Use of real‐time magnetic resonance image guidance in endoscopic sinus surgery

We evaluated the effectiveness of magnetic resonance image (MRI) guidance using an optical tracking system (MRI-guided therapy: MRT) in performing endoscopic sinus surgery (ESS). The profiles of the fourteen patients in the present study were as follows: eleven with mucocele in the paranasal sinus, one with recurrent chronic sinusitis, one with maxillary cancer, and one with Graves' ophthalmopathy. Preparation of the MRT system required an additional 54 min in cases involving general anesthesia, and an additional 17 min in cases involving local anesthesia, in comparison with corresponding control groups undergoing ESS in a traditional operating room. We developed nonmetal probes that were visualized in a real-time mode and assistive devices for the optical tracking system that were equipped to avoid obstruction caused by surgical instruments as well as by the hands of surgeons. Using these unique devices, anatomic landmarks were visualized using the present MRT system. The prognosis of patients was favorable, and in particular, no patients with sinus mucocele showed a recurrence of their lesions. We concluded that the MRT system used here for performing ESS was beneficial, especially in terms of the intranasal marsupialization of sinus mucoceles and for the verification of orbital contents.

Cortical and subcortical vestibular response to caloric stimulation detected by functional magnetic resonance imaging

The posterior insula, central sulcus, and inferior parietal lobule including the intraparietal sulcus have been considered the vestibular cortex based on functional brain mapping in humans as well as experiments in lower primates. The same regions receive optokinetic, visual, and proprioceptive projections. We examined the cortical and subcortical projection of vestibular activity with visual and proprioceptive input eliminated during caloric stimulation (CS), using functional magnetic resonance imaging (fMRI). Single-shot gradient-echo echoplanar image (EPI) volumes were sensitive to BOLD contrast in oblique orientation. We adopted a pharmacokinetic model for analysis of imaging data from 10 subjects as a group. The insular gyrus, intraparietal sulcus, superior temporal gyrus, hippocampus, cingulate gyrus, and thalamus showed activation by CS. Cortical and subcortical activation during CS in the present study was observed within regions less precisely delineated by other methods. As intraparietal sulcus activation showed right hemispheric dominance, this region may have an oculomotor projection as well as the vestibular input.

Effects of endolymphatic-perilymphatic fistula on endolymphatic hydrops in guinea pig

The endolymphatic-perilymphatic shunt operation between the scala media and scala tympani was performed in 22 guinea pigs with endolymphatic hydrops induced by the silver nitrate injection method 2 months before the operation. Two (n = 10), 7 (n = 6), and 28 (n = 6) days after the operation, the condition of the fistula and the inner ear pathology were studied histopathologically. In half of the animals, the fistula was open, whereas in the other half, the fistula was closed. In the group examined after 2 postoperative days, the animals with open fistulas showed a slight collapse of Reissner's membrane, which might indicate that excess endolymph escaped through the fistula into the scala tympani. In the groups examined later, especially in the group examined after 28 postoperative days, the animals showed distention of hydrops despite preservation of the fistula. Moderate-to-severe degenerative changes of the organ of Corti, macula sacculi, and stria vascularis were observed in the vicinity of the fistula. We conclude from this study that the endolymphatic-perilymphatic fistula created inside the cochlea apparently was not sufficient to reduce the hydrops. Rather, it caused degenerative changes of the inner ear structure. This type of surgery is not suitable for Meniere's disease.

C-type natriuretic peptide-like immunoreactivity in the rat inner ear

C-type natriuretic peptide (CNP) is a member of the atrial natriuretic peptide family (ANP family). The family also includes ANP and brain natriuretic peptide (BNP). These peptides regulate the homeostasis of body fluid and blood pressure as a neuropeptide in the central nervous system as well as a cardiac hormone in the periphery. We have recently reported the expression of CNP mRNA in the inner ear. To assess the possible physiological role of CNP in the inner ear, we investigated the localization of CNP peptide in the rat inner ear by immunohistochemistry at the light and electron microscopic level. CNP-like immunoreactivity was widely distributed in the secretory and the neuronal portion of the inner ear, i.e. the spiral ligament, the dark cell region of the utriculus, the epithelium of the endolymphatic sac, the spiral ganglion cells and the vestibular ganglion cells. The results suggest that CNP may play a role in the homeostasis of the perilymph and endolymph and may also influence nerve activities in the inner ear.

Regulation of inner ear fluid in the rat by vasopressin

The anti-diuretic hormone vasopressin has been shown to be important in regulating inner ear fluid. The diuretic hormone, CNP, and its receptor, ANP-B receptor, may also function in the regulation of inner ear fluid. To determine whether vasopressin directly affects the fluid level, we infused this hormone to rat and assay of V2-AVP receptor mRNA by semiquantitative RT-PCR demonstrated a significantly lower level of this transcript in vasopressin-infused animals than in saline-infused animals. The levels of CNP and ANP-B receptors mRNA, however, were the same in both groups of rats. Results suggest that high plasma levels of vasopressin may be a principal causal factor of endolymphatic hydrops in Meniere's disease, perhaps by down-regulating the number of vasopressin receptors.

Immunohistochemical detection of vasoactive intestinal polypeptide (VIP) and the VIP receptor in the rat inner ear

Vasoactive intestinal polypeptide (VIP) is a 28 amino acid peptide that was originally isolated from porcine duodenum. The presence of VIP has been demonstrated in the central nervous system and peripheral tissues. However, there have been few reports on VIP as a neurotransmitter, especially in the inner ear. To investigate the function of VIP in the rat inner ear, we examined the expression of VIP and the VIP receptor by immunohistochemistry. Using the anti-VIP and VIP receptor antibodies, scattered fibres in the cochlear nerve trunk demonstrating VIP-like immunoreactivity were found, and the spiral ganglion cells demonstrated ring-shaped VIP-like immunoreactivity. Immunoreactivity for the VIP receptor was predominantly found in the spiral ganglion cells. Our results suggest that VIP may play an important role as a possible neurotransmitter not only in the local control of cochlear blood flow, but also in the auditory system.

Expression of inducible nitric oxide synthase in human thyroid papillary carcinomas

To evaluate the relationship between nitric oxide (NO) and carcinogenesis, we assayed 4 human thyroid papillary carcinomas (TPC) and 3 normal thyroid glands for the presence of inducible nitric oxide synthase (iNOS). Using an antibody against iNOS, we observed immunohistochemical staining if iNOS in the TPC samples, but not in normal thyroid. When we incubated TPC samples with antibodies against both iNOS and human leukocyte antigen (LCA), a macrophage marker, we found that while most TPC cells were stained with anti-iNOS antibody, only a few were stained with both. Reverse transcription polymerase chain reaction (RT-PCR) showed that iNOS mRNA was expressed in the samples of TPC, but not in normal thyroid. The sequence of iNOS message in the TPC samples was identical to that previously detected in a human colon cancer cell line. These results suggest that iNOS in human TPC is mostly derived from tumor cells, rather than macrophages, and that it may play a direct role in carcinogenesis.

Presence of mRNA for vasoactive intestinal polypeptide (VIP) and its receptor in the rat inner ear

Although mechanisms regulating inner ear fluid have not been yet elucidated, control of blood flow has been thought to be of great importance. Vasoactive intestinal polypeptide (VIP) was the first neuropeptide demonstrated in cerebrovascular nerves. To study the possible role of VIP in regulation of inner ear fluid, we investigated the presence of mRNA for VIP and VIP receptor in the rat inner ear using a reverse transcription-polymerase chain reaction (RT-PCR) method. A single band of the size expected for VIP and its receptor was detected in mRNA from the rat inner ear by using primers specific for VIP and the receptor. The nucleotide sequences of the subcloned RT-PCR products were identical to those of rat VIP and the rat lung VIP receptor. These results indicate that both VIP and VIP receptor are expressed in the inner ear of the rat and suggest that VIP may be implicated in regulation of fluid in the inner ear.

RT-PCR analysis of mRNA expression of natriuretic peptide family and their receptors in rat inner ear

To assess the possible physiological role of the atrial natriuretic peptide (ANP) family, we investigated the expression of mRNA of ANP, brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), and their receptors in rat inner ear using the reverse transcription-polymerase chain reaction method. ANP and CNP message bands were detected in the inner ear, but the BNP message band was not. Amplification products of the expected sizes of ANP-A, ANP-B and ANP-C receptors were detected in the inner ear. These results suggest that natriuretic peptide family may influence the function of the inner ear through the ANP-A, ANP-B, and ANP-C receptors.

Vasopressin and oxytocin receptor mRNAs are expressed in the rat inner ear

The cause of endolymphatic hydrops, a characteristic finding in Menière's disease, is not known. To study the possible involvement of the neurohormones vasopressin and oxytocin in this condition, we investigated whether transcripts of the genes encoding the arginine vasopressin (AVP) and oxytocin receptors are expressed in the rat inner ear. Utilizing the reverse transcription-polymerase chain reaction (RT-PCR) method, primers specific for each receptor showed a single message band of the expected size in the rat inner ear. When the PCR products were cloned, the sequences were identical to those of the real-type (V2) AVP receptor and oxytocin receptor transcripts. The finding of vasopressin and oxytocin receptor mRNAs in the inner ear suggests that these neurohypophyseal hormones may have roles in the regulation of inner ear fluid. In particular, the presence of vasopressin receptor mRNA in the inner ear supports the hypothesis of a relationship between high plasma vasopressin levels and endolymphatic hydrops.

[Clinical features of Sjögren syndrome]

Between 1985 and 1995, 134 patients presented to our clinic with complaints of either dry mouth, decreased salivary flow or salivary gland swelling of unknown origin. These patients were diagnosed retrospectively based on the criteria established by the Sjögren's disease research committee (1977), and 30 patients were definitively diagnosed with Sjögren's disease while 23 were considered suspect. The gender distribution of these 30 patients was 25 female (83%) and 5 male (17%). The average patient age was 55.8 years for females and 42.6 years for males. Of 30 patients, 10 (33.3%) had only sicca syndrome and the other 20 (66.7%) had various complications such as collagen diseases, autoimmune diseases, and malignant lymphoid infiltration. Subjects included 14 cases of rheumatoid arthritis (RA), 1 case of systemic lupus erythematosus (SLE), 1 case of RA with periarteritis nodosa (PN), 1 case of progressive systemic sclerosis (PSS) with SLE, 1 case of PSS with Hashimoto disease, 1 case of malignant lymphoma and 1 case of RA with Waldenström's macroglobulinemia. Positive blood tests showed a relatively high incidence of elevated erythrocyte sedimentation ratios (ESR) (75%), elevated IgG levels (69.2%), positive anti-nuclear antibody (52.3%), positive anti SS A antibody (75%) and positive anti-SS B antibody (50%).

Detection of C-type natriuretic peptide (CNP) and atrial natriuretic peptide (ANP-B) receptor mRNAs in rat inner ear

C-Type natriuretic peptide (CNP) is the third member of the natriuretic peptide family which plays an important role in body fluid homeostasis. To determine a possible role of CNP in regulation of an inner ear fluid, we investigated the expression of CNP and atrial natriuretic peptide B receptor (ANP-B receptor) mRNAs in rat inner ear using a reverse transcription polymerase chain reaction (RT-PCR) method. Amplification products with sizes expected for CNP and ANP-B were detected in the inner ear. After cloning and analysis, the sequences for PCR products were identical to those of CNP or ANP-B receptor in the brain. These results indicate that both CNP and ANP-B receptor are expressed in the inner ear of the rat and suggest that CNP may play a role in inner ear function (such as regulation of inner ear fluid) in an autocrine and/or paracrine manner.

Clinical findings in Menière's disease with bilateral fluctuant hearing loss

Our department conducted an examination of the clinical characteristics of Menière's disease with bilateral fluctuant hearing loss, using data obtained in a survey involving sixteen institutes associated with the Vestibular Disorder Research Committee, Japan. A total of 480 cases were surveyed, of which 204 showed normal hearing in the second ear, and were thus classified as unilateral Menière's disease, or Menière's disease with unilateral involvement; 135 cases showed fluctuating cochlear symptoms in the second ear, and were therefore classified as Menière's disease with bilateral fluctuant hearing loss or bilateral involvement. Our results show that patients with bilateral involvement experience increased disruption of daily life activities, and respond poorly to therapy with diuretics or steroids. Hospitalization is often considered for these patients. For these reasons it is especially important that bilaterality be diagnosed as early as possible, and that intensive treatment be carried out. ENT specialists must recognize the seriousness of bilateral involvement, and take particular precautions against its occurrence.