A 65 year-old. male has been complaining of a sensory disturbance of the upper bilateral extremities for the past 5 years and of dysphagia for the past 4 months. Radiographic examinations revealed a remarkable change of spondylosis deformans of the 5th and 6th cervical vertebrae. Surgical intervention including chiseling of the osseous prominence of the body of the vertebra, removal of the intervertebral discs and anterior fusion of the cervical vertebrae were performed. Complete recovery from the sensory disturbance and dysphagia was obtained about 6 months after the operation. Literatures concerning with the similar cases are reviewed and the problems of surgical treatment are discussed.
Making use of the special quality of Periodic Acid Methenamine Silver Staining (PAM staining) for the collagenous fiber, auther studied on the malleus and incus, and the results were as follows : 1) About ossification and formation of the joint of the ossicles : Ossification consisted of perichondral, endochondral and intrachondrial ossification, and its process was devided into four stages (1st: 4-5 embryonal month, 2nd: 6 e.m., 3rd: 7-8e.m. and 4th: 9-e.m.). Perichondral ossification was completed at 3rd stage, but the endochondral delayed one period. Formation of joint was devided into four too, and it was completed at 3rd stage. 2) About the normal ossicle of all ages: In the ossicle physiologically the bone fiber was sometime PAM-negative, in spite of no findings in any other skeletal bone. This PAM-negative part was devided into four types as follows ; diffusive type (D type), marrow type (M type), solitary type (S type) and globular type (G type). Its grade was higher in the incus than in the malleus. The etiology of being PAM-negative was considered as “masking” of PAM staining caused by some regressive degeneration of ground substance of the bone, which was derived from the senile changes and the general prostration. 3) About the ossicles in chronic otitis media: When the lesion of the ossicle was slight, being PAM-negative was as like as normal in type, but its grade was a little higher, it was considered that otitis media brought the changes of the ossicle like regressive degeneration. About the management of the ossicle at operation : When the lesion was slight and reversible, it could be available, but it was no available, when the lesion was high degree, and by using an operations-microscope its decision was considerably possible.
A case of MUCOEPIDERMOID CARCINOMA of the left submaxillarygland was reported in a woman aged 35. In this case, the tumor building was found at her left jaw angle part 3 years ago, and the tumor was fixed on the jaw bone. The first and the third large molar tooth of the left side were defected and the raw of teeth was irregular. It was considered this tumor was probably ADAMANTINOMA after the examinational excision. However, the tumor was surgically removed together with the left submaxillarygland and diagnosed as MUCOEPIDERMOID TUMOR by tissue examination. Exacerbation was not found for her life, but, metastasis to the lung, vertebra and skull appeared after about 9 months, and then, she died after bout 28 months postoperative course. In this case, mixed tumors of the salivarygland are histologically so variable that the examinational excision is not only unusefle for diagnosis but also harmful for prognosis. The tumor of the submaxillaryglands has to be considered for malignant and complete extirpation of the submaxillarygland, if necessary, resection of lymph tissues in the neighbourhood, is to be performed.
During the last three years, sixty cases of the head and neck cancer were treated with seventy courses of regional arterial chemotherapy, including infusion, one shot injection, perfusion and a new method, i. e., infusion of anti-cancer agents into the regional artery and simultaneous removal of the equal amount of venous blood. The present report concerns with discussions of the technical aspects of regional arterial chemotherapy, together with its early results and complications. Following cases showed poor results; cases of recurrent cancer, cases irradiated with more than 6000 rads, cases of poor general condition, far advanced cases (excluding maxillary cancers) and cases with large metastases to the cervical lymphnodes. Regional arterial chemotherapy was effective for those cases in which irradiation therapy was effective and radical surgery was possible. Regional arterial chemotherapy was performed in combination with surgery and irradiation, since regional arterial chemotherapy alone was not very effective. In the maxillary and intra-oral cancers, it proved to be effective to inject radiosensitizing agents continuously when irradiation was performed. In these case, the relationship between radiation doses (D) and frequencies of intra-arterial infusion (T), at the time of tumor disappearance, was established as follows; D=11000T-0.24 By combining irradiation with regional arterial chemotherapy, the extension of surgical procedures as well as the doses of irradiation was made minimal. For the advanced cases of laryngeal cancer, regional perfusion was done preoperatively, in order to avoid cancerous dissemination. Twenty-four cases of the head and neck cancer were treated with intra-arterial infusion of radioisotopes. In these cases, three discussions were done as follows: (1) The relation between the speed of infusion and the regional isotope concentration. When a radioisotope was infused rapidly, the regional concentration was rather high but it was maintained only for a short period. When a radioisotpe was infused slowly, the regional cocentration was a little higher than the level obtained by intra-venous administration. It was necessary to take one to two hours in order to maintain the level of concentration at double of that of the intra-venous administration. (2) Affinity of radioisotopes to the cancerous tissue. 131I. RISA (Radioactive Iodinated human Serum Albumin) concentrated mainly to the heart, 131I. AA (Aggregated Albumin), 203Hg. MH (Hematoporphyrin-Na), 198Au. colloid and 197Hg. Neohydrin mainly to the liver and/or kidney, 99mTcO4 and 131I. MAA (Macro Aggregated Albumin)mainly to the areas of cancer. Fractionated “one shot” infusion will be suitable for such an agent as 131I. MAA in order to bring about the better results. (3) In order to reconfirm the exact site of the tip of the catheter, the use of 131I. MAA is highly recommended.
A rare case of chondroma of the larynx is herein reported in which the neoplasma originated in the cricoid cartilage extended to left arytenoid region, and it obstructed severly the laryngeal cavity. Total laryngectomy was necessary in this case. Some problems on diagnosis and therapy of this desease are discussed in refering the bibliographies.
One hundred patients with malignant tumors of the head and neck have been treated by infusion chemotherapy for the past three years. Retrograde catheterization of the superficial temporal artery was performed in the most cases, by inserting a polyethylene tube of appropriated size until the tip of the tube was placed in the proximal part of the external carotid artery. The drugs were administered and daily doses of them were as follows : Toyomycin (chromomycin A3) 0.5mg/d., Mitomycin C 2.0mg/d., Endoxan (cyclophosphamide) 100mg/d., 5-fluorouracil 250 mg/d. Each drug was dissolved in 20m1. of 5% glucose or physiolgic saline. One of these drugs was infused through the catheter in a very short period of time (quick shot method) or infused for periods of one to two hours, by using an infusion pump. Eighty cases were treated by intra-arterial infusion of anticancer drugs, as an adjuvant method of radiotherapy or surgery. Twenty patients were treated by the combined method of infusion chemotherapy and the simultaneous irradiation. Out of 100 patients, thirteen were not evaluated for anticancer effects of the drugs because complications or side effects have occurred in these cases and infusion was discontinued within five days. Out of 87 patients, 22 had total or significant regression of the tumor and 38 had partial regression of the tumor and 27 had no response of the tumor. In the most cases the tumor regressed within 20 days after the bigining of infusion therapy. The Most cases, which were treated by the combined method of infusion chemotherapy and the simultaneous irradiation, had varying degrees of tumor regression. In the early stage of clinical trial, anticancer drugs for each patient, were selected at random, but since Nov, 1964, the drugs were selected, if possible, according to the results of SDI test, which is one of the sensitivity tests of anticancer drugs. In patients with malignant tumors of the maxillary sinus and the nasopharynx the good resunts were obtained. It is believed that the daily administration of an anticancer drug for periods of 20 days by quick shot method, followed by surgery or irradiation, is superior to the methods previously employed. The better results were obtained by the combined method of infusion chemotherapy (by quick shot method, for periods of 20 days) and the simultaneous irradiation with Cobalt or Linac. (4000_??_6000r of tumor doses). Leucopenia was noticed in 28 of 100 patients, in the most of them due to Mitomycin C and Endoxan. Mucositis of the oral cavity and alopecia of the infused side were found in 8 cases.
The guinea pigs were perfused with tetrazolium reagents for succinic dehydrogenase through the circulatory system. After finishing the perfusion, the organ and tissue were dissected and examined under a microscope. Two organs have revealed us the marked formazan formation within them, one was the kidney in which the proximal tubules were the main site of coloration, another the cochlea in which the stria vascularis, the plexus cochlearis, and the round window were the site of distinct coloration. The proximal tubule of the kidney is known to be the most easily damaged after kanamycin.The drug is also known to have a toxic effect on the cochlea. According to the available literature, the drug accumlates mainly within both the kidney and the inner ear fluids. The author is inclined to think that the site of formazan formation would indicate the site of entrance of kanamycin into the organ from the circulatory system. Therefore, the drug may be supposed to reach the inner ear through the stria vascularis, the plexus cochlearis and the round window.
For the establishment of a better therapy for cholesteatoma otitis, an exact knowledge of its pathogenesis is necessary. The present study has been attempted to know the functional characteristics of cholesteatoma epithelium by histochemical and histological techniques. Histochemical investigations concerning PAS reaction, acid and alkaline phosphatases, aldolase, lactate dehydrogenase, DPN diaphorase, succinate dehydrogenase and also leucine aminopeptidase were performed. On the other hand, the cholesteatoma tissues were stained by H.E., Van Gieson and methylgreen-pyronin for general morphology.The epithelium of normal skin taken from the affected patients was utilized as control. In the cholesteatoma epithelium, the stratum spinosum was stained intensely with the PAS reaction, rather than the stratum corneum, stratum granulosum and stratum basalis. In the skin epidermis, there was a slight PAS reaction, the hypodermis of both cholesteatorna and skin being stained weakly. Acid phosphatase activity was characterized with the high reaction in the stratum granulosum, while the level of the enzyme activity of acid phosphatase in the cholesteatoma epithelium was relatively lower than that in the skin. There was no alkaline phosphatase in the cholesteatoma or in the skin. Lactate dehydrogenase and DPN diaphorase activities were found intensely only in the stratum basalis of cholesteatoma tissues. The skin exhibited strong reactions of these enzymes in every layer. Leucine aminopeptidase and Aldolase characteristics were never demonstrated in cholesteatoma epithelium.Succinate dehydrogenase activity in cholesteatoma epithelium was weak in the stratum corneum, but moderate in the stratum granulosum. It was concluded that most of the enzyme activities examined in cholesteatoma epithelium showed weaker reactions than normal skin.
The important role of acid mucopolysaccarides (AMP) in the cochlea has been already pointed out by Hayashido, Bleanger, Dohlman and Müsebeck. In Hayashido's report chondroitin sulfate (ChS) was supposed as the most important AMP to keep the cochlear function. The author have studied on the enzymatic synthesis of ChS in the guinea pig cochlea. Five guinea pigs were guillotined and their cochleae were homogenized with 0.25 M sucrose.The homogenate was centrifugated at 18, 000xg for 10min, and the supernatant fluid was collected.All procedures were done at 4°C. Using the crude extract of cochleae prepared previously according to above method, PAPS (3'-phosphoadenosine-5'-phosphosulf ate) -synthesizing enzyme system and ChS-transferase were evaluated by means of electrophoresis (citrate buffer, pH5.9, 16 V/cm, 3h) and radioautography. In acoustic trauma, the PAPS-synthesizing enzyme system decreased at first, and then increased. In KM intoxication, the PAPS enzyme activity decreased. On the other hand, ChS-transferase in both condition showed its almost normal activity. These observation would suggest that decrease of the enzyme activity of PAPS system may be one of the causes for hard of hearing. Histochemical investions for KM intoxicated cochlea were also performed by several staining methods. The decreased reaction of the hyaluronidase resistant sulfate AMP, probably ChS in the tectorial membrane and hyaluronic acid in the limbus was investigated. The perceptive mechanism of sound vibration in the cochlea may be realized through the knowledge of AMP obtained in this paper, included the action as anion, and the clinical use of the adenosine-5'-phosphosulf ate or PAPS for perceptive hearing loss may be suggested according to the above results.