In order to study various pathological changes caused by chronic sinusitis, particularly the changes in the unstable stage of chronic sinusitis, secretion from the mucous membrane of the maxillary sinus was collected and examined immunologically by means of electrophoresis, then the distribution of protein fractions in the mucosal secretion was identified and compared with those in the serum.
Significance of protein and secretory IgA in the mucosal secretion in cases with chronic sinusitis was discussed. The results of X-ray mucosal function test, endoscopic examination of the maxillary ostium (sinus side) and histopathological study of the mucous membrane of the maxillary sinus were compared in each case with chronic sinusitis to study possible inter-relations among these findings particularly in unstable stage of chronic sinusitis. A total of 63 cases (44 males and 19 females) ranging in age from 15 to 62 were studied at the Department of Otorhinolaryngology at the Jikei University School of Medicine. The 63 cases were first categorized into 6 standard groups based on the results of X-ray mucosal function test of the maxillary sinus.
Those cases classified as complete diffusely spread type were excluded from the study as they did not contain any serection in the maxillary antrum.
Cases showing imcomplete diffusely spread type, spotted type and diffuse-localized transitional type were categorized as in unstable stage whereas those cases showing localized and scattered types were categorized as in advanced stage.
Each case was subjected to radical operation of the maxillary sinus after the contrast medium (15% Moljodol) was excreted completely from the sinus.
Prior to elevation of the antral mucosa, appearance of the natural ostium was recorded photographically, then, the secretion accumulated in the antrum was collected by a syringe.
The secretion was tested for occult blood to eliminate any specimen containing blood.
The removed mucous membrane of the maxillary sinus was subjected to histopathological examination.
Endoscopic findings of the natural ostium was categorized grounded on the classification proposed by Kawakubo and Shimada. They were normal type, mildly hypertrophied type, severely hypertrophied type, Obstructed type and overhanging type.
Interrelations among the results of the three studies could be summarized as follows:
1. A parallel was found between the results of X-ray mucosal function test and endoscopic findings of the natural ostium.
2. In pathological examinations of the mucous membrane of the maxillary sinus, it was demonstrated that the changes are characterized by edema in cases with unstable stage whereas by fibrotic changes in cases that belonged to advanced stage.
3. Secretion in the maxillary sinus contained 5 different types of protein, which were albumin, haptoglobin, transferrin, IgA and IgG.
4. Haptoglobin and transferrin were lacking in some cases in unstable stage.
5. Haptoglobin and transferrin were also lacking in some cases which showed normal ostium, mildly hypertrophied and severely hypertrophied ostiums.
6. Haptoglobin and transferrin were lacking in cases which were characterized by edematous changes of the maxillary sinus mucosa.
7. Haptoglobin was found to be most frequently absent in cases with mucoid fluid accumulation, which was followed by cases with mucopurulent accumulation and then by cases with purulent accumulation in the decreasing order of frequency.
8. No specific protein fraction was found in the secretion of the mucosa in the maxillary sinus.

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A man aged 42 years came to our clinic with anterior swelling in the middle of the neck. He had a large hemangioma of the tongue which was treated by both radiotherapy and surgery fifteen years ago.
Some yellowish fluid was obtained on puncture and 38% Lipiodol was injected. X-ray examination demonstrated that the cyst extended to the posterior surface of the hyoid bone.
According to Sistrunk's method, the cyst was completely extirpated with partial resection of the hyoid bone.
Pathological examination was compatible with median cervical cyst. The cyst wall was chiefly lined with ciliated epithelium. The thyroglossal duct is either situated 1. in front of the hypid bone, 2. through the hyoid bone, or 3. behind the hyoid bone. For the purpose of prevention of recurrence, partial resection of the hyoid bone is necessary. The authors concluded that Sistrunk's method is most preferable.

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The close co-operation of rhinologists and dentists is needed for the diagnosis of dental sinusitis.
To evaluate the pathological condition, rhinologists are required to have a basic knowledge of odontology.
We described the value of the intraoral roentgenograms in the diagnosis of dental sinusitis. Intraoral roentgenograms are most important in understanding the changes in teeth and surrounding structures in patients with dental sinusitis.
The changes of teeth, supporting structures and floor of maxillary sinus could be classified as follows:
1. Standard type
2. Lower type
3. Lower type of apex area
4. Lower type of interradicular area
5. Indistinct type
6. Absorption type.

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Isoproterenol has a potent dilating effect on the peripheral blood vessels.
A total of 45 patient with vertigo were treated by three different methods with isoproterenol; in the first group by a combination of isoproterenol hydrochloride (10mg) and pronase 3.75mg (KIP-01); in the second group, isoproterenol hydrochloride only (10mg) (KIP-02) and in the third group by pronase (3.75 mg) (KIP-03).
Improvement of subjective symptoms was seen in 86.7% in the first group, 66.7% in the second group and 53.3% in the third group.
Objective improvement of the findings was seen in 73.3% in the first group, 66.7% in the second group and 20.0% in the third group.
The results were tested statistically by x² test, which showed no significant difference in alleviation of subjective symptoms but significant difference was demonstrated between the first group and the third group (1%), between the second group and the third group (5%) while no significant difference was seen between the first group and the second group.
The results indicate that isoproterenol has beneficial effect on the control of vertigo.

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