Two cases of angiofibroma that occurred in different areas are reported.
Case one: A 55-year-old woman who complained of repeated epistaxis and nasal obstruction on the right side. Magnetic resonance imaging (MRI) examination showed a homogeneous solid mass without flow-void pattern occupying the right nasal cavity.
Case two: A 20-year-old man complained of persistent epistaxis. MRI examination showed a large solid mass with flow-void pattern originating from rich capillary proliferation in the nasopharynx. The tumor was removed incompletely because of massive bleeding. Although the histopathological diagnosis was angiofibroma in both cases, there were some differences between them. The tumor in case one was composed of loose fibro-proliferative tissue with capillary and myxoid degeneration, whereas that in case two was composed of thick proliferation of a fibroblasts and capillaies. It seems that differences in imaging and clinical findings reflected the differences in histological findings.

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In order to examine a possible difference in the number of H₂ receptors in the inferior nasal choncha mucous between groups with and without nasal allergy, a histamine H₂ receptor binding assay was attempted in human inferior nasal choncha mucous (n=46). In the receptor binding assay for the above-mentioned cell membrane specimens using ³H-tiotidine, high-and low-affinity regions were observed according to its concentration.
B_max (maximum binding volume) was 38.5±5.2 and 26.8±3.4fmol/mg protein in nasal allergic and nonallergic groups, respectively, showing a significant by higher values in the former group (P<0.05). No difference was evident in thce KD value (affinity).
In patients with nasal allergy, B_max was 41.1±5.9 in the group below 41 years of age and 29.0±19.1fmol/mg protein in the group above 40 years of age. No difference was, however, observed between the two age groups.
It is well-known that the histamine H₂ receptor is involved in the negative feedback mechanism that accurs during histamine release.
The experimental results indicated that histamine H₂ receptors changed in number in response to the occurrence of allergic rhinitis, possibly playing a role in the suppression of type I allergic rhinitis.

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We investigated the pathophysiological aspects of chronic sinusitis in view of 1) the effects of chronic sinusitis on the lower respiratory tract, 2) histopathological findings with special reference to adhesion molecules, 3) the inhibitory effects of medical treatment on nasal secretion, and 4) underlying mechanisms of recovery of mucociliary function following endoscopic sinus surgery, and revealed the following.
1) Chronic sinusitis is a triggering factor for bronchial hyperresponsiveness.
2) Inflammatory cells in the sinus mucosa were infiltrated by ICAM-1.
3) Hyperrhinorrhea is reduced by the inhibitory effects of a variety of drugs on ion transport.
4) Recovery of mucociliary function in the maxillary mucosa was confirmed.

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The measurement of nasal resistance is important for understanding the pathophysiology of nasal obstruction. However, it is difficult to define the normal range of nasal resistance because of physiological factors. Several authors have reported that nasal resistance is not correlated with the sensation of nasal obstruction.
On the other hand, acoustic rhinometry was introduced by Hilberg et al. (1989) to assess the geometry of the nasal cavity. This method, which is based on sound reflection analysis, provides an estimate of the cross-sectional area of the nasal cavity as a function of the distance from the nostril. Recently, the measurement of acoustic rhinometry is also becoming popular in our country. However, assessment by acoustic rhinometry may be different from that using nasal resistance because the cross-sectional area is measured without air flow.
The aim of this study is to investigate the physiological meaning of acoustic rhinometry in comparison with rhinomanometry and Rhinograph.
Both rhinomanometry and Rhinograph are good methods for understanding respiratory function in patients with nasal obstruction. However, they are unable to diagnose the location of obstruction in the nasal cavity with those methods.
On the other hand, acoustic rhinometry enables the quantitative measurement of size and location. However, the cross-sectional area must be measured without air flow. In normal subjects the minimal cross-sectional area and volume of the nasal cavity (from nostril to 32mm) were significantly correlated with nasal resistance (P<0.001).
In the next study, changes in nasal resistance and the area-distance curve were measured with exercise in a patient with allergic rhinitis. The left side of nasal resistance was increased 20 minutes after exercise, and the patient subjectively complained of difficulty in breathing on the left side of the nasal cavity. It was helpful to understand the change in the area and location in nasal cavity with exercise. However, it was difficult to evaluate nasal breathing, because the patient was ordered to breathe through the mouth.
These results suggest that acoustic rhinometry has a different function of evaluation of nasal physiology compared with rhinometry and Rhinograph. Namely, rhinomanometry and Rhinograph are objective dynamic methods expressing characteristcs of air flow, and acoustic rhinometry provides the cross-sectional area of the nasal cavity. Therefore, it is more helpful to use both of these methods to evaluate nasal obstruction.

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ニュージーランド白色兎の上顎洞粘膜の再生における形態学的変化を検討するために実験をおこなった。上顎洞の中央部で, 直径4mmの円形に粘膜を除去し, この部位に再生した上顎洞粘膜を1日後, 3日後, 5日後, 7日後, 14日後, 28日後に摘出した。摘出標本を Con A, DBA, RCA-I, SBA, UEA-I, WGA で免疫染色して検討した。 再生した上顎洞粘膜の線毛上皮は, 28日後の標本ではほとんど正常であった。レクチン結合パターンは, 14日後には回復した。これらの所見は, 分泌細胞や杯細胞は線毛上皮細胞より形態学的に早く回復することを示唆している。

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Nasal patency is usually expressed by nasal resistance. However, nasal resistance is not the same throughout the total respiratory cycle. Therefore, a reference point for expressing resistance is necessary for the comparison of the data. Although the International Committee for the Standardization of Rhinomanometry has attempted to provide a definite reference point, it has not yet reached a final consensus. This is one of the reasons why rhinomanometory has not generally been used in clinical practice.
There have been three main methods of assessing nasal patency by evaluating an entjre pressureflow curve. They are determination of the effective cross-sectional area, Broms' method and percent expression. To clarify the significance of pressure-flow curves, these methods were compared. A series of pressure-flow curves through cross-sectional areas from 0.2 to 1.0cm² were obtained. From each curve, percentage values and the v₀ of Broms' method were calculated. v₀ values did not correlate with the cross-sectional areas and were too small to compare with each other when the cross-sectional area exceeded 0.4cm². On the other hand, the percentage values exhibited strong correlation with the cross-sectional areas even though one standard curve was changed to others. From these results, it was suggestjd that percent expression was convenient for the mutual comparison of the pressure-flow curves.

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The clinical significance of the osteomeatal complex has been deeply appreciated among otolaryngologists due to the increasing popularity of functional endoscopic sinus surgery in recent years. In this study, we have examined the morphological features of surface epithelium covering this area in 35 cases with chronic sinusitis. Surface cell types were identified and thier relative proportion was measured by using scanning electron microscopy (SEM). Coronal CT scan assessment was achieved preoperatively in every case, and disease extent of each sinus system including the presence of anatomic variants was scored in compliance with the staging system proposed by Lund and Mackay (1993).
Severity of the pathological changes to surface epithelium in the osteomeatal complex was categorized into three groups on the basis of the relative dominance of the ciliated cells (more than 80%, 50 to 80% and less than 50%). The average values of radiological grading scores in the three group were 3.53±1.2SD, 6.5±1.5SD and 9.16±1.9SD respectively, and statistical differences were noted between the groups. The osteomeatal unit has been considered as the key region for mucociliary drainage from anterior paranasal sinuses. Our results showed a close relationship between pathological changes in this area and the degree of disease extension to the peripheral sinuses. This fact might also support Messerklinger's basic FESS concept that most infections of the larger sinuses are rhinogenic.

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To determine the relationship between nasal allergy and atopic dermatitis, which are major allergies, we retrospectively investigated 760 cases of nasal allergy in the Department of Otolaryngology, Fujita Health University, and 838 cases of atopic dermatitis in the Department of Dermatology of the same university. Fifty-six (7.4%) nasal allergy cases were accompanied with atopic dermatitis, and atopic dermatitis with nasal allergy was seen in 197 cases (23.5%). The onset of atopic dermatitis occurred at a younger age than nasal allergy. The clinical characteristics of the cases of nasal allergy with atopic dermatitis were perennial attack, sensitization to house dust, and higher levels of serum total IgE.
Another prospective study of 42 nasal allergy cases accompanying atopic dermatitis in otolaryngology and 25 cases of atopic dermatitis accompanying nasal allergy in dermatology showed simultaneous changes in attacks in 30-50% of the cases. One quarter of the 42 otolaryngology patients showed aggravation in the spring pollen season.
Foods affected mainly atopic dermatitis in both the prospective and retrospective studies.

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The incidence of elderly persons among outpatients with nasal diseases is increasing. In the present paper, clinical studies of nasal diseases, especially chronic sinusitis, were performed in elderly patients (60y/o or more) who visited the outpatient clinic of the Department of Otolaryngology, Niigata University School of Medicine, during the 5-year period from 1989 through 1993.
The results were as follows.
1. Chronic sinusitis was the most prevalent disease in elderly persons (49.4%), and only a few patients (2.0%) suffered from allergic rhinitis, the most prevalent disease in young adults (32.4%).
2. Postnasal drip was the prominent symptom (20.5%) in elderly persons.
3. Rather high percentages of complications were noted. Hypertension was seen most frequent (36.6%), followed by respiratory (16.9%) and circulatory (11.2%) diseases.
4. The majority of elderly persons requested treatment for the sinusitis itself. The preferred mode of treatment was regional therapy, and neither systemic medication nor surgery was preferred.

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A case of nodular fasciitis is reported. The patient was a 7-year-old boy who complained of a painless swelling in his left zygomatic bone region. On histologic examination, a non-malignant tumor was detected. Three months later, the tumor was removed under general anesthesia. The final histological diagnosis was nodular fasciitis. This tumor was invasive to bone tissue and so bone wax was filled in the defective area of the zygomatic bone. Regrowth of the mass in the same area occurred about one year after the first operation. This distention was removed surgically again and histologically diagnosed as cyst derived from the foreign body reaction of bone wax. The defective space was reconstructed by using his own temporal bone patty. There has been no recurrence for two years after surgery.

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It is generally known that histamine and peptide leukotrienes (LTs) are important chemical mediators in nasal allergy. However, the extent to which they are involved in swelling of the nasal mucosa still remains to be investigated. The main causes of the mucosal swelling are thought to be dilatation of capacitance vessels and submucosal edema.
To elucidate the effects of histamine and LTs on this vasodilatation and edema by increased vasopermeability, a histamine antagonist (H₁ antagonist; Mequitazine) was administered to 32 perennial allergy patients for 5 days, and after a 7-day wash-out period, a peptide leukotrienes antagonist (LTs antagonist; ONO-1078) was also administered to these patients for 5 consecutive days. During these periods the patients recorded the number of times a day they sneezed and blew their nose, and the grade of nasal obstruction. Rhinomanometry was performed before and after administration of the histamine antagonist and LTs antagonist, as described below.
Rhinomanometry was performed 1) before extensive treadmill exercise for 10 minutes, 2) immediately after the exercise, 3) 10 minutes after the exercise, 4) 30 minutes after the exercise and before provocation with HD for 10 minutes, 5) immediately after provocation, 6) 20 minutes after provocation and immediately before the second 10-minute extensive exercise session, 7) immediately after the second exercise session, and 8) 30 minutes after the second exercise session.
Results
1. The number of daily sneezed and nose blows decreased significantly after administration of the H₁ antagonist. The number of sneezed and the weight of nasal secretions after provocation with the HD also significantly decreased, but there was no significant difference in mucosal swelling after provocation when estimated rhinomanometrically.
2. The LTs antagonist was not effective against HD challenge-induced sneezing and nasal discharge. However, mucosal swelling 10 and 20 minutes after provocation, and immediately after the second exercise session decreased significantly.
Conclusion
The results of the present study suggest that histamine released by basophilic cells mainly affects sensory nerve endings, resulting in sneezing and nasal discharge, and only partially affects the nasal vasculature causing mucosal swelling.
In contrast, LTs appear to mainly affect the nasal vasculature and cause mucosal swelling.

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Nasal diseases in patients over 60 years old
Between 1910 and 1990, the number of elderly outpatients (over 60 years old) visiting the Department of Otolaryngology, Kyushu University greatly increased. We selected the case records of elderly patients (over 60 years old) with a diagnosis of deviated nasal septum, epistaxis, chronic rhinitis including allergic rhinitis, nasal polyp, chronic sinusitis, cysts and tumors of the nose and sinuses from among the outpatient records for 1910, 1920, 1931, 1941, 1950, 1960, 1970, 1980 and 1990. We counted the number of patients with each nasal disease and calculated the ratio of the number of patients with each nasal disease to the total number of elderly patients that year.
The number of patients with de viated nasal septum and hypertrophic rhinitis decreased during the period. The number of the patients with nasal polyps did not change. The number of patients with epistaxis, allergic rhinitis, chronic sinusitis and cysts, and of patients being followed after tumor therapy increased during the period, but the ratios of patients with each of these diseases to the total number of elderly patients decreased, the only exception being allergic rhinitis. Allergic rhinitis was the only nasal disease whose incidence seemed to increase among elderly patients.

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Histamine is a potent mediator of nasal inflammatory and allergic reactions. It is vasoactive, mediating vasodilation and plasma extravasation, and it promotes eosinophil migration.
In this study, expression of the histamine receptor gene in eosinophils and endothelial cells was investigated using the reverse transcription-polymerase chain reaction. We detected histamine H1 receptor (H1R) mRNA in endothelial cells isolated from the nasal mucosa of patients with nasal allergy and patients with nonallergic rhinitis. There was no diffference between the amount of H1R gene expression in the two groups. We were unable to detect H2R mRNA in endothelial cells from either patients with nasal allergy or nonallergic rhinitis. Neither H1R nor H2R was defected in eosinophils isolated from peripheral blood. The effect of cytokines on H1R and H2R gene expression was investigated. Interleukin (IL)-2, IL-3, IL-4, IL-5, tumor necrosis factor-α and granulocyte colony stimulating factor did not alter H1R or H2R gene expression. These findings have raised the possibility that histamine stimulates endothelial cells via the H1R but not the H2R. The class of histamine receptor in eosinophils has not been identified.

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In North America we have particularly witnessed revolutionary advances in the management of myeloproliferative disorders (ie the leukemias), continued refinements in the management of certain metabolic disorders (ie diabetes) and successful treatment of organ failure by transplantation. Increased survial rates however have been accompanied by the patients who are either inherently or iatrogenically immunocompromised. Although distinctly different disease entities may be involved, all immunocompromised patients share a common final pathway; that being the development of grave and life-threatening complications in clinical situations which would have been easily treated in patients with a normal immune system.
Sinusitis is not generally thought to be a serious condition but in an immunocompromised host it may ultimately prove lethal as the characteristic findings of purulent rhinorrhea, percussion tenderness, facial pain and edema are subtle or entirely absent. As a result, in this patient population, disease may spread insidiously until a fulminant picture with necrosis and infarction of the mid face, orbital contents and the cavernous sinus has occurred. Early recognition and aggressive treatment is therefore imperative if the patient is to survive.

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Messerklinger's extensive investigation into the anatomy, mucociliary clearance mechanism and pathology of recurrent sinusitis has clearly demonstrated that most infections of the paranasal sinuses are of rhinogenic origin. These infections which begin inside the nose spread into the paranasal sinuses.
Messerklinger's research clearly demonstrated that the health of the larger paranasal sinuses is completely dependent upon their pre-chambers through which they are connected to the anterior ethmoid and to the nasal cavity.
Messerklinger's surgical concepts have revolutionized the surgical treatment of patients with recurring sinusitis by enabling the surgeon to carry out a specifically targetted minimally invasive and functional endoscopic surgical resection.

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