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OBJECTIVE: We administered a questionnaire survey to a working population in an attempt to clarify the relationships between self-reported nasal obstruction, observed apnea during sleep, and daytime sleepiness. STUDY DESIGN: A total of 7980 daytime workers were asked to complete questionnaires about nasal obstruction, apnea during sleep, and daytime sleepiness. Of the 7702 responses, the data from 4818 subjects were analyzed. Nasal obstruction and observed apnea were graded into 3 categories. Daytime sleepiness was assessed by the Epworth Sleepiness Scale. RESULTS: Subjects with chronic nasal obstruction had 5.22 and 2.17 times higher odds for having habitual observed apnea and excessive daytime sleepiness (EDS), respectively, compared with those without nasal obstruction (P < 0.001). After adjusting for 3 potential confounding factors (age, sex, and body mass index) and the presence of habitual observed apnea, odds ratios for having EDS decreased, but still remained significant. CONCLUSION: Nasal obstruction is likely to cause daytime sleepiness, at least in part, by causing sleep-disordered breathing including apnea during sleep.

Summary Background Eikenella corrodens ( E. corrodens ) is a Gram-negative facultative anaerobic bacillus that originally was thought to be an attenuated and indigenous bacterium. In recent years, a number of reports have documented that E. corrodens can be a potential pathogen not only in immunocompromised patients but also in hosts with normal immunity. We herein study E. corrodens infections of the head and neck encountered in our department. Methods Twenty-two consecutive patients treated in our department for E. corrodens infections of the head and neck were retrospectively analyzed. Microbial specimens were subjected to light microscopic examination, aerobic culture using chocolate and sheep blood agar media, and anaerobic culture using Brucella HK agar medium. Cultured bacteria were subjected to antimicrobial susceptibility tests by means of the broth microdilution method. Results There were 16 males and 6 females with an average age of 29.9years. Two patients had malignancy, while the other patients had no particular risk factors or underlying diseases. Infected sites were the ear in 6 cases, pharynx in 12 cases (tonsil in 10 cases), paranasal sinuses in 3 cases, and salivary gland in 1 case. Seventeen patients suffered polymicrobial infections. Staphylococcus and Streptococcus were the most frequently detected pathogens coexisting with E. corrodens , and mixed infections of E. corrodens and Streptococcus milleri group bacteria were prone to form abscesses. Isolated E. corrodens was susceptible to third-generation cephems (MIC90=0.15–0.25μg/ml), carbapenems (MIC90≦0.15μg/ml), and new quinolones (MIC90≦0.15μg/ml), and resistant to oxacillin (MIC90>8μg/ml), cefazolin (MIC90>4μg/ml), macrolides (MIC90=4–8μg/ml), and clindamycin (MIC90>4μg/ml). Conclusions E. corrodens infections of the head and neck occur most frequently in the tonsil even in hosts with normal immunity. Coexistence with Streptococcus milleri group bacteria and the use of ineffective antibiotics can be exacerbating factors. First-choice drugs for E. corrodens infections should be third-generation cephems, carbapenems, or new quinolones.

In our controlled retrospective analysis of medical records in tertiary care academic medical center, we aimed to investigate the therapeutic effects of hyperbaric oxygen (HBO) therapy combined with steroid administration for idiopathic sudden sensorineural hearing loss (ISSNHL) in comparison with that of steroid administration alone. Our subjects were 130 consecutive inpatients with ISSNHL (hearing levels/=40 dB; time from the onset of hearing loss to the start of treatment/=30 days). Sixty-seven patients underwent HBO plus steroid therapy (HBO group), and 63 were given steroids alone (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to that in the unaffected contralateral ear. The cure rate and hearing improvement rate were not statistically different between the two groups; however, the recovery rate was significantly higher in the HBO group than in the steroid group (59.7% vs. 39.7%; P0.05). With regard to patients with initial hearing levels of/=80 dB, the hearing improvement rate was significantly higher in the HBO group than in the steroid group (51.1 +/- 7.0% vs. 27.1 +/- 7.8%; P0.05), while in patients whose initial hearing levels were80 dB, hearing outcomes were not statistically different between the two groups. In both the HBO and steroid groups, patients with initial hearing levels of80 dB showed a better hearing improvement rate than those with initial hearing levels of/=80 dB. In conclusion HBO therapy shows a significant additional effect in combination with steroid therapy for ISSNHL, particularly in patients with severe hearing loss.

Nasal symptoms of allergic rhinitis, such as watery rhinorrhea, sneezing and nasal obstruction, are thought to result in reduction in quality of life (QOL). In this study, we evaluated the QOL scores of patients suffering from allergic rhinitis, using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and the Short Form-36 (SF-36). One hundred twenty six patients with allergic rhinitis who visited the department of otolaryngology of UOEH and affiliated hospitals from April, 2003 to March, 2004 were enrolled in this study. Each symptom of allergic rhinitis was shown to degrade the RQLQ scores. In particular, nasal obstruction and severity of the disease strongly related to the RQLQ scores. All the SF-36 scores of allergic rhinitis patients were lower than those of standard Japanese. Nasal obstruction was severer, and ocular symptoms were milder in the perennial group than in the seasonal group. The QOL scores of emotional aspects were significantly different between generations. The QOL score of social functioning increased, and that of mental health decreased with age. These results clearly indicate that nasal symptoms of allergic rhinitis cause degradation of QOL in daily and social lives. It would be interesting and necessary to evaluate QOL disturbance and loss of working efficiency in workers with allergic rhinitis in further studies.

内耳性聴覚障害に対するステロイドの効果発現部位を明らかにする事を目的に, 内耳での局在が報告されているグルココルチコイドレセプター (GR) の拮抗剤を音響曝露後に投与し, 内耳性聴覚障害の回復過程にどのように働くのかを検討した。加えて, 突発性難聴の予後予測に対する歪み成分耳音響放射 (DPOAE) の有用性を明らかにする事を目的に, 入院の上ステロイド投与および高気圧酸素療法を行った突発性難聴耳を対象として, 聴力予後とDPOAE出力改善との関係についても検討した。騒音曝露後の回復過程では, かなりの強大音曝露後のCAP閾値回復に対しGR拮抗剤は阻害作用を示したが, DPOAE出力は変化せず, 内耳の中でも内有毛細胞周囲に影響を与えたのではないかという結果が示唆された。また突発性難聴の聴力改善とDPOAE出力改善との間には有意な相関は認められず, 治療の効果発現部位は外有毛細胞以外の部位なのではないかと考えられた。

The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens.To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA).Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method.MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.

Objectives: There has been growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey on a working population to clarify the relationships among nasal obstruction, daytime sleepiness, and quality of life (QOL). Methods: Seven thousand nine hundred eighty daytime workers were asked to complete questionnaires, and the data from 7,180 subjects without any missing answers were finally analyzed (90.0% of the total participants). The severity ofnasal obstruction was graded into the following three categories: never/rarely, sometimes, and always/often. Daytime sleepiness and QOL were assessed by the Epworth Sleepiness Scale and the Medical Outcomes Study 36-Item Short-Form Health Survey, respectively. Results: Younger subjects reported a higher degree of nasal obstruction. Subjects who reported a higher degree of nasal obstruction had higher daytime sleepiness and lower quality of life. Subjects with higher daytime sleepiness had lower quality of life. The degree of nasal obstruction was not associated with body mass index. Conclusions: Taking into account the impact of nasal airway resistance on sleep-disordered breathing, the present results suggest that chronic nasal obstruction impairs QOL, at least partially, through excessive daytime sleepiness possibly caused by sleep-disordered breathing. We stress that sufficient and appropriate rhinologic treatment may improve the quality of daily and social activities of individuals with sinonasal diseases.

Hyalinizing clear cell carcinoma is a low-grade indolent and rare salivary gland tumor originally described by Milchgrub et al. in 1994. We herein report a case of this tumor of the base of the tongue. A 66-year-old Japanese woman presented with a large painless mass in the throat. Computed tomography and magnetic resonance imaging revealed a 40x30-mm well-defined ovoid tumor arising from the base of the tongue. She underwent tracheostomy followed by a resection of the tumor via the transmandibular approach combined with a right-sided supra-omohyoid neck dissection. Because the tumor invasion of the surrounding tissue was limited, the surgical defect at the base of the tongue was relatively small, and no reconstructive procedure needed to be performed. The tumor was histopathologically diagnosed as hyalinizing clear cell carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the eighth postoperative day. The patient is currently free from disease 21 months after surgery. The pathology, clinical characteristics, and treatment of hyalinizing clear cell carcinoma are bibliographically reviewed.

We report a rare case of schwannoma arising from the pharyngeal branch of the vagus nerve. An 18-year-old woman presented with an egg-sized nontender upper cervical swelling. Computed tomography and magnetic resonance imaging (MRI) revealed a well-defined tumor measuring 50mm in its major axis in the left carotid space. The tumor was moderately enhanced, and showed hypointensity and isointensity on T1- and T2-weighted MRI, respectively. Otorhinolaryngological findings were otherwise normal. A schwannoma was most likely suspected, and she underwent transcervical resection of the tumor. A cordlike strand connected to the cephalad end of the tumor was severed, while both the vagus and hypoglossal nerves were identified and preserved. The histopathological diagnose is schwannoma. After surgery, the patient manifested a curtain sign toward the unaffected side without showing vocal cord palsy or Homer's syndrome, indicating that the tumor had arisen from the pharyngeal branch of the vagus nerve. Clinical characteristics of schwannomas in the carotid space were reviewed.

This study attempts to investigate the development of sensorineural hearing loss following a head blow without skull fracture in association with physiological and histopathologic changes in an experimental animal model. With the head in a freely movable position, albino guinea pigs were given a single blow to the occipital region by a head blow device. At 1, 7, and 14 days after the blow, the animals’ auditory brainstem response (ABR) and cochlear microphonics (CM) were examined, and both the temporal bone and brain stem were observed by light and electron microscopy. The ABR threshold was unchanged at day 1, was significantly increased at day 7, and was fully recovered at day 14. The I–V and I–II interpeak latencies were significantly prolonged at days 1 and 7, and wave I latency was significantly prolonged at day 7 only. These latencies were recovered to normal limits at day 14. On the other hand, no significant change in CM versus the control group was observed at any point in the measurements. Histopathologically, no abnormal finding was seen at the light microscopic level. However, at the electron microscopic level, there were some injuries to the eighth nerve. At day 1, the lamellar structure of the myelin sheath was irregular, and the periaxonal space was expanded; at day 7, the myelin sheath was disintegrated. At day 14, however, these changes were partially reversed. These results suggest that sensorineural hearing loss following a head blow in this model is attributed to dysfunction of the eighth nerve rather than to cochlear impairment.

We report two cases of large vestibular aqueduct syndrome, a rare congenital malformation of the inner ear originally described by Valvassori and Clemis in 1978.The first case was a 38-year-old woman who had complained of progressive hearing loss since childhood and periodic episodes of recurrent vertigo since 30 years of age. She had been misdiagnosed as having Meniere's disease by previous doctors. The second case was a 9-year-old boy with acute hearing loss several hours after minor head collision. Psychogenic hearing loss was initially suspected, but was eventually ruled out based on diminished auditory brainstem response. When these patients were initially seen in our clinic, both patients showed severe bilateral combined hearing loss on pure tone audiogram. Definitive diagnosis was established by magnetic resonance imaging, which demonstrated expanded endolymphatic ducts and sacs.Clinical characteristics and possible pathogenesis of large vestibular aqueduct syndrome is discussed with a review of the literature.

Rehabilitation and return-to-work are important problems for laryngectomized patients. Here, we report 2 cases of laryngectomized middle-aged men, and discuss the role of otolaryngologists from the viewpoint of an industrial physician. The first case is a 55-year-old post-office male clerk, who underwent radical and reconstructive surgery for hypopharyngeal carcinoma. He started light work following 3-month-rest at home after discharge, and fully returned to his previous work 3 years later. The second case is a 50-year-old mailman who also underwent radical and reconstructive surgery for hypopharyngeal carcinoma. He could not return to work because of the recurrence of tumor during rehabilitation. In such cases, comprehensive management including medical, mental and social supports is essential according to the occupational environment. Industrial otolaryngologists should play an important role in rehabilitation and return-to-work of laryngectomized patients.

MALT lymphoma is characterized as a type of low-grade extranodal B cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). It is thought to be associated with autoimmune diseases, e. g., Sjogren's syndrome and Hashimoto's disease, or inflammatory diseases, e. g., Helicobacter pylori infection of the stomach. We report a rare case of MALT lymphoma of the cheek. A 76-year-old woman was referred to our clinic, complaining of swelling of the left cheek. CT and MRI showed a solid mass with a smooth surface in the subcutaneous region of her left cheek. Total resection of the tumor was performed. The tumor was histopathologically diagnosed as MALT lymphoma. No other lesions were detected in systemic examinations. A complete remission was obtained with 4 courses of Rituximab (anti-CD20 monoclonal antibody) therapy and irradiation at 40Gy. The patient is currently free from disease 21 months after surgery.

Immunoreactivities of endothelin-1, endothelin-3, endothelin receptor type A, and Na,K-ATPase were investigated in the stria vascularis of adult male WBB6F1 +/+ mice and in that of W/Wv mutants lacking strial intermediate cells. In the +/+ mice, electron microscopic immunoreactivity for the endothelins was seen on the rough endoplasmic reticulum, Golgi apparatus, cytoplasmic vesicles and lysosomes exclusively in the strial intermediate cells by the postembedment method. Immunoreactive endothelin receptor A was localized along the plasma membrane of strial marginal cells of both wild and mutant types although the immunoreactivity of the latter was much less than that of the former by the preembedment method. These findings suggest that the endothelins, which are produced in the strial intermediate cells, may play a role in the maintenance of the stria vascularis function in the +/+ mice. Since the plasma membrane of the marginal cells of the W/Wv mice, which do not generate a high positive endocochlear potential, also showed immunoreactivity for Na,K-ATPase, it seems likely that the endothelins are involved in the activation of sodium pump of the strial marginal cells by mediation of endothelin receptor A. In addition, the role of lysosomes in the crinophagy of the endothelins in the strial intermediate cells is proposed in the +/+ mice.

BACKGROUND Apical tubules (ATs) in marginal cells (MCs) of the stria vascularis appear in limited stages of differentiation of the MCs, but their origin and roles remain uncertain. The present study was designed to solve the problem of whether the ATs are intracellular compartments derived from the Golgi apparatus (GA). METHODS The cochleae of Wistar rats at ages of postnatal days 1, 3, and 5 were prepared for electron microscopy and cytochemistry using thiamine pyrophosphatase (TPPase) and coenzyme A phosphatase (CoA-Pase) as marker enzymes of trans Golgi cisterns and fluorescent labelled lectin, griffonia simplicifolia agglutinin-I (GS-1). RESULTS The ATs appeared in the apical cytoplasm of the MCs between postnatal days 1 and 5. Reaction products of TPPase and CoA-Pase activities were localized in the trans-Golgi cisterns and the ATs, which were occasionally in a close apposition to the GA. The reaction was found along the apical plasma membrane of the MCs only in case of TPPase. Heavy reactions to GS-1 were seen in the supranuclear region as well as along the apical plasma membrane of the MCs. CONCLUSIONS The present ultrastructural and cytochemical studies indicate that the ATs, which appear in the MCs at limited perinatal stages, originate from the trans-Golgi cisterns. These ATs may be involved in the apical plasma membrane supply for the differentiation of the MCs prior to the generation of EP.

Dark-skinned people are known to be more tolerant of ototraumatic noise than are light-skinned people, and pigmented animals are more tolerant of ototraumatic noise and aminoglycoside ototoxicity than are albino animals. Such tolerance may be dependent on the local ability of detoxification and antioxidant enzymes, including glutathione S-transferase (GST) and glutathione peroxidase (GSPx). In the present study, we examined the difference in GST/GSPx expression in the lateral wall of the cochlea between pigmented and albino guinea pigs. Eight-week-old male pigmented and albino guinea pigs were killed by transcardiac perfusion with 2% paraformaldehyde. The cochlear ducts were isolated, further fixed with 4% paraformaldehyde, decalcified, and then embedded in paraffin. Sections prepared at 5-microm thickness were incubated with anti-GST-alpha,-mu,-pi, or anti-GSPx antibody, reacted with Alexa Fluorconjugated secondary antibody, and examined under a Carl Zeiss Axioskop 2 plus fluorescence microscope. The cochlea ducts were also subjected to immunoelectron microscopy for GST-pi by the postembedment method. The stria vascularis of pigmented guinea pigs was strongly immunoreactive for GST-alpha,-mu,-pi, and GSPx, whereas no or only weak immunoreactivities were seen in the stria vascularis of albino guinea pigs. The spiral ligament showed positive but different immunoreactivities for these enzymes between the strains. Double-stained immunofluorescence micrographs for GST-pi and GSPx showed a close resemblance of localization between the two enzymes in both pigmented and albino guinea pigs. At the ultrastructural level, immunoreactivity for GST-pi was localized preferentially in the melanin cells of pigmented guinea pigs. These results suggest that correlation between pigmentation and inner ear susceptibility is, at least partially, attributed to the different distribution of GST/GSPx in the stria vascularis.

BackgroundThere has been a growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey in a working population to clarify the contribution made by snoring concomitant with nasal obstruction to daytime sleepiness and quality of life (QOL).MethodsSeven thousand nine hundred eighty daytime workers were asked to complete questionnaires, 7702 responded, and the data from 3442 subjects were finally analyzed. Nasal obstruction and snoring were graded into three and four categories, respectively. Daytime sleepiness and QOL were assessed by the Epworth Sleepiness Scale (ESS) and the Medical Outcomes Study 36-Item Short-Form Health Survey, respectively.ResultsSubjects with chronic nasal obstruction, even if snoring was absent, reported significantly higher ESS scores and lower QOL scores than control subjects, and the presence of habitual snoring had an additive influence on these changes. The ESS and mental QOL scores adjusted for age, sex, and body mass index showed the same tendency.ConclusionInduction of sleep-disordered breathing (SDB) is a possible cause of excessive daytime sleepiness and impaired QOL in subjects with nasal obstruction. A variant of SDB such as silent upper respiratory resistance syndrome may participate in this phenomenon in the absence of snoring.

Prostaglandin E1 (PGE1) is less effective than stellate ganglion block (SGB) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) patients with severe hearing losses when used together with hyperbaric oxygen (HBO) therapy. In contrast with the systemic action of intravenous PGE1, SGB's localized vasodilating action may explain its advantage over intravenous PGE1.To investigate the effect of PGE1 plus HBO therapy on ISSNHL in comparison with that of SGB plus HBO therapy.We retrospectively analyzed 205 consecutive patients with ISSNHL (hearing levelsor = 40 dB; time from the onset of hearing loss to the start of treatmentor = 30 days). Ninety-five patients underwent intravenous PGE1 plus HBO therapy (PG group) and 110 underwent SGB plus HBO therapy (SGB group). Hearing recovery was evaluated by grade assessment and by hearing improvement compared to that in the unaffected contralateral ear.The overall hearing outcome was not statistically different between the two groups. For patients with initial hearing levels80 dB, the groups had roughly equivalent hearing outcomes, whereas in patients with initial hearing levelsor = 80 dB, the hearing improvement rate was significantly higher in the SGB group than in the PG group (53.0 +/- 5.0% vs 35.3 +/- 6.8%; p0.05).

Objective We conducted a controlled retrospective analysis of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) in order to investigate the effect of prostaglandin E1 (PGE1) plus hyperbaric oxygen (HBO) therapy in comparison with that of steroid plus HBO therapy. Methods One hundred and ninety-six consecutive patients with ISSNHL (hearing levels ≧40 dB; time from the onset of hearing loss to the start of treatment ≦30 days) were enrolled. Ninety-five patients underwent PGE1 plus HBO therapy (PG group) and 101 underwent steroid administration plus HBO therapy (steroid group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. Results The hearing levels after treatment were 52.2 ± 3.0 and 47.5 ± 2.8 dB, the hearing gains were 31.3 ± 2.2 and 27.2 ± 2.3 dB, the cure rates were 28.4% and 28.7%, the recovery rates were 54.7% and 53.5%, and the hearing improvement rates were 48.4 ± 5.1% and 53.9 ± 4.2% in the PG and steroid groups, respectively. There were no significant differences between the two groups. Conclusion We concluded that PGE1 and a steroid are equally effective in the treatment of ISSNHL when used together with HBO therapy. PGE1 plus HBO therapy can be one of the potential alternative treatments for ISSNHL, particularly in steroid-intolerant patients such as those with severe diabetes mellitus, an active peptic ulcer, or viral hepatitis.

It is well known that inverted papilloma (IP) is sometimes associated with malignancies; however, the association of IP with verrucous carcinoma (VC) is extremely rare. We herein report a case of IP in the nasal cavity with VC in the maxillary sinus. A 73-year-old Japanese woman presented with a 3-month history of right-sided nasal obstruction and repetitive epistaxis. A biopsy of the mass was performed and the pathological result proved to be IP. Computed tomography and magnetic resonance imaging revealed a moderately enhanced soft-tissue lesion filling the right nasal cavity and a ring-enhanced expansive lesion in the maxillary sinus. Under a tentative diagnosis of IP of the nasal cavity with maxillary empyema, she underwent right medial maxillectomy via a lateral rhinotomy approach, and a histopathological diagnosis of IP in the nasal cavity with VC in the maxillary sinus was obtained. Her postoperative clinical course was uneventful. She is currently free from symptoms, and there is no evidence of recurrence 5 months after surgery. The pathology, clinical manifestation, and treatment of VC associated with IP are reviewed from literature.

Internuclear ophthalmoplegia (INO) is a distinctive ocular motor disorder resulting from dysfunction of the medial longitudinal fasciculus, which lies in the pontine tegmentum. We retrospectively analyzed clinical and magnetic resonance imaging (MRI) findings for four consecutive patients with internuclear ophthalmoplegia who were treated in our hospital. The causes of the disease were cerebral infarction in three cases and multiple sclerosis in one case. Vertigo and facial nerve palsy were associated in three cases and one case, respectively. MRI studies visualized an ischemic lesion in the responsible portion of the brainstem in one patient but failed to reveal responsible lesions in the other three patients. All the patients completely recovered in 1 to 22 days, with an average recovery period of 9.3 days. The etiology, diagnosis and management of INO were bibliographically reviewed.

Dominant white spotting W/W(v) and W(v)/W(v) mice are well-known mutants that lack strial intermediate cells in their cochlea and manifest hereditary sensorineural hearing loss. We recently reported marked thickening of and IgG deposition on the basement membrane of strial capillaries in W/W(v) mutant mice, similar to observations made in aged animals and in animals with autoimmune sensorineural hearing loss. The present study aimed to clarify the age-dependent changes in these pathological findings of strial capillaries in the W/W(v) mice. Male WBB6F1 +/+ and dominant white spotting W/W(v) mutant mice were sacrificed by transcardiac perfusion with paraformaldehyde solution. The cochlear ducts were isolated and subjected to light- and electron-microscopy, immunohistochemistry, immunoelectron microscopy. Alternatively, lanthanum chloride tracer examination in the isolated cochlear ducts was performed in order to compare the permeability of the strial capillaries between +/+ and W/W(v) mice. In the W/W(v) mice, thickening of and IgG deposition on the basement membrane of strial capillaries were observed as early as 1 week after birth and became more noticeable with age. Deposited IgG was preferentially localized to the thickened basement membrane and was also observed in partially the intercellular space between adjacent of endothelial cells. In addition, pinocytotic vesicles both in the apical and basal lesions of such cells also showed IgG deposition. Lanthanum chloride was retained along apical plasma membrane of the endothelial cells in the +/+ mice but penetrated through the endothelial layer in the W/W(v) mice. These results indicate that active transport via pinocytotic vesicles as well as increased permeability of strial capillaries in the W/W(v) mice occur in the early stage after birth, resulting in the morphological alterations in the strial capillaries of these mice.

The differentiating choroid plexus in rats at ages ranging from prenatal day 16 to postnatal day 3 was investigated with a special emphasis on the immunolocalization of Na+.K+ATPase in the choroid epithelium and neocapillarization of the choroid stroma. Immunoreactions for Na+.K+ATPase were localized on the apical plasma membrane of the simple choroid epithelium throughout the stages examined, but it also appeared on the basolateral plasma membrane till prenatal day 18, prior to the formation of the tight junctions as seen from both a marker experiment using lanthanum chloride and immunoreactions for tight junction-associated protein (ZO-1). This suggests that a polarity of the enzyme localization to the apical plasma membrane may take place after the establishment of the blood-cerebrospinal fluid barrier. Mesenchymal cells in the choroid stroma immunoreacted to the laminin antibody and occasionally contacted each other--forming solid cell cords--or endothelial cells of the preexisting capillaries. The contact areas immunoreacted to this antibody. Since there were few or no mitotic figures of the endothelial cells, the involvement of laminin in a mechanical linkage between the adjacent vasoformative mesenchymal cells as well as the endothelial lining in a manner suggestive of vasculogenesis was indicated.

A five-year-old boy with squamous cell carcinoma of the parotid gland is presented. The patient had a painless mass in his left parotid region with left facial palsy. Squamous cell carcinoma of the parotid gland shows high grade malignancy and is extremely rare in children, especially under five years old. After neo-adjuvant chemotherapy, he was given a total parotidectomy and radical neck dissection. The left facial nerve could not be preserved. Radiotherapy was also administered postoperatively. There was no evidence of local recurrence or distant metastasis 18 months after the surgery. Careful long-term follow-up is mandatory for this patient.

The role of intermediate cells (ICs) in the stria vascularis (SV) of the cochlear ducts in the generation of endocochlear potential (EP) is clear because certain mutants cannot generate EP. Recent reports have shown that endothelin (ET) stimulates or inhibits the function of Na + ,K + -ATPase in various organs. This study was designed to examine the immunocytochemical localization of ET and its receptor in the SV. The cochlear ducts of WBB6F 1 (+/+) mice and mutants (W/W v ) devoid of the ICs were used for light and electron microscopic immunocytochemistry using rabbit anti-ET-1, ET-3, and ET A receptor antisera. The location of Na + , K + -ATPase using rabbit anti-rat Na + , K + -ATPase was also examined. Immunoreactivity to Na + ,K + -ATPase was seen in the marginal cells (MCs) in both species. Immunoreactivity to ET-1 and ET-3 was preferentially localized in the rough endoplasmic reticulum and cytoplasmic vesicles of the ICs and along the plasma membrane of the ICs and in the MCs apposed to the ICs. Immunoreactive sites for ET A were almost identical to those of ET-I and ET-3. Because Na + ,K + -ATPase activities also exist in the MCs of the mutants, it appears likely that ET, synthesized and released by the ICs, may participate in generation of EP by regulating the function of Na + ,K + -ATPase for production of the endolymph of the MCs.