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Takeshi KUBO
1994 Volume 87 Issue 12 Pages
1613-1621
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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Surgical treatments of vertigo are reviewed. The operations which sacrifice hearing in Meniere disease, are labyrinthectomy and trans-labyrinthine vestibular neurectomy. The commonest operation is an endolymphatic sac operation, with several variations. Vestibular neurectomies through middle fossa, retro-labyrinthine and retro-sigmoid approaches are the most effective ways to control vertigo, but these operations require neurootological skills and knowledge. We reported our results of retrosigmoid vestibular neurectomy: complete relief of vertigo in all 14 patients ; hearing preserved in 91.7%; tinnitus decreased in 78.6%. Shea described streptomycin perfusion into the lateral semicircular canal as a conservative operation for Meniere disease. In our experience with this operation vertigo was eliminated in 83.3%, and hearing was preserved in only 16.6%. Various sac operations (Fick, Cody, Cochleosacculotomy) are considered to be conservative surgery, but hearing loss is a frequent complication. Operations for other kinds of dizziness mentioned here are singular neurectomy and posterior canal block for benign paroxysmal positional vertigo, decompression operation for vascular compression syndrome, and obliteration operation for perilymphatic fistula.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1994 Volume 87 Issue 12 Pages
1622-1623
Published: December 01, 1994
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Yasuo MISHIRO, Takeshi KUBO, Masashi SAKAGAMI, Mieko ANDO, Kazuo YAMAD ...
1994 Volume 87 Issue 12 Pages
1625-1629
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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A 52-year-old female had lost hearing in her right ear in childhood due to middle ear infection. She had sudden left hearing loss in 1980. Idiopathic sudden deafness was diagnosed at that time. Hearing was partially restored but then became gradually worse. In 1983 bilateral total deafness was noted. She visited our clinic to receive a cochlear implant. She had no facial palsy, no cafe-au-lait spots and no family history of neurofibromatosis. CT and MRI showed a tumor in the C-P angle and at the base of middle cranial fossa. Total removal was accomplished through a translabyrinth approach and middle and posterior craniotomy. Two different tumors were found, one of the acoustic nerve and one of the facial nerve. The acoustic neurinoma extended from the internal auditory canal to the CPA, and the facial nerve neurinoma from the geniculate portion to the middle ear, the base of the middle cranial fossa and the CPA. The sural nerve was used as a facial nerve graft.
This is a rare instance of facial and acoustic nerve neurinoma in a patient without neurofibromatosis. Our investigations have turned up only two reports of such cases in the literature.
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Tomoko SHINTANI, Tetsuo HIMI, Iwao YOSHIOKA, Akikatsu KATAURA
1994 Volume 87 Issue 12 Pages
1631-1637
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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The 22-channel cochlear implant was placed in 12 postlingual profoundly deaf patients since 1988. Psychological, physical, and speech functioning were investigated in 7 of the 12 patients, one year or more after surgery. The threshold level and maximum comfort level showed minimal changes even 4 years after first programming. The number of applicable electrodes (mean value, 17) was stable for over one year. Speech perception with and without lipreading was examined 3 months, 1 year and 4 years after first programming. Without lipreading, correct responses in the vowel test (mean, 67.1%) were better than in the consonant test (mean, 31.3%). Speech tracking scores with lipreading (18.5 phrases/min.) were considerably high for regular speech perception, and 3 of the 5 patients tested more than 4 years after surgery had excellent speech tracking scores (29 phrases/min.), which seemed to be very close to those with normal hearing. The other 2 patients did not use their cochlear implant systems much because of their limited social activity. It is concluded that the routine use of the implant system and/or adequate personal social activity are probably important factors in attaining acute speech perception.
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Takahiro ASAKAGE, Hiroaki FUNAI, Nobuo KITAHARA, Yuki HOHSAKO
1994 Volume 87 Issue 12 Pages
1639-1642
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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A ten-year-old girl with right conductive hearing loss was found to have unilateral congenital stapedial tendon ossification. Exploratory tympanotomy revealed absence of the incus long crus, anomaly of the stapes superstructure and a stapedial tendon ossification. After excision of the tendon and insertion of the cartilage piece between the malleus neck and the superstructure, her hearing was almost normal.
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Kenji TAKASAKI, Ryuichirou YOSHIMI, Hiromitsu TAKAMURA, Hiyoshi TSURUM ...
1994 Volume 87 Issue 12 Pages
1643-1649
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We studied the distribution of T-lmphocyte subpopulations and activated EG2 positive cells in nasal polyps. CD4 positive cells and CD8 positive cells were seen in the epithelium and lamina propria. The CD4/CD8 ratio in nasal polyps was 2.13 on the average. EG2 positive cells were present in nasal polyps, and in the superficial lamina propria extracellular ECP release was seen.
Treatment with Roxithromycin lowered the CD4/CD8 ratio in nasal polyps from 2.13 to 0.91, but the distributions of EG2 positive cells did not change.
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Yoichi ISHIZUKA, Hideaki SAKATA, Hisao SAKURAI
1994 Volume 87 Issue 12 Pages
1651-1658
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We investigated snoring and sleep apnea in 105 patients who came to the hospital complaining of a stuffy nose. Pathological apnea was observed in 48 of 83 patients treated with submucous resection of the nasal septum and turbinectomy (57.8%) and in 9 of 22 treated with endonasal ethmoidectomy as well as submucous resection of the nasal septum and turbinectomy (40.9%).
After the treatment, the pathological apnea decreased noticeably. It was found in the post-operative questionnaire that the respiratory disturbances during sleep, such as snoring and restlessness, were greatly reduced. Snoring was observed in 67.7% before treatment. After treatment 66.7% of them showed improvement.
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Yuki YAMAUCHI, Hideo OMORI, Kunihiko SEKIMOTO, Hidenobu IIDA, Minoru I ...
1994 Volume 87 Issue 12 Pages
1659-1663
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We treated two patients with nasal tuberculosis. One was a 58-year-old female who visited our clinic because of right nasal obstruction and bleeding. Mild swelling of the inferior turbinate and a bloody nasal discharge were observed. Mycobacterium tuberculosis was cultured from the nasal discharge. Biopsy of the mucous membrane of the inferior turbinate showed a granuloma with epithelioid cells. The other was a 59-year-old female who visited us with complaints of right nasal obstruction, purulent nasal discharge, and frontal headache. Granulation, bleeding and crust attachment were observed on the right concha nasalis inferior and the nasal septum. Mycobacterium tuberculosis was cultured from the nasal discharge. Both patients had strongly positive Mantoux tests. Chest X-ray films showed evidence of old tuberulosis but no active pulmonary tuberculosis. Both patients were treated mainly with streptomycin and other anti-tuberculous drugs with satisfactory results.
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Makio UTSUMI, Isao INOUE, Shuichiro OKATO, Yuzo YAMAMOTO, Kazuo MAKIMO ...
1994 Volume 87 Issue 12 Pages
1665-1670
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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A 70-year-old female visited our hospital complaining of left recurrent epistaxis. A pink tumor with a hemorrhagic surface was found in the left nasal cavity. The patient underwent left lateral rhinotomy for total tumor resection. Transmission electron microscopy revealed an olfactory neuroblastoma with microfilaments, microtubules and densecore vesicles. Preoperative levels of dopamine, a catecholamine metabolite were above normal in her urine and blood. They fell to normal postoperatively. At the present time, about 2 years afteroperation, she is asymptomatic with no evidence of local recurrence or metastasis. Our experience with this patient confirms the necessity of electron microscopic examination for the exact diagnosis of olfactory neuroblastoma. The level of dopamine in the urine and blood can be followed as a marker of tumor recurrence.
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Yosaku SHIOMI, Kyosuke KURATA, Yoshinao NISHIDA, Tadahiko SUGIMARU, Ke ...
1994 Volume 87 Issue 12 Pages
1671-1676
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We devised a new combined therapy of CO2 LASER surgery and low-dose macrolide chemotherapy for chronic sinusitis. The effectiveness of this therapy was investigated in patients with chronic sinusitis and bilateral nasal polyps.
Sixteen adult patients were first treated with 150mg of roxithromycin (RXM) per day for more than 3 months, and if nasal symptoms failed to improve further, LASER surgery was performed. Under local anesthesia, nasal polyps were resected and vaporized with 6-8W CO
2LASER focused on the morbid mucous membrane of the middle meatus and/or the middle turbinate.
The patients rated the severity of nasal symptoms before and after therapy according to a 4-point scale (0: none; 1: slight; 2: moderate; 3: severe). Nasal symptoms were 1) obstruction, 2) amount of discharge, 3) sense of smell. Nasal obstruction and amount of nasal discharge were relieved in all patients, and in 82% of the patients the sense of smell improved. The degree of opacification of the maxillary and the ethmoid sinuses on X-ray films improved in 71% and 64%, respectively. There were no major complications.
We think that we should choose this therapy for chronic sinusitis before performing Caldwell-Luc operation or endoscopic sinus surgery.
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Toshiki SHIMAZAKI, Hideyuki KAWAUCHI, Yuichi KURONO, Noritake WATANABE ...
1994 Volume 87 Issue 12 Pages
1677-1681
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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Two patients (a 58-year-old man and a 58-year-old woman) had branchial cysts in the parotid gland, and the other patients had one in the submandibular gland. Branchial cysts usually occur in the lateral cervical area and are rare in salivary glands. Branchial cysts in salivary glands are classified as first branchial cleft cyst and second branchial cleft cyst depending on the site of origin.
First branchial cleft cysts are rarer than second branchial cleft cysts and usually appear in the preauricular area. The cysts are lined with stratified squamous epithelium, and scant lymphoid tissue is seen in the subepithelial area. Second branchial cleft cysts usually occur in the lower portion or superficial lobe of a parotid gland. They are lined with stratified squamous epithelium plus columnar or cuboidal epithelium. Beneath which is abundant lymphoid tissue with clear lymphoid follicles. Clinical and pathological examinations showed that the two parotid gland cysts were probably second branchial cleft cysts and the one in the submandibular gland was probably a first branchial cleft cyst.
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Hirotaka ITO, Shunkichi BABA
1994 Volume 87 Issue 12 Pages
1683-1686
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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The application of laser beams for the fragmentation of salivary stones was examined. Studies of the absorption and reflection spectra of sections of salivary stones showed that optimal fragmentation was achieved with a pulsed dye laser with a pulse width of 1.4 psec and a wave-length of 504nm. Further studies of particle size were conducted, and a new “sialoendoscope” technique was developed. Two patients with a sialolithiasis of the submandibular gland were treated. Under continuous endoscopic monitoring, laser-induced shock wave lithotripsy was performed. In one patient complete fragmentation and removal of the salivary stones was achieved and in the other 70% fragmentation was possible, and salivary flow was restored. This approach to laser lithotripsy of salivary stones with endoscopic monitoring represents a novel method that permits treatment on an outpatient basis under local anesthesia with little inconvenience to the patient.
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Naohiro WAKISAKA, Toshiro NISHIMURA, Ikuo NAGAYAMA, Mitsuru FURUKAWA
1994 Volume 87 Issue 12 Pages
1687-1692
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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From 1986 to 1992, we treated 79 patients with tumors of major salivary glands. We review here the histopathology, age, sex, time between onset and admission, tumor size, surgical procedure, postoperative complications, and incidence of recurrence.
There were 71 parotid gland tumors and 8 submandibular gland tumors. Of the parotid gland tumors, 24%, and of the submandibular gland tumors, 25% were malignant.
The most common benign tumor in both the parotid and the submandibular glands was pleomorphic adenoma. Adenoid cystic carcinoma was the most common malignant tumor in both glands.
Patients with malignant tumors complained more often of spontaneous pain and facial nerve palsy. Pain and facial palsy are significant differential features between benign and malignant tumors, although a few benign tumors caused spontaneous pain or difficulty opening the mouth because of inflammation. We should not mistake such cases for malignancy. We think fine needle aspiration cytology and intraoperative pathological examination are useful in making decisions about surgical procedures.
Postoperative facial nerve palsy was more frequent after removal of malignant than of benign tumors, since the facial nerve must be cut if it is invaded by a malignant tumor.
We performed nerve grafts and static suspensions, but a more sophisticated way to restore facial movement is necessary.
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Itsuo HARA
1994 Volume 87 Issue 12 Pages
1693-1705
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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Uvulopalatopharyngoplasty (UPPP) a surgical treatment for obstructive sleep apnea syndrome (OSAS) fails to achieve satisfactory results in nearly half the patients. It would be desirable to predict the outcome preoperatively. We conducted all-night sleep tests of 23 patients (20 males and 3 females) before and after surgery to determine the indications for this procedure. All 23 patients had OSAS and were scheduled for UPPP. They were tested before and again 3 to 6 months after the operation. All 23 patients showed obstructive, central and mixed types of sleep apnea before UPPP. The effects of surgery were correlated with the distribution of the central and obstructive components during the total period of apnea (% of central component). To evaluate the test results, we calculated the Apnea Index, O
2 saturation C 90%, minimum O
2 saturation <90% and correlated the patients quantitative improvement following UPPP with the improvement in the % of central component. Patients with a % of central component below 15% had satisfactory improvement after UPPP. However, in patients whose % of central component exceeded 50% surgical results were not good. These results suggest that measurement of the % of central component with the all-night sleep test can help in the decision about the indications for UPPP. In conclusion, in all the patients with obstructive OSAS who were tested there were episodes of central apnea. The distribution of this central component was related to the outcome of UPPP. It is therefore important to investigate the episodes of apnea in detail before deciding on surgery.
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Hideaki KITA, Tetsuo HIMI, Hiroko SAITOH, Iwao YOSHIOKA, Makoto HAMAMO ...
1994 Volume 87 Issue 12 Pages
1707-1712
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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Silent thyroiditis is a transient form of hyperthyroidism characterized by a painless, nontender thyroid gland, elevated blood levels of thyroxine (T
4) and triiodothyronine (T
3), a low radioactive technesium uptake, and spontaneously resolving hyperthyroidism.
We report a case of silent thyroiditis after head and neck surgery. Total laryngectomy and right hemithyroidectomy was performed on a 67-year old man with a diagnosis of recurrent laryngeal carcinoma. After this surgery, the patient had symptoms of thyrotoxicosis: hypertension, hyperglycemia, palpitation, tremor and weight loss. Silent thyroiditis was diagnosed on the basis of both the clinical course and the laboratory data: low uptake of radioactive technesium, and elevated blood levels of T
3 and T
4. We treated him with β-blocker and insulin. The symptoms disappeared within one month after the operation. This case suggests that silent thyroiditis can be a post-operative complication of head and neck surgery.
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-Cat Scratch Disease and Castleman's Lymphoma-
Tadahiko SAIKI, Naohito HATOH, Yasushi KAGAJYOH
1994 Volume 87 Issue 12 Pages
1713-1718
Published: December 01, 1994
Released on J-STAGE: December 12, 2011
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We examined and treated two patients with neck lymphadenopathy due to two different relatively uncommon diseases: cat scratch disease and Castleman's lymphoma. The swollen lymphnodes of the former were under the left auricle and those of the latter were in the left posterior cervical region. Detailed anamnesis and pathological examination of open biopsy specimens were useful for making the diagnosis. The clinical courses of both patients were uneventful.
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Seiji KAWAKITA, Masamitsu HYODO, Toshihiro MORI, Eiji YUMOTO, Hiroshi ...
1994 Volume 87 Issue 12 Pages
1719-1725
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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A 64-year-old male complained of sore throat on February 29, 1992. He was admitted to the Matsuyama Red Cross Hospital for left peritonsillitis and neck phlegmon on March 2. Antibiotic therapy failed to improve his inflammatory symptoms. Seven days after the onset of symptoms crepitation was felt beneath the skin of the neck and anterior chest, suggesting the presence of gas gangrene in the neck. He was referred to Ehime university hospital on March 7. On the day of admission he underwent extensive surgical debridement followed by the administration of high-dose PC-G, hyperbaric oxygen therapy and repeated local cleaning with H2O2. Cultures of the neck abscess grew out Bacteroides spp. Tonsillectomy was performed on May 12, 1992 to remove the focus of the initial infection. He has been well for the two years since then.
Gas gangrene in the head and neck region has a significantly high mortality, and the number of reports of non-clostridial gas gangrene in this region has continued to increase during the last ten years. The authors emphasize that extensive surgical debridement immediately after a diagnosis is reached and the administration of appropriate antibiotics are indispensable for the treatment of gas gangrene.
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Kazuhiko SHOJI, Hisayoshi KOJIMA, Shigeru HIRANO
1994 Volume 87 Issue 12 Pages
1727-1731
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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In general, the primary therapy for mutational voice disorder is voice therapy since the disorder is believed to be mainly functional. However, we sometimes see organic changes such as slight vocal cord atrophy in some patients with mutational voice disorder who have mainly voice breaks as well as high pitch and hoarseness. We assume that asynchronous growth of the laryngeal cartilage and vocal cords might cause imbalance of tension of the vocal cords that results in atrophic appearance of vocal cord and prolonged mutational voice. When organic changes such as atrophy or tension imbalance of the vocal cords exist, voice therapy may not be effective and surgical treatment may yield better results.
We performed thyroplasty type III with lateral compression in three patients with mutational voice disorder with organic change. If the imbalance of the vocal cord tension causes mutational voice disorder associated with vocal cord atrophy, thyroplasty type III conbined with lateral compression may correct both the imbalance of the vocal cord tension and the glottal gap caused by vocal cord atrophy.
The effect of the operation was rapid and dramatic. In all three patients the voice pitch became much lower immediately after the procedure, and breathiness and voice breaks were reduced or disappeared. None of the patients required voice therapy after the operation. In conclusion, thyroplasty type III is quite effective for mutational voice disorder with unilateral vocal cord atrophy.
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Makoto Miura, Eni Naito, Jun Tsuji, Yasushi Naito
1994 Volume 87 Issue 12 Pages
1733-1738
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We performed a randomized controlled study on the effect of Ibudilast (Ketas) in patients with Meniere's disease. Forty-six patients were included in the study: 28 were given 3 capsules of Ketas® daily (group A), and 18 were treated with other medications (group B). In group A, 20 of 28 patients (71%) were relieved of dizziness and 12 of 25 (48%) had reduction of tinnitus and 13 of 23 (57%) had improvement of hearing. In group B, 15 of 18 patients (83%) were relieved of dizziness and 7 of 15 (47%) had reduction of tinnitus and 4 of 18 (22%) had improvement of hearing. No side effects were noted in group A. The results suggest that Ketas® is a clinically useful drug for patients with Meniere's disease, especially in the treatment of hearing loss.
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Shinichiro NARITA, Kohji ASAKURA, Akikatsu KATAURA
1994 Volume 87 Issue 12 Pages
1739-1744
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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We studied the effect of local hyperthermia (skainar steam 11) in 16 pregnant women with allergic rhinitis and 4 with acute rhinitis. Treatment was continued for 14 days. Nasal symptoms (sneezing, rhinorrea and nasal blockage) were reduced markedly in 12.5%, moderately in 56.3% and slightly in 12.5% of the allergic patients. The nasal blockage was significantly reduced by local hyperthermia in the allergic patients. In some of the patients with acute rhinitis nasal symptoms were relieved. In conclusion, local hyperthermia was found to be very effective in pregnant women with allergic rhinitis.
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[in Japanese]
1994 Volume 87 Issue 12 Pages
1746-1747
Published: December 01, 1994
Released on J-STAGE: November 04, 2011
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