Superior mediastinal lymphadenopathy by silicosis mimicking metastasis of papillary thyroid carcinoma - Case report and literature review.

Silicosis is caused by inhalation of silica dust and is the most common type of pneumoconiosis. The characteristics of silicosis are inflammation of lung tissue and calcified lymphadenopathy of pulmonary hilum, mediastinum and paratrachea. We present a papillary thyroid carcinoma (PTC) case with paratracheal and superior mediastinal calcified lymphadenopathy caused by silicosis. The patient did not exhibit any respiratory symptoms or abnormal chest x-ray findings due to early phase silicosis. The lymph nodes were thought to be metastasis of PTC before surgery. Patient underwent total thyroidectomy with neck and superior mediastinum dissection. Post-surgery pathological examination exhibited coexistence of silica nodules and micrometastasis of PTC in paratracheal lymph nodes, but only silica nodules were observed in superior mediastinum lymph nodes. Patient's occupation was office worker but had worked as a stonemason for several decades prior. This is a first observed case of superior mediastinal lymphadenopathy by silicosis mimicking metastasis of PTC. Benign calcified lymphadenopathy may mimic metastasis of PTC in the evaluation of neck or mediastinal lesions.

Schizophyllum commune-induced allergic fungal rhinosinusitis and sinobronchial mycosis.

We present 32- and 38-year-old males with Schizophyllum commune-induced allergic fungal rhinosinusitis (AFRS). S. commune-induced AFRS was diagnosed by clinical and radiographic findings, positive specific IgE antibodies against S. commune as measured by the ImmunoCAP system, and sequencing analysis of the fungus. Our two cases with S. commune-induced AFRS for the first time showed evidence for type 1 hypersensitivity to S. commune as determined by using specific IgE antibodies against S. commune, and the fungus was identified by sequence analysis.

Usefulness of curry odorant of odor stick identification test for Japanese in olfactory impairment screening.

CONCLUSION: The curry odorant of the odor stick identification test for Japanese (OSIT-J) is useful in screening for olfactory impairment in Japanese subjects. OBJECTIVE: The present study was designed to determine the most useful odorant of the OSIT-J in screening for olfactory impairment in Japanese subjects. SUBJECTS AND METHODS: We studied olfactory impairment screening with the OSIT-J in 83 participants (49 male, 34 female; average age 50 years) in an executive check-up at NTT West Kanazawa Hospital. Olfactory discrimination acuity was evaluated with three odorants of the OSIT-J (rose, curry, and sweaty-smelling clothes), each known to be significantly correlated with the assessment of the Japanese standard olfaction test (T&T olfactometer). Those participants who did not score full marks in tests with the three odors were assessed with another nine odorants of the OSIT-J. RESULTS: The positive predictive value was 100% in the screening with the curry odorant. In 38 participants who did not identify all three odors correctly, the identification of the curry odor was significantly correlated with the scores for all 12 odors (p<0.005). Identification of the curry odor was not significantly correlated with identification of the menthol odor of OSIT-J.

Odor detection ability and thallium-201 transport in the olfactory nerve of traumatic olfactory-impaired mice.

Although olfactory nerve damage is a contributing factor in the diagnosis of posttraumatic olfactory loss, at present, there are no methods to directly assess injury to these nerves. We have shown that following olfactory nerve injury in mice, thallium-201 (201 Tl) transport from the nasal cavity to the olfactory bulb decreases. To determine if olfactory function after nerve injury could be assessed with nasal administration of 201 Tl, we measured the correlation between odor detection ability (ODA) and the rate of transport of 201 Tl in olfactory nerves. Both ODA and 201 Tl transport were measured after bilateral olfactory nerve transection for a 4-week period. Cycloheximide solution was used for ODA against tap water. 201 Tl transport was measured as the ratio of radioactivity in the nasal cavity and olfactory bulb with gamma spectrometry. There was a significant correlation between ODA and the rate of 201 Tl transport in the olfactory nerve. These findings suggest that olfactory function after nerve injury can be objectively evaluated with the nasal administration of 201 Tl.

Thallium transport and the evaluation of olfactory nerve connectivity between the nasal cavity and olfactory bulb.

Little is known regarding how alkali metal ions are transported in the olfactory nerve following their intranasal administration. In this study, we show that an alkali metal ion, thallium is transported in the olfactory nerve fibers to the olfactory bulb in mice. The olfactory nerve fibers of mice were transected on both sides of the body under anesthesia. A double tracer solution (thallium-201, (201)Tl; manganese-54, (54)Mn) was administered into the nasal cavity the following day. Radioactivity in the olfactory bulb and nasal turbinate was analyzed with gamma spectrometry. Auto radiographic images were obtained from coronal slices of frozen heads of mice administered with (201)Tl or (54)Mn. The transection of the olfactory nerve fibers was confirmed with a neuronal tracer. The transport of intranasal administered (201)Tl/(54)Mn to the olfactory bulb was significantly reduced by the transection of olfactory nerve fibers. The olfactory nerve transection also significantly inhibited the accumulation of fluoro-ruby in the olfactory bulb. Findings indicate that thallium is transported by the olfactory nerve fibers to the olfactory bulb in mice. The assessment of thallium transport following head injury may provide a new diagnostic method for the evaluation of olfactory nerve injury.

[Olfactory disturbance screening with the odor stick identification test (OSIT-J) in executive checkups].

The odor stick identification test for Japanese (OSIT-J) has been shown to be useful for detecting and evaluating olfactory disturbances in Japanese people. We studied the usefulness of OSIT-J in screening for olfactory disturbances in 83 Japanese participants (49 male, 34 female) participating in an executive checkup at NTT West Kanazawa Hospital in Japan. The olfactory ability was self-reported on a grade scale. Olfactory function was then evaluated with a three-odors OSIT-J (rose, curry and sweaty socks). Participants with low self-reported olfactory ability or less-than-full scores in the three-odor test were evaluated with an additional 10 odors of OSIT-J. Eight or less points are considered to be lower than average in the 13-odor test of OSIT-J (Saito S, et al.). Eleven of the 83 participants had low self-reported olfactory ability. Four participants with a full score in the three odors test with low self-reported olfactory ability scored more than eight points in the 13-odor test. Thirty-eight participants scored less than three points in the three-odor test. Seven of 29 participants with two points in the three-odor test scored eight or less in the 13-odor test. In the 29 participants, subjects with low self-reported olfactory ability scored significantly lower scores than those without a low self-reported olfactory ability in the 13-odor test. The self-reported olfactory ability was not related to the score in the 13-odor test in the nine participants with one point or less in the three-odor test. Males scored significantly lower scores than females in the three-odor test. However, gender was not significantly related to the rate of olfactory disability estimated based on the 13-odor test. Use of a three-odor OSIT-J along with a self-administered questionnaire pertaining to olfactory disability is useful for olfactory disturbance screening during executive health checkups.

Expression and localization of the cell adhesion molecule SgIGSF during regeneration of the olfactory epithelium in mice.

Spermatogenic immunoglobulin superfamily (SgIGSF) is a cell adhesion molecule originally discovered in mouse testis. SgIGSF is expressed not only in spermatogenic cells but also in lung and liver epithelial cells and in neurons and glia of the central and peripheral nervous systems. In the present study, we examined the expression and localization of SgIGSF in mouse olfactory epithelium before and after transection of the olfactory nerves, by RT-PCR, Western blotting and immunohistochemistry. In normal olfactory mucosa, SgIGSF showed 100 kDa in molecular weight, which was identical with that in the lung but different from that in the brain. SgIGSF was expressed on the membrane of all olfactory, sustentacular and basal cells, but more abundantly in the apical portions of the olfactory epithelium where the dendrites of olfactory cells are in contact with sustentacular cells. After olfactory nerve transection, mature olfactory cells disappeared in 4 days but were regenerated around 7-15 days by proliferation and differentiation of basal cells into mature olfactory cells through the step of immature olfactory cells. During this period, both the mRNA and protein for SgIGSF showed a transient increase, with peak levels at 7 days and 11 days, respectively, after the transection. Immunohistochemistry showed that the enriched immunoreactivity for SgIGSF at 7-11 days was localized primarily to the membrane of immature olfactory cells. These results suggested that, during regeneration of the olfactory epithelium, the adhesion molecule SgIGSF plays physiological roles in differentiation, migration, and maturation of immature olfactory cells.

Lipopolysaccharide-induced apoptosis of olfactory receptor neurons in rats.

CONCLUSION: Daily intranasal perfusion of lipopolysaccharide (LPS) for 14 days in rats induced apoptosis of olfactory receptor neurons (ORNs) over >3 but <7 days. OBJECTIVES: Smoking is one of the factors causing olfactory dysfunction. LPS is a major glycolipid component of the gram-negative bacterial cell wall and an active component of cigarette smoke. We studied whether LPS is one of the causes of tobacco-induced olfactory dysfunction by examining apoptosis in the olfactory epithelium after local exposure to LPS. MATERIALS AND METHODS: Rats received intranasal instillation of LPS or saline. Histochemical changes in the olfactory epithelium were examined using antibodies against single-stranded DNA, Bcl-2, Bax, and Caspase-3. We used different concentrations of LPS to examine the dose dependency and observed changes in the olfactory epithelium for a week after exposure cessation to see the duration of the effect of smoking. RESULTS: We found that numbers of cells positive for ssDNA, Bcl-2, Bax, and Caspase-3 were increased on the exposed side. The number of ssDNA-positive cells reached a maximum on the first day and decreased to normal levels on the seventh day after cessation of exposure.

Bilateral vocal cord paralysis caused by laryngeal mask airway.

The laryngeal mask airway (LMA) is regarded as a safer supraglottic airway for general anesthesia compared with conventional endotracheal tubes. We report a case of bilateral vocal cord palsy temporarily observed after using the LMA, which required urgent tracheotomy. Severe swelling of the arytenoid suggested that bilateral recurrent laryngeal nerve palsy was caused by prolonged compression on the pyriform fossa. One month later, vocal cord movements were fully recovered. It should be noted that bilateral vocal cord palsy is a possible complication associated with use of the LMA.

Aberrant internal carotid artery as a cause of objective pulsatile tinnitus.

An aberrant internal carotid artery (ICA) is a rare vascular anomaly and causes to objective pulsatile tinnitus and retrotympanic mass. In the past, it was often diagnosed during ear surgery or biopsy, which may lead to massive bleeding. We present a case of 37-year-old woman complaining of pulsatile tinnitus. The tinnitus was objectively audible at the right ear through an otoscope. Previously, MRA plays a pivotal role in the evaluation of the aberrant ICA. But in this case, the resolution of magnetic resonance angiography (MRA) was not enough to portray the course of the ICA, because dephasing of the spins due to turbulence may cause loss of the signal intensity on MRA. Computed tomography (CT) of the temporal bone revealed aberrant internal carotid artery passing through the middle ear. It is important to diagnose approximately this anomaly using with combination of high-resolution CT, MRI, and MRA.

Comparison of diagnostic findings using different olfactory test methods.

OBJECTIVE: To quantify discrepancies in the diagnosis of olfactory function that might exist when comparing results obtained from centers using different methods of olfactory testing. STUDY DESIGN: Prospective study of 50 healthy adult volunteers and 25 adult patients with olfactory complaints. METHODS: Two test methods, the Connecticut Chemosensory Clinical Research Center (CCCRC) test widely used in the United States, and the Jet Stream Olfactometer (JSO) test used in Japan, were used to measure and categorize the diagnostic level of olfactory function (normosmia, mild hyposmia, moderate hyposmia, severe hyposmia, anosmia). Olfactory function was measured separately for each nostril. RESULTS: There was a significant correlation (rs = 0.788, P < .01, n = 150 nostrils) between diagnostic categories assigned by the CCCRC and JSO test methods. Diagnostic categories were identical for 66.7% of the nostrils tested, and in only 7.3% of the cases did the results differ by more than one category. For the anosmic and normosmic categories, test results were in agreement 91.7% of the time, whereas for the hyposmic categories (mild, moderate, and severe) results were in agreement only 22.2% of the time. CONCLUSIONS: Our results demonstrate that when comparing clinical or research data obtained from centers using different olfactory test methods, subjects with diagnoses of anosmia or normosmia may be more reliably compared than those with different levels of hyposmia.

[CT and ultrasonographic findings in patients with carotidynia].

We report 2 cases of clinical signs and symptoms consistent with idiopathic carotidynia, evaluating and following up the appearance of carotidynia on CT and ultrasonography. Subjects were a 22-year-old woman and an 82-year-old man reporting pain and mass on the left side of the neck. They had abnormal soft-tissue infiltration surrounding the symptomatic carotid artery centered at the distal common carotid and carotid bifurcation in CT and ultrasonography. Their symptoms were resolved within 2 weeks. Repeat CT and ultrasonography after resolution of symptoms showed an absence of the previous abnormality. Few reports have described radiological findings in carotidynia, and CT and ultrasonography enable the evaluation of patients with suspected carotidynia and of most common entities in the differential diagnosis of carotidynia, including aneurysm, aneurysmal dissection, thrombosis, lymphadenitis, submandibular gland disease, and head and neck tumors.

[Clinical usefulness of odor stick identification test for patients with olfactory disturbance].

The odor stick identification test for Japanese (OSITJ) is the latest in measuring olfactory identification. It consists of 13 odorants familiar to the Japanese population. We studied the relationship between the Japanese standard olfactory test (T & T olfactometer) and the OSITJ in 182 patients with olfactory disturbance. The identification ratio in 2 of OSITJ tests using 13 odorants was correlated significantly negatively with the detection and recognition threshold measured by the T & T olfactometer. A high correlation between identification ratio and olfactory thresholds was maintained even when the number of odorants in the OSITJ was reduced to 2. For each odorant used, the identification ratio correlated significantly with olfactory thresholds. Results from the OSITJ provide a measure of the degree of olfactory deficit because the ratio of correct answers obtained by the OSITJ decreased gradually with of the severity of olfactory disturbance. Compared to the T & T olfactometer, the OSITJ has several advantages for use in the clinic. These include minimal odor pollution of the test room, simplicity of use, and shorter clinical time needed to administer the test. The OSITJ may be ideal for use in screening due to the minimum number of odorants needed. In conclusion, the OSITJ is useful for detecting and evaluating olfactory disturbance in Japanese people.

Matrix metalloproteinase expression in the olfactory epithelium.

The olfactory epithelium contains neuronal progenitor cells capable of continuous neurogenesis and is a unique model for studying neural degeneration, regeneration, axon outgrowth and recovery from injury. Matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs), have been implicated in cell turnover, development, migration, and metastatic processes. We used Western blot and immunohistochemistry to determine whether MMP-2 and associated proteins TIMP-2 and membrane type 1 matrix metalloproteinase (MT1-MMP) are present in the olfactory epithelium of mice. We found MMP-2 expression localized to the olfactory basal cells and immature neurons. After injury-induced neural degeneration, MMP-2 and MT1-MMP levels decreased while TIMP-2 levels increased. However, following 35 days of neurogenesis and cell replacement TIMP-2 and MT1-MMP returned to control levels. The results show a correlation between MMP and TIMP levels and the stages of neural degeneration, regeneration and recovery of the olfactory epithelium following injury.

Detection thresholds for phenyl ethyl alcohol using serial dilutions in different solvents.

Detection thresholds are typically obtained by presenting a subject with serial dilutions of an odorant. Many factors, including the solvent used to dilute the odorant, can influence the measurement of detection thresholds. Differences have been reported in detection thresholds for phenyl ethyl alcohol (PEA) when different solvents are used. In this study we used gas chromatography (GC) to investigate further the effect of solvent on odor detection thresholds. We used a single ascending method and serial dilutions of PEA in four different solvents--liquid paraffin (LP), mineral oil (MO), propylene glycol (PG) and dipropylene glycol (DPG)--to determine the PEA thresholds for 31 adult subjects. For each solvent, we prepared eight serial log base 10 step dilutions (1-8), with corresponding liquid PEA concentrations of 6.3 x 10(1)-6.3 x 10(-6) (% v/v). We found that the threshold concentrations for PEA in LP (step 6.5) and PEA in MO (step 5.5) were significantly lower (P < 0.05) than for PEA in PG (step 4.0) and DPG (step 4.0) We then used GC to measure both the liquid and gas PEA concentrations for the dilution steps prepared with LP and PG. Although there were large threshold differences in the liquid concentrations of PEA in LP and PG, the headspace gas concentrations of PEA were the same. These results demonstrate the importance of determining the gas concentration of odorant stimuli when performing odor threshold measurements, in particular when comparing odor detection thresholds obtained using different solvents.

Potential changes with gamma-band oscillation at the frontal scalp elicited by intravenous olfactory stimulation in humans.

Intravenous olfaction is a unique stimulation method often used in Japan to diagnose olfactory disturbances. Odorant is injected into a vein and transported by blood flow and respiration to the upper air tract. The intravenous olfaction might allow the potential at the frontal scalp to be recorded without contamination from electromyograms, such as those caused by sniffing. We injected Alinamin (thiamine propyldisulphide) into healthy subjects according to a standard protocol for clinical intravenous olfaction testing and we simultaneously recorded potential changes at the frontal scalp. When Alinamin was injected into the right median cubital vein over a 20 s period, the potential changes with gamma-band oscillations were detected 17.6 +/- 6.7 s (mean +/- SD) after the start of the injection. The main frequency component of this gamma-band oscillation is 30-160 Hz. The gamma-band oscillation elicited by intravenous olfactory stimulation (VOP) was similar to the induced wave of the olfactory bulb. Mapping the VOPs on the frontal scalp of a subject with less developed frontal sinuses and the relation between the thickness of the frontal sinuses and VOP amplitude suggest an intracranial source, possibly the olfactory bulb. The gamma-band potential at the frontal scalp is a useful measure of central disturbance.