Takashi Hiramatsu

A Study of Pediatric Allergic Rhinitis-Investigation of the Number of Cytological Examinations-

Clinical features and diagnosis of pediatric allergic rhinitis need to be clarified. In our clinic, children suspected of having allergic rhinitis often undergo cytological examination of nasal smear (CENS) because the detection of eosinophils in nasal smear has a significant diagnostic value for allergic rhinitis in children, especially infants. To clarify the features of pediatric allergic rhinitis, the number of CENS conducted at our clinic during 2005 was investigated.1. when a microscope was skillfully used for observation of nasal cavity, the positive quantification of eosinophilia in nasal smears from children was compared with that from adults.2. The total number of CENS conducted for patients aged between one and 10 years old was higher than that of patients aged above 14 years old.3. Two peaks were found in the monthly numbers of CENS and they corresponded to the two turning points of atmospheric pressure, humidity, and temperature each year. Moreover the main peak for infants appeared around November, while that of adults peaked around March.These findings suggest that particular managements may be necessary for pediatric allergic rhinitis, differing from those for adults.

Clinical Study of Patients with Bullous Myringitis (BM) : Is BM Merely an Acute Otitis Media (AOM)?

Bullous myringitis (BM) is an acutely painful condition of the ear characterized by bulla formation on the tympanic membrane. The etiology is unknown despite its recognition over a hundred years ago by Lowenberg (1892). BM was described in early articles as occurring in association with acute otitis media; however, BM has different features from AOM: usually unilateral, more often in school age children and frequently in adults, and almost always with a self-limited clinical course.We studied 74 patients with BM aged 0 to 83 years (average age: 8.53), of which 65 patients had allergic rhinitis and others nasal disorders. Most patients had a sudden onset of very severe otalgia, but rarely had a high temperature. In all cases, bulla formations on the tympanic membrane were unilateral, and 54 of 69 patients had significant bulging of the pars tensa, whereas only 44 of 69 patients had significant middle ear fluid. As other findings of the tympanic membrane, including a patient who strongly blew the nose, 24 of 72 patients had bleeding and 32 of 36 patients with analysis of recorded photography had significant bulging of the pars flaccida.Merifield (1966) considered that BM is a mechanical injury, which follows upper-respiratory infection of any sort (eg, Eustachian tube insufficiency, fever etc). We thought that BM might be a middle ear barotrauma: abnormal nasopharynx pressure due to allergic rhinitis and others nasal disorders caused a sudden reflux of secretions and air from the nasopharynx into the middle ear such that a vibration and positive pressure suddenly struck the tympanic membrane.

Gas Gangrene in the Neck caused by Peritonsillar Abscess; A Case Report

The patient was 89-year-old male who complained of sore throat and swallowing pain. X-ray and CT showed gas formation in the neck. We performed an emergency operation, found necrotic tissues and diagnosed gas gangrene. In our earlier experiences with gas gangrene, there were many bacteria in the pathological specimen. In this case, anaerobic bacteria were detected in the necrotic tissues, contributing to the pathological diagnosis. Furthermore, we paid attention to the change in LDH based on past experiences. In the blood test, LDH rose simultaneously as his condition got worse. Findings of necrotic tissues in the pathological investigation was useful to the detection of bacteria and LDH showed the degree of gas gangrene.