Surgical treatments of adult chronic sinusitis--a study by questionnaire from 434 hospitals in Japan]

Information concerning surgical treatment of adult patients with chronic sinusitis was obtained through questionnaires from 434 hospitals in Japan. The hospitals were authorized for an in-service otorhinolaryngological training institute by the Oto-Rhino-Laryngological Society of Japan. The questionnaires were sent to the hospitals in December, 1989, and answers were obtained from 370 hospitals within 2 months, an 85.3% response rate. The following results were obtained. In 96.2% of the hospitals, permaxillary sinus surgery was performed on patients whose maxillary and ethmoid lesions were severe. With moderate lesions of both the maxillary and ethmoid sinuses, permaxillary sinus surgery and endonasal sinus surgery were performed in 76.0% and 24.9%, respectively. Application of an endoscope for sinus surgery was reported by 89 hospitals. In January, 1990, a further survey was sent to the 89 hospitals where endoscopic sinus surgery was performed. Questionnaire responses were obtained from 75 hospitals. Rigid endoscope was used most frequently and operative microscope was also used. Endoscopy was applied to all of the sinus surgery procedures in 21.6%, and to a portion of the procedures in 74.3% of the hospitals. About 50% of the hospitals performed endoscopic surgery in fewer than 30% of sinus surgery cases. When questioned as whether endoscopic surgery had been successful, 42.6% said yes, 10.7% said no, and 42.6% were unsure.     

Mostly separate distributions of CLAC- versus Abeta40- or thioflavin S-reactivities in senile plaques reveal two distinct subpopulations of beta-amyloid deposits

Collagenous Alzheimer amyloid plaque component (CLAC) is a unique non-Abeta amyloid component of senile plaques (SP) derived from a transmembrane collagen termed CLAC-precursor. Here we characterize the chronological and spatial relationship of CLAC with other features of SP amyloid in the brains of patients with Alzheimer's disease (AD), Down syndrome (DS), and of PSAPP transgenic mice. In AD and DS cerebral cortex, CLAC invariably colocalized with Abeta42 but often lacked Abeta40- or thioflavin S (thioS)-reactivities. Immunoelectron microscopy of CLAC-positive SP showed labeling of fibrils that are more loosely dispersed compared to typical amyloid fibrils in CLAC-negative SP. In DS cerebral cortex, diffuse plaques in young patients were negative for CLAC, whereas a subset of SP became CLAC-positive in patients aged 35 to 50 years, before the appearance of Abeta40. In DS cases over 50 years of age, Abeta40-positive SP dramatically increased, whereas CLAC burden remained at a constant level. In PSAPP transgenic mice, CLAC was positive in the diffuse Abeta deposits surrounding huge-cored plaques. Thus, CLAC and Abeta40 or thioS exhibit mostly separate distribution patterns in SP, suggesting that CLAC is a relatively early component of SP in human brains that may have inhibitory effects against the maturation of SP into beta-sheet-rich amyloid deposits.     

Study of the toughening mechanisms in bone and biomimetic hydroxyapatite materials using Raman microprobe spectroscopy

A Raman microprobe spectroscopy characterization of microscopic fracture mechanisms is presented for a natural hydroxyapatite material (cortical bovine femur) and two synthetic hydroxyapatite-based materials with biomimetic structures-a hydroxyapatite skeleton interpenetrated with a metallic (silver) or a polymeric (nylon-6) phase. In both the natural and synthetic materials, a conspicuous amount of toughening arose from a microscopic crack-bridging mechanism operated by elasto-plastic stretching of unbroken second-phase ligaments along the crack wake. This mechanism led to a rising R-curve behavior. An additional micromechanism, responsible for stress relaxation at the crack tip, was recognized in the natural bone material and was partly mimicked in the hydroxyapatite/silver composite. This crack-tip mechanism conspicuously enhanced the cortical bone material resistance to fracture initiation. A piezo-spectroscopic technique, based on a microprobe measurement of 980 cm(-1) Raman line of hydroxyapatite, enabled us to quantitatively assess in situ the microscopic stress fields developed during fracture both at the crack tip and along the crack wake. Using the Raman piezo-spectroscopy technique, toughening mechanisms were assessed quantitatively and rationally related to the macroscopic fracture characteristics of hydroxyapatite-based materials.     

Effect of amlexanox on experimental allergic rhinitis in actively sensitized guinea pigs

The effect of amlexanox given orally for 3 weeks was studied on the IgE-mediated experimental allergic rhinitis in the actively sensitized guinea pigs. The intranasal instillation of antigen (egg albumin) induced the increase of nasal vascular permeability (dye leakage), histamine content in nasal perfusate and nasal resistance in sensitized guinea pig. Amlexanox, 20 and 60 mg/kg/day given orally for 3 weeks significantly inhibited the increase of dye leakage into the nasal cavity, histamine content and nasal resistance in a dose-dependent manner. These results suggest that amlexanox given orally may be useful therapeutic agent for human allergic rhinitis.     

Antibody assay of rabbit sera for outer membrane vesicles ofHaemophilus influenzae by enzyme-linked immunosorbent assay

Enzyme-linked immunosorbent assay (ELISA) was applied to the detection of IgG and IgM antibodies against outer membrane vesicles (OMV) antigen ofHaemophilus influenzae type b. In this ELISA system, IgG antibody titers were about 40 fold higher than those in indirect hemagglutination assay (IHA). The IgG antibody titers by this ELISA of rabbit sera obtained after immunization were comparable with those by radioimmunoassay (RIA) of the same sera. A significant correlation was established between these two assays (r=0.973,P<0.001).Subject section: Bacteriology (infection and immunity)     

Bilateral diffuse nephroblastomatosis, pancortical type. A case report with immunohistochemical investigations

A variation of Perlman's syndrome of the pancortical type is reported in a male neonate whose parents were cousins. The patient was the product of a 35-week pregnancy, the Apgar score was 3, and the patient died of respiratory failure one hour and 12 minutes after delivery. Autopsy revealed bilateral diffuse nephroblastomatosis, pancortical type, associated with malformations (usually facial), congenital anomalies of the heart, hepatosplenomegaly, pancreatic islet cell hyperplasia, bilateral cryptorchidism, and hyperflexibility of the left knee joint. Renal immunohistochemical investigations revealed positive bindings with peanut and soybean agglutinins and epithelial membrane antigen along the luminal surface of the epithelium in the moderately differentiated tubules, but not in blastoma or primitive epithelium.     

Sarcomatoid carcinoma of the urinary tract

Sarcomatoid carcinoma is a rare variant of malignant tumor arising from the urinary tract. This tumor had been termed carcinosarcoma because of its carcinomatous and sarcomatous components. There is still some confusion in the terminology between true carcinosarcoma and sarcomatoid carcinoma; however, the latter is now regarded as primarily a malignant epithelial tumor with pseudosarcomatous transformation.
Four cases of sarcomatoid carcinoma arising from the urinary tract are reported. The patients were a 77 year old female, and three males aged 62, 69 and 80 years. All but the eldest patient complained of gross hematurla. Surgical removal was performed in the younger three cases, and an autopsy was done in the remaining case. All the tumors were macroscopically polypoid. Histopathologic examination revealed fasciculated spindle-cell tumors with myxold stroma or malignant fibrous histiocytoma-like spindle cell tumors. The epithelial nature was proven in these sarcomatous cells by immunohistochemical andlor electron-microscopic examinations. Only a small amount of squamous cell carcinoma components was also evident in the latter three cases. Although the younger three patients were alive at 44, 23 and 39 months'follow-up, respectively, constant careful monitoring Is recommended.     

Tumor Necrosis Factor Gene Polymorphism in Chronic Sinusitis

Objectives It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis. Study Design Thirty‐eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films. Methods Both tumor necrosis factor‐α (TNF‐α) and tumor necrosis factor‐β (TNF‐β) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects. Results A significantly higher frequency (P < .05) of TNFB*2 allele of TNF‐β gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF‐α and chronic sinusitis. Conclusion We concluded that TNF‐β gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.