Abstract
One hundred seventy nine cases of this disease that have been treated in Japan for recent. 10 years remain the subjects of dispute. As regards extent of lesion, malignant granulomas of the nose are classified into 5 clinical types: lesion is not widespread and located near the nares in Type I, limited in the unilateral nasal cavity in Type IL located in the unilateral nasal cavity with external ulceration of the face or palate in Type III, lesion is spread in the bilateral nasal cavities in Type IV, spread in the bilateral nasal cavities with destructive ulceration of the face or palate in Type V. The prognosis of these cases, is notoriously poor. Five year survival ratio is 17% (1/6) in Type I, 37% (13/35) in Type II, 0% (0/10) in Type III, 21% (3/14) in Type IV, 0% (0/7) in Type V. Considered from the therapeutic standpoint, 5 year survival ratio of the unilateral lesion (Type I, II, III) is 16% (1/6) by treatment of cortisone and antibiotics, 45% (10/22) by combined irradiation and surgical excision ; in contrast with this, that of the bilateral lesions (Type IV, V) is 30% (2/7) by cortisone and antibiotics, 7% (1/14) by surgical excision or irradiation. It is no argument that the so-called malignant granuloma of the nose are divided into two different diseases, sarcoma and Wegener's granulomatosis. Many cases of Type I, II, III belong to the former and Type IV, V to the latter.
Thirteen cases who came under the author's care are 6 cases of sarcoma (5 alive, 1 died) and 7 cases of Wegener's disease (3 alive, 4 died). As to the therapy of malignant granulomatosis, irradiation is the best treatment to sarcoma ; however, to Wegener's granulomatosis, ACTH, steroid hormone therapy, small dosis irradiation and cervical sympathectomy have curative or temporary curative effect in some cases but in others no effect. Author's two cases were treated by autovaccine combined with above mentioned other methods. It was found that both autovaccine and steroid hormone were the most effective to Wegener's granulomatosis. The autovaccine therapy to Wegener's disease deserve particular emphasis and attention. This paper is the first report conceinirig the effectiveness of autovaccine to Wegener's disease.
