[Show abstract][Hide abstract] ABSTRACT: Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16-40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment.
[Show abstract][Hide abstract] ABSTRACT: Skull base osteoradionecrosis is one of the most serious post-irradiation complications. In spite of localized lesions, patients have symptoms of foul odor and headache, which are very uncomfortable. What is even worse, without appropriate management, is that a mortal complication such as a rupture of the internal carotid artery may occur. We must recognize this disease and take a positive attitude toward this problem.We report on a 61-year-old man with skull base osteoradionecrosis after re-irradiation for a recurrence of nasopharyngeal carcinoma. Based on a few literature reviews, endoscopic sequestrectomy is very effective for relief of symptoms and prevention of the rupture of the internal carotid artery. But, if we accidentally expose the internal carotid artery during surgery, we may induce rupture of said artery. So, we must choose the method of treatment carefully. Furthermore, we should understand the structure of the skull base in detail and work cautiously during surgery.
[Show abstract][Hide abstract] ABSTRACT: Pyriform sinus fistula is a cause of repeated suppurative thyroiditis or neck abcesses. Between April 2006 and March 2011, we encountered four cases of pyriform sinus fistula. The fistula was removed via two approaches, namely, direct hypopharyngoscopy via an external incision. To visualize the fistula, a dye solution was injected during hypopharyngoscopy. The fistula was identified by its staining in two cases. In one of the two cases, a partial thyroidectomy was performed. In contrast, we were unable to detect the fistula in two cases, because no staining could be observed. In one of the nonidentified cases, a partial thyroidectomy was performed and a semithyroidectomy in combination with a fistulectomy was performed in the other. No recurrence was observed except in a pediatric case during the follow-up period. To prevent recurrence, complete identification and extirpation of the fistula are mandatory. The fistula should be identified by a procedure appropriate for each particular case. We concluded that thyroid lobectomy is necessary for preventing recurrence if the fistula cannot be identified by staining during surgery.
[Show abstract][Hide abstract] ABSTRACT: Chronic rhinosinusitis (CRS) is classified in CRS without nasal polyp (CRSsNP) and CRS with nasal polyp (CRSwNP) in western countries, whereas this classification was not common so far in Japan. Studying inflammatory mediators in clearly defined disease subgroups may lead to a better differentiation of chronic sinus diseases.
Homogenates of sinonasal mucosal tissue from 14 controls, 9 CRSsNP patients, and 19 CRSwNP patients were assayed for transforming growth factor (TGF)-β, interleukin (IL)-5, immunoglobulin E (IgE), Staphylococcus enterotoxin (SAE)-IgE, eosinophil-catioic protein (ECP), myeloperoxidase (MPO), IL-1β, IL-6, and IL-8 by enzyme-linked immunosorbent assay or UNICAP system.
CRSwNP had significantly higher levels of IL-5, IgE, SAE-IgE, and ECP compared with CRSsNP and controls. CRSsNP was characterized by high levels of TGF-β, while CRSwNP showed a Th2 polarization and lower levels of TGF-β. Especially, in CRSwNP samples, 68.4% were eosinophilic (ECP/MPO ratio >1), and 52.6% were SAE-IgE positive. On the other hand, in 9 CRSsNP patients, eosinophilic or SAE-IgE positive sample was only one sample respectively. Additionally, 31.6% of CRSwNP were asthmatic patients, while none of CRSsNP patient was suffering from bronchial asthma.
This study is thought to be the first one that showed the cytokine profiles in Japanese CRSs/wNP similar to those of European CRS. Based on mediator profiles, we suggest that CRSsNP and CRSwNP are distinct disease entities within the group of chronic sinus diseases.
Allergology International 03/2012; 61(1):115-22. DOI:10.2332/allergolint.10-OA-0290 · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hereditary hemorrhagic telangiectasia (HHT)-a systemic autosomal dominant disorder adversely affecting skin, mucous membranes, and visceral blood vessels-typically shows epistaxis. In this pathological condition, even minor stimulation may cause bleeding and hemostasis is unlikely to occur. Subjects with HHT showing severe nasal bleeding require nasal dermoplasty (ND). We report our experience in 22 cases of HHT undergoing ND seen from January 2000 to November 2009. Average age at surgery was 55.8 years. Since April 2008, we modified ND, cut the harvested skin graft from the lateral thigh in halves and spread each strip on the anterior halves of the nasal cavity. Placement was circumferential in the sequence of agger nasi, nasal valve, septum, floor, and inferior turbinate. Before this technique was used, bleeding could not be controlled in 3 of 14 cases. Two of the 3 had histories of arterial embolization. Subjects undergoing the new technique have enjoyed improved quality of life.
[Show abstract][Hide abstract] ABSTRACT: Nasal dermoplasty is effective in controlling epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). Skin graft take failure occurs mostly in cases of large septal perforation. The MW method was developed as a modification of nasal dermoplasty designed for patients with HHT having a large septal perforation. It seems to be a safe and effective approach and should be tried for recurrent bleeders with septal perforation.
The Laryngoscope 08/2011; 121(8):1715-7. DOI:10.1002/lary.21875 · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation.
Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities.
Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery.
Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required.
[Show abstract][Hide abstract] ABSTRACT: Nasal polyps are one of the most common findings of physical examination in the otolaryngology area and the experimental model of nasal polyps in the rabbit maxillary sinus is helpful for clarifying the mechanism of polyp formation. Several protocols have been reported for this model, but most of them involved infectious polyps without eosinophil infiltration. We have attempted to establish a novel rabbit model of polyps associated with eosinophil infiltration.
Rabbits were either untreated (group A) or sensitized with ovalbumin (OVA; groups B-D). After repeated exposure to OVA, some animals further received valine-glycine-serine-glutamine (group C) or poly-L-arginine (group D) in their maxillary sinuses for 4 weeks. Subsequently, sinus tissues were dissected and subjected to histological analysis. The changes in mRNA expression were analyzed by DNA microarray.
Remarkable histological changes were observed in groups C and D but not in group B in eosinophil number in the maxillary sinus mucosa, the width of the lamina propria, and polyp scoring. These changes in group D were greater than those in group C. DNA microarray analysis revealed that up-regulated genes in group D included those related to inflammation and extracellular matrix metabolism. On the other hand, down-regulated genes in group D involved those related to anti-inflammation.
Our results indicate that treatment with inflammatory agents, in combination with an antigen-dependent immune response, could induce nasal polyp formation associated with eosinophil infiltration and mucosal hypertrophy. The gene expression profile supported the clinical relevance of this model.
American Journal of Rhinology and Allergy 09/2010; 24(5):341-7. DOI:10.2500/ajra.2010.24.3519 · 1.81 Impact Factor