The detection of lesions of the paranasal sinuses as incidental findings during magnetic resonance imaging of patients suspected of intracranial disease who have no nasal symptoms has been far more common than we expected. The present study was performed on 325 patients a mean age of 60.7 years. Medical histories were taken whether they had any nasal symptoms or not. Asymptomatic sinus disease was present in 41.6% of the 257 patients who had no nasal symptoms, and 9.7% of the patients had either marked mucosal thickening, excessive fluid or polyps in the maxillary sinuses. Although the mean age of these patients was comparatively high, we can infer that 1 in 10 have relatively severe sinus lesions. Mucociliary transport time was measured using the saccharin method in 15 patients who had sinus disease but no nasal symptoms. The mean transport time was 15.6 minutes and within normal limits. Routine ENT examination revealed no lesions in the nasal cavity of any of the subjects. We classified the patients with asymptomatic sinus disease into two groups; group A: patients with sinus disease associated with some nasal manifestations but who do not complain about them, group B: patients who have sinus disease but do not have any nasal problems. Group B represents genuine asymptomatic sinus disease in the narrow sense. Most asymptomatic patients in this study appeared to belong to group B. They had some sinus disease, but because their mucociliary function in their nasal cavity was normal, they did not have any nasal symptoms. When we find patients with asymptomatic sinus disease, we have to determine which group they belong to by examining their nasal cavity and measuring their saccharin time. Patients in group A should be medically treated, but those in group B should be followed without medical treatment.
Sixteen patients with lymphatic metastases to the neck and a histological diagnosis of undifferentiated carcinoma from an unknown primary lesion were assessed using immunohistochemical staining. The results revealed a non-epithelial tumor in 11 cases (malignant lymphoma in 5 cases) and an epithelial tumor in 3 cases. The patients with malignant lymphoma had a good outcome, but those with other non-epithelial tumors did not. Treatment of patients with an unknown primary tumor, especially undifferentiated carcinoma, should be carefully evaluated based on immunohistological examinations to identify malignant lymphoma.
Over the past twenty years hearing impairment has become widely recognized as one of the most important problems in the children with Down's syndrome. We have continued longitudinal observations of the hearing and speech development of children with Down's syndrome during the 10-year period from 1982 to 1991. One hundred ten children with Down's syndrome were examined and followed in the Department of Otolaryngology, Teikyo University Hospital. The examinations included otomicroscopy, behavioral audiometry, auditory brain stem response audiometry and tympanometry. Questionnaires were also administered to obtain information on the speech and hearing development of the children. In the present paper, we discuss assessment of hearing evaluation and the characteristics (degree, incidence, and types) of hearing impairment in Down's children. We divided the children into the following groups according to hearing acuities: 35 children with a normal hearing level (0-39dB), 54 children with a moderately impaired hearing level (40-79dB) and 21 children with a hearing level above 80dB, and in 12 of these 21 children the finding was unilateral, and the 9 remaining children was bilateral. Thus the incidence of hearing impairment with a threshold higher than 40dB was 68%. We detected otitis media with effusion (OME) in 34 (63%) of the 54 children with moderate hearing loss. Active treatment with medication or minor surgery, such as myringotomy or insertion of a ventilation tube, resulted in remarkable improvement in hearing in 26 children with OME. We used hearing aids for patients with prolonged otitis media and those with a hearing loss greater than 50dB in both ears. When their hearing acuity improved in response to appropriate medical care and the use of hearing aids, human-relations improved and speech development accelerated. We emphasize that appropriate medical care and management of hearing impairment, including the use of hearing aids, were required for both patients' emotional and linguistic development.
We previously found that an increased number of mast cells and eosinophils accumulated in nasal inverted papilloma and in the nasal mucosa of allergic subjects. Two subtypes of mast cells, i.e., mucosal mast cells and connective tissue mast cells are known to be present in the allergic nasal mucosa. Eosinophils in the allergic nasal mucosa are also heterogeneous. In addition, we demonstrated accumulation of formalin-sensitive mast cells at the tumor site of nasal inverted papilloma. The morphological characteristics and function of mast cells and eosinophils, however, have not yet been identified. The purpose of this study was to determine the ultrastructural characteristics of mast cells and eosinophils in relation to their function in tumor tissue. The results revealed two subtypes of mast cells in nasal inverted papilloma, one distributed mainly in the tumor site, the other mainly in the stromal site. These two subtypes of mast cells had different ultrastructural characteristics. In contrast to stromal mast cells, mast cells in the tumor site were characterized by a smaller cell diameter, fewer specific granules and a higher rate of degranulation. This suggested that they may have played some role in the pathogenesis of the tumor, however, their precise function is still unknown. In comparison with the mast cells in the allergic nasal mucosa, previously reported by Okuda et al, the mast cells in the tumor site were similar to those in the epithelial layer of the allergic nasal mucosa (MMCs), while mast cells in the stromal site resembled those in the lamina propria (CTMCs). There were no marked morphological differences between eosinophils in the tumor site and the stromal site. In conclusion, there were two subtypes of mast cells in nasal inverted papilloma suggesting that the microenvironment of this tumor of epithelial cell origin is related to the maturation and accumulation of mucosal mast cells.
Electronystagmography (ENG) has been widely used in physiological studies of eye movements. It is generally known that ENG is at a disadvantage in recording the vertical component of eye movements, and thus there has been a great deal of difficulty in physiological studies of vertical eye movements using ENG. The eye mark recorder is an instrument which has already been used in the study of visual point movement in various situations. We tried to apply the eye mark recorder to the recording of eye movements in normal volunteers, and then compared its recording characteristics with those of ENG. When recording vertical eye movements with the eye mark recorder there is little baseline drift and no confusing waves caused by blinking, which is sometimes misinterpreted as nystagmus. The result is easy calibration of the device and more accurate measurement of the slow-phase velocity of nystagmus than ENG. Recording with the eye mark recorder is atraumatic and allows binocular visual stimulation. There are certain other techniques, such as search coil or video oculography, which allow more accurate recording of vertical eye movements than ENG. The search coil techniques, however, requires the attachment of a measuring contact lens during the examination and video oculography is still in development process, so both of them are difficult to use widely. Thus, we found that the eye mark recorder has a great advantage in recording the slow-phase eye velocity of vertical nystagmus and the vertical component of smooth eye movements in humans. We think that eye mark recorder can serve as a powerful new tool to investigate vertical OKN and OKAN.
Three-dimentional (3D)-CT was introduced to represent abnormal findings in the temporal bone area utilizing a SOMATOM DRH CT scanner with accessory 3D reconstruction software and an exclusive high-speed 3D processing system, VOXEL FLINGER. In a patient with eosinophilic granuloma, a defect in the squamous part of the temporal bone was demonstrated suggesting exposure of the dura mater during surgery. In a patient with a normal ear, well-developed mastoid cavity, a part of the handle and the head of the malleus, the incudomalleal joint, the short limb, body and a part of the long limb of the incus and the round window niche were demonstrated. In a case of chronic otitis media, poorly developed mastoid cavity and a possible defect of the tip of the long limb of the incus were demonstrated, in contrast to the patient with the normal ear. 3D-CT yields objective and solid images which are useful for diagnosis, treatment planning and explanation of the pathology to patients and their family. To obtain convincing 3D images, physicians themselves have to choose exact rotation angles. It is not adequate to reconstruct original CT data using a CT computer with accessory 3D software whose processing capability is not good enough for this purpose. The conclusion is as follows: 1) it is necessary and effective to transfer original CT data into the memory of the exclusive high-speed 3D processing system and 2) process the data by the voxel memory method to establish a clinically valuable 3D-CT imaging system.
Forty-two patients with non-Hodgkin's lymphoma were treated between October 1983 and December 1992 in the department of Otolaryngology, Kagawa Medical School Hospital. The twenty-six of these patients whose tumor originated in Waldeyer's ring and who were diagnosed as Stage I or II have been reviewed. In principle, method of treatment was a combination of chemotherapy and radiotherapy. Between 1983 to 1987, COP was primarily used (9 cases) as combination chemotherapy, and after 1988 CHOP was used (17 cases). VAMA was used to treat the poor response and recurring cases. The five-year estimated overall survival rates calculated by the Kaplan-Meier method were 33.3% and 94.1% in the COP and CHOP groups, respectively. We investigated age, stage, cell type and grade, as factors related to recovery, but except for cell type, there were no significant differences in overall survival. The most serious side effect was decreased leucocyte count, but we prescribed G-CSF and were able to continue treatment.
Cellular DNA content and succinate dehydrogenase activity of 92 human head and neck (34 laryngeal, 24 pharyngeal, 21 oral cavity, 13 maxillary) squamous cell carcinomas were examined, and DNA ploidy status and chemosensitivity were analyzed and compared. DNA aneuploidy was observed in 54 tumors (58.7%). The aneuploid pattern was most common in tumors of the maxillary sinus (84.%), and least common in tumors of the larynx (41.3%). Histologically, aneuploidy was detected in 71.4% of poorly-differentiated, 63.8% of moderately-differentiated and 37.5% of well-differentiated squamous cell carcinomas. There was a statistically significant difference between the survival rates of patients with diploid and aneuploid patterns. Chemosensitivity was determined by exposing fresh tumor material to five antitumor drugs: adriamycin (ADM), cisplatin (CDDP), carboquone (CQ), 5-fluorouracil (5-FU) and mitomycin C (MMC). The average decrease in succinate dehydrogenase (SD) activity was 49.8% with ADM, 33.6% with CDDP, 39.9% with CQ 68.4% with 5-FU and 45.5% with MMC. Histologically, poorly-differentiated squamous cell carcinomas were most sensitive to these five antitumor drugs. We also compared average SD activity in tumors from different organs and found that pharyngeal tumors tend to be most sensitive to these drugs, except for MMC. The chemosensitivity of a tumor with DNA diploidy tended to be higher among well- and moderately-differentiated squamous cell carcinomas. In contrast, tumors with DNA aneuploidy tended to have higher chemosensitivity in the poorly-differentiated type. The results of this study indicate that simultaneous analysis of DNA ploidy and chemosensitivity will be helpful in understanding the characteristics of tumors as well as in predicting the most effective chemotherapy agents for head and neck cancer patients.
Aerosol therapy has been widely used for upper and lower airway diseases. However, maximal permissible concentrations of drugs have not yet been clarified. The purpose of this study was to find the maximal drug concentration for transnasal medication that does not inhibit ciliary activity or tissue. Human paranasal sinus mucosa taken at surgery was cut into small pieces. These were cultured in RPMI-1640 medium under the conditions of 5% CO2 and 100% relative humidity at 37°C. Histopathologic damage was observed under a microscope at 400×magnification. The rate of ciliary beating was measured by a photoelectric method with a cadmium sulphite photometer. In order to compare the findings with those of repeated clinical nebulizer therapy, drug application once a day for 3 days and combined use with steroids were examined for 30min, considering maximal retention time of the drugs in the nasal cavity as an aerosol therapy. The maximal permissible concentrations of several drugs in single use obtained by these experiments were as follows: acetylcysteine 4.4%, tyloxapol 0.03%, sodium cromoglycate 4%, Broncasma Berna® 2 times, prednisolone 1%, dexamethasone 0.2%, betamethasone 0.4%, kanamycin 20%, gentamicine 1%, amikasine 4%, dibekasin 4%, astromysin 4%, fosfomycin 3%, clindamycin 3%, ampicillin 10%, cefazolin 5%, and lidocaine 0.01%. When antibiotics and ateroids were used at the same time, the ciliary activity and the tissue were damaged more strongly than with single use. Therefore, the maximal concentration of some drugs has to be reduced. For example, the maximal concentration of prednisolone, 1%, was reduced to 0.2%, and that of kanamycin, 20%, was changed to 10%.
Recent studies have shown that inactivation of tumor suppressor p53 gene is a key point in the development of human carcinomas and that normal p53 protein acts as a "molecular policeman" monitoring the integrity of the genome. In the present study, a series of 22 primary human salivary gland carcinomas were examined for alterations and expression of the p53 gene by a combined molecular and immunohistochemical approach, polymerase chain reaction single-strand conforma tion polymorphism (PCR-SSCP), direct gene sequencing and p53 protein immunostaining. In addition, in order to identify correlations between p53 abnormalities and genetic instability, DNA aneuploidy and tumor growth characteristics were analyzed by cytofluorometry and the AgNOR technique. Seven of the 22 cases displayed nuclear p53 overexpression as revealed by immuno staining with p53 monoclonal antibody (Do-7), and 2 of these 7 cases were associated with the presence of point mutations [codon 140: ACC (Thr)→ATC (Ile), codon 175: CGC (Arg)→CAC (His)] of the p53 gene. Twelve of the 22 cases were aneuploid on the DNA histogram, and this phenomenon was statistically correlated with the 7 cases exhibiting p53 nuclear accumulation. AgNOR staining, on the other hand, was not statistically correlated with p53 abnormalities. These findings support the view that abnormal nuclear accumulation of the p53 protein is correlated with genetic instability of human salivary gland carcinoma cells.