Practica Oto-Rhino-Laryngologica

A Trial for E. N. T. Training in Undergraduate Students

Tokuji Unno

1980 Volume 73 Issue 8 Pages 1267-1274
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1267

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A training method in the field of otolaryngology has been practised since 1979 at Asahikawa Medical School. A manual was previously distributed to each student for preparation. A patient's chart and a sheet for students were provided in actual practice. In addition to medical history, E. N. T. examination and lavoratory examination, diagnosing process and initial planning were especially emphasized. Contents of the manual were explained and their meaning was discussed. Three main purposes of this method are as follows: 1. reasonable and grading approach to a correct diagnosis. 2. planning of detailed further examinations. 3. proper otolaryngological consultation.
Criticisms for this method from specialists will extremely be appreciated.

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Six Cases of Blow-out Fracture Examined by Biplane CT

Satoshi Koike, Takao Tomozu, Masanori Sadamoto, Kazuhiko Sadamoto

1980 Volume 73 Issue 8 Pages 1275-1279
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1275

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Six cases of blow-out fracture have been experienced by us recently. They consist of one case of orbital floor fracture and five cases of lamina papyracea fracture.
The biplane computed tomography (CT), i. e. axial and coronal CT, which is a newly developed diagnostic procedure, was employed to make a definite diagnosis.
This CT examination clearly showed the fracture of the lamina papyracea, which is difficult to find by the conventional radiological methods and evaluation of the CT value could delineate the nature of the masses prolapsing from the orbit.
In the case of patients with no eye-movement disturbances, we concluded that preservative therapy and follow-up without surgical intervention could lead to cure with no dysfunction.

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Two Cases of Maxillary Fibromyxoma and Classification of Myxoma

Michi Yagi, Hideo Nishimura, Fumihiko Sato, Hitoshi Saito

1980 Volume 73 Issue 8 Pages 1281-1286
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1281

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Two cases of fibromyxoma involving the maxilla are reported. One was a 34-year-old female complaining of maxillary swelling and nosebleeds. Although the maxilla was free from tumor after the combined therapy, she died of lung metastasis after three years and three months. The other was an 18-year-old male complaining of toothache and gingival tumor. He had sciatic metastasis 10 months after the combined therapy including subtotal maxillectomy. He is still alive one year and five months after the first examination. A classification of myxoma is proposed.

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A Case of Inter-Arytenoid Band

Mikikazu Yamagiwa, Yasuo Sakakura, Keizo Fukukita, Takashi Matsubara

1980 Volume 73 Issue 8 Pages 1287-1293
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1287

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The authors report on a 50-year-old woman with an interarytenoid band which is a web formation between the two arytenoids with intact anterior and posterior commissures.
Three years ago she underwent right hemithyroidectomy for follicular thyroid cancer during which the recurrent laryngeal nerve was sacrificed and on March 9, 1979 left-hemithyroidectomy with radical neck dissection on the right side for the recurrence. Because of bilateral vocal cord paralysis, an endotracheal tube had been introduced postoperatively for seven days and then tracheotomy was performed on March 16, 1979.
She was admitted to the Department of Otolaryngology on November 29, 1979. On inspection the vocal cords were fixed on the median line. EMG examination revealed that discrete activity was observed on the left laryngeal adductor muscles. Although the paralytic vocal cord on the left side slightly responded to massive intravenous administration of ATP, right extralaryngeal arytenoidectomy with vocal cord lateralization was performed on December 7, 1979. Subsequently an inter-arytenoid band was found. The simple excision of the band was successfully done through a suspension laryngoscope on December 13, 1979. In this case, the band may have resulted from the fixation of denuded and paralysed vocal cords on the median line. At present, the left vocal cord is functionally normal and the right one is fixed in the paramedian position.
The authors discussed the etiology, diagnostic procedure and treatment of this disease.

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Immunological Studies on Human Malignant Tumor

IX. Natural Cell-Mediated Cytotoxicity of Patient Lymphocytes Against ⁵¹Cr-labeled Tumor-Derived Cells

Noriko Kane, Toshihide Tabata, Mitsuo Mukudai, Yoshihiro Dake, Tadao E ...

1980 Volume 73 Issue 8 Pages 1295-1300
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1295

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Natural cell-mediated cytotoxicity of normal lymphocytes against cultured tumor cells in animals and humans has been reported. The overall concept of natural cytotoxicity was derived from the in vitro observation that lymphocytes of both healthy and patient donors exerted direct cytotoxic reactions against tumor-derived cells. In the present study, using a cultured cell line of maxillary cancer with the characteristics of epidermoid carcinoma as the target, it was demonstrated that lymphocytes of patients bearing malignant tumor in the head and neck region possessed cytotoxic activity. Mononuclear cells were separated by centrifugation on Ficoll-Hypaque gradients. Monocytes were removed by incubation at 37°C for one hour in a plastic dish with complete medium (RPMI 1640 and 20% FCS). After removal of monocytes, T cells and non-T cells were separated by the rosette forming technique using sheep erythrocytes. Whole lymphocytes from normal healthy donors exhibited higher cytotoxic activities with dose response reaction. On the other hand, patient lymphocytes showed weak activity, in paticular, at low E/T ratios.
Removal of monocytes from lymphocyte suspension did not influence cytotoxicity. T cells showed extremely decreased cytotoxicity in comparison with non-T cells. It was suggested that the population of non-T cells mainly contributed in vitro to natural cytotoxic activity against malignant tumor cells.

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Two Cases of Hyperimmunoglobulinemia with Head and Neck Cancers

Akira Tamada, Toshiyo Kobayashi, Satoru Tanaka, Tadahiro Ito

1980 Volume 73 Issue 8 Pages 1301-1306
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1301

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Waldenstrom claims that benign monoclonal gammopathy is probably associated with cancer based on the cases he encountered. This observation has been confirmed by not only foreign but also Japanese researchers.
Its etiology, however, is, unknown.
This first patient had benign monoclonal gammopathy of the IgG type and was afflicted with neck cancer. The cancer cells did not produce IgG.
The second patient had hyperimmunoglobulinemia E that was associated with cancer in the parotid gland. This cancer did not produce IgE either. From the history, this patient was also considered to have benign monoclonal gammopathy of the IgE type.
These two cases suggest that excessive production of immunoglobulin, IgG or IgE, may be conductive to cancer development.

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A Case Report of an Euthyroid Patient with Hyperfunctioning Thyroid Nodule

Toshio Yamashita, Masao Shinomiya, Yuko Suzuka, Sae Nishitani, Akira S ...

1980 Volume 73 Issue 8 Pages 1307-1312
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1307

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A thirty-two-year old female came to our clinic with a firm nodule at the anterior neck. It was 2×2cm in size, located in the right lobe of the thyroid gland and diagnosed as a thyroid nodule. The patient was considered as being in an euthyroid state according to the constitutional and laboratory findings. Radioiodine scintigraphic study revealed selective iodine uptake confined to the nodule and not to the rest of the gland. The study indicated that the hyperfunctioning thyroid nodule completely surpressed the activity of the thyroid gland, and yet the patient remained euthyroid. After exstirpation of the nodule, iodine uptake of the thyroid was restored to a normal level. The nodule was diagnosed as being a hyperfunctioning follicular adenoma of the thyroid. Since a functioning nodule like the one presented here is extremely rare in Japan, this case report should be informative for thyroid specialists.

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Evaluation of Vinpocetine Effect on Cochlear Blood Flow by Direct Plasma Space Counting

Jun Morimoto, Kazuo Uede, Hideo Nishimura, Hitoshi Saito

1980 Volume 73 Issue 8 Pages 1313-1320
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1313

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In order to evaluate the effect of Vinpocetine, a new vasoactive agent, on the cochlear blood flow, the numbers of the plasma spaces running through the radiating arterioles per minute at the third turn of the guinea pig cochlea were counted under a stereomicroscope before and after intraperitoneal injection of this drug. The numbers were normalized to the percentages of the number counted before the injection. The percentages at the different times were statistically compared to those of the control by Student's t-test. In each group given Vinpocetine at a dose of 0.5, 1.0 and 2.0mg per kg of body weight respectively, the numbers of the plasma spaces increased significantly at the certain periods from 10 to 30 minutes after the injection. Therefore, Vinpocetine appeared to be useful for treatment of inner ear diseases caused by circulatory impairment.

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Posture and Nystagmus

with Reference to Nystagmic Responses due to Torsion of the Neck in Rabbits with Various Postures

Shinsuke Ito, Manabi Hinoki

1980 Volume 73 Issue 8 Pages 1321-1341
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1321

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1) We devised a new method to provoke nystagmic responses of cervical origin in which a rabbit's trunk is hung and fixed with cloth while the head and four limbs are unrestrained. The head of the animal is then rotated around its longitudinal axis at the rate of 90 degrees either to the right or to the left. The nystagmic responses provoked in this way are recorded at the maximum point of torsion of the neck using ENG. We found that the appearance of nystagmic responses of cervical origin was more marked in the neck torsion test referred herein than in those reported by Philipszoon. The nystagmic responses thus provoked were oblique and directed to the same side as that of the torsion of the neck.
2) We made a series of experiments in which nystagmic responses of cervical origin were tested in the method described in (1) with the following postures: i) a posture of standing with the four limbs on a horizontal platform, ii) a posture of standing with the four limbs on a platform inclined forwards, iii) a posture of standing with the hindlimbs on a horizontal bar, iv) a posture of standing with the forelimbs on a horizontal bar, v) a posture in which the trunk and four limbs are fixed to a cage, while the head is unrestrained, vi) a posture, in which the hindlimbs are pulled and stretched down-wards, and vii) a posture in which the forelimbs are pulled and stretched downwards. From a series of experiments we found that the appearance of nystagmic responses of cervical origin was the most marked in the postures described in ii) and iii), whereas nystagmic responses were fewer in the posture described in vi). The nystagmic responses induced in the postures described in i), iv) and vii) were similar to that induced in the posture described in (1). In the posture described in v), most animals showed deviation of the eyes with some exceptions in which a weak and short-lasting nystagmic response was observed. Taking into account the hitherto reported results and our animal experiments which were recently performed, we concluded:
(a) The method referred to herein is useful in producing nystagmic responses of cervical origin.
(b) The proprioceptors of the hindlimbs, which are involved in the maintenance of the standing posture, play a major role in the promotion of nystagmic responses of cervical origin. In contrast, no significant role has been found in the proprioceptors of the forelimbs.
(c) The proprioceptors of the hindlimbs exert an inhibitory action on the development of nystagmic responses of cervical origin when the flexors and extensors of the hindlimbs are simultaneously stretched. In contrast, in the case of stretching both kinds of muscles of the forelimbs no significant effects have been found with regard to the appearance of the above-mentioned nystagmic responses.
(d) The results obtained in the present experiments indicate that the physiological meaning of nystagmic responses should be interpreted in relation to the bodily reflexes which appear simultaneously with the nystagmus.

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Current Status and Problems of Cochlear Implant

Kiyofumi Gyo

1980 Volume 73 Issue 8 Pages 1343-1353
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1343

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At the present time there is no defined treatment for profound sensory hearing loss. Clinically, it is possible to stimulate the remaining auditory nerve fibers by electronic devices (cochlear implant) in order to restore hearing. This paper will give an outline of the current status of cochlear implant.
The electronic devices that receive their input from a microphone/amplifier system and send their output to the implanted electrodes are classifed into the following three systems: 1) percutaneous transmission system, 2) transcutaneous transmission system, and 3) implantable package system. Two locations, the scala tympani and modiolus, are reported as suitable sites for cochlear implant. The scala tympani approach takes advantage of the cochlea's tonotopic organization to stimulate the auditory nerve fibers selectively, though it is limited by the current shunting in the cochlear fluid The modiolar approach permits access to the fibers coming from all parts of the cochlea, though selective stimulation of small groups of fibers is difficult. It is proved that a cochlear implant with a single channel system is useful only as an aid to lip reading and for distinguishing some environmental sounds. To improve speech discrimination, a multichannel system is indispensable, though it is unknown how many channels may be necessary in order to provide intelligible speech. The indication of the cochlear implant is assessed by the electrical promontory or round window stimulation test. The etiopathological backgrounds considered suitable for implantation are deafnesses caused by ototoxic drugs or head trauma, hereditary sensory deafness of adult onset, and advanced bilateral Meniere's disease.

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Peripheral Facial Paralysis Analysed by Integration of Conventional EMG

Nobuya Yagi, Yasuyuki Ishikawa

1980 Volume 73 Issue 8 Pages 1355-1361
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1355

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Conventional electromyograms on voluntary movements can be converted into square waves with the aid of an AC-DC converter. The height of these waves contains components of the amplitude and firing frequency of original muscle discharges. Consequently, this means that the wave height indicates the degree of muscle paralysis.
Following this conversion method, EMGs of the frontal muscle, orbicularis oculi muscle, and orbicularis oris muscle were recorded in 10 normal subjects and 11 facial paralysis patients. In the normal, the ratios of the one to the other side were 86.4±5.9% in the frontal muscle, 88.5±9.5% in the orbicularis oculi muscle and 96.1±3.4% in the orbicularis oris. In facial paralysis, paralysis scores of rating scale proposed by Yanagihara (1977) were served as a degree of facial paralysis, and EMG measurements above mentioned were undertaken at several points during the recovery process.
Each EMG ratio of the affected side to the normal side was calculated. EMG ratios showed increase acompanied by recovery of paralysis score value.
The ratios for all patients had good correlation with paralysis scores in rating scales showing the correlation factor, 0.86 in the orbicularis oculi muscle and 0.74 in the oris muscle.
This means that integration of conventional EMGs is a good parameter of facial paralysis.

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A Study of Influence of Tracheal Fenestration on the Surface Architecture of the Respiratory Mucosa

Shinpei Yamamoto

1980 Volume 73 Issue 8 Pages 1363-1378
Published: August 01, 1980
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.73.1363

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The nasal, laryngeal and tracheal mucosa of the dog was studied with a scanning electron microscope and an X-ray microanalyser (EDX) after shunting air from the nasal passages by tracheal fenestration using a modified technique of Whicker et al. On the anterior third of the lateral wall, the nasal septum and localized regions of the subglottic area, the mucous membrane was composed of various types of non-ciliated cells such as squamous, low cuboidal and columnar epithelia. These areas, so-called inactive areas, were replaced by numerous ciliated cells about three months after tracheal fenestration. At the same time, the respiratory mucosa on the opposite side of the tracheal stoma was covered by stratified squamous epithelium following marked proliferation of goblet cells within the first two weeks after the operation. In addition, the same characteristic morphology of non-ciliated cells as in the above-mentioned inactive areas was observed on the peripheral mucosa right below the edge of the stoma.
The respiratory epithelium was investigated with EDX. Phosphorus, sulfur and small amounts of calcium were found on the ciliated mucosa. On the non-ciliated mucosa, phosphorus and sulfur were found. On the squamous epithelium, phosphorus and much sulfer were found.

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