FOCAL INFECTIONS FROM CHRONIC SINUSITIS
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概要
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Various clinical studies of 243 patients with chronic sinusitis were made and the findings were summarized as follows:1)Myocardial disturbance was demonstrated on electrocardiogram in 33(13.6%)out of the 243 cases.Surgical managements achieved recovery in 27(81.9%)out of the 33 cases, but failed in the remaining 6 cases.(18.1 %).2)Renal functions examined by the phenolsulphonphthalein and urea clearance test were abnormal in 45(18.5%a)out of the 243 cases.In kidney, glomeruli seemed to be affected more often than renal tubules.Surgical procedures achieved recovery in 38(84.4%)out of the 45 case.There was no definite relation between the recovery and the degree of disturbance of kidney function.3)In patients with chronic sinusitis accompanied by cardiac and renal dysfunction, symptoms suggestive of allergy were obviously present.Eosinophils in the blood were increased in 63.6_??_55.5%;and the presence of eosinophils in the nasal exudate was observed in 78.7_??_73.3%.The autonomic nervous system was unstable in 87.7_??_82.2%, and, especially, was vagotonic in most cases. The capillary resistance of skin was reduced in 90.9_??_88.8%.4)The intracutaneous reaction to bacterial and alimentary allergens was positive in 72.7_??_65.7%. "The agglutination test was positive in 63_??_57.8%.The incidence of the positive reaction to bacterial allergen was highest, to alimentary allergen was lowest, and to both bacterial and alimentary allergens was between the two.The rate of recovery by surgical treatment was highest in the cases with positive reaction to bacterial allergen, lowest in the cases with positive reaction to alimentary alle rgen, and intermediate between them in the cases positive for both bacterial and aimentary allergens.5)The histological pictures of the mucous membranes of the sinus comprised the fibrous type.the infiltration type, and the edematous type of the conventional classification.However, unlike the common of sinusitis, bacterial count and gamma-globulin level in the tissues were not in equilibrium.In the cases that failed to respond to surgical treatment, the so-called allergic edema was present, and the tissues were either negative for microorganisms or had them only in very small numbers, and the gamma-globulin level was also declined.Besides, the agglutination test was positive in most instances to only alimentary allergen, so that the condition could not be defined as a secondary disease ascribable to focal infection.6)The studies above stated have led to the conclusion that the cardiac and renal dysfunction accompanied by chronic sinusitis can generally be classified as follows, depending upon the etiologic mechanism:a)Focal infections due to the chronic suppuration of the paranasal sinuses.i)Lesions ascribable to allergic reaction to bacterial toxin(including the decomposition products of tissues).ii)Lesions due to the direct action of bacterial toxin in the instances of allergic predisposition.b)Lesions produced by allergic reactions similar to those responsible for the development of sinusitis.The morbid condition in this instance is no focal infection from the chronic suppuration of the paranasal sinus.
- 一般社団法人 日本耳鼻咽喉科学会の論文