Kazutoshi Inamura

Treatment of Ranula with Intracystic Injection of the Streptococcal Preparation Ok-432

Intracystic injection of OK-432 was developed as a therapy for operatively difficult lymphangioma (cystic hygroma) and is currently becoming a treatment of first choice for this disease. We tried this therapy in 32 patients with ranula (oral floor type in 21 cases and plunging type in 11 cases). Disappearance or marked reduction of the lesion was observed in 31 patients (97%) who had this therapy, and local scarring did not occur in any patient. As side effects, local pain at the injection site and fever (37°C to 39°C) were observed in almost half of the patients who had this therapy, but such problems resolved within a few days. We treated the initial 4 cases in the hospital for 4 to 5 days, but after the safety of this method had been confirmed, we treated the other 28 cases on an outpatient basis. Thus, we confirmed that intracystic injection therapy with OK-432 is relatively safe and can be used as a substitute for surgery in the treatment of ranulas.

Cystic lymphangioma and plunging ranula treated by OK-432 therapy: a report of two cases.

Among head and neck angiotumors, cystic lymphangioma occurs in infancy in most cases and it is rare in adulthood. Plunging ranula is one of the diseases which need to be distinguished from lymphangioma, though operation is the first choice therapy for both of these. In the present study, we report on 2 cases in whom we conducted intralesional injection of OK-432 for cervical lymphangioma and ranula found in 20 and 35 year-old female patients. We obtained excellent improvement. First of all, we punctured the tumors and sucked out the liquid content as much as possible, and then used OK-432 in the same volumes to those drawn out. No swelling was observed in either patient after 1 month, and cysts disappeared in CT 4 and 12 months after injection, respectively; at present, the prognosis is satisfactory, without recurrence. The intralesional injection of OK-432 is considered an effective method, as the speed of complete disappearance by this therapy is high. Cosmetically it is superb, leaving no lesions in the skin of the injection site.

Eosinophil and Eosinophil Cationic Protein in Allergic Rhinitis

To evaluate the roles of eosinophils in allergic rhinitis, eosinophil cationic protein (ECP) levels in sera and nasal secretions were measured in 28 patients with allergic rhinitis. In patients, blood eosinophil counts and serum ECP levels were significantly higher than in controls (p < 0.05). However, there was no statistically significant correlation between blood eosinophil count and serum ECP level (r = 0.025). The number of eosinophils and the ECP level in nasal secretion were also measured. In patients, the ECP level increased with the number of eosinophils, and the ECP level in nasal secretion was significantly higher than in controls (p < 0.05). These results suggest that eosinophils and ECP play important roles in allergic rhinitis.

Diagnostic Specificity of Anti-neutrophil Cytoplasmic Antibodies (ANCA) in Otorhinolaryngological Diseases

The incidence and titer of ANCA were examined with 871 sera from patients with otorhinolaryngological diseases at our hospital. The cytoplasmic pattern of ANCA (c-ANCA) whose titer was more than 16 was detected only in the sera of patients with Wegeners granulomatosis (WG). The incidence of c-ANCA in active WG was more than 90%. The perinuclear staining pattern of ANCA (p-ANCA) was detected in almost 40% of patients with Sjögrens syndrome, 2.0% of inflammatory diseases and 1.0% of tumorous diseases. A high diagnostic value of c-ANCA in WG was found in patients with otorhinolaryngological diseases.

Effects of erythromycin on human peripheral neutrophil apoptosis

Erythromycin is reported to have an anti-inflammatory action, which may account for its clinical effectiveness in treating chronic inflammatory diseases of the respiratory tract such as diffuse panbronchiolitis (DPB) and chronic sinusitis. The evaluate the anti-inflammatory action of erythromycin, we examined apoptosis of isolated neutrophils incubated with and without erythromycin. As a result, erythromycin augmented neutrophil apoptosis in a dose-dependent manner, with a maximal effect at 10 micrograms/ml and above. The percentage of neutrophil apoptosis at 12 h was 79.2 +/- 2.3% in medium with 10 micrograms/ml of erythromycin compared with 51.2 +/- 4.1% in control medium (p < 0.005). In a manner similar to that of erythromycin, another macrolide antibiotic, roxithromycin, also increased neutrophil apoptosis. However, there was no effect on apoptosis induced by treatment with josamycin (macrolide antibiotic), ampicillin (beta-lactam.) and cefazolin (cephalosporin antibiotic), or gentamycin (aminoglycoside). These findings suggest that erythromycin shortens neutrophil survival by accelerating neutrophil apoptosis.

Detection of Anti-neutrophil Cytoplasmic Antibodies (ANCA) Using the Immunoperoxidase Method

Anti-neutrophil cytoplasmic antibodies (ANCA), which are present in Wegeners granulomatosis (WG) and other systemic vasculitis, were detected using the immunoperoxidase method rather than the indirect immunofluorescence method. It was possible to distinguish ANCA patterns (c-ANCA, p-ANCA) by the immunoperoxidase method. When neutrophil smears were treated with 0.4% hydrogen peroxide solution, the endogenous peroxidase activity was sufficiently inhibited. ANCA was also detected, using HL-60 cells (human promyelocytic leukemia) and THP-1 cells (human myelocytic leukemia) as substrates.