Kenji Dejima

A clinical study of endoscopic sinus surgery for sinusitis in patients with bronchial asthma.

Background: An association between bronchial asthma and sinusitis has long been suspected. Our aim is to study the clinical features of chronic sinusitis associated with bronchial asthma as two manifestations of one airway disease. Methods: We conducted a prospective analysis of the outcome of 88 patients, with or without bronchial asthma, who underwent endoscopic sinus surgery (ESS) for chronic sinusitis. Patients were divided into two groups by the presence or absence of asthma and were evaluated. One surgeon performed the ESS, and the same postoperative treatment was given to both groups. The postoperative outcomes of symptoms and objective findings related to sinusitis were evaluated numerically, with a maximum score of 2 points for each examination item. Twenty-eight patients with asthma symptoms were assessed before and after surgery, using peak flow (liter/second) and medication scores (according to US Food and Drug Administration) to determine whether bronchial asthma was improved by first-time ESS. Results: The outcomes of ESS were signifi- cantly worse in the asthma group, especially the endonasal findings. Patients suffering from chronic sinusitis and bronchial asthma showed improvement following ESS in terms of their asthma symptoms, peak flow and medication score. Patients with a good ESS result tended to have the greatest improvement in their asthma. Conclusions: We conclude that sinusitis and asthma are closely related to each other, acting as two manifestations of one airway disease. We recommend treating cases of sinusitis complicated by asthma as a single disease of the entire respiratory tract.

Prevalence of Japanese Cedar Pollinosis among Schoolchildren in Japan

Background: Japanese cedar pollinosis is an important allergic rhinoconjunctivitis in Japan in spring. We investigated the relationship between the amount of pollen in the air and the prevalence of the disease and sensitization to Japanese cedar pollen in this ecological study. Methods: The IgE antibody to Japanese cedar pollen (JCP-IgE) was determined in human serum and rhinoconjunctival symptoms were surveyed in 407–510 children in May or June every year from 1995 to 2001. Japanese cedar pollinosis was defined as being JCP-IgE ≧1.5 IU/ml and having any rhinoconjunctival symptom lasting 3 weeks or longer in March or April. Results: Prevalence rates of Japanese cedar pollinosis were 13.8–22.9%. Prevalence rates of being JCP-IgE ≧1.5 IU/ml were 39.0–50.1%, and those of being JCP-IgE ≧15.01 IU/ml were 11.4–23.2%. All prevalence rates were significantly related to the amount of pollen in the air. The proportion of subjects with rhinoconjunctival symptoms was relatively constant in each stratum of low JCP-IgE levels (<0.35, 1.50–2.99, 3.0–14.9 IU/ml). Conclusion: High exposure to Japanese cedar pollen was associated with higher levels of JCP-IgE antibody and a high prevalence of Japanese cedar pollinosis. The relationship between the level of JCP-IgE and the proportion of subjects with symptoms was relatively constant.

A 13-year Study of Japanese Cedar Pollinosis in Japanese Schoolchildren

BACKGROUND Japanese cedar pollen (JCP) sensitization and Japanese cedar pollinosis (JCPS) appear to be increasingly prevalent in younger children. The present study investigated factors affecting JCP sensitization and JCPS development in school children. METHODS In May or June each year from 1994 to 2006, 275-510 children were assessed for serum JCP-IgE and house dust mite (HDM)-IgE levels, and surveyed regarding rhinoconjunctival symptoms. RESULTS Strong JCP sensitization (IgE > or = 17.5 U(A)/ml) was associated with age (odds ratio (OR) = 2.65), the amount of dispersed pollen in the observed year (OR = 2.03) and in the year following birth (OR = 1.51), the month of birth (OR = 2.18), and the recent birth cohort (OR = 1.96). Symptoms were negatively correlated with the recent birth cohort (OR = 0.69) after adjusting for JCP-IgE levels. Strong HDM sensitization was associated with gender (OR = 0.65 for girls) and the recent birth cohort (OR = 1.76). CONCLUSIONS JCP sensitization appeared to be associated with the recent birth cohort and to increases in dispersed pollen just after birth and in the observed season. Although the recent birth cohort was more easily sensitized, they were not more likely to develop symptoms. In contrast to JCP sensitization, strong HDM sensitization appeared to develop prior to commencement of primary school and was more likely to affect boys.

Quercetin Stimulates Na+/K+/2Cl− Cotransport via PTK-Dependent Mechanisms in Human Airway Epithelium

We investigated regulatory mechanisms of Cl(-) secretion playing an essential role in the maintenance of surface fluid in human airway epithelial Calu-3 cells. The present study reports that quercetin (a flavonoid) stimulated bumetanide-sensitive Cl(-) secretion with reduction of apical Cl(-) conductance, suggesting that quercetin stimulates Cl(-) secretion by activating an entry step of Cl(-) across the basolateral membrane through Na(+)/K(+)/2Cl(-) cotransporter (NKCC1). To clarify the mechanism stimulating NKCC1 by quercetin, we verified involvement of protein kinase (PK)A, PKC, protein tyrosine kinase (PTK), and cytosolic Ca(2+)-dependent pathways. A PKA inhibitor (PKI-14-22 amide), a PKC inhibitor (Gö 6983) or a Ca(2+) chelating agent did not affect the quercetin-stimulated Cl(-) secretion. On the other hand, a PTK inhibitor (AG18) significantly diminished the stimulatory action of quercetin on Cl(-) secretion without inhibitory effects on apical Cl(-) conductance, suggesting that a PTK-mediated pathway is involved in the stimulatory action of quercetin. The quercetin action on Cl(-) secretion was suppressed with brefeldin A (BFA, an inhibitor of vesicular transport from ER to Golgi), and the BFA-sensitive Cl(-) secretion was not observed in the presence of an epidermal growth factor receptor (EGFR) kinase inhibitor (AG1478), suggesting that quercetin stimulates Cl(-) secretion by causing the EGFR kinase-mediated translocation of NKCC1 or an NKC1-activating factor to the basolateral membrane in human airway epithelial Calu-3 cells. However, the surface density of NKCC1 was not increased by quercetin, but quercetin elevated the activity of NKCC1. These observations indicate that quercetin stimulates Cl(-) secretion by activating NKCC1 via translocation of an NKCC1-activating factor through an EGFR kinase-dependent pathway.

A case of angiosarcoma of the nasal cavity successfully treated with recombinant interleukin-2.

Angiosarcomas very rarely arise in the nose and paranasal sinuses, with an incidence of about 4%. To our knowledge, there have been only 4 reported cases in the literature. This paper reports a case of angiosarcoma arising in the nasal cavity that decreased in size after the administration of recombinant interleukin-2 (rIL-2), with a brief review of the literature. A 55-year-old male with a chief complaint of frequent epistaxis on the left side was referred to our department for close examination on January 21, 2000. His past and family histories were unremarkable. No abnormal findings were noted in the ear, pharynx, larynx, or neck. Examination of blood coagulation was normal. Enhanced CT showed a mass lesion with an enhancement effect in the left nasal cavity. T1-weighted images of MRI also demonstrated an enhanced tumor in the left nasal cavity (Fig 1a). After septal correction surgery on April 20, 2000, a dark red tumor was found in the left nasal cavity. A biopsy specimen was taken during surgery. Pathological examination of HE-stained sections showed proliferation and irregular arrangement of vascular endothelial cells (Fig 1b and c). Immunohistochemical analyses using CD34 showed a specifically positive staining corresponding to vascular endothelial cells. We concluded that the nasal tumor was angiosarcoma. Angiography of the left carotid artery was performed on May 8, 2000. The tumor was supplied by both the anterior ethmoid artery, a branch of the internal carotid artery, and the greater palatine artery, a branch of the external carotid

Endolaryngeal extension of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling. We observed a case of extension of the thyroglossal duct cyst to the supraglottic area without neck swelling. A 50-year-old man presented with a 1-month history of foreign-body sensation in the throat. Fiberscopic and radiologic findings were similar to those associated with a saccular cyst, but its proximity to the hyoid bone raised the possibility of thyroglossal duct cyst. Operation was performed via an external incision to completely remove the cyst. Postoperative fiberscopy revealed that the aryepiglottic fold swelling had disappeared. Diagnosis of thyroglossal duct cyst was confirmed on the basis of pathological findings. In cases in which it is difficult to remove the cyst from the hyoid membrane, the hyoid bone midline portion should be dissected. Thyroglossal duct cysts should be considered in cases with a submucosal tumor in the supraglottic region, and radiological examinations should be performed.

Teratoma of the soft palate with multifocal cyst formation in the tongue and the brain.

SummaryWe report a case of a solid and cystic teratoma appearing in the soft palate that was associated with a cyst in the tongue and a huge cystic formation in the arachnoid of the brain. Histologically, the tumor of the soft palate contained elements of all three germ layers, with a predominance of mature glial tissues. This typical teratoma and the two other concurrent lesions were all located on the same side of the head, and were thought to have a common embryonic origin. These multifocal tumors may represent an incomplete manifestation of a “teratoma complex”.

Magnetic resonance imaging for aspirated peanut in the bronchus

Peanut inhalation in the right main bronchus of a 15-month-old boy was diagnosed using a T1-weighted image produced by magnetic resonance imaging (MRI) because of the high fat content of the peanut. The T1-weighted MRI image may also be useful in diagnosing other kinds of aspirated nuts with high lipid content as well as peanuts. This method does not involve any X-ray exposure.

Distribution of Goblet Cells in the Rat Nasal Septum by Use of Quantitative Histological Technique

In this quantitative, histological study, both goblet cell number and distribution of secretory granules in normal septal mucosa of rats were examined by computer-based color image analysis combined with a new, simple whole-mount method. Our new method has proved to be a very useful and highly accurate means of examination. The count and size of the mucous area of goblet cells decreased toward the antero-posterior direction with the exception of the apical region of the septum. The regional difference characteristic of the goblet cell is noteworthy. The results are assumed to be closely related to both flow direction of mucous blanket and distribution of nasal gland orifices. Goblet cells are assumed to be controlled by some regulatory factor of the secretory system and to play an important role in nasal physiological mechanism.

Preoperative evaluation of surgery for intractable aspiration based on the prognostic nutritional index

Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patients preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients. In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI. Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01. A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower. Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable aspiration. Based on the O-PNI score, it was possible to evaluate the survival benefit associated with this operative procedure. We showed a treatment algorithm based on the preoperative O-PNI value. We believe there is a necessity to develop preoperative effective nutritional therapy as a future issue.