The influence of environmental exposure to formaldehyde in nasal mucosa of medical students during cadaver dissection.

BACKGROUND: Environmental exposure to formaldehyde is commonly associated with clinical symptoms such as mucosal irritation and olfactory disorders. However, the impact of such exposure on the development of mucosal inflammation and its outcome has not been carefully evaluated. METHODS: The observational non-comparative study was planned. The study population consisted of group of 41 medical students who had signed up for a cadaver dissection course as part of their gross anatomy teaching at the school of medicine Chiba University in Japan. During such dissection course, the students are exposed to variable levels of environmental formaldehyde routinely employed for the preservation the cadavers. The subjects were evaluated by a detailed medical examination. We measured their serum IgE levels. In addition, an olfaction test and nasal mucosal sensitivity to histamine was serially determined, immediately before and after the course and 6 months after the completion of the course. RESULTS: Olfactory abnormalities were observed in 13/41 (32%) subjects and increased nasal mucosal hypersensitivity to histamine was observed in 17/41 (41%) during and immediately after completion of the course. These subjects had evidence of preexisting allergic rhinitis. 6/41 (15%) other students with no prior evidence of allergic rhinitis also exhibited formaldehyde associated clinical symptoms during the dissecting course. However, the symptoms disappeared upon completion of the course in all subjects studied. CONCLUSIONS: Temporary abnormalities in the olfaction test and increased nasal mucosal hypersensitivity to histamine were observed in a few students with preexisting allergic rhinitis after environmental exposure of high concentrations of formaldehyde. These effects appeared to be transient.

Analysis of natural history of Japanese cedar pollinosis.

BACKGROUND: The marked increase in the incidence of Japanese cedar (Cryptomeria japonica; JC) pollinosis is a social problem in Japan. Elucidation of its natural history is, therefore, essential. METHODS: Cross-sectional and vertical-sectional studies were performed regarding the effects of aging on sensitization to Japanese cedar pollen (JCP) and development of JC pollinosis by measuring serum IgE titers to JCP and by oral examination of residents of the Maruyama Town, Chiba, Japan from 1995 to 2001. We also studied the incidence of its spontaneous remission and the background factors. RESULTS: In a vertical-sectional study, the serum IgE titer to JCP was strongly influenced by the amounts of pollen scattered. An increase in age by 6 years did not reduce the IgE titer to JCP in subjects in their 40s. However, in subjects aged 60 or more, annual differences in the JCP count did not affect serum IgE titer to JCP, which remained low even after a season with a high pollen count. In subjects with JC pollinosis aged over 40 showing a CAP RAST score of more than 2 to JCP in 1995, spontaneous remission of JC pollinosis was observed in 16.1% over a period of 6 years. Factors affecting spontaneous remission include sex, age at the time, serum IgE titer to JCP and age at first onset of JC pollinosis. CONCLUSIONS: The CAP RAST score was strongly associated with spontaneous remission in the multivariable model.

State of mastication affects quality of life in patients with maxillary sinus cancer.

OBJECTIVES/HYPOTHESIS: The quality of life of head and neck cancer patients after treatment is poor compared with a typical population sample. However, little is known about patients with maxillary sinus cancer. The identification of symptoms that are most troublesome for these patients and the development of strategies to minimize these negative sequelae should be matters of high priority. STUDY DESIGN: A restrospective study of patients with maxillary sinus cancer who underwent maxillary bone resection. METHODS: Thirty patients with maxillary sinus squamous cell carcinoma participated in the study. The relationships among the degree of masticatory ability, the extent of the surgically resected area, and quality of life after combined treatment of maxillary cancer were evaluated. RESULTS: Scores of all physical and mental factors as assessed by the Short Form-36 questionnaire decreased as the masticatory ability of patients worsened. In edentulous cases, the masticatory ability was higher in the reduced operation group than in the extensive operation group. CONCLUSION: Maintaining adaptability to a denture is essential to preserve quality of life, particularly in patients with anodontia.

Interleukin-13 induces thymus and activation-regulated chemokine (CCL17) in human peripheral blood mononuclear cells.

BACKGROUND: In allergic inflammation involving allergic rhinitis, the predominance of Th(2) lymphocytes is one of the primary causal agents in promotion of the allergic condition. Thymus and activation-regulated chemokine (TARC/CCL17) is a recently identified chemokine that induces the development of Th(2) lymphocytes. One of the sources of TARC has been reported to be peripheral blood mononuclear cells (PBMCs). OBJECTIVE: We investigated TARC production from PBMCs by the stimulation of specific antigens and Th(2) type cytokines. METHOD: PBMCs were isolated from both allergic rhinitis patients and healthy volunteers. PBMCs were incubated with cytokine. TARC mRNA expression was examined by real time PCR methods and the amount of TARC production was examined by ELISA. RESULTS: IL-13 was found to be the most potent inducer for TARC mRNA expression and protein production in PBMCs. Furthermore, tumour necrosis factor alpha and IL-13 synergistically induce TARC. The amount of TARC from allergic rhinitis patients was significantly larger than that from healthy volunteers. Moreover, TARC was induced by a specific antigen, and was 35% inhibited by an anti-IL-13 neutralizing antibody. CONCLUSION: These results indicate that IL-13 is important in TARC mediated Th(2) lymphocytes infiltration in the nasal mucosa.

[Sarcoidosis of the head and neck].

Sarcoidosis is a systemic granulomatous disorder characterized varying degrees of involvement of the skin, viscera, and lymph nodes by non-caseating granulomata. Otolaryngologic manifestations of sarcoidosis are seen in about 10% of patients with sarcoidosis; neck mass, followed by parotid swelling and reversible facial nerve palsy are most common. Hearing loss and peripheral vestibulopathy are rare, and are incompletely understood. Nasal sarcoidosis shows nasal obstruction, rhinorrhea and nasal bleeding, and nasal mucosa of the patients has small sarcoid nodules in the endoscopic findings. The otorhinolaryngologist is critical to the diagnosis, because of the ease of biopsy in most cases of sarcoidosis in the head and neck. Steroids are central to treatment.

Hemodynamic changes of the hand after radial forearm flap harvesting.

After radial forearm flap harvesting, there is some risk for hand circulatory disorders. To reveal the changes in circulatory dynamics in the hand after harvesting this flap, the authors compared blood pressure and flow by color Doppler ultrasonography in the donor and nondonor hands, and evaluated the long-term changes in these factors in 40 patients undergoing this operation. Blood pressure and flow of the index finger in the donor hands were lower than those in the nondonor hands during the first 2 months postoperatively, but they virtually returned to the level of those in the nondonor hands within 1 year of the operation. These results suggest that after harvesting the radial artery, collateral circulation in the hand developed during a short postoperative period. Therefore, the authors can predict the long-term safety of forearm flap harvesting by evaluating the hemodynamic changes of the digits caused by acute occlusion of the radial artery preoperatively, which would reflect the hemodynamics at an early postoperative stage.

Usefulness of color Doppler sonography for assessing hemodynamics of free flaps for head and neck reconstruction.

This report focuses on the monitoring of intraoperative and postoperative hemodynamics of free flaps for repair of head and neck defects by color Doppler sonography (CDS). The study group included 20 patients with head and neck cancer who underwent resection and reconstruction with free flaps. The hemodynamics in the feeding arteries of the flaps were measured during the following six stages: before surgery, immediately after microvascular anastomosis, and on postoperative days 1, 3, 5, and 7. The pulsatility index (PI) was used as the index for measuring changes in hemodynamics over time. Grafts showed the maximal PI immediately after vascular anastomosis. PI decreased over 3 to 7 days. Of the 20 patients, 1 patient in whom the hypopharynx was reconstructed with the radial forearm flap developed venous occlusion. This was diagnosed during the early stage using CDS, allowing the flap to be saved. CDS proved to be very useful for real-time observation of the hemodynamics in free flaps.

Effect of formaldehyde on the expression of adhesion molecules in nasal microvascular endothelial cells: the role of formaldehyde in the pathogenesis of sick building syndrome.

BACKGROUND: Formaldehyde is associated with sick building syndrome (SBS), a set of diffuse and irritative symptoms predominantly involving the eyes and the respiratory tract. However, its pathophysiological mechanism in SBS has not yet been clarified. OBJECTIVE: In this study we investigated the effect of formaldehyde on the expression of adhesion molecules on human mucosal microvascular endothelial cells (HMMECs). Furthermore, we investigated the effect of formaldehyde on adhesiveness of HMMECs to eosinophils. MATERIALS AND METHODS: HMMECs were incubated with various concentrations of formaldehyde (1 ng/mL-1 microg/mL) for 24 h, and the expressions of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) on HMMECs were evaluated by flow cytometry. The change in the expression of ICAM-1 and VCAM-1 mRNA was then evaluated by reverse transcriptase polymerase chain reaction. To understand the role of formaldehyde in eosinophilic inflammation of the nasal mucosa, we examined the effects of formaldehyde on the adhesiveness between HMMECs and eosinophils by eosinophil adhesion assay. RESULTS: Formaldehyde increased the surface expressions of ICAM-1 and VCAM-1 on HMMECs. Formaldehyde also induced ICAM-1 and VCAM-1 mRNA. In addition, the adhesiveness between HMMECs and eosinophils was also increased by formaldehyde. CONCLUSION: These in vitro studies suggest that formaldehyde may play a role as the irritant of the nasal mucosa by increasing the expressions of adhesion molecules on HMMECs and by enhancing the adhesiveness between HMMECs and eosinophils.

The effect of Japanese cedar-specific immunotherapy on cytokine production in peripheral blood mononuclear cells.

The most common cause of seasonal allergic rhinitis in Japan is the Japanese cedar (JC). Recently, a pullulan-conjugated antigen (CS-560) has been developed to reduce adverse effects and to enhance the effect of JC-specific immunotherapy (IT). If the mechanism of IT can be fully elucidated and the treatment can be used safely and with specificity, IT should be reconsidered as a superior treatment for JC pollinosis. Thirteen patients with JC pollinosis who received IT were compared to 10 patients who did not receive IT. All patients were followed through two pollen seasons by means of allergy diaries. Peripheral blood mononuclear cells (PBMC) were collected before IT and just before each pollen season, and these were stimulated with pollen extract. The concentrations of IL-4, IL-5, IL-13 and IFN-gamma in the culture supernatants were determined using an ELISA. Furthermore, messenger (m)RNA expressions of IL-4 and IL-5 from cultured PBMC were also studied. As a result of the allergy diaries, we confirmed the clinical efficacy of CS-560. The symptom-medication scores were significantly decreased by IT. The levels of IL-4, IL-5 and IL-13 declined only in the IT group. However, the level of IFN-gamma did not change in either group. IL-4 and IL-5 mRNA expressions were inhibited in the IT group compared to that in the non-IT group. In conclusion, specific IT for JC pollinosis using CS-560 clearly modified cytokine expression by PBMC.