Kenzo Inoue

Pathological and biochemical study in the adenoid of mucopolysaccharidosis II

In the patients with mucopolysaccharidosis II (MPS II, Hunters syndrome), conductive and sensorineural hearing deficits are frequently observed. Two patients with MPS II underwent adenoidectomy and an ear douche, and their conductive hearing loss recovered after the surgery. Pathological examination of the adenoids revealed the infiltration of faintly PAS-positive plasmacytes with perinuclear vacuole and strongly Alcian-blue positive fibrotic area. Biochemical study was performed by chromatoscanning of electropholesis. The amount of glycosaminoglicans (GAG) in the specimens was increased 2.8-fold compared with the normal control. The electropholetic pattern showed an increase of dermatan sulfate (DS), heparan sulfate (HS) and hyaluronic acid (HA) in the adenoids of the patients. The ratio of DS to HS was 1.1-1.2. In the patients of MPS II, the accumulation of GAG occurs in the pharyngeal tonsil and causes conductive hearing impairment. We recommend adenoidectomy for such patients.

SEVENTEEN YEAR'S EXPERIENCE IN THE TREATMENT OF CARCINOMA OF THE MOBILE TONGUE

Two hundred and forty-two patients with squamous cell carcinoma of the mobile tongue were reviewed. Most of them were initially treated by irradiation and then treated surgically for salvage. Cervical node metastases were frequently developed during or after the initial therapy. The patients in the advanced stage showed poor prognosis due to uncontrolled cervical node metastases and/or local recurrence. In the patients with no initial cervical node involvement, better local control and less frequent incidence of subsequently developed cervical node metastases were observed in the group treated by surgery than in those treated by irradiation. In the patients with initial cervical node involvement, no significant difference was noted in the survival yielded by either treatment modality. In advanced carcinoma, combined treatment with radiotherapy and surgical therapy seemed to give better results than with either radiotherapy or surgical therapy alone in this study.

A case of rhinoscleroma.

Rhinoscleroma is endemic in eastern Europe, North and Central Africa, and South and Central America. It is a rare disease in Japan. In 1917, Kuzume first reported a Japanese case of scleroma of the pharynx. Until 1982, only 3 Japanese cases had been reported. Rhinoscleroma is a chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here is a 41-year-old Japanese female. Her chief complaint is nasal deformity and nodular swelling of the nasal vestibule. Physical examination revealed: narrow nostrils, hard nasal wings, tumefaction of the left nostril, crusting of the nasal cavity, nodular swelling of the posterior wall of the naso- and mesopharynx, and scarring of the lateral wall of the pharynx. Laboratory findings were normal. The TB skin test was negative. A biopsy of the inferior turbinate showed a marked subepithelial infiltration with lymphocytes, plasma cells and macrophages. A PAS stain of the specimen showed large vacuolated histiocytes containing Klebsiella organisms (so-called Mikulicz cells). Klebsiella, Streptococcus agalactiae and Escherichia coli were recovered from the nasal secretion, and Klebsiella rhinoscleromatis was identified biochemically. The patient was treated with total doses of 20g of streptomycin and 8.4g of minocyclin and at the time of this writing is clinically free of disease.

Report of Perforation of the tympanic membrane due to explosion of gun powder

Three high school students, 16 years of age, experienced sudden explosion while experimenting with gun powder. The major damage was burn on their faces and bilateral rupture of the tympanic membranes. The perforations were repaired surgically and conservatively.