Cellular components of the nasal discharge vary depending on pathologic processes of the nose and the paranasal sinuses. Thus, the nasal discharge obtained from the common nasal cavity and the middle meatus, were studied quantitatively following the operations of the chronic paranasal sinusitis for a period of one year. These results were evaluated in conjunction to the pathologic changes of the nasal cavities and the paranasal sinuses. Under normal and slightly diseased condition, the nasal discharge mainly consisted of the polymorphonuclear neutrophils (three nucleated neutrophils) and abundance of the cylinder epithelial cells, while the polymorphonuclear neutrophils especially 4 to 5 nucleated neutrophils, increased in number accompanied by correspondingly less epithelial cells under the chronic imflammation. With aggravation of the chronic imflammation, the epithelial cells, especially the ciliated epithelial cells, showed marked decrease and the deeply located epithelial cells were found increased. It was also found that the nasal discharge obtained from the common nasal cavity well reflected the mucosal pathology of the maxillary sinus and the discharge from the middle meatus corresponded to the pathology of the paranasal sinuses. In another word, it can be stated that the cellular findings of the nasal discharge well represent the pathologic processes of the nasal cavities. Studying both findings of the discharge and the pathologic specimen of the maxillary sinus mucosa, it could be also stated that the epithelial cells were dominating cells of the nasal discharge with the well functioning sinus mucosa, and the neutrophils were found to be increased in the nasal discharge with the poorly functioning mucosa. From 52 cases which had operations for the chronic paranasal sinusitis, 257 specimen of the nasal discharge were obtained and were subjected to detail examinations. In results the following three types were differentiated: Type I; cases which showed satisfactory increase of the regenerative epithelial cells with prompt decrease of the imflammatory neutrophils. These cases took good clinical courses. Type II; cases in which the increase of the epithelial cells and the decrease of the neutrophils were observed but less in extent than Type I. Type III; cases which revealed persistent presence of the neutrophils and relative lack of the regenerative epithelial cells. In summary, it was concluded that the cellular findings of the nasal discharge reflected the histologic reactions fairly accurately of the nasal cavity and the paranasal sinuses.
Two of the most common disorders of the throat encountered in grade school children are adenoids and tonsillitis, and their incidence in relation to chronic sinusitis has been widely investigated but basic knowledge of these conditions is still incomplete. As a means of elucida-ting some aspects of this problem, we have conducted periodic examinations in selected groups of urban and rural children, consisting of all age groups from childhood to puberty, for many years. This long-range study has provided us with information regarding the actual state and prevalence of these disorders, the changes associated with the growth of the individual which had not been observed in previous studies limited to a single period, and some differences due to environmental influence which were revealed by comparison of the findings in the urban and rural groups. The results of this long-range study with respect to the findings in the throat and of the adenoids and our observations concerning the influence of chronic sinusitis are presented. Physiologic hypertrophy and hyperplasia of the adenoid, tissue, faucial tonsils, lateral pharyngeal bands and lymph follicles on the posterior pharyngel wall were found to differ in degree with the ages of the children. The greatest degree of adenoid hypertrophy was seen at the ages of 6 and 7 years, with subsequent atrophy which progressed rapidly after the age of 11 or 12. By observing the changes in single individuals over the years, we found that atrophy of the adenoid tissue took various forms which were divided into 6 types. It was also revealed that this stage differed between urban and rural chidren. The faucial tonsils showed maximum enlargement at the ages of 6 and 7 years with gradual reduction in size thereafter, but physiologic hypertrophy was still present up to the age of 10 or 11, after which atrophy rapidly occurred. Atrophy of the faucial tonsils tended to occur more slowly in rural children. The lateral pharyngeal bands and lymphoid nodules on the posterior pharyngeal wall showed marked enlargement after the age of 12, possibly, it is thought, to compensate for atrophy of the adenoid and tonsils which normally occurs during this period. There is as yet no established theory based on pathological and physiological grounds regarding the functions of the various groups of lymphoid tissue in the pharnx, and the reason for their changes with growth cannot be definitely explained. It is obvious though that their presence is not entirely meaningless during physical growth and that they possess certain signicant functions. The observations made in this study produced no evidence contradicting fi the view that ring of lymphoid tissue in the pharynx serves as a barrier against bacterial invasions into the body and that they aid in acquisition of immunity to such infections. The closest correlation between the various groups of lymphoid tissue was shown by the adenoid and faucial tonsils, which proved to be statistically significant. The other groups of lymphoid tissue were also found to be related in varying degrees and moreover showed effects due to age. Fairly close correlation between the adenoid and sinusitis was observed, particularly in elementary school children in the lower grades. Observations in individual children revealed that the degree of adenoid hypertrophy was considerably influenced by aggravation, improvement or alleviation of the inflammatory disorder of the sinuses. Although the influence of the adenoid on the paranasal sinuses is still controversial, in view of the strong effects demonstrated in this survery, the indication for adenoidectomy at a suitable time could be considered in the treator prevention of sinusitis.
Plastic and reconstructive surgery of the facial structures often requires the use of hard grafting materials to serve as supporting structures or to produce elevations of the skin surface. Among such grafting materials, autogenous cartilage grafts are probably the most widely employed. because of their obvious advantages. Autografting of cartilage, however, may not always be successful due to such factors as infection of the recipient site, the general condition of the patient, the condition of the graft, mechanical stimulation at the site of the graft, exposure of the graft, or when removed cartilage pieces are reinserted, and autografting also subjects the patient to the additional stress of obtaining the graft from other parts of the body. Actually, such conditions are interrelated and manifested in a complicated fashion in most instances. As. very few detailed studies of the effects of the condition of the implanted cartilage have been made, an experimental study of the effects of mechanical stimulation of the grafted site and exposure of the cartilage graft was undertaken in rabbits. The experimental autografts, taken from the costal cartilage and the auricular cartilage of rabbits, weighing about 2 kilograms each, were mostly transplanted to the most frequent site of implantation of such grafts in clinical cases; that is, below the periosteum of the nose. To observe the effects of active mechanical irritation of the grafted cartilage, the back of the animal. under the skin was also selected for the recipient site. As cartilage for grafts are usually shaped into different forms according to the purpose for which they are used, the experimental grafts were also shaped into various simple forms to observe the relation between the shape of the graft and its eventual condition. Auricular cartilage grafts were also implanted in the bone to investigate the reactions between the bone and cartilage. In all the experiments cartilage autografts with and without perichondrium were used. The effects of mechanical irritation were studied by transplanting costal cartilage autografts. to the subcutaneous tissue of the back and auricular cartilage autografts below the dorsum of the nose subperiosteally. After varying periods the regions of the implanted grafts were massaged with the fingers for a period of one week. Rapid absorption of the cartilage grafts. occurred the earlier the mechanical irritation was started after the operation, but rapid absorption could be prevented by waiting for about two weeks before commencing massage of thegrafted area. The auricular cartilage autografts transplanted subperiosteally under the dorsum of the nose appeared to be more pronouncedly affected by the mechanical irritation than the costal cartilage autografts placed under the skin of the back of the animals. The effects of exposure of the cartilage grafts after transplantation were studied with both costal and auricular cartilage, which were implanted subperiosteally below the dorsum of the nose and then partially exposed after varying periods. Removal of the grafts one week after exposure revealed degenerative changes marked by necrosis of the exposed surfaces of the grafts. in practically all of the specimens. The auricular catilage grafts, in particular, had become separated from the recipient bed, showing necrotic changes of both surfaces, and there was a tendency for the exposed recipient sites to be covered by growth of skin from the edges. Late exposure of the implanted cartilage produced stronger degenerative changes than when the graft was exposed in an earlier period. In the event of exposure of the grafted cartilage in actual clinical cases, therefore, immediate covering of the exposed surface with skin or other tissue that will provide nourishment and sufficient pressure to assure close contact of the graft to the recipient site are advisable.
In view of a recent trend of increasimg number of patients with vertigenous complaints various kind of drugs are being tried for this annoying condition. The authors reported on their experiences with a use of a new drug, Betahistine mesylate for patients with vertigo. Among 40 cases treated with Betahistine mesylate (28 male & 12 female) vertigo was diagnosed as of central origin in 19 cases and of peripheral in 21 cases. Betahistine mesylate was given for a period from two to four weeks. The authors reported the drug was effective in most of the cases and the side-effect was not encountered in any of the cases.
The authors administered IP-82 and placebo for patients who underwent radical sinusectomies, for a period of seven days, in order to test the efficacy of this drug for postoperative inflammatory reactions through a double blind method. A total of 40 sinuses were studied postoperatively to found that IP-82 was extremely effective for prevention of postoperative fever and local pains. No significant difference was observed between IP-82 and the placebo group as to the severity of local inflammation and of tenderness at the cheeks. It was reported that of the group to which IP-82 was administered a remarkable effect was seen in 11 sinuses, effective in 6 sinuses, fairly effective in 3 sinuses, while no effect was seen any of the cases. With the placebo group, on the other hand, it was remarkably effective in 2 sinuses, effective in 6 sinuses fairly effective in 7 sinuses and not effective in 5 sinuses. Thus, it appeared obvious from the above. that IP-82 has a potent effect in controlling inflammatory reactions seen at postoperative site. No side effects were witnessed in any of the cases.
IP-82, an anti-inflammatory agent derived from Ibunac was given to a total of 49 patients who manifested acute or chronic inflammation at the pharynx-laryx region. A high curative effect of this drug was shown as a statistical analysis proved a significant difference from placebo group with p<0.005 in X2 test. This drug was found to have a potent effect particulary against pains due to acute inflamma-tory process in the throat.