Expression of inflammatory mediators in the otitis media induced by Helicobacter pylori antigen in mice.

Helicobacter pylori is a Gram-negative bacterium that is recognized as one of the key factors in gastric diseases such as gastritis, peptic ulcer and gastric cancer. Recent studies have shown relationships between H. pylori and extra-digestive diseases, and the presence of H. pylori in the middle ear and upper respiratory tract has been reported. However, the role of H. pylori in middle ear disease remains unclear. The present study demonstrated that H. pylori whole-cell protein directly induces macrophage migration inhibitory factor, macrophage inflammatory protein 2, interleukin 1 beta and tumor necrosis factor alpha in middle ear epithelium in mice, and severe proliferation of inflammatory cells was observed in middle ear cavity inoculated with H. pylori whole-cell protein. In addition, trans-tympanic injection of macrophage migration inhibitory factor up-regulated expression of macrophage inflammatory protein 2 in the middle ear. These findings indicate that H. pylori infection causes immunological inflammation in middle ear epithelium, and H. pylori may play a significant role in otitis media.

Laser-assisted tympanoplasty for preservation of the ossicular chain in cholesteatoma.

We report the use of potassium titanyl phosphate laser-assisted tympanoplasty in amputations of the malleus and incus in 2 patients with cholesteatoma medial to those ossicles that had not destroyed the ossicular chain continuity. In both cases, the laser successfully removed portions of the ossicles to allow removal of the cholesteatoma; importantly, the laser preserved certain ossicular ligaments, thus keeping the ossicular chain continuous. Postoperatively, both patients showed satisfactory hearing. Although the prevalence of cholesteatoma medial to the ossicles with maintained ossicular continuity is limited, the laser-assisted procedure described here is useful for maintaining hearing ability in these cases.

A case of infantile neuroblastoma with intramucosal metastasis in a paranasal sinus.

An 8-year-old boy with neuroblastoma of the right adrenal gland is reported. His initial treatment included chemotherapy and surgery, with complete response (CR) being achieved at the initial site. A metastatic lesion was found in the right maxillary sinus 32 months after his initial treatment. A mass in the right soft palate was detected and was clinically suspected of being a metastasis. The results of biopsy were negative and the differential diagnosis from the imaging studies of CT included odontogenic disease, fungal infection, paranasal sinus cyst or hematoma, and benign tumors. Open transantral biopsy was done under general anesthesia, revealing severe inflammation in the right maxillary sinus as well as bone erosion. The histopathological diagnosis was metastatic neuroblastoma from the adrenal lesion. The local field was irradiated with 20 Gy of linear accelerator (linac) radiation, then the local field was eradicated. Extensive skeletal metastases were subsequently found by bone scintigraphy. Despite further treatment his general condition deteriorated rapidly and he died 24 months after starting treatment. We review the previous reports and discuss metastasis to the sinuses.

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.

Calbindin and calmodulin localization in the developing vestibular organ of the musk shrew (Suncus murinus).

The distribution of the Ca(2+)-binding proteins, calbindin and calmodulin, in the adult inner ear has been described previously. We undertook immunohistochemical investigation of developmental changes in the distribution of calbindin and calmodulin in the vestibular organ of the musk shrew (Suncus murinus). Expression of calbindin was seen first in the hair cells and the vestibular ganglion on gestational day (GD) 19, in nerve fibres on GD23 and in the otoconia on GD26. On GD19 calmodulin was demonstrable only in the hair cells. On GD26 both Ca(2+)-binding proteins showed a distribution of immunoreactivity in hair cells similar to that seen in adults. The developmental differences in distribution of these binding proteins may suggest different roles in the vestibule. Additionally, Ca(2+)-binding proteins may be a useful index of hair cell maturity.

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.

Appearance and distribution of two Ca2+-binding proteins during development of the cochlea in the musk shrew.

In the developing cochlea of the musk shrew, Suncus murinus, the localization of two Ca2+-binding protein, calbindin and calmodulin, which are thought to play different roles in the nervous system, was examined during gestational and postpartum periods. Calbindin is thought to play a Ca2+ buffering role, while calmodulin activates other proteins. Cochleae from the musk shrews sacrificed from gestational day (GD) 15 to postnatal day (PP) 9 and as adults, were immunohistochemically analyzed. The localization and order of appearance of calmodulin in sensorineural elements were similar to those of calbindin, except for timing of appearance. Calmodulin-staining was recognized first in the spiral ganglion neurons on GD21, followed by the inner hair cells (IHCs) on GD23 and outer hair cells (OHCs) on GD26, while calbindin immunoreactivity in the spiral ganglion neurons on GD19, the IHCs on GD21 and the OHCs on GD23. In hair cells, during development, immunostaining of calbindin and calmodulin was initially seen in the cytoplasm, followed by the cuticular plate. Cytoplasmic staining then decreased in mature hair cells. Non-sensorineural components also showed positivity for both calbindin and calmodulin. The lateral wall of the cochlear duct was positive for calbindin, while the stria vascularis was positive for calmodulin. Immunoreactivity for calbindin was present earlier than that of calmodulin in sensorineural elements, suggesting that in the developing cochlea, calbindin and calmodulin have different functions and that Ca2+ buffering capacity, which is regulated by Ca2+ buffer proteins, such as calbindin, may be required before trigger proteins, such as calmodulin, function.