In the present study, we used animal models to induce chronic inflammatory bone resorption which was associated with or without development of skin cysts in order to understand the pricise role of the skin to born resorption in middle ear cholesteatomas. The following tissues were implanted subcutaneously in the back of a total of 60 rats. Group 1: Fresh cortical cochlea wall bone alone. Group 2: Fresh cortical cochlea wall covered with full thickness skin obtained from the external ear canal. Group 3: Fresh cochlea wall wrapped with carrageenan granuloma. Group 4: Fresh cochlea wall combined with full thickness canal skin and carrageenan granuloma. All the animals were sacrificed between 45 to 57 days after the implantation. After each specimen was removed, the size of the bone fragment was determined by the longest diameter with calipers under the operative microscope. Then, the specimen was fixed in formalin and used for histological study. In our stndy, the buried skin made a complete epidermal cyst subcutaneously in 70% of the 42 specimens. Microscopically, most of the bones implanted in various graft combinations indicated that the graft was the seat of a dual process, destruction and reconstruction. The inflammatory connective tissue, pyogenic or foreign body reaction produced by the skin cyst, was the common finding in bone resorption margins. The presence of the skin cyst with carrageenan was associated with the highest incidence of bone resorption in our series. On the other hand, the fact in our series that the skin cyst lied in a shallow or deep depression on the surface of a bone indicated that there might be a certain type of mechanical bone destruction in interaction of the skin cyst and bone. Therefore, it is suggested that the skin cyst adjacent to the bone or conective tissue may play an enhancing role in the localized bone destruction by: a. Promoting a persistent chronic inflammatory response in the underlying connective tissue, and b. Influencing bone cells by the physical presence as a space occupying structure.
Reconstruction of hypopharynx and cervical esophagus after laryngopharyngoesophagectomy using free jejunal graft was done on two patients with hypopharyngeal cancer. This procedure was performed with a term approach; the responsibility of head and neck surgeons'team was to resect the tumor. General surgeons'team harvested a jejunal graft. Plastic surgeons'team performed its micro-vascular surgery, and again general surgeons'team anastomosed the jejunal graft to the pharynx and the esophagus. Thus one-stage reconstruction was completed. No post-operative complication was encountered. These patients were able to take a regular diet by 20 and 26 postoperative days respectively. We consider this method of reconstruction is acceptable and reliable. Its advantage over the other methods of reconstruction is that it is a one-stage technique with, probably, a low incidence of post-operative complication. In this paper, we emphasized this method is excellent for the reconstruction in the patients with hypopharyngeal cancer.
Mucociliary clearance by the nasal mucus from the patients with chronic sinusitis (CS mucus) and the patients with nasal allergy (A mucus) was studied with and without load of gravity. The mucus from the different source had quite different macroscopic appearance. The CS mucus was highly viscoelastic and mucoid or mucopurulent. The A mucus was less viscoelastic or watery. The mucociliary transport rate of the mucus on mucus depleted frog palate was measured at horizontal position. The mucociliary transport rate was 6.71±1.49mm/min in CS mucus and 5.49±3.62mm/min in A mucus. This difference was not statistically significant. In the diseases of respiratory tract, where the mucus is hypersecreted, gravity may have the important influence on mucociliary clearance. To investigate the role of gravity on mucociliary clearance in hypersecreted state in vitro, 100μl mucus was pooled in a container and rectangular strip (about 3cm. in length and 1cm. in width) of palatal mucosa obtained by excision from mucus depleted frog palate was stood upright in the mucus. The weight of mucus carried by frog cilia against force of gravity for 5 minutes was measured. The weight percentage of the mucus, which was carried, to 100μl mucus was designated as Transported Amount of Mucus at 90 degrees (TAM-90). TAM-90 was 60.36±27.44% in CS mucus and 15.38±9.40% in A mucus. This difference was statistically significant (p<0.005). The results indicated that low viscoelastic mucus, such as A mucus, is not carried effectively by cilia in the load of gravity when the mucus is hypersecreted.
It has been said that the property of mucus is one of important factors for mucociliary transport mechanism. A useful system for studying mucociliary transport has been established by Sade: using bullfrogs, he measured mucociliary transport rate of the ciliated epithelium of the palate from which mucus has been depleted. On the mucus depleted palate of the bullfrog, mucociliary transport was dependent on the addition of an exogenous mucus. Nasal secretions were collected from the patients with chronic sinusitis, and the samples were pooled, dialized, lyophilized, and then reconstituted to various concentrations of nondializable solids in 0.15M NaCl. The measurements of mucociliary transport rate (MTR) on frog palate of 4% reconstituted mucus were repeated and were reproducible. The MTR on frog palate was stable at relative humidity between 58-100%. The fastest MTR on frog palate was noted at 25-35°C. The MTR on frog palate was maximum at 2.5% reconstituted mucus. At higher concentration MTR on frog palate was decreased and at 20%, mucociliary transport was not observed. Under the conditions of a load of gravity, at 45 or 90 degrees, MTR was decreased at 2.5, 4.0, and 15% reconstituted mucuses, repectively. Mucociliary transport was drastically decreased at 0.5% reconstituted mucus and mucociliary transport at 90 degrees was not observed. These results indicate that (a) mucus depleted palate of the bullfrog is simple and useful method for the evaluation of rheologic property of the mucus in mucociliary transport system, (b) the effective mucociliary clearance was obtained at the optimal concentration of the reconstituted mucus, and (c) the load of gravity had an important effect on the mucociliary transport in certain condition of the mucus.
It has been approved that the basophilic cells emigrate on the mucosal surface of nose and play an important role in the nasal manifestation of allergy. In this study, we counted the number of surface basophilic cells in 33 patients of chronic paranasal sinusitis with nasal polyps, in 18 patients of chronic paranasal sinusitis without nasal polyps and in 16 normal adults, and then the following results were obtained. 1) The basophilic cells were found in 5% of controls, in 11% of patients without nasal polyps and in 91% of patients with nasal polyps. (p<0.001) 2) In patients with the unilateral nasal polyps, the basophilic cells were increased only on the side with nasal polyps but not on the side without nasal polyp. There was a significant correlation between the positive basophilic cells and the presence of nasal polyps. (p<0.001) 3) Based on the results of allergic examination, the nasal polyps were classified into two types, i. e. allergic and non-allergic polyps. The majority of allergic polyps were bilateral and associated with a large number of basophilic cells. On the other hand, non-allergic polyps were mostly unilateral and had a small number of basophilic cells only on the side of polyp-formation. 4) The basophilic cells seemed to increase as a consequence of blockage of the airway but not as a cause of polyp-formation in non-allergic type.
Plasmin is one of the major fibrinolytic proteases and is activated by plasminogen activators and other proteases. It has been reported that there are many plasminogen activators in various tissues (heart, uterus and nasal mucosa) and in the external secretions such as urine and saliva, which are so called secretory activators. We have studied protease versus antiprotease system and protease inhibitors in nasal secretions which were collected from normal adults and patients with nasal allergy. The activity of total trypsin-like enzyme (amidase) was quantitated by the Eriksson's method and the activities of plasmingen activator and of streptokinase (SK)-reactive activator were determined by the fibrin plate method of Astrup. There was little plasmin, plasminogen and plasminogen activator in nasal secretion of both groups. However, the activity of SK-reactive activator was detected in both groups, and there was significant difference between control and allergy group (p<0.01). There was no relationship between the activity of SK-activator and the amount of albumin. Plasminogen purified from human plasma by lysine-sepharose affinity chromatography was activated to plasmin by urokinase (1000IU/ml). Fraction I of this chromatography was used as inhibitor fraction of the nasal secretion. It was not found that there was inhibitory activity against various proteases (plasmin, papain and trypsin) in the fraction I. Their fibrinolytic activity increased by adding the nasal secretion. Protease inhibitors in both groups were not detected by single radial immunodiffusion. α1-antitrypsin was detected by Ouchterlony's method in 6 of 10 samples from the normal group. Although abundant existence of plasminogen activator in the nasal mucosa has been reported, we could not detect plasminogen activator and other fibrinolytic activity in the nasal secretion retained in nasal cavity in this study. It is concluded from these data that fibrinolytic activity has no essential difference between in the nasal secretion of normal group and that of allergy group.
To determine the muscles responsible for the pumping function of the Eustachian tube and to examine the detailed processes of this function, 1) a measurement of the intratympanic pressure during swallowing and during electrical stimulation of the tensor veli palatini muscle (TVPM) and of the levator veli palatini muscle (LVPM), 2) microscopic and radiographic observations of fluid movement through the tube in open middle ear cavity, and 3) endoscopic observation of fluid clearance in closed middle ear cavity, were conducted in dogs, cats, and a monkey. The results were, 1) pressure drop in dilated tube by TVPM contraction, 2) displacement of the fluid from the tympanum into the tube by the negative pressure, and 3) expulsion of the fluid out of the tube to the pharynx by TVPM relaxation and tubal closure. It was concluded that TVPM contractions and relaxations cause the pumping-like function of the tube, which expells any fluid from the tympanum into the pharynx. However, it was also suggested that ventilatory function of the tube might be indispensable for fluid clearance in the closed middle ear cavity. To investigate the significance of the tensor tympani muscle (TTM) in tubal functions, 1) electromyographic and microscopic observation of TTM contraction, 2) a measurement of the intratympanic pressure both during independent TTM contraction and during combined contraction of TVPM and TTM, were conducted in cats. The results were 1) TTM contraction during swallowing did not result in any change of middle ear pressure. 2) TTM contraction by acoustic stimulation consistently raised middle ear pressure, but it failed to enhance the TVPM contraction for opening of the tube. It was concluded that TTM does not play any role in tubal functions.