Tsutomu Nonoyama

Immunohistochemical localization of cytokines and cell adhesion molecules in maxillary sinus mucosa in chronic sinusitis

OBJECTIVE Chronic sinusitis is a common disease characterized by persistent inflammation of the nasal and paranasal sinus mucosa. Accumulating evidence supports the importance of proinflammatory cytokines and endothelial cell adhesion molecule (CAM) expression as an initiating process in tissue inflammation. This study was conducted to investigate the localization of major cytokines and CAMs in the maxillary sinus mucosa from patients with chronic sinusitis and from normal subjects. METHODS Maxillary sinus mucosal specimens from patients with chronic sinusitis (n = 10) and from normal subjects (n = 6) were immunostained with specific antibodies directed against the cytokines (IL-1alpha, IL-1beta, IL-6, IL-8 and TNF-alpha) and the CAMs (intercellular adhesion molecule-1, ICAM-1 and vascular CAM-1, VCAM-1). RESULTS The number of immunoreactive cells for IL-1alpha, IL-1beta, IL-6, IL-8, and TNF-alpha was increased significantly in patients with chronic sinusitis compared with normal controls. Immunoreactivity for ICAM-1 was also increased significantly in patients with chronic sinusitis compared with normal controls, whereas VCAM-1 is only minimally expressed or is absent in both groups. CONCLUSION These findings indicate that bacterial and/or viral infection may induce functional and morphologic changes in the maxillary sinus mucosa in chronic sinusitis through enhanced generation of specific cytokines in conjunction with CAMs.

Quantitative Analysis of Mucin and Lectin in Maxillary Sinus Fluids in Patients With Acute and Chronic Sinusitis

Objectives Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea. Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients.

Two Cases of Tuberculosis of the Parotid Gland.

Tuberculosis of the parotid gland is not a common disease. We reported here two cases of tuberculosis of the parotid gland. The first case is a 78-year-old man who had a left parotid gland mass for 10 years. We suspected pleomorphic adenoma from the preoperative findings of MRI and performed a parotidectomy. Postoperative pathological findings showed a Warthins tumor of the parotid gland with tuberculosis. We realized that this case was very rare.The second case is a 76-year-old woman who had had a left parotid gland mass for 1 month. The mass had rapidly enlarged and adhered to the skin, in addition to the skin becoming reddish. She complained of tenderness at the mass. We suspected a malignant tumor of the parotid gland and performed surgical resections with the skin. Postoperative pathological findings showed tuberculosis of the parotid gland.Tuberculosis is one of the most important of the re-emerging infectious diseases in the world. We should always consider tuberculosis, because early diagnosis and treatment are mandatory.

Inverted Papilloma of the Nose and Paranasal Sinuses.

Inverted papilloma of the nose and paranasal sinuses is an uncommon lesion recognized as a neoplastic growth of the epithelium which inverts into the underlying stroma rather than proliferating outwardly from the surface. This neoplasm is uniquely characterized by its capacity to destroy bone, tendency to recur after incomplete removal, and association with malignancy. Most authors recommend lateral rhinotomy as the initial surgical approach. In 1992 and 1993, we treated 5 patients with inverted papilloma, one of which presented with bilateral disease. On computed tomography, 3 patients demonstrated opacification of the maxillary sinus, 2 showed localized mass. None of the patients showed bone destruction. Antrostomy and ethmoidectomy were performed in 5 of these cases. Lateral rhinotomy was added in one patient. Intranasal ethmoidectomy was performed in one case. Complete resection and lifelong follow-up are recommended to prevent recurrence and association with malignancy.