Megumi Kumai

Association between HLA Antigens and Birch Pollen Allergy in Japanese Subjects

Birch pollen is a very common cause of nasal allergy (pollinosis) not only in Scandinavia, Europe, Canada, and the northern part of the United States but also in Hokkaido, Japan. Although there are many papers describing the association of HLA antigens and pollinosis caused by many other allergens, there is no report about the association of HLA antigens and birch pollen allergy. In this paper, we performed an HLA population study of birch pollen-allergic patients in Japan and their pattern analysis of HLA-DRB and HLA-DQB gene by the Southern blot hybridization technique. Our population study data indicated that the HLA-DR9 and HLA-DQw3 phenotypes strongly associated with the development of birch pollen allergy in Japanese subjects. By restriction fragment length polymorphism pattern analysis, some restriction fragments of the HLA-DQB gene were detected only in the patient group. These data suggested that there was a significant association between HLA class II antigens and the development of birch pollen allergy in Japanese subjects.

Our Operation for severehyper thyroidism

We performed 11 total thyroidectomy and 13 sub-total thyroidectomy for 24 cases of hyperthyroidism patients from January, 1993 to March, 1996. There were several reasons of operative indication for our cases that (1) uncontrol of anti-thyroid drugs, (2) side effects of anti-thyroid drugs as allergic reaction or agranulocytopenia, (3) prevention of thyroid crisis and (4) to have babies. We selected those two types of operations not to re-use anti-thyroid drugs after our treatment. In operation, we left not only recurrent nerves but also two or three parathyroid glands with active blood supply. After operation there were two cases of transient recurrent nerve palsy and two cases of hypo function of parathyroid glands. But we had no cases of recurrent hyperthyroidism after surgical treatment.

Treatment of postoperative hypoparathyroidism with activated vitamin D3.

We report here the effect of activated vitamin D3 (Vit. D3) in postoperative hypoparathyroidism. We performed 42 total thyroidectomies and 43 sub-total thyroidectomies from 1978 to 1989.Hypoparathyroidism occurred in 36 patients (85.7%) after total thyroidectomy and 5 (11.6%) after sub-total thyroidectomy. We treated 18 of these patients with Vit. D3 only (43.9%) and 21 with Vit. D3+calcium (51.2%) orally. Treatment with Vit. D3 only is easier and more useful than that with Vit. D3 + calcium in controlling the serum calcium level of patients with hypoparathyroidism.We should monitor not only the serum calcium level but also the serum albumin to determine the real serum calcium level.With Vit. D3, which we prescribed in doses of 0.5-6.0μg (mean: 2.47±1.45μg) per day, we could control the serum calcium level well in patients with postoperative hypoparatyroidism without a high calcium level in the urine.It is probably concluded that Vit. D3 treatment alone is adequate for postoperative hypoparathyroidism patients, who have normal calcium uptake from the digestive tract, and it is the easiest and safest way to control the serum calcium level.

Glomus tympanicum tumor; A case report. Benefits of preoprative diagnostic imaging.

The patient was 67-year-old female who complained of pulsatile tinnitus in the right ear. Otoscopy revealed a reddish mass that extended to the annulus.CT, MRI and angiography localized it in the middle ear cavity and distinguished it from the jugular bulb. The tumor was completely resected by posterior hypotympanotomy after embolization of the superior tympanic artery. Absence of tumor recurrence was con-firmed 8 months after surgery. We discuss the benefits of preoperative diagnostic imaging methods.

Osteocalcin and multiple scanning X-ray photodensitometry (MD/MS) for postoperative hypoparathyroidism treated with vitamin D3.

In order to rule out low-grade osteoporosis in postoperative hypoparathyroidism patients treated with activated vitamin D3, we examined (1) the midportion of parathyroid hormone (M-PTH, relatively stable compared to other PTH), (2) osteocalcin (osteoblast producing Gla protein), (3) multiple scanning X-ray photodensitometry (MD/MS method, using X-ray film of secondary metacarpal bone with alminium steps).Sixteen patients were examined: 13 of a series of 45 who had had total thyroidectomy and 3 of a series of 49 who had had subtotal thyroidectomy. In spite of normal serum calcium levels, 9 patients were diagnosed as osteoporosis by the MD/MS methods. Increasing of the vitamin D3 dose reduced the lower-grade osteoporosis in these patients within 3-4 months.It is concluded that osteocalcin and the MD/MS methods are useful in demonstrating mild osteoporosis in patients with postoperative hypoparathyroidism, in spite of normal serum calcium levels. We can monitor the doses of vitamin D3 during long term therapy with the use of these examinations.

Evaluation of simultaneous bilateral neck dissection.

From 1976 to 1989, 51 patients with squamous cell carcinomas of the head and neck underwent simultaneous bilateral neck dissections, 19 had secondary contralateral neck dissections, and 169 had unilateral neck dissections at the Department of Otolaryngology, Asahikawa Medical School.The indications for simultaneous bilateral neck dissection were categorized into six groups: I, clinically palpable bilateral nodes; II, primary lesions large enough to suggest bilateral neck metastasis; III, development of bilateral neck masses during preoperative treatment; IV, recurrence of primary lesions with doubtful neck metastasis; V, large ipsilateral lymphnodes suspicious of contralateral metastasis; VI, technical convenience for reconstructive procedure and/or the patients general condition.According to the TNM classification, the coincidence of N and pN was 25.5% in the simultaneously operated group, although 39.2% of them had bilateral neck metastase. The most common cause of death was distant metastasis to lungs or bones. Gontralateral neck dissection was performed secondarily in 19 of the 188 patients treated with unilateral neck dissection.Postoperative complications were mainly venous stagnation and neurological dysfunction. Bilateral ligation of the internal jugular veins was not related to these complications.The results suggest that more than two-thirds of patients with squamous cell carcinoma of the head and neck can be treated with unilateral neck dissection and that simultaneous bilateral neck dissection is justified in selected cases.