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Patients with pollinosis sometimes complain of oral symptoms (itching and tingling with or without edema of the lips, mouth and tongue) after eating fresh fruits and vegetables. This condition has been termed Oral Allergy Syndrome (OAS). Twenty-three patients with Japanese cedar pollinosis and OAS for fresh fruits and vegetables were included in this study. Their mean age was 31.3 years (range = 5 to 62). The fruits that caused OAS in these patients included melon, apple, peach, and kiwi fruit. Most patients with OAS exhibited hypersensitivity to more than two foods. Specific IgE antibodies to inhaled allergens of mite, Japanese cedar pollen, birch pollen, melon, apple, peach, and kiwi were evaluated using the Pharmacia CAP system. Eleven of the 16 subjects with specific IgE antibodies for birch pollen, did not suffer symptoms during the birch and alder pollen season. In subjects with specific IgE antibodies for fruits, 13 out of 20 patients showed specific IgE antibodies for apple, and 8 out of 9 patients with OAS for apples were also positive for specific IgE antibodies for apples. On the other hand, 17 patients had no specific IgE antibodies for melon, and only two patients and one patient showed specific IgE antibodies for kiwi fruit and peach, respectively. These results suggest that the evaluation of specific IgE antibodies to birch pollen and apple may be useful for diagnosing OAS in patients with Japanese cedar pollinosis.

We evaluated a possible role for fibrinolytic components in nasal secretion by tissue localization with immunohistochemical techniques and by measuring their antigen concentrations in nasal discharge by means of ELISA and fibrin autography. Nasal mucosa was obtained surgically from the inferior turbinate. Urokinase-type plasminogen activator (u-PA) specific staining was observed in pseudostratified ciliated epithelium and was predominant in mucous cells of the seromucinous gland, while serous cells were almost devoid of stain. The pattern of staining of plasminogen activator inhibitor-2 was similar to that of u-PA. In contrast, plasminogen activator inhibitor-1 (PAI-1) immunoreactive material was localized exclusively in serous cells of seromucinous glands. Positive staining for tissue-type plasminogen activator (t-PA) was observed in endothelial cells and basal cells, which differentiate into either ciliated or goblet cells. Nasal secretions were partially fractionated by immunospecific antibody-immobilized Sepharose. Subsequent fibrin autography patterns indicated the presence of u-PA, PAI-1, and t-PA. After methacholine provocation, the level of t-PA increased transiently but decreased rapidly with subsequent challenges. These differential stainings of fibrinolytic components and the existence of PAs and PAI-1 in the nasal discharge suggest that the fibrinolytic system may play a role in the movement and fluidity of nasal secretion.

Pharyngeal or esophageal injuries secondary to endotracheal or nasogastric intubation are not uncommon. Since complication related to injuries of the pharynx and esophagus can be fatal, early diagnosis and adequate treatment are essential. We present a case of hypopharyngeal bleeding following a difficult endotracheal intubation and difficult nasogastric tube placement. Our patient was a 60-year-old man who complained of excessive pharyngeal bleeding. Angiography revealed extraluminal leakage from the left superior thyroid artery. The neck was explored surgically through the left anterior border of the sternocleidomastoid muscle. We ligated the vessel responsible for the bleeding, removed the ulcerated mucosa on the left pyriform sinus, and then closed the defect in the pharyngeal mucosa. The total blood loss was 7000ml from the initial bleeding to the end of the surgical procedure. The patient did not suffer from bleeding, mediastinitis and other complications after the operation. The patient then made an uneventful and prompt recovery.

亜鉛内服薬に抵抗を示した特発性味覚障害が, 漢方の投与により回復を示した症例を経験した。45歳の男性で, 1994年11月に味覚の異常に気付き, 近くの病院の耳鼻科を受診した。味覚検査で4基本味全般に対する認知の低下がみられた。血清亜鉛値は基準値内であったが亜鉛剤が投与され, 3ヵ, 月間服用するも効なく, 1995年3月当科を訪れた。既往歴に十二指腸穿孔の開腹術があったが腹診に異常はなく, 腹力も中等度で中間証と判断した。柴胡桂枝湯エキス剤7.5g/日の投与を開始したところ, 第3週目に何種類かの飲食物に対する異和感が減少して摂取できるという味覚回復の徴候がみられ, 第12週目には全般的な味覚の回復が認められた。漢方は体調を整えることによって間接的に味覚の回復をもたらすことが推測された。味覚障害に対し, 漢方の積極的な適応が期待される。

Background Plasminogen activators (PAs) and their inhibitors are thought to play an important role in tumor invasion and metastasis. However, there have been few reports in which histologic localization of PAs has been demonstrated in head and neck tumors. Methods We examined the patterns of expression of urokinase-type plasminogen activator (u-PA), tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), and vitronectin in head and neck squamous cell carcinomas using immunohistochemical techniques. We also studied the correlation between the immunohistologic expression of these fibrinolytic proteins and the clinical staging of the tumor. Results Of 28 tumor specimens, 15 (54%) showed immunoreactivity for u-PA; 8 (36%), for t-PA; and 23 ( 82%), for PAI-1. There was a significant correlation between PAI-1 expression and the extent of the primary tumor. Conclusions The present study demonstrates the existence and possible pathophysiologic significance of u-PA and PAI-1 in squamous cell carcinomas of the head and neck. © 1997 John Wiley & Sons, Inc. Head Neck19: 611–616, 1997.