The mucociliary transport system is a crucial defense mechanism in the airways. This system is dependent on both the ciliary beats and the properties of the periciliary fluid. In the nasal mucosal epithelial surface, there are two major types of cells which play an important role in the system, ciliated cells and goblet cells. In this study, we used the nasal mucosa of rats and examined the effects of neuropeptides which coexist in the nociceptive trigeminal sensory nerves, i.e., substance P (SP), neurokinin A (NKA), and calcitonin gene-related peptide (CGRP), on these two types of cells by a videoenhanced microscopic technique. We could observe ciliated cells and epithelial goblet cells on the same preparation simultaneously. The effect on ciliated cells was estimated by measuring the frequency of ciliary beat with a fast Fourier transformation (FFT) analyzer (ciliary activity), and the effect on goblet cells was evaluated by counting every exocytotic response in a single goblet cell (secretory activity).
SP (1μM) significantly promoted both secretory activity and ciliary activity. NKA (1μM) also stimulated the secretory responses of goblet cells significantly, and promoted the ciliary activity. Increased secretion of goblet cells were induced by SP and NKA simultaneously or a few seconds later when ciliary activity was accelerated. These two responses seemed to be functionally cooperative. In contrast, CGRP (1μM) did not stimulate secretory or ciliary activity.
We showed that neuropeptides in the trigeminal sensory neurons are involved in regulating both ciliated cells and goblet cells and play an important role in host defense mechanism in the rat.

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We performed conservative myringoplasty according to Sinkawa's method to the patients with chronic otitis media, traumatic perforation, perforation after tympanostomy tube operation. Forty-six ears underwent the surgery using lyophylized homograft dura and tissue adhesive agent. Most of the patients stayed overnight in our clinic after surgery. The rate of the perforation closure by the first operation was 67.4%, while the results of more than one operation was 84.8%. However, the rate for those who had frequent otorrhea preoperatively was only 30% after the first operation. As for complications, infection after the operations was found in four cases but no serious complications in both during and after the operation were observed.

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Neurilemmoma is a benign tumor deriving from schwann cells. It is relatively uncommon that the tumor occurs in the tongue. We report a case of neurilemmoma of the tongue in a 15-year-old girl. The tumor was beneath the mucosa of medial lingual dorsum and about 3cm in diameter. The tumor was excised under general anesthesia. We could not determine which nerve it derived from. It was encapsulated, elastic and hard, and diagnosed histologically as neurilemmoma (Antoni type A+ B). The postoperative course has been satisfactory without recurrence at three months after the operation. We performed ultrasonic tomography, CT, MRI as preoperative examinations, and MRI was the most useful in obtaining clear image and taking three-dimensional position of the tumor.

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A 24-year-old female visited Tokyo Medical College Hospital with complaints of dull headache.
Roentgenographic examinations revealed an osteoma-like shadow in the anterior part of the left ethmoid sinus.
The tumor was removed via trans-antral approach under general anesthesia.
Histopathological diagnosis of the tumor was made as a benign osteoblastoma, which is uncommon bone forming neoplasma in the head and neck region.
After removal of the tumor, her headache completely disappeared.

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Three cases with mucocele of the sphenoid sinus are reported. Case 1 was a 47-year-old female with acute visual disturbance, nausea and headache. CT scan showed a mucocele locating in both sphenoid sinuses. On the third illness day, she underwent intranasal operation. Postoperatively, the symptoms markedly improved. Case 2 was a 53-year-old female with acute loss of vision. We operated upon her on the second day, but her symptom was unchanged. Case 3 was a 46-year-old male with facial and occipital pain for 6 months. He visited a neurosurgeon and was pointed out a cystic lesion of the posterior paranasal sinus by MR image. CT scan showed a mucocele in the posterior ethmoid and sphenoid sinuses. Intranasal operation relieved him from pain.
Mucocele of the sphenoid sinus is rare and shows few nasal signs. Loss of vision, headache and facial pain are common initial symptoms. Patients with visual disturbance need treatment without delay. Recovery of vision may be difficult in severe cases. In this series, each case has histories of previous surgery of the paranasal sinus. Attention should be paid to prevent mucoceles when sinusitis may be treated surgically.

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The change in the rhinomanometric values in response to a change in the body position or urination was studied in three patients with cervicaldamage. Nasal resistance increased when the body position was changed from the sitting position to the dorsal position, while it decreased by urination. This phenomenon is inferred to occur in association with autonomic hyperreflexia, a phenomenon specific for patients with cervical damage. In the said hyperreflexia, stimulation of a paralytic region by such as fullness of the urinary bladder causes sympathetic reflex resulting in an increase in the systemic blood pressure. As a result, the blood vessels of the nasal cavity, a non-paralytic region, are dilated to cause nasal obstruction. In healthy persons, the change in the body position from the sitting position to dorsal position also causes a slight increase in the resistance in the nasal cavity. The finding that this phenomenon is more marked in patients with cervical damage suggests that a disorder of the sympathetic function due to trauma is involved in the observed phenomenon.

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Toxic shock syndrome (TSS) is a serious, potentially fatal multisystem disease due to toxin produced by certain strains of Staphylococcus aureus. Many cases of TSS after nasal/sinus surgery have been reported from USA and European countries. We experienced two cases of TSS following sinus surgery in the last 3 years. This is the first case report of TSS following nasal or sinus surgery in Japan. Appropriate hydration, antibiotics, irrigation of nasal and sinus cavities, and administration of immune globulin are important as management of TSS. Althogh serious post-operative infections are rare, prophylactic consideration and prevention of hospital-acquired infections are essential after nasal/sinus surgery.

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As a surgical treatment for sleep apnea or heavy snoring, late Dr. Takenosuke Ikematsu devised uvulopalatoplasty through his 39 years of investigations. The authors have simplified this technique by the application of electrocoagulation using high frequency current and have obtained good results.
To decide the indication of this technique, listening to the recorded tapes of snoring, inspection of soft palate without using tongue depressor and laryngofiberscopy through the nose are important. The patients with excessively large uvula and wide posterior palatal arches are indicated.
In this technique, a part of the uvula and the posterior palatal arches are coagulated by weak high frequency current mildly at first, then removed by round cutting forceps. When coagulation is adequate, this technique can be done without bleeding, so, hospitalization is unnecessary.
The following results were obtained in 161 cases.
(1) Cured (complete disappearance of snoring): 40 cases, 25%.
(2) Much improved (slight snoring remained, but much lighter than prior to the surgery): 61 cases, 37%.
(3) Little improved (relatively heavy snoring remained, but a little better than prior to thesurgery): 46 cases, 29%.
(4) No change: 14 cases, 9%.
In the cases for which the inspection of the soft palate is easy, or the narrow part is located at 10-12 cm from the nostril under the laryngofibers-copy through the nose, good results were obtained. In contrast, for obese short-necked patients or patients with high tongue dorsums, other techniques should be recommended.
The authors would like to name this technique “Conservative Uvulopalatoplasty (CUPP) ”.

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[in Japanese]

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[in Japanese]

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