Expression of transforming growth factor-beta 1 and alpha-smooth muscle actin of myofibroblast in the pathogenesis of nasal polyps.

The pathophysiology of nasal polyps remains unclear, but recent work suggests that many cytokines are produced in nasal polyps (NPs) and that they may play various important roles in the pathogenesis of NPs. Transforming growth factor-beta 1 (TGF-beta 1), secreted by many inflammatory cells, is a potent inducer of myofibroblasts. Myofibroblasts express alpha-smooth muscle actin (alpha-SMA) and a source of extracellular matrix (ECM). In this study, we investigated a potential link between inflammation and the growth process in human NPs. Sixteen patients who were affected by NPs and who had undergone functional endoscopic sinus surgery were included in this study. Nasal mucosa of inferior turbinate (NM) of 10 patients who had received rhinoplasty or turbinectomy for other disease was used as the control. alpha-SMA and TGF-beta 1 were detected using immunohistochemistry and the number of labeled cells were counted (alpha-SMA and TGF-beta 1 indices). The expression of alpha-SMA and TGF-beta 1 indices found in NPs and NM was compared using Student's t-test. In our study, alpha-SMA and TGF-beta 1 indices were found to be significantly higher in nasal polyps than in nasal mucosa. TGF-beta 1 produced by inflammatory cells can influence the development of myofibroblasts which in turn can induce extracellular matrix accumulation and, therefore, TGF-beta 1 plays a important role in the formation of nasal polyps.

Otogenic brain abscess--a case report.

Brain abscess is one of the life-threatening complications of otitis media. Mortality and morbidity have decreased with the advent of antibiotic therapy. More frequently encountered in cases of acute otitis media in the preantibiotic era, in recent years otogenic brain abscess was noticed almost only in patients of chronic otitis media with cholesteatoma. A case of brain abscess in a 49-year-old female was initially diagnosed as a headache. A high resolution computed tomography (HRCT) scan of the temporal bones later revealed that there were two abscesses over the right side temporal lobe. A modified radical mastoidectomy was performed. Cultures of the middle ear cholesteatoma later grew Pseudomonas aeruginosa and Strenotrophomonas maltophilia. Antibiotic therapy was carried on for three months postoperatively. The patient improved but retained a conductive hearing loss.

Traumatic ossicular chain discontinuity--report of two cases.

In addition to hemotympanum and traumatic eardrum perforation, traumatic ossicular chain discontinuity should also be considered in the differential diagnosis of conductive hearing impairment resulting from head injury. The most common form of these ossicular chain lesions following head injury is incudostapedial joint (I-S joint) separation. We successfully managed two patients with I-S joint separation resulting from head injury through exploratory tympanotomy with ossiculoplasty within the recent 2 years. Both were young females who had sustained head injury resulting from traffic accident with the sequelae of persistent hearing impairment. They both gained significant hearing improvement postoperatively.

Age and the prognosis of tympanoplasty type I.

The purpose of this study is to evaluate the influence of the age factor on the prognosis for tympanoplasty type I. One hundred subjects (41 males, 59 females, 16-65 years old, mean age 37.9 years old) who accepted tympanoplasty type I during a four-year period were reviewed. The success rate of the surgery was analyzed using the three criteria suggested by the Japan Clinical Otology Committee. In addition, linear regression was used to analyze the correlations between age and pre-operative hearing, post-operative hearing and hearing gain. Using the proportion of patients with a postoperative hearing threshold within 40 dB as the criterion, the 16-25 year-old group had the best results (80%) and the 56-65 year-old group had the worst results (66.7%). Using hearing gain exceeding 15 dB as the criterion, the best result was for the 36-45 year-old group (60.9%), and the worst result was for the 56-65 year-old group (26.7%). Using post-operative air-bone gap within 20 dB as the criterion, the best result was for the 16-25 year-old group (70%), and the worst result was for the 56-65 year-old group (40%). The best total success rate was for the 16-25 year-old group (80%) and the worst was for the 56-65 year-old group (66.7%). The total average success rate was 74%. Linear regression analysis showed that the postoperative hearing thresholds increased significantly with advancing age. But there was no statistically significant difference in hearing gain between the various age groups and the preoperative hearing thresholds also increased with advancing age. In conclusion, although tympanoplasty type I offered the patients a similar hearing gain among the different age groups, from the point of view of social function, it offered younger people a better chance of social hearing than the elderly and a higher surgical success rate. The poor postoperative hearing of the elderly was a result of their poor preoperative hearing condition.

Evaluating the sensation of nasal obstruction with acoustic rhinometry and rhinomanometry.

The relationships among subjective sensation of nasal obstruction, data of rhinomanometry and acoustic rhinometry between individuals or for each individual were explored. Thirty-nine subjects with nasal obstruction problems were examined using the visual analogue scale, nasal airflow resistance (NAR), nasal minimal cross-sectional area (MCA), and nasal cavity volume (NCV). No significant correlation was found between the sensation of unilateral or bilateral nasal obstruction to NAR, MCA, or NCV. Strong correlations between MCA and NAR, and NCV and NAR were noted in this study. Another 10 healthy volunteers were investigated and correlation was studied on each individual level. Strong correlations within subject were found more commonly in persons with short-term follow-up than with the long-term follow-up group. In the present study, rhinomanometry results were compatible with acoustic rhinometry results. However describing the sensation of nasal patency with only rhinomanometric or acoustic rhinometric measurements seems still inadequate.

Primary cervical neuroblastoma in infants.

Although neuroblastoma is a relatively common malignancy of childhood, it is rarely of cervical origin. We encountered two cases of primary cervical neuroblastoma in infants. The first case was in a newborn who presented with noisy breathing, dyspnea, and choking on feeding soon after birth. Physical examination disclosed a left retropharyngeal mass near the midline causing aerodigestive compromise. Magnetic resonance imaging showed a well-defined hyperintense mass in the corresponding region. The infant underwent complete surgical excision of the mass 1 month after birth. The pathology report confirmed neuroblastoma. Horner's syndrome developed soon after surgery but resolved spontaneously within 6 months. No recurrence was noted during a 3-year follow-up period. The second patient, a 5-month-old female, presented with stridor and shortness of breath of 2-weeks' duration due to a right cervical mass. Magnetic resonance imaging showed a parapharyngeal mass suggestive of neuroblastoma. Complete surgical excision was done at the expense of sacrificing the sympathetic nerve trunk. The pathologic diagnosis was moderately differentiated neuroblastoma. No recurrence was noted when the patient was seen 2 years after surgery, although right-sided Horner's syndrome persisted. Surgical intervention can result in a good prognosis for low stage cervical neuroblastomas; however, long-term follow-up is important.

Pneumocephalus in a case of nasopharyngeal carcinoma.

An extensive mass involving the skull base was found in a 49-year-old male patient with nasopharyngeal carcinoma. Deteriorating neurologic status developed 2 weeks after radiation to the nasopharynx with the initial dosage of 5480 cGy and boosted dosage of 3520 cGy. Computerized tomography revealed multiple foci of air occupying the subarachnoid space, and an air-fluid level was found in the lateral ventricle. Antibiotics and conservative treatments were administered to the patient and consciousness returned gradually. Unfortunately, he died of hypovolemic shock owing to massive bleeding from the nasopharynx 7 days later.

Nasal septal cyst--a case report.

The usual complications of submucous resection of the nasal septum (SMR) are septal hematoma, infection, hemorrhage, septal perforation, and nasal deformity. We present a case of nasal septal cyst which may be a rare complication of SMR. Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa is thought to be the cause. The patient underwent deroofment of the left cystic wall by lateral rhinotomy. There was no recurrence after one year.