An electron microscopic study on fine structure of the human tracheal glands, on which few reports have been published, was carried out.The materials were obtained duing surgical procedures of the larynx and trachea. The human tracheal gland mainly locates in submucosa of the trachea.The shape of gland is simple or compound tubulo-alveolar, and the gland has a duct and a secretory portion(acinus).The secretory portion of the gland comprise of mucous cells and serous cells consistently in a regular arrangement.The mucous cells adjoin directly distal to the branched duct and followed by serous cells.Serous cells form frequently a deanilune.The secretory portion of the gland is surrounded by myoepithelial cell sresembling smooth musclefiber, and they are encased further by metnbrana propria comprised of a basement membrane and connective tissue. The duct of the tracheal gland has double layers of epithelial cells, viz.tall columnar cells facing the lumen and basal cells outside.The tall columnar cell frequently contains round granules suggestive of anactive secretory function. In our observation ultrastructural characteristics of the unicous cells and of the serous cells are investigated separately, and the mechanism of secretion is morphologically elucidated through the electron microscopic investigation of their morphological changes corresponding to the secretory cycle.No appreciable morphological difference exists between the serous cells constituting serous tubules and demilune. Mitochondria-rich cells(oncocytes)are occasionally found within the epithelium of the secretory portion and in a rare instance they contained secretory granules. Several findings on myoepithelial cells resembling smooth muscle fiber which are found in a considerable number at the base of the glandular cells of the secretory portion are described.
The present paper was designed to study acoustic trauma, particularly C5-dip, audiologically;and histopathologically. An audiological analysis was performed on 49 persons with hearing loss of C5-dip. The method used was detailed audiometry, a new method for detailed measurement of hearing threshold along the frequency scale, in which very slow frequency sweep was adopted in ordinary Bekesy audiometry. On the other hand, the integrity of the organ of Corti after exposure to high intensity impulse noise was studied on guinea pigs with the use of surface preparation technique. Twenty-five guinea pigs were exposed to impulse noise at the intensity of 150 dB SPL, with irregular intervals of 2-3 sec, for 30 min. After exposure, with survival time of 7 days, materials were sacrificed for histological study of the organ of Corti. The results were as follows: 1) Analyzing the detailed audiogram of C5-dip, it was observed that the hearing threshold declined suddenly at a certain point between 2 and 4 kHz, and reached the bottom of wide or narrow range and then recovered to a nearly normal level with very sharp slope. According to the width of the bottom, two different types of “dish” and “bowl” were distinguished principally. 2) At the histological observation, hair cell damage of two different types, “notch” and “gradual”, were recognized. In the “notch” type, hair cell damage was sharply limited against the both sides of intact structures. In the “gradual” type, scattered damage area was observed between the normal and completely damaged area. 3) It was suspected that functional disturbance and structural disturbance might be related each other: the “dish” type corresponded to the “notch” type, and the “bowl” type coincided with the “gradual” type
In an experimental pathologic study, guinea pigs and rabbits were infused into the middle ear cavity: with the following stimuli (1) turpentine oil, (2) 3% FNa solution, (3) heparin, (4)cholesterin suspension, and (5) ferritin solution. The granuloma accompanying foam cells was observed in the animals treated with turpentine oil and 3% FNa solution. This finding is probably the step preceding the formation of cholesterin granuloma. Exudates from the cholesterin granuloma were biochemically assayed, cholesterin granulomas contained not not only cholesterols but also methemoglobin and storage iron due to hemorrhage. In the granulation tissue, fatty degeneration resulted from anoxia due to hemorrhage was observed. In view of these iesults, the etiology of cholesterin granuloma may be considered as follow: the constriction of the eustachian tube due to inflammation induces granulation at the aditus ad antrum in the antrum mastoideum; this produces a negative pressure in the middle ear cavity, which, in turn, causes peripheral circulatory failure and inflammation to occur, resulting in transdation of blood components, necrosis of the granulation tissue, and eventually the deposition of cholesterin; the occurrence of intragranular hemorrhage further leads to the deposition of storage iion and the appearance of methemoglobin, causing intragranular hypoxia, which eventually gives rise to fatty degeneration, depostion of cholesterin and appearance of giant cells and fibroblasts.
Evoked E.M.G. test has been applied in patients with peripheral facial palsy to evaluate the degree of nerve injury. However, prognosis of peripheral facial palsy has not been estimated under a definite criteria based on the results of evoked E.M.G. test. The author reported previously that the number of spikes in evoked wave represented the degree of degeneration of the nerve in more details than the threshold and the latency. The purpose of the present study is to establish a criteria for prognosis of peripheral facial palsy deduced by the results of evoked E.M.G. test. Eighty three patients who were examined in our clinic within one month after the onset of symptom were subjected to this study. The result of evoked E.M.G. test was compared with the degree of recovery of facial palsy in each patient after the laspe more than six months. These results led me to the conclusion that prognosis of peripheral facial palsy should be estimated by the number of spikes in the evoked waves as follows: 1) Cases showing spike discharges more than ten recover completely within three months after the onset. Specially, cases under sixty years of age may recover within one month, but cases more than sixty years of age may require more than one month for complete recovery. 2) Cases showing nine to six spike discharges may require more than three months after the onset for complete recovery. 3) Cases under sixty years of age, showing five to three spike discharges may recovery completely but cases more than sixty years of age recover incompletely. 4) Cases showing two to one spike discharges recover incompletely. 5) Cases under fifty years of age showing no spike discharge may recover incompletely and in cases more than fifty years of age no improvement may be obtained.
The most rational procedure of determining response threshold in evoked response audiometry (ERA) is to estimate the stimulus intensity level, with which 50 per cent positive resposes (ED50) can be obtained. In order to measure ED50 efficiently with a small number of experiments, simplified up-and-down method (UDM) by Brownlee et al. was applied and its validity in ERA was investigated. Up-and-down method was first described by Dixon and Mood in 1947. It is a sequential procedure in which the stimulus level of any trial is determined by the preceding stimuli and responses. 1. Variability of threshold values obtained from UDM (a chip experiment) On the basis of average rates of positive responses as a function of stimulus intensity in normal and hard-of-hearing children, a chip experiment of UDM was carried out to estimate response threshold of both groups. In normal children 85-97% of the estimated thresholds ranged between 20 and 50 dB, while in impaired children 91 -98% lay within a limit of 70dB±10 dB. 2. Determination of thresholds in ERA with UDM Response thresholds in ERA were measured by using UDM in 3 young children during sleep and their testing processes were presented in detail. 3. Comparison of thresholds obtained from ERA and COR or play audiometry Thresholds of ERA for young children determined with UDM were compared with those obtained from COR or play audiometry. Thirty-nine pairs of thresholds in 22 young children were used for the comparison. In normal or slightly impaired children, the mean threshold of ERA was about 10 dB higher than that of behavioral tests, whereas in severely impaired children the mean threshold of both tests almost coincided with each other
For improving reliability of the judgement in ERA, the author investigated the relationship between the response detectability and the number of stimuli in a summated trace (denoted by N), and 3 multisample scoring methods: Juntendo University's method, multichannel method by Burian et al. and 4 sample method by Rapin et al.. Auditory evoked responses were recorded during sleep on 9 young children with normal hearing aged from 2 to 9 years. The test was performed with 1000 Hz pure tone at the intensity levels of 0, 20, 40, 60 and 80 dB (HL), and without stimulus. Each subject received consecutive 250 stimuli in a test run and all records were stored once in a data recorder. Then the following sununated traces were made at each intensity level and without stimulus. 1. Eight traces with consecutive 25 stimuli (N25), 4 with 50 (N50), 2 with 100 (N100) and 1 with 200 (N200). 2. A set of 4 traces containing 50, 100 150 and 200 stimuli respectively (Juntendo University's method). 3. A set of 3 individual traces each with 50 stimuli and 1 trace with 150 stimuli of the 3 traces above mentioned (multichannel method by Burian et al.). The summated traces were judged independently by 3 trained scorers. Results obtained were as follows: 1. The rate of positive responses increased significantly as N increased till N100, but N200 showed almost similar results to N100. 2. No relation was found between the ratio of false positive decisions and N. 3. The response detectability in Juntendo University's method resembled closely with that in N200. 4. No false positive decision and a high detectability of the responses were obtained by multichannel method of Burian et al.. 5. Marked tendency to negative decision was found in 4 sample method by Rapin et al..
A 3-year-old female suspected of laryngomalacia had nasotracheal intubation for 23 days after birth. Tracheotomy was performed because of asphyxia on removal of the nasotracheal tube. Tracheostomy tube was left in place thereafter because of difficulty of decannulation for three years. During these years, repeated direct laryngoscopies revealed “bilateral vocal cord paralysis” with the cords in paramedian position, and finally s little adhesion between the posterior margin of the true vocal cord was discovered. This adhesion was divided with a knife and forceps and the both cords were apart and began to move well with respiratory effort. The day after the operation, tracheostomy tube was removed and the tracheostoma closed spontaneously. The patient could breathe and speak without difficulty. The histopathological finding of this adhesion removed by operation, was characterized by chronic inflammatory granulation tissue. In regard to this case, the several short comments could be made as follows. 1. The true diagnosis of the case reported was vocal cord adhesion after prolonged nasotracheal intubation. However, it could be called as “pseudo-bilateral abductor paralysis” which Jaffe had already reported in 1973. We apt to misdiagnose vocal cord adhesion as vocal cord paralysis. 2. Infection, as well as vocal cord standstill caused by trachestomy, might be some of the main factors of development of adhesion. 3. The vocal cords move well and prevent a further adhesion, after removing adhesion by the operation and phonation and breathing through larynx were satisfactory