Mikikazu Yamagiwa

INHALATION OF DIETHYLAMINE—ACUTE NASAL EFFECTS AND SUBJECTIVE RESPONSE

Adult volunteers were exposed to 25 ppm (75 mg/m3) diethylamine in a climate chamber for 15 min in order to study the acute nasal reactions to an exposure equivalent to the present threshold limit value-short-term exposure limit. Changes in nasal volume and nasal resistance were measured by acoustic rhinometry and by rhinomanometry. Acute change in nasal volume, usually seen as acute nasal mucosa response to thermal stimuli, was not observed, nor was an acute change in nasal airway resistance. In a subsequent experiment, the aim was to measure acute sensory effects. Exposure to a concentration increasing from 0 to 12 ppm took place for 60 min, equal to an average concentration of 10 ppm (30 mg/m3). A moderate to strong olfactory response and distinct nasal and eye irritation were observed. In spite of considerable individual variation, the results were in agreement with sensory effect estimates obtained from animal studies.

Nasal Cavity Dimensions in Guinea Pigs Measured by Acoustic Reflections

Acoustic reflections have been used in adult humans to determine nasal cavity dimensions in terms of cross-sectional areas as a function of the distance from the nostril (J. Appl. Physiol., 66:295–303, 1989). In order to measure nasal cavity dimensions in guinea pigs, we modified equipment for use in humans by decreasing sound tube dimensions, increasing sampling frequency, and applying a special nosepiece. We measured 5 guinea pigs (Duncan Hartley strain, 500 g) on two days, before and after instillation of epinephrine and histamine in one nostril. In the control measurements, the minimum cross-sectional area of a nasal cavity was 1.1 mm2 (SD = 0.3 mm2), and the volume from the nostril to 20 mm into the nasal cavity was 60 mm3 (SD = 19 mm3). There was a tendency (P < 0.10) for epinephrine to increase minimum cross-sectional area on the treated side and volumes on both sides. Histamine decreased volume on both sides (P < 0.05), but not uniformly between animals. Measurements in a tube with 2 mm internal diameter (area 3.1 mm2) underestimated true area by approximately 30%. The method, therefore, at its present state of development, measures changes in dimensions rather than absolute values. It is concluded that the acoustic reflections technique may be a useful alternative to other, more invasive methods to assess nasal cavity dimensions in guinea pigs, but further studies are necessary to improve and validate the method.

Endotoxin and Lysosomal Protease Activity in Acute and Chronic Otitis Media with Effusion

Endotoxin levels and lysosomal protease (collagenase, cathepsin B, and lysozyme) activity were measured in 104 middle ear effusions (MEEs) from patients with otitis media with effusion (OME). The MEE samples were classified into four groups: Pediatric serous, mucoid, and acute, and adult serous. Endotoxin levels and lysosomal protease activity in MEEs were significantly different in the following order: Adult < serous < mucoid < acute groups, indicating that both endotoxin and lysosomal proteases are more closely related to the pathogenesis of pediatric chronic OME than to adult OME. In pediatric serous and mucoid effusions, endotoxin level had a significant correlation with activity of the lysosomal proteases. In conclusion, endotoxin enhances leukocyte infiltration into the middle ear, and lysosomal proteases released from leukocytes damage the middle ear mucosa and thereby prolong mucosal inflammation, which may be responsible for delayed recovery from acute OME.

Nasal passage patency in patients with allergic rhinitis measured by acoustic rhinometry: nasal responses after allergen and histamine provocation

We investigated nasal passage patency after allergen and histamine provocation in patients with allergic rhinitis by acoustic rhinometry. In total, 75 outpatients with allergic rhinitis were studied. The threshold of nasal hypersensitivity to histamine was measured by the 10 microliters instillation of serial 10-fold dilution in the ipsilateral nasal cavity. Nasal provocation testing to specific antigen was applied to the anterior part of inferior turbinate in bilateral sides in sitting position. Measurement of nasal patency by acoustic rhinometry was repeated three times in each nasal cavity. The minimal cross-sectional area and total volume of nasal cavity were measured in an individual subject. The minimal cross-sectional area and total volume in the histamine challenged-side significantly decreased on the 10(-2), 10(-1), 10(-0) of end point, and up to 30 min after challenge with the threshold dose, but not in the unchallenged side. This means acoustic reflection technique is sensitive at least 100-fold in comparison with classical method like findings by anterior rhinoscopy and symptom scores. Nasal passage patency after bilateral allergen provocation showed predominant in the unilateral side, suggesting the cross over-reflex effects. It was concluded that acoustic rhinometry is one of the highly quantitative and sensitive method which can observe the change of nasal congestion.

Birch-pollen sensitization in an area without atmospheric birch pollens

OBJECTIVE To clarify the incidence of individuals with a subclinical allergy to birch pollen and the possible allergic association between birch pollen and other allergens in areas without atmospheric birch pollen. METHODS Birch-pollen-specific immunoglobulin E concentration in sera, together with those for some other inhaled and ingested allergens, was measured in 409 male and 525 female patients (an average age of 58.6 years, born and raised in an area without atmospheric birch pollen) with suspicious nose and/or throat allergies. Concomitantly, types and concentrations of pollen grains in the regional air were examined. RESULTS Of 934 patients 13.2% showed birch-pollen-specific immunoglobulin E although no birch pollens were observed in the atmospheric air. The rate was relatively low in comparison with those for clinically important inhaled allergens in this area: 35.2% for Japanese cedar pollen, 24.7% for house dust and 23.2% for cypress pollen. Spearmans rank correlation analysis and logistic regression analysis revealed that birch pollen correlated strongly with apple and some foodstuffs commonly ingested by all age groups (rho>0.6000, odds ratio>27.191). CONCLUSIONS A considerably large number of patients with a subclinical allergy to birch pollen exist in an area without atmospheric birch pollen. Measurement of specific immunoglobulin E to birch pollen is important even in such areas for screening and diagnosing patients with oral allergy syndrome.

Chondrosarcoma of the ethmoid sinus extending to the anterior fossa

A 27-year-old women with chondrosarcoma of the ethmoid sinus extending to the anterior fossa had initial symptoms of blurred vision on the left and slight proptosis. Neuroradiological examination, however, disclosed that the tumor extended not only to the anterior cranial fossa, but also to the orbit, nasal cavity, and maxillary sinus. It is difficult to predict the biological behavior of chondrosarcoma by means of histological examination. The effectiveness of radiotherapy, chemotherapy, or both is also a matter of controversy. Clinical aspects of chondrosarcoma are briefly discussed.

Sensation Elicited by Mechanical Stimuli to the Oropharyngeal Mucosa

An inaccurate localization of the site of stimulus, a higher two-point threshold for touch than those at lower lip or soft palate mucosae, and reference of touch sensation to the submaxillary cervical region following mechanical stimuli to the posterior oropharyngeal wall or lateral pharyngeal band were observed in the present study on otolaryngologists, medical students and patients with abnormal sensations in the throat. These results indicated that not only the somatic but also the visceral nervous system might contribute to the elicitation of sensation from the oropharyngeal structures behind the soft palate.

Congenital stridor caused by redundant arytenoid mucosa

Two cases of congenital stridor caused by merely unusual redundancy of the mucosa covering the arytenoids are reported in this paper. The stridor was noted only when the patients were awake, and was not affected by postural changes of patients. The patients who did not reach their full mental and physical development had congenital abnormalities: cleft palate in one case, and hypertrichiosis, short palpebral fissures of camptodactyly in the other. No abnormalities were revealed in the patients on examinations of chromosomes, thyroid hormones and brains using the techniques of computerized axial tomographic scanning and electroencephalography. The diagnosis of these cases should be confirmed by a direct laryngoscopy or a laryngofiberscopy. Although the etiology of redundant arytenoid mucosa is not known, it may be suggested that this condition is incidental to other congenital abnormalities.

Effect of Beclomethasone Dipropionate Aqueous Nasal Spray on Nasal Obstruction in Pediatric Patients with Perennial Nasal Allergy.

The author evaluated the efficacy of beclomethasone dipropionate aqueous nasal spray (BDANS) at 300μg/day for 2 weeks, followed by 100μg/day for 1-8 weeks, on nasal obstruction in 12 pediatric patients (9 males and 3 females, aged 6-14 years, mean age 8.8 years) with perennial nasal allergy symptoms. A 100mm visual analogue scale (VAS) was used for subjective measurement of the nasal sensation of airflow, and acoustic rhinometry (AR) was used for objective measurement of the nasal cavity dimensions on entering the trial, and at 1, 2 and 3-11 weeks after the start of medication.1. The mean±standard error (SE) of the VAS score was 45.8±8.3 before treatment, 14.3±4.0 at one week, 14.0±2.8 at two weeks, and 22.9±4.3 at more than 3 weeks after the start of medication. The Friedman test for overall analysis showed significant variance in the VAS scores (P=0.0070).2. The mean±SE of the right+left minimum cross-sectional area of the nose (MCA) was 0.29±0.06cm2 before treatment, 0.46±0.04cm2 at one week, 0.45±0.04cm2 at two weeks, and 0.44±0.05cm2 at more than 3 weeks after the start of medication. The Friedman test showed significant variance in the MCA values (P=0.0045).3. The mean±SE of the right+left nasal cavity volume (NCV) was 4.50±0.46cm3 before treatment, 5.66±0.40cm3 at one week, 5.69±0.39cm3 at two weeks, and 5.39±0.34cm3 at more than 3 weeks after the start of medication. The Friedman test showed significant variance in the NCV values (P=0.0002).In conclusion, the present VAS and AR studies demonstrated that BDANS was effective in reducing allergy-induced nasal obstruction in children.

Discharge Quantity Drained after Thyroid Surgery

The need for drainage to prevent complications after thyroid surgery has been questioned by many authors since the late 1980s. However, little is known about the quantity of discharge after thyroid surgery.We measured the amount of discharge drained continuously after hemithyroidectomy with or without contra-lateral tumor enucleation in 90 consecutive patients (10 males and 80 females, mean age 56 years, ranging in age from 24-79 years) with benign (78 cases) and malignant (12 cases) thyroid tumors. The amount of drainage was not huge and ranged from 8 to 132ml with a mean of 51ml during the 4 days after surgery. The average amount was significantly larger in the patient group drained with a stronger suction system (J-VAC), when compared to that in the group with a weaker suction system (MANOVAC).Where immediate action based on close observation of patients is available under life-threatening conditions, such as massive bleeding or airway obstruction, prophylactic routine drainage is not necessary after uncomplicated thyroid surgery.