Practica Oto-Rhino-Laryngologica

ABR in Central Nervous System Disorder

Shin Aso, Masaru Aoyagi, Hiromi Wada, Isao Kato, Yoshio Koike

1982 Volume 75 Issue 11 Pages 2143-2154
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2143

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The auditory brain-stem responses (ABR) have been evaluated to see if they can be effectively used in neuro-otological examination. We reported ABR findings in 40 patients with central nervous system disorders and 26 healthy adults. The results were as follow:
1) ABR was useful in diagnosis of upper brain-stem damage but not of cerebellar or oblongatal damage.
2) Eight patients with degenerative diseases (three multiple sclerosis and five spinocerebellar degeneration patients) had no abnormal findings in ABR except one patient with multiple sclerosis.
3) The affected side in 9 of the 16 patients with upper brain-stem lesions and in all 6 patients with cerebello-pontine angle tumor corresponded to that of the ABR findings.
4) The ABR patterns of those with cerebello-pontine angle tumor were classified into three types based on the findings obtained on stimulation of the affected side: i) no response (3 patients); ii) presence of only wave I (2 patients); and iii) prolongation of I-V interval (1 patient).
5) The ABR is a useful neuro-otological phenomenon for differential diagnosis of whether cerebellar lesions involve the upper pons or not.

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Vertical Ocular Dysmetria. Vertical Rebound Nystagmus and Optokinetic Vertical Ocular Dysmetria

Eiji Sakata, Kyoko Ohtsu, Akinori Itoh, Kunio Takahashi

1982 Volume 75 Issue 11 Pages 2155-2164
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2155

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1) Ocular dysmetria were observed and recorded on electronystagmograms in one hundred cases of posterior fossa lesion especially in the midbrain and cerebellum. These are observed and recorded in vertical spontaneous ocular movement and vertical ocular movement which are induced by vertical optokinetic stimulation.
2) Ocular dysmetria which appear in the movements of the eyeballs in returning to the midpoint from the position of upward or downward gaze, is regarded as vertical rebound nystagmus. This phenomenon is more frequently observed in the movement returning to the midpoint from the upward gaze position than that of the downward gaze position.
3) Optokinetic vertical ocular dysmetria are recorded in 93 cases, and more frequently induced by the stimulation to the downward direction than upward.
4) The patterns of optokinetic vertical ocular dysmetria are classified into the next four types.
a) the dysrhythmic type which is characterized by the disorder of the rhythm of fast phase and slow phase.
b) the overshoot type which is characterized and originated by the overshoot of the fast phase of nystagmus.
c) the ataxic type which is characterized by an ataxic ocular movement originated by the disappearance of the distinction between the fast phase and the slow phase.
d) the saccadic (semi-inversive) type which is characterized by the disturbance of the smooth slow phase.
5) The neuronal system of vertical and horizontal ocular dysmetria is different. The former usually appear in the case of lesions of the cerebellum and its afferent system, and the latter usually appear in those of the cerebellum and its efferent one.

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Determining Pathological Conditions in the Maxillary Ostium by Means of Rhino-Maxillo-Aerodynamic Gram (Report No. 2)

Tomoshige Fukutake, Kunio Kuno, Tsukasa Ishibe, Yoshiaki Okuno, Takayu ...

1982 Volume 75 Issue 11 Pages 2165-2171
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2165

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The degree of ostial obstruction was measured with rhinomaxillo-aerodynamic grams (RMAG), and classified into 3 types, namely patent type (normal type), partially obstructed type and obstructed type. It has been confirmed again that the ostial state measured with RMAG correlates well with the result of the X-ray mucosal function test (X-MFT, test of excretion capacity). In addition to RMAG, other paranasal sinus functions were performed on a certain schedule. From these test data the policy of treatment was decided, giving good results. As contrast medium for X-MFT 20% Moliodol has been used so far, but it has been found that mixed lipiodol can replace it.

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A Case of Congential Adrenal Hyperplasia with Cleft Palate

Masahiko Tamaki, Hiroshi Okamura, Masaharu Niino

1982 Volume 75 Issue 11 Pages 2173-2178
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2173

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A soft cleft palate was complicated with congenital adrenal hyperplasia of saltlosing type in a 2-year-old boy. Specific surgical care was needed in performing the palatoplasty in fear of electrolyte disturbance and shock which were prone to occur in this particular disease as a result of surgical intervention, postoperative dehydration and fever. The clinical manifestation of the adrenal hyperplasia was reviewed. Deficiency of a kind of enzymes assisting the biosynthesis of corticosteroids in the adrenal cortex is a determining factor of the variety of clinical findings of the congenital adrenal hyperplasia. Prevention of electrolytic disorder associated with surgery was described. Within the scope of our review of the literature, there has been no case of congenital adrenal hyperplasia complicated with cleft palate.

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Multiple Primary Cancers in Laryngeal Cancers

Takashi Kondo, Yoshitaka Kawabe

1982 Volume 75 Issue 11 Pages 2179-2185
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2179

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From 1965 to 1980, we encountered 23 cases (5.5%) of multiple primary tumors associated with 420 laryngeal cancers. Fourteen of these were located in the stomach, and 2 in the lung and thyroid.
To obtain a better prognosis in laryngeal cancer patients, early diagnosis and treatment of multiple cancers is important.
The importance of inquiry regarding other malignancies in treatment of laryngeal cancer is discussed.

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A Case of Necrotizing Lymphadenitis

Yoichi Ishizuka, Shutaro Unoki, Toshio Ogoshi, Nobuo Usui, Toru Shindo

1982 Volume 75 Issue 11 Pages 2187-2192
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2187

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This paper describes a necrotizing lymphadenitis diagnosed by lymph node biopsy in a woman aged 28yrs, who had suffered from fever and lymph node swelling on 20 consecutive days prior to diagnosis. Histopathologically, necrosis was extensively present in the cortex through the paracortical area, while abscess or granuloma was absent. Clinically, no abnormality was found except for a decrease in WBC and increase in ESR. Response to antibiotics was negative, and steroid treatment brought about cure. Though prognosis is generally believed to be favorable, relapse occurred 4 years after the above episodes. The progress is now being observed.

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Pathology of Tympanic Perforation

Toshio Yamashita

1982 Volume 75 Issue 11 Pages 2193-2198
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2193

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Forty temporal bones with tympanic perforation were studied with a view to the feature of the epithelial growth on the edge of perforation.
Mucosal invasion to the external ear canal was seen in about 20% of all the cases, and this phenomenon was thought not to be rare.
Twenty-eight percent of the central perforation cases had epidermal invasion onto the middle ear; thus, central perforation was not thought to be safe.
Based on these findings of tympanic perforation after tubing, the necessity of the closed tubal input to the ear drum was suggested.

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Neutrophil Chemotactic Ability in Patients with Head and Neck Malignant Tumors

Keiichi Ichimura, Hiroyuki Mineta, Yasuo Mori, Michihiko Nozue

1982 Volume 75 Issue 11 Pages 2199-2205
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2199

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Neutrophil chemotaxis in patients with head and neck malignancy was measured with the in vitro agarose plate technique. In 44 patients, chemotactic ability was evaluated both before and three months after treatment. In addition, 13 end-stage patients were examined.
The chemotactic index, a ratio of chemotaxis to random migration, in patients with neoplasms was 1.82±0.30 (S. D.), which was significantly less than that of healthy controls (2.01±0.25) [P<0.05]. There was no difference before or after treatment in these patients. However, in regard to the posttreatment condition of the patients without tumor the chemotactic index was significantly more than that of those with residual neoplasia [P<0.05]. Chemotaxis of the end-stage patients was much smaller.
These results suggest that chemotactic capability of neutrophils in patients with tumor is decreased, and the more advanced the tumor is, the less the chemotaxis becomes.
Random migration of leukocytes was not impaired in patients at any stage.

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Diagnostic Significance of Neck Vibration for Patients with Vertigo of Uncertain Origin

Hideyuki Iwasa, Toshiaki Yagi, Tomokazu Kamio

1982 Volume 75 Issue 11 Pages 2207-2218
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2207

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The purpose of this report is to determine whether or not neck disorder is related to vertigo of uncertain cause. In 48 patients with no neurotological abnormalities, eye and body movements provoked by neck vibration to the dorsal neck area were investigated. In 25 (52.1%), nystagmus was induced by neck stimulation. The patients with neck-induced nystagmus showed the following clinical characteristics compared to those who showed no neck-induced nystagmus.
(1) The age of the patients was higher.
(2) Roentogenological abnormalities in the neck were found in more patients.
(3) Neck stiffness or sympathetically-provoked symptoms such as nausea, palpitation, perspiration or blurred vision were often observed as accompanied-symptoms of dizziness.
In 14 (56%) of the 25 patients with neck-induced nystagmus, the nystagmus was horizontal with a rotatory component and changing the side of stimulation reversed the direction of the nystagmus.
With respect to the body movement induced by neck stimulation, postural deviation to the side of the slow phase of the neck-induced nystagmus was often observed. In those with very tender, localized spots or a bruised portion of the neck, violent dysequilibrium was often provoked by the vibration of these points.
The authors pointed out the possibility that some of the vertigoes of uncertain cause may originate in the abnormality of the neck proprioceptors, which can be examined precisely by neck vibration.

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Side Effect of Tobramycin Administered Via a Nasal Nebulizer

Setsuko Morinaka, Toshiko Yoshinobu, Yasutoshi Kamamoto

1982 Volume 75 Issue 11 Pages 2219-2223
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2219

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Tobramycin was administered nasally via a nebulizer and the tobramycin activity in the serum was examined.
In normal persons who received tobramycin nasally of 17.5mg, 35mg or 70mg, the activity of tobramycin in their serum was 0μg/ml or 0.3μg/ml. In patients with chronic sinusitis receiving tobramycin of 17.5mg several times (from 5 to 71 times), the serum concentrations were also 0 or 0.3μg/ml. No patients, receiving tobramycin complained of the symptoms due to its toxicity and nobody showed abnormalities in various examinations.
It is, therefore, conclude that it is safe to use tobramycin by means of a nasal nebulizer.

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The Effect of Seaprose-S on Chronic Sinusitis

Yuichi Majima, Yasuo Sakakura, Hiroshi Mitsui, Takashi Matsubara, Yasu ...

1982 Volume 75 Issue 11 Pages 2225-2233_1
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2225

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The effect of proteolytic enzyme, Seaprose-S, on chronic sinusitis was examined. Subjects of this study included a total of 64 patients comprising 28 men and 36 women aged from 18-80 years old. The patients received Seaprose-S 15mg p. o. three times a day. No antibiotics or other proteolytic enzymes were given to the subjects. The effectiveness of Seaprose-S was evaluated by the parameters based on subjective symptoms, rhinoscopic observation and X-ray findings. In regard to subjective symptoms, the percentage of patients who felt good effects from the drug was 60.7% for nasal obstruction, 57.4% for nasal discharge and 54.1% improvement of difficulty in blowing the nose.
In regard to rhinoscopic observations, the effectiveness of the drug on the amount of nasal secretion and properties of nasal secretion was observed in 55.7% of the patients.
In X-ray findings, the effectiveness of the drug was observed in 37.5% of the maxillary sinuses and 28.3% of the ethmoid sinuses. The general effectiveness estimated from these results were excellent in 1 case (1.6%), good in 21 (32.8%), fair in 27 (42.2%) and poor in 15 (23.4%). A side effect of the drug was observed in one patient who complained of stomach-ache.
Seaprose-S was considered to be a useful drug for conservative treatment of chronic sinusitis.

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A Study on Antimicrobial Activity and Tissue Levels of a Cephem Antibiotic in Upper Respiratory Tract Infection

Yutaka Fujimaki, Shozo Kawamura, Rinya Sugita, Hiroyuki Osawa, Koichi ...

1982 Volume 75 Issue 11 Pages 2235-2247
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2235

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The usefulness of cefmetazole (CMZ), a cephem antibiotic, in the treatment of upper respiratory tract infections was assessed in respect to antibacterial activity and antibiotic concentrations in tissues.
The in vitro antibacterial activity was determined by the re-revised minimum inhibitory concentration (MIC) assay procedure of the Japanese Society of Chemotherapy. For estimation of tissue antibiotic concentrations, specimens of the palatine tonsilla and maxillary sinus mucosa obtained at operation from patients given an intravenous dose of 1-2g of CMZ or cefazolin (CEZ) were assayed by the thin agar layer-cup method and sensitivity disc method, using Micrococcus luteuss ATCC 9341 or Bacillus subtilis ATCC 6633 as the test organism, respectively.
Results:
1) The antimicrobial susceptibility tests revealed an increased activity against Haemophilus influenzae and indole-positive Proteus isolates.
2) There was a remarkable proximity of the MIC and minimum bactericidal concentration (MBC) of CMZ against the various clinical isolates in vitro.
3) Ten to 40% of the serum level of CMZ were demonstrated in the maxillary sinus mucosa and palatine tonsils. These tissue levels sufficiently surpassed the MICs of frequent isolates from upper respiratory tract infections.
4) The tonsil level of CEZ, another cephem antibiotic, was about t he same as that of CMZ, but the rate of transfer from the serum to tonsils was less variable in the case of CEZ.
The results indicate considerable usefulness of CMZ in the treatment of upper respiratory tract infections.

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A Study of the Blood and Tissue Concentrations of a Cephalosporin Antibiotic, Ceftezole

Takehiko Iwasawa

1982 Volume 75 Issue 11 Pages 2249-2258
Published: November 01, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.2249

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Investigation of the blood and tissue concentrations of Ceftezole was performed with the results which led to the following conclusions:
1) Blood concentration: The blood level of Ceftezole in healthy adults given 500mg reached a maximum of 10.7μg/ml 30 minutes after intramuscular injection; clinically effective blood Ceftezole concentration of 0.8μg/ml was still demonstrable.
2) Tissue concentration: Activity of Ceftezole was demonstrable at the concentration of 1.7μg/g in human palatine tonsilla and 1.8μg/g in mucous membrane of the maxillary sinus 30 minutes after intramuscular injection of 500mg, when the blood concentration of Ceftezole was 7.2μg/ml and 9.0μg/ml, respectively.

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