We report the clinical manifestation of a rare case of low-grade central osteosarcoma (LGCOS) originating in the right ethmoid sinus.
A 64-year-old woman consulted our hospital with a chief complain of left nasal obstruction. CT showed osteosclerosis in left ethmoid sinus, which was considerd as benign tumor. We performed tumor resection, and the diagnosis was fibrous dysplasia. One year later, osseous swelling of the root of nose was found and CT revealed recurrent osteosclerosis in the left ethmoid sinus, which extend left nasal cavity and left ethmoid sinus. We performed tumor resection again, and the diagnosis was low-grade central osteosarcoma (LGCOS). We considered that fibrous dysplasia changed into LGCOS.
LGCOS are associated with a good prognosis. The pathological diagnosis of LGCOS from fibrous dysplasia is difficult. To diagnosis of LGCOS, it is necessary to confirm whole is low grade.

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we studied the effect of atopy or allergic rhinitis on the results of treatment of pediatric acute rhinosinusitis in a prospective study. Forty children with acute rhinosinusitis (27 boys and 13 girls, age 4-10 yeas, mean age 6.1±2.5 years) were recruited. The subjects were first treated with an antibiotic, i. e., clarithromycin, penicillin, or cephem, for less than one week, and low-dose clarithromycin was continued for three weeks, without any other drugs, including anti-allergic drugs. Response to treatment was judged on the basis of changes in symptoms, nasal findings by ENT specialists, and radiographs of the maxillary sinus. The results showed no effect of atopy or allergic rhinitis on the results of treatment of pediatric acute rhinosinusitis. However, some subjects with allergic rhinitis showed improvement in objective findings, but not in their symptoms. Such patients may develop a negative impression of treatment of acute rhinosinusitis.

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Objective
Nebulizers are widely used to treat diseases of the nasal cavity and paranasal sinuses, but contamination of drug solutions by reflux has recently become a concern. In this study we used to assess the usefulness of an anti-reflux valve, a safety device designed to prevent contamination of ultrasonic nebulizers. (1) scintigraphy and (2) bacterial cultures.
Methods
Round filters 5mm in diameter soaked in 370MBq technetium phytate were applied to the anterior ends of the bilateral inferior nasal conchae of 10 healthy adults, and the subjects were asked to inhale through an ultrasonic nebulizer (UN-703, Alfresa Pharma Corporation) for 3 minutes. Each subject inhaled through the nose for 2 seconds and exhaled through the mouth for 3 seconds, and the total expired gas was collected in an expiration bag (Xenon-133VSS). The experiment was divided into 2 parts: the 1st part was performed without the anti-reflex valve, the 2nd part was performed with the valve placed between the nasal tube and corrugated tube (flexible hose). (1) On scintiscanning, images were acquired with an ECOM (Toshiba Corporation) for a scintigraphy camera and a low-energy high-resolution parallel collimator. A Toshiba Nuclear Medical Data Processing Computer GMS7700 was used for analysis. Radioactivity in the face before inhalation and the face, nasal tube, anti-reflux valve, corrugated tube, residual solution in the medication cup, expiration bag, lung, and stomach after inhalation was counted. (2) Bacterial cultures were performed on swabs of the nasal cavity before using the nebulizer, and of the nasal tube, anti-reflux valve, corrugated tube, and residual solution in the medication cup after using the nebulizer.
Results
(1) When the anti-reflux valve was inserted, no reflux (RI accumulation) was noted in the corrugated tube or lower regions of nebulizer in any of the 10 subjects. Without the anti-reflux valve, reflux into the corrugated tube (RI accumulation) was noted in 6 of the 10 subjects. (2) When the anti-reflux valve was inserted, bacterial cultures of the corrugated tube and lower regions of nebulizer were negative in all 10 subjects. Without the anti-reflux valve, the corrugated tube or residual solution in the medication cup was positive in 4 of the 10 subjects, and reflux was detected by RI counts in all 4 of these subjects.
Discussion
Anti-reflux valves are useful in preventing reflux-induced contamination of drug solutions when ultrasonic nebulizers are used.

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Japanese cedar pollinosis (JCP) is a relatively common disease in Japan and is a serious problem between February and April each year. H1 antagonists (antihistamines, including second-generation antihistamines) are used as first-line treatment in most patients. It has recently been recommended that patients who develop severe symptoms of pollinosis every year begin treatment immediately after the start of pollen release or the onset of symptoms. A physician should choose the drug regimen for each patient by selecting from among many second-generation antihistamines according to the amount of pollen release expected during the season and the type and severity of symptoms usually experienced by the patient during the peak season. However, there is wide variation in pollen release among the regions of Japan and from year to year. If constant effectiveness of an antihistamine for patients with JCP were demonstrated by a large-scale multicenter study for several years, it would please both patients with JPC and their physicians.
In this study we investigated the efficacy of the second-generation anti-histamine olopatadine in 1611 patients with JCP attending the clinics of 83 hospitals, for 3 consecutive years. Prophylactic olopatadine was effective against JCP, especially in the season pollen level was low (under 2000/season). In the season when there was a high pollen level, prophylactic olopatadine was effective until the peak pollen release. After one day of therapy olopatadine also significantly improved the nasal symptom scores of patients with moderate to severe symptoms of JCP. These results suggest that olopatadine is a very effective drug for the treatment of JCP.

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