The electron microscopic study of an extramedullary plasmacytoma of the pharynx was performed and the results were as follows: 1) The electron microscopic features of pleomorphic tumor cells were consistent with that of plasma cells. 2) The tumor cells had a mature-appearing, well-organized cytoplasm with abundant rough endoplasmic reticulum. 3) In contrast to the cytoplasm, cells had immature nuclei with very little chromatin aggregation or with scattered small aggregations of chromatin. Nucleoli were frequent, and in some cells were prominent. 4) Tumor cells demonstrated nuclear/cytoplasmic asynchrony with cytoplasms disproportionately mature in comparison to the degree of nuclear differentiation. The degree of nuclear/cytoplasmic asynchrony was compatible with moderate asynchrony proposed by Graham and Bernier. 5) The phagocytosis of erythrocyte by the neoplastic plasma cell was observed. We reviewed the literature on the ultrastructural study of extramedullary plasmacytoma from the viewpoint of nuclear/cytoplasmic asynchrony. The correlation between ultrastructural features of the tumor cells and the clinical course of the disease was discussed.
Since the advent of various kinds of antibiotic and steroid therapy, it becomes apparent that fungal infection of the paranasal sinuses is much more common than ever reported. The lack of recongnition of this disease entity makes the scarcity of reports with effective management even though there were abundant patients with chronic sinusitis in daily clinic. We reported here 5 cases that were treated at Yamaguchi University Hospital since 1976. One of the cases was presented precisely. The treatment of the fungal infection of the sinuses was re-evaluated from the standpoint of empirical and literature view. Our trial of systematic antifungal therapy is emphasized, which consists of: 1) surgical intervention, meticulous sinusotomy to open every cells and keep the effective drainage and ventilation. 2) postoperative infusion-irrigation with simple saline solution and Rivanol-oxyful solution and 3) irrigation with antifungal solution such as Amphotericin B (0.1-1.0%) in Aspergillosis and others.
The radical operation initiated with Caldwell-Luc is generally adopted for operation of chronic sinusitis. The method, however, leaves the point that it occasionally develops hyperplasia of granulation and changes the operative cavity due to re-infection in the postoperative course. Then the route to the proper nasal cavity is closed to induce occasional onsets of postoperative maxillary cyst. The operation method established in an attempt to improve this point is Akaike's sinoplasty. The author has conducted the sinoplasty for patients with chronic sinusitis. The postoperative course was investigated on subjective symptoms, endoscopy, roentgenography, and histopathological tests for comparison with that in the cases of radical operation. No appreciable difference was seen in the postoperative symptoms between the two groups of sinoplasty and radical operation. Endoscopy of the patency of the intranasal ethmoid sinus and naso-antral openings revealed no specifically appreciable difference between the two groups, but the patency of the inferior nasal meatus was more favorable in sinoplasty than the radical operation. The X-ray contract radiography and laminagraphy of the patency of naso-antral openings and ethmoid sinus revealed almost the same results. Histopathology of the postoperative maxillary sinus revealed that the mucosa was less edema and the cell infiltration and growth of connective tissues were prominent in about half of the treated cases of the 10th postoperative month. On the other hand, the antral tissues from radically treated cases of the end of the first postoperative month consisted of granulation with only hyperplasia of connective tissues. The emergence of squamous cells and regenerated mucosa of the columnar epithelium were noted around the 3rd or 4th postoperative month. The examination of the cases treated separately with sinoplasty and radical operation revealed that naso-antral openings created with sinoplasty were less susceptible to closure than those with radical operation and the resistivity of mucosa to infection in sinoplasty seemed to be stronger than that of the so-called regenerated mucosa following radical operation.
The precise role of skin and its products on chronic inflammatory bone destruction in middle ear cholesteatoma is still poorly understood. Inflammatory connective tissues produced in response to keratinizing epithelium, carrageenan and granuloma from open wound in the skull of rat were analyed for bone resorbing activity to determine their importance in chronic imflammatory bone resorption. Granuloma were induced in rats under the frontal scalp with three different methods: 1. As the standard granuloma inducing agent, carrageenan in the form of 1% suspension was injected. 2. Wounds were produced in the frontal area of the scalp by incising skin and suturing the edge back to prevent epithelial closure. 3. Keratin and epithelium debris were removed from rat skin, dried, powered and injected as 1% suspension. The resulting granulation tissue was excised at one, two, and four weeks after induction, examined chemically. Prostaglandine E2 (PG E2) was measured by radioimmunoassay. Osteoclast activating factor (OAF) was determined with a pre-labeled fetal bone tissue culture assay. Leucine aminopeptidase (LAP) was determinend with a coloremetric assay. Although there was variability among different samples of each granuloma, keratin granuloma produced the highest OAF activity with little decline at four weeks after induction. OAF activity from carrageenan granuloma at one and two weeke is just slightly below the activity of keratin granuloma. Wound granuloma and keratin granuloma exhibited higher PG E2 levels than did carrageenan granuloma or normal skin. The highest levels of PG E2 were found two weeks after induction. Levels of LAP in various granulomas at one week after induction were considerably higher than that of normal skin, but differed little from one another. The presence of numerous macrophages in various granulomas correlated with the degree of activity of bone resorption noted chemically. This would tend to highlight the importance of OAF, PG E2 and LAP in the resorption induced by macrophage. It leads to the conclusion that keratin debris enhances the bone resorbing capacity of granulation tissue in rats just as it does in human otitis media.
In a 15-year-old boy with congenital ocular motor apraxia the movements of the eyes and head during lateral gaze were recorded without eliminating head motility. The following characteristics of eye-head coordination were clarified. 1. The sequence of eye and head movements is divided into three periods according to the direction in which they are moving relative to one another. First, the head turns in the direction of the target and the eyes move in the opposite direction. Second, both head and eyes move toward the target, the eyes having changed their direction. Third, the head turns back from the overshooting position, while the eyes continue moving toward the target. 2. During all three periods the gaze in space, i. e. the sum of the eye and head movements, continues to shift toward the target and reaches it. 3. The patient was able to fixate a target more quickly with the head free than with the head fixed.
Ten cases with labyrinthine window ruptures associated with hearing loss and vertigo are reported. Eight cases were treated surgically, and two conservatively. Surgical exploration revealed that the round window alone was ruptured in five cases, oval window alone in one, and both windows in two. The ruptures of the windows were closed with perichondrium or fascia. After surgical intervention, the attacks of vertigo subsided, while improvement of hearing was attained only in a few cases. In 7 of 10 patients, there was a definite history of head trauma prior to onset. In the other three patients, history of severe vomiting, cough, or physical exertion prior to the onset was proved. At the onset of the disease, the auditory and vestibular symptoms did not always developed simultaneously. In four cases, vertigo developed a few hours or a few days later following the onset of the hearing loss and tinnitus. The vestibular findings of positional nystagmus, canal paresis, and fistula symptom, associated with sudden or fluctuating hearing loss, were of diagnostic value in labyrinthine window ruptures. Positional nystagmus was usually prominent especially in head hanging position or in supine position with the involved ear down, in which the flow of perilymph from the fistula increased. Positive fistula test in oval window rupture was important to determine the side of the involved windows. There was no specific type of hearing loss peculiar to labyrinthine window rupture.
Although it is well known that some cases of sudden deafness heal spontaneously, there have been very few detailed studies on their clinical courses. The present study was made to clarify the difference in audiological findings and the the clinical course of sudden deafness between spontaneously healed cases and those of healed and non-healed cases by treatment. One hundred and eighteen patients of sudden deafness visited us within 10 days after the onset. Thirty eight cases of them healed spontaneously. Eighty cases were treated with steroid, stellate blockade and/or other drugs. Auditory and vestibular functions of these patients were almost daily examined. Data obtained were statistically examined using X2-test and the following results were obtained: 1. Spontaneous healing of hearing impairment was achieved in two different groups, i. e. rapidly in one group within 10 days after the onset and rather slowly in another group within 15 days. Although effectiveness of early treatment has been emphasized, possibility of early spontaneous recovery must be taken into consideration in evaluation of the effect of treatment. 2. If the initial audiogram shows upward slope (low tone loss), trough or horizontal type, favorable prognosis can be expected. 3. Positive recruitment, Jerger types I or II are signs of good prognosis. 4. Those cases having vestibular symptoms an downward slope, abrupt high tone drop and deaf type in the initial audiogram show difficult recovery. 5. In some cases, the treatment appeared to facilitate the speed of healing. 6. From these results, it is assumed that sudden deafness consists of two different kinds of morbidity; one is reversible type characterized by low tone loss without vestibular sumptoms and another is irreversible type characterized by high tone loss with vestibular symptoms. 7. The incidence of spontaneous recovery is considered to be within the range of 32-55%. Therefore, a given treatment can not be evaluated as effective, unless the cure rate exceeds 50%.
There were many reports concerning the studies of the interstimulus interval (ISI) on SVR. However, many of them were performed at the condition of the same number of stimuli. From the viewpoint clinical application, it's desirable to study the influence of the ISI on SVR in the same test period. As the test period becomes longer, there are more chances to obtain artifacts due to change in sleep stage, restlessness and so on, and the number of test trial is limited under the long test period. I observed SVR with 5 kinds of ISI (0.4, 0.6, 0.8, 1, 3sec) in the same test period, and obtained the results as follows. (1) The amplitude of average responses had the tendency to increase as ISI became shoter and an ISI of 0.4sec yielded the maximum amplitude. (2) At the stimulus near threshold, the best result was obtained for ISI of 0.4sec, that is, this ISI showed the highest rate of response with reliable stability. In analizing these results, the increase in amplitude by increase in number of samples is greater than the decrease in the amplitude of a single response due to decrease in ISI. The threshold of evoked response for ISI of 0.4sec (SVR to rapidly repeated auditory stimuli) was lower than that for ISI of 3sec. Considering the results, SVR to rapidly repeated auditory stimuli is to be a practical use.