Simulated nasal cavities with variously formed turbinates and different patency were ventilated by Harvard respirator. The effective cross sectional areas were assessed while the stroke volumes were changed from 300 to 700ml and the respiratory frequency from 10 to 50 times per minute. The estimated values of the effective cross sectional area were increased when the stroke volume and the frequency were increased. However, the increase was so small that it was not necessary to keep the stroke volume and frequency constant in estimation of the area. The sum of the value of each nasal cavity was greater than that of both cavities measured simultaneously. The data obtained in this study were analysed aerodynamically with special considerations for the air flow resistance of the nasal cavity and the apparatus. It was concluded that the effective cross sectional area was an expression of the nasal resistance and was not the same as the anatomical area of the nasal passages, and that it could practically be applied during spontaneous breathing except too wide or too narrow nasal cavities.
Case 1: A 54-year-old female had complained of bilateral complete hearing loss, left facial palsy and gate disturbance. A diagnosis of cholesteatoma was given from the findings of left ear drum, X-ray, vestibular function test, C-T scanning, and so on. Cholesteatoma was removed as completely as possible from the left temporal bone by a left paramedian suboccipital craniotomy. Histopathological examination confirmed it to be cholesteatoma. Case 2: A 33-year-old male had complained of right severe hearing loss and facial palsy. A diagnosis was made as cholesteatoma in the right temporal bone from the X-ray, vestibular function test, C-T scanning, and so on. Cholesteatoma was removed as completely as possible by a right middle cranial fossa approach. Histopathological examination revealed the mass to be cholesteatoma. Cholesteatoma of the temporal bone is rare. It is difficult to diagnose it before surgery. We could differenciate it from the cerebellopontine angle lesions, particularly acoustic neurinoma in two cases with temporal bone cholesteatoma. We conclude from our experience of present cases that trans-labyrinthine approach is best in case of the temporal bone cholesteatoma with ipsilateral complete hearing loss and facial palsy and trans-labyrinthine approach plus suboccipital craniotomy or suboccipital-trans-temporal combined approach is better in such a case.
The bony lateral wall of the inferior nasal meatus was studied in 40 cases (45 sides) of chronic sinusitis. The specimen, containing three layers in to-to (nasal mucosa, bony wall and mucosa of the maxillary sinus) was obtained during the Caldwell-Luc operation for the maxillary sinus. The specimen was fixed and stained by H-E method, and each section as a whole was examined under microscope and photocopies were taken using Nikon MacroMultiphoto microscope under the magnification of six times. A photocopy for each section was enlarged to the cabinet size and this enlarged photocopy was used for the final analysis. The characteristic finding of the present study was the irregular cleft-formation in the bony wall. Using the cabinet-sized photocopy, the area for the clefts and the area for the compact bone were measured. The corresponding area was separated from the photocopy and the weight was measured using a Metrer automatic balance up to 10 mg as the minimal unit. The area for the clefts versus the area for the compact bone was expressed in per cent using the weights thus obtained. In 37 sides out of 45, the cleft-formation was found with the average per cent of 8.63 (standard deviation 7.53). As a control study, the anterior wall of the maxillary sinus was also similarly evaluated. The anterior wall of all specimens of the present study did not show any cleft-formation. The percentage of the cleft-area did not show statistically significant differences as regards to the age, sex, years after onset, the degree of sinus wall changes and the presence of allergy detected by skin tests. The irregular spaces occupied by the clefts were filled with dense connective tissue with minimal inflammatory reactions. The nasal surface of the bony wall appeared resorptive and the sinus surface was depository according to Enlow's classification. It was concluded that the lateral nasal wall shows the characteristically developping patterns of resorptive and depository surfaces as a part of the facial growth, and that the bony wall is ordinarily provided with irregular clefts filled with connective tissues. The cleft itself is more of a physiological origin than of an inflammatory. The presence of clefts in 82. 2 per cent of cases suggests a rather free communication between the nasal cavity and the maxillary sinus.
Scintigram with the use of 67Ga-citrate was taken from the patients with head and neck tumors, of whom 86 were with malignant tumors and other 16 with benign tumors or suspected tumors. Positive rate was studied according to the site, size and type of the tumors. The effect of the therapy and intake of 67Ga-citrate in the patients with recurrent tumor were also investigated. Accumulation of 67Ga-citrate in the normal head and neck tissue and tumor was determined by an animal experiment using rabbits. For the group of those with malignant tumors in the throat, nasal and paranasal cavity, epipharynx and tonsil, positive rate was more than 60% while it was less than 35% for the group with malignant tumors of the tongue, oral cavity or thyroid gland. Tumor of less than 1cm in diameter could not be delineated while it was possible with that of more than 1cm. The positive rate of reticulosarcoma and squamous cell carcinoma was higher than that of adenocarcinoma. Accumulation of 67Ga-citrate in the recurrent tumors was high. This method was also useful for detection of tumor spread by lymphatic permeation. Accumulation of 67Gacitrate was lowered by radiotherapy and chemotherapy. 67Ga-citrate was occasionally found accumulating in abscess as well as in benign tumor, and therefore the differential diagnosis of these two necessitated concurrent employment of other tests. In the animal experiment, a high accumulation of 67Ga-citrate in the normal bone tissue was observed in contrast with the cartilaginous, membranous and soft tissue where its accumulation was low. There is a difference noticed between the ratio of tumor vs bone and that of tumor vs muscle with the result that tumor of the soft tissue was more easily identified than that of the bone tissue. From the foregoing finding, 67Ga-citrate scintigram was proved useful in making diagnosis of head and neck malignant tumor.
There are many questions unanswered about otosclerosis related to its different incidences between races; to its mode of inheritance; to the possibillity of abnormal karyotypes. The authors conducted chromosomal studies in 15 Japanese otosclerotic patients, 9 female and 6 male, ranged in age from 20 to 62 years, including 7 familial otosclerosis from 3 different families and 8 sporadic cases. In 11 patients the diagnosis was confirmed during operation, and in 4 it was confirmed by the audiometric batteries. The preparations for karyotype examinations were made using a short-term culture of peripheral blood, and about 25-50 suitable cells in metaphase were photographed and examined. And the the results are as follows: 1) Normal karyotypes were demonstrated in all male patients (46, XY) and all but one female (46, XX), and there was no mosaicism, trisomy or tetrasomy contended previously by J. M. Tato et al. in 1963. 2) A 24-year-old female patient, apparently normal and with regular menstrual periods but slightly retarded mentality, was found to have 47 chromosomes with one extra X-chromosome in all 20 cells examined. Sex chromatin bodies in the nuclei of the epithelial cells from buccal mucosa were also examined and 34% of the nuclei contained two X-chromatin bodies, and this woman was diagnosed as Triple-X female (47, XXX). Her mother was also diagnosed as having otosclerosis but her karyotype was normal. 3) Reviewing the literature, Triple-X females can have a variety of physical anomalies, but no deafness or otosclerosis have been reported. The patient, therefore, was judged to possess 47, XXX karyotype accidentally accompanied with otosclerosis. 4) In conclusion to this present study, there is no evidence of karyotype abnormality characteristic to Japanese otosclerotic patients.
A case of arteriovenous malformation of the right buccal region was reported. The patient was a 46 year-old male who complained of recurrent right nose bleeding of 3 months' duration and a mass in his right cheek. The mass was walnut-sized when he first noticed at the age of 36. It grew progressively to be a fist-size at the age of 41. Then, he was treated by radiotherapy at a certain institution. The mass was not increased in size but pulsations became markedly palpable after the treatment. On examination, a fist-sized pulsating mass was noted in his right cheek. The vascular dilatations were found on the right nasal and oral mucosa. Examination of the blood showed the marked anemia; Hb: 4.9g/dl, Ht: 16.4%. Carotid arteriogram revealed a vascular malformation of the buccal region. The dilated and torturous maxillary artery was diagnosed as a main component of the malformation. The right internal carotid artery, the left facial and maxillary arteries also gave blood supplies to the lesion in some extent. After the ligations of the right external carotid artery and left maxillary artery, the mass was resected. Histopathological diagnosis was arteriovenous malformation. No recurrence of symptom has been noted on 1 year follow-up. It is our impression that bilateral carotid arteriograms are essentially important for the surgical treatment because the malformation has many complicated collateral vessels. The diagnosis and treatment for arteriovenous malformations of the head and neck are briefly discussed.
The effects of ozone, main constituent of oxidant, on rabbits tonsil were observed and the scanning electron-microscopic findings were compared to the microscopic findings. The results are as follows. (1) Exposure to the highly concentrated ozone (5ppm) In the microscopic observation there were remarkable stimulative changes such as detachment and falling of the tonsilar epitherium in and around the intra-surface of the lacunar layer. A large number of lacunar plugs of the tonsil was also seen. In the scanning electron-microscopic findings of the free surface of the tonsil in the oral cavity, the epitherium of the tonsilar surface was detached and fallen, and many granular globules of all sizes were distributed under the epitherial cells. (2) Exposure to the moderately concentrated ozone (1ppm) In the microscopic findings, detachment of the tonsilar epitherium and of the epitherium around the lacunar layer and cell infiltration in the lacunar epitherium were remarkably observed. There was emigration of a large number of cells. In the scanning electron-microscope findings, many granular globules were widely noticed under the epitherium which detached more slightly than in the cases of 5ppm ozone exposure. (3) Exposure to the low concentrated ozone (0.2ppm) In the microscope findings, no remarkable changes were observed in the rabbits with a shortterm exposure. But as the duration of exposure was increased detachment and disarrangement of the tonsilar epitherium and in the epitherium at the entrance of the lacunae were increased. There also noted slight cell infiltration in the intra-surface layer of the lacunae. In the scanning electron-microscope findings with a high magnification, disarrangement, falling and defect of pavement of the epitherium were observed in the free surface of the tonsil against the oral cavity and around the lacunar layer.