副鼻腔の異物反応(硫酸バリウムによる)の研究
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Barium sulfate was used to study foreign body reaction of the nasal sinus. This substance possesses strong foreign body effect and to the mucous membrane and produces remarkable swelling of the sinus mucosa after instillation into the antrum and the swelling of the sinus membrane can be demostrated roentgenologically.The observation was carried out on the chronic sinusitis patients. X-ray film was taken 24 hours after instillation of barium in the maxillary sinus in 77 cases, and also on the 8th day in 88 cases. All cases were operated after the roentgenological examination. The changes on X-ray films were com pared with that of obtained histological specimens. From this study the following results were obtained: The swelling of the membrane was most remarkable in mild cases of chronic sinusitis which showed minimal swelling of the mucosa on X-ray film. In the cases with extensive rnucosal changes, no reaction to barium was seen.On the other hand, swelling of the mucosa was remarkable in the cases with large sinuses, while it was not so severe in the cases with small sinuses.This reaction of the mucosa consists of edematous swelling and round celhnfiltration with increased eosinophils. Those findingsin the mucosa resembles to the picture of the edematous type of chronic sinusitis. Allergy test proved to be negative in the cases with marked mucosal reaction.The author has previously stated that this reaction of the mucosa could be ascribed to the foreign body effect of the Ba SO4, and not to its chemical stimulation. The mucosal change in chronic sinusitis might be the result of foreign body effect of the infected bacteria which have relatively weak toxisity. This study revealed that the mucous membrane of the sinus displayed different reactions against the same stimuli depending on its grade of pneumatization. The well-developed large sinuses reacts foreign body with edematous change, but this reaction is minimal in the under-developed small sinuses. This reaction against foreign body should be recognized as that of the sinus itself, because the foreign body was insilled in the sinus cavity and not in the mucosa.The author would like to emphasize that this results of the clinical study can serve as the valuable data to understand pathology of chronic sinusitis. Unfortunately our experiment of similar foreign body reaction in rabbits failed to find significant change to confirm these clinical findings.
- 社団法人 日本耳鼻咽喉科学会の論文
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