Takaki Miwa

Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study.

Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS.

Prognostic Value of EGFR and TGF-α in Early Laryngeal Cancer Treated With Radiotherapy

The purpose of this study was to determine the overexpression of both epidermal growth factor receptor (EGFR) and transforming growth factoralpha(TGF‐α) (a ligand of EGFR) in early laryngeal squamous cell carcinoma. In addition, we attempted to evaluate the prognostic values of our findings.

Olfactory disturbance induced by deafferentation of serotonergic fibers in the olfactory bulb

The serotonergic neurons of the brain stem project widely throughout the central nervous system, and the olfactory bulb is one of the major forebrain targets of the ascending serotonin pathway. According to physiological studies, neurons of the olfactory bulb were found to reduce their spontaneous discharge rates by electrophoretically applied serotonin. However, roles of the bulbar serotonin in the sense of smell remain unanswered. In the present study, using 5,7-dihydroxytryptamine, a specific neurotoxin for serotonin, we found that the conditioned rats who learned to avoid a repellent by olfaction lost ability of discrimination by deafferentation of the bulbar serotonergic fibers. Such olfactory dysfunction did not occur in the early stage (three days after injection of the toxin) when the serotonergic fibers disappeared in the bulb, but developed a few weeks later. Interestingly, histological examination revealed marked shrinkage of the bulbar glomerulus which is a major termination site of the bulbopetal serotonergic fibers, and also a synaptic site of olfactory receptor cells and bulbar output neurons. The results indicate that depletion of the serotonergic fibers in the olfactory bulb causes glomerular atrophy and olfactory disturbance in the rat.

Significance of Intravenous Olfaction Test Using Thiamine Propyldisulfide (Alinamin) in Olfactometry

The significance of intravenous olfaction test in olfactometry was studied by injection of thiamine propyldisulfide (Alinamin) intravenously. An original solution of Alinamin is a thiol-type derivative of vitamin B1, and releases a mercaptan smell (garlic smell) in expired air when it arrives at the olfactory epithelium via the nasopharynx. In the intravenous olfaction test (Alinamin test), the latent time which is a period between the initiation of injection and recognition of garlic smell, and duration time which is a period between the recognition and disappearance of smell are measured. Our results indicated that latent time is influenced by olfactory acuity and duration time depends on olfactory adaptation phenomenon. Central olfactory disorders were highly suspected in hyposmia patients with duration time of less than 15 sec, and nonresponders in Alinamin test always showed poor prognosis in the recovery of olfactory acuity. It was considered that the Alinamin test is useful not only for estimating the degree of olfactory disorders, but also for differential diagnosis of impaired lesions and olfactory prognosis.

Posttraumatic Olfactory Loss

Head injury is the leading cause of posttraumatic anosmia. Complete or partial loss of olfactory function may occur when the nasal passages are blocked, olfactory nerves are injured or there are contusions or hemorrhages in olfactory centers of the brain. Evaluation of patients with posttraumatic olfactory loss should include a physical examination by the otolaryngologist. Nasal endoscopy and radiological studies should be performed as well as olfactory function tests to determine the degree and type of olfactory impairment. Although treatment options may be limited, physicians should provide information and counseling regarding the risks and hazards associated with loss of olfactory function. For some individuals such as cooks, firefighters, and research scientists, an assessment of vocational activities should be performed prior to reentry into the workplace. Individuals with impaired olfactory function may be unable to detect important warning signs such as gas leaks, volatile chemical fumes and fires and therefore place themselves and coworkers at an increased risk for serious injury or death.

System for Nasopharyngeal Carcinoma: Comparison of Fourth and Fifth Editions of UICC TNM Classification

Staging nasopharyngeal carcinoma (NPC) by the UICC 4th-edition TNM classification system (the old system) did not give an accurate prognosis because of the uneven distribution of patients in each stage. This system was revised in 1997 (the new system). To evaluate the performance of the new system, 35 patients with NPC who had been staged by the old system were restaged according to the new system. Restaging of the patients resulted in an overall “downstaging.” Differences in the overall survival rates of the early group (stages I, II, III), stage IVA, stage IVB, and stage IVC patients were statistically significant (75%, 48%, 74%, and 0%, respectively; p = .01). T4 was a significant factor of poor outcome (hazard rate, 2.932; 95% CI, 1.667 to 8.545), whereas N3 was not (hazard rate, 0.858; 95% CI, 0.281 to 2.618). The new staging system is more useful than the old system.

Retrograde transport of nerve growth factor from olfactory bulb to olfactory epithelium

NGF is produced in the olfactory bulb and transported from the bulb to cholinergic neurons in the horizontal limb of the diagonal band. Although the expression of NGF receptors has been reported in olfactory epithelial cells, no correlation between NGF and olfactory epithelial cells has been found. This study aimed to define whether or not retrograde transport of NGF occurs in the olfactory neural system using the method of radioluminography. 125I-labeled NGF injected into the olfactory bulb was taken up and transported to the olfactory epithelium 18 h after injection. This finding suggests that bulbar NGF may act as a neurotrophic factor in olfactory epithelial cells.

Transection of the olfactory nerves induces expression of nerve growth factor receptor in mouse olfactory epithelium

Expression of nerve growth factor receptor (NGFR) was found in the mouse olfactory epithelium after olfactory nerve transection, although no immunoreactivity to NGFR was detectable in the olfactory epithelium in the control animals. After axotomy, however, NGFR-immunoreactive cells transiently appeared in the supporting cells, receptor neurons and basal cells between postoperative day 7 and 35, and thereafter disappeared by postoperative day 49. The results indicate that nerve growth factor may contribute to the regeneration of olfactory receptor neurons after olfactory nerve transection.

View from beneath: pathology in focus. Renal cell carcinoma metastasis to the tongue.

: Metastases to the tongue from distant primaries are very rare. A case of renal cell carcinoma metastasis to the tongue, occurring in a 58-year-old man, is presented and previously reported cases are reviewed.

Importance of Unilateral Examination in Olfactometry

Hyposmia, the decreased sense of smell, and anosmia, the loss of sense of smell, may be unilateral or bilateral. If the olfactory acuity examined by means of bilateral test is normal, olfactory disorders are not found; unilateral examination is therefore necessary for definite evaluation of olfactory acuity. As evidence, 7 cases out of 94 patients with chronic rhinosinusitis and 6 cases out of 12 patients who received the surgery of anterior cranial fossa showed definite different olfactory threshold between nasal cavities, and there were no patients who recognized the diminished sense of smell in spite of unilateral high olfactory threshold. Additionally, we have experienced that a patient with brain tumor was diagnosed by the help of unilateral olfactory test. We thus strongly recommend the unilateral olfactometry as a method for simple and reliable test in clinical measurement of the sense of smell.