Masahiko Yoshitsugu

Results of Dacryocystorhinostomy in 96 Patients

Between years 1895 and 1995, 112 patients underwent dacryocystorhinostomy in the Department of Otorhinolaryngology at Tampere University Hospital. A questionnaire considering the recent symptoms of patients was sent to 108 patients. Four of the patients have died. Ninety-six patients returned the questionnaire. Seventy-nine (61 primary operations) lacrimal systems underwent dacryocystorhinostomy (DCR) by external approach (Toti) and 25 (23 primary operations) by transnasal approach (West). Mean follow-up time was 5 years and 8 months. In extranasal DCR group 13% (8/61) of patients required a re-operation and of the others 85% (45/53) were satisfied with the result and still chose the same operation. In transnasal surgery group 30% (7/23) of patients required a re-operation and of the others 56% (9/16) were satisfied and still chose the same operation. Twelve extranasal DCR were made due to trauma or congenital deficiency and 67% of them reported relief of their symptoms. In both groups the results were significantly better if silicon tubes were introduced after operation between eye and nose to keep the lacrimal system open.

Degeneration of human respiratory cell ciliary beat in monolayer cell cultures

SummaryThe degeneration of ciliary beat of human respiratory cells was studied in monolayer cell cultures by using a differential interference microscope equipped with a high speed video system. This method for studying ciliary beat in cell cultures on collagen-coated cover glasses is quite advantageous, because it allows for detailed study of all parts of ciliary function and not just ciliary beat frequency (CBF). In the present study both CBF and ciliary beat amplitude (CBA) were found to decrease continuously from the 1st day after plating but the wave form of ciliary beat did not change. Cultures with high cell density provided better preservation of normal ciliary beat for a longer period. In contrast, ciliary beat degenerated quickly in cultures with low cell density. CBF and CBA in cell cultures less than 5 days after plating were always high, supporting use of these cultures for studies of normal ciliary motility.

Effect of Exogenous ATP on Ciliary Beat of Human Ciliated Cells Studied with Differential Interference Microscope Equipped with High Speed Video

To study the detailed effects of exogenous adenosine triphosphate (ATP) on ciliary function, we used the differential interference microscope equipped with high speed video and evaluated ciliated cells from the human sinus mucosa in monolayer culture. With this system it was possible to evaluate all parts of ciliary motility with a minimum of interference from the mucous membrane, secretory cells and the autonomic nervous system. The best direct ciliostimulative effect of exogenous ATP on ciliary beat frequency (CBF) and ciliary beat amplitude (CBA) was observed at concentrations of ATP ranging from 10(-5) M to 10(-3) M. Exogenous ATP appeared to normalize the slightly damaged ciliary motility in groups with an initial CBF of 14 Hz or higher. When the CBF was less than 14 Hz, ATP produced an increase in CBF greater than 40%, an increase in CBA greater than 30%, but these did not reach the normal level in 5 min. The biggest increases: 59.9% in CBF and 40.7% in CBA were seen in the group with an initial CBF less than 9 Hz. In the cells with a low initial CBF and unsynchronized motility exogenous ATP increased the synchrony of ciliary movement together with an increase in CBF and CBA.

Effects of oxygen radicals on ciliary motility in cultured human respiratory epithelial cells.

There are few reports about direct effects of specific oxygen products on ciliary function because of their instability and reactivity. We investigated the direct effects of superoxide anion (O2-) and of hydrogen peroxide (H2O2) on the ciliary function of human respiratory epithelial cells, using monolayer cell cultures, high speed video analysis of frequency (CBF), amplitude (CBA), and coordination of ciliary beats and evaluating the surface structural changes of ciliated cells at the same time. 10(-2) M H2O2 decreased ciliary beat activity. The CBF was 36.5 +/- 4.4% and the CBA was 51.0 +/- 3.8% of the baseline (time = 0) after 5 min (all p < 0.001). Catalase (2 micrograms/ml) abolished the ciliotoxic effect of H2O2. The O2- produced by reaction of xanthine (0.06 mM)-xanthine oxidase (0.04 U/ml) caused a temporary rapid increase of 26.8 +/- 1.7% in CBF and an increase of 42.5 +/- 4.1% in CBA after 15 sec (all p < 0.001). Superoxide dismutase significantly reduced these increases. Results indicated that O2- activated ciliary function with a temporary increase in O2(-)-production. This suggests that the removal of H2O2 from the O2- reaction is important in improving mucociliary clearance in excessive oxygen metabolites.

Ciliary motility and surface morphology of cultured humanrespiratory epithelial cells during ciliogenesis

Summary— We used human respiratory epithelial cells in floating culture to study the motility and surface morphology of the cilia during ciliogenesis. Ciliary motility and surface morphology was examined by a high‐speed video system and electron microscopy, respectively. On day 8 of floating culture, but rarely before, cells with numerous moving short cilia with mean ciliary beat frequency (CBF) of 17.8 ± 2.5 Hz (mean ± SD) were seen. The mean CBF was highest on day 10 (19.6 ± 3.9 Hz) and reached 17.4 ± 2.5 Hz on day 14. The ciliary beat amplitude (CBA) was recognized on day 8, abruptly increased on day 9, then continued with aging of the culture. The intracellular coordination of ciliary beats was poor on day 8 with random beat direction but improved up to day 12 when the intracellular uniform beat direction was established. However, intercellular coordination remained absent even on day 14. Results suggest that immature short cilia have a rigid beat pattern. With the elongation of the cilia and the resulting whip‐like movement, the ciliary beat was gradually synchronized. Although a ciliary elongation seems to be required for making intracellular coordination, other factors are involved in intercellular coordination. Also, a high CBF does not always indicate the activity of mature cilia.

Reduced sialylation of glycoproteins in nasal glands of patients with chronic sinusitis.

This study was conducted to investigate the sialylations of glycoproteins in the nasal glands of patients with chronic sinusitis. Sialic acids were detected using lectin histochemistry, and the mRNA of sialyltransferase was evaluated by in situ hybridization histochemistry. Sambucus nigra agglutinin (SNA), which recognizes terminal sialic acids, strongly stained the glandular mucous cells of normal subjects, but not those of patients with chronic sinusitis. In situ hybridization histochemistry showed that the expression of alpha2,6 sialyltransferase mRNA was decreased in the secretory cells of patients with chronic sinusitis. Our present results suggest that a reduction in sialyltransferase activity at the mRNA level in the nasal glands may lead to the persistence of chronic sinusitis.

Effect of Exogenous ATP and Physical Stimulation on Ciliary Function Imparied by Bacterial Endotoxin

The effects of exogenous ATP and physical stimulation on ciliary beat depressed by lipopolysaccharide from Pseudomonas aeruginosa were studied in cell culture. Both the ciliary beat frequency (CBF) and the amplitude (CBA) of human respiratory cells in monolayer cell cultures were studied by using a differential interference microscope equipped with a high speed video. Both the ATP and the physiol stimulation stimulated temporarily the depressed CBF and CBA. In both groups the CBF and CBA increased in 1 min to the initial level and then gradually decreased to the level before the stimulation. The duration of the ATP stimulation on the CBF (10.1 +/- 1.8 min) and CBA (10.1 +/- 2.3 min) were significantly better than the duration of physical stimulation on CBF (8.0 +/- 1.8 min) and CBA (6.8 +/- 1.6 min). However, the areas under the CBF/CBA curves (from the beginning of stimulation until the initial level of CBF or CBA was reached again) did not differ significantly. After the removal of the bacterial toxin the CBF was restored to the initial level. In the present study the adenosine receptor antagonist could not prevent the ciliostimulative effect of exogenous ATP combined with the physical stimulation. Both exogenous ATP and physical stimulation have a clear but temporary stimulative effect on the ciliary beat depressed by bacterial toxin, ATP being slightly more effective. It seems that the effects of ATP are not mediated by adenosine receptors.

Necrotizing Fasciitis of Cervicothoracic Region after Treatment for Tonsillar Carcinoma.

Necrotizing fasciitis is a rare disease characterized by cutaneous necrosis, suppurative fasciitis, and vascular thrombosis. The disease commonly causes a rapidly progressive toxic systemic illness (i. e. toxic shock-like syndrome) in which the mortality has been reported to be between 20 and 36%.Necrotizing fasciitis of the neck and chest occurred in a patient with tonsillar carcinoma one month after treatment with surgery and radiotherapy. The patient was admitted to our hospital ICU in renal and respiratory failure, septic shock and DIC. He recovered after treatment which included debridement of necrotized tissue in the cervicothoracic region. Streptococcus pyogenes was solated in blood cultures. We speculated that the bacterial infection might have entered through the incision for tumor resection.The recent literature concerning necrotizing fasciitis is reviewed. It is important for otolaryngologists to be aware of this disease since early excision of necrotic tissue and high dose intravenous antibiotics are necessary for patient survival.

Clinical and Statistical Studies of Facial Trauma.

We have treated 68 patients with facial trauma from 1979 to 1990 in the otolaryngologic clinic of Kagoshima University Hospital. There were 52 males and 16 females of all ages. The incidence was highest among 10-19-year old males.Traffic accidents caused the most traumas followed by fights and sports accidents. In 62 of the 68, there were facial bone fractures: nasal, maxilla, zygoma and orbital floor in almost equal numbers.Miniplates used for the fixation of maxillo-zygomatic bones were quite useful. Questionaires to the patients showed that post-operative distress was more often a cosmetic problem than functional disability.