Naobumi Nonomura

Otitis media with effusion following inoculation of Haemophilus influenzae type b endotoxin

SummaryLipopolysaccharide endotoxin (LPS) was extracted from Haemophilus influenzae type b by using Westphals phenol water method. The ears of 40 adult male guinea pigs were subsequently inoculated with 10 μg/ml solutions of LPS by transmeatal injections. Groups of animals were then sacrificed from day 2 to day 24 after the injections to observe the pathological changes produced. Massive serous effusions filled the tympanic bullae on days 2 and 4, after which the amount of fluid present gradually decreased so that it could hardly be seen on day 11. Pathological changes found in the mucosa included marked interstitial edema, dilated capillaries, as well as elevated and thickened epithelium with intracellular edema. These findings gradually subsided by day 24. We believe that the major pathogenetic factors present were due to the transudation and injury of the middle ear epithelium disturbing mucociliary transport activity, with increased secretions participating somewhat in inducing the effusion. We further suggest that H. influenzae endotoxin may play an active role in the clinical development of otitis media with effusion.

Age-related changes in dividing cells of the olfactory epithelium of the maturing guinea pig.

Abstract Changes in dividing cells of the olfactory epithelium from guinea pigs of different ages were examined by immunohistochemical staining using anti-proliferating cell nuclear antigen antibody. Numerous dividing cells were scattered diffusely in the basal layer of the olfactory epithelium at 1 and 2 months following birth and then gradually decreased with maturation until 4 months. Findings then remained constant between 4 and 24 months. Subsequently, cell numbers were found to decrease as animals became older. The number of olfactory receptor cells did not vary significantly between 1 and 30 months. Although no correlation could be found between the numbers of dividing cells and olfactory receptor cells, it is still possible that the longevity of the olfactory receptor cells changes to maintain the overall size of the neuronal population.

Four cases of familial hearing loss with large vestibular aqueducts

Sirs: A large vestibular aqueduct (LVA) has been recognized as a congenital inner ear anomaly that can cause congenital or early acquired sensorineural hearing loss. In the past 20 years most reports of the LVA syndrome (LVAS) have occurred sporadically. Recently, a familial LVAS has been reported, indicating that molecular genetic mechanisms might provide a clue to explaining the mechanisms of congenital hearing loss associated with the syndrome. We report four cases in two families who had profound hearing loss in combination with LVA. Case 1 was an 11-year-old Japanese boy who was bom on 25 December 1985. Pre- and perinatal histories were unremarkable. Delayed speech was noted at 2 years of age, at which time a congenital hearing loss was diagnosed. Hearing aids were fitted to both ears. Referral was made to our hospital at the age of 6 years when his family moved to our city. Bilateral tympanic membranes and shapes of the malleus handles were normal by microscopic examination. Pure-tone audiogram showed down-sloping 40-110 dB sensory changes in the right ear and an 80 dB mixed hearing loss with a predominant sensorineural component in the left ear (Fig. 1). At the age of 8 years, he experienced minor left temporal trauma and the left hearing threshold deteriorated about 40 dB at mid- and upper frequencies. This threshold recovered after 4 weeks administration of corticosteroids, nicotinic acid, adenosine triphosphate disodium and vitamin B 12 . Speech reception thresholds at the age of 11 years were 65 dB in both ears, speech discrimination scores were 85% in the right ear and 95% in the left ear, and a Bekesy audiogram was consistent with a Jerger type II pattern at 1000 Hz. A stapedial reflex was presented in the right ear and absent in the left ear. Magnetic resonance imaging (MRI) of the temporal bone showed enlarged bilateral endolymphatic ducts and sac, but without any other inner ear anomalies (Fig. 2). Case 2 was a 6-year-old boy who was born on 24 July 1989 and was the brother of case 1. Prenatal history and delivery were unremarkable.

Desmoid-type infantile fibromatosis in the mandible: A case report

A 3-year-old boy with desmoid-type infantile fibromatosis arose in the mandible was reported. He was referred to our hospital because of suspected malignant bone tumor of the mandible. Histological examination of an open biopsy specimen was performed followed by tumor resection with marginal mandibulectomy and reconstruction by iliac bone grafting, which caused no functional complications nor mandibular deformity. To treat tumors in the facial skeleton, the surgical procedure should be planned based on the histological diagnosis in order to determine the proper area of resection to prevent functional or cosmetic complications. Especially in children, attention should be taken for benign but clinically resembling malignant rare diseases such as desmoid-type infantile fibromatosis.

Radiological findings of adenolymphoma (Warthin's tumor)

The radiological findings of adenolymphomas (Warthins tumor) treated in six hospitals between 1985 and 1994 were compared with the operative and histological findings and the usefulness of the radiological examinations was evaluated. The total number of patients was 72. The mean age was 61.8 years; 61 were males and 11 were females. All tumors developed in the parotid gland. Tc-99m-pertechnetate salivary gland scanning was performed in 13 patients and an increased uptake of the isotope was observed in only six patients. Even if Tc-99m-pertechnetate salivary gland scanning does not reveal intense accumulation, this tumor should not be ruled out. By computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI), the margin of all tumors was evident; however, the contents of the tumor varied. The contents and multiplicity of the tumors were well demonstrated by MRI, which was found to be the most accurate imaging modality.

Experimentally induced otitis media with effusion following inoculation with the outer cell wall of nontypable Haemophilus influenzae

SummaryPreviously, we extracted lipopolysaccaride endotoxin (LPS) from an axenic culture of Haemophilus influenzae and inoculated it into the middle ears of guinea pigs, inducing temporary serous effusions. In the present study, we tried to clarify whether the immunological mechanism responsible for producing the otitis media following outer cell wall inoculation was persistent. We extracted the outer cell wall from nontypable H. influenzae, using Zollingers method, and inoculated extracts into the middle ears of guinea pigs that had previously received three injections of nonviable H. influenzae in Freunds complete adjuvant. Histological evaluations were performed from day 2 to day 24. Effusions and mucosal changes persisted for a longer time than in the LPS-inoculated model. Hypertrophied mucosae and increased numbers of goblet cells with hypersecretion were visible in the specimens on days 23–24. The condition seemed to show a greater similarity to chronic otitis media with effusion in children than did the LPS-inoculated model. We concluded that both the biological activity of the outer cell wall and immunological mechanisms might induce prolonged otitis media. We speculate that not only single middle ear infection but also general infections and repetitive middle ear infections may contribute to prolonged otitis media.

A Case Of Pharyngolaryngeal Stenosis In Behçet's Disease

A rare case of pharyngolaryngeal stenosis in Behçets disease is reported. A 44-year-old female who had Behçets disease for 13 years complained of dysphagia and dyspnea, and was referred to our hospital for treatment in May 1988. The bilateral meso-hypopharyngeal walls were swollen, and the epiglottis was edematously folded, occluding the larynx. Epiglotectomy and thyrohyoidpexia were performed, with dysphagia and dyspnea disappearing after the operation. Two years after the operation, dysphagia and dyspnea recurred because of two stepped cicatricial stenoses at the mesopharynx. An enlargement operation, incising the pharyngeal cicatricial tissue bilaterally and covering raw surfaces with free skins and the pedunculated cervical flap, was performed. Colchicine, corticosteroid, and tranilast (anti-allergy drug) were administered to prevent re-stenosis. Stenosis was not observed for 10 months after the second operation. Two cases undergone surgical interventions have been reported, and this is the first case reporting long term result of the surgical procedure. Because the skin and mucosa of patients with Behçets disease shows hyperreactivity to stimuli, the choice of surgical procedure is controversial and recurrence of stenosis is possible.

MALIGNANT LYMPHOEPITHELIAL LESION

A case of undifferentiated carcinoma arising from benign lymphoepithelial lesion (BLEL) of the parotid gland was studied by light and electron microscopy. Histopathologically, the carcinoma was composed of pleomorphic anaplastic cells showing an undifferentiated type among abundant lymphoid tissue forming germinal center. Among the prominent lymphoid tissue, epithelial hyperplasia, dysplasia, and squamous metaplasia of the duct epithelium were found. Dysplastic epithelium revealed a transition with carcinomatous component in some areas. On the electron microscopic observation, the tumor cells were poorly differentiated, possessing desmosomes and intracytoplasmic filaments. The patient is alive and well 2 months after resection of the tumor, but has a high titer of serum Epstein‐Barr virus capsid antigen in IgG. Eighty five cases of the malignant lymphoepithelial lesion (MLEL) including the present case are summarized.

Immunohistochemical Study of Pleomorphic Adenoma of the Nasal Septum

A rare case of pleomorphic adenoma of the nasal septum is reported. A 48-year-old man complaining of nasal obstruction and nasal bleeding was referred to our hospital for treatment of a left nasal tumor. The tumor, including the nasal septum, was resected by the modified Denker operation and lateral rhinotomy. The tumor was firm, parenchymatous, pedunculated, and 24 x 22 x 14 mm in size. Pathological examination revealed pleomorphic adenoma with slight cellular atypism. Immunohistochemical observations suggested that characterization of this tumor might be similar to pleomorphic adenoma of the parotid gland.

Acquired airway obstruction caused by hypertrophic mucosa of the arytenoids and aryepiglottic folds

Congenital laryngomalacia is the most common condition that causes stridor in the neonate, infant, and child. It is characterized by laryngeal collapse, including: (1) inward collapse of the aryepiglottic fold and enlarged cuneiform cartilage; (2) a long tubular epiglottis, or the so-called “omega-shaped” epiglottis, which becomes curled in on itself; (3) anterior medial collapse of the arytenoid cartilages; and (4) posterior inspiratory displacement of the epiglottis against the posterior pharyngeal wall or vocal cord. These symptoms usually appear within the first 2 weeks of 1ife.l In 1988, Peron et al2 reported 7 cases of redundant aryepiglottic fold in elderly patients as a new cause of stridor. Since then, several reports have investigated acquired laryngeal collapse caused by epiglottis prolapse and edematously swollen mucosa of the arytenoid and aryepiglottic fold in elderly patients.3-6 Most of these patients had sustained severe central nervous system injury, a head and neck tumor, and/or undergone head-andneck surgery. Two elderly patients without such history, but complaining of stridor and inspiratory dyspnea as a result of hypertrophic mucosa of the arytenoids and aryepiglottic folds, were studied.