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The frequency of either CD4(-)8(-) (double negative; DN) or CD4(+) V alpha 24(+)V beta 11(+) NKT cells, the expression of CD1d and the binding of CD1d-tetramer loaded with alpha-galactosylceramide (alpha-GalCer) to NKT cells were analysed in peripheral blood mononuclear cells (PBMCs) of patients with Wegener's granulomatosis (WG), relapsing polychondritis (RP) and healthy subjects (HS). DN and CD4(+) V alpha 24(+)V beta 11(+) NKT cells as well as CD1d-alpha-GalCer tetramer-positive NKT cells, were significantly decreased in number in both WG and RP patients compared to those from HS. When cytokine profiles were analysed in these PBMCs upon stimulation with phorbol ester and calcium ionophore, CD4(+) T cells from patients with WG and RP exhibited a Th1 bias, whereas CD4(+) NKT cells from WG patients in remission showed a Th2 bias. These findings suggest that NKT cells (especially CD4(+) NKT cells) play a regulatory role in Th1 autoimmunity in patients with WG and RP. The reduction in NKT cell counts appears to be associated with the low responsiveness to alpha-GalCer. The dysfunction of NKT cells to recognize ligands such as alpha-GalCer may also contribute to the defects observed in NKT cells from WG and RP patients.

The aim of this study was to assess the potential role of macrophage migration inhibitory factor (MIF) in the pathogenesis of allergic rhinitis (AR). Serum MIF concentrations were measured by a specific enzyme-linked immunosorbent assay. In order to elucidate the cellular source of MIF, we performed double immunostaining of biopsy specimens of the nasal mucous membrane with markers for MIF and for inflammatory cells. The mean MIF level in sera from patients with AR was significantly higher than that in sera from healthy controls. Moreover, the levels were significantly correlated with the severity of the clinical symptoms. The majority of the MIF-positive cells at the site of allergic inflammation were eosinophils. These data suggest that MIF plays a role in the initiation and maintenance of AR. Eosinophils formed the largest population of MIF-producing cells; this finding suggests that they may be a major source of MIF at inflammatory sites in atopic disease.

頭頸部癌の場合では治療方針の決定, 治療中, 治療後と一連の治療過程の中で看護師は大きな役割を果たしており, チームとして医師と看護師が連携し有機的に機能することが治療を行っていく上で非常に大切である。治療過程を治療方針の決定まで, 治療中, 治療後の3つに分けて北海道大学の実際を紹介した。医師・看護師が連携しあって患者・家族の希望や病気に対する理解を把握して, 患者・家族に十分な説明を行い治療方針を最終的に決定していくように心がけている。合同カンファレンスを行い, お互いに患者に対する理解を深めたり, 我々が看護師に対して耳鼻咽喉科・頭頸部外科についての勉強会を行うなどの努力をしている。また, “チーム医療”を成功させるためには, スタッフ間の信頼関係が必要であり, そのためには意思の疎通が大切である。医師と看護師が連携し同じ方向に向かって努力していくことにより, より良い医療を提供できるようになるものと考える。

フッ化ピリミジン系抗悪性腫瘍剤TS-1を用いて頭頸部癌再発23症例に対して外来経口投与を行い以下の結果を得た。1) CR1例を含め、奏効率は30.4%であった。2) 同一症例にて血小板, 呼吸器に Grade 4の有害事象が認められた。腎機能障害を有する症例で治療として血小板輸血, ステロイド投与しその後, 有害事象は回復し可逆的である事が確認された。この症例以外は, 特に重篤な有害事象は, 認めなかった。3) 頭頸部癌再発症例においても他剤と同等の効果をもち外来で安全に投与できた。4) 肺転移症例においては, TS-1投与群で median survival time 585日, TS-1非投与で入院化学療法中心群では120日であった。5) 外来通院可能なTS-1投与群のほうが治療後のPSの悪化を認めず, QOLは良好であった。これらのことより, TS-1投与により肺転移症例においてQOLの維持の可能性が外来通院化学療法にて示唆された。

We report a case of mucocele of the frontal sinus treated with reconstruction of the skull base. The patient showed swelling of the left side of the medial ocular angle and was diagnosed as mucocele of the frontal sinus. At first, endoscopic sinus surgery was carried out and the mucocele was unfolded into the nasal ' cavity. However, acute frontal sinusitis with MRSA emerged and this inflammation spread to dura mater. Debridement of the frontal sinus granulation and reconstruction of the anterior skull base by a galeo-pericranial flap were performed with craniotomy. It is an effective method to shield the cranial cavity from the nasal cavity by utilizing a galeo-pericranial flap to prevent infection from the frontal sinus from spreading to the cranial cavity.

Background. Few published large series have described a surgical approach to maxillary skeletal reconstruc- tion on the basis of the extent of maxillectomy. Methods. We have reviewed a 10-year experience with 38 consecutive maxillary reconstructions with respect to maxillec- tomy defects, reconstructive procedures, reconstructed but- tresses, and functional and aesthetic outcomes. Results. Maxillectomy defects were classified into three categories on the basis of the buttress concept. Buttress reconstruction was most frequently performed in category III maxillary defects (56%), followed by category I (50%) and categoryII(20%).Thevascularizedcompositeautograftincluded the rectus abdominis myocutaneous free flap combined with costal cartilage, and the latissimus dorsi myocutaneous free flap combined with the V-shaped scapula is an effective method for reliable reconstruction of both skeletal and soft tissues. Conclusions. A critical assessment for skeletal defects and associated soft tissue defects is essential for an adequate approach to solve complex problems in maxillary reconstruction. On the basis of retrospective analysis of this series, a recon- structive algorithm for surgical management of maxillectomy

Purpose. The purpose of this study was to evaluate the efficacy of rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced head and neck cancer. Methods. Forty-three patients for whom surgery was contraindicated or who rejected radical surgery were given superselective intra-arterial infusions of cisplatin (100–120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extra-beam radiotherapy (65 Gy/26 f/6.5 weeks). Results. Thirty-nine patients had stage IV disease, and the remaining four had stage III disease. During the median follow-up period of 21 months, the 3-year locoregional progression-free rates of all patients (n = 43) and patients with unresectable disease (n = 24) were 68.9% and 56.4%, respectively. In addition, the 3-year overall survival of all patients and patients with unresectable disease was 54.0% and 39.6%, respectively. Thirty-five patients (81.4%) experienced nonhematologic grade III to IV toxicity, including mucositis (n = 16), nausea/vomiting (n = 8), and neurologic signs (n = 2). No patient died as a result of treatment toxicity. There are 29 surviving patients without evidence of disease, all of whom are able to have oral intake without feeding-tube support. Conclusions. We confirmed the efficacy of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of supradose cisplatin on locoregional disease. Even patients with unresectable disease can be cured. Further studies are needed to establish the indications, long-term outcome, and possible late side effects of this treatment. © 2004 Wiley Periodicals, Inc. Head Neck27: 65–71, 2005

S100A2はカルシウム結合タンパク質であるS100ファミリーに属するが, その機能はまだ明らかでない。喉頭癌においてその発現減少が予後不良と関連していること, 気道上皮細胞の発癌モデル系で悪性化に伴いその発現が段階的に減少することが指摘されている。本研究では, 気道上皮細胞においてS100A2が癌抑制遺伝子産物として機能しているかを知る目的で, RNA干渉法を用いて不死化ヒト気道上皮細胞1799でのS100A2発現抑制を試みた。S100A2遺伝子に特異的なshort hairpin RNAを発現するベクターを導入した細胞ではその発現は著明に抑制されていた。さらにS100A2発現欠如細胞は寒天培地でコロニーを形成する能力をもち, anoikis (接着喪失による細胞死) 耐性であるなど, 悪性細胞に特徴的な形質を示した。これらの結果はS100A2が癌抑制遺伝子として機能しているという仮説を支持するものである。

The mechanism by which reactivation of varicella-zoster virus (VZV) causes facial paralysis in Ramsay Hunt syndrome remains unclear. The relationship between VZV load and the onset of facial paralysis was analyzed in 42 patients with Ramsay Hunt syndrome. The patients were divided into three groups according to the times of appearance of zoster and of facial paralysis; group I (zoster preceding, n = 13), group II (simultaneous, n = 22), group III (paralysis preceding, n = 7). A real-time quantitative PCR assay was used to measure VZV DNA copy number in saliva, and paired sera were assayed for anti-VZV IgG and IgM antibodies. In group I, the VZV DNA-positive rate was low and virus load decreased gradually after the initial hospital visit around the time of onset of paralysis. The level of anti-VZV antibodies had in most cases already increased at that time. In group III, viral load tended to increase after the onset of paralysis and peaked around the time of appearance of zoster. The level of anti-VZV antibodies was low at the onset of paralysis but showed a significant increase when paired sera were tested. In group II, virus load and changes in level of anti-VZV antibodies either resembled group I or group III behavior. These results indicate that facial paralysis in Ramsay Hunt syndrome can occur at various times between the early and the regression phase of VZV reactivation, suggesting that there are variable patterns of development of facial nerve dysfunction caused by VZV reactivation and the progression of neuritis.

First bite syndrome (FBS) is one of the complications after surgery for parapharyngeal space tumor, which is characterized by pain in the parotid region after the first bite of each meal. The loss of the sympathetic nerve supply to the parotid gland by surgical procedures, causing a denervation supersensitivity of salivary gland myoepithelial cells, has been proposed as an etiologic factor in FBS. Here we report our experience of two typical FBS cases, in which FBS developed after surgery for a parapharyngeal sympathetic neuroma and a deep lobe parotid tumor. Since we were not aware of FBS at the time after surgery, it was very difficult to treat and counsel these patients. In our retrospective review of patients who underwent excision of parapharyngeal space tumors, including deep lobe parotid tumors, FBS was not a rare complication. Head and neck surgeons should be aware of FBS and be cautious at the time of preoperative informed consent.

Robbins の原法にほぼ準じて大量シスプラチン (100～120mg/m2) の超選択的動注療法と照射の同時併用療法を切除不能, 手術拒否の進行癌新鮮例44例に対して行った。原発巣のCRが38.6%, PRが56.8%, 奏効率は95.4%で, 原発巣の progression free survival (2年) は全体で66.9%, 新しいUICC分類のT4b例でも57%が得られた。しかし粗生存率 (2年) は全体で52.4%であった。有害事象は, 脳神経麻痺, 菌血症などの合併症が出現する場合はあったが, 粘膜炎を含めて概ね許容範囲のものと考えられた。局所に集中的に大量のシスプラチンを投与できる超選択的動注療法は非常に効果の高い治療法であり, 切除不能例でも治癒を期待できる方法であるが, 今後は長期の治療成績, 晩期の合併症を明らかにし, 適応を確立していくことが必要である。

喉頭全摘後の音声再建法として, 長期に留置可能であり交換も容易な Groningen voice prosthesis または Provox IIをT-Eシャントとして用いる方法が本邦においても普及し, さらに遊離空腸再建症例にも試みられている。我々は遊離空腸再建症例において Groningen voice prosthesis を一期的にT-Eシャントとして挿入する方法を6症例において試みた。広瀬の会話機能評価基準に従い評価すると, 8～9点の excellent レベルが5例, 7点の moderate レベルが1例であり, おおむね良好な発声が可能であった。本法の利点は移植した空腸に操作が加わらず安全であること, 退院時までには発声ができるようになり早期の社会復帰が可能であることが挙げられる。但し, 頸部食道まで浸潤している症例においては二期的T-Jシャント作成を考慮する。Voice prosthesis の改良により, 今後普及する方法と思われる。

Parotidectomy by U-shaped Skin Incision for small Benign Tumors Objectives: The facelift incision has been used as a more cosmetically favorable alternative to the traditional cervicofacial, S-shaped incision for parotidectomy. However, the facelift incision has the disadvantage of requiring a long skin incision and wide skin-flap elevation. As an alternative, we analyzed the application and safety of a more limited U-shaped skin incision for parotidectomy. Methods: A U-shaped incision, consisting of pre- and postauricular incisions and a curved incision around the earlobe, was applied in 28 female patients. Their tumors were located in the superficial region of the parotid gland except one patient with a deep lobe tumor. Maximum diameter of the tumor was

上顎癌症例の正常鼻粘膜組織, 異形成上皮, 癌組織における遺伝子発現変化について, 既知遺伝子約1000種類からなるcDNAマイクロアレイを用いて解析を行った。癌病変で亢進または抑制されていた遺伝子の多くは, 異形成上皮において既に同様の発現変化が生じていた。さらに癌化のステップにおいて特異的に発現が亢進している遺伝子を3つ (Humig, Diubiquitin, Stat-1) 同定した。

BACKGROUND: Squamous metaplasic cells are rarely seen in sputum of female nonsmokers. CASE: A 47-year-old female nonsmoker presented with massive amounts of squamous metaplasic cells in sputum and an elevated level of squamous cell carcinoma (SCC) antigen in serum present for months, while no causative lesion was detected either by lung computed tomography or bronchoscopy. The patient was eventually diagnosed as having inverted papilloma in the right nasal cavity. Resection of the tumor brought about disappearance of squamous metaplastic cells in sputum and return of serum SCC antigen to the normal range. CONCLUSION: This case clearly demonstrates that Squamous metaplastic cells in sputum can originate in lesions in the nasal cavity, although they are rare. It should be kept in mind that the nasal cavity is a potential site producing squamous metaplastic cells in sputum.

Objective To investigate the time course of synkinesis as a sequela of facial nerve palsy so that we are able to determine an appropriate time for deciding the outcome of recovery in patients with facial nerve palsy. Methods Nineteen consecutive patients with peripheral facial nerve palsy who developed synkinesis were enrolled. We compared the degree of synkinesis at 6 and 12 months after the onset of palsy. Our investigation consisted of (1) scoring using the Sunnybrook facial grading system and (2) computing the asymmetry (%) in eye opening width. We also judged whether all 19 cases were cured or not based on the treatment outcome criteria of the Japan Society of Facial Nerve Research at 6 and 12 months. Results The synkinesis score based on Sunnybrook facial grading system and the degree of asymmetry in eye opening width during mouth movement deteriorated significantly between the 6th and 12th month after the onset of palsy. One of the cases regarded as “cured” at the 6th month was later judged to be “non-cured” due to deterioration in the synkinesis score at the 12th month. Conclusion From our results, synkinesis deteriorated after the 6th month from the onset of palsy. Therefore, we should follow up the degree of synkinesis until at least the 12th month, and the outcome of recovery in patients with facial synkinesis should be evaluated at least 12 months after the onset.

Objective This study investigated whether magnetic resonance imaging (MRI) patterns were different between patients with Bell's palsy and those with herpetic facial palsy in whom varicella-zoster virus (VZV) or herpes simplex virus type 1 (HSV-1) reactivation had been confirmed by polymerase chain reaction (PCR) or serologic assay. Study design A retrospective study of 15 patients with acute peripheral facial palsy was performed to compare virologic tests and gadolinium (Gd)-enhanced MRI findings. Results Ramsay Hunt syndrome was diagnosed in one patient. By use of virologic tests, zoster sine herpete (VZV reactivation without zoster) was diagnosed in four patients and HSV-1 reactivation in three. Bell's palsy was diagnosed in the remaining seven patients. No significant difference in the frequency of Gd-enhanced MRI was observed between herpetic facial palsy and Bell's palsy. However, in those patients who underwent MRI on the day viral reactivation was confirmed by PCR, Gd enhancement of the meatal fundus was observed infrequently. In addition, when MRI was performed within 10 days of the onset of palsy, Gd enhancement was not detected at the geniculate ganglion in any patients with herpetic facial palsy. By contrast, both the meatal fundus and the geniculate ganglion were enhanced in all patients with Bell's palsy, regardless of when MRI was performed with respect to the onset of palsy. Conclusion This study shows a difference in the pattern of Gd enhancement at the meatal fundus and the geniculate ganglion between patients with Bell's palsy and those with herpetic facial palsy. The results suggest that the meatal fundus or the geniculate ganglion may be affected first by virus reactivation in patients with herpetic facial palsy.

Objective: To evaluate the efficacy and safety of concurrent carboplatin (CBDCA) and radiotherapy for laryngeal carcinoma, we investigated survival rates and laryngeal preservation rates in patients with this treatment modality and those with radiation therapy only. Methods: We underwent chemotherapy with CBDCA and conventional radiotherapy concurrently to 17 patients with untreated stage II (T2N0M0) supraglottic squamous cell carcinoma since November 1990. CBDCA (100 mg/m2) was administered intravenously once a week concurrently with radiotherapy (2.5 Gy/fr, 4 times a week). At the dose of 40 Gy, the results were evaluated, and some of the patients underwent planned surgery and others continued the radiotherapy up to 65 Gy. Results: Overall 5-year survival rate by Kaplan–Meier method was 81.1%. Actual laryngeal preservation rate was 76.0%. Toxicity over grade III was noticed in two patients. Compared with 14 cases of historical controls, which were treated by radiation therapy alone between 1988 and 1990, the cases with concurrent radiotherapy and chemotherapy had statistically significant advantage in overall successful laryngeal preservation rate (P

Objective: We examined prognostic factors and outcome of the primary treatment in patients with adenoid cystic carcinoma (ACC) of the head and neck. Methods: Twenty patients with ACC of the head and neck who had been treated in our institution from 1985 to 1998 were enrolled in this study. Disease-specific survival rate was analyzed by the Kaplan–Mejer method, and the log-rank test was applied to compare the survival rates. Results: The overall 5- and 10-year survival rates determined by Kaplan–Meier analysis were 81 and 57%, respectively. Patients with major salivary gland ACC obtained the best 10-year survival rate (83%), while those with paranasal sinus ACC had the worst survival rate (33%). Predominance of the solid component on pathological examination might indicate a worse prognosis. Our study revealed that postoperative radiotherapy could yield better control of the lesion focus. Chemotherapy failed in some patients and was not dramatically effective by itself. Conclusions: The long-term prognosis of ACC was poor. Long-term follow-up is necessary for better prognosis of patients treated with radical treatment regimens.

Background Lyme borreliosis has been implicated in the pathogenesis of acute peripheral facial palsy (APFP). Few studies, however, have used Western blot analyses to confirm the serological diagnosis. Purpose To analyze the prevalence of anti-Borrelia antibodies in patients with APFP compared with healthy control subjects living in Hokkaido Island, Japan. Patients and Methods In total, 113 patients with APFP were analyzed. They included 32 patients with varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome and zoster sine herpete) and 81 patients with Bell's palsy. Fifty-eight healthy control subjects were also included. IgM and IgG antibodies to Borrelia garinii and afzelii were tested by Western blot, and diagnoses were made according to the Centers for Disease Control and Prevention criteria. Results Five of 81 (6.2%) patients with Bell's palsy, 1 of 32 (3.1%) patients with VZV reactivation, and 1 of 58 control subjects (1.7%) were judged to have both IgM and IgG antibodies to Borrelia. This difference was not significant (P >.05, χ2 test). Patients with Bell's palsy who had herpes simplex virus type 1 (HSV-1) reactivation at the onset of palsy had a higher IgM-immunoreactivity to Borrelia afzelii. Conclusions Although it is one of the endemic areas of Lyme disease in Japan, the prevalence of APFP caused by Lyme borreliosis is low in Hokkaido Island. In addition, cross-reactivity to B. afzelii in IgM blots is often observed in patients with HSV-1 reactivation, suggesting that careful interpretation of Borrelia IgM immunoblot data are needed for accurate serological diagnosis.

Varicella-zoster virus (VZV) and herpes simplex virus (HSV) are considered to be the major causes of acute peripheral facial palsy (APFP). One hundred and forty-two patients with APFP were analyzed by serological assays and polymerase chain reaction analysis. Ramsay Hunt syndrome was diagnosed in 21 patients. Of the remaining 121 patients clinically diagnosed with Bell's palsy, VZV reactivation without zoster (zoster sine herpete) was detected in 35 patients (29%). The prevalence of antibodies to HSV among patients with Bell's palsy was significantly higher than the prevalence among those with VZV reactivation (Ramsay Hunt syndrome or zoster sine herpete). In contrast, a high incidence (88%) of VZV reactivation among HSV-seronegative patients with APFP was observed. Our data indicate that VZV is one of the major etiologic agents of clinically diagnosed Bell's palsy and that VZV reactivation causes APFP in most patients who lack antibodies to HSV.

In rare cases, acute peripheral facial palsy occurs several days after dental treatment and oro-facial surgery. Surgical procedures have been known to trigger reactivation of varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The present study examined eight patients who exhibited delayed facial palsy after dental treatment or oro-facial surgery. Ramsay Hunt syndrome was diagnosed in three patients and varicella-zoster virus (VZV) reactivation without zoster lesions (zoster sine herpete) was diagnosed in three patients either by PCR or serological assay. Therefore, VZV reactivation was detected in 75% (6 of 8) of patients who exhibited delayed facial palsy after dental or oro-facial treatment. The results suggest that VZV reactivation is a major cause of delayed facial palsy after dental treatment or oro-facial surgery.

われわれは, 頬上顎部の骨性輪郭を支持する3つの zygomatico-, pterygo-, naso-maxillary buttresses (以下ZMB, PMB, NMB) の重要性に着目し, 中顔面悪性腫瘍切除後の上顎再建において, 症例に応じた maxillary buttresses の骨性再建を行なってきた。ここでは, われわれが開発した肋軟骨弁付き遊離腹直筋皮弁を用いたZMB再建の手術手技について報告する。本複合皮弁は, 肋間血管系と上下腹壁血管系の吻合を利用し, 深下腹壁動静脈を血管柄として第8肋間動静脈を含めて挙上する第8&9肋軟骨弁付き遊離腹直筋皮弁である。本再建法は, 血流を有する自家組織による中顔面軟部・骨性支持組織の一期的再建が可能で, 異物や遊離骨・軟骨移植を用いた再建に比べ, 合併症の出現が少ないことが期待され, また肋軟骨弁の形状は, 眼窩下壁から頬骨弓に及ぶ頬部輪郭の再現に適しており, 上顎再建において非常に有効な方法と考える。

We evaluated postoperative results in 49 patients (39 men, 10 women) who underwent pharyngoesophageal reconstruction with free-jejunal autograft following total pharyngolaryngoesophagectomy in the Department of Otolaryngology, Hokkaido University School of Medicine from 1989 to 1997. Evaluation was performed regarding the following points: 1) postoperative complications, 2) factors that determine the functional results of swallowing, 3) relation between forms of jejunal anastomosis and swallowing. The primary malignancy site was hypopharynx (39), cervical esophagus (4), larynx (3), thyroid (2) and trachea (1), Reconstructions were made with free jejunal autograft alone in 45 cases and with free jejunum in combination with gastric pull-up in 4. In patients who underwent reconstruction with jejunum alone, the anastomosis of the jejunum to the pharynx was performed in side-to-end fashion in 22, end-to-end in 18 and rho-shaped in 4. In the 1 remaining case, we used jejunal-patch graft. Postoperative complications including minor or nongraft related, occurred in 24 of 49 (49.0%) patients. Among these, graft-related complications were graft failure in 1 (2.0%), fistula formation in 3 (6.1%) and graft stricture in 2 (4.0%). Re-operations were required in one case of graft failure and 2 of fistula formation. Consequently, the overall graft-survival rate was 98.0% (48/49). Therefore, we considered the method of reconstruction to be a reliable procedure with a high-success rate. The swallowing function after reconstructive surgery was studied in 35 patients who underwent side-to-end (18) and end-to-end (17) anastomosis of the jejunum to the pharynx. We indicated that appropriate tension in the jejunum was the most important factor for adequate swallowing function. The end-to-end group had a higher rate of taking normal diet compared with the side-to-end group. The rate of swallowing dysfunction was only 5.9% (1/17) in the end-to-end group. On the other hand, 4 of 18 (22.2%) cases in the side-to-end group were regarded as having poor swallowing function. As a result we considered the end-to-end proximal jejunal anastomosis to be the more desirable form.

The purpose of this study was to evaluate our experience of microvascular anastomosis of intraperitoneal vessels. Between 1985 and 1994, 117 microsurgical reconstructions were done using intraperitoneal vessels. These included oesophageal reconstruction (n = 106), reconstruction of the hepatic arterial, superior mesenteric arterial, or portal venous system (n = 8), and reconstruction of the chest or abdominal wall (n = 3). We used 129 intraperitoneal arteries and 117 intraperitoneal veins. Of a total of 246 intraperitoneal vessels, five hepatic arteries, seven splenic, 14 gastroepiploic, six superior mesenteric, 178 jejunal, 30 ileocolic, four middle colic arteries or veins, and two portal veins were used for microvascular anastomosis. The overall successful rate for these reconstructive cases was 97% (114/117). Microsurgical use of intraperitoneal vessels is a safe and developing procedure in plastic and reconstructive surgery.

Varicella-zoster virus (VZV) reactivation without cutaneous vesicles (zoster sine herpete) has been demonstrated in 8 to 25% of patients with acute peripheral facial palsy (APFP) by serological methods. To make an early diagnosis of zoster sine herpete, VZV DNA in oropharyngeal swabs from patients with APFP was examined by the polymerase chain reaction (PCR). VZV DNA was detected in oropharyngeal swabs from 6 of 36 (17%) patients with APFP by PCR. VZV DNA was detected in the oropharyngeal swabs from the six patients at their initial visit (2 to 4 days after the onset of APFP), while the anti-VZV IgM and IgG antibody titers were not increased significantly. In contrast, VZV DNA was undetectable in the oropharyngeal swabs at the time when the VZV specific antibody response appeared. These results indicate that detection of VZV DNA in oropharyngeal swabs by PCR is more useful than currently available serological assays for the early diagnosis of zoster sine herpete in patients with APFP.

We investigated the patterns of cervical lymph node metastasis in the patients with tongue carcinoma who were treated in our institute from 1988 to 1994 and discussed how to deal with the cervical lymph nodes in the patients. The lymph nodes in the submandibular region and in the jugular chain were the main targets of the subsequent metastasis in T1 and T2N0 patients. The salvage rate with surgery was higher than that with radiation therapy in the patients with this type of metastasis. The prophylactic irradiation to the neck seems to be useless because the subsequent metastasis was often observed in the area of the external radiation An en-bloc operation with neck dissection should be conducted for the T2 and T3N0 patients with the tumor invaded deeply into the tongue. A careful neck dissection is required when the tumor invades into the anterior or posterior part of the tongue, or when the lymph node metastasis was found. In these cases, the effort should be made to detect metastasis to the lymph nodes in the other side of the neck.

Annexin I is a calcium- and phospholipid-binding protein that is involved in the regulation of cellular differentiation. The aim of the present study was to determine the localization of annexin I mRNA expression in normal and diseased human skin. In situ hybridization with a specific digoxigenin-labelled RNA probe was used throughout. We detected no annexin I mRNA signals in basal and suprabasal cells of normal epidermis, but positive signals were evident in the sudoriferous ducts. Annexin I mRNA expression was detected in the keratinizing squamous cells in keratotic type seborrhoeic keratosis and in keratinocytes at the periphery of the horn pearl in well-differentiated squamous cell carcinoma. Positive signals were also seen at the border between involved and noninvolved skin in psoriasis vulgaris and in dyskeratotic epidermal keratinocytes in keratosis follicularis Darier. By contrast, no annexin I mRNA signals were detected in tumour cells in basal cell carcinoma. The present results suggest that annexin I expression is related to, and may play a role in, keratinization disorders.

The G-->A mutation of nucleotide (nt) 1896 in the precore region of hepatitis B virus (HBV) prevents production of hepatitis B e antigen (HBeAg) by creating a TAG stop codon. This mutation is often found in anti-HBe-positive patients with productive HBV infection and has been associated with severe chronic and fulminant hepatitis in some geographic areas. Emergence of the TAG mutation during HBe seroconversion was studied as was its relationship with nt 1858, which forms a base pair with nt 1896 in the pregenomic RNA loop. A TAG mutant evolved in 18 (72%) of 25 patients with a T-1858 strain but in only 1 (8%) of 13 with a C-1858 strain. Viremia with C-1858 strains was, despite their limited ability to develop the TAG mutation, as persistent as with T-1858 strains. Generally, T-1858-infected patients in whom a TAG mutant did not emerge were HBV DNA-negative by polymerase chain reaction on follow-up, whereas patients who developed the TAG mutation had prolonged viremia.

A new method for detecting the hepatitis B virus (HBV) precore 1896 G-->A mutation is described. This mutation prevents hepatitis B e antigen production by introducing a TAG stop codon and has been associated with severe chronic and fulminant hepatitis. The method is based on a polymerase chain reaction (PCR) that creates a restriction enzyme (Bsu36I) cleavage site if the mutation is present. After incubation of the PCR product with Bsu36I and a subsequent agarose gel electrophoresis, the presence of the TAG mutant is revealed by an altered position of the DNA band. The method was compared with direct sequencing on 36 serum samples and correctly identified all samples containing mutant HBV. The TAG mutant was present in 17 cases (as mixed wild type and mutant virus in 4). Twelve of 18 patients with advanced liver disease confirmed by biopsy carried mutant HBV. This method of detecting HBV precore 1896 G-->A should be useful for evaluation and follow-up of patients and for prevalence studies.

Objective: The facelift incision (FLI) has been reported to be a more cosmetic approach than the traditional Blair incision for parotidectomy. However, a long skin incision and a wide skin-flap elevation are required for the FLI. To overcome the disadvantages of the FLI, we have employed a U-shaped skin incision (UI).Method: From July 2007, 79 parotidectomies were performed for benign parotid tumors. A Blair incision was used in 41 patients and an FLI in 25 patients. In the remaining 13 patients, a UI, which consists of pre- and postauricular incisions and curved incision around the lobe of the ear, was employed.Results: In all patients with a UI, the tumors were located in the superficial lobe of the parotid gland. By contrast, 10 of the 25 (40%) patients with an FLI had a tumor in the deep lobe. The size of the tumor was significantly smaller and the time of surgery was significantly shorter in patients with a UI than in those with an FLI. The incidence of hematoma was higher in FLI than in UI (12% vs 0...

BACKGROUND: To assess the efficacy of a new endonasal medial maxillectomy technique (EMM) for the treatment of inverted papilloma (IP). METHODOLOGY: A prospective series of 55 consecutive patients diagnosed with IP between March 2002 and April 2009 were entered into this study. The new surgical technique was applied to tumors arising from the anterior part of the maxillary sinus. After conventional EMM, the entire nasolacrimal duct was separated from the bony component of the nasolacrimal canal and preserved. Schirmer`s test and a visual analog scale (VAS) score were used to assess the lacrimal duct function after surgery. RESULTS: Ten of the 55 patients underwent the new surgical procedure. All patients were categorized with stage T3 or T4 tumors. No patients suffered tumor recurrence. There was no difference in lacrimal duct function between the diseased side and healthy side of the nasolacrimal duct. The mean VAS score was 2.8/100. CONCLUSIONS: This new surgical technique preserves the whole length of the nasolacrimal unit. It also offers several advantages including good visualization, nasolacrimal function after surgery and fewer adverse effects such as facial numbness and epiphora.

We applied in situ hybridization (ISH) using RNA probes which hybridize with infected-cell protein number zero (ICP0) mRNA or latency-associated transcripts (LAT) to detect herpes simplex virus type 1 (HSV-1) in both latent and productive infections. In the productive stage, in which the production of viral particles can be shown by immunohistochemistry and electron microscopy, we demonstrated the presence of ICP0 mRNA and LAT, which indicates that LAT may also be transcribed in productive infection. In latent infection of the trigeminal and geniculate ganglia, where HSV antigen cannot be detected by immunohistochemistry, we detected positive hybridization signals using ISH with ICP0 sense RNA probe, which is complementary to LAT. Positive signals were not detected with ICP0 antisense probe. We could not demonstrate HSV latency in the spiral ganglia using ISH, although the HSV genomes were amplified by using the polymerise chain reaction method. These results demonstrate that ISH is a convenient, but limited, technique for the detection of latent HSV.

Viral infection has been considered to be a possible pathogenesis of vestibular neuronitis, and reactivation of the herpes simplex virus (HSV) is one of the most likely causes. However, it remains unknown whether the human vestibular ganglia contain latent HSV. We examined 26 vestibular ganglia from autopsied adults in search of HSV type 1 (HSV-1). To detect HSV-1, we used polymerase chain reaction (PCR), in situ hybridization and immunohistochemical staining. HSV DNA was detected in 6 of 10 vestibular ganglia using the PCR method. However, the latency-associated transcript (LAT) of HSV-1 was negative in all of the 16 vestibular ganglia examined. No HSV antigen was detected in any of the ganglia. These results indicate that HSV-1 is latently infected in the human vestibular ganglia, and that LAT is transcribed weakly or not at all.

Recent studies have shown that tumor necrosis factor-alpha (TNF-alpha) plays an important regulatory role in several inflammatory and infectious diseases. In the present study, we evaluated serum TNF-alpha levels of patients with acute peripheral facial palsy using an ELISA method. We examined sera from each group (n = 25 per group) of patients with herpes simplex virus type 1 reactivation (HSV-1). varicella-zoster virus (VZV) reactivation, and with no HSV or VZV reactivation. We also tested the sera of 25 normal controls. No significant difference was found between the serum TNF-alpha levels in facial palsy and controls. No correlation was found between serum TNF-alpha levels in cases with HSV-1 or VZV reactivation and with no HSV-1 or VZV reactivation. These results indicate that serum TNF-alpha levels are not affected by HSV-1 or VZV reactivation in patients with facial palsy.

A unique case of carcinosarcoma in the maxillary sinus is reported. A 47-year-old man visited our hospital with complaints of right nasal obstruction and bloody rhinorrhea. Examination revealed a hemorrhagic mass with necrosis in the maxillary sinus that infiltrated the right nasal cavity. Histologically, the tumor was composed of both carcinomatous and sarcomatous elements. Nests of squamous cell carcinoma and adenocarcinoma were scattered in the sarcomatous element with osteosarcomatous differentiation. No distinct demarcation between the two elements was observed and some spindle-shaped cells in the sarcomatous component were immunoreactive to epithelial markers by immunohistochemical staining. Although the histogenesis of carcinosarcoma remains unclear, the histologic pattern of the present case indicates the possibility that a multipotential cell, capable of both epithelial and mesenchymal differentiation, was the origin of the rare tumor.

There is an increased risk of wound complications in patients undergoing salvage laryngectomy following chemoradiotherapy. To reduce the rate of wound complications after a salvage total laryngectomy, a fresh tissue reinforcement of the pharyngeal suture line (pharyngeal interposition graft) has been reported to be useful. In the present study, wound complications after a salvage total laryngectomy with a pectoralis major muscle flap as a pharyngeal interposition graft were analyzed. Four patients with recurrent laryngeal cancer (three with supraglottic, and one with glottic cancer) after chemoradiotherapy underwent salvage total laryngectomy using a pectoralis major muscle interposition flap. Minor wound complications were observed in three of the four patients, with an infection around the tracheostoma, a minor subcutaneous abscess, and a superficial skin necrosis in one patient each. These complications were managed with local wound care. No patients had major wound complications such as pharyngocutaneous fistulas. There were no necroses or wound complications of the pectoralis major muscle flap. This study has suggested that the pectoralis major muscle flap as a pharyngeal interposition graft is safe and useful for prevention of wound complications in salvage total laryngectomy following chemoradiotherapy.

BACKGROUND There have been no reports on the presence of the tissue renin-angiotensin system in the human heart, although the presence of angiotensinogen has been described in the animal heart. METHODS AND RESULTS To determine whether angiotensinogen is synthesized in the human heart, we examined angiotensinogen messenger RNA (mRNA) synthesis in autopsy hearts by using ribonuclease protection assay. As a result, angiotensinogen mRNA was detected in the atrial muscle, muscles of the conduction system, and the left ventricular wall. In the left ventricular wall, mRNA expression was more prominent in the subendocardial muscles than in the midcardial or epicardial muscles. Using a monoclonal antibody to human angiotensinogen in immunoblotting experiments, we detected two closely spaced bands at approximately 70 kd in the heart, which was quite consistent with the human angiotensinogen molecule. Immunohistochemical studies with this monoclonal antibody demonstrated intense immunoreactivity in the atrial muscles, the muscles of the conduction system, and those of the subendocardial layers. CONCLUSIONS We conclude that angiotensinogen was synthesized in the human heart. It was evident that the localization of angiotensinogen was not ubiquitous in the cardiac muscles, showing its predilection for the atrial muscles, muscles of the conduction system, and subendocardial layer of the left ventricle.

Viral infection, especially by reactivation of herpes simplex virus (HSV) has been considered to be a possible explanation for the pathogenesis of idiopathic peripheral facial nerve palsy (Bell's palsy). We investigated whether the geniculate ganglia of man contain latent HSV type 1 (HSV-1), and compared the frequency of HSV-infected ganglia and that of latently infected neurons in human geniculate ganglia and in trigeminal ganglia. From autopsy specimens of eight adults 15 geniculate ganglia and 16 trigeminal ganglia were examined by means of in situ hybridization and immunohistochemical staining. The HSV-1 genome was detected in 11 of the 15 (71%) geniculate ganglia and in 13 of the 16 (81%) trigeminal ganglia. No HSV antigen was noted in any of the ganglia. The incidence of latently infected neurons was 0.9% in the trigeminal ganglia and 5.3% in the geniculate ganglia. The difference in percentages between the two types of ganglia was significant. Our results suggest that reactivation of latent HSV in the geniculate ganglia is a probable cause of some cases of herpetic stomatitis and of idiopathic peripheral facial nerve palsy.

By using the polymerase chain reaction (PCR) we detected latent herpes simplex virus type 1 (HSV-1) in human geniculate and trigeminal ganglia obtained from autopsy cases. A pair of primers which were specific for a part of the HSV-1 thymidine kinase domain were used for detection of HSV DNA. We also examined the latency-associated transcript (LAT), known as latency-specific RNA, by means of reverse transcription-PCR with a pair of LAT-specific primers. HSV-1 DNA was detected in 16 of 17 (94%) trigeminal ganglia and in 15 to 17 (88%) geniculate ganglia of adults. We also demonstrated HSV-1 RNA derived from the LAT in both types of ganglia. These findings suggest that HSV-1 latently infects the majority of geniculate and trigeminal ganglia of adults, and that PCR and reverse transcription-PCR are useful tools for analysis of HSV latency.

頭頸部領域の悪性腫瘍25例について, 抗癌剤の多剤耐性に関与する膜タンパク質であるP-糖タンパクの発現を免疫組織化学的に検索した。その結果, 悪性線維性組織球腫の1症例では, 化学療法施行後にP-糖タンパクの発現がみられた。また, 腺様嚢胞癌では5例中4例で, 化学療法施行前でもP-糖タンパクの発現がみられ, 本腫瘍の自然多剤耐性に関与している可能性があるものと思われた。以上のことより, 頭頸部領域の悪性腫瘍についてもP-糖タンパクの発現が認められる症例があり, 化学療法に対する感受性との相関が示唆された。

Objectives: To evaluate the risk factors for perioperative complications among patients undergoing craniofacial resection for the treatment of skull base tumors. Design: Retrospective analysis. Participants: The study group comprised 29 patients with skull base tumors (22 malignant and 7 benign) who underwent 30 craniofacial resections at Hokkaido University Hospital between 1989 and 2006. Of these cases, 21 had undergone prior treatment by radiation (16 cases), surgery (7 cases), or chemotherapy (1 case). Moreover, 19 needed extended resection involving the dura (11 cases), brain (5 cases), orbit (12 cases), hard palate (5 cases), skin (3 cases), or cavernous sinus (2 cases). Main outcome measures: Perioperative complications and risk factor associated with their incidence. Results: Perioperative complications occurred in 12 patients (40%; 13 cases). There was a significant difference between complication rates for cases with and without prior therapy (52.4% vs. 11.1%). The complication rate for dural resection cases was 81.8%. There was a significant difference between complication rates for cases with and without dura resection. No postoperative mortality was reported. Conclusions: Craniofacial resection is a safe and effective treatment for skull base tumors. However, additional care is required in patients with extended resection (especially dural) and those who have undergone prior therapy.

Neurological disorders are a common cause of morbidity and mortality in the acquired immunodeficiency syndrome (AIDS). In this report we describe the neuropathological changes associated with both human immunodeficiency virus (HIV) infection and with the major opportunistic virus infections, cytomegalovirus (CMV), JC papovavirus (JCV) and herpes simplex virus (HSV) seen in AIDS. In addition "in situ" hybridization studies have been employed for the detection of virus genomic material in each case and the usefulness of this method in supporting the pathological diagnosis is demonstrated. Mechanisms whereby HIV infection results in leukoencephalopathy and the possible contributing roles of the three opportunistic virus infections are discussed.

There have been only three case reports of histological study on injection of atelocollagen into the human vocal cords, and none of these have indicated foreign body reaction. We histologically examined the larynx of a 70-year-old man, which had to be excised 44 days after infusion of atelocollagen into the vocal cords. The atelocollagen infused was found to have been replaced with the collagen of host cells, but no foreign body reaction was observed. As in conventional reports, the histoaffinity of atelocollagen was confirmed.