I.Relation between epithelial function of maxillary sinus and thickness of mucous membrane. Fifty per cent Molojodol wa s injected into the maxillary sinus and X-ray films from the occipito-frontal direction were taken in prone (face down) and normal (standing) positions.Thus, in 245 cases on 475 sides, comparative were studies made as tothe relation between the M. shadow type which expressed the epithelial function of the sinus mucous membrane and the thickness of the mucous membrane. In most cases the intensity of lesion judged from these roentgenograms paralleled the epithelial fuaction. However, a lowered epithelical function was found in some patients with slight thickness of the sinus mucous membrane and a relatively good epithelial function in some with marked thickness of the mucous membrane. The discrepancy between the lesion in the tunica propria of the sinus mucous membrane and the epithelium function was supposed to be due to the difference of improvement and worsening, above all reversibility, between them. Therefore, in chronic maxillary sinusitis, the examination of the thickness of the sinus mucous membrane combined with the roentgenological functional examination assured a higher diagnostic value. II. Chronic maxillary sinusitis observed seasonly and yearly by roentgenological functional examination. A follow-up roentgenological functional examination was made on fifty-two patients with chronic maxillary sinusitis of varying intensity for more than three years and the improvement and worsening were studied in relation to season, age episodes of cold, malformation of the septum nasi and others. In four cases (7.7%) unilateral paranasal sinusitis was always observed throughout the observation period. The epithelial function of mucous membrane did not always change bilaterally in parallel. The great difference which was observed at one time was supposed to be due to the abnormal structure in the nasal cavity and the anatomical pathological abnormalities near the meatus of the sinus. In aditions, from the change in the M. shadow type, a labile state of mucous membrane was assumed. It was also confirmed that, by slight inflammation during repeated attects of cold, the epithelial function was lowered and the symptoms were worsened. From the above stated results, among the various factors which developed and fixed chronic paranasal sinusitis, three, repeated slight inflammation, abnormal structure in the nasal cavity and predisposition of the sinus mucous membrane, presumably played an important part. III. Effects of plastic operation of nasal cavity on chronic maxillary sinusitis which was studied by roentgenological functional examination. A follow-up roentgenological functional examination was made on 20 patients, on whom plastic operation of nasal cavity and fenestration of maxillary sinus combined with pernasal opening of ethmoid cellulae had been made, to study the healing process of the mucous membrane of the maxillary sinus for the periods ranging between one month and four years. In most cases the state of the sinus mucous membrane was worsened for a while after the operation. However, it soon recovered and the healing process proceeded. Though this process was different in each case, in those with marked lesions of the sinus mucous membrane, the marphological recovery of the mucous membrane was not observed pathohistologically even after the recovery of the epithelial function and healing was achieved in the form of the production of con-nective tissue. This operation is indicated for the patients with abnormal structures in the nasalcavity and with the focus of paranasal sinusitis in the ethmoid cellulae. Even if it is applied to those with paranasal sinusitis of considerably severity, sufficient cure can expected with suitable after-treatment. Therefore, this trertment has an indication wider than that which has been hitherto accepted.
The postoperative processes in the ethmoid were studied histopathologically in patients with chronic ethmoiditis who had undergone ethmoidectomy once or more times prior to reoperation. Specimens of the regenerated tissue and of the primary mucosa were taken at the time of reoperation and studied in respects to lapse of time following operation and to the mutual relationship between the two tissues. Regeneration of the ciliated epithelial cells of the regenerated tissue is observe das early as the 34th postoperative day and is completed at about the fifth month. After 5 months to one year, inflamatory changes such as cell infiltration and edema in the regenerated tissue are most frequently found especially in parallel withthe grade of inflammation in the primary mucous membrane of the ethmoid cells. The severer the pathologic changes in the primary mucous membrane, the greater is the cell infiltration in the regenerated tissue together with less proliferation of the connective tissue. It is considered that the resistance of the tissue is at its lowest at the fifth postoperative month when the regenerations of the mucous membrane has just been completed. After the first postoperative year, inflammatory changes become less significant, the proliferated connective tissue becomes dense and thin and the resistance of the tissue increases.
In 120 cases, ranging in age from 3 to 16 years, the problem of physiologic and inflammatory hypertrophy of the faucial tonsil has been studied both clinically and histopathologically with the following results. Between the two types of faucial tonsil hypertrophy, differences in the frequency of habitual involvement, clinical symptoms, complications, family histories, tuberculin reactions, macroscopic findings of the tonsil surface, crypts, superior tonsillar fossa and anterior pillar have been observed. Histopathologically, mild pathological changes of the epithelial cells and lacunae, especially in the deep portion of the latter, might be considered as a physiologic and functional reaction.
In 22 cases of oral candidiasis encountered at the Otorhinolaryngeal Department of Tokyo Jikeikai School of Medicine, clinical and experimental investigations have been carried out. In general, oral ulcers due to candidiasis show various forms and courses. In particular, a major characteristic of these ulcers is their frequent recurrences from one form and type to another. No untreated dental caries were found in the 22 patients. Four of them had completely sound teeth and the others had artificial dentures or gold, siver alloy or sanplatina crown fixtures. There is no known remedy for satisfactory control of this disease. However, it is considered that potassium iodide and Tricomycin might be useful in large dosage. The pH of the saliva in these patients shows a tendency towards the alkaline side and in vitro tests with Candiada isolated from the ulcers reveal maximum growth at pH 7.5. Accordingly, the clinical observation that oral candidiasis was encountered only in patients with no dental caries in this study may be noteworthy. Blood sugar tests in the 22 patients did not reveal any specific findings. Althoug the isolated strains of Candida grew in test tubes at any concentration of glucose, the optimum percentage for growth appeared to be 2%. Examination of the function of the autonomic nervous system in these patients with Wenger's test shows a slight tenency of sympathicotomia. Of course, further investigation is required but it might be surmised that this clinical observation could be an important causal factor in this disease.