Although the Chlamydia genus causes many human diseases, the clinical characteristics of otolaryngeal Chlamydia infections are not yet elucidated. The genus has two species: trachomatis and psittaci. C. trachomatis, which was originally associated with trachoma and lymphogranuloma venereum, is now recognized as the most common cause of sexually transmitted diseases. In our study, 26.2% of patients with tonsillitis had C. trachomatis isolated from the tonsillar crypts. Generally tonsillitis due to C. trachomatis is not severe and develops to recurrent or lingering tonsillitis. We reported recurrent acute otitis media and otitis media with effusion due to C. trachomatis. In some cases, C. trachomatis was detected by immuno-fluorescence method andantibodies to the agent by micro-IF test in themiddle ear fluid. The immune complex appears to be important role of the pathogenesis. C. psittaci infections are usually associated with pneumonia. A continuing source of human infection is pet birds. However, recently reported were a series of respiratory tract diseases due to C. psittaci spread from human to human. In this paper, microbiology, diagnostic and therapeutic problems have also been reviewed.
Chronic otitis media with cholesteatoma (Cholesteatoma) causes a much higher degree of bone destruction as compared with chronic otitis media without cholesteatoma (N on-cholesteatoma), resulting in destruction of the auditory ossicles, semicircular canal, facial canal and tegmen, and causing conductive deafness, inner ear disturbance and intracranial complication. Thus numerous investigations have long been performed on the etiology and mechanism of bone destruction in cholesteatoma. To date, pressure, circulatory disturbance du to inflammation, biochemical reactions such as enzyme activities within inflammatory granulation tissue or involvement of the epithelium have been proposed as the mechanism of bone destruction in cholesteatoma. In addition, studies have been made of the involvement of cells (such as fibroblast-like cells, osteoclasts, osteocytes, osteoblasts, macrophages, neutrophils, etc.) that appear at the site of bone destruction, but pathology specific to cholesteatoma has not been fully elucidated. In this paper, we discuss our histological study using experimental cholesteatoma-like lesion in mongolian gerbils and human cholesteatoma with special attention to the cells that appear at the site of bone destruction in cholesteatoma as well as briefly review the literature as an effort to elucidate some of the mechanism of bone destruction in cholesteatoma.
Growth characteristics and Epstein-Barr virus (EBV) induction in EBV-genome-negative Ramos Lymphoma lines and three sublines of Ramos (Ramos/B 95-8, AW-Ramos and Ramos/NPC) carrying different EBV-genomes derived from cells of infectious mononucleosis (IM), Burkitt's lymphoma and nasopharyngeal carcinoma (NPC) were comparatively examined. In addition, the difference of growth characteristics and immunoglobulin production in human cord blood lymphoblastiod cell lines (CBLs) transformed by two strains of EBV (B 95-8 and NPC-KT) derived from cells of IM and NPC were also studied. Cells of EBV-genome-negative Ramos line died rapidly after having reached saturation density, whereas all three cells of EBV-genome-positive Ramos sublines maintained constant number of living cells for several weeks even after having reached saturation density. However, no differences were shown in growth chracteristics between cells of Ramos sublines and CBLs which carry different EBV genomes. On the other hand, there was a clear difference in EBV induction after the treatment of cells of EBV-genome-positive Ramos sublines with 12-tetradecanoylphorbol-13-acetate, n-butyric acid, and 5-iododeoxyuridine. Ramos/B 95-8 and AW/Ramos cells could synthesize early antigen (EA) after their treatment with the above chemical drugs, whereas Ramos/NPC cells could not show EA induction after the treatment of cells with any chemical drugs. From three different blood samples (human cord, human adult seronegative, and cotton-top marmoset bloods), total six cell lines were established by exposure to either B 95-8 strain or NPC-KT strain. All these established cell lines contained more than 90% EBV-associated nuclear antigen (EBNA)-positive cells. While tranforming virus could regularly be rescued from human adult and cotton-top marmoset lymphocytes tranformed by either B 95-8 or NPC-KT virus strain, attempts to rescue virus from human cord blood lymphocytes transformed by two virus strains or from the EBV-converted Ramos sublines (Ramos/B 95-8 and Ramos/NPC) were unsuccessful. In addition, only virus stock obtained from cotton-top marmoset lymphocytes transformed by NPC-KT EBV strain could superinfect Raji cells. From these results, it was suggested that characteristics of the EBV-transformed lymphoblastoid cell lines and their EBV production may be determined by cellular facters and mutual interaction between cells and EBV strains employed rather than the differences among the virus strains.
We evaluated optokinetic nystagmus quantitatively on the basis of pattern recognition and qualitatively by computerized procedure in the same patients. The results of qualitative and quantitative tests agreed 85-72%, though with some variations according to the parameters examined. The total slow phase amplitude and the total slow phase velocity showed particularly high correlations. About half of patients who were considered to have borderline findings in the qualitative test showed abnormal values in the quantitative test. In these patients, the final judgment of normal or abnormal must be made comprehensively according also to the results of other examinations. The total slow phase amplitude and total slow phase velocity were reliable parameters for quantitative evaluation of nystagmus. These parameters were less liable to the effects of transient cessation, and showed high correlations between the results of qualitative and quantitative evaluations. Most of the patients who showed abnormal values in none or only one of the parameters in quantitative evaluation were considered to be normal in qualitative evaluation, but most of those who showed abnormal values in 4 parameters quantitatively were considered to be abnormal qualitatively. The number of parameters showing abnormal values, as well as the values per se, are considered to be useful for evaluation of the test.
It is said that pharyngeal tonsils physiologically become swollen at age 4 to 5, reaching peak levels at age 6-7 and shrinking in later years. Adenoid hypertrophy which is a pathologic enlargement of pharyngeal tonsil has been a subject for debate because it is suspected of being closely associated with development of sinusitis in children. This paper discusses the clinical effect of adenotomy that was performed on children with sinusitis. The subjects were 38 children who had sinusitis during the past one year. The subjective symptoms (nasal obstruction, snoring), objective symptoms (nasal discharge, swelling of the concha nasalis inferior), and tomographic findings of the paranasal sinus were graded in four steps (+ + +, + +, +, -) 3 months before and after adenotomy. The rate of moderate or better improvement after adenotomy was 89.5%(34/38) for nasal obstruction, 85.8%(24/28) for snoring, 57.9%(32/38) for nasal discharge, 60.0%(21/35) for swelling of the concha nasalis inferior, and 71.1%(27/38) for tomograms of the paranasal sinus. Our results seem to justify our conclusion that adenotomy provides an effective therapeutic tool for sinusitis.
Percentage of foods prepared for patients with any degree of dysphagia at 32 Hospitals has been found to be 100% in two hospitals, 28% in one hospital, 10-20% in three hospitals and nine percent or below at 25 hospitals. The types of such foods were minced, mixing machine-prepared and liquid for use with the feeding tube. In 60% of the hospital pudding-like food and minced foods were available. The kinds of food not adequate for patients with dysphagia included vegetable with much fibers, or strong odor, rice-cake, fish with many tiny bones and devils tougue.
The laterality in nasal resistance was studied by rhinomanometry. The left-right ratio of nasal resistance was 1.3±0.3 for healthy controls. In patients who underwent intranasal operation, it was 1.8±0.7 before and 1.2±0.2 after the operation in 14 patients with septal deviation, 1.9±0.9 before and 1.3±0.4 after the operation in 13 patients with septal deviation complicated by hypertrophic rhinitis, 1.6±0.4 before and 1.3±0.3 after the operation in 15 patients with chronic sinusitis, and 1.6±0.4 before and 1.3±0.3 after the operation in 16 patients with nasal allergy. The laterality was large in the patients before the operation but became near to that of healthy controls after the operation.
We experienced 74 cases of unilateral paranasal sinus disease at the ENT clinic of Kudansaka Hospital since July, 1984 to February, 1986. Seventy of the 74 cases (94.6%) were inflammatory paranasal sinus diseases, and among them chronic sinusitis was the most common disease. The rest of the patients were affected by tumors. Among them, 2 cases were benign and the other 2 cases were malignant tumors (squamous cell carcinoma and extramedullaryplasmacytoma). Although CT-scan was a useful tool to detect the unilateral paranasal sinus disease, it will help to detect the early case of maxillary carcinoma without bone destruction. When conservative therapy fails to improve the unilateral sinus disease, surgical treatment should be considered.
Recently, we hardly meet the cases of orbital phlegmone caused by acute paranasal sinusitis because of development of antibiotics. We have experienced 4 children with orbital phlegmone from acute paranasal sinusitis during the last 10 years and in one of them the inflammation spreaded intracranially. The history, physical examination, plain radiography, CT and orbital ultrasonogram are useful for diagnosis. Identification of the pathogen is necessary for the treatment. Initial therapy with high-dose of broad-spectrum antibiotics must be started as soon as possible. Surgical procedures may be required when clinical signs do not improve within 48 hours in spite of the antibiotic treatment or the inflammation may spread into the intracranium.
A case of internal jugular vein thrombosis (IJVT) in a 73-year-old female is reported. The patient complained of left neck pain, left otalgia and fever for the past several days. On physical examination, the patient presented tenderness on the sternocleidomastoid muscle and a large perforated eardrum with purulent discharge. A CT study of the head and neck revealed a left internal jugular vein thrombosis. On contrast CT, the thrombosed vein appeared as an enlarged vein containing a low density lumen surrounded by sharply defined walls. The CT finding of IJVT was confirmed by IV-DSA (intravenous digital subtraction angiography). IV-DSA demonstrated a left jugular and sigmoid sinus thrombosis. The patient was successfully treated with antibiotics alone and discharged on the 30 th hospital day in good condition.