Nasal polyps in the olfactory cleft

OBJECTIVES

Nasal polyps frequently arise from the middle meatus in patients with nasal polyposis, but caution is required when polyps are seen protruding from the olfactory cleft. The purpose of this study was to evaluate a method to achieve effective and safe access to the olfactory cleft, and to determine the actual incidence of polyps arising from the olfactory cleft in patients with nasal polyposis.

PATIENTS

Eighty-four patients with bilateral or unilateral nasal polyps (n = 143) ranging in age from 16 to 72 years underwent endoscopic sinus surgery in the period from January 1994 to December 1996.

METHODS

To observe and gain access to the olfactory cleft, septoplasty combined with endoscopic sinus surgery was needed in patients with nasal polyposis.

RESULTS

The endoscopy during the combined septoplasty and endoscopic sinus surgery revealed that 36.4% (n = 52) of bilateral or unilateral nasal polyps (n = 143) arose from the olfactory cleft. Of 52 polyps of olfactory cleft origin, 45 (86.5%) arose from the superior turbinate and/or superior meatus, 32 (67.3%) from the medial side of the middle turbinate, 24 (46.2%) from the anterior face of the sphenoid sinus, and 17 (32.7%) from the mucosa of the nasal septum.

CONCLUSIONS

These findings suggest that for surgeries of nasal polyposis an approach to the olfactory cleft as well as to the middle meatus is required.

[Case of multiple posterior mediastinal and retroperitoneal neurinomas]

We report a case of multiple neurinomas arising in the posterior mediastinum and the retroperitoneum. A 49-year-old man was admitted to our department for operation after an abnormal shadow appeared on routine chest X-ray film. A left adrenal tumor was found incidentally with ultrasonography at the time of a previous thoracic surgery. First, the posterior mediastinal tumor was surgically removed. Histologic diagnosis was neurinoma. After resection, endocrinologic findings were within normal limits. A left adrenal tumor was diagnosed, and surgery was performed. The tumor was separated from the adrenal gland; the histologic diagnosis was neurinoma. Neurinomas are usually solitary; multiple neurinomas are extremely rare.

Inhibitory effects of JTE-522, a novel prostaglandin H synthase-2 inhibitor, on adjuvant-induced arthritis and bone changes in rats

OBJECTIVE AND DESIGN

To investigate the effect of JTE-522, a novel selective prostaglandin H synthase (PGHS)-2 inhibitor, on adjuvant-induced arthritis and bone changes.

SUBJECTS

Male Lewis rats at 8 weeks old were immunized with heat-killed mycobacteria.

TREATMENT

JTE-522 (0.1-30 mg/kg) and indomethacin (0.1-3 mg/kg) were administered orally once-daily after immunization.

METHODS

Paw swelling, bone changes in arthritic paws and vertebrae, urinary levels of deoxypyridinoline and pyridinium crosslinks, and the incidence of gastric lesions were determined in arthritic rats.

RESULTS

JTE-522 (from 0.3 mg/kg) suppressed the development of paw swelling, and also reduced bone damage (score and bone mineral density) in arthritic paws and the urinary excretion of deoxypyridinoline and pyridinium crosslinks. However, JTE-522 did not cause gastric lesions even at 30 mg/kg in arthritic rats.

CONCLUSIONS

These results suggest that JTE-522 possesses potent anti-arthritic activities and suppressive activity on inflammatory bone resorption without gastric side effects.

[A case of rectal cancer metastatic to the tonsil]

Metastatic tumors of the tonsils are rarer than primary tumors. Few cases of metastatic tonsillar tumor have been reported. A 51-year-old man expectorated a portion of a tumor from the left side of the pharynx after an operation for cancer metastatic to the lung. Biopsy revealed that the pharyngeal tumor was rectal cancer (adenocarcinoma) metastatic to the tonsil. To our knowledge, this is the first case of primary rectal cancer metastatic to the tonsil to be reported in Japan. The clinical features of metastatic tonsillar tumor are discussed.

Pharmacological profile of JTE-522, a novel prostaglandin H synthase-2 inhibitor, in rats

OBJECTIVE AND DESIGN

The antinociceptive, antipyretic, and anti-inflammatory effects of JTE-522, a novel selective prostaglandin H synthase (PGHS)-2 inhibitor, were examined in rats.

MATERIALS

Sheep seminal vesicle PGHS-1 and placenta PGHS-2 were used for in vitro assay, while for in vivo experiments, male rats (4-8 weeks old) were used.

TREATMENT

JTE-522 and reference compounds (0.01-100 microM) were subjected to enzyme assay. JTE-522 (0.3-30 mg/kg) and indomethacin (0.3-10 mg/kg) were administered orally.

RESULTS

JTE-522 inhibited PGHS-2 (IC50: 0.64 microM) without affecting PGHS-1 activity at 100 microM. In rats with yeast-induced hyperalgesia, JTE-522 showed a dose-dependent antinociceptive effect (ED50: 4.4 mg/kg). In rats with yeast-induced pyrexia, JTE-522 significantly reversed the pyrexic response (ED50: 3.9 mg/kg). Orally administered JTE-522 dose-dependently inhibited carrageenin-induced rat paw edema (ED30: 4.7 mg/kg). In rats with adjuvant-induced arthritis, JTE-522 showed a significant inhibitory effect at daily doses of 0.3-3 mg/kg. JTE-522 did not cause severe gastric lesions at oral doses up to 300 mg/kg.

CONCLUSIONS

Our results indicate that the selective PGHS-2 inhibitor JTE-522 may represent a novel type of anti-inflammatory drug without adverse effects on the gastrointestinal tract. JTE-522 may thus be a promising agent for treating both acute inflammatory disease and chronic inflammatory diseases such as rheumatoid arthritis.

[A case of asymptomatic posterior mediastinal pheochromocytoma diagnosed during the procedure of video-assisted thoracic surgery (VATS)]

The patient was a 20-year-old male. On routine check-ups, a posterior mediastinal tumor was found radiologically and referred to our hospital for the operation. During the Video-Assisted Thoracic Surgery (VATS), sudden elevation of the blood pressure up to 270 mmHg was observed by the tumor palpation. At once we diagnosed as pheochromocytoma. Changing the VATS to usual thoracotomy the tumor was completely removed and histologically confirmed. After the operation the patient was uneventful and the value of norèpinephrine reduced to normal range from 2912 pg/ml. The posterior mediastinal pheochromocytoma is rare and this report is the 6 th case in Japan. Clinical characteristics were discussed in addition to the review of the literature.

[Influence of smoking on medical care expense of middle-aged workers]

An analysis was made to elucidate influence of smoking habits on medical care expense. Subjects were 4,795 male workers aged 40 to 73 who participated in the routine medical check-up in 1988 at a health insurance society in Tokyo. Their daily habits including smoking habit were also surveyed. Data on medical care utilization were derived from the medical records for 1989 provided by the health insurance society. The data on medical care fees were examined, and hospitalization costs analyzed separately. Compared to other subjects, ex-smokers had a higher frequency of having a history of medical care. Ex-smokers showed higher and current smokers lower values of both visiting (percentage of subjects utilizing medical facilities at least once a year) and monthly rate of receiving examinations when compared to non-smokers. Current smokers had the lowest average number of days utilized for medical services, lowest average medical care fee per visit and annual medical care fee per person. The average number of days utilized and annual medical care fee per person was weakly correlated to smoking index. Ex-smokers had the highest average medical care fee per visit. There was a weak correlation to smoking index. Annual medical care fees per person decreased with age in non-smokers, but not in current smokers whose total fees were generally already low. In ex-smokers, fees increased until age fifties. From these results it would be difficult to identify on increase of medical care fees in middle-aged current smokers, especially in active businessmen. While the effect of smoking on health were still subclinical, average medical care fee per visit relate to and reflect the health effects of smoking.

[Characteristics of medical institutions visited by patients with 26 intractable diseases who are residents of Saitama Prefecture (comparison of the data for 1984 and 1988)]

To obtain basic data concerning the availability of medical care for intractable diseases in a large city and its environs, we analyzed the data of Saitama Prefecture. These data were selected from a nationwide survey conducted by the Epidemiology of Intractable Diseases Research Committee of the Ministry of Health and Welfare in Japan. The characteristics of medical institutions visited by patients with 26 intractable diseases were analyzed. The patients were receiving financial aid for treatment. The subjects were 4234 patients in 1984 and 6804 patients in 1988. In addition, we compared the data of 1984 with those of 1988. The results are as follows: 1) In both years, the characteristics of medical institutions which were visited varied in terms of the individual disease. The proportion of patients who visited medical institutions in the same medical service area and in the same prefecture were both very low. The percentage of patients who visited medical institutions in Tokyo was more than 30% of the total, and was more than 50% for the disease with the highest proportion of patients. The dependency on Tokyo for medical institutions was inversely proportional to the distance from Tokyo. Most patients were highly dependent on a large hospital, but the proportion of patients with SMON and ulcerative colitis who visited a large hospital was markedly lower than that for other diseases. 2) A comparison of the data of 1984 with those of 1988 showed that in most of medical service areas, the proportion of patients who visited medical institutions in the same medical service area and in Saitama Prefecture increased, but in Tokyo Prefecture the proportion decreased. We continuously observed a high dependency on a university hospital located about 60km distance from downtown Tokyo, but the dependency slightly decreased in 1988. When a new branch of a university hospital opened, many intractable disease patients then depended on that branch. These results suggest that the self-sufficiency levels of medical services for intractable diseases gradually rose in Saitama Prefecture. The illness behavior of intractable disease patients in Saitama Prefecture did not show any remarkable changes, therefore those results in Saitama Prefecture might indicate a universal characteristic of medical institutions visited by intractable disease patients who live in the envirous of a large city (Tokyo).

Synthesis and structure-activity relationships of 2-(4-benzhydryl-1-piperazinyl)-1-phenylethanols as new calcium blockers

A series of 2-(4-benzhydryl-1-piperazinyl)-1-phenylethanols (4) was synthesized and evaluated for calcium entry-blocking activity, assessed as inhibitory activity on calcium current in rat hippocampal pyramidal neurons by using a patch-clamp technique (10(-5) M), and cerebral vasodilating activity, assessed in terms of increase of vertebral blood flow after intravenous administration (1 mg/kg) in anesthetized dogs. Alkoxy substituents on the phenyl ring of the phenylethanol moiety conferred potent calcium entry-blocking activity and potent cerebral vasodilating activity. Among these compounds, 4i (NC-1100) was selected as the best analog. Some pharmacological properties of 4i are presented.

[Clinicopathological study on reported case for bronchogenic carcinoma]

After a primary operation for bronchogenic carcinoma, eight out of 253 patients (3.2%) underwent reoperation for local recurrence or intrathoracic metastasis. The histology was well or moderately differentiated adenocarcinoma in all cases. The average interval between the first and second operation was 34 months (range: six to 63 months). There were three local recurrences, two lung metastases and one mediastinal lymph node metastasis (#3a) ipsilaterally two lung metastases contralaterally. Completion pneumonectomy was underwent in one, wedge or segmental resection in five and excision of lymph node in one case after an initial ipsilateral lobectomy. Two patients underwent contralateral wedge or segmental resection after initial lobectomy. Four of eight patients died of brain, liver, or bone metastases after reoperation, the time of survival averaging 63 months. Two patients died of pneumonia, the time survival averaging 92 months. Two patients are still alive, one in 52 months and another in 20 months after reoperation.

Two cases of asymptomatic adrenocortical insufficiency with autoimmune thyroid disease

Two cases of asymptomatic adrenocortical insufficiency are reported. Both patients had a normal cortisol and increased ACTH. The cortisol response to ACTH was impaired, although not absent, in both cases. One case was associated with autoimmune polyglandular syndrome type II (Graves' disease and vitiligo), and the other was possibly associated with an early stage of Hashimoto's thyroiditis, suggesting autoimmune pathogenesis of their adrenocortical insufficiency. CT of the abdomen revealed unilateral enlargement of the adrenal glands in one case, but no enlargement of the adrenal glands in another case. Adrenal hypofunction seemed to be compensated for by increased trophic hormone (ACTH), as in subclinical hypothyroidism. However, prolonged ACTH stimulation increased urinary 17-OHCS in both cases, and normalized cortisol response to ACTH in one case. In both cases, the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were normal, and adrenal autoantibodies were negative, suggesting that neither negative adrenal autoantibodies nor normal PRA can exclude asymptomatic adrenocortical insufficiency. The results suggest that a rapid ACTH test should be performed in cases with increased ACTH, especially those associated with other autoimmune endocrine disorders.

Zollinger-Ellison syndrome and pheochromocytoma. Report of a case

A 49-year-old woman was diagnosed in 1985 as having pheochromocytoma because of hypertension with high levels of plasma catecholamine concentration and 24-hour urine excretion of vanillyl-mandelic acid and metanephrine together with a right adrenal mass. The excised tumor cells had fine granular basophilic cytoplasm with argyrophilic granules by Grimelius' method. Four years later, she was diagnosed as having a duodenal bulb ulcer. Serum gastrin showed an abnormally high level of 1900 pg/ml. Abdominal echogram and computed tomography revealed a hypoechoic lesion in the pancreas and intrahepatic multiple tumors. A needle biopsy specimen of the liver tumor was compatible with the histology of metastatic islet cell tumor. A diagnosis of Zollinger-Ellison syndrome was made due to malignant gastrinoma with multiple liver metastases. The patient had no family history of endocrinological or neoplastic disorders. The present case indicates the possibility that pheochromocytoma and gastrinoma, that is, endocrine tumors characteristic of multiple endocrine neoplasia (MEN) I and MEN II, may be coincident even in a person without MEN. A continued awareness of previously rare or undescribed manifestations is important in patients with islet cell tumors or pheochromocytoma.

[Two cases of post-thymectomy myasthenia gravis]

The first patient was a 37-year-old man with an invasive and lymphoid cell dominant thymoma (stage III). He underwent extended total thymectomy and partial resection of the upper lobe of the left lung. Four years after the operation, he had ptosis and diplopia and was diagnosed as having myasthenia gravis (positive Tensilon test and raised antiacetylcholine receptor antibody titer). His symptoms improved with the steroid therapy. The second patient was a 37-year-old woman with an invasive and mixed type thymoma (stage III). Extended total thymectomy with combined resection of the mediastinal pleura and right phrenic nerve was performed, but the tumor recurred in the right thorax 2 years postoperatively. Subtotal resection of the parietal pleura and recurrent tumors was performed by right thoracotomy, and steroid therapy was given. She developed malaise, ptosis and diplopia three months later, and was diagnosed as having myasthenia gravis. Her symptoms disappeared after the steroid therapy was stopped. A review of the Japanese literature is presented and problems regarding the pathogenesis of this disease are discussed.

Synthesis and structure-activity relationships of substituted 2-[(2-imidazolylsulfinyl)methyl]anilines as a new class of gastric H+/K(+)-ATPase inhibitors. II

A series of 2-[(2-imidazolylsulfinyl)methyl]anilines (2) having various substituents on their imidazole and aniline rings was synthesized and examined for their H+/K(+)-ATPase (adenosine triphosphatase) inhibitory effects and antisecretory activity against histamine-stimulated gastric acid secretions in Heidenhain pouch dogs. Although substitutions on the imidazole ring did not enhance biological activity, substitutions on the aniline ring by electron-donating substituents potently enhanced the enzyme inhibitory activity and also showed an inhibitory effect on histamine-stimulated gastric acid secretion after oral administration. In particular, the in vitro activity of the dimethyl (2u--w) and trimethyl (2ac) derivatives was about 10 times that of omeprazole. Also, 4-methyl (2k), 4-methoxy-5-methyl (2y) and 3,5-dimethyl-4-methoxy (2ab) derivatives showed a potent antisecretory effect of more than 80% after oral administration at 6 mg/kg. Although these aniline derivatives have relatively low stabilities in aqueous solution, replacement of the isobutyl group at the aniline nitrogen atom with N-(2-methoxyethyl) group enhanced the stability.

One-eye and locomotor compensation in guinea pigs

This study was carried out to examine the effect of blindfolding one eye on locomotor compensation after unilateral labyrinthectomy in guinea pigs. A platform runway, designed to examine the locomotion of this species of animals, was used. Eighteen Hartley-strain albino guinea pigs were used. These animals were divided into three groups, with seven in the control group, six whose right eye had been surgically closed in another group, and five whose left eye had been surgically closed in yet another group. After 7 to 11 days of training, a chemical labyrinthectomy by chloroform injection into the middle ear was performed under light ether anesthesia. Animals were checked for locomotion daily by the aforementioned platform method for about a week until regaining preprocedure levels. The locomotor compensation, depicted through the decrement of the deviation count and running time, was observed. Results have shown that the animal's locomotor compensation retarded significantly in the one-eye groups compared to the control group. In addition, those animals whose one eye, ipsilateral to the labyrinthectomy side, was closed required significantly longer time to resume the preprocedure running performance level than the animals whose one eye, contralateral to the lesion side, was closed. Thus, during locomotor compensation, the visual input obtained by animals with one eye ipsilateral to the labyrinthectomy side may be important compared to the visual input of the animals with the contralateral eye.

[A case of intrathoracic multiple schwannoma]

A case of intrathoracic multiple schwannoma originating in the left sympathetic nerve was reported. A 38-year-old male was admitted to our department for re-evaluation of his nephrotic syndrome, the chest X-ray revealed an abnormal shadow. A chest tomogram and a chest computed tomogram revealed multiple masses along the left 10th thoracic vertebra. The operation was done on September 4, 1989 under the diagnosis of posterior mediastinal tumor. At thoracotomy, four tumors were seen along the 10th thoracic vertebra and the sympathetic nerve was ascertained to be connected. Histologically, the tumors were composed of spindle cells arranged in scattered palisading fashion, and diagnosed as schwannoma. Multiple schwannomas are very rare. There have been only 12 cases of intrathoracic multiple schwannoma in Japan. Available Japanese literature on the subject was reviewed and discussed.

[Flow chart of the diagnosis and treatment of a case of catamenial pneumothorax]

A 44-year-old female had sudden cough during menstruation. She visited a clinic and mild right pneumothorax was pointed out on chest X-ray. She was admitted to our hospital for continuous pneumothorax and tube drainage was performed. Although pneumothorax improved within a week after drainage, catamenial pneumothorax was suspected because her serum CA 125 showed a high value of 109 U/ml. Therefore diagnostic pneumoperitoneum was performed during the next menstruation, and right pneumothorax occurred. Laparoscopy revealed pelvic endometriosis and thoracoscopy revealed a few small holes in the right diaphragm. The case was diagnosed as catamenial pneumothorax and hormonal treatment was given. She had been well for one year without recurrence of pneumothorax. The authors made a flow chart for diagnosis and treatment based on this case and discussed its value in relation to cases described in the literature.

Synthesis and structure-activity relationships of N-substituted 2-[(2-imidazolylsulfinyl)methyl]anilines as a new class of gastric H+/K(+)-ATPase inhibitors

A series of N-substituted 2-[(2-imidazolylsulfinyl)methyl]anilines (3) was synthesized and evaluated for its biological activity against gastric H+/K(+)-ATPase prepared from rabbit stomach and gastric acid secretions in Heidenhain pouch dogs. Monoalkyl substituents on the nitrogen atom of the aniline moiety markedly inhibited the enzyme activity to the same degree as omeprazole, a representative H+/K(+)-ATPase inhibitor. Most of these compounds, administered at 3 mg/kg i.v. inhibited histamine-stimulated gastric acid secretion. The inhibitory activity of these derivatives on the enzymes at pH 6.0 was more potent than that at pH 7.4, and was distinctly correlated to stability in aqueous solution at pH 5.0.

Estimation of absorbed doses in humans due to intravenous administration of fluorine-18-fluorodeoxyglucose in PET studies

Radiation absorbed doses due to intravenous administration of fluorine-18-fluorodeoxyglucose in positron emission tomography (PET) studies were estimated in normal volunteers. The time-activity curves were obtained for seven human organs (brain, heart, kidney, liver, lung, pancreas, and spleen) by using dynamic PET scans and for bladder content by using a single detector. These time-activity curves were used for the calculation of the cumulative activity in these organs. Absorbed doses were calculated by the MIRD method using the absorbed dose per unit of cumulated activity, "S" value, transformed for the Japanese physique and the organ masses of the Japanese reference man. The bladder wall and the heart were the organs receiving higher doses of 1.2 x 10(-1) and 4.5 x 10(-2) mGy/MBq, respectively. The brain received a dose of 2.9 x 10(-2) mGy/MBq, and other organs received doses between 1.0 x 10(-2) and 3.0 x 10(-2) mGy/MBq. The effective dose equivalent was estimated to be 2.4 x 10(-2) mSv/MBq. These results were comparable to values of absorbed doses reported by other authors on the radiation dosimetry of this radiopharmaceutical.

The destructive effects of sclerosant ethanolamine oleate on mammalian vessel endothelium

Ethanolamine oleate (EO) used widely in sclerotherapy against esophageal varices was studied for its pharmacological effect on blood coagulation and vascular damage in animals. Blood coagulation was completely inhibited by EO at a concentration of 0.31%. EO destroyed the endothelial cells of the vessel of dog and rat within one minute after injection into the vessels. An accumulation of fibrin and platelets on the surface of the damaged vessel was observed electron microscopically. Mural thrombus was formed in a few hours and the thrombus occluded the blood stream in the vein. From these animal experiment, intravasal injection of EO was considered to cause the disappearance of varices by the following two processes: collapse of varices because of occlusion of the blood stream and shrinking of the obstructed thrombus through organization.

Optical resolution and absolute configuration of a nonsteroidal antiinflammatory drug, 2-(10,11-dihydro-10-oxodibenzo- [b,f]thiepin-2-yl)propionic acid

The title compound (+/-)-1 (CN-100) was efficiently resolved into a pair of enantiomers by fractional crystallization of the diastereomeric salts of (-)- and (+)-phenylethylamine. The purity of the enantiomers was determined using the chiral cellulose column (CHIRALCEL OJ) which was allowed direct separation of the enantiomers. A separation factor (alpha) of 1.73 was obtained. X-Ray crystallographic analysis of the (+)-isomer [salt of (-)-1-(4-bromophenyl)ethylamine] showed that this enantiomer has S-configuration. Biological studies have shown that only the (+)-isomer has antiinflammatory activity. Racemizaiton of (-)-isomer was carried out by heating its propionic acid solution in the presence of mineral acid, such as HBr.

A new macrolide, TE-031 (A-56268), in treatment of experimental Legionnaires' disease

The activity of a new macrolide, TE-031 (A-56268), against Legionella pneumophila in vitro was superior to the activities of roxithromycin, erythromycin and josamycin. The tissue concentrations of TE-031 in guinea pigs after oral administration (20 mg/kg) was much higher than those of roxithromycin, erythromycin and josamycin. The maximum concentration of TE-031 was 107.0 mg/kg in the lung, and 1.4 mg/l in the serum. The uptake of macrolides by cells collected by bronchoalveolar lavage in guinea pigs was measured by a radioisotopic method. The maximum ratios of intracellular to extracellular concentration of TE-031, roxithromycin, josamycin and erythromycin were 71.9, 24.8, 39.7 and 7.9, respectively. In infected guinea pigs, with the exception of erythromycin, the ratios were reduced to approximately half the values in normal animals. TE-031 showed greater therapeutic efficacy against experimental L. pneumophila pneumonia than roxithromycin, erythromycin and josamycin. TE-031 is a promising drug for treatment of legionella pneumonia and should be investigated in a clinical study on human Legionnaires' disease.