Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration.

A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake.

Traumatic pneumolabyrinth: air location and hearing outcome.

OBJECTIVE: To describe 3 cases of pneumolabyrinth after penetrating injury to the middle ear and to review previously reported cases, comparing precipitating factors and hearing outcomes. DATA SOURCES: Three cases we encountered and the PubMed and Japan Medical Abstracts Society databases. STUDY SELECTIONS: In addition to our 3 cases, we identified 48 cases from 41 articles regarding pneumolabyrinth. DATA EXTRACTIONS: All articles describing cases of pneumolabyrinth were used for this review. DATA SYNTHESIS: Among the 51 cases, audiologic evaluation was not available in 16 cases. In the remaining 35 cases, hearing outcomes were analyzed focusing on 3 factors: 1) differences in and interval until medical intervention, 2) existence of stapes lesions, and 3) extension of air bubble into the inner ear. We failed to find any significant differences in interventions, although operation less than 2 weeks after injury tended to be associated with a higher rate of hearing recovery (54%) than operation 2 weeks or longer after injury (25%). Furthermore, 11 (48%) of 23 cases with pneumolabyrinth limited to the vestibule or semicircular canals showed improved hearing, whereas none of 6 cases (0%) with pneumolabyrinth extending from the vestibular organs to the cochlea showed hearing recovery. This difference was statistically significant (p < 0.05). CONCLUSION: Assessment of the location and extension of pneumolabyrinth appears important in predicting hearing outcomes and planning the management of middle and inner ear trauma.

Management of patulous eustachian tube with habitual sniffing.

OBJECTIVES: Evaluation of the effect of conservative and surgical treatment in patients with patulous Eustachian tube (PET) associated with habitual sniffing. STUDY DESIGN: Retrospective case review. SETTING: University hospital otolaryngology department. PATIENTS: Ninety-seven (23.4%) of 414 PET patients were found to have habitual sniffing to alleviate uncomfortable aural symptoms. Of these, 38 PET patients with sniffing habit were selected. INTERVENTIONS: Conservative intervention included instructions to stop sniffing and nasal instillation of saline. Surgical interventions used ventilation tube (VT) insertion to the eardrum and/or transmyringeal insertion of the PET plug (PEP). MAIN OUTCOME MEASURES: Relief of uncomfortable symptoms and stopping sniffing. RESULTS: In 52 (53.6%) of the 97 sniff-positive cases, retraction-type eardrum abnormalities or operated ear due to cholesteatoma were identified, whereas normal bilateral eardrums were observed in 34 (87.2%) of 39 sniff (-) cases. Abnormal findings in the eardrum were significantly more common in the sniff-positive group than in the sniff-negative group (p < 0.0001). Twenty-three patients (65.7%) stopped sniffing with conservative treatment. VT insertion was performed in 8 ears. Subsequent PEP was necessary in 2 of the 8 ears because of PET symptoms. PEP was successful in the other 11 ears, including one ear which needed additional VT insertion because of middle ear effusion. CONCLUSION: The management of habitual sniffing is difficult, but blocking the Eustachian tube by nasal instillation of saline and/or PEP could help PET patients to stop sniffing.

An analysis of clinical risk factors of deep neck infection.

OBJECTIVES: To clarify the clinical risk factors that aggravate deep neck infection. PATIENTS AND METHODS: Sixty-five patients with deep neck infection (abscess or cellulitis), 42 males and 23 females, who were treated at the ear, nose, and throat department in Iwaki Kyoritsu General Hospital in the past 10 years, were retrospectively reviewed. Cases of inflammation of the upper airway including the oral cavity, laryngopharynx, palate tonsil and salivary gland, and cases of lymphadenitis were investigated. These patients were divided into five localized types and one wide range type according to the abscess locations as follows: oral cavity floor type, upper deep cervical type, submandibular type, submental type, retropharyngeal type, and wide range type. RESULTS: Seventeen of the 65 patients had diabetes, and significantly more diabetics had the wide range type than the localized type (P<0.05, Fisher's test). Diabetes complication was more often seen in the upper deep cervical type among patients aged 61 years or older, and in the wide range type among males aged 41 years or older and elderly women aged 61 years or older. No patients with odontogenic infection or sialolithiasis had associated diabetes mellitus. Two cases developed mediastinitis, and one was caused by retrotonsillar abscess and needed thoracic drainage. More than half of the wide range type cases and more than a quarter of each of the localized type cases except the upper deep cervical type also had laryngeal edema, and eight of them needed emergency tracheotomy. Thirteen of the 40 cases had bacteria belonging to the Streptococcus milleri group (SMG), and all were detected in patients who underwent surgical drainage. Four of the 13 cases where SMG was detected showed drug resistance to some sorts of antibiotics. CONCLUSION: Oral disorders can develop deep neck infection independently of the presence of diabetes mellitus, compared with other causes. The presence of diabetes mellitus is associated with deep neck infection, aggravating parotitis and wide spread of inflammation. Retrotonsillar abscess often spreads to the retropharyngeal and parapharyngeal spaces, causing mediastinitis, so caution is necessary. Infection due to SMG tends to form abscess independently of diabetes mellitus. Since more than half of the wide range type and more than a quarter of each of the localized types except the upper deep cervical type were associated with laryngeal edema, airway management should be considered.

The distinct role of the Runx proteins in chondrocyte differentiation and intervertebral disc degeneration: findings in murine models and in human disease.

OBJECTIVE: Runx2 is a transcription factor that regulates chondrocyte differentiation. This study was undertaken to address the role of the different Runx proteins (Runx1, Runx2, or Runx3) in chondrocyte differentiation using chondrocyte-specific Runx-transgenic mice, and to study the importance of the QA domain of Runx2, which is involved in its transcriptional activation. METHODS: Runx expression was analyzed in the mouse embryo by in situ hybridization. Overexpression of Runx1, Runx2 (lacking the QA domain [DeltaQA]), or Runx3 was induced in chondrocytes in vivo, to produce alpha(1)II-Runx1, alpha(1)II-Runx2DeltaQA, and alpha(1)II-Runx3 mice, respectively, for histologic and molecular analyses. Runx expression was also examined in an experimental mouse model of mechanical stress-induced intervertebral disc (IVD) degeneration and in human patients with IVD degeneration. RESULTS: Runx1 expression was transiently observed in condensations of mesenchymal cells, whereas Runx2 and Runx3 were robustly expressed in prehypertrophic chondrocytes. Similar to alpha(1)II-Runx2 mice, alpha(1)II-Runx2DeltaQA and alpha(1)II-Runx3 mice developed ectopic mineralization of cartilage, but this was less severe in the alpha(1)II-Runx2DeltaQA mice. In contrast, alpha(1)II-Runx1 mice displayed no signs of ectopic mineralization. Surprisingly, alpha(1)II-Runx1 and alpha(1)II-Runx2 mice developed scoliosis due to IVD degeneration, characterized by an accumulation of extracellular matrix and ectopic chondrocyte hypertrophy. During mouse embryogenesis, Runx2, but not Runx1 or Runx3, was expressed in the IVDs. Moreover, both in the mouse model of IVD degeneration and in human patients with IVD degeneration, there was significant up-regulation of Runx2 expression. CONCLUSION: Each Runx protein has a distinct, yet overlapping, role during chondrocyte differentiation. Runx2 contributes to the pathogenesis of IVD degeneration.

[Management of cervical tuberculous lymphadenitis: evaluation of 6 cases].

Unlike other advanced nations, secondary spread of tuberculosis still occurs in Japan. Cervical tuberculous lymphadenitis is still an important disease of the neck, and between 2001 to 2005, we treated 6 patients with cervical tuberculous lymphadenitis. All 6 patients were females, and their ages ranged from 28 to 77 years old (average: 62 years). One patient had received antitubercular chemotherapy for pulmonary tuberculosis 40 years earlier. Two patients had a family history of pulmonary tuberculosis. One patient was an immigrant from Thailand. Three patients underwent open biopsy of the cervical lymph node, and were diagnosed with tuberculosis histologically. The remaining three patients had an abscess, and fine-needle aspiration (FNA) biopsy was performed. The diagnosis of tuberculosis was made by detection of acid-fast bacilli, MTD (Mycobacterium tuberculosis direct test), PCR (polymerase chain reaction), and culture. All six patients were treated with antitubercular chemotherapy for 6-9 months and recovered. MTD and PCR of the FNA sample seemed to enable early treatment. Attention needs to be paid to countries around Japan where tuberculosis is spreading. We suggest that treatment should be performed while at the same time making an effort to grasp the trend of spread in other countries as well as Japan.

Structural features of the glycogen branching enzyme encoding genes from aspergilli.

A maltose binding protein, p78, was purified to homogeneity from Aspergillus nidulans by a single column chromatography step on cross-linked amylose. The partial amino acid sequence was highly homologous to the glycogen branching enzymes (GBEs) of human and yeast, and p78 did show branching enzyme activity. The genomic gene and its cDNA encoding GBE (p78) were isolated from the A. nidulans genomic and cDNA libraries. Furthermore, a cDNA encoding A. oryzae GBE was entirely sequenced. A. nidulans GBE shared overall and significant amino acid sequence identity with GBEs from A. oryzae (83.9%), Saccharomyces cerevisiae (61.1%) and human (63.0%), and with starch branching enzymes from green plants (55-56%).