Akihiro Kojima

Prevalence of Allergic Rhinitis and Sensitization to Common Aeroallergens in a Japanese Population

Background: Allergic rhinitis (AR) is recognized as a major health problem worldwide, and its prevalence depends on the age range of the subjects. The aims of this study were to determine the current prevalence of AR, effects of age on the prevalence of IgE sensitization to inhalant allergens, and serum total IgE levels in Japanese subjects. Methods: We conducted a survey of 1,540 subjects between 20 and 49 years of age in 2006 and 2007 and examined the prevalence of AR and sensitization to 7 common aeroallergens. We measured serum total IgE and specific IgE to 7 aeroallergens. AR was determined based on symptoms, predominantly in the nose and eyes, caused by aeroallergens as mentioned in a questionnaire and sensitization to any of the 7 aeroallergens as assessed by measurement of serum specific IgE. Results: The prevalence of AR was 44.2% (681 of the 1,540 subjects) and there was no difference among age decades. Of the 1,540 subjects, 1,073 (69.7%) were sensitized to at least 1 of the 7 aeroallergens. The most common allergen in AR was Japanese cedar pollen (89.6%, 610 of the 681 with AR) in all the age decades examined. The sensitization rate to mites was significantly higher in the younger subjects. Conclusion: Our data suggest that the prevalence of AR between 20 and 49 years of age has increased by nearly 10% during the last 10 years. Cedar pollen and mites were predominant allergen sources among the 7 aeroallergens in the Japanese population.

Cough reflex induced by capsaicin inhalation in patients with dysphagia

Abstract Conclusions: We conclude that the capsaicin inhalation test is useful to directly assess cough reflex and sensation around the larynx, while it indirectly reflects central nervous system function. Objectives: To understand the state of the cough reflex before patients with dysphagia start eating. Methods: We studied the cough reflex by the capsaicin inhalation test in 21 patients with dysphagia and 12 healthy persons without dysphagia. Results: The control group showed a cough reflex at a capsaicin concentration of 2.61 μM (0.98–7.80), while patients with mild dysphagia did so at 7.28 μM (1.95–15.6), those with moderate dysphagia at 22.07 μM (15.6–62.5), and those with severe dysphagia at 71.75 μM (31.2–250). Control vs mild p < 0.01, control vs moderate p < 0.01, control vs severe p < 0.01, mild vs moderate p < 0.01, mild vs severe p < 0.01, moderate vs severe p < 0.05. There was a significant correlation between the grade of dysphagia and the threshold capsaicin concentration that provoked a cough reflex (ρ = –0.796, p < 0.001).

Benign Cystic Teratoma of the Parotid Gland: A Case Report

BACKGROUND Mature cystic teratomas of the major salivary glands are rare. This report describes a case of a mature cystic teratoma of the left parotid gland, including the cytologic and histopathologic findings. CASE A 17-year-old young woman presented with a slow-growing left parotid mass that had been present for 4 years. Preoperative fine needle aspiration cytology showed the presence of acinar and ductal cells, foamy cells and multinucleated giant cells. Imprint cytology of the surgical material showed the presence of some squamous cells and sebaceous gland-like cells with hair shafts. Cellular atypia was inconspicuous. Grossly, the 3-cm lesion was unicystic and embedded within the parotid gland parenchyma. Microscopically, the inner surface of the cyst was lined with keratinized squamous epithelium. The cyst wall contained skin adnexa such as sebaceous, eccrine and apocrine glands, as well as hair follicles. Some mature cartilage tissue was also detected. Foreign body granulomatous change was seen focally. No immature tissue or malignant transformation was found. CONCLUSION There is no previous report describing the cytologic findings of a mature cystic teratoma of the parotid gland. Mature cystic teratomas should therefore be considered in the differential diagnosis of a cystic lesion of the parotid

Antrolithiasis in the Frontal Sinus

A very rare case of sinusitis with antrolithiasis in the left frontal sinus of a 63-year-old male patient is reported. Various conservative treatments had no effect on the decrease of his left frontal pain and of postnasal drip. Neither bacteria nor fungus were detected in the discharge. Computed tomographic scanning revealed several high-dense spots in an isodense shadow in the left frontal sinus. At first, endoscopic sinus surgery (ESS) was employed and a stony mass was detected in the nasofrontal duct and sinus. Patency of the nasofrontal duct was insured and a sticky paste and small masses were removed as well as possible. However, the flow of discharge from the frontal duct continued after surgery. We performed a second operation with extranasal approach and additional stones in the sinus were successfully removed. Most cases of antrolithiasis are caused by a foreign body or caseous sinusitis with fungus. The maxillary sinus is the most common site of disease in antrolithiasis. It is unknown why the present case of antrolithiasis was in the frontal sinus. In such cases of antrolithiasis or cases having pastelike contents in the frontal sinuses, we conclude that ESS may be an unsuccessful treatment and a classical surgical approach may be required.

Interleukin-19 Downregulates Interleukin-4-Induced Eotaxin Production in Human Nasal Fibroblasts

BACKGROUND Interleukin-19 (IL-19), a member of the IL-10 family, is characterized as the cytokine suppressing the release and function of several proinflammatory cytokines. For regulation of local reaction in allergic rhinitis (AR), IL-19 might play an especially important role. METHODS We examined effects of IL-19 on IL-4-induced eotaxin production by human nasal fibroblasts. Early receptor-mediated events (expression of the suppressors of cytokine signaling (SOCS) and phosphorylation of signal transducer and activator of transcription 6 [STAT6]) by IL-19 was examined. Knockdown methods by RNAi were administered to investigate the involvement of those signal transductions. RESULTS Pretreatment with IL-19 downregulates IL-4-induced eotaxin production, but not interferon-γ(IFN-γ)-induced RANTES. Pretreatment with IL-19 suppressed the IL-4-induced STAT6 phosphorylation. The IL-19 induced SOCS-1, but not SOCS-3 or SOCS-5. The SOCS-1 knockdown by RNAi diminished pretreatment with IL-19-induced down-regulation of eotaxin production. CONCLUSIONS These results suggest that IL-19 down-regulates IL-4-induced eotaxin production via SOCS-1 in human nasal fibroblasts. In non-hematopoietic cells in AR, IL-19 might be an immunosuppressive factor.

Platelet Derived Endothelial Cell Growth Factor/Thymidine Phosphorylase Enhanced Human IgE Production

BACKGROUND Angiogenesis is one pathogenesis of allergic airway disease. METHODS A potent angiogenic factor is platelet-derived endothelial cell growth factor (PD-ECGF), also known as thymidine phosphorylase (TP) in the field of cancer-associated research. Vascular endothelial growth factor (VEGF) is another representative angiogenic factor. Both factors were added to the culture system of human peripheral blood mononuclear cells (PBMC) with IL-4 and anti-CD40 monoclonal antibody (mAb). Total IgE levels in the supernatants and signal transduction of stimulated PBMC were evaluated. RESULTS Addition of PD-ECGF enhances in vitro IgE production by PBMC in the presence of IL-4 and anti-CD40 mAb, but VEGF does not enhance IgE production. Although PD-ECGF catalyzes the reversible phosphorolysis of thymidine to 2-deoxy-D-ribose-1-phosphate (2DDR), treatment of 2DDR has no effect on IgE production by human PBMC. Both IL-4 and anti-CD40 mAb induce PD-ECGF by human PBMC. Thymidine phosphorylase inhibitor (TPI), 5-chloro-6-[1- (2-iminopyrrolidinyl) methyl] uracil hydrochloride reduce IgE production via blocking of STAT6- phosphorylation. CONCLUSIONS Taken together, these results suggest TP involvement in the enhancement of IgE production and suggest that TPI is a novel strategy against IgE-related allergic disease.

Intact-PTH Level after Surgery for Thyroid Cancer

We determined the level of serum intact parathyroid hormone (intact-PTH) in 122 thyroid cancer patients after 6 postoperative months. Hemithyroidectomy was performed in 92 patients, subtotal thyroidectomy in 20 patients, and total thyroidectomy in 10 patients. The normal level of intact-PTH in patients who underwent hemithyroidectomy or subtotal thyroidectomy was kept without parathyroid autotransplantation. The level of intact PTH in 89 patients who underwent extirpation of regional lymph nodes was significantly higher than that in 22 with ipsilateral neck dissection or 11 with bilateral neck dissection. There were no clinical factors, such as gender, age, clinical stage, tumor size or pathological classification, showing correlation with the level of postoperative intact-PTH. In the entire series, postoperative permanent hypocalcemia occurred in 9 (7%) patients. Of these 9 patients, 8 had undergone total thyroidectomy and only 1 subtotal thyroidectomy. The strategy for preservation of parathyroid function during total thyroidectomy was determined as follows: 1) preservation of bilateral superior parathyroid gland, 2) preservation of 1 superior parathyroid gland and autotransplantation of at least the other 1 parathyroid gland, or 3) autotransplantation of 2 parathyroid glands.

Sebaceous Epithelioma in the External Auditory Canal

Sebaceous epithelioma is a rare skin tumor with sebaceous differentiation. Histopathologically, it is composed of undifferentiated basaloid cells, differentiated sebaceous cells and transitional cells. Our patient was an 80 year-old man with an asymptomatic tumor in the right external auditory canal. The tumor was 1.2×0.8cm and had a stem at the lower wall of the external auditory meatus and could be completely resected. During a one-year follow-up period, there was no recurrence of the tumor.