The authors analysed the clinical findings and symptoms appeared in 53 patients with malignant tumor in the hypopharyngeal region in comparison with those in 817 patients with abnormal sensation such as a lump in the throat. As the result, it was strongly suggested that the cases with the symptoms and features listed below should be examined very carefully in order to detect hypopharyngeal malignancies among the patients with abnormal sensation in the throat. 1) Elder than 50 years of age 2) Dysphagia 3) Throat pain 4) Abnormal sensation in the throat within the course of a year 5) Smoking and/or drinking 6) Anemia
The Crib-O-Gram neonatal hearing screening audiometer, invented by Prof. F. Blair Simmons, M. D., was used from February 1980 to March 1983 to screen 1, 510 newborns in the department of neonate and premature medicine, Japanese Red Cross Medical Center. Prior to implementing the Crib-O-Gram screening tests, babies were classified into high risk and low risk infants, based on our established risk factors. At the age of 6 to 10 months, all the cases of Crib-O-Gram screened infants were followed up by a questionnaire. For all cases which showed abmoralities in the questionnaire, screenings using ABR and BOA were then conducted at 10 to 12 months. These tests showed 6 infants with hearing impairments. All happened to be high risk infants, and all but one were referred after undergoing tests on the Crib-O-Gram. It follows that among the 203 infants screened by the Crib-O-Gram and referred to more testing, 5 had hearing impairments - an incidence of 1:50. We thus conclued that Crib-O-Gram screenings should be implemented for infants who weight at least 2200g and who are at least 38 weeks of gestational age. We also found that the Crib-O-Gram can detect neurological problems.
Ninety three patients with cancer of the hypopharynx were treated in the Center for Adult Diseases, Osaka, from 1978 to 1983. According to the site of origin, these were classified to 69 piriform sinus cancers (PSC), 15 postcricoid cancers (PCC) and 9 posterior cancers (PWC). Only eight (11.8%) of 69 patients with PSC were female and three (20.0%) of 15 patients with PCC were male. In PSC patients, average of Brinkman index (B. I.) and Sake index (S. I.) were 893.6 and 83.6 respectively which were significantly high comparing with control group (p<0.02). On the other hand, in PCC patients, B. I. and S. I. were remarkably low. Four of eight female patients with PSC were smokers and drinkers. The average of B. I. and S. I. of them were 1010.0 and 72.5 respectively. These figures were similar to those of PSC in males (B. I. 950.6, S. I. 89.9). Remaining four female-patients with PSC had history of irradiation, which were done for tuberculous cervical lymphadenitis (3 cases) or cancer of the thyroid (1 case). The present conditions of these four cases were considered to be so called radiation induced cancer and had no habits of smoking or drinking. This result suggests that heavy smoking and heavy drinking are the high risk factors in the development of PSC in both male and female except radiation induced cancer patients.
The cause of the shock induced by local anesthetics remains to be unexplained. The measurements of serum electrolytes, blood sugar and serum catecholamine, the recording of electrocardiogram and blood gas analyses were performed in 46 patients during surgical intervention under local anesthesia. The results showed that the administration of epinephrine mixed with local anesthetics caused severe degree of hypopotasium. Especially in the case of nasal operation using nasal tampon immersed with epinephrine, the condition of hypopotasium stayed well over sixty minutes. Hypopotasium brought, about by the application of epinephrine is suspected to be one of the causes of the shock during operation, The authors emphasized that special attention to the level of serum electrolytes should be paid when local anesthetics are used with epinephrine.
The purpose of this study is firstly to evaluate the abnormality of autonomic nerve receptors in human nasal mucosa in nasal allergy, and secondly to define whether this abnormality of these receptors are congenital or acquired. Autonomic nerve receptors in the nasal mucosa were measured using receptor binding assay in 14 subjects with perenial nasal allergy (ages 13-41, average age 35) and 13 subjects with chronic sinusitis (ages 15-44, average age 37).As radioligands we used [3H]-quinuclidinyl benzilate (QNB) for muscarinic cholinergic receptor, [3H]-prazosin for α1 adrenergic receptor and [3H]-dihydroalprenolol (DHA) for β adrenergic receptor. Compared with the nasal mucosa with chronic sinusitis an increased density (Bmax) of muscarinic cholinergic receptors (44% increased) and decreased densities of α1 adrenergic (37% decreased) and β adrenergic (41% decreased) receptors were observed in the nasal mucosa with nasal allergy. No differences were observed between both groupes in the dissociation constant (Kd) of each ligand to adrenergic and cholinergic receptors. The organ parasympathicotonia may explain the mucosal hyperreactivity to acetylcholine observed in subjects with nasal allergy. Decreased density of α1 adrenergic receptors will result in less constriction of the nasal vasculature in response to sympathetic stimulation. Decreased density of β adrenergic receptors may promote the release of chemical mediators from mast cells and basophils. We have already suggested that hypersensitivity of nasal mucosa observed in nasal allergy is nonspecific and that it is largely a result of antigen-antibody reaction. The organ parasympathicotonia in the nasal mucosa could be reproduced with TDI (toluene-2, 4-diisocyanate) sensitized guinea pigs which showed typical symptoms both of nasal allergy and bronchial asthma. But in the guinea pigs sensitized with bacterial crystalline α amylase, which appeared typical symptoms of bronchial asthma and no apparent symptoms of nasal allergy, the increased density of muscarinic cholinergic receptors could not be observed. These results suggest that the organ parasympathicotonia in the allergic nasal mucosa is not congenital, but is acquired secondarily to antigen-antibody reaction in the nasal mucosa.
Twenty-five cases of blowout fracture were treated at Yamaguchi University hospital between 1981 and 1984. Eighteen cases were male and seven cases were female. Chief complaints and major symptoms were diplopia, disturbance in eyeball movement and disturbance of vison. Sinus-x-ray examination by occipito-frontal view, Waters' view and occipito-frontal polytomography were recommended for precise diagnosis. Ophthalmological evaluation, including Hess chart and forced duction. test should be done both preoperatively and postoperatively. Fifteen cases were treated surgically and ten cases, who did not have visual acuity loss, were conservatively treated. Among the surgically treated (15 cases), diplopia, disturbance in eyeball movement and disturbance of vision improved in 73.3%, 80.0%, 73.3%, respectively. Site of the fracture was mostly seen at the orbital floor. Postoperative results were satisfactory. The blowout fracture with such major symptoms as the loss of visual acuity should be carefully and conservatively treated for two weeks. If the symptoms remained without improvement, the surgical intervention should be considered within a month.
An electrical recording method for arm tonus reaction (ATR) was devised, and analyses of the graphs of spontaneous and post-rotatory ATR's were conducted on 34 normal subjects and 54 vertigo patients. The patterns of spontaneous ATR's were categoried as normal (Type 1) or abnormal types (Types IIa, IIb, III). Type I showed few differences in the height of the reaction between patients' left and right arms, and the normal limit of this difference was within 25mm. The abnormal types of spontaneous ATR showed a progressive downward curve of the diseased-side arm, and the so-called reversion phenomenon such as observed in the normal type curve was not detected. Although only 25% of patients with vestibular lesions showed abnormal differences of more than 25mm, the incidence of abnormality rose to 52.5% when no-reversible curves of the spontaneous ATR were detected. Moreover, the incidence of abnormality rose even more highly when the curve of post-rotatory ATR was observed. On the other hand, 75% of the cases with tumors of the posterior cranial fossa showed abnormal types of spontaneous ATR. This incidence of abnormality did not change even when observing the post-rotatorv ATR. The result of observation using electromyograms (EMG) suggested that the appearance of spontaneous ATR was caused by hypotonus of the m. triceps brachii of the diseased side. It was concluded from this investigation that ATR testing was valuable for diagnosis of the diseased side in patients with vertigo and that the electrical recording of ATR was useful in raising the detection rate of abnormalities in patients with peripheral vestibular disorders.
A total of 71 cases of squamous cell carcinoma of the head and neck were investigated in terms of the existence of a basal membrane, the type and amount of infiltrative cells and blood vessels in the interstitial tissue surrounding tumor. The existence of the basal membrane was investigated using H. E stain, PAS stain, Azan stain and ABC method using anti-human fibronectin antibody. As for the infiltrative cells, the number of cells per 1000μmm3 and the types of cells were investigated using a micrometer. Concerning blood vessels examinations of the endothelium and the basal membrane of the vessels stained by ABC method using anti-factor VIII antibody were reformed. As for clinical factors, recurrence stage, existence of the local or distant metastasis, clinical prognosis, and non-specific immunoparameters including lymphocytes, T cell and B cell populations, etc. were studied. The clinical significance of the interstitial reaction was examined statistically based on the above results. The amount of infiltrative cells showed a significant positive correlation with the clinical prognosis, immune parameter (Index of PHA × peripheral lymphocyte count), and degree interstitial fibronecrotin stain. The basement membrane of the carcinoma was composed of a collagenic membrane, separated in the interstitial tissue from the carcinoma. The prognosis was remarkably in cases with defects in the basal membrane often due to distant metastasis of the carcinoma, while an intact basement membrane was related to a good prognosis. The condition of the basement membrane also significantly correlated with the increase of fibrin in the interstitial tissue. A variety of vascular changes were observed even within the same histologic type of squamous cell carcinoma. In case with a well-defined basement membrane vessels were abundant. Immunereaction against the tumor was considered to occur mainly in surround interstitial tissue. It was concluded that interstitial tissue changes would have a clinical significance concerning therapeutic course and evaluation of prognosis in cancer lost.
The patient was a 76-year-old female. Because of heart disease she was administered on 40mg tablets of furosemide, a loop diuretic at the department of internal medicine. During taking furosemide, she noticed bilateral hearing loss, which developed into profound deafness. Therefore furosemide was withdrawn, and started treatment of steroid(Rinderon), MethycobalR and other drugs which were considered appropriate for acute sensorineural deafness. As a result, her hearing recovered. The authors described the course of deafness in this case and reviews in the literature. A search of the literature reveals no clinical case of furosemide-induced deafness in Japan, but in Western countries the following three characteristics of furosemide-induced deafness have been revealed. Briefly, (1) it is liable to occur after an intravenous bolus of 1, 000 to 2, 000mg; (2) hearing loss often occurs immediately or 10 to 20 min. after intravenous administration of the drug; and (3) the disturbance is generally transient, reversible sensorineural deafness that improves toward normal in 4 to 5 hours. Furthermore, the following three factors are considered to be related to the onset of furosemide ototoxicity; (1) dose per unit time, (2) severe renal function impairment, and (3) coadministration of furosemide and an aminoglycoside antibiotics. However, our patient was negative for renal function impairment and aminoglycoside antibiotics, and developed severe deafness after usual oral doses of furosemide. As compared to cases thus far described in the literature, our patient can be considered rather exceptional.