Recently, neck abscess or mediastinal abscess occuring from oral infection is appeared uncommonly. But, it certainly is possible that this disease is fatal if neck swelling due to infection grows rapidly and airway is obstracted progressive. When we have to treat these disease, we get the accurate diagnostic information and immediately start the appropriate treatment. Recently, we experienced 2 cases of cervical abscess and 2 cases of cervicomediastinal abscess occuring from oral infection. Anaerobic infection participated in the all of cases. In two cases, there were diabetes mellitus as the past illness. In all cases, we have done the surgery in combination with appropriate antibiotics. Now they are good in health. In comparison to the case of cervical abscess, drainaged operation was postponed in the case of cervicomediastinal abscess. These cases suggested to us that we had to do accurate and quick treatment in order to guard these patient.
Preoperative CT images of 69 cases (75 sides) of postoperative cysts of the maxilla, seen from 1982 to 1986, were analyzed as to the bony partitions bordering between the cyst and the sinus walls. Three scanned planes, i.e., middle inferior meatus level, superior inferior meatus level, and middle meatus level (each level in 0.5cm distance) were included in the study, and both medial and posterior sinus walls were investigated. The bony partitions were classified into three groups, i.e., dehiscence, thinned-out (less than 1.0mm in thickness) and normal (more than 1.0mm) groups. The dehiscence (or destruction) was seen in 50% at the anterior two thirds of the medial wall, and in 20% at the middle one third of the posterior wall.
Twenty-six cases of nasal and paranasal 'transitional' papilloma seen at our clinic during last 10 years were reviewed. Four of these 26 cases had associated malignancy. One case of papilloma showed malignant change during following up period, whereas in the other 3 cases, the initial biopsy proved the existence of carcinoma. It is considered that in two of these 4 cases carcinoma may arise from a previously benign papilloma, according to histopathologic criteria. It can be concluded that 'transitional' papilloma, in the so-called cancer-prone age, showing bleeding and evidence of bone destruction in radiological findings, has higher risk of associated malignancy. More extensive operative procedure and careful follow-up examination are strongly recommeded for such cases.
Physical examinations including inspection, palpation and endoscopy may not give us sufficient information about the neck because of its deformity and scarring induced by surgery and/or radiation. Review of CT images of 46 postoperative/postirradiation patients has afforded a new radiographic perspective. Subjects included are 29 patients with hypopharyngeal cancer, 12 with laryngeal cancer and 5 with other head and neck cancers. The effects of surgery and radiation such as edema and/or fibrosis of preepiglottic space and aryepiglottic fold on each patient were observed for a long period at least 6 months on the CT images. A reconstructed neopharynx (composed of a skin tube with subcutaneous fat) could clearly be differentiated from surrounding tissues by its low density on the CT image. Recurrences were easily found out by obtaining a follow-up CT. Nodal metastasis, local recurrences or extended invasions incidentally found by CTs in posttreatment patients may help indicate how to manage them. The purpose of this report is to demonstrate the versatility of posttreatment CT imagings and to recommend the use of follw-up CTs.
The present study was undertaken in vitro to examine the effect of histamine on the nasal vascular beds of normal and chemical sympathectomized dog and to determine the nature of histamine receptors at the adrenergic nerve terminal and vascular smooth muscle cells. Histamine, maximum concentration 10-2M, and epinephrine, maximum concentration 10-5M, increased contractile responses in a dose dependent manner. This contractile response of histamine was inhibited with each one of pyrilamine (10-4M), and cimetidine (10-4M) and the combined use of pyrilamine and cimetidine, and phentolamine (2.6×10-4M). After chemical sympathectomy, such response was also inhibited with pyrilamine (4×10-4M) and cimetidine (4×10-4M). In other observation of nasal mucosa treated with histamine (10-2M) and after chemical sympathectomy, the fluorescences were apparently reduced as compared with those of control specimens. These results indicate that histamine may be related to the release of endogenous norepinephrine and its contractile response is mediated by H1 receptor on the terminal of the noradrenergic fiber and H1-, H2- and α-receptor on the vascular smooth muscle cell. From the results thus obtained, the role of histamine on adrenergic tonic control in allergic reaction was discussed briefly.
Various solutions (saline, tap water, distilled water) with different osmolarities and with or without certain concentration of free residual chlorine were poured into the nasal cavities of 70 tracheostomized guinea pigs. The exposure durations were ranging from 5 minutes to 60 minutes. The septal mucosa was removed and observed under a light microscope and an electron microscope (H-600) with the accelerating voltage of 80KV. Histological findings of the nasal epithelium obtained were as follows: 1) Physiological saline solution (286mos/l) did not cause any obvious morphological changes after 30 minutes' exposure, whereas tap water (9mos/l) and distilled water (0mos/l) caused dominant morphological changes even after 5 minutes' exposure. 2) Thirty or 60 minutes' exposures against tap water caused exfoliation of the damaged epithelium from the basal lamina. 3) Free residual chlorine at the concentration 1ppm caused no histological damages in the nasal epithelium, whereas concentrations of 50 or 100ppm brought chemical damages in the epithelial cells. 4) Fifteen minutes' exposures against water with 1ppm free residual chlorine gave reversible minor changes in the nasal epithelium which returned to normal findings within 4 hours. Thirty minutes' exposures to water with 50ppm free residual chlorine, on the other hand, showed remarkable degenerations of the epithelial cells, most of which exfoliated from the basal lamina. Even in the severely damaged epithelium, intact basal cells remained within normal structure and some of them began to show the new cellular arrangement. According to the present experiments, it was concluded that the osmotic pressure of the injected solutions seemed to be critical to maintain the static environments for the nasal epithelium. And it was also clearly demonstrated that duration of water-exposure to the nasal mucosa is one of the most important factors to determine the degree of the epithelial damage and its reversibility.
Recently, it was reported that neutrophil affects the ethiology and process of inflammation or malignant tumor. In this paper, I estimated peripheral neutrophil chemotaxtic and phagocytic activity in patient with chronic sinusitis, nasal allergy, and malignant tumor of head and neck region. Chemotactic activity was measured by Boyden chamber method, and phagocytic activity was measured by chemilumicescence (CL) method, by which the quantity of active oxygens from neutrophils are deteced. Although chemotactic activity was not significantly different between healthy volunteers and patient with sinusitis, nasal allergy and malignant tumor respectively, chemotactic activity in patients with chronic sinusitis and malignant tumor were slightly higher than healthy volunteers. Neutrophil chemotactic activity in patient with T3 laryngeal carcinoma was significantly lower than T1 and T2 laryngeal carcinoma. Significant difference was not demonstrated between neutrophil phagocytic activity (per 1×105 counts) of healthy volunteers and that of patient with chronic sinusitis or malignant tumor. According to these results, I consider that active oxigen released by neutrophil may probably protract inflammation in chronic sinusitis and decreased chemotactic activity causes infection and tumor growth.
The transient increase in auditory evoked response amplitude was observed before the complete hearing loss after daily administration of Kanamycin (KM). Such transient phenomena in the auditory system can be seen occasionally in the basic experiments such as noise exposure experiments. The mechanism of this transient amplitude change, however, has not been well established. By examinig the course of recovery time of the depressed amplitude of the auditory evoked responses immediately after intense noise exposure, which is well known as temporary threshold shift (TTS), we obtained following results: (1) From our preliminary experimental results, the 2KHz pure tone at 115dBSPL with 10min duration was used as the exposure sound. (2) In 10 normal hearing guinea pigs without KM administration, the recovery function of auditory brain stem responses (ABR) which was evoked by 2KHz short tone burst at 95dBSPL with repetition rate of 20/sec, was examined after the completion of the sound exposure. The recovery time to the pre-exposure level (100%) was about 5min. (3) The cochlear microphonics (CM) recorded chronically from the round window after the sound exposure showed no suppression contrary to that of ABR. (4) Five of 14 animals which received 400mg/kg KM daily injection exhibited overshoots (20-100%) of the ABR amplitude after several to 10 days treatments of KM and showed sudden disappearance of the ABR about 14 days after the first administration. (5) During the period of the transient amplitude increase, the input-output curves showed a recruitment-like overshoot by high intensity sound stimuli at above 80dBSPL and a slight threshold elevation by low intensity stimuli. (6) The recovery time to the pre-exposure level after the sound exposure was about 10min in KM-treated animals at the period of the transient amplitude increase.
One hundred eighty three family lines with juvenile unilateral total deafness treated in the authors' clinic to children with sensori-neural hearing loss during 15 years from 1970 to 1985 were studied. Their clinical history and the results of hearing, tomography, caloric tests and pedigree patterns were investigated. A total of 553 relatives were examined for their hearing by the audiometry. Following results were obtained. 1. In the 183 family lines with juvenile unilateral total deafness, there were 10 cases of 5 family lines (or 2.73%). Their family lines were 3 cousin's families, 1 brother's family and 1 aunt and boy's family. 1 case of 10 cases was found to have inner ear deformity in the side of hearing loss. 2. The total of family lines with sesori-neural hearing loss relatives were 75 family lines (or 41.0%). The family lines with unilateral deafness relatives were 37 (or 20.2%). The family lines with bilateral sesori-neural hearing loss cases were 45 (or 24.6%). 3. The occurring rate of hearing loss in relatives with unilateral total deafness was higher than in normal hearing cases. That rate in lower children was 3-7% (0% in normal hearing cases), and that in the age of 30-40 years old was 14-35% (4-10% in normal hearing cases). 4. Summing up, it may be concluded that the occurrence of unilateral total deafness is related to the hereditary nature, and there are hereditary unilateral total deafness cases.
The activity of the primary horizontal canal neurons was investigated in alert and anesthetized guinea pigs.The average resting rate in the alert guinea pigs was 47.3±21.2 spikes/sec. These values were significantly higer than those from anesthetized animals which had an average rate of 39.1 spikes/sec. In alert animals the average gain from a total of 66 units tested at 0.3Hz sinusoidal rotation was 0.42±0.37 spikes/sec/deg/sec and this value was not different from the results for anesthetized guinea pigs. The average phase lag for the angular acceleration was 57.3±20.7 degrees in alert guinea pigs, and this was significantly smaller than that for the anesthetized animals. The number of cutoff neurons at 0.3Hz was one out of 67 neurons in the alert guinea pigs and seven out of 64 neurons in the anesthetized guinea pigs. The vestibular efferent system is most likely to be responsible for these different results from alert vs anesthetized guinea pigs. This system appears to help control the generation of functional distortion of the semicircular canal endorgans, when mechanical stimulation is trasformed to neural activities.
Mechanical properties of the vocal fold have been investigated by means of ultrasonic variant M mode. Vibrations of the vocal fold elicited by a single rectangular pulse were displayed on an oscilloscope. These oscillation waves were analysed by a wave analyser with fast Fourier transform, and resonance frequency, Q value, and damping ratio of the vocal fold in vivo and in vitro were obtained, respectively. In the present study, the damping ratios were mainly discussed in various cases as follows; normal vocal folds in vivo, normal vocal folds of totally excised human larynges loaded with tension or a mass, vocal folds with unilateral lesions such as polyps, recurrent nerve paralysis and cancer. Results 1) As phonation pitches were higher, the damping ratios of the vocal fold significantly decreased at phonation neutral gesture. In the excised larynges, as loaded tension stronger, damping ratio also decreased. These results suggested that damping ratio was correlated with the tension of the vocal fold. 2) In the vocal fold with polyp or cancer without vocal cord fixation, higher damping ratios were obtained when compared with healthy side. The damping ratios increased when the vocal folds of the excised larynges loaded with a mass. Mass effect of the vocal fold could be related to the damping ratio. 3) In the vocal fold with recurrent nerve paralysis, damping ratio increased and in the fixed vocal fold with cancer, damping ratio decreased. Stiffness of the vocal fold altered by these lesions changed the damping ratios. 4) The damping ratios of the normal vocal fold during quiet respiration ranging from 0.091 to 0.144 (mean value 0.116±0.014). The damping ratios of male (mean value 0.121±0.016) was slightly higher than that of female (mean value 0.108±0.006). 5) Lower resonance frequencies in comparison with healthy side were obtained in the vocal fold with polyp, cancer without fixation, and with recurrent nerve paralysis. In the case of fixed vocal fold with cancer, the resonance frequency was markedly higher. These results were nearly accordant with the data of the previous investigations obtained by continuous sinusoidal wave.
In this study, an attempt was made to understand functional roles of Deiter's neurons (cells of origin contributing to the vestibulo-spinal tract) for postural control. The acute precollicularpostmammillary decerebrate cats which were maintained in a reflex standing posture with or without external support were employed. During standing, the force exerted by each of the hindlimbs was measured by a force transducer placed underneath the foot along with the electromyographic activities of hindlimb extensor muscles. The force and the EMGs were considered to represent the degree of hindlimb muscle tone. To perturb standing posture, the dorsal portion of the caudal tegmental field in the pons was selectively stimulated by means of a microelectrode. The stimuli consisted of pulse trains (duration 0.2ms; frequency 50 pulses/s) lasting 5s at intensities ranging from 20 to 60μA. Such stimuli decreased the tone of the hindlimb muscles. The decrease in the force and tonic discharges of extensor muscles increased with an increase in stimulus intensity, and persised even after termination of the stimulation. During this period the cat was able to maintain standing posture only with the aid of external support. Deiter's neurons (n=62) discharged tonically during reflex standing of the cat. There were, however, no significant relation between the firing frequency of neurons and the level of hindlimb muscle tone. During postural disturbance, most Deiter's neurons (n=54) increased their firing frequencies. The faster and the larger were the force decrease, the greater the phasic increase in the firing frequencies of neurons. Furthermore, time to the maximum firing freqencies of Deiter's neurons tended to be shorten with an increase in the decreasing rate of the hindlimb forces. During immobilization of decerebrate cats, such phasic increases in the firing frequencies were not consistently observed but the tonic increases of them remained. All these results indicate that two different neuronal mechanisms underly the increase in the firing frequencies of Deiter's neurons. One is peripheral or feedback excitation resulting in the phasic increase in the firing frequencies of Deiter's neurons, and the other is the central or feedforward excitation resulting in the tonic and the phasic increases of them possibly by pathways within the brain stem. Based on these results, it can be concluded that Deiter's neurons play an important role for compensating centrally induced postural disturbances.