Tomotaka Miyamura

Blockade of interleukin-6 receptor suppresses inflammatory reaction and facilitates functional recovery following olfactory system injury.

We previously reported that anti-inflammatory treatment with steroids improves recovery outcome in an olfactory nerve injury model. Clinically, however, steroid administration is not recommended in the acute phase of head injury because of concerns regarding side effects and no evidence of its efficacy. Recently, it has been reported that interleukin-6 (IL-6) plays an important role in the inflammatory reaction. The present study investigates if anti-IL-6 receptor (IL-6R) antibody can facilitate functional recovery in the olfactory system following injury. Rat anti-mouse IL-6R antibody (MR16-1) was intraperitoneally injected to severe olfactory nerve injury model mice immediately after the nerve transection (NTx). Histological assessment of recovery within the olfactory bulb was made at 5-70 days. X-gal staining labeled the degenerating and regenerating olfactory nerve fibers and immunohistochemical staining detected the presence of reactive astrocytes and macrophages/microglia. MR16-1-injected animals showed significantly smaller areas of injury-associated tissue, fewer astrocytes and macrophages/microglia, and an increase in regenerating nerve fibers. Olfactory function assessments using both an olfactory avoidance behavioral test and evoked potential testing showed improved functional recovery in MR16-1-injected mice. These findings suggest that blockade of IL-6R could provide a new therapeutic strategy for the treatment of olfactory dysfunction following head injuries.

Tumor necrosis factor-α antagonist suppresses local inflammatory reaction and facilitates olfactory nerve recovery following injury

OBJECTIVE Olfactory dysfunction is a common finding in head trauma due to injury to the olfactory nerve. We previously reported that anti-inflammatory treatment with steroids improves recovery outcome in olfactory nerve injury models. Clinically, however, steroid administration is not recommended in the acute phase of head injury cases because of concerns regarding its side effects. Tumor necrosis factor (TNF-α) is known to play a key role in inflammatory response to injury. The present study examines if the inhibition of TNF-α can facilitate functional recovery in the olfactory system following injury. MATERIALS AND METHODS Olfactory nerve transection (NTx) was performed in olfactory marker protein (OMP-tau-lacZ) mice to establish injury models. We measured TNF-α gene expression in the olfactory bulb using semi-quantitative and real time polymerase chain reaction (PCR) assays and found that they increase within hours after NTx injury. A TNF-α antagonist (etanercept) was intraperitoneally injected immediately after the NTx and histological assessment of recovery within the olfactory bulb was performed at 5-70 days. X-gal staining labeled OMP in the degenerating and regenerating olfactory nerve fibers, and immunohistochemical staining detected the presence of reactive astrocytes and macrophages/microglia. RESULTS Etanercept-injected mice showed significantly smaller areas of injury-associated tissue, fewer astrocytes and macrophages/microglia, and an increase in regenerating nerve fibers. Olfactory function assessments using both an olfactory avoidance behavioral test and evoked potential recordings showed improved functional recovery in etanercept-injected animals. CONCLUSION These findings suggest that inhibition of TNF-α could provide a new therapeutic strategy for the treatment of olfactory dysfunction following head injuries.

Metastasis of Thyroid Cancer to the Sternum after Total Thyroidectomy and Laryngectomy

Metastasis of thyroid cancer to the sternum is rare. Ablation is the therapy of choice for patients with metastasizing differentiated thyroid cancer, while surgical resection is an option for those with resectable bony metastasis. This report describes a case of a 65-year-old woman with a sternal tumor. The patient was treated by partial sternal resection and sternal reconstruction with new material polypropylene/expanded polytetrafluoroethylene (ePTFE) composite. The postoperative course was uneventful, and she was free of recurrence after 1 year of follow-up. We conclude that surgery should be used to manage solid bony metastasis from thyroid papillary carcinoma. Further more, a polypropylene/ePTFE composite may be useful for sternal reconstruction after thoracotomy.

Anti-Thyroid Therapy for Basedow's Disease

Sixty-one patients with Basedows disease were treated by anti-thyroid therapy in Yamada Red Cross Hospital. Of 44 patients who finished this therapy, complete response was observed in 41 patients. Whereas, relapse was observed in 7 of 9 patients who did not finish this therapy. Forty-one patients who maintained complete response were compared with the relapse group included 17 patients. Surgical operation was selected in 7 patients who relapsed during the anti-thyroid drug therapy. The relapse rate was high in the lower age group, and the group of patients who could not take MMI. Therefore, other therapies should be selected in these groups.

A Clinical Study of Nasopharyngeal Carcinoma.

Forty previously untreated patients with nasopharyngeal carcinoma treated for 18 years from 1981 through 1998 at the Mie University Hospital are reviewed. The male to female ratio was 2.3:1. The most frequent chief complain was cervical mass. More than half of the patients were classified into stages IIB or III. Until 1988, patients were treated mainly with radiotherapy, but the results were unsatisfactory. Since 1992, to decrease the occurrence of locoregional relapse and/or distant metastasis, we have used pirarubicin, cisplatin and peplomycin alternating with radiation, two cycle of chemotherapy alternating with two courses of radiation (30 Gy each after the first and second chemotherapy cycle). The chemotherapy consisted of pirarubicin, 30mg/m2/day on day 1, cisplatin, 50mg/m2/day on day 2 and peplomycin 5 mg/day on day 3-6, all given intravenously. The 5 years survival rate of 13 patients who recieved this new trearment was 61.5%. We conclude that alternative chemoradiotherapy is necessary for a better prognosis of nasopharyngeal carcinoma.