The morphological changes in the nasal mucosa caused by topical aerosol agents, were observed in an experimental study. The agents were dibekacine sulfate (Panimicine) 0.0313% and 3.3%, histamine-added globulin (Histaglobin) 0.0375%. Physiological saline solution was used as a control. After a guinea pig was exposed to each of these agents for 1 week, 2 weeks, and 4 weeks respectively, specimens of the nasal mucosa were observed under a light and an electron microscope. After the exposure of DKB 3.3% aerosol, inflammatory morphological changes in the nasal mucosa were more severe than that caused by DKB 0.0313% aerosol. The tissue changes after the exposure of DKB 0.0313% and HG 0.0375% were the same as that caused by physiological saline solution. There were inflammatory changes of the nasal mucosa even after the exposure of physiological saline solution which normally does not act as a stimulant on the nasal mucosa. This indicates that nebulization itself has a mechanically stimulating effect on the nasal mucosa. From this study, it is suggested that nebulization itself and a high concentration of DKB, as an aerosol agent, may cause inflammatory morphological changes in the nasal mucosa.
In our histological study using pig and human temporal bones, two bone metabolic systems, membranous ossification system and chondral ossification system, were observed in the process of pneumatization and growth of the mastoid process. In chondral ossification points, middle ear inflammatory stimulus did not suppress the bone metabolism. But in membranous ossification points, it suppressed the bone metabolism and it caused the suppression of pneumatization and the suppression of growth of the mastoid process. In pigs, the chondral ossification ceased until the late phase of pregnancy and only the membranous ossification was observed after birth. So the experimental studies of the suppression of pneumatization and the suppression of the mastoid process were clearly observed in pigs. But in human temporal bone, after birth, the chondral ossification was still observed in two points. It is suggested that the suppresion of the pneumatization is not so clear compared to the pig temporal bone. But in the membranous ossification points of human temporal bone, the suppression of pneumatization will be caused by the middle ear inflammatory stimulus.
Laser Doppler flowmetry was introduced to estimate the microvascular blood flow in the superficial nasal mucosa of patients with Japanese cedar pollinosis, and to compare with the flow of normal individuals. The pollinosis patients were divided into “Before the pollen season group” and “During the season group” depending on the time of patients' first visits to the hospital. There were no significant differences between the blood flow of “Before the season group” and that of the normal group. The value were maintained stationary throughout the season only when treatments were continued. On the other hand, the blood flow of “During the season group” dropped significantly when the allergic symptoms appeared. Nevertheless, the blood flow would be increased showing a similar value to that of normal individuals, after the patients were treated properly. It can be concluded that the non-invasive laser Doppler technique may be valuable in studying and monitoring the pathology and/or pharmacological vascular effects in the superficial nasal mucosa of patients with nasal allergy.
The patient is a 49-year-old male who complained of diurnal variation of visual acuity in his left eye for one year. CTscans showed left ethmoidal sinusitis without other abnormal findings in his left orbit. After parasinuectomy in his left side, clinical symptoms and signs have been improved. Although the mechanism of diural variation of visual acuity in this case has not been confirmed, the case was infered to be rhinogenous optic neuropathy.
infection, which has been usually recognized as atypical pneumonia, has epidemic outbreaks at four year intervals. M. pneumoniae is also a pathogen of upper respiratory infections, such as pharyngitis and otitis media. In 1992, 9 cases of patients, who visited my ENT office complaining of acommon cold, showed high titers of M. pneumoniae antibody. All of them were childen. Five cases had otitis media, 3 cases had pharyngolaryngitis and 1 case had tonsilitis with pneumonia. I experienced anothere pidemic outbreak of M. pneumoniae infection 11 years ago in 1980. Atypical pneumonia (M. pneumoniae Pneumonia) has been one of a number of epidemic diseases under a national statistic survey since 1982. Cases with atypical pneumonia at reporting clinics are informed to local health centers, prefectural offices and the Welfare Ministry which publicly reports statistic data of this disease every week. According to the rlational report, atypical pneumonia had an epidemic outbreak in Isikawa Prefecture in 1992. In Isikawa Prefecture, the number of weekly reported cases per reporting clinic was more than 1.0, and much higher than the national average, Because of this outbreak, I found many patients with M. pneumoniae infection presenting ENT symptoms. Local epidemic outbreak of the disease, however, is not always accompaind with the rise of the number of the national statistic survey. There was one case, whose pharyngeal tonsil was markedly swollen and covered with thick exudate. This finding is suspected to be due to the histologic specificity of the pharyngeal tonsil.
A 51-year-old woman with systemic lupus erythematosus suffered from bilateral intermittent sensorineural hearing loss at an interval of about two years. Treatment with systemic administration of alprostadil (prostaglandin E1) mecobalamine and ATP improved the bilateral intermittent hearing loss. Recent clinical reports suggested a possible association between sensorineural hearing loss and systemic lupus erythematosus. It was considered that bilateral intermittent sensorineural hearing loss in our case was caused by silght angitis of the inner ear during the course of systemic lupus erythmatosus. We reviewed literature for sensorineural hearing loss caused by systemic lupus erythematosus and disscussed from the viewpoint of the treatment.
We have experienced a case who suddenly manifested severe hemorrhage during and after open surgery for cysts of posterior paranasal sinuses. In this case, severe hemorrhage was caused by a rupture of aneurysm of the internal carotid artery. The following risk factors for internal carotid artery injuries during surgery have been listed, (1) internal carotid artery runs along sphenoidal sinus, (2) its areas of attachment are broad, (3) the growth of sphenoidal sinus is good, and (4) the sphenoidal sinus walls are thin. In our case who has cysts of posterior paranasal sinuses, there was a risk that the arteries might directly be damaged during surgery because of spatial relationship between the internal carotid artery and sphenoidal sinus, particularly when cysts were destructive to surrounding walls of bones and invasive. Damages to the internal carotid artery could be potentially fatal. In order to avoid possible injuries during surgery, it is important to understand anatomical localization of the posterior paranasal sinuses and internal carotid artery. However, in this type of case, it is important for prevention of complications and injuries to utilize an endoscopy all the time, and to perform operation very carefully with clear visual fields.
A statistical analysis was made on 89 patients with tracheo-bronchial and esophageal foreign bodies seen at the Department of Otolaryngology, the Jikei University School of Medicine from 1980 to 1990. The results were as follows: 1) As the tracheo-bronchial foreign bodies, beans were more frequently found in children under 3 years old.2) All cases of the tracheo-bronchial foreign bodies were removed by the rigid endoscopeunder general anesthesia. 3) As the esophageal foreign bodies, especially, PTP (press through package) had increased in elderly people. 4) In the cases of the esophageal foreign bodies, 47% cases were removed by the rigid endoscope under general anesthesia and 39% cases were removed by the flexible fiberscope under local anesthesia. In the high-risk cases or the elderly people, flexible fiberscope would be useful in removal of the foreign bodies.
Vagal body tumor develops from the vagal bodies which lies near the ganglion nodosum of the vagus nerve. Vagal body tumor is a paraganglioma (Chemo-dectomas), the same as carotid body tumor or glomus juglare. We report a case of a 22-year-old male with vagal body tumor. The diagnosis was difficult, because the patient was young and the symptoms were only a feeling of discomfort in the pharynx and cough. However, MRI and angiography helped to diagnose the tumor in the parapharyngeal space from the level of the mandibular angle to the level of the jugular foramen. We removed the entire tumor through a neck incision without cutting the mandibular bone. The tumor was found to have derived from the vagus nerve and its pathology was paraganglioma, that is a vagal body tumor. We discuss the clinical characteristics of vagal body tumors in this report.
It is well-known that a high percentage of patients with diffuse panbronchiolitis (DPB) have a history of chronic sinusitis (CS). Fortyone patients with DPB were clinically investigated for association of the disease with CS. As a result, 32 (78%) of these patients were found to have concurrent CS and 21 (51%) had been operated upon for CS, with the onset of DPB occurring 12 years after that of CS on an average. Patients with associated CS were significantly younger and had a significantly lower mortality rate than those without associated CS. From these results it was surmised that CS might be the precipitating cause of DPB.