Three cases of gastrointestinal bleeding observed on the patients with head and neck tumor, who were treated by the combined method, were presented. They were 53-year-old male with advanced squamous cell carcinoma of the mouth floor, 81-year-old female with the gingival carcinoma and 59-year-old male with advanced malignant lymphoma of the paranasal sinus. Two cases died of general weakness caused by the gastrointestinal complication. In the advanced or aged patients of head and neck tumors, special care should be taken for the general condition because complications occur often during the treatment. The effects on gastrointestinal tract during the combined treatment were discussed from the viewpoint of the following items; 1) characteristics of head and neck tumors, 2) an influence of postoperative and emotional stress, 3) after-effects of irradition, 4) side effects of the drugs such as oncolytics or antibiotics or steroid hormones, and 5) the age and general condition of the patient.
Atypical saccadic nystagmus was observed preoperatively (prior to reoperation) in a patient with recurrent neurinoma of the left acoustic nerve. The eye movements were identical with those described by Alpert et al as saccadic nystagmus in amplitude (2 to 4 degrees), frequency (2 to 3Hz) as well as in the fact that they are fixation-induced, continuous, conjugate-horizontal, square wave-like oscillations of both eyes, the only difference being that they are elicited only with upward gaze. Postoperatively, these oscillatory movements of the eyes disappeared and at the same time marked improvement of trunk ataxia was noted. Other neurological findings (left-sided cerebellar hemiataxia, gaze nystagmus, a disturbance of horizontal optokinetic nystagmus and of horizontal smooth following eye movements and symptoms of left cranial nerve involvement) remained unimproved or even worsened after operation. A lesion responsible for the occurrence of saccadic nystagmus is thus suggested to be located in the cerebellar vermis in the present case.
A standard olfactory acuity test using T & T olfactometer has recently been developed and gradually becomes in wide use, while the conventional intravenous olfaction test is also widely used. In the present experiment we studied the relationship between results of these olfactory tests and prognosis in 180 patients with olfactory disturbances who had received the nose-drop treatment with glucocortico steroid hormone. As a result, cure or improvement was attained in 88 percent of the patients who gave a positive reaction to the standard olfactory acuity test and in 66 percent of those who were judged to be scaleout in this test. In the case of the intravenous olfaction test, cure or improvement was attained in 90 percent of cases which gave a positive reaction and in 40 percent of the negative cases. Particularly in reference to the patients who gave a negative reaction to the intravenous olfaction test, one out of 65 cases attained cure and 39 cases remained unchanged. The intravenous olfaction test proved most effective among the tests to tell the prognosis of olfactory disturbances.
Measurements of attic and tympanic cavity were performed in 45 normal adults (90 sides) using Polytome. Cochlear plane in the sagittal projecction and tympanum (ossicular) plane in the lateral projection were used for the measurements. In the cochlear plane, a horizontal line running through the base of the radiological spur was used as a line separating the attic from the tympanic cavity (mesotympanum). In the tympanum plane, a similar line passing the anterior tympanic spine was used. The results of measurements were as follows: in the cochlear plane, height of the attic 7.2mm, width of th attic 7.3mm, and length of the radiological spur 3.7mm, and in the tympanum plane, height of the attic 6.1mm, anterior-posterior diameter of the attic 7.7mm, height of the tympanic cavity 10.3mm, and anterior-posterior diameter of the tympanic cavity 8.9mm. No statistically significant differences were seen between the right and left sides. In almost all the measurements, the male showed larger values than the female and statistically significant differences were seen in the height, width and anterior-posterior diameter of the attic. There was a close correlation between the height and the anterior-posterior diameter of the attic, but little correlation between values of the attic and those of the tympanic cavity.
The first case of vagal body tumor in Japan was reported. A 49-year-old woman complained of hoarseness for five years. A firm mass which was deeply located behind the left angle of the mandible was recognized. The left faucial tonsil was displaced forward and the left walls of the epipharynx, mesopharynx and hypopharynx were swollen by the parapharyngeal tumor. Paralysis of the left X and XII nerves was also noted. X-ray (axial position) and C-T scan demonstrated tumor shadow below the left floor of the middle cranial fossa. No destructive change in the cranial and other bones was observed. Carotid angiogram revealed that the tumor was of high vascularity and that the bifurcation of the carotis was not widened. The tumor was removed by radical neck dissection, combined with simple mastiodectomy and removal of the styloid process, by which the base of skull, foramen stylomastoideum and foramen jugulare were exposed. The carotis interna was ligated because the tumor was very vascular and firmly adherent to the surface of the vessel, but no serious complications followed. The resected tumor was well encapsulated, measuring 6×3×3cm. No evidence of recurrence has been found up to the present. We considered that carotid angiography was the most important examination for the diagnosis of vagal body tumor.
In the previous reports, we have demonstrated that, in the patients with nasal allergy, the basophilic granular cells (BGC) increase in the nasal secretion. These cells are thought to originate mostly from the blood basophils and to play an important role in the manifestation of nasal symptoms. We carried out this study in order to elucidate the mechanism of BGC appearance in nasal secretion after the exposure to the antigen in patients with Japanese ceder pollinosis. The following parameters were chosen; 1) the basophilic leukocytes count of peripheral blood 2) the degree of the nasal symptom, 3) the degree of nasal provocation reaction, 4) the numbers of BGC in nasal secretion, 5) the appearance times of BGC in nasal secretion after nasal provocation, 6) the serum IgE and serum IgE antibody levels, 7) the percent histamine release from leukocytes. The parameters were measured both in a pollination season and in an off-season of Japanese ceder pollen. The results were as follows: 1) The numbers of BGC in nasal secretion and the degree of nasal provocation reaction were concurrently increased in a pollination season more than in an off-season. These changes were more significant in the patients with single sensitization of ceder pollen when compared with the patients who had combined sensitization to other antigens. 2) The numbers of blood basophils increased in a pollination season and decreased in an offseason. 3) The serum IgE levels remained unchanged but the IgE antibody levels and percent histamine release slightly increased in a pollination season. 4) In a pollination season, it took only 2 hours for the marked increase of the BGC in nasal secretian after nasal provocation, while in an off-season, it took longer than 16 hours. The decrease of blood basophils was observed one hour after provocation in a pollination season. We conclude that 1) the antigen exposure induces the increase of BGC in nasal secretion and 2) the increase of BGC contributes significantly to the increased sensitivity to antigen provocation in a pollination season. The mechanism of the difference of the appearance time of BGC after provocation in a pollination season and in an off-season remains unknown.
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 Ryûkyûs, 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 regions. The statistical details of malignant laryngopharyngeal 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. Laryngopharyngeal tumors (20 cases) occupied 8.8% of the malignant head and neck tumors. 2) The ratio between males (19 cases) and females (1 case) was 19: 1. 3) The age was distributed from 41 to 87 years. A peak of the incidence was in the fifth to seventh decades. The average age was 64.3 years. 4) Chief complaints of the malignant laryngopharyngeal tumors were dysphagia, hoarseness, dyspnoea, cervical lymphadenopathy, pharyngeal pain, foreign body sensation and so on. 5) The primary tumor sites were the postcricoid area of the laryngopharynx (2 cases-10%), posterior pharyngeal wall (3 cases-15%) and pyriform sinus (15 cases-75%). The primary tumor sites of 19 cases (males) were the pyriform sinus in 15 cases, postcricoid area in 1 case and posterior pharyngeal wall in 3 cases. That of only one female case was postcricoid area. 6) Histopathology of all 20 cases showed well differentiated squamous cell carcinoma. 7) According to TNM classification (UICC) and stage classification (The American Joint Committee), 4 cases (20.0%) were in stage I, 6 cases (30.0%) in stage II, 3 cases (15.0%) in stage III and 7 cases (35.0%) in stage IV. The advanced stages of III and IV were seen in 10 cases (50.0%). 8) Eleven patients were treated by external radiation (mainly cobalt 60 irradiation), chemotherapy and immuno-chemotherapy. Five patients were treated by chemotherapy and immuno-chemotherapy. Pharyngolaryngoesophagectomy was performed in one case with recurrence of tumor after radiotherapy, chemotherapy, and immuno-chemotherapy, but he was died. 9) The 3-year-crude survival rate in 7 patients was 0%.