Detection of immune complexes (ICs) of IgG, IgM, or IgA isotypes in middle ear effusions (MEEs) by the solid-phase anti-C3 ELISA and cytologic analyses of MEEs were done in 245 patients with otitis media with effusion (OME). In 320 ears, the clinical classification was acute, 10.3%; subacute, 16.6%; chronic, 73.1%. In the cytologic analyses, the predominant types in each clinical stage were as follows: neutrophil dominant (N) type (63%) in acute cases; neutrophils and lymphocytic (Mixed) type (37%) in subacute cases; and cellular remnant (CR) type (37.8%) in chronic cases. In all the clinical stages IgG-ICs were positive in over 50% of cases and acute cases showed the highest positive rate (64%). IgA)ICs were found in all clinical stages and the highest positive rate was found in subacute cases (67%). In chronic cases, MEEs of N type showed the highest IgG-ICs level and positive rate (75%). These results suggested that immune complexes formed in the middle ear cavity might play an important role in the prolonged inflammatory process of OME through the complement activation following chemotaxis of neutrophils.
Streptococcus pneumoniae, Haemophilus influenzae and, to a lesser extent, Moraxella catarrhalis are major causative agents of acute otitis media (AOM) during childhood, especially in children under 10 years of age. These bacteria frequently colonize the upper respiratory tract during childhood. The same organisms have been recovered simultaneously from the nasopharynx and the middle ear during episodes of otitis media, indicating that sometimes they translocate from the nasopharynx to the middle ear to cause otitis media (3, 11). Otitisprone children tend to be colonized by bacteria more often than non-prone children (4). The repeated appearance of bacteria in the nasopharynx is caused by translocation of colonized bacteria from other sites into the nasopharynx (endogenous reinfection) and/or infection from siblings (household transmission). There is some evidence of turnover of non-typable H. influenzae in the nasopharynx of otitis-prone children (2, 13, 15), but it is unclear whether recurrent otitis media is caused by chronic colonization of etiological bacteria or by new infections. In this study, we have isolated bacteria over time from the nasopharynx of children with repeated episodes of otitis media and examined the identity of these bacteria.Otitis-prone children were defined as those who had more than 3 episodes in 6 months, more than 4 episodes in 1 year, or more than 4 episodes by 2 years of age, as described by Yamanaka and Faden (17). Informed consent was obtained from the parents of all children. Repeated nasopharyngeal swabs were obtained from 7 otitis-prone (OP) and 2 non-prone (NP) children and used for the isolation of bacteria. The isolated colonies were identified by a MicroScan WalkAway40 system (Dade Behring, Tokyo).Bacteria were repeatedly isolated from nasopharyngeal swabs and, in some cases, otorrhea. S. pneumoniae isolates were obtained at least once from all patients. H. influenzae and/or M. catarrhalis were also isolated in most cases (Fig. 1). The identity of strains isolated at various times from the same patient was examined by randomly amplified polymorphic DNA-PCR (RAPD-PCR). S. pneumoniae and M. catarrhalis were cultured Abstract: Recurrent otitis media are frequently intractable during childhood. It is unclear whether recurrent otitis media is caused by etiological bacteria colonization or by new infections. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were isolated from the nasopharynx of 7 otitisprone and 2 non-prone children with recurrent otitis media. Plural bacterial species and strains were found in all children while affected by otitis media. The same strain was repeatedly isolated from all otitisprone children even after administration of antibiotics but was not from the non-prone children. Antibiotic susceptibility did not differ significantly among the same repeatedly isolated strains. This pilot study suggests that the etiological bacteria tend to colonize and is hard to eliminate in otitis-prone children.
Cystadenocarcinoma (papillary cystadenocarcinoma) of the salivary gland is a rare malignant neoplasm. Major locations of this neoplasm are the parotid gland, the sublingual gland, and minor salivary glands, while occurrence in the submandibular gland is extremely rare. As far as we know, only one report, written in the French language, has been published concerning cystadenocarcinoma of the submandibular gland, but no report is available in the English language. In this report, we describe a case of cystadenocarcinoma arising from the submandibular gland of a 54-year-old male patient. The neoplasm is a low-grade carcinoma, and pre-operative examination may not show typical characteristics of malignant neoplasms. Therefore, as was true in this case, the differential diagnosis from benign lesions is sometimes difficult. This is the first report on cystadenocarcinoma of the submandibular gland in the English language and the first to show a computed tomography (CT) scan and magnetic resonance imaging (MRI) of this neoplasm in the submandibular gland.
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