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Volume 42 (1991)
- Issue 6 Pages 457-
- Issue 5 Pages 387-
- Issue 4 Pages 317-
- Issue 3 Pages 237-
- Issue 2 Pages 73-
- Issue 1 Pages 1-
Volume 42, Issue 5
Displaying 1-10 of 10 articles from this issue
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Takemoto Shin, Tadatsugu Maeyama1991 Volume 42 Issue 5 Pages 387-393
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSRespiration, phonation and deglutition are very important functions. Preserving these functions in good condition is necessary for a comfortable life. Therefore, we actively try to treat functional disorders caused by neuromuscular diseases and should join forces with neurologists to obtain adequate results. Respiration, phonation and deglutition are very intimately related. Furthermore, pharyngo-laryngeal and respiratory muscles participate in all functions. Consequently, disorders of these muscles simultaneously induce functional abnormality in respiration, phonation and deglutition and treatment must be planned to correct these three functions. The neuromuscular mechanism in respiration, phonation and deglutition is extremely complicated. The activities of the muscles in respiration, phonation and deglutition are each controlled by a specific pattern generator in the medulla oblongata. These pattern generators are modulated by suprabulbar structures and peripheral information carried through the sensory pathways. Very many neurotransmitters and neuropeptides participate in these neuronal circuits. Numerous diseases cause disturbances in respiration, phonation and deglutition. Diseases of the pyramidal tract, motor nucleuses, and motor nerves induce dysfunction caused by paralysis or weakness of muscles, while diseases of the extra-myramidal tract disturb the pattern of muscle activities. Appropriate movements are not carried out in dysfunction of the sensory pathways. The conditions of disorders are markedly complicated and differ from case to case. Precisely discerning the cause, detailed analysis of the condition and careful planning of treatment produce satisfactory results. Surgical rehabilitation is mainly recommended in paralysis or weakness of muscles, and surgery is occasionally adopted in extra-myramidal tract lesions.View full abstractDownload PDF (400K) -
Seiji Niimi1991 Volume 42 Issue 5 Pages 394-399
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSVoice and speech production is one of the most highly organized performances of the human activities. It requires several motor systems which are operated independently but cooperatively by the neuromuscular system. It is obvious that any kind of perturbation occurred on the neuro-muscular system can produce voice and speech disorders as a clinical symptom.
In this review article, voice and speech disorders were discussed in terms of pyramidal system and extrapyramidal system.
From clinical point of view, the recurrent laryngeal nerve palsy cannot be neglected. Situations of the unilateral palsy and bilateral palsy are quite different. The treatment strategies for these conditions are also discussed.View full abstractDownload PDF (288K) -
Hiroshi Okamura, Toshihiro Mori, Shoko Inaki1991 Volume 42 Issue 5 Pages 400-406
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSThe swallowing mechanisms and methods of treatment of dysphagia caused in various neuromuscular diseases were brieny described. The diseases reviewed were neurovascular diseases, amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, peripheral nerve diseases, myasthenia gravis, muscular dystrophy, collagen diseases and cricopharyngeal dysphagia.View full abstractDownload PDF (6336K) -
Toshiko Nagashima1991 Volume 42 Issue 5 Pages 407-412
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSRespiratory abnormalities can be noticed in various neuromuscular disorders, and often encountered as the direct cause of death in such patients. Numbers of recent studies in mammalians and humans have revealed the localization of the respiratory center in the ponto-medullary reticular formation in the brainstem. Respiratory failures are produced by the diseases of either central or peripheral organs, in other words, neurogenic or myogenic mechanism.
Neurogenic respiratory failures can be accompanied mainly by intracranial and upper cervical diseased states including cerebrovascular disturbances, tumors, infections, intoxications, etc. Neurodegenerating disorders are also included, such as amyotrophic lateral sclerosis (ALS), Parkison's disease, spinocerebellar degenerations (SCD), and multiple system atrophy (MSA), in which a selective abductor vocal cord paralysis has been suspected as the cause of respiratory failure.
Myogenic hypoventilations are well known in the advanced stage of progressive muscular dystrophies, myotonic dystophy, and some rare congenital myopathies.
Recently, sleep apnea syndrome (SAS) has been paid particular attention in relation with unexpected sudden death. In neuromuscular disorders SAS is frequently observed, especially in MSA and myotonic dystrophy. Some functional and/or organic disturbances of the central rhythmogenesis controlling both sleep and respiration are suspected, which was in part disclosed by clinicopathological analyses in several autopsy cases with SAS in our previous studies.View full abstractDownload PDF (1034K) -
Yoshikazu Yoshida1991 Volume 42 Issue 5 Pages 413-418
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSThe pathophysiology of neuromuscular disorders in the pharynx and larynx has been provided from an overview of neurologist's approaches. So as to understand relevant neuroanatomy, nuclei and nerves innervating the muscles which participate in pharyngo-laryngeal movement such as in swallowing and speech were introduced with their physiological function. In the oral preparatory, oral and pharyngo-laryngeal phases excluding an esophageal phase of the swallowing, various aspects of the neuromuscular control of pharyngo-laryngeal dysfunction were evaluated. Findings causing dysphagia or dysarthria were pointed out in some principal neuromuscular diseases such as bulbar and pseudobulbar palsies, motor neuron diseases, cranial polyneuropathy, disease of the neuromuscular junction, muscular dystrophy, Parkinson's disease, multiple sclerosis and so on.View full abstractDownload PDF (328K) -
Toshio Yoshihara1991 Volume 42 Issue 5 Pages 419-423
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSSome of the neuromuscular diseases may cause various pharyngeal and laryngeal muscle dysfunction such as dysphagia, dysphonia and severe dyspnea. In this report the histopath ological features of the muscles in amyotrophic lateral sclerosis (ALS), aquired autoimmune myasthenia gravis (MG) and progressive muscular dystrophies were described. ALS is one of the motor neuron diseases. The cricothyroid muscles and the sternohyoid muscles of the ALS patient were examined. Neurogenic changes such as small grouped atrophy, large grouped atrophy and small angulated fibers were observed. MG is an aquired autoimmune disorder of neuromuscular transmission associated with acetylcholine receptor (AchR) deficiency at the motor end-plate. Ultrastructurally, MG end-plates were characterized by a decrease in thelength of the postsynaptic membrane. In muscular dystrophies various degrees of degenera tion, necrosis and regeneration of the muscle fibers were observed. A cross-sectional view of the muscles showed a fiber size variation by atrophy and hypertrophy of the muscle fibers.View full abstractDownload PDF (680K) -
Hiroyuki Ito1991 Volume 42 Issue 5 Pages 424-430
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSThis report deals with the rehabilitation of the tracheoesophageal disorders in neuromuscular diseases. Neuromuscular diseases can divide into two groups. The one is the group of diseases which are expected to cure such as myasthenia gravis and Guillain Barré syndrome. The other in those which are difficult to cure such as Parkinson disease and spino cerebellar degeneration.
In the first group the rehabilitation of the tracheo-esophageal disorders is effective. When the patients are in the acute period and have dysphagia, the treatment and management should be concentrated on preventing aspiration pneumonia. If the dysphagia is not improved by the treatment, the rehabilitation for dysphagia will be performed. When he was tracheostomized, the phonation must be recovered for the first time. In the second group which mainly includes progressive seuro-muscular disease, much in not expected the surgical and non surgical treatment on the dysphagia. The main purpose of the rehabilitation are to delay their progress, to keep their slight disorders, and to prevent respiratory infection. The family and patients teaching on the care of the patients is stressed in the rehabilitation. Because of the progressiveness the effect of the training does not continue long. If the patients were tracheostomized, the phonation must be maintained to make contact with surrounding people in order to get higher quality of assistance. But in the terminal stage, laryngectomy or laryngeal closure in not avoidable to prevent aspiration pneumonia.View full abstractDownload PDF (731K) -
Using the Ileocecal Valve: Evaluation of Its Function as a Voice SourceTakeshi Shiraishi, Hideyuki Kawahara, Hiroki Ishikawa, Tsunehiro Oyama ...1991 Volume 42 Issue 5 Pages 431-437
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSWe developed a new method of surgical reconstruction of the cervical esophagus after laryngopharyngoesophagectomy with free ileocecal grafting. In this technique we reconstructed the esophagus using the colic segment, while a phonatory shunt is fashioned from the terminal ileum. The ileocecal valve functions not only as an anti-reflux valve against aspiration but also as a pseudo-glottis. We evaluated functions of the ileocecal valve both experimentally and clinically as a source of vocalization. Experimental studies showed that the average frequency of phonation with the ileocecal valve ranges 122-197 Hz in dog series and 89-104 Hz in monkey series, and that the driving pressure during phonation varied 18-52 mmHg in the former series and 10-14 mmHg in the latter. These driving pressures did not exceed those of healthy people during easy phonation. Out of the 6 patients undergoing this operation, three are alive at the time of this writing. All of them aquired fair to good shunt voice without marked aspiration. We conclude that our procedure can be used as a new surgical method of voice restoration after laryngopharyngoesophagectomy.View full abstractDownload PDF (2492K) -
Yoshihiro Ohashi, Yoshiaki Nakai, Hideki Okamoto, Yoshiharu Ohno, Yosh ...1991 Volume 42 Issue 5 Pages 438-445
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSFor many years mast cells were assumed to play a vital role in the pathogenesis of asthma. However, recent evidence argues against a critical role of mast cells in respiratory asthma. However, recent evidence argues against a critical role of mast cells in respiratory allergic disorders. Eosinophil infiltration is a key feature of allergic airway. Plateletactivating factor (PAF) is the only mediator that selectively attracts and activates eosinophils to induce epithelial injury in airways. The present study was aimed to investigate PAFinduced mucosal injury in the trachea of guinea pigs.
Eosinophilic accumulation was observed as early as 15 min after the intravenous administration of 50ng/kg of PAF. A burst of mucus secretion from goblet cells was observed at 25 min. The morphology and beating activity of ciliated cells were intact up to 1h. The most dramatic recruitment of eosinophils in the epithelium was observed at 1-3h when some of eosinophils were morphologically activated and ciliated cells demonstrated vacuolization of endoplasmic reticulum. Then eosinophilic accumulation decreased up to 3 days, but a dramatic accumulation was again observed after 7 days when some of eosinophils were morphologically activated and epithelial injury including cytoplasmic protrusion with compound cilia and sloughing of ciliated cells was prominent.
Our study has demonstrated that PAF administration could cause eosinophil accumulation, mucociliary dysfunction, and epithelial destruction. Such pathology could contribute to hyperresponsiveness and easy interaction between antigens and antibodies, resulting in a prolonged allergic inflammation in the airway.View full abstractDownload PDF (849K) -
Yasuo Hisa, Kenji Toyoda, Takao Sonoda, Masahiko Shindo, Toshiyuki Uno ...1991 Volume 42 Issue 5 Pages 446-450
Published: October 10, 1991
Released on J-STAGE: October 20, 2010
JOURNAL FREE ACCESSWe report the clinical course of a severe case of idiopathic granulomatous subglottic stenosis and present a treatment protocol.
A 25-year-old male complained of cough, occasional dyspnea and hoarseness. Fiberscopic examination revealed a large subglottic reddish brown tumor with a rough surface. Vocal cord mobility was normal and neck examination revealed no lymphadenopathy. Tomography and CT confirmed the presence of the mass occupying the majority of the subglottic space with no evidence of cricoid cartilage, tracheal ring or thyroid gland extension. Biopsy results performed under laryngomicrosurgery were consistent with granulomatous disease.
Under general anesthesia, the cricoid cartilage and first tracheal ring were incised exposing the tumor within the lumen, which was removed by curettage. The eroded surface was cauterized with the CO2 LASER. A silicon tube was then positioned within the subglottic and tracheal lumen as a stent after which the cut ends of the cricoid cartilage and tracheal rings were reapproximated. On the 18th postoperative day, the silicon stent was removed and replaced with a T-tube. On the 48th postoperative day, the T-tube was removed. The stoma was closed on the 55th postoperative day.
Follow up one and a half years after the initial surgery showed the patient to have a normal voice and no evidence of recurrent disease.View full abstractDownload PDF (4344K)
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