On performing endoscopic microsurgeries of the larynx, a conventional intubation tube may interfere not only with full exposure of entire portion of the true vocal folds but with delicate manupulation by utilizing microinstruments upon pathological changes in the vocal folds. The reason for such obstacles to be met is because the size of a conventional intubation tube is too large in its outer diameter at the level of the true vocal folds. A newly devised intubation tube, therefore, is made significantly smaller in its outer diameter for endoscopic microsurgeries. This new intubation tube comprised of two segments which are directly connected by adhesive material; it is a compounded tube, having different lumen sizes between the central and the periphery of both proximal and distal segments. The central portion of the tube is only 25mm in its length. The size of this shorter central seg ment of the tube is either French 20 or 22 which connects respectively with either French 32 or 34 in its proximal and distal segments. The cuff is of adult size. A compound tube of French 22 in its central with French 34 in the periphery parts is employed for the adult male while French 32-20-32 is used for the adult female and children. The central portion of the tube must be positioned at the level of the true vocal folds so that significant enlargement of the operating field in the larynx for allowing a surgeon the finest endoscopic microsurgeries is evident. Basic respiratory studies including flow resistance tests of this type of intubation tube and also blood gas analysis before, during and after general anesthesia with this tube are conducted with favorable results. It is concluded as a results of flow resistance studies that a newly devised intubation tube of French 34-22-34 corresponds to a conventional tube of French 26 while French 32-20-32 has approximately the same flow resistance as a conventional tube of French 24; with a newly devised intubation tube, therefore, one can significantly decrease the outer diameter of a conventional tube by the degree of French 4 or by 1. 33mm at the level of the glottis. Clinical experiences with this intubation tube in 308 cases with various pathologies of the larynx showed not only safety throughout all procedures but no complications encountered.
The phonatory function following laser surgery for glottic Tla carcinomas was investigated with 15 subjects. It was compared with the function following radiotherapy studied in 14 subjects. The results are summarized as follows: 1) The occurence of a slight or moderate degree of rough and/or breathy hoareness was more frequent in laser surgery, especially for extensive removals, than in radiotherapy. 2) An impaired phonatory efficiency resulted from laser surgery a little more frequently than from radiotherapy. 3) Following laser surgery, the amplitude of vocal fold vibration was small or zero and there was little mucosal wave during vibration, indicating that the normal vocal fold tissue was replaced with firm scar tissue. 4) An incomplete glottal closure during vibration was found more frequently after laser surgery than after radiotherapy. 5) There were no significant differences in maximum phonation time, mean airflow rate, fundamental frequency range of phonation and intensity range of phonation between laser surgery and radiotherapy.
Plasma levels of norepinephrine (NE), which are useful index of sympathetic nervous function, were measured in vertiginous patients by gas chromatograph-mass spectrometer using selected ion monitoring method. There was no significant difference in the resting plasma NE levels between healthy subjects and patients groups such as Meniere's disease, vertigo (central and peripheral origin) and sudden deafness. NE and blood pressure increased in all groups when the subjects were kept at the standing errect position. No significant differences were found in the increment of NE at the errect position, however, there was less elevation in blood pressure in patients groups, especially in Meniere's disease patients. Using another patients group of subjecus such as Meniere's disease and sudden deafness patients, pressor response for intravenously administered NE was studied. Meniere's disease patients showed hyporesponsiveness of blood pressure to exogenously administered NE. These facts suggest that sympathetic effector organs in Meniere's disease patients are functionally disturbed.
For the purpose of the examination of allergen in nasal allergy, skin test and RAST are performed, and the nasal provocation test is also examined. In order to examine and determine the allergen using a disc the nasal provocation test was conducted with 50 patients, 113 allergens in total, suffering from nasal allergy or vasomotoric rhinitis. As a method of the examination, placing allergen disc at the anterior part of the inferior turbinal, observing the different symptoms appearing within 5 to 10 minutes after provocation, and simultaneously the temperature in nasal mucosa before and after provocation was measured. The change of the temperature after provocation showed the correlation with skin test, but the concordance rate showed a low value. Moreover, it showed a good correlation with eosinophilia and with the frequency of the symptoms which appeared after provocation was made and concordance rate was high. The change of temperature showed a good correlation with the results of RAST score. As mentioned above, the nasal provocation test is useful to determine allergen, and by giving the change of the temperature the diagnosis is more accurate than the mere observation of the symptoms. It may be used for the judgement of the efficacy of the hyposensitisation and the effect of the medicaments.
Eleven patients diagnosed of subacute thyroiditis and other two patients suspected initially of subacute thyroiditis were reported and discussed. Eight patients of subacute thyroiditis have been first seen by internist and rest of them have been seen by otorhinolaryngologist of Kyushu University Hospital last five years. It is interesting to note that the patients having rather atpical symptoms and signs of subacute thyroiditis tended to visit otorhinolaryngology clinic, and the patients are given working diagnoses of acute otitis media, acute tonsillitis and so on. Two patients visited otorhinolaryngology clinic with painful tumor who received working diagnosis of subacute thyroiditis were finally found to have neck abscess and Hashimoto's disease, respectively. For exact diagnosis of subacute thyroiditis, besides checking thyroid mass, necessity of a battery of examination including BMR, blood T3, T4, TSH, 131I-uptake and ESR are stressed.
Trachoma, lymphogranuloma venereum and psittacosis are well known as human diseases caused by chlamydial infection. Between June 1979-April 1981 we treated 260 cases of a possible new infectious disease, of which the main symptom was upper deep cervical lymphadenitis, with increased CF titers of chlamydia. The disease serologically was diagnosed by the following criteria. 1) CF titer of 1:16 at the first examination. 2) A greater than four-fold difference between twice or more sera and/or a serum increased CF titer of 1:16 during tetracycline therapy. 3) The CF titer of 1:8 of a patient with upper deep cervical lymphadenitis whose member of his family was diagnosed as contracting a chlamydial infection. After the disease was diagnosed, the patients' chief complaints, symptoms and values of CF titers were analysed statistically. The complaints were otalgia 101 (38.8%), cough 90 (34.6%), fever 38 (14.6%), swelling of upper neck legion 27 (10.4%), rhinorrhea 24 (9.2%), sore throat 24 (9.2%), otalgia on opening the mouth 15 (5.8%), epistaxis 10 (3.8%), cervical pain on rotating the neck 10 (3.8%), abdominal pain 9 (3.5%), diarrhea 7 (2.7%), general fatigue 3 (1.2%), vomiting 3 (1.2%), headache 2 (0.8%) and hemoptysis 1 (0.4%). The symptoms were upper deep cervical lymphadenitis 260 (100%), nasopharyngitis 260 (100%), sinusitis 157 (57.7%), otitis media 15 (5.8%), bronchitis 14 (5.4%), splenitis 17 (6.5%), diarrhea 5 (1.9%), epistaxis 5 (1.9%), fever 4 (1.5%) and pneumonia 3 (1.2%). Their highest chlamydial CF titers were from 1:8 to 1:2048. Numbers of the cases of CF titer were 41 (15.77%) of 1:8, 97 (37.31%) of 1:16, 87 (33.40%) of 1:32, 25 (9.62%) of 1:64 and 10 of above 1:128. Serological studies for chlamydia were performed in 1982 by both National Institute of Health, Japan and the laboratory of Shionogi Pharmaceutical Co. Ltd. The studies revealed a high positive rate of psittacosis. 42 cases out of 317 acute respiratory infected patients who visited National Sagamihara Hospital (Kanagawa, Japan), between 1956-1958, were retrospectively serologically diagnosed as contracting psittacosis. The symptoms of reported cases of psittacosis in Japan are not as severe as reported cases in other parts of the world. There is great possibility that this chlamydial infected disease accounts for high percentage of reported psittacosis cases in Japan. Psittacossis is a chlamydial infection rarely contracted by humans through exposure to avian species, However, 108 (41.5%) cases out of 260 did not have any contact with birds in this study. There is a high percentage of populations of positive chlamydial. CF titer. We concluded that the chlamydial infected disease exceeds our expectations in number.
It is generally accepted that functional disturbance of the autonomic nerve is one of the causes of allergic rhinitis. Our purpose of the present study was to investigate the changes of the adrenergic innervation in the inferior turbinate of allergic rhinitis and the effect of histamine on the adrenergic fibers. Biopsied specimens from inferior turbinates of 5 patients with allergic rhinitis were freezedried for 5-7 days, treated with formaldehyde gas for one hour at 80°C and observed under fluorescence microscope, according to the histochemical method of Falck & Hillarp. Fluorescence around the glands was obviously reduced, compared with the control of non-allergic specimens. Inferior turbinates of 5 normal guinea-pigs were taken and treated with 10-3M histaminefor 10min. The pieces were immersed in ice-cold 2% glyoxylic acid solution for 30min. The specimens were stretched on glasses and heated for 4min at 100°C. The fluorescence was apparently reduced, compared with non-treated specimens. The effect of histamine on the spontaneous release of noradrenaline was investigated. Isolated inferior turbinate of guinea-pig was incubated with (H3)-noradrenaline (28.1Ci/m mol, 0.1μM) for 60min. Histamine (2×10-4M, 10-3M) increased the spontaneous release of (3H)noradrenaline in a dose-dependent manner. The action of histamine was inhibited with diphenhydramine, and not inhibited with cimetidine. This indicates that this excitatory action of histamine is mediated by H1 receptors. These results have suggested that the noradrenaline was released from adrenergic vesicles and the fluorescence was reduced by the direct effect of histamine on the terminal of the noradrenergic fiber. We consider that the hypofunction of adrenergic nerve in nasal mucosa is caused by allergic reaction.