Practica Oto-Rhino-Laryngologica

Clinical Studies on Auditory Brain Stem Responses Influenced by Total Spinal Anesthesia, Subarachnoidal Block and Intravenous Lidocaine Treatment

Nobuyuki Urabe

1985Volume 78Issue 8special2 Pages 1711-1730
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1711

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The effects of total spinal anesthesia (TSA), subarachnoidal block (SAB) and i. v. lidocaine treatment (ILT) on auditory brain stem responses (ABRs) were studied by time-course recording in 28 cases. A dose (20ml) of 1.5% mepivacaine hydrochloride was injected into the subarachnoidal space at the Th₁-Th₂ level for TSA and at the L₄-L₅ level for SAB, respectively, and 2 or 3ml of 2% lidocaine hydrochloride, i. v. for ILT. On application of TSA, the 2nd to 5th or 1st to 5th waves in ABR disappeared for about 2hr reversibly in most cases. Changes in blood pressure and pulse rate seemed not to affect ABRs during TSA. Mepivacaine injected into the subarachnoidal space presumably exerted direct effects on the brain stem. The depression of awareness during TSA appeared to be caused by direct anesthesia of the brain-stem reticular formation. The direct effects of mepivacaine on the brain stem were also ascertained by the changes of the pupillary diameter and prolongation of interwave latency (1st to 5th) during TSA. Neither SAB nor ILT affected ABRs.

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A Clinicostatistical Study of Tinnitus

Nobuyuki Urabe

1985Volume 78Issue 8special2 Pages 1731-1745
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1731

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Cases of tinnitus totaling up to 163 examined at the Oto-Rhino-Laryngological Clinic of Tottori University Hospital have been reviewed. They consisted of 78 men and 85 women aged from 15 to 84 years. Tinnitus was attempted to be expressed verbally by onomatopoeia. The most frequent expression was “geen” [d i n]. Pitch matching and loudness matching tests were carried out in 146 patients. The most frequently observed pitch and loudness of tinnitus was 8000Hz and 0dB HL., respectively. The masking curve examined by bands of noise showed 7 types, including the convergence type (42% of 77 cases). Residual inhibition (RI) was studied by 1-min delivery of bands of noise in 82 cases, in 58 of which RI was positive. Effects of i. v. injected lidocaine (60mg for males, 40mg for females) were examined in 121 cases: tinnitus disappeared entirely in 39 cases; and was reduced partially in 53. The i. v. injected agent was effective in most of the RI-positive cases. To sum up these findings and ones obtained by auditory brain-stem response examination, suppression of tinnitus by RI and i. v. injected lidocaine may result from participation in the brain stem.

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Quantitative Analysis of Horizontal Saccadic Eye Movements in Healthy Individuals

Shinji Hiraki

1985Volume 78Issue 8special2 Pages 1746-1757
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1746

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Horizontal saccadic eye movements were recorded in 10 healthy subjects (5 males and 5 females) aged from 19 to 33 years. Reaction time, correction time, mean velocity and peak velocity of horizontal saccades were analyzed quantitatively. The binocular direct-current electronystagmographic system was applied for the recording, and the data presented on the recording paper were analyzed. The results obtained were as follows:
1. Reaction time did not differ between 2 different kinds of target amplitude, and decreased as the target jump frequency was increased.
2. Correction time was prolonged when target amplitude was enlarged, and decreased as the target jump frequency was increased.
3. The larger target amplitude led to the higher mean velocity and peak velocity, and both velocities were not related to the traget jump frequency.
4. The mean velocity and peak velocity at the same target amplitude were faster in alternate gazing at 2 fixed targets than gazing at a pursuiting jumping target.

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Dropping-out of Immunotherapy for Nasal Allergy

Takeo Suzuki, Motoo Takaoka, Hiromi Takeuchi, Yoshihiko Ishizu

1985Volume 78Issue 8special2 Pages 1758-1766
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1758

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Cases which dropped out of specific immunotherapy using house dust extract for nasal allergy were studied. The rate of dropout of the therapy within a year from the start was 41.6% in 202 cases where the therapy was begun before July 1981, and 32.0% in 75 cases where it was started in 1983. Many of these cases stopped the therapy within 6 months from the start. The rate was lower in the age group of 12 years or less than that of 13 years or more. The rate showed differences by medical institutions where respective patients received therapy. Better nasal conditions were produced in the group that continued than that which dropped out.

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Two Cases of Agranulocytosis

Saburo Sugihara, Kiyoshi Inaga, Hiroshi Kouzaki, Yukisato Kitamura

1985Volume 78Issue 8special2 Pages 1767-1772
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1767

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Recently experienced 2 cases of agranulocytosis are reported. One was a 83-year-old female complaining of sore throat, dysphagia, general fatigue and fever. Because blood examination revealed pancytopenia, blood transfusion and administration of r-globulin were conducted. The patient died of complicated pneumonia. The other was a 39-year-old male with thrombopenia and delayed anemia, complicated with a periproctal abscess and a cervical abscess, who recovered by administration of steroid hormones and antibiotics.

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Semi-Single Reconstruction of the Hypopharynx

Michiaki Yokoyama, Kiyoshi Inaga, Keiichi Kadowaki

1985Volume 78Issue 8special2 Pages 1773-1776
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1773

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In treating hypopharyngeal carcinoma T3N3M0, semi-single reconstruction was carried out after laryngopharyngoesophagectomy, using a pectoralis major myocutaneous flap. Procedurally, the hypopharynx was not closed, but a small fistula was made. After post-operative radiation therapy, the fistula was closed using a local hinge flap and a rotation flap under local anesthesia. As advantages of this method, it may be pointed out that major complication due to salivary leakage is absent; the fistula can be closed under local anesthesia; and no influence is exerted on post-operative radiation therapy.

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A Scanning Electron Microscopic Observation of the Crypt Epithelium and Basement Membrane of the Human Tonsil

Kiyoshi Inaga, Tetsuro Tsujita

1985Volume 78Issue 8special2 Pages 1777-1787
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1777

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Surgically obtained human tonsils were subjected to scanning electron microscopic (SEM) observations of the crypt epithelium and its basement membrane. In removing the epithelium, surface tension, prolonged fixation in 0.1% osmium tetraoxide and ultrasonic vibration were applied to a subject simultaneously. The observed sites were the superficial and deeper layers of the epithelium, basal cells, basement membrane and subepithelial connective tissues.
The results obtained were as follows:
1. In the superficial layer of the epithelium, microcrypts penetrated into the squamous epithelial cells. In the deeper layer, polygonal cells formed a channel. The basement membrane showed many micropores 1.5 to 10μm in diameter. These structures were considered to be the pathways of infiltrating cells.
2. Some micropores of the basement membrane included no infiltrating cells. This fact suggests that these micropores might maintain their own structures rather perpetually in sites where cellular infiltration is conspicuous.
3. The surface of basement membrane consisted of relatively smooth areas, fibrous structures and aggregated granular materials.

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A Pharmacotherapeutical Study of Tinnitus

Nobuyuki Urabe, Tetsuo Yamamoto, Kazuhisa Fujita, Takashi Amano

1985Volume 78Issue 8special2 Pages 1788-1797
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1788

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Effectiveness of mecobalamin (MA), cloxazolam (CL) and carbamazepine (CA) on tinnitus was compared in 77 patients divided into 3 groups by the agents administered: 35 by MA, 17 by CL and 25 by CA. Groups MA and CL showed no side effects, but 8 (32.0%) of group CA were excluded from study because of the appearance of side effects. Prescriptions in respective groups were as follows: 1.5-mg dose of MA 3 times a day; 4-mg dose of CL twice a day; and 100-mg dose of CA once a day. In group CA, daily dosage was incresaed by 100mg if no effect resulted even a week after. The ratio of symptomatic improvement in tinnitus 4 weeks after was 48.6% in group MA, 88.2% in group CL and 70.6% in group CA. These results may prove that CL exerts its action on tinnitus most effectively among the 3 agents.

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Five Cases of Strawberry Pollinosis

Motoo Takaoka, Yoshihiko Ishizu, Takahiro Maeda

1985Volume 78Issue 8special2 Pages 1798-1805
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1798

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In addition to a subjective case of strawberry pollinosis, 4 cases of the same disease found by an epidemiological survey focused on farmers engaged in vinyl plastic hothouse culture of strawberry are reported. The subjective case, a 39-year-old woman engaged in the hothouse culture of strawberry, had suffered from rhintis and conjunctivitis, which strawberry pollen extract can provoke. She showed also a positive skin test and a positive score of radio-allergo-sorbent test (RAST) to strawberry pollen extract. Results of the epidemiological survey revealed that 14 (12.2%) of 115 subjects were with one or more symptoms of allergy. Diagnosis of the 4 cases was based on results of examinations including skin test, provocation test and RAST.

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A Study of 14 Cases of Parapharyngcal Space Tumors

Wataru Takeuchi, Hisaaki Ikoma, Michiaki Yokoyama, Nobuyuki Urabe, Tet ...

1985Volume 78Issue 8special2 Pages 1806-1812
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1806

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Parapharyngeal space tumors (PSTs) have been studied in 14 cases treated in our clinic between 1960 and 1983. The results obtained are as follows: 1. The incidence of malignant PSTs predominated in males aged 40 years or over.
2. Though subjective symptoms of PSTs are generally lacked, 80% of the malignant cases suffered from severe and persistent pain.
3. The incidence of malignant PSTs in our clinic, 35.7%, was much higher than those described in other reports.
4. The area from the paratopharyngeal to postpharyngeal wall was hyperemic and swollen only in the malignant cases.
5. As indicative from the above 1-3, preoperative biopsy seems unnecessary, except when malignancy is strongly suspected etiologically and clinically.
6. The combined CT-sialogram was very useful in revealing the size, extent and origin of tumors and in determining the best surgical approach for complete and safe excision.

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Ultrasound Diagnosis of Diseases of the Head and Neck

Tetsuro Tsujita, Keiichi Kadowaki, Shinji Hiraki, Kazuhisa Fujita, Tak ...

1985Volume 78Issue 8special2 Pages 1813-1821
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1813

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Gray-scale ultrasound was applied to 55 cases of tumorous disease in the head and neck except the thyroid gland, and its availability in diagnosis was examined and proved.
1. Concerning diseases of the parotid gland, the usefulness of gray-scale ultrasound was less distinguished in inflammatory cases than in tumorous cases, where differential diagnosis between benigncy and malignancy was enabled. This method was especially superior in searching internal morphology.
2. In examining neck masses, diagnostic usefulness of the ultrasound was scarce in inflammatory cases, because ecography presented patterns like in malignant cases. For benign tumors (especially cystic disease and lipoma), this method proved hghly useful. For malignat tumors (metastatic lymph nodes, mostly), the following functions are appraciated: i) capability of detecting tumors that are in uneasily palpable sites; and ii) ability of searching signs of tumor invasion and adhesion to neck vessels.

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A Case of Zenker's Diverticulum Associated with Plummer-Vinson Syndrome

Mikio Nakashima, Michiaki Yokoyama, Kiyoshi Inaga, Yukisato Kitamura

1985Volume 78Issue 8special2 Pages 1822-1828
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1822

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A case of Zenker's diverticulum is reported. The patient was a 53-year-old woman having a 6-month history of dysphagia, angular stomatitis and hypochromic microcytic anemia. The esophagogram showed a web and a diverticulum. This case was diagnosed as a rare complication of the Plummer-Vinson syndrome with Zenker's diverticulum. The diverticulum was removed surgically.
Clinical significance of the diseases has been discussed.

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Tumors of the Hard and Soft Palates

Mikio Nakashima, Takeo Suzuki, Wataru Takeuchi, Yoshihiro Majikina, Yu ...

1985Volume 78Issue 8special2 Pages 1829-1834
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1829

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Cases of tumor originating in the hard and/or soft palates experienced in this department between 1950 and 1979 have been reviewed and subjected to case analysis. The cases totaled up to 41, of which 23 were benign and 18 malignat. Pleomorphic adenoma showed the highest incidence.

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A Case of Lipoblastoma of the Parapharyngeal Space

Takashi Horie, Takeo Suzuki, Kouei Asaki, Hiroshi Kouzaki

1985Volume 78Issue 8special2 Pages 1835-1839
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1835

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A case of lipoblastoma of the parapharyngeal space in a 37-year-old male was reported.
The patient complained of a swelling in the left parotid region.
The tumor, existed in the parapharyngeal space, was removed using a cervical approach without angle mandibulotomy.
A histopathological examination revealed lipoblastoma. Parapharyngeal lipoblastoma is a rare finding. No report of such nature is found in the literature of this country, there is only a report of single instance in those of America.

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A Large Sphenoid Sinus Pyocele with Bilateral Severe Visual Disturbance

Hiroshi Kouzaki, Hideo Kadowaki

1985Volume 78Issue 8special2 Pages 1840-1846
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1840

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A 71-year-old male case of a large sphenoid sinus pyocele with bilateral severe visual disturbance is reported. The patient complained of headache and bilateral visual disturbance of light sensation. Preoperative CT-scan showed a clear outline of the lesion. After surgery by the transnasal approach, the headache was perfectly improved and visual acuity was recovered to normal in both eyes.
Japanese literature on sphenoid sinus mucocele written between 1965 and 1984 has been reviewed. Among the total of 87 cases including the present case, 78 had visual disturbance, laterally in 65 (83%) and bilaterally in 13 (17%). The rest 21 (27%) had lateral visual disturbance of null. In about 50 eyes of the 78, the relation between preoperative visual acuity and recovery from visual disturbance was investigated.

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A Case of Maxillary Neurofibroma

Yukisato Kitamura, Michiaki Yokoyama, Tetsuo Yamamoto, Kiyoshi Inaga

1985Volume 78Issue 8special2 Pages 1847-1851
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1847

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A case of maxillary neurofibroma is reported that arose from the right maxillary sinus of a 10-year-old girl. The right cheek was swollen by tumor formation. Preoperatively performed CT-scan revealed lack of the maxillary anterior wall, from which malignancy was suspected. Samples obtained by tentative opening of the maxillary sinus were subjected to rapid histopathological diagnosis during operation. Because this case was diagnosed as benign, partial resection was determined. The rapid diagnosis during operation was very useful for the determination. The remnant tumor was attempted to be excluded by re-operation. The patient has been well without signs of recurrence for these 3 months. Further, 14 cases of maxillary tumor originating from Schwann cells are reviewed.

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A Case of Adenoid Cystic Carcinoma Occurring in the Larynx

Yoshihiko Ishizu, Michiaki Yokoyama, Motoo Takaoka

1985Volume 78Issue 8special2 Pages 1852-1855
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1852

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Adenoid cystic carcinoma in the larynx is very rare. We have experienced a case of adenoid cystic carcinoma arising from the supraglottic region. A granulated, peduncular tumor was observed at the left false vocal cord, partially reaching the anterior commissure. Because bilateral true vocal cords had good movements, laryngomicrosurgery using CO₂ LASER was applied for maintaining the laryngeal function. The follow-up study of this case has presented no evidence of recurrence.

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Five Cases of Multiple Primary Malignant Tumors

Takashi Amano, Nobuyuki Urabe, Kiyoshi Inaga, Hisaaki Ikoma

1985Volume 78Issue 8special2 Pages 1856-1863
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1856

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Five cases of multiple primary malignant tumors were examined in this clinic in last 5 years. Case 1 (64-year-old man) had adenocarcinoma of the rectum and squamous cell carcinoma of the larynx. Case 2 (72-year-old man) was with squamous cell carcinoma of the larynx and adenocarcinoma of the stomach. Case 3 (53-year-old man) had adenocarcinoma of the rectum and squamous cell carcinoma of the maxilla. Case 4 (69 year-old man) was affected by squamous cell carcinoma of the maxilla and malignant lymphoma of the testes. Case 5 (72-year-old man) had squamous cell carcinoma of the larynx and malignant lymphoma of the inguinal lymph node. Literary speculations on multiple tumors have been made also, especially on incidence, age at onset, sex difference, affected organs and interval of cancerous pathogenity.

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Speech Disturbance and Rehabilitaion after Wide Glossectomy

Milene Miyuki Shimoda, Takeo Suzuki

1985Volume 78Issue 8special2 Pages 1864-1870
Published: August 24, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.8special2_1864

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Patients who have undergone wide resection of the tongue for carcinoma meet problems of postoperative speech disturbance and rehabilitation. The subjective cases were disturbed in speaking vowels produced by the lips that are deeply concerned with the shape and position of the tongue, especially [u] and [e], and in uttering consonants that require contact of the tongue with the palate, teeth and gingiva. The degree of speech disturbance was influenced by difficulty of swallowing, mobility of the palatine and lips, and changes in shape of the oral cavity. Postoperative rehabilitation of language disorder is a hard and slow training, which request therapists to treat patients with love, tenderness and comprehension.

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