[An electron microscopic study of the relation between epithelial cell damage and eosinophilia in the nasal mucosa of patients with nasal allergy].

To determine the relationship between epithelial damage and eosinophilia in the nasal mucosa of patients with nasal allergy, we examined the nasal mucosa (obtained by surgery) from 74 patients with allergic rhinitis, using light and electron microscopy. The extent of eosinophilia correlated significantly to grades of epithelial damage and torn tight junctions of the epithelial cells. No significant relationships were found between the severity of nasal symptoms and the extents of eosinophilia or grades of torn tight junctions of the epithelial cells. More than 50% specific granules in eosinophils in the allergic nasal mucosa showed normal findings. There were no significant relationships between the extent of eosinophil degranulation and grades of epithelial damage. Based on our results, the release of tubular vesicular structures from the eosinophil granule may be one form of eosinophil degranulation in the nasal mucosa of patients with nasal allergy.

The alteration of nasal resistance before and after local exposure to heated aerosol in perennial allergic rhinitis.

To determine the patho-physiological effects of heated vapour to the normal or allergic nasal mucosa, we measured the nasal resistance before and after a 10 min. exposure of hyperthermal (43.0 degrees C) aerosol to the nasal mucosa in normal subjects and perennial allergic rhinitis patients. In the allergic patients the mean nasal resistances after hyperthermal stimulation were significantly higher than those resistances without stimulation, both in expiration or inspiration. No significant differences of nasal resistances in normal individuals during the whole schedule with and without heated aerosol stimulation were found on expiration or inspiration. The local heated aerosol exposure increases the nasal resistance in nasal allergic patients while in normal subjects no changes were found, and the reaction may have arisen from a non-specific hypersensitivity of the susceptible allergic nasal mucosa.

[Local eosinophilia of the nose, the larynx and the trachea in rats sensitized with Japanese cedar pollen].

Eight Brown Norway rats were immunized twice at days 0 and 13 by intraperitneal injections of 10 micrograms Cry j I, one of major allergen to Japanese cedar pollinosis, mixed with 4.5 mg aluminium hydroxide gel. Serum level of Anti-Cry j I IgE antibody was detected by the method of ELISA. Mean value of serum levels of specific IgE to Cry j I in the sensitized rats was significantly higher than that in the non-sensitized five rats (p < 0.01). The grades of eosinophil and lymphocyte accumulation in the nasal mucosa of the sensitized rats were higher than those in the non-sensitized rats respectively (p < 0.05, p < 0.01). In the laryngeal mucosa, the grade of eosinophilia in the sensitized rats was higher than that in the control (p < 0.01), but no significant differences of lymphocyte accumulation in the larynx between the two groups were found. Only a small number of eosinophil and lymphocyte accumulations in the trachea of the both groups were observed and no significant differences of the grade of inflammatory cells accumulation between the two groups were found. According to the results of this fundamental study, allergic laryngitis in Japanese cedar pollinosis might be originated from Japanese cedar pollen.

Seasonal variations of nasal resistance in allergic rhinitis and environmental pollen counts. III: Efficacy of antiallergic agents.

We previously reported that, in a patient with Japanese cedar pollinosis, preseasonal increase in total nasal airway resistance (NAR) possibly caused from circannual endogenous rhythm was suppressed by preseasonal systemic administration of antiallergic agent. In this study, in order to determine the influence of preseasonal use of a topical antiallergic agent and seasonal administration of a peroral antiallergic agent, we made measurement of nasal airway resistance and pollen counts under the previous respective conditions in separated years. Preseasonal high mean values of total NAR for a couple of weeks was not suppressed by the preseasonal topical administration of ketotifen nasal spray in 1992 which was a low pollen season (974/cm2). However, the patient did not complained of severe episodes of hay fever at all throughout the season. Preseasonal increases in mean values of total NAR were observed in 1993 which was a high Japanese cedar pollen season (4,875/cm2) with NAR the same as untreated seasons. This may have been because the patient was not treated with preseasonal use of peroral azelastine. On extremely high Japanese cedar pollen count days further increased NAR occurred in the patient. The patient experienced relatively severe hay fever episodes, but used no other anti-histamine nor topical steroid during the season.

Seasonal variations of nasal resistance in allergic rhinitis and environmental pollen counts.

We made measurements of nasal airway resistance in a patient with Japanese cedar pollinosis and also measured the environmental pollen counts under different exposure conditions. In the season of high Japanese cedar pollen counts in Japan values of mean nasal airway resistance were significantly increased, remained elevated for 2 months after the season, and eventually decreased. In the season of low pollen counts, the mean values of nasal airway resistance measurements were increased during the season but decreased more rapidly after the season. In a year with no exposure to the environmental allergen because the subject lived out of Japan, the mean nasal airway resistances were relatively increased closely in phase with the Japanese cedar pollen season.

The distribution of eosinophil cationic protein positive eosinophils in the nasal mucosa of the nasal allergy patients.

The relationship between the distribution of eosinophils and epithelial damage of the nasal mucosa in nasal allergy was investigated by means of hematoxylin and eosin staining and a technique of immunohistochemistry using the anti-human EG2 mouse monoclonal antibody that reacts with the secreted form of eosinophil cationic protein (ECP). Nasal mucosa tissue of 26 adult nasal allergy patients and of 24 adult non-allergic rhinitis patients was removed surgically. Eosinophilia in the nasal mucosa of the allergy group was greater than that in the non-allergy group. A great number of ECP positive eosinophils accumulating in the nasal mucosa of the allergy group were mostly degranulated at the superficial layer of the lamina propria. Desquamation of the epithelium was observed mainly in the area of eosinophilia with degranulation of the secreted form of ECP in the nasal allergy group.

Seasonal variations of nasal resistance in allergic rhinitis and environmental pollen counts. II: Efficacy of preseasonal therapy.

We gave Mao-bushi-saishin-to, a Chinese blended medicine, and azelastine to an adult patient with hay fever due to Japanese cedar pollen and measured nasal resistance and ambient floating pollen counts throughout the time of Japanese cedar pollination in separated years. In the patient Mao-bushi-saishin-to was effective against preseasonal increases in nasal airway resistance but could not control severe episodes of allergic rhinitis caused by high dose exposure to Japanese cedar pollen and also perhaps caused by a priming effect. Azelastine inhibited both pre- and post-seasonal increases in nasal airway resistance but not only on high pollen counts days.

[Assessment of right ventricular afterload in mitral valve diseases with radionuclide angiography].

Right ventricular function at rest and during exercise was studied in 33 patients with mitral valve disease by equilibrium gated radionuclide angiography using 99mTc in vivo labeled red blood cells. Radionuclide measurements of right ventricular ejection fraction (RVEF) were correlated with mean pulmonary arterial pressure (mPAP). RVEF decreased significantly with exercise. There was no significant correlation between RVEF at rest and mPAP. However, mPAP showed significant negative correlation with RVEF during exercise and with the changes of RVEF from rest to exercise. It is concluded that RVEF during exercise in mitral valve disease is affected by right ventricular afterload, and the measurements of RVEF at rest and during exercise by equilibrium gated radionuclide angiography is useful to assess right ventricular afterload.

Axonal swellings in the corticospinal tracts in amyotrophic lateral sclerosis.

In 2 of 16 cases with sporadic amyotrophic lateral sclerosis (ALS) large numbers of axonal swellings were observed in the corticospinal tracts over a region extending from the posterior limbs of internal capsules to the bulbar pyramids. On electron microscopy, these axonal swellings were seen to consist of accumulations of neurofilaments and altered neuronal organelles (mitochondria and secondary lysosomes). Their morphology differed from the spheroids seen in the anterior horn in ALS.