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Yoshiaki Itasaka, Soichiro Miyazaki, Hiroyuki Tada, Kazuo Ishikawa, Ki ...
1997 Volume 1997 Issue Supplement94 Pages
1-6
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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A retrospective statistical analysis of adult patients with sleep dyspnea who had consulted the sleep clinic in Akita University Medical Center between January 1992 and November 1996 is described in this report. Six-hundred-and-fifty-four patients (481 males and 173 females) who had complained of snoring or sleep apnea visited our department. The mode of their ages was in the fifties. All ight monitoring of oxygen saturation or polysomnography was performed on 501 patients (3n88males and 113 females). Three-hundred-and-twenty-seven patients were examined by polysomography. A total of 289 patients were subsequently diagnosed with sleep apnea snyndrome (88.4%). Seventy-eight out of 308 patients underwent surgical treatment and 46 patients received prosthetic treatment. Our results may provide some useful information regarding the incidence of respiratory disorders during sleep.
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Soichiro Miyazaki, Koji Yamakawa, Yoshiaki Itasaka, Kazuo Ishikawa, Ki ...
1997 Volume 1997 Issue Supplement94 Pages
7-13
Published: October 25, 1997
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Polysomnography is the best method for precise evaluation of the grade of respiratory disorders during sleep. However, it is laborious and time consuming to analyze the variations in respiratory pattern, apnea index, oxygen saturation, blood pressure etc. in relation to sleep stages and body position. We tested an autoanalyzer DEE-1100 (Oxford) to facilitate evaluation of these data, especially the evaluation of respiration-related parameters. The results obtained with the autoanalyzer showed fairly good accordance with those obtained by examiner's reading in severely disturbed cases. However, the evaluation of apnea in slightly or moderately disordered cases was of questionable value, because no consideration was paid to intraluminal pressure recordings. In order to give fully satisfactory results to users, improvements in the software will be necessary.
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Yoshiaki Itasaka, Soichiro Miyazaki, Hiroyuki Tada, Kazuo Ishikawa, Ki ...
1997 Volume 1997 Issue Supplement94 Pages
14-19
Published: October 25, 1997
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Sixteen patients who complained of snoring or obstructive sleep apnea were examined before and after the use of a tongue retaining device (TRD). The mean age of the patients was 53.4 years (range 33 to 64 years) and the mean body mass index (BMI) was 26.5 kg/m
2 (range 22.5 to 30.8 kg/m
2). The daytime polysomnography was performed with the use of zopiclone, and simultaneous monitoring of upper airway pressure in the epipharynx, mesopharynx, hypopharynx and esophagus (Peso) was carried out. The sites of obstruction during sleep were determined from the pressure radients among the four sensors. Analysis of the Peso and the apnea plus hypopnea indegx (AHI)were made with and without the TRD. The subjects were classified according to reductions in the Peso and AHI values. Five cases (group A) showed a 50% or more reduction in the Peso and AHI with the TRD. Four cases (group B) showed a 50% or more reduction of in the Peso with the TRD. Seven cases (group C) showed less than a 50% reduction in the Peso and AHI with the TRD. In group B, obstruction at the base of the tongue improved, but obstruction of the soft palate remained with the TRD. In group C, neither obstruction at the base of the tongue nor obstruction of the soft palate were improved with the TRD. The value of AHI was smaller in group A, when compared with values in groups B and C. These obsevations suggest that the TRD may be effective in patients with mild or moderate sleep dyspnea.
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Hiroyuki Tada, Souichirou Miyazaki, Kiyoshi Togawa, Yoshiaki Itasaka
1997 Volume 1997 Issue Supplement94 Pages
20-25
Published: October 25, 1997
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The purpose of this study was to investigate the mechanism of development of central sleep apnea (CSA) in patients with obstructive sleep apnea syndrome (OSAS). Sixteen patients with SAS underwent polysomnography before and after uvulopalatopharyngoplasty (UPPP). FifOteen control subjects were subjected to polysomnography, and a comparison of respiratory factors among these subjects was performed. Before surgery, CSA was found in eight of the sixteen OSAS patients (50%) and this number was significantly more than two in the control subjects (13%). Among SAS patients, the rate of mixed sleep apnea in the apnea hypopnea index was higher in the pOatients with CSA than in the patients without CSA. Since this trend was not changed after surgery, it suggested that respiratory control by nervous system appears to be involved in the development of CSA in OSAS patients.
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Soichiro Miyazaki, Yoshiaki Itasaka, Kazuo Ishikawa, Kiyoshi Togawa
1997 Volume 1997 Issue Supplement94 Pages
26-31
Published: October 25, 1997
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Electrical stimulation of the genioglossus muscle during sleep has been reported to be effective in decreasing the incidence and duration of obstructive sleep apnea. However, the influence of submental electrical stimulation upon sleep architecture has not been examined.
Healthy volunteers without any sleep apnea (5 male, average age: 23.2 years) were enrolled in the study for 3 consecutive nights (1st night: oxygen saturation monitoring,2nd night: without stimulation,3rd night: with stimulation). Three hundred randomized electrical stimulations (20 V,0.5 second) were applied to the subjects over a period of 5 hours. Average sleep efficiency was 93.6% during the night without stimulation, and 89.9% during the night with stimulation. Sleep efficiency in one patient was 65.2%, although sleep architecture was not disturbed. The average incidence of microarousal induced by stimulation was 4% out of 300 stimulations.
Electrical stimulation of the genioglossus during sleep did not have any unfavorable effects on the sleep architecture of healthy subjects. Electrical stimulation may be a safe and non-invasive method of treatment for obstructive sleep apnea.
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Soichiro Miyazaki, Yoshiaki Itasaka, Hiroyuki Tada, Kazuo Ishikawa, Ki ...
1997 Volume 1997 Issue Supplement94 Pages
32-37
Published: October 25, 1997
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Thera Snore® is a prefabricated dental appliance invented by Dr. Meade. It causes the mandible to protrude forward in order to prevent airway obstruction during sleep in obstructive sleep apnea. TheraSnore® can be easily fabricated by physicians. TheraSnore® was originally designed to lock only the maxilla. We modified the TheraSnore® device so that it locked both the maxilla and the mandible. Efficacy of the TheraSnore® in the prevention of airway obstruction was examined by the evaluation of oxygen saturation during night and daytime polysomnography in eleven sleep apnea cases. The subjects consisted of 10 men and 1 woman (average age: 53.7 years). Their mean apnea + hypopnea index was 47.3/hr. and mean body mass index was 26.8 kg/m
2. The lowest oxyen saturation value during sleep increased from 74.4% to 84.9% with the modified TheraSnorge device. Forty percent of the subjects demonstrated more than a 10% increase in the lowest oxygen saturation value with the TheraSnore® device and 70% of the subjects demonstrated more than a 5% increase. The apnea + hypopnea index decreased from 49.5/hr. to 32.0/hr., and intraesophageal pressure improved from -68.1 cmH
2O to -45.9 cmH
2O with TheraSnore®. Sixty-five percent of the subjects showed a considerable improvement in subjective symptoms, and 45% of the patients indicated a significant reduction of sleep dyspnea. There were no serious complications except a tight feeling in the anterior teeth.
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Masakazu Masaki
1997 Volume 1997 Issue Supplement94 Pages
38-51
Published: October 25, 1997
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A quantitative analysis of eye movement with optokinetic and caloric nystagmus was undertaken in normal subjects using a digital computer. Fifteen parameters were established to differentiate nystagmus from artifacts. Eight of the parameters were used to diagnose the quick phase and the other 7 parameters were used to diagnose the slow phase. On OKN (optokinetic nystagmus), the velocity gain was calculated. The adaptation limits of slow phase velocity were a maximum slow phase velocity, while the velocity gain was over 0.8. In 20 normal subjects, the average slow phase velocity was 90°/sec (S. D.15.5). In the caloric test, the average maximum slow phase velocity was 32°/sec (S. D.11) and the average with the visual suppression test was 70% (S. D.10.5) in 31normal ears. In this analysis, the frequency of nystagmus was not necessarily reduced with visual suppression, so that the FFI (failure of fixation suppression index) was not a valid parameter.
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Kazuo Ishikawa, Misao Nakazawa, Michinori Yokomizo, Soichiro Miyazaki, ...
1997 Volume 1997 Issue Supplement94 Pages
52-57
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Neurotological examinations were performed in patients with vertigo caused by chronic otitis media. The total number of patients was 23, consisting of 11 males and 12 females. Age distribution ranges from 25 to 71 years with an average of 50 years. Patients' complaints were varied, however whirling type of vertigo was a common complaint in several cases with active labyrinthitis. Under wearing Frenzel's glass, spontaneous nystagmus of more than I degree was observed in 40% of the patients, positional nystagmus in 27% and positioning nystagmus in 32%. Under electronystagmography, the detection rate of spontaneous nystagmus was increased. Although most of the cases with spontaneous nystagmus were directed toward the intact side, a few cases were directed toward the lesion side. Saccadic or unidirectional saccadic pursuit was found in 30% and an abnormality in optokinetic after nystagmus test was found in 70%. The occurrence rate of abnormalities in the equilibrium examinations was somewhat high in cases with decreased hearing acuity. In two cases, a fistula was found in the lateral semicircular canal during surgery, however positive fistula sign were not observed preoperatively.
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Misao Nakazawa
1997 Volume 1997 Issue Supplement94 Pages
58-63
Published: October 25, 1997
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Hearing in 35 babies whose birth weight was below 1500 g were screened at the Akita Public Health Center between November 1991 to September 1995. Hearing screening was performed with a sheet of paraffin (baking) paper which produces at most approximately 44 dBnHL from 50 cm distance. The babies were first tested with the paraffin paper at four months of clinical age. Babies who demonstrated head turning toward the noise were considered to “pass” the hearing test. Those who showed no response, some reflex, or a change of facial expression only were recommended to be tested again several months later. COR (conditioned orientation response) audiometry was performed in 15 cases, ABR was performed in 9 cases mainly because of their high risk of hearing impairment. The results were as follows; 1) No moderate to severe hearing impairment was found.2)One boy seemed to show reduced hearing in the higher frequencies beyond 2 kHz.3) The development of auditory behavior seemed to depend on maturation of the brain. These observations suggest that hearing development should be assessed by reflex age (the age calculated from the due date) rather than by clinical age.4) After five months of reflex age, these infants turned their heads toward the sound.5) It was difficult to evaluate the hearing of those infants who had cerebral palsy, mental retardation, or frequent episodes of serous otitis media. The evaluation of hearing impairment in low birth weight infants should be carried out very carefully.
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Nobuhisa Terada, Nanako Hamano, Kiyoshi Hiruma, Gen Houki, Kazumasa Su ...
1997 Volume 1997 Issue Supplement94 Pages
64-70
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Diesel exhaust particulates (DEP) are common air pollutants from diesel-engine-powered car exhaust and are thought to cause chronic airway diseases. DEP has been shown to enhance IgE production by promoting interleukin-4 (IL-4) production by lymphocytes and mast cells. Recent reports have demonstrated that epithelial cells and endothelial cells in the airway may produce certain cytokines in response to various stimulants. In this study we examined the effects of DEP extract (extract of polyaromatic hydrocarbons) on the production of granulocyte macrophage-colony stimulating factor (GM-CSF), IL-8 and the regulated on activation normal T expressed and secreted chemokine (RANTES) by human mucosal microvascular endothelial cells (HMMECs) and by human asal epithelial cells (HNECs). HMMECs and HNECs were obtained by isolation from nnasal mucosa and maintained subsequent continuous subcultures and were stimulated with DEP extract.
After stimulation with 50 ng/ml of DEP extract, HMMECs and HNECs produced GM-CSF and IL-8 time-dependently. The amounts of GM-CSF and IL-8, produced by HMMECs and HNECs after stimulation with DEP extract, was significantly higher than those produced by unstimulated HMMECs and HNECs.
Given that GM-CSF and IL-8 contribute to the recruitment and activation of eosinophils, and that eosinophil-derived lipid mediators and toxic proteins play important roles in the development of asal allergies, the above findings strongly suggest that DEP plays an important role in promotingn nasal hypersensitivity.
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Koji Shirotori
1997 Volume 1997 Issue Supplement94 Pages
71-78
Published: October 25, 1997
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Human nasal mucosal samples exposed in vitro to substance P (SP) or specific antigen were tested for the presence of mRNA for interleukin (IL)- 1β, IL-2, IL-3, IL-4, IL-5, IL-6, tumor necrosis factor α, and interferon γ by employing specific reverse transcriptase-polymerase chain reaction assays. Following the administration of 10
-4 to 10
-12 M SP, the enhanced expression of all of these cytokines, except for IL-2 and IL-4, was observed in all mucosal samples from allergic patients and in half of non-allergic patients. The expression of IL-2 and IL-4 was low.
The administration of specific antigen similarly enhanced the expre ssion of these cytokines in the nasal mucosa of allergic patients, to an even greater extent than SP. However, no enhancement was observed in nasal mucosae from non-allergic patients.
The administration of 10
-8 M of Dexamethasone with specific antigen inhibited expression of these cytokines, but 4, μg/ml of Azerastin did not. In the clinical in vivo study, SP administration to the nasal mucosa of allergic patients induced neither the allergic symptoms nor local histamine release. However, in the challenging test with specific antigen, allergic symptoms were significantly augmented after the consecutive application of SP. These augmented allergic symptoms may be due to the contribution of cytokines induced by SP.
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Kazuo Kudo
1997 Volume 1997 Issue Supplement94 Pages
79-86
Published: October 25, 1997
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Employing specific reverse transcriptase polymerase chain reaction assays, the presence of mRNA for various immunoregulatory cytokines was tested in the nasopharyngeal secretions of infants with RSV bronchiolitis. The mRNAs for tumor necrosis factor α (TNFα), interleukin (IL)-1β, IL-3, IL-5, and IL-6 were detected regularly, whereas, interferon-γ was observed only infrequently.
In organ cultures of adenoid tissues, inhibition of mucociliary activity of the mucosal surface was frequently observed after inoculation with RSV in vitro. However, such inhibitory activity was blocked by the coadministration of anti-TNF antibody.
These studies indicate that RSV infection may induce inflammation of the respiratory mucosa through synthesis of immunomodulating cytokines. In order to develop effective strategies in the prevention of RSV-associated diseases, the development of immune and pathological responses to RSV in human mucosal sites need to be carefully explored.
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Hideki Ando
1997 Volume 1997 Issue Supplement94 Pages
87-91
Published: October 25, 1997
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It is generally accepted that abnormal autonomic responsiveness may contribute to the pathogenesis of hyperesthetic rhinitis. Histologically, cholinergic fibers in the nasal mucosa are located close to blood vessels, but are particularly numerous around the glands. Adrenergic fibers are found mainly around the vasculatures. Physiological and pharmacological studies have demonstrated that parasympathetic hypersensitivity causes hypersecretion, and that sympathetic hypersensitivity causes vasodilatation.
Using radioligand binding techniques, it has been found that there is an increased number of muscarinic cholinergic receptors and a decreased number of α
1- and β-adrenergic receptors in patients with nasal allergy, while the binding affinities remain unchanged.
In this report, using radioligand binding techniques, I investigated the relationship between the number of muscarinic cholinergic receptors, and the degree of the hyperreactive nasal symptoms in patients with hyperesthetic rhinitis, was investigated. The results were as follows.
1. The number of muscarinic cholinergic receptors in the human nasal mucosa in patients with hyperesthetic rhinitis was significantly related (p<0.05) to the degree of hypersecretion induced by methacholine and to the frequency of nose blowing, based on observations in an allergy diary.
2. There was no relationship between the frequency of sneezing and the number of muscarinic cholinergic receptors.
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Soichiro Miyazaki, Michinori Yokomizo, Kazuo Ishikawa, Kiyoshi Togawa, ...
1997 Volume 1997 Issue Supplement94 Pages
92-97
Published: October 25, 1997
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The effect of emedastine difumarate on nasal obstruction was examined in 21 patients (8 males and 13 females, average age: 26.3 years) with perennial nasal allergy. The patients received 2 mg of emedastine difumarate twice a day for one or two weeks. Objective measurement of nasal obstruction was performed by active anterior rhinomanometry using nozzle before and after treatment. Nasal resistance at the point of ΔP100Pa in inspiration was calculated for the analysis. For the statistical analysis the paired t test was applied.
The decrease in the subjective symptom score was significant. However, there was a small but ot statistically significant decrease [0.416 Pa/(ml/sec)→0.360 Pa/(ml/sec)] in nasal resistance inn all cases. A significant decrease [0.500 Pa/(ml/sec)→0.307 Pa/(ml/sec), p < 0.05] in nasal resistance was noted in patients who had complained of slight nasal obstruction.
Our findings confirm the efficacy of emedastine difumarOate in the treatment of nasal obstruction in allergic rhinitis.
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Soichiro Miyazaki, Yoshiaki Itasaka, Kazuo Ishikawa, Kiyoshi Togawa
1997 Volume 1997 Issue Supplement94 Pages
98-101
Published: October 25, 1997
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Rhinomanometry is useful for the diagnosis of nasal obstruction and the evaluation of nasal surgery. In this report, we describe the results of questionnaires regarding the application of rhinomanometry in Japan.
Questionnaires, including 13 questions regarding rhinomanometric use, were sent to 113university medical centers in Japan and 76 replies were obtained (recovery rate: 67%) between September 1993 and December 1993. Fifty-nine out of 76 medical centers possessed a rhinomanometer. Fifty-five institutes (93%) utilized rhinomanometers clinically. Examinations were usually done by an otolaryngologist in 95% of the institutes. Active anterior rhinomanometry was employed in 92% of the institutes. Active posterior rhinomanometry was employed in 8% and oscillatory rhinomanometry in 6%. Nasal resistance was measured at the point of ΔP100Pa in 41%of the centers and at the point of maximum pressure in 27%.
Eighty-five percent of the centers acknowledged the usefulness of rhinomanometry. However, some problems associated with rhinomanometry were pointed out. The most common problem was a discrepancy between the sensation of nasal obstruction and the rhinomanometric value.
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Shigeki Nishihira, Hiroyuki Yamauchi, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
102-111
Published: October 25, 1997
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Fibrous dysplasia rarely arises from membranous bone. In this paper a case of fibrous dysplasia originating in the vomer bone of the nasal septum is presented.
The patient was a 57-year-old Japanese woman. The tumor-like lesion was detected by chance with MR imaging when the patient was ill with transient vertigo. An operation was performed under general anesthesia by means of an endonasal approach combined with a transpalatal approach. The tumor was totally removed along with a part of the anterior wall of the sphenoid sinus. The vomer bone was extirpated segmentally along with the middle part of the hard palate. The pathological diagnosis was fibrous dysplasia.
As far as we are aware, this is the first report of fibrous dysplasia arising from the vomer bone.
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Shigeki Nishihira, Takakazu Moriguchi, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
112-118
Published: October 25, 1997
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A concha bullosa is an aerated turbinate. It is the most common anatomic variant of the middle turbinate. Inferior concha bullosa is a less frequent anatomic variation. Recently we treated a patient with a massive superior concha bullosa with an infection which mimicked a nasal tumor.
A 16-year-old boy presented with a right nasal obstruction. He had no medical history of nasal problems. On physical examination a large, firm, nonpulsatile mass was found to fill his right nasal cavity. A CT scan revealed a large intranasal bony rimmed mass. MR imaging showed a cyst-like mass in the right nasal cavity with secondary obstruction of a part of the right posterior ethmoid sinus. We thought that the mass was a massive, infected concha bullosa at the time of examination. A subsequent biopsy revealed a thin, bone-lined, hollow cavity filled with whitish mucopurulent material. A CT scan examined three months later revealed that this extraordinary spreading bullous concha originated from the inner aspect of the right superior turbinate and that the opening of the concha bullosa was the posterior ethmoid air cell. It was evident that the mass was in fact a superior concha bullosa. Nearly the entire wall of the superior concha bullosa was removed by endoscopic technique.
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Masaji Yamada, Hiroshi Iida, Yoshihiko Nakada, Kazuo Ishikawa, Kiyoshi ...
1997 Volume 1997 Issue Supplement94 Pages
119-122
Published: October 25, 1997
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A 63-year-old man was admitted with left eyelid ptosis, diplopia, bilateral reduced visual acuity and ophthalmoplegia. These clinical symptoms were compatible with a diagnosis of orbital apex syndrome.
CT was very helpful in the diagnosis. The cause was thought to be due to a mucocele in the sphenoidal sinus. Intra-nasal operation was performed under local anesthesia. These symptoms mentioned above disappeared rapidly after surgery.
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Shigeki Nishihira, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
123-135
Published: October 25, 1997
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Chondromyxoid fibroma (CMF) is an uncommon benign tumor of the bone system first described by Jaffe and Lichtenstein in 1948. A review of world wide literature revealed 38 cases of head and neck CMF lesions up to October 1996. There were 15 cases in the mandible,4 in the maxilla,13 in the cranium,1 in the pterygopalatine fossa,1 in the zygoma and 4 in the nose and paranasal sinus. In this paper we present a new case of CMF which arose in the ethmoid sinus. In addition, a review of the literature is presented. A 34-year-old Japanese man presented with left exophthalmus. The patient had noticed the protuberance on the left side of the nasal base 12 months previously. Anterior nasal specullum examination revealed no tumors in the nasal cavity. A plain CT scan revealed a large lump involving the left ethmoid sinus, extending superiorly into the bilateral frontal sinuses and into the left orbit. R imaging showed a low intensity signal relative to the gray matter on T
1-weighted imMages, isointensity on proton density images, a jagged island like lesion with a hyperintense high signal was seen within the high intensity signal on T
2-weighted images and marked peripheral enhancement was noted on postcontrast (Gd-DTPA) studies of T
2-weighted images. The tumor was removed completely by way of external ethmoid approach. The tumor dimensions were 6×4×3.5 cm. Grossly the surface was grayish-white, capsule-less, lobular, solid in texture and rather firm, but rubbery in consistency. The cut surface of the tumor was glazed and enerally yellowish-white in color. Histopathologic examination confirmed the diagnosis of CMgF. After 34 months of clinical and radiological follow-up, the patient showed no evidence of recurrence.
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Shigeru Hanazawa, Masataka Edo, Kohei Honda
1997 Volume 1997 Issue Supplement94 Pages
136-145
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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A 10-year-old male with giant juvenile angiofibroma with a suspicion of intracranial extension is reported. Preoperative embolization of the bilateral maxillary arteries was performed 7 days before tumor resection at another institution and the operation was performed under hypothermic anesthesia. A transfacial approach through an extended Moure incision was undertaken. The tumor was completely resected under high magnification using wide field high power (×4.5) loops. Blood loss totalled 1218 g. The patient has remained asymptomatic with no evidence of recurrence for the 2 years since surgery. Appropriate treatment for patients with juvenile nasopharyngeal angiofibroma (JNA) is discussed in the context of a literature review.
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Shigeki Nishihira, Koji Shirotori, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
146-150
Published: October 25, 1997
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A 89-year-old man presented to us with a squamous cell carcinoma of the lower lip. The tumor was 3 7 mm i n diameter, and no lymph nodes could be palpated in the neck (T
2N
0M
0). A radica l fullthickness rectangular shaped excision, including a 10 mm safety margin around the tumor, was performed under general anesthesia. Bilateral oral commissures were preserved at a distance of 7 mm (distance from the angle) from the right side and 3 mm from the left. The excisional defect (85.5%)was immediately reconstructed basically by way of the Webster modification of Bernard cheiloplasty. Since reconstructed commissures tend to form cicatricial contractures and secondary cornmissuroplasty may sometimes be required with this modification, we altered the procedure. (1)Each side of the preserved vermilion with the labial angle was raised as a vermilion flap from the advancement buccal flap, and (2) to decrease the downward tension and to raise the central portion of the advancement buccal flaps we a dded a h orizontal sawed-off t he mental protuberance of t he mand ible. (3) After making the frontal wall of the lower lip using advancement buccal flaps, the raised vermilion flaps were replaced to form a new oral commissure on each side. (4) Stripped mucosal flaps, which are usually used for formation of t he oral c ommissures and the vermilion of the lower lipi n t he Webster modification, were placed between the new oral commissures. No contracture was observed in the new commissure six months postoperatively. The results of this technique were excellent both cosmetically and functionally.
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Yoshikazu Asano, Soichiro Miyazaki, Kazuo Ishikawa, Kiyoshi Togawa, Sy ...
1997 Volume 1997 Issue Supplement94 Pages
151-155
Published: October 25, 1997
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A case of infratemporal fossa abscess caused by upper molar infection in a 82-year-old male is reported.
The patient presented with a pain in his right upper molar region, and had been seen by a dentist on December 25th 1996. A caries was found in the 7th tooth and treated by extraction, systemic administration of antibiotics, and analgesics. Despite treatment, the patient subsequently complained of progressive pain in his upper jaw and eventually trismus developed.
He was then referred to our clinicon January 8th 1997.
On examination, trismus and a diffuse swelling withonut fluctuation of the right temporal region and cheek were found. The patient's body temperature was 37°C and other vital signs were normal. The white blood cell count was 9,000/mm
3 and the CRP was 16.5 mg/dl. Free blood sugar was 203 mg/dl and glycosuria was found.
MRI revealed multilocular abscess in the right infratemporal fossa. Under local anesthesia, he underwent an incision in the right upper gingivo-buccal sulcus and drainage of the infratemporal fossa abscess. After the operation, intravenous clindamycin and fosfomycin were administered for 6 days with local lavage. Gradual improvement was noted, and disappearance of the abscess with moderate thickening of external pterygoid muscle was seen by MR study 24 days after the operation.
In this case, aging and diabetes were considered to have exacerbated the inflammatory process.
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Hiroshi Iida, Masaji Yamada, Tatsurou Sugiyama, Kazuo Ishikawa, Kouich ...
1997 Volume 1997 Issue Supplement94 Pages
156-160
Published: October 25, 1997
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The case of a 10-year-old female with congenital lingual fistula, the opening to which was located on the dorsal, and the anterior two thirds of the tongue, is reported. Pathological report was dermoid cyst. A similar case has not been previously reported in the literature. MRI was available for the diagnosis. This case had complications including perceptive deafness and mitral valve insufficiency. Further investigation of the development of congenital deafness in such cases is required.
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Masataka Edo, Shigeru Hanazawa, Takayoshi Tsushima
1997 Volume 1997 Issue Supplement94 Pages
161-166
Published: October 25, 1997
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A 49-year-old male with a mucoepidermoid tumor of the parotid gland was treated surgically after combined therapy using radiation and a daily low dose of cisplatin with excellent results. The histological diagnosis based on an open biopsy was a solid type mucoepidermoid tumor with epidermoid cells dominant. The tumor was classified as a high grade malignancy.
The tumor was remarkably decreased in size with radiation therapy. The total dose of cisplatin was 240 mg and the total dose of radiation was 60 Gy. Xerostomia and dermatitis were observed as side effects, but the patient recovered following symptomatic therapy. Neither recurrence nor metastasis has been found in the 2 year follow-up period since radical surgery.
These results suggest that radiation therapy might be useful for the treatment of mucoepidermoid tumors.
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Kazuo Ishikawa, Kiyoshi Togawa, Soichiro Miyazaki, Hiroyuki Tada, Koic ...
1997 Volume 1997 Issue Supplement94 Pages
167-172
Published: October 25, 1997
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Based upon our policy for treatment of laryngeal cancer, a clinical study was performed on 114patients with laryngeal cancer who had been treated at our facility. Our policy is as follows: 1)primarily curative radiation (60 Gy) is indicated for T
1and T
2tumors. When tumor remnant is found, a total or partial laryngectomy is performed in accordance with the degree of tumor invasion; 2)preoperative radiation followed by partial or total laryngectomy is performed for T
3 and T
4tumors. When radiation is very effective, curative radiation may be indicated. The patients included 108 males and 6 females, whose age ranged from 39 to 80 years old with a peak occurence rate in the sixties. Glottic cancer was present in 76 cases, supraglottic cancer in 36 cases and subglottic cancer in only 2 cases. Regarding tumor size,25 cases were classified as T
1,18 as T
2,31 as T
3 and 2as T
4 among the glottic cancer group. On the other hand,11 were T
1,8 were T
2. 12 were T
3 and 5were T
4in the supraglottic cancer group.
At the initial examination, the incidence of cervical lymphnode metastasis was nearly five times higher among the supraglottic cases than the glottic cases. Although curative radiation therapy (60 Gy) was carried out in 60 of the glottic cancer cases,21 of these patient needed further surgical treatment due to the tumor remnant, and preoperative radiation therapy (40 Gy) was performed in 16 cases. Whereas in supraglottic cases, curative radiation therapy was carried out in 29 cases, but in 19 cases surgical treatment were performed due to tumor remnant.
Based upon the classification of disease stage,5-year survival rate, excluding the cases which had other causes of death, was 95% in stage I patients,83% in stage II,66% in stage IIi and in 43% in stage IV in the glottic cancer group. In cases with supraglottic cancer,75% were in stage I,100% in stage II,86% in stage III and 39% in stage IV. The overall 5-year survival rate was 76%. In 17 cases (15%) other malignant tumors were found.
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Hideki Ando, Kohei Honda, Joji Soma
1997 Volume 1997 Issue Supplement94 Pages
173-176
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Lymphangioma of the larynx is a very rare benign tumor.
A 66-year-old male first visited an internist for gastric fiberscopy, and a laryngeal tumor was accidentally discovered. The patient was subsequently referred to our department for further examination.
Laryngoscopy showed a slightly purple tumor in the right ventricular fold. A biopsy of the tumor was performed on November 24th 1995, and the tumor was eventually revealed to be a lymphangioma histopathologically.
The patient was carefully observed for 7 months. Slight enlargement of the tumor was noted during this period. Accordingly, an excision of the tumor by using a Nd-YAG laser under microlaryngoscopy was undertaken on June 7th 1996. No recurrence of the tumor has been observed since then.
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Keiji Iizuka, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
177-183
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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The skin incision of 67 laryngeal and hypopharyngeal cancer patients who were treated surgicaly were analyzed and grouped on the basis of three unilateral basic patterns and bilateral lpatterns with various modifications. The basic patterns consisted of parallel P-shaped, L-shaped, and inverted L-shaped designs. Modifications included Pm, Lm, Ls, and inverted Lm. Bilateral patterns were symmetrical and identified by preceding the single basic patterns with the term bilateral. The bilateral L-shaped pattern was most useful and reliable in laryngeal and hypopharyngeal cancer operations. The bilateral Ls pattern was suitable for simple total laryngectomy, with or without radiotherapy. When cervical lymph node metastasis appears, neck dissection could be done by the unilateral, or, bilateral Lm type skin incision. The P pattern or bilateral P pattern were applied when neck dissection had to be done before resection of the primary lesion. The inverted L, or, bilateral inverted L pattern could be used in a limited number of patients. The selection of skin incisions must be designed in accordance with the viability of the skin flap, in order to reduce skin flap complications.
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Yoshitaka Okamoto, Zensei Matsuzaki, Norio Sarashina, Michinori Yokomi ...
1997 Volume 1997 Issue Supplement94 Pages
184-190
Published: October 25, 1997
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The results of planned combination therapy in 63 cases of stage 111 IV hypopharyngeal cancer at our institute between 1972 and 1992 were reviewed. The combination therapy consisted of intravenous chemotherapy, Linac X-ray irradiation (50-60 Gy) followed by sufficiently extensive resection and primary reconstruction. The actual 3 year survival rate was 42.9%. The histopathological effects (pT, pN) of preoperative chemotherapy and radiotherapy were the most important factor in patient prognosis. In particular, the presence of pN predicted a very low possibility of survival and a very high incidence of distant metastasis. The advantages and disadvantages of preoperative radiotherapy were discussed.
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Zensei Matsuzaki, Yoshitaka Okamoto, Michinori Yokomizo, Kazuo Ishikaw ...
1997 Volume 1997 Issue Supplement94 Pages
191-195
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Michinori Yokomizo, Kazuo Ishikawa, Soichiro Miyazaki, Kiyoshi Togawa, ...
1997 Volume 1997 Issue Supplement94 Pages
196-200
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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An unusual case of two separated extracranial meningiomas is reported. One meningioma was ocated in the internal jugular vein and the sigmoid sinus, and the other was located in the middle l ear cavity.
A 34-year-old man complained of swelling of the right neck and occasional bloody otorrhea with hearing disturbance, but there were no associated symptoms of pain or tenderness.
Our initial diagnosis, based upon radiological examinations, was a parapharyngeal tumor with a middle ear invasion. This tumor was surgically removed. The clinicopathological and immunohistochemical findings revealed it to be a meningioma. Pertinent papers were reviewed with regard to the origin of extracranial meningiomas.
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Michinori Yokomizo, Hiroyuki Tada, Kazuo Ishikawa, Kiyoshi Togawa, Yos ...
1997 Volume 1997 Issue Supplement94 Pages
201-205
Published: October 25, 1997
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A comparative study was performed to evaluate difference in the histological effects and side effects between a group of tongue cancer and hypopharyngeal cancer patients treated with 5FU (250 mg×3days/week) and 60 Gy radiation, and those treated with CBDCA (50-80mg×lday/week) followed by 5FU (250 mg×2days/week) and 40 Gy radiation. In the tongue cancer patients, there was no significant change in histological effects according to Shimosato's classification system. A decrease in leukocytes was found in the CBDCA group, which was not statistically significant. In cases with hypopharyngeal cancer, the number of leukocytes was significantly decreased in the CBDCA group. However the number of platelets and degree of stomatitis was not significantly altered.
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Kouhei Honda, Michinori Yokomizo, Kiyoshi Togawa, Yoshitaka Okamoto, Z ...
1997 Volume 1997 Issue Supplement94 Pages
206-210
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Sixteen patients with mucosal melanoma of the head and neck were treated in our department from 1972 to 1996. Among these patients,7 melanomas originated from the nasal cavity,6melanomas from the oral cavity,2 melanomas from the oropharynx and 1 melanoma from the paranasal sinus.
According to the criteria of the National Institute of Health,9 cases were classified as stage I,5as stage II, and 2 as stage III.
Five patients with resectable tumors underwent radical surgery. Three patients whose surgical margin was histologically free of tumor cells remained alive for 35 to 114 months after surgery. However,2 patients with tumor cell positive surgical margins died due to local recurrence within 25months.
Of 11 patients who received palliative therapy, only one patient remains alive. The other 10patients died within 4 years. Chemotherapy with DTIC or CDDP did not significantly improve the control rate of the disease.
The efficacy of combined chemotherapy and radiotherapy will remains to be determined.
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Koji Shirotori, Masao Sakamoto, Nobuhisa Terada, Kazuo Ishikawa, Kiyos ...
1997 Volume 1997 Issue Supplement94 Pages
211-216
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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A case of thyroid hemiagenesis is described. The patient was a 35 year-old female with hemiagenesis of the left thyroid lobe associated with a papillary carcinoma in the right lobe. Upon physical examination, a firm elastic tumor was palpable in the right lobe. Thyroid function test results were normal. Thyroid scintigrams using both
99mtechnetium pertechnetate and 201thallium chloride revealed accumulation in the right thyroid lobe, but not in the left. Computed tomography revealed a tumor in the right thyroid lobe and hemiagenesis of the left lobe. A complete absence of the left lobe and a papillary carcinoma in the right lobe were confirmed surgically. Thyroid hemiagenesis is a rare congenital anomaly, and thyroid carcinoma in the remaining lobe is extremely rare.
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Tatsuya Fujiyoshi, Hiroyuki Masuda, Tokuji Nishinaka, Tetsuo Futami, H ...
1997 Volume 1997 Issue Supplement94 Pages
217-225
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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We saved the life of a 53-year-old man who attempted suicide by swallowing sodium hydroxide solution. Two days after the episode, the thoracic esophagus, the stomach, and the spleen were removed to avoid fatal mediastinitis and peritonitis caused by total tissue necrosis and perforation of the digestive tract. Eight days after this operation, cervical esophagectomy, hyponharyngectomy, and total laryngectomy were performed, followed by reconstructive surgery both with two deltopectoral (DP) flaps and with a colic segment. Our report focuses on the superiority of the DP flap in the treatment of this case.
The DP flap, which consists of the anterior deltoid portion and the pectoral portion, was first used on the left side for reconstruction of the cervical esophagus when laryngo-pharyngo-esophagectomy was performed. At the second surgery, this skin roll was extended from the neck to the midportion of the anterior chest with the basal portion of the former flap and using the DP flap on the right side. Finally, a colic segment supplied by the left colic artery was prepared and elevated subcutaneously by the ante-sternal route, and then connected with the previously reconstructed esophagus. The surface skin defect on this connecting portion was able to be covered with the remaining pedicule tissue of the DP flap on the right side.
We chose the DP flap for its simplicity, taking the general condition of the patient into consideration. Although 6 months were required for reconstruction of the entire esophagus and for the patient to begin eating, 'no serious complications occurred. Not only the paddle portion of the DP flap but also its basal portion were useful for step-by-step reconstruction. The simplicity and reliability of the DP flap were confirmed in this case.
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Shigeki Nishihira, Kazuo Ishikawa
1997 Volume 1997 Issue Supplement94 Pages
226-231
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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Radiolucent foreign body inhalation in infants is sometimes very difficult to diagnose without an eye-witness. Infrequently, some families will not grant permission to operate because they desire positive proof of foreign body aspiration. In the present paper a case of bronchial peanut foreign body complicated with mediastinal herniation of the lung is described. The patient was a 22 month old boy. He presented to us because of continuation of a hyper radiolucent area with a reduction in breathing sounds in the left lung. His parents denied the possibility of foreign body aspiration. Chest radiography demonstrated air trapping in the left lung and mediastinal deviation to the right. An inhaled foreign body in the left bronchus was strongly suspected. The family was asked to permit bronchoscopy under general anesthesia to confirm and remove the foreign body. However, since the boy was very lively in outward appearance and had no symptoms, they desired convincing evidence of foreign body aspiration. Although the chest CT revealed a narrowing of the left bronchus, MRI demonstrated no intraluminal object in this site. Four days after diagnosis, the chest radiography showed remarkable mediastinal herniation of the lung. Since remarkable mediastinal herniation which happens rapidly is sometimes followed by collapse of the cardiovascular and respiratory system, the parents were advised that this state was a sign of pressing danger.
Removal was undertaken by means of ventilation bronchoscopy under general anesthesia the following morning. One half of a peanut was removed. Intraoperative and postoperative courses were uneventful. Following surgery, the mediastinal herniation disappeared and the breathing sounds were normal.
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Masao Sakamoto, Koji Shirotori, Yoshitaka Okamoto, Nobuhisa Terada, Ka ...
1997 Volume 1997 Issue Supplement94 Pages
232-237
Published: October 25, 1997
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A case of adenoid cystic carcinoma of the cervical trachea is presented here. The case was a 61year-old woman with discomfort in the laryngeal region. Progressive recurrent nerve palsy and swelling of the posterior tracheal wall were revealed by X-ray film, suggesting a malignant tumor. The patient underwent resections of the lower pharynx, larynx, a part of the cervical esophagus and the entire thyroid gland in conjunction with right radical neck dissection followed by reconstruction with the free intestinal graft. During abdominal surgery, metastatic lesions of the liver were discovered. Histrogical examination revealed an adenoid cystic carcinoma. Adjuvant chemotherapy was performed with CDDP and 5-FU. Postoperative irradiation will be indicated.
Primary malignant tumors of the trachea are rare. Adenoid cystic cartinoma is the second most common cancer of these. Although this tumor is classified as a low-grade malignancy, early diagnosis is important because of the high probability of multiple organ metastasis.
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Tatsuya Fujiyoshi
1997 Volume 1997 Issue Supplement94 Pages
238-244
Published: October 25, 1997
Released on J-STAGE: November 27, 2012
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The clinical efficacy of treatment with tosufloxacin tosilate (TFLX) of 165 bacterial infections diagnosed in 130 adults over a fourteen-month period in the outpatient otolaryngology clinic was analyzed. Patients with severe manifestations of bacterial disease were not included in this study, since intravenous administration of antibiotics was indicated as initial therapy in the treatment of such patients. The infections comprised three groups: (1) Acute infections of the throat and the upper respiratory system, in 137 cases; (2) Acute infections of the skin and the subcutaneous connective tissue, in 11 cases; and (3) Chronic infections and their acute exacerbation, in 17 cases. The patients were administered oral TFLX (300-450 mg/day) for 5 to 14 days. The clnical efficacy rate for the three groups was 98.5%,90.9%, and 70.6%, respectively. Skin eruption in 2 and pruritus in 1 of the 130 patients (2.3%) were observed as adverse drug reactions. No particular pattern was noted in the distribution of causative organisms isolated from patients in whom TFLX was ineffective. Some cases displaying marked efficacy with TFLX treatment and some without TFLX efficacy were presented in detail, and the usefulness of therapy was then discussed. In cases of chronic sinusitis and its exacerbation, which exhibited the lowest efficacy rate, TFLX was considered to play a role in the induction of long-term therapy with clarithromycin.
These findings indicate that TFLX is useful for the treatment of otolaryngological bacterial infections.
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