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The right superior cervical ganglia of 11 cats were removed. After intravenous injection of horseradish peroxidase, both sides of the cochleas were infused with 2% glutaraldehyde and the lateral wall of the cochlea was then microdissected. As control group, both sides of the cochleas of 4 cats were extracted while the superior cervical ganglia remained intact. The samples were incubated after a modified Graham-Karnovsky method and observed by light microscopy. The diameters of the capillaries of the stria vascularis and spiral ligaments were measured. In 8 cats (73%), the diameters of the capillaries of the stria vascularis on the side on which sympathectomy was performed were significantly greater than those on the opposite side. There was no statistical difference between the diameters of the capillaries of the spiral ligament on either the sympathectomized side or the intact side, except in 2 cats. In the control group (in which the superior cervical ganglia were left intact), no statistical difference was found as regards the diameters of the stria vascularis capillaries on either the left or right side. In summary, sympathectomy affected only the capillaries of the stria vascularis and not those of the spiral ligament.

Department of Otolaryngology, Tokyo Medical and Dental University, School of Medicine, Tokyo The distribution of basophiloid cells in nasal mucosa was examined both in the patients of nasal allergy and normal controls. Basophiloid cells were stained in alcian blue (P.H. 5.8) with 0.4M MgCl2.1) The basophiloid cells in the nasal mucosa of allergic patients were far outnumbered those of normal controls.2) The basophiloid cells in the epithelial layer were very few in normal controls.3) In allergic nasal mucosa, the most numerous basophiloid cells were found in the upper lamina propoia of the mucosa.4) No difference of the number of basophiloid cells was found between ciliated area and nonciliated area except deep lamina propria of the mucosa.

A rare case of foreign bodies in the auditory tube is reported. Pieces of gauze, which had been inserted as a drainage for dental abscess into the space between hard and soft palate, were found in the auditory tube and had caused a suppurative and exudative otitis media.The gauze had apparently passed through the soft palate into the nasopharynx, produced a chronic inflammation of the soft tissue around the auditory tube, emerged into the auditory tube and was enforced deep into the tube by catheterization for treatment of the patent auditory tube. The gauze was removed with a forceps and using the celpoc endoscope.

The fine structure of human nasal blood vessels was studied in 15 nasal allergic patients. Biopsies were taken at different stages after provocation. In the early stage (two minutes after provocation), characteristic alterations of capillaries and venules were congestion, gap formation between two endothelial cells, and swollen vascular endothelial cells. Evidence of locally increased vascular permeability and congestion causing mucosal edema was found. In the late stage (20 minutes after provocation), evidence of congestion disappeared. Vascular dilatation and marked interendothelial cell gaps were observed. In both perivascular space and sometimes in intravascular space, de-granulated eosinophils were observed, suggesting that not only histamine but also lysosomal enzymes in eosinphil granules may be involved in causing increased vascular permeability.

The transendothelial passage of horseradish peroxidase (HRP) and colloidal carbon and diffusion of HRP in pericapillary space, injected intravenously into rats, was studied at the light microscopic and ultrastructural level in the nasal mucosa. In the lamina propria of the mucosa in the middle third of the nasal septum of rats, the capillaries directly beneath the epithelium were mostly with fenestrae, while the capillaries around the nasal gland were without the fenestrae. The permeability of the capillaries in the lamina propria of the nasal mucosa was very high and some of the endothelial cells were wide open, like liver sinusoid, allowing free passage of carbon particles. Marked transendothelial passage was also noted at ten seconds after HRP infusion through the capillaries without fenestrae located around the nasal gland. On the other hand, no extracapillary leakage of HRP was noted even at 150 seconds after its infusion in the capillaries without fenestrae located in the muscles. The permeability of small venules located in the lamina propria of nasal mucosa also was extremely high. The reasons for the greater permeation of HRP through capillaries of nasal mucosa are as follows. First, the endothelial cell junction was loose in the nasal mucosa and in some capillaries endothelium had holes like liver sinusoid. Second, interstitium surrounding the capillary was loose in nasal mucosa.

Two cases of pleomorphic adenoma of the nasal septum were reported, and a statistical and clinical observation was made on 19 cases of pleomorphic adenoma of the nasal septum collected from Japanese literature.Case 1: A 70-year-old woman was admitted to the out-patient clinic of the ENT department of the Tokyo Medical and Dental University on October 17, 1975, with the complaints of right-sided nasal obstruction, recurrent epistaxis, and a swelling on the right side of the external nose.Examination showed a large, grayish pink, rounded mass almost completely filling the right nasal cavity.Successful surgical excision was performed via the intranasal approach.Histopathological examination showed plemorphic adenoma (mixed salivary tumor) showing mainly masses of oval cells with duct-like structure, mucinous tissue and cartilage-like tissue also seen with occasional of squamous metaplasia foci.Postoperative course was uneventful and there has been no recurrence.Case 2: A 67-year-old woman was admitted to the university hospital on May 23, 1978, with the complaints of right-sided nasal obstruction and recurrent epistaxis of 5 years' duration.Examination showed a large, smooth, grayish pink, rounded mass almost completely filling the right nasal cavity.The tumor was excised by lateral rhinotomy as it was too big to be completely removed otherwise.Histopathological examination showed pleomorphic adenoma. Postoperative course was uneventful and there has been no recurrence.From the statistical and clinical observation on 19 cases of pleomorphic adenoma of the nasal septum in Japanese literatures, the following results were obtained.1) Ages ranged from 23 to 70-year-old.2) There were 12 female and 7 male patients.3) The most frequent chief complaints were epistaxis, nasal obstruction, and a swelling of the external nose.4) In 11 cases, tumors located in the right side, and in 8 cases, in the left side.5) The duration of symptoms ranged from 3 months to 20 years.6) As surgical procedure, the intranasal approach was used more frequently, that was in 12 cases while the extranasal approach was employed in 6 cases.7) All cases were followed and no recurrence was reported.

Propranolol (β-blocker) was administered to five guinea pigs in doses of 6 mg/day for ten days; five uninjected animals were used as controls. The first or second tracheal ring was cut in round slices. The number of overall epithelial cells facing the airway and the epithelial cells with peroxidase were counted. The mean percentage of peroxidase-positive cells to total epithelial cells was 49% in the control and 11% in animals after the administration of propranolol. This result apparently meant that the peroxidase activity was decreased by the administration of propranolol. The relationship between allergic diseases and the synthesis of peroxidase is discussed.

Although the concentration of the japanese cedar specific IgE antibody in blood can be measured with RAST, the Phadebas RAST Kit contains no japanese cedar allergen disc. Japanese cedar allergen disc (I : 20) was newly prepared. It was evaluated whether this japanese cedar allergen disc was practical or not in the RAST of Japanese Cedar Pollinosis. Serum samples werecollected from 86 patients with Japanese Cedar Pollinosis and 10 normal adults. RAST was performed with Phadebas reagents and (1 :20) japanese cedar allergen disc according to Phadebas experimental instructions. Results were as follow: 1) Phadebas, mountain cedar allergen discs did not react with the japanese cedar specific IgE in the sera of Japanese Cedar Pollinosis. 2) Japanese cedar allergen was well coupled to paper discs and japanese cedar allergen discs (1 : 20) absorbed so well the japanese cedar specific IgE antibody that RAST with this japanese cedar allergen disc can be carried out without the modification of Phadebas experimental directions. 3) The results of RAST with this japanese cedar allergen disc should be expressed following new criteria other than Phadebas RAST criteria. According to the RAST results of normal persons, negative RAST, doubtful RAST and positive RAST were newly classified instead of Phadebas RAST class. 4) The RAST results of 86 patients suffering from Japanese Cedar Pollinosis were 4 cases of negative RAST. 13 cases of doubtful RAST and 69 cases of positive RAST.

Endogenous peroxidase activity was demonstrated in seromueous-secreting cells of human nasal glands, using the diaminobenzidine method for cytochemical demonstration of perox-activity was localized in cisternae of rough-surfaced endoplasmic reti-culum including nuclear envelope, some vessicles and saccules of the Golgi complex and secreting granules.Peroxidase activity in nasal glands diminished or disappeared in the case of house dust nasal allergy patients. After giving steroid hormone(Dexamethasone 5 mg/day for 7 days) to these nasal allergy patients, peroxidase activity appeared again in the nasal glands.It can be considered that if nasal glands depend on the same nerve system as salivary glands, the diminution of peroxidase activity is due to the diminution of sympathetic stimu-lation.

Carbonic anhydrase activity was demonstrated ultracytochemically in the dark cells of the vestibular labyrinth and in the stria vascularis of the guinea pig. Reaction products were found both in the dark cells and in the stria vascularis. Localization of carbonic anhydrase was very similar between the dark cells and the intermediate cells, but the marginal cells had a different localization pattern. In both the dark cells and the intermediate cells, the reaction products were deposited in the cytoplasm, especially in the infoldings. In the marginal cells, carbonic anhydrase activity was observed on the lateral plasma membrane of the apical area and in a few apical vesicles, but was not detected in the infoldings of the deep portion. Reaction products were also observed in the intercellular spaces between the marginal cells. No reaction products were observed in the basal cells and transition cells. Carbonic anhydrase activity was observed in the cytoplasm of capillary endothelial cells and the fibrocytes of the spiral ligament. It is considered that carbonic anhydrase may play a major role in water and electrolyte transport in both the dark cells and stria vascularis.

Various effects upon respiratory and circuratory systems induced by breath holding have been investigated by many physiologists for a long time. For instance, it increases the systoric and diastoric blood pressure, and decreases the rate of finger tip blood flow and finger tip volume.These circuratory effects have been considered by the excitation of the sympathetic nerve. The nasal mucous membrane is rich in vessels and these vessels are innervated by sympathetic and parasympathetic nerves. In this paper, it was investigated whether breath holding could have any effect on the vessels in the nasal mucosa. For this purpose, the changes of nasal airway resistance (NAR) were examined. In fifteen normal adults, NAR was determined before and after breath holding. For the determination of NAR, the combined method was used, and the variant ratio of NAR (NAR after breath holding/NAR before breath holding) was calculated. The mean value of fifteen normal adults was 0.57 and the standard deviation was 0.18 In order to investigate the sympathetic effect on this reflex, changes of NAR by breath holding were estimated in four patients with sudden deafness who were treated by stellate ganglion block.In these patients, changes of NAR were not observed. In conclusion, this reflex is highly suspected to be transmitted by the sympathetic nerve.

Endogenous peroxidase activity was localized in seromucous-secretion cells of human nasal glands with the diaminobenzidine method for light and electron microscopic histochemistry.Localization of the activity occurred in the cisternae of rough surfaced endoplasmic reticulum, including the nuclear envelope, some vesicles and saccules of the Golgi complex, and secreting granules.In the case of patients with a house dust nasal allergy, peroxidase activity in the nasal glands diminished or disappeared. However, activity recovered after reception of steroid hormone (dexamethasone 5mg/day for 7days). If nasal glands rely on the same nervous system as do salivary glands, then the diminishing of peroxidase activity may be due to the diminishing of sympathetic stimulation. Therefore, the relationship between nasal allergy and the sympathetic nerve will be considered.

Guinea pigs were killed by decapitation, and blood sludging and HRP (horseradish peroxidase) leakage out of the capillaries was examined in the stria vascularis. This phenomenon was observed in almost all of the upper three turns, but it was less marked in the basal turn. It is thought that this discrepancy is caused by the difference in the number of capillaries which first enters the stria vascularis, leave it and then pass through the spiral ligament at each turn. In the basal turn larger numbers of capillaries enter the stria vascularis and pass through the spiral ligament and a smaller number of capillaries leave the stria vascularis than in the upper turns. The difference between the numbers of capillaries entering and leaving the stria vascularis is thought to influence the strial blood flow, especially when a capillary leaving the stria vascularis is constricted as after decapitation.

The permeability of the stria vascularis to horseradish peroxidase (HRP) was examined. Ten minutes after an intravenous injection of HRP, 15 guinea pigs were killed and fixed by four different methods: 1) cochleas fixed 3 minutes after decapitation, 2) administration of an overdose of pentobarbital, 3) cochleas fixed for 5 minutes before decapitation, and 4) cochleas fixed immediately after decapitation. In the animals in group 1, HRP leakage was observed in almost all strial vessels (86%), and blood sludging and amorphous HRP reaction product in 98% of strial capillaries. In the animals in group 2, strial capillaries were observed both with noticeable HRP leakage and with no evidence of leakage. Blood sludging was associated with amorphous HRP reaction product, while no blood sludging was associated with granular HRP reaction product. In group 3 animals, only faint or no HRP reaction product was observed in the perivascular spaces. Only 3% of the capillaries had blood sludging. In the animals in group 4, blood sludging but no HRP leakage was observed in almost all capillaries (82%). It is speculated that HRP does not normally leak from the strial capillaries, although many researchers have reported to the contrary. It appears that HRP leaks from the strial capillaries only when acute anoxia or hypotension continues for a few minutes. These conditions induce blood sludging and are followed by the appearance of many marginal folds in these capillaries.

Summary The protective effect of sodium cromoglycate (DSCG) on the allergic reaction in the nose was compared with placebo in a double blind crossover study of sixteen patients diagnosed as allergic rhinitis. The drug effect was assessed by both a rhinomanometric method and by symptom scores in all patients. DSCG protected the nasal mucosa against antigen challenge and was significantly better than placebo. There was a correlation between the objective and subjective assessments.

The activity of endogenous peroxidase was demonstrated in light ciliated cells, mature goblet cells, and nonciliated serous cells, but not in basal cells, intermediate cells, dark ciliated cells or immature goblet cells of the upper tracheal epithelium of rats, using the diaminobenzidine method for cytochemical demonstration of peroxidase activity. The peroxidase activity was the most intense in the epithelium of the first tracheal ring and gradually diminished at lower tracheal levels, becoming extremely faint in the vicinity of the middle of the trachea. The activity was localized in cisternae of rough-surfaced endoplasmic reticulum (r-ER) including the nuclear envelope, some vesicles and saccules of the Golgi complex, secretory granules, and small apical vesicles. It is believed that the basal cells were transformed into the intermediate cells, and some of the intermediate cells were turned into the ciliated cells, while other intermediate cells were differentiated into the goblet cells. The dark ciliated cells proved to be the immature ciliated cells immediately after the transformation from the intermediate cells. In these cells, peroxidase is not yet produced.

Summary The changes in peroxidase of the granules of eosinophils were examined in cells in the nasal mucous membranes of persons allergic to house dust. There was a slight leakage of peroxidase from eosinophil granules immediately after placing an antigen-treated disc (house dust, Torii, 2560 μg/disc) on the nasal mucous membrane. Leakage of peroxidase from the eosinophil granules into the cytoplasm, and extracellular release from some eosinophils, was greater 20 min after provocation, than at 30 sec. There were two forms of peroxidase release from the plasma membrane. In one, the granule membrane fused with the plasma membrane and the peroxidase was released from the cell through destruction of the two fused membranes. This was considered to be active secretion. In the other form, the plasma membrane was damaged by peroxidase released from the granules into the cytoplasm. This was considered to be passive release following degeneration of the cell.

A surgical approach to tumors of the septum is discussed. Two patients who had tumors in the posterior two thirds of the septum are shown in this paper. One had a benign mixed tumor and the other had an extramedullary plasmacytoma in the posterior two thirds of the septum. They underwent resection of the tumors with the septum by lateral rhinotomy. The first case additionally underwent an oval-shape resection of the palate. The postoperative profiles of the nose are good.

The diagnosis of pollinosis is in general made on the basis of detailed clinical histories, nasal smear, skin tests, the dilution threshold of the skin, provocation tests, P-K tests, the quantity of serum total IgE concentrations and so on. Since the circulating allergen specfic IgE antibody could be measured by the radioallergosorbent test (RAST), the elevation of allergen specific IgE antibody in serum has been considered to be one of the important diagnostic evidences in the reagin (IgE)mediated allergic diseases. The cedar specific IgE antibody was measured by RAST from 86 cases of Japanese cedar pollinosis (with positive histories, positive nasal smear, positive skin test and positive provocation test) and 8 cases of suspicious Japanese cedar pollinosis (with positive histories, positive nasal smear, positive skin test and negative provocation test). The significance of RAST on diagnosis of Japanese cedar pollinosis was evaluated by comparing RAST results with in vivo results (skin tests, the dilution threshold of the skin and provocation tests), total IgE levels and blood eosinophil counts. Results are as follows: 1. The results of skin tests agreed with the RAST results in 76.5%. The correlation between provocation tests and RAST was 80.2%. These experimental results mean that the circulating cedar specific IgE antibody is increased in 70 to 80% of patients with cedar pollinosis diagnosed in vivo diagnostic criteria. The rise of serum cedar specific IgE antibody is regarded as an important evidence of diagnosis of Japanese cedar pollinosis. 2. There is a close relationship between the dilution threshold of the skin and the cedar specific IgE antibody levels (r=0.845).3. The total IgE concentrations of serum did not correlate to the serum cedar specific IgE antibody levels.4. The blood eosinophil counts had no relation to either total IgE levels or the cedar specific IgE antibody concentrations.

It has been reported that the normal epithelium of the anterior nares is covered by a mucopolysaccharide layer with a depth of approximately 0.8μ1. In the present study, a patient with an allergy to the Japanese cedar was found to develop a very thin mucopolysaccharide layer (0.05μ in depth) when the mucosal tissue was taken off before provocation. Adhering pollen particles could have readily come in contact with the plasma membranes of the epithelial cells. The epithelium of the nonciliated cells exfoliated in a relatively short period of time after provocation. Ten minutes after provocation, a thick mucus layer covered the exfoliated epithelial mucosa. Pollen particles could no longer be brought into contact with mucosa due to the mucus layer. On the other hand, no difference from the normal condition was seen before provocation in the middle and posterior nares where ciliated cells were located. However, at ten minutes after provocation, a large number of goblet cells appeared in place of ciliated cells, and mucus production was very much activated. Many signs appeared at this stage which suggested the impairment of ciliary beating. Specifically, there was swelling and damage of plasma membranes of cilia, bending of cilia, existence of extra cytoplasm around the microtubules in the cilia, and intrusion of mucus fluid between cilia. In the regions where ciliated cells were replaced by goblet cells, the exfoliation of epithelium could be noted, but it is generally difficult to find that ciliated cells are exfoliated even when the ciliary beating is impaired. Taking into account the above-mentioned results, it can be assumed that pollen particles penetrate the submucosa not only through the posterior nares where ciliary beating is impaired, but also through the anterior nares where epithelial cells are exfoliated.

The total synthesis of (±)-norketotrichodiene (14) is described. The photocycloaddition reaction of 3,6-dimethylcyclohexenone and cyclotene afforded the tricyclo[4.3.23,5.O1,6]undecane derivatives ...