We have described the influence (dF/dP) of transglottal pressure on vocal fundamental frequency (F₀). It was previously reported that dF/dP varied with the stiffness of the vocal folds, and that the vocal fold membrane when dry was stiffer than when wet. Normal subjects were injected with atropine sulfate in order to dry their larynx, as a model of stiffer-than-normal vocal folds. Transglottal pressure changes during sustained phonation were applied by partially closing a shutter valve mounted on a mouthpiece. Both before and after atropine sulfate injection, the values of dF/dP, in modal register, decreased and increased as F₀ increased, and the smallest values of dF/dP were negative in all subjects. The absolute values of both the largest and smallest dF/dP in subjects with atropine sulfate were smaller than those in normal subjects. These finding indicated that dF/dP is correlated with the stiffness of the vocal folds.

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Hypopharyngeal cancer has been reported to be frequently associated with cancer of the upper gastrointestinal tract, especially the esophagus. We recently reviewed the records of patients who had undergone closed-chest esophagectomy to assess the value of endoscopy with iodine staining as a means of preoperative diagnosis of double cancers in this area and to investigate the characteristics of the hypopharyngeal and esophageal mucosa as sites for multicentric carcinogenesis.
The subjects of this study were 30 patients who had undergone closed-chest esophagectomy between January 1992 and December 1995 because of hypopharyngeal cancer. The following results were obtained: 1. Preoperative iodine staining often revealed the presence of cancer, with unstained areas covering more than half the circumference of the esophagus and being more than 3cm in size. 2. Esophageal cancer and hypopharyngeal cancer were detected concurrently in 15 cases (synchronous double cancer) and at different times in 6 cases (metachronous double cancer). Synchronous esophageal cancer was more common in cases of advanced hypopharyngeal cancer, especially Stage IV. 3. When the number of cancer foci, their distribution along the circumference of the esophagus, and the extent of tumor spread in the esophagus were investigated, multiple and localized foci smaller than 1cm were found to be more common in synchronous cancer, and solitary foci were more common in metachronous cancer. 4. The second primary esophageal cancer often occupied the Im or Ei area, and in metachronous double cancer, it was often localized in the middle and/or inferior segment of the esophagus. 5. In 60% of cases of synchronous double cancer, the esophageal cancer was confined to the mucosa. The esophageal cancer was early stage in 86.7% of cases of synchronous double cancer.
These findings allow us to draw the following conclusions: (i) Because esophageal cancer which occurs synchronously with hypopharyngeal cancer tends to recur, it is suggested that a technique that allows complete extraction of the esophagus be selected. (ii) Local treatment such as endoscopic mucosal resection should be selected in metachronous early double cancer. (iii) Unstained areas extending along more than half the circumference of the esophagus and more than 3cm in size suggest a high probability of the presence of cancer in this area. Adequate examination is needed in such cases. (iv) Screening of the upper gastrointestinal tract is important to detect head and neck cancer. An adequate examination schedule, tailored to the features of individual cases, seems essential.

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We determined the extent of pneumatization in the temporal bone and reconstructed three-dimensional structures of air cells by computer-assisted digital processing of high resolution CT images of the bone. We attempted morphological classification of temporal bone air cells by characterization of the three-dimensional structures obtained. A total of 52 ears in 33 normal subjects (18 males and 15 females; mean age 51 years) was examined. The volume of pneumatization in the temporal bone, as measured by CT, ranged from 2.08 to 20.05ml (mean 6.40±4.09). The morphological characteristics of air cells in the three-dimensional images were examined with reference to the volume of air cells and the direction of their growth. The three-dimensional structures were observed from four directions (lateral, supralateral, anterolateral and supramedial). Large air cells existed plentifully in all directions. Anteriorly, air cells were growing in two directions; laterally and toward the petrous apex. The growth in the latter direction was especially marked, and this contributed to the growth in the medial direction. Air cells that grew anteriorly had two directions of growth (lateral and toward the petrous apex). The directional difference in growth varied with the ear. On examining the suprainferior growth, air cells that grew large in the anterior direction were found to grow large in the suprainferior direction and those that did not grow large in the anterior direction were found contrarily to grow poorly in the suprainferior direction.
With the above morphological characteristics taken into consideration, morphological classification of air cells into five types was attempted by the volume of air cells and the direction of their growth.

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It is well known that EG2-positive cells, CD68-positive cells and other inflammatory cells significantly increase after antigen provocation in the nasal mucosa of an allergic patient. However, there are few reports of the immunohistological study if the infiltrating cells in nasal lavage fluid are not seen. In this study, the infiltrating cells in nasal mucosa as well as in nasal lavage fluid were immunohistologically examined by means of monoclonal antibodies 30 minutes after the antigen provocation. Seven patients with perennial allergic rhinitis were challenged by an antigen disk placed on one side of the inferior turbinates and each nasal cavity was irrigated separately 30 minutes after the antigen provocation. About seven days later, these patients were operated on and the nasal mucosa was removed 30 minutes after the antigen provocation.
No marked change in CD4-and CD8-positive cells in the nasal mucosa and lavage fluid was found after provocation. On cytospin glass slides, there was a slight increase in the number of CD68- (P=0.1), EG2- (P=0.09), and neutrophil elastase-positive (P=0.2) cells. A significant increase in EG2-positive cells was also seen in the superficial layer of the lamina propria (P<0.05) but not in the deep layer. CD22-positive cells were not seen on the cytospin glass slide, whereas many positive cells were observed in the deep layer of the lamina propria. These results indicate that EG2-positive cells participate strongly in the early phase of the allergic response after provocation in spite of the absence of significant changes in CD4-and CD8-positive cells. Immunohistological evaluation of nasal lavage is thought to be beneficial concerning the movement of each kind of cells. Each kind of cell is thought to fulfill the main physiological role in the epithelial layer or the lamina propria in early allergic inflammation.

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We studied the relationship between MRI findings and ocular abnormalities in 46 patients with spinocerebellar degeneration. MRI was performed for all patients. In order to evaluate the severity of atrophy in the brainstem and cerebellum, we delineated the region of the pons, mesencephalic tegmentum, medulla oblongata, cerebellar hemisphere, and vermis on a typical section of their T₁weighted image. Each area or the longest diameter of each regions were measured by using a computed graphic analyzer. The data were compared with those of 10 normal subjects and the severity of atrophy in each region was quantitatively estimated. In all of the patients, electrooculographic tests including gaze nystagmus, positional and positioning nystagmus, smooth pursuit eye movements (smooth pursuit), optokinetic nystagmus test (OKN), horizontal saccade test, and visual suppression of the caloric nystagmus test (VS test) were examined. Eight patients with rebound nystagmus showed more severe atrophy than those of 38 patients without rebound nystagmus in the cerebellar hemisphere and vermis. Nine patients with apogeotrophic derection- changing nystagmus indicates more severe atrophy than those of 35 patients without it in the cerevellar hemisphere, pons, mesencephalic tegmentum, medulla oblongata. Twenty three patients who showed severe impairments of OKN, 11 patients with a burst phenomenon on VS test and 19 patients with significantly reduced saccade velocity showed particularly severe pontine atrophy. A significant atrophic change in the pons and medulla oblongata was seen in 4 patients with severely impaired pursuit eye movements. Our finding that there is good correlation between ocular abnormalities and markedly atrophic regions on MRI support the neurophysiological findings which had been reported concerning the generation of ocular abnormalities in humans and animals.

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The effect of 10% CO₂ (in air) and apnea on cochlear blood flow (CBF) and middle ear blood flow (MEBF), capillary vessel diameters and blood pressure (BP) were investigated in guinea pigs. Intravital microscopic techniques (IVM) using video system, and laser Doppler flowmetry (LD) were used. MEBF was measured in the blood vessels of the middle ear mucosa over the cochlea and CBF was measured in the lateral wall vessels in the second or third cochlear turn. During 10% CO₂respiration for 10min, the highest vessel diameter dilated about 11% in the middle ear and 5% in the cochlea. During 5 minutes apnea, the highest vessel diameter constricted about 30% in the middle ear and 5% in the cochlea. Elevation of PCO₂ dilate blood vessels with constant PO₂, but constriction of blood vessels as observed in extremely low PO₂ range even if PCO₂ was elevated. The ratio of the change in blood flow volume to the change in BP was obtained after the change in blood flow volume was calculated from blood flow velocity and blood vessel diameter. The mean change of ratio in MEBF was a 10% decrease with 10% CO₂, 28% decrease with apnea in IVM. The mean change of ratio in CBF was a 44% increase with 10% CO₂, 14% increse with apnea in IVM, 67% increase with 10% CO₂, 42% increse with apnea, in LD. The change of CBF in LD was about 20% larger than in IVM. Our results showed that CBF belonging to vertebral artery sytem was more strongly maintained in association with autoregulation even under conditions of low PO₂ or high PCO₂compared to MEBF in the external carotid artery system. It was suggested that blood flow behavior was significantly different betwwen the middle ear and inner ear.

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During a 66-month period, 2849 patients with thyroid gland tumor were examined by fine needle aspiration cytology (FNA) under ultrasonographic imaging at Yamada Red Cross Hospital. Of these patients, 333 received surgical therapy and histological examinations were performed. FNA yielded an accuracy of 92.4%, a specificity of 100%, and a sensitivity of 88.3%. There were 16 false-negative reports which were mainly considered to be due to calcified lesions, cystic lesion, or follicular carcinoma. Among the 188 negative cases, 24 cases (12.8%) proved to be positive by repeated FNA. Preoperative FNA provides cytological information and may assist in the determination of the operative indication. This approach resulted in an increased rate of surgery of thyroid malignancies among all thyroid gland surgeries. This method need to be improved to reduce false-negative results and the combination of FNA diagnosis and other examinations is necessary.

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The effect of salicylate and quinine on the spontaneous firing rate in the cat primary auditory cortex was investigated in 13 healthy cats. Spontaneous firing rates were calculated for each single unit. A dose of 200mg of sodium salicylate per kg was administered intraperitoneally to six cats, and the findings from the same single unit were recorded prior to application and continuously up to, on average, 6 hours after application. A dose of 100 or 200mg of quinine hydrochloride per kg was administered intramuscularly to seven cats, and the findings from the same single unit were recorded in the same manner as for the cats treated with sodium salicylate. Twenty-one single units in salicylate-treated cats and 29 single units in quinine-treated cats were evaluated. All animals treated with salicylate showed a 20-30 dB threshold shift about 2 hours after application and showed no recovery during the course of the investigation. All animals treated with quinine showed a 10-40 dB threshold shift about 1 hour after application and recovered during the course of the investigation. There was no consistent difference in overall spontaneous firing rate before and after application in either salicylate-treated cats or quinine-treated cats. In order to investigate a potential different effect on units with different spontaneous firing rates, we divided the cats into two groups, a high-firing rate group (pre-application firing rate>1 spike/s) and a low-firing rate group (preapplication firing rate<1 spike/s). A significant decrease in the high-firing rate group (p<0.05) and a significant increase in the low-firing rate (p<0.01) were observed in salicylate-treated cats. The same tendencies were observed in quinine- treated cats, but only the difference in the low-firing rate group was significant (p<0.05). The difference in the high-firing rate group was close to the significant level (p=0.055). These changes in spontaneous firing rates in cat primary auditory cortex may be related to the generation of tinnitus.

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Hypopharyngeal squamous cell carcinomas (HPC) has an extremely poor prognosis. Characteristics of cell lines of head and neck squamous cell carcinomas including HPC were studied by various methods, e. g., chemosensitivity test and the immunohistochemistry staining method, to determine whether this poor prognosis is due to the biological behavior of this cancer. An HPC cell line was found to be resistant to anti-tumor drugs, i. e., PEP, MTX and CPM and moderately sensitive to CDDP, 5-FU and ADM. Thermoresistance to hyperthermatic treatment and weak expression of ICAM-1 on the HPC cell line were observed. DNA synthesis by the HPC cell line was induced by stimulation with a low concentration of EGF and the amount of EGFR on these HPC cells was very high. In addition, cyclinD1 overexpression was found in the HPC cell line. Based on the above findings, further analysis of hypopharyngeal carcinoma cells and the development of a new treatment modality to control tumor growth and metastatic factors influencing the poor outcome are necessary to improve the prognosis of this cancer.

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