Sumiko Murai

Nasal Mucociliary Clearance Under Various Conditions

We applied the tagged-particle method or the saccharin method or both to the nasal mucociliary clearance. There was no effect of ageing on the transport time of saccharin in control subjects of ages under 60, and 70% of control subjects of ages more than 60 had the same transport time as that obtained in younger control subjects. The significant inverse correlation between the mucociliary transport rates with the particle method and the transport time with the saccharin method were established in control subjects, but not, however, in patients with chronic sinusitis. The mucociliary transport rates were measured under non-physiologic conditions of the nose: laryngectomy, chronic sinusitis, Sjögrens syndrome, and Kartageners syndrome.

Mucociliary clearance in chronic sinusitis: related human nasal clearance and in vitro bullfrog palate clearance.

Nasal mucociliary clearance was measured in both healthy subjects and patients with chronic sinusitis using saccharin granule technique. Nasal mucociliary transit time (ST) was significantly slower in the patients with chronic sinusitis compared with that in controls (p less than 0.005). Nasal mucus collected from each nasal cavity was used for in vitro bullfrog palate clearance studies and compared to the in vivo nasal ST. Mucociliary clearance rate (MTR) on frog palate was 12.5 +/- 2.5 mm/min in the mucus from control subjects, 6.1 +/- 1.5 mm/min in the mucus from the patients. The difference was statistically significant (p less than 0.005). The MTR on frog palate in the patients whose nasal ST was within normal range was significantly slower than that in controls (p less than 0.005), but not significantly different from that in the patients whose nasal ST was over the normal range. These results suggest that the nasal mucous properties which decreased the mucociliary clearance on frog palate did not contribute to the mucociliary clearance of the patients who had a normal one. No significant correlation existed between MTR on frog palate and nasal ST in both control and chronic sinusitis. In chronic sinusitis patients, decelerated nasal ST was recovered significantly by normal saline nebulization compared with the value before the nebulization (p less than 0.01). None of the significant change of ST was observed in control before and after the nebulization.

Nasal Mucociliary Clearance in Sjögren's Syndrome: Dissociation in Flow between Sol and Gel Layers

Nasal mucociliary clearance was measured with two methods in 8 patients with Sjögrens syndrome and in 6 normal subjects. The movement of two different tracers placed 1.5 cm posterior to the inferior turbinate tip was measured respectively. The transport rate of a 500 microns anion resin particle tagged with 99mTc was measured. The clearance of 10 microliters saline labelled with 99mTc was monitored and the clearance rate was calculated. Whereas the measurement with the particle method revealed the lowered transport rate in Sjögrens syndrome, measurement with the saline method did not reveal any difference in clearance rate between the two groups. Since the former method measures the transport of particle in the gel phase (the outer mucous layer) and the latter measures the clearance of both gel and sol (periciliary fluid) layers, it is postulated that there is a dissociation of flow between sol and gel layers in Sjögrens syndrome.

Application of Mucodyne to Chronic Sinusitis.

The therapeutic effect of S-carboxymethyl cystein (S-CMC, Mucodyne®) was examined in 54 patients with chronic sinusitis. A dose of 1500mg/day of S-CMC was administered to the patients for 4 weeks, and its effectiveness was evaluated at the end of treatment.1) The overall efficacy rate was 78.7% and the efficacy rate for good responses was 46.8%.2) An adverse reaction was noted in only one patient (1.9%).

Clinical study of cefixime in the treatment of otitis media and paranasal sinusitis.

Cefixime (CFIX) was administered to 22 patients with acute otitis media, 43 patients with acute exacerbation of chronic otitis media, 27 patients with acute paranasal sinusitis and 14 patients with acute exacerbation of chronic paranasal sinusitis.1. It was effective in 81.0 00 of those with acute otitis media, in 54.

Massive antiemetic therapy with metoclopramide for cisplatin-induced emesis.

% of those with acute exacerbation of chronic otitis media, in 65.400 of those with acute paranasal sinusitis, and in 100.0 % of those with acute exacerbation of chronic paranasal sinusitis.2. Bacteriological studies showed an elimination rate of 59.5% (47/79).3. No side effect was noted.4. The above results indicate that CFIX is a very useful antibiotic in the treatment of otitis media and paranasal sinusitis.

Thyroglossal Cysts During the Last 20 years

Large doses of metoclopramide as an antiemetics were administered to 9 patients recieving cisplatin (CDDP) (50mg/m2) for head and neck cancers. Metoclopramide, 2mg/kg was administered four times intravenously on the first day of CDDP therapy and once a day on days 2-7. Neither emesis nor nausea occurred in 8 of the 9 patients (89%). Side effbcts were minimal: mild sleepiness(66.7%)and diarrhea(22.2%). It is concluded that the antiemetic effect of intravenous metoclopramide in large amounts can prevent cisplatin-induced emesis.

Measurement with nasal scintigraphy of nasal mucociliary clearance in normal man.

1) 1961年から1980年までの20年間に当教室で正中頸嚢腫の診断のもとに手術を行なった症例は47例で, 瘻孔を伴うものは5例であった.2) 年令では0-29歳に69%の症例を認めた. 本疾患は青壮年期に発症すると思われる.3) 男女比は男25例, 女22例で男女間に差を認めなかった.4) 全例に手術を行ない, 新鮮例では嚢腫摘出+舌骨切除12例, 嚢腫摘出+舌骨非切除31例であり, 非新鮮例では前者2例, 後者2例であった.5) 術後追跡調査可能症例は新鮮例27例, 非新鮮例4例で, このうち嚢腫摘出+舌骨非切除症例に再発を3例認めた. また, 嚢腫摘出+舌骨切除症例には再発を認めなかった.6) 正中頸嚢腫の手術的治療は症例を選べば舌骨を保存しうる症例もあると考えられるが, より確実な治療のためには舌骨切除によって甲状舌管を完全に摘出する方法によらねばならないと思われる.