The influence of age and sex on auditory improvement after stapes surgery was investigated retrospectively on 127 otosclerotic ears (99 subjects) that were follomed up for 6 month postoperatively.The prostheses used were the Shuknecht type Teflon wire piston (87 ears), the House type wire loop (29 ears), and the Cawthone type Teflon piston (11 ears). While closure of the air bone gap after surgery was good at 2 kHz and 4 kHz, it was poor at 8 kHz and frequencies lower than 1 kHz, and especially poor at 250 Hz. At all frequencies, both air and bone thresholds were significantly improved by the surgery, but the greatest improvements in air and bone thresholds resulted from the use of Teflon wire pistons. Ears receiving Teflon wire prostheses were divided into 5 age groups: uner 20 years.184.108.40.206.40.49, and 50 or above. Both air and bone thresholds at higher frequencies before surgery worsened with increasing age. However, there were no significant differences among age groups in the postsurgical improvement of either air or bone thresholds. Similary, no gender related differences in either air or bone thresholds were recognized postsurgically. The speculate that light cases of cases of otosclerosis are common among Japanese patients, while severe cases are rare even among the elderly.
It is well known that congenital anomalies are often associated with malformation of the inner, middle and external ear. In temporal bone studies, it has been found that abnormality of the facial nerve often occurs in patients with congenital aberrations. The temporal bone collections of the Teikyo University School of Medicine include 32 human temporal bones obtained from 19 infants ranging in age from one day to 7 months, who had chromosomal aberration and severe visceral anomalies. We histologically studied routinely processed sections of these temporal bones under a light microscope. Facial anomaly was observed in 20 of the 32 ears (63%). An abnormal course was observed in 18 ears (56%); 5 ears showed hypoplastic development, 4 showed displacement of geniculate ganglion cells into the internal auditory meatus, and 3 ears showed bifurcation. Abnormal course of the facial nerve was found in a significant number of ears with aural and mandibulal abnormalities (76%). However patients with multiple inner ear anomalies showed an abnormal course and hypoplasia of the facial nerve. There was no correlation between the incidence of facial abnormalities and inner ear anomalies. Key words: congenital anomaly, facial nerve, temporal bone
As part of a study on chronic inflammatory disease of the mucous membrane, silicon of the medium in postoperative maxillary cysts and in other cysts was measured, and following results were obtained. Silicon concentrations of the medium in the postoperative maxillary cysts and in the postoperative ethmoidal cysts were 34.5 ppm and 42.9 ppm (geonmetrical mean) respectively, and they were higher than in other primary cysts such as frontal cyst. nasal vestibular cyst. and dental cyst. The silicon content of the medium in the postoperative maxillary cyst varied with the water content of the medium; the lower the water content the higher was the silicon content and the relationship was expressed by the following equation, log S=7.43+7.14 log d-6.14 log w.where S Si(mcg).d=dry weight(g). The high concentration of silicon in the postoperative cyst was considered to be due to the large amount of silicon transudate from the surrounding fibrous tissue through a highly damaged or missing epithelial wall of the cyst.
Telomerase is a maintaining enzyme of telomere repeats. Telemorase is expressed in immortal and cancer cells, but not in the normal tissues. We investigated telomerase activity of tumors in the head and neck. Telomerase activity was found in all of the cell lines derived from squamous cell carcinomas of the head and neck. Six of 9 (67%) primary fresh tissues from squamous cell carcinomas of the head and neck contained detectable telomerase activity. There were no apparent relationship between telomerase activity and clinical stage. Telomerase activity differed, depend on the responses to chemotherapy and radiotherapy: complete response, 0 of 3 (0%) ; partial response ; 0 of 1(0%); no change ; 7 of 7 (100%). Therapy-resistant tumor seemed to have much telomerase activity and much malignant potential. In benign tumors, neither of 2 benign parotid tumors expressed telomerase activity, but one of 2(50%)papillomas had the telomerase activity. Telomerse is considered useful tumor marker for the diagnosis and prognosis.Kov words: telomere. telomerase, squamous cell carcinoma, head and neck tumor
Overexpression of cyclin D1 has been found in a variety of malignancies and is suggested to be related to tumor progression. We immunohistochemically investigated the overexpression of cyclin D1 protein in 92 laryngeal carcinomas. Twenty eight (30.4%) of the carcinoma specimens showed overexpression of cyclin D1. This overeypression was not related to the tumor stage, lymph node matastasis, or clinical outcome. However, the overexprc ion of cyclin D1 in patients with local recurrence was significantly higher than in patients with no recurrence. Cyclin D1 immunohistochemical staining is considered to be a useful marker for predicting tumor recurrence.
Carcinoma of the hypopharynx has a great tendency to metastasize to the neck. In addition it often metastasizes to the upper retropharyngeal lymph nodes (Rouviere's lymph nodes) and to the paratracheal lymph nodes. In this study, in order to determine the pattern of lymph node metastasis. 112 patients with carcinoma of the hypopharynx who had undergone bilateral radical neck dissection, bilateral paratracheal dissection, bilateral dissection of retropharyngeal nodes as an initial treatment between January 1982 and June 1997 in the Kurume University Hospital. were retrospectively reviewed in detail. Special attention was paid to retropharyngeal nodes and paratracheal lymph nodes. In NO cases neck metastases were seen in more than one quarter of the patients. Metastasis to retropharyngeal lymph nodes and toi the paratracheal lymph nodes was seen in 5.4% and 12.5% of the patients, respectively. The frequency of metastasis to paratracheal lymph nodes had a significantly close relation- ship with that to, the upper and lower jugular lymph nodes. The frequency of metastasis to retropharyngeal lymph nodes also had signficantly close relationship with that to paratracheal lymph nodes, while having no relationship with that to other neck lymph nodes. These results suggest the following: 1) In patients with T1 or T2 PS type carcinoma of the hypopharynx, in which the lesion is confined unilaterally and is presumed to have been successfully treated by laser surgery prior to radiotherapy, unilateral neck dissection in alone will be sufficient. In all the other patients with carcinoma of the hypopharynx bilateral neck dissection must be performed. 2) In all patients retropharyngeal lymph nodes and paratracheal Iymph nodes should be dissected as much as possible and postoperative irradiation to both areas will be necessary.
Optokinetic Nystagmus(OKN)exhibit different responses depending on the direction of gravity.with respect to head and body.In 13 normal healthy volunteers(10 experimental subjects and 3 controls), we studied the OKN evoked by horizontal and vertical stimuli.in upright, side lateral, and repeated upright positions during a long time course of six test stages.Stage 1 was an upright sitting position Stage 2 was a 90-degree recumbent lateral position immediately after Stage 1.Stage 3 was the same position as in Stage 2, but 2h later.Stage 4 was the same position, another 2h later(total of 4h).Stage 5 was a return to the upright position (the same as Stage 1) immediately after Stage 4.Stage6 was a teturn to the same upright position, 2h after Stage 5.The results showed continuous modifications of OKN.A lateral tilt produced different effects on the horizontal and vertical optokinetic oculamotor systems.The gain in horizontal OKN(HOKN)decreased during Stages2-4with time, and returned to normal in Stage5end6.As for vertical OKN(VOKN), the gain of upward (the direction by slow phase)OKN increased during Stages2 4.and returned to normal in Stages5 and 6.But the gain of dowwnward OKN did not show any clear modulation.We showed that the change in gravity direction has a clear effect on OKN.and that it takes some time to reach the maximal and desirable level of modification.The difference in time dependent modifications between HOKN and VOKN should be due to the difference in OKN producing mechanisms and velacity storage systems.
Results of surgery for middle ear cholesteatoma were investigated in 202 ears of 197 patients who had undergone surgery by the staged intact canal wall technique.Surgical procedures used in the second stage for prevention of a retraction pocket were classified into three types:Type S1, no scutumplasty;Type S2, scutumplasty;Type S3, scutumplasty plus mastoid obliteration.Recurrent cholesteatoma was found in 9 ears(4%)and retraction pocket in 47 ears(23%).They occurred between 2 and 120 months (average:26 months)after the second stage, most frequently at 1 to 3 years.The incidence was higher after Type S3 surgery than after the other types, probably because the middle earwas severely involved in patients who were indicated Type S3 surgery.For prevention of a retraction pocket, bone putty and cartilage were proved to be appropriate materials for suctumplasty, and hydroxyapatite for mastold. obliteration.As the ratraction pocket tended to recur in patients with the pocket at the second stage, these patients needed abliteration of the mastoid cavity to prevent a retraction pocket.Postcaperative hearing was evaluated according to the criteria proposed by the Japan Society of Clinical Otology.Of 145 ears of the 142 patients who were followed for more than lyear, 118 ears(81%)the surgery was judged successful.The success rate in hearing was in good accordance with the condition of the tympanic membrane.