Nobuo Usui

Immunohistochemical Localization of Subtypes of Muscarinic Receptors in Human Inferior Turbinate Mucosa

The regulation of glandular secretions and vasomotor tone in human nasal mucosa implicates muscarinic receptors. There are 5 recognized classes (m1 through m5) of muscarinic receptor subtypes, and the aim of our study was to localize muscarinic receptor subtypes (m1 through m5) in human inferior turbinate mucosa by an immunohistochemical method. We found m1 and m2 receptors distributed on glands, arteries, veins, and epithelia; m4 receptors were found around arteries; and m5 receptors were identified on glands and arteries. We found m3 receptors to be the most extensively distributed on glands, arteries, and veins of all of the muscarinic receptor subtypes. The m3 receptor is probably important in the physiology of the human inferior turbinate. This study may help identify the best target for more selective muscarinic drugs and guide the treatment of allergic and nonallergic rhinitis.

Ventilatory Function in Laryngectomized Patients

It is established that maximum expiratory flow-volume curve coupled with closing volume curve may give important information on obstructive impairment in the laryngectomized patients. In the patients after laryngectomy, the pattern of the flow-volume curve was similar to that found in patients with chronic bronchitis. These abnormalities of the flow-volume curve which became convexity to the volume axis can be reversed at least partially by bronchodilator drug inhalation. It is concluded that the patients after laryngectomy have abnormalities of ventilation distribution despite relatively normal results of routine pulmonary function tests and respiratory resistance.

Temporal Change in the Airway Resistance Following Stimulation of the Nasal Mucosa

In the present study, the effect of stimulation of the nasal mucosa produced by gauze packing on the lower airway was evaluated in normal subjects by measuring the airway resistance with a body plethysmograph at scheduled intervals for 60 min after packing and 60 min after its removal. In subjects exhibiting rising of the airway resistance after stimulation, the value rose immediately or in 5 min after stimulation, then reverted to the pre-packing level and remained constant thereafter. In those exhibiting lowering of the airway resistance, the value fell immediately or in approximately 20 min after stimulation, rose thereafter but remained constant at a lower level than the pre-packing. The response of the lower airway due to the stimulation of the nasal mucosa has individual differences and shows a variety of patterns.

Flow-Volume Curves in Patients With Allergic Rhinitis

This study was undertaken in order to determine whether or not the lower airways of men are influenced by ragweed and house dust allergens to a degree comparable to that of dynamic pulmonary function tests. Through a careful analysis of the expiratory spirograms, the maximum expiratory flow-volume curves, and the respiratory resistance among nine patients with ragweed allergic rhinitis and 15 with house dust nasal allergy, it was determined that the ragweed allergic patients maintained a normal pulmonary function throughout the experiments. On the contrary, the house dust allergic patients maintained normal baseline, but their expiratory flow rate at 50 percent and 25 percent levels of the vital capacity showed a tendency to decrease respectively. In addition, after the bronchodilator drug inhalation, the flow-volume curve returned toward the normal pattern for the patients with house dust nasal allergy. The hyperresponsiveness to the bronchodilator drug inhalation is similar to that found in asymptomatic bronchial asthma. It might be suggested that the differences between the two groups of the nasal allergic patients are due to the different types of causative allergens, and especially to the size of the causative allergens particle as it is indicated by several allergologists. The maximum expiratory flow-volume curve is easily obtainable, reproducible, and is more enabling to detect obstructive changes in the lower airways.

The Effect of Nasal Irritation on Lung Compliance in Laryngectomized Patients

The present study was undertaken in an attempt to see whether the stimulation of nasal mucosa can or cannot initiate a change in lung compliance of laryngectomized patients. Twelve totally laryngectomized patients were used as the subjects. The subjects were coupled to a pneumotachograph by means of a common spirometric rubber mouthpiece that was connected by adhesive plaster to the tracheostoma. The lung compliance has been measured by means of dynamic compliance, using the transpulmonary pressure and the volume by integration of air flow as parameters. The measurements of each param eter were first performed both before and after the irritation of the nasal mucosa. Then the same measurements were repeated after an injection of atropine. No remarkable change of lung compliance was noted both before and after the nasal stimulation, and the same nasal stimulation after an atropine injection did not cause any appreciable change in lung compliance.

Transition from Nasal to Mouth Breathing with Increasing Nasal Obstruction Estimated by Airflow Resistance Measurement

There have been numerous attempts to evaluate the relationships between the upper and lower airways. However, there are no available data indicating when the shift from nasal to oral breathing takes place as a subjects nasal obstruction increases. In this experiment twenty-four subjects, each with varying degrees of nasal obstruction, were examined. Their nasal and pulmonary resistances were measured for both nasal and oral breathing. Each airflow resistance was analyzed according to the Rohrers equation. The examination results of those subjects who fell into the fourth degree classification of nasal obstruction showed transition from nasal to oral breathing. The pressure-flow curves of the nasal passages and the pleural surface during oral breathing had a same pattern. For the fourth degree cases, the nasal resistance was approximately onehalf of the total pulmonary resistance. In these circumstances the results from our study indicated that at the flow rate of 0.5 liter/sec the nose contributes about 53 % of the total pulmonary resistance.

Effect of Neo-Synephrine Nasal Spray on Pulmonary Resistance in Man

The study to be presented was undertaken in an attempt to investigate whether airflow stimulation in nose can or cannot initiate a change in tracheobronchial airway resistance in man. Eight subjects with nasal obstruction were tested both before and after the application of neo-synephrine nasal spray. Measurements of nasal resistance and pulmonary resistance were made during both nose and mouth breathing. The resistance of the conducting airways below the pharynx was obtained by subtracting the nasal resistance from the pulmonary resistance during nose breathing. Each airflow resistance was analyzed according to the Rohrers equation. Probability was determined by studying the significance of the difference in airflow resistance before and after the application of the nasal spray. Its application resulted in a significant reduction in resistance during nose breathing. The main effect of the spray manifested itself as a reduction in the value of k 2 . No statistically significant changes were noted concerning the value of k 1 . There was a consistent change in airflow resistance after the application of neo-synephrine nasal spray during nasal breathing, whereas the pressure-flow patterns were similar to each other. However, no significant change was found during oral breathing. The interacting mechanism between nasal and pulmonary resistance that was observed after the application of neo-synephrine nasal spray was not explainable.

Subjective and Objective Assessment of UPPP.

Objective: In this study, we evaluated the efficacy of uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS) both subjectively and objectively, on the basis of responses to a mailed questionnaire from subjects, as well as pre- and post-operative physiological examinations and upper respiratory magnetic resonance imaging (MRI).Subjects and Methods: This study comprised 23 patients who had undergone UPPP during the 9-year period from 1990 to 1998, together with physiological examinations and upper respiratory MRI before and 3-6 months after the UPPP, and who responded to the mailed questionnaire. The questionnaire survey was conducted before and 43 months (mean) (±23.8; range: 13-89) after UPPP: the response rate was 64.7%.Results: The frequency of snoring was significantly correlated with the postoperative length of the soft palate (p<0.05), that is, the shorter the postoperative length of the soft palate, the lower the frequency of snoring became. In addition, postoperative sleep quality was found to be significantly correlated with AHI improvement rates (p<0.05) as well as to the postoperative transverse diameter of the pharyngeal cavity (p<0.01). In other words, sleep quality increased in parallel with the increase in AHI improvement rates as well as with the increase in the transverse diameter of the pharyngeal cavity. With regard to the degree of interference in the sleep of a bed-partner, the higher the preoperative AHI (p<0.05), the lower the degree of interference. The degree of general satisfaction with the surgical outcome was higher among patients with higher preoperative AHI (p<0.01).Conclusion: These findings indicate that the length of the soft palate is associated with the frequency of snoring and that the transverse diameter of the pharyngeal cavity is related to the frequency of sleep apnea. Therefore, shortening of the soft palate and the uvula as well as lengthening the diameter of the pharyngeal cavity may be indicated as surgical treatment for snoring and sleep apnea, respectively.

The Effect of Therapy on Sleep Apnea and Simple Snoring.

A sleep test was performed 108 times on 85 patients at the Self-Defense Forces Central Hospital for one year between September 1997 and August 1998. 36 patients (42%) had sleep apnea and 46 (57%) had simple snoring. Surgery was performed on 41 patients (55%) and a dental splint was used on 3 (4%). We issued a questionnaire about the effect of the therapy to the 44 patients after surgery and dental splint use. We received questionnaires back from 34 patients (77%). The improvement ratio of snoring was 94% and that of apnea during sleep was 93% after surgery. 88% of the patients raised their health awareness and 82% and significantly decreased their body weight after therapy.

A Clinical Study Evaluating the Effects of EN028 in Patients with Simple Snoring.

The efficacy of EN028 was evaluated in 25 patients (20 males, 5 females) who had been diagnosed with simple snoring by the sleep test. All patients did not wish to undergo surgical treatment and gave their consent to participate in the present clinical study after having been given full and adequate information about the purpose and investigational nature of the study.The efficacy rate was 68%, and two patients dropped out in the middle of the study because of alleged post-drug discomfort. Non-responds for the most part were found to have severe hypoventilation or a low post-drug decrease in nasal airway resistance. If such patients could be avoided in the selection of study subjects, the efficacy rate of EN028 would be higher than in the present study.