Kousuke Yoshifuku

Effect of vascular endothelial growth factor on nasal vascular permeability

One of the major functions of vascular endothelial growth factor (VEGF) is increasing vascular permeability. We previously reported that VEGF is present in nasal secretions in rhinosinusitis, particularly in allergic rhinitis, and is hyperproduced immediately after antigen provocation. However, its function in nasal mucosa has not yet been investigated. This study was designed to estimate the increased vascular permeability by VEGF in nasal mucosa and to discuss its possible role in allergic rhinitis.

Polymyositis with dysphagia treated with endoscopic balloon dilatation

Polymyositis is characterized by non-specific inflammatory disease associated with an autoimmune disorder involving muscles of the limbs and neck. We report a case of an 80-year-old man who was referred to our clinic with a chief complaint of dysphagia and muscle weakness in all four limbs. The patient was diagnosed with polymyositis based on pathological findings, muscle weakness, electromyogram findings, and an elevated creatine phosphokinase level. The patient was also positive for HLA-DR3. Intravenous predonine administration was initiated, but dysphagia was not improved. We considered a cricopharyngeal myotomy, but this could not be performed because of heart failure. Endoscopic balloon dilation was performed and dysphagia improved on the same day. Therefore, we suggest that this method is a safe and effective approach for polymyositis with dysphagia.

Association of a globus sensation with esophageal diseases

OBJECTIVE The aim of the study was to clarify the relationship between a globus sensation and esophageal diseases using upper gastrointestinal endoscopy. METHODS The study population consisted of 52 consecutive patients (33 men, 19 women, age 46-94 years old) with a globus sensation without laryngeal and hypopharyngeal findings who were referred to the Department of Otolaryngology at Ooshima Prefecture Hospital. The subjects were examined by upper gastrointestinal endoscopy. RESULTS Nineteen patients (36.5%) had esophageal disorder, including 10 cases of reflux esophagitis, 5 of esophageal candidiasis, 3 of esophageal cancer. and 1 of herpes and reflux esophagitis. Neither age nor duration of symptoms differed significantly between patients without an esophageal disorder and those with reflux esophagitis or esophageal candidiasis. CONCLUSIONS The results suggest that examination for esophageal diseases is important in patients with a globus sensation without laryngeal and hypopharyngeal findings.

Adenocarcinoma of the paranasal sinuses and nasal cavity with lung metastasis showing complete response to combination chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF): a case report.

Malignant tumors in the paranasal sinuses and nasal cavity are mostly squamous cell carcinomas, with comparatively few adenocarcinomas. Adenocarcinoma developing in paranasal sinuses and nasal cavity generally has a low response to radiotherapy and low chemotherapeutic sensitivity, making surgery the most reliable treatment. However, advanced adenocarcinoma is often difficult to treat due to anatomical complexity, and the outcome may not be satisfactory. We report the case of a 62-year-old man who presented with nasal congestion and epistaxis. We were unable to observe an oncogenic lesion in the nasal cavity directly, but the tumor gave inhomogeneous low intensity signals on T1-weighted images and an isointense signal on T2-weighted images in MRI. Adenocarcinoma was diagnosed by open biopsy. Six courses of chemotherapy by super-selective intra-arterial infusion of cisplatin with concurrent intensity-modulated radiation therapy of 70Gy were performed at another hospital. However, the tumor enlarged and developed distant metastasis to the lung after this therapy. Therefore, TPF chemotherapy (docetaxel, cisplatin and 5-fluorouracil) was performed 5 times, after which the tumor gradually reduced in size. The patient is alive after a follow-up period of 43 months, indicating that TPF chemotherapy may be useful for adenocarcinoma of the paranasal sinuses and nasal cavity.

A useful procedure for observing the cervical esophagus via the hypopharynx

OBJECTIVE The aim of the study was to evaluate upper gastrointestinal endoscopy with movable over tube (i.e., the movable over tube method) for observing the hypopharynx to cervical esophagus, for use in treatment, and to determine its safety. METHODS The study population consisted of 28 patients (23 men, 5 women; a mean age of 66.6 years old; age range of 50-80 years old). The patients consisted of nine cases of globus sensation, eight cases of hypopharyngeal cancer (post-chemoradiotherapy), three cases of hypopharyngeal cancer (untreated), two cases of hoarseness, two cases of unknown primary carcinoma, two cases of foreign body, one case of esophageal cancer, and one case of dysphagia. We used upper gastrointestinal endoscopy with movable over tube to examine the hypopharynx to the cervical esophagus in subjects. RESULTS With the movable over tube method, which was performed under pharyngeal surface anesthesia and an infusion of diazepam (5-10mg/kg body weight), one could observe from the hypopharynx to cervical esophagus without any blind spots. There were no complications after the examination. CONCLUSIONS The results suggest that the movable over tube method is an easy, useful, and safe method to observe the region from the hypopharynx to the cervical esophagus.

[Operative field limited by in the case of a tonsillectomy due to temporomandibular arthrosis--a case report].

We report herein on a patient with unexpected trismus after the induction of general anesthesia due to temporomandibular arthrosis. A 30 year old man visited our hospital complaining of hematuria, and he was scheduled for bil tonsillectomy under general anesthesia. Preoperative examination revealed no evidence of difficult airway and no sign of trismus. Despite the administration of muscle relaxants, it was impossible to expand the operative field due to by trismus after the introduction of general anesthesia. Malignant hyperthermia was excluded, and the trismus was judged to be due to temporomandibular arthrosis. Manual repositioning was performed, trismus was improved and expansion of the surgical field became possible. During any head and neck surgical procedure, if an otolaryngologist should encounter trismus after the induction of general anesthesia, temporomandibular arthrosis should be borne in mind if temporomandibular arthrosis is diagnosed as the cause, manual repositioning should be employed as soon as possible.

Bilateral Auricular Pericondritis that Occurred by Relapsing Polychondritis: A Case Report

Relapsing polychondritis is a chronic inflammatory disease associated with an autoimmune disorder involving the cartilaginous tissue, eyes, and blood vessels.This case report describes an 82-year-old man who was referred to our clinic with a chief complaint of a one-month history of bilateral perichondritis of the auricles. The patient was diagnosed as having relapsing polychondritis in the early stage, one month after onset. The diagnosis was based on bilateral perichondritis and the response to systemic predonine. Antinuclear antibodies, P-ANCA, C-NACA were negative. HLA-DR4 was positive. Intravenous predonine administration was initiated, and auricular chondritis was improved within 3 days.

Effectiveness of Oral Steroid Administration for Eosinophilic Sinusitis

Special attention has been recently paid to chronic sinusitis with marked eosinophilic infiltration given its resistance to conservative as well as surgical treatment. This pathology is now classified as eosinophilic sinusitis (ES). Several reports suggest that systemic steroid administration is effective and necessary as maintenance therapy after surgery. However, the optimal doses and duration of steroid therapy following surgery remain unknown. The present study was performed to examine the effectiveness of oral steroid therapy for ES after endoscopic sinus surgery (ESS). Two hundred and three patients with chronic sinusitis complicated with nasal polyps who underwent ESS in the ENT clinic of Kagoshima University Hospital from January 2000 to December 2003 were enrolled in the study. Biopsy of nasal polyp was performed prior to ESS, and ES was diagnosed by the histological findings of more than 60 eosinophils/field at the magnification of 200. ES cases were classified into two groups based on clinical records; one group was orally administered with steroid after ESS (SG), the other group did not receive steroid after ESS (NSG). Topical findings and laboratory data such as eosinophils and eosinophil cationic protein (ECP) within peripheral blood were compared between the SG and NSG groups. In the results, ES was observed in 30 out of 203 (15%) cases of sinusitis. ES was complicated with asthma in 63%, and with allergic rhinitis in 33%. Recurrence of nasal polyp was statistically less in SG than in NSG. Oral steroid administration was particularly effective in patients with both ES and asthma. Decreased nasal polyp recurrence rates were observed in patients with lower peripheral blood eosinophil counts and lower serum ECP levels. Those findings indicate that oral steroid therapy is effective to reduce recurrence in patients with ES by decreasing the number of activated eosinophils in peripheral blood.

A Case of Suspected Laryngeal Tuberculosis Accompanied by Lung Tuberculosis

A case of suspected laryngeal tuberculosis accompanied by lung tuberculosis was reported in this paper. The patient was a 72 year-old male. He had developed hoarseness, sore throat and pain on swallowing, and consulted our clinic. Laryngoscopic examination showed swelling of the left arytenoid as well as laryngeal palsy. Pulmonary tuberculosis was diagnosed by microbiological identification of tubercle bacillus in the sputum. Although there was no evidence indicating laryngeal tuberculosis, local areas in the larynx were markedly improved after treating the patient with anti-tuberculosis chemotherapy. Consequently the patient was diagnosed as having laryngeal tuberculosis. Laryngeal tuberculosis is now rare in Japan, but it was suggested that careful attention should still be paid to the differential diagnosis of laryngeal inflammatory diseases.