Cervical lymphadenopathy with packet formation as the sole presentation of tuberculosis is very rarely seen in modern Japan. During the four years from 1987 to 1990, 5 cases of cervical scrofula with packet formation were treated with selective neck dissection followed by antituberculous chemotherapy at the ENT-department of Haibara General Hospital. Clinical evaluation of these cases suggested the following: 1) The physician must keep in mind that cervical scrofula should be included in the differential diagnosis of any neck masses, and malignant neck tumors particularly should be differentiated from cervical scrofula. 2) The treatment of cervical scrofula should be appropriate to the clinical stage diagnosed by CT or MRI. Recommended therapy for cervical scrofula with packet formation is selective neck dissection followed by antituberculous chemotherapy, which can shorten the period of treatment. 3) We present here a 22-year-old female from the Philippines with cervical scrofula and suggest that, in the future in Japan, tuberculosis may frequently be encountered in the immigrant population from the countries with high incidences of tuberculosis.
The terminal care of patients with cancer has come to involve important medical and social problems. We evaluated our terminal care in 52 patients with head and neck cancer. The results were that pain couldn't be controlled in 40% of these patients. In the last two weeks before death, only 28.8% of the patients could take food orally and only 23.1% could speak. We also assessed dyspnea, mental symptoms, and the management of general condition. Although it is still difficult to maintain Q. O. L. for head and neck cancer patients, improvement in the near future is essentiated.
Behavioral and histological changes in mice following bilateral olfactory bulbectomy were studied. Mice were trained to discriminate between a 0.01% Cycloheximide solution and distilled water. After olfactory bulbs were removed, discrimination was lost, and had not returned 300 days after bulbectomy. The histological changes observed by light microscope were as follow. Degeneration of olfactory epithelium was observed immediately after the bulbectomy, followed by decrement of the epithelial thickness and the number of olfactory cells. An increase in both epithelial thickness and the number of olfactory cells was observed 14 days after the bulbectomy, and epithelial thickness 300 days after the bulbectomy was similar to that of the sham-operation group. At 300 days after the bulbectomy, axons of olfactory cells migrated through the lamina cribrosa, but didn't contact the forebrain. In this study, the olfactory bulb was considered to have played a role in functional recovery of olfactory behavior, and that olfactory cells were continuously renewed under conditions of target organ, i. e. olfactory bulb, loss.
HRCT images in axial sections obtained from various otologic lesions were used for morphological studies of the sphenoid sinus. 412 cases including 224 males and 188 females, with an average age of 47.5 years were included in the study. None of the cases showed any evidence of sinus lesions. The internal carotid artery, at its close connection with the sphenoid sinus, was classified into five portions: I, the second turn; II, between the second and third turns; III, the third turn, IV, between the third and fourth turns, and V, ascending portion of the fourth turn. Protrusion into the sphenoid sinus was seen at I in 30.4% of the cases, at II in 39.8%, at III in 34.3%, at IV in 22.3%, and at V in 11.2%, The second turn, where the internal carotid artery emerges from the carotid canal in the petrous bone and turns upward into the cavernous sinus, showed the highest incidence of the carotid eminence. The incidence-of protrusion increases as the sinus grows larger. The average distance between the natural orifice and the carotid canal was 19.3mm on the right and 18.9mm on the left. The distance between the posterior end of the nasal septum and the natural orifice was, on average, 3.6mm on the right and 3.6mm on the left.
Seventy patients with the hypopharyngeal cancer who underwent pharyngolaryngoeso-phagectomy with bilateral neck dissection between 1978 and 1990 were examined retrospectively to compare TN and pTN in these patients and clarify the clinical pathology of the hypopharyngeal cancer. Among the 70 cases of hypopharyngeal cancer, there were 46 cases of piriformis sinus cancer (PSC) and 24 cases of postcricoid cancer (PCC). The pathological diagnosis of all these cases was squamous cell carcinoma (SCC). The following results were obtained: 1. Invasion of the thyroid gland was seen in 8 cases of PCC (33.3%) and 6 cases of PSC (13.0%). The thyroid gland can be preserved in PSC, whereas its removal is indicated in PCC. 2. Twenty-nine cases of N0 necks proved to be pN0-2b in 27 cases (93.1%) which may be controlled by homolateral neck dissection, and pN2c in 2 cases (6.9%), which requires bilateral neck dissection. On the other hand, 29 cases of N1-2b necks which represent one-sided neck metastasis were pN0-2b in 15 cases (51.7%) and pN2c in 14 cases (48.3%). These results demonstrate that N0 necks can, in the majority of cases, be controlled by homolateral neck dissection alone but that N1-2b necks require bilateral neck dissection. 3. Occult neck metastases were observed in PCC more often than in PSC, because paratracheal metastases of PCC were difficult to expose before surgery. 4. Pathological neck metastases of both PSC and PCC were most commonly situated in the superior and middle internal jugular nodes. Paratracheal metastases of PCC was found pathologically in 10 cases (41.7%). Paratracheal nodes must be dissected meticulously during the resection of PCC. 5. Seven of 69 pathologically confirmed cases were poorly differentiated SCC, 6 were PSC and one was PCC. Six of 7 cases of poorly differentiated SCC were pN positive. Poorly differentiated SCC was more frequently found in PSC and apt to metastasize to neck nodes. Neck dissection should be performed for this type of cancer.
Pathological data and the outcomes of 29 patients with adenoid cystic carcinoma of the head and neck treated between 1975 and 1990 were reviewed. Patients consisted of 21 females and 8 males, with a median age of 59 years. The overall 5-year and 10-year survival rates determined by Kaplan-Meier analysis were 84.2% and 52.9%, respectively. Patients in whom pathological data indicated a frequent solid pattern of carcinoma had high incidences of metastasis and poor prognoses. The effectiveness of local control was found to have no relation to the pathological data of the tumor, but rather depended upon whether anatomical limitations restricted complete resection of the tumor. All 7 patients who had cervical lymph node metastasis underwent neck dissection, which was useful in controlling metastatic spread. Distant metastases were present in 6 patients, and the lung was the most frequent site of metastasis.
In order to maintain an ordinary upright posture, the body's center of gravity must be predicted and controlled on the supporting surface based on synthesis of multiple-sensory inputs. In order to evaluate the accuracy of predictive (feedforward) posture control during the performance of actions, we measured maximal shifts in the body's center of gravity using a force platform in 6 normal adults under two visual conditions (with eyes open and closed) and four standing conditions (one-legged; heel to toe posture; and both legs together or apart). Subjects were asked to perform five kinds of voluntary actions (static standing; head tilting forward, backward and laterally; head turning; bending forward; and maximal inclinations to the anterior, posterior and lateral directions). The smaller the supporting surface, the more markedly displacement of the body's center of gravity was increased upon closing the eyes. This finding suggests that the accuracy of predictive posture control decreases as a result of the reduction in the number of multisensory inputs which determine spatial orientation. Assessing purposive shifts in center of gravity during voluntary actions, we can conclude that the body's center of gravity is accurately controlled even in the presence of head movements under ordinary standing conditions. To evaluate balance during the performance of routine actions, we must devise a better method of discriminating purposive shifts in center of gravity from control disorder errors as well as a method of quantifying the accuracy of feedforward regulation.
Primary carcinomas are rarely encountered in the laryngeal ventricle of Morgagni. They are classified into the subgroup of supraglottic laryngeal carcinoma in the TNM classification system of malignant tumors. However, detailed investigations have not hitherto been made on the possible occurrence of carcinomas in this region of the larynx. To find out whether the laryngeal ventricle could be the site of carcinogenesis, the author examined squamous metaplasia in the mucosal epithelium of 60 human laryngeal ventricles which were taken from 38 larynges removed operatively from patients with laryngeal carcinoma (14 cases), hypopharyngeal carcinoma (20 cases), carcinoma of the upper esophagus (two cases), tracheal carcinoma (one case) or thyroid carcinoma (one case). The patients consisted of 31 males and 7 females, with an age distribution of 44 to 80, average 62.7. The laryngeal ventricles were selected for investigation only when they did not show any carcinomatous invasion macroscopically. Macroscopic observations were performed after gross staining with pyronin Y, which permits differentiation of squamous metaplasia from respiratory epithelia. Tissues were embedded in paraffin, sectioned serially and stained with hematoxylin and eosin. The clinical records of the patients were also made. The results are summarized as follows: 1. Squamous metaplasia of the stratified ciliated epithelium was found in 38 out of 60 specimens (63%) of the laryngeal ventricles examined. 2. The metaplasia seemed to be precipitated by smoking or exposure to radiation, along with aging. 3. The incidence and extent of metaplasia of the ventricular mucosa depended on the disease entity which had necessitated total laryngectomy, and the metaplasia was most prominent in cases with the supraglottic type of laryngeal carcinoma. 4. The metaplastic epithelium was occasionally associated with hyperplasia or dysplasia of the epithelium. 5. Microinvasive carcinoma was found in one laryngeal ventricle with severe metaplasia. These findings suggested a possible de novo carcinogenic process in the laryngeal ventricle through squamous metaplasia of the respiratory epithelium. From this observation, the author proposes to call carcinoma of this region of the larynx the ventricular type of laryngeal carcinoma.
The localization of the motorneurons innervating facial muscles and the masseter muscle was examined by the retrograde horseradish peroxidase (HRP) technique. Ten microliters of 50% HRP was injected into the orbicularis oculi muscle, the orbicularis oris muscle, the zygomaticus muscle and the masseter muscle of rabbits. At 48 hours after the HRP injection, perfusion fixation was done through the left ventricule of the heart under general anesthesia. The brain stem was removed and reacted with diaminobenzidine. The nucleus of the orbicularis oculi muscle was distributed in the medial-dorsal portion of the facial nerve nucleus. On the other hand, the nucleus of the orbicularis oris muscle and the nucleus of the zygomaticus muscle were located in the lateral-ventral, and medial-ventral portions, respectively. The nucleus of the masseter muscle (trigeminal motornucleus) was located about 1.1mm proximal to the facial nucleus. Experimental facial nerve palsy was produced by the following procedures. The intratemporal facial nerve was exposed under local anesthesia and crushed for 20sec. using a hemostatic forceps. Recovery from the facial nerve palsy was evaluated by evoked electromyography 3 months later. After another 3 months, HRP was injected into the zygomaticus muscle. In animals that had recovered from the facial palsy, motorneurons labeled with HRP were found not only in the medial-ventral portion but also partially in the medial-dorsal portion, which was the position of the labeled nucleus of the orbicularis oculi muscle in control animals. However, there was no significant difference in the size or number labeled motorneurons between the control and recovered animals. In 5 animals with synkinesis, hypolabeled premotorneurons of various size were observed bilaterally in the reticular formation form the pons through the medulla oblongata. Synkinesis seems to result in premotorneurons which are newly promoted. These findings suggest that the reticular formation is involved in the recovery from facial palsy.
Because of the efficacy of tonsillectomy, palmoplantar pustulosis (PPP) has been regarded as a tonsillar focal infection. The immune mechanism underlying focal infection has been considered to be one of the autoimmune diseases mediated mainly by immunoglobulins, but this remains to be clarified. The present study demonstrates the expression of HLA-DR antigen in tonsillar epithe lium. An HLA-DR positive area in the epithelium was computed by an image-analyzing program, and evaluated by means of comparisons among hypertrophic tonsil, recurrent tonsillitis, and tonsils with PPP. HLA-DR antigen appeared at high intensities in hypertrophic tonsils and with PPP. The positive areas were mutually related to aging in hypertrophic tonsil and recurrent tonsillitsis. Then, the infiltrating lymphocytes in tonsillar epithelium were counted and compared with the intensity of HLA-DR expression. A close correlation was found between the appearance of HLADR antigens and activation of infiltrating T-lymphocytes, but no clear relationship was found between HLA-DR antigen intensity and the number of B-lymphocytes. From these findings, it seemed that, in the tonsils with PPP, high HLA-DR intensity was observed in the epithelium and T-lymphocyte infiltration and activation were prominent. Moreover, the pustules on the soles of PPP patients were investigated. T lymphocytic infiltration was already observable in the upper dermis and epidermis in the early stage. Generally speaking, CD4 positive cells were present in substantially greater number than CD8 positive cells. Many CD25 positive cells were also observed around the basement membrane. But there were few cells adjacent to the pustules. These findings indicate that celluar immunity may influence the formation of pustules in the early stage.
The immunocytochemical distribution and morphological characteristics of substance P and neurofilament in vestibular endorgans and the vestibular ganglion of the guinea pig were investigated. The effect of capsaicin on substance P-like immunoreactivity was also evaluated in this study. Substance P-like immunoreactivity was found in the peripheral region of vestibular endorgans and in small or medium size vestibular ganglion cells. Approximately 85% of vestibular ganglion cells showed substance P-like immunoreactivity. Although substance P-like immunoreactivity was depleted in the nasal mucosa and trigeminal ganglion by capsaicin treatment, substance P distributed in the primary vestibular neurons was not affected. In contrast to the distribution of substance P, neurofilament was also found in the primary afferent neurons in the central regions of vestibular endorgans. Neurofilament immunoreactive cells, which were larger in size than cells without neurofilament-like immunoreactivity comprised about 34% of vestibular ganglion cells. These immunocytochemical findings suggest that vestibular ganglion cells can be classified on the basis of size and immunocytochemical characteristics.
Inhibitory activity against the proliferation of group A β-streptococci by α-streptococci, part of the normal flora of the oral cavity and throat, plays a role in host defense against infection. We speculated that there might be some relationship between alteration of oral flora and the presence of recurring tonsillitis. Accordingly, 141 cases of tonsillitis have been investigated for the detection of inhibitory α-streptococci. In patients scheduled for tonsillectomy, the mean number of inhibitory α-streptoccoci was preoperatively decreased and postoperatively increased. In patients in whom β-streptococcus had been detected (including patients scheduled for tonsillectomy), the mean number of inhibitory α-streptococci was markedly decreased, indicating a high incidence of β-streptococci in patients withtonsillitis. As inhibitory strains of α-streptococcus are sensitive to almost all antibiotics, it is suggested that chemotherapy may disrupt the normal flora of the throat. In summary, investigation of the oral cavity and the throat for the detection of inhibitory α-streptococcus appear to be useful in the management of group A β-streptococcal infection.