日本耳鼻咽喉科学会会報
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
93 巻, 7 号
選択された号の論文の13件中1~13を表示しています
  • 伊藤 壽一, 本庄 巖, 竹内 真理子, 榊原 淳二
    1990 年 93 巻 7 号 p. 1015-1020
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    The mechanism of speech perception in patients with Australian multi-channel cochlear implant was investigated. 1) Vowel recognition abilities of patients were sufficient with this implant, whereas, consonant recognition abilities were insufficient. 2) Although the cochlear hair cells were functionally damaged, cochlear nerves had the ability to characterize frequency. 3) The signals from the implanted material were very simple compared to those from normal cochlea, however these patients could understand speech well, perhaps due to aid from the central nervous system.
  • 呼吸相と上喉頭神経内枝の関与について
    三橋 敏雄
    1990 年 93 巻 7 号 p. 1020-1033
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    It is generally considered that the vocal cord is finely and reflexively controlled during phona-tion. In order to investigate the effect of vibratory stimulation of the subglottis on laryngeal reflex, experiments have been performed using cats' larynx under urethane-chloralose general anesthesia. The effect of vibration was estimated by the latency and the area of integrated EMG of the reflex.
    The glottic closure reflex was induced by electrical stimulation of the internal branch of the superior laryngeal nerve (ISLN) and electromyogram was recorded from contralateral Thyroar-ytenoid muscle (TA). When ISLN was stimulated, short latency response (early response) and long latency response (late response) in TA was observed. Maximum responses were obtained during the transitional phase, namely, from inspiration to expiration, especially before the denerva-tion of ISLN from the larynx. This phase was tentatively designated as " phase I ", being followed by " phase II ", the phase prior to " phase I ", as " phase III ".
    Vibratory stimulation (100 or 200Hz, 40pm), applied to the contralateral subglottic portion as a conditioning stimulation, had no effect on early response but enhanced late response, particularly in phase I. After denervation of ISLN, the vibratory effect on late response became phase independent. Furthermore, when the vibratory frequency was elevated from 100Hz to 350Hz at 50Hz interval in phase I, vibration effect was observed in all frequencies investigated. Maximum effect was obtained at 300Hz. However, after denervation of ISLN, this effect was minimized, and no peak observed. The vibratory effects disappeared soon after local anesthesia of the subglottic mucosa.
    These results suggest that the activity of the mechanoreceptors to vibration in the subglottic mucosa enhances reflexive contraction of the contralateral TA primarily via the recurrent laryngeal nerve and partially via ISLN, both of which are indispensable for reflexive laryngeal control. It is conceivable that early response is one of the primitive reflexes for the protection of the lower airway, and late response is a sort of more evolved reflexes involved in vibration and respiration during phonation.
  • 臨床的特徴および上顎洞計測による検討
    金子 功, 原田 宏一, 石井 豊太, 古川 浩三, 八尾 和雄, 高橋 廣臣, 設楽 哲也
    1990 年 93 巻 7 号 p. 1034-1040
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of thesecond and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal dis-charge from an early stage.
    The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.
  • 舌弁による下咽頭再建
    室伏 利久, 船井 洋光, 太田 康, 田久保 正道, 田島 文司
    1990 年 93 巻 7 号 p. 1041-1045
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    The authors reported a 47-year-old man with hypopharyngeal stenosis caused by late radiation injuries. At the age of ten he underwent irradiation (3000rads) to the neck because of the cervical lymphadenopathy. He had keroid skin change at the age of 19, hypothyroidism since 26, right cervical and brachial plexus neuropathy since 33, and paralysis and papilloma of right vocal cord at 34. And at the age of 41 he underwent tracheostomy owing to laryngeal stenosis.
    In November 1984 (at age 43) he felt abnormal sensation on the throat but had no dysphagia nor misdigulutition. On November 1987 he had difficulties of swallowing, and could not take anything but fluid. At that time he was diagnosed as hypopharyngeal stenosis. With steroids and antibiotics his difficulties of swallowing were reduced. He experienced the same difficulties on April 1988. Since December 1988 his dysphagia got worse and was not recovered with medication.
    On May 17 1989, laryngopharyngectomy was performed. At the level of cricoid cartilage iypopharynx was resected. As for the posterior wall, pharynx and cervical esophagus were fixed :o prevertebral fascia and anastmosed with end-to-end. And antero-lateral defects were recon-;tructed with myomucosal tongue flap. Postoperatively he could eat orally.
    On the basis of the experience of this case and the review of the literature the authors conclude hat myomucosal tongue flap is one of alternatives for hypopharyngeal reconstruction.
  • デジタルフィルタと位相スペクトル解析による検討
    原田 次郎
    1990 年 93 巻 7 号 p. 1046-1054
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    40Hz event related potential, or 40Hz-ERP, described by Galambos in 1981 has been considered as the useful potential in predicting hearing threshold across the audiometric frequencies. Although 40Hz-ERP was reported by Galambos as the summation of middle latency responses (MLR), its origin has not been clarified. Moreover reports of the clinical use of 40Hz-ERP in patients with the neurological disorders were rare. Therefore, we recorded ABR, MLR and 40Hz -ERP in 35 patients with central nerve system disorders, or CNS disorders, and analysed the relation between central lesions and modality of MLR or 40Hz-ERP from the view point of phase spectral analysis compairing with the digital filtered waveform analysis. For the phase spectral analysis, synchrony measure method described by Fridman in 1984 was applied to MLR and 40Hz-ERP.
    Following results were obtained.
    1) By the digital filtered waveform analysis, the latencies of Po, Na, Pa and the amplitudes of Po, Na, Pa, Nb were recorded clearly in normal cases. In cases with the central lesions, many of them were revealed reduction of the amplitude of Po, but other parameters were not useful for the detection of CNS disorders because of their wide normal ranges.
    2) The parameters of the phase spectral analysis were obtained from 17 records of the normal subjects. The SM(30+40+5OHz), which is the average of CSM 30Hz, CSM 40Hz and CSM 50Hz, was applied to MLR, and the SM(40+80+120Hz) was applied to 40Hz-ERP. The criteria was adopted as the SM value subtracted 2 standard deviations from mean value of the normal subjects at 80dBnHL stimulation.
    3) The phase spectral analysis of MLR were abnormal in 6 out of 35 cases with central lesions, but 11 cases were judged abnormal by the waveform analysis. On the contrally, abnormal findings in 40Hz-ERP were observed in 24 cases, and 8 of those were cases with no response by the phase spectral analysis, although only 4 cases were judged abnormal by the waveform analysis.
    4) Out of 15 cases with disorders of midbrain or thalamus revealed by CT and the neurological examinations, 14 cases showed abnormal findings of 40Hz-ERP in the phase spectral analysis.
    Therefore, phase spectral analysis, especially of 40Hz-ERP, was useful for the detection of CNS disorders.
  • 小島 好雅, 加我 君孝
    1990 年 93 巻 7 号 p. 1055-1063
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    The neuropsychological signs and prognosis of patients with localized lesions in the vicinity of Broca's area of the left inferior frontal gyrus have been controversial. We studied periodic changes in the neuropsychological signs of four patients who had relatively localized lesions in the vicinity of Broca's area and manifested aphasia of the non-fluent type. The ages of the four patients at the onset were 62, 66, 30 and 37 years. The localized lesions in their brains were the result of brain infarctions revealed by CT scans, and included so-called Broca's center in the left inferior frontal gyrus along with adjacent brain tissue. The neuropsychological signs of the four patients were periodically assessed by means of the standard language test of aphasia (SLTA). In the early stage of aphasia, they had moderate difficulties in speaking to explain test materials or recall words and mild difficulties in reading aloud, repeating and writing words. One year later, most of their neuropsychological signs disappeared except for mild difficulties in speaking fluently and recalling words. It should be noted, however, that all four patients were able to return to their previous occupations one or two years later, because they had recovered from aphasia. Based on the results of this study, we conclude that the neuropsychological signs of Broca's aphasia caused by relatively localized lesions in the left inferior frontal gyrus are mild and largely disappear within one or two years.
  • 羽田 達正
    1990 年 93 巻 7 号 p. 1064-1075
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    We studied the incidence and mode of development of parapharyngeal space invasion from head and neck cancers by both retrospective examination of our 172 patients and tracing the dynamics of lymph flows to the parapharyngeal space from the hypopharynx, the mesopharynx and the posterior portion of oral cavity.
    Of the patients examined 23 (13.4%) were found the parapharyngeal invasions (20% in mesopharyngeal cancers, 17.3% in hypopharyngeal cancers, 11.9% in cancers of posterior portion of oral cavity). Parapharyngeal space invasions occur frequently in a direct or indirect way when meso-or hypo-pharyngeal cancers or those of posterior parts of oral cavity invade deeply into the uscle layers and extend to the palatine arch, retromolar region, pharyngoepiglottic fold, lateral base of tongue, or posterior buccal mucosa. These invasions frequently induced such symptoms as trismus (47.8%), swelling of the lateral pharyngeal wall (39.1%), otalgia (34.8%), swelling of infra-auricular and submandibular regions (34.8%, 26.1%) and facial palsy (26.1%).
    Computed tomography was very useful to the diagnosis of the parapharyngeal space invasion.The parapharyngeal space invasions were successfully removed under a wide surgical field without injuring the important nerves and vessels and with preservation of mandibular function by our modification of Attia's technique.
    The lymph flow from the hypopharynx was chiefly upward and reached terminally to the parapharyngeal space including the retropharyngeal lymph nodes. The lymph flow from the mesopharynx revealed to drain chiefly into the lower internal jugular nodes. The lymph flow from the posterior parts of oral cavity was divided into anterior and posterior groups. Anterior groups of lymphatic drained into the root of tongue and reached terminally to the vallecula and posterior groups drained into the internal jugular nodes.
    We should cover all routes for extension of head and neck cancers, including the parapharyn-geal space, in the diagnosis and the management of these conditions.
  • 即時相反応の鼻汁中ヒスタミン,ロイコトリエン,キニンに関する検討
    小島 正, 朝倉 光司
    1990 年 93 巻 7 号 p. 1076-1082
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    For the purpose of studying the roles of chemical mediators during early phase response of allergic rhinitis, the levels of histamine, leukotriene C4 (LTC4) and kinins in the nasal lavage fluid were measured before and after the nasal challenges with antigens. Seventeen patients with perennial allergic rhinitis with positive intradermal skin reactions to mite antigen extracts were included in this study. The nasal samples were obtained both by aspirating and instilling 5ml of saline into patient's nostrils before and ten minutes after the nasal challenges. After the nasal challenge with control disk, the concentration of histamine in the nasal samples increased, and the concentrations of LTC, and kinins did not increase significantly. After the nasal challenges with mite or house dust disk, the concentration of histamine increased as much the same as that after thenasal challenges with control disk, and the concentrations of LTC, and kinins increased significantly compared with those after the nasal challenges with control disk. 0 histamine and n kinins (_??_: net increments in the concentrations after the nasal challenge with antigen over values before the nasal challenge) were significantly correlated with _??_ albumin. The patients with severe nasal symptoms tended to present more remarkable net increments of chemical mediators than the patients with mild and moderate nasal symptoms. Similar tendencies were recognized in the relationships between the severity of nasal symptoms provoked by nasal challenge with antigen and net increments of chemical mediators. We suggest that the amounts of chemical mediators during the allergic reaction denoted the severity of nasal symptoms in allergic rhinitis patients.
  • 予後相関因子の多変量解析による分析
    韓 徳民, 山下 公一, 松平 登志正
    1990 年 93 巻 7 号 p. 1083-1092
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    The biological characteristics of supraglottic carcinoma was studied with special reference to the correlations of various biological factors with the prognosis of the lesion. The study included 100 cases of supraglottic carcinoma treated by total laryngectomy in the First Hospital of China Medical University in the period from 1975 to 1978, and 7 factors including histopathological findings observed in serial sections of the whole larynx, clinical findings, clinical course, etc. These factors were statistically analyzed by multiple correlation analysis using the theory of quantification I to determine the relations of these factors to the prognosis, as well as their participations in post operative course.
    1. Twenty-seven cases died within 5 years after surgery, and 4 cases could not be followed up. 3 and 5 year survival rates were 79.5% and 72.2%, respectively, as calculated in accordance with the UICC General Rule.
    2. Histopathologically 5year survival rate was 10.0% in cases with poorly differentiated carcinoma, 78.0% in cases with moderately differentiated type, and 83.5% in cases with well differentiated type. It was remarkably lower in poorly differentiated carcinoma than that in moderately or well-differentiated carcinoma.
    3. In cases having dense lymphocyte infiltration associated with lymph follicles in peripheral region of tumor, 5-year survival rate was higher (90.4%) than in the other cases.
    4. It was found that, as tumor size increased, 5-year survival rate decreased and the risk of lymph node involvement increased in the neck region.
    5. 5-year survival rate was lower (48.5%) in cases with lesion infiltrating the surrounding tissues than in cases with other growth patterns.
    6. Multiple correlation coefficient between prognosis and the 7 factors analyzed was 0.766. The important factors were the degree of differentiation (0.735), the degree of lymphocyte infiltration (0.260), the size of primary tumor (0.215), the growth pattern of tumor (0.141) and neck metastasis (0.028).
  • 麻生 伸
    1990 年 93 巻 7 号 p. 1093-1105
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    Transtympanic electrocochleography (ECochG) was performed on 137 definite Meniere ears, 29 normal ears and 383 ears with other diseases. The average SP/AP amplitude ratio (SP/AP) was significantly larger than that of normal subjects in the following four disease groups whose causes are thought to be endolymphatic hydrops: 1) definite Meniere's disease, 2) suspected Meniere's disease, 3) delayed endolymphatic hydrops and 4) labyrinthine syphilis. The SP amplitude could not nor from other sensorineural deafnesses. provide any information for a differential diagnosis of endolymphatic hydrops from normal subjects nor form other sensorineural deafnesses.
    The upper 99% confidence limit of normal SP/AP using a 100d$SPL click was 0.37 for 29 subjects. In patients with Meniere's disease the relationship between SP/AP and clinical data such as pure tone threshold, audiogram pattern, results of glycerol test and duration of illness from the first vertiginous attack to the test were investigated. In patients with severe hearing loss, the number of those showing SP/AP of greater than 0.37 was much higher than in patients with less severe hearing loss. There were no relationship, however, between SP/AP and or audiogram pattern, or glycerol test.
    ECochG was recorded before and after intravenous administration of 50 gr of glycerol (10% solution, 500ml), and a significant decrease of SP/AP was found in 21 Meniere ears. However, there were no change of SP/AP after oral administration of 50 gr of glycerol (50% solution, 100ml) an disosorbide (70% solution, 2.Ogr/kg of body weight).
    After endolymphatic sac surgery a decrease of SP/AP of 10% or more was found in ears, an increase of SP/AP in 3 ears, and no change of SP/AP in 3 ears. In the patients showing no change of SP/AP after the surgery, numerical values of vertigo by AAOHNS were higher than in patients showing an increase or a decrease of SP/AP.
    The results demonstrate the usefulness of ECochG in diagnosis of endolymphatic hydrops and indicate a possibility of monitoring the state of hydrops after administration of glycerol and endolymphatic sac surgery.
  • 唾液腺細胞の組織再構築について
    鈴村 滋生, 田中 治, 宮原 裕, 松永 喬, 鶴田 至宏, 家根 且有, 今井 俊介, 日浅 義雄, 岩井 良昭, 岩井 峯子
    1990 年 93 巻 7 号 p. 1106-1111
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
    Embedding culture was performed on nomal salivary gland cells from five subjects using 0. 2% irradiated collagen gel. Collagen was collected from rat tail tendon and gelatinized at the finalconcentration of 0. 2%. D-MEM added BSA(5mg/ml), insulin (10ug/ml) and EGF (5ug/ml) was used as a serum-free medium.
    Within the collagen gel, the cells were found to grow in a branch-like pattern, and then to form a lot of radial duct-like structures containing alcian blue positive secretions.
    Immunohistochemical observation of myoepithelial cells with monoclonal antibody from human mammarian cancer suggested that these cells play an important role in the process of glandular ducts formation.
    Salivary gland cells being able to grow in collagen gel in a very similar fashion to in-vivo condition, the present collagen gel embedding culture is useful for morphological or functional studies on salivary gland cells.
  • 瀧本 勲
    1990 年 93 巻 7 号 p. 1156-1159
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
  • 第8回日本耳鼻咽喉科免疫アレルギー研究会
    田端 敏秀
    1990 年 93 巻 7 号 p. 1160
    発行日: 1990/07/20
    公開日: 2008/03/19
    ジャーナル フリー
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