Squamous cell carcinoma of the nasal septum with Wegener's granulomatosis treated with cyclophosphamide and corticosteroids.

Well differentiated squamous cell carcinoma of the nasal septum developed in a 55-year old man with Wegener's granulomatosis. It is suggested that the malignancy was induced by immunosuppressive state from an increased and prolonged use of cyclophosphamide and corticosteroids. Although the efficacy of the therapeutic concept using cyclophosphamide and corticosteroids is well established, there have been some few reports that cyclophosphamide could be implicated in the genesis of malignancies. The pathophysiology of Wegener's granulomatosis should be better understood, and effective and less toxic alternative protocol should be established.

[Relationship between dietary fiber intake and food intake patterns of the general population, evaluated by a regional nutrition survey].

This study was performed to estimate the dietary fiber intake calculated using individual food intake data and the dietary fiber tables, and to ascertain the relationship between food intake patterns and dietary fiber intake of the general population. The 805 subjects over 15 years old were obtained from the Tottori Prefecture Nutrition Survey. The results are summarized as follows: 1. The average dietary fiber intake per capita per day was 18.19 g; 18.67 g in men, and 17.81 g in women. Dietary fiber intake per energy was different among sexes and ages: women had more dietary fiber than men and the aged had more than the young. Those who had high fiber intake per energy took green vegetables, fruits, milk, soybean products, seaweed and potatoes more frequently, and did not take oil so frequently. 2. Total dietary fiber intake from 20 food-group sources was analyzed by Multiple Regression Analysis. For both men and women fruits, vegetables and soybean products mostly influenced dietary fiber intake. 3. Based on the intake of the 20 food-groups obtained from 356 men and 449 women, the correlation matrix among these foods was calculated. The correlation matrix was also submitted to a Principal Component Analysis. The result of the Principal Component Analysis told that food intake patterns were different among the levels of dietary fiber intake. Food intake patterns of men and women who had high fiber intake per energy had an eating pattern characterized by relatively more non-processed vegetable food, bread and milk. 4. The level of blood pressure was significantly related to dietary fiber intake per energy in men over 60 years old. In the hypertensive men over 60 years old, 23.3% were in the low fiber intake group, 37.2% in the middle group, and 39.5% in the high group. But in the normal blood pressure men over 60 years old, 50.0% were in the low fiber intake group, 8.3% in the middle group, and 41.7% in the high group.

Patient with primary tonsillar and gastric syphilis.

A male patient with syphilitic lesions in the tonsil and stomach is presented. The patient was infected while practising oral sex with heterosexual friends. He complained of nausea and snoring; his left tonsil was enlarged. Spirochetes were detected in a smear preparation from the left tonsil. As a gastric lesion, initially believed to be cancer, appeared to result from spirochete ingestion, the case is considered to represent primary syphilis. After antibiotic therapy with ampicillin, the left tonsil returned to normal size and gastric changes were no longer evident endoscopically. Gastroscopy should be considered if syphilis of the tonsil is observed, particularly when gastrointestinal symptoms are present. Both the oral and the gastric lesion can be mistaken for malignant neoplasm.

Oral reconstruction using the peroneal flap.

Eight cases of oral reconstruction using the peroneal flap are reported. Six are for tongue and two are for oral wall. All flaps survived completely. The peroneal flap has many merits: the flap is thin and wide, the peroneal vessels have a large diameter lumen and long pedicle, the donor site has few sequela, and simultaneous surgery is possible. In addition, the characteristics of the flap skin change gradually to that of mucous membrane, and hairs disappear in a year or two. We believe that for reconstruction of the oral cavity the peroneal flap is a better source than any other flap.

[Interaction between Epstein-Barr virus (EBV) gene expression and antibodies to EBV in nasopharyngeal carcinomas].

In situ hybridization using EBERs and BHLF oligonucleotide probes and immunohistochemistry using monoclonal antibodies against LMP1, EBNA2, BZLF1 protein, p53 protein and bcl-2 protein were performed on 56 primary nasopharyngeal carcinomas. EBERs was detected in 46 cases (82%), and LMP in 17 cases (30%), but EBNA2 was not detected. While 30 of 32 cases (94%) in differentiated non-keratinizing carcinoma (NKC) and 16 of 17 cases (94%) in undifferentiated carcinoma (UNPC) showed EBERs, neither 5 cases of squamous cell carcinoma (SCC) nor 2 cases of adenocarcinoma showed EBERs. This finding confirms latent infection of EBV, especially phenotypical latency II, in NKC and UNPC but not in SCC. Bcl-2 protein was positive in 50 cases (89%), but its expression did not depend on expression of LMP1, which did not demonstrate induction of bcl-2 by LMP1 as seen in vitro. Cytoplasmic BZLF1 expression was detected in 18 cases (32%) whereas BHLF was positive only in 6 cases (11%). This suggests dysfunction of BZLF1, which disrupts viral latency despite its expression. p53 protein was positive in 31 cases (55%), and there was a distinct correlation between expression of BZLF1 and p53 protein (p < 0.001). This suggests that the interaction between BZLF1 protein and p53 protein, which inactivate each other, is one of the tumorigenic factors in NPC.

Prognostic value of EGFR and TGF-alpha in early laryngeal cancer treated with radiotherapy.

The purpose of this study was to determine the overexpression of both epidermal growth factor receptor (EGFR) and transforming growth factor-alpha (TGF-alpha) (a ligand of EGFR) in early laryngeal squamous cell carcinoma. In addition, we attempted to evaluate the prognostic values of our findings. Expression of EGFR and TGF-alpha in tumor tissue was examined immunohistochemically in 68 patients who had been treated with radiotherapy for early laryngeal cancer. Overexpression of the two factors was noted in 42.6% and 55.9%, respectively. No significant differences due to age, tumor size, and location or grade of cancer tissues were seen. Higher survival rates, found in patients with EGFR (-) and TGF-alpha (-) tumors as compared with those with EGFR (+) and TGF-alpha (+) (97.4%, 100% and 86.2%, 86.8%, respectively), were not statistically significant. The recurrence rates were similar between EGFR (+) and EGFR (-) (37.9% and 35.9%, respectively). However, the recurrence rate in patients with TGF-alpha (+) was significantly higher (57.9%) than in those with TGF-alpha (-) (10%; P<.01). Therefore overexpression of TGF-alpha may be an important indicator for recurrence in patients with early laryngeal squamous cell carcinoma treated by irradiation.

Expression of EGF, EGFR and PCNA in laryngeal lesions.

The expression of EGF/EGFR in 47 laryngeal surgical specimens from 44 patients was examined. PCNA analysis as an index of proliferating cells was also performed in 32 cases of laryngeal cancer, six cases of pre-cancerous lesions and nine cases of normal laryngeal mucosa. EGFR failed to show a significant correlation with tumour behaviour, but EGF expression was statistically significantly higher in malignant (SCC) than in non-malignant tissues (pre-cancerous and normal tissues) (p < 0.006), and PCNA also showed a statistically significant difference (p < 0.016) between the two. In malignant tissues when EGF/EGFR in 'double-positive' and 'double-negative' cases was compared, a statistically significant difference in PCNA was found (p < 0.029); but this was not seen in non-malignant tissues. Our results support the hypothesis that an autocrime mechanism exists in laryngeal cancer and in this mechanism EGF may play an important role in tumour progression, especially when EGFR is overexpressed.

Development of high frequency vestibulo-ocular responses to active head shaking.

Computer aided active head shaking test has several advantages because it can be used clinical at frequencies higher than 2 Hz. In this study, VOR gain and phase were examined over age. For this experiment, we designed an original measurement system composed of EOG, an angular velocity sensor and a microcomputer. VOR gain was expressed by transfer function. Forty normal subjects ranging from 10 to 75 were examined for high frequency VOR responses to active head shaking. VOR gain at frequencies higher than 2 Hz attained the same value as that seen in children below the age of 10 years. The VOR gain was nearly 1 within 2 Hz, decreasing with frequencies above 4 Hz. The effect of aging was shown at frequencies of more than 4 Hz, and appeared in patients above 50 years of age. No obvious phase lag was observed within 5 Hz.

Importance of pre-operative recognition of the nonrecurrent laryngeal nerve.

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

Subject-based reference values in thyroid function tests.

To evaluate the diagnostic value of subject-based reference values in thyroid function tests, we compared intra-individual and inter-individual variation. Five specimens were collected over a period of 2 weeks from each of 47 normal subjects, 29 women and 18 men, aged 20-47 yrs. T4, FT4, T3, and FT3 were assayed by RIA, and TSH by a sensitive immunoradiometric assay. One-way ANOVA for each test was statistically significant for a main subject effect, indicating that the subjects differed in their personal mean values for the thyroid function tests (T4, P < 0.01; FT4, P < 0.05; T3, P < 0.01; FT3, P < 0.05; TSH, P < 0.01). The ratio value (intra- over inter-individual variation) was T4, 0.41; FT4, 0.60; T3, 0.53; FT3, 0.63; TSH 0.36. The data indicate that conventional reference values are insensitive when compared to subject-based reference intervals in assessing the thyroid status of a given subject. Reactivity of the thyroid to the stimulation of endogenous TSH was assessed by the ratio delta FT 3/delta TSH in TRH stimulation tests. A positive correlation between basal FT3 and delta FT3/delta TSH (r = 0.566, P < 0.05) indicates that the thyroid with higher reactivity to TSH secretes more daily thyroid hormone. Negative correlation between basal TSH and delta FT3/delta TSH (r = -0.536, P < 0.05) means that a subject with lower reactivity of the thyroid needs a higher basal TSH level to compensate. The thyroid reactivity to TSH may be an important determinant for the individuality of the pituitary-thyroid axis.

Inhibition of the ATP-sensitive potassium channel by class I antiarrhythmic agent, cibenzoline, in rat pancreatic beta-cells.

1. Cibenzoline, a class I antiarrhythmic agent, was investigated for its effect on the ATP-sensitive K+ channel of pancreatic beta-cells by the patch clamp technique. 2. In perforated patch clamp experiments, cibenzoline depolarized the membrane of single beta-cells and thereafter, caused firing of action potentials in the presence of 2.8 mM glucose. 3. Cibenzoline inhibited the activity of the ATP-sensitive K+ channel in cell-attached recordings in the presence of 2.8 mM glucose and evoked repetitive fluctuations of the baseline current, apparently reflecting the action potentials of the beta-cell. 4. In whole-cell clamp experiments, time-independent outward current was induced by depleting cytoplasmic ATP with 0.1 mM ATP and 0.1 mM ADP in the solution contained in the pipette. The outward current was inhibited by cibenzoline in a dose-dependent manner in the concentration range of 1 microM to 100 microM and half maximum inhibition occurred at 1.5 microM. 5. Cibenzoline blocked substantially the ATP-sensitive K+ channel current when applied at the inner side of the membrane in isolated inside-out membrane patches. 6. It is concluded that cibenzoline blocks the ATP-sensitive K+ channel of pancreatic beta-cells and, thereby, stimulates insulin secretion at sub-stimulatory levels of glucose.

Subdural hematoma associated with dural metastasis from paranasal sinus cancer: a case report and review of the literature.

We report a 72-year-old woman who developed a subdural hematoma following dural metastasis from paranasal sinus carcinoma. Subdural hematoma with malignant neoplasm is a serious condition seen only in advanced stages. The prognosis is poor, but appropriate measures can help the patient. Head and neck surgeons should note this unusual clinical entity.

Malignant schwannoma arising in a paranasal sinus.

A case of malignant schwannoma arising in a paranasal sinus is reported. In this case, histological hallmarks were lost because of the poorly differentiated nature of the tumour. Immunohistological techniques were applied to the diagnosis, confirming the neural origin of this tumour. Malignant schwannoma is a relatively rare disease in the nasal cavity and paranasal sinuses. For the treatment of this tumour, wide resection is recommended. In this patient, radical resection of the maxilla with orbital and ethmoid exenteration was performed. The patient recovered uneventfully with no evidence of disease three years after surgery.

View from beneath: pathology in focus. Renal cell carcinoma metastasis to the tongue.

Metastases to the tongue from distant primaries are very rare. A case of renal cell carcinoma metastasis to the tongue, occurring in a 58-year-old man, is presented and previously reported cases are reviewed.

Intratemporal facial nerve neurinoma without facial paralysis.

A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.

[The effects of individual milk-drinking habits on nutrient intake and dietary patterns in men and women in Tottori Prefecture].

This study was performed to determine the actual conditions of milk-drinking habits in men and women, and to ascertain their effects on nutrient intake and dietary patterns. The 809 subjects were over 20 years of age and were obtained from the Tottori Prefecture Dietary Survey. The results are summarized as follows: 1. Over 40 percent of the subjects did not consume any milk during the three days of the dietary survey. Furthermore, only 38 percent of men and 46 percent of women have daily milk-drinking habits according to the results of the questionnaire. 2. Calcium and Vitamin B2 intake level and total serum cholesterol level were higher in milk-drinkers than non-milk-drinkers, in both men and women. The regression of total calcium intake from 6 groups of food was analyzed by multiple regression analysis. For both men and women who were milk-drinkers, total calcium intake was determined mostly by milk. In the case of non-milk-drinkers, total calcium intake came mostly from green vegetables for men, and other vegetables for women. 3. The ratios of both animal proteins and animal fats were higher in milk-drinkers. For women, energy percentage of fats was high and that of carbohydrates was low in milk-drinkers. The results seem to suggest that differences in dietary patterns is based on milk-drinking habits. Using the Hayashi's quantification method 3, dietary patterns were classified into two groups based on milk-drinking habits. Dietary patterns of milk-drinkers included the characteristic of eating bread, meats, and fats more frequently in men, fresh vegetables, eggs, fats and bread in women. In men, milk-drinking habits had a lesser influence on diet than in women.

Preservation of sodium-dependent iodide transport activity by methimazole and mercaptoethanol in phospholipid vesicles containing thyroid plasma membranes: with evidence of difference in the action of perchlorate and thiocyanate.

The effect of methimazole (MMI) and 2-mercaptoethanol (ME) on I-transport was studied using phospholipid vesicles (P-vesicles) made from porcine thyroid plasma membranes and soybean phospholipids by sonication. 1. When buffer solutions contained either 1 mM MMI or 2 mM ME, I-uptake by P-vesicles in the presence of external Na+ was apparently higher than that in the absence of external Na+. Na+-dependent I- uptake was inhibited by both C1O4- and SCN- added externally. 2. When PM was treated with 4 mM N-ethylmaleimide prior to preparation of P-vesicles, the activity of Na+-dependent I- transport was completely lost even when P-vesicles were incubated in the presence of ME. 3. When neither MMI nor ME was added to buffers, I- uptake in the presence of external Na+ was not at all higher than that in the absence of external Na+. In these instances, however, I- uptake was much higher compared than the baseline uptake in the presence of MMI or ME, and was inhibited by external SCN- and not by C1O4- without relation to external Na+. These data indicate that MMI or ME has two distinct effects on our model system of I- transport. The one is preservation of the Na+-dependent I- transport activity by protecting a sulfhydryl group, and the other is reduction of nonspecific I- binding to P-vesicles. In addition, C1O4- is a more specific inhibitor of thyroid I- transport than SCN-, when non-specific I- oxidation is imperfectly prevented.