Expression of ecalectin, a novel eosinophil chemoattractant, in nasal polyps.

CONCLUSION: Ecalectin, which is produced in the mucosa of nasal polyps, seems to play an important role in the accumulation and activation of eosinophils in nasal polyps, regardless of the presence or absence of atopic predisposition. OBJECTIVE: Ecalectin is a recently discovered eosinophil chemoattractant which elongs to the galectin family. We investigated the expression of ecalectin in nasal polyp tissues associated with various nasal and paranasal diseases in order to clarify the pathogenesis of eosinophilia in nasal polyposis. MATERIAL AND METHODS: Nasal polyps were taken from 56 patients diagnosed as having chronic sinusitis with nasal polyposis. The surgically resected polyps and nasal turbinates were immunohistochemically stained using antibodies against EG2, human mast cell tryptase, CD3 and ecalectin. RESULTS: The number of EG2- and ecalectin-positive cells was significantly higher in nasal polyps than control turbinates. Ecalectin-positive cells were observed in the subepithelial layer, where many EG2-positive cells were present. The number of ecalectin-positive cells correlated significantly with the number of EG2-positive cells in nasal polyps. Many ecalectin mRNA-positive cells were also observed in nasal polyps with an accumulation of EG2-positive cells.

Eosinophil chemoattractants in the middle ear of patients with eosinophilic otitis media.

BACKGROUND: Patients with intractable otitis media associated with bronchial asthma have an extensive accumulation of eosinophils in the effusion and mucosa of the middle ear; this condition is called eosinophilic otitis media (EOM). It remained to be determined how eosinophils accumulate in the middle ear. OBJECTIVES: To clarify the pathogenesis of middle ear diseases, we measured the concentration of eosinophil chemoattractants in middle ear effusion (MEE), and carried out immunohistochemical studies of middle ear mucosa specimens to demonstrate the expression of eosinophil chemoattractants. METHODS: Middle ear effusion samples were obtained from 15 EOM patients with bronchial asthma and from six controls for the measurement of eosinophil cationic protein (ECP), IL-5, eotaxin and regulated on activation, normal T expressed and secreted concentrations. Middle ear mucosa samples were also taken from 14 EOM patients and 16 controls for immunohistochemical study. In 10 EOM patients, the numbers of immunoreactive cells as well as apoptotic cells were determined before and after the topical application of triamcinolone acetonide into the middle ear. RESULTS: In EOM, significantly higher ECP and IL-5 concentrations were detected in MEE than in serum, and ECP, IL-5 and eotaxin concentrations in MEE were higher in the EOM patients than in the controls. ECP concentration positively correlated with that of IL-5. Immunohistochemically, the numbers of cells positive for EG2 and ecalectin were significantly higher in the EOM patients than in the controls. After the topical application of triamcinolone acetonide, the numbers of infiltrating cells and immunoreactive cells distinctly decreased, whereas the number of apoptotic cells significantly increased. CONCLUSION: In EOM, locally produced IL-5 may play a crucial role in the accumulation of eosinophils in the middle ear. Chemokines such as ecalectin and eotaxin are also produced in the middle ear, and help activate and enhance the survival of eosinophils to induce the intractable condition in the middle ear. The topical application of triamcinolone acetonide induces the apoptosis of not only eosinophils but also eosinophil chemoattractant-producing cells, thereby improving the middle ear condition.

[Laryngeal manifestations of gastroesophageal reflux disease (GERD) in pediatric patients: the usefulness of therapeutic (proton pump inhibitor (PPI)) trials].

Gastroesophageal reflux, common in infants, usually resolves spontaneously by 12 to 18 months. Gastroesophageal reflux disease (GERD) contributes to certain respiratory symptoms, but is reported to be due to other causal diseases, such as tracheolaryngeal anomaly, congenital esophageal hiatal hernia, and cerebral palsy, in pediatric patients. We report 4 pediatric cases with unusual laryngeal disorders, especially posterior glottic lesion, induced by gastroesophageal reflux without other causal disease. Subject 1 was a 1-year-old boy showing severe laryngeal spasm, Subject 2 a 3-year-old boy with life-threatening supraglottic stenosis, Subject 3 a 5-year-old boy whose voice had reached near aphonia with multiple laryngeal granulomatous lesions, and Subject 4 an 8-year-old boy with persistent abnormal throat sensations. Their symptoms were recalcitrant to conventional therapy. Their case histories (much belching and hiccups) and findings for the posterior glottitis, etc., suggested that symptoms might be induced by GERD, but, barium esophagography and esophagoscopy provided no conclusive proof. We could not monitor their ph because of the excessive physical and psychological stress involved. After therapeutic trials with a proton pump inhibitor (lansoprazole 10-15 mg) for 8 weeks, all had recovered almost completely without side effects.

Morphological and histochemical studies of the genioglossus muscle.

The purpose of this preliminary study was to assess the histo-anatomic composition of the genioglossus muscle fibers. The genioglossus muscles were obtained from 4 cadavers and 1 autopsy specimen. On morphological study, the average diameters of the muscle fibers were seen to gradually increase, from the fibers that ran anteriorly to the dorsum of the tongue, to the fibers that ran posteriorly to the root of the tongue. Histochemical study revealed that type II fibers were significantly predominant in the anterior portion; there was no dominant fiber type in the posterior portion. Gradual changes in diameter were independent of fiber type. These findings may suggest that the fibers of the anterior portion are suitable for phasic action, and that the posterior is relatively tonic; and the posterior has larger absolute muscle strength than the anterior. It is thought that the fibers of the posterior portion might contribute to the maintenance of the mesopharyngeal airway and to vowel production, and that the anterior fibers might contribute to some fine movements and to consonant production.

["Direct" indirect training approach to rehabilitation of dysphagia patients--a new method for rehabilitation with a feeding-tube].

The rehabilitation approaches for training patients with dysphagia consist of both direct approaches (eating training) and indirect approaches (basic training for dysphagia patients without food). On the other side, some recent reports revealed that some patients who had had severe dysphagia were improved while the feeding approach was with a naso-gastic tube and an oral-esophago feeding tube. So we thought that stimulation of these feeding tubes for the pharynx and the larynx would produce some useful reactions for dysphagia patients. We developed a new method for the rehabilitation of such patients. The technique is the repeated insertion of the naso-gastric tube at the time of the swallowing motion, which we called the "direct" indirect training approach. Sometimes, other basic training procedures for dysphagia patients are admissible. We treated 26 patients by this method. The patients included those with disorders of the corticobulbar tract (n = 11), a disorder of the medulla (n = 5), a disorder of the peripheral nerve (n = 7), and a long-lasting disused state (n = 3). Twenty-four patients were improved and could eat orally without major problems. Laryngeal elevation curves of this approach in the pre- and post-therapeutic states revealed that the threshold of the swallowing reflux was lower, and the swallowing actions were changed dynamically, and became more useful.

[Relationship between oral food intake and nausea caused by intravenous injection of iodinated contrast material].

From December, 1990 to July, 1992 we investigated the relationship between the time after oral food intake and nausea and vomiting caused by the intravenous injection of iodinated contrast media in 2,414 patients who underwent contrast enhanced CT. The contrast media used were as follows: amidotrizoic acid (high-osmolality contrast medium, HOCM, iodine 292 mg/ml) in 1173 patients, iopamidol (low-osmolality contrast medium, LOCM, iodine 300m g/ml) in 641 patients, and iohexol (LOCM, iodine 300 mg/ml) in 600 patients. All the patients had an intravenous injection of 100ml in volume. The overall incidence of nausea and vomiting was 3.8% (96/2412 patients). The incidence was 6. 7% (79/1173 patients) in the HOCM group and 1.4% (17/1241 patients) in the LOCM group. The incidence of nausea and vomiting increased with the interval between the oral intake of food and the intravenous injection of contrast medium. It is concluded that fasting before contrast-enhanced CT enhances the adverse effect of nausea and vomiting.

[A case of Klinefelter's syndrome with acute mitral regurgitation caused by idiopathic chordal rupture].

It has been reported that the incidence of mitral valve prolapse was remarkably increased in patients with Klinefelter's syndrome. Some cases which have been previously reported were associated with hemodynamically significant transvalvular regurgitation, however, none of them underwent a surgical treatment such as valvular replacement. Here we report a case of Klinefelter's syndrome which underwent MVR for mitral regurgitation caused by idiopathic chordal rupture. Pathological microscopic examination showed topical and minor myxomatous changes on the free edge of the leaflet and no inflammatory changes such as in infectious endocarditis. It is, therefore, suggested that an echocardiographic follow-up should be carried out in case of Klinefelter's syndrome during its life and also in the case treated by a prophylactic therapy for endocarditis with antibiotics. And when, unfortunately, surgical treatment is required, valve replacement would be preferable to valvuloplasty because of a fragility of leaflet.

[Pacemaker infection with superior vena cava thrombotic obstruction, followed by bacteremia: a case report].

Infection is one of the complications brought about sometimes by pacemaker implantation. This is a case report, showing superior vena cave obstruction after pacemaker implantation, followed by bacteremia after 5 years. Gallium-67 scintigraphy was the most effective method to survey the source of the infection. We performed the operation and found vegetation (1 cm x 1 cm) attaching to the pacemaker lead and an organized thrombosis in the superior vena cava. The lead and the vegetation were removed. The administration of antibiotics after the operation led to the patient's complete recovery. Post operative gallium-67 scintigraphy didn't reveal any sign of infection at the mediastinum.

[A case of supravalvular aortic stenosis treated by Doty's operation].

A 11-year-old boy with supravalvular aortic stenosis was treated by extended aortoplasty (Doty's operation) with excellent results. The extended aortoplasty provided satisfactory relief of aortic stenosis and improved function of the aortic valve.

[A case of systemic origin of an aberrant artery to the basal segments of the left lung].

A thirteen-year-old asymptomatic boy was referred to our hospital because of a cardiac murmur detected on a routine physical examination at school. A plane chest radiography showed increased vascular markings in the left lower field. An Aortogram revealed a large artery arising from the descending aorta and suppling the left posterior basal segment which had no pulmonary arteries. A bronchogram showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic origin of an aberrant artery to the basal segments of the left lung was made, and left lower lobectomy was performed successfully. We discussed the difference of this anomaly from pulmonary sequestration as well as the surgical procedure.

[Spontaneous coronary artery dissection with left ventricular aneurysm--a case report of successful surgical repair].

Spontaneous coronary artery dissection is a rare entity. To our knowledge, 86 cases have been reported, and there are 7 operative treatment. The patient was 56 year-old male with a history of the previous myocardial infarction. A selective coronary angiography demonstrated marked dilatation of both coronary arteries. The thin radiolucent lines were shown within the LAD and first diagonal branch as a result of partial separation of the intima. A very large left ventricular myocardial aneurysm was also demonstrated within anteroapical walls, he underwent open heart surgery with left ventricular myocardial aneurysmectomy and aorto-first diagonal branch saphenous vein graft. This present case is the second report which describe a successful surgical treatment for the spontaneous coronary artery dissection with left ventricular aneurysm.