A sixty-nine year-old male with laryngeal cancer, treated previously with radiation to the primary site, suffered a recurrence of cancer in the parapharyngeal space. Cis-Diamminedi-hloride platinum and 5 Flurouracil were injected intraarterially through the external carotid artery, previously ligated at bifurcation, followed by killer cells which had been induced in culture by mixed lymphocyte and allogenic tumor cells, with subsequent recombinant interleukin-2. The therapy significantly reduced the tumor mass. Two factors were considered responsible for this effect. The ligation of the external artery prior to the intraarterial infusion made it possible to provide direct infusion into most branches of the external carotid artery, demonstrated by Digital Subtraction Angiography examination. The application of the combined anticancer drugs and the killer cells may also have been a factor, and has been reported as highly effective therapy for head and neck cancer.

View full abstract

Significance probability mapping (SPM) of auditory brainstem responses (ABRs) was studied using statistical data from thirty subjects with normal hearing, and compared to that of two patients with intracranial lesions, one with a cerebellopontine angle tumor, the other with a pontine tumor. A bandwidth with 400-1520 Hz of digital filter was chosen to obtain stable and reproducible ABR waveforms for preparing SPM, because the filter bandwidth minimized the influences of the amplitude and phase variation during averaging. Then, based on the results of the normality and the inter-subject variability of latency, amplitude, and area of ABR waveforms, the following paramenters for SPM were obtained:(1) absolute latencies of waves PI, PIII, and PV:(2) inter-peak latencies of waves PI, PIII, and PV:(3) base-peak amplitudes of waves PI, PHI, PV, NIII, and NV:(4) peak-peak amplitudes of waves III and V: and (5) areas of waves PIII, PV, NIII, NV, III and IV/V. The latency, amplitude, and area of the SPMs of ABR from the two patients with intracranial lesions showed more abnormality than the mono-derivation of recording. This suggests that SPM of ABR topography may be clinically useful for functional diagnostic imaging.

View full abstract

Thirty-five cases of deep neck abscess were evaluated (three recently encountered and 32 reported in the literature). The presence of mediastinal abscess, gas-forming infection, and chronic liver failure were associated with death. Diabetes only slightly affected the outcome. In seven of 15 patients with mediastinal abscess as a complication, the abscess was confirmed by chest X-ray examination and CT scan within seven days of the development of inflammatory symptoms in the pharynx. CT was indispensable for the diagnosis, and the survival rate was higher after thoracotomy than after mediastinal drainage.

View full abstract

Indication for tympanoplasty in children has been a controversial subject. Thirty-seven children (42 ears) undergoing tympanoplasty were studied. From this study it was concluded that:(1) tympanoplasty can be recommended for children of all ages with simple otitis media;(2) the postoperative airone gap was within 20 dB in 90% of the cases; and (3) pneumatization of the temporal bone progressed after tympanoplasty.

View full abstract

Preoperative and postoperative bone conduction (BC) thresholds of 34 patients with cholesteatoma were reviewed. Postoperatively, the mean value of the BC thresholds was slightly better. When the subjects were divided into groups related to the pathological changes in the middle ear, BC thresholds were markedly improved in the ossicular fixation group. The BC thresholds of 2000kHz significantly improved in the ossicular discontinuation, or stapes fixation group. Mechanisms for these changes were analyzed based on previously published data describing the relationship between the BC thresholds and pathological changes in the middle ear. Correction of the sound transmission system seemed to improve the BC thresholds.

View full abstract

Olfactory neuroblastoma is an uncommon malignant tumor of neural crest origin, arising in the nasal cavity. We recently treated a 43-year-old female diagnosed with olfactory neuroblastoma of relatively short duration, in stage A according to Kadish et al. Surgery, radiotherapy and chemotherapy were performed. Thirty-one cases reported in Japan were reviewed. The tumors had a tendency to metastasize and the prognosis was poor. For the original focus of the disease, surgical removal and radiotherapy were the treatments of choice. To prevent metastasis, chemotherapy may also be beneficial.

View full abstract

A 36-year-old man presented with neurinoma arising in the parapharyngeal space. The tumor was removed using cervical approach. After surgery, the patient showed a Homer's sign and experienced hoarseness which disappeared gradually over three months. Between 1981 and 1990, 176 cases of parapharyngeal tumor were reported in Japan. Fifty-five cases werr selected for this report, and reviewed from a surgical perspective.

View full abstract

Vestibulo-toxicity of aminoglycoside antibiotics was investigated in 20 patients with renal disorders; 18 with renal failure (hemodialysis 8, continous ambulatory peritoneal dialysis 10) and two with temporary renal dysfunction. The aminoglycosides used were streptomycin sulfate (SM) for tuberculosis cases, and gentamicin (GM) for patients with panperitonitis. Vestibular symptoms such as dizziness were experienced by 15 patients. The average doses given to the patients prior to the symptomatic manifestation were; SM 7.1g, and GM 1013mg. Hearing loss was found in only one case. Jumbling phenomenon was noted in nine cases, but only two cases showed negative response to caloric stimulation with ice water and also to pendular rotation stimulus. Seven of the aforementioned nine cases showed some improvement of the jumbling phenomenon at the follow-up examinations.

View full abstract

Clinical studies were conducted on 226 patients with cysts in the paranasal sinuses at Juntendo University Hospital between January 1980 and December 1989. Of the 226 patients, 186 were classified as having postoperative cysts, 38 had idiopathic cysts, and two had traumatic cysts. Findings of the 186 patients with postoperative cysts were compared to those of the 38 with idiopathic cysts. Incidence of both postoperative and idiopathic cyst occurrence was most frequent in patients in their forties. The ratio of male to female sex was 1.6: 1 in postoperative cysts, and 1.1: 1 in idiopathic cysts. Postoperative cysts were found most frequently in the maxillary sinuses, while idiopathic cysts were found in the ethmoid and frontal sinuses. Cheek pain or swelling was the most frequent complaint of patients with maxillary sinus systs. Eyelid swelling and exophthalmos were noted in patients with frontal sinus cysts. Disturbance of vision or ocular movement was noted in patients with ethmoidal or sphenoidal cysts. Postoporative cysts had a tendency to occur 16-30 years after the initial surgery for chronic sinusitis, when 66% of the patients were between 16 and 20 years of age.

View full abstract

We investigated the clinical efficacy of the topical steroid beclomethasone dipropionate (Rinocort, RCT) in nasal polyps and examined the mechanism of action of this drug by measuring arachidonic acid metabolites (AAM) and histamine (HA) in the polyps. Twenty-four subjects with comparable polyp involvement in the bilateral nasal cavity underwent unilateral nasal polypotomies and the opposite side was sprayed with a powdered preparation of RCT for one week. After observation of nasal symptoms, nasal polyps of the opposite side were also removed. Six patients who were not treated with RCT served as the control. Topical application of RCT showed a tendency toward reduction in size of polyps as well as a tendency toward improved symptoms. AAM concentrations in polyps before treatment were higher in improved subjects than in non-improved subjects. In subjects with improved symptoms, AAM concentrations tended to be lower in the RCT-treated polyps than in polyps excised before treatment. However there was no significant change in AAM concentrations in non-improved subjects. HA concentrations did not differ significantly among improved and non-improved groups. These results suggest that topical steroid application is effective for treating nasal polyps and that the mechanism of the action appears related to inhibition of synthesis of arachidonic acid metabolites by the steroid.

View full abstract