Shinichi Haruna

Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery.

Objectives: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis.

Histopathological features of nasal polyps with asthma association: an immunohistochemical study.

Background Myofibroblasts are related to airway remodeling and may play an important role in the pathogenesis of the histological features of nasal polyps associated with asthma. The aim of this study was to analyze and compare the eosinophilic cationic protein, transforming growth factor (TGF) β, and myofibroblasts in the nasal polyps of patients with chronic sinusitis associated with and without asthma. Methods Nasal polyp samples were obtained during endoscopic sinus surgery and were classified into asthma and nonasthma groups. Immunohistochemistry was performed using antibodies against activated eosinophils, TGF-β, and myofibroblasts. Results The asthma group showed an increased number of activated eosinophils, TGF-β, and myofibroblasts compared with the nonasthma and control groups. We found no correlation of asthma and aspirin intolerance with the immunohistochemical findings. Conclusion The increased number of myofibroblasts in the nasal polyps of the asthma group may be responsible for the extracellular matrix accumulation, polyp formation, and polyp recurrence.

TNF-α and IL-4 regulate expression of fractalkine (CX3CL1) as a membrane-anchored proadhesive protein and soluble chemotactic peptide on human fibroblasts

The CX3C chemokine, fractalkine (FKN, CX3CL1), has multiple functions and exists as two distinct forms, a membrane‐anchored protein and a soluble chemotactic peptide that cleaves from the cell surface FKN. In this study, we first demonstrated the expression of FKN in tumor necrosis factor (TNF)‐α‐ and interleukin (IL)‐4‐stimulated human fibroblasts. The induction of FKN was observed for both forms. We also demonstrated monocyte chemotactic activity in the culture supernatant from the fibroblasts stimulated with these cytokines. These results suggest that TNF‐α‐ and IL‐4‐stimulated fibroblasts may play an important role in accumulation of monocytes at inflammatory sites.

Endoscopic transethmosphenoidal approach for pituitary tumors with image guidance

The advantages of endoscopic transethmosphenoidal surgery for pituitary tumors using a navigation system were reported. The surgical technique was as follows. First, sphenoidal sinuses were opened via the bilateral ethmoidal sinuses and the olfactory clefts. Then the septum of the sphenoidal sinuses was resected. Next, an endoscope was inserted via the left nasal cavity and fixed in place. The tumor was then removed via the right nasal cavity. Our approach for pituitary tumors provided sufficient working space and permitted the surgeon to carry out the procedure using both hands. In addition, use of the InstaTrak System made it possible to recognize the orientation of the surgical field in the sella turcica. Thus, the tumor could be resected more easily and safely. It is concluded that this approach will be particularly useful for patients with narrow nasal cavities or poor development of the paranasal sinuses.

Endoscopic Transnasal Approach to the Pituitary Lesions Using Navigation System (InstaTrakTM System)

Summary Endoscopic transnasal approach has become a procedure of choice for the surgical management of pituitary lesions. However, in conventional endoscopic transnasal surgery, the surgeon may become disorientated to the actual operating position. In our series, 47 patients have undergone an endoscopic transnasal approach to the pituitary with the use of the navigation system called InstaTrakTM for real-time imaging. This image guidance system proved valuable for anatomical localization during pituitary surgery. We have reduced the average surgical time, and improved patient outcome. As a consequence, complications during surgery should decrease and safety should increase. Intra-operative image guidance is expected to have major advantageous effects on pituitary surgery by allowing the surgeon to remove lesions more efficiently. As this system is improved technically and surgeons become more proficient in their use, there should be better postoperative outcomes.

Outcomes of frontal mucocele marsupialization: endonasal and external approaches.

Background Frontal sinus mucoceles are known to undergo repeated recurrences, and the management of this disease constitutes a challenge regarding the ideal treatment. The aim of this study was to evaluate the postoperative results of the endoscopic ventilation approach in the treatment of frontal mucoceles. Methods We retrospectively reviewed the charts of 24 subjects with mucocele who underwent endoscopic marsupialization. The preoperative characteristics of the frontal sinus on computed tomography scans were compared with the postoperative results. Results Postoperative endoscopic examination revealed in 15 nasal sides wide patency of the frontal outflow tract. The ostium was patent but had become slightly narrowed in nine nasal sides. Restenosis of the ostium was found in six cases. Conclusion A membranous type of obstruction in the region of the frontal outflow tract was related to a better outcome.