Prevalence and Risk Factors for Retropharyngeal and Retro-Styloid Lymph Node Metastasis in Hypopharyngeal Carcinoma

PURPOSE/OBJECTIVE(S)

We evaluated the prevalence and identified the risk factors for retropharyngeal and retro-styloid lymph node metastasis (LNM) in patients with hypopharyngeal carcinoma (HPC). This was achieved using a combination of MR and FDG-PET/CT images.

MATERIALS/METHODS

Two board-certified radiation oncologists, who experienced 16 and 18 years in the diagnosis and treatment of head and neck cancers retrospectively reviewed pretreatment FDG-PET/CT images and contrast-enhanced thin-slice CT and MR images of 155 patients with HPC who underwent radiotherapy. Observers assessed these images without prior knowledge of the patient's clinical information and disagreements were resolved by consensus. The radiological diagnostic criteria for lateral retropharyngeal LNM (RPLNM) and retro-styloid LNM (RSLNM) were a short-axis diameter of ≥5 mm and/or necrosis and/or abnormal FDG uptake. Any visible medial RPLN was defined as LNM.

RESULTS

RPLNM was confirmed in 20 (13%) patients. Of these, 10 (6%) had ipsilateral RPLNM, 5 (3%) had contralateral RPLNM, and 5 (3%) had bilateral RPLNM. No patients were diagnosed with medial RPLNM. Fisher's exact test revealed tumor site (p = 0.006), T category (p = 0.049), and cervical LNM (p < 0.001) to be significantly associated with RPLNM. Logistic regression analysis revealed posterior wall (PW) tumors (odds ratio [OR]: 4.128, 95% confidence interval [CI]: 1.339-12.727; p = 0.014) and bilateral or contralateral cervical LNM (OR: 11.577, 95% CI: 2.135-62.789; p = 0.005) to be significantly correlated with RPLNM. The RPLNM was found in 9 (32%) of the 28 patients with PW tumors. Of these 9 patients, 2 (7%) had ipsilateral RPLNM, 3 (11%) had contralateral RPLNM, and 4 (14%) had bilateral RPLNM. Fisher's exact test revealed the PW tumors to be significantly associated with contralateral RPLNM (p < 0.001). Retro-styloid LNM (RSLNM) was confirmed in two (1%) patients, both of whom had ipsilateral RSLNM with lymph nodes (LNs) of ≥15 mm in the upper limit of ipsilateral level II. Fisher's exact test revealed the LN of ≥15 mm in the upper limit of ipsilateral level II to be significantly associated with ipsilateral RSLNM (p = 0.001).

CONCLUSION

The RPLNM was identified in 13% of patients with HPC. The PW tumors and bilateral or contralateral cervical LNM were risk factors for RPLNM; particularly, PW tumors were a specific risk factor for contralateral RPLNM. Although the RSLNM was rare, LNs of ≥15 mm in the upper limit of ipsilateral level II were a risk factor for ipsilateral RSLNM.

Coronary microvascular function in patients with angina with no obstructive coronary artery disease-What factors affect it clinically or angiographically?

Background

In the clinical setting, we have often experienced patients with angina with no obstructive coronary artery disease (ANOCA), and it has been proposed that the presence of coronary microvascular dysfunction (CMD) play a pivotal role in the pathogenesis of ANOCA. Thus, it is important to assess coronary microvascular function (CMF). However, it has not been clarified what clinical factors or lesion characteristics on coronary angiography (CAG) affect CMF. Thus, we investigated the relationship between CMF and clinical factors or lesion characteristics on CAG in patients with ANOCA.

Methods

Thirty-four patients with chest pain, who underwent CAG, spasm provocation test (SPT) and CMF test, were enrolled. We excluded patients who had moderate coronary stenosis (% stenosis &gt;30%). In the SPT with acetylcholine for left coronary artery and right coronary artery (RCA), the coronary spasm was defined as &gt;90% narrowing of coronary artery on CAG accompanied with chest symptoms and/or ST-T changes on ECG during SPT, and coronary microvascular spasm (MVS) was defined as ≤90% narrowing of coronary artery on CAG with accompanied with chest pain and ST-T changes during SPT. In each coronary artery, the presences of atherosclerosis (20%≤%stenosis≤30%), focal spasm (spasm occurred within one segment of AHA classification), diffuse spasm (spasm occurred over two segments of AHA classification) and MVS, were checked. In the CMF test with a pressure-wire during adenosine triphosphate infusion, the index of microvascular resistance (IMR) was measured. IMR values were obtained in 34 of the left anterior descending coronary artery (LAD) and 12 in RCA. In each patient, conventional coronary risk factors, blood chemical parameters, peripheral endothelial function such as flow-mediated dilation (FMD) of brachial artery and left ventricular mass index (LVMI) were checked.

Results

In 34 patients, clinical factors including blood chemical parameters, FMD and LVMI, except for smoking status did not affect IMR values on LAD. Only the smoking status was associated with IMR values as follows: median IMR values were 44, 22 and 25 in current smokers (n=5), past smokers (n=8) and never smokers (n=21, p=0.03), respectively. In 46 coronary arteries, the presence of atherosclerosis, the type of the coronary spasm, such as focal and diffuse spasm and MVS, did not affect the IMR values, however, it was significantly higher in the RCA (median 38) than that in the LAD (median 26, p=0.02).

Conclusion

These results suggest that smoking status affected CMF in patients with ANOCA, suggesting the possibility of improvement of CMF by stop smoking in such patients. In addition, in the assessment of CMF, it may be important to take into account which coronary artery being evaluated.

Funding Acknowledgement

Type of funding sources: None.

Clinical characteristics and prognosis in patients with multi-vessel coronary spasm – comparison with those in patients with single-vessel coronary spasm

Background

We have sometimes experienced patients with vasospastic angina (VSA), who showed multi-vessel spasm (MVS) on coronary angiography (CAG) and spasm provocation test (SPT). However, it has not been clarified what clinical characteristics VSA patients with MVS have or whether such patients have poor prognosis. Therefore, we compared the clinical characteristics and prognosis in VSA patients with MVS with those in VSA patients with single-vessel spasm (SVS).

Methods

One hundred and fifty-two patients (mean age: 67 yrs, 74 men and 78 women) with VSA, in which presence of coronary spasm was assessed in both left coronary artery (LCA) and right coronary artery (RCA) on SPT, were subjected. We defined VSA as the presence of more than 90% narrowing of the epicardial coronary artery on angiograms, accompanied by the usual chest symptoms and/or ischemic ST-T changes on electrocardiogram. On SPT, MVS was defined as the presence of spasm on ≥ two major coronary arteries. Base on the presence of MVS, patients were divided into the following 2 groups: MVS group and SVS group. The frequencies of conventional coronary risk factors, the average times of anginal attack (per month), the findings of SPT such as spasm provocation induced by low dose of acetylcholine (LDA) and total occlusion due to coronary spasm (TOC), the number of coronary vasodilators at discharge, and the major cardiovascular events (MACE) including death of any cause and readmission due to heart failure, acute coronary syndrome and unstable angina, were compared in the two groups.

Results

There were 98 patients (64%) in the MVS group and 54 patients (36%) in the SVS groups. The frequencies of conventional coronary risk factors and the average times of anginal attacks (4/month in both groups) were not different in the two groups. The frequencies of LDA (33% in MVS and 17% in SVS, p&lt;0.05) and TOC (12% in MVS, 0% in SVS, p&lt;0.01) were higher in the MVS group than in the SVS group. The average numbers of coronary vasodilators was higher in the MVS group (1.1±0.4) than in the SVS group (0.9±0.4, p&lt;0.01). The frequency of MACE did not differ in the two groups as follows (figure).

Conclusions

These findings suggest that there was no clinical characteristic, suggesting the presence of MVS in VSA patients. Such patients may have higher VSA activity on SPT and have more aggressive medications, leading to the similar prognosis in VSA patient with SVS.

Funding Acknowledgement

Type of funding sources: None.

Perfusion-metabolic mismatch in myocardial scintigraphy in patients with vasospastic angina: what does it mean clinically?

Background

It has been reported that perfusion-metabolic mismatch (PMM) in thallium-201 (Tl) and 123I-βmethyl-p-iodophenyl-pentadecanoic acid (BMIPP) shows important information regarding myocardial ischemia in the clinical setting. Such findings have been frequently obtained, even in patients with vasospastic angina (VSA). However, it has not been fully clarified what such findings mean clinically in patients with VSA. There, we investigated the frequency of PMM in patients with VSA as well as clinical characteristics of patients with VSA who have PMM.

Methods

Seventy-eight patients (mean age: 70 yrs, 29 men and 49 women) were diagnosed with VSA by coronary angiography and spasm-provocation test (SPT). We defined VSA as the presence of more than 90% narrowing of the epicardial coronary artery on angiograms, accompanied by the usual chest symptoms and/or ischemic ST-T changes on electrocardiogram. On SPT, multi-vessel spasm was defined as the presence of spasm on ≥ two major coronary arteries. Dual myocardial scintigraphy with Tl and BMIPP was performed, and the presence of PMM was defined as the summed rest score (SRS) in BMIPP scintigraphy ≥4 and difference in SRS in BMIPP and Tl-201 ≥4. Patients were divided into two groups according to the presence of PMM: Group I (+PMM, n=30) and Group II (−PMM, n=48). Each patient with VSA was assessed for conventional coronary risk factors, numbers of angina attacks per month, and taking vasodilators.

Results

Age, gender distribution, and conventional risk factors were not different between the groups. The median number of angina attacks was higher in the Group I than in the Group II (Group I: 4.5 vs. Group II: 0.1, p&lt;0.01), and fewer patients were taking vasodilators in Group I (Group I: 1.1±1.0 vs. Group II: 1.5±1.1, p&lt;0.05). On SPT, the presence of multi-vessels spasm was significantly higher in Group I (76%) than Group II (44%, p&lt;0.05). Logistic regression analysis showed that the presence of multi-vessels spasm (p&lt;0.05) and taking a smaller amount of vasodilators (p&lt;0.05) were associated with PMM.

Conclusions

These findings suggest that PMM in Tl and BMIPP scintigraphy are associated with multi-vessels spasm and a smaller amount of vasodilator medication. This imaging data may provide important information regarding activity of VSA and sufficient medication.

Funding Acknowledgement

Type of funding source: None

A ten-year survey of bacteriuria in the Osaka university hospital

10 consecutive years of observation of the laboratory data of quantitative urinary bacterial culture in the Central Clinical Laboratory of Osaka University Hospital was made. The marked rise of Pseudomonas and other Enterobacteriaceae was clearly demonstrated. The difference in bacterial species in bacteriuria between inpatients and outpatients strongly suggests that the origin of infection was quite different. The disappearance of Staph. aureus as a causative agent was also demonstrated.

Ménière's disease in childhood

We report 3 rare cases of Ménière's disease in children. In Case 1 and 3, vertigo, hearing loss and tinnitus recovered soon after medical therapy. In Case 2, however, vertigo recurred and the hearing level on the right side markedly deteriorated. The equal-loudness contours on three-dimensional audiogram showed that right-sided aggravated hearing loss fluctuated for 4 years at middle-and low-frequencies despite medication. Finally intratympanic injection of gentamicin sulfate was performed. The patient has had no definitive spell of vertigo after gentamicin therapy. At our department, the incidence of Ménière's disease in pediatric patients with vertigo was 2.9%.

Vestibular abnormalities in congenital disorders

This paper reviews the histopathologic features of vestibular abnormalities in congenital disorders affecting the inner ear, based upon a comprehensive literature survey and a review of cases in our temporal bone collection. The review proceeds in three systematic steps. First, we surveyed associated diseases with the major phenotypic features of congenital abnormalities of the inner ear (including the internal auditory canal and otic capsule). Second, the vestibular anomalies are examined specifically. Finally, the anomalies are discussed from a developmental perspective. Among vestibular anomalies, a hypoplastic endolymphatic duct and sac are observed most frequently. Anomalies of the semicircular canals are also often observed. From embryological and clinical viewpoints, many of these resemble the structural features from fetal stages and appear to be associated with vestibular dysfunction. It is expected that progress in genetic analysis and accumulation of temporal bone specimens with vestibular abnormalities in congenital diseases will provide crucial information not only for pathology of those diseases, but also for genetic factors that are responsible for the specific vestibular abnormalities.

Temporal bone histopathological study of Noonan syndrome

Four temporal bone specimens, obtained from three individuals 1--6 years of age with Noonan syndrome (NS), were studied histopathologically. All four specimens were accompanied by similar inner ear abnormalities including the reduced number of spiral ganglion cells, enlarged lateral semicircular canal, and dislocated endolymphatic sac and vestibular aqueduct. The mean population of spiral ganglion cells (15,699 cells) was approximately half of those (32,978 cells) in four age-matched control cases. In addition, they had several middle ear abnormalities including the remaining mesenchyme and dehiscence of the facial canal. To our knowledge, this is the first report to describe the histopathological temporal bone findings in patients with NS. We discuss the implications of the observed abnormalities with regard to clinical issues.

Apoptosis induced by hypertonicity in Madin Darley canine kidney cells: protective effect of betaine

BACKGROUND

In mammals, the renal medulla is in a hypertonic environment related to the renal concentrating mechanism. Renal cells accumulate osmolytes such as betaine to protect cells from the perturbing effect of high concentration of electrolytes. Hypertonicity-induced cell death and the effect of betaine were investigated in Madin Darby canine kidney (MDCK) cells.

METHODS

Cell viability was detected by 3-(4,5-dimethylthiazo-2-yl)-2,5-diphenyl tetrazolium bromide assay. DNA fragmentation was determined by FACS analysis, terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) staining and agarose gel electrophoresis. Activities of caspase-1, -3, -8, and -9 were measured.

RESULT

When the cells were exposed to 700 mOsm medium for 24 h, 40% of the cells were detached. TUNEL staining showed that about 20% of detached cells were apoptotic, indicating that both necrosis and apoptosis contributed to the hypertonicity-induced cell death in MDCK cells. DNA laddering was demonstrated in hypertonic cells. Caspase-3, -8, and -9 activities of the adherent cells exposed to 700 mOsm for 24 h increased approximately 20-, 3-, and 4-fold the value of isotonic cells, respectively. However, there was no significant change in caspase-1 activity. Addition of 1 mM betaine into the medium protected the cells against the hypertonicity-induced cytotoxicity and apoptosis. Betaine prevented the induction of caspase-3, -8, and -9 activities after hypertonic exposure to about 50%.

CONCLUSIONS

The present study demonstrates that (i) apoptosis is involved in the hypertonicity-induced cell death in MDCK cells; (ii) caspase-3, -8, and -9 may contribute to the apoptosis; and (iii) betaine has protective effect on the hypertonicity-induced apoptosis.

Transcardiac 8-iso-prostaglandin F(2 alpha)generation from acute myocardial infarction heart: insight into abrupt reperfusion and oxidant stress

8-iso-prostaglandin F(2 alpha)(8-iso-PGF(2 alpha)), a representative isoprostane, has been reported to be a reliable marker for oxidant stress in vivo. To examine if 8-iso-PGF(2 alpha)is generated in patients with acute myocardial infarction (AMI), we measured the level of immunoreactive 8-iso PGF(2 alpha)in the great cardiac vein as well as classical eicosanoids, 6-keto-prostaglandin F(1 alpha)(6-keto-PGF(1 alpha)) and thromboxane B(2)(TXB(2)) in the process of urgent coronary balloon angioplasty. Fourteen patients with anterior AMI were divided into two groups: the totally occluded (n=7) and the already perfused groups (n=7). In the former, transient elevation of 8-iso-PGF(2 alpha)was observed immediately after the angioplasty, i.e. the ratio of post-angioplasty level to pre-level was approximately 2.4 for 8-iso-PGF(2 alpha), 14 for 6-keto-PGF(1 alpha), and 5 for TXB(2). In the already perfused group, the levels of these eicosanoids were unchanged. In the totally occluded group, peak creatine phosphokinase in a peripheral vein was correlated with the level of 8-iso-PGF(2 alpha)(r(2)=0.841, P<0.01), but not with those of the other two eicosanoids. In conclusion, transcardiac 8-iso-PGF(2 alpha)generation is a reliable marker for the size of myocardium exposed to oxidant stress.

Evaluation of nasotracheal aspiration as a diagnostic tool for Rhodococcus equi pneumonia in foals

The reliability of preparing bacteriological cultures from nasotracheal aspirates of foals routinely in order to diagnose R. equi pneumonia in foals was studied by isolating Rhodococcus equi from specimens obtained from 96 foals by nasotracheal aspiration with a silicon catheter. Results were compared with specimens obtained from 21 foals by transtracheal aspiration (percutaneous tracheal puncture). These 117 foals showed clinical signs of respiratory tract infection at sampling. R. equi was isolated from 14 of 21 (66.7%) specimens by transtracheal aspiration and from 59 of 96 (61.4%) specimens by nasotracheal aspiration, 649 of 655 isolates (99.1%) from the 73 positive specimens were virulent R. equi, and the culture-positive foals were diagnosed as having R. equi pneumonia. To assess the contamination of aspirates by organisms from the nasopharynx, the results of R. equi isolation from nasal swabs obtained from 56 of the 96 foals were compared to those obtained by nasotracheal aspiration from the same foals. R. equi was isolated from 2 of the 56 nasal swabs: one from a tracheal aspirate was positive, and the other was not. These results suggest that the nasotracheal aspiration technique, which is noninvasive and not associated with complications, could be used as an alternative to the transtracheal aspiration method, especially for the diagnosis of R. equi pneumonia in foals.

Liposarcoma of the tongue: case report and literature update

Liposarcoma is an exceedingly rare tumor in the oral cavity. We report a case of a 70-year-old man with liposarcoma that presented as a lump on the tongue. The excised tumor was diagnosed as a well-differentiated lipoma-like liposarcoma. The majority of cases of well-differentiated liposarcoma follow a relatively benign course, but the disease has a high recurrence rate. It appears that accurate clinical and histopathologic diagnosis of this lesion is difficult. The prognosis seems to depend on the histologic type, size, and location of the lesion. Wide surgical excision is important for successful management of these liposarcomas.

Necrosis of the tongue after transient ischemic attack

We report an unusual case of necrosis of the tongue after transient ischemic attack in a 67-year-old man. Angiography revealed occlusion of the right external carotid artery at the bifurcation of the common carotid artery. Debridement of the wound and removal of the necrotic tissue resulted in good healing.

4-methylcatechol, a potent inducer of nerve growth factor synthesis, protects spiral ganglion neurons from aminoglycoside ototoxicity--preliminary report

The degeneration of spiral ganglion neurons after hair cell destruction following aminoglycoside ototoxicity is associated not only with the direct effect on the neurons, but also with a loss of neurotrophic factors provided by auditory hair cells. The neurotrophic factors, including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), have been reported to be effective in enhancing neuronal survival against aminoglycoside ototoxicity in vivo. To determine whether 4-methylcatechol (4-MC), a potent inducer of nerve growth factor synthesis, can protect spiral ganglion neurons after aminoglycoside treatment in vivo, we studied the spiral ganglion neurons of gentamicin (GM)-treated mice with or without 4-MC administration. We found that the number of surviving spiral ganglion neurons of 4-MC-treated animals was significantly greater than for those treated with GM alone. Our results suggest that 4-MC promotes synthesis of NGF (and/or other neurotrophins), which enhances spiral ganglion neuron survival after gentamicin treatment.

Does TUNEL staining during peri- and post-natal development of the mouse inner ear indicate apoptosis?

Terminal deoxyribonucleotidyl transferase (TDT)-mediated dUTP-digoxigenin nick end labelling (TUNEL) is being used more frequently to investigate programmed cell death (PCD). We have applied this method in order to examine how PCD is involved in the development of the mouse inner ear. In a series of studies, we identified a population of TUNEL-positive cells in the perinatal mouse ear that could not be regarded as apoptosis based upon morphological features of the nuclei. Theoretically, TUNEL detects DNA fragmentation, which can also occur in necrosis. Other authors regard TUNEL-positive cells in the sensory epithelia of the rat equilibrium organs between gestational day (GD) 19 and 7 days after birth (DAB) as apoptosis. We determined whether or not cells in the inner ear of perinatal and post-natal mice were TUNEL-positive due to apoptosis. We stained the inner ears of BALB/c mice aged GD17.5-4 weeks by the TUNEL method and analysed morphology by light microscopy and transmission electron microscopy (TEM). TUNEL-positive cells were distinct in the saccule from DAB3, and in the cochlea from DAB8. The number of TUNEL-positive cells in the hair cells of the saccule and in the cochlea increased with age, and seemed to reach a plateau just before 2 weeks of age. However, morphological analyses did not reveal findings characteristic of apoptosis. We conclude that these TUNEL-positive cells were labelled not because of apoptosis, but due to necrosis or post-mortem autolysis. We surmise that TUNEL staining can identify vulnerable cells of the inner ear that consume high levels of oxygen and easily undergo autolysis.

TUNEL staining of inner ear structures may reflect autolysis, not apoptosis

A recent study (Usami et al., 1997) using the TUNEL method has suggested that age-related cell death in the senescence-accelerated mouse inner ear is due to apoptosis. TUNEL staining detects not only apoptosis but also late necrosis or autolysis because it detects DNA breaks. Autolysis may occur in inner ear structures during fixation. To determine whether or not age-related cell death is due to apoptosis, TUNEL staining of the inner ear of normal mice should be understood. However, studies of TUNEL staining of the normal inner ear have not yet been reported. We investigated whether the fixation method or the interval between the death of normal mice and the initiation of fixation influences the results of TUNEL staining of the inner ear. Marginal cells of the stria vascularis and hair cells of the saccule were TUNEL-positive, irrespective of the fixation method or the interval between death and fixation. Interdental cells, Reissner membrane cells, fibrocytes in the suprastrial region, and inner and outer hair cells were also occasionally stained. Transmission electron microscopy showed no morphological characteristics of apoptosis in the hair cells of the saccule. Moreover, patterns of TUNEL staining in the normal and senescence-accelerated mouse inner ear were similar. These stained tissues may require a high level of oxygen, making them more susceptible to autolysis. We concluded that the results of TUNEL staining in the inner ear require confirmation by morphological studies.

Effect of hypertonic stress on amino acid levels and system A activity in rat peritoneal mesothelial cells

OBJECTIVE

Peritoneal mesothelial cells (PMC) are exposed to a hypertonic environment during peritoneal dialysis. When exposed to a hypertonic medium, many types of cells accumulate small osmotically active organic solutes, which are called osmolytes, to match the higher external osmolality. However, no information has been available concerning the osmolytes in PMC. To investigate osmoregulation in rat PMC, the levels of amino acids in the cells and the activity of system A, a major neutral amino acid transport, were measured after switching to a medium made hypertonic by the addition of NaCl. System A was measured by Na+-dependent [14C]-2-methylamino-isobutyric acid (MeAIB) uptake.

RESULTS

Total amount of 20 amino acids increased from 306 to 757 nmol/mg protein after 12 hours of hypertonicity. The amount of neutral amino acids accounted for 81% of the increase in total amino acids. Glutamine, alanine, glycine, threonine, and serine were the major neutral amino acids that accumulated in the hypertonic mesothelial cells. The amount of neutral amino acids increased 2.9-fold after 12 hr of hypertonicity, and decreased thereafter. MeAIB uptake increased 36-fold relative to the uptake in isotonic cells after 4-8 hr of hypertonicity. When the culture medium was made hypertonic by adding raffinose or glucose, the activity of system A was also stimulated (raffinose > glucose > NaCl). System A was located on both the apical and basal sides of isotonic PMC, and extracellular hypertonicity stimulated the MeAIB uptake on both sides.

CONCLUSIONS

These data indicate that neutral amino acids and system A transport play an important role in early-phase osmoregulation in rat peritoneal mesothelial cells.

Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete

On the basis of alterations in varicella-zoster virus (VZV) antibody titers, it appears that Bell's palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bell's palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bell's palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bell's palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bell's palsy in some patients could be associated with VZV reactivation.

Gap junction change in supporting cells of the organ of Corti with ryanodine and caffeine

It has been demonstrated that the gap junctions of the supporting cells of the organ of Corti are controlled by H+ and Ca2+. Inside these cells there is a tubular structure. It is supposed that this network is endoplasmic reticulum. Calcium release from inside the cells, and the effect of calcium on the gap junctions of these cells, were investigated under whole cell clamping application of ryanodine and caffeine. Membrane capacitance and membrane resistance were calculated, with corrections for changes in whole cell parameters. Ryanodine-treated cells (1 microM-10 mM), caffeine-treated cells (5 mM 500 nM) and A23187-treated cells were uncoupled at their gap junctions. Therefore, Ca2+ plays a role in the uncoupling of the gap junctions in supporting cells of the organ of Corti from inside the cells.

Programmed cell death in the development of the mouse external auditory canal

Programmed cell death (PCD) is an essential event for development. The purpose of this work was to ascertain how PCD, in vivo designated apoptosis, is involved in the development of the external auditory canal. We performed a time sequence study of the distribution of apoptosis during the development of external auditory canal (EAC) of the mouse. ICR mice ranging in age from embryonic day 11.5 (E11.5) to 12 days after birth (DAB) were used in the present study. A part of each head including both ears was removed and was processed according to its purpose. Light and electron microscopy for morphological studies and TUNEL method (Gavrieli et al. [1992] J Cell Biol., 119:493-501) for histochemical studies were used. On E11.5, distinct TUNEL-positive staining occurred in the branchial arch. Between E15.5 and 1DAB, TUNEL-positive cells were observed throughout the EAC and the number of these cells decreased with age. On E15.5 and E16.5, numerous TUNEL-positive cells were observed in a cavity remained in the epithelial plate. Transmission electron microscopy revealed that these cells had the features of apoptosis. From 3-12 DAB, no apoptosis was observed in the EAC except for the terminal differentiation of the skin of the EAC. Apoptosis was not observed during recanalization of the EAC, but occurred during the formation of the epithelial plate. The investigation established that PCD is involved in the formation of the epithelial plate, whereas only cornification of the epithelium of the EAC is associated with recanalization.

Programmed cell death in the mouse cochleovestibular ganglion during development

Programmed cell death (PCD) is as essential to development as is cell proliferation. Our objective was to elucidate the spatiotemporal occurrence of PCD during the development of the cochleovestibular ganglion. We performed a time-sequence study on the distribution of in situ PCD, apoptosis, during the development of the mouse cochleovestibular ganglion by using the TUNEL method to detect apoptosis histochemically. Apoptosis in the cochleovestibular ganglion was observed from the 11.5th gestational day (GD) to the 18. 5th GD. Apoptosis was seen most extensively in the vestibular ganglion cells at the 13.5th GD, while in the spiral ganglion cells apoptosis was maximal between the 15.5th and 16.5th GD. Because these times of peak apoptotic activity almost exactly corresponded to the events of innervation and terminal mitosis of the cochleovestibular ganglion cells, we infer that PCD is involved in the innervation and modulates the number of cochleovestibular ganglion cells overproduced by terminal mitosis.

Serum and urinary boron levels in rats after single administration of sodium tetraborate

The pharmacokinetics of boron was studied in rats by administering a 1 ml oral dose of sodium tetraborate solution to several groups of rats (n=20) at eleven different dose levels ranging from 0 to 0.4 mg/100 g body weight as boron. Twenty-four-hour urine samples were collected after boron administration. After 24 h the average urinary recovery rate for this element was 99.6+/-7.9. The relationship between boron dose and excretion was linear (r=0.999) with a regression coefficient of 0.954. This result suggests that the oral bioavailability (F) of boron was complete. Another group of rats (n=10) was given a single oral injection of 2 ml of sodium tetraborate solution containing 0.4 mg of boron/100 g body wt. The serum decay of boron was followed and found to be monophasic. The data were interpreted according to a one-compartment open model. The appropriate pharmacokinetic parameters were estimated as follows: absorption half-life, t1/2a=0.608+/-0.432 h; elimination half-life, t1/2=4.64+/-1.19 h; volume of distribution, Vd = 142.0+/-30.2 ml/100 g body wt.; total clearance, Ctot=0.359+/-0.0285 ml/min per 100 g body wt. The maximum boron concentration in serum after administration (Cmax) was 2.13+/-0.270 mg/l, and the time needed to reach this maximum concentration (Tmax) was 1.76+/-0.887 h. Our results suggest that orally administered boric acid is rapidly and completely absorbed from the gastrointestinal tract into the blood stream. Boric acid in the intravascular space does not have a strong affinity to serum proteins, and rapidly diffuses to the extravascular space in proportion to blood flow without massive accumulation or binding in tissues. The main route of boron excretion from the body is via glomerular filtration. It may be inferred that there is partial tubular resorption at low plasma levels. The animal model is proposed as a useful tool to approach the problem of environmental or industrial exposure to boron or in cases of accidental acute boron intoxication.

Osteoma with cholesteatoma in the external auditory canal

We report an unusual case of a 13-year-old girl with a benign osteoma associated with a cholesteatoma in the external auditory canal and serous otitis media. The osteoma was located in the antero-inferior wall of the right external auditory canal. A cholesteatoma was present between the osteoma and the tympanic membrane. Computed tomography revealed a soft tissue density within the external auditory canal and in the middle ear cleft. The shadow in the middle ear cleft was considered to represent the serous otitis media. Surgical removal of the osteoma and cholesteatoma proved successful, and no recurrences or complications have occurred in the first year postoperatively.

Programmed cell death in the developing epithelium of the mouse inner ear

Programmed cell death is as essential to development as is proliferation. Thus, the objective of this study was to elucidate the spatiotemporal involvement of programmed cell death in the development of the inner ear epithelia. Programmed cell death is seen in situ as apoptosis. A time-sequence study was performed on the distribution of apoptosis during the development of the inner ear epithelia of the mouse using the TdT-mediated dUTP-biotin nick labeling (TUNEL) method to detect apoptosis histochemically. Apoptosis occurred during the early stages of development of the inner ear and took place earlier in the organs of equilibrium than in the cochlea. These periods corresponded to those of active proliferation of epithelial cells in the inner ear. Since cell-cell interactions change after the removal of neighboring cells by apoptosis, apoptosis may influence cytodifferentiation.

A full-thickness chondrocutaneous flap from the auricular concha for repair of tracheal defects

A free full-thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft.

Combined hepatocellular carcinoma and cholangiocarcinoma in a mare

A hepatic malignant tumour composed of both hepatocellular and cholangiocellular elements was studied histologically, immunohistochemically and electron microscopically in an 18-year-old Thoroughbred mare. Bile canaliculi and alpha-fetoprotein were useful in identifying the hepatocellular element, and mucin and keratin were good markers of biliary differentiation. The simultaneous presence of bile canaliculi and mucin-producing cells in most of the neoplastic lesions suggested that this tumour arose from a stem cell with capacity to differentiate into hepatocytes and biliary epithelium.

A double-muscle transfer using a divided rectus femoris muscle for facial-paralysis reconstruction

There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

Osmotic regulation of amino acids and system A transport in Madin-Darby canine kidney cells

The effects of hypertonicity on the intracellular amino acid content and system A transport activity were studied in Madin-Darby canine kidney (MDCK) cells. Total content of 20 amino acids increased from 274 to 689 nmol/mg protein after 8 h of hypertonicity (500 mosmol/ kg), remaining almost constant until after 6 days of hypertonicity. The content of neutral amino acids increased from 77 to 307 and 395 nmol/mg protein after 8 h and 6 days of hypertonicity, respectively, accounting for 73% of the increased amount of total amino acids. In the hypertonic MDCK cells, system A transport activity, measured by Na+-dependent 2-(methylamino)isobutyric acid (MeAIB) uptake, increased approximately 60-fold relative to the uptake in isotonic cells. MeAIB was taken up primarily on the basal side in the isotonic MDCK cells cultured on permeable supports. Extracellular hypertonicity stimulated the MeAIB uptake predominantly on the basal side. These results indicated that amino acids, especially neutral amino acids, can function as volume-regulating osmolytes and that the stimulation of system A activity appears to contribute to the accumulation of neutral amino acids in hypertonic MDCK cells.

Three-dimensional combined flaps for reconstruction of complex facial defects following cancer ablation

Instead of conventional multiple-paddle or folded free flaps, the authors introduce three types of free combined tissue transfers for cosmetic and functional restoration of massively large facial defects. Three cases reported here were repaired with combined flaps consisting of two or more tissues, such as combined free anterolateral thigh flaps and vascularized muscle or bone grafts. In cases with complex defects in the upper lateral face, facial dynamics were also reconstructed with a free vascularized innervated muscle graft. A complex hemifacial defect involving the orbita and nose can be easily reconstructed with free osteocutaneous flaps in two stages. For complex craniofacial defects, the concept of combined chimeric tissue transfers is most suitable. The ideal pedicle vessels for the combined flaps are considered to be those in the lateral circumflex femoral system, which is far from the head and neck regions, because flap elevation can proceed simultaneously with tumor resection.

Mechanism of induction of prostaglandin E2 production by endothelin 1 in cultured rat mesangial cells

The phospholipase A2 inhibitors mepacrine, ONO-RS-082, and AACOCF3 completely inhibited prostaglandin E2 production induced by endothelin 1 in cultured rat mesangial cells, suggesting that phospholipase A2 is a critical enzyme in this process. TMB-8, an inhibitor of calcium mobilization from intracellular stores, abolished its production, while neither nicardipine nor chelation of extracellular calcium by EGTA did. The protein kinase C inhibitors, H-7 and staurosporine, and downregulation of protein kinase C could not inhibit prostaglandin E2 production, while W-7, a calmodulin inhibitor, abolished it. Pertussis toxin never influenced its production. Thus, endothelin 1 evokes prostaglandin E2 production in mesangial cells mainly through the activation of phospholipase A2, dependent on intracellular calcium and calmodulin and independent of extracellular calcium, protein kinase C, and pertussis toxin sensitive guanosine 5'-triphosphate binding proteins.

[Report on the accuracy and the reliability of dip sticks]

Urinary examination with dip sticks is essential for clinical screening test and primary health care. Recently Japanese Society of Clinical Pathology has stressed the clinical use of dip sticks. Many dip sticks are available in Japan. However, few attempts have been done for external quality control of dip sticks. It is well known that there are considerable differences in the accuracy, sensitivity and stability of dip sticks. Makers are at variance in indicating concentration levels in accordance with the given color charts. Some urine chemistry analyzers for dip sticks have been developed. There was a few cases of simultaneous study on dip sticks from various makers. We, four technologists have attempted external quality control of eleven dip sticks for protein, glucose and occult blood with the same lot number (one was only for glucose) using the four different pooled urine samples and two artificial urine samples. Based on the results of this study, the following proposal to improve the accuracy and reliability of dip sticks was derived. 1) Users should have a plenty of knowledge on the difference of the quality of dip sticks of each makers. 2) Makers of dip sticks should clarify to users the method of examination, standard materials and errors. 3) Users should perform internal quality control using different pooled urine samples or different artificial urine samples on a daily basis before going with the routine work.

Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application

The medial thigh flap is a perforator-based flap nourished with septocutaneous or muscle perforators originating from the femoral vessels. To date, 8 patients have been repaired with this flap and extended or connected flaps including this flap: 4 patients with lower leg defects and 4 patients with intraoral and neck defects. The advantages of this flap are (1) several pedicle perforators exist for this flap, which makes possible duplicated vascular anastomoses to establish reliable circulation of the transferred flap; (2) the flap can be extended or connected to other neighboring flaps in the anterior thigh, so that extensively wide defects can be closed in one stage; (3) the great saphenous vein can be simultaneously used as a vein graft or for venous drainage for the flap; (4) the anterior branch of the femoral nerve can be used for sensory potential; and (5) there is minimum morbidity of the donor defect and a large dominant vessel for the leg can be preserved. The suitable indications for this flap are defects after removal of skin cancer in the foot or lower leg and wide defects after resection of head and neck cancer, which can be reconstructed with the flap connected to neighboring skin flaps. The disadvantages of this flap are that it has a small, short vascular pedicle and the bulkiness of the flap's fatty tissue often requires thinning.

[Pathological evaluation of superselective one-shot intra-arterial infusion chemotherapy for head and neck tumors]

Since 1992, we have treated 43 patients with head and neck tumors by superselective intra-arterial infusion chemotherapy (SIIC) via femoral artery. In 8 patients among then, operation was performed thereafter with/without radiation therapy (RT). CDDP and/or CBDCA were utilized as the chemotherapeutic modality. Only SIIC or RT showed Grade (Gr.) 0-2b pathological effects on Oboshi-Shimosato classification scheme, while a combination of SIIC and RT exhibited Gr. 2b-4 pathological effects. We conclude that a combination of SIIC and RT was most effective and had induced degeneration or necrotic changes in the tumor tissue.