The test-retest reliability and the threshold differences among the responses of action potential (AP), brain stem response (BSR), middle latency response (MLR), and slow vertex response (SVR) in the same individual are still uncertain. This is partly due to the fact that each response has not been obtained in the same condition. The response wave form might be affected by spontaneous EEG or various artifacts during the test period. Then, it must be one of the important things that these responses should be obtained during the same recording period. From this standpoint of view, a new device is developped, that is, so-called simultaneous recording of various kinds of responses (AP, BSR, MLR, and SVR). A single click and click train composed of 30 clicks are generated alternatively at the interval of about 3 seconds. The SVR to single click is averaged by one averaging computor. Other responses (AP, BSR, MLR) to click train are averaged by another computor with different analysis time. One series are composed of 50 click train and 50 single clicks. So, there are 50 samples for SVR and 1500 samples for AP, BSR and MLR. In the trial on 5 adults with normal hearing, it was noticed that the distribution of artifacts was almost equal among these responses. Thus, the comparative study of these responses would be possible by this recording technique.
In order for early diagnosis of the reactivation of varicella-zoster virus (VZV) in facial paralysis, viral specific IgM determination was performed by fluorescent antibody technique (FA) using anti-human IgM FITC. The sera for the examination were obtained from 16 cases of Ramsay-Hunt syndrome, 10 of Bell's palsy suspected of VZV reactivation from significant rise and/or higher antibody levels (Bell(V+)), and 9 of Bell's palsy without reactivation of VZV (Bell(V-)). The results were as followes; 1) In all the cases of Ramsay-Hunt syndrome, 7 of Bell(V+) and one of Bell(V-), VZV specific IgM antibody was found. 2) The higher was IgG antibody level, the higher IgM level was. However, IgM antibody level was always lower than IgG level in all the cases. Cases of Ramsay-Hunt syndrome tended to have higher IgM and IgG antibody levels than those of Bell(V+). 3) In most cases, IgM antibody was shown during a few months after the onset. 4) Generally, the antibody levels by neutralization (NT), FA (IgG), and immune adherence hemagglutination (IAHA) fluctuated in the same pattern, but the level by complement fixation (CF) was lower than those by NT, FA, IAHA. The levels of IgM and by CF were decreased earlier than those of the three other methods. 5) It was concluded that viral specific IgM determination by FA was useful for early diagnosis of Bell(V+).
Thirty-five cases of Sjögren's syndrome were presented. These cases were analyzed in terms of age, presenting symptoms, laboratory findings and immunoserological examinations, sialographic findings of the parotid gland, histopathological findings of the minor salivary gland in the lower lip and ophthalmological examination. Taste, smell and nasal mucociliary function were examined in certain subjects. All the patients were female. The average age was 47.9 years at the time of diagnosis. Sixteen patients had sicca syndrome alone and 19 were complicated by connective tissue disorders. There was no statistically significant difference in the results of the above mentioned analyses but ESR between the two groups. Keratoconjunctivitis sicca was noted in 75% and enlargement of the salivary glands was present in 43% of the patients. Hypergammaglobulinaemia was present in 90% and a marked elevation of IgG was found with a slight increase in IgA and IgM levels. Rheumatoid factor was positive in 80% of the patients. Parotid sialograms revealed severer changes than punctate sialoectasis in all the patients. The most prevalent finding in sialograms was globular sialoectasis, which was found in 45.7% of the patients. In labial biopsy, more than moderate infiltration of lymphoid cells was observed in the minor salivary gland. Focal involvement of lymphoid cells was predominant in 56.7% of the patients. Sialographic and histopathological studies correlated well. However, there was a tendency toward higher scoring in the histopathological findings than the sialographic. Both sialographic and histopathological examinations were essential for the diagnosis and evaluation of the severity of the disease. A general discussion on the methods of treatment was also given, including steroid, radiation and immunosuppresive therapies.
Five nasal and paranasal papillomas were examined microscopically (i. e, stereoscopically and histopathologically) and ultrastructually (i. e. scanning electron microscopically and transmission electron microscopically). The following results were obtained. 1. Characteristics of stereoscopical findings The surface of papilloma showed various findings comparatively smooth surface; shallow dendritic or reticular wrinkles; a mass of coarsely granular or papillary prominence; many sharkskinlike spinous processes. There was a correlation between the appearance of the hematoxylin-stained surface and the histological findings. That is, the area consisting of columnar epithelia was uniformly stained; that consisting of columnar epithelia and transitional epithelia or squamous epithelia was stained irregularly; that consisting of transitional epithelia was poorly and irregularly stained; that consisting of squamous epithelia and that lacking epithelia were not stained. 2. Characteristics of histopathological findings The surface of papilloma was characterized by metaplasia. Papillomatous epithelia were composed of one or mixture of ciliated columnar epithelia, transitional epithelia, and stratified squamous epithelia. According to the growth of papillomas, they can be classified into exophytic or inverted. Papillomas observed in this study revealed both exophytic and inverted growth. Mitosis was observed in all cases and some differentiating cells also showed mitosis. Abundant inflammatory cells were observed in the intraepithelial layers and the stroma. Slightly atypical cells were observed. 3. Characteristics of scanning electron microscopic findings Ciliated cells, secretory cells, and non-ciliated cells were observed in the area consisting of columnar epithelia. Only non-ciliated cells were observed in the area consisting of transitional epithelia. Only squamous epithelial cells were observed in the area consisting of squamous epithelia. Papillomas consisted of one or mixture of these epithelia. In general, the papilloma was characterized by many exfoliative cells. 4. Characteristics of transmission electron microscopic findings Mitotic figures were frequently observed especially in the basal cells and sometimes observed in the differentiating cells. Fragmentation and loss of the basement membrane were rarely observed. Some of the basal cells were protruded into the stroma. The superficial cells consisted mainly of cells which had degenerated, had been exfoliated, and were immature. Virus-like particles were not observed. These histological findings (namely metaplasia, fragmentation of the basal membrane, mitoses of the intermediate cells and others) of nasal and paranasal papilloma are sometimes in accordance with those in cases of cancer. Therefore, it was suggested that papillomas are morphologically located between cancer tissues and normal epithelial tissues.
Statistical observation of 226 cases of head and neck tumors, during the period of April, 1973, when Department of Ear, Nose and Throat was commenced, March, 1978, was done at the Department of Otolaryngology, University Hospital of the RyÛkyÛ, College of Health Science, Okinawa. The head and neck tumors were found in approximately 4.0% of all the ENT patients in each year. The number of the patients and the locations of the malignant tumors were as follows: 38 cases (16.8%) in the oral cavity, 76 cases (33.6%) in the pharynx, 53 cases (23.5%) in the larynx, 42 cases (18.6%) in the nasal and paranasal cavities, 2 cases (0.9%) in the acoustic organs and 15 cases (6.6%) in the other head and neck region. The statistical details of malignant pharyngeal tumors were as follows: 1) Epipharyngeal tumors were found in 18 cases (23.7%), oropharyngeal tumors in 38 cases (50.0%) and laryngopharyngeal tumors in 20 cases (26.3%) out of total 76 cases. Oropharyngeal tumors (38 cases) occupied 16.8% of the malignant head and neck tumors. 2) The ratio between males (30 cases) and females (8 cases) was 3.75 and 1. 3) The age was distributed from 31 to 83 years. Its high incidence was noted in the sixth and seventh decades. The average age was 60.0 years. 4) Initial symptoms of the malignant oropharyngeal tumors were pharyngeal pain, foreign body sensation, dysphagia, cervical lymphadenopathy, pain in swallowing and so on. 5) The primary tumors sites were the lateral wall of the oropharynx (22 cases 57.9%-21 cases in palatine tonsils), anterior wall (6 cases 15.8%), superior wall (10 cases 26.3%) and posterior wall (0 case 0%). 6) Histopathologically, squamous cell carcinoma was found in 26 cases (68.4%), malignant lymphoma in 11 cases (28.9%)-reticulum cell sarcoma in 10 cases and malignant mixed tumors in 1 case (2.6%). 7) According to TNM classification (UICC) and stage classification (The American Joint Committee), 7 cases (18.4%) were in stage I, 6 cases (15. 8%) in stage II, 14 cases (36.8%) in stage III, 10 cases (26.3%) in stage IV and last one (2.6%) was unknown. The advanced stages of III and IV were seen in 24 cases (63.2%). 8) Most patients were treated by external radiation (mainly cobalt 60 irradiation), chemotherapy and immuno-chemotherapy. 9) The 3 year crude survival rate in 12 patients with malignant oropharyngeal tumors was 25.0%.
The evaluation of isolated bacteria from patients with acute otitis media varies among investigators, and to elucidate this problem microbiological investigations and a study on the related host defense mechanism were carried out in a total of 183 out-patients between December 1977 and December 1978. Middle ear fluids were aspirated when the patients were first seen and again 24 hours later. The following results were obtained: 1) Sole strain was isolated in 134 cases. On the initial investigation, Haemophilus influenzae was the most frequent organism grown from the fluids in children under 5 years of age. Staphylococcus aureus (S. aureus) was predominantly isolated from the patients older than 6 years of age. The predominant organisms except S. aureus isolated in the first visit altered to S. aureus in 20. 9% of the patients in the reexamination after 24 hours. 2) Mixed isolates were found in 49 cases. It was observed that in many cases the mixed isolates including both low and high pathogenic strains in the first examination had changed into the single strain high pathogenicity 24 hours later. An increasing frequency of low pathogenic organisms was remarkable particularly in older patients. 3) Nitroblue-tetrazolium test; A significant increase in number and percentage of NBT-positive neutrophils were noted in patients with leukocytosis (104/mm3 or more) and fever (above 37.5°C), and notably in patients with S. aureus infection. 4) Serum immunoglobulins; It was impossible to obtain the satisfactory result on the correlation between each immunoglobulin (IgG, IgA and IgM) and acute middle ear infection. 5) Our conclusion was that the isolates from middle ear fluids are varied with the passage of time and the relationship between host defense mechanism and parasite.
Cryosurgery has now been widely utilized in the treatment of malignant tumors. In spite of many experimental and clinical studies, the true mechanism of cryotherapy remains uncertain yet and the most appropriate modality in cryotherapy is not well established. The present study was performed to try to elucidate the mechanism by light and electron microscopy. Both transplanted syngeneic mammary adenocarcinoma 755 of C57BL/6 and human squamous cell carcinoma of the head and neck regions were treated. The degree of the tissue damage was campared in terms of the following four conditions, 1) when the tumors were treated either by freezing alone or freezing-thawing, 2) when the tumors were treated either at -180°C by liguid nitrogen gas or -70°C by nitrogen oxide gas, 3) when the tumors were treated by one- or three- cycled cryosurgery, and 4) when the area of treatment was either limited to the tumor mass or included the surrounding tissues. The main histological change was the destruction of cell membrane. Cryonecrosis was presumably due to the destruction of cells during thawing subsequent to freezing. It is concluded from our data that to carry out effective cryotherapy, the tumor mass should be treated including wide margin of normal surrounding tissues by three-cycled freezing-thawing at -180°C.