In Japanese cedar (Cryptomeria japonica: CJ) pollinosis, release of major allergens (Cry j 1 and Cry j 2) from CJ pollens in the nasal cavity and their incorporation into the nasal mucosa are essential for the onset of the disease. The effect of nasal fluid on the release of major allergens from the pollen grains was studied in vitro.
CJ pollens were suspended in normal saline and nasal fluid solution (NFS), and the ratio of rupture of the pollen grain wall on a slide glass was determined under a light microscope. The concentration of protein eluted in the supernatant of the cedar pollen suspension was determined by modified Lowry's protein assay. The major allergens of CJ in the supernatant were quantified by sandwich enzyme-linked immunosorbent assay (ELISA) using rabbit polyclonal antibody. The antigenicity of the pollen extract was examined by the proliferative response of mouse Cry j 2 specific helper T cell lines.
Both the ratio of rupture of the pollen grains and the concentration of protein in the supernatant significantly increased in the presence of NFS. Elution of the major allergens also increased in the presence of NFS, and the amount of Cry j 1 was larger than Cryj 2. The study on various factors involved in elutionof major allergens suggested that elution is promoted by components of nasal fluid, such as proteins, mutins, and lysozyme, as well as such physicochemical factors as pH and temperature. In conclusion, this study indicates that CJ pollens are in the state that is easy to release the major allergens in the nasal cavity of patients with allergic rhinitis.

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Reconstructions of articulatory and masticatory functions are important for quality of life of cancer patients receiving the resection of the tongue and/or the oral floor. We examined postoperative articulatory functions in 10 patients reconstructed with recto-abdominal myocutaneous free flap after glossectomy. The functions were investigated by standardized perceptual and acoustical tests, including questionnaires test, 100 Japanese monosyllable speech intelligibility test, single-word intelligibility test and sound spectrography. In some selected cases, X-ray videography was also performed.
On the basis of the resection site, the present cases were classified into two types ; i, e, anterior type and lateral type. In cases of lateral type, the speech intelligibility was higher than those of anterior type. In cases of anterior type, dental and alveolar sounds were often confused with fricatives, whereas, in lateral type, velars sounds were often confused with affricates or flaps. These tendencies were also detected by acoustical analysis. X-ray videography showed that the above mentioned confusion was most likely due to compensatory movements of the reconstructed structure and remaining vocal tract organs. In conclusions, those results suggest that perceptual, acoustic and videographic evaluations are efficacious for representing the postoperative articulatory function after glossectomy followed by reconstruction surgery.

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This study was carried out to clarify how vocal abuse harms the vocal folds using vocal abuse rat model. 5 rats were vocalized 0.6 second a time, 650-1300 times a day for 7-48 days by electrical stimulation in a brain stem thought to be a final common pathway of the limbic system. Stimulation was ceased by fatigue in 3 rats, disconnection of an electrode in 1 and by death in 1. One of 5 rats which exhibited the most intense vocalization for 16 days (totally 12, 800 vocalization) changed its voice quality and abnormal microscopic features were found in the vocal folds. In both sides of the vocal folds, dense eosinophilic material and intersperse extravascular RBCs were found in deep portion of the lamina propria. The eosinophilic material was abundant in the mid membranous portion of the vocal folds but it decreased in serial section. This is thought to be a result of hemorrhage after vocal abuse and extravascular fibrin deposition.

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We describe a 2-month-old infant with cervical lymphadenitis due to Cytomegalovirus (CMV) infection. She was brought to our hospital for evaluation of a right neck mass on July 25, 1995.
The lymphadenitis involved bilateral subdigastric nodes and para-aortic nodes as demonstrated by the CT scan and abdominal echo examination. We administered antibiotics therapy for 10 days, and conducted serum examinations to detect viral infections and immunological deficiencies. Serum CMV IgM and IgG antibody levels were elevated, and the CD 4 (OKT 4-epitope) ratio was low. We performed surgical drainage on August 7, 1995. Culture of the drainage fluid revealed staphylococcus aureus, but CMV-DNA was not detected by in situ hybridization. The low CD 4 (OKT 4-epitope) ratio may have contributed to susceptibility to infection in this patient.

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There are several diseases as the cause of strider in a newborn. We report a girl with pharyngeal congenital cyst in age of 16 days. The cyst with a diameter of 1.5 cm was located at 0.5cm below the lower pole of the right tonsil. The cyst was successfully resected under general anesthesia. Pharyngeal congenital cyst may be important in differential diagnosis of newborn strider.

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A 34-year-old woman with an open neck injury after automobile accident was transferred to the emergency center. When she hit an anterior portion of her neck, she was sitting next to the driver with a three point seat belt on. An open neck wound was found in the anterior upper left to lower right part of her neck. The airway was defect in the subglottic portion of the trachea.
Emergency surgery was performed after an endotracheal tube was inserted through the mouth with a fiberoptic scope under NLA. The defect of the subglottic portion of the larynx was covered with a pedicled sternocleidomastoid muscle and a tracheostomy was made. Hoarseness appeared on the 10th postoperative day (10 POD). Inflammatory granulation tissue was found in the place where anterior the wall was repaired with local muscle flap. On the 26 postoperative day, she was dischrged without any hoarseness or dyspnea.
Following points were thought to be important; 1. Insertion of the endotracheal tube under NLA to prevent an iatrogenic occlusion of the airway by the cuff. 2. Tracheostomy is useful for better wound healing. 3. Use of local muscle flap and meticulous handling of the cricoid cartilage. 4. Seat belts sometimes make various types of neck injuries.

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The results of endoscopic sinus surgery were evaluated with the computed tomography scans (CT) which were taken before and after the surgery. At first, the volume of the lumen in the inflammatory maxillary sinus (V. L.) and the volume of the maxillary sinus (V. M.) were measured with CT. Then the percentage of V. L./V. M. were compared with preoperative and postoperative stage. The patients were separated into three groups. Group A (35sinuses). bilateral chronic sinusitis; in this group, the fontanelle and maxillary ostium were not treated surgically. Group B (15 sinuses). bilateral chronic sinusitis; in this group, the fontanelle and maxillary ostium were widened surgically. Group C (seven sinuses). unilateral chronic sinusitis; in five sinuses of this group, the fontanelle and maxillary ostium were not treated surgically, in two sinuses the fontanelle and maxillary ostium were widened surgically.
The results were as follows: 1. The percentage of V. L/V. M of the postoperative stage were more than that of the preoperative stage in all three groups (p<0.01). 2. The degree of the differentiation of the percentage between preoperative stage and postoperative stage of group C was more than those of group A, group B and Group A+B (p<0.01). 3. The degree of the differentiation of the percentage between preoperative and postoperative stage of group B was more than that of group A.
We concluded as the following: 1. Performing the endoscopic sinus surgery, the surgical techniqe with widening the fontanelle and maxillary ostium may get better result for healing the maxillary sinus than that without widening the fontanelle and maxillary ostium, but when it is difficult to perform by former method because of bleeding or anatomical problems, operating by latter method with sufficient following treatment will be able to expect nice results. 2. The pathogenesis of bilateral chronic sinusitis and unilateral chronic sinusitis may be different. The combination of local and whole body conditions may be important for the cause of bilateral chronic sinusitis, on the other hand, the local condition may play an important part for the cause of unilateral chronic sinusitis.

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We have often encoutered pediatric nasal disorders in routine clinical examinations. Therefore, in this study we report cases in which we performed operations for pediatric nasal disorders, mainly sinusitis. We have included clinical discussions that cover nasal disorders, X-ray diagnosis, age, techniques used, postoperative results. The subjects in this report consisted of 145 cases (79 boys and 63 girls), all experiencing pediatric nasal disorders. Their ages ranged from 5 to 16. The operations were performed from 1985 to 1994. In regard to the number of cases by age, the peak age was 15 showing that nasal disorders increase with age. Ages 11 and older accounted for 90% of the cases. In regard to the number of cases per year, there has been a decline since 1992. A study on the long term prognosis by means of a questionnaire revealed the complete recovery rate to be 46.3%. For pediatric nasal disorders, there may be a need to consider patients age and growth rate when deciding on the type of operation or techniques to be employed.

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We had a patient with Aspergillosis in the nasal and paranasal sinuses causing the formation of rhinoliths. The patient was a 64 year-old male, and his maxillary sinus was opened by surgery to remove lesions on June 23, 1995. During surgery we found rhinoliths in the maxillary sinus and nasal cavity, and submitted them to Grocott's stain for microscopic observation. The structure of the rhinoliths resulted from the clustering of degenerate hyphae, suggestive of a highly calcareous concretion of Aspergillus fungi. The rhinoliths, when observed by SEM, showed dense clusterings of hyphae on the cracked surface of the specimen, and the presence of hyphae in granular structures on the surface. The patient has suffered no relapse until now.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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