[Endoscopic sinus surgery for a paranasal sinuses mucocele with light guide and dacryoendoscopy].

It is hard to cure dacryocystitis caused by a paranasal sinus mucocele with treatment which only targets the mucocele. Also, it is difficult to identify the lacrimal sac and the nasolacrimal duct preoperatively and intraoperatively when the lacrimal passage is markedly changed by the mucocele or previous surgery. We experienced four cases of mucocele complicated by lacrimal stenosis or obstruction. We performed marsupialization of the mucocele and direct silicon intubation or endoscopic dacryocystorhinostomy simultaneously with the use of a fiberoptic illuminator or dacryoendoscopy. Assisted by those devices, lacrimal procedures can now be done quickly and safely regardless of the surgeon's experience. In addition, performing surgeries both for the lacrimal passage and for the mucocele at the same time can minimize the burden on patients.

Fos induction in the amygdala by vestibular information during hypergravity stimulation.

Altered gravity environments including both hypo- and hypergravity can elicit motion sickness. Vestibular information is known to be essential for motion sickness, but its other neural substrates are poorly understood. We previously showed that bilateral lesions of the amygdala suppressed hypergravity-induced motion sickness in rats, using pica behavior as an emetic index. We show in the present study that during hypergravity stimulation, vestibular information activated the central nucleus of the amygdala (CeA), as determined by the induction of Fos expression, in comparison between normal and bilaterally labyrinthectomized rats. The finding that Fos expression was confined to the CeA and almost completely absent in other subnuclei of the amygdala contrasted with many previous studies that used other stressful stimuli such as foot shock, restraint and forced swimming, suggesting a specific vestibular effects on the amygdala. Prolongation of hypergravity resulted in reduction of Fos expression in the CeA, suggesting a process of habituation. Such decreases appeared earlier than in the vestibular nucleus, suggesting that adaptive changes in the CeA to hypergravity were independent of changes in the vestibular input. Our results suggest the amygdala is a neural substrate involved in the development of and habituation to motion sickness.

The alteration of odor-induced c-Fos immunoreactivity in the rat olfactory bulb after olfactory nerve transection.

We used the rats in which one olfactory nerve had been transected and observed the odor (Propionic acid) -induced c-Fos immunoreactivity in the bulb at different times (2, 4, 8 weeks) after nerve transection. The exposure to odor produced a strong cluster of c-Fos positive cells in the mediodorsal region of the intact bulb. On the other hand, the transected bulb showed much less reactivity 2 weeks after neurectomy; however, a large number of positive cells were observed in the whole of the bulb from 4 weeks after neurectomy. Furthermore, we measured the levels of mRNA for tyrosine hydroxylase (TH), which was the marker of odor-induced olfactory nerve activity in the bulb, by using real-time PCR. The level of TH mRNA decreased on the transected side at 2 weeks but recovered to the level of the contralateral side at 4 weeks after neurectomy. We firstly demonstrated that projection mapping of odor receptors was altered after olfactory nerve transection by using an immunohistochemical method.

Clinical usefulness of intraoperative sentinel-node biopsy in gastric cancer.

BACKGROUND/AIMS: Minimally invasive surgery has been used to improve the quality of life after operation in patients with gastric cancer. Sentinel-lymphnode biopsy can help to limit the extent of lymph node dissection, but the diagnostic and therapeutic usefulness of this technique has not been accurately evaluated in gastric cancer. This study was designed to clarify the role of intraoperative sentinel-node biopsy in patients with gastric cancer. METHODOLOGY: We were conducted to evaluate 1) mapping sentinel nodes according to tumor location 2) comparison sentinel node metastases as assessed by frozen section, permanent section (HE stain) and immunohistochemical diagnoses, and 3) comparison non-sentinel node metastases as assessed by permanent section (HE stain) and immunohistochemical diagnosis. RESULTS: All sentinel nodes were identified in the regional perigastric lymph node group close to the tumor. Four of the 43 sentinel lymph nodes were positive for metastasis. Similar diagnostic results were obtained by the 3 different procedures. Lymph node metastasis was found in 10 (4 sentinel nodes and 6 non-sentinel nodes) of 779 lymph nodes (1.28%) on HE staining. Immunohistochemical studies revealed a similar number of positive sentinel nodes as that obtained on HE staining, but identified metastases in 15 in non-sentinel nodes in 2 patients, as compared with only 6 nodes on HE staining. In one patient, sentinel nodes at No. 1 and No. 3 were negative for metastasis, whereas non-sentinel lymph nodes at NO. 3 were positive for metastasis. The other patient had negative sentinel nodes at No. 3 and No. 4d, but positive non-sentinel nodes at No. 4d. CONCLUSIONS: The results of this small study do not yet provide a firm basis for recommending that sentinel-node biopsy is used to reduce the extent of lymph node dissection.

Modulation of T-cell functions by laser surgery in patients with allergic rhinitis.

OBJECTIVE: Potassium-titanyl-phosphate (KTP) laser turbinectomy is an established treatment for hypertrophied inferior turbinates that do not respond to other medical treatments. KTP laser surgery is usually performed with the aim of reducing the size of hypertrophied inferior turbinates. We hypothesized that laser vaporation may also inhibit the allergic reaction in the nasal mucosa of inferior turbinates. MATERIAL AND METHODS: We examined the effect of KTP laser therapy on T-cell responses using peripheral blood mononuclear cells (PBMCs). RESULTS: Levels of T-cell proliferation after stimulation with Staphylococcus enterotoxin B (SEB) were higher in post- than pre-surgery patients. Levels of interferon-gamma and IL-2 produced by PBMCs after stimulation with SEB appeared to be higher in post- than pre-surgery patients. Serum levels of house dust-specific IgE were lower in post- than pre-surgery patients. These results indicate that KTP laser therapy modulates T-cell responses and probably tilts the Th1/Th2 balance towards the Th1-dominant state. CONCLUSION: KTP laser surgery eases or cures allergic rhinitis not only by reducing the volume of the inferior turbinates but also by modulating T-cell functions.

Effects of cooling the pharyngeal mucosa after bipolar scissors tonsillectomy on postoperative pain.

CONCLUSION: Bipolar scissors tonsillectomy followed by cooling down the pharyngeal mucosa has advantages in terms of postoperative pain and intraoperative blood loss compared with cold dissection. OBJECTIVES: The purpose of this study was to compare the postoperative pain between bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa and a traditional cold dissection. METHODS: A total of 189 patients aged more than 16 years were operated due to habitual tonsillitis, obstructive sleep apnea syndrome, and IgA nephropathy. Of these, 79 patients were operated using bipolar scissors followed by cooling the pharyngeal mucosa with 4°C saline for 10 min just after the removal of tonsils. The other 110 patients underwent cold dissection tonsillectomy. Outcome measures were intraoperative blood loss, operative time, postoperative pain evaluated on a visual analog scale, and postoperative secondary hemorrhage. RESULTS: Significantly lower levels of intraoperative blood loss and less postoperative pain were obtained in bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa compared with cold dissection. Postoperative hemorrhage needing hemostatic surgery occurred in 2 of 79 patients who underwent bipolar scissors tonsillectomy with cooling, while it occurred in 1 of 110 patients after cold dissection. However, the difference was not statistically significant.