CT values were estimated at the fatty layer in contact with the posterior wall of the maxillary sinus in various condition, i.e., normal, sinusitis, postop. sinus, and mucocele. By the unilateral sinusitis (40 cases), CT values obtained by the affected sides were significantly higher than those of the non-affected normal sides. A single maxillary bone was used for experiments to show that the dene materials filling the sinus do not affect the CT values of the fatty layer, thus confirming the above clinical data was real and not artifact. In addition, by the mucocele of the maxillary sinus (9 cases) with negligible inflammatory change in the sinus, the CT values of the fatty layer did not show any remarkable increase such as seen by sinusitis. These data lead us to the impression that the increased density is due to the transmitted effects of maxillary sinusitis through the posterior wall. In postop, sinuses (11 cases) with various postop periods, CT values were slightly higher than those in normal sinuses, suggesting that the sinus infection was under improvement. The enhancement performed by 14 cases (28 sides) showed increased density of the fatty layer, but the increase was similar in both affected and non-affected sinuses. This suggests that the increased rate of circulation at the fatty layer is not the contributory factor to higher CT values. The results described above, combined with the previous reports concerning the bony changes in sinusitis, will lead to the conclusion that the increased CT values at the fatty layer is caused by the direct engagement of the inflammatory conditions in the sinus cavities.
No other infectious diseases in the field of otolaryngology cause rapid and lethal course than cervical abscess. A case of cervicomediastinal abscess secondary to acute tonsillitis was presented. The patient was a 43-year-old male with liver cirrhosis and primarily had the treatment of tonsillitis. The complication of duodenal perforation caused marked general deteriotation, and cervical abscess occured. Immediately after transfer to our department, he was treated by cervical drainage, laparotomy and chemotherapy. However, hepatic failure occured, and he died of sepsis on the 16th day after the onset of tonsillitis. Cervicomediastinal abscesses were classfied according to severity in Stage 1-4. 34 cases of advanced cervical abscess were reported in Japan from 1976 to 1989. These cases were analyzed statistically in terms of primary focus of infection, surgical procedures, clinical isolates and chemotherapy, etc., and following results were obtained. 1) Primary focus; approximately 50% was due to the infection of the tonsills and the pharynx occupied about 50%, and the odontogenic infections, approximately 40%. 2) Surgical procedures; the neck doranaige approaching through the vertical incision resulted more effective. 3) Clinical isolates; aerobes and anaerobes accounted for 50% each of all strains. α-Streptococcus was predominant among aerobes, and Peptostreptococcus and Bacteroides were predominant among anaerobes. In order to confirm pathogenic bacteria of cervical abscess, clinical isolates of peritonsiller abscess and mandibular ostesis were compared with those of cervical abscess, because these infections are primary infectious diseases of cervical abscess. In these infectious diseases, the percentage of patients from whom anaerobes were detected and the percentage of the anaerobic strains detected were both 30% higher than those in the case of cervical abscess. It is not unreasonable to consider that the type of infections and frequency of isolation of bacteria detected of cervical abscess will be virtually closer to those of these infections. Taking into this account, clindamycin (CLDM), which is highly effective against anaerobes, was recommended as the first choice of antibiotics for the chemotherapy of cervical abscess.
The water flow across the respiratory epithelia is an important determinant of the efficiency of mucociliary clearance. Bulk water flow has been shown to be coupled to net ion flux. We studied ion transport across rabbit nasal mucosa by measuring bioelectric properties using Ussing chambers. Results were summarized as follows. (1) Compared with tracheal mucosa, nasal mucosa exhibited lower potential difference (p<0.01), lower short-circuit current (p<0.05), and higher conductance (p<0.01). (2) Ouabain 10-4M inhibited short-circuit current when added to the submucosal bath of Ussing chambers, and amiloride decreased short-circuit current to about 40% when added to the mucosal bath. (3) When the bubbling of the solution was changed from 95% O2, 5% CO2 to 100% N2, shortcircuit current remarkedly decreased. (4) A significant positive correlation existed between temperature ranging from 33° to 41° and short-circuit current (r=0.46, p<0.02).
We evaluated the effects of horizontal and vertical optokinetic stimulation on head movement (HM) and body sway (BS) in children and adults, using a Jung type optokinetic stimulator, a strain gauge-platform, and a cephalograph. Twenty healthy children aged 7 to 9 years and twenty healthy adults aged 20 to 26 years were instructed to stand with feet close together on the platform with eyes open with and without optokinetic stimulation for 60 seconds. In all subjects, optokinetic stimulation significantly increased the total lengths of HM and BS. In addition, optokinetic stimulation significantly increased the areas of HM and BS in children, but not in adults. Although the ratio of the anteroposterior component to the lateral component in BS was significantly higher in children than in adults, the value of HM was not. Children exhibited a characteristic BS in which the anteroposterior swaying velocity was larger than the lateral swaying velocity. In the anteroposterior component, averaged divisional frequencies of BS were significantly larger in children than in adults. However, averaged divisional frequencies in the lateral component of BS and those in the anteroposterior and lateral components of HM did not differ between the two age groups. The ratio of the total length of HM to that of BS was significantly higher in children than in adults. These results suggest that HM and BS of children are readily affected by optokinetic stimulation, and that in children, the BS velocity in the anteroposterior direction is higher than that in the lateral direction.
Fixation suppression of caloric nystagmus was examined in 33 cases with unilateral cerebral vascular lesion. Only Lesion included the unilateral internal capsule was certified by CT scan in all of the subjects. The rate of fixation suppression (FS%): FS%=(1-F/D)×100 was calculated by the mean slow-phase velocity (F) of caloric nystagmus during fixation and the maximum slow-phase velocity (D) during eyes open in darkness. The normal FS% of nystagmus to both sides was observed in 12 cases, the reduction of FS% of nystagmus to the ipsilateral side of the lesion was obseved in 11 cases, that of nystagmus to the contralateral side in one, and that of nystagmus to the bilateral side in eight. In 30 out of 32 cases which were able to measure the slow-phase velocity (SPV) of caloric nystagmus, FS% of nystagmus to the ipsilateral side of the lesion was lower than that to the contralateral side, and there was statistically a significant difference between them (p<0.05). Furthermore, the difference between the SPV of nystagmus to the ipsilateral side of the lesion and that to contralateral side was examined during fixation and during eyes open in darkness separately. The SPV of nystagmus to the ipsilateral side of the lesion was significantly (p<0.01) higher than that to the contralateral side during fixation. There was no significant difference between them during eyes open in darkness. In 15 cases, however, tonic eye deviation over 20 degrees to the slow-phase side was only observed during nystagmus to the ipsilateral side. Our results suggest that the difference between FS% of nystagmus to the ipsilateral side of the lesion and that to the contralateral side is mainly caused by the asymmetry of nystagmus during fixation, and also by nystagmus during eyes open in darkness. The SPV of nystagmus in both condition is affected by the impairments of pursuit and cerebro-fugal tonic fibers making tonic balance of the vestibulo-ocular system in brain-stem.
Attempts were made to demonstrate herpes simplex virus (HSV) type 1 and type 2, varicella zoster virus (VZV) and cytomegalovirus (CMV) in specimens obtained from aphthous ulceration lesions by the immunofluorescent method using fluorescein-labeled monoclonal antibodies. HSV-1 and VZV were detected in 2 and 4 out of 30 patients, respectively. Although almost all viruses that can infect the oral cavity could occasionally cause stomatitis, neither HSV-2 nor CMV was not found in this study. VZV was detected in 1 out of 8 patients with recurrent aphthous ulceration. After treatment with acyclovir, the patient's symptoms has become less severe and recurrence rates of attacks reduced, however, the patient has not been totally free of the disease. There were no differences in clinical aspects of stomatitis between the patients with and without viral isolation. Further clinical investigation is encouraged to confirm the relationship between aphthous stomatitis and viral infection.
We evaluated the activity of dilator naris EMG (Electro-Myo-Graphy) and submental EMG during sleep in three patients with obstructive sleep apnea syndrome. Both EMG activities involved periodic changes which proved to be correlated with each other (r=0.85). Apnea and hypopnea episodes always occurred at the nadir of these periodic changes. The activity of dilator naris EMG, as well as submental EMG, at the nadir of these periodic changes was significantly lower during REM (Rapid Eye Movement) sleep than non-REM sleep and also significantly lower during severe airway obstruction accompanied by paradoxical movements of thorax and abdomen. The correlation of this EMG activity with SaO2 or the duration of obstructive apnea was more remarkable in submental EMG than dilator naris EMG in the observed patients.
Adenoid cystic carcinoma generally consists of the following histlogic features: tubular, cribriform, trabecular, and solid. To investigate how these histological patterns affect the prognosis of this carcinoma, we determined the proliferative activity of each of the histologic patterns by cytofluorometry. Twenty-six cases of adenoid cystic carcinoma, obtained by surgical resection, were studied. According to predominant histological pattern, they were divided into three groups: seven cases were of cribriform pattern, nine cases of trabecular pattern, and ten cases of solid pattern. The region with each dominant pattern was obtained from biopsy specimen, and the nuclear DNA contents of the tumor cells of the regions were assayed. In four of twenty-six cases, that of the tumor cells of the region with other patterns in the same specimens were also assayed. The results were the following: 1) The mean incidence of over 4.5C-polyploid cells of the region with predominant pattern of each tumor significantly increased in the following order: cribriform pattern, trabecular pattern and solid pattern. 2) The incidence of over 4.5C-polyploid cells, in comparison of a predominant pattern with other histologic patterns in the same tumor, were calculated. It was higher in solid pattern than in trabecular pattern, and was higher in trabecular pattern than cribriform pattern. 3) Only two of ten cases, had aneuploidy in the region with predominant solid pattern and the other cases had diploid stem line. Judging from the above results, it was concluded that proliferative activity of each pattern increased in the following order: cribriform pattern, trabecular pattern, solid pattern. This suggests that proliferative activities of the component cells of each pattern may be related to the degree of the differentiation of the tumor. Moreover, it was speculated that the proliferative activity and prognosis of adenoid cystic carcinoma may be determined by quantitive ratio of component cells in solid pattern.
Electromyographic (EMG) responses of the intrinsic laryngeal muscle have been investigated to clarify reflexogenic laryngeal controls from a viewpoint of its functional significance during phonation. Twenty-five adult cats were anesthetized with intraperitoneal injection of 4ml/kg of a mixture of 10% urethane and 1% alpha-chloralose. Either the internal branch of the superior laryngeal nerve (ISLN) or the recurrent laryngeal nerve (RLN) was carefully dissected and central end of the dissected nerve was electrically stimulated. EMG of the contra-lateral Thyro-Arytenoid muscle (TA muscle) to the stimulation was recorded using a hooked-wire electrode inserted through the laryngeal mucosa. EMG of the TA muscle evoked by the stimulation of the ISLN were analized with respect to its latency and discharge pattern either in intact cat or inter-collicular brainstem transsected. Together with the electrical stimulation of the RLN, vibratory stimuli were given mainly to the subglottic mucosa as conditioning stimuli. The vibratory frequency was changed from 50Hz to 400Hz stepwisely. Following results were obtained. 1. EMG response of the contra-lateral TA muscle to the stimulation of the ISLN showed two different kinds of latency, approximately 8-10msec, and 40-60msec. 2. After inter-collicular brainstem transsection, evoked response of the latter disappeared. This result indicates that the ISLN-RLN reflex loop consisted of more than two routes, different in the number of synaptic junctions. 3. The vibratory stimuli given to the laryngeal mucosa had facilitatory effect on the reflexive EMG response evoked by the stimulation of the RLN. 4. This facilitatory effect of the vibratory stimuli disappeared after topical anesthesia of the laryngeal mucosa. 5. The facilitatory effect on the reflex responses was partially increased depending on the vibratory frequencies applied. In conclusion, vibratory stimuli to the laryngeal mucosa reflexively modulate the activity of the intrinsic laryngeal muscles.
The purpose of this study was to clarify the etiological role of immune responses in tonsillar lymphocytes of the patients with pustulosis palmaris et plantaris (PPP). In order to determine their immune response to S. pyogenes T4, S. pyogenes T12, S. mitis, S. salivarius, S. sanguis I, S. sanguis II and S. pneumoniae, tonsillar lymphocytes from patients with PPP, CT, and sleep apnea syndrome (control) were cultured with formalinized streptococcal cellular antigens. Blastoid transformation was investigated by [3H]-tymidine uptake, while antistreptococcal antibody production were measured by an enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. Tonsillar lymphocytes from PPP patients underwent blastoid transformation and accelerated the production of immunoglobulin G following the addition of S. sanguis I, S. sanguis II S. mitis, S. pyogenes T4, and S. pyogenes T12, while those form CT patients and controls did so only with S. pyogenes T4 and S. pyogenes T12. 2. The spontaneous production of specific IgG against various streptococci, including S. sanguis I, S. sanguis II and S. mitis by tonsillar lymphocytes from patients with PPP was already higher than that from CT patients and controls. The specific IgM production was also increased above that in PPP patients without any antigens. 3. S. sanguis I, S. sanguis II and S. salivarius antigens stimulated antigen-specific IgM production in tonsillar lymphocytes from PPP patients. 4. The levels of specific IgG production against S. sanguis I and S. sanguis II by tonsillar lymphocytes from PPP patients showed a relationship with the serum levels of the PPP patients. These results suggested that the sensitization of α-streptococci, especially S. sanguis, in the tonsillar lacunae may lead to the specific production of anti-S. sanguis antibodies in patients with PPP, and these may be involved in the pathogenesis of PPP.