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Automatic Threshold Detection by Phase Spectral Analysis
Masaru Aoyagi, Takeo Fuse, Toshihisa Suzuki, Teruo Kiren, Yoshinori Ki ...
1991 Volume 1991 Issue Supplement51 Pages
1-9
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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A computer program for automatic threshold detection of auditory steady state response (SSR) using a phase spectral analysis was developed. To estimate the usefulness of this automatic threshold detection program, auditory steady state response was examined on 15 adults with normal hearing while awake and during sleep. As an auditory stimulus,1000 Hz sinusoidally amplitude-modulated tone, with a modulation frequency of 40 Hz and a modulation depth of 95% was applied. When comparing SSR threshold while awake and during sleep, the threshold during sleep was higher than while awake in 8 subjects (53.3%) and the threshold during sleep was lower than that while awake in 2 subjects (13.3%). Differences between the threshold while awake and during sleep were less than 10 dB in 11 subjects (73.3%) and were 20 dB in the other 4 subjects (29.7%).
These findings suggested that the SSR thresholds during sleep are not so different from those while awake, and that the automatic SSR threshold detection using phase spectral analysis during sleep is as useful as while awake.
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Isao Kato, Tomoyuki Okada, Shoji Watanabe, Shigeki Sato, Isamu Takeyam ...
1991 Volume 1991 Issue Supplement51 Pages
10-17
Published: December 10, 1991
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The nucleus of the optic tract (NOT) in the pretectum is the visuo-motor relay between the retina and preoculomotor structure in the pathway, and it conveys signals responsible for optokinetic nystagmus (OKN). However, what parts of the retina and what kinds of retinal ganglion cells project their fibers into the NOT are still unknown. In the present study, horseradish peroxidase conjugated with wheatgerm agglutinin was injected into the NOT in the rat. Labeled cells are diffusely demonstrated in the contralateral retina, whereas the labeled cells, only in the lower temporal crescent of the ipsilateral side. Ganglion cells were predominant in the range of small cells, i. e., W cells. However, medium-sized and large cells were also labeled. This suggests the participation of these cells in OKN.
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Masaru Aoyagi, Masashi Yokota, Takeo Fuse, Toshihisa Suzuki, Yosinori ...
1991 Volume 1991 Issue Supplement51 Pages
18-25
Published: December 10, 1991
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Results of acoustic neurinoma surgery via middle cranial fossa approach performed on 3 patients with normal hearing in the speech frequency range are reported. All of the patients had small (from 1.5 to 2.0 cm) neurinomas. Although the normal hearing and facial nerve function were preserved in 2 patients,1 patient had deafness in the operated side and severe facial palsy was observed postoperatively. Tumors in the patients with preserved hearing were soft and adhesion to cochlear and facial nerve were not observed, but the tumor was hard and tightly adhered to the cochlear and facial nerve in the patient with no hearing postoperatively.
The significance of diagnosis in the early stage in acoustic neuroma and hearing preservation in acoustic neurinoma surgery are discussed.
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Isao Kato, Kaoruko Takahashi, Shoji Watanabe, Hiroaki Nakashima, Shige ...
1991 Volume 1991 Issue Supplement51 Pages
26-30
Published: December 10, 1991
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When patients with vertigo are seen in the clinic, the presence or absence of spontaneous nystagmus is generally tested using Frenzel's glasses, and when spontaneous nystagmus is not found, a head-shaking test (HST) is conducted to detect spontaneous nystagmus. We recorded the ENG of these patients with eyes open in total darkness who showed no spontaneous nystagmus under Frenzel's glasses. In patients with no nystagmus under Frenzel's glasses, clear nystagmus was recognized with a maximum slow-phase velocity of 7.8°/sec and a minimum slow-phase velocity of 3.9°/sec. Therefore, in cases with a maximum slow-phase velocity of less than 7.8°/sec, the possibility that nystagmus may not be recognized with Frenzel's glass was indicated. Thus, ENG recording is useful and we use this as an index for treatment and follow-up studies.
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Ryoji Kanayama, Tadashi Nakamura, Yo Kimura, Makoto Ohki, Ryoichi Sano ...
1991 Volume 1991 Issue Supplement51 Pages
31-37
Published: December 10, 1991
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Quantitative analysis of pursuit eye movement was performed by means of fast Fourier transform (FFT). Normal subjects were examined with various stimuli to detect changes in parameters. Stimuli consisted of sinusoidal curves of varying amplitudes and frequencies.
The subjects were 5 healthy normal persons.
The analysis was performed using a computer (Masscomp MC5450). Eye movement data were converted to digital signals at a rate of 100 samples/sec., and after smoothing, eye velocity was calculated by the least square method. After the removal of saccade components, only smooth eye movement components were extracted by FFT.
Parameters for analysis were pursuit gain (stimulus velocity / eye velocity) and phase. Pursuit gain decreased with an increase in stimulus frequency, while no significant differences were seen with changes in the magnitude of the stimulus amplitude. In the phase analysis, phase lag was recognized for all stimuli. Phase lag was also strongly influenced by the stimulus frequency rather than by the stimulus amplitude. Based on the relationship between stimulus velocity and pursuit gain, the limit of smooth pursuit eye movement was established at 70 deg/s.
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Takao Ikarashi, Tadashi Nakamura, Ryoji Kanayama, Makoto Ohki, Ryoichi ...
1991 Volume 1991 Issue Supplement51 Pages
38-43
Published: December 10, 1991
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Frenzel's spectacles and an infrared CCD camera were used to investigate head shaking nystagmus (HSN) while the subjects had their eyes open in the dark. The tests were performed on 30 normal subjects and 62 patients with peripheral or central vestibular dysfunction.
Head shaking tests were conducted during 30 cycles of horizontal head shaking with excursions of approximately +/- 45 degrees and a frequency of about 2 Hz (Kamei's method). HSN was recorded on ENG and a video recorder simultaneously. The slow phase velocity, the fast phase amplitude and duration of nystagmus were quantatively analyzed with a computer.
The HSN was observed in seven out of 30 normal subjects (23.3%) by an infrared CCD camera. On the other hand, in 40 out of 62 patients (64.5%), the HSN was observed with the infrared CCD camera. In our series, the rotatory factor of HSN was demonstated by the infrared CCD camera in 24 out of 40 patients (60%).
In conclusion, a high ratio of HSN is detectable with an infrared CCD camera. This camera should therefore be useful for diagnosing patients with vestibular disorders.
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Takeo Fuse, Masaru Aoyagi, Toshihisa Suzuki, Yoshinori Kim, Yoshio Koi ...
1991 Volume 1991 Issue Supplement51 Pages
44-49
Published: December 10, 1991
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Evoked otoacoustic emissions (eOAEs) are considered to be due to energy leakage from cochlear traveling waves and studies on eOAEs may help to clarify the normal cochlear functions and the cochlear pathology in several disease through noninvasive and objective means. In the present study, several parameters of eOAEs, such as “total echo power” and “reproducibility” proposed by Kemp, were evaluated on 40 adults (80 ears) with normal hearing to estimate the clinical usefulness of these parameters.
Although the “total echo power” has a wide variation among normal subjects, the relationship between the “total echo power” and the “reproducibility” was relatively stable in normal subjects. From the evaluation of the parameters, a normal range of the “total echo power”, was set up in relation to the “reproducibility” of responses.
When using this method of analysis, these parameter s are considered to be useful in clinical application and eOAEs are expected to be a diagnostic tool for some cochlear dysfunctions such as Meniere's disease.
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Yoshinori Kim, Masaru Aoyagi, Masashi Yokota, Takeo Fuse, Toshihisa Su ...
1991 Volume 1991 Issue Supplement51 Pages
50-56
Published: December 10, 1991
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Idiopathic sudden deafness is a cochlea type hearing loss of unknown origin. The prognosis is good in a considerable number of patients and response to the treatments good. Since 1987 we have been applying high dose steroids therapy (Stennert's method) for cases of sudden deafness.
The effects of high dose steroid therapy and the conventional steroid therapy were compared. The subje c ts were 84 cases of sudden deafness, which have been treated during the last 3 years. The overall improvement rate was 42.5% (23/54) for the patients assigned to high dose therapy and 30% (9/30) for the patients assigned to the conventional steroids therapy. Thus, patients given high dose steroid therapy showed a significantly higher recovery rate.
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Teruo Kiren, Masaru Aoyagi, Takeo Fuse, Masashi Yokota, Toshihisa Suzu ...
1991 Volume 1991 Issue Supplement51 Pages
57-63
Published: December 10, 1991
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Cis-diamine-dichloro-platinum (Cisplatin, CDDP) is known as a common carcinostatic drug. On the other hand, it has harmful side effects, such as ototoxicity, renal toxicity and bone marrow depression.
Audiometric analyses w ere performed in 21 patients treated with CDDP from 1986 to 1990. Pure tone threshold shift of more than 20 dB at least one frequency was recognized in 8 out of 21 patients. After CDDP treatment,1 patient demonstrated total deafness, and 7patients demonstrated a significant hearing loss at 8 kHz. All of the 5 patients complained of tinnitus revealed a significant hearing loss. A hearing disorder was recognized in all patients treated with CDDP at a single dose of more than 150 mg, but no patient showed any hearing disorder among the patients treated with a single dose of less than 100 mg. These findings suggested that hearing disorders induced by CDDP occur in the relation to a single dose of CDDP rather than a total dose.
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Masaru Aoyagi, Tadashi Nakamura, Hitoshi Tojima, Hiroyuki Maeyama, Yos ...
1991 Volume 1991 Issue Supplement51 Pages
64-70
Published: December 10, 1991
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To clarify the usefulness of the folded silastic sheet in staged tympanoplasty,98 patients who had undergone staged tympanoplasties from 1977 to 1989 were divided into the following 3 groups with regard to the preventive method of re-adhesion between ear drum and promontry wall. No material was inserted into the tympanic cavity for the prevention of adhesion in group A (43 cases). One piece of simple shaped silastic sheet was inserted in group B (21 cases) and a folded silastic sheet was inserted from tubtympanum to mastoid cavity in group C (34 cases). The findings in the second stage operation and the postoperative hearing results were compared among the 3 groups.
Granulation tissues were less frequently observed in group C (7.7%) than in group A (65.2%) and B (62.5%) and antral blocks were also less frequently found in group C (11.5%) than in group A (78.3%) and group B (68.7%). Moreover, the postoperative hearing results in group C were better than in group A or B. These results suggests that folded silastic sheet is more useful to prevent re-adhesion and proliferation of fibrous tissue in the tympanic and mastoid cavity than simple shaped silastic sheet.
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Masaru Aoyagi, Ryoji Kanayama, Yoshio Koike
1991 Volume 1991 Issue Supplement51 Pages
71-78
Published: December 10, 1991
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Twenty patients (24 ears) with clinical otosclerosis have been operated on using various methods in our clinic from 1979 to 1990. In 3 ears, stapedectomy was performed using gelfoam wire. Ten ears were operated on using tragal cartilage and 11 ears using a teflonpiston wire. The value of average air-conduction hearing threshold of 500-2000 Hz was 54.8 dB preoperatively. The postoperative average hearing thresholds were within 40 dB in 22 ears (91.7%). The postoperative air-bone gaps were less than 20 dB in 21 ears (87.5%)and were between 21-30 dB in 3 ears (12.5%). From another aspect of analysis, the postoperative air-bone gap was diminished 79.7% of the preoperative air-bone gap by the stapes surgery.
Among the three methods, the tragal cartilage group was less successful than the other two groups. Tinnitus was improved postoperatively in 6 ears (40%) out of 15 ears which had tinnitus preoperatively.
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Yo Kimura, Tadashi Nakamura, Ryoji Kanayama, Juichi Yokoyama, Hitoshi ...
1991 Volume 1991 Issue Supplement51 Pages
79-87
Published: December 10, 1991
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Between December,1987 and December,1990, we performed 27 microvascular reconstructions with free flaps and jejunums to the head and neck. All patients had a malignant tumor. Three flaps failed due to venous obstruction, thus the overall survival rate was 88.9%. In the cases of primary reconstruction, the survival rate was 92.3%, whereas in secondary cases the survival rate dropped to 85.7%.
Therefore, microvascular tissue transfer is a safe and suitable procedure of head and neck reconstruction and is also helpful in maintaining both speaking and swallowing functions.
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Tadashi Nakamura, Masaru Aoyagi, Yo Kimura, Yoshio Koike, Isao Kato
1991 Volume 1991 Issue Supplement51 Pages
88-94
Published: December 10, 1991
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Between November,1976 and December,1990,90 patients underwent surgical treatment for thyroid disease at our department. Fifty of these patients (55.6%) were pathologically diagnosed as having malignant tumors (papillary carcinomas in 38 cases, follicular carcinomas in 6, squamous cell carcinomas in 3, aplastic carcinomas in 2 and malignant lymphoma in 1 case). The 40 other patients (44.4%) were diagnosed as having benign diseases (adenomatous goiters in 13 cases, follicular adenomas in 13, thyroid cysts in 6, papillary adenomas in 4 and other diseases in the remaining 4 cases). All 17 patients, in whom recurrent nerve paralysis was observed preoperatively, had malignant tumors of papillary carcinomas in 14 cases, squamous cell carcinomas in 2 cases and follicular carcinoma in 1 case.
201Tl delayed scintigrams were obtained for 79 patients. Forty-seven of these patients (59.5%) showed abnormal activity on the delayed scintigram and 34 out of 47 patients were pathologically diagnosed as having malignant tumors.
Total or subtotal thyroidectomy was performed in 80% of the patients with malignant tumors and radical or modified neck dissection was carried out in 23 cases in which the metastasis of cervical lymph node was recognized.
Eleven of our patients showed recurrent nerve paralysis after the operation. In 3 of these cases, the recurrent nerve was dissected because of direct invasion into this nerve. In 5 of the remaining 8 cases, complete recovery from recurrent nerve paralysis occurred within 6 months following the operation, while 2 cases retained incomplete paralysis of this nerve.
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Hachiro Suzuki, Tomohiko Hasegawa, Hiroo Inamura, Jiro Harada
1991 Volume 1991 Issue Supplement51 Pages
95-101
Published: December 10, 1991
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One hundred and seventy-seven patients with recurrent laryngeal nerve paralysis, who were referred to our clinic during the past 8 years (1983-1990), were investigated clinically. The left vocal cord was affected in 109 cases (61.6%), the right in 56 cases (31.6 %) and both in 12 cases (6.8%). The highest incidence was found in the group of 60 years. There was no difference in incidence between males and females.
The cause of 59 cases was surgical operation a r o und the vagus and recurrent nerves. Malignant tumors were found in 56 cases. However, the cause was unknown in 42 cases. Among 56 cases of malignancies, lung cancers and esophageal cancers were found in 37cases, and in these cases, the incidence was higher in females. In recurrent nerve paralysis due to thyroid diseases, there was a higher incidence in females and no difference in in cidence between the left and the right vocal cord.
The recovery rate was relatively low. However, the recurrent nerve paralysis following endotracheal intubation and caused by polyneuritis had a very high recovery rate.
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Akihiko Ichige, Yoshio Koike
1991 Volume 1991 Issue Supplement51 Pages
102-110
Published: December 10, 1991
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Among cases of Bell's palsy (diagnosed within 2 weeks after onset, complete remission and more than 6 months' management in our out-patient-department),287 cases regularly followed up by electroneuronography (ENoG), percutaneous nerve excitability test (NET), stapedial reflex (SR), lacrimation (LAC), and electrogustometry (EGM) were evaluated. Furthermore, the relationship between the prognosis and the above laboratory data within 2weeks after onset were analyzed statistically.
The prognosis could be predicted by only ENoG for over 90% cases. When ENoG was over or equal to 15%,99.1% of cases showed complete recovery. Unfortunately, other examinations did not reveal data helpful in determining the prognosis of Bell's palsy owing to broad variations. When ENoG was less than 15%, the following examinations were useful for those patients with ENoG <15%, that is, the difference between right and left was less than 3.5 mA on NET and early appearance on SR. The cases showing normal EGM or LAC also showed a good prognosis.
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Masashi Yokota, Masaru Aoyagi, Toshihisa Suzuki, Yo Kimura, Tadashi Na ...
1991 Volume 1991 Issue Supplement51 Pages
111-118
Published: December 10, 1991
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Pure-tone audiometry, auditory evoked brainstem response (ABR) and electronystagmographic examination (ENG) were studied before and after microvascular decompression (MVD) in 41 patients with trigeminal neuralgia (TN) and 39 patients with hemifacial spasm (HFS).
Fourteen patie n ts (34.1%) with TN and 16 (41.0%) with HFS suffered from hearing loss postoperatively, while 1 patient (2.4%) with TN and 2 (12.8%) with HFS had a hearing gain after MVD. Latencies of peak V of ABR were longer on the affected side than on the unaffected side before MVD in 6 patients with TN and 3 with HFS. Among these 9 patients, decreased latency of peak V were observed after MVD in 4 patients. Latencies of peak V were increased after MVD in 13 (33.3%) patients with TN and 25 (73.5%) with HFS. Various abnormalities were observed in ENG before MVD in 15 patients (45.5%)with TN and 10 (29.4%) with HFS. Abnormalities in optokinetic nystagmus (OKN)and/or eye tracking test (ETT) were detected before surgery in 7 patients (45.5%) with TN and disappeared after MVD in 5 patients, whereas no abnormality in OKN and ETT was observed in patients with HFS. Postoperative improvements in spontaneous and/or positional nystagmus were observed in 2 patients with HFS.
These postoperative improvements of the abnorm alities in neurotological examinations suggest that the effect of causative vessels extend to the 8th cranial nerve and brain stem, although no patient complained of any otological symptoms before surgery.
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Hitoshi Tojima, Masaru Aoyagi, Hiroo Inamura, Yoshio Koike, Shin-ichi ...
1991 Volume 1991 Issue Supplement51 Pages
119-126
Published: December 10, 1991
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Hemifacial spasm (HFS) is characterized by involuntary contructions of the mimetic muscles, and it is usually accompanied by synkinesis. When spasm and synkinesis spread to the stapedius muscle, tympanic noise (tinnitus due to the stapedius muscle contruction)arise. In the present study,57 patients with HFS who had normal tympanogram and stapedius reflex were examined by impedance audiometry to determine the spasm and synkinesis of the stapedius muscle before and after microvascular decompression. Only 18patients complained of tympanic noise, but 54 showed the stapedius muscle spasm and synkinesis. After operation, in all cases tynpanic noise disappeared and 50 patients showed neither spasm nor synkinesis of the stapedius muscle. During the operation,5 of these patients were also recorded by electrical stimulation on supraorbital nerve using needle electrodes inserted through the external auditory meatus. Synkinetic responses of the stapedius muscles could be recorded in 4 cases, and these abnormal potentials disappeared after intraoperative procedures. These results suggests that spasm and synkinesis spreads to the stapedius muscle even in patients without tynpanic noise, and these disappear during the microvascular decompression operation.
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Shigeru Fukase, Yo Kimura, Ken Sakata, Nobuo Ota, Masaru Aoyagi, Yoshi ...
1991 Volume 1991 Issue Supplement51 Pages
127-132
Published: December 10, 1991
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Two patients with Wegener's granulomatosis not sufficiently reacting to predonisolone and cyclophosphamide therapy were treated with cyclosporin A (CSA). CSA was effective in both patients, and remission was sustained. Both patients continued to receive CSA for more than 2 years. Type B hepatitis was noted as a side effect of CSA in one patient, but was completely cured by interferon a within 4 months without stopping the administration of CSA. No other severe side effects could be detected in either patient. CSA was thus concluded to be an effective and safe drug for patients with Wegener's granulomatosis.
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Masakazu Kawai, Mika Yoshida, Yoshinori Kim, Takashi Okuyama
1991 Volume 1991 Issue Supplement51 Pages
133-137
Published: December 10, 1991
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A modified method of submucosal turbinectomy is reported.
The incision was made on the lowest position of the free edge of inferior turbinate. After elevating the mucosa against meatus nasi communis, the turbinate bone and mucosa against the inferior nasal meatus were cut and removed. The elevated mucosa was laid down on the exposed edge of the bone.
The mucosa covering the cut e dge of the turbinate reduced the postoperative bleeding and promoted the cure without postoperative nasal crust on the mucosal defect.
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Hiroyuki Maeyama, Yo Kimura, Hitoshi Tojima, Masaru Aoyagi, Yoshio Koi ...
1991 Volume 1991 Issue Supplement51 Pages
138-142
Published: December 10, 1991
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A case of aspergillosis with the maxillary sinus cured by peroral antimycotic drug was reported.
A 71-year-old woman visited our clinic complaining of right nasal obstruction and purulent nasal discharge. A necrotic mass was found in the middle meatus of the right nasal cavity. A CT-scan revealed a large soft tissue mass occupying the right maxillary sinus extended through the medial wall to the nasal cavity. Biopsy specimens from the mass showed a characteristic picture of aspergillosis. Conservative treatment with oral administration of the antimycotic drug, fluconazole was carried out. The aspergillosis was cured within seven weeks.
Treatment with oral administration of fluconazole is recommended as the first choice of the paranasal sinus mycosis as well as follow-up treatment for the prevention of recurrence after surgery.
In addition to this case report,10 cases of primary fungal infections in the paranasal sinuses treated in Yamagata University Hospital during the 14 years from 1976 to 1991, have been reviewed.
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Hitoshi Tojima, Hiroo Inamura, Masaru Aoyagi, Yoshio Koike
1991 Volume 1991 Issue Supplement51 Pages
143-149
Published: December 10, 1991
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Six cases of herpes zoster in the oral cavity are reported. Three cases were affected with severe facial palsy (Hunt syndrome), and the other 3 were trigeminal herpes without facial weakness. Localization of symptoms and lesions was limitted within the distribution of each branch of the nerve on the affected side. Especially, in the cases of facial palsy, vesicular eruptions or erosins overlying only the soft palate (greater petrosal nerve area)and/or anterior two-thirds of tongue (chorda tympani area) were observed. Acyclovir greately reduced the pain and shortened the illness. But this drug was not effective on nerve disturbances, especially on the loss of tasts in the 3 patients with Hunt syndrome.
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Tomohiko Hasegawa, Hachiro Suzuki, Hiroo Inamura, Koji Harada, Hitoshi ...
1991 Volume 1991 Issue Supplement51 Pages
150-158
Published: December 10, 1991
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The statistics of 2,014 inpatients (1,205 males and 809 females) in Yamagata Prefectual Central Hospital, Department of Otolaryngology, between 1983 and 1990 are presented. The age distribution showed that the patients in their fifties constituted the larg est group among the inpatients. The location of diseases was the nasal cavitiy and paranasal sinuses in 470 cases (23.3%), the pharynx in 387 cases (19.2%), the larynx in 321 cases (15.9%), the ear in 289 cases (14.4%), the neck in 129 cases (6.4%), the salivary glands in 121 cases (6.0%),52 in the oral cavity and tongue (2.6%), the trachea and esophagus in 20 cases (1.0%) and the other regions in 98 cases (4.9%). The number of facial palsy was 127(6.3%). Since 1985, the number of inpatients has decreased, mainly because of a decreased number of inflammatory cases such as chronic sinusitis and chronic tonsillitis. There were 217 cases with malignant tumors of head and neck.
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Akira Kikuchi, Hidehiro Koshu, Takeo Fuse, Teruo Kiren
1991 Volume 1991 Issue Supplement51 Pages
159-162
Published: December 10, 1991
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The therapeutic effect of Saibokuto was studied in 9 patients with several subjective complaints due to irradiation therapy for head and neck cancer.
They were given oral Saibokuto (TJ-96) 7.5 g daily ( 2.5 g three times a day), and the severity of their complaints was investigated before and at least four weeks after the start of treatment.
The medication was effective in all patients and their complaint points were reduced from 12 to 7 as average. No side effects of Saibokuto administration were recognized.
This suggests that Saibokuto is useful to improve the quality of life in p atients with post-irradiated head and neck cancer.
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Hiroo Inamura, Hachiro Suzuki, Tomohiko Hasegawa, Juichi Yokoyama, Jir ...
1991 Volume 1991 Issue Supplement51 Pages
163-172
Published: December 10, 1991
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Recently, we have experienced three cases of Ramsay Hunt syndrome associated with central disorder at our department. Case 1 was in a 38-year-old man, who had the complaint of right hearing impairment and right facial palsy and was diagnosed as right Ramsay Hunt syndrome, thus was admitted in our hospital. The day after the admission, numbness dyskinesia occurred abruptly on the right half of the body, and CT scan revealed right thalamo and left cerebellar infarcted lesions. This patient had accompanying diabetes mellitis, but zoster virus vasculitis may also have let to the infarcted lesions.
Case 2 was in a 43-year-old man, who had the compalint of right facial palsy, vertigo and right hearing impairment and was admitted in our hospital under the diagnosis of right Ramsay Hunt syndrome. Three days after the admission, high fever, headache and stiffness of neck appeared. Cerebrospinal fluid examination revealed a remarkable increase in cell count, thus be was diagnosed as zoster virus meningitis. Treatment with aciclovir resulted in rapid improvement.
Case 3 was in a 58-year-old man, admitted to our hospital complaining of right facial palsy, vertigo and right hearing impairment and was diagnosed as right Ramsay Hunt syndrome for a detected right auricular herpes, thus was admitted in our hospital. From the tenth day after the admission, ataxic gait occurred, vertigo became strong and cerebrospinal fluid examination disclosed a remarkable increase in cell count, thus he was transfered to the department of neuro-internal medicine of our hospital under the diagnosis of brainstem encephalitis.
Such severe complications as mentioned above must be taken into consideration in the treatment of Ramsay Hunt syndrome.
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Takashi Okuyama, Tadashi Nakamura, Ryoji Kanayama, Koji Harada, Yo Kim ...
1991 Volume 1991 Issue Supplement51 Pages
173-179
Published: December 10, 1991
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Acquired pendular continuous eye movement was observed in a 43-year-old male with vertebral basilar aneurysm. He complained of gait disturbance, numbness on extremities and vertical oscillopsia. Vertical pendular eye movements with frqeuencies ranging from 3to 4 Hz and amplitudes between 5 and 15 degrees with eye's open in the dark were recorded. This patient demonstrated impaired smooth pursuit eye movement and optokinetic nystagmus in the horizontal and vertical axis.The saccade velocity was reduced markedly.
The vertebral-basilar aneurysm of 12 mm in a diameter was confirmed by CT and VAG at the level of the pons.
Eight years after the onset of the initial symptoms, adduction disturbance in both eyes were developed and bilateral MLF syndrome revealed. At the time, vertical pendular eye movements were completely disappeared. From the findings of neurotological examinations, mechanism of vertical pendular eye movement was discussed.
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Makoto Ohki, Masaru Aoygai, Yo Kimura, Tadashi Nakamura, Ryoji Kanayam ...
1991 Volume 1991 Issue Supplement51 Pages
180-186
Published: December 10, 1991
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A case was a 42-year-old male complained of slowly progressive gait disturbance over the previous 7 years. Diffuse pigmentation on his mouth and lip mucosa was seen, and neurological symptoms consisted of typical cerebellar signs, pathological reflex and cortical visual disturbance. On the basis of these neurological findings and result of biochemical analysis, he was diagnosed as having adult-type Adrenoleukodystrophy.
Neuro-otological examinations were also carried out. The audiogram was almost normal, but in the auditory evoked brainstem response, the latencies of the bilateral waves M, IV and V were markedly delayed. The electro-oculographical tests showed vertical opposing positioning nystagmus and hypometric saccade. The optokinetic nystagmus was impaired in more than 50 deg/sec of stimulus velocity. On the other hand, results of eye tracking and visual suppression tests were within normal limits.
Therefore, these neuro-otological findings indicated lesions of the ventral portion of the pons and vermis of cerebellum and these lesions were confirmed by MRI.
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Neuro-Otological Findings
Tatsuo Funakubo, Tadashi Nakamura, Yo Kimura, Ryoji Kanayama, Makoto O ...
1991 Volume 1991 Issue Supplement51 Pages
187-191
Published: December 10, 1991
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Tatsuo Funakubo, Tadashi Nakamura, Yo Kimura, Ryoji Kanayama, Makoto Ohki, Ryoichi Sano and Yoshio Koike (Yamagata University)A case of acute lithium intoxication is reported. The patient was a 34-year-old woman, administered lithium at a daily dose of 1000 mg for depression since 1981. On January 21,1990, she took 20 g of lithium to commit suiside and fell into a state of coma. She recovered and was admitted in our Department of Psychiatry.
She showed low consciousness, lingual and mandibular involuntary movements, ataxic gait and dysarthria and was diagnosed as acute lithium intoxication. CT and MRI in dicated no abnormal findings in the brain.
Neuro-otological examination w a s performed on February 19,1990. Spontaneous down-beat nystagmus was shown in the light. A gaze test showed gaze directional nystagmus horizontally and rebound nystagmus. An eye tracking test indicated saccadic pursuit on the horizontal axis and superimposed spontaneous nystagmus on the vertical axis. Slow phase OKN velocity was severely impaired bilaterally. A saccade test showed hypometric saccade, but velocity of which was normal.
These findings suggested that the lesion in t h is case was not only in the cerebellum but also in the brainstem.
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Jiro Harada, Hachiro Suzuki, Juichi Yokoyama
1991 Volume 1991 Issue Supplement51 Pages
192-199
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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A 77-year-old female suffering from gas gangrane in the neck is reported. Insect biting injury was suspected as the primary focus and infection spread over the platysmal muscle and other deep neck spaces with subcutaneal gas production. Therefore this case was regarded as non-clostridial gas gangrane infection. She was treated by drainage, chemotherapy and intensive care in ICU, but she died of complicative pneumonia due to MRSA infection on the 59thy day from insect biting. We reviewed the 33 cases regarding gas gangrane in the head and neck region in Japan from 1931 to 1991 including our case, and found that the incidence of gas gangrane in the head and neck region was not so rare especially after 1983.
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Toshihisa Suzuki, Masaru Aoyagi, Yo Kimura, Masashi Yokota, Akihiko Ic ...
1991 Volume 1991 Issue Supplement51 Pages
200-206
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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Three cases with haemangiopericytoma were reported.
In case 1, a 59-year-old male with tumor in the left middle ear cavity complained of vertigo, left hearing impairment, tinnitus and facial palsy. Subtotal removal after ligature of the left external carotid artery was performed.
In case 2, a 80-year-old male wi t h tumor of the left parotid gland noticed induration of the left parotid region. Total removal of the tumor was performed.
In case 3, a 15-year-old male with tumor of the left na s al cavity complained of the left nasal bleedings. Total removal of the tumor after embolization of the left spheno-palatine artery was performed.
The pathological reports indicated malignancy in cases 1 and 3, and mitosis was partially observed in case 2. Therefore, postoperative irradiation followed the surgical treatment in all cases. No regional recurrence or distant metastasis occurred in any cases within one to five years. Combination of surgical treatment with irradiation was effective.
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Masashi Sakai, Senshi Kawakami
1991 Volume 1991 Issue Supplement51 Pages
207-210
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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An unusual case of internal jugular vein thrombosis is reported. A 73-year-old woman complained of swelling and pain in the left neck. Computed tomography with contrast enhancement and angiography demonstrated the characteristic features of the left internal jugular vein thrombosis. The patient's neck swelling subsided after antibiotic therapy.
The literature of internal jugular vein thrombosis was reviewed.
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Ryoichi Sano, Tadashi Nakamura, Hiroo Inamura, Hiroyuki Maeyama, Yoshi ...
1991 Volume 1991 Issue Supplement51 Pages
211-214
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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Omohyoid muscle syndrome was reported by R. B. Zachary for the first time in 1969. The syndrome is characterized by remarkable distention of the omohyoid muscle during swallowing, which completely disappear at rest.
This case was a 40-year-old male who complained of discomfort of the throat and bulging of the neck during swallowing over several years, and he was diagnosed as having omohyoid muscle syndrome. The operation was performed under local anesthesia in 1990, and the omohyoid muscle was simply transected at superior belly of this muscle. Following the operation, abnormal distension during swallowing completely disappeared. The patient has had no symptoms for 9 months postoperatively and no signs of recurrence have been found.
Although the pathogenesis of omohyoid muscle syndrome is still unknown, some investigators have reported that pathological examination of the removed muscle showed myogenic degeneration. In our case, the pathological findings revealed slight degeneration of omohyoid muscle.
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Shigeru Fukase, Juichi Yokoyama, Masakazu Kawai, Humiaki Yuda, Yo Kimu ...
1991 Volume 1991 Issue Supplement51 Pages
215-221
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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Autopsy findings in a case of nasal T cell lymphoma were reported. A 56-year-old male first developed bilateral nasal obstruction, and was operated as sinusitis in another hospital. Four months later, he developed spiking fever and severe crusting in the nasal cavity. He was treated as Wegener's granulomatosis with prednisolone and cyclophosphamide, but the treatment was not effective. Necrosis of hard palate was rapidly developed, the biopsy specimens from the palate showed proliferation of lymphoma cells. The lymphoma cells were considered to be T cell origin immunohistochemically. After receiving the diagnosis, he was treated with irradiation and VEMP therapy. However, he died from respiratory insufficiency 6 months after onset of spiking fever. The infiltration of lymphoma cells was observed in almost all organs at the autopsy.
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Nobuo Ohta, Takeo Fuse, Hiroo Inamura, Juichi Yokoyama, Toshihisa Suzu ...
1991 Volume 1991 Issue Supplement51 Pages
222-226
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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A case of extramedullary plasmacytoma originating in the right maxillary sinus in a 68year-old man is reported. The patient was treated by surgical resection, irradiation and chemotherapy. Histological examination of the mass revealed plasmacytoma. Bone marrowaspiration, urine examination and systemic X-ray bone survey did not reveal any evidence of multiple myeloma. Almost invariably plasmacytoma produces monoclonal immunoglobulin. In this case, IgG (κ) was demonstrated in the tumor cells by immunohistochemical methods (PAP methods). Two years after operation, bone involvement was found in the vertebrae.
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Hidehiro Kohsyuu, Akira Kikuchi
1991 Volume 1991 Issue Supplement51 Pages
227-231
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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A case of primary meningioma in the right maxillary sinus is reported.
A 19-year-old man complained of a bulging of his right upper gingiva and cheek of three months duration. There were no tenderness and no any other nasal symptoms. The bony hard and clear margined tumor was palpated at his upper gingiva. He had no history of traumatic head injury.
The radiological examination revealed a round shadow in the right maxillary sinus without any bone destructions.
The tumor was surgically removed. The pathological findings revealed spindle shaped tumor cells, cellular whorl, and bone and calcification granules. The tumor was histologically diagnosed as fibroblastic meningioma.
Several hypotheses have been prop o sed on the tumor origin of the extracranial meningioma. Some cases of meningioma originating from the fibroblast or Schwann's cell have been reported.
In the present case the tumor was considered to have originated from the mesenchymal cells of the maxillary sinus mucosa or the anterior maxillary wall.
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Kazuhiko Takeda, Jiro Harada, Kunio Arai
1991 Volume 1991 Issue Supplement51 Pages
232-235
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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A patient with hematoma in the left maxillary sinus, who had complained of unilateral nasal obstruction and nasal bleeding was examined. The X-ray examination showed a diffuse shadow without destruction of the wall on the left maxillary sinus. The patient was operated on and found to have a hematoma in the maxillary sinus. Histopathological examination revealed bleeding, blood clotting, fibrosis and abnormal vascularization. In this disease, it is difficult to rule out maxillary sinus tumors.
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Tomohiko Hasegawa, Hachiro Suzuki, Hitoshi Tojima, Masashi Sakai, Take ...
1991 Volume 1991 Issue Supplement51 Pages
236-240
Published: December 10, 1991
Released on J-STAGE: November 27, 2012
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Chondroma of the larynx is a rare benign tumor. Such a case originating from the cricoid cartilage is reported. A 73-year-old man was admitted to our hospital complaining of dysphagia with accompanying hoarseness. A tumor was found in the subglottic space. The findings of computed tomography were useful for diagnosis.
The tumor was removed without the need for total laryngectomy, and the postoperative course was good. Some problems on therapy of this disease are discussed with reference to the previous literature.
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