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Argyrophilic nucleolar organizer regions (AgNORs) were determined by a semiautomatic image analyzer in a group of 28 patients with T2 or T3 maxillary sinus squamous cell carcinoma. The group was separated into recurrent and non-recurrent groups, metastatic and nonmetastatic groups, as well as groups strongly or weakly positive for epidermal growth factor receptor (EGFR). The mean number and area of AgNOR dots per nucleus and the mean size of each dot were calculated. The mean number and area were significantly greater than those in normal cells (P < 0.001), but not in recurrent and non-recurrent groups, metastatic and non-metastatic groups and groups separated by EGFR. There was also no difference found in the mean sizes of tumor and normal cells. These results suggest that AgNOR is related to malignant transformation, but not prognosis.

Adenocarcinoma of the middle ear is seldom encountered in clinical practice. In the past 20 years, nearly 20 cases of primary adenocarcinoma of the middle ear have been reported, and most cases of these tumors have been described without histologic presentation. To our knowledge, only one case of adenocarcinoma originating in the postoperative middle ear has been reported. We describe a case of primary poorly differentiated adenocarcinoma in the middle ear which was surgically treated for chronic otitis media 50 years ago. Planning diagnostic and therapeutic procedures in connection with middle ear tumors is also discussed.

The effects of granulocyte colony stimulating factor (G-CSF) were evaluated in 9 patients with malignant lymphoma of the head and neck. The effects of 31 cycles of cytotoxic chemotherapy were treated with G-CSF. G-CSF was given by one of the following three routes: 1) administration before or with cytotoxic chemotherapy, 2) administration after cytotoxic chemotherapy with leukocyte counts of more than 2000/mm3, and 3) administration after leukocyte counts had dropped to less than 2000/mm3. The first group consisted of one cycle of CHOP therapy and 2 cycles of VAMA therapy. The second group consisted of 10 cycles of CHOP therapy. The third group consisted of 13 cycles of CHOP therapy and 5 cycles of VAMA therapy.Leukocyte nadirs occurred on around day 14 for CHOP therapy and around day 21 for VAMA therapy without G-CSF treatment. In the first group, the leukocyte nadirs occurred earlier with G-CSF treatment. Additional G-CSF treatments were given in two of the three cycles. In the second group, the leukocyte counts did not drop below 2000/mm3 in three of the ten cycles. Additional G-CSF treatments were given in five of the remaining seven cycles. The two other cycles went without additional treatment. The mean volume of G-CSF was 305±86μg. In the third group, the leukocyte counts increased to more than 2000/mm3 immediately after G-CSF administration in CHOP therapy. The mean volume was 227±78μg, significantly less than that of the second group. The leukocyte counts also exceeded 2000/mm3 3-5 days after G-CSF administration in 5 cycles of VAMA therapy. These data indicate that the most appropriate administration of G-CSF is 50-75μg/body/day×3-5 days after leukocyte counts fall below 2000/mm3.

Enophthalmos is usually a consequence of orbital trauma resulting in a blowout fracture of the orbital floor. We report here the case of a 35-year-old male who had a radical operation of the maxillary sinus and the ethmoidal sinus, and 2 months after the operation, developed spontaneous enophthalmos and ocular pain. The left orbit was enophthalmic by 5mm according to Hertel enophthalmometry. Surgical correction was performed under general anesthesia. The left orbit was explored through a transcutaneous incision of the left lower lid which revealed marked periosteal adhesions and absence of the bony floor of the orbit. A rib cartilage graft was used to reconstruct the floor of the orbit, and the globe was brought forward by means of retrobulbar placement. Enophthalmos and ocular pain disappeared postoperatively.

A statistic analysis of 372 patients with maxillary sinus carcinoma treated between 1972 and 1983 was undertaken. One hundred eight patients were treated with the combined method consisting of 50 Gy irradiation, 2,000 mg 5-FU intraarterial infusion and tumor reduction surgery, the socalled extensive Denker's operation. Two hundred twenty-two patients were treated with the combined method not including extensive Denker's operation, and the other 42 patients with radiotherapy alone. The 5-year survival of these three groups were 48, 43, and 17 %, respec tively. The cumulative local control of the two groups with and without extensive Denker's operation was 51 and 33 %, respectively. Maxillectomy as the second treatment was performed in 24 cases (22 %) and 71 cases (32 %) of the two groups of the combined method with and without extensive Denker's operation, respectively. On the other hand, 5-year survivors without maxillectomy of the two groups were 41 cases (38%) and 54 cases (24%), respectively. It was concluded that extensive Denker's operation plays an important role to increase the success rate of the initial treatment, decrease the rate of maxillectomy and increase the survival rate although it has a certain limit for the indication.

We had a total of 372 patients with maxillary carcinoma in the period from 1972 to 1983. 108 patients were treated with 50Gy irradiation, intraarterial infusion of 2000 mg 5-FU and extensive Denker's operation in combination. 222 patients were treated with 50 Gy. irradiation and intraarterial infusion of 2000 mg 5-FU. The remaining 42 patients were treated with radio-therapy alone. The 5-year survival in these three groups was 48%, 43%, and 17%, respectively. The cumulative local control of the two former groups was 51%, and 33%, respectively. Total maxillectomy was performed as a second treatment only in 24 of 108 patients (22%) of the first group. Nine of them survived for 5 years and 15 died. On the other hand, 84 of 108 patients not treated with total maxillectomy consisted of 41 five year survivors and 43 deads. From the above, we believe that extensive Denker's operation plays a role to increase success rate of initial treatment, decrease in the necessity of total maxillectomy and improve survival rate, but its indication is limited.

A 23-years-old female with no known previous contact with tuberculosis complained of right otorrhea. Treatment with antibiotics agent was resisted, and a tympanic perforation became two. Her tuberculin test was positive, but her chest X-ray showed no signs of lung tuberculosis. Posterior rhinoscopy revealed a granuloma in the epipharynx. Histological examination of a biopsy specimen revealed tuberculosis changes. Treatment with antituberculosis agents, SM.INH.RFP greatly reduced the mass and the tympanic perforation.

The aim of this retrospective study was to investigate a correlation between histopathological differentiation and metastasis in patients with carcinoma of the nasal cavity and paranasal sinuses to improve the survival. Between 1984 and 1992, 52 cases of sino-nasal malignant tumors were treated at Kagawa Medical School Hospital. Squamous cell carcinoma was evaluated in 29 patients and undifferentiated carcinoma in five patients. Treatment in most cases consisted of radiotherapy, 50 Gy/25 fr/5 weeks, continuous intra-arterial infusion of 5-FU 2000 mg/4 weeks, and an extensive Denker's operation 2-3 weeks after the completion of radiotherapy. The 5-year survival rate was 53%, and the local control rate was 82%. Patients died of local failure (six), distant metastases (six), lymph node metastases (one) and other causes (three). Twenty-eight patients with local control were classified into G1-2 (well- and moderately-differentiated) and G3-4 (poorly-differentiated and undifferentiated) groups. Lymph node metastasis was unrelated to the degree of differentiation, but distant metastasis was significantly correlated to the degree of differentiation (P = 0.014). The 5-year survival rates in lymph node metastasis (n = 7), non-lymph node metastasis (n = 21), distant metastasis (n = 7), non-distant metastasis (n = 21), and the G1-2 (n = 17) group and the G3-4 group (n = 11) with local control were 57%, 63%, 14%, 78% (P = 0.002), 72% and 44% (P = 0.0384), respectively. The results of combination therapy were poor in patients with poorly-differentiated or undifferentiated carcinoma because of distant metastasis, and adjuvant chemotherapy may be necessary in such patients to prevent distant metastasis.

Nine oral and oropharyngeal squamous cell carcinomas were removed with a contact Nd-YAG laser. Clinical and morphological studies on wound healing and effects of the Nd-YAG laser were performed. The wounds were not sutured and patients did not complain of any severe symptoms. The wound healing was prolonged to 3–6 weeks. Cells and glands degenerated at a depth of 2–3 mm by the direct effects of the laser. The epithelium exhibited acantholysis 5 mm from the site of laser injury. Scanning electron microscopy showed no coagulation or other coated material in the wound created by a surgical knife, while the wound surface by laser consisted of carbonization, well-coated and non-coated areas. These findings varied with the laser power. The coagulation and thermal effects of the Nd-YAG laser resulted in autolysis of tumor cells at least within 5 mm of the cutting surface. The contact Nd-YAG laser was useful for the removal of the malignant tumor in the oral cavity and oropharynx where it is difficult to maintain a generous safety margin.

The expression of epidermal growth factor receptor (EGFR) was determined immunohistochemically in two groups of maxillary sinus squamous cell carcinomas, one with recurrences at the primary site after combination therapy with radiotherapy, chemotherapy and/or surgery and one without local recurrences. Using a four-graded scale (-, +, + +, + + +), 9 of the 10 recurrent carcinomas had a staining intensity and proportion of stained cells of + + or more. A comparable staining intensity was found in 9 of the 18 non-recurrent carcinomas. This difference is statistically significant (Fisher's exact probability test, P0.05). These results indicate that an increased expression of EGFR may influence the recurrence rate of squamous cell carcinoma of the maxillary sinus after combined therapy.

Symptoms at first onset and on initial examination were analyzed in 845 patients with maxillary sinus carcinoma. About 20–30 per cent of the patients became aware of swelling of cheek, nasal obstruction, nasal discharge and epistaxis as first symptoms. About 50–80 per cent of the patients complained of such symptoms on initial examination. Symptoms of maxillary sinus carcinoma are similar to those of chronic sinusitis which results in a delay in diagnosis. Such symptoms should be recognized to improve survival rate. CT and MRI scans are useful for early diagnosis and determination of tumour extension. Sinoscopy with biopsy is most important to detect the earliest tumour stage.

The complement receptor (CR1) in the maxillary sinus mucosa of normal patients and in cases of chronic sinusitis was studied with the peroxidase-antiperoxidase, avidin-biotin peroxidase and immunofluorescent methods. CR1 was localized on the ciliary surface and in the cytoplasm of the covering epithelium in both normal controls and the cases of chronic sinusitis. CR1 tended to be denser in the mucosa of chronic sinusitis than in normal mucosa. CR1-binding capacity was also studied with the immunofluorescent method, using C3b-conjugated zymosan. Although CR1 did not bind to C3b in vivo, it was found to bind to C3b in the normal maxillary mucosa when it was treated with C3b-conjugated zymosan. CR1-binding capacity could not be detected in the mucosa from cases with chronic sinusitis, indicating that CR1 was already bound to activated C3b in these cases.

Of the 1102 cases of nasal-and paranasal malignancies, life condition of the long term survivors was studied. The total number of patients were 258, of which 87 cases have been observed for 5-9 years, 149 for 10-19 years and 22 for more than 20 years.The causes of the patients' death which occurred during the observation period were double cancer, apoplexy, decrepitude etc. As the focus of the apoplexy occurred more frequently on the side of maxillary malignancies, it could be related with the late effect of radiation therapy. The case with no symptom or with slight symptom in the performance status amounted to 80% of the subjects studied (258 cases), however, the percentages relative to the number of all registered cases (1102 cases) were 29.1% in the group of 5 years observation period, 22.9% in 10 years group and 3.4% in more than 20 years group, respectively. The results suggest the severe circumstance of this disease.The first factor limiting everyday life was the aging of the patients and the second was the radiation cataract. The cataract always occurred on the affected side, and 87.9% cases lost their sight in 10 years after the treatment. Even on the eye of the healthy side, the intact vision was foundonly in 65.8% of 10 years survivors.These observations showed that our recent therapy in adequate, but gave a warning in the way to select the indication patients for the radiotherapy. It is most important to avoid the overdosis, to decide the appropriate field and protector, and to reduce the radiation dose on the eye of the healthy side.As far as the total maxillectomy is concerned, further effort must be given for deciding the cutting margin, and for improving the operation method. Cooperation with plastic surgeon is also suggested. After the operation, attention should be paid to practice the mouth opening and to treat the middle ear effusion.

Movements of the centre of gravity during 60 s of standing with eyes closed and eyes open were analysed before and after alcohol ingestion up to 8 h in 37 healthy human subjects. Blood alcohol and acetaldehyde concentrations (BAC and BAcHC) were measured simultaneously. Among the parameters analysed, area of posturogram was the most sensitive indicator; it increased to 3.8 times that of the control value at 60 min, after 3.5 ml/kg of ingested whisky (mean BAC of this group was 1.4 mg/ml), with the eyes open. The Romberg ratio, which denotes eyes closed relative to eyes open, remained constant. By contrast, there was little change in stabilometry in cases of 1.2 ml/kg of whisky ingestion (mean BAC at 60 min was 0.58 mg/ml). It is considered that body sway starts to increase when the BAC level exceeds 0.6 mg/ml on average; this value is only higher than the threshold of positional alcohol nystagmus. Correlation coefficients between BAC and each parameter of the stabilogram in the eyes open condition, such as area, X- and Y-axis diameters, and velocity of body sway, were 0.53, 0.45 and 0.48, respectively (p less than 0.01). There was no positive correlation between BAcHC and these parameters.

Acceleration and deceleration tests are performed on 100 subjects who are free from possiple motion sickness in an attempt to define physiological permissible limits on a comfort index basis. The results obtained are as follows : 1) Through a mathematical approach it is disclosed that physiologically 0.19 g for acceleration, ration are found to be limits. 2) The passenger's sitting position is the best, and in standing position with the face in running direction is the worst on comfortable index. cted to chronological changes. parative changes before during and after the tests. 5) None have developed car sickness during and after the tests, 36 subjects have complained of fatigue.

One hundred seventy-one maxillary carcinoma patients who survived more than 10 years after initial treatment were surveyed. Performance status was unrestricted in 35.1% of the patients, slightly restricted in 34.5%, moderately restricted in 21.1%, restricted in 7.0%, and very restricted in 2.3%. Radiation-induced cataracts on the affected side occurred in 100% of the patients treated with radiation. Good visual acuity was maintained in only 65.8% of the patients, even on the contralateral side. Fifty-five percent of the patients retained symmetric facial animation due to our policy of conservative therapy. Restricted mouth opening occurred in 32.2% of the patients, taking liquid diet in 21.1%, and middle ear effusion in 26.3%, which were closely linked to maxillectomy operation. This study suggests that avoiding excess radiation dosage, strict control of radiation field, adaption of two portals with 60 grades wedge pair filter, use of appropriate protectors, limiting removal at the maxillactomy, and postoperative care for trismus or tympanic effusion are necessary.

Six patients of olfactory neuroblastoma were treated, and two of them were studied with electron microscopy and immunohistochemical staining. These patients, four male and two female, ranged in age from 37 to 73 years old. Five patients had nasal bleeding, and only one patient had frontal pain and optic disorder without nasal bleeding. None of the patients had metastasis. However, three patients had local recurrence and invasion into the intracranial region. The tumors of three patients were confined to the nasal cavity and one or more paranasal sinuses. The tumors of the other three patients extended beyond the nasal cavity and paranasal sinuses. Two patients, treated with radiotherapy and cryosurgery, died of the disease 7 and 21 years after treatment, respectively. Two patients, treated with radiotherapy alone or a combination of radiotherapy and chemotherapy, died of other causes without recurrence 2 and 3 years later, respectively. A patient treated with craniofacial resection alone is still alive after 4 years. However, he has local recurrence and has been treated with radiotherapy and adjuvant chemotherapy. The last patient, treated with craniofacial resection following radiotherapy, is still alive after 3 years without any symptoms of recurrence. The two most recent cases were studied with electron microscopy, stains for PAS, Grimelius and Bodian, and immunohistochemical staining for S-100 protein, neuron-specific enolase, and glial fibrillary acidic protein. The tumor cells of one case were well differentiated because they contained neurosecretory granules and neurites, and the tumor cells of the other case were poorly differentiated because they contained only neurites-like structures.

The proposal of the JJC, established in 1977 in an effort to establish a TNM classification of maxillary sinus carcinoma, proved superior to the American Joint Committee for Cancer Staging and End Results Recording (AJC) proposal in terms of reproducibility, well-balanced distribution of cases of T, and prognostication using TNM as the indices, after a nationwide analysis of 474 N0M0 Patients who were among the 541 patients first treated between 1970 and 1973 in 11 leading Japanese medical institutions. The number of patients, with their 5-year cumulative survival rates in parentheses, classified by T1, T2, T3, and T4 were as follows: AJC proposal — 0 (−), 21 (68%), 283 (44%), and 170 (31%); JJC proposal — 6 (83%), 148 (51%), 237 (40%), and 83 (22%). The 283 cases for T3 under the AJC classification are to be redistributed over three JJC T units of T2, T3, and T4, with the respective numbers of cases and 5-year cumulative survival rates of 133 (50%), 128 (41%), and 22 (26%). In a similar manner, the 170 T4 cases under the AJC classification are reclassified into 109 (37%) for T3 and 61 (20%) for T4 under the JJC proposal. The JJC proposal enables closer prognostication than the AJC.

A case of malignant fibrous histiocytoma (MFH) in the right maxillary sinus is reported. Patient was a 30-year-old male, and was diagnosed as pleomorphic type of MFH by biopsy before therapy. The tumor shrunk and changed into xanthoma-like tumor after radiotherapy. A case like the present case has not been reported previously in the literature.