Practica Oto-Rhino-Laryngologica

Vascular Disturbances in Patients with Equilibrium Disorders

Isao Takimoto, Meiho Nakayama

1992 Volume 85 Issue 9 Pages 1357-1364
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1357

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This comparative neurotology and vertebral angiography study comprised 60 patients presenting with equilibrium disorders at the Aichi Medical University Hospital. They were divided into two age groups: less than 60 and 60 years of or older.
Hallpike testing clearly showed that vertebro-basilar and central lesions were more severe in the older group. Electronystagmography revealed that the eye tracking test is more effective and more accurate than the optokinetic nystagmus test at depicting the difference in the severity of vascular pathology between the two groups. Vertebral angiography also demonstrated vascular disorders to be more severe in the older group. Resolute treatment of vertebral insufficiency in the young is important in the prevention of progressive pathology later in life.

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Use of Tissue Expanders in the Head and Neck

[in Japanese], [in Japanese]

1992 Volume 85 Issue 9 Pages 1366-1367
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1366

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Cenesthopathy Secondary to Dizziness and Tinnitus; A Case Report

Hajime Nakagawa, Yukio Watanabe, Kanemasa Mizuoshi, Naoki Ohashi, Yuka ...

1992 Volume 85 Issue 9 Pages 1369-1374
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1369

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A 51-year-old male was referred to our outpatient clinic complaining of dizziness and tinnitus associated with stiffness of his right hand on January 17, 1989. He had been treated for seven months after the sudden onset of bilateral ear fullness.
The equilibrium function test revealed no evidence of neither peripheral or central vestibular abnormalities except for a positive Schellong test. The pure tone audiogram showed slight bilateral high tone loss. The neurological examination was otherwise within normal limits. A CT scan showed no intracranial abnormalities.
On March 27, 1990, he visited to our clinic again complaining of bilateral tinnitus. At the same time his family members reported that he became so nervous that he had to return from his office and that he suffered from insomnia. A minor-tranquilizer, adenosine triphosphate, vitamin B and Chinese-Oriental herb medicine (Boufuu-Tsuushousan, reputed to be a remedy for tinnitus) were administered. As tinnitus and dizziness were relieved, he experienced a cenesthopathic sensation that something was ringing near both ears, around his head, in his left shoulder, under his left axilla, in his left hand, under both feet. This sensation varied with time, emotion, mental and physical stress. After treatment with anti-anxiety medicines, this sensation was relieved to some degree.
There have been few reports on cenesthopathy in the head and neck region. This disease is characterized by peculiar sensations that are localized or disseminated, and is difficult to describe. Schizophrenia could be ruled out as he showed no personality changes.
This experience points out that when treating patients, we should take into account possible pshychiatric problems.

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Relationship between Meniere's Disease and Type I Allergy Tested by MAST System

Kayoko Bessho, Satoshi Ogino, Noriaki Takeda, Hitoshi Ogino, Tamotsu H ...

1992 Volume 85 Issue 9 Pages 1375-1381
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1375

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The etiology of Meniere's disease has been investigated by various methods, but is still not clear. It is thought that one aspect of the pathology is concerned with allergy, especially food allergy. In this study we examined the correlation between Meniere's disease and type I allergy using the MAST system. MAST is a new system for detecting allergen-specific IgE antibodies. Multiple antigen can be examined simultaneously and quickly by this method. We could find no relationship between Meniere's disease and type I allergy, especially food allergy. If food allergy is involved in the etiology, it may be a different type of allergy.

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Intracranial Abscess due to Cholesteatoma of the Middle Ear; A Case Report

Yasuyuki Yoshida, Shinkawa, Hideshige Kimura, Yutaka Kitta, Sakai

1992 Volume 85 Issue 9 Pages 1383-1390
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1383

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A 46-year-old man, with a history of right otitis media since childhood, complained of right otalgia and aural discharge for a month. The patient was admitted immediately because of severe headache and mastoid destruction seen on X-ray films. On admission, he showed signs of meningeal irritation and an intracranial complication was suspected. Intensive chemotherapy was begun. CT scan was done on the next day and revealed massive destruction of the right mastoid. Emergency mastoidectomy was performed, and a cholesteatoma was found in the antrum and the mastoid. Headache was improved postoperatively, but a relatively well encapsulated abscess of the right temporal lobe was found by postoperative MRI. Following chemotherapy, sudden arrest of respiration occurred on the 14th postoperative day, and emergency craniotomy was done, but the patient died 3 days postoperatively.
It has been reported by many authors that with the advance of diagnosis by imaging and therapeutic methods, the mortality of otogenic intracranial complications has been greatly reduced. Yet the mortality due to otogenic intracranial abscess has not been lowered enough. There are two therapeutic approaches: one is otologic surgery first, followed by neurosurgical treatment ; and the other is intracranial surgery first, followed by otologic treatment, waiting for the improvement of the general condition. In the present case, we treated the patient by the first method unsuccessfully. We discuss, with a review of the literature, the degree to which conservative treatment is possible after otologic surgery.

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Differential Diagnosis of Middle Ear Inflammatory Diseases by MRI Findings

Yuki Muneta, Etsuo Yamamoto, Masaki Ohmura, Chikashi Mizukami, Hiroyuk ...

1992 Volume 85 Issue 9 Pages 1391-1397
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1391

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Although computed tomography can reveal a soft tissue mass in middle ear diseases as an area of increased density, it cannot differentiate cholesteatoma from other inflammatory tissue. We prospectively studied 30 patients with various middle ear inflammatory diseases, including inflammatory granulation tissue, cholesteatoma and cholesterin granuloma with magnetic resonance imaging (MRI) with or without Gd-DTPA enhancement. Cholesteatoma and inflammatory granulation tissue showed intensity ranging from low to high on Ti-weighted images and from high to very high on T2-weighted images. However, cholesteatoma showed either no enhancement or ring enhancement on MR imagings with Gd-DTPA, and it could be differentiated from the Gd-DTPA-enhanced inflammatory granulation tissue. Cholesterin granuloma showed very high intensity on both T1 and T2-weighted images. Therefore, MRI with Gd-DTPA is considered to be useful in the differential diagnosis of these middle ear diseases.

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Giant Cell Tumor in the Temporal Bone; A Case Report

Takekazu Mishima, Hiroshi Yoshikawa, Masae Kusunoki, Akira Yanai, Haji ...

1992 Volume 85 Issue 9 Pages 1399-1405
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1399

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A 42-year-old male visited our hospital because of a mass in anterior to the right ear. It was 3.5×3.5cm in size, round and immobile. There were no other otorhinolaryngologic abnormalities. A plain X-ray film showed a radiolucent lesion, and a CT scan showed a bone destroying tumor in the right temporal bone. An open biopsy was performed; the histopathological diagnosis was giant cell tumor. The tumor was totally extirpated. The patient was discharged in good condition and there have been no signs of recurrence for 8 months. A review of the literature is added.

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Increase in Surgery for Chronic Sinusitis among Aged Patients and Attendant Problems

Masuo Yamagishi, Yuichi Nakano

1992 Volume 85 Issue 9 Pages 1407-1414
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1407

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The number of aged patients requiring nasal surgery for chronic sinusitis has been increasing as the population ages.
A clinical study on the number of aged patients, complications and factors responsible for the increasing incidence of sinusitis was conducted on patients who underwent nasal surgery for chronic sinusitis from 1983 to 1990. Patients who underwent the operation from 1963 to 1970 served as controls.
In the control group, most patients were 10 to 30 years of age. In the study group the number of aged patients had increased markedly and the distribution of patients was more equal among the age groups. There were many associated disorders, including cardiovascular disorders, lower respiratory tract disease, endocrine disorders and psychoneurotic disease. It is suspected that drugs used to treat hypertension or psychiatric diseases may aggravate chronic sinusitis, and diabetes itself may make it worse. Among aged patients, pathological change in the nasal cavity was marked, and the mucosa showed fibrosis, which was assumed to be irreversible. Nevertheless, the prognosis was good in aged patients.
These results indicate that nasal surgery for aged patients with chronic sinusitis should be performed carefully and with a full understanding of the background factors.

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X-ray Diagnosis of Bone Destruction in Patients with Maxillary Cancer

-Comparison of Caldwell's and Waters' Views, Tomography and CT Scan-

Jiro Tanita, Jiro Hozawa, Hideichi Shinkawa, Hitoshi Jin, Shinichi Sai ...

1992 Volume 85 Issue 9 Pages 1415-1420
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1415

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The detectability of bone destruction is discussed and a comparison is presented of Caldwell's and Waters' views, maxillary tomography and CT scans of 10 patients with maxillary cancer. Destruction of the lateral wall of the maxillary sinus was confirmed in all 10 patients by CT scan, but destruction of the tuber maxillary line (T-M line) could not be seen in Caldwell's and Waters' views in 5 of the patients. As a rule, frontal tomography was helpful in the observation of the orbital base, the median wall of the maxillary sinus and the nasal cavity. However, CT scan was the best method, and accurate with observation of the anterior wall of the maxillary sinus was possible only with axial CT.

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Distinctive Features in the Gircumferential Structure of the Capsule of Parotid Gland Adenolymphoma

Yoshiyuki Tanigaito

1992 Volume 85 Issue 9 Pages 1421-1426
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1421

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From May 1984 to September 1991, 17 patients (male: 16, female: 1, average age:64) with parotid gland adenolymphoma were treated surgically in my department of otolaryngology. I have already described the distinctive features in the circumferential structure of the capsule of benign parotid gland pleomorphic adenoma. This time I studied parotid gland adenolymphomas, which are considered to have an entirely different origin from pleomorphic adenomas. In 13 patients the entire capsule around the tumor was very thin and there was no capsuler invasion by the tumors as is often found with pleomorphic adenomas. In two patients the capsules were partly thick but contained few duct tissues. Nine patients had partial defects of their capsules, the histological features of which were similar to the defective parts of the capsules of normal lymphnodes in the parotid gland. The atrophy of the lobules surrounding the tumor was less than that seen in pleomorphic adenomas. The histological findings in the capsule and the parotid gland tissue surrounding adenolymphomas were very different from those of pleomorphic adenomas. Furthermore, in six lymphonodes contained in the parotid gland, there were small adenolymphomas. These findings suggest that the greater part of adenolymphoma capsules originates in the capsules of the lymphnodes contained in the parotid gland.

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Kabuki Make-up Syndrome with Submucosal Cleft Palate; A Report of Two Cases

Masanori Asai, Takashi Yokoi, Hiroshi Okamura

1992 Volume 85 Issue 9 Pages 1427-1431
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1427

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Kabuki make-up syndrome reported by Niikawa and Kuroki in 1981 is a malformation syndrome characterized by specific craniofacial malformations such as long palpebral fissures, large ears and depressed nasal tip associated with postnatal dwarfism and mental retardation. In the present paper, we report two cases of Kabuki make-up syndrome accompanied by submucosal cleft palate and chalasia. One was a 5-year-old boy with submucosal cleft palate, chalasia, coarctation of the aorta, urinary tract anomaly and diabetes insipidus. Palatoplasty was performed by the push back method. Chalasia is improving as he grows. The other was a 7-month-old boy accompanied with submucosal cleft palate, chalasia, micrognathia, ventricular septal defect, and inguinal hernia.
Kabuki make-up syndrome is often accompanied by otitis media, high arched palate, depressed nasal tip, cleft palate, etc. Cleft palate is present in 41% of children with this syndrome. Otolaryngologists need to keep this syndrome in mind when they treat patients with cleft palate.

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Psychotherapy of Patients with Abnormal Sensation in the Throat

Mikikazu Yamagiwa, Yasuo Sakakura

1992 Volume 85 Issue 9 Pages 1433-1444
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1433

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We have treated 100 patients with abnormal sensation, such as a lump or choking, in the throat without using any medicine for 3 weeks. We classified the effectiveness of psychotherapy into 4 groups: markedly effective (the initial abnormal sensation was reduced by 80% or more), moderately effective (more than 50% but less than 80%), slightly effective (more than 20% but less than 50%) and not effective (less than 20%) at the end of 1, 2 and 3 weeks of treatment.
1) The average reduction of the initial sensation was 29% at 1 week, 35% at 2 weeks and 38% at 3 weeks. The marked and moderate effectiveness rates were, respectively, 9% and 27% at 1 week, 17% and 27% at 2 weeks, and 25% and 20% at 3 weeks.
2) The present psychotherapy seemed to be effective for the following patients: more than 50 years of age; without any occupation; with symptoms other than throat discomfort; those who responded well to previous medication for throat discomfort; not cancerphobic; less than 6 months since onset; complaining of discomfort higher than the hyoid bone; those with a choking sensation; not very neurotic by psychiatric tests.
The results indicate that psychotherapy for this condition is not very effective if total cure is the goal and that it should not be the first choice of treatment. On the other hand, these data obtained from psychotherapy can provide a good reference for determining the effectiveness of various drugs in the treatment of abnormal sensation in the throat as long as the same criteria are used for the classification of effectiveness.

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Cases of Primary Unknown Neck Carcinoma in Our Department

Chihiro Hatta, Minoru Ishida, Tatsuji Matsumoto, Yoshio Sugiyama, Nobu ...

1992 Volume 85 Issue 9 Pages 1445-1449
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1445

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Between 1982 and 1991, 326 patients were treated for head and neck malignant tumors at Osaka Prefectural Hospital. Among them, there were 5 patients (4 males, 1 female) with primary unknown neck carcinoma. The carcinomas were located in the submandibular area (2 cases) and upper jugular area (3 cases). There was one case in which the stage of the disease was N 1, two cases in which it was N2a and two in which the disease had reached the N3 stage. The histological diagnosis of all cases was squamous cell carcinoma of various levels of differentiation (1-low, 2-middle, 3-well).
After treatment of the carcinoma, the primary lesions appeared in two cases, one in the buccal mucosa, the other on the base of the tongue, and both patients died of the disease. The remaining patients who showed no primary lesion included one patient who died of distant metastasis and two patients who showed no evidence of disease and are still alive. Both of the cases in N3 stage at first examination later died of the disease.

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Chromosomal Analysis of Adenomatous Goiter

Michiaki Hiromoto, Hisayoshi Kojima, Hisao Koyama, Chotatsu Tsukayama, ...

1992 Volume 85 Issue 9 Pages 1451-1455
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1451

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We present the results of the chromosomal analysis of adenomatous goiter. It has been reported that the incidence of this tumor increases with age, and also that it is more apt to become malignant with age.
Some abnormal karyotypes were recognized: one patient had tetraploidy, and another had a change mainly in aneuploidy (monosomy, trisomy). Tetraploidy cells are still in the benign stage, but aneuploidy cells are thought to be in the process of becoming malignant.
The relationship between chromosone number and malignancy may be useful in the early diagnosis of cancer.

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Non-recurrent laryngeal nerve

A Case of Non-Recurrent Laryngeal Nerve with Abnormal Right Subclavian Artery

Masaki Ohmura, Etsuo Yamamoto, Koichi Omori, Chikashi Mizukami, Hiroyu ...

1992 Volume 85 Issue 9 Pages 1457-1462
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1457

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A case of right non-recurrent laryngeal nerve recognized during thyroid operation is reported.
An abnormal right subclavian artery was detected by esophagography and intravenous digital subtraction angiography of the aorta.
In a case in which the recurrent laryngeal nerve cannot be found, the possibility of nonrecurrent laryngeal nerve should be considered, and the nerve around the cricoid cartilage should be examined retrogradely.

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Spontaneous Neck Emphysema; A Case Report

Keiji Moriya, Toru Sekitani, Tetsuya Tahara, Masako Miura

1992 Volume 85 Issue 9 Pages 1463-1467
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1463

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20-year-old boy was seen at our out patient clinic because of the neck pain since the previous day. There was no causal disease or apparent precipitating episode. Plain neck X-ray study and CT of the neck revealed neck emphysema, but there was little sign of intramediastinal emphysema or clinical symptoms. He was treated conservatively with antibiotics and rest.

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Spontaneous Retropharyngeal and Cervicomediastinal Emphysema; A Case Report

Toru Takimoto, Makoto Itoh, Hideaki Katoh

1992 Volume 85 Issue 9 Pages 1469-1472
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1469

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A healthy 13-year-old girl developed spontaneous retropharyngeal and cervicomediastinal emphysema after complaining of a sore throat. Subcutaneous crepitus in the neck was noted, and computerized tomographic scan revealed cervical subcutaneous, retropharyngeal and intramediastinal air. She was treated with bed rest and administration of prophylatic antibiotics. Sore throat, subcutaneous emphysema, and mediastinal emphysema subsided spontaneously within several days.

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Significance of Gontralateral Masking in ABR

Mono Yamauchi

1992 Volume 85 Issue 9 Pages 1473-1492
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1473

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The influences of contralateral masking on the click evoked auditory brainstem response (ABR) were investigated in 16 patients with unilateral total deafness and in 44 normal adult subjects. Simultaneous recordings of auditory nerve action potentials (APs) and ABRs to clicks at intensities of 90 and 70 dBnHL were recorded by a conventional signal averaging technique with or without contralateral masking (white noise was used as a masker at intensities of 40-80 dB), and a peak amplitudes and latencies of component waves were measured. In subjects with a unilateral totally nonfunctioning ear, shadow responses (synonymous with crossover responses) were recorded in both tracings (APs & ABRs) when the click intensity exceeded 50 dBnHL. The majority of these shadow responses were eliminated by masking noise at a level equal to the click presentation level minus 30 dB. Although it was enough to eliminate these shadow responses by applying masking noise at a level equal to the click presentation level minus 20 dB, the phenomenon of overmasking was observed in the recording of auditory nerve action potentials ipsi-lateral to the stimulation. In normal subjects, the most significant influences of contralateral masking were observed with amplitude changes of wave VI. There were statistically significant differences between the responses with or without contralateral masking (p<0.05, by paired t-test), and the decrease of the amplitude was relatively propotional to the amount of contralateral masking noise. As long as the contralateral masking did not exceed the level that strongly affected the APs and wave I of ABRs, the influence of contralateral masking had little effect on both wave III and V in contrast to that of waves II, IV and VI which were strongly affected by the contralateral masking. In clinical practice, appropriate contralateral masking can eliminate shadow responses in patients with unilaterally profound deafness when tke click intensity exceeds 60 dBnHL and in patients with responses that can not show a clear distinction between wave V and the other waves, particularly wave VI.

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Effect of Steroid Nasal Spray on TDI-Sensitized Guinea Pigs

Yoshiyuki Abe, Morihiro Irifune, Satoshi Ogino, Toru Matsunaga, Ikuo I ...

1992 Volume 85 Issue 9 Pages 1493-1499
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1493

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To determine whether topical corticosteroid inhalation inhibits symptoms of nasal allergy, we studied toluene 2, 4-diisocyanate (TDI)-sensitized guinea pigs as an experimental model of nasal allergy. TDI-sensitized guinea pigs were challenged with TDI after treatment with a nasal spray of beclomethasone dipropionate. In animals not treated with beclomethasone, TDI cuased nasal allergy like signs: sneezing, nasal discharge, nasal obstraction and decreased histamine in the nasal mucosa. TDI-induced signs were markedly reduced in the groups challenged with TDI 15 and 30 minutes and 1, 2 and 3 hours after beclomethasone treatment, and the decrease of histamine content was prevented in the groups challenged with TDI 15, 30 minutes and 2 hours after beclomethasone treatment. These results indicate that the topical application of beclomethasone dipropionate is effective in the suppression of TDI-induced nasal allergy-like signs and suggest that beclomethasone inhibits histamine release from mast cells in the nasal mucosa induced by TDI challenge.

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Antiplatelet Therapy for Peripheral Vertigo

Noriko Kashiwagi, Takashi Matsunagi

1992 Volume 85 Issue 9 Pages 1501-1509
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1501

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Comelian^® (dilazep dihydrochloride) and aspirin were administered for 8 weeks to patients with peripheral vertigo, and clinical effects and platelet aggregation were investigated.
1. Subjective symptoms were significantly or moderately improved in 11 patients (55.0% of total series). Slight improvement was noted in 19 (95.0% of that).
Objective findings were improved more than subjective symptoms.
2. Maximal aggregation, maximal slope and aggregability induced by collagen was reduced after the administration of Comeliane

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Clinical Effect of Saireito in the Treatment of Otitis Media with Effusion

Tetsuya Ishiyama, Keiji Sato, Osamu Fukazawa, Haruki Yokoyama, Toshizo ...

1992 Volume 85 Issue 9 Pages 1511-1519
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1511

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Kanebo Saireito Extract fine granules (EK-114) was administered to 43 patients (total 56 ears) with otitis media with effusion per os. Moderate effects were observed in 80.0% of the patients and general improvement in 82.5%. Since no side effects were noted, such a small dosage was considered fairly safe. Saireito was recognized as an effective medicine for otitis media with effusion.

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Abnormal Sensation in the Throat Treated with Chinese Medicine, Hangekobokuto

Yasuhiro Fujisaki, Chikahide Maetani

1992 Volume 85 Issue 9 Pages 1521-1527
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1521

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Forty-three patients with abnormal sensation in the throat were treated with Hangekobokuto (a Chinese medicine) administered orally for 4 weeks, without concomitant treatment with other drugs.
1) This Chinese medicine was effective in 72.1% of the patients.
2) It was much more effective in the group with normal results than in psychological tests with neurotic or anxiety.

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Percutaneous Intracordal Injection for Unilateral Recurrent Laryngeal Nerve Paralysis

[in Japanese]

1992 Volume 85 Issue 9 Pages 1528-1529
Published: September 01, 1992
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.85.1528

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