耳鼻と臨床
Online ISSN : 2185-1034
Print ISSN : 0447-7227
ISSN-L : 0447-7227
13 巻, 4 号
選択された号の論文の10件中1~10を表示しています
  • ラウフ S.
    1967 年 13 巻 4 号 p. 209-221
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    内耳の血管の大部分は蝸牛軸に認められ, 蝸牛外側壁には比較的少ない. その割合は3: 1であり, 前者についての研究は後者のそれと比較して非常に少ない.
    内耳血管系に関する研究は今日迄, 大部分次の2つの方法が用いられてきた. つまりコロイド状のdye stuff注入による形態学的観察, 血管条を被う蝸牛壁を開放しての血管の機能的観察である. これらの方法においても非生理的状態における観察であることは否定出来ない. 私の協同研究者, MAASSはベンチヂン法を改良して, 毛細血管系を生理的状態で示した. それによると前庭階の毛細血管は蝸牛外側壁に添つて4つの分岐をし, それぞれの間には吻合はほとんど認められない. われわれはこの明らかな流域の分離は, このそれぞれの部位が独自の機能を有しているものと信じたい. われわれは幾らかの実験結果にもとづき, これらのうちの1つの部位, つまり血管条について言及する.
    血管条における毛細血管の占める割合は20%程で, 血液の供給は脳におけるより良好であるが, 網膜ほどでなく, 活動せる心筋におけるよりはるかに良くない.
    一器官への酸素供給は, 毛細管血液量のみならず, 血液循環における流れの速さによる. 内耳は流量測定法や, クリアランス法を適用するにはあまりに小さすぎるので, AET (arm-ear-time) のような色素物質か, 放射性物質の注入による方法などが考えられる. 24Naを使用するが, fluorescinの使用, また3H-insulin, crypton85の使用がより適当である.
    蝸牛の血行は, その代謝を考える上に重要である. 酸素の需要が多ければ多いほど, 多量の血液の循環を必要とする. われわれは例えば乳酸を用いて環流実験を行なつた.
    血管条はその形態に注目すべきであるが, また一方, その機能についても同様である. われわれはラジオアイソトープを用いてクリアランス実験を行なつた. 24Na, 42K, 131Jを, モルモツト蝸牛の基底回転の前庭階に小孔を通して注入した. 圧を調節するために鼓室階に小孔を開いた. 各蝸牛回転を別個に観察することにより問題の解明がなされた. つまり, 基底回転より尖回転に到る各回転の, ラィスネル膜を介しての滲透は, 尖回転に行くにしたがい増加することを示している. そしてまた, ライスネル膜の滲透は血管条の活動性に依存していることとなる. 24Naまたは42K 液を注入した場合, その/5は血管系に吸収され, 1/5のみが内リンパ腔に滲透する.
    血管条は形態学的に三層よりなり, 内リンパに近い層ではdark marginal cellがあり, 多くのミトコンドリアを有している. marginal cellは申間層により結合され, 基底層に続く. これら三層の由来や構築の詳細については諸家の光顕的, 電顕的観察が多い.
    血管条の機能についてみると, この組織は内耳の全ての構造の中で最も細胞代謝が活濃である. そうして RAUCH (1962) によれば, 血管条のエネルギー消費は基底回転より尖回転に行くにしたがい減少するという. Corti以来, このエネルギーは2つの働きに必要であると信じられてきた. つまり内リンパの生成と聴細胞への酸素補給である. これらの推測は今日幾分修正されてきた. RÜEDIは1951年光学顕微鏡を用い, 血管条には時に吸収機能があることを示した. われわれ自身の1963年のラジオアイソトープを使用しての実験は, 前庭階への42Kの注入後血液循環を阻止すると, 血管条は強力に42Kを再吸収するであろうことを示した. 私は個人的に血管条は内リンパの生成に関与していると思つており, また再吸収は血管条が行なう唯一の機能ではないと思いたい. SPOENDLINによれば血管条の表面の“unit-membrane”は再吸収能力を示す特徴であるという. 私は他のもつと信じ得るcriteriaがあると思う. それはつまり, 1) pinocytosisの出現. 2) vesicleが内リンパ腔へ向つては発育しないこと. 3) 42K, 131Jの再吸収に関する所見. しかし私は血管条の分泌および再吸収機能は形態学のみでは説明出来ぬことを強調したい.
    血管条の機能に関するもう一つの問題は, 有毛細胞への酸素供給である. 血管条自体の酸素需要はむしろ高いので, 血管条表面に残つたごとく少量の酸素が, 有毛細胞に広がる. さらに血液循環に関する実験は, 血管条の血液は前述の他の三部位の血液より, 血流が遅いことを示した. こゝでさらに考えねばならぬことは, 組織代謝を維持するための酸素供給は, 血行が確保されておれば充分であるということである.
    ラセン隆起や外ラセン溝の周辺には, 血管条よりO2-donorとしての機能を有する血管領域がある. この問題は充分に説明されていない. このようにわれわれは, うたがいなく, 内耳血液循環に対してさらに深い理解を探求すべき地点に達している.
  • 下田 又季雄
    1967 年 13 巻 4 号 p. 222-248
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    The author, at the beginning, illustrated diseases of regulating mechanism of the brainstem: epilepsy of brainstem origin, diencephalosis, mesencephalosis and medioencephalosis, discussing his own data and those of other researchers. Correlation between clinical characteristics and EEG was stressed, and certain. EEG abnormalities: paroxysmal bilateral slow dysrhythmia or paroxysmal bilateral spike and wave complex and 6-14 c/s positive spike pattern, were regarded as the most available indicator of diseases of regulating mechanism of the brainstem. Dysrhythmic vertigo: one of epilepsy of brainstem origin, was dealed in this paper, and the author tried to describe an outline of this disease.
    Out of 234 patients with main complaints of recurrent attacks of dizzy state consulted in our clinic in the previous two years, 79 cases: 38 of dysrhythmic vertigo, 15 of epilepsy (grand mal and petit mal) and 26 of Menier's syndrome served this study because of their established symptomatology. Dizzy state of the former two is considered to be of central origin and that of the latter as a symptom of peripheral Cotogenic and vestibular) origin. Investigations were carried out to find out symptomatological and clinical differences between these three diseases.
    Age of the onset: 11-55 with the average of 28.9 in dysrhythmic vertigo, 5-32 with the average of 17.3 in epilepsy and 12-55 with the average of 30.3 in Menier's syndrome, showed younger age of the onset of the patients' dizzy state in epilepsy. Features of dizzy state were examined and three categories were settled: vertigo, dizziness and black-out. Frequencies of these three in each of the diseases: 9 vertigo, 26 dizziness and 21 black-out in dysrhythmic vertigo (38 cases), none of vertigo, 9 dizziness and 8 black-out in epilepsy (15 cases) and 16 vertigo, 19 dizziness and 8 black-out in Menier's syndrome (26 cases), showed that vertigo was most correlative to Menier's syndrome while black-out was relatively rare in this syndrome, and that in epilepsy vertigo was neglected. Duration of attacks of dizzy state: a moment to several seconds in 17 cases and several minutes in 3 of dysrhythmic vertigo, a moment to several seconds in 5 and several minutes in 2 of epilepsy, and a moment to several seconds in 3, several minutes in 5, several hours in 5 and several days in 1 of Menier's syndrome, suggested that duration of attacks was much shorter in dysrhythmic vertigo and epilepsy than in Menier's syndrome. Some symptoms and signs were detected at the intervals between the attacks otogenic ones such as deafness, tinnitus, feeling of ear-stenosis and otalgia, ophthalmologic ones such as nystagmus, blurred vision, dimness of vision, double vision, flimmerscotoma, blind spot and photophobia, and those which might be originated from vestibular insufficiency such as arm deviation, positive stepping test, deviated gait and Romberg or Mann phenomena. Distributions of these three kinds of symptoms and signs were compared in the three diseases, showing no significant difference, but Menier's syndrome only had a considerable density in the symptoms and signs of otogenic nature, no matter whether the patients' dizzy state was vertigo, dizziness or black-out. Recurrent or habitual headache at the intervals of the attacks of dizzy state was registered in 61% of the cases of dysrhythmic vertigo, 27% of those of epilepsy and 38% of those of Menier's syndrome, and dysrhythmic vertigo was considered to be most correlative with recurrent headache (dysrhythmic headache).
  • 宮城 自強
    1967 年 13 巻 4 号 p. 249-285
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    I have observed clinically the 215 cases of laryngeal cancer treated in the Otolaryngological Clinic of Kyushu University during 9 years from August, 1957 to July, 1966. There were 192 male and 23 female patients among them and the ratio of male to female was 8.4: 1. The range of age was from 38 years old to 84 years old and its distribution was as follows: 38-39 years old 2 cases (0.9%), 40-49 years old 16 cases (7.4%), 50-59 years old 58 cases (27%), 60-69 years old 96 cases (44.7%), 70-84 years old 43 cases (20%).
    In the prognosis, 55 cases (25.6%) of the all cases died (24 died from laryngeal cancer and 21 from other diseases). The total survival ratio was 74.4%, the 5-year survival ratio being 69%.
    The next table shows the analysis of the results according to the treating method.
    _??_

    The T. N. M. classification was done on the all cases and its conclusions were as follows.
    1. Radiation therapy was most effective for the T1N0 group of glottic cancer. Especially, the interstitial radium-irradiation (Sasaki's method) which was carefully indicated proved 100% curability.
    2. Partial resection was effective against the confined supraglottic cancer.
    3. Laryngectomy was very effective for the T1N0 and T2N0 groups, but there were many recurrence cases in the T3N0_group. So T3N0 group should be treated not only by laryngectomy but by prophylactic neck dissection.
    4. Laryngectomy combined with prophylactic neck dissection was effective for the T3N0 group, and the T4N0 group should be treated by some more strong and combined therapy.
    The second subject of my clinical study is as follows. Radio-isotope Au198 of 100μc was injected in the mucous membrane of the various sites of the larynx and in the submucous soft tissue of the ventricular band of 10 cases who were over 50 years old, on the supposition that the cancer invaded the various sites deeply, and the condition of lymphatic stream from the larynx to the cervical lymph nodes was examined by multiscintigram.
    The results were as follows
    1. Radio-isotope Au189 clearly transferred to the deep cervical lymph nodes of the injected side in the most sites of the larynx.
    2. In the arytenoid radio-isotope Au198 transferred to the bilateral cervical lymph nodes. So the neck dissection should be exercised not only on the affected side, but the prophylactic neck dissection should be done on the other side, when the arytenoid region suffered from cancer, even if it was unilateral.
    3. In the ventricular band the transference of radio-isotope Au198 showed different when I injected in the depth of 3 and 5mm in one side of it. The radio-isotope Au198 injected there clearly transferred to the bilateral cervical and tracheal lymph nodes. The dissection of the tracheal lymph nodes should be done, not to mention the bilateral neck dissection, in the cases whose cancers developed deeply, though it was unilateral supraglottic cancer.
    For that reason, clinically the T. N. M. classification is much more useful than many other classifications in the past.
    This classification is the one in which much consideration was paid to the site and extent of the lesion, but not sufficiently to the depth of it.
    Actually, it may be very difficult to make a clinical diagnosis about the deep development of cancer, and there is much room left for improvement at this point.
  • 富田 英寿, 小池 祐一, 富田 春英
    1967 年 13 巻 4 号 p. 286-294
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    Histochemical demonstrations of lipoid, succinic dehydrogenase and phosphorylase were done in the intrinsic laryngeal, the heart, the diaphragm and the femoral muscles of the dog.
    The results obtained were as follows:
    1). The intrinsic laryngeal muscles were chiefly composed of two kinds of muscle fibers, i. e. the one which shows a high enzymatic activity of succinic dehydrogenase and an intense affinity to Sudan Black B and the other which gives very low activities of them. The former corresponds to the red muscle fiber and the latter to the white fiber. Besides these muscle fibers, there exist a few muscle fibers of intermediate type which show a moderate enzymatic activity.
    2) The distribution ratio of the red muscle fibers to the white was approximately 1: 1 in every intrinsic laryngeal muscle, while it was 1: 1.5 in the femoral muscle.
    3) In general, the peripheral parts of the muscles were predominant in white fibers, while the central parts in red ones. In the thyroarytenoid muscle, the distribution ratio of the red muscle fibers to the white was approximately 1: O.9 in the central parts and 1: 2.3 in the peripheral parts.
    4) The activity of phosphorylase was high in the femoral muscle, medium in the intrinsic laryngeal muscles and low in the diaphragm and the heart muscle.
    5) The function of the intrinsic laryngeal muscles is considered more tonic than that of the femoral muscle and more phasic than that of the heart and the diaphragm muscle.
  • 野垣 俊幸
    1967 年 13 巻 4 号 p. 295-297
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    41 year old male, a case of foreign body in the right maxillary sinus was reported.
    The material of foreign body was dental instrument, a broach. He was treated twice in his right maxillary carious teeth, first 28 years ago (1939), and secondly 15 years ago (1952). Without any symptom the broach had been left in the maxillary sinus as long as 15 years, and was fortuitously detected at hospital when he complained of headache.
    Many cases of the maxillary sinus foreign body were reported, but few in which it was left for such a long time as in our case.
  • 茂木 五郎
    1967 年 13 巻 4 号 p. 298-305
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    Primary amyloidosis is a rare disease of unknown cause, but the amyloidosis of the tongue is not infrequently seen in the primary type.
    The author regarded a case of amyloidosis of the tongue roported here as of the primary tumor-forming type.
    A 53 year-old male developed many masses, approximately 1×0.5×0.3 cm. in size, in the anterior dorsal surface of the tongue and in the left-side buccal mucosa about 10 months prior to his death. He had complained of a slight difficulty in swallowing. The diagnosis was established by the Congo-red stain preparations of the biopsy specimen taken from the tongue. The autopsy revealed the deposits of amyloid in part of the small intestine and in the masses of the subcutaneous tissue layer of the chest and the hip, each mass being approximately 2cm. in diameter. Pyelonephritis, the increase of plasma cells in the bone marrow and the early-staged cancer of the pancreas were also observed.
  • 神崎 正紀, 新 昭, 川出 薫
    1967 年 13 巻 4 号 p. 306-313
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    Eosinophilic granuloma (Kimura's disease) occurring in the parotid gland of a 37 years old male and its histopathological findings were examined.
    Histologically the lesion can be separated from Letterer-Siwe disease, Hand-Schüller-Christian disease and Eosinophilic granuloma of the bone (Otani & Ehrlich) on account of the appearance of many prominent lymphatic nodules in the former case, in which develope germinal centers not only in the parotid gland but in the adjacent soft tissue.
    It seems to be an interesting and important fact that the disease has never been reported about Europeans and Americans.
  • 野村 和, 富田 英寿, 宮城 平, 岩下 明弘
    1967 年 13 巻 4 号 p. 314-322
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    Primary nasal carcinoma is rare, and only 32 cases have been reported in the domestic literature. A case of primary nasal septal carcinoma which occurred in a 45 year old man was reported.
    His chief complaint was nasal obstruction and epistaxis. The patient had extirpation of the carcinoma under maxillotomy (Menker's method) and received Cobalt irradiation (5000r) after the operation. Histological examination revealed that it was adenocarcinoma.
    No recurrence of the carcinoma was noted in 2 years after the operation.
  • 江川 俊治, 松村 益美, 曲田 公光, 上村 良彦, 勝田 兼司, 大野 政一
    1967 年 13 巻 4 号 p. 323-330
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    Mittels “ectite”, ein Methyl-Cystein-Hydrochlorid, wurde die chronische Sinusitis erfolgreich behandelt. Bei 20 von 24 Fallen, bei welchen nur dieses Mittel verabreicht wurde, verbesserten sich die objektiven und subjektiven Beschwerden deutlich. Bei 8 Fällen war der Erfolg ausgezeichnet, bei 4 Fallen gut, während er bei 8 Fällen etwas geringer war. Bei 4 Fallen konnten wir keine Besserung feststellen.
    Durch die Verabreichung von “ectite” in Verbindung mit verschiedenen konservativen Operationen, welche die Nasenhöhle durchgängig machten, konnten wir bei 3 Fällen ausgezeichnete Erfolge erzielen.
    Bei 3 Fällen, bei welchen das Mittel nach der Radikaloperation verabreicht wurde, haben wir eine Verkürzung der Behandlungsdauer festgestellt.
    Bei allen Fällen gab es keine Nebenwirkungen.
  • 特にビタミンB1投与の影響について
    本村 一彦
    1967 年 13 巻 4 号 p. 331-356
    発行日: 1967/12/20
    公開日: 2013/05/10
    ジャーナル フリー
    The fine structural changes in the cochleas of guinea pigs, acoustically stimulated with or without vitamin B1 administration, were observed under an electron microscope.
    The observations were performed on the intermediate zone of the outer and inner hair cells, the nerve endings at the base of the outer hair cells and the myelinated nerve fibers in the osseous spiral lamina. The correlation between the structural changes by acoustic stimulation and the effects of vitamin Bi administration in relation with these changes were examined.
    All the experimental animals of the first group were exposed to white noise at 110 phon without vitamin B1 administration. The exposure time ranged from 15 min. to 24 hrs. In the second group the animals were given vitamin B1 (10mg/day, for 7 days, intraperitoneally) and then were exposed to white noise as well as in the first group.
    Immediately after the noise exposure, the cochleas were removed and fixed in glutaraldehyde and osmium tetroxide, dehydrated with aceton and then embedded in Epon 812. Ultrathin sections which were cut out of the blocks and stained with uranylacetate and then with lead hydroxide were examined under a HU-10A electron microscope.
    The structural changes observed were as follows:
    1. In the intermediate zone of the outer hair cells, some of the smoothsurfaced endoplasmic reticulums along the cell membrane showed swelling, their lamellae increasing in number and their lamellar arrangement coming out of order. Mitochondria in this zone began to swell and degenerate in the long exposed animals (over 6 hrs.). These changes were found to be more dominant in the group without vitamin Bi administration.
    2. In the intermediate zone of the outer hair cells, some kinds of cell particles, all regarded as lysosomes, were found. With the shortly exposed animals (within 60 min.), electron dense inclusions in the cell particles appeared thicker in proportion to the exposure time. On the other hand, with long exposed animals (over 6 hrs.), these electron dense inclusions were found thick if vitamin B1 was administered, while with the animals without vitamin B1 administration, they were found remarkably thin.
    3. In the intermediate zone of inner hair cells, structural changes were less noticeable than in that of the outer hair cells.
    4. In the non-vesiculated (afferent) nerve endings at the base of the outer hair cells, the mitochondria showed swelling and degeneration in the long stimulated animals (over 6 hrs.), without vitamin Bi administration.
    5. In the axon of myelinated nerve fibers in the osseous spiral lamina of some long exposed animals (over 6 hrs.), extraordinary membranous structures were found.
    6. As finding of great interest, in the intermediate zone of outer hair cells of the two of all the experimental animals, a group of virus-like particles was discovered.
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