We report 4 cases of olfactory neuroblastoma with anterior cranial fossa extension treated by craniofacial surgery. Three patients have been alive and well for 4 years, 1 year and 11 months after the initial treatment without major surgical complications but one patient died of local recurrence 11 months after treatment. Multidisciplinary surgery for olfactory neuroblastoma with intracranial extension permits radical tumor excision and reconstruction of the anterior skull base. This one-stage procedure combining neurosurgery and plastic surgery with pre or post-operative radiotherapy is considered to be essential for eradicating this tumor.
Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa. Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles. During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material. In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated. Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave -motion of the vocal mucosa, thus resulting in an acceptable voice quality.
A one-step PCR system was developed for detection of two types of EBV, using a single pair of primers that were complementary to both sequences coding the EBV nuclear antigen (EBNA)2, and encompassing a large deletion in the sequence of type 1 EBV. Type 1 and type 2 EBV were detected simultaneously by polyacrylamide gel electrophoresis and ethidium bromide stains after amplification. The specificity of amplification was confirmed by Southern blot hybridization with the oligonucleotide probe that was complementary to both EBNA-2 regions. Additionally, two pairs of type specific primers were synthesized from divergent sequences in the EBNA-2 regions of type 1 and type 2 EBV. The PCRs were employed for analysis of the EBV genotype in the oral cavities of healthy donors and patients with various tonsillar disorders. EBV was detected in 60 samples from healthy donors and patients with various tonsillar disorders. Fifty-six contained type 1 and four type 2. Double infection was not seen in either healthy donors or patients. These results indicate that type 1 EBV is highly dominant in Japan. It is interesting to note that patients with acute tonsillitis and palmoplantar pustulosis showed a statistically higher frequency (P<0.01) of EBV excretion than healthy donors. In examining anti-EBV viral capsid (VCA) -IgG antibody titers and EBV excretion in the oral cavity, EBV excretion was not found to correlate with the VCA-IgG antibody titers.
The polymerase chain reaction method (PCR) was employed for the analysis of EBV genotypes in nasopharyngeal carcinoma, malignant lymphoma of head and neck origin and infectious mononucleosis. In nasopharyngeal carcinoma, type 1 EBV was detected in 12 cases and type 2 in one. Type 1 EBV was also detected in 3 out of 8 malignant lymphoma and 2 infectious mononucleosis. These results indicate that type 1 EBV is strongly predominant in nasopharyngeal carcinoma and predominant in malignant lymphoma and infectious mononucleosis. Our results may reflect the general prevalence of these two types of EBV in Japan, as we previously reported.
The effect of aging on middle ear function has not been investigated thoroughly, as there is no simple measuring apparatus except for the conventional impedance meter (IM). However, the reliability of the IM is insufficient, because the stimulus frequency is fixed and the information provided by the IM is minimal. We have developed a sweep frequency middle ear analyzer (MEA), which provides much more information on middle ear dynamic characteristics than a conventional IM, and have obtained various measurements with this device. In this paper, middle ear dynamic characteristics of 187 normal subjects (309 ears) ranging from a 4-year-old child to an elderly person, 79 years old, were measured with the MEA in the middle ear resonance frequency region where dynamic characteristics can be seen clearly, and the effect of aging on middle ear dynamic characteristics was examined. The main results obtained were as follows: Middle ear mobilities tend to increase up to the twenties, then decrease up to the forties. Subsequently, a clear difference between those of males and females is observed. The middle ear mobilities of males decrease gradually with an increase in age. In contrast, although the standard deviation values are large, those for females tend to rise with increasing age.
The sympathetic nervous system, which originates in the superior cervical ganglion (SCG) and is distributed in vestibular end organs, has been proposed to have some influence on vestibular function. The present investigation was conducted to assess the effects of unilateral electrical stimulation of the SCG, administration of a vasopressor drug, and introduction of KCl (0.7 M/ml) into the tympanic cavity on vestibular function in alert guinea pigs. Nystagmus was not observed as result of electrical irritation of the SCG (22 test animals), infusion of the KCl solution into the middle ear cavity (5 test animals), or the combination of SCG stimulation and vasopressor drug administration (7 test animals). However, when the SCG was stimulated electrically after introduction of the KCl solution into the ipsilateral cavity, nystagmus and postural deviation were observed (5 out of 12 animals). Furthermore, after the administration of a vasopressor drug to these 12 animals, irrespective of the manifestation of nystagmus, the same changes took place in response to the electrical stimulation (7 animals). These results suggest that SCB stimulation is a provocative factor for nystagmus, that infusion of KCl solution into the tympanic cavity induces a hypersensitive state in the inner ear, and that high blood pressure increases this hypersensitivity.