Causative factors of taste disorders in the elderly, and therapeutic effects of zinc.

OBJECTIVES: To determine the characteristics of causative factors of taste disorders amongst the elderly, and to examine the therapeutic effect of a zinc agent, taking into account age-related factors. SUBJECTS: A total of 408 patients with taste disorders were divided into three groups by age: 49 years or younger, 50 to 64 years old, and 65 years or older. RESULTS: The incidence of taste disorders caused by drug administration and systemic disease were significantly higher in the elderly group. A serum zinc concentration of 69 microg/dl or lower was found in 33 per cent of the elderly group, significantly more (p < 0.001) than the 19 per cent of the 49 years or younger group with such a concentration. Zinc administration was therapeutically effective in 70 per cent of the whole population studied, and in 74 per cent of the elderly population. CONCLUSIONS: In the elderly, the incidence of taste disorders caused by drug administration or systemic disease was significantly greater compared with other age groups. The curative effects of zinc administration were not observed to be influenced by age.

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children.

OBJECTIVES: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Induction of apoptosis by sulindac sulfide in HL60 cells is enhanced by p21CiP1 or p27KiP1.

The nonsteroidal anti-inflammatory drug (NSAID) sulindac and its derivatives induce apoptosis in a variety of carcinoma cells in vitro and display antitumor effects in vivo. The effects of these agents have not, however, been studied in detail in leukemia cells. In the present study we compared the effects of sulindac sulfide to those of 12-0-tetradecanoylphorbol ester (TPA) on the human promyelocytic leukemia cell line HL60. The latter compound is known to induce monocytic differentiation in these cells. We found that both sulindac sulfide and TPA caused growth inhibition, cell cycle arrest in G0/G1 and increased levels of the cell cycle inhibitory proteins p21Cip1 and p27KiP1. However, whereas the TPA treated cells underwent subsequent differentiation the sulindac sulfide-treated cells displayed extensive apoptosis and negligible differentiation. Ectopic overexpression of p21Cip1 or p27KiP1 markedly enhanced the apoptosis induced by sulindac sulfide. Therefore, sulindac sulfide and related compounds may be useful in the treatment of leukemia and other neoplasms, especially when used together with agents that increase cellular levels of p21Cip1 or p27KiP1.

[Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma].

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.

Postnatal development of the tympanic cavity: a computer-aided reconstruction and measurement study.

A computer-aided 3-D reconstruction and measurement method was used to assess postnatal volume and height changes in the tympanic cavity. Materials used were 14 normal human temporal bones obtained from 6 infants (under 1 year of age) and 8 adults (over 18 years of age). After defining the boundaries of the tympanic cavity, its total volume and height and the volume and height of the epitympanum, mesotympanum and hypotympanum were measured. The relationship between the volume of the tympanic cavity and age, and the correlation between the volume of the tympanic cavity and the grade of pneumatization of the air cells were also studied. The average volume of the tympanic cavity in adults (640.1+/-69.1 mm3, n = 8) was about 1.5 times larger than the volume of the infant cavity (451.7+/-68.2 mm3, n = 6). The hypotympanum increased most postnatally and the mesotympanum least. The volume of the tympanic cavity increased in proportion to increasing pneumatization in bone surrounding the cavity. The postnatal increase in the height of the tympanic cavity appears to be the major contributor to the increase in volume of the cavity. Postnatal changes in the tympanic cavity have clinical implications.

The protein kinase C beta-specific inhibitor LY379196 blocks TPA-induced monocytic differentiation of HL60 cells the protein kinase C beta-specific inhibitor LY379196 blocks TPA-induced monocytic differentiation of HL60 cells.

The ability of the promyelocytic leukemia HL60 cell line to differentiate in response to various stimuli has provided a widely used model of differentiation. The phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA), acting via its cellular receptor protein kinase C(PKC), induces these cells to acquire a monocytic phenotype. We set out to identify the specific isoform of the multigene PKC family that is involved in this differentiation event. To do so, we utilized a highly specific PKCbeta inhibitor, LY379196. We found that LY379196 could prevent the growth arrest, cellular adherence, and changes in several marker proteins that occur after the addition of TPA to HL60 cells and that these effects were not simply due to nonspecific cytotoxicity. Thus, the present studies provide strong evidence that the beta isoform of PKC plays a critical role in TPA-induced HL60 monocytic differentiation.

[Acute otitis media associated with bone conduction hearing loss].

Eleven patients (12 ears) with acute otitis media associated with raised bone conduction were studied. The patients were from 19 to 70 years old and came to our hospital between November 1996 through May 1997. Pure tone audiometry revealed mixed hearing loss, but there was no bullous myringitis in all cases. They were treated by oral or intravenous antibiotics, steroids, and myringotomy. Bacteriological examination was done in seven cases, and revealed penicillin resistant Streptococcus pnumoniae in three cases. Complete recovery of hearing loss was obtained in 10 of 12 ears, but sensorineural hearing loss remained in 2 patients. Bacteriological examination and pure tone audiometry in acute otitis media are important for detecting the severity of the disease, determining the administration of steroids, and for the selection of antibiotics.

[A case report and an experimental study of esophageal foreign body of lithium battery].

In recent years an increase in the incidence of esophageal injury due to battery ingestion by infants with miniaturization of batteries has been noted. A case of esophageal ulceration due to lithium battery ingestion is reported. Moreover, an experimental model of esophageal injury due to lithium battery ingestion was produced in dogs, and the tissue damage was evaluated histologically. When the battery was inserted and left in the esophagus for one hour, the structure of the esophagus was well preserved. Minor injury was histologically found in the group in which the battery was retained for two hours. Esophageal injury from the epithelium to the muscle layer was found when the battery was retained for four hours. On the basis of our experimental findings, early extraction within four hours is desirable in the case of an esophageal foreign body of electric battery.

Narrowest (isthmus) portion of eustachian tube: a computer-aided three-dimensional reconstruction and measurement study.

Nine normal human temporal bones from persons 16 to 88 years old were studied by computer aided three-dimensional reconstruction and measurement. The length of the eustachian tube (ET) lumen in three portions (from pharyngeal orifice to tympanic orifice: cartilaginous, junctional, and bony) averaged 23.6 +/- 4.3 mm, 3.0 +/- 1.9 mm, and 6.4 +/- 2.6 mm. The narrowest portion of the ET lumen was in the cartilaginous portion in all cases: 20.5 +/- 4.2 mm from the pharyngeal orifice and 3.1 +/- 1.6 mm from the pharyngeal margin of the junctional portion. The cross-sectional area of the narrowest portion was 0.65 +/- 0.2 mm2. The tendon of the tensor veli palatini muscle (TVPM) inserted into the lateral lamina in the narrowest portion of the ET lumen in five of nine cases. These results suggest that contraction of the TVPM opens the narrowest portion of the ET lumen to ventilate the middle ear and that this portion also plays a role in protecting the middle ear.

Postnatal change in angle between the tympanic annulus and surrounding structures. Computer-aided three-dimensional reconstruction study.

Postnatal developmental relationships in human ears were studied by a computer-aided three-dimensional reconstruction and measurement method. We measured the angle, in reference to the horizontal plane, between the tympanic annulus, the oval window, and the internal auditory canal (IAC) in 20 normal temporal bones obtained from individuals between 1 day old and 76 years old. The horizontal plane was defined as the plane sloped 30 degrees infero-anteriorly from the plane of the horizontal canal in each specimen. The plane of the tympanic annulus changed from a nearly horizontal orientation (34.2 degrees from the horizontal plane) in neonates to a more vertical orientation (63.3 degrees from the horizontal plane) in adults. The tympanic annulus and oval window planes remained at the same angle to each other (11.9 degrees +/- 5.1 degrees) throughout postnatal development, as did the plane of the tympanic annulus and the IAC (68.6 degrees +/- 5.3 degrees). These findings have implications for ear surgeons, especially those operating on young children.

Immunohistopathological investigation on unspecific chronic sclerosing sialadenitis of the submandibular gland (Küttner tumor).

An immunohistochemical investigation was conducted on infiltrating lymphocytes in submandibular glands removed from three cases with unspecific chronic sclerosing sialadenitis of the submandibular gland (unspecific CSSS) which has been described for the first time by Küttner. A high degree of lymphocyte infiltration was recognized and formation of lymphatic follicles was observed. In particular, activated B cells were predominantly observed in that part of the lymphatic follicles which was equivalent to germinal centers. In the T cell subset, the helper/inducer T cells displayed significant dominance over suppressor/cytotoxic T cells, and were distributed in the dark peripheral zone of the follicles. The distribution pattern of these lymphocytes seemed to be similar to antigenically stimulated lymph nodes and it was recognized that the unspecific CSSS could be a site of exceedingly active local immune responses. The authors believe that these findings support the view that unspecific CSSS (Küttner tumor) is an immune disorder.