Clinical significance of MYC family protein expression in surgically resected high-grade neuroendocrine carcinoma of the lung

OBJECTIVES

MYC family genes including MYC, MYCN, and MYCL are amplified and overexpressed as oncogenic drivers in high-grade neuroendocrine carcinoma of the lung (HGNEC), but little is known about their clinical significance. This study evaluated the prognostic impact of MYC family protein expression in patients with surgically resected HGNEC.

METHODS

Immunohistochemical analyses were performed on 83 resected specimens of HGNEC using antibodies against MYC family proteins (c-MYC, n-MYC, and l-MYC). When nuclear staining of any intensity in ≥10% of tumor cells showed immunoreactivity with any one or more of c-MYC, n-MYC, or l-MYC, the specimens were defined as MYC family-positive.

RESULTS

A total of 83 patients were analyzed. MYC family-positive status was observed in 33.7% (28 of 83 cases) and was not correlated with clinicopathological factors. The protein expression was mutually exclusive and no duplicate cases were observed. A log-rank test showed that MYC family-positive status was significantly associated with shorter overall survival (OS) (p = 0.003) and recurrence-free survival (RFS) (p = 0.039). According to Cox multivariate analysis, MYC family-positive status had a significant effect on shorter OS (hazard ratio [HR] = 2.217, 95% confidence interval [CI] 1.179-4.169, p = 0.014) and RFS (HR = 1.802, 95% CI 1.014-3.202, p = 0.045). In patients with pathological stage I, MYC family-positive status also showed significantly poor OS (HR = 2.847, 95% CI 1.236-6.557, p = 0.014) and RFS (HR = 2.088, 95% CI 1.006-4.332, p = 0.048) in the multivariate analysis.

CONCLUSIONS

MYC family protein expression could be an independent unfavorable prognostic factor in patients with surgically resected HGNEC.

Retroperitoneal paraganglioma with loss of heterozygosity of the von Hippel-Lindau gene: a case report and review of the literature

Von Hippel-Lindau (VHL) disease is an autosomal dominant disease related to germline mutations in VHL. In VHL disease, pheochromocytoma develops in 10%-20% of patients because of germline mutations and loss of heterozygosity of VHL. However, the rate of paraganglioma associated with VHL is low compared with that of pheochromocytoma, and the reason is unknown. In this study, we performed germline and somatic mutation analyses of retroperitoneal paraganglioma that developed in a patient with clinically diagnosed VHL disease and investigated the tumorigenic mechanism of paraganglioma. The patient was a 25-year-old woman who was considered to have VHL disease on the basis of her family history. She was referred to our clinic to investigate a tumor at the bifurcation of the common iliac artery. The tumor was diagnosed as retroperitoneal paraganglioma by clinical evaluations. A left renal cell carcinoma was also suspected. Polymerase chain reaction direct sequencing analysis and polymorphic microsatellite analysis within the VHL locus suggested that loss of heterozygosity of VHL was associated with paraganglioma and renal cell carcinoma. Multiplex ligation-dependent probe amplification analysis showed a loss of the copy number of VHL exons in paraganglioma. These results suggest that VHL disease contributes to the development of paraganglioma. A literature review showed no reported common missense variants involved in the progression of paraganglioma. The loss of heterozygosity of VHL can be a tumorigenic mechanism of retroperitoneal paraganglioma in VHL disease. However, the low rate of paraganglioma compared with pheochromocytoma is not explained by their genetic background alone.

Brain and spinal cord metastases with seminoma: A case report

Introduction

Brain and spinal cord metastases from testicular cancer occur rarely, and metastases with seminoma are extremely rare.

Case presentation

A 42‐year‐old man who was diagnosed with seminoma and multiple metastases underwent first‐line and salvage chemotherapy. Brain metastases were noted; consequently, surgery, third‐line chemotherapy, and whole‐brain irradiation were performed. Subsequently, paralysis developed, and spinal cord metastases were detected. He received fourth‐line chemotherapy but died. Pathological autopsy revealed metastases only in the spinal cord. The cause of death was considered respiratory failure due to cervical spinal cord involvement from spinal metastases.

Conclusion

Brain and spinal cord metastases from seminoma are rare. Thus, similar future cases should be treated appropriately.

BRAF V600E-mutated combined large cell neuroendocrine carcinoma and adenocarcinoma responding to targeted therapy

We present a case of combined large cell neuroendocrine carcinoma (LCNEC), harbouring a BRAF V600E mutation, which significantly benefited from BRAF-targeted therapy. A 57-year-old woman was referred to our hospital for headache and vomiting. A head MRI showed a large tumour in her brain, and a whole-body CT revealed a tumour in the hilum of the right lung and mediastinal lymphadenopathies. Both the resected brain tumour and the mediastinal lymph node tissue contained LCNEC. Next-generation sequencing revealed a BRAF V600E mutation, and a combination therapy with dabrafenib and trametinib was initiated. The patient had a good response to treatment. Like non–small cell lung cancer patients, LCNEC patients should undergo multiplex somatic mutation testing.

Is Preoperative Magnetic Resonance Imaging in a Daily Clinical Setting Useful to Evaluate Tumor Invasion Beyond the Pseudocapsule in Renal Cell Carcinoma?

Background

We wanted to clarify whether preoperative magnetic resonance imaging (MRI) in the clinical setting can evaluate the pathologic pseudocapsule (PC) morphology with high accuracy in renal cell carcinoma (RCC).

Methods

We retrospectively analyzed 34 consecutive patients who underwent MRI (1.5 or 3.0T, 5 mm slices) prior to partial nephrectomy (PN) for RCC at our institution between January 2010 and December 2019. First, the correlation between PC morphology (complete or incomplete) and tumor infiltration to the renal parenchyma was examined as pathologic validation. Second, the concordance rate of PC morphology between pathologic tissue and preoperative MRI was evaluated as radiologic validation. Third, risk factor for renal parenchymal invasion in RCC was analyzed.

Results

In the pathologic validation, parenchymal invasion rates were 11% and 28% in the "complete PC" and "incomplete PC" groups, respectively. In the radiologic validation, pathological PC morphology could be diagnosed on preoperative MRI in 17 patients (50.0%). "None PC" on MRI had the lowest positive predictive value (PPV) (0%), "partial PC" on MRI had a good PPV (76.5%), "complete PC" on MRI had a relatively low PPV (33.3%). Unfortunately, these data were insufficient for diagnostic accuracy. As risk factor for renal parenchymal invasion in RCC, only pathologic subtype (non-clear cell) was found to have significant differences in the multivariate analysis.

Conclusion

The results of this study suggest that renal tumors with pathologically incomplete PC have a high possibility of renal parenchymal invasion. However, it is currently difficult to accurately evaluate pathologic PC morphology by preoperative MRI in the clinical setting.

A rare case of combined thymoma and a multilocular thymic cyst discovered due to chest pain

Background

A thymoma with chest pain and multilocular thymic cysts (MTCs) is very rare.

Case presentation

A 49-year-old man presented to another hospital complaining of an anterior chest pain. Chest computed tomography (CT) showed an anterior mediastinal tumor 60 × 30 × 55 mm in size. The boundary with the pericardium or left brachiocephalic vein seemed to be partially unclear while enhanced by the contrast medium, and so the tumor could have invaded them. No definitive diagnosis of myasthenia gravis was made although the serum anti-acetylcholine receptor antibody count was high. We performed an extended thymectomy with combined partial resection of left brachiocephalic vein, left upper lobe, and left phrenic nerve. He was discharged with no chest pain and no complications post-surgery. The tumor was pathologically type B2 thymoma with hemorrhage necrosis and MTCs, and we diagnosed Masaoka stage II because of no histological infiltration to the organs.

Conclusions

We speculated that hemorrhagic necrosis due to infarction in tumor caused the inflammation to spread to the surrounding organs, which was related to the chest pain and the development of MTCs.

Sign of Hard-X-Ray Pulsation from the γ-Ray Binary System LS 5039

To understand the nature of the brightest γ-ray binary system LS 5039, hard x-ray data of the object, taken with the Suzaku and NuSTAR observatories in 2007 and 2016, respectively, were analyzed. The two data sets jointly gave tentative evidence for a hard x-ray periodicity, with a period of ∼9  s and a period increase rate by ∼3×10^{-10}  s s^{-1}. Therefore, the compact object in LS 5039 is inferred to be a rotating neutron star, rather than a black hole. Furthermore, several lines of arguments suggest that this object has a magnetic field of several times ∼10^{10}  T, two orders of magnitude higher than those of typical neutron stars. The object is hence suggested to be a magnetar, which would be the first to be found in a binary. The results also suggest that the highly efficient particle acceleration process, known to be operating in LS 5039, emerges through interactions between dense stellar winds from the massive primary star, and ultrastrong magnetic fields of the magnetar.

Downward Terrestrial Gamma-Ray Flash Observed in a Winter Thunderstorm

During a winter thunderstorm on 24 November 2017, a strong burst of gamma rays with energies up to ∼10  MeV was detected coincident with a lightning discharge, by scintillation detectors installed at the Kashiwazaki-Kariwa Nuclear Power Station at sea level in Japan. The burst had a subsecond duration, which is suggestive of photoneutron production. The leading part of the burst was resolved into four intense gamma-ray bunches, each coincident with a low-frequency radio pulse. These bunches were separated by 0.7-1.5 ms, with a duration of ≪1  ms each. Thus, the present burst may be considered as a "downward" terrestrial gamma-ray flash (TGF), which is analogous to upgoing TGFs observed from space. Although the scintillation detectors were heavily saturated by these bunches, the total dose associated with them was successfully measured by ionization chambers, employed by nine monitoring posts surrounding the power plant. From this information and Monte Carlo simulations, the present downward TGF is suggested to have taken place at an altitude of 2500±500  m, involving 8_{-4}^{+8}×10^{18} avalanche electrons with energies above 1 MeV. This number is comparable to those in upgoing TGFs.

Upregulation of glucose and amino acid transporters in micropapillary carcinoma

Micropapillary carcinoma (MPC), a relatively rare histologic carcinoma observed in various organs, is associated with vascular invasion, nodal metastasis, and poor prognosis. MPC is different from papillary carcinoma as it has no fibrovascular core and is thus considered essentially hypovascular. MPCs are known to upregulate glucose transporter 1 (GLUT1) via the activation of a transcription factor, hypoxia-inducible factor (HIF)-1. Here we evaluated the expression of nutrient transporters in MPCs to gain a better understanding of the system used by MPCs to compensate for their intrinsic poor vascularity. We immunohistochemically evaluated 29 MPCs including breast (n=14), lung (n=8), gastrointestinal tract (n=5), and urinary tract cancers (n=2), and compared them with non-micropapillary control cancers (n=32) regarding the expression of amino acid (ASCT1, ASCT2, LAT1, and SNAT1) and glucose (GLUT1, GLUT2) transporters. Each section was scored by the staining intensity (0-3) multiplied by the occupying area (0-10), with a possible range 0-30. The average scores of the MPC and control groups were compared by Student's or Welch's t-test according to the homoscedasticity. The MPC group showed significantly higher scores for ASCT1 (p=0.007), ASCT2 (p=0.001), GLUT1 (p<0.001), and GLUT2 (p<0.001), whereas no significant scores were noted for LAT1 and SNAT1. In conclusion, MPC could be associated with the upregulation of several nutrient transporters, which may contribute to the malignant potential by supporting the survival of cancer cells.

On-ground detection of an electron-positron annihilation line from thunderclouds

Thunderclouds can produce bremsstrahlung gamma-ray emission, and sometimes even positrons. At 00:27:00 (UT) on 13 January 2012, an intense burst of gamma rays from a thundercloud was detected by the GROWTH experiment, located in Japan, facing the Sea of Japan. The event started with a sharp gamma-ray flash with a duration of <300 ms coincident with an intracloud discharge, followed by a decaying longer gamma-ray emission lasting for ∼60 s. The spectrum of this prolonged emission reached ∼10 MeV, and contained a distinct line emission at 508±3(stat.)±5(sys.) keV, to be identified with an electron-positron annihilation line. The line was narrow within the instrumental energy resolution (∼80keV), and contained 520±50 photons which amounted to ∼10% of the total signal photons of 5340±190 detected over 0.1-10 MeV. As a result, the line equivalent width reached 280±40 keV, which implies a nontrivial result. The result suggests that a downward positron beam produced both the continuum and the line photons.

Possible evidence for free precession of a strongly magnetized neutron star in the magnetar 4U 0142+61

Magnetars are a special type of neutron stars, considered to have extreme dipole magnetic fields reaching ∼ 10(11) T. The magnetar 4 U 0142+61, one of the prototypes of this class, was studied in broadband x rays (0.5-70 keV) with the Suzaku observatory. In hard x rays (15-40 keV), its 8.69 sec pulsations suffered slow phase modulations by ± 0.7 sec, with a period of ∼ 15 h. When this effect is interpreted as free precession of the neutron star, the object is inferred to deviate from spherical symmetry by ∼ 1.6 × 10(-4) in its moments of inertia. This deformation, when ascribed to magnetic pressure, suggests a strong toroidal magnetic field, ∼ 10(12) T, residing inside the object. This provides one of the first observational approaches towards toroidal magnetic fields of magnetars.

Hardening and termination of long-duration γ rays detected prior to lightning

We report the first observation of 3-30 MeV prolonged gamma-ray emission that was abruptly terminated by lightning. The gamma-ray detection was made during winter thunderstorms on December 30, 2010, by the Gamma-Ray Observation of Winter Thunderclouds experiment carried out in a coastal area along the Sea of Japan. The gamma-ray flux lasted for less than 3 min, continuously hardening closer to the lightning occurrence. The hardening at energies of 3-10 MeV energies was most prominent. The gamma-ray flux abruptly ceased less than 800 ms before the lightning flash that occurred over 5 km away from the experimental site. In addition, we observed a clear difference in the duration of the 3-10 MeV gamma rays and those >10 MeV, suggesting that the area of >10 MeV gamma-ray emission is considerably smaller than that of the lower-energy gamma rays. This work may give a manifestation that a local region emitting prolonged gamma rays connects with a distant region to initiate lightning.

Observation of an energetic radiation burst from mountain-top thunderclouds

During thunderstorms on 20 September 2008, a simultaneous detection of gamma rays and electrons was made at a mountain observatory in Japan located 2770 m above sea level. Both emissions, lasting 90 sec, were associated with thunderclouds rather than lightning. The photon spectrum, extending to 10 MeV, can be interpreted as consisting of bremsstrahlung gamma rays arriving from a source which is 60-130 m in distance at 90% confidence level. The observed electrons are likely to be dominated by a primary population escaping from an acceleration region in the clouds.

Detection of high-energy gamma rays from winter thunderclouds

A report is made on a comprehensive observation of a burstlike gamma-ray emission from thunderclouds on the Sea of Japan, during strong thunderstorms on 6 January 2007. The detected emission, lasting for approximately 40 sec, preceded cloud-to-ground lightning discharges. The burst spectrum, extending to 10 MeV, can be interpreted as consisting of bremsstrahlung photons originating from relativistic electrons. This ground-based observation provides the first clear evidence that strong electric fields in thunderclouds can continuously accelerate electrons beyond 10 MeV prior to lightning discharges.

Topical applications of trichloroacetic acid as therapy for nasal allergy

A group of 22 patients (27 nostrils) with nasal allergies was treated with 80 w/v trichloroacetic acid applied to the inferior turbinates. Patients were then evaluated prospectively based on both subjective responses and clinical examinations. Allergic symptoms were reduced significantly, especially those involving nasal obstruction and watery rhinorrhea. Nasal airflow resistance also improved after treatment (P < 0.001). Nasal provocation testing revealed a significant decrease in post-treatment responses (P < 0.001). No severe side effects were noted after treatment. Findings demonstrated that local application of trichloroacetic acid is a safe, effective and simple treatment for outpatients with symptomatic nasal allergies.

Effects of acoustic overstimulation on cochlear evoked potentials

Guinea pigs were exposed to 2 kHz pure-tone or octave-band pass noise at an intensity of 100 dBSPL for 30 min. The effects of sound exposure on cochlear microphonics (CM) and compound action potential (AP) were studied using a test condition devised to complete the measurement of the sensitivity of both potentials for the frequency from 1 to 7 kHz within several minutes. The loss of CM sensitivity was limited to around 5 dB for all test frequencies in animals exposed either to pure-tone or band noise. In contrast, the loss of AP in both exposure conditions was significantly greater than that of the CM, and the magnitude of the AP losses reflected the frequency characteristics of the exposure sounds. From these observations, the AP is considered to be a more sufficient index than the CM in studying the effects of acoustic overstimulation.

Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination

The number of airborne methicillin-resistant Staphylococcus aureus (MRSA) before, during and after bedmaking was investigated. Air was sampled with an Andersen air sampler in the rooms of 13 inpatients with MRSA infection or colonization. Sampling of surfaces, including floors and bedsheets, was performed by stamp methods. MRSA-containing particles were isolated on all the sampler stages-stage 1 (>7 microm diameter) to stage 6 (0.65-1.1 microm). The MRSA-containing particles were mostly 2-3 microm diameter before bedmaking and >5 microm during bedmaking. The number was significantly higher 15 min after bedmaking than during the resting period, but the differences in counts after 30 and 60 min were not significant. MRSA was detected on many surfaces. The results suggest that MRSA was recirculated in the air, especially after movement. To prevent airborne transmission, healthcare staff should exercise great care to disinfect inanimate environments. Further studies will be needed to confirm the level of MRSA contamination of air during bedmaking and establish measures for prevention of airborne transmission.

[A case of chronic masticator space abscess]

Different neoplasms and infections are known to involve the masticator space, but pathological diagnosis and treatment of these lesions are not always simple due to anatomical complexity. We treated a 66-year-old man with an abscess in the nasopharyngeal masticator space. Physical and CT findings resembled those of neoplastic lesion because the onset dated back 5 years and the patient was lacking in notable signs of infection. Surgery through the maxillary sinus to the lesion enabled us to confirm its pathology and drain pus, with subsequent cure. We noted periodontal infection of the mandibular molars accompanied with osteomyelitis as a cause of this abscess, so infected molars were extracted 13 days after surgery. The infection had spread upward along the mastication muscles, resulting in an abscess in both the upper masseter muscle and the lower temporalis muscle. Based on a review of the literature, most abscesses in the masticator space originate from the mandibular molar, while the most impressive physical finding varied between the submandibular region and temporal fossa, as did its acute or chronic clinical course. Such clinical manifestations appear to reflect the pattern of infection spread along the muscles of mastication and a pattern involving adjacent spaces. We emphasize diagnostic significance when assessing findings for each mastication muscle and mandibular bone depicted using computed tomography, magnetic resonance imaging, and bone-scan technetium.

Effect of salicylate and short-term sound exposure on extracochlear electrically-evoked otoacoustic emissions

The effects of salicylate and acoustic overstimulation on the electromotility of the cochlear outer hair cells (OHCs) were assessed in vivo using electrically-evoked otoacoustic emissions (EEOAEs). Alternating currents to evoke the EEOAE were delivered by means of an extracochlear electrode on the round window, with which the compound action potentials (CAPs) were also monitored before and after the manipulations. The EEOAE outputs were a linear function of the injected currents between 52 and 267 microA rms. Administration of salicylate (500 mg/kg) reduced the EEOAE outputs significantly at 5 and 8 kHz (p < 0.005). while no change in EEOAEs was observed at any frequency after exposure to a 4 kHz pure tone at 100 dB SPL for 10 min or at 120 dB SPL, for 30 min. These results indicate that administration of salicylate reduces the electromotility of the OHCs, and thus produces losses in neural sensitivity of the cochlea. In contrast, the electromotility of OHCs appears to be protected against short-term intense sound exposure.

Effects of histamine and interleukin-4 synthesized in arterial intima on phagocytosis by monocytes/macrophages in relation to atherosclerosis

We investigated the localization of histidine decarboxylase (HDC), which is the rate-limiting enzyme that generates histamine from histidine, in human aorta/coronary artery. RT-PCR and immunohistochemical staining revealed that the HDC gene was expressed in monocytes/macrophages and T cells in the arterial intima but not in smooth muscle cells in either the arterial intima or the media. A luciferase promoter assay with U937 and Jurkat cells demonstrated that interleukin-4 (IL-4) inhibited the expression of the HDC gene. In contrast, among a scavenger receptor family, IL-4 as well as histamine up-regulated U937 cells to express the LOX-1 gene but not the SR-A gene, which genes encode receptors that scavenge oxidized lipids. These findings suggest that histamine synthesized in the arterial wall participates in the initiation and progression of atherosclerosis and that IL-4 can act as an important inhibitory and/or stimulatory factor in the function of monocytes/macrophages modulated by histamine in relation to the process of atherosclerosis.

[Clinical significance of the Streptococcus milleri group in peritonsillar abscesses]

Few researchers have microbiologically studied peritonsillar abscesses in detail, and their results have been conflicting. Although Streptococcus pyogenes (Group A beta-streptococcus) is commonly considered an important pathogen in this infection, recent studies have demonstrated the recovery of many other streptococci mainly consisting of alpha-streptococci. Few studies have identified these streptococci at the species level, however. We studied details of bacteriology in 31 cases of peritonsillar abscess treated between 1991 and 2000. The Streptococcus milleri group was most frequently isolated (25.8%), followed by Eikenella corrodens (9.7%), Staphylococcus aureus (6.5%), and S. pyogenes (3.2%). The S. milleri group, consisting of 3 species of Streptococcus constellatus, S. intermedius, and S. anginosus, forms part of the normal flora most commonly found in the mouth, throat, gastrointestinal tract, and genital tract. These species have become known as an important pathogen in abscess disease but little attention has been paid to their role in peritonsillar abscesses. To adequately culture the S. milleri group, incubation in air containing carbon dioxide or in an anaerobic condition is required, and then the differentiation of the 3 species requires the biochemical reactivity tests. Since hemolytic patterns of the S. milleri group vary, we studied the population of alpha-, beta-, and gamma-hemolytic strains among 36 strains of this group. We found 32 (88.8%) to be alpha-hemolytic. Although not all alpha-hemolytic strains belong to the S. milleri group, a considerable number of this group could be missed among alpha-streptococci isolated from the peritonsillar abscess. As antibiotics began being used widely, normal flora such as the S. milleri group may have become an important pathogen in peritonsillar abscesses due to an imbalance between organisms and host defense.

Significance of airborne transmission of methicillin-resistant Staphylococcus aureus in an otolaryngology-head and neck surgery unit

OBJECTIVES

To quantitatively investigate the existence of airborne methicillin-resistant Staphylococcus aureus (MRSA) in a hospital environment and to perform phenotyping and genotyping of MRSA isolates to study MRSA epidemiology.

DESIGN

Prospective surveillance of patients with MRSA infections or colonizations was performed, as was an observational study of environmental airAirborne samples were taken by an air sampler; samples were obtained from object surfaces by stamping or swabbing. Epidemiological study of MRSA isolates was performed with an antibiotic susceptibility test, coagulase typing, and pulsed-field gel electrophoresis.

SETTING

Three single-patient rooms in a 37-bed otolaryngology-head and neck surgery unit.

PATIENTS

Three patients with squamous cell head and neck cancer were observed to have been colonized or infected with MRSA after surgery.

RESULTS

The MRSA samples were collected from the air in single-patient rooms during both a period of rest and when bedsheets were being changed. Isolates of MRSA were detected in all stages (from stage 1 [>7 microm] to stage 6 [0.65-1.1 microm]). About 20% of the MRSA particles were within a respirable range of less than 4 microm. Methicillin-resistant S aureus was also isolated from inanimate environments, such as sinks, floors, and bedsheets, in the rooms of the patients with MRSA infections as well as from the patients' hands. An epidemiological study demonstrated that clinical isolates of MRSA in our ward were of one origin and that the isolates from the air and from inanimate environments were identical to the MRSA strains that caused infection or colonization in the inpatients.

CONCLUSIONS

Methicillin-resistant S aureus was recirculated among the patients, the air, and the inamimate environments, especially when there was movement in the rooms. Airborne MRSA may play a role in MRSA colonization in the nasal cavity or in respiratory tract MRSA infections. Measures should be taken to prevent the spread of airborne MRSA to control nosocomial MRSA infection in hospitals.

Transcriptional activation of the human HMG1 gene in cisplatin-resistant human cancer cells

The nonhistone chromosomal protein, high mobility group 1 (HMG1), which is ubiquitously expressed in higher eukaryotic cells, preferentially binds to cisplatin-modified DNA. The observation that HMG1 is overexpressed in cisplatin-resistant human cancer cells suggests that cisplatin resistance may be closely associated with HMG1. To decipher the mechanism of HMG1 overexpression in cisplatin-resistant cells, we isolated two overlapping genomic DNA clones containing the entire human HMG1 gene. These clones, which span approximately 15 kb of contiguous DNA, include 5 kb of the 5' flanking region as well as the entire coding sequence. We sequenced 1500 bp upstream of the first exon. The segment proximal to the transcription initiation site did not contain a TATA box but did possess an activating transcription factor site, an activator protein-2 site, one CCAAT box, and two CCAAT-binding transcription factor/nuclear factor-1 (CTF/NF-1) sites. HMG1 promoter activity was 3-10-fold higher in cisplatin-resistant KB-CP20 cells than in parental KB cells. An in vivo footprint experiment showed several differences of dimethyl sulfate modifications between KB and KB-CP20 cells in the area around the CTF/NF-1 sites. In addition, electrophoretic gel mobility shift assays showed that binding of a nuclear factor from cisplatin-resistant cells to the CTF/NF-1 site was significantly higher than the binding of the same factor from parental cells. Semiquantitative reverse transcription-PCR and Western blot analysis also showed that expression of CTF/NF-1 was 3-20-fold higher in the resistant cell line than in its parental counterpart. These findings suggest that, in cisplatin-resistant cells, the expression of HMG1 gene product is enhanced at the transcriptional level and that this probably occurs through the enhanced expression of the CCAAT binding factor, CTF/NF-1.

[Clinical and bacteriological significance of the Streptococcus milleri group in deep neck abscesses]

Streptococcus constellatus, S. intermedius, and S. anginosus, the three species of the S. milleri group, form part of the normal flora most commonly found in the mouth, throat, gastrointenstinal tract, and genital tract. The S. milleri group has become known as an important pathogen in abscess disease, but little attention has been paid to their role in deep neck abscesses. We have treated 9 patients with deep neck abscesses relating to the S. milleri group since 1991, and regarded this group as an important pathogen also in these abscesses. We studied the frequency of the S. milleri group isolated from deep neck abscesses in our cases and from the literature and discuss clinical significance and bacteriological pathogenesis. Cases numbered 27 treated at our facility since 1991 and 200 cases reported in the Japanese literature since 1990. Of our 9 cases, 4 originated from acute pharyngitis, 3 from peritonsillar abscesses, and 2 from odontogenic infection. Serious complications such as mediastinitis, cervical necrotizing fasciitis, sepsis accompanied by disseminated intravascular coagulation, and spondylitis of the cervical vertebrae were seen in 4 cases. Among organisms isolated, the S. milleri group appeared to be a pathogen contributing to abscess formation and to serious complications. The genus Streptococcus was most frequently isolated both in our 27 cases (66.7%) and the 200 in the literature (45.5%). Among species of the genus Streptococcus, the S. milleri group numbered the highest in our cases at 33.3% but only 8.5% in the literature. Cases in the literature, however, contained many unknown species of Streptococci--31.5% vs. 18.5% in our cases. alpha-streptococcus was frequently reported in the literature among unknown species of Streptococci--36 of 63. Culture-negative cases were also numbered more in the literature than in our case--29.0% vs. 18.5%. Special conditions and procedures are required to suitably isolate and detect the S. milleri group. Since not all facilities use identical techniques in routine bacteriological examination, a considerable number of the S. milleri group could be missed in unknown species of Streptococci or alpha-streptococcus and culture-negative cases. The detailed pathogenesis of the S. milleri group remains to be clarified. Infection by normal flora on mucosa is thought to occur due to an imbalance between organisms and host defense in deep neck abscesses. Some strains of the S. milleri group have been reported to produce many tissue-destroying enzymes such as collagenase and hyaluronidase. The co-existence of the S. milleri group with some anaerobe strains has also been suggested to accelerate inflammation. We discuss the mechanism inducing the massive release of cytokines through T cell response to certain exotoxins produced by S. milleri group, as reported in toxic shock-like syndrome due to the group A beta-streptococcus and in alpha-streptococcal shock syndrome due to viridans streptococci (alpha-streptococci).

Relationship of nasal carriage of Staphylococcus aureus to pathogenesis of perennial allergic rhinitis

BACKGROUND

Several studies have previously shown some factors that modify the pathogenesis of perennial allergic rhinitis (PAR). However, the association between bacterial colonization and PAR has not been well understood.

OBJECTIVE

We sought to study the association between superantigen-producing Staphylococcus aureus and PAR.

METHODS

S aureus colonization in the nasal cavity and its superantigen production were studied in 65 patients with PAR and 45 nonallergic control subjects. The nasal symptom scores of the patients were evaluated. Furthermore, we examined the response to staphylococcal enterotoxin B or toxic shock syndrome toxin 1 of peripheral blood lymphocytes from both patients and control subjects by measuring proliferative responses and production of cytokines (IFN-gamma, IL-4, and IL-5).

RESULTS

The rate of nasal carriage of S aureus in the patients (44%) was significantly higher than that of the control subjects (20%, P <.01). Moreover, the rate of nasal carriage of superantigen-producing S aureus in the patients (22%) was significantly higher than that of the control subjects (6.7%, P <.05). The nasal symptom scores of the S aureus -positive patients were significantly higher than those of the S aureus -negative patients (P <.05), although there was no significant association between symptom scores and superantigen production. Peripheral blood lymphocytes from the patients showed significantly higher proliferative responses and were more likely to produce T(H2 )type cytokines in response to superantigens (P <.01), but the responses were not different among the patients with S aureus carriage and superantigen production.

CONCLUSION

This study suggests that PAR leads to a higher carriage rate of S aureus, and nasal carriage of S aureus may aggravate PAR.

[The effects of sleep position change in sleep apnea syndrome]

Changing the sleep position from supine to non-supine is a simple but effective treatment for some patients with sleep apnea syndrome. In the present study, we compared the clinical data for good responders (GRs), those who responded well to the sleep position change, with those for poor responders (PRs), and also evaluated the effect of surgical treatment on the positional improvement of ventilation in the PR group. Forty-one adult patients with sleep apnea syndrome (mean age: 47.1 years, mean obesity index: 125.8%) were divided into two groups based on their polysomnographic responses to sleep position change. Thirty-two patients were classified as the GR group, whose apnea-hypopnea index (AHI) in the non-supine position declined to less than half of their AHI in the supine position, and nine whose non-supine AHI remained greater than half of their supine AHI were classified as the PR group. The AHI and the desaturation index (DI) for the PR group were significantly higher than those for the GR group, and the obesity index was also higher in the PR group. For the eight PRs who had surgical therapy, their polysomnographic data improved much more in the non-supine position than in the supine position. Of six patients whose total AHI was still 10 or more after surgery, four changed into GRs. The combination of surgery and sleep position change seemed to be an effective treatment even for patients with a little improvement before surgery.

[Effects of salicylate on electrically evoked otoacoustic emissions in the guinea pig]

Clinically, salicylates have been known to have a ototoxic side effect of reversible hearing loss and to reduce the voltage-dependent length change (electromotility) in experiments on isolated outer hair cells (OHC). In order to clarify how the reduction of OHC electromotility due to salicylates contributes to cochlear dysfunction in vivo, we observed compound action potentials (CAP) threshold as well as the outputs of the electrically evoked otoacoustic emissions (EEOAE) before and after intravenous administration of 500 mg/kg sodium salicylate in a guinea pig model. A silver ball electrode placed on the round window membrane of the animal was used for both recording of the CAP and stimulation to elicit the EEOAE. The CAP threshold to tone bursts with frequencies from 2 to 10 kHz elevated by 13 to 22 dB, and outputs of the EEOAE decreased approximately 4 dB for 5 kHz stimulation, and 12 dB for 8 kHz after salicylate administration. These results suggested that systemically administered salicylate also reduced the electromotility of the OHC, and caused the hearing impairment in vivo.

Immunoreactivity of endothelins and endothelin receptor in the stria vascularis of the mouse cochlea

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.

[Hyperbaric oxygenation therapy in idiopathic sudden sensory neural hearing loss]

We analyzed statistically the prognosis of hearing impairment in patients with idiopathic sudden sensory neural hearing loss. 119 patients (HBO group) were treated with a combination of hyperbaric oxygenation (HBO) and stellate ganglion block (SGB), as well as oral administration of vasodilator and vitamins. Another 107 patients (control group) were treated with various other therapies. Collectively, the therapeutic outcome in the HBO group was better than in the control group. In addition, the recovery rate of hearing in the HBO group was superior to that in the control group for those cases which had severe hearing loss at the first medical examination, had been seen more than two weeks after onset, and had resisted other treatments. As a result of this study, we conclude that HBO is an effective therapeutic tool.

[Preoperative examination for estimating the course of the facial nerve]

In surgery for a parotid tumor, facial palsy is the most serious complication. Facial palsy tends to occur in the operation in which the facial nerve runs outside of the parotid tumor. Therefore, we developed the facial nerve electric stimulating test (FNEST) to determine more accurately the relationship between the facial nerve and the tumor. The FNEST diagnosed the condition in half of the patients whose facial nerve ran outside of the parotid tumor. Furthermore, a combination of CT and FNEST increased the diagnostic efficiency. The FNEST was a very efficient preoperative examination for estimating the course of the facial nerve.

[Speech audiometry using the American Word Lists for Japanese subjects with normal hearing]

The characteristics of listening to English words for Japanese people were studied in ten normal hearing subjects who had taken English classes to the level of college graduates and had opportunities to learn English continuously. Following pure tone audiometry, speech audiometry was performed using the Central Institute for the Deaf (CID) W-1 and W-22 word lists for English and the 67-S word lists for Japanese. The speech reception thresholds (SRTs) for the CID W-1 lists were significantly higher than average pure tone threshold (PTT), although the SRTs for the 67-S lists were equal to the average PTT. The difference in average SRT between the CID W-1 lists and the 67-S lists was about 15dB, which is statistically significant. The speech discrimination rate for the CID W-22 lists ranged from 78 to 100 percent with an average of 89.5 percent, while all subjects achieved the discrimination rate of 100 percent for the 67-S lists. Analysis with transient matrices of the perceived words demonstrated that the articulation rates were below 90 percent for the consonants /m/, /n/, /p/ and /delta/ . The observed variation in the speech discrimination score and the pattern of confusion among the subjects was assumed to be much more pronounced in noisy conditions.

[Importance of AUC of carboplatin in head and neck cancer]

Combination chemotherapy with Carboplatin (CBDCA) and 5-fluorouracil (5-FU) was given to 115 patients with head and neck cancer. The area under the blood concentration-time curve (AUC) of CBDCA was calculated by Calvert's formula for 111 of the 115 patients. A retrospective study was conducted to define the relationship between the clinical outcome of the combination chemotherapy and the AUC of CBDCA. The overall response rate was 58.4% in the 115 patients. The objective response rate for 103 patients with squamous cell carcinoma was 61.9% with eight (7.6%) with complete responses (CR) and 57 (54.3%) with partial responses. The mean AUC for the administration of 300 mg of CBDCA per m2 was 3.91 +/- 0.68 mg/ml.min in the patients with squamous cell carcinoma. Although, there was no statistically significant relationship between the AUC of CBDCA and therapeutic efficacy, all CRs were obtained at an AUC above 3. Thrombocytopenia was the major dose-limiting toxicity in this study. The magnitude of thrombocytopenia increased significantly with increase in AUC values. Severe thrombocytopenia did not seem to occur in the patients with an AUC under 4.5. From these results, the AUC was considered helpful for determining the CBDCA dose to prevent severe side effects. In respect of both therapeutic efficacy and toxicity, AUC values from 3 to 4.5 are recommended for neo-adjuvant chemotherapy with CBDCA and 5-FU. Prospective validation is necessary to settle the question of whether a higher AUC value within this range can improve the outcome.

[Otoacoustic emissions evoked by electrical stimulation]

Otoacoustic emissions evoked by electrical stimulation of the cochlea were measured in guinea pigs. Alternating current with acoustic frequencies was delivered directly to the scala tympani and the vestibuli of the basal turn by using a constant current stimulator made in our laboratory. The amplitude of the electrically evoked otoacoustic emmisson (EEOAE), which was 21.0 dB SPL in response to 2 kHz electrical stimuli of 120 microArms, was decreased gradually with anoxia of the animal and was reduced to below the noise level by extirpation of the ossiculum. The EEOAEs rose with a delay of 100 microseconds from the beginning of the stimulus, and reached maximum amplitude within three cycles. The output of EEOAE was magnified in a linear manner as the stimulus current increased from 10 to 200 microArms. The averages and standard deviations of the EEOAE output at the stimulus level of 170 microArms in six animals were 20.5 +/- 4.1 dB SPL for 1 kHz, 23.3 +/- 4.8 dB SPL for 2 kHz, 10.5 +/- 6.0 dB SPL for 3 kHz, 17.1 +/- 4.7 dB SPL for 4 kHz, 13.6 +/- 4.4 dB for 5 kHz and 18.3 +/- 4.8 dB SPL for 6 kHz. Measurement of EEOAE, in which stable responses could be obtained with simple and easy preparation, was considered a potential procedure for assessing the electromotility of the cochlear outer hair cells in vivo.

[Suppression tuning characteristics of the 2f1-f2 distortion product in cochlear microphonics and otoacoustic emissions]

Suppression of the 2f1-f2 distortion product (DP) by the third tone was measured in cochlear microphonics (CM) and otoacoustic emissions (OAEs) in guinea pigs to clarify the generation site of the DPs. The DPs were elicited by the primary tones with frequencies of 4.62 kHz (f1) and 6 kHz (f2). Five dB-iso-suppression tuning curves (STCs) of the DPs were obtained by plotting the suppressor level as a function of its frequencies. The STCs in both CM DP and DPOAE had the shape of the letter "V" with the tip centering around the frequency of f2. The slopes of the STC on the higher frequency side were steeper than those on the lower side. As the intensity of the primary tones was decreased, the turning of the STC became sharper. These suppression properties indicate that the 2f1-f2 DPs were generated in the area on the basilar membrane where the characteristic frequency corresponded to those of primary tones, especially for the primaries at lower intensities. Because the suppression properties in CM DP and DPOAE were similar to each other, we concluded that these two phenomena had a common generation site.

Apical tubules in marginal cells of the differentiating stria vascularis

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.

Different effects of noise and salicylate and their interactions on the guinea pig cochlea

We investigated the effects of noise and salicylate on the guinea pig cochlea by monitoring the acoustic nerve compound action potential (CAP) as well as the 2f1-f2 distortion product in the cochlear microphonics (DP-CM). The alterations of DP-CMs by noise and salicylate revealed an apparent difference, even when the noise-induced and salicylate-induced CAP threshold shifts were equal. This result indicated that noise and salicylate might have an effect on different sites in the cochlea. Combined effects were altered by changing the order in which the two agents were applied. The existing noise-induced damage attenuated the additional ototoxicity of salicylate. In contrast, attenuation did not occur when salicylate administration preceded noise exposure. Considering known effects of noise and/or salicylate altering mechano-electrical transduction (MET) and electro-mechanical transduction of the cochlear outer hair cells, our results seem to suggest that the MET plays a key role in the transduction mechanism in the cochlea.

[Experimental study on directional asymmetry of vertical OKN and OKAN]

We studied the directional asymmetry of human vertical optokinetic nystagmus (OKN) and optokinetic after nystagmus (OKAN) based on two experiments conducted in 22 normal subjects. The results of the first experiment indicated that, during upward optokinetic stimulation OKN is produced by the pursuit system and the velocity storage system while during downward optokinetic stimulation the velocity storage system plays no significant role. Up-down asymmetry in vertical OKN seemed to be caused mainly by directional asymmetry of the velocity storage system. Furthermore, as the velocity storage function is very important for producing OKN at a higher stimulation velocity, domination of upward slow phase velocity becomes more apparent with a high stimulation velocity. In our second experiment the subjects were exposed to optokinetic stimulation with or without a stable fixation point. When subjects were exposed to optokinetic stimulation with fixation, they felt a rotating sensation within themselves or a moving sensation of the fixation point. When the stimulation disappeared, most experienced an illusion of small dots moving in the direction opposite the stimulation. In this condition some of the subjects showed after-nystagmus the slow phase of which was in the opposite direction. Subsequently the after-nystagmus became more distinct, with pursuit of the moving dot illusion. This result shows the existence of a mechanism which produces reverse after-nystagmus by mean of a retinal error input. We speculate that these phenomena play causative roles in reverse after-nystagmus (RAN), pursuit reverse after nystagmus (pRAN), and the RAN system.

[Squamous cell carcinoma of the parotid gland in children]

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.

[Hearing acuity in the elderly in Japan]

In Japan, the elderly population has progressively increased. It is therefore expected that various social services for the elderly will be demanded. As most of the elderly have hearing impairment due to presbycusis, it is difficult to communicate smoothly with them. To provide the various social services, it is necessary to investigate hearing acuity in the elderly. Accordingly, the Hearing Research Group, which belongs to the Research Project on Aging and Health in the Ministry of Health and Welfare of Japan, investigated the hearing acuity of people 65 years old, or more. One thousand one hundred ninety two subjects were divided into five groups, Group A consisted of 170 males and 216 females between 65 and 69 years old, Group B, 186 males and 158 females between 70 and 74; Group C, 147 males and 140 females between 75 and 79; Group D, 63 males and 61 females between 80 and 84; and Group E, 29 males and 22 females 85 years old or more. We examined the 175 subjects 80 years old or more. Therefore, it is considered that this study could indicate the present condition of hearing acuity of the elderly of Japan. The average hearing levels measured at seven frequencies (125, 250 and 500Hz, and 1, 2, 4, and 8KHz) were 35.0dB in group A, 42.1 in group B, 46.1 in group C, 52.1 in group D, and 55.6 in group E. There were no differences in the average hearing level between males and females in any group. The audiogram pattern indicated a gradually descending curve in most subjects in all groups. The average speech discrimination rate was 75.4% in group A, 70% in group B, 63.8% in group C, 59.7% in group D, and 52.1% in group E. The percentage of subjects showing a short increment sensitivity index of more than 70% was 45.2% in group A, 49.3% in group B, 47.9% in group C, 51.6% in group D, and 59.7% in group D. In conclusion, hearing loss due to aging tended to be more progressive at higher frequencies while hearing acuity of frequencies covering normal speech was preserved. However, the speech discrimination rate decreased relative to changes in the pure tone hearing level. It was considered that the pathology of hearing loss due to aging begins with retrocochlear changes and cochlear factors are added to retrocochlear changes with aging.

[Immunohistological study on proliferative activities and expression of c-erbB-2 oncoprotein in salivary gland tumors]

The proliferative activity of tumors and the expression of c-erbB-2 oncoprotein were investigated in 86 salivary neoplasms (54 pleomorphic adenomas and 32 malignant tumors), and in 17 normal salivary glands. Numbers of cells that stained positive to anti-proliferating cell nuclear antigen (PCNA) antibody and the nucleolar organizer region associated protein (AgNOR) were used as an index of the proliferative activity. The results obtained in this study were as follows: 1) PCNA-positive and AgNOR-positive cells were elevated in malignant tumors relative to pleomorphic adenomas and normal salivary glands. 2) Salivary gland tissue around the pleomorphic adenoma with high proliferative activity demonstrated higher activity than normal gland tissue. 3) The proliferation of pleomorphic adenoma was not affected by the age or size of the tumors. 4) Expression of c-erbB-2 oncoprotein was not observed in pleomorphic adenoma and normal gland but was observed in malignant tumors. 5) In one case of a carcinoma in pleomorphic adenoma, the pleomorphic adenoma region also revealed c-erbB-2 positive cells.

[Suppression of spontaneous AC potentials in guinea pig cochlea by external tones]

Spontaneous electrical oscillations (AC potentials) were observed in the cochlea of three guinea pigs without any exposure to noise or drugs. The AC potentials disappeared completely within one minute after the cessation of artificial ventilation, and were suppressed by presenting external tones to the ear. As the frequency of the external tone was displaced toward that of the spontaneous oscillation, the signals were increasingly suppressed. Exposure to intense tone produced residual suppression of the AC potentials for several minutes. The time course of recovery from the suppression appeared to be similar to that in the noise induced temporary threshold shift measured psychoacoustically. From these results, it was concluded that the spontaneous AC potentials in the guinea pig cochlea were generated by the active mechanical vibration system at the area on the basilar membrane where the characteristic frequency corresponded to that of the AC potentials.

Differentiation of the rat stria vascularis

The differentiation of the rat stria vascularis (SV) was investigated by light- and electron microscopy and by immunocytochemistry. Loss of the basal lamina at the epithelial-mesenchymal interface of SVs as indicated by immunoreactions of laminin and fibronectin induces the formation of vascular feet by basal infoldings of the marginal cells (MCs), and the development of the strial capillaries (SCs) by mesenchymal cells in a manner of vasculogenesis is progressing at the same time. The production of fibronectin in the rough endoplasmic reticulum of mesenchymal cells and the involvement of this glycoprotein in a mechanical linkage between the vasoformative mesenchymal cells and endothelial ones of the SCs are indicated by immunocytochemistry. The plasma membrane of the marginal cells (MCs) begins to show immunoreactions of Na+.K+ ATPase at postnatal day 5 and is conjugated to each other by tight junctions at postnatal day 14. The apical tubules of the differentiating MCs do not seem to be involved in the endocytotic activity but are involved in the plasma membrane supply for the rapid differentiation.

[Angiotrophic lymphoma in the paranasal sinuses]

Angiotrophic lymphoma (neoplastic angioendotheliosis) is a peculiar disease which increases large extraordinary sized cells originating from B lymphocytes, in the small blood vessels and the capillary vessels of each viscera of the whole body, including brain. This disease, which was first reported by Pfleger and Tappeiner in 1959, has many clinical manifestations. CNS, skin, lung, kidney, and adrenal gland are often damaged by the disease. A case of this disease appearing in the paranasal sinus with successful remission following chemotherapy is reported. The patient was a 78-year-old woman with bilateral occulomotor nervous paralysis. Ethmosphenoidectomy was conducted under a working diagnosis of pansinusitis following CT. The surgical specimens were studied histopathologically and diagnosed as angiotrophic lymphoma. Six courses of chemotherapy (THP-COP) were applied. This disease is not necessarily rare, but the possibility of its being overlooked without enough diagnosis and treatment is very high. If we detect and treat it at an early stage, recovery of the disease can be expected, as in the case described above.

Effects of acoustic overstimulation on 2f1-f2 distortion product in the cochlear microphonics

The cochlear microphonics (CM) in response to two-tone stimuli as well as the threshold of compound action potential (CAP) were measured before and after exposure to 4 kHz pure tone at 100 dB SPL for 10 min. Although the loss of CM output at the primary frequencies was limited to around 2 dB, the 2f1-f2 distortion products in the CM (CM-DPs) were markedly reduced immediately after the exposure, especially at low primary levels (i.e. less than 65 dB). The low level CM-DPs recovered gradually near the initial level within 7 days from the exposure. The elevation of CAP threshold closely paralleled with the reduction of CM-DPs in not only the acute phase but also in the recovery phase from the exposure. These results show that the active transduction process in the cochlea was affected by acoustic overstimulation. This impairment of the active transduction was postulated to play an important role in developing the noise induced temporary threshold shift.

[Recording characteristics of the eye mark recorder in measurements of vertical eye movements]

Electronystagmography (ENG) has been widely used in physiological studies of eye movements. It is generally known that ENG is at a disadvantage in recording the vertical component of eye movements, and thus there has been a great deal of difficulty in physiological studies of vertical eye movements using ENG. The eye mark recorder is an instrument which has already been used in the study of visual point movement in various situations. We tried to apply the eye mark recorder to the recording of eye movements in normal volunteers, and then compared its recording characteristics with those of ENG. When recording vertical eye movements with the eye mark recorder there is little baseline drift and no confusing waves caused by blinking, which is sometimes misinterpreted as nystagmus. The result is easy calibration of the device and more accurate measurement of the slow-phase velocity of nystagmus than ENG. Recording with the eye mark recorder is atraumatic and allows binocular visual stimulation. There are certain other techniques, such as search coil or video oculography, which allow more accurate recording of vertical eye movements than ENG. The search coil techniques, however, requires the attachment of a measuring contact lens during the examination and video oculography is still in development process, so both of them are difficult to use widely. Thus, we found that the eye mark recorder has a great advantage in recording the slow-phase eye velocity of vertical nystagmus and the vertical component of smooth eye movements in humans. We think that eye mark recorder can serve as a powerful new tool to investigate vertical OKN and OKAN.