Takuo Haruyama

Expression of IL-17 and Its Role in Bone Destruction in Human Middle Ear Cholesteatoma

Purpose: The present study was designed to elucidate the immunoreactivity and protein level of IL-17 in human cholesteatomas. Procedures: The expression and localization of IL-17 and receptor activator of nuclear factor ĸB ligand (RANKL) were examined by immunohistochemistry in tissue specimens collected from 24 patients with cholesteatomas. The cellular sources of IL-17 were assessed by double staining with CD4. The level of IL-17 protein was determined using an enzyme-linked immunosorbent assay. The degree of bone destruction was compared with the IL-17 immunoreactivity. Results: IL-17 immunoreactivity was detected in the inflammatory cells in the granulation tissues and there were increased levels of IL-17 protein. The localization of IL-17 expression coincided with CD4-positive lymphocytes. IL-17 was correlated with the cells positive for RANKL. The degree of bone destruction was dependent on the number of infiltrated IL-17-positive cells. IL-17-driven pathology was observed in the congenital type as compared with the acquired type. Conclusions: The present study suggests that IL-17 is related to the pathogenesis of the disease.

Clinical effectiveness of ototopical application of mupirocin ointment in methicillin-resistant Staphylococcus aureus otorrhea.

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) otorrhea has become an increasing problem with regard to infection through the tympanic membrane perforation and postsurgical infection. In particular, dry ear, at the preoperative stage, is considered to be a crucial factor in surgery. We evaluated how to control MRSA otorrhea before and after ear surgery. Patients and Methods: Twenty-six patients having MRSA otorrhea were enrolled in the present study and randomly divided into 2 groups, namely, mupirocin ointment therapy for 16 patients and ofloxacin ear drops for 10 patients. Approximately 0.6 mg of mupirocin ointment was administered locally to the tympanic membrane and the promontory around and through the perforation with its adjacent external ear canal 1 to 4 times for 2 or 3 weeks at the clinic. On the other hand, ofloxacin ear drops were administered daily by the patients for 2 or 3 weeks at home. Results: Complete elimination of MRSA from the ear was obtained in all patients of the mupirocin group. This showed a significant improvement (p < 0.001) as compared with the ofloxacin group (improvement + cure rate, 40%). Local application of mupirocin did not aggravate hearing acuity of any patients who were evaluated by pure-tone audiometry before and after treatment. Conclusion: The present findings first indicate that minimally essential application of mupirocin ointment is an extremely useful ototopical agent against MRSA otorrhea without ototoxicity.

An immunohistochemical study of sinonasal hemangiopericytoma

We present herein the imaging and pathological features of a 28-year-old male with a sinonasal hemangiopericytoma-like tumor occupying the left nasal meatus. At the initial visit, a nasal polyp was suspected, but, as the patient was bleeding readily, an angiomatoid lesion was also regarded as a possible diagnosis. Based on a thorough histopathological analysis, a sinonasal hemangiopericytoma-like tumor was diagnosed. Hematoxylin and eosin staining also showed a mild degree of nuclear pleomorphism and a slight increase in mitotic activity, and immunohistochemical studies using anti-CD34, MIB-1, and Vimentin antibodies were useful for distinguishing the hemangiopericytoma-like tumor from true hemangiopericytoma and a solitary fibrous tumor.

Atypical Lemierre syndrome, thrombophlebitis of the facial vein.

A young man complained of fever and left-sided neck pain. Computed tomography (CT) scan of the neck showed a round low-density areawith enhancement at themargin.We suspected a deep neck abscess, and the antibiotic treatment was started. After 3 days, CT scan showed that the oval low-density area extended to its junction with the left internal jugular vein. We diagnosed him as having Lemierre syndrome of the facial vein thrombosis. CT scan of the chest showed multiple pulmonary embolisms. The patient started to receive intravenous anticoagulant therapy. The swelling and tenderness of the neck gradually resolved, and the patient improved without complications. Lemierre syndrome is potentially fatal. Prompt diagnosis and appropriate therapy are needed. Radiographic findings are characteristic and facilitate the diagnosis of Lemierre syndrome. A positive scan typically shows a filling deficit representing occlusive thrombus in the internal jugular vein. In this case, it was difficult to diagnose because the patient had thrombus involving only a facial vein. Recently, cases of Lemierre syndrome have increased, so it is necessary to know Lemierre syndrome of the facial vein thrombosis. In November 2011, a 23-year-old man presented with a 1-week history of sore throat and 3-day history of left-sided neck pain without improvement after outpatient antibiotic therapy from the general hospital. He had no medical history. Initial examination revealed fever (38.4°C), swelling and tenderness in the left side of the neck, and flare and swelling of the bilateral palatine tonsils with pus. Laboratory tests showed a leukocyte count of 15.9 × 109/L (neutrophils, 87.7%); Ddimer, 4.38 μg/mL; and C-reactive protein, 8.5 mg/dL. Computed tomography (CT) scan of the neck showed a round low-density area (diameter, 7 mm) anterior of the left internal jugular vein with enhancement at the margin of the area. We suspected a small, deep, neck abscess. The antibiotic treatment was started using cefepime and clindamycin on an inpatient basis. Three days after hospitalization, inflammatory parameters continually dropped, swelling and tenderness in the ☆ Grants or financial support: None. 0735-6757/

Surgical Management of Myringosclerosis over an Entire Perforated Tympanic Membrane by Simple Underlay Myringoplasty

– see front matter. Crown Copyright

Laryngeal stenosis in epidermolysis bullosa dystrophica

The aim of our study is to demonstrate the surgical management of myringosclerosis over a perforated whole tympanic membrane using simple underlay myringoplasty. Simple underlay myringoplasty with fibrin glue was performed in 11 ears with myringosclerosis over the entire tympanic membrane. The patients were one male and ten females and their mean age was 61.8 years (range, 40–73 yr). Surgical success was defined as an intact tympanic membrane 12 months after surgery. Closure of the perforation was successful in 10 (91%) of the 11 patients. Failure of the graft occurred in one patient who then underwent a revision procedure using her stored fascia in the outpatient clinic with a successful outcome. The overall success rate was 100%. Although this study included a small number of cases, removal of myringosclerosis at the edge of a perforation is a beneficial technique for simple underlay myringoplasty in terms of the success rate and postoperative hearing threshold, especially when myringosclerosis extends over the entire tympanic membrane.

Bacterial contamination of multiple-use atomizers commonly used in Japan.

Epidermolysis bullosa dystrophica is a rare hereditary skin disease of infancy in which minor trauma causes blister formation. We report a rare case of epidermolysis bullosa dystrophica (recessive) with a stenosis of the larynx due to epiglottic deformity. We performed a tracheotomy, and we detained a trachea aperture in the long term this time. In a characteristic of a disease though stimulation to the trachea causes the erosion on a trachea mucous membrane, postoperative course was uneventful and we are going to observe it in future.

Concurrent weekly docetaxel and hyperfractionated radiotherapy for advanced head and neck cancer.

Before performing transnasal fiberscopy to observe the nasal cavity, pharynx and larynx in outpatient clinics, nasal anesthetics and vasoconstrictive agents are routinely sprayed into the nares in order to improve patients’ comfort. Bacterial contamination of the nozzles of Venturi principle atomizer barrels and their solutions after being used for multiple patients over a long-term period without cleaning is controversial. We evaluated the potential risk of atomizer-associated cross-infection by using atomizers commonly available in Japan that use compressed air to atomize medication. Eighteen of the 23 samples (78.3%) from the external nozzle tips of the atomizers resulted in positive bacterial cultures. These detected bacteria are suggested to be colonized in the nares and to cause bacterial contamination of the atomizer. Of the 25 samples obtained from the spray of the drug solutions, 11 samples showed positive bacterial culture, whereas 16 control samples produced no growth of bacteria. The present study demonstrated that the atomizer widely used in the outpatient ENT clinics in Japan has a potential risk of causing cross-infection of patients.