In an attempt to study the incidence of injuries to the base of the skull during nasal surgery, a total of 1, 166 questionnaires were sent to the members of the Japan Rhinologic Society. Three hundred and sixty-seven questionnaires returned. The tally of the sinus operations performed by the above doctors was approximately 450, 000. The exposures of the dura mater during the operations amounted 668 in the series. The rate of exposure of the dura mater during sinus surgery was, therefore, one in every 680 operations. The rate of occurrence of CSF leakage during sinus operation turned out to be one in every 3, 000 operations and the rate of development of acute meningitis due to injury to the dura mater was one in every 8, 800 operations. The mortality rate due to acute meningitis after sinusectomy was found to be one in every 30, 000 operations. A more detailed questionnaire was sent to 107 rhinologists who encountered injury to the base of the skull during surgery in order to study various factors which were responsible for the development of the side injuries. Forty-eight different factors were surveyed in the second questionnaire and the results were subjected to a computor analysis to evaluate each factor for the development of the complications. Some of the results obtained include ; 1. Injury to the base of the skull is more likely to occur in young patients than in elderly subjects. 2. Intranasal approach showed a little higher incidence of side injury than in permaxillary approach. 3. Exposure of the dura mater occurs mainly at the roof of the ethmoid sinus. 4. Seventy-five percent of the injuries to the base of the skull were inflicted either by cup forceps or a curet. 5. Eighty percent of intracranial complications after dural injury were developed from a relatively small' dural injury which was less than 3 mm in diameter. 6. The rate of incidence of meningitis after dural injury was highest at the cribriform plate, followed by the posterior ethmoid sinus and then by the anterior ethmoid sinus. 7. Of a total of 107 cases with exposure of the dura mater during intranasal surgery, 19 cases or 17.8% developed intracranial complication and 4 cases of the 19 died of the intracranial complication. The mortality rate due to acute meningitis appears to be quite high. Although this is partly due to the fact that this series includes cases in the pre-antibiotic era, the intracranial complication due to nasal surgery is considered to be of grave consequence even today.
Purpose of study: This study was carried out to determine by microspectorophotometric method the NDA content of the nuclei of maxillary cancer cells in an attempt to investigate the relationship between the DNA content of the cancer cell nuclei and the degree of differentiation of the tumor as evaluated histomorphologically to make a comparison of the variation in the DNA content in the course of treatment by irradiation with combined use of radiosensitizer agents under different programs, to assess the value of DNA detemination as applied to the diagnosis of maxillary cancer and the evaluation of its therapeutic response. Materials and methods: Used in the present study were 14 patients with maxillary cancer, of whom 10 had squamous cell carcinoma and 4 undifferentiated carcinoma. These patients were sinusectomized to keep the tumor in sight so that tumor tissue specimens could be collected at the most comparable possible site of the lesion both before and during the course of anticancer therapy with drugs or irradiation. Specimens thus obtained were submitted to histopathologic examination and at the. same time to the Feulgen test to determine the amount of DNA contained in cancer cell nuclei by the two wave length technique in a microspectrophotometer (Olympus MSP-A IV Model). Results: 1) The mean DNA content (M) of the cancer cell nuclei prior to anti-cancer treatment of maxillary cancer ranged from 15.0-24.1, values for triploidy to under-pentaploidy, with a standard deviation (S) as great as 3.4-9.5. Thus, the cancer cells had apparently higher values for both M and S than noncancerous maxillary sinus or mucous epithelial cells. 2) The histogram of the DNA content of cancer cell nuclei characteristically indicated the presence of nuclei with a value for tetraploidy or higher. Nuclei having such a value accounted for 10 per cent or more of the total in almost all cases. 3) The moderately differentiated form of squamous cell carcinoma of the maxillary sinus was associated with the highest DNA content of cell nuclei as viewed in terms of M and S values. The highly differentiated type showed relatively low values for M and S. The values were low but high in other cases of cancer of poorly differentiated or undifferentiated forms. 4) The increased DNA content of cancer cell nuclei was found at 12-24 hours after administration of radiosensitizer agents (mainly 5-fluorouracil). Here the increment in the DNA content was greated with increasing dosage of 5-Fu. With irradiation implemented in combination with administration of radiosensitizers, an apparent therapeutic response was elicited as the DNA content of cancer cell nuclei diminished drastically and the tumor was reduced even macroscopically in size. 5) The results described above indicate that the DNA content of cell nuclei can provide valid evidence for diagnosis of maxillary cancer. The observed variation in the DNA content in association with administration of radiosensitizers and irradiation may also be helpful as an indicator for improved anticancer therapy, considering the mechanism of action of such agents and the irradiation schedule adopted.
Heptoglobin (Hp) is a glycoprotein in the α2-globulin fraction, which has a specific affinity for binding with Hb. The biochemical, biological and pathological significance of its affinity to Hb has been studied in 252 subjects consisting of patients with cancer, malignant lymphoma, or inflammatory diseases of the ear, nose and throat. Serum haptoglobin level of the cancer patients is found to be higher than that of normal individual, and roughly parallels the serum seromucoid level. Also, it was found that the serum haptoglobin level in acute inflammation is the highest among the various diseases. It was felt that the qualitative measurement of serum haptoblobin values is quite valuable not only as a supplement for diagnosis of malignant neoplasmas but also for diganosis of acute reactionary phase of inflammation.
During the past 7 years, the author encountered 8 patients whose chief complaint was a swelling of the bone at the infraorbital region. Seven of the eight patients were operated on for removal of the bony bulge. In the five patients the anterior plate of the maxillary sinus protruded anteriorly associated with thinning of the bony plate, while in the other two cases were found an accessory maxillary sinus underneath the swollen bone. These findings are in contrast with those of pneumocele of the maxillary sinus in that the swelling is confined to the infraorbital region. A search of literature revealed only one such case rei5orted by Cottle. This pathology may be called pneumosinus dilatans of the maxillary sinus. The author inferred that such bulging of the anterior plate of the maxillary sinus is the result of unusually active pneumatization of the maxillary sinus creating prominent protrusion of the anterior wall of the sinus.
This new technique for the treatment of epistaxis is a method of nerve block. The block is performedby the trans-oral approach, through the mid-point of retromolar pad with an angled long needle and nfiltration of 2 ml of 2% Xylocaine to the superior carotid triangle. It attempts to block the parasympathetic nerve plexus. After the block, the nasal bleeding will be controlled immediately. Locally, dryness of nasal mucosa, oral mucosa, retropharyngeal mucosa, lips and tongue was observed. This method is indicated .also for the treatment of bleeding in the oral cavity, hiccough and esophageal spasm. The block was done on 88 cases and the results showed 80.7% of these cases with sucessful effect, 13.6% with partial effect and 5.7% failure.