It is known that allergy is concerned in the origin of chronic sinusitis. In this report, localization of immunoglobulins and the distribution of immunoglobulin producing cells in the sinus mucosa of chronic maxillary sinusitis were studied with direct fluorescent antibody technique. Furthermore, lymphocytes in the sinus mucosa and peripheral blood were analyzed for T cell and B cell, and how allergic mechanisms are concerned in the chronicity of sinusitis wes studied from a view point of the relationship between cellular and humoral immunity. Specimens were collected from 76 patients with chronic maxillary sinusitis at the time of operation, and frozen sections were prepared. Localization of immunoglobulins (IgG, IgA, and IgM) in the mucosa was observed with direct fluorescent antibody technique, and the numbers of immunoglobulin containing cells were counted. After fluorescent microscopic observation, the same specimen was stained with hematoxylineosin and methylgreen-pyronine and the cells were identified morphologically. Classification and counting of T cells and B cells were made with E-rosette and EAC-rosette technique respectively in the sinus mucosa and in the peripheral blood of the patients normal subjects. Results:(1) In the mucosa, IgG and IgM were localized in the epithelial layer and subepithelial interstitium. IgA was localized in the mucous layer and the subepithelial interstisium and also in the mucous gland. (2) The number of the cells which contain each immunoglobulin was in the following order, IgG>IgA>IgM. Most of the cells were morphologically plasma cells, with also a few lymphocytes. (3) The percentages of the T cells and B cells in the sinus mucosa were 34.8±12.9% and 47.5±15.1%, respectively ; and in the peripheral blood 42.1±15.9% and 43.6±14.7, respectively. In the peripheral blood of the normal subjects, the percentages of the T cells and B cells were 63.1±6.2% and 35.2±8.4, respectively. (4) Comparing the numbers of T and B cells in the peripheral blood of the normal subjects with those of the patients, T cells were decreased and B cells were increased in the blood of the patients. (5) As f or the histological findings of the mucosa and the percentages of T and B cells, there were more B cells in the infiltrating type, and more T cells in the fibrous type. Definite tendency was not seen in the edematous type. Conclusion: From the above results, it is considered that humoral protective function in the maxillary mucosa is mainly performed by GgG and IgA. On the allergic mechanisms, the type III allergic reaction of Gell & Coombs seems to be more concerned with the infiltrating phases and to some extent to the edematous phase. It is assumed that the type IV reaction which is mainly due to T cells in much more concerned with the fibrotic phase, owing to the chronicity of sinusitis.
It is often pointed out that intranasal structural abnormalities might constitute a non-specific factor of nasal allergy, aggravating the symptoms and preventing a smooth healing of the disease. In such instances, submucous resection or conchotomy has been reported effective in not a few instances. Furthermore, concurrence of chronic sinusitis, as seen in many Japanese nasal allergy patients, presents a complicated picture, where nasal surgery should become a part of treatment for a successful cure of nasal. allergy. Nasal operations, reconstruction of the lateral nasal wall and submucous resection, were performed in the.cases with nasal allergy which had not responded to one-year of conventional treatments of nasal allergy seemingly due to the concomitant presence of instanasal structural abnormalities or chronic sinusitis. The authors followed the patients for 1.5 to 2.5 years postoperatively and report the results of clinical evaluation of the effect of nasal surgery in cases with nasal allergy.
Psychosomatic aspects of patients with chronic sinusitis during pre-and post-operative periods were studied by sending questionnaires to a total of 54 sinusectomized patients, 38 males and 16 females ranging in age from 13 to 62. The questionnaires were designed to collect data on psychosomatic factors in the patients using CMI (Cornell Medical Index), MAS (Modified Taylor Anxiety Scale) and STAL (State-Trait Anxiety Index). The pre- and post-operative results in sinusectomized patients were compared with the results on subjects without chronic sinusitis which were reported by Samejima in 1973 and 1975. The present study revealed that: 1) Anxiety in patients with chronic sinusitis appears greater than that in normal subjects. 2) Mean STAI A-state scores were much higher prior to surgery than after surgery. The degree of postoperative decline in A-state was unrelated to severity of the disease the type of surgery performed, surgical history or to age of patients. 3) STAI A-trait scores were essentially the same pre-and postoperatively. The results of this study lead us to conclude that psychosomatic consideration should be given to the patients with chronic sinusitis particularly when surgical treatment is performed.
Two cases of juvenile angiofibromarising at sites other than the nasopharyngeal region are reported. Since almost all such tumors occur in the nasopharynx our recent cases, one originating in the maxillary sinus and the other in the nasal cavity, are considered very rare. Although the etiology of the tumor is still controversial, many researchers agree theat the tumor is a true neoplasm consisting of varying amounts of fibrous and vascular components. It is noteworthy that Girgis and others, in their recent publication, suggested that angiofibroma is a tumor arising from paraganglionic tissue, thus the tumor can occur in any area supplied by the internal maxillary artery inclusive of the nasal cavity and nasopharynx, and that the development of the tumor may have some connection with hormonal disturbances.
The method of interpretation of the patterns obtained by a gravimeter varies from direct observation to complicated computer processing after A-D conversion of the outputs The direct observation is most practical and handy, but it can not be served for comparison purposes because the interpretations are more subjective than objective. On the other hand, conventional computer processing method in use by researchers is too sophisticated for clinical use. The author devised, in cooperation with Sanei Co. Ltd., a new easy to handle multi-analyzer of data from the gravimeter for clinical use. The details of the microprocessor and the results obtained are reported.