Recently, a rapid immunohistochemical technique without the radioisotope have been developed in which a thymidine analogue, 5-brome-2′-deoxyuridine (BrdU), is incorporated into replicating DNA and subsequently localized using a specific monoclonal antibody. Cell dynamics of olfactory mucosa in mice were investigated by means of immunohistochemical technique. The labelled elements were concentrated at the basal layer of the epithelium, which were observed 1hr after the first injection, and the labelling index were 7.2±3.0%. At 14 days after administration of BrdU, the labelled elements were immigrated in the midlayer of the epithelium, where can be recognized as the compartment of nerve cells. After 30 days, the labelled cells disappeared from the epithelium. It indicates that the period of turnover in the olfactory epithelium of mice are within 30 days. Seven days after axotomy of the olfactory nerves, the labelling index significantly increased to 11.6±2.6%. Next, the localizations of N-CAM (neural cell adhesion molecule), MAP5 (microtubule associated protein 5), NSE (neuron-specific enolase) were studied in the mouse olfactory epithelium. N-CAM and MAP5 immuno-positive stainings were exclusively found in the basal layer of the epithelium and axons in the lamina propria. In contrast, mature neurons located in the upper layer were stained with anti-NSE antibody. It is indicated that the difference of immunostaining localizations reflects the maturity of the olfactory neurons.
We have examined the influence of preservation before fixation and the procedure of making permanent section on the staining properties of mast cells in human nasal mucosa. Operative specimens of human nasal mucosa was fixed in MLA (Mota's basic lead acetate fixative). And sections were stained with toluidine blue solution. 1. The influence of preservation of specimen in saline upon the stainability of mast cells. Before fixation a part of specimen was rinsed and preserved in saline for 1 hr. Another part of specimen was fixed directly in MLA without preserving in saline. There was no significant differnce of mast cell counts whether specimen was preserved in saline before fixation or not. 2. The influence of mounting procedure on the staining property of mast cells. After fixation in Mota's BLA fixative, sections were stained with toluidine blue PH0.5. One drop of toluidine blue was put on the section and immediately mast cell count was done for 20min. After counting mast cells, the same section was rinsed in water and taken through graded alcohls to xylene and mounted in coverbond malinol. Then mast cell counting was done again. The number of mast cells in permanent section were fewer than that of mast cells counted immediately after staining. About 20% of mast cell stainability was reduced after mounting procedure. The reduction of stainability was seen in epithelial layer and in lamina propria at same grade.
Several factors are known to affect the mucociliary transport system. Among them this study was focused on the mucous blanket. By virtue of monoclonal antibodies two carbohydrate structures, sialosyl I and sialosyl difucosyl Lex, were detected in the glycocaryx of ciliated cells. These sugar chain generated negative charge on the surface of cilia and seemed to play some roles in preventing fusion of cilia. Several histochemical study also demonstrated several structures in the periciliary fluid layer, which were fibriler links between cilia, connection between ciliary glycocalyx and frame works of outer mucous, and surfactant-like structures. These structures are supposed to play specialized roles in the mucociliary transport system and the lack of any structures will cause a deteriorated mucociliary clearance.
The long term Erythromycin (EM) therapy has been reported as useful in chronic respiratory tract disease including chronic sinusitis. We investigated the clinical effects of long term EM derivative, Clarithromycin (CAM) therapy for chronic sinusitis. Twenty-three adults were treated with 400mg of CAM per day and 11 children were treated with 100 or 200mg of CAM per day for 4 to 12 weeks. 1) Total improvement rate of symptoms and rhinoscopic findings were estimated in 56.5% of adults and in 72.7% of children. 2) The Saccharin time was examined before and after the therapy. The CAM therapy reduced significantly the saccharin time, namely CAM improving mucociliary transport function. 3) The clinical effects depended on the term of the therapy within 12 weeks. Longer therapeutic term which exceeds 12 weeks may improve the clinical results. 4) The clinical effects tended to appear earlier in the CAM therapy than in the EM therapy. 5) No significant side effects were noted during the therapy. EM derivative, CAM was useful for the treatment of chronic sinusitis as well as EM.
We have performed the maxillary sinus irrigation with Schmidt's maxillary sinus trocar and sinus irrigation with YAMIK on the patients with chronic sinusitis, and compared the effects of them. There was no apparent difference of the effect between both methods as a result of the synthetic judgment, but YAMIK method was more effective on postnasal drip and dysosmia, on the other hand Schmidt's method was more effective on nasal obstruction and headache. There was no different effect on rhinorrhea between them. Judging by X-ray findings, Schmidt's method had an effect on maxillary sinusitis, and YAMIK method had an effect on ethomoid sinusitis. YAMIK method had much effect even on postnasal drip of the postoperative patients. We suppose that we should examine X-ray findings, and perform Schmidt's method on the patients with severe maxillary sinusitis. YAMIK method on the patients with severe ethomoid sinusitis, moreover both methods on the patients with severe maxillary and ethomoid sinusitis. We should try YAMIK method on the patients complaining postnasal drip without regard to X-ray findings.
Recently, there are some procedures which will maintain the function of sinuses. We have applied to the methods using the physical energy for the treatment of chronic sinusitis. They consist in the endonasal and extranasal surgeries using laser tevhnology, the localized hyperthermia therapy, and the physical therapy using the interference low frequency (ILF). The laser antrostomy, the laser polypectomy, and the laser turbinectomy will improve the patency of the nasal cavity and the fontanella. The localized hyperthermia will increase the blood flow of nasal mucosa and inhibit allergic reaction in patients with nasal allergy. The ILF will stimulate nasal discharge by the alternation of reological status. The results indicate that these methods will be useful for a mean of the treatment of chronic sinusitis, while might not be enough effect independently.
This study was designed to evaluate the efficacy of various therapies in chronic sinusitis. The general effectiveness of a treatment on subjective symptoms and rhinoscopic observations was determined by the same protocol in cooperation with different clinics. It was 40% in adult and 18% in pediatric patients who received an antibiotics and a steroid by aerosol through the nose. Nasal mucociliary clearance was measured by the scaccharin method. In this method, 50% of a saccharin granule was placed on a nasal septal mucosa just below the antero-inferior tip of a middle terbinate and measured the time between placing the saccharin and the moment when the subject tested its sweetness on swallowing. The patients who received repeated antral lavage improved their decelerated nasal mucociliary clearance. Since the patients with chronic sinusitis complain hypersecreted viscous nasal discharge, results from the rheological measurement of nasal mucus is an important parameter of a therapy. The elasticity and the viscosity of nasal mucus were determined by an oscillating sphere magnetic rheometer. The measurement of x-ray opacity of a maxillary sinus by microdensitometer is useful for quantitative evaluation of pathologic conditions of the sinus. In both the maxillary sinuses treated by aerosol through the nose and sinuses which received topical application of an antibiotics, the ratio of a maxillary sinus density to the same side of orbital density (M/O ratio) in post-treatments was significantly improved compared with that in pre-treatments.
Jikei university School of medicine, Kashiwa hospital. At the present time, operations on children for sinusitis are not common. However, we have performed this operation since a couple of years ago and have spoken about the method and its results several times at recent meetings. In this study, we evaluated the result of pediatric sinus surgery by using several markers for example rheological properties, nasal resistance, nasal clearance. These results show that pediatric sinusitis surgery is significantly effective at 6 months after operation. But, just the results of rhelogical properties of them did not improve at that time. These results show that pediatric sinusitis is not completely cured 6 months after the operation. We think that all of the patients of pediatric sinusitis will be perfectly cured about 2 years after this operation.
The Nd: YAG laser is used because of its ability to combine its flexible laser fibers with nasal endoscopes. The Nd: YAG is mainly a vaporizing and coagulating laser. Our experiences at our hospital in the management of endoscopic sinonasal diseases with YAG laser are reviewed. The charts of 27 patients who underwent endoscopic surgery with laser from October 1991 through May 1992 were reviewed and were displayed by a VTR-system. The laser fibers may be inserted into channels that are part of a sheath through which the fiberscope may pass or may be taped with the rigid endoscope. The mean age was 41 years (5 years old to 74 years old). 18 patients had chronic sinusitis. 5 of 27 patients had allergic rhinitis. YAG laser, coupled with a 4mm Storz endoscope or flexible fiberscope was used at a spot size. Almost all patients were relieved of a nasal obstruction, and 8 patients reported fewer complaints of nasal discharge or choanal drip. Concerning plain X-ray findings, only 3 cases revealed diminished shadows. 95% of the patients obtained a significantly improved or completely free nasal airway. Using the endoscope, the pyogenic polypose mass can be removed afterward vaporizing and coagulating the tissue. In the case of a polypose mass which may be extensive, and partially blocks, the nasal cavity or middle meatus, foramen fontanelle can be removed eventually by a lasser.
From the point of view that the naso-paranasal sinus is a single organ, the fundamental and clinical experiments were performed to examine the instruments making the nebulizer therapy for paranasal sinusitis more effective, and how to use, and the following results were gained. 1. According to the experiment that the deposition parts of aerosol particles were examined of a pig ment in the human modeled nasal cavity and of a Tc-isotope in the nasal cavity of heal-thy adults, the instruments of the jet and the ultrasonic nebulizer gave the most steady deposition of aerosol particles at the middle nasal meatus in various kinds of nebulizer instruments on the market. 2. If the case is that the ultrasonic nebulizer therapy can improve the lesion of the middle nasal cavity, it can also improve the lesion of the paranasal sinusits. 3. After making the middle nasal meatus open by improving its lesion by the nebulizer therapy or the operation, the deposition concentration of the used drug at the maxillary sinus mucosa was higher than that in the case of the unopened middle nasal meatus. 4. The histolgical improvement of the paranasal sinus muxosa injuried by experimental allergic paranasal sinusitis was demonstrated both light and electron microscopically after the ultra-sonic nebulizer therapy of steroid. 5. The nebulizer instrument with adding a pressure showed a lower deposition rate but a larger amount of deposit in the paranasal sinus than that with both a pressure and a vibration. 6. According to the comparative study of the radiolucency of the X-ray shadow of the maxillary sinus before and after the nebulizer therapy with or without adding a pressure for paranasal sinusitis, the nebulizer therapy with a pressure showed a significantly higher rate of improvement. 7. From the above results, after improving the lesion of the middle nasal meatus by the jet or the ultrasonic nebulizer therapy or by the operation, the further nebulizer therapy can improve the lesion of paranasal sinusitis. Moreover, the nebulizer instrument with adding a pressure can give more deposit of drugs in the paranasal sinus and make the lesion of paranasal sinusitis more impro ved.
Ameloblastoma is generally considered to be a benign tumor, but it often recurs postoperatively, and in a few cases malignant changes have been reported. We treated a 64-year-old male with an ameloblastoma of the right maxilla which recurred in the left maxilla 1 year later. The first symptom was swelling of the right cheek. He had a severe respiratory disorder as a complication. Therefore at first operation the tumor was removed along with its capsule. But the capsule adhered to the nasal septum, so the tumor was removed with bone of the palate at the adhesion. One year after the operation, the tumor recurred in the left maxilla. The tumor was removed along with the capsule again, because the patient still suffered from the severe respiratory disorder. His postoperative course was followed for 1 year sfter the second operation, but he died of an asthma attack.
Angiofibroma arising from portions other than the nasopharynx is very rare, but recently there have been several reports of this kind of tumor. A very rare case of angiofibroma arising from the middle turbinate in a 15-year-old female who complained of severe epistaxis is reported. A gray-white mass with a smooth surface which originated from the middle turbinate occupied the posterior part of the right nasal cavity and nasopharynx. Computed tomography showed no tumor extension into the other portion. The tumor was removed by transantral approach under local anesthesia. There has been no recurence for 11 months postoperatively.