We report a case of embryonal rhabdomyosarcoma originating in the right ethmoidal sinus. A 68-year old man reporting right cheek swelling and epiphora for 2 months was found in computed tomography to have a tumor in the right ethmoidal sinus and bilateral neck lymph nodes metastasis. Bone scintigraphy showed metastasis to the ribs. We treated him with irradiation and chemotherapy. The chemotherapy protocol was CYVADIC (cyclophosphamide, vincristine, adriamycin, dacarbazine). He underwent chemotherapy 5 times but the tumor was not controlled. Imatinib mesilate (Glivec^®) is a new drug targeting mutations of the c-kit gene that can have therapeutic effects in gastrointestinal stromal tumors and leukemia. We tried imatinib mesilate because the tumor showed positive staining for c-kit. The drug was not effective, but gene-targeting drugs such as imatinib mesilate may be useful for patients with malignant tumors because there are many such c-kit positive tumors.

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A 58-year-old man was found on casual examination to have a small bony mass in the left nasal cavity attached to the left inferior nasal concha from the base of the nose. He had no history of nasal trauma or surgery. Computed tomography showed a bony mass in the left nasal cavity. The mass was easily removed by an intranasal approach under general anesthesia. It was 18.5×3.5mm. Histological examination showed the extracted specimen to contain dentin. The patient's teeth were intact and the projection was thus thought to be a supernumerary tooth. No symptoms were noted after removal.
Since 1901, 141 cases of inverted tooth eruption into the nasal cavity, including ours, have been reported in the Japanese literature.

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We recently treated a patient with a bleeding nasal polyp that was localized in the nasal cavity. Since its histological features, such as an admixture of capillary congestion, dilated vessels, hemorrhage, and fibrin exudation, which resembled those of hematoma-like mass of the maxillary sinus (HLMMS), which we previously reported; the polyp was diagnosed as a hematoma-like mass of the nasal cavity. The finding that the most frequent site of attachment of the hematoma-like masses in our patients was near the ostium of the maxillary sinus suggests that the masses arose from in that site. The present findings led us to propose the following hypothesis to explain the pathogenesis of hematoma-like mass. Dysfunction of venous return at the ostium of the maxillary sinus leads to capillary and venous congestion in the mucosa, and the vessels become dilated and partially discontinuous. Despite leakage of red blood cells and fibrinogen from these discontinuous vessels, fibrin does not replace collagen, because these conditions do not mobilize inflammatory cells. These conditions cause a hematoma-like mass expansion in the maxillary sinus or the nasal cavity or the maxillary sinus.

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In recent years, a new stick-type odor identification test has been developed in Japan. Thirteen odors familiar to Japanese people are used in this test.
In this study, we evaluated the suitability of the odor stick identification test for Japanese (OSIT-J) in patients with olfactory disturbances. We then compared the results with those for T&T olfactometry, which is the standard olfactory test used in Japan, and examined the efficacy of the OSIT-J. A significant correlation was seen between the results of the OSIT-J and the average recognition threshold of T&T olfactometry. We recommend the OSIT-J for evaluating olfactory disturbances.

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Bronchial asthma has been reported to greatly influence the outcome of endoscopic sinus surgery (ESS) in patients with chronic sinusitis. We studied 191 patients undergoing ESS from January 2000 to December 2004, focusing on postoperative improvement in olfactory disorders, recurrence, and incidence of reoperation in 143 patients with follow-up exceeding 6 months. Airway hypersensitivity was observed in 35% of patients undergoing ESS, compared to 75% of asthmatic patients and 81% of those with both asthma and allergic rhinitis who had preoperative olfactory disorders. Olfactory disorders improved in 82% of patients undergoing ESS. Over 50% of relapsed patients had airway hypersensitivity. Asthmatic patients had an especially high relapse 37% (10 of 27 patients) . The outcome of ESS was significantly worse in patients with asthma. We conclude that patients with chronic sinusitis and asthma, who tend to experience more recurrence, require regular examination and early treatment.

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The concept of so-called eosinophilic sinusitis has recently come to be understood, but since the definition and the diagnostic criteria for this intractable form of sinusitis are unclear, we reviewed the clinical features of 104 patients (16 with eosinophilic sinusitis and 88 with non-eosionphilic sinusitis) who underwent endonasal sinus surgery in our department. So-called eosinophilic sinusitis was usually accompanied by severe bronchial asthma, and the characteristic clinical findings of so-called eosinophilic sinusitis were an increase in peripheral blood eosinophil count, a paranasal sinus shadow in computed tomograms (CT score), and a high ethmoid sinus/maxillary sinus score ratio (E/M ratio) in our study. We determined the cutoff value to review sensitivity, specificity and correct diagnosis rate in screening for eosinophilic sinusitis. When we judged using three cutoff values, a peripheral blood eosinophil count≥500/μl, CT score≥13 and E/M ratio≥1, a sensitivity of 69%, specificity of 97% and correct diagnosis rate of 81%. On the other hand, when we judged using two cutoff value, peripheral blood eosinophil count≥500/μl and E/M ratio≥1, sensitivity of 75%, specificity of 94% and correct diagnosis rate of 88%. Because all three studies can be performed in outpatient clinics, we concluded that they are useful as a method of screening for so-called eosinophilic sinusitis without the need for histological examinations for eosinophil infiltration of nasal polyps in biopsy specimens.

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Angiomyolipoma is thought to be a form of hamartoma, with most reported arising in the kidneys. Cases have also been described for the liver, mediastinum, fallopian tubes, vaginal wall, spermatic cord, skin, and oral cavity. However angiomyolipoma at other sites is extremely rare, and to our knowledge, only five cases have been described in the nasal cavity. A 71-year-old man with recurrent epistaxis of the left nasal cavity was found in intranasal examination to have a soft tissue mass arising the bottom of the nasal cavity. Computed tomography showed an enhanced soft tissue mass. Under general anesthesia, an incision was made into the tumor about 5mm from the margin. Histopathologically, it was generally benign, composed of a mixture of mature fat, smooth muscle, and blood vessels in various proportions, yielding the diagnosis of angiomyolipoma. The no recurrence has been seen in the last two years.

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We report the case of a 27 year-old female with meningitis and brain abcesses secondary to acute frontal sinusitis. The patient complained of a high fever, headache and nasal discharge. The brain abscess in the frontal lobe was treated with trephination and neurosurgical drainage. At the same time the transfrontal approach and endoscopic sinus surgery were carried out. After drainage the brain abscess reappeared, and trephination and neurosurgical drainage were repeated.
Close monitoring by computed tomo—graphy of the intracranial and nasal regions is useful for deciding both the timing of the surgery and the surgical approach. Endoscopic sinus surgery or the transfrontal approach in combination with trephination and neurosurgical drainage is effective therapy for rhinogenical intracranial complications.

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The clinical effects of CO₂ laser surgery in children with allergic rhinitis have been reported by few authors, so our objective is to clarify the background of such cases and the clinical effects of CO₂ laser surgery. Subjects were 26 patients aged 7 to 12 years unable to attain sufficient results with conservative treatments, e. g., antiallergic drugs or allergen-specific immunotherapy. All have a positive immunological reaction to house dust and mite allergen, and 31% had pollenosis. CO₂ laser surgery was administered to bilateral nasal mucosa of the inferior turbinates at the outpatient clinic under local anesthesia. Symptom scores before laser surgery and improvement after surgery were measured based on practical guidelines for the management of allergic rhinitis in Japan. About 80% of patients suffered from nasal obstruction before surgery, thought to be peculiar in allergic children. Two months after CO₂ laser surgery, 65.4% (17 patients) had excellent or satisfactory results, and 15 responded to conservative treatment. The symptom score for nasal obstruction decreased well after the surgery. Treatment for pediatric allergic rhinitis tends to be prolonged. Viewed from release from conservative therapies, treatment using CO₂ laser is significant in those cases. Unfortunately, the remaining 2 patients with severe allergic rhinitis had no satisfactory result. If CO₂ laser surgery does not alleviate symptoms such as severe allergic rhinitis, it still may provide benefits in treatment.

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Objective: The purpose of our study was to measure the activated glucocorticoid receptor (GR) protein level in the nuclei of nasal polyp cells and compare the results in nasal polyposis patients with chronic rhinosinusitis alone and with chronic rhinosinusitis associated with asthma, before and after glucocorticoid (GC) therapy.
Methods: We used enzyme-linked immunosorbentassay (ELISA) techniques to quantitatively measure the activated-GR protein level in the nuclei of the nasal polyp cells. Nasal polyp tissues were obtained from patients with chronic rhinosinusitis alone and with both chronic rhinosinusitis and bronchial asthma. In the latter, polyp tissues were separately obtained before and after GC therapy.
Results: Our data showed no significant differences between the activated-GR protein level of the nasal polyposis patients with chronic rhinosinusitis alone and with both chronic rhinosinusitis and bronchial asthma before GC therapy. However, the activated-GR protein level was significantly upregulated after GC therapy in the patients with both chronic rhinosinusitis and bronchial asthma.
Conclusion: The result of our research clearly showed that GCs upregulated the activated-GR protein level in the nuclei of nasal polyp cells and that the upregulation is essential for the anti-inflammatory action of GCs.

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