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Platelet-derived endothelial cell growth factor (PD-ECGF) was isolated as an endothelial mitogen from platelets and demonstrated to have angiogenic activity and thymidine phosphorylase (TP) activity. It was reported that the overexpression of PD-ECGF occurred with the rapid tumor growth in vivo. In this study, we transfected PD-ECGF into the head and neck squamous cell carcinoma cell line IMC-3 and investigated the property of transfectants in vitro. Highly overexpressed PD-ECGF transfectants rapidly grew compared with parental cells and control vector (CV) transfectants (p<0.05). The expression of cyclin D1 and cyclin E were more enhanced in PD-ECGF transfectants than parental cells and CV transfectants, while the p27kip1 was inhibited in PD-ECGF transfectants. In PD-ECGF transfectants, S and G2/M-phase cells rapidly increased compared with parental cells and CV transfectants. These results showed that the cancer cell line with high expression of PD-ECGF had a rapid cell cycle and consequently facilitated rapid cell growth not only in vivo but also in vitro. Furthermore, the inhibitor of thymidine phosphorylase (TPI) suppressed the cell cycle and rapid cell growth that were acquired by PD-ECGF transfection. Since PD-ECGF was reported to be an independent, poor prognosis factor for head and neck cancer, TPI might be useful for the inhibition of cancer cell growth.

We retrospectively evaluated clinical profiles and prognoses in 152 patients with thyroid papillary carcinoma treated at Fukui Medical University between 1986 and 2000. As standard treatment, 106 (70%) underwent hemithyroidectomy to preserve the normal thyroid lobe. Subtotal thyroidectomy or total thyroidectomy was conducted on 40 cases (23%). Regional lymphnodes were extirpated in 104 (68%) with pathological N0, and radical or conservative neck dissection for 46 cases (30%) with pathological N1. Overall survival for 10 years, estimated using the Kaplan-Meier method, was 100% in both stage I and II, and 95% in stage III. Of 152 thyroid papillary cases, 22 (14%) had tumor recurrence. Of 51 in stage III, 14 (27%) had tumor recurrence. The 14 recurrent in stage III showed local extrathyroidal invasion. Note that 5 of 10 (50%) T4N1 treated with hemithyroidectomy had tumor recurrence in the residual thyroid lobe. Of 11 T4N0 cases who underwent hemithyroidectomy, none had tumor recurrence in the residual thyroid lobe. Results suggest that patients with T4N1 should be treated by total thyroidectomy and neck dissection at initial treatment. Tumor size, cervical lymphnodal metastasis, and distant metastasis may be prognostic factors for thyroid papillary carcinoma.

Objective: To identify genes regulated in human cholesteatoma compared with normal skin tissue using complementary DNA arrays., Study Design: In vitro analysis., Methods: Eight cholesteatoma and retroauricular skin samples were obtained from the same patients during surgery. Upregulated and downregulated genes were highlighted using complementary DNA arrays for screening. Reverse transcriptase-polymerase chain reaction and immunohistochemical staining were performed to confirm the results of the complementary DNA array., Results: Twelve genes were found to be induced or upregulated in cholesteatoma compared with skin samples. These included genes involved in cell proliferation and differentiation (eg, calgranulin A, calgranulin B, psoriasin, thymosin beta-10) and cell invasion (eg, cathepsin C, cathepsin D, cathepsin H). Analyses by means of reverse transcription-polymerase chain reaction showed enhanced expression of several genes including calgranulin A, calgranulin B, psoriasin, thymosin beta-10, cathepsin C, cathepsin D, and cathepsin H in cholesteatoma, supporting the findings from the gene array. In addition, it was verified by immunohistochemical analysis that the expressions of Calgranulin A, Calgranulin B, and Cathepsin D were mainly located in cholesteatoma epithelium., Conclusion: The observed alteration in gene expression may play a role in various mechanisms of pathogenesis in cholesteatoma.

Objective: To decrease the aspiration rate of the previously reported simple mucodermal tracheoesophageal (TE) shunt method for voice restoration after total laryngectomy with the use of omohyoid muscle loop., Design: Retrospective clinical analysis., Setting: Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan., Patients: Ten male patients underwent total laryngectomy and received TE shunt by the omohyoid muscle loop method for voice restoration. There were 5 patients with glottic laryngeal cancer, 2 with supraglottic laryngeal cancer, and 3 with hypopharyngeal cancer. Patients' age ranged from 46 to 66 years., Intervention: The dermal incision on the neck was U-shaped with a superiorly pedicled, small U-shaped dermal flap. This small flap was used to form the anterior wall of the shunt. Bilateral omohyoid muscles were preserved at the total laryngectomy site with or without neck dissection. After creating a TE shunt directly on the posterior wall of the tracheal stump, the bilateral omohyoid muscles were looped through each other beneath the TE shunt., Main Outcome Measurements: Maximum phonation time, maximum phonation intensity, and rating scales of shunt voice, aspiration rate, and survival time., Results: Mean maximum phonation time was 20 seconds, while mean maximum phonation intensity was 83 dB. The first voice was obtained on postoperative day 29 on average. Of the 10 patients, 9 could phonate, with 1 case (10%) of slight aspiration 3 months after the surgery., Conclusions: Although this omohyoid muscle loop method needs to preserve the hyoid bone with those muscles, aspiration was prevented more effectively compared with the former, direct mucodermal TE shunt method. The indication for this method is preferably glottic laryngeal cancer.

Recently, a close relationship between the cell cycle and apoptosis was confirmed in oral squamous cell carcinoma (SCC). To clarify the expression of cell cycle-related proteins and apoptosis in the oral premalignant state, we investigated the expression of p27, cyclin D1 and proliferating cell nuclear antigen (PCNA) using immunohistochemical staining, and apoptotic index (AI) using ApopTag in situ staining. The positive expression-score of p27 was 42.0% in leukoplakia (34.8% in hyperplasia, 55.4% in dysplasia) and 31.1% in SCC (43.3% in the early stage of SCC, 25.9% in the advanced stage of SCC). The level of p27 expression showed a peak in dysplasia and decreased in SCC. The expression of cyclin D1 was almost constant between hyperplasia and SCC. The expression of PCNA increased sequentially with disease progression. The apoptotic index (AI) in the p27-positive leukoplakia group was significantly higher than that in the p27-negative leukoplakia group (3.9 +/- 3.6 vs. 1.5 +/- 1.6, p = 0.026). From these results, we suggest that the abundance of p27 in oral leukoplakia may inhibit cell proliferation and lead premalignant tumor cells to apoptosis, and thus is concerned with prevention of tumor progression.

To clarify paranasal sinus change in patients with Japanese cedar pollinosis, we studied reactions to medical treatment via X-ray images of patients during the 2000 cedar pollen season. Medication was administered to 577 patients consulting facilities in 3 regions--Kyoto, Fukui and Osaka--having different pollen counts i.e., 4555/cm2 in Fukui, 801/cm2 in Kyoto and 531/cm2 in Osaka. The paranasal sinus was X-rayed by Water's method, and the degree of positivity was classified by Katagiri'shadow classification. Patients were grouped into 334 suffering extensive Fukui pollen dispersion and 243 suffering relatively limited Kyoto and Osaka pollen dispersion. At 3-4 weeks after pollen dispersion, contrast shadow positivity was 22.2%, with no difference before pollen dispersion (22.2%) in Kyoto and Osaka. In Fukui, positivity was 39.7%, a clear increase over pre pollen dispersion (19.2%). In the initial treatment group, positivity was 25.8% in Fukui and 28.6% in Kyoto and Osaka. Our results suggest that the incidence of sinusitis in patients with Japanese cedar pollinosis tended to increase with exposure to extensive pollen dispersion and to be suppressed by initial treatment.

Objectives: The long-term effect of submucous turbinectomy for patients with perennial allergic rhinitis was assessed., Study Design: A cohort study of 45 patients with severe perennial allergic rhinitis who underwent submucous turbinectomy and were followed up after surgery for more than 3 years was performed. We investigated quality of life in 30 of 45 patients who had passed over 5 years after the surgery., Methods: Nasal symptoms were assessed with a standard symptom score by diary cards. Nasal congestion was evaluated by rhinometry. Nasal challenge tests in vivo were performed to evaluate allergic reactions. These examinations were performed before surgery and at 1 year, more than 3 years, and more than 5 years after submucous turbinectomy. We determined the symptom scores and the quality of life using card questionnaires in 30 patients at the time point of more than 5 years after surgery., Results: The mean [+/- SD] total nasal symptom score (maximum 9) was significantly lower at 1 year after surgery (7.5+/-1.6 vs. 1.8+/-1.8, P <.0001) compared with before surgery. A significant improvement in nasal symptoms was noted at the 3-year (2.8+/-2.3, P <.0001) and 5-year (3.3+/-1.6, P <.0001) time points. A significant increase in total nasal airflow value was noted at each time point after surgery, with a gradual reduction in the total nasal symptom score as well (before surgery, 269.4+/-249.5 cm3/s; 1 y after surgery, 450.1+/-197.7 cm3/s; more than 3 y after surgery, 385.1+/-182.3 cm3/s). The nasal challenge test score was also reduced 1 year after surgery (2.1+/-1.0 vs. 0.6+/-0.7, P <.0001). However, there was no further significant increase at the 3-year time point (0.4+/-0.7, P <.0001) after surgery. In regard to postoperative quality of life, according to the results of the card questionnaire, 50% of the patients had not been receiving antiallergic treatments in the postoperative period., Conclusion: Our results suggest that submucous turbinectomy is a useful strategy for the longterm management of nasal allergic reaction and contributes to the improvement in quality of life.

A very rare case of a 50-year-old female showing psychogenic hearing loss with a panic anxiety attack that complicated an acute organic sensorineural hearing loss is reported. At the first visit to our clinic, the patient showed left sensorineural hearing loss with an inner ear disorder pattern. Five days after the onset, her left hearing threshold markedly increased without any subjective signs. On the next day, she suddenly experienced a severe panic attack with anxiety. After the attack, she felt mildly anxious and depressed. A combined therapy using primary corticosteroid therapy for the acute inner ear disorder, psychiatric counseling based on cognitive therapy and the administration of a minor tranquilizer was performed. Her left hearing threshold recovered to within normal ranges except in the high-frequency ranges immediately after the treatment. This case was considered very rare because: (1) the panic anxiety attack occurred in the conversion disorder as psychogenic hearing loss and (2) the psychogenic hearing loss complicated the primary sudden deafness. We suggest that otorhinolaryngologists should have psychiatric knowledge and be able to treat psychogenic hearing loss as a primary care.