萎縮性鼻炎に関する知見補遺 その病理組織学的研究 : 第2編 萎縮性鼻炎の組織像と病因的考察
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Thirty-two cases of atrophic rhinitis operated on by a surgical procedure originated by M. Kubo and modified by T. Kitamura have been classified into several groups in accordance with the differences in clinical manifestations, and histologic pictures of the mucous membrane of the paranasal sinuses, as well as of the nasal cavity, have been correlated with clinical findings in each type. 1. Type Ia: The patients falling under this type are those in which diathesis seems to be an important factor in the onset of the disease. This form of atrophic rhinitis is attended with atrophy of the nasal mucous membrane and under-development of the paranasal sinuses. Histologic sections of the mucous membrane are characterized by marked metaplasia and extensive cornification of the epithelium, abnormally small number of the glands, changes of a high degree in the epithelium of the secretory ducts, dilatation of the orifices of the ducts and the presence of secretions in the ducts. The mucous membrane of the maxillary sinus is of the primary fibrous type (according to Kitamura's classification). 2. Type Ib: This group consists of patients with atrophic rhinitis of the type Ia combined with chronic paranasal sinuitis. 3. Type Ic: This type represents patients with well-developed or over-developed paranasal sinuses, quasi-normal mucous membrane of the maxillary sinus and the infiltration of eosinophilic leukocytes of a high degree in the area underneath the epithelium, though their nasal cavities have the characteristic features of type I The cause of this form of atrophic rhinitis is uncertain. 4. Type II: The patients of this type are those who are afflicted with a form of atrophic rhinitis which is the outgrowth of chronic inflammation (paranasal sinuitis).Though the development of the paranasal sinuses of the patients belonging to this group could not readily be distinguished from that of the patients with simple chronic paranasal sinuitis, the epithelium demonstrated disintegration of a .high degree and metaplasia of a minor degree. Examinations of the glands and other parts indicate that atrophy of the mucous m.ambrane of the inferior turbinal has been caused by inflammation of a high degree. The mucous membrane of the maxillary sinus shows the aftermath of chronic paranasal sinuitis. 5. Type III: Hypofunction of the glands is assumed to be mainly responsible for this type. Though the characteristic features of this type have not been clarified histologically, the disease may be related with Sjogren's syndrome in some ways. Elucidation of the cause of type Ic may entail clarification of the pathology of this form of atrophic rhinitie. 6. Type IV: Disintegration of the mucous membrane of the nasal cavity, hypofunction of the nose and multiplication of microorganisms attributed to a strong catarrhal inflammation are assumed to be the cause of this form of atrophic rhinitis. 7. The follow-up study of a patient, who had been operated on by Kubo's method for implantation of a portion of the mucous membrane of the maxillary sinus to replace the inferior turbinal that underwent atrophy, revealed that the inferior turbinal created by the operation was free from atrophy or disintegration 10 and 15 months after the operation. This would prove that this surgical procedure is effective in improving physiologic function of the nose as has originally been intended.
- 千葉大学の論文
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