日本耳鼻咽喉科学会会報
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
89 巻, 2 号
選択された号の論文の10件中1~10を表示しています
  • 西澤 典子, 真鍋 敏毅, 西澤 伸志
    1986 年 89 巻 2 号 p. 135-141
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    To establish high-risk criteria for early detection of congenital sensorinenural hearing loss, the
    study was carried out. Definition of "congenital hearing loss" in this study is hearing impairment
    diagnosed within infantile period with no definite clinical cause nor onset of disease after brith.
    Life histories of 400 children with congenital sensorineural hearing loss and of 2500 children without
    any problem of hearing were investigated in terms of familial and clinical problems until one year
    of age. 63 items were explored. In the hearing loss group, positive rates of the following items
    appeared statistically higher than in the control group; 1) family history of hearing loss with
    unknown origin, 2) bloodrelated parents, 3) malformation or congenital abnormality except
    hearing loss, 4) history of induced abortion, 5). rubella or influenza during the first half of pregnan-
    cy, 6) daily drinking in pregnancy, 7) fetoplacental disfunction, 8) birth weight less than 2500g, 9)
    assistance of incubator, 10) neonatal distress, 11) pollusion of amniotic fluid, 12) severe neonatal
    jaundice, 13) febrile disease during one year of age. Through consideration of literature, most of
    these items seemed to be related to congenital sensorineural hearing loss.
  • 高岡 佳弘, 窪田 哲昭, 吉田 篤正, 海野 博之, 岡部 英子, 堀 雅明, 白倉 真人
    1986 年 89 巻 2 号 p. 142-151
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    We have recently encountered 6 cases of tumor that developed in the parapharyngeal space (2 cases of neurinoma, a case of angioneurinoma, pleomorphic adenoma, mucoepidermoid tumor and acinic cell tumor).
    This paper reports these cases and discusses the problems on diagnosis and treatment.
    As for the surgical approaches, the oral method and external cervical incision with or without median mandibulotomy are available. Adopting the external cervical incision method for all of the six cases, we were able to remove the tumor safely. It is characteristic that the tumor is benign and large in most cases and that the site of development is anatomically complex and the surgical field is restricted. Even with the external cervical incision, therefore, the surgical field is narrow and finger dissection is necessary, though the tumor can easily be extirpated since it is surrounded by loose connective tissue without invasion.
    Whether or not the tumor is benign and the relationship between the tumor and the surrounding tissue should therefore be studied throughly before surgical procedure.
    We have stressed that the CT examination is the most useful for this purpose.
  • 福武 知重, 野添 恒幹, 山下 敏夫, 熊沢 忠躬
    1986 年 89 巻 2 号 p. 152-161
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    Twenty laryngectomees underwent voice rehabilitation using the Blom-Singer voice prosthesis. A Duckbill prosthesis was utilized in 11 patients, while a Trapdoor prosthesis was in 9 patients. Five of the 20 cases inadvertently lost their prostheses prior to speech training. Eleven of the remaining 15 achieved fluent speech. The airway resistance value, success rate, fluency of speech and phonatory functions were compared between the two groups using the different types of prostheses. The Trapdoor prosthesis exhibited a lower resistance and produced more fluent speech. However, there were no differences in success rate and phonatory functions between the two groups. Fluency of speech correlated closely with the expiratory pressure during phonation, so that the handling of the inferior pharyngeal constrictor, which controls expiratory pressure, seemed to be the most important factor in the success of voice restoration using the Blom-Singer voice prosthesis.
  • 今井 昭雄, 中野 雄一
    1986 年 89 巻 2 号 p. 162-166
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    Mastoid obliteration with autogenous cortical bone flakes and chips was performed in 113 ears. In some cases, pedicle periosteal flaps and/or free cartilagenous grafts from conchal cavity were used simultaneously. The reconstructed posterior canal wall had a tendency to widen slightly, and local infection did not occur. Clinically 80% of the cases were assessed as success.
    Hearing results were not at all superior to the closed method of tympanoplasty.
    The surgical method was safe and usefull for obliteration of cavity in contrast with mastoid obliteration using a pedicle muscle flap.
    In cholesteatoma cases, it is very difficult to reconstruct the well aerated mastoid cavity. The method to obliterate the mastoid and to open the epitympanum to the external canal is recommended for prevention of a retraction pocket.
  • 阪上 雅史, 酒井 俊一, 佐野 光仁, 原田 保, 松永 亨
    1986 年 89 巻 2 号 p. 167-172
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    The permeability of blood vessels of the modiolus, especially cochlear plexus, in rats and guinea pigs has been studied ultrastructually by tracer experiments with horseradish peroxidase (HRP). Extravasation of intravenously injected HRP spread into intercellular spaces, but not outside the cochlear plexus. The capillary endothelium showed fenestrae with single-layered diaphragm, high distribution of labelled pinocytotic vesicles and penetration of HRP through endothelial tight junctions. On the other hand, blood vessels within the modiolus except for the cochlear plexus did not allow to leak HRP.
    These findings suggest that tight junctions bordering the cochlear plexus play a role in a part of the blood-perilymph barrier, whereas other blood vessels within the modiolus themselves act as the barrier.
  • 第2報 回転刺激に対する応答
    八木 聰明, 上野 博史
    1986 年 89 巻 2 号 p. 173-176
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    Physiological characteristics of first order horizontal canal neurons, especially in their response to angular acceleration, were studied in 20 albino guinea pigs. The stimulus frequencies from 0.05 to 0.9Hz at the pendular angle of 25 degrees were employed in this experiment.
    The average sensitivity of neurons to the angular velocity at the frequencies employed was about 0.4 to 0.5 spikes/sec/deg/sec. The Bode plots of the gain (10 log gain re acceleration) and phase lag against the logarithms of frequency were similar to those obtained in pigmented guinea pigs reported by Curthoys.
  • 川出 和彦, 横井 久, 柳田 則之
    1986 年 89 巻 2 号 p. 177-191
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    When anticancer drugs are used clinically, steroid hormone are combined commonly for prevention of the side effects. We studied the cochlear damage by anti-cancer drugs (Nitromin, Cisplatin) and the infuluence of steroid hormone against this damage, in guinea pigs. Now, we observed the cochlear damage by Nitromin or Cisplatin with or without steroid hormone. Nitromin was administered intracardially by one shot, while, Cisplatin was administered intraperitoneally for 5 days once a day. We measured Nitromin-concentration in cochlear emulsion, and Pt-concentration in cochlear emulsion and blood. This damage was also observed morphologically by sccanning electronmicroscopy and light microscopy.
    The following interesting findings were obtained:
    (1) As for the Nitromin-induced cochlear damage, it was observed mainly in outer hair cells, and it started at the lower basal turn in about 8 hours after administration of Nitromin. In case of the combined steroid hormone, the degree of this damage was more severely and broadly. However, it was impossible to measure the Nitromin-concentration in cochlear emulsion.
    (2) As for the Cisplatin-induced cochlear damage, it was observed mainly in outer hair cells, too. The degree of this damage were not depended on Pt-concentration in blood, but in cochlear emulsion. Pt- concentration in blood with steroid hormone was more lower than that without steroid hormone. However, Pt-concentration in cochlear emulsion with steroid hormone was more higher than that without steroid hormone, in one hour after adminstration. But, the former was more lower than the latter, in 24 hours after administration. In case of the combined steroid hormone, the degree of this damage was more severely like a Nitromin-induced cochlear damage.
    Therefore, steroid hormone would accelerate the drug-permeability into the cochlea when we conjectured this cause.
  • (第1報 臨床編)
    菊池 章
    1986 年 89 巻 2 号 p. 192-196
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    Electroneurography (ENoG) is an electrophysiological diagnostic method for predicting the prognosis of peripheral facial palsy. It provides an electric stimulation to the facial nerve from the stylomastoid foramen and records mainly the orbicularis oris muscle contraction by surface electrodes, and the prognosis is evaluated in terms of the ratio of the amplitude of the normal side to that of the lesion side (ENoG value). In 175 patients with Bell's palsy seen within 2 weeks after the onset and given a conservative therapy in our department, recovery of the facial movement (May's score modified by Hosomi) at 1, 2 and 6 months after the onset and the appearance of sequelae were examined. Diagnostic criteria of the prognosis were formulated on the basis of the ENoG values within 2 weeks after the onset.
    The criteria indicated that patients with an ENoG value above 40% almost recovered within a month without any sequela, those with an ENoG value of 20-39% almost recovered within 2 months with a 1/10 incidence of sequela and those with an ENoG value of 5-19% recovered in many cases within 6 months. The incidence of sequela was 1/5 for those with al ENoG value above 10% and 1/2 for those with an ENoG value below 10%. In patients with an ENoG value of 0-4%, the ENoG value was mostly 0% without sufficient recovery even after 6 months in whom the sequela amounted to 1/2.
    The present criteria provide a larger advantage for precise evaluation than the conventional Esslen's criteria in that the former permits more patient distribution of cases, detailed assessment of the prognosis and quantification of the incidence of sequela. It was also found that 10-19% was a clinical critical limit below which a complete recovery was not expected.
  • (第2報 基礎編)
    菊池 章
    1986 年 89 巻 2 号 p. 197-202
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    To elucidate the pathology of facial palsy due to a paralyzed facial nerve of the corresponding severity, an experimenal rat model was prepared by compression of the facial nerve with a pean's forceps for 30 seconds. The electrophysiological and histological changes of the facial nerve in this model were examined. ENoG was performed under general anesthesia 3, 5, 14, 28 and 56 days after induction of facial palsy. The buccinator ramus of the facial nerve proximate to the parotid gland was excised and immediately fixed with glutaraldehyde and osmium tetrodoxide. After dehydraion, it was embedded in epoxy resin for light and electron microscopy.
    The mean ENoG value was 13% on the 3rd day, 18% on the 5th day, 27% on the 14th day, 32% on the 28th day and 78% on the 56th day, indicating recovery with time. Light microscopy revealed a reduction of residual myelinated nerve fibers in the beginning, which were reduced on the contralateral side to 33% on the 3rd day, to 16% on the 5th day and to 5% on the 14th day; however, they increased to 28% on the 28th day and 51% on the 56th day. The ratio of myelinated fibers' increased in parallel with the ENoG value but with a 10 day delay. This delay was due to the 10mm distance between the electrically stimulated region and the excised region. Electron microscopy revealed no distinct evidence of degeneration on the 3rd day, but on the 5th day a high density area within the axis cylinder appeared, and degenerative changes such as disappearance of microfilaments and microtubules were observed. On the 14th day, the nerves had almost completely gone with the exception of only myelinated fibers and Schwann cells. By the 28th day these degenerative changes had reversed and myelinated fibers had increased. A numerous myelinated fibers were visible on the 56th day.
    These findings indicate that this experimental model of facial palsy corresponding to approximately 13% ENoG is a pathological condition from perfectly which complete recovery can be made. Reinnervation in possible because the surrounding connective tissue in preserved, despite Waller's degeneration.
  • 谷口 俊夫, 藤谷 哲造
    1986 年 89 巻 2 号 p. 203-209
    発行日: 1986/02/20
    公開日: 2008/03/19
    ジャーナル フリー
    It is generally accepted that an imbalance of the autonomic nervous system is one of the factors to cause allergic symptoms. It is reported that the parasympathetic nerve is predominant in the patients with allergic rhinitis and that autoantibodies to β2 adrenergic receptors may mediate β adrenergic hyporesponsiveness in allergic rhinitis and asthma. Our purpose of this study was to investigate α adrenergic, β adrenergic and muscarinic acetylcholine receptors in the inferior turbinate of allergic rhinitis. The nasal mucosa was obtained from 17 patients with allergic rhinitis who demonstrated a positive skin test, positive provocation test and marked eosinophilia in nasal secretion. As a control, samples were obtained from 14 patients with hypertrophic rhinitis and nasal obstruction. The nasal mucosa of the inferior turbinate was resected and stored at -80°C. It was homogenized with a polytron and then centrifuged at 24000g for 20 minutes. The final supernate was made of to suspense the pellet. As radioligand, 3H-DHE, 3H-DHA and 3H-QNB were used. Using these radioligands, a adrenergic, β adrenergic and muscarinic acetylcholine receptors were identified. Binding affinity (Kd) and maximum binding(Bmax) of these receptors were determined according to the method of Scatchard. In patients with allergic rhinitis, the Bmax values of a adrenergic receptors, β adrenergic receptors and muscarinic acetylcholine receptors were 124.8±33.1 (mean±SEM) fmol/mg protein, 45.57±18.20fmol/mg protein and 222±75fmol/mg protein, respectively. In those with hypertrophic rhinitis, the Bmax values of those were 200.2+53.3 (mean±SEM) fmol/mg protein, 59.84± 24.48fmol/mg protein and 184±56fmol/mg protein, respectively. The Smax values of α adrenergic receptors were reduced significantly in patients with allergic rhinitis compared with those with hvpertrophic rhinitis. But those of β adrenergic receptors were not reduced significantly. Those of muscarinic acetylcholine receptors were not increased significantly in patients with allergic rhinitis compared with those with hypertrophic rhinitis. In patients with allergic rhinitis, the Kd values of α adrenergic receptors, β adrenergic receptors and muscarinic acetylcholine receptors were 1.41±1.00 (mean±SEM) nM, 0.56±0.28nM and 2.94±1.00nM, respectively. In those with hypertrophic rhinitis, the Kd values of those were 1.21±0.69nM, 0.48±0.13nM and 2. 72±1.44nM, respectively. There was no significant difference in the Kd values between patients with allergic rhinitis and those with hypertrophic rhinitis. We consider that a significant decrease of the Bmax values of α adrenergic receptors in patients with allergic rhinitis compared with those with hypertrophic rhinitis was based on down regulation.
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