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Volume 103, Issue 11
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Kyoichi Terao, Masakatsu Toda, Kiyotaka Murata2000 Volume 103 Issue 11 Pages 1205-1211
Published: November 20, 2000
Released on J-STAGE: March 19, 2008
JOURNAL FREE ACCESSNonrecurrent inferior laryngeal nerves (NRILNs) are generally discovered during thyroid or parathyroid gland surgery, If the presence of the NRILN is unknown, nerve injury can easily occur during surgery. Here we report seven cases of NRILN, describe how to identify a NRILN, and discuss whether preoperative or postoperative examination is necessary.
Between October 1998 and March 2000, we performed cervicotomv in 1889 patients for thyroid and parathyroid disease and identified a NRILN in 7 of them (0.37%). A NRILN was found in 7 of 903 patients(0.78%)on the right side but in none of 855 patients on the left, The NRILN branched off the vagus nerve at the level of the upper or middle third of the thyroid in 5 patients, and in the other 2 patients branched off the vagus nerve at the level of the lower third of the thyroid. We had not predicted the presence of NRILN before surgery in any of these 7 NRILN patients. Clinically. three patients with NRILN had mild dysphagia and the sensation of a foreign body in the throat. Three patients had abnormal chest X-ray findings showing a linear aortic arch shadow, a sign regarded as evidence of arteria lusoria. Three patients underwent MR ngiography, and an aberrant right subclavicular artery was identified. Surgery was performed safely, and no postoperative vocal cord palsy occurred in any of the seven NRILN patients.
It is to some extent possible to predict the presence or absence of NRILN by routine diagnostic examinations before surgery for thyroid and parathyroid disease. We emphasize that digital subtraction angiography, MR angiography, or barium esophagography is not necessary for all patients before surgery, since NRILN is a relatively rare anomaly, and such examinations are either invasive or not cost effective. When a NRILN has been identified during surgery, there is no need to examine for the presence of a vascular anomaly: Its presence is a matter of course. Surgery must be performed however, with knowledge of the possibility of a NRILN.View full abstractDownload PDF (1172K) -
Isao Wada, Haruto Mishima, Tadashi Hida, Yasuhiro Kase, Toshitaka Iinu ...2000 Volume 103 Issue 11 Pages 1212-1217
Published: November 20, 2000
Released on J-STAGE: March 19, 2008
JOURNAL FREE ACCESSAlthough nasal foreign bodies very commonplace in daily clinical practice, their simplicity in pathology and diagonsis is so unique that case reports based upon a large number have been rather scarce.
We report 299 verified cases of nasal foreign bodies seen during the past 13 years from January 1986 to December 1998, at our institute, together with clinical and statistical analysis. The total number of first visits during the surveyed period was 55, 312 and nasal foreign bodes comprised 0.54%.
Of these 217 subjects (72.6%) appeared in emergencies. Man comprised 172 (58%) and woman 127 (42%).with the right side comprising 166 cases (57%), the left side 123 (42%) and bilateral 3 cases (1%).
In monthly distribution, cases are more often seen in November and December and less often seen in January, with the monthly average being 25.
In age distribution, the majority were seen in those under 10 years old, excluding 6 cases. The average age was 4.0 and the range 1 month to 81 years.
In the majority of cases, foreign bodies remained only a short time (with in 24 hour) but in 15 cases stayed rather a long time (over 24 hour).
In specificity, the majority of foreign bodies were toys, with plastic bullets used with air guns most frequent, in 46 cases (15.3%). followed by beads in 36 cases (12.0%). Other foreign bodies seen comparatively often were pieces of tissue paper, buttons, and plastic toys components.View full abstractDownload PDF (506K) -
Naoko Takemoto2000 Volume 103 Issue 11 Pages 1218-1227
Published: November 20, 2000
Released on J-STAGE: March 19, 2008
JOURNAL FREE ACCESSFollicular B cells and follicular dendritic cells (FDCs) form FDC-lymphocyte clusters and play a central role in events related to humoral immunity in the lymphoid follicle (LF). The secondary LF is divided into five zones, each of which exhibits functional differences. However, the distribution of the clusters across the five follicular zones remains unclear. We here report a procedure for isolating FDC-lymphocyte clusters from fixed tonsillar tissues and compare of the structure of clusters isolated from three follicular zones: the mantle, light and dark zones. First, the germinal centers (GCs) of the secondary LFs were removed under a stereoscope, and the GCs were enzymatically digested for 20, 30, 40 and 50 minutes at 37°C. The FDC-lymphocyte clusters were then isolated using a discontinuous density gradient and a Magnetic Particle Concentrator, followed by microbeads. The number of isolated medium sized clusters composed of 6-25 cells was greatest when the samples were incubated for 40 minutes. To detect the mantle, light and dark zones, and GCs, isolated FDC-lymphocyte clusters from each zone were immunostained. Their cell structures were then compared. The clusters were composed mainly of B cells (comprising about 80% of the cells in each cluster, on average), T cells, natural killer/T cells and macrophages were also observed, but less frequently. The proportions of CD 45 RO-positive cells and CD4-positive cells were clearly different for each zone, with CD4-positive cells in the majority. No clear differences in isolated clusters from fixed and unfixed tonsillar tissues were observed. Our data indicate that this procedure is suitable for isolating FDC-lymphocyte clusters from fixed lymphoid tissues and that the proportions of cells composing the clusters differ in the three follicular zones.View full abstractDownload PDF (2013K) -
A Study of PAS-stained Temporal Bone SectionsHideo Tomisawa2000 Volume 103 Issue 11 Pages 1227-1237
Published: November 20, 2000
Released on J-STAGE: March 19, 2008
JOURNAL FREE ACCESSSensorineural hearing loss can be caused by diabetes mellitus, and diabetic microangiopathy contributes to diabetic complications such as nephropathy. I compared the outer diameter of strial capillaries, the strial atrophy rate, and basement membrane thickening in the strial capillaries of temporal bone sections from 16 diabetics and 16 non-diabetics matched for age and sex and assessed the correlations between these values and age, duration of disease, fasting blood sugar, and glycohemoglobin.
In the non-diabetic group, the minimum and maximum outer diameters of the capillary in the cochlear apical turn were larger than in the basal and middle turns. The strial atrophy rate in the apical turn was higher than in the basal and middle turns. There was no significant difference in basement membrane width between the turns. In the diabetic group, there were no significant differences in minimum outer diameter and basement membrane width between the turns. The maximum outer diameter of the middle turn was larger than that of basal turn. The strial atrophy rate in the apical turn was higher than in the basal and middle turn. In the comparison between the dianetic group and the non-diabetic group, the maximum outer diameter of the apical turn in the diabetics was smaller than in the non-diabetics, the basement membrane width in the basal, apical and all three turns as a whole in the diabetics was thicker than in the non-diabetics, the strial atrophy rate in the basal turn and all three turns as a whole in diabetics was higher than in non-diabetics.
There were two correlations in the non-diabetics, between age and strial atrophy rate and between age and basement membrane width in the basal turn, and there were positive correlations in the diabetics, between the strial atrophy rate and fasting blood sugar and between strial atrophy rate and glycohemoglobin in the basal turn. Because of basement membrane thickening toward capillary lumen, these results led to the hypothesis that serial atrophy is one factor in diabetic hearing loss.View full abstractDownload PDF (2606K) -
Kazuhiro Moriwaki, Yoshiharu Sakata, Takashi Kato, Atsuhiko Uno, Miki ...2000 Volume 103 Issue 11 Pages 1238-1241
Published: November 20, 2000
Released on J-STAGE: March 19, 2008
JOURNAL FREE ACCESSWe report two cases of actinomycosis of the neck, one acute and one chronic. The acute actinomycosis patient was a 63-year-old woman who complained of high fever, sore throat, and swelling of her neck on her first visit. Plain CT revealed gas-formation in the soft tissues of the left parapharyngeal space, the hyoid area and the cartilage thyroid area. We performed emergency tracheotomy and surgically drained her neck. No actinomycotic bodies were found microscopically in the surgically resected material, but cultures of the neck pus grew out actinomyces. A diagnosis of actinomycosis was made, and the patient was treated with administration of antibi-otics, an ASPC drip infusion for about 7 weeks and oral BAPC for about 6 months, and the lesion was improved. The patient has been symptom-free for 4 years since the operation. The chronic actinomycosis patient was a 61-year-old woman who complained of swelling in the right submandibullar region. Surgical resection was performed to exclude the possibility of a malignant tumor. Actinomycotic bodies were detectedd microscopically in the surgically resected material. The patient was treated with oral AMPC for about 6 months, and she has been symptom-free for 1 year since the operation.View full abstractDownload PDF (1628K)
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