Masaru Toshima

Bone destruction mechanisms in chronic otitis media with cholesteatoma : specific production by cholesteatoma tissue in culture of bone-resorbing activity attributable to interleukin-1 alpha

To clarify specific mechanisms underlying cholesteatoma-induced bone destruction, surgical specimens of middle ear inflammatory granulation tissue with or without cholesteatoma were maintained in vitro and the bone-resorbing activity in their culture supernatants was analyzed by means of calcium release from mouse calvaria. Almost the same levels of bone-resorbing activity and prostaglandin (PG) E2 were found in the supernatants of both types of tissue. By contrast, aural polyp tissue yielded hardly any such activity or PGE2. Under the influence of indomethacin, however, only tissue with cholesteatoma produced considerable bone resorption activity, whereas PGE2 production was suppressed completely. Such activity in the cholesteatoma culture supernatant was not due to contamination of endotoxin and proved to be blocked by the introduction of anti-interleukin (IL)-1α antibody into the calvarial assay system. Anti-IL-1β antibody had no effect on such activity. Interleukm-1α was detected only in cholesteatoma tissue culture supernatants by means of enzyme-linked immunosorbent assay and by bioassay. These data suggest that the bone destruction in otitis media with cholesteatoma may be attributed to IL-1α in addition to PGE2.

Sudden bilateral hearing loss and dizziness occurred with cerebellar infarction.

Sudden hearing loss (SHL) with equilibrium disturbance usually suggests peripheral pathology. SHL occurs unilaterally in most cases, and sudden bilateral hearing loss (SBHL) is a rare disorder accounting for approximately 2% of cases.1 Vertebrobasilar occlusive disease (VBOD) sometimes causes SHL because the vertebrobasilar system is the blood supply of the inner ear and most auditory pathways. SBHL caused by VBOD is very rare and tends to have a grave outcome.2,3 We now report SBHL with dizziness that occurred with cerebellar infarction. The patient did not show other obvious neurologic deficits.

A Case of Psoas Abscess due to Methicillin Resistant Staphylococcus Aureus after Total Laryngectomy.

A 78-year-old Japanese man was admitted to Iwaki Kyoritsu General Hospital for treatment of laryngeal cancer (T2N2aM0). Total laryngectomy with bilateral modified neck dissection was performed, and the patient initially showed good recovery. On the 12th postoperative day, the patient suddenly obtained a high-grade fever. Sustained lumbago followed two days later. Broad spectrum antibiotics were administered under suspicion of a bacterial infection. However, the antibiotics were not effective. Hemoptosis from gastric ulcer appeared on the 19th post-operative day, causing anemia and deterioration of his general condition. Since computed tomography revealed bilateral psoas abscess on the 20th postoperative day, open drainage under general anesthesia was performed. At the end of the operation, cardiac arrest of unknown origin occurred. Bacteriological examination of the abscess and blood after surgery proved Methicillin resistant staphylococcus aureus. Consciousness of the patient was never recovered, and the patient died on the 44th day after the initial surgery. This is the first case of psoas abscess reported as a postoperative complication after head and neck surgery in Japan. The pathogenesis of psoas abscess in this patient was discussed.

Result of High-Dose Steroid Therapy (Stennert) in Facial Palsy

Since 1988, more than 100 patients have been treated in our clinic by high dose steroid therapy, which was first introduced by Stennert in 1979. We have slightly modified the method from the original. The initial dose of prednisolone is 200 mg/day in adults and 2 mg/kg per day in children. Hydroxyethyl starch instead of dextran 40 is used in order to reduce liver dysfunction. In patients with Ramsay-Hunt syndrome, acyclovir is used for 5 days. The cure rate is 94% and most patients showed complete recovery within 8 weeks. Ten patients showed denervation in NET before or during the treatment bur five patients among them recovered completely. All children recovered completely and more quickly than adults. No severe side effects were observed during the treatment. Liver dysfunction was often observed but recovered quickly after the treatment.

Facial Palsy Due to Intracranial Vascular Lesion

Of the many disorders which may cause facial nerve palsy, vascular lesions in the cerebellopontine (CP) angle are uncommon. Two cases of such etiologies will be presented and discussed in this paper. The first case was that of a 73- year-old woman. She had suffered from left-sided incomplete facial nerve palsy for 2 months. She was referred to our clinic because therapy had not been effective. MR imaging revealed a mass lesion in the left CP angle adjacent to the left vertebral artery, which was proven to be an aneurysm by angiography. The second case was that of a 15-year-old girl. She was referred to our clinic for further examination and treatment of left-sided incomplete facial nerve palsy. Neurotological examination revealed left hearing loss, horizontal gaze nystagmus to the right, and hypesthesia of her left face. MRI revealed a mass lesion in the left CP angle with signal voids interpreted as hemosiderin deposits. Angiography was normal in that region. These findings suggested cavernous hemangioma in the left CP angle.

Is facial nerve decompression surgery effective

Since steroid therapy has been proven to be effective on facial nerve palsy, many doctors have abandoned facial nerve decompression surgery (FND), and it is usually used only for traumatic facial palsy. However, there are still a few cases which cannot be cured by steroid therapy. With such cases or the cases which were not properly treated, we have used FND in the late period. In this paper, the results of this surgery are reported and its effectiveness is discussed.

Penetration through the Upper Eyelid and into the Maxillary Sinus by a Piece of Bamboo; A Case Report.

A piece of bamboo accidentally pierced the upper eyelid of a 40-year-old man. Computed tomography (CT) revealed a foreign body in the orbit and maxillary sinus. The maxillary sinus was explored five days after the injury. A piece of bamboo with a split end had traversed the bony orbital floor, and several fragments were found in the maxillary antrum. After removal of the foreign body, the patient recovered quickly with only a slight decrease in visual acuity.In the Japanese literature this is the first case report of a wooden foreign body penetrating through the upper eyelid deep into the maxillary sinus.It is important to suspect the existence of a foreign body and to evaluate the CT in detail, in such cases.

Bone resorption mechanisms of middle ear cholesteatoma. Immunohistochemical study of decalcified ossicles and biochemical study of bone-resorbing activity produced by cholesteatoma tissue in culture.

Middle ear cholesteatoma consists of a layer of keratinized stratified squamous epithelium overlying subepithelial granuloma tissue with inflammatory cell infiltration, and is feared for its destructive properties. The bone resorption mechanism in cholesteatoma is thought to be a cellular and biochemical reaction associated with the chronic inflammatory component of cholesteatoma. The purposes of this study are, on one hand, to analyze immunohistochemically the interaction between subepithelial granuloma tissue and eroded ossicles in cholesteatoma using a new decalcifying technique, and on the other hand, to analyze biochemically the bone resorbing activity produced by cholesteatoma tissue in culture. It was found that numerous number of T-lymphocytes, which predominantly belonged to helper/inducer T-cell subset, and HLA-DR positive cells were accumulated beneath the epithelial layer and near the eroded ossicles. The bone resorbing activity produced by cholesteatoma tissue was suggested to be attributable to interleukin-1α and prostaglandin E2, whereas the granulation tissue in cases of simple chronic otitis media without cholesteatoma produced only prostaglandin E2 but not interleukin-1α.