf III) procedure for the treatment of a recurrent orbitofrontal cholesterol granuloma: A case report.

Orbitofrontal cholesterol granuloma is a rare occurrence. Here, we present a case involving a 64-year-old man with a recurrent orbitofrontal cholesterol granuloma treated by the Modified Lothrop (Draf III) procedure. The patient, who had a history of trauma and previous sinus surgery, presented with chief complaints of nasal congestion, olfactory impairment, and diplopia. We suspected chronic sinusitis; computed tomography showed a soft-tissue shadow extending from the bilateral frontal sinuses to the ethmoid sinuses, with a cyst in the right orbitofrontal region. We performed endoscopic surgery for removal of the mass, and histopathological analysis of the resected specimen confirmed a diagnosis of cholesterol granuloma. The lesion recurred 2 months later, and we performed revision surgery using the Modified Lothrop or Draf III procedure. The patient showed no relapse at the 5-year follow-up. These findings suggest that the Draf III procedure is an effective surgical treatment for cholesterol granulomas.

Bisphenol A induces Nrf2-dependent drug-metabolizing enzymes through nitrosylation of Keap1.

Bisphenol A (BPA) is an endocrine-disrupting chemical, and activates the aryl hydrocarbon receptor (AhR) and the estrogen receptor, leading to the induction of drug metabolizing enzymes. In this study, we found that BPA increased nitric oxide (NO) levels but not reactive oxygen species (ROS) levels in the human hepatoma cell line, Hep3B, and induced drug-metabolizing enzymes such as UDP-glucuronosyltransferase (UGT). Nuclear factor erythroid 2-related factor 2 (Nrf2) has been reported to be activated by ROS through inactivation of its regulating protein, Kelch-like ECH-associated protein (Keap1), and to be the key mediator of phase I and phase II drug metabolizing enzymes, and phase III drug transporters. Treatment of Hep3B with BPA increased the levels of nitrous oxide, a metabolite of nitric oxide and activated Nrf2 by nitrosylation of Keap1, leading to the induction of heme oxygenase-1 (HO-1) and UGT2B1 mRNAs. A nitric oxide donor, 1-Hydroxy-2-oxo-3-(N-methyl-3-aminopropyl)-3-methyl-1-triazene (NOC7), also activated Nrf2 and a NOS inhibitor, NG-Monomethyl-l-arginine, monoacetate salt (L-NMMA), inhibited activation of Nrf2 by BPA. Furthermore, calcium efflux by BPA was observed. These results suggested the new idea that BPA increases NO levels and activates Nrf2 via Keap1 inactivation, leading to induction of Nrf2-dependent drug-metabolizing enzymes.

Rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity: A case report and literature review.

We report a patient who had rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity. A 72-year-old woman had undergone surgery for frontal sinusitis via external incision at another hospital 13 years previously. Left-sided hemiparesis appeared in the patient and gradually worsened. Five days later, she exhibited disorientation, abnormal behavior, poor articulation, and difficulty in standing. Therefore, she was taken to the neurosurgery department by ambulance. An extensive frontal sinus pyocele was suspected, and a cerebral abscess and edema of the frontal lobe were observed on magnetic resonance imaging. After antibiotics, steroid and glycerol were administered for a few weeks; disorientation and left hemiparesis improved. Next, craniotomy for complete removal of the brain abscess by neurosurgeons and endoscopic endonasal surgery by otolaryngologists were carried out at the same surgery. From the analysis of the pathological mucosa sample taken from the right ethomoidal sinus during surgery, an inverted papilloma was diagnosed. The patient completely recovered and is currently receiving follow-up examination. Regarding rhinogenic intracranial complications, ascertaining clinical condition in order to determine the need for either immediate radical surgery, or for curative surgery after waiting for improvement of the overall body condition by conservative management, is still needed.