Many authors described the clinical importance of asymmetry of the laryngeal framework. However, its pathogenesis is generally unknown. In this study, CT images of 315 Japanese subjects were investigated to define the laryngeal position relative to the midline of the cervical vertebra. The CT slice of each subject within 5mm cephalad of the cricoarytenoid joint was traced. Then, the deviation and rotation angles were measured using our method. Seventy one percent of the subjects' larynges deviated and/or rotated to the right side, while 17% to the left side. Six percent showed neither deviation nor rotation. As to the rest of 6%, deviation and rotation were in opposite directions. Besides, the length of the thyroid alae were measured in 282 subjects. Left ala was longer in 55%, and right was in 23%, and almost equal in 22%. The conclusions are as follows, 1. The majority of the subjects' CT images showed deviation and/or rotation of the laryngeal framework to the right side. 2. So called idiopathic laryngeal deviation is a case which observed in those cases with remarkable deviation and/or rotation of the laryngeal framework. 3. Aging seemed to be an important factor in accerelation of the laryngeal deviation and rotation. 4. The type of diseases and the side of mass lesions had no statistical significance in deviation and rotation of the larynx.
The purpose of this study was to clarify the mechanism of tonsillar focal infections such as pustulosis palmaris et plantaris (PPP), especially the role of tonsil on it. In 88 cases of various tonsillar diseases, i.e., PPP, chronic tonsillitis, and sleep apnea syndrome, distribution of immunocompetent cells, i.e., B cells having various immunoglobulin isotypes (IgG, IgM, IgA, IgD, IgE, IgA1, and IgA2) on their surfaces and T cell subsets, helper/inducer (CD4+) T cell and suppressor/ cytotoxic (CD8+) T cell were investigated immunohistologically using monoclonal antibodies and ABC method. The proportion of the immunocompetent cells in four anatomical sites in tonsil (germinal center, mantle zone, interfollicular area, and subepithelial area) were quantitatively studied by the image analyzer (CUE-2, Olympus, USA) and compared among various age groups and among three groups of tonsillar diseases. The difference of immunocompetent cells in tonsils between the effective group (showing marked improvement of skin lesions of PPP after tonsillectomy) and the not-effective group (showing no improvement of skin lesions after tonsillectomy) was also investigated. The results were summarized as follows. 1) Every type of Ig-positive cells in tonsils was decreased in proportion to age, especially the changes of IgG-, IgM-, and IgD-positive cells were inversely proportional to age with statistical significance. On the other hand, changes to T cell subsets with age were smaller in comparison with those of Ig-positive cells, especially the proportion of CD4-positive cells showed almost no changes in accordance with age. 2) Eighty percent of cases with PPP were classified into the effective group, whereas only 20% of them into the not-effective group. 3) IgG-, IgM-, and IgD-positive cells in tonsils of PPP were found to be significantly increased in the effective group compared to the not-effective group. In addition, in the effective group, CD4-positive cells were significantly increased in the interfollicular area and the subepithelial area of the tonsil. These results indicate that the image analysis will be a breakthrough in quantitative study on the immunohistology of the tonsil and give us useful informations in terms of the mechanism of tonsillar focal infections, i.e., immunological abnormalities in tonsils may play one of the important roles in the pathogenesis of PPP.
Surgically dangerous type of frontal sinus was first reported by Boenninghaus in 1923. The present study concerns with the types and incidence of the dangerous frontal sinus as investigated by axial scans of HRCT. A total of 286 adult and 33 infant cases was included. The anterior end of the olfactory groove was first classified into three types, i.e., normal type, obliterated type (obliterated by cancellous bone) and dangerous type (with Recessus cristae galli and Torus olfactorius). In the adult, the incidences of these types are, 67.2, 18.5 and 14.3%. In the infant, incidences are 42.4, 51.5 and 6.1%. In the adult, the incidences do not differ in sex and sides. The dangerous type was classified into moderate and severe according to the depth of Recessus cristae galli, those with 1.5-2.9mm depth are moderate and those over 3.0mm are severe. The moderate dangerous type was seen in 30 sides and severe in 46 sides. In addition to the depth of Recessus cristae galli, distances from Torus olfactorius to the anterior sinus wall and the frontal skin surface were also included. These distances tend to be larger in male.
A 40-year-old white female was seen with the chief complaint of recurrent episodes of severe pulsating occipital headache. The headache was temporarily controlled with the treatment of antibiotics only to recur. Sinus X-ray revealed an increased radioopacity in the left sphenoidal sinus. The sinus walls showed sclerotic reaction. X-Ray CT demonstrated a small piece of metalic density within the soft-tissue density. Intranasal sphenoidotomy was performed under general anesthesia. A small piece of stone, measuring 3×2×1.5mm, was found in the sphenoidal sinus, with purulent discharge and caseous concrements. Histopathologic examination of the caseous concrements demonstrated fungal hyphae with branching and septate suggesting Aspergillus sp. Chemical analysis of the stone (3mg dried weight) was done and it consisted of calcium phosphate (88%) and calcium carbonate (12%). Postoperative course for five years was uneventful, and postop. CT confirmed the aerated sphenoidal sinus.
Primary cell culture system from middle-ear epithelium of the guinea pig was established in defined condition. Mucosal cells were dispersed with enzymatic procedure and over 90% of the cell viability was obtained. Collagen gel and fibronectin coated Thermanox plate were used as culture substrates, and cultured cells on both materials formed confluent epithelial linings. Histochemical localization of succinate dehydrogenase, cytochrome oxidase and adenosine triphosphatase in mitochondria were examined. Cultured ciliated cells and some non-ciliated cells with numerous microvilli showed strong activities of succinate dehydrogenase and cytochrome oxidase. Also in vivo, normal ciliated epithelium near the eustachian tube in the middle-ear cavity of the guinea pig revealed strong mitochondrial metabolic activities. We concluded that this system would be useful for the study of cellular multiplication and differentiation systems of the middle-ear epithelium.
The absorption of Dibekacin (DKB) through rabbit's tracheal mucosa with and without nasal mucus were examined in vitro. The modified double chamber method was used for the purpose of this study. DKB solution (20mg/ml) and Hanks' balanced salt solution were put into the donor compartment (DC) and the receiver compartment (RC), respectively. A plate with a hole and the tracheal mucosa were inserted between the compartments in the order of DC, dialytic membrane, the plate, the rabbit tracheal mucosa and RC. The hole of the plate was filled with nasal mucus or Hanks' solution. The latter was used as the control. The chamber was incubated in a humidified atomosphere of 5% CO2 in air for 3 hours at 37°C. The absorption rate (AR) was obtained by dividing the concentration of DKB in RC by that in DC. The nasal mucus from patients with chronic sinusitis significantly decreased the AR of DKB compaired with that in the control (P〈0.05). The AR significantly decreased with increments in the thickness of nasal mucus by chronic sinusitis. This decreased AR was improved by the addition of N-Acetyl-L-cystein (NAC) to DKB solution in DC. NAC can cleave disulfied bonds of mucus glycoprotein and this results in the decrease of viscoelasticity of nasal mucus. The results indicate that nasal mucus by chronic sinusitis intercept the absorption of drugs through respiratory epithelium in vitro. One of the mechanisms of the intercepter may be due to the high molecular-reticular structure of nasal mucus.
The evalution of visual scoring in the ABR audiometry was performed by the two groups of scorers 3 experienced and 3 inexperienced. The sample traces of responses for visual scoring were obtained from 3 normal adults, and consisted of 300 which were deriverd from 100 each on with clicks of 0, 5, 10, 15, 20, 30dBSL and without stimulation. The forced choice method and the five confidence level method were applied from estimation when the traces were presented to the scorers separately on duplicatively. Judgment was given twice with a 2 months intervals. Results obtained were as follows: 1. The rate of positive responses in the forced choice method was 15% at 0dB and 96% at 15dB in the experienced group. 2. In the forced choice method the lowest rate that all scorers of a group had the same judgment, was 78% at 10dB in the experinced and 55% at 5dB in the inexperienced. 3. The lowest rate of the repeated judgments were same, was 90% at 10dB in the experienced and 79% at 0dB in the inexperienced. 4. The rate of the false positive response was significantly smaller in the duplicate presentation than in the separate one. 5. A tendency of great subjectivity was observed more often in the confidence level method than in the forced choice method, especially in the inexperienced group.
The development of digital radiography (DR) has made it possible to analyze the contour of the laryngeal soft tissue structures in more detail than the conventional screen-film method. We analyzed the contour of the paralyzed vocal cord during phonation using motion subtraction technique. Forty four patients with unilateral recurrent nerve palsy were examined. The images were obtained by means of frontal tomography of the larynx during quiet inspiration and normal (expiratory) phonation. Tomography during inspiratory phonation was also examined in ten patients who can perform it. The thickness of the slices was 5.0mm. The authors found that the free margin of the paralyzed vocal cord shifted by the aerodynamic power along the direction of the air flow, i.e. it shifted to the cranial direction during normal phonation and to the caudal during inspiratory phonation. The displacement phenomenon of the paralyzed vocal cord was significantly correlated with the degree of vocal cord atrophy (p〈0.01). The result would indicate that the aerodynamic power during phonation is one of the factors eliciting the higher position of the paralyzed vocal cord during phonation, in addition to its anatomical displacement due to abduction of the paralyzed arytenoid. This notion should be taken into consideration in selecting the surgical approach for the treatment of unilateral recurrent nerve palsy.
Proliferation index of biopsied specimens from 11 cases of hypopharyngeal carcinoma was studied immunohistochemically using anti-BrDU monoclonal antibody. S-phase cell labelling index (SLI) was measured and compared with the extent of submucosal invasion that was evaluated histologically in each extirpated specimen by means of continuous large section technique. Conclusions were as follows: 1. The largest SLI was obtained in a moderately differentiated carcinoma, and calculated up to 56, while the smallest was encountered in a well differentiated carcinoma as 18. Meanvalue in these 11 cases was 35. 2. It seemed likely that moderately or poorly differentiated carcinomas show larger SLI, but its statistical significance could not be delineated in these materials. 3. Submucosal invasion was much longer in the oral direction than in the anal. The longest invasion was observed in a case that showed the largest SLI, and measured up to 22mm. The shortest invasion, on the contrary, was seen in a case with the smallest SLI, and was only 9mm. Mean value in these 11 cases was 14.4mm. 4. SLI correlates well in every case to the extent of submucosal invasion toward the oropharynx. 5. SLI evaluated preoperatively in biopsied specimen may help to indicate an ample safety margin at the surgery.
When we treat patients of otitis media, it is important to know the pathogenesis of otitis media. Therefore histopathological change of epithelium and bone in each site of tympanic cavity was observed using human temporal bones. Histopathological change of epithelium was classified as: acute, subacute and chronic in eighteen sites of tympanic cavity. Histopathological change of bone was observed in thirteen sites of tympanic cavity. And the frequency of histopathological change of epithelium and bone in each site was compared. A review of 350 temporal bones collected from autopsy cases revealed 171(49.1%)to have otitis media, and a review of 170 temporal bones of otitis media cases revealed 165(97.1%)to have bone changes. Differences in frequency of histopathological change of epithelium and bone existed in each site. Histopathological change in inferior portion of mastoid cells, round window niche and tympanic sinus was more frequent than in the other sites. Change of epithelium: in acute inflammation, no differences in frequency of histopathological change existed; in subacute inflammation and chronic inflamation, differences in frequency of histopathological change existed in each site. Change of bone: most changes were bone formation and bone reconstruction, but there was no clear finding that bone formation narrowed tympanic cavity without mastoid cells. Osseous destruction was found in mastoidectomy cases and cholesteatoma cases. It is thought that the frequency of inflammation is related to structure of cavity, aeration, immunologic activity or structure of the epithelium, and that the pathogenesis of otitis media, especially in chronic otitis media, is different in each site of tympanic cavity. It is thought that because the subjects of this study were not operated cases but autopsy cases, slight bone change was very frequent, but severe bone change, was rare. And we examined the pathogenesis of tympanic cavity of each case of acute inflammation and chronic inflammation of pars tensa and cases where there were no findings of inflammation in the pars tensa. In most cases of acute inflammation of pars tensa, inflammation of tympanic cavity was acute; in chronic inflammation of pars tensa, chronic. It was interesting that, in cases of normal pars tensa, inflammation was frequently found in tympanic cavity. Therefore, it is important to pay attention to the possibility of inflammation in tympanic cavity, even if the tympanic membrane appears normal.