In patients with chronic maxillary sinusitis, x-ray functional tests of the maxillary sinuses were performed in each, two or more times during the course of the changing pattern of the intrasinus pathology, based on the contrast images projected, was studied together with histopathological examination of specimens of the sinus mucosa which were obtained after the final x-ray functional test. The intrasinus changes observed with the x-ray functional tests were classified into the 6 standard types. Histopathological examination of the mucous membrane was performed with the usual staining methods and also with alkaline phosphatase and acidic mucopolysaccharide staining methods. On the basis of the results of the x-ray functional tests and histological examination of the mucosal specimens, the lesions were divided into mild, moderate and severe, and were also studiedin regard to the state of stability of the intrasinus changes. In the group with mild lesions, the major change was subepithelial edema. Alkaline phosphatase staining demonstrated regular and distinct arrangement of the subepithelial capillaries and little or no positive reaction in the connective tissue. Positive reaction to mucopolysaccharide stain was seen in scattered goblet cells and in some of the glandular cells but not in other parts of the specimens. It is believed that allergic reactions are to some extent involved in this group of mild lesions. The results of the x-ray functional tests varied to the greatest degree in those with moderate lesions, probably due to the fact to that relatively mild lesions in this group still showed unstable changes. The prominent histopathological finding in this group was subepithelial edema, there were also connective tissue proliferation, cellular infiltration and other changes. These findings as well as the results of the functional test varied widely. Alkaline phosphatase staining revealed some derangement of the capillaries and positive reaction in a part of the connective tissue. Mucopolysaccharide staining demonstrated positive-stained abundant goblet cells in the recessed parts of the mucosa, whereas the reaction in other parts was only faintly positive or negative. In the connective tissue, positive activity was first seen in the glandular cells and around the blood vessels, tending to spread throughout the tissues thereafter. The appearance of mast cells, staining positive in the thickened portion of the blood vessels, was also observed. In moderate lesions that were still in an unstable state, aggravation and fixation of the pathologic condition appeared to be associated with subepithelial edema which increased in severity or was complicated by connective tissue proliferation, cellular infiltration or other morbid changes. With repeated episodes of improvement and aggravation of such changes, an eventual state of irreversibility seemed to be reached, resulting in chronic fixation of the pathology. The prominent finding in severe lesions was pathologic change of the connective tissue, associated in some with marked edema. In each case the lesion appeared to be irreversible or in a stable condition. Alkaline phosphatase staning demonstrated derangement of the capillaries with development of new vessels. Many specimens showed positive activity throughout the connective tissue layer. Acidic mucopolysaccharide staining revealed diffuse positive reactions throughout the connective tissue, numerous mast cells and positive staining of the thickened vascular walls. These observations would seem to indicate that the disease in chronic sinusitis passes through a period of instability and then eventually becomes chronically stabilized.
The author conducted an experimental study of the preserved homogeneous bone as part of a series of experiments of grafting materials in the field of otolaryngology. Sixty-two rabbits were divided into two groups, one consisting of 18 rabbits and the other of 44 rabbits. The rabbits of the first group was further divided into three groups, rabbits grafted with a preserved homogeneous bone, rabbits grafted with fresh autogeneous bone and rabbits grafted with a fresh homogeneous bone. An iliac bone was grafted upon the bridge of the nose after the periostium had been removed. The grafted bone was histologically examined by H-E stain and PAS-stain at 2, 4, 8 and 24 weeks. Serum protein fractions were also examined to study the effect of the transplantation upon the rabbits. Changes in eash fraction especially in γ-globulin, were also studied. The rabbits of the second group were also divided into three groups and bone grafting was performed in the same manner as in the first group. To determine the biological stability of the grafted bones, they were removed at 3 days, 1, 2 and 4 weeks and grafted again on the same site of the nasal bone. The changes in the grafted bones were histologically examined. Homogeneous bones were grafted after preservation in a refrigerator at -20°C for two weeks. The following results were obtained from this experiment. 1) The preserved homogeneous bones showed much the same satisfactory results as the autogeneous bones. Satisfactory bone fusion occured in two months after grafting, and osteogenesis also appeared. Although it was unable to confirm whether the new bone developed from the preserved bone or from the recipient, the author presumed that the preserved bone possesses such osteogenetic potency that activates the host to such an extent as to promote osseous fusion. 2) Absorption and substitution by the connective tissue were slower in the preserved homogeneous bone than in the autogeneous bone. This tendency was by far more marked after regrafting. 3) Histological and serological examination revealed the difference in biological characteristic between the preserved homogeneous bone and fresh homogeneous bones. 4) In the group of rabbits grafted with a fresh homogeneous bone, many developed sequestrum or abscess, whereas the group of rabbits grafted with a preserved homogeneous bone showed much the same biological stability as the group of rabbits grafted with autogeneous bone. This difference was by far more marked after regrafting. 5) The serum protein fractions, especially, γ-globulin, changed with time in the group of rabbits grafted with a fresh homogeneous bone. On the other hand, there was little or no difference between the group grafted with a preserved homogeneous bone and the group grafted with autogeneous bone. 6) Although it was difficult to demonstrate the antigenicity of the bone, the preserved frozen bone was as excellent as the autogeneous bone in this experiment. It may therefore be reasonable to presume that the antigenicity of the bones was reduced during their preservation in a refrigerator. Successful osseous grafting with the homogeneous or heterogeneous bone, largely depends upon immunological factors. 7) The author concluded that local blood circulation, proper fixation of the graft and prevention of infection were the prerequisite for a successful grafting of the bone.
A 15-year-old girl was admitted on April 16, 1969 with the complaint of a reddish peasized tumor in the right nasal cavity. A biopsy of the tumor showed extramedullary plasmacytoma. Bence-Jones test was negative, and there were no abnormalities in the X-ray findings of the cranium or skeleton. Only a low albumin/globulin ratio was observed. Betatron irradiation treatment was performed through the right lateral surface of the nose, and after 4, 000 rad. irradiation the tumor disappeared completely. She was discharged after a 65-day-admission. On March 23, 1970, she had a new reddish tumor in the left middle nasal meatus, Bilateral paranasal sinusitis was also observed. The patient was again admitted on April 8, 1970. Plasmacytomas were found in both nasal cavities and both maxillary sinuses after histopathological examinations of specimens. This time, no effect was observed on the tumor with betatron or telecobalt irradiation treatment. Corticosteroid treatment was adopted. Betamethason (Rinderon: Shionogi) was given 5 mg daily for 17 days, the tumors started decreasing in size. Corticosteroid was lessened gradually, and on August 24, 1970, the tumor disappeared both in inspection and by histopathological examination. She was discharged on December 14, 1970 after 250 days, She has had no recurrence of the tumor for 19 months.
Only 8 cases of mastoid cyst have been reported in the Japanese literature. A case of mastoid cyst is added along with the operative findings. The patient was a 33-year-old male who visited our hospital on June 17, 1971 with the chief complaints of left side headache and tinnitus aurium of the left ear. X-ray examination of the mastoid revealed cystic changes in the left mastoid cavity. An extensive mastoidectomy was performed and the cyst was successfully removed but resulted in exposure and herniation of the cerebellum. The large posterative defect was obliterated with a iliac bone graft. The postoperative course was uncomplicated. The authors reviewed the cases appearing in the literature and discussed the etiology of the disease.