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Nasal cytograms, as an aid to diagnosis of pathological conditions of the nose and paranasal sinuses, have not been adopted by the majority of otolaryngologists. This situation exists because of technical problems with the preparation of a slide and the difficulty in finding someone competent and interested in its interpretation. The work of the Bryans has provided an analysis of the cytology of nasal secretions. Adopting their methods, we have been using the nasal cytogram in clinical practice and find it helpful in determining appropriate therapy for problems encountered in otolaryngological practice. In the authors' experience, profuse nasal mastocytosis is a consistent finding in cytograms from patients having varied symptoms that are associated with hypersensitivities that are not accompanied by positive objective findings. This is especially true in patients with constantly recurring headaches and those with a chronically obstructed nose. Once many mast cells are found by the cytogram, attempts are made to relieve these patients by selective dietary restrictions. These attempts are often successful. The nasal cytogram is also used to help explain periodic symptom flares in the long term allergy patient undergoing immunotherapy for inhalants, by identifying superimposed viral and bacterial infections.

Disseminated intravascular coagulation was the cause of death of a 19-year-old woman with a lifelong history of paroxysmal atrial tachycardia. Her final illness began with a bout of tachycardia during her second trimester of pregnancy and was then characterized by sustained tachycardia with hypotension, oliguria, and renal failure, with a steadily falling hematocrit in the absence of significant bleeding externally. At necropsy there were numerous platelet and fibrin emboli throughout the heart. Small arteries in both the sinus node and in the atrioventricular (A-V) node and His bundle were involved. The sinus node was virtually destroyed by recent infarction. Structural variation in the A-V node and His bundle, probably congenital in nature, provided an anatomic substrate for re-entrant loops which may have been the basis for the paroxysmal atrial tachycardia.

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