Three cases with familial adenomatous polyposis diagnosed as having malignant lesions in the course of a long-term trial using docosahexanoic acid (DHA)-concentrated fish oil capsules.

The inhibitory effect of n-3 polyunsaturated fatty acids on human colorectal cancer has been speculated on from epidemiological data and animal studies. We conducted a long-term trial of docosahexanoic acid (DHA)-concentrated fish oil capsules for patients in a high-risk group for colorectal cancer. During this trial, we experienced three patients with familial adenomatous polyposis (FAP) diagnosed as having malignant lesions. Three patients with FAP and two patients with multiple (more than 30) colorectal polyps were administered DHA-concentrated fish oil capsules_Hlk427554600[2.2 g of DHA and 0.6 g of eicosapentanoic acid (EPA) per day] for one or two years. Compliance with DHA-concentrated fish oil capsules was more than 90% in four patients and 61% in one patient. A marked increase or decrease in the number of polyps was not observed. Three patients with FAP developed endometrial cancer after 12 months, colon cancer after 24 months and lung cancer after 12 months, respectively. All cancers were diagnosed at an early stage and were resected curatively. We thought that the possibility of developing cancer from the long-term administration of fish oil capsules to patients with FAP needs to be investigated further, and that we should report these cases.

Acute sensorineural hearing loss caused by Mycoplasma pneumoniae.

Four cases with acute sensorineural hearing loss on one side and one case with bilateral ear fullness associated with Mycoplasma pneumoniae (MP) were described. These cases were characterized by highly elevated MP complement fixation titer, and cold hemagglutinin titer. All patients experienced cochlear symptoms in an early stage following common cold. In all cases, clarythromycin (CAM) had been administered for 10 days, and adenosine triphosphate (ATP), vitamin B1, B12, and prednisolone were concurrently administered for 14 days. Two cases with acute hearing loss and one case with ear fullness returned to normal hearing after treatment. The other cases were remarkably improved in hearing level. MP is a common causative agent for protein respiratory disease. The true incidence of hearing loss in this disease may be higher than has been reported so far. Prompt diagnosis possibly facilitates the administration of specific treatment and leads to good prognosis.

Vertical optokinetic nystagmus in normal individuals.

In this study, 20 subjects (5 women and 15 men, 22-28 years old) were tested for vertical optokinetic nystagmus (OKN) to establish the asymmetry between up and down OKN responses in humans. The subjects were exposed to both upward and downward OKN stimulus at constant velocities of 30, 40, 50, 60, 70, 80, 90 degrees/s in the upright position. Eye movements were recorded precisely using the magnetic search coil system in order to eliminate any methodological problem associated with the eye-lid artifact. Slow phase velocity during upward OKN stimulus was higher than that during downward OKN stimulus for each OKN velocity. It is likely that otolithic stimuli cause up and down asymmetry. Statistical significance in the gain between upward and downward OKN was noted for stimulus velocities of 30-60 degrees/s (p < 0.01), but not for higher velocities, because vertical OKN saturated around 40-50 degrees/s.

Primary position upbeat nystagmus with special reference to alteration to downbeat nystagmus.

A 24-year-old man was admitted to the University Hospital showing severe dehydration that might have been the result of medicine-induced gastritis. Wernicke's encephalopathy was suspected in this patient. On admission, primary position upbeat nystagmus (PPUN) was found. The patient showed tongue fasciculation and loss of gag reflex, which, however, soon returned to normal. Electronystagmographic (ENG) findings were suggestive of lesions in the brainstem. Based on neurological signs and symptoms, we concluded caudal brainstem lesions might be a possible site responsible for the upbeat nystagmus. This nystagmus, however, was later found to be reversed to downbeat nystagmus. This is considered to have been due to predominant differences in vertical velocity which are induced by gravity.

Role of the neuronal activity of nucleus prepositus hypoglossi in optokinetic stimulation in the cat.

The role of the neuronal activity of nucleus prepositus hypoglossi (NPH) in optokinetic stimulation (OKS) and the changes of the activity between OKS and off-OKS (resting condition) were investigated in 5 adult cats. In order to make OKS velocity equal to retinal slip velocity, the cats' eyes were immobilized. The directions of the OKS were clockwise (CW) and counterclockwise (CCW), and 3 types of velocities, 2 degrees/s, 5 degrees/s and 10 degrees/s, were used. The numbers of spikes of 37 NPH neurons to OKS did not increase compared with those to off-OKS, also there were no significant differences between those to CW-OKS and CCW-OKS, and between those of the rostral and caudal parts of NPH. The NPH neurons did not react to the retinal slip, and we suppose the result is due to the immobilized eye condition.

Autoradiographic evidence of steroid affinity sites in nasal tissue.

Affinity sites of glucocorticoid (GC) in nasal tissue were investigated using radiolabelled synthetic GC. The affinity sites of GC are epithelium, vein, leukocyte and gland. The tracer was retained in the cytoplasma but not in the nuclei in most parts of the nasal tissue except for the endothelial cells of the vein. Therefore we assume that there is a direct mechanism of steroid action on nasal tissue suffering from allergic rhinitics other than the so-called steroid-receptor complex. Affinity sites of corticosterone (CS) in nasal tissue were investigated using radiolabelled CS. The differences of affinity sites of GC and mineralcorticoid in unsensitized rats were evaluated, but no major differences between them could be confirmed.

Pollinosis etiologic relationship between excessive IL-4 production and down-regulation of the inflammation-suppressive system.

Previous findings suggest a bi-directional relationship between the immune and endocrine systems, which may expand to a major inflammation-regulatory mechanism, although its mechanism is largely unknown, especially in the human body. Lymphokine and neuroendocrine peptide hormones have been identified as two major groups of immunologic mediators. The particularly pivotal molecules among them are interleukin (IL-1), considered to be a mediator of inflammation, and ACTH, whose activation is induced by IL-1. Among the important functions of lymphokines related to atopic inflammation is the regulation of IgE secretion from B cell through the action of IL-4, produced from the Th2 subset stimulated by IL-1, as a switch factor. IL-4 is the major IgE secretagogue. IL-4 is, moreover, a potent suppressive stimulant of IL-1 secretion. In this study, we tested the hypothesis whether a immunologic interaction exists in patients with allergic rhinitis to Japanese cedar pollen. We performed immunohistochemical staining of IL-1 beta, interleukin 1 receptor (IL-1r) and interleukin-4 (IL-4) in the nasal tissue, and evaluated serum levels of the biochemical mediators involved in the inflammation-regulatory mechanism: IL-1 beta, IL-4, interleukin 1 receptor antagonist (IL-1ra), IgE, cortisol, and ACTH before, during, and after allergen-provoked rhinitis in pollinosis sufferers. Our morphological study showed that, even before the pollen season, large amounts of IL-4 and IL-1r, exclusive of IL-1 beta, were produced in the nasal tissue of patients with seasonal pollinosis. IL-1-positive cells were observed in small amounts in the same tissue, but the quantity was probably enough to cause secretion of intrinsic IL-4 to produce sufficient IgE for atopic inflammation. Upon immunoenzymatic measurement of serum IL-4, even before the pollen season, almost all atopic patients also showed a higher IL-4 level than controls. Serum IgE data also showed a high level before the pollen season in atopic patients. This evidence suggests that atopic patients have already set the first step of inflammatory event not only in the nasal epithelium but also generally even before inhaling proper quantity and quality of the allergen. On the other hand, although atopic patients had inflammation, they did not show an extremely high value of serum IL-1, regarded as inflammatory lymphokine, compared with non-atopic individuals. In contrast, a higher serum level of IL-1ra was observed before and during the pollen season in atopic patients, subsiding to normal level after the season. Serum levels of both cortisol and ACTH did not show a high value in atopic patients during the season. These results demonstrate that excessive IL-4 production of atopic patient causes down-regulated transformation of IL-1 and up-regulated secretion of IL-1ra generally, followed by failure to increase secretion of ACTH from hypophysis and cortisol generally, resulting in defective performance of a specifically useful function of the anti-inflammatory mechanism.

Serum levels of RIST, RAST, and cortisol of patients with allergic rhinitis.

It is generally known that in Type 1 allergy, adrenal steroid hormonesregulate the production of IgE antibody. This study was carried out to determine whether patients with rhinitic allergy to Japanese cedar pollencan modulate the interaction between the immune and endocrine systems normally. The subjects were 61 patients allergic to Japanese cedar pollen, and 14 healthy volunteers served as control. Our study suggests that downregulation of the HPA axis may be caused by high specific and non-specific IgE production in patients with allergic rhinitis, Our data suggest that cortisol may play a role as an immuno-suppressive agent in specific IgE production during the pollen season, as this phenomenon was not observed before or after the pollen season.

Immunohistochemical observations of antigen presenting cells and follicular dendritic cells in the tonsil.

In the present study, in order to investigate the behavior in the lymphatic system of phagocytic cells which incorporate potential antigen in the tonsile crypt, the distribution of HRP stained macrophages in the tonsillar system was observed with regard to changes with time. Furthermore, in the tonsillar tissue, in order to investigate the relationship among HRP marked macrophages, follicular dendritic cells and adhesion molecules, such as ICAM-1, immunological double staining was performed. It is open to discussion whether ICAM-1 plays an important role as an adhesive molecule in this migration of macrophages. Immunohistochemical double staining method detected a relation between anti-ICAM-1 antibody positive cells and antigen stained macrophages. In the stained area between anti-ICAM-1 antibodies and anti-DRC-1 antibodies, positive cells were clearly observed to have reticular form, particularly in the mature germinal center. This phenomenon implies that dendritic cells express ICAM-1 on the cell surface to contact other immunorelated cells and/or substances. In the inter-follicular space, anti-ICAM-1 antibody positive cells were observed to form a cluster composed of ICAM-1 positive cells, lymphocytes and HRP stained macrophages. This cluster may be considered the most primary stage of follicles or as triggering the creation of an inmature follicle.

A case report of acquired choanal atresia.

A case of acquired choanal atresia of unknown origin is reported. A 68-year-old woman had been complaining of nasal obstruction for 28 years. Bilaterally her nasal choanae were found to be completely closed at the depth of the orifice of the eustachian tube. Surgical intervention into the margin of the soft and hard palate removed the adhesive connective tissue from the choanae, which had involved no osseous component. Because part of the intranasal basal epithelium was missing due to surgery, buccal mucosa was removed and implanted to prevent proliferation of granulation. A silicone tube was placed in each choanae for a week postoperatively. An adequate nasal passage has been maintained for 10 months postoperatively, and the patient was followed up closely.

Surgical treatment for caustic ingestion injury of the pharynx, larynx, and esophagus.

A 45-year-old female drank Sunpole (9.5% hydrochloric acid), an acidic toilet cleaner, in a suicide attempt. Notwithstanding intravenous administration of steroids and bougienage dilation, corrosive changes progressed. The patient underwent surgery for severe caustic ingestion injury of the pharynx, larynx, and esophagus. Colon bypass surgery from the left vallecula to the stomach was performed. Excellent results, both in deglutition and phonation, were obtained. We report on the case and stress several points of importance in dealing with severe caustic ingestion injuries.

US-guided drainage of deep neck space abscess.

Infection of oropharyngeal or upper airway origin may extend to potential spaces formed by fascial planes of the cervical area. These space infections have been greatly reduced by modern antibiotic therapy. However, serious complications continue to occur. An 18-year-old man who presented with neck mass was admitted and treated. He underwent ultrasonically guided drainage procedure using Percuflex drainage catheter within 6 h of his arrival. He was discharged from the hospital 10 days later. Although it is still thought that early open surgical drainage is the most appropriate method for treatment of deep cervical abscess, early treatment with a drainage catheter such as Percuflex may replace surgery. Life threatening complications can thus be avoided with good cosmetic results and rapid recovery.

Effectiveness of formula ophiopogoins in the treatment of xerostomia and pharyngoxerosis.

A multicenter study was carried out in 24 institutions in Kanagawa Prefecture, Japan. The subjects were 113 male and 145 female patients, ranging in age from 28 to 86 years (mean 63.7) who complained of dryness of the mouth and throat. The following illnesses were diagnosed: xerostomia and pharyngoxerosis in 161, radiation xerostomia and pharyngoxerosis in 56, chronic pharyngitis with dry mouth and throat in 22, and Sjögren's syndrome in 7. Eleven patients had other symptoms. The subjects were given a 3-g pack of granules of formula ophiopogoins three times a day before a meal. Their subjective symptoms and objective signs were examined prior to, 2, and 4 weeks after the beginning of therapy.

Transcutaneous intracordal silicon injection for unilateral vocal cord paralysis.

Unilateral recurrent laryngeal nerve paralysis causes the vocal cord to atrophy, leading to glottic incompetence. The voice is characterized by hoarseness, breathlessness, rapid air escape, ineffective cough and aspiration. Traditional treatments of unilateral vocal cord paralysis include intracordal injection, laryngeal framework surgery, and laryngeal reinnervation for medialization of the vocal cord. In this paper we report on a new technique of transcutaneous intracordal silicon injection in which the injection is made through the thyroid lamina under local anesthesia monitoring fiberscopy. We performed this procedure on 30 patients with unilateral vocal cord paralysis and later evaluated their post-operative voice. The silicon injection resulted in improvement of vocal quality, favorable clearance of sputum, and aspiration control. We found that, since it can be performed under local anesthesia without hospitalization, transcutaneous intracordal silicon injection should be performed as a therapy for treating unilateral vocal cord paralysis.

Two cases with glossopharyngeal neuralgia treated by nerve reaction: oropharyngeal approach.

Two patients with idiopathic glossopharyngeal neuralgia received glossopharyngeal nerve resection by the oropharyngeal method, and their symptoms were relieved. Both patients had suffered proxysms of severe pain in the unilateral glossopharyngeal innervation for many years, and pharmaceutical treatment had been made in vain and, although surgical intervention in one patient had resulted in temporary relief, it had not been possible to prevent recurrence. As the identification of trigger zones by the method of local nerve block caused us to think that surgical treatment would be more effective in both patients, the glossopharyngeal nerve was resected, using the oropharyngeal method, with a view to attaining permanent symptomatic relief. Consequently, satisfactory results were obtained.

Visually guided eye movements in patients with Wallenberg's syndrome.

To determine the lesions and the lateralization in patients with Wallenberg's syndrome, visually-guided eye movements were quantitatively analysed and these findings were compared with a lesioned site as revealed by magnetic resonance imaging (MRI). The 8 patients could be clearly classified into two subgroups based on the functional test of eye movements. In 4 patients, optokinetic nystagmus (OKN), pursuit eye movements and fixation-suppression of caloric nystagmus (FS), utilizing the slow phase velocity as a parameter, were impaired toward the lesioned side in the medulla. In the remaining 4 patients, OKN and pursuit eye movements were impaired toward the side contralateral to the lesion, whereas FS toward the lesioned side, indicating a lesion affecting not only the medulla but also the inferior peduncle and/or the cerebellum. Therefore, the functional visually-guided eye movements can provide a useful test battery with which to detect the lesion site in Wallenberg's syndrome.

Indications and results of gentamycin injection into the middle ear of patients with meniére's disease.

Forty-six cases in whom endolymphatic drainage surgery was performed between 1986 and 1992 were followed up for more than 2 years. The results of numerical values (1985 AAOHNS) revealed complete control of definite spells in 26 cases; substantial control of definite spells in 18 cases; limited control of definite spells in 1 case; and insignificant control of definite spells in 1 case. Hence, endolymphatic drainage surgery for Meniére's disease was effective. There are, however, cases who cannot be operated on because of old age or underlying diseases. In these, we injected gentamycin sulfates mixed with prednisolone through a ventilated tube into the middle ear. The results for gentamycin injection based on numerical values showed complete control of definite spells in 12 cases; and substantial control of definite spells in 7 cases. Our treatment of choice for Meniére's disease is endolymphatic drainage surgery which resulted in 96% control of vertigo. In patients for whom operation has failed, in old patients and in those with hearing impairment more than 50 dB, gentamycin injection into the middle ear has proved to be an effective procedure to control vertigo attacks.

Increased platelet aggregability in patients with vertigo, sudden deafness and facial palsy.

Many patients suffering from episodic vertigo have no cochlear symptoms. These patients have so far been diagnosed as having Meniere's disease of the vestibular type. However, the underlying mechanisms are still to be established. In the present study, we investigated platelet aggregability in patients with dizziness, Meniere's disease, sudden deafness and facial palsy, to examine whether abnormalities in platelet aggregation is one of the causes of episodic vertigo. In 36 patients with dizziness, in 13 with Meniere's disease, in 7 sudden deafness, and in 7 facial palsy, platelet aggregability to adenosine diphosphate (ADP) was assessed by optometric technique. It was found that platelet aggregability was increased in the patients with dizziness as well as with Meniere's disease, sudden deafness and facial palsy and only the two former patient groups showed a tendency of hyperlipidemia. The administration of antiplatelet and lipidemia drugs resulted in no recurrence of vertigo during at least 3 months' follow-up. Hence, the results of our study suggest that a possible initializing factor of vertigo without cochlear symptoms might be disturbed microcirculation due to platelet hyperaggregability.

[Expression of human papillomavirus (HPV) gene in HPV-positive laryngeal tumors and activity of the HPV long control region in cultured normal laryngeal epithelial cells].

Expression of the human papillomavirus (HPV) gene was examined in HPV-positive laryngeal tumors. Moreover, the activity of the HPV long control region (LCR) was tested in cultured laryngeal epithelial cells. HPV-11 early genes were heterogeneously expressed in adult laryngeal papillomas. We found one laryngeal carcinoma case in whom the HPV-16 transforming genes, E6 and E7, were expressed. Both HPV-11 and -16 LCRs were active in cultured laryngeal epithelial cells from vocal cords. These results suggest that laryngeal epithelial and tumor cells are target cells for HPV gene expression.

Immunohistochemical study and an electron microscopic observation of the nucleus of the optic tract in the rat.

In the present study, gamma aminobutyric acid (GABA)-positive cells and terminals were detected in the nucleus of the optic tract (NOT) in the rat. However, GABA-positive cells in the NOT receiving projections directly from retinal ganglion cells could not be identified. To determine the role of GABA in the projection from the retinal ganglion cells to the NOT, we used electron microscopy to observe this nucleus of a rat in which one eyeball had been removed. In the nerve synapse binding region of the NOT on the side opposite to the enucleated eyeball, the symmetrical and asymmetrical types were recognized; the ratio between the two was the same as before the eyeball was enucleated. From these results, we conclude that the inhibitory axon terminals in the NOT do not have GABA activity. The GABA-positive cells seem to act indirectly as intrinsic interneurons, when processing or transmitting the information from the retina to the inferior olivary nucleus.