食道穿孔を疑った，Zenker憩室に嵌入した魚骨異物症例を経験したので報告する。症例：52歳の男性。鯛のあら炊きを食べた後に咽頭痛が出現し，当院の救急外来を受診した。咽頭喉頭に異物を認めず，翌日CTにて頸部食道に食道壁外へ突出する魚骨を疑う高吸収域と，頸部気腫像を認めた。上部消化管内視鏡にて魚骨を摘出したが，異物による食道損傷を確認した。食道穿孔の可能性を疑い，頸部外切開による手術治療を行った。頸部膿瘍はみられず，術中造影にてZenker憩室と診断，憩室摘出術を施行した。術後嚥下障害はなく，経過良好である。異物誤飲においては，食道憩室への異物陥頓の可能性を念頭におく必要があり，また個々の症例に応じて，治療方法を考慮する必要がある。

There is accumulating evidence that fibroblasts are target cells for steroids such as sex hormones and corticoids. The characteristics of fibroblasts vary among tissues and organs. Our aim in this study is to examine differences in responses to steroid hormones among fibroblasts from different cervicothoracic regions. We compared the actions of steroid hormones on cultured fibroblasts from the vocal folds, which are considered to be the primary target of steroid hormones, and the trachea and esophagus in adult male rats. Expression of steroid hormone receptors (androgen receptor, estrogen receptor α, and glucocorticoid receptor) was identified by immunofluorescence histochemistry. Androgen receptor was much more frequently expressed in fibroblasts from the vocal fold than in those from the trachea and esophagus. Cell proliferation analysis showed that administration of testosterone, estradiol, or corticosterone suppressed growth of all 3 types of fibroblasts. However, mRNA expression for extracellular matrix-associated genes, including procollagen I and III and elastin, and hyaluronic acid synthase I was elevated only by addition of testosterone to fibroblasts from the vocal fold. These results indicate that each steroid hormone exerts region-specific effects on cervicothoracic fibroblasts with different properties through binding to specific receptors.

Objectives/Hypothesis: We report the first case of laryngeal stenosis with granuloma in a patient with severe congenital neutropenia (SCN). Study Design: Case report and retrospective review. Methods: Review of medical records. Results: A 6-year-old female who was diagnosed with SCN presented with a cough and wheezing. An endoscopic study revealed laryngeal stenosis with granuloma. Tracheotomy and direct laryngoscopy were performed under general anesthesia, and administration of granulocyte colony-stimulating factor was started. The laryngeal granuloma disappeared 3 weeks later, and the tracheal stoma was closed. Conclusions: Presence of a laryngeal lesion should be considered in SCN patients with persistent airway symptoms.

Potassium chloride cotransporters (KCCs) mediate electroneutrally-coupled transport of K(+) and Cl(-), and play crucial roles in various cell functions including regulation of cell volume and homeostasis of cellular Cl(-)content. Four isoforms of KCCs (KCC1, 2, 3, and 4) have been identified. KCC1 is ubiquitously expressed, whereas KCC2 is mainly expressed in neuronal cells of central nervous system. KCC3 is highly expressed in heart, skeletal muscle, kidney, lung and placenta. KCC4 is mainly expressed in epithelial cells. In this study, we investigated roles of KCCs in NGF-induced neurite outgrowth of rat pheochromocytoma PC12 cells. The most abundantly expressed isoform in PC12 cells was KCC1. Inhibition of KCCs using [(dihydronindenyl)oxy] alkanoic acid (DIOA), an inhibitor of KCCs, enhanced the NGF-induced neurite outgrowth of PC12 cells in a dose-dependent manner. Treatment of PC12 cells with NGF significantly decreased mRNA expression of KCC1, whereas other isoforms, KCC2-4, showed no changes in their mRNA expression in response to NGF treatment. Knockdown of KCC1 using small interfering RNA (siRNA) enhanced the NGF-induced neurite outgrowth. These results suggest that KCC1 negatively regulates the NGF-induced neurite outgrowth of PC12 cells.

CONCLUSION:Expression of aquaporins (AQPs) in the vocal folds and the parasympathetic regulation of AQPs in the laryngeal glands may be important for controlling laryngeal secretion and vocal fold hydration. These findings are thought to be an initial step towards understanding potential mechanisms of water flow through the vocal fold surface.OBJECTIVES:Lubrication of the vocal folds is important for phonation and laryngeal defense. However, the system of water transport in the laryngeal epithelium has not yet been clarified. We investigated the expression of AQP water channnels (AQP1-9) in the murine larynx and examined the neural regulating mechanisms of these subtypes.METHODS:The distribution of AQPs (AQP1-9) in the murine larynx was examined by immunohistochemistry. Next, the neural mechanism regulating AQPs in the larynx was investigated using unilaterally vagotomized mice.RESULTS:AQP1, 4, and 5 were expressed in the laryngeal epithelium including the vocal folds. Vocal fold AQP expression was minimal at the vocal process. AQP2, 3, 5, 6, 7, and 8 were localized to the submucosal glands. Expression of AQPs in the vagotomized region was significantly decreased compared with the contralateral intact side. The expression in the laryngeal glands was also decreased in the aged mice.

Takeshi Nishio, Kaheita Hirasugi, Hiroyuki Okano, Hideki Bando, Ken-ichiro Toyoda, Ryuichi Hirota, Hirokazu Shogaki, Shinobu Koike, Hitoshi Bamba, Toshiyuki Uno and Yasuo Hisa A total of 562 patients with recurrent laryngeal nerve paralysis (RLNP) who had visited our department of otolaryngology at the Kyoto Prefectural University of Medicine between 1988 and 2000 were examined and the results were compared with those from 436 patients with RLNP who had visited the same hospital between 1971 and 1987. Compared with the later mentioned group, the rate of infant patients affected had increased. Cases of RLNP caused by esophageal cancer, heart and aortic disease as well as post-endotracheal intubation had grown in number. Cases of RLNP from unknown causes had decreased. This was probably due to progress in diagnostic techniques utilizing imaging such as CT, MRI and ultrasonic examination. In some cases, the chest CT revealed causes which chest radiographs could not diagnose. A high rate of recovery was observed in patients with RLNP due to intubation as well as after common cold infections in both groups of patients.

顆粒細胞腫は全身に発生が報告されている腫瘍であるが，喉頭では稀である。今回われわれは，喉頭披裂部の喉頭顆粒細胞腫を経験したので報告する。症例は44歳男性，近医で喉頭の腫瘤性病変を指摘され，当科紹介受診となった。初診時，左披裂部に直径5 mm，白色隆起性の病変を認めた。喉頭ファイバースコープ下生検で顆粒細胞腫との結果を得たため喉頭微細手術下にCO2レーザーを用いて腫瘍摘出術を施行した。病理組織学的に偽上皮腫性過形成を示す扁平上皮に覆われた腫瘍を認めた。腫瘍内には小型の核を持ち細胞質中に好酸球性の小顆粒を持つ，卵円状の細胞の増殖を認めた。異型性は認めなかった。腫瘍細胞はPAS染色陽性，免疫染色ではS-100蛋白が陽性で病理診断は顆粒細胞腫であった。本邦における顆粒細胞腫の喉頭発生例の報告は現在まで10数例である。ほとんどが良性であるが，稀に悪性の報告がある。病理組織学的に良悪性の区別がつきにくいことがあるため，治療には腫瘍の全摘出術を期すべきである。

Adenoid cystic carcinoma of the larynx is very rare and only 31 cases have been reported in Japanese literature in the last 30 years.A 44-year-old-woman complained of hoarseness and dyspnea. Fiberscopic examination revealed fixation of the right vocal cord and a smooth mass involving the subglottic area. An excisional biopsy was performed with laryngeal microsurgery. The pathological diagnosis was adenoid cystic carcinoma.The patient underwent total laryngectomy with a right modified neck dissection and subsequent radiation therapy of 50 Gy.She has remained well for the last 24 months without any evidence of recurrence and metastasis.

The localization of heme oxygenase-2 (HO-2) in the larynx of the dog was investigated using immunohistochemistry. HO-2-positive cells were seen among neurons in intralaryngeal ganglia. Nerve fibers positive to HO-2 immunohistochemistry were seen surrounding laryngeal glands and arterioles and also in the adventitia of arterioles. HO-2-positive fibers were also seen running parallel to the mucosa in the lamina propria but no positive fibers were seen in the epithelium. Some of the intramuscular neurons found in the intrinsic laryngeal muscles were HO-2-positive, although no positive motor fibers were seen, and the neuromuscular junctions were also HO-2-negative. The results implicate the participation of HO-2-in the parasympathetic innervation of the larynx.

A case of cervical thymic cyst is reported, and the Japanese literature is reviewed in this paper. A 12-year-old-boy presented with a painless left neck mass (5 x 4 cm). The preoperative diagnosis was cystic disease of the neck, based on ultrasound examination, CT and MRI study. At surgery, a cyst adhering to the vagus nerve was extirpated from both the carotid artery and the jugular vein, which were connected to the mediastinum. The pathological diagnosis was multilocular thymic cyst, which showed normal thymic tissue, in addition to granulation with areas of chronic inflammation and fibrosis with cholesterol clefts and Hassall's corpuscles in the cystic wall.Twenty-eight cases of cervical thymic cyst in the Japanese literature are reviewed and discussed briefly. The mean age of the patients was 31 years. Sixteen cervical thymic cysts (57%) occurred on the left side of the neck. Painless neck swelling was noticed in all except 3 patients. Seven cervical thymic cysts (32%) had mediastinal connections. Some cysts included foci of thyroid tissue (one patient) and parathyroid tissue (3 patients). Due to their rare occurrence, cervical thymic cysts can be misdiagnosed as other cystic lesions of the neck. Cervical thymic cysts should be taken into account in the differential diagnosis of neck masses.

We report a rare case of a foreign body, a large snail, in the esophagus. A 20-year-old male, a freshman in college, was invited to a party at a music club and was requested by senior students to do a comical performance. He decided to swallow a large snail in its shell. Severe throat pain was immediately noted. He tried to induce vomiting, but was unable to and came to our hospital for emergency case. No foreign body was found in the hypopharynx. Plain X-ray examination showed a circular shadow in the neck, 3 centimeters in diameter. We identified the foreign body in the esophagus in the neck. We tried to remove the object with an endoscope under general anesthesia. The shell was found at the inlet of the esophagus and was spherical and smooth, which made it impossible to grip with forceps. Therefore, we removed the foreign body via external incision of the neck.