A clinical survey was performed on 110 patients treated for dental sinusitis during the seven year period from September, 1969 to September, 1976. The following results were obtained. 1. There was no remarkable sex difference in incidense (51 males and 59 females), and no remarkable difference between right and left (52 left-sided and 58 right-sided). 2. The incidence was highest in 20s (32.7 %), followed by the 30s (31.8 %) and 40s (19 %). 3. The most frequent complaint was pus discharge from the oro-antral fistula (40%), followed by fetid rhinorrhea (22.7 %) and buccal pain (15.4 %). 4. The first molar was the highest causative (63.6 %), followed by the second molar (20 %) and second premolar (10 %). 5. There were 56 cases without pus in the nasal cavity. All of them were chronic type with oro-antral fistula. The pus might be discharged through the oro-antral fistula rather than middle meatus and this might be more accerelated by the irreversible change of the mucous membrane of the sinus. 6. X-ray findings revealed unilateral lesion in all cases, and ethmoid sinus inclusion was found only in 13.6%. It should be emphasized that the pathology was mostly confined to the maxillary sinus. 7. This disease is generally assumed to take an acute course, however, persistent pus discharge from the oro-antral fistula was found in as many as 61 cases in our series (55.4%). This indicates that a considerable number of cases turned into chronic changes. 8. Based on the clinical course and clinical findings, the clinical manifestations of this disease may be classified into the groups with and without dental extraction. The former is classified into the sub type with fistula and that with intrusion of tooth root. This method of classification is usefull for therapeutic purpose. 9. Eight methods are available for the treatment of this disease with otorhinological and dental approach combined.
Six patients with malignant melanoma in nasal cavity and paranasal sinus were treated in our clinic during 27 years from 1950 to 1976. Age ranged from 49 to 79 years. Sex distribution was 3 males and 3 females. The malignant melanoma was observed in nasal septum in three cases. In remaining three cases it developed in middle turbinate, in middle meatus, and in middle turbinate as well as maxillary sinus, respectively. They were treated with a combination of operation, irradiation, and administration of anticancerous drugs. In two cases, who were treated recently, immunotherapies (BCG etc.) were also administered. One case, whose tumor was classified as the spindle cell type histologically, survived more than five years without recurrence. Four of the five cases with the large epitheloid cell type died within one and a half year. Remaining one case, treated with BCG and b'Co irradiation has been surviving for about ten months. Electron micrograph of one case revealed large nuclei and deep invaginations of the nuclear membranes, but no desmosome in cell membranes. The nuclei contained very large nucleoli and exhibit some vacuolelike structures. Autopsy was performed in two cases. One case showed predominant, hone metastasis (thecranial base and the spinal column etc.) along with lung metastasis. In the second case, predominant visceral metastasis (lungs, liver, and pancreas etc.) was observed as well as pleura, bone (the spinal colum etc.) and forehead skin metastasis. We collected 67 cases of malignant melanoma in nose and paranasal sinus from Japanese literature (which were published from 1965 to 1975). In Japan, malignant melanomas originated in nasal cavity and paranasal sinus are thought not so rare disease as mentioned before.
The epithelium of the human circumvallate papillae was divided into three transverse portions from its superior surface; upper (UP), middle (MP) and lower portion (LP). Three transverse sections of the taste bud in one portion, totally nine sections in three portions, were selected from many sections and photographed in 6, 500 time magnification by electron microscope. After making photomontages of these nine sections magnified in 25, 000 times, the areas of the somata were measured from the traced pictures of photomontages by planimeter. The exact method used in this study was previously reported in Jap. Jour. Otol. Tokyo (1977). The areas of 255 somata at LP, 241 at MP and 292 at UP were measured. The mean value of the area was 3.6μ2 at LP, 7.8μ2 at MP and 6.9μ2 at UP. Fifty to 65 % of the somata showed the area of 0 to 2.0μ2 at each portion. The area of LP was generally smaller than that of remaining two portions. The somata were divided into three components, cell body, intercellular detritus and branching cytoplasmic process, from the view point of their location and morphological figures by electron microscope. The areas of these components were measured. The area of the cell body was over 12.0μ2, intercellular detritus among 1.0 to 9.0μ2 and branching cytoplasmic process under 0.3μ2. It was suggested that the cell number in one taste bud is 10.7 to 27.3 from area distributions of somata.
The aim of the present study was to investigate the development of the tracheal mucosa morphologically and cytodynamically using 3H-thimidine autoradiography as well as light and electron microscopy. Using rats aged 20 fetal days, 1, 2, 3, 4, 5, 6, 8, 10, 12, 14, 18, 20, 24, 26, 28 and 30 postnatal days obtained from healthy parental Wistar rats weighing 150 to 250g, experimental animals of each age group were injected 3H-thimidine 3 mc/g and sacrificed 1 hour later. A few tiny pieces of tissue were taken from the tracheal mucosa as experimental specimens. Tracheal specimens for light microscopy were embedded in paraffin, thin-sectioned and stained with HE and PAS. Another paraffin sections were used for autoradiography. With light microscopy, morphologic, numeric and distributive change in the differentiating mucosal epithelial cells of different types were examined with 3H-thimidine autoradiography. Progressive change in label indices of the mucosal epithelial cells, fibroblasts in the lamina propria and chondroblasts of the tracheal cartilage were also investigated. As to numeric changes, the ciliated cells were proportionally small in number (10% of all the mucosal epithelial cells) in 20th day fetus. However, they rapidly increased in number after birth with beginning of respiration, becoming to 40% on the 4th postnatal day and 60% on the 30th day. The mucous cells were found to be 30% on the 20th fetal day, and then decreased in number until 10% at the birth. They increased again to 20% after 10th day and, there after became stable at 10%. The non-ciliated cells were 30% on the 20th fetal day. The numeric proportion was relatively invariable for a while after birth and became 20% on the 20th postnatal day. The basal cells were varied within the range of 20 to 10% until 14 days after birth, but settled at 20% on the 26th day and thereafter decreased to 10%. The label index of fibroblasts of the lamina propria was 14.9% on the 20th fetal day, which rapidly decresed after birth; 9.0% on the 1st neonatal day, 6.3% on the 2nd day, 5.8% on the 6th day, 2.1% on the 12th day, 4.3% on the 14th day, and thereafter, 2.0_??_3.0% until the 30th day. The label index of chondroblasts of the tracheal cartilage showed essentially identical tendency to that of fibroblasts, indicating 11.9% on the 20th fetal day, rapidly declining to 7.9% on the 1st neonatal day, 4.7% on the 2nd day, 2.0% on the 6th day, 1.9% on the 14th day and thereafter 0.6_??_1.5% until the 30th day. Thus, it can be concluded that the label index of the fibroblasts and the chondroblasts became stable after 14th postnatal day.
There is still no consensus concerning clinical significance of the posterior indentation at the pharyngo-esophageal junction noted by radiological examination. In the present investigation, an attempt has been made to clarify whether there is an abnormal temporal relationship between pharyngeal peristaltic wave and pharyngo-esophageal sphincteric relaxation and contraction, and whether such a phenomenon could result from some abnormality of function of the upper esophageal sphincter, such as premature contraction or failure of relaxation. The subjects employed were normal adults, both male and female, ranged in age from twenty-three to seventy-four years. In all cases, cineradiographic studies have been made at 24 frames per sec. on 16 mm film, which consisted of lateral pharyngo-esophagram taken with the subjects in standing position and while swallowing a mouthful of fluid barium. In the lateral projection standard radiographs have also been taken to estimate the degree of indentation at rest and while Valsalva manoeuvre being performed. As to time relationship between the occurrence of this phenomenon and pharyngeal peristaltic wave, following two types were observed: (1) occurrence in succession with pharyngeal peristaltic wave, (2) occurrence immediately ahead of the passage of pharyngeal peristaltic wave. The first type was observed in 24 of 59 subjects, and appeared more frequently as age increased. Especially, in middle-age and beyond, 20 subjects out of 36 showed this phenomenon. The second type was observed in three cases aged more than 70 years, all of them being accompanied by a transitory diverticulum at the posterior wall of the hypopharynx just above indentation. During Valsalva manoeuvre, this phenomenon was observed in all the subjects, and its degree became more prominent than in the resting state. In 30 cases of 59, this test caused a depression of the posterior wall of the trachea at the level of the pharyngo-esophageal depression. The results of investigation are summarized as follows. Indentation showed no clear evidence for incoordination between the upper esophageal sphincter and the pharyngeal peristaltic wave. In three cases, however, premature closure of the sphincter was identified, and considered to be an important factor in the development of transitory diverticulum. According to observation with Valsalva manoeuvre, I reached the conclusion that the upper esophageal sphincter consists, in part at least, of the circular muscles of the upper end of the esophagus.
Since1963, the combination of surgery, radiotherapy, and chemotherapy was used for malignant tumours of the paranasal sinuses. This method reduced the rate of local recurrences and improved survival rate. Maxillary resection has not been performed even on the advanced cases since August 1965. At present, to eradicate the cancer without excessive destruction of structures and functions, irradiation (average 800 rad), maxillary antrotomy and tumour removal, regional application of anticancerous ointment following day-by-day removal of necrotic tissue are our routine treatment even for the advanced cases. In this paper, recent 66 cases, treated with this therapeutic regimen, were compared with 45 cases treated by arterial infusion of 5-FU and BUdR. The conclusions are as follows; 1. The planning of treatment in the combined therapy on the cancer of the maxillary sinus should be determined according to clinical findings in each case. Antrotomy and tumour removal, repetitive removal of the necrotic tissues were performed with regional application of anticancerous ointment. As the result, arterial infusion of the anticancer drugs is now not necessary and average irradiation dosis have decreased to 800 rad in most cases. 2. In non-infused group, the residual tumour or to recurrence was successfully treated by the removal of the lesion. 3. In some cases, further irradiation under inhalation of the mixed gas (5 percent CO2 and 95 percent 02) and removal of the necrotic tissues were performed. Thus, in most patients preservation of the eyes, the palate, and the skin of the cheek were possible.
The early clinical diagnosis of cerebellar vermian tumor is sometimes difficult, because the initial symptoms are often insidious and the objective findings are scanty at its early stage. Reported herein are 3 cases of cerebellar vermian tumors that were successfully diagnosed with the aid of otoneurological examination and the local diagnosis was affirmed by the operations. In these cases, vertical or symmetrical horizontal nystagmus was often observed. However, nystagmus was hardly detected with u very localized lesion in the vermis. Asymmetrical extention of the primary lesion to the adjacent areas of the cerebellar hemisphere or the brainstem could also be diagnosed by otoneurological tests. It was concluded from the experience about these 3 cases that the otoneurological exami-nation was very helpful for early diagnosis and local diagnosis of the adjacent invaded area of cerebellar midline tumor.