[OCULAR SYMPTOMS OF CEDAR POLLINOSIS IN OTOLARYNGOLOGY].

BACKGROUND: Cedar pollinosis is a disease with various symptoms. Ocular symptoms as well as nasal symptoms appear frequently. However, there are only a few studies examined the incidence rate of ocular symptoms caused by cedar pollinosis. METHODS: Subjects consisted of 545 patients who have consulted our hospital and the affiliated hospitals without any previous treatment during the peak season for cedar pollen dispersal from 2009 to 2013. The patients were asked about their symptoms and quality of life (QOL) using the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ). RESULTS: Of all the patients, 86% had ocular symptoms. Moreover, itchy eyes had the higher symptom prevalence than watery eyes. The nasal and ocular symptoms were correlated with each other; those patients with ocular symptoms had more severe nasal symptoms. CONCLUSIONS: This study showed that nasal symptoms in pollinosis patients with ocular symptoms were more likely to be severe than those in patients without ocular symptoms.

Ultrastructural cell wall characteristics of clinical gentamycin-resistant Staphylococcus aureus isolates.

The frequent use of gentamycin (GM) ointment for the treatment of skin infections has led to an increase in the number of GM-resistant clinical isolates of Staphylococcus aureus. We examined the ultrastructural characteristics of 14 clinical strains of S. aureus by transmission electron microscopy. Seven of these isolates were GM-resistant, and seven isolates were GM-sensitive. We found that the cell wall of GM-resistant strains (32.24 ± 5.99 nm) was significantly thicker than that of GM-sensitive strains (19.02 ± 2.72 nm). We genetically characterized these isolates by polymerase chain reaction, targeting the genes for three aminoglycoside-modifying enzymes, aac(6')-aph(2''), aph(3')-III, and ant(4')-I. All GM-resistant strains tested carried the gene encoding aac(6')-aph(2''). However, we were unable to establish a link between a specific gene and cell wall thickening, because one GM-resistant strain was also positive for aph(3')-III. We also demonstrated that a GM-resistant mutant strain, derived in vitro from a GM-sensitive S. aureus parent strain (209P), also exhibited a thickened cell wall. These results strongly suggest that a thickened cell wall is a common ultrastructural characteristic of GM-resistant S. aureus clinical strains.

Thickening of the cell wall in macrolide-resistant Staphylococcus aureus.

Macrolides are widely used at low dosage for long-term therapy of chronic sinusitis. Twenty clinical macrolide-resistant Staphylococcus aureus strains were morphologically compared with 10 clinical macrolide-sensitive strains. PCR amplification was performed to determine the presence of four known macrolide resistance genes. Transmission electron microscopy revealed significantly thicker cell walls in clinical macrolide-resistant strains. Even though the ultrastructural characteristics were shared by all macrolide-resistant strains, they were not associated with the presence or absence of the known macrolide-resistance genes. We also demonstrated that macrolide-resistant mutant strains derived in vitro from a macrolide-sensitive parent strain had thickened cell walls and did not harbor the known macrolide-resistance genes. These results, therefore, revealed that macrolide-resistant S. aureus strains have thickened cell walls as a common ultrastructural characteristic and that cell wall thickening is likely mediated by an unknown gene which is unrelated to any known macrolide resistance gene.

Esophageal motor dysfunction plays a key role in GERD with globus sensation--analysis of factors promoting resistance to PPI therapy.

OBJECTIVE: Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy. DESIGN: The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study. RESULTS: A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex. CONCLUSION: Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.

Antimicrobial effects of Burow's solution on Staphylococcus aureus and Pseudomonas aeruginosa.

Burow's solution has been shown to be effective against chronic suppurative otitis media and otitis externa. We demonstrated that Burow's solution had antibacterial effects against Staphylococcus aureus and Pseudomonas aeruginosa, inducing ultrastructural changes in these bacteria in vitro. S. aureus strain 209P and P. aeruginosa strain IID1130 were treated with 13% Burow's solution. Viable cell counts were determined to measure bactericidal effects. Ultrastructural changes in cells of both strains were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Viable cell counting revealed that S. aureus cells treated with Burow's solution were killed within 30 min. The viable cell count of P. aeruginosa was reduced by 1 × 10(7) colony-forming units/ml (CFU/ml) after a 60-min treatment. SEM examination of S. aureus revealed blebbing on the surface of bacterial cells, whereas TEM revealed undulating deformation of the bacterial cell wall, diluted cytoplasm, and cell membrane detachment. SEM observations of P. aeruginosa revealed a more apparent undulating deformation of the bacterial cell surface. TEM observations also revealed deformations in the bacterial cell wall and diluted cytoplasm in both bacteria. These findings show that Burow's solution is active against S. aureus and P. aeruginosa, resulting in damage to the cell wall.

Nasal septal abscess caused by anaerobic bacteria of oral flora.

Although nasal septal abscess (NSA) was formerly common, it has become rare since the development of antibiotics. NSA, if left untreated, can lead to intracranial complications such as meningitis and eventually result in saddle-nose deformity. NSA often occurs after injury, and indigenous skin bacteria such as Staphylococcus aureus are frequently detected. We treated a patient who had injured the upper alveolus in a fall on the stairs and developed NSA two weeks later. Anaerobic bacteria, including Veillonella parvula and Peptostreptococcus sp., were detected. Symptoms were relieved by needle and incisional drainage. Our patient represents a very rare case of NSA in terms of the cause of onset and the detected bacteria. Early drainage can result in good outcomes.

Sudden deafness and right-to-left shunts.

PURPOSE: One of the etiologies for idiopathic sudden deafness is considered to be ischemia of the inner ear. Cryptogenic stroke is caused by a right-to-left shunt (RLS). The present study investigated whether RLS is associated with the occurrence of sudden deafness. METHODS: Contrast saline transcranial Doppler ultrasonography was performed to detect RLS. Subjects comprised 23 consecutive sudden deafness patients and 46 age- and gender-matched controls. Clinical characteristics, including vascular risk factors, were compared between sudden deafness and control groups. RESULTS: RLS was more frequent in the sudden deafness group than in controls (48 vs. 17%, p = 0.011). No significant differences in other clinical characteristics were seen between groups. CONCLUSION: RLS may be a potential cause of sudden deafness.

Superselective angiographic embolization for intractable epistaxis.

CONCLUSIONS: Routine embolization of the ipsilateral facial artery (FA) is effective because of the high success rate. The use of different embolic materials for the internal maxillary artery (IMA) and the FA was considered safe because of the absence of major complications. OBJECTIVE: To evaluate outcomes of routine embolization of the FA as well as the IMA ipsilateral to the bleeding site for intractable epistaxis, and outcomes using different embolic materials for the FA and the IMA. PATIENTS AND METHODS: Twenty-two patients with intractable epistaxis who underwent superselective embolization were retrospectively analyzed with a mean follow-up of 7 months. The FA and the IMA ipsilateral to the bleeding site were embolized. Two embolic materials, gelatin sponge and microcoils, were used for the IMA and the FA, respectively. RESULTS: The short-term success rate within the first 7 days was 77.3% (17/22). The long-term success rate was 95.5% (21/22). There were no major complications in 22 cases. Minor complications occurred in 13 cases (59%). These minor complications usually did not last more than a week and most resolved within a day.

Improvement of the tumor-suppressive effect of boron neutron capture therapy for amelanotic melanoma by intratumoral injection of the tyrosinase gene.

Boron neutron capture therapy (BNCT) is successful when there is a sufficient (10)B concentration in tumor cells. In melanoma, (10)B-para-boronophenylalanine (BPA) accumulation is proportional to melanin-producing activity. This study was done to confirm enhancement of the tumor-suppressive effect of BNCT on amelanotic melanoma by intratumoral injection of the tyrosinase gene. D178 or FF amelanotic melanomas were implanted s.c. in Syrian hamsters. One group of D178- or FF-bearing hamsters (TD178 or TFF group) received intratumoral injections of pcDNA-Tyrs constructed as a tyrosinase expression plasmid. The other hamsters (pD178 and pFF groups) were injected with pUC119, and control hamsters (D178 and FF groups) only with transfection reagents. All the groups underwent immunofluorescence analysis of tyrosinase expression and BPA biodistribution studies. BNCT experiments were done at the Kyoto University Research Reactor. Tyrosinase expression increased in the tumors of the TD178 and TFF groups but remained the same in the pD178 and pFF groups. Tumor boron concentrations in the TD178 and TFF groups increased significantly (TD178: 49.7 +/- 12.6 versus D178: 27.2 +/- 4.9 microg/g, P < 0.0001; TFF: 30.7 +/- 6.6 versus FF: 13.0 +/- 4.7 microg/g, P < 0.0001). The BNCT tumor-suppressive effect was marked in the TD178 and TFF groups. In vivo transfection with the tyrosinase gene increased BPA accumulation in the tumors, the BNCT tumor-suppressive effect on amelanotic melanoma being significantly enhanced. These findings suggest a potential new clinical strategy for the treatment of amelanotic melanoma with BNCT.

Autonomic responses during motion sickness induced by virtual reality.

OBJECTIVE: To examine the development of subjective symptoms and heart rate variability (HRV) during motion sickness induced by virtual reality (VR). METHODS: Subjects were 10 healthy young volunteers. During VR immersion, subjects were immersed in a visual-vestibular conflict produced by VR. The levels of the subjective symptoms were assessed by Graybiel's and Hamilton's criteria. HRV was determined by measuring microvascular blood flow or electrocardiogram. RESULTS: Subjective symptoms evaluated by Graybiel's and Hamilton's criteria were gradually worsened during VR. Power spectrum analysis of HRV demonstrated a gradual increase in the low frequency but no change in the high frequency during VR. In this study, individual subjective symptoms were not correlated with the individual result of power spectrum analysis. CONCLUSION: These findings indicate that there was an increase in sympathetic nervous activity, but no change in parasympathetic nervous activity during motion sickness induced by VR. Given the large inter-individual variability and the reliability of subjective measures, it is not surprising that there is scarcely a relation between the subjective symptoms and the results of power spectrum analysis.

Preoperative flurbiprofen for pain prevention after tonsillectomy in adults.

STUDY OBJECTIVE: To investigate the analgesic efficacy of preoperative flurbiprofen on postoperative pain after tonsillectomy. DESIGN: Prospective, randomized, nonblinded, non-placebo-controlled study. SETTING: Municipal hospital. PATIENTS: Twenty-five ASA physical status I patients older than 20 years of age, who were scheduled for tonsillectomy. INTERVENTIONS: Patients were randomly allocated to two groups to receive preoperative intravenous (IV) 50 mg flurbiprofen (group F) or not (group C). Anesthesia was induced with IV propofol two mg/kg and maintained with nitrous oxide and sevoflurane. MEASUREMENTS: Pain scores at rest and at swallowing, intraoperative bleeding, vital signs during the postanesthetic period, interval until diclofenac sodium suppository rescue, and the total dose required for 12 hours postoperatively were all recorded. MAIN RESULTS: Pain scores at rest as well as those recorded after swallowing 30 minutes after tonsillectomy were significantly lower in group F than in group C. During the first postoperative 1.5 hours, significantly fewer patients in group F required rescue diclofenac suppository than did group C patients. However, total dose of required rescue during the postoperative 12 hours in group F did not significantly differ from that of group C. There were no significant differences in intraoperative bleeding or in any vital signs during the postanesthetic period either. CONCLUSION: Preoperative flurbiprofen suppressed immediate postoperative pain after tonsillectomy. The analgesic effect, however, disappeared in a few hours and was insufficient for overnight pain relief.

Two cases of thermal burns of the larynx in older men.

Cases of thermal burns of the larynx in infants and in patients with mental illness have been reported, but those in older people are rare. We report two cases of thermal burns of the larynx in older people caused by ingestion of microwave-heated food (meat and potato stew or a bean-jam filled bun). Both patients were users of full dentures. Conservative therapy was effective in one patient, while tracheotomy was performed in the other patient at the time of the initial examination. Hot food is expelled from the mouth as a reflective response, preventing thermal burns of the larynx. However, in older individuals, sense perception is impaired and reflexes are slowed. Further, the oral mucosa is protected if full dentures are placed. Therefore, heat is likely to not be perceived and reflexes occur only after the food has reached the larynx, thereby causing thermal burns of the larynx. The number of such cases may increase as the number of older patients rises in the current aging society. Therefore, raising awareness of such cases is important.

Structural basis for cholinergic regulation of neural circuits in the mouse olfactory bulb.

Odor information is regulated by olfactory inputs, bulbar interneurons, and centrifugal inputs in the olfactory bulb (OB). Cholinergic neurons projecting from the nucleus of the horizontal limb of the diagonal band of Broca and the magnocellular preoptic nucleus are one of the primary centrifugal inputs to the OB. In this study, we focused on cholinergic regulation of the OB and analyzed neural morphology with a particular emphasis on the projection pathways of cholinergic neurons. Single-cell imaging of a specific neuron within dense fibers is critical to evaluate the structure and function of the neural circuits. We labeled cholinergic neurons by infection with virus vector and then reconstructed them three-dimensionally. We also examined the ultramicrostructure of synapses by electron microscopy tomography. To further clarify the function of cholinergic neurons, we performed confocal laser scanning microscopy to investigate whether other neurotransmitters are present within cholinergic axons in the OB. Our results showed the first visualization of complete cholinergic neurons, including axons projecting to the OB, and also revealed frequent axonal branching within the OB where it innervated multiple glomeruli in different areas. Furthermore, electron tomography demonstrated that cholinergic axons formed asymmetrical synapses with a morphological variety of thicknesses of the postsynaptic density. Although we have not yet detected the presence of other neurotransmitters, the range of synaptic morphology suggests multiple modes of transmission. The present study elucidates the ways that cholinergic neurons could contribute to the elaborate mechanisms involved in olfactory processing in the OB. J. Comp. Neurol. 525:574-591, 2017. © 2016 Wiley Periodicals, Inc.

Large vestibular aqueduct syndrome: a human temporal bone study.

OBJECTIVES/HYPOTHESIS: Large vestibular aqueduct syndrome (LVAS) is one of the common causes of hearing loss (HL). All prior studies have reported some anomalies associated with LVAS by imaging techniques. This study was undertaken to determine prevalence of LVAS in our temporal bone (TB) collection and its relationship to other systemic or otologic anomalies. STUDY DESIGN: Retrospective, TB histopathologic study. METHODS: Anteroposterior diameters of internal (IA) and external (EA) apertures were measured in 40 normal TBs (40 cases). TBs were considered as large vestibular aqueduct (LVA) if width of apertures was 95% greater than "normals." Systemic and otologic anomalies and histopathology of ears with LVAS were noted. RESULT: Of 1,608 non-"normal" TBs, 63 had LVA. There was negative correlation between IA and EA in 48 TBs with only enlarged IA. Fifteen TBs with enlarged EA always had enlarged IA and were therefore considered as LVAS. The most common pathologic condition was congenital heart anomaly. The most common syndrome or dysplasia was Mondini's. The most common anomalies of external and middle ears were dehiscent facial nerves, low set auricles, and ossicular deformities. Inner ear anomalies included modiolar deficiencies, hair cell loss, interscalar septum defects, and strial atrophy. There was no record of family history of HL, head injury, or craniofacial, branchial, or thyroidal abnormalities. CONCLUSION: Because HL associated with LVAS may be attributed to other ear anomalies, it is important to investigate other inner ear problems and system diagnoses that may indicate a syndrome in patients with radiologically diagnosed LVAS.

Effects of type 2 diabetes mellitus on cochlear structure in humans.

OBJECTIVE: To evaluate the effects of type 2 diabetes mellitus on cochlear elements in humans. DESIGN: Comparative study of the histopathologic characteristics of human temporal bones. SETTING: Otopathology laboratory in a tertiary academic medical center. PATIENTS: Temporal bones from 18 patients with type 2 diabetes mellitus were divided into 2 groups according to the method of management of diabetes: insulin in 11 patients (mean age, 51.9 years; age range, 44-65 years) and oral hypoglycemic agents in 7 patients (mean age, 54.4 years; age range, 45-64 years). The diabetic groups and 26 age-matched controls (mean age, 52.9 years) were examined using light microscopy, and the cochlear changes were compared between groups. MAIN OUTCOME MEASURES: Morphometric measurements of vessel wall thickness in the basilar membrane and stria vascularis were made in all turns of the cochlea at the midmodiolar level. Area measurements of the stria vascularis were made in all turns of the cochlea at the midmodiolar level. Cochlear reconstructions and standard cytocochleograms were prepared using an oil immersion objective. The number of spiral ganglion cells was determined for each segment of the cochlea. Comparisons were made in each segment between diabetic and control groups. RESULTS: In the insulin group, walls of the vessels of the basilar membrane and stria vascularis in all turns were significantly thicker than those of controls. Walls of the vessels of the stria vascularis in the basal turn were also significantly thicker in the oral hypoglycemic group than in controls. Atrophy of the stria vascularis in most turns of the insulin group and the lower middle turn of the oral hypoglycemic group was significantly greater than in the controls. Loss of cochlear outer hair cells was significantly greater in the lower and upper basal turns in both diabetic groups. No significant difference was found in the number of spiral ganglion cells or inner hair cells between groups. CONCLUSION: This study demonstrates that cochlear microangiopathy and degeneration of the stria vascularis and cochlear outer hair cells are found in patients with type 2 diabetes mellitus.

Laryngeal tuberculosis following laryngeal carcinoma.

Laryngeal tuberculosis is a rare entity and the disease related to laryngeal cancer is extremely rare. We describe a case of laryngeal tuberculosis in a 74-year-old man with a history of radiotherapy for laryngeal carcinoma four months earlier. Laryngoscopy demonstrated a white mass on the right vocal fold at the site carcinoma had previously occupied. Recurrence of the cancer was suspected, but the biopsy result showed histological features of tuberculosis. We discuss the derangement of the host's mucosal barrier by the malignancy as a contributing factor in secondary tuberculous infection. Tubercular bacilli may be reactivated due to the immunosuppression associated with the therapy.

[Epidemiological survey of allergic diseases in first-year junior high school students in Wakayama Prefecture in 2003].

Allergic diseases have been increasing in prevalence in developed countries, including Japan. The aim of the present report was to determine the prevalence of allergies in Wakayama prefecture using an epidemiological study. In total, 759 first-year students attending junior high school in Hidaka country, Wakayama prefecture, were surveyed. The results for 699 cases were then analyzed. A questionnaire regarding allergic diseases, specific IgE measurements performed using a MAST26 system (Hitachi Co., Ltd.), and total serum IgE levels measured using RIST (Pharmacia Co., Ltd.) were performed. The prevalence (present + past) of various allergic diseases was 37.9%. The prevalence of rhinitis, including pollinosis, was 31.0%, while that of atopic dermatitis was 26.2% and bronchial asthma was 11.3%. The positive rates for specific IgE antibodies against Japanese cedar pollen was 48.6%. The positive rate for Dermatophagoides farinae, timothy and housedust II were 44.2%, 29.6%, and 28.9%, respectively. Statistically significant differences were recognized between the students with allergic rhinitis, atopic dermatitis, allergic conjunctivitis or bronchial asthma and positive results for D. farinae, housedust II, cedar pollen, Penicillium, Cladosporium, or Aspergillus-specific antibodies. Regarding family history (two generations), a statistical significant difference between family history and positivity for specific IgE antibodies like D. farinae, housedust II, ragweed, cedar pollen or Cladosporium was observed. The total IgE titer was correlated with the number of positive allergen items. The increasing prevalence of various allergic diseases in developed countries remains a mystery, but the hygienehypothesis has attracted some attention. The findings of this epidemiologic study will contribute to basic data on the increasing prevalence of various allergic diseases.

Iliopsoas Abscess Possibly due to Klebsiella pneumoniae Infection after Chemoradiotherapy for Hypopharyngeal Cancer.

Iliopsoas abscess was once an uncommon condition but now occurs somewhat more frequently due to the increasing number of immunocompromised patients, such as those with diabetes. We encountered a case of iliopsoas abscess following chemoradiotherapy for hypopharyngeal cancer. A 60-year-old man was admitted for a sore throat and left neck swelling. Hypopharyngeal cancer was diagnosed, but the patient refused surgery. After two rounds of chemotherapy, febrile neutropenia developed and chest computed tomography (CT) revealed an iliopsoas abscess. The platelet count was low but recovered after administration of antibiotics and could not be explained by puncture of the abscess. CT-guided drainage eventually improved his symptoms. Even for disorders of the head and neck region, iliopsoas abscess should be suspected in immunocompromised patients who develop a fever. CT and magnetic resonance imaging should be performed at an early stage as it is important to determine whether surgical drainage is indicated.

Endoscopic transantral orbital floor repair with antral bone grafts.

OBJECTIVE: To evaluate the endoscopic transantral insertion of antral bone grafts into the orbit for repair of orbital floor defects. DESIGN: A retrospective analysis with a mean follow-up of 5.3 months. PATIENTS: Eleven patients who underwent surgical repair of orbital floor fractures. SETTING: Municipal hospital. MAIN OUTCOME MEASURES: Preoperative and postoperative Hess screen tests and the presence of diplopia, enophthalmos, donor site complications, cosmetic deformity, infection, and graft extrusion. RESULTS: Subjectively, 3 patients with diplopia had complete resolution of their symptoms after surgery, and 8 patients had improvement of their symptoms. Objectively, 11 patients had significant improvement in the postoperative Hess area ratio compared with the preoperative Hess area ratio. In 1 patient with a floor defect measuring 2.5 cm, enophthalmos existed after surgery, but reoperation was not performed in this case because diplopia was improved. There were no donor site complications, cosmetic deformity, infection, or graft extrusion. CONCLUSIONS: The endoscopic transantral insertion of antral bone grafts through the floor defect into the orbit is an effective technique that prevents injury to the lower eyelid, carries minimal donor site morbidity, and provides an optimal support function for the globe. It merits consideration in cases of orbital defects less than 2 cm in diameter.

Cochlear changes in patients with type 1 diabetes mellitus.

OBJECTIVE: To evaluate the effects of diabetes on cochlear elements in human beings. STUDY DESIGN AND SETTING: Twenty-six temporal bones (mean age, 37.5 years) with type 1 diabetes and 30 age-matched controls were examined by light microscopy. We compared the findings of cochlear vessels, hair cells, spiral ganglion cells, and cochlear lateral walls. RESULTS: In diabetics, the walls of vessels of the basilar membrane (P < 0.001) and vessels of the stria vascularis were (P < 0.01) significantly thicker in all turns and loss of outer hair cells (OHCs) was significantly greater in the lower basal turn (P < 0.01). Atrophy of the stria vascularis in all turns (P < 0.0001) and loss of spiral ligament cells in upper turns (P < 0.01) were significantly higher than controls. No significant difference was obtained in the number of spiral ganglion cells between groups. CONCLUSION: This study suggests that type 1 diabetes mellitus can cause cochlear microangiopathy and subsequently degeneration of cochlear lateral walls and OHCs.