Kazunori Itoh

Localization of il‐1β mrna and cell adhesion molecules in the maxillary sinus mucosa of patients with chronic sinusitis

Interleukin‐1β (IL‐1β) is a predominant cytokine in retained paranasal sinus fluid of chronic sinusitis where infiltration by polymorphonuclear neutrophils (PMNs) of nasal and paranasal mucosa is characteristic. The authors investigated the localization of IL‐1β messenger RNA (mRNA) in the maxillary sinus mucosa of patients with chronic sinusitis, using digoxigenin‐labeled oligonucleotide probes. IL‐1β mRNA was detected in some extravascular PMNs and small numbers of mononuclear leukocytes but was not detected in other tissue cells or intravascular leukocytes. The expression and distribution of the cell adhesion molecules, intercellular adhesion molecule‐1 (ICAM‐1) and endothelial‐leukocyte adhesion molecule‐1 (ELAM‐1), were also studied in cultured human mucosal microvascular endothelial cells and in the maxillary sinus mucosa in chronic sinusitis by immunohistochemistry using monoclonal antibodies against these cell adhesion molecules. Only ICAM‐1 was expressed on cultured human mucosal microvascular endothelial cells without IL‐1β stimulation. With IL‐1β activation of these cells, ELAM‐1 was expressed strongly and the expression of ICAM‐1 was enhanced. In the maxillary sinus mucosa, ICAM‐1 was strongly and universally expressed on endothelial cells of all small vessels, whereas ELAM‐1 was expressed only in the subepithelial region. These findings suggest that IL‐1β, one of mediators in chronic sinusitis, is produced by PMNs, induces the expression of ICAM‐1 and ELAM‐1 on endothelial cells, and, thereby, stimulates PMN infiltration in chronic sinusitis.

Retention fluids of chronic sinusitis induce neutrophil adherence to microvascular endothelial cells

The adherence of circulating leukocytes to the vascular endothelium is a critical step in the emigration of leukocytes through blood vessel walls to inflammatory lesions. The influence of nasal secretions on the adherence of neutrophils to the vascular endothelium was investigated using monolayers of human mucosal microvascular endothelial cells derived from the inferior turbinate. Preincubation of vascular endothelial cells with retention fluids from the maxillary sinus of the patients with chronic sinusitis showed increased neutrophil adherence. Recombinant IL-1 beta was also tested and found to induce adherence of neutrophils to human mucosal microvascular endothelial cells. However, no adhesive effect was observed with the nasal secretions of nasal allergy. An enzyme-linked immunosorbent assay detected considerable amounts of IL-1 beta in the chronic sinusitis retention fluids, while the amounts of IL-1 alpha and TNF-alpha were very low. The increased adhesion of the neutrophils by the retention fluids of chronic sinusitis was also neutralized by the incubation with anti-IL-1 beta antibody in a dose dependent manner. These findings suggest that IL-1 beta in the paranasal secretion of chronic sinusitis induces the adherence of neutrophils to vascular endothelium and subsequent infiltration of neutrophils in the paranasal sinuses, thus contributing to the persistence of chronic sinusitis.

Chondrosarcoma of the hyoid bone.

Chondrosarcoma of the head and neck is relatively rare. We report the sixth case known to us in which the chondrosarcoma had originated in the hyoid bone. The patient, a 66-year-old man, underwent surgery. The resected tumour was a 5 cm encapsulated lesion composed of lobulated, firm, gray-white tissue. Histologically it showed mature chondrocytes without capsular invasion. There was high cellularity and a few binucleated chondrocytes. Although the tumour grade was prognostic significance, our literature review of the five other cases suggests that the location of the primary lesion and the adequacy of its resection to be more important. Our patient continues to do well 15 months post-operatively. However, long-term follow-up is essential as recurrences have been reported even after eight or 10 years.

Laser Beam in Treating Congenital Choanal Atresia in Three Patients

We present the results of 3 patients with congenital unilateral choanal atresia who were treated surgically at our department. We report a method of surgical approach for repair of choanal atresia. A transpalatal procedure offers an approach which is straightforward. The use of carbon dioxide or Nd:YAG laser seemed better for recurrent cases. A tube stent should be placed for at least 6 weeks postoperatively.

A Protease Inhibitor from Human Allergic Nasal Secretions

Protease and antiprotease activities were estimated in nasal secretions from patients with chronic sinusitis and nasal allergy, using [3H]-casein as substrate. In the purulent nasal secretions, strong protease activity was measured, but there was less activity in the allergic nasal secretions. In contrast, trypsin inhibitory activity in allergic nasal secretions was much higher than in nasal secretions from the patients with chronic sinusitis. A protease inhibitor was partially isolated from nasal secretions of the nasal allergic patients by Sephadex G-150 gel chromatography and characterized. This protease inhibitor has an apparent molecular weight of 10,000 D, determined by SDS-polyacrylamidegel electrophoresis. It depresses the activities of bovine pancreatic trypsin, bovine pancreatic chymotrypsin and proteases in nasal purulent secretions, whereas it does not inhibit porcine pancreatic elastase, papain, or human plasmin.

Latent Collagenase Production by Cells Derived from Nasal Polyps in Culture

We investigated the interactions between nasal polyp-derived fibroblast-like cells (NPFCs) and nasal secretions to clarify the role of connective tissue metabolism in nasal and paranasal pathology, especially in chronic sinusitis. In response to stimulation by human interleukin 1 (IL-1), NPFCs produced latent collagenase. Collagenase production was also stimulated by nasal secretions from patients with chronic sinusitis in vitro, but not by nasal secretions from nasal allergic patients. A soluble factor was isolated from the nasal secretions of patients with chronic sinusitis by ammonium sulfate precipitation and Sephadex G-75 gel chromatography. High performance liquid chromatography indicated that the molecular weight of the active fraction was approximately 20,000 daltons. This factor affected NPFCs, but did not affect the endothelial cells derived from nasal mucosa in culture. Collagenase production by NPFCs was considerably inhibited by anti-IL-1 antibody. These results indicate that IL-1 is one major factor to prolong the nasal and paranasal inflammatory lesions.

Neutrophil adhesion to microvascular endothelial cells in chronic sinusitis.

The adherence of circulating leukocytes to the vascular endothelium is a critical step of inflammatory infiltration. In order to understand the influence of the nasal secretion on vascular endothelium, adherence of neutrophils to monolayers of endothelial cells was assayed using 51Cr-labeled leukocytes and human mucosal microvascular endothelial cells derived from inferior turbinate. Quantitative analysis of interleukin-1α, β and tumor necrosis factor-α were made in the retention fluid of the maxillary sinus of chronic sinusitis and the nasal secretion of nasal allergy using ELISA kit. The vascular endothelial cells acquired adhesiveness for neutrophils after preincubation with maxillary sinus retention fluids of chronic sinusitis. However, no adhesive effect was found in the nasal secretion of nasal allergy. Quantitative analysis revealed the presence of interleukin-1 and the absence of tumor necrosis factor-α in the retention fluids of chronic sinusitis. The adherence inducing effect was heatlabile and almost neutralized by anti-IL-1β antibody in dose dependent manner.These findings suggest that the IL-1 in the para-nasal secretion of chronic sinusitis induce the adherence of neutrophil to vascular endothelium and further promoted leukocytes infiltrates in the paranasal sinuses, playing an important role in persistency of chronic sinusitis.

A case of hysterical trismus.

A 19 year-old male with hysterical trismus reported. The patient had various signs such as sudden facial palsy, progressive trismus and spastic type gait disturbance. On the laboratory examinations including X-ray Computed tomography, Electric myogram and Cerebro-spinal fluid analysis, there were no findings suggesting any pathological changes.The results of psychiatric analysis suggested that these clinical symptoms represented a hysterical reaction.By Jacobsons progressive relaxation method and symptomatic treatment, these symptoms improved and disappeared completely after three weeks.

Quantitative analysis of sialic acid and L-fucose in patients with chronic sinusitis or nasal allergy.

慢性副鼻腔炎 (副鼻炎), 鼻アレルギー (鼻ア) の病態解明の一端として, 血清, 組織, 鼻汁中の可溶性蛋白結合シアル酸およびフコースの定量をチオバルビツール酸法, システイン硫酸法を用いてそれぞれ行い, 以下の結果を得た.1. 血清中シアル酸は副鼻炎, 鼻ア症例ともに正常者と有意差はなく, フコース値は副鼻炎, 鼻ア症例の順で有意に高値を示した. また副鼻炎患者レ線所見の程度, および鼻茸の有無と血清中フコース値との間には高い相関関係が認められた.2. 副鼻炎上顎洞粘膜, 鼻茸中のシアル酸は, 肥厚性鼻炎下甲介および鼻ア下甲介のそれに比して有意に高値, もしくは高い傾向がみられた.3. 副鼻炎鼻汁と上顎洞内貯留液中のシアル酸, フコースは, ともに鼻ア鼻汁のそれに比し高値をしめした.