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Objective: Late phase response (LPR) is difficult to investigate in patients with perennial nasal allergy because of their continuous presentation with nasal symptoms. Contribution of histamine to the LPR is also controversial. In this study, we investigated whether exogenous histamine can induce LPR in asthmatic patients with perennial nasal allergy to house dust. Methods: A total of 40 asthmatic children were divided into clinical, subclinical and non-rhinitis groups based on their daily nasal symptoms. Changes in nasal patency and in inflammatory cells in nasal secretion were quantitatively measured for 6 h by acoustic rhinometry and light microscopy respectively before and after nasal challenge with allergen or histamine. Results: The allergen challenge produced a significant biphasic decrease in nasal patency in the subclinical group and a marginal decrease in the clinical group, with increases in eosinophils 6 h after the challenge. By contrast, histamine challenge induced significant responses in the clinical group and only a slight response in the subclinical group. Eosinophils also accumulated in nasal secretion of the clinical group to significant levels 6 h after histamine challenge. Eosinophil accumulation following histamine challenge was earlier than that after exposure to allergen. Conclusion: We conclude that LPR can be demonstrated in asthmatic children with perennial nasal allergy. Exposure to exogenous histamine also induced LPR, mediated mainly by eosinophil-related mediators.

Objectives Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea. Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients. Study Design To assess the concentrations of mucin and lectin in aspirates of 11 acutely and 11 chronically inflamed maxillary sinuses, the concentration of mucin was measured by enzyme-linked immunosorbent assay (ELISA) and that of lectin by sandwiched enzyme-linked lectin assay (ELLA). Results The concentrations of mucin and lectin that were measured using monoclonal antibodies (HCS 4, HCS 14, and HCS 18) and Ulex europaeus agglutinin-1 (UEA-1) in chronic sinusitis were higher than those in acute sinusitis. The concentration of total protein in chronic sinusitis was lower than that in acute sinusitis. Each mucin and lectin versus total protein ratio in chronic sinusitis was higher than that in acute sinusitis. Conclusions These data suggest that hypersecretion in chronic sinusitis may result from locally increased mucin production. Comprehension of this mechanism may be a strategy to prevent the viscous cycle of paranasal sinus fluids in chronic sinusitis.

Objective: The purpose of this study is to find out the effects of hearing impairment on the QOL of nursing home residents. Methods: We constructed the self-assessment questionnaire designed for evaluating the QOL for the elderly in nursing homes. The questionnaire is constructed of physical, social, communicational and psychological states. It was administered to 60 subjects >65 years of age (mean age: 79 years) living in nursing homes, with hearing threshold levels in the better ear ranging from normal to severe and their response were analyzed. Results: Chronbach's α-values of the questionnaire obtained ranged from 0.66 to 0.91 and was 0.84 overall. The reliability and validity of the questionnaire as well as its brevity, simplicity, ease of administration and interpretation, all satisfied its use in assessing the QOL of the elderly in nursing homes. It tended to decrease the points of communication scale, sociability scale and psychological scale (PGC Morale Scale) accordingly to elevate the threshold. As for subscales of communication, hearing disability was correlated statistically to the sociability and psychological. Conclusion: Our questionnaire is regarded as a useful tool for evaluating the QOL of the elderly. Hearing loss affects the communication, sociability and psychological aspect of the QOL for the elderly in the nursing homes.

A clinical study of papillomas in the nose and paranasal sinuses was performed. A total of 17 cases of papilloma was seen at our clinic during the last 11 years and they consisted of 14 males and 3 females with a mean age of 57.9 years. The combination of MRI and CT scan was more useful than CT scan alone to distinguish between papillomas and chronic sinusitis. The recurrence rate was 29%.

Forty previously untreated patients with nasopharyngeal carcinoma treated for 18 years from 1981 through 1998 at the Mie University Hospital are reviewed. The male to female ratio was 2.3:1. The most frequent chief complain was cervical mass. More than half of the patients were classified into stages IIB or III. Until 1988, patients were treated mainly with radiotherapy, but the results were unsatisfactory. Since 1992, to decrease the occurrence of locoregional relapse and/or distant metastasis, we have used pirarubicin, cisplatin and peplomycin alternating with radiation, two cycle of chemotherapy alternating with two courses of radiation (30 Gy each after the first and second chemotherapy cycle). The chemotherapy consisted of pirarubicin, 30mg/m2/day on day 1, cisplatin, 50mg/m2/day on day 2 and peplomycin 5 mg/day on day 3-6, all given intravenously. The 5 years survival rate of 13 patients who recieved this new trearment was 61.5%. We conclude that alternative chemoradiotherapy is necessary for a better prognosis of nasopharyngeal carcinoma.

We studied the case of a 48-year-old woman who had resection of a pineal body tumor in terms of postoperative audiological function. Postoperative magnetic resonance imaging disclosed partial inferior colliculi destruction and medial geniculate body degeneration. A pure tone audiogram revealed only moderate sensorineural hearing loss, but her speech perception was totally impaired. The binaural sound localization function was also impaired. The auditory brain stem response (ABR) showed waves I, III, and V to have normal latencies. The amplitude of wave III was larger than that of wave V. These results support the view that the waves of the ABR are elicited from multiple sources in the auditory brain stem nuclei and tracts. This case suggests a substantial role for the inferior colliculus and medial geniculate body in the processing of speech perception and sound localization.

Objectives It is likely that genetic factors play a role in the etiology of chronic sinusitis, and airway inflammation is an important pathological feature in chronic sinusitis. We hypothesized that individuals with greater inflammatory responses may be more likely to acquire the disease. Polymorphisms of the tumor necrosis factor (TNF) genes have been described, and certain inflammatory diseases are reportedly associated with certain alleles of TNF genes. The purpose of this study is to examine whether there is an association between some alleles of TNF genes and chronic sinusitis. Study Design Thirty-eight Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells on plain radiographic films. Methods Both tumor necrosis factor-α (TNF-α) and tumor necrosis factor-β (TNF-β) gene polymorphisms were analyzed by polymerase chain reaction (PCR) with restriction fragment length polymorphisms in these patients and 35 healthy control subjects. Results A significantly higher frequency (P < .05) of TNFB*2 allele of TNF-β gene polymorphism was observed in patients with chronic sinusitis (74%) compared with control subjects (56%). There was no association between alleles of TNF-α and chronic sinusitis. Conclusion We concluded that TNF-β gene polymorphism may form a component of the genetic predisposition to chronic sinusitis in Japanese patients.

Macrolide antibiotics have a variety of actions along with antimicrobial action. To determine the effects of oral administration of clarithromycin (CAM) on rheological properties, we measured the spinability, dynamic viscoelasticity, and solid composition of human nasal mucus from 18 patients with chronic sinusitis before and after administration of CAM for 4 weeks. After administration of CAM, the spinability and percent solid composition of nasal mucus increased from 26.5 ± 12.2 mm to 40.2 ± 18.7 mm and 7.86% ± 3.47% to 13.90% ± 3.67% (p < .05), respectively, whereas the ratio of the viscosity to the elasticity (η′/G′) of nasal mucus after the administration of CAM decreased in all of the mucus samples. These results suggest that treatment with CAM may modulate the rheological properties of nasal mucus in patients with chronic sinusitis.

We have employed immunohistochemistry to obtain baseline information on the molecular constituents of the extracellular matrix (ECM) of the endolymphatic duct (ED) and endolymphatic sac (ES) of the chinchilla. The results demonstrated that collagen types I and III were distributed in the subepithelial layer in the ED and ES, type IV collagen and laminin in the basement membranes, and fibronectin in the subepithelial layer and partly in the conglomerated cells in the ES. Collagen type III was diffusely distributed in the whole subepithelial layer of the ES, whereas collagen type I was concentrated densely in the deep layer of the interstitium, although gradually, the cuboidal epithelium in the ES was transformed into a flatter type in the ED. The epithelial cells of the ED and ES were clearly positive for keratin. This study deals, in particular, with the normal distribution of ECM components of the ED and ES of the chinchilla.

Endoscopic sinus surgery is commonly used to treat chronic sinusitis. Subjects were 79 chronic sinusitis patients--50 men and 29 women aged 17 to 79 years (average: 50.6 years) undergoing endoscopic sinus surgery in our department from January 1993 to December 1997. Mean follow-up was 17.5 months. We evaluated preoperative staging of chronic sinusitis based on Kennedy staging. Most were stage 3. This type of staging was not effective in predicting nasal polyp relapse. We found that cases with diffuse polyposis and associated disease such as bronchial asthma or aspirin-induced asthma tended to experience a polyp relapse. Our results suggest that postoperative treatment is important in maintaining patency of the ostiomeatal complex, nasal polyp or edematous mucosa relapse must be treated early in on in occurrence.

Incipient symptoms of multiple myeloma usually include such symptons as pain, anemia, malaise, and loss of body weight. A case of multiple myeloma occurring as a buccal mass is reported. The patient was a 65-year-old female. She visited our hospital complaining of a buccal mass with tenderness. A 4×4cm mass was observed the left buccal region. From CT and MRI findings, our preoperative diagnosis was a osteocartilaginous tumor. The buccal tumor with adjacent bone was removed surgically. Post-operative histological examination revealed proliferating plasmacytes in the tumor, and a pathological fracture in the right clavicula two days after the operation. The final diagnosis was multiple myeloma (IgA-κtype).

A statistical study was made of 69 cases of esophageal foreign bodies treated after hospitalization at our clinic during the 21 years from 1978 to 1998 and 20 ambulatory cases of esophageal foreign bodies treated at our clinic during the 9 years from 1990 to 1998. Two peaks were observed in age distribution, one in children below age 4 and the other in elderly people above 70. Coins were found especially in children. Dentures and PTPs were found in the elderly. Cerebrovascular disease was the most common past history.

From 1990 through 1998, 143 patients with laryngeal cancer were treated in our department. Of the 143 patients, 94 had glottal, 43 had supraglottal, and 6 had subglottal cancer. The 5-year survival rate in patients with laryngeal cancer was 90.0% for stage I, 81.3% for stage II, 77.9% for stage III, and 42.6% for stage IV. The 5-year survival rate was 86.5% for glottal, 55.9% for supraglottal and 66.7% for subglottal cancer patients. The laryngeal preservation rate was 90.4% for stage I, 60.5% for stage II, 21.4% for stage III and 28.1% for stage IV.A loco-regional recurrence occurred in 24 of 143 patients (16.8%). The salvage rate for these patients was 45.8% (11/24). Six of 11 patients who died of primary disease and nodal failure (including 2 stomal recurrences) had supraglottic stage N carcinoma.In conclusion, laryngeal preservation surgery should be recommended in the early stages of cancer after radiation failure and local recurrence. It is recommended to dissect the anterior compartment including the delphian lymph node, pretracheal, and parathyroidal nodes bilaterally for patients with laryngeal tumors that have significant anterior subglottic extension, tumors arising in the subglottic region, or advanced tumors arising in any region, especially the supraglottis.

The effect of biochemical components on the viscoelasticity of nasal mucus from 24 patients with chronic sinusitis (CS) was investigated by multiple stepwise regression analysis. The dynamic viscosity (eta') and the elastic modulus (G') of nasal mucus were determined with an oscillating sphere magnetic rheometer at oscillatory frequencies of 1 and 10 Hz. The eta' and G' values of mucus determined at 1 Hz were 1.6 +/- 1.5 Pa/s and 31.8 +/- 31.0 Pa, respectively, and these values were much higher than optimal viscoelasticity for mucociliary transport. The concentrations of fucose, N-acetyl neuraminic acid, albumin, IgG, secretory-IgA, and lysozyme were measured in the same mucus samples. The multiple regression analysis showed that the concentration of fucose, a marker of mucous glycoproteins, was the most important determinant of eta' and G'. The analysis also revealed that the level of IgG was the next important determinant. The coefficients of multiple determination for fucose and IgG were 0.732 and 0.733 when the response variables were eta' and G', respectively. The results indicate that locally produced mucous glycoproteins may largely contribute to the high viscoelasticity of nasal mucus in CS.

Nasal obstruction is one of the major symptoms of allergic rhinitis. In the study of the mechanism of nasal obstruction, experiments on animal are useful. In adult humans, acoustic rhinometry has been used to evaluate nasal obstruction by determining nasal cavity dimensions in terms of cross-sectional areas as a function of the distance from the nostril. We modified the equipment used on humans to assess dimensions of nasal airway geometry of small experimental animals. The purpose of this study was to investigate the accuracy of measurement of the modified acoustic rhinometry applied to small experimental animals using nasal cavity models and guinea pigs. Measurement of the nasal cavity models (made of cylindrical silicone tubes) showed that the acoustic rhinometry estimated 85.5% of actual area and 79.0% of actual volume. In guinea pigs, nasal cavity volume determined by the acoustic rhinometry was 73.7 ± 20.0% of actual volume. The actual volume was estimated by impression material instilled into the nasal cavity of the animals (IM volume), and volume determined by acoustic rhinometry significantly correlated with IM volume. Furthermore, there was a significant negative correlation between the volume and nasal airway resistance in guinea pigs. Measurement of the nasal airway resistance is the method frequently used in the evaluation of the nasal obstruction in guinea pigs. These results suggest that acoustic rhinometry is useful in evaluating nasal obstruction in small experimental animals.

1996年10月から1998年3月までに当科小児聴覚外来を受診した乳幼児児童について, その診断に至る過程及び実態を調べ, 早期発見, 療育に対する今後の取り組みを検討した。 紹介元は小児科を主として医療機関が最も多かった。 受診児の約半数が聴覚障害を示し, 両側性難聴児の7割が高度・重度難聴であった。 また, 中等度難聴を示す滲出性中耳炎罹患児も認められた。 診断時の平均年齢は軽・中等度難聴児では4歳2ヵ月であったのに対し, 高度・重度難聴児では1歳6ヵ月で, 聴力レベルが高度であるほど低年齢で診断されていた。 しかし, 早期発見の観点からすると十分に早期とはいえなかった。 聴覚障害の原因は原因不明が多く, 17%に家族歴が認められ, 35%に重複障害が認められた。 軽度難聴児以外は何らかの形で療育機関に関わっていた。 乳幼児健診のさらなる充実, 重複障害児への対応, 及び関連諸機関との連携, 療育施設の充実が重要と考えられた。

三重県における三歳児耳鼻咽喉科聴覚検診は, 厚生省方式の質問票から耳鼻咽喉科医が要精検児を抽出し精検票を発行し, 委託医療機関で精密検診を受けるシステムになっている。 このシステムの現状と問題点を把握するために, 平成9年度4-12月の三歳児聴覚検診について県下69市町村にアンケート調査を行い, 63市町村, 162名の精検票を確認した。 精検票発行率は2.18%, 受診医療機関は77.8%が診療所で, 聴力検査の実施率は32.7%, ティンパノメトリーの実施率は71.2%であり, 一側性神経性難聴が1例検出された。 健診の場での問題点として市町村の精検票発行率のばらつきが大きいこと, 精密検診機関の問題として聴力検査の実施率が低いこと, 診断名が検診の目的に対し不十分であること, その後の問題として高次精密検診のルートが確立されていないこと, 検診結果のとりまとめや市町村への啓蒙の中核となるシステムが整備されていないこと, が挙げられた。

A 7-year-old girl with CHARGE association is reported. This patient exhibited coloboma, tetralogy of Fallot, retarded development, ear anomaly and deafness, which fulfiled the criteria of CHARGE association. Pure tone audiography showed bilateral moderate conductive hearing loss. CT of her temporal bone revealed normal cochlea and hypoplastic bilateral semicircular canals. She was unresponsive to cold water stimuli in the caloric test. As an ossicular chain anomaly was suspected, an exploratory operation was carried out on her right ear. The stapes lacked its anterior crus and footplate, which was considered to be the cause of her conductive hearing loss. This disease is not rare and otorhinolaryngologists should consider this condition when examining young patients with deafness and ear anomalies.

A rare case of adenosquamous carcinoma of the larynx was reported. The patient was a 79-year-old female who visited our clinic with complaints of dyspnea and hoarseness which had lasted for about four months. A large tumor extending into the supraglottic region was found. The histological diagnosis of a biopsied specimen was squamous cell carcinoma. Total laryngectomy and radical neck dissection on the right side were performed. The ultimate diagnosis of the removed tumor was adenosquamous carcinoma. There was a lymph node metastasis which consisted of squamous cell carcinoma only in the right mid-internal jugular nodes. The patient was free from recurrence for nine months, but died as a result of a hemorrhage in her digestive tract and pneumonia.

The effects of antigen and histamine on the changes of nasal passage patency in 112 guinea pigs with or without allergic rhinitis were evaluated by acoustic rhinometry. The percent change of volume from the nostril to 2 cm into the nasal cavity showed significant reduction of 31.10 ± 4.11% at 10 minutes and 31.10 ± 4.11% at 30 minutes after antigen challenge in sensitized guinea pigs. The pretreatment with ketotifen, an H1-histamine receptor antagonist as well as mast cell stabilizing drug, blocked dose-dependently the effects of antigen on those changes in volume. Furthermore, instillation of 104 μg/mL histamine reduced significantly nasal passage patency to 33.77 ± 4.63% at 10 minutes and 42.76 ± 3.32% at 30 minutes after challenge compared with that before challenge and ketotifen inhibited the effects of histamine, which indicated that histamine is an important mediator of allergic upper airway responses in guinea pigs. These results show that acoustic rhinometry is a useful technique to assess the nasal blockade in allergic guinea pigs.

Mucociliary clearance serves to remove inhaled participate matters from the upper and lower respiratory tracts. Since mucociliary clearance is composed of ciliary activity and mucus and their interactions, any abnormal function of these components could contribute to mucociliary dysfunction. Primary ciliary dyskinesia (PCD) is a congenital anomaly in ciliary structure, and mucociliary clearance is totally absent in such patients. Patients with PCD suffer from chronic upper and lower respiratory diseases, such as bronchiectasis, chronic sinusitis and otitis media with effusion. Thus, mucociliary clearance is essential to host defense mechanisms. Mucociliary dysfunction in PCD can not be treated properly, because ciliary activity is impaired due to the abnormal structure of the cilia.Mucociliary dysfunction is also observed in upper and/or lower respiratory diseases even in patients without PCD. In these patients, mucociliary clearance is recoverable by treatment of the disease. The treatment of nasal mucociliary dysfunction in chronic sinusitis is discussed in relation to the mechanisms of nasal mucociliary dysfunction.

In order to elucidate the immune response in otitis media with effusion, polymerase chain reaction was employed to examine

The effect of emedastine difumarate after antigen challenge was investigated on nasal passage patency and the number of inflammatory cells in the nasal secretion of allergic rhinitis patients. The results showed that the change in nasal passage patency after 8 weeks of emedastine difumarate administration was significantly inhibited 30 minutes after the antigen challenge. No significant changes in the number of inflammatory cells in nasal secretion was observed during the acute or late phases.

Previous reports suggest that thromboxane (TX) A 2 plays an important role in bronchial asthma, especially in the development of airway hypersensitivity. Similarly to asthmatic subjects, the nasal mucosa in patients with allergic rhinitis is hypersensitive to non-specific stimuli. Allergic rhinitis is mediated by chemical mediators released from inflammatory cells. However, the involvement of TXA 2 in allergic rhinitis has been studied very little. Recently, TXA 2 receptors from humans and mice have been characterized at the molecular level. We performed RT-PCR to examine whether TXA 2 receptor mRNA expression is elevated higher in allergic rhinitis than in chronic sinusitis. We found that TXA 2 receptor mRNA was expressed both in the nasal inferior turbinates with allergic rhinitis and in the maxillary sinus mucosa with chronic inflammation at a similar level. This result suggests that TXA 2 receptor mRNA expression is not enhanced in allergic rhinitis.

Oligosaccharides, especially mannose residues, expressed on the cell surface, are thought to be important for virus-induced membrane fusion. We examined the effect of mannose-binding compounds, pradimicin derivative BMY-28,864 (PRM) and concanavalin A (Con A), on cell fusion of human parainfluenza type 2 virus (hPIV2)-infected HeLa cells. Syncytium formation of hPIV2-infected HeLa cells was suppressed in the presence of Con A. On the other hand, PRM enhanced cell fusion of hPIV2-infected HeLa cells. These effects were blocked by addition of mannose-rich mannan. However, PRM shows little effect on virus growth and the expression of viral glycoproteins on the cell surface in hPIV2-infected HeLa cells. Fluorescein-isothiocyanate-labeled pradimicin and Con A bound to both uninfected and hPIV2-infected mononuclear cells, indicating that these compounds have an affinity to several cellular component(s). In contrast to Con A, PRM had little affinity to the viral glycoproteins. It is inferred from these results that the enhancement of hPIV2-induced cell fusion is probably due to the interaction between PRM and cellular component(s).

To compare the preoperative and postoperative changes on ciliary surface of maxillary sinus mucosa in patients treated with functional endoscopic sinus surgery.The maxillary mucosa of both the superolateral wall and the ostium were sampled during the operation and 6 to 12 months (mean duration, 7.6 months) after the operation. Ciliary surface was determined using scanning electron microscopy in combination with an image analyzer and was expressed in terms of ciliary area, which is the percentage of mucosal surface occupied by cilia.The samples were taken at a hospital-based clinic. An electron microscopic study was performed at Mie University School of Medicine, Mie, Japan.Sixteen patients (20 maxillary sinuses) undergoing functional endoscopic sinus surgery for treatment of chronic sinusitis.The mean (+/-SD) ciliary area before the surgery was 60.7%+/-28.8% and 39.9%+/-21.5% in the superolateral wall of the maxillary sinus and the ostium of the maxillary sinus, respectively. The ciliary area of the superolateral wall was significantly higher than that of the ostium (P.001). The mean (+/-SD) postoperative ciliary area value was 74.3%+/-22.6% in the superolateral wall and 51.3%+/-16.1% in the ostium. These postoperative values were significantly higher than the preoperative values (P.001).This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration, and the damaged ciliated epithelium could return toward normal with the improvement of ventilation and drainage of the maxillary sinus following functional endoscopic sinus surgery.

Summary Methods We have investigated the effects of allergen immunotherapy on the nasal responses in the guinea-pigs with allergic rhinitis. Thirty-three male Hartley guinea-pigs with allergic rhinitis were divided into three groups; those receiving intradermal injection of saline (Group 1) or 0.1% ovalbumin (Group 2) 6 days after the last intranasal sensitization, and those injected with 0.1% ovalbumin intradermally once daily for 6 consecutive days from the next day after the last intranasal sensitization (Group 3). Results The dye leakage and histamine content into the nasal lavage significantly decreased at 30min after antigen challenge in Group 3, compared with Group 1 or 2. We also observed the change of mast cell numbers in superficial nasal mucosa, lamina propria and injected dorsal skin. The number of mast cells in superficial nasal mucosa significantly decreased in Group 3 compared with Group 1 or 2, but not those in nasal lamina propria or dorsal skin. Conclusions These results suggest that the improvements of nasal responses such as dye leakage and histamine content may be caused by the decrease of mast cell numbers in the superficial mucosal layer after the specific immunotherapy. which may be developing tolerance and one of the mechanisms underlying the beneficial effect of immunotherapy.

Use of a maxillary prosthesis is now considered one of the good methods to ameliorate the crippling caused by the defect in the maxillary palate area after an ablative procedure for a maxillary tumor and it consumes no physical resources from the patient. There has been debate on whether the prosthesis should be made in the very early postoperative days or after the wound is stabilized. In this study, changes in the area of the defect in the palate after surgery were investigated by using plaster models from clinical cases we have experienced. Twenty-one cases were investigated according to the following features: "maxillary sinus cancer "+" more than 1.5 years of follow-up for maxillofacial prosthetics "+" presence of more than two casts of the case". These casts were photographed from a distance of 1.5 m, and the photographs were enlarged to the original size of the cast, then the defect area was measured with a Planimeter (Uchida Co. Ltd). The area of the defect had shrunk in 16 cases. It took over 1 year to get stabilized in 80% of the cases. It is believed to take around 3.5 years for all cases to become stable. This tendency had no relationship with the pattern of the defect, the stroke of the mouth opening, the pattern of the rest of the teeth, or the defect area itself. These findings suggest that it may be advisable to start the prosthetic work as early as possible rather than waiting for stability of the defect wound, to improve the patients's QOL.

A statistical study was made of 69 cases of tracheo-bronchial foreign bodies treated at our clinic during the 16 years from 1978 to 1994. Fifty-five cases (80%) were under 3 years of age and 38 cases (55%) were one-year-old babies. The foreign bodies were found in the right bronchus in 24 patients, in the left bronchus in 32 patients, and in the trachea in 6 patients. Of the various kinds of foreign bodies removed, peanuts predominated (34 cases, 49.3%). The foreign bodies were removed by means of a ventilation bronchoscope under general anesthesia. Most of the cases were treated within a few days successfully. However, the longest period of lodgement was 87 days.

疑似騒音下における中等度感音難聴者の聴取能力を調べることを目的として, 騒音源にマルチトーカーノイズ, 信号音に単音節67S語表, TY-89の日常生活文を使用し, 正面から信号音, 両側方から騒音が出る状況においてS/N比を変化させて健聴者10名, 中等度感音難聴者13名に聞き取らせ, 語音明瞭度, 文章了解度の変化を比較した。 その結果中等度難聴者の聴取能力はS/N比の条件が悪くなると健聴者に比し急激に低下し, 健聴者と同程度の了解度を得るためには, 平均S/N比で+15-+20dBほどよい状態でなければならないこと, 文章の聞き取りには, 個人の日常生活における, 興味・関心が関与する等, 聴力以外の影響が見受けられた。

Information concerning the medical and surgical treatment of pediatric patients with chronic sinusitis was obtained through questionnaires from 433 hospitals in Japan. The hospitals were authorized as an inservice otorhinolaryngological training institute by the Oto-Rhino Laryngological Society of Japan. The questionnaires were sent to the hospitals in February, 1995, and answers were obtained from 311 hospitals within one month, a 73.5% response rate. Conservative therapies were the most common treatment for pediatric sinusitis. The removal of hypersecreted nasal mucus by aspiration in combination with alphaadrenergic decongestants was performed in 89.1% of the hospitals. Treatment by oral administration of drugs was adapted in 88.1%. The administration of antibiotics and/or steroids by aerosol was performed in 86.2%. The antral lavage was performed in only 17.7%. In the medical treatment, macrolide antibiotics and proteolytics enzymes were most frequently administered. Surgical therapy was performed if the patient was indicated for surgery in 241 hospitals (77.5%). Nasal polyps were removed surgically in 202 hospitals. The intranasal ethmoidectomy was performed in 98 hospitals. Five years of age was the youngest limit of the surgical indication. In most hospitals, the population of surgically treated patients was less than 5% of all pediatric patients with chronic sinusitis. Adenoidectomy was adapted for the improvement of chronic sinusitis in 33.8% of the hospitals.

Fusion regulatory protein-1 (FRP-1) regulates virus-mediated cell fusion and induces poly-karyocyte formation of monocytes without any fusogen. We have recently reported that FRP-1 and the 4F2/CD98 heavy chain are identical molecules. Cell fusion in Newcastle disease virus (NDV)-infected HeLa cells was enhanced when cells were incubated with anti-FRP-1 MAb. Anti-FRP-1 MAbs also induced human immunodeficiency virus gp160-mediated cell fusion. However, HBJ127, an anti-FRP-1/4F2/CD98 MAb that enhanced cell fusion in NDV-infected cells, delayed human parainfluenza virus type 2 (HPIV-2)-induced cell fusion in HeLa cells, although these viruses belong to the same genus Rubulavirus. No anti-FRP-1 MAbs enhanced cell fusion in HPIV-2-infected HeLa cells. Anti-FRP-1 MAbs including HBJ127 showed no effect on virus growth and expression levels of virus-specific poly-peptides in HPIV-2-infected HeLa cells, indicating that the delay in cell fusion by an anti-FRP-1 MAb is not due to suppression of virus replication. When HeLa cells were transfected with an expression vector harbouring HPIV-2 HN and F genes, cell fusion was also suppressed by HBJI27, but the effect was weak in comparison with virus-infected cells. These data indicate anti-FRP-1 antibodies not only induce/enhance, but also inhibit/delay virus-induced cell fusion and therefore FRP-1 molecules are multifunctional.

fibromatosis は線維芽細胞と膠原線維が浸潤性に発育し, 急速な増大と再発しやすい性質から悪性腫瘍との鑑別が重要視される。今回 infantile fibromatosis の2例を経験したので報告する。症例1は1歳4ケ月の女児で右頬部内眼角下方に発症し, 周囲の骨・軟部組織に浸潤していた。外科的切除後6ケ月で局所再発をきたし, 再手術後1年4ケ月再発なく経過観察中である。症例2は生後8ケ月の女児で副咽頭間隙に巨大腫瘤を形成し, 初回手術後1年3ケ月再発なく経過観察中である。fibromatosis は周囲組織に浸潤・侵食性に増殖するため充分な正常組織を含めた広範な外科的切除術が基本とされるが, 自然消失した例も報告されており, 頭頸部領域では美容上あるいは解剖学的に切除範囲が限定されるため, 後遺症の生じない程度に切除し厳重な経過観察を行うことも治療方針を決定するうえで1つの選択肢と考えられる。

Background Histamine plays an important role in producing nasal symptoms via histamine H 1 receptor (H 1 R) in allergic rhinitis. It is reported that the minimum histamine concentration that induces sneezing is lower in allergic patients than in normal control subjects. Previous studies by binding assay on H 1 R gave divided results on whether the number of H 1 Rs is increased in allergic rhinitis or not. Objective The objective of this study was to examine if H 1 R mRNA expression is increased in patients with allergic rhinitis compared with normal healthy volunteers. Methods We extracted RNA from scrapings of inferior turbinate mucosa of 10 patients suffering from allergic rhinitis and 10 control subjects. As the H 1 R gene lacks introns, we treated RNA pellets by DNase to distinguish RNA from contaminating genomic DNA. Since amplification of H 1 R and β-actin mRNA remained in an exponential phase at 35 cycles, H 1 R and β-actin mRNAs were amplified for 35 cycles by reverse transcription-polymerase chain reaction (RT-PCR). The PCR products were hybridized with internal probes and band intensities were quantitated by a densitometer. Results The mean ± SD of H 1 R/β-actin ratio was 0.88 ±0.62 for the patients with allergic rhinitis and 0.29 ± 0.17 for the normal subjects ; the difference was statistically significant (P < 0.01). Conclusions These data suggest that expression of H 1 R mRNA is increased in the nasal mucosa of the patients with allergic rhinitis.

In order to elucidate the immune response in otitis media with effusion (OME), the polymerase chain reaction was employed to examine T cells in middle ear effusions in patients with OME for utilization of T cell receptor (TCR) variable region genes. Specimens of RNA were extracted from 13 ears of 12 patients (9 children and 3 adults). Oligonucleotide primers specific for individual TCR Vbeta gene families were used to amplify TCR gene products in each sample. Although the number of Vbeta families utilized by each sample varied from 1 family to 21, a few significant trends emerged. Eleven ears out of 13 expressed Vbeta7, which was the most frequently utilized (84.6%) Vbeta family among the 24 Vbeta families. In 5 of the 13 samples, the number of Vbeta families utilized was restricted to 1, which was Vbeta7 in all 5 samples. This result indicates the possibility that Vbeta7-bearing T cells in the middle ear are responding to a certain common antigen in some cases of OME.

The canalith repositioning procedure is designed to relocate free-floating otoliths from the posterior semicircular canal back into the utricle, thus relieving the patient of bothersome, often long-standing vertigo. We treated ten cases of benign paroxysmal positional vertigo using the canalith repositioning procedure. On follow-up, 7 patients were free from dizziness, 2 had improved significantly and one patient remained unchanged. This procedure is simple and cost-effective. We highly recommend this procedure for the treatment of benign paroxysmal positional vertigo.

In the present study, we examined the in vivo and in vitro effects of erythromycin (EM) on epithelial mucus production. We produced hypertrophic and metaplastic changes of goblet cells in rat nasal epithelium by the intranasal instillation of endotoxin. The in vivo effects of EM on epithelial mucus production were studied using this animal model. Intraperitoneal injection of EM (100 mg/kg body weight × 8 days), ampicillin (ABPC, 200 mg/kg body weight × 8 days), and cefalotin (CET, 200 mg/kg body weight × 8 days) inhibited epithelial mucus production induced after 7 days of endotoxin instillation. EM had a greater inhibitory effect than ABPC or CET.The in vivo effects of EM on epithelial mucus secretion were studied using cultured human nasal epithelial cells. Mucus secretion was quantitatively measured by the monoclonal antibody HCS18, which specifically reacts with mucin-like materials in human epithelial goblet cells. The spontaneous mucus secretion from cultured epithelial cells did not change after incubation with 10-4 to 10-6 M EM, 10-4 M ABPC, or 10-4 M CET.These results indicate that EM has a greater inhibitory effect on endotoxin-induced epithelial mucus production than ABPC or CET, and that this effect is not caused by the direct action of EM on epithelial secretory cells.

From January 1990 to June 1995, nasal and/or sinus surgery was performed on 21 children with chronic sinusitis. There were 9 males and 12 females aged 5 to 15 years, with an average age of 11.3 years. Ten children received a polypotomy alone, and functional endoscopic sinus surgery was performed on 13 patients. Three patients underwent a Caldwell-Luc operation. The follow-up information was gathered by questionnaires mailed to all 21 patients and all of the patients replied. The mean follow up period was 32 months. Before the surgery, nasal obstruction was the most predominant symptom and rhinorrhea was the second. Of the 21 patients, 18 patients (85.7%) had complete resolution of their symptoms, and when questioned as to whether their surgical therapy had been successful, 16 patients (76.2%) recorded positively.In 9 of the patients, we performed rhinoscopic and X-ray examinations 28 months after the operation. Endoscopic sinus surgery was performed on 5 patients (8 diseased sides), and a polypotomy was performed on 4 patients (6 diseased sides). In this study, we found that endoscopic sinus surgery was more effective than the polypotomy. We conclude that endoscopic sinus surgery is effective in the treatment of chronic sinusitis in children.

A 58-year-old woman was referred to our department because of globus. X-ray examination, real-time ultrasonography, CT, and MRI were performed. A parathyroid tumor was revealed at the back of the left lobe of the thyroid. A functional parathyroid adenoma was suspected based on the results of a fine needle aspiration biopsy and high serum levels of both calcium (12.4mg/dl) and PTH (2800pg/ml). The patient subsequently underwent surgery. During surgery a parathyroid tumor was removed and the histological diagnosis was benign parathyroid adenoma.

Purpose: The MUC2 gene encodes the core protein of a mucin expressed in the intestine and lower airway. The purpose of this study is to examine if the MUC2 gene is expressed in the nose and maxillary sinus. Materials and Methods: A Northern blot analysis and reverse transcription-polymerase chain reaction (RT-PCR) were performed. For the Northern blot analysis, RNAs were extracted from maxillary mucosae and nasal polyps of patients with chronic sinusitis and from the inferior turbinates of a nasal allergy patient. For RT-PCR, RNAs were extracted from 10 patients with chronic sinusitis, 4 patients with allergic rhinitis, 2 patients with hypertrophic rhinitis, and 6 volunteers with normal nasal mucosa. Results: Hybridization of the Northern blot with SMUC41 (a part of MUC2) cDNA probe showed clear bands in 2 of the 3 samples. In RT-PCR, the first round of amplification (35 cycles) failed to give any bands, but the additional 30 cycles with internal primers gave bands in 6 of 22 samples. Conclusions: These results indicate that MUC2 mucin gene is expressed in the nose and paranasal sinus. This two-round RT-PCR method will be useful for analysis of MUC2 mucin gene expression using relatively small amount of RNA.

Purpose Interleukin-8 (IL-8), a monocyte-derived and macrophage-derived cytokine, displays potent chemotactic activating properties toward neutrophils and thus may contribute to the pathogenesis of chronic sinusitis. The object of this investigation was to show the expression of the IL-8 gene in chronic sinusitis by Northern blot analysis and a reverse transcription-polymerase chain reaction (RT-PCR). Materials and Methods: For Northern blot analysis, RNAs were extracted from maxillary mucosa and nasal polyps from two patients with chronic sinusitis, respectively, and from the inferior turbinate of a nasal allergy patient. For RT-PCR, RNAs were extracted from 11 patients with chronic sinusitis, 8 patients with allergic rhinitis, and 4 patients with hypertrophic rhinitis. Results: Whereas IL-8 mRNA was expressed in the maxillary mucosa, IL-8 transcript was not detected in the inferior turbinate by Northern blot analysis. IL-8 transcripts were detected in 45% of chronic sinusitis RNAs ( 5 11 ) and in 50% of allergic rhinitis RNAs (5/10) by RT-PCR. Conclusion: These data suggest IL-8 may contribute to neutrophil involvement in chronic sinusitis.