Clinical Characteristics of Corynebacterium ulcerans Infection, Japan.

Corynebacterium ulcerans is a closely related bacterium to the diphtheria bacterium C. diphtheriae, and some C. ulcerans strains produce toxins that are similar to diphtheria toxin. C. ulcerans is widely distributed in the environment and is considered one of the most harmful pathogens to livestock and wildlife. Infection with C. ulcerans can cause respiratory or nonrespiratory symptoms in patients. Recently, the microorganism has been increasingly recognized as an emerging zoonotic agent of diphtheria-like illness in Japan. To clarify the overall clinical characteristics, treatment-related factors, and outcomes of C. ulcerans infection, we analyzed 34 cases of C. ulcerans that occurred in Japan during 2001-2020. During 2010-2020, the incidence rate of C. ulcerans infection increased markedly, and the overall mortality rate was 5.9%. It is recommended that adults be vaccinated with diphtheria toxoid vaccine to prevent the spread of this infection.

Capillary hemangioma of the tympanic membrane.

We report a case of capillary hemangioma of the tympanic membrane in a 51-year-old man with conductive hearing loss, otalgia, and otorrhea. On examination, the external auditory canal was obstructed with a hard, dark red tumor, and purulent discharge was observed. The infection was controlled with antibiotics, but hearing loss persisted. Therefore, transcanal resection was performed. The tumor was attached to the postero-superior quadrant, and arose from the lamina propria. Histologically, the tumor was composed of multiple capillary-sized vessels surrounded by fibrous connective tissue and diagnosed as capillary hemangioma. After surgical treatment, hearing loss was diminished, and there has not been any sign of recurrence for 3 years despite the positive surgical margin.

The presence of large lymph node metastasis as a prognostic factor of papillary thyroid carcinoma.

OBJECTIVE: Papillary thyroid carcinomas often metastasize to regional lymph nodes, but the significance of lymph node metastasis as a prognostic factor has not been established. This study was conducted to determine the survival rate in patients with and without large lymph node metastasis greater than 3 cm in the maximum diameter, which are N2 or N3 for other head and neck cancers. METHODS: The survival rate was determined by using Kaplan-Meier method in 67 patients with previously untreated papillary thyroid carcinoma who underwent radical surgery at the Department of Otolaryngology, Toyooka Hospital, between 1993 and 2000. RESULTS: The prognosis was significantly poor (P=0.004) in patients with large lymph node metastasis greater than 3 cm in the maximum diameter. No significant difference was noted in the prevalence of large lymph node metastasis greater than 3 cm in the maximum diameter between different T groups. CONCLUSION: Large lymph node metastasis was considered to be a poor prognostic factor of papillary thyroid carcinoma independent of the T classification.

Increased expression of integrin beta-4 in papillary thyroid carcinoma with gross lymph node metastasis.

Although the prognosis is generally good for patients with papillary thyroid carcinoma, gross nodal metastasis of carcinoma has a poor prognosis. It is necessary to clarify how carcinoma progresses to gross nodal metastasis in order to establish a cure. The adhesion molecule integrin beta-4 is considered to be related to cell migration and metastasis in many carcinomas. In the present study, we examined integrin beta-4 expression in 65 cases of human papillary thyroid carcinoma using immunohistochemical methods. Expression of integrin beta-4 was found in all papillary carcinomas, but in few normal thyrocytes. Interestingly, integrin beta-4 expression in the carcinomas with gross (> or =3 cm) lymph node metastasis was significantly higher than that in carcinomas with small (<3 cm) or no lymph node metastasis. These results suggest that integrin beta-4 expression in thyroid carcinoma may play a role in the development of gross lymph node metastasis of papillary carcinomas.

Is corticosteroid therapy effective for sudden-onset sensorineural hearing loss at lower frequencies?

OBJECTIVE: To assess the efficacy of corticosteroid therapy for sudden-onset sensorineural hearing loss at lower frequencies. DESIGN: Retrospective, nonrandomized, controlled study. PATIENTS AND METHODS: The recovery rate, recovery/improvement rate, and period between the start of therapy and improvement of symptoms were studied in 2 groups: the control group, consisting of 36 patients treated with adenosine triphosphate disodium, kallidinogenase, and cyanocobalamin between March 1, 2000, and January 31, 2001; and the corticosteroid-treated group, consisting of 42 patients treated with corticosteroids in addition to the previously mentioned drugs between April 1, 1997, and February 29, 2000. RESULTS: No significant difference (P =.83) was noted in the recovery rate between the control group (81%) and the corticosteroid-treated group (79%), and the recovery/improvement rate was the same for the 2 groups (83%). In addition, there was no significant difference (P =.84) for the mean +/- SD period between the start of therapy and improvement of symptoms between the control group (3.9 +/- 2.7 days) and the corticosteroid-treated group (3.7 +/- 2.1 days). CONCLUSION: Corticosteroids were not effective for sudden-onset sensorineural hearing loss at lower frequencies.

Radiosensitive hemangiopericytoma in the soft palate.

Hemangiopericytomas are uncommon neoplasms of vascular origin, and rarely arise in the pharynx. We report a case of a 78-year-old female with hemangiopericytoma in her soft palate exhibiting prominent radiosensitivity. Hemangiopericytomas are considered to be radioresistant and wide local excision is a treatment of choice, but their nature is widely variable. In treating aggressive hemangiopericytomas, radiation therapy can be selected.