Akiyoshi Konno

The role of chemical mediators and mucosal hyperreactivity in nasal hypersecretion in nasal allergy.

This study was designed to elucidate, first, the degree of participation of direct effects of histamine on the nasal glands and the nasal vasculature in clinical manifestation of hyperrhinorrhea in nasal allergy and, second, the existence of hyperreactivity of the nasal glands to acetylcholine in nasal allergy. The study demonstrates that histamine released by degranulation of basophilic cells in the nasal mucosa causes nasal hypersecretion mostly by way of the reflexive pathway. Approximately 4% of the amount of nasal secretion induced by an antigen challenge in subjects with house-dust nasal allergy was due to a leakage of plasma. There were almost no direct effects of histamine on the nasal glands. Nasal secretion induced by nasal challenge with acetylcholine after vidian neurectomy comes from the nasal glands by its direct effects on the nasal glands, the amount of which indicates degree of reactivity of the nasal glands to acetylcholine independent of hypersensitivity of the mucosal sensory system. The nasal glands of vidian neurectomized subjects having nasal allergy reacted more excessively to extrinsic acetylcholine than nasal glands of subjects of the control group. This verifies the existence of hyperreactivity in the nasal glands to acetylcholine in nasal allergy. The nasal glands of nasal allergy patients may respond more excessively to a given amount of acetylcholine released from parasympathetic terminals.

Influence of upper airway obstruction by enlarged tonsils and adenoids upon recurrent infection of the lower airway in childhood

The influence of hypertrophied tonsils and adenoids upon ventilation during sleep was evaluated by polygraphic recording before and after adenotonsillectomy. In all 19 cases, esophageal pressure during sleep was elevated as high as 4‐6 times normal. This was caused by nasal obstruction due to adenoid hypertrophy and obstruction of the “oral airway” by hypertrophied tonsil and collapse of the tongue due to muscular relaxation during sleep. When minimal amount of contrast media was instilled slowly into the nasopharynx aspiration of the contrast media into the lung was found significantly more frequently in subjects with upper airway obstruction. Active aspiration of the secretion by marked inspiratory negative pressure during sleep may play a major role in causing recurrent infection of the lower airway frequently seen in these children.

A physiologic study on respiratory handicap of the laryngectomized

ZusammenfassungDie Untersuchung der Atemfunktion bei dreizehn laryngektomierten Patienten zeigte, daß sich das Fehlen der oberen Luftwege ungünstig auf die unteren Atemwege auswirkt. Besonders auffällig war eine ungleichmäßige Verteilung der Atemluft in der Lunge.SummaryLack of the upper airway function after laryngectomy creates unfavorable effects on the lower respiratory tract. The purpose of this study is to re-evaluate this relationship objectively.Respiratory function tests were performed on 13 laryngectomized patients. Pulmonary volumetry and ventilometry revealed increased RV and FRC, and decreased FEV1.0%, indicating evidence of obstructive changes in the lung. MEFV-recordings showed greater downward convexity than those of the normal at the lower volume level. The value of MEF50/body-height was definitely smaller than normal average in the same age group.Pulmonary resistance was in wide variety but definitely lower than normal because of lack of the upper airway resistance. If this component is added to the value, the total will be in normal range or even higher.Dynamic compliance remained mostly in the normal range when measured using a mask at the tracheostoma. The value was lower than normal when measured through a cuff-canule. The difference in static and dynamic compliances was greater than that in normal cases, which may indicate evidence of uneven distribution of air in the lung. Regular check-up and suitable respiratory care are recommended on the laryngectomized.

Carotid artery resection for head and neck cancer

BACKGROUND Carotid artery resection has been shown to yield a chance of cure in patients with advanced head and neck carcinoma involving the carotid artery. However, the criteria for the identification of those who are vulnerable to neurologic injury after resection have not been established. Interposition grafting may minimize the risk of neurologic morbidity, although it is technically difficult when there is involvement of the internal carotid artery close to the skull base. METHODS We studied 24 patients with head and neck tumor involvement of the carotid artery. We performed carotid artery resection in 16 of them, including 10 in whom the carotid artery was reconstructed with interposition grafts covered with muscle flaps. When it was thought that the reconstruction would be difficult, positron emission tomography was performed during balloon test occlusion of the internal carotid artery to assess the adequacy of hemispheric collateral blood flow before carotid resection. In one patient with interposition graft, carotid rupture occurred as a result of wound infection, but none of the other patients experienced perioperative death, persistent hemiplegia, or delayed stroke. RESULTS Twelve patients have survived longer than 8 months, and seven (43.8%) were alive without disease at 12 months after resection, whereas all four patients who could not be treated operatively died within 8 months as a result of local primary tumors. CONCLUSIONS Carotid artery resection is the only therapy offering any potential for cure or palliation. Positron emission tomography is a rapid quantitative means of determining the cerebral blood flow, particularly when resection is planned without reconstruction.

Chronic sinusitis and woodworking as risk factors for cancer of the maxillary sinus in Northeast Japan

In the period 1983 to 1985, 66 patients presented to six Japanese university hospitals with squamous cell carcinoma of the maxillary sinus. Using self‐administered questionnaires, a case‐control study was conducted to examine history of nasal diseases, occupational exposures, and other possible risk factors for this disease. For each patient, two controls were selected from the general population, matched to the patient by sex, age (± 5 years), and district of residence. A history of chronic sinusitis was associated with a 2.3‐fold increase in risk (p = 0.05). A high relative risk was also observed in males with an occupational history of woodworking or joinery, particularly when these jobs involved sanding or lathing practices (RR = 7.5, p = 0.02). No association between cigarette smoking and maxillary sinus cancer was observed in this study and no evidence was found that indoor air pollution in the home is involved in cancer development.

PARTICIPATION OF VASCULAR REFLEX IN MUCOSAL SWELLING IN NASAL ALLERGY

A study was performed to evaluate whether vascular reflex participates in mucosal swelling in nasal allergy, by measuring changes in mucosal swelling in both nasal cavities and changes in blood flow in the bilateral inferior turbinates caused by antigenic challenge in one inferior turbinate. On unilateral challenge, the mucosa of the ipsilateral nasal cavity became swollen, with a concomitant increase in mucosal blood flow. In the contralateral nasal cavity, however, an increase in mucosal blood flow was not necessarily accompanied by mucosal swelling. An increase in mucosal blood flow on antigenic challenge was observed even in nasal mucosa, most of the parasympathetic and sympathetic innervation to which was transected by vidian neurectomy. Vascular reflex certainly participates in nasal allergy but it is not always related to mucosal swelling. Mucosal swelling in nasal allergy is considered to be caused mainly by a direct effect of chemical mediators on nasal vasculature and partly by vascular reflex.

Microcapsule Chemoembolization for Head and Neck Cancer

SummaryCisplatin (CDDP) was microencapsulated with ethylcellulose, and microcapsules (CDDP-mc) were infused into the maxillary arteries of patients with various head and neck carcinomas. We then found that the CDDP level in the circulating blood was significantly lower than that in patients administrated intravenous non-excapsulated CDDP. However, significantly high concentrations of CDDP were found in the tissues of patients treated with CDDP-mc. Our results suggest that selective arterial infusions of CDDP-mc can exert an intensive topical antitumor effect through microinfarction of malignant tissues. The prolonged release of drug from the microcapsules has also been associated with minimal systemic side effects.

Effects of Female Hormones on the Muscarinic and α1-Adrenergic Receptors of the Nasal Mucosa

During pregnancy aggravation of nasal allergic symptoms is occasionally observed in subjects with nasal allergy. To evaluate the effect of female hormones on the muscarinic receptor and the alpha 1-adrenergic receptor of the nasal mucosa, receptor binding assay was performed using the nasal mucosa of pregnant guinea pigs and of male guinea pigs; the latter were treated either with estrogen or with progesterone. Pregnancy induced a significant decrease of the density of the alpha 1-adrenergic receptor of the nasal mucosa (p less than 0.05). Estrogen induced a significant increase of the density of the muscarinic receptor (p less than 0.05), while progesterone induced a significant decrease of the density of the alpha 1-adrenergic receptor of the nasal mucosa of guinea pigs. When similar changes of the receptor can be induced by female hormones in the nasal mucosa of the human subjects, this may facilitate secondary development of hyperreactive nasal symptoms in subjects who have been sensitized before without apparent nasal symptoms.

Changes of Adrenergic and Muscarinic Cholinergic Receptors in Nasal Mucosa in Nasal Allergy

Receptor-binding assays were performed to evaluate the changes of beta- and alpha 1-adrenergic and muscarinic receptors in the nasal mucosa of subjects with nasal allergy and in guinea pigs sensitized with ovalbumin using radioligands 3H-DHA, 3H-prazosin and 3H-QNB, respectively. In subjects with nasal allergy, a decrease in density of beta- and alpha 1-adrenergic receptors and an increase in density of muscarinic cholinergic receptors were observed. An increase in density of muscarinic cholinergic receptors could be reproduced in the nasal mucosa of guinea pigs which were sensitized with ovalbumin and had typical hyperreactive nasal symptoms. These results indicate that the increase in the density of muscarinic receptors observed in the nasal mucosa of subjects with nasal allergy has been induced secondarily by an allergic reaction in the nasal mucosa with hyperreactive nasal symptoms, which in turn acts as an aggravating factor in the vicious circle promoting hyperreactivity of the nasal mucosa.

Vidian neurectomy for allergic rhinitis

SummaryVidian neurectomy was performed in 28 patients with perennial nasal allergy and changes in symptoms and complications 3–7 years after the operation were examined in order to evaluate the effect and limitation of the operative therapy on nasal allergy. Vidian neurectomy could completely stop hyperrhinorrhea in all cases for a limited period of time. In 43% cases, however, recurrence of rhinorrhea was observed. As for nasal obstruction, disappearance of the symptom or marked improvement was noted in only 33% of the cases and in many cases, intranasal operation was also required for improvement of nasal obstruction. Disappearance of nasal obstruction and marked improvement when intranasal operation was also applied was noted in 85% of cases. If the grade one improvement was included, general improvement of the symptoms of nasal allergy lasted in 86–90% of the cases. Effect of operative removal of sneezing, nasal obstruction, and rhinorrhea which are considered to be defensive reflex, on lower airway or whole body was examined by pulmonary function tests and measurement of serum total IgE level. There were no postoperative tendency to development of obstructive ventilatory impairment at the lower airway or to increase in serum total IgE level. There is room to improve the operative technique to inhibit reinnervation, however, the merit of Vidian neurectomy is large for selected patients with perennial nasal allergy, because when combined with intranasal operation to relieve nasal obstruction it can remove the symptoms in high percentage of cases by a single performance.