Relationship between infiltrating cells and adhesion molecules in the nasal mucosa of patients with allergic rhinitis

Antigen-induced changes of cell adhesion molecules and their relationships to infiltrating cells were investigated immunohistochemically in nasal mucosa of perennial allergic rhinitis patients. An increased expression of E-selectin and VCAM-1 was noted on the vascular endothelium of the nasal mucosa 15-25 h after the topical antigen challenge. Although there was no increased expression of ICAM-1, we noted a positive correlation between the expression of E-selectin and ICAM-1. The expression of E-selectin and VCAM-1 as well as ICAM-1 was revealed to be correlated with the number of EG2-positive cells and CD4-positive cells, but not with elastase-positive cells. These findings suggest that all these adhesion molecules play a role in the topical influxes of eosinophils and CD4-positive cells in allergic nasal mucosa.

Neurotrophin-4/5 promotes proliferation of oligodendrocyte-type-2 astrocytes (O-2A)

In this study, the ability of neurotrophin-5 (NT-4/5) to promote the proliferation of oligodendrocyte precursor (O-2A) cells has been examined. This has been accomplished by the addition of exogenous NT-4/5 to purified cultures of O-2A cells maintained in an undifferentiated state by the addition of the mitogens platelet derived growth factor (PDGF-AA) and basic fibroblast growth factor (bFGF). Counts of cells incorporating bromodeoxyuridine (BrdU) showed that the addition of NT-4/5 for 24 h increased O-2A cell proliferation by 1.8-fold above that seen in PDGF-AA and bFGF alone. These data demonstrate a previously unidentified role for the neurotrophin NT-4/5 in oligodendrocyte biology.

Effects of anti-VLA-4 monoclonal antibody treatment in murine model of allergic rhinitis

In order to study the role of VLA-4 in allergic rhinitis, the effects of anti-mouse VLA-4 monoclonal antibody (mAb) were evaluated in a murine model. BALB/c mice were sensitized first by i.p. injections (general sensitization) and then by daily nasal dripping of antigen (local sensitization) before performing a nasal antigen challenge. The mAb was applied either before the antigen challenge (BC group), before the local sensitization (BL group) or before the general sensitization (BS group). The effects were evaluated in terms of antigen-induced early-phase nasal symptoms (sneezing), late-phase nasal eosinophilia and the serum level of antigen-specific IgE. Antigen-induced nasal eosinophilia was significantly (p = 0.009) reduced in the BL group but not in the BC group (number of eosinophils = 114 +/- 15.1, 244 +/- 52.8 and 347 +/- 50.5 in the BL, BC and control groups, respectively). The serum level of the specific IgE was also significantly (p = 0.038) reduced in the BL group but not in the BC group (optical density = 1.18 +/- 0.07, 1.28 +/- 0.13 and 1.58 +/- 0.14 in the BL, BC and control groups, respectively). The suppressive effect on sneezing was not significant in either the BL or BC groups. In the BS group, suppressive effects on antigen-induced nasal responses and the specific IgE level were not statistically significant. These findings suggest that VLA-4 plays an important role in the topical booster or priming effects during repeated nasal antigen exposures in pre-sensitized animals.

Repeat intervention for in-stent restenosis: re-expansion of the initial stent is a predictor of recurrence of restenosis

BACKGROUND

In-stent restenosis has become a significant clinical problem as use of stents has increased. The optimal strategy for dealing with in-stent restenosis needs to be evaluated.

OBJECTIVE

To compare the acute and late results of interventions for in-stent restenosis according to the device used, and to analyze the clinical and procedural variables of the lesions treated and identify the determinants of recurrence of restenosis and target lesion revascularization (TLR).

METHODS

Procedural and late outcomes for 58 lesions in 50 patients who underwent repeat intervention for in-stent restenosis were analyzed. The results of interventions according to the device employed were compared. The predictors of recurrence of restenosis and TLR within 6 months were analyzed. The ratio of balloon diameter in repeat intervention to minimal lumen diameter after initial stenting (MLD0) was used as an index of re-expansion of stents. Serial intravascular ultrasound imaging was performed before and after repeat intervention for 33 lesions, and re-expansion of the initial stent was evaluated.

RESULTS

Repeat intervention was successful in treating all lesions. Angiographic follow-up was possible for 49 lesions (84%). The overall incidences of recurrence of restenosis and TLR were 40.1 and 27.6%, respectively. Despite the immediate results having been good, the late results of stenting for in-stent restenosis were not favorable. Diffuse-type in-stent restenosis, early in-stent restenosis, and balloon diameter:MLD0 ratio > 1.25 are independent predictors of poor late results. Intravascular ultrasound findings have shown that expansion of the initial stent leads to recurrence of restenosis and TLR.

CONCLUSIONS

Re-expansion of the initial stent can cause further vascular injury and there is a risk of recurrence of restenosis. Alternative therapeutic strategies that work without dilating the initial stent may be necessary for treating lesions with high risk of recurrence of restenosis.

alpha-eudesmol, a P/Q-type Ca(2+) channel blocker, inhibits neurogenic vasodilation and extravasation following electrical stimulation of trigeminal ganglion

In this study, we investigated the effect of alpha-eudesmol, which potently inhibits the presynaptic omega-agatoxin IVA-sensitive (P/Q-type) Ca(2+) channel, on neurogenic inflammation following electrical stimulation of rat trigeminal ganglion. Treatment with alpha-eudesmol (0.1-1 mg/kg. i.v.) dose-dependently attenuated neurogenic vasodilation in facial skin monitored by a laser Doppler flowmetry. In addition, alpha-eudesmol (1 mg/kg. i.v.) significantly decreased dural plasma extravasation in analysis using Evans blue as a plasma marker. On the other hand, alpha-eudesmol (1 mg/kg, i.v.) did not affect mean arterial blood pressure in rats. The calcitonin gene-related peptide (CGRP) and substance P (SP) released from activated sensory nerves have recently been suggested to be associated with the neurogenic inflammation. In this study, we also showed that alpha-eudesmol (0.45-45 microM) concentration-dependently inhibits the depolarization-evoked CGRP and SP release from sensory nerve terminals in spinal cord slices. These results indicate that the anti-neurogenic inflammation action of alpha-eudesmol, which does not affect the cardiovascular system, may be due to its presynaptic inhibition of the neuropeptide release from perivascular trigeminal terminals. We also suggest that the omega-agatoxin IVA-sensitive Ca(2+) channel blocker, alpha-eudesmol, may become useful for the treatment of the neurogenic inflammation in the trigemino-vascular system such as migraine.

Human monoclonal antibodies reactive to oligodendrocytes promote remyelination in a model of multiple sclerosis

Promoting remyelination, a major goal of an effective treatment for demyelinating diseases, has the potential to protect vulnerable axons, increase conduction velocity, and improve neurologic deficits. Strategies to promote remyelination have focused on transplanting oligodendrocytes (OLs) or recruiting endogenous myelinating cells with trophic factors. Ig-based therapies, routinely used to treat a variety of neurological and autoimmune diseases, underlie our approach to enhance remyelination. We isolated two human mAbs directed against OL surface antigens that promoted significant remyelination in a virus-mediated model of multiple sclerosis. Four additional OL-binding human mAbs did not promote remyelination. Both human mAbs were as effective as human i.v. Ig, a treatment shown to have efficacy in multiple sclerosis, and bound to the surface of human OLs suggesting a direct effect of the mAbs on the cells responsible for myelination. Alternatively, targeting human mAbs to areas of central nervous system (CNS) pathology may facilitate the opsonization of myelin debris, allowing repair to proceed. Human mAbs were isolated from the sera of individuals with a form of monoclonal gammopathy. These individuals carry a high level of monoclonal protein in their blood without detriment, lending support to the belief that administration of these mAbs as a therapy would be safe. Our results are (i) consistent with the hypothesis that CNS-reactive mAbs, part of the normal Ig repertoire in humans, may help repair and protect the CNS from pathogenic immune injury, and (ii) further challenge the premise that Abs that bind OLs are necessarily pathogenic.

Preferential expression of myelencephalon-specific protease by oligodendrocytes of the adult rat spinal cord white matter

Myelencephalon-specific protease (MSP) is a novel serine protease that is expressed predominantly in the nervous system. In the adult rat spinal cord, MSP mRNA expression was dramatically upregulated, in both the white and gray matter, after systemic exposure to the glutamate receptor agonist, kainic acid (KA) (Scarisbrick et al. J Neurosci 17: 8156-8168, 1997b). To determine the cell-specific expression patterns of MSP, we generated MSP-specific monoclonal antibodies. These have been used in immunohistochemical and in situ hybridization colocalization studies, to demonstrate that MSP mRNA and protein are produced predominantly by CNP-immunoreactive oligodendroglia, but not by GFAP-immunoreactive astrocytes, in the white matter of the normal adult cord. In vitro, the soma of oligodendrocytes were also densely MSP immunoreactive, as were their growth tips, while astrocytes were associated with lower levels. These findings suggest that the enzymatic activity of MSP is likely to be important in the biology of oligodendrocytes and/or in the maintenance of the nerve fiber tracts of the adult spinal cord.

omega-agatoxin IVA-sensitive Ca(2+) channel blocker, alpha-eudesmol, protects against brain injury after focal ischemia in rats

omega-Agatoxin IVA-sensitive Ca(2+) channels have been thought to be involved in physiological excitatory amino acid glutamate release and these channels may also contribute to the development of ischemic brain injury. Recently, we demonstrated that alpha-eudesmol from Juniperus virginiana Linn. (Cupressaceae) inhibits potently the presynaptic omega-agatoxin IVA-sensitive Ca(2+) channels. In the present study, we investigated the effects of alpha-eudesmol on brain edema formation and infarct size determined after 24 h of reperfusion following 1 h of middle cerebral artery occlusion in rats. We first found that alpha-eudesmol concentration-dependently inhibited glutamate release from rat brain synaptosomes and that its inhibitory effect was Ca(2+)-dependent. In the middle cerebral artery occlusion study, intracerebroventricular (i.c.v.) treatment with alpha-eudesmol significantly attenuated the post-ischemic increase in brain water content. alpha-Eudesmol also significantly reduced the size of the infarct area determined by triphenyltetrazolium chloride staining after 24 h of reperfusion. Using a microdialysis technique, we further demonstrated that alpha-eudesmol inhibits the elevation of the extracellular concentration of glutamate during ischemia. From these results, we suggest that alpha-eudesmol displays an ability to inhibit exocytotic glutamate release and to attenuate post-ischemic brain injury.

Accelerated radiotherapy for T1, 2 glottic carcinoma: analysis of results with KI-67 index

PURPOSE

Hyperfractionated and accelerated radiotherapy without a split was performed to improve the local control probability of early glottic carcinomas. We analyzed the results of this regimen by using the Ki-67 index.

METHODS AND MATERIALS

Over a 12-year period, 85 T1N0M0 glottic cancers and 50 T2N0M0 glottic cancers were treated with conventional fractionation (CF) from 1984 to 1989 and with accelerated fractionation (AF) since 1990. The CF program consisted of five daily fractions of 2 Gy per week, for a total of 64 Gy. The AF program consisted of 1.72 Gy per fraction, two fractions per day, 5 days a week, for a total of 55 or 58 Gy. The specimens, taken before radiotherapy, were immunohistochemically stained with anti-Ki-67 antibody.

RESULTS

The 5-year local control probability for T1 tumors was 79.6 +/- 6.9% with CF treatment, whereas with AF it was 86.9 +/- 5.6%. For T2 tumors it was 62.7 +/- 12.2% with CF, whereas it was 74.7 +/- 7.8% with AF. The difference between CF and AF did not reach the point of statistical significance. However, when T1 tumors had a Ki-67 index lower than 50%, the local control rate achieved with AF was significantly better than that with CF (p = 0.018). When the tumors had a Ki-67 index that was 50% or more, there was no difference in the local control rate between CF and AF, whether they were T1 or T2. The peak mucosal reactions at the larynx and/or hypopharynx were much more severe and appeared at smaller doses and earlier in AF than in CF. The patients with AF showed no severe late complications.

CONCLUSIONS

AF could not obtain statistically significant improvement in local control probability of T1 or T2 glottic carcinomas.

Effect of CT digital image compression on detection of coronary artery calcification

PURPOSE

To test the effect of digital compression of CT images on the detection of small linear or spotted high attenuation lesions such as coronary artery calcification (CAC).

MATERIAL AND METHODS

Fifty cases with and 50 without CAC were randomly selected from a population that had undergone spiral CT of the thorax for screening lung cancer. CT image data were compressed using JPEG (Joint Photographic Experts Group) or wavelet algorithms at ratios of 10:1, 20:1 or 40:1. Five radiologists reviewed the uncompressed and compressed images on a cathode-ray-tube. Observer performance was evaluated with receiver operating characteristic analysis.

RESULTS

CT images compressed at a ratio as high as 20:1 were acceptable for primary diagnosis of CAC. There was no significant difference in the detection accuracy for CAC between JPEG and wavelet algorithms at the compression ratios up to 20:1. CT images were more vulnerable to image blurring on the wavelet compression at relatively lower ratios, and "blocking" artifacts occurred on the JPEG compression at relatively higher ratios.

CONCLUSION

JPEG and wavelet algorithms allow compression of CT images without compromising their diagnostic value at ratios up to 20:1 in detecting small linear or spotted high attenuation lesions such as CAC, and there was no difference between the two algorithms in diagnostic accuracy.

Evaluation of scaffolding effects of five different types of stents by intravascular ultrasound analysis

The acute elastic recoil of 5 types of stents immediately after deployment by intravascular ultrasound and quantitative coronary angiography measurements was analyzed. Successfully implanted stents were: Palmaz-Schatz in 104 lesions, Gianturco-Roubin in 65, Wiktor in 45, gfx in 22, and Multi-Link stents in 22. Before and after stenting, the cross section of the smallest luminal area and vessel area was measured with intravascular ultrasound. The postdilatation balloon area was calculated by quantitative coronary angiography. Percent recoil was calculated as: [1-(preluminal area)/balloon area)] x 100. The ratio of balloon area-to-vessel area was also compared. Although preluminal areas in Gianturco-Roubin and Palmaz-Schatz stents were similar (2.4 +/- 0.1 vs 2.5 +/- 0.1 mm2, p = NS), postluminal area in the Gianturco-Roubin was significantly smaller than the area in the Palmaz-Schatz (6.3 +/- 0.2 vs 8.3 +/- 0.3 mm2, p <0.05). Although both the balloon area/vessel area (0.68 +/- 0.05, 0.80 +/- 0.08 vs 0.83 +/- 0.02, p <0.05) and the preluminal area (2.1 +/- 0.4, 1.6 +/- 0.2 vs 2.5 +/- 0.1 mm2, p <0.05) were smaller in gfx and Multi-Link than in the Palmaz-Schatz, postluminal area was comparable to the area in the Palmaz-Schatz (7.8 +/- 0.4, 7.4 +/- 0.4 vs 8.3 +/- 0.3 mm2, p = NS). Percent recoil in the Gianturco-Roubin was poorest among these 5 groups. More favorable initial gain can be obtained with Palmaz-Schatz, Wiktor, gfx, and Multi-Link stents than with the Gianturco-Roubin stent.

Internalization and sorting of plasma membrane sphingolipid analogues in differentiating oligodendrocytes

We studied the formation of early endosomes in differentiating oligodendrocytes and type-2 astrocytes, which are derived from common precursor cells in rat neonates, using fluorescent analogues of lactosylceramide (LacCer) and sulfatide labeled with 4,4-difluoro-5,7-dimethyl-4-bora-3a,4a-diaza-s-indacene++ +-3-pentanoic acid (BODIPY FL C5). These sphingolipid analogues exhibit a concentration-dependent shift in their fluorescence emission maximum from green to red wavelengths that can be used to estimate the relative concentration of an analogue in the intracellular membranes of living cells by quantitative fluorescence microscopy. When oligodendrocytes at various stages of differentiation were incubated with 1 microM BODIPY-sphingolipid at 10 degrees C and washed, yellow/green plasma membrane fluorescence was observed. Quantitative studies confirmed that the amount of BODIPY-LacCer or -sulfatide incorporated into the plasma membrane of a given cell type was identical. When these cells were subsequently warmed to 37 degrees C for 2-10 min to allow internalization to occur, the BODIPY-sphingolipid analogues were distributed in a punctate pattern throughout the cytoplasm. Within individual cells labeled with BODIPY-sulfatide, some endosomes exhibited green fluorescence, whereas others emitted red/orange fluorescence. In contrast, when BODIPY-LacCer was used, only green endosomes were observed. Although this phenomenon could be observed at earlier stages of differentiation, it was most obvious in mature oligodendrocytes, where quantitative measurements of the red/green ratio of individual endosomes suggested about a threefold difference between the concentration of the LacCer and sulfatide analogues in endosomes. These results suggest that "lipid sorting" takes place during endocytosis in mature oligodendrocytes, resulting in selective exclusion of certain lipid species during the internalization process. This sorting event may result in the net addition of lipids to the differentiated oligodendrocyte plasma membrane.

Successful stenting on tortuous coronary artery with accordion phenomenon: strategy--a case report

Guidewire manipulation through tortuosities is difficult. Straightening a tortuous coronary artery by using a stiff guidewire has been recognized to induce vessel wall shortening referred to as an "accordion phenomenon." With inappropriate identification as dissection or thrombus formation, the risk of performing unnecessary dilation at the pseudo-narrowing site exists. The authors describe here two cases showing the accordion phenomenon induced by a stiff guidewire during successful stenting at a tortuous right coronary artery. In another case, the authors experienced an "accordion phenomenon" at the proximal edge of the Palmaz-Schatz stent implanted in a tortuous right coronary artery. The stent edge was better positioned at the straight portion than at the contour portion in a tortuous coronary artery.

Detection of small peripheral lung cancer by digital chest radiography. Performance of unprocessed versus unsharp mask-processed images

PURPOSE

To clarify whether processed digital chest radiography can improve the detection rate for small peripheral lung cancer.

MATERIAL AND METHODS

Five radiologists independently interpreted 54 digitized chest radiographs of 18 patients with small peripheral lung cancers measuring less than 20 mm, which were displayed following 3 types of digital processing: 1) an original version; 2) unsharp mask processing with a type 1 filter (very low-frequency-enhancing, mid-frequency-suppressing, and high-frequency-enhancing filter); and 3) unsharp mask processing with a type 2 filter (very low- and high-frequency-enhancing filter). A total of 1,620 pooled observations were evaluated by receiver operating characteristic (ROC) analysis.

RESULTS

The mean area under the ROC curves was 0.68 for the type 1 filter, 0.68 for the type 2 filter, and 0.65 for the unprocessed (original) image. There were no statistically significant differences among these 3 kinds of image processing (p>0.05). In all types of images, the small lung cancer with an alveolar lining tumor growth was less visible than a solid tumor growth (p<0.01); the sensitivity increased with tumor size when the 3 groups of cancers, those measuring less than 10 mm, 11-15 mm, and 16-20 mm, were compared (p<0.01).

CONCLUSION

Unsharp mask-image processing of digital chest radiography will not improve the detection rate of small peripheral lung cancer, probably due to a substantial drawback: the limited conspicuity of cancer lesions in the surrounding lung and superposition of structures.

Angioplasty/bypass combination therapy in an 89-year-old man with left main trunk disease

We report a case of an 89-year-old man presenting with unstable angina and left main trunk disease. Minimally invasive direct coronary artery bypass grafting supplemented by catheter intervention was successfully performed. In view of the increasing elderly population, angioplasty/bypass combination therapy may be an important alternative for elderly coronary artery disease patients.

Stretch-activated ion channel blocker gadolinium attenuates ischemic ST-segment elevation in canine myocardium

Regional transmural ischemia causes both ST-segment elevation and systolic elongation (bulging) of the myocardium. Mechanical stretch might alter the transmembrane potential via stretch-activated ion channels (SAC); however, the role of SAC on ischemic ST-segment elevation has not yet fully studied. The present study investigated the role of SAC in the genesis of ischemic ST-segment elevation in the in-vivo canine heart. In 6 anesthetized dogs, an extracorporeal conduit connected to the left anterior descending coronary artery was occluded for 5 min before and after the intracoronary infusion of gadolinium (Gd, 500 micromol/min). To eliminate the effect of ischemic preconditioning, the bypass was occluded for 5 min before the experiment. Percent systolic shortening (%SS) and percent systolic elongation (%bulging) were measured using a pair of ultrasonic dimension crystals. A unipolar epicardial ECG was monitored at the center of the ischemic area for the measurement of the ST-segment level. At the end of coronary occlusion, there was no difference in the reduction of %SS or the increase of %bulging between before and after infusion of Gd. ST-segment elevation, however, was significantly attenuated by the infusion of Gd. These data demonstrated that the activation of SAC is one cause of ischemic ST-segment elevation.

Nonischemic ST-segment elevation induced by negative inotropic agents

The present study investigated whether regional ventricular dyskinesia (ie, systolic bulging) is a direct cause of ST-segment elevation in canine hearts in vivo. Regional ventricular dyskinesia was induced in 33 anesthetized open-chest dogs by injection of negative inotropic agents into the left anterior descending coronary artery (LAD) without disruption of coronary blood flow. Regional myocardial contraction was assessed in terms of the percent systolic shortening (%SS) and percent systolic bulging (%bulging), which were measured using ultrasonic crystals. The ST-segment elevation of the LAD-perfused area was measured with a unipolar electrode. Lidocaine, a sodium channel blocker, nicorandil, a potassium channel opener, propranolol, a beta-adrenergic blocker, or verapamil, a calcium channel blocker, was administered by intracoronary injection during maximal vasodilation induced by adenosine. All drugs induced dose-dependent ST-segment elevation in association with a parallel reduction in %SS and a parallel increase in %bulging. The absence of myocardial ischemia was confirmed by the absence of NADH fluorescence. It was concluded that regional ventricular dyskinesia had an important role in ST-segment elevation not associated with myocardial ischemia.

Topical CTLA4-Ig suppresses ongoing mucosal immune response in presensitized murine model of allergic rhinitis

Allergic rhinitis is thought to be mediated by CD4+ T cells producing Th2-associated cytokines. Optimal Ag-specific T-cell activation requires the engagement of T-cell receptor with antigen (Ag) in the context of MHC, and the engagement of appropriate costimulatory molecules. One of the most well-characterized costimulatory pathways is the interaction of B7/CD28-CTLA4 molecules. Recent studies have suggested that the costimulatory pathway may influence the development of Th2 immune responses. The objective of this study was the examination of the role of B7/CD28-CTLA4 costimulatory pathway in the pathogenesis of ovalbumin (OVA)-induced immune response in presensitized murine model of allergic rhinitis. Systemically presensitized BALB/c mice significantly developed Ag-induced early phase nasal symptoms, nasal hyperresponsiveness to histamine, nasal eosinophilia, serum levels of OVA- specific IgE and Th2-associated cytokines following repeated topical Ag challenges. Topical administration of CTLA4-Ig during nasal challenges inhibited Ag-induced nasal symptoms and histamine hyperresponsiveness. We also found a significant reduction in nasal lavage eosinophilia and serum levels of OVA-specific IgE. Furthermore, CTLA4-Ig treatment significantly decreased interleukin (IL)-4 content in nasal tissue, while there was no significant change in IL-5 or IFN-gamma levels. These results suggest that B7/CD28-CTLA4 costimulatory pathway mediates the development of ongoing Th2 immune responses and plays a major role in regulating allergic disease, such as allergic rhinitis.

[A relationship between birch pollen and meteorological factors during the past four years and pollen survey in Sapporo in 1997]

It is well known that grass pollinosis has been the most representative pollinosis in Hokkaido prefecture, Japan, However, it is also well known that birch (Japanese white birch, Betula platyphylla var. japonica) pollinosis is gradually increasing, which is marked especially in Sapporo and its neighborhood. We analyzed a relationship between the birch pollen count and meteorological factors statistically. Moreover, the principal airborne pollen counts in Sapporo in 1997 were assessed and compared with the previous pollen data. As a results of this study, it was showed a close relationship between the annual amounts of birch pollen and meterological factors of the year before, especially in May and June might be important. Moreover, there is a strong negative correlation between the birch pollen count and humidity, which seems to affect bringing up flower buds. As for the principal airborne pollen counts, some kinds of tree pollen, including birch pollen, were observed from the end of March, followed by grass (Gramineae) pollen in June and mugwort (Artemisia) pollen from the end of August, respectively. The annual amounts of grass pollen showed a decreasing trend.

The mobile hospital--an experimental telemedicine system for the early detection of disease

To detect early disease, especially lung disease, we created a new telemedicine system, called the Mobile Hospital. It consists of a satellite or ground communication system using a large vehicle in which is installed a whole-body spiral computerized tomography scanner and a multimedia telecommunications system. The Mobile Hospital goes to small villages and carries out mass screening for early lung disease, especially lung cancer. It travelled over 8000 km from May 1996 to March 1997. In this period 6358 persons aged 50-85 years and younger heavy smokers were screened in the Matsumoto area. As a result, 37.7% of the subjects were suspected of having various latent lung diseases. The cost of medical treatment for the lung cancers detected by the Mobile Hospital was 44% of that for a conventional medical care group, and the length of hospital treatment with surgical operation was 30% of that of the conventional group.

[Effects of immunotherapy on cytokine production from peripheral blood mononuclear cells in patient with house dust mite allergic rhinitis]

We studied effects of immunotherapy on mite antigen-induced cytokine production from peripheral blood mononuclear cells in patient with house dust mite allergic rhinitis. In good response group, IL-4 production were lower than that of poor response group. In contrast, IFN-gamma production and the ratio of IFN-gamma to IL-4 synthesis were significant higher than that of poor response group. The production of IFN-gamma significantly correlated with the periods of immunotherapy. These results suggest that the changes of cytokine synthesis have a close relationship to clinical effects of immunotherapy.

A case of anaplastic thyroid carcinoma surviving disease free for over 2 years

A 52-year female presented with an enlarged thyroid mass and lump sensation in the throat. The cytologic examination showed class five and she was admitted to the hospital to undergo operation. Total thyroidectomy was done and the tumoral invasion of the trachea was removed. We performed tracheoplasty using a sternocleidomastoid muscle-clavicle myoosseous flap in a single stage operation. Histologic diagnosis revealed anaplastic thyroid carcinoma After upper mediastinal dissection had been performed, systemic chemotherapy using pirarubicin, cisplatin and etoposide was administered. In addition, she was treated with radiochemotherapy using pirarubicin, cisplatin and a total of 58 Gy was administered. No recurrence of the tumor has been noted since the above operation 2 years ago. Immunohistochemical studies of primary and metastatic tissues in this case revealed a positive expression of p53 protein in both.

Chondrosarcoma of larynx: a case successfully reconstructed after total cricoidectomy

A case of a 64-year-old male with low-grade chondrosarcoma of the left posterolateral lamina of the cricoid cartilage is reported, in which a total cricoidectomy and partial resection of the left thyroid cartilage were performed. The rest of the thyroid cartilage and the arytenoid mucosa were approximated with sutures to the first tracheal ring, and a silastic T-tube was placed through the tracheostoma as a stent. The postoperative course has been successful except for the existence of a tracheal stoma and slight hoarseness. There has been no evidence of laryngeal stenosis nor recurrence at about 9 years postoperatively.

The nonpeptide alpha-eudexp6l from Juniperus virginiana Linn. (Cupressaceae) inhibits omega-agatoxin IVA-sensitive Ca2+ currents and synaptosomal 45Ca2+ uptake

Recently, the omega-agatoxin IVA (omega-Aga-IVA)-sensitive Ca2+ channel has been demonstrated to play an important role in the physiological neurotransmitter release in mammalian nerve terminals. In this study, we demonstrate that alpha-eudesmol from Juniperus virginiana Linn. (Cupressaceae) inhibits omega-Aga-IVA-sensitive Ca2+ channels in rat brain synaptosomes and cerebellar Purkinje cells. Thirty millimolar KCl-induced 45Ca2+ uptake into the synaptosomes was inhibited by omega-Aga-IVA but insensitive to omega-conotoxin GVIA (omega-CTX-GVIA, N-type Ca2+ channel blocker) and nicardipine (L-type Ca2+ channel blocker). We found that alpha-eudesmol concentration-dependently inhibited the above synaptosomal 45Ca2+ uptake with an IC50 value of 2.6 microM. Co-treatment with alpha-eudesmol and omega-Aga-IVA did not cause any additive inhibitory effect against the synaptosomal 45Ca2+ uptake. Using the whole-cell patch clamp electrophysiological technique, we further demonstrated that alpha-eudesmol concentration-dependently inhibited omega-Aga-IVA-sensitive Ca2+ channel currents recorded from Purkinje cells with an IC50 value of 3.6 microM. The current-voltage relationship of the omega-Aga-IVA-sensitive Ca2+ channel currents was not changed by alpha-eudesmol. On the other hand, alpha-eudesmol also displayed an inhibitory effect on N-type Ca2+ channel currents recorded from differentiated NG108-15 cells with an IC50 value of 6.6 microM. However, alpha-eudesmol had little inhibitory effect on L-type Ca2+ channel currents. Thus, the present data indicated that alpha-eudesmol is a potent nonpeptidergic compound which blocks the presynaptic omega-Aga-IVA-sensitive Ca2+ channel with relative selectivity.

Suppressive effects of CTLA4-Ig on nasal allergic reactions in presensitized murine model

Ag-specific T cell activation requires the engagement of T cell receptor (TCR) with antigen in the context of MHC, and the engagement of appropriate costimulatory molecules. It is well established that B7/CD28-CTLA4 costimulatory pathway plays an important role in the induction of T helper (Th) cells in T-cell dependent immune reactions. In this study, we evaluated the effects of blocking the costimulatory pathway by systemic administration of CTLA4-Ig during repeated nasal antigen challenges in systemically presensitized mouse. The antigen-induced early phase nasal symptoms, nasal hyperresponsiveness to histamine and nasal eosinophilia were significantly suppressed by CTLA4-Ig treatment. Elevation of serum level of antigen-specific IgE, but not IgG1 or IgG2a was inhibited by the treatment. In relation to cytokine levels in the tissue extracts of the nasal mucosa, an up-regulation of IL-4 was significantly inhibited, however, the levels of IL-5 and IFN-gamma were not affected by the treatment. These results suggest that B7/CD28-CTLA4 costimulatory pathway plays an important role in on-going Th2-related allergic reactions in the nose.

Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published TNM staging

PURPOSE

To examine the usefulness of MR imaging for predicting local control of nasopharyngeal carcinoma (NPC) and the value of MR imaging in the newly published fifth edition of the TNM classification.

METHODS AND MATERIALS

We studied 29 patients with NPC with MR imaging and CT before and after treatment. Staging was done according to the fourth and newly published fifth editions of the International Union Against Cancer (UICC) staging system. The radiotherapy protocol was designed to deliver 66 to 68 Gy to the primary tumor and clinically involved nodes.

RESULTS

MR proved better than CT at identifying obliteration of the pharyngobasilar fascia, invasion of the sinus of Morgagni, through which the cartilaginous portion of the eustachian tube and the levator veli palatini muscle pass, invasion of the skull base, and metastases to lymph nodes in the carotid and retropharyngeal spaces. All seven patients without invasion of the pharyngobasilar fascia had local control. The local control rates of patients with invasion of the skull base were not good (60 to 73%). There was no apparent relationship between tumor volume determined by T1-weighted MR images and local control when the tumor volume was more than 20 cc. The newly published N staging system appears to successfully identify the high-risk group for distant metastasis as N3. In our series, four of five patients with N3 disease developed distant metastases.

CONCLUSION

Deep infiltration of the tumor is a more important prognostic factor in NPC than tumor volume. Since the newly published T staging system requires a search for tumor invasion into soft tissue such as parapharyngeal space and bony structures, MR imaging may be indispensable for the newly published NPC staging system.

[Cytokine production of peripheral mononuclear cells in HD-mite-allergic rhinitis patients]

To elucidate the role of cytokines in the pathogenesis of allergic rhinitis, the proliferative response and cytokine production of peripheral mononuclear cells (PMNC) following stimulation with mite-antigen were evaluated in HD-mite-allergic rhinitis patients (mite-allergy group), non-HD-mite pollinosis patients (non-mite-allergy group) and normal subjects (normal group). The proliferative response of PMNC to PHA stimulation was not different among the groups, whereas that to mite-antigen stimulation was significantly higher in the mite-allergy group than in the normal group. Production of both IL-4 and IL-5 from PMNC after stimulation with mite-antigen was significantly higher in the mite-allergy group than in the normal group. Production of IFN-gamma from PMNC after antigen stimulation was significantly increased in both the mite-allergy and normal groups. The ratio of IFN-gamma to IL-4 synthesis was significantly higher in the normal group than in the mite-allergy group. This study revealed cytokine synthesis from PMNC after the antigen-stimulation was predominantly Th2-cytokines in patients with HD-mite-allergic rhinitis.

Role of CD4-positive T cells in the pathogenesis of nasal allergy in the murine model

BACKGROUND

Antigen-induced upregulation of cytokines, especially Th2-type cytokines, has been proven to be closely related to allergic inflammation in nasal allergy. CD4-positive T cells are supposed to play an important role not only in the induction of allergy but also in allergic inflammation.

METHODS

The anti-CD4 mAb was administered to the murine model of nasal allergy either at the beginning of sensitization, just before antigen challenge or during a topical booster sensitization. Then, the effects on the antigen-induced nasal responses and the serum level of antigen-specific IgE antibody were evaluated.

RESULTS

When the mAb was applied at the beginning of sensitization, the early-phase nasal symptoms and the late-phase nasal eosinophilia were significantly inhibited, and the 8-day passive cutaneous anaphylaxis (PCA) titer tended to be inhibited. When the mAb was applied just before the challenge, there were no differences in the nasal symptoms, the nasal eosinophilia or the 8-day PCA titer between the mAb-treated animals and the control animals. When the mAb was applied during a topical booster sensitization, the nasal eosinophilia, the 8-day PCA titer and histamine hypersensitivity were significantly suppressed in the treated animals.

CONCLUSION

CD4-positive T cells play an important role in the induction of IgE-mediated nasal allergy, occurrence of late-phase allergic inflammation and histamine hypersensitivity, but not in antigen-induced early-phase nasal symptoms in the murine model. In cases of chronic topical antigen exposure, however, the suppressive effects of a single application of the anti-CD4 mAb are not remarkable.

Differentiation-specific mRNA expression of a mouse bipotential glial cell line

We have previously reported that a bipotential glial cell line from mouse cerebrum, designated OS3, phenotypically differentiates into oligodendrocytes and astrocytes both in vitro and in vivo. To study the potential mechanisms of differentiation, in this study we investigated mRNA expression of cytokines and developmentally regulated proteins in OS3 during differentiation into oligodendrocytes by semi-quantitative reverse transcription and polymerase chain reaction. In the presence of 10% calf serum OS3 cells expressed IL-1alpha and IL-1beta mRNA. However, when the cells were cultured in chemically defined medium or low serum-containing medium the expression of IL-1alpha and IL-1beta mRNA was down-regulated. Under stimulation of phorbol ester, expression of IL-6 and nerve growth factor mRNA was up-regulated. The capacity for differentiation of OS3 cells into oligodendrocytes in vitro was limited and most OS3 cells ceased their differentiation at the proligodendroblast stage. However, expression of proteolipid protein (PLP) and DM20 mRNA was detectable and was up-regulated in accordance with the differentiation into oligodendrocytes. As a control, primary astrocytes expressed DM20 mRNA but not PLP mRNA and the expression of DM20 mRNA was independent of culture condition. Therefore, OS3 cells will be of use for the study of differentiation of progenitor cells into type-2 astrocytes or oligodendrocytes at the molecular level.

Antigen-specific IgA response of NALT and cervical lymph node cells in antigen-primed rats

Using antigen-primed rats, we examined the occurrence of antigen-specific antibody forming cells in mononuclear cells (MNC) of nasopharynx associated lymphoid tissues (NALT) and cervical lymph nodes (CLN) following in vitro stimulation with lipopolysaccharide (LPS), cytokines and antigen using the ELISPOT assay method. The rats were immunized with ovalubumin (OVA) by intraperitoneal injections, then by daily intranasal boostering for 2 weeks. In the nasal lavage fluid, the level of OVA-specific IgA antibody was higher and that of OVA-specific IgG antibody was lower than those antibodies in the serum. Following incubations. most of the IgA spot forming cells (SFC), but only 5 10% of IgG SFC were proved to be antigen-specific in the NALT and CLN MNCs. Following LPS stimulation, both the antigen-specific IgA and IgG SFCs increased 1.5- to 2-fold in the NALT MNC. However, following OVA stimulation, the antigen-specific IgA SFC increased 6- to 8-fold, which was remarkably higher than the antigen-specific IgG SFC. The changes of the antigen-specific immunoglobulin SFCs in the CLN MNC following the antigen stimulation were similar to those in the NALT MNC. These findings suggested that NALT might be one of the induction sites for antigen-specific IgA responses in rats.

[Clinical study of hypopharyngeal carcinoma]

A clinical study was performed of 83 patients with hypopharyngeal cancer treated in the Sapporo Medical University Hospital from 1982 to 1995. Five-year cumulative survival rate was 34.9% in the whole group and 37.2% in the radical surgical and/or radiation treatment group. In the radiation treatment group, the patients with T1, T2, N0 or N1 stage disease, especially those whose original disease responded almost completely to 40Gy irradiation, showed high tumor control rates following full-dose irradiation with or without radical neck dissection. In the radical surgery group, the patients with T4 or N2 stage disease showed better prognosis than those in the radiation group. However, among the patients with N3 lymph node metastases, there were no long-term survivors in either the radiation or the surgery groups.

Targeting of IgMkappa antibodies to oligodendrocytes promotes CNS remyelination

We previously identified the remyelinating activity of a natural IgMkappa oligodendrocyte-reactive autoantibody (SCH94.03), using a virus-induced murine model of multiple sclerosis. We now describe a second mouse IgMkappa monoclonal antibody (mAb) (SCH79.08) raised against normal mouse spinal cord homogenate, which reacts with myelin basic protein and also promotes remyelination. Because these two mAbs recognize different oligodendrocyte antigens, several previously identified oligodendrocyte-reactive IgMkappa mAbs (O1, O4, A2B5, and HNK-1), each with distinct antigen specificities, were evaluated and found to promote remyelination. In contrast, IgMkappa mAbs that did not bind to oligodendrocytes showed no remyelination. One of these, CH12 IgMkappa mAb, which shares variable region cDNA sequences with SCH94.03 except for amino acid differences in the complementarity-determining region 3 in both heavy and light chains, did not bind to oligodendrocytes and did not promote remyelination. The fact that multiple oligodendrocyte-reactive antibodies with distinct antigen reactivities induce remyelination argues against direct activation by a unique cell surface receptor. These findings are most consistent with the hypothesis that the binding of mAbs to oligodendrocytes in the lesions induces myelin repair via indirect immune effector mechanisms initiated by the mu-chain. Importantly, these studies indicate that oligodendrocyte-reactive natural autoantibodies may provide a powerful and novel therapeutic means to induce remyelination in multiple sclerosis patients.

Expression of substance P (NK1) receptor mRNA in human nose

In airway tissues, it has been suggested that substance P is the transmitter of afferent sensory nerves which respond to various irritants and may be involved in airway allergic reactions. Three classes of tachykinin receptor are currently recognized, denoted as NK1, NK2 and NK3, which exhibit preferential affinity for substance P, neurokinin A and neurokinin B, respectively. We used molecular probes to study the gene expression and distribution of NK1 receptor in human nose. Total RNA was isolated from human nasal mucosa and NK1 receptor mRNA was detected in these tissues by using reverse transcription and polymerase chain reaction (RT-PCR). For in situ hybridization study of human nasal mucosa, we utilized the PCR directly to incorporate a T7 RNA polymerase promoter sequence onto the NK1 receptor cDNA, and these PCR products were used as the DNA templates for producing digoxigenin-labelled anti-sense and sense RNA probes. These studies revealed that NK1 receptor mRNA was expressed in submucosal glands and airway epithelium. The results may have an important clinical implication, and also promote further investigation of gene regulation of NK1 receptor in health and disease.

Successful predilation of a resistant, heavily calcified lesion with cutting balloon for coronary stenting: a case report

A 65-year-old man with a restenotic lesion of the mid LAD was scheduled for Wiktor stent placement. The IVUS revealed circumferential severe calcification. Two conventional, non-compliant angioplasty balloons inflated to high pressures failed to achieved sufficient dilatation and both ruptured. At this point, we selected high pressure inflation of the Cutting Balloon. The Cutting Balloon achieved adequate dilation for stenting and proved to be useful in predilating a circumferential, heavily calcified lesion.

The effect of a cysteinyl leukotriene antagonist, ONO-1078 (pranlukast) on agonist- and antigen-induced nasal microvascular leakage in guinea pigs

The in vivo model of nasal microvascular leakage was used for the nasal allergic challenge in ovalbumin (OA)-sensitized guinea pigs, or nasal stimulation with leukotriene D4 (LTD4) in non-sensitized animals. An intravenous injection of Evans blue dye was given as an index of nasal microvascular leakage. Following the nasal stimulation with LTD4, the concentration of dye in the nasal lavage fluid rapidly increased. Oral administration of ONO-1078 (pranlukast) (3-30 mg/kg) significantly inhibited the LTD4-induced nasal microvascular leakage. In OA-sensitized guinea pigs, the excretions of dye into nasal lavage fluid were recognized soon after the topical antigenic stimulation and continued for over 60 minutes. Oral administration of ONO-1078 (30 mg/kg) significantly inhibited the antigen-induced microvascular leakage. These results suggest that ONO-1078 may be of therapeutic use for nasal allergy.

A unique population of circulating autoantibodies promotes central nervous system remyelination

In previous studies we demonstrated that the humoral immune response directed against unique central nervous system (CNS) antigens enhanced CNS remyelination in the Theiler's virus experimental model of multiple sclerosis (MS). To expand on this observation, a mouse IgM kappa monoclonal antibody (mAb) which enhances CNS remyelination, was raised against normal mouse spinal cord homogenate. Characterization of this mAb revealed that it is polyreactive towards variety of intracellular antigens but also reacts to an unidentified surface antigen on oligodendrocytes. The mAb is encoded by germline immunoglobulin genes without somatic mutations consistent with the observation that it is a natural autoantibody. Recently we generated another mouse IgM kappa mAb raised against normal spinal cord homogenate, which also promotes CNS remyelination. Further characterization revealed that both mAbs which promote remyelination have similar binding characteristics. Conventionally Abs which recognize normal CNS components, especially oligodendrocytes or myelin, have been considered to be a disease marker or be involved in the pathogenesis of MS. However, we have identified a unique population of circulating autoantibodies which are beneficial for myelin repair. Therefore this observation indicates the need to reevaluate autoantibody production against myelin components in CSF and blood as markers of disease activity versus repair in MS.

The effect of adenotonsillectomy in children with OSA

Adenotonsillar hypertrophy and abnormal facial morphology are thought to be important for the occurrence of obstructive sleep apnea syndrome (OSA). We evaluated the effects of adenidectomy and/or tonsillectomy and the relationship between the treatment results and facial morphology in 134 children with OSA. Significant improvements in apnea-hypopnea indes (AHI) and lowest blood oxygen saturation (SaO2) were noted and 78.5% of the patients improved after adenoidectomy and/or tonsillectomy. Additional operations were needed in two out of 13 cases of the adenoidectomy group and two out of four cases of the adeno-monotonsillectomy group. In the adenotonsillectomy group, the unimproved children tended to have smaller tonsils, narrower epipharyngeal airspace, and more poorly-developed maxillary and mandibular protrusion than the improved children.

Solitary fibrous tumor of the parotid gland extending to the parapharyngeal space

Solitary fibrous tumors (SFT) arise in the pleura and less commonly in extrapleural sites. Head and neck regions have included the nose and paranasal sinuses, soft palate, epiglottis, thyroid, parotid and submandibular glands, as well as the infratemporal fossa and parapharyngeal space. We report a case of SFT arising from the parotid gland and extending to the parapharyngeal space. To our knowledge, this is the fourth case of SFT originating from the parotid gland and is the largest of its kind among the extrapleural lesions described. The characteristics revealed by computed tomography and magnetic resonance imaging are presented.

Polymorphism in the Ialpha1 germ-line transcript regulatory region and IgA productivity in patients with IgA nephropathy

Enhanced in vivo and in vitro production of IgA has been reported in patients with IgA nephropathy (IgAN) and their family members. It is generally considered that IgA1 is a prominent subclass of IgA in IgAN. Although genetic mechanisms of IgA class switch recombination in IgAN have been studied enthusiastically, the critical factors that induce IgA1-specific class switching in IgAN have yet to be elucidated. A large body of data indicates that the germ-line transcript of Ig constant region (C(H)) genes that precedes actual class switching has regulatory effects on class switch recombination. To analyze structural abnormalities in the Ialpha1 germ-line transcript regulatory gene, a region about 1000 bp long located upstream of Ialpha1 exons was surveyed by the PCR-single strand conformation polymorphism method, and the polymorphism detected was confirmed by subsequent DNA sequencing. Three hot spots for point mutation were detected upstream of the promoter region of the Ialpha1 germ-line transcript, and the mutations were observed more frequently in patients than in controls. Patients with the mutations showed higher levels of serum IgA and higher in vitro IgA synthesis. In the luciferase assay, the regulatory gene with the mutations showed a potent effect for induction of the Ialpha1 germ-line transcript. The polymorphism in the Ialpha1 regulatory region possibly causes enhanced IgA production in some patients with IgAN.

Effects of anti-IL-5 monoclonal antibody on the murine model of nasal allergy

IL-5 is known to be closely related to the infiltration, activation and proliferation of eosinophils. In this study, we evaluated the in vivo effects of anti-IL-5 monoclonal antibody (mAb) in the murine model of nasal allergy. The mAb treatment inhibited the antigen-induced late phase eosinophilia, but had no effects on the number of basophilic cells. It also inhibited early phase nasal symptoms, and tended to inhibit histamine hypersensitivity. These findings suggest that IL-5 plays an important role in the pathogenesis of allergic nasal disorders.

Mucoepidermoid carcinoma of the larynx: a case which responded completely to radiotherapy and a review of the literature

Most laryngeal cancers are squamous cell carcinomas, and adenocarcinomas account for < 1% of cancers of the larynx. Among them, mucoepidermoid carcinoma is extremely rare and there is little agreement about the treatment of this carcinoma. We encountered one patient with mucoepidermoid carcinoma of the bilateral vocal cords (T1bN0M0, Stage 1). For this, most investigators recommended a surgical procedure. However, because of his old age, the early stage and low grade of histopathology, we treated this patient with radiotherapy alone, delivered by accelerated hyperfractionation, which is a more effective strategy for treating radioresistant tumors than conventional irradiation. Following radiotherapy, the tumor disappeared and the patient has been alive and well for more than six years. An old patient with mucoepidermoid carcinoma of the larynx was successfully treated with radiotherapy alone.

Mass screening for lung cancer with mobile spiral computed tomography scanner

BACKGROUND

The incidence of and mortality from lung cancer have increased steadily. Most lung cancers are not localised when first detected, but early detection is mandatory to improve prognosis. Since curable early cases are hard to visualise with conventional chest radiography, a new diagnostic means must be found. We assessed whether population-based mass screening with a spiral computed tomography scanner could contribute substantially to detection of smaller cancers, and decrease mortality.

METHODS

In 1996, we screened in a mobile unit 5483 individuals from the general population of Matsumoto, Japan, aged between 40 years and 74 years who had undergone annual chest radiography (miniature fluorophotography) and cytological assessment of sputum. All participants had a low-dose X-ray spiral computed tomography (CT) scan of the thorax; 3967 also underwent miniature fluorophotography. We compared smokers and non-smokers. Further assessments were done for probably benign but suspicious lesions; suspicion of cancer; and indeterminate small nodules by chest radiography and conventional CT, with additional transbronchial biopsy when possible. Thoracotomy was recommended when it was strongly suspected that the patients had lung cancer.

FINDINGS

19 patients were diagnosed as having lung cancer--14 with suspicion of lung cancer, three with benign but suspicious lesions, and two with indeterminate small nodules. 18 cases were surgically confirmed, and one was clinically diagnosed. The mean size of lesions was 17 mm (range 6-47). In four of 19 patients, lung abnormality was seen on CT and miniature fluorophotography. The lung-cancer detection rate with CT was 0.48%, significantly higher than the 0.03-0.05% for standard mass assessments done previously in the same area. CT missed one case that was found solely on a sputum cytology examination.

INTERPRETATION

Our results show that miniature fluorophotography or conventional chest radiography, which have been the main diagnostic techniques for lung cancer, showed few small cancers. CT was more accurate in mass screening for lung cancer and led to early detection and an accurate diagnosis of lung cancer, and should be considered in future health plans.

[Obstructive sleep apnea in children with cerebral palsy]

To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using a questionnaire was conducted on parents of 233 CP children (1-5 years old, mean age: 2.7) and on those of 343 control children during a routine medical check-up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.4% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter (Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea-hypopnea index (AHI) of greater than 5 and a low level of SaO2 (LSaO2) of less than 85%, respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in 1 child, tracheostomy in 2 children, and nasal CPAP in 1 child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.