Tadashi Kojima

Evaluation of the effects of antigen specific immunotherapy on chronic sinusitis in children with allergy.

The purpose of this study is to evaluate the clinical significance of allergy in children with chronic sinusitis. After allergic examinations, 52 sinusitis children were divided into allergic and non-allergic groups: 37 allergic children were treated with either the combination of antigen specific immunotherapy and medication with lysozyme chloride preparation (AI group, n = 20) or medication alone (AM group, n = 17); 15 non-allergic patients were also treated with lysozyme chloride preparation (NAM group). The treatment results including the radiographic improvements were significantly better in the AI group than in the AM or NAM group. The clinical effects of lysozyme chloride preparation tended to be better in the NAM group than in the AM group.

Study on the Dye Leakage Response of Nasal Mucosa Following Topical, Capsaicin Challenge in Guinea Pigs

We examined the serial changes of intravenously applied dye leakage and preliminary examined histamine release into nasal lavage fluid after topical stimulation with capsaicin in guinea pigs. A significant increase in the dye leakage response was detected for 30-40 min, with the maximum response occurring between 5 and 10 min after topical capsaicin stimulation. The dye leakage response to nasal capsaicin challenge was abolished by pretreatment with topical lidocaine, general substance P analogue, topical or general high dosage capsaicin. The dye leakage response to topical capsaicin challenge was significantly reduced following pretreatment with antihistamine, diphenhydramine or atropine sulfate, although it was not affected by pretreatment with an anti-leukotriene, FPL 55712. Topical methacholine challenge did not induce a dye leakage response. An increase in the concentration of histamine in the nasal lavage fluid was noted at 5 min after topical capsaicin challenge. The concentrations of released histamine tended to be positively correlated with those of leaked dye in the nasal lavage fluids. The histamine release induced by topical stimulation with capsaicin tended to be reduced following general and topical pretreatments with high dosage of capsaicin, and was almost completely abolished following atropine pretreatment. From this study it was concluded that nasal capsaicin stimulation can reflexively induce an intravenously applied dye leakage into the nasal cavity, and that C-fiber related cholinergic nerve reflex and histamine release might, at least partially, be related to this response.

The pathophysiological role of kinin and chemical mediators on experimental allergic rhinitis.

In order to clarify the pathophysiological role of the chemical mediators, the releases of kinins, histamine and leukotriene C4(LTC4) into the nasal cavity were measured following nasal allergic challenge in ovalbumin(OA)-sensitized guinea pigs, or following nasal stimulation with one of these chemical mediators in OA-non-sensitized animals. In sensitized animals, an increased vascular permeability of nasal mucosa was recognized immediately after antigenic stimulation and lasted for 60-90 minutes. Releases of kinins and LTC4 into the nasal lavage fluid augmented not only immediately after the antigenic challenge, but also during 60 to 90 minutes after the stimulation. Release of histamine into the nasal lavage fluid was observed only immediately after the antigenic stimulation. In non-sensitized guinea pigs, nasal stimulation with bradykinin accelerated nasal vascular permeability. Nasal stimulation with histamine or LTC4 resulted in increase of nasal vascular permeability and of kinins concentration in the nasal lavage fluid. These results suggest that kinins might be concerned with the immediate and later vascular permeability during the allergic response.

Role of Capsaicin-Sensitive Sensory Nerve Reflexes in Guinea Pig Model of Nasal Allergy

The aim of this study was to examine the pathophysiological role of capsaicin-sensitive sensory nerves in an animal model of nasal allergy. In ovalbumin (OA)-sensitized guinea pigs, a significant increase in nasal total airway resistance (TAR) was noted for at least 180 min after topical antigen challenge. The TAR response to antigen challenge was significantly inhibited for 120 min by general capsaicin pretreatment (167 +/- 12.1 vs. 113 +/- 5.0%, p < 0.001, and 186 +/- 14.9 vs. 119 +/- 6.6%, p < 0.001, control vs. capsaicin pretreatment group at 20 and 90 min after challenge, respectively). However, TAR was significantly though slightly affected even after general capsaicin pretreatment. Following nasal capsaicin challenge, TAR increased for 90 min, and nasal secretion for 30 min. Both the TAR and secretory responses to nasal capsaicin challenge were significantly greater in OA-sensitized guinea pigs than in nonsensitized animals (171 +/- 12.1 vs. 137 +/- 7.4% at 30 min, p < 0.05, and 82.3 +/- 8.6 vs. 13.4 +/- 1.7 mg/10 min, p < 0.05, TAR and secretory response to 300 microM nasal capsaicin challenge, respectively). These results suggest that capsaicin-sensitive sensory nerve reflexes play an important role in the occurrence of early-phase nasal symptoms following topical antigen exposure and are accelerated in OA-sensitized guinea pigs.

Release of kinin and other chemical mediators after antigenic stimulation in allergic rhinitis patients.

In generally, allergic reaction is precipitated within a few minutes after the challenge with a specific antigen in allergic patients. This reaction is called either the immediate response or the early phase response (EPR). However, it was recently reported that a similar allergic response is observed in some asthmatic patients after several hours following the challenge with antigen. This response is so-called the late phase response (LPR) in contrast with EPR. Pelican (1978) and Taylor & Shivalka (1971) described in some patients with allergic rhinitis that the nasal symptoms developed several hours after the antigen exposure. In this study, therefore, to reveal the details of a late phase response in allergic rhinitis, the serial changes of nasal symptoms with special reference to kinin and other chemical mediator levels in nasal lavage fluid were investigated after the nasal antigen challenge.

A Case Report of Malignant Lymphoma in the Buccal Space

The buccal space is a potential anatomical space bounded by the buccinator muscle medially and the parotid space posteriorly. This space chiefly consists of adipose tissue named the Buccal fat pad. Other contents are the parotid duct, facial nerve, accessory parotid gland, buccinator lymph nodes, facial artery and vein. Here we report a case of malignant lymphoma arising in the Buccal space.A 78-year-old woman presented with a painless tumor in her left cheek. The tumor had been present for approximately nine months and was slowly enlarging. Magnetic resonance imaging (MRI) and computed tomography (CT) of the head and neck demonstrated a 32mm×30mm×27mm tumor in the left buccal space. We surgically removed this tumor through the transoral approach. The pathologic diagnosis was follicular lymphoma grade 2 and there was no lesion in other organizations, therefore, she was not treated with radiotherapy and chemotherapy. No sign of recurrence or metastatic lesion has so far been found postoperatively.

Peripheral Facial Nerve Palsy; A Statistical Study.

A statistical analysis of the prognostic factors of peripheral facial nerve palsy was performed on 110 patients with Bells palsy and 24 patients with Hunts syndrome admitted to the Department of Neurotology at Nakamura Memorial Hospital from 1981 to 1989. The patients treated within 13 days after the onset got to be recovered significantly better than those treated after 14 days. The final recovery rate was significantly higher in patients with Bells palsy than those with Hunts syndrome. High evoked electro nerve potential and low nerve excitability differences were good prognostic signs in both disease. Steroid and acyclovir were significantly effective in the patients with Hunts syndrome.