Yoshiaki Iguchi

Autologous transplantation of fascia into the vocal fold as a treatment for recurrent nerve paralysis

Objectives To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure.

Chemosurgery with Trichloroacetic Acid for Allergic Rhinitis

The use of 80 w/v% solution of trichloroacetic acid (TCA) for the treatment of allergic rhinitis was reported. The solution was applied to the inferior turbinates only once bilaterally. The result of the treatment in 77 nonselected cases of perennial allergic rhinitis for over 3 years showed that an improvement was obtained in 72% for nasal obstruction, 60% for sneezing, and 50% for watery nasal discharge. The result of provocation tests after treatment showed an improvement in 77% of the cases, and the histamine concentration in the nasal wash decreased. These results were discussed with reference to the result of our previous histological studies. We concluded that our method of treatment using TCA was simple and effective for allergic rhinitis without any serious side effects.

Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses: review of the last 30 years.

The clinical and pathologic features of four patients with malignant fibrous histiocytoma of the maxillary sinus were studied. All patients were male, with an age range of 43-71 years at the time of diagnosis. The main symptoms were pain in the facial region, swelling of the cheek and nasal bleeding. Pathologically, three patients were subclassified with the striform-pleomorphic type of malignant fibrous histiocytoma and one with the myxoid type. All patients were operated on and received various combinations of pre- and postoperative irradiation and intra-arterial chemotherapy given via the temporal artery. In the patient with the best prognosis, tumor extension within the maxillary sinus was minimal. Two patients developed local recurrences and died. None of the patients developed locoregional lymph node or systemic metastases.

A comparative study of suturing techniques in microlaryngosurgery.

Different types of suturing device for microlaryngosurgery were compared. A new device was developed based on the results of this comparison, and proved to be very useful.

Distribution of two types of mast cells in the nasal mucosa after chemosurgical treatment of allergic rhinitis using trichloroacetic acid.

To evaluate the efficacy of chemosurgery using trichloroacetic acid (TCA)for allergic rhinitis, two types of tissue mast cells [tryptase-positive, chymase-negative mast cells (MCT) and tryptase-positive, chymase-positive mast cells (MCTC)] in the nasal turbinate mucosa were immunohistochemically identified and their distribution was assessed in clinical cases of patients who underwent unilateral TCA treatment. A comparison of the number of MCT and MCTC between the treated and nontreated sides indicates that both types of mast cells are significantly decreased in number in the treated side both in epithelial and lamina propria layers. The results indicate that TCA treatment was effective in suppressing MCT infiltration, regarded as a major cause of antigen-dependent allergy.

Evaluation of mucociliary function in patients with allergic rhinitis treated with trichloroacetic acid : Mucociliary transit time (Saccharin time) measurements

By means of the saccharin time measurement, the mucociliary function of the nasal mucosa of the inferior turbinate was evaluated in clinical cases with allergic rhinitis after the therapeutic application of trichloroacetic acid solution. It was found that the saccharin time (ST) tended to be prolonged within 1 year after the treatment, whereas it gradually became shortened to reach the level of normal control after 3 years. The result would indicate that the mucociliary function recovered correspondingly with regeneration of the ciliary epithelium.

Chemosurgery with trichloroacetic acid for allergic rhinitis: Evaluation of the efficacy in terms of inhibition of Th2 cell infiltration

OBJECTIVE To examine local inhibition of Th2 cell infiltration as the basis for demonstrating the superior clinical effect of trichloroacetic acid (TCA) treatment for allergic rhinitis. METHODS Mirror-image sections of the inferior turbinate mucosae of both sides were obtained from 26 patients who underwent TCA treatment on one side because of the nasal anatomy status and who eventually underwent bilateral inferior turbinectomy because of failure of the TCA treatment. Th2 cell counts, defined as counts of cells positive for anti-CD4 antibody and anti-CKR4 antibody (double-positive cells) were obtained for comparison. The differences between the TCA-treated and non-TCA-treated mucosae were analyzed by Mann-Whitneys U test. RESULTS Th2 cell infiltration was characteristically found just beneath the epithelium and in the periglandular areas. The mean count+/-standard deviation of Th2 cells was 4.96+/-2.72 cells/mm(2) in the TCA-treated mucosae and 12.03+/-7.19 cells/mm(2) in the non-treated mucosae, the difference being significant (p<0.01). CONCLUSION TCA treatment induces inhibition of Th2 cell infiltration. This corroborates the suggestion that TCA treatment can inhibit local type I allergic reactions.

Reduction by a kallikrein inhibitor of the increased nasal airway resistance of allergic patients after antigen challenge.

Kallikrein activity in nasal lavage fluid, which was measured with a synthetic substrate, Pro-Phe-Arg-methylcoumarilamide, was increased in accordance with the severity of the symptoms of house-dust-mite allergic rhinitis. Antigen challenge was applied to patients with allergic rhinitis by placing a disk containing allergen on the nasal mucosa of the right inferior turbinate. Kallikrein activities and kinin levels in the nasal lavage fluid had increased significantly 15 min after the antigen challenge. These increases were accompanied by a marked increase in nasal airway resistance 15 min after antigen challenge. Pretreatment of the patients with camostat mesilate (60 mg/kg, p.o), a non-peptide serine proteinase inhibitor clinically used in Japan, inhibited the kallikrein activity in the nasal lavage fluid. The increase in nasal airway resistance after antigen challenge was also markedly reduced by oral administration of the inhibitor, indicating involvement of the kallikrein-kinin system in induction of the nasal symptoms.

An immunohistological study of the localization characteristics of thymus and activation-regulated chemokine in the allergic inferior turbinate mucosa with reference to the effectiveness of trichloroacetic acid treatment

To investigate the background of the effectiveness of trichloroacetic acid (TCA) treatment, we examined the localization of thymus and activation-regulated chemokine (TARC) on allergic inferior turbinate mucosa using immunohistological methods. After obtaining informed consent, only one side of the inferior turbinate was treated with 80% (wt/vol) TCA solution under topical anesthesia using 4% lidocaine with epinephrine in 19 cases of allergic rhinitis. Among those, 17 cases did not show clinical improvement and underwent nasal septal reconstruction surgery and turbinectomy. Bilateral inferior turbinate specimens were obtained. The untreated turbinate specimens showed positive TARC findings. The positive findings were confirmed in the outer side of cytoplasm in the stratified ciliated columnar epithelium but not in the goblet cell. In the lamina propria, the glandular tissue and a few of the infiltrated lymphocytes just beneath the epithelium up to the depth of 120 m were found TARC-positive (TARC+). The average number of positive cells in one microscopic visual field using 1003 magnification was 3.97 6 4.04. On the other hand, the epithelium of the TCA-treated side showed positive findings only in two cases. The TCA-treated side also showed a relative decrease in infiltrated cells. Even in areas where there still were infiltrated cells, they were confirmed to be TARC-negative (TARC2) after TCA treatment. It is considered that the regenerated epithelium after TCA treatment originates from the glandular epithelium with negative TARC expression existing in the area deeper than a 120-μm level and that this immunohistological change would lead to the effectiveness of TCA treatment.

Binaural Interaction of Stapedius Reflex

It is known that stapedius reflex (SR) shows bilateral interaction and that its center is located in the brainstem. In the present study, the pattern of SR was compared in two different conditions, either with binaural acoustic stimuli or with monaural stimuli using the impedance measurement method. When the sound source was placed in front of the head model, the amplitude of impedance change was higher in the binaural hearing condition than in the monaural condition, suggesting bilateral superposition. When the sound source was placed laterally to the head model, the amplitude of impedance change was higher in the ipsilateral ear than in the contralateral ear in the binaural condition. In the monaural condition, the amplitude of impedance change in the ipsilateral ear was as high as that obtained in the ipsilateral ear in the binaural condition, whereas it was markedly low in the contralateral ear. It is assumed that sense of sound direction cannot be well maintained without binaural interaction of SR.