[Meta-analysis of pharmacotherapies for allergic rhinitis].

We performed meta-analysis using the data in literatures of the clinical study related to pharmacotherapies for allergic rhinitis in Japan as evidences. We extracted double-blind studies which used first-generation antihistamines, early-stage second-generation antihistamines, late-stage second-generation antihistamines and arachidonic acid metabolite-receptor antagonists as investigational drugs. In meta-analysis of first-generation antihistamines and early-stage second-generation antihistamines, significant differences between them were detected in final overall improvement and usefulness. In meta-analysis of early-stage second-generation antihistamines and late-stage second-generation antihistamines, significant differences between them were detected in usefulness and sleepiness as an adverse effect. In meta-analysis of late-stage second-generation antihistamines and arachidonic acid metabolite-receptor antagonists, significant differences between them were detected in final overall improvement and usefulness. These results indicate a historical trend in the development of drugs including measures to deal with sleepiness as an adverse effect. The arachidonic acid metabolite antagonists appeared to be promising among the oral drugs for allergic rhinitis, although data related to the arachidonic acid metabolite antagonists are still few and further collection of them is necessary.

Exposure to Japanese cedar pollen in early life and subsequent sensitization to Japanese cedar pollen.

The effect of exposure to Japanese cedar pollen (JCP) in early life on subsequent sensitization to it was evaluated. Specific IgE antibody to JCP was examined in 440-504 school children in a rural town each year during 1995-98. The amount of dispersed pollen measured by a Durham sampler widely ranged from 165 to 5941 grains/cm2/year during this period. The amount had been measured during the period of 1982-91 in which these children were born, and it also widely ranged from 148 to 8566 grains/cm2/year. Children born during November to January, who were exposed to JCP within 6 months of age, increased at the risk of sensitization to JCP, especially severe sensitization, relative to those born in the other months. Age-adjusted prevalence rate ratio (RR) of having a JCP-IgE > or = 15 U/ml (control; < 0.35 U/ml) for children born in December to February relative to children born in the other months was 1.74 (95% confidence interval; 1.06-2.87, examined in 1998), and for those born in November to January was 1.57 (95% CI; 1.00-2.46, examined in 1997). The risk of sensitization to JCP was low for those born in May to July (RR = 0.42, 95% CI; 0.19-0.93, examined in 1998). There was also a strong correlation between the amount of the dispersed pollen during the period of 2-6 months after birth and the prevalence of sensitization to JCP.

[Simple evaluation of CT findings in the paranasal sinuses for chronic sinusitis].

The CT scores and scoring for improvement based on them, which we proposed previously, is a simple and highly reproducible method of evaluation of sinus units before and after an operation for chronic sinusitis. We compared this evaluation method with the results of quantitative assay and showed its advantages and disadvantages. The subjects were 258 sinuses in patients who underwent endonasal sinus surgery (ESS) in the department of otolaryngology, Kyoto Prefectural University of Medicine Hospital from April 1996 to April 1997. The subjects were evaluated according to the following 4 grades negligible shadow in the paranasal sinus CT scored 0, less than 50% shadow scored 1, more than 50% of shadow scored 2, and mostly filled with shadow scored 3. Furthermore, the preoperative and postoperative CT scores were compared and the rate of improvement was rated in the following 3 grades: score 0 for unchanged or aggravated subjects, score 1 for subjects showing improved CT score by 1 grade, and score 2 for those showing improved CT score by 2 grades or a postoperative CT score of 0. Quantitative image analysis was input into a personal computer and the ratio occupied by the shadow was calculated, as the shadow ratio. While some discrepancies were seen in parts in the comparison of the quantitative image analysis and CT scores as the former captures minute shadows, a positive correlation was obtained overall. Attention is needed to accurately evaluate small paranasal sinuses such as the frontal sinus, and small amounts of shadow, which are areas where errors may occur. A satisfactory correlation was obtained between the score for the improvement rate and the difference in the shadow ratios before and after surgery. The CT scores and the scores for the improvement rate showed no difference from the results of other evaluation methods reported in the past, and evaluation of similar precision was possible. It was thought that this simple evaluation method of CT findings in the paranasal sinuses, which we examined in the present study, was quite useful as a simple stage-classification method that could be utilized in everyday practice considering its facility, reproducibility and satisfactory precision.

Magnetic resonance imaging for aspirated peanut in the bronchus.

Peanut inhalation in the right main bronchus of a 15-month-old boy was diagnosed using a T1-weighted image produced by magnetic resonance imaging (MRI) because of the high fat content of the peanut. The T1-weighted MRI image may also be useful in diagnosing other kinds of aspirated nuts with high lipid content as well as peanuts. This method does not involve any X-ray exposure.

[A study of goblet cells in the rat nasal septum by quantitative histological techniques].

The number and area of goblet cells in the normal rat septum were examined quantitatively using a whole-mount method and image analysis. With this approach, the number of goblet cells can easily be counted and quantitative analysis of secretory granules under different conditions can be determined histologically. When the whole mucosa of the nasal septum was divided from anterior to posterior into 8 equal sections, the third and fourth sections contained many large goblet cells. This finding may reflect the physiological role of the nasal mucosa, which warms and humidifies nasal air streams. The distribution of goblet cells in the nasal septum seems to be complementary with that of glandular orifices, which may serve the purpose maintaining the mucous blanket in the nasal cavity. ACh perfusion demonstrated an area of alcian-blue-positive secretory granules in goblet cells which decreased immediately afterwards, but recovered in 10 minutes. These results strongly suggest that ACh initially increases secretion in goblet cells and then enhances the production of secretory granules in these cells approximately 10 minutes later. IPR perfusion, on the other hand, showed an area of alcian-blue-positive secretory granules in goblet cells which decreased 30 minutes after treatment. Furthermore, there was variety in the area of each goblet cell. These results strongly suggest the possibility that IPR may slowly elevate secretion from goblet cells. It seems most likely that goblet cells have the same secretory reaction characteristics to autonomic nerve agents as glandular secretory cells.

Distribution of goblet cells in the rat nasal septum by use of quantitative histological technique.

In this quantitative, histological study, both goblet cell number and distribution of secretory granules in normal septal mucosa of rats were examined by computer-based color image analysis combined with a new, simple whole-mount method. Our new method has proved to be a very useful and highly accurate means of examination. The count and size of the mucous area of goblet cells decreased toward the antero-posterior direction with the exception of the apical region of the septum. The regional difference characteristic of the goblet cell is noteworthy. The results are assumed to be closely related to both flow direction of mucous blanket and distribution of nasal gland orifices. Goblet cells are assumed to be controlled by some regulatory factor of the secretory system and to play an important role in nasal physiological mechanism.

[A relationship between the annual onset day of Japanese cedar pollinosis and pollen dispersion].

A statistical analysis of the annual day of onset of Japanese cedar pollinosis was carried out on a total of 305 patients seen at the out-patient clinic for allergic diseases in the Department of Otorhinolaryngology of Kyoto Prefectural University of Medicine between 1989 and 1991 (3 years). The day of onset varied among individuals and was distributed over a period of about one month, in patient number statistics, however, a clear single peak was seen for all 3 years. The day of onset in most patients showed tendency to peak after January 1, i.e., when the maximum temperature integral is approximately 450 degrees C, on warm days where the maximum temperature exceeds 15 degrees C, on days where there is little rain, and on days when there is a strong southerly wind. This peak onset day is about 3 weeks after first day of pollen count, or 3 or 4 days before the first dispersion peak, which corresponds to the day on which pollen dispersion begins in earnest. Furthermore, it was found that there was a drastic increase in the attack rate (from 10% to more than 50%) in pollinosis patients about 1 week before the peak day of onset. By the first dispersion peak, 70-80% of the patients had experienced an attack. The results of the present study may be useful in pollen forecasting and in treating early pollinosis in the dispersion season.

Teratoma of the soft palate with multifocal cyst formation in the tongue and the brain.

We report a case of a solid and cystic teratoma appearing in the soft palate that was associated with a cyst in the tongue and a huge cystic formation in the arachnoid of the brain. Histologically, the tumor of the soft palate contained elements of all three germ layers, with a predominance of mature glial tissues. This typical teratoma and the two other concurrent lesions were all located on the same side of the head, and were thought to have a common embryonic origin. These multifocal tumors may represent an incomplete manifestation of a "teratoma complex".