Michihiro Nakada

CD80 (B7-1) and CD86 (B7-2) antigens on house dust mite–specific T cells in atopic disease function through T-T cell interactions

BACKGROUND CD80 (B7-1) and CD86 (B7-2) play an important role in antigen presentation to effector cells. Recent studies have demonstrated that these costimulatory molecules are also expressed on activated T cells. However, the functional role of CD80 and CD86 expressed on allergen-specific T cells in atopic diseases has not yet been clarified. OBJECTIVE We sought to determine the functional role of CD80 and CD86 expressed on allergen-specific T cells in atopic diseases. METHODS We assayed the expression of CD80 and CD86 on allergen-specific T-cell lines from patients with perennial allergic rhinitis stimulated by Dermatophagoides farinae-crude (Der f-c) antigen, 1 of the major allergens causing house dust mite allergy. T-cell proliferation induced by Der f-c-specific T-T cell interactions was measured, and the role of CD80 and CD86 in this proliferation was examined. In addition, we compared the proportion of CD45RO+CD86(+) T cells in primary culture of PBMCs stimulated by Der f-c antigen between patients with perennial allergic rhinitis and control subjects. RESULTS On T-cell activation, CD86 antigen was upregulated earlier than CD80. Both CD80 and CD86 expressed on Der f-c-specific T cells could provide costimulatory signals to induce allergen-specific T-cell proliferation that was partially inhibitable by both anti-CD80 and anti-CD86 mAbs. The proportion of CD45RO+CD86(+) T cells in primary culture from atopic patients was significantly higher than that from control subjects. CONCLUSION These results suggest that costimulatory molecules, such as CD80 and CD86, expressed on allergen-specific T cells may be involved in the amplification of allergen-specific immune responses through T-T cell interactions in atopic diseases.

CD86 (B7–2) antigen on B cells from atopic patients shows selective, antigen‐specific upregulation

To determine whether B7 signals are associated with atopic responses in man, we assayed CD80 and CD86 expression on B cells and monocytes from atopic patients and controls. Peripheral blood mononuclear cells from 10 patients with perennial allergic rhinitis and from 10 normal subjects were cultured in the presence or absence of house‐dust‐mite antigen, and B cells and monocytes were assayed for expression of CD80 and CD86 by flow cytometry. CD86 on B cells was significantly and selectively upregulated in all atopic subjects, but not in normal subjects, whereas CD80 expression was not altered in B cells from the atopic subjects or controls. In contrast, both CD80 and CD86 were upregulated in monocytes from the atopic subjects as well as the controls. However, CD86 upregulation was significantly higher in the atopic subjects than in controls. Our results seem to suggest that selective upregulation of CD86 on B cells by a challenging antigen may play a critical role in the development of Th2 cells in patients with atopic disease.

Prevalence and prediction of allergic rhinitis using questionnaire and nasal smear examination in schoolchildren.

Allergic rhinitis is a common condition among schoolchildren. However, little is known about the prevalence of nasal eosinophilia. We investigated the prevalence of rhinitis via questionnaire and nasal smears for eosinophils. The questionnaire was administered in 1992 and 1995. Complete responses were obtained from 1044 and 431 schoolchildren, respectively, of whom 26.5% and 22.5% claimed to have nasal symptoms. Nasal smears were taken in 1992, 1993 and 1994, and 415, 285 and 384 samples were collected, respectively. Positive eosinophilia were seen in 39.8%, 35.1% and 35.9% children in 1992, 1993 and 1994, respectively. In 1992, we utilized both questionnaire and nasal smears simultaneously to evaluate 415 schoolchildren. Of 415 schoolchildren, 72 (17.3%) had both nasal symptoms and nasal eosinophilia. Interestingly, those who showed positive eosinophilia in 1992, especially those who had eosinophilia with nasal symptoms, had significantly higher incidence of nasal symptoms three years later in 1995 than those who showed negative eosinophilia in 1992. These results suggest that nasal eosinophilia in schoolchildren are associated with subsequent nasal symptoms, and that nasal smear examination may be a potentially valuable test to predict prolonged or recurrent allergic rhinitis.

Prognostic factors and effects of early surgical drainage in patients with peritonsillar abscess.

Peritonsillar abscess is a frequently encountered otorhinolaryngological emergency, but the characteristics of patients with this disease have not been described in detail. The objective of this study was to delineate prognostic factors associated with peritonsillar abscess and the effects of early surgical drainage for the treatment of peritonsillar abscess. We conducted a retrospective analysis of the medical records of 240 consecutive patients with PTA during the period from 2007 to 2013. Univariate analysis indicated that the period between symptom onset and relief was significantly longer in patients with high levels of C-reactive protein (CRP) (>8.53 mg/dL, p = 0.0073) and without early surgical drainage of pus (p < 0.0001). Multivariate analysis identified both of these values as independently associated with longer duration of symptoms (high CRP, P < 0.0001; no early drainage, P < 0.0001). Univariate analysis indicated that the duration between symptom onset and complete recovery from the disease was significantly longer with age ≥40 years (P = 0.0004), no history of recurrent tonsillitis (P = 0.022), high CRP level (P = 0.0017), and no early surgical drainage of the abscess (P = 0.0014). Multivariate analysis identified older age (P = 0.0004), high CRP level (P = 0.0001), and no early drainage (P < 0.0001) as independently associated with longer duration between symptom onset and complete recovery. Early surgical drainage of the abscess is important for the treatment of peritonsillar abscess. Patients ≥40 years old with peritonsillar abscess and high CRP levels should be recognized as a high-risk group.

Factors that make it difficult to diagnose cervical tuberculous lymphadenitis

Cervical tuberculous lymphadenitis is mainly diagnosed by analyzing tissue samples obtained by fine-needle aspiration (FNA). However, some cases remain diagnostic challenges even after polymerase chain reaction analysis of FNA specimens. To delineate differences between cases that are relatively easy to diagnose and those for which diagnosis is difficult, 22 patients with cervical tuberculous lymphadenitis were studied retrospectively. FNA tissues were used to diagnose 14 cases (group A), whereas excisional biopsy was required for accurate diagnosis of 8 cases (group B). These two groups were compared with regard to results of blood examinations, ultrasound appearance, and various other procedures required to reach the final diagnosis. The results indicated that diagnosis of cervical tuberculous lymphadenitis was more difficult for patients with lower white blood cell counts, lower serum C-reactive protein levels, and absence of lymph node fusion or abscess formation on ultrasonography. The possibility of tuberculosis as a cause of cervical lymphadenopathy should always be considered, even when the presenting symptoms are not typical of this disease.

The role of bacteriological studies in the management of peritonsillar abscess

OBJECTIVE Since most patients with peritonsillar abscess (PTA) can be successfully treated with surgical drainage and empirical antibiotic therapy, routine bacteriologic studies for all patients with PTA may be unnecessary. This study tried to evaluate which patients with PTA should certainly undergo bacteriologic studies. METHODS Hundred consecutive patients with PTA were treated and underwent culture tests of purulent contents obtained by surgical drainage between April 2008 and December 2013. RESULTS In 62 of the 100 patients, 71 pathogenic bacteria were identified; 61 (86%) were Gram-positive cocci (GPC), 8 (11%) were Gram-negative rods (GNR), and 6 (8%) were anaerobes. Normal flora were isolated in 27 patients, and culture results were negative in 11 patients. Although not significant, primary (without prior antibiotic therapy) case (odds ratio (OR)=2.19; 95% CI, 0.95-5.05) and laryngeal edema (OR=2.04; 95% CI, 0.82-5.03) showed a tendency of associations with detection of pathogenic bacteria. After taking into account interactions between smoking habit and laryngeal edema, the covariate-adjusted OR for non-smokers with laryngeal edema was significant and showed a strong relationship (OR=7.43; 95% confidence interval, 1.05-52.73) compared to non-smokers without laryngeal edema. CONCLUSION Although empirical antibiotic therapy was effective for most of the PTA patients, bacteriologic studies might be indispensable for the patients with laryngeal edema considering the failure of the first treatments. Particularly, the culture tests may be useful for non-smokers with laryngeal edema.

Canal wall-down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma: focus on postoperative middle ear status*

Abstract Objectives: We reviewed surgical results of canal wall-down tympanoplasty (CWDT) with soft posterior meatal wall reconstruction (SWR) for acquired cholesteatoma (AC), and identified factors associated with surgical outcomes. Methods: Results from 119 ears with AC (pars flaccida, n = 99; pars tensa, n = 20) that underwent CWDT with SWR were retrospectively reviewed. We defined postoperative balloon-like retraction (PBR) with web formation, which needed reoperation to clean accumulated cerumen, as postoperative deep retraction pocket (PDRP). Results: Residual cholesteatoma was found in 11 ears (9.2%). Seven residual cholesteatomas were treated with outpatient operation. Seven ears (5.9%) showed PDRP. A transcanal approach was applied to all PDRPs. Postoperative mastoid reaeration was observed in 57 ears (47.9%). No factors significantly associated with residual cholesteatoma or PDRP were identified. The frequency of postoperative mastoid reaeration was significantly higher among cases with young age (<50 years), stage I cholesteatoma, or type I ossiculoplasty. Conclusion: CWDT with SWR showed low rates of residual cholesteatoma or postoperative deep retraction pocket (PDRP). Most residual cholesteatomas and PDRPs could be dealt with using a minimally invasive procedure. Young age, stage I cholesteatoma, and type I ossiculoplasty were associated with postoperative mastoid reaeration. This procedure seems fully feasible for surgical treatment of AC.

Prognostic factors and importance of recognition of adult croup

Abstract Objectives: Croup, or laryngotracheobronchitis, is a common disease in childhood. On the other hand, to our knowledge, there are only 14 cases in six English literatures describing adult croup (AC). The clinical features of AC have not been well known. Methods: We conducted a retrospective analysis of medical records of 18 patients with AC during the period from 2008 to 2016. Results: None of the 18 patients required an urgent airway intervention. Univariate analysis indicated that the duration of symptoms was significantly longer in patients with cough (p < .01) and younger patients (age < 60, p = .037). The duration of subglottic edema was significantly longer in female (p = .035), patients with high levels of CRP (≥1 mg/dL, p = .049), and patients with cough symptom (p = .035). Conclusions: Female, young age (<60 years), the symptom of cough, and high levels of CRP should be recognized as signs of prolonged AC. It is important to confirm the diagnosis of AC by laryngoscopic examination, which also help to avoid airway intervention.

Time-lag between symptom onset and laboratory findings in patients with subacute thyroiditis

OBJECTIVE The objective of this study was to delineate the frequency of delayed diagnosis in cases of subacute thyroiditis (SAT) and intervals between onset of clinical symptoms and appearance of abnormal laboratory findings. METHODS We reviewed the medical records of 27 patients (7 men and 20 women) with SAT who visited our hospital between 2007 and 2013. RESULTS On presentation to the hospital, 5 of 27 SAT cases (18.5%) showed normal laboratory findings. Among these 5 cases, the mean interval between symptom onset and thyrotropin (TSH) suppression was 6.3 weeks, and the mean interval to elevation of fT4 was 6.7 weeks. The longest interval from symptom onset to appearance of an abnormal laboratory finding was 11 weeks. CONCLUSION Sometimes time-lag exists between onset of clinical symptoms and the appearance of abnormal laboratory findings in patients with SAT. The possibility of this disease should not be excluded from the differential diagnoses for patients with clinical symptoms consistent with SAT but showing normal laboratory findings.

Three Cases of Nasal and Paranasal Hematocele

Hematoceles are benign hemorrhagic masses. We report three cases of nasal and paranasal sinus hematocele involving prolonged nasal bleeding. Computed tomography (CT) showed an expanding enhanced lesion with a bone defect at the maxillary sinus and magnetic resonance imaging (MRI) varied lesion intensities. We conducted preoperative angiography and selective embolization to be controlled very effectively enabling surgical bleedings. We conducted endoscopic sinus surgery in 1 case and Caldwell-Luc or Denker procedure in 2 cases. We found preoperative imaging to be vital in determining surgical procedures, with preoperative embolization providing an adjunct in estimating vascular proliferation.