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Osamu Jinnouchi, Yasuo Koike, Kiyoshi Fukui
1999 Volume 1999 Issue Supplement101 Pages
1-6
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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Fast excitatory synaptic transmission in the inner ear has been proposed to be mediated by an excitatory amino acid, possibly L-glutamate, and its receptors. Previous studies have revealed that certain types of ionotropic glutamate receptors are expressed in various combinations of subtypes in the cochlea and vestibule. Other studies have suggested that some glutamate receptors may have non-neural functions, such as cell differentiation and migration. Recently the glutamate receptor a subfamily has been identified, although little is known about its physiological characteristics thus far. Since 1997 it has been known that the 61 subunit is highly expressed in hair cells of auditory and vestibular systems, which suggests that the 61 subunit may play an important functional role in these systems. The expression of NMDA receptor mRNA in spiral ganglion cells has also been demonstrated, suggesting involvement of the NMDA receptor in neurotransmission in the inner ear. In search of coagonists of the NMDA receptor other than glycine, D-serine has been found to be present in mammalian central nervous systems and is regarded as a possible neuro-modulator of the NMDA receptor. We have demonstrated the gene expression of D-amino acid oxidase (DAO) in the rat temporal bone using RT-PCR analysis. This observation suggests that D-serine, which is the substrate of DAO, may exist in the inner ear and may modulate the neurotransmission of NMDA receptor subunit NR1.
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Katsuhiko Nakamura, Junji Koda, Naoya Takeda, Hironori Masuda, Yasuo K ...
1999 Volume 1999 Issue Supplement101 Pages
7-13
Published: February 25, 1999
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Electromyographic (EMG) studies of the laryngeal muscles were thought to be difficult because of the small size and deep location of these muscles. However, EMG methods to study the cricothyroid and the thyroarytenoid muscles had been established. The EMG techniques used to study these muscles were described in this paper.
EMG study of the posterior cricoarytenoid muscle (PCA) was limited, and different PCA recording techniques had been proposed. The approach to evaluate this muscle had been developed along three main lines: oral, percutaneous and nasal. Electrode placement techniques for study of the PCA were reviewed.
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Fumitoshi Tachibana, Katsuhiko Nakamura, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
14-18
Published: February 25, 1999
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Children with otitis media with effusion (OME) were divided into two groups: a group administered Oxatomide which had anti-leukotriene (LT) effects (Oxatomide-administered group) (17 cases,17 ears) and a control group (15 cases,16 ears), and the concentrations of LTC
4, LTD
4 and LTE
4 in middle ear effusion were measured by radioimmunoassay.
In the Oxatomide-administered group, the LTC
4 concentration was 28.7±15.3 picograms per milligram of total protein (pg/mgTP) and total concentration of LTD
4 and LTE
4 (LTD
4 + LTE
4 concentration) was 80.3±53.8 pg/mgTP. On the other hand, in the control group, the LTC
4 concentration was 50.5±42.5 pg/mgTP and the LTD
4 + LTE
4 concentration was 288.2±144.6 pg/mgTP. The LTD
4 + LTE
4 concentration was significantly lower (p<0.001) in the Oxatomide-administered group than in the control group, and duration of treatment for OME showed a tendency to be shorter in the Oxatomide-administered group than in the control group.
On the basis of these results, it was suggested that LTD
4 and/or LTE
4 might be related to the prolongation of OME.
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Ghen Ohyama, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
19-29
Published: February 25, 1999
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This paper discusses some methods of modifying the disordered voice. It is uncomfortable to hear the disordered voice. In the first part of this paper, the acoustical characteristics of the disordered voice are discussed. The major acoustical characteristics of the disordered voice indude weak intensity, weak periodicity, large periodic perturbation and large intensity perturbation. Because the acoustic characteristics of disordered voices differ, it is necessary to use different methods to modify the disordered voice. A speech analysis synthesis method is employed to modify the disordered voice. Prepliminary results suggest that this method is useful for modification of the disordered voice.
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Ghen Ohyama, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
30-39
Published: February 25, 1999
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This paper examines the acoustical characteristics of the ornaments of the Singing Voice in Koto (Japanese Harp) and Shamisen (Japanese Guitar) music. The ornaments of Koto music are‘furi’(shake),‘atari’ (push),‘suriage’(slowly up),‘sun-sage’(slowly down), etc.‘Atari’and‘furi’are the glottal techniques. In the cases of‘sun-age’and‘sun-sage’the target tone is specified, and the fundamental frequency changes continually. On the contrary, in the cases of‘atari’,‘furi’, no target tone is specified, the power decreases while the fundamental frequency increases. The change in fundamental frequency is not continuous. Controll of the glottis may differ between the various techniques.
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Junji Koda, Naoya Takeda, Katsuhiko Nakamura, Hironori Masuda, Yasuo K ...
1999 Volume 1999 Issue Supplement101 Pages
40-44
Published: February 25, 1999
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One of the major complications of thyroid surgery is damage to the recurrent laryngeal nerve (RLN). This injury can be avoided by intraoperative nerve identification. A technique is described for electromyographic monitoring of the RLN during thyroidectomy. The RLN was electrically stimulated with a hand-held bipolar stimulator, delivering a voltage of 1 to 7 V. Hooked-wire electrodes were placed in the thyroarytenoid muscles through the cricothyroid membrane. Laryngeal evoked responses were readily recognized by a EMG waveform. No responses were evoked by stimulation of tissue 1 or 2 mm adjacent to the RLN. This procedure can be used to confirm the presence of the RLN during the course of the operation.
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Koichi Tamura, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
45-49
Published: February 25, 1999
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Muscle spindles were investigated using enzyme histochemistry in serial sections of human intrinsic laryngeal muscles obtained from surgical specimens. Muscle spindles were demonstrated in the middle one third of each laryngeal muscle. Five muscle spindles were observed in the interarytenoid, three in the posterior cricoarytenoid, two in the cricothyroid and thyroarytenoid, and one in the lateral cricoarytenoid. The maximum width of the muscle spindles ranged from 35 to 150 μm. Each muscle spindle contained three to eight intrafusal fibers, and the intrafusal fibers ranged from 7.7 to 15.6 μm in diameter. On the basis of enzyme reactivity, intrafusal fibers could be classified into three kinds of muscle fiber, nuclear bags fibers, nuclear bag
2 fibers and nuclear chain fibers, which is the same classification observed in other skeletal muscles.
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Akio Kondo, Katsuhiko Nakamura, Hitomi Ueeda, Masako Naka, Aki Endo, S ...
1999 Volume 1999 Issue Supplement101 Pages
50-55
Published: February 25, 1999
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Polysomnography is one of the most useful diagnositc methods for detecting sleep apnea syndrome (SAS). The subjects consisted of 30 adult patients suffering from snoring or sleep apnea. In order to diagnose the location of stenosis and severity of SAS, the mesopharyngeal pressure amplitude (MPA), lowest SaO
2 and apnea index (Al) are analyzed. Al< 5 is defined the snoring group, and AI>5 defined the SAS group. The MPA obtained in the SAS group was higher than in the snoring group (P<0.01). The lowest SaO
2 obtained in the SAS group was lower than in the snoring group (P<0.01).
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Kouji Abe, Hironori Akizuki, Katsuhiko Nakamura, Junji Koda, Kohji Kim ...
1999 Volume 1999 Issue Supplement101 Pages
56-61
Published: February 25, 1999
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Thyroid antibodies have typically been measured by the passive agglutination method (PA method) until now but this method it is semiquantitative and development of a more objective method has been awaited. Recently, a method measuring thyroid antibodies by radioimmunoassay (RIA) was developed and this method has increased sensitivity in the measurement of antibodies. Moreover, in cases, of abnormal sensations in the throat (AST) this method facilitates, screening for thyroid disease.
In the present study, thyroid antibodies were measured by the RIA method in patients who complained of AST and the results were compared with those obtained by the PA method. The subjects were 26 patients (7 males and 19 females) with AST as the major complaint. There were 4 patients (16%) who were judged negative by the PA method but determined to be positive by t he RIA method. One patient among these was treated with levothyroxine sodium, and was suspected to be euthyroid due to the presence of Hashimoto's disease. The AST in this patient was improved by this treatment. Thus, it seems possible that latent Hashimoto's disease may be the cause of AST in patients having this symptom. Measurement of anti-thyroid antibodies by the RIA method was considered to be useful in the detection of these patients.
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Kouji Abe, Hironori Akizuki, Junji Koda, Hironori Masuda, Hitomi Ueeda ...
1999 Volume 1999 Issue Supplement101 Pages
62-64
Published: February 25, 1999
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Arytenoid edema is a critical clinical signs under any conditions. However, the severity of arytenoid edema is variable and this condition has therefore been very difficult to quantitate. The authors have attempted to quantitatively evaluate the status of edema in patients with abnormal sensations in the throat (AST) as well as in healthy subjects. The degree of arytenoid edema has been classified into five categories from level 0 to 4. According to this classification system, edema has been identified in more AST patients (69%) than in healthy subjects (30%), and the severity has been found to be greater among the AST patients. Based on the present results, the proposed classification system appears to incorporate paramaters suitable for precisely classifying the presence and degree of edema with reasonable reliability. Thus, this system appears to be an effective tool for quantitatively evaluating arytenoid edema.
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Hironori Masuda, Junji Koda, Shinichi Nakagawa, Osamu Jinnouchi, Yasuo ...
1999 Volume 1999 Issue Supplement101 Pages
65-69
Published: February 25, 1999
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Transnasal hypopharyngoesophagofiberscopy was performed on eighteen patients whose chief complaint was a foreign body sensation in the throat and in whom hypopharyngoesophageal disease was suspected. This fiberscopy was performed by attaching a hood equipped with an air line to a laryngofiberscope. In five patients, lesions were detected in the esophageal mucous membrane, and they were diagnosed as having reflux esophagitis. Administration of Lansoprazole, a proton pump inhibitor, led to improvement of symptoms in all patients. Compared to conventional transoral insertion, the present transnasal fiberscopy utilizing a hood not only places less stress on patients, but also is able to detect lesions in the hypopharynx and the esophageal mucous membrane more easily and quickly.
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Toshitaka Nakayama, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
70-75
Published: February 25, 1999
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In the southern part of the Tokushima Prefecture, the RAST positive rate for eight pollen antigens was measured in 309 patients with allergic rhinitis between January 1996 and March 1997. The RAST positive rate for cedar pollens and cypress pollens was 72.2 and 59.2%, respectively. The RAST positive rate for two other pollens, orchard-grass pollen and mugwort pollen, was less than 30%, and that for the remaining four pollens, from short ragweed, oak, Japanese white birch and Japanese alder, was less than 20%. Therefore, most patients with pollinosis in Tokushima were allergic to cedar and cypress pollen. Furthermore, the RAST positive rate for dust mites among the 309 patients was 43%. Regarding the age distribution of these patients was concerned, occurence peaked, among teens. The RAST score for cedar pollens was the highest at 4, and that of all the other antigens was less than 2.
Of 223 patients who were allergic to cypress pollens, five patients were only allergic to cypress pollens, but the remaining patients were also allergic to cedar pollens.
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Naoki Toda, Shin-ya Ohtsu, Junji Koda
1999 Volume 1999 Issue Supplement101 Pages
76-81
Published: February 25, 1999
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A questionnaire concerning the loudness and continuity of tinnitis was administered to 194 patients who had been diagnosed with tinnitis. These patients also underwent pitch match and loudness balance tests. Zinc levels were measured in 22 of the 194 patients. Serum zinc level was less than 70 μg/dl in 15 of these patients. Zinc (polaplesing 150 mg/day) was administered to these 15 patients daily for at least 1 month. The serum zinc level was subsequently measured in 10 patients. Zinc levels had recovered in all of the patients. The influence of zinc on tinnitis was then examined with the questionnaire and loudness balance test in these 10 patients. Tinnitis decreased in 4 patients according to their score on the loudness balance test, suggesting that zinc exerts a positive effect on tinnitis in some patients.
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Masahiro Kanamaru
1999 Volume 1999 Issue Supplement101 Pages
82-86
Published: February 25, 1999
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In this study, the effects of reductions in nasal obstruction by endonasal surgery on the sense of smell were exarmined by an intravenous olfaction test using thiamine propyl disulfide (TPD). Ten cases of nasal obstruction (5 cases of chronic sinusitis 2 cases of hypertrophic rhinitis and 3 cases of allergic rhinitis) were treated surgically from January,1997 to November,1997. Among 8 cases that became conscious of an improvement in nasal obstruction, duration time was prolonged in 5cases, while latent time was shortened in 7 cases, in the intravenous olfaction test. The findings in this study suggested that the improvement of nasl obstruction by the endonasal surgery involving, the removal of the barrier to the olfactory mucosa, contributed to a reduction in the time required to perceive a smell.
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Naoya Takeda, Junji Koda, Hironori Masuda, Shinichi Nakagawa, Koji Abe ...
1999 Volume 1999 Issue Supplement101 Pages
87-95
Published: February 25, 1999
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A total of 108 patients with an abnormal sensation in the throat were evaluated and then followed up by questionnaire. The patients described the intensity and frequency of the abnormal sensation in the throat in addition to the value of abnormal sensation. The clinical background of each patient were also studied using another questionnaire. The degree and frequency of abnormal sensation in the throat were useful in determining what treatment would be most effective. Most of the patients complained of shoulder stiffness and general fatigue in addition laryngeal symptoms. The patients who had a family history of malignancy showed better improvement of the abnormal sensation in the throat than other patients.
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Fumitoshi Tachibana, Katsuhiko Nakamura, Junji Koda, Koichi Tamura, Hi ...
1999 Volume 1999 Issue Supplement101 Pages
96-106
Published: February 25, 1999
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One hundred and ten patients with laryngeal cancer who were treated at Tokushima University Hospital during the 9 years between January 1989 and December 1997 were studied clinically. The mean age of patients was 66.2 years, and the male to female ratio was approximately 11: 1. The 110 patients included 60 (54.5%) with glottic cancer,49 (44.5%) with supraglottic cancer, and 1 (1.0%) with subglottic cancer. Accord1ing to the 1987 UICC TNM classification system,2 cases (1.8%) were in stage 0,34 (30.9%) were in stage I,24 (21.8%) were in stage II,23 (20.9%) were in stage III, and 27 (24.6%) were in stage IV. The five-year survival rate was 69.4% for all cases with laryngeal cancer (stage 0,100.0%; stage I,90.6%; stage II,65.7%; stage III,66.3%; and stage IV,45.6%),74.3% for cases with glottic cancer (stage 0,100.0%; stage I,94.1%; stage II,41.7%; stage III,66.7%; and stage IV,44.4%), and 62.1% for cases with supraglottic cancer (stage I,66.7%; stage II,85.7%; stage III,66.7%; and stage IV,44.5%). For the case with subglottic cancer, the five-year survival rate was 100.0%.
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Hironori Akizuki, Kouji Abe, Katsuhiko Nakamura, Kohji Kimoto, Akio Ko ...
1999 Volume 1999 Issue Supplement101 Pages
107-111
Published: February 25, 1999
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Between January 1984 and December 1996,74 patients (18 males and 26 females) with thyroid tumor were treated surgically in our hospital. Patient ages ranged from 18 to 76 years, with an average of 50.7 years. Benign tumors were diagnosed in 18 patients (follicular adenoma in 16), malignant tumors in 26 (papillary adenocarcinoma (PAC) in 23, anaplastic carcinoma, medullary carcinoma, malignant lymphoma in 1 patient each), and tumor-like lesions were diagnosed in 30(adenomatous goiter in 27, cyst in 3). Preoperative recurrent laryngeal nerve paralysis was found in 11 cases (PAC in 9, PAC with laryngeal carcinoma in 1, adenomatous goiter in 1). Nerve invasion of the tumor was observed in 6 cases, laryngeal paralysis due to complications of laryngeal cancer was observed in 1 patient, and in the remaining case, paralysis was considered to derive from some other factor. Postoperative recurrent laryngeal nerve paralysis due to surgical treatment was seen in 5cases. Four were temporary, and one was permanent due to nerve invasion of PAC.
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Akio Kondo, Kohji Kimoto, Masahiko Taniguchi, Masakatsu Toda, Yasuo Ko ...
1999 Volume 1999 Issue Supplement101 Pages
112-117
Published: February 25, 1999
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The factors associated with postoperative recurrent laryngeal nerve palsy (RLNP) were analyzed in 718 patients with differentiated thyroid cancer (size of cancer tumor > 11 mm) treated between 1991 and 1995. The papillary cancer group included 658 patients. Of these 658 patients,114developed RLNP (17.3%). Follicular cancer group was 60 patients. Of the 60 patients,2developed RLNP (3.3%). The RLNP in papillary cancer group was significantly worse than that in follicular cancer group (P<0.01). The risk factor for RLNP was analyzed. In papillary cancer group, age, size of cancer tumor, adhesion of the tumor to the recurrent laryngeal nerve, and neck dissection were identified as significant risk factors for occurence of RLNP. Papillary cancer was more malignant, if age was older and size of cancer tumor was bigger.
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Kazunori Sekine, Katsuhiko Nakamura, Junji Koda, Makoto Miyako, Yasuo ...
1999 Volume 1999 Issue Supplement101 Pages
118-124
Published: February 25, 1999
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Tumors of the salivary glands were fairly frequent among head and neck tumors. One hundred and three patients (53 male,50 female, average age 54.5 years) were resected surgically in the Department of Otolaryngology, University of Tokushima between 1982 and 1997. The most common type of tumor was pleomorphic adenoma (72.0%), followed by adenolymphoma (21.8%). Preoperative investigations included ultrasound echography, CT, MRI, radioisotope imaging, and sialography, malignancy was correctly diagnosed with 84% sensitivity (false negatives = 3). Seventynine subtotal parotidectomies were performed for a variety of benign and low-grade malignant tumors. Total parotidectomy and neck dissection were required in 3 cases.
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Koichiro Sakamaki, Katsuhiko Nakamura, Kenji Kashima, Shinichi Takeuch ...
1999 Volume 1999 Issue Supplement101 Pages
125-130
Published: February 25, 1999
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A statistical analysis was performed on 145 patients with facial nerve palsy treated at the Department of Otolaryngology of Tokushima University Hospital between January 1996 and December 1997. The Incidence of Bell's palsy and Hunt syndrome was 66.2% and 17.9%, respectively. Five patients with Bell's palsy and 7 patients with Hunt syndrome showed poor recovery in their facial motor function. Five patients with Bell's palsy who showed poor recovery were generally older; they were aged between 57 to 75 years. The 7 patients with Hunt syndrome who showed a poor recovery aged between 10 to 69 years. Of these 7 patients,4 cases were misdiagnosed as Bell's palsy at onset because the auricular helpetic eruptions appeared later. In those cases, the Shirmer test was thought to be useful for screening Hunt syndrome before the appearance of the eruptions.
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Koichi Tamura, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
131-134
Published: February 25, 1999
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Acting on a government guideline enacted in 1992, hearing examinations were performed on 492 employees working at a noise exposed manufactoring plant.
Audiometry revealed 221 cases of noise-induced hearing losses (44.9%), and 54 abnormal findings (11%). In the latter cases,29 patients with neural and 9 with conductive hearing loss were identified on additional otological tests. In the noise-induced hearing loss group,95% of the subjects were grade I. The longer the workers were exposed to noise, the greater was the hearing loss. One hundred and fifty of the 221 cases of noise-induced hearing loss were aware of their hearing disturbance, tinnitus or both. In spite of these problems, the proportion of sound-proofing users increased only gradually. Howerer, the proportion of sound-profing users was not high (57.9%), and thus this could be improved. The noise levels of this factory were reduced to below Leq 90 dB (A), and the work environment were improved.
We conclude that education on hearing health and the greater usage of sound-proofing is important in preventing hearing impairments.
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Yoshiaki Kitamura, Yohji Hori, Kouji Abe, Naoki Toda, Masahiro Kanamar ...
1999 Volume 1999 Issue Supplement101 Pages
135-139
Published: February 25, 1999
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Abacteriological examination of the maxiUary sinus and nasal cavity was conducted in 93 patients with chronic sinusitis. A bacteriological examination of the larynx was also carried out in those patients who had pus retention on the surface of the arytenoid region of the larynx. The results from these examinations were compared to each other. Staphylococcus epidermidis was frequently detected from the maxillary sinus and the nasal cavity. Various kinds of bacteria were detected from the larynx, which suggested that the sputum had mixed flora. The species of bacteria from the maxillary sinus were coincident with those from the nasal cavity at a rate of approximately 69.2%. When the chronic sinusitis was due to anaerobic bacteria, however, it was diiificult to isolate the causative bacteria from the nasal cavity. The coincidence rate between bacteria from the nasal cavity and those from the larynx was 31.4%. It was presumed that postnasal drip had some effect on the laryngeal pus.
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Masahiko Taniguchi, Yasuo Ishitani, Syuji Okada
1999 Volume 1999 Issue Supplement101 Pages
140-144
Published: February 25, 1999
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From 1973 to 1996,14 cases of tracheo-bronchial foreign bodies were experienced at our hospital. Of these 14 cases,6 were males and 8 were females. Sixty-four percent of tracheo-bronchial foreign bodies occurred in children under 2 years of age.
In nine cases (64%), peanuts were found. Foreign bodies were found in the right bronchi in 12cases (86%). With respect to the radiological diagnosis, emphysema was noted in 10 cases (71%). The foreign bodies were removed by means of ventilation bronchoscopy under general anaesthesia except one case, which received a thoracostomy.
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Kohji Kimoto, Katsuhiko Nakamura, Fumitoshi Tachibana, Yasuo Koike, To ...
1999 Volume 1999 Issue Supplement101 Pages
145-149
Published: February 25, 1999
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Nonrecurrent inferior laryngeal nerve (NRILN) is a rare disorder. We report here a 65 year-old male with a right NRILN whose chief complaint was a foreign-body sensation in the throat. The NRILN was detected incidentally during surgery for thyroid cancer. A NRILN usually results fr om an aberrant right subclavian artery due to abnormal embryonic development of the aortic arch. The aberrant right subclavian artery was diagnosed by MR angiograghy and esophagography after the surgery. The foreign-body sensation in the throat was not altered after the surgery. Therefore the foreign-body sensation in the throat may have been due to compression to the esophagus by the abnormal right subclavian artery.
Surgeons must always be aware of the possibility of NRILN during the thyroid and parathyroid surgery.
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Yohji Hori, Koichi Tamura, Kohji Kimoto, Yasuo Koike
1999 Volume 1999 Issue Supplement101 Pages
150-156
Published: February 25, 1999
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A rare case of a retropharyngeal lipoma is reported here. A hypopharyngeal submucosal tumor was found in a 53 year-old female who had been suffering from a foreign-body sensation in the throat for about 10 years. According to the imaging studies, the hypopharyngeal submucosal lipoma was diagnosed as fatty tissue-like lesion in the retropharyngeal space. In the course of obtaining diagnosis, the MRI (STIR method, fatty suppression imaging) was found to be very usefull. The retropharyngeal tumor was removed via a transoral approach. An encapsulated, white-yellowish tumor measuring 29×18×17 mm in size was diagnosed as an infiltrating lipoma. After the surgery, the patient's foreign-body sensation disappeared. Since recurrences or malignant transformations of lipomas have been reported, a long term follow up was thought to be prudent
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Junji Koda, Katsuhiko Nakamura, Naoya Takeda, Hironori Masuda, Jiro Ud ...
1999 Volume 1999 Issue Supplement101 Pages
157
Published: February 25, 1999
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Two cases of pharyngolaryngeal myoclonus are presented here. The first case was a 48-yearold man who complained of tremor in his throat. On inspection involuntary rhythmic movements were recognized on both sides of the soft palate and the arytenoid region. Electromyography performed on both sides of the thyroarytenoid muscles showed rhythmic (4-5 Hz) grouped discharges. The second case was a 53 year-old man who complained of a sudden onset of a voice tremor. Involuntary rhythmic movements were observed on the left side of his lower lip, tongue, soft palate and the epiglottis. Rhythmic (10-14 Hz) grouped discharges were observed in both sides of the thyroarytenoid muscles, and the left side of the soft palate by electromyographic examination. MRI failed to demonstrate any causative lesions for the myoclonus in either cases.
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Makoto Miyako, Junji Koda, Shinichi Nakagawa, Fumitoshi Tachibana, Aki ...
1999 Volume 1999 Issue Supplement101 Pages
163-167
Published: February 25, 1999
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We present here the case of a 65 year-old male with an adenosquamous carcinoma originating in the larynx. The patient had complained of pain in the pharynx for three months prior to his visit. At the time of the initial examination, a dark-red tumor as large as the distal phalanx of the fifth metacarpal, with a smooth surface and a clear border could be observed between the right false vocal cord and the right arytenoid region. The tumor was removed by laryngeal microdissection, and the patient was diagnosed histopathologically as having adenosquamous carcinoma. As a result, a tracheostomy and vertical partial laryngectomy were performed, since no neoplastic cells were detected in the resection stump of the tumor following surgery, the patient was followed on an outpatient basis. However, the tumor metastasized to the right cervical lymph nodes approximately four months after the surgery, and therefore a right radical neck dissection was performed. The excised tumor was diagnosed histologically as being a poorly differentiated adenocarcinoma. Except for a metastasized tumor in the right superior deep cervical lymph node, no other remarkable findings were detected. As an adjunctive treatment, chemotherapy (2 cycles of CAP therapy) was performed. At present (four months after surgery), the tumor has not recurred.
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Kohji Kimoto, Junji Koda, Akio Kondo, Osamu Jinnouchi, Mitiko Kinosita ...
1999 Volume 1999 Issue Supplement101 Pages
168-172
Published: February 25, 1999
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An aberrant thyroid occurs due to an improper descent of the thyroid primordium. Thus, the thyroid of such patients may not be in the appropriate position, and often occupies the base of the tongue. The prevalence of malignant tumors in an aberrant thyroid is extremely low. This paper presents a patient with a papillary carcinoma arising from an aberrant thyroid. The patient was an 85 year-old male who presented with a foreign-body sensation in the throat as his chief complaint. An enlarged tumorous growth was confirmed in the base of the tongue, and the results of
201Tl scintigraphy suggested a malignant tumor. Therefore, a biopsy was performed and the patient was diagnosed as having a papillary carcinoma. Based on his clinical course and the results of the diagnostic imaging, we determined that the thyroid occupied an appropriate position, and thus the papillary carcinoma was believed to have developed in the aberrant thyroid at the base of the tongue
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Hirofumi Tanamoto, Katsuhiko Nakamura, Fumitoshi Tachibana, Koichiro S ...
1999 Volume 1999 Issue Supplement101 Pages
173-176
Published: February 25, 1999
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A case of foreign body pigmentation of oral mucosa is reported. A 42 year-old woman who had been treated for her teeth was referred to our hospital. A bluish round region with two small satellite spots was observed in her buccal mucosa opposite to her right upper dental crowns. Under general anesthesia, the bluish round region was extirpated. Brown linear granules were found scattered in the connective tissue in the lamina propria of the lesion. It is suggested that the pigmenta. tion was due to an amalgam tattoo.
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Hironori Masuda, Katsuhiko Nakamura, Koichi Tamura, Fumitoshi Tachiban ...
1999 Volume 1999 Issue Supplement101 Pages
177-181
Published: February 25, 1999
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Sarcoidosis is a disease of unknown origin characterized by the formation of granulomatous lesions in different organs. This systemic disease was named based on the histopathological findings. Granulomatous lesions can be found in the larynx, particularly in the supraglottic tissues, of a small number of patients with sarcoidosis. This condition often causes dyspnea and hoarseness that can be attributed to upper airway constriction, as well as occasionally coughing, a sore throat, dysphagia and pharyngolaryngeal abnormalities. Poe first described laryngeal sarcoidosis in 1940and since then, many cases have been reported throughout the world. However, there have only been eight cases of laryngeal sarcoidosis reported in Japan, including the present patient. We treated a 33 year-old man with localized laryngeal sarcoidosis who presented with hoarseness and a sore throat as his chief complaints. A turban-like swelling was observed in the supraglottic tissue around the epiglottis. The local and systemic administration of steroid drugs decreased the swelling of the epiglottic lesion. Based on our findings, we recommend that otolaryngologists consider laryngeal sarcoidosis when patients present with the above laryngeal findings.
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Shinichi Nakagawa, Katsuhiko Nakamura, Junji Koda, Koichi Tamura, Koic ...
1999 Volume 1999 Issue Supplement101 Pages
182-187
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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A eight year-old male with early myoclonic epileptic encephalopathy underwent a tracheostomy to prevent aspiration pneumonia. Thirty-four months after the tracheostomy, a sudden, massive hemorrhage occured from the tracheostoma. A tracheo-innominate artery fistula was then diagnosed by CT scanning. The fistula was closed surgically, and the patient was rescued. Glottic closure surgery was also performed to prevent aspiration pneumonia. Based on our experience and a review of the literature, the type of canula and the insertion period of the canula did not seem to be associated with the occurrence of a fistura.
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Masahiko Taniguchi, Yasuo Ishitani, Syuji Okada
1999 Volume 1999 Issue Supplement101 Pages
188-192
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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Four patients with acute mastoiditis were treated at the Tokushima Prefectual Central Hospital from 1992 to 1996. Three patients were successfully treated with a simple mastoidectomy and postoperative antibiotic therapy. One patient recovered after conservative therapy consisting of intravenous antibiotics. The etiological agent cultured from one of the mastoids was Streptococcus pneumoniae. None of the patients had serious intracranial complications such as facial nerve paralysis, meningitis or brain abscesses. In two patients, the clinical features and course of the acute mastoiditis were masked by prior therapy with antibiotics.
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Takaaki Shimada, Junji Koda, Shingo Wakatsuki
1999 Volume 1999 Issue Supplement101 Pages
193-198
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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Warthin's tumor and malignant tumors rarely occur simultaneously. We report here a case of Warthin's tumor combined with a malignant lymphoma. The patient, a 74-year-old man, visited our clinic and reported a mass under his left parotid gland. An imaging study suggested that the mass was a Warthin's tumor of the parotid gland, and a superficial parotidectomy was performed. A diagnosis of Warthin's tumor was made on the basis of the histopathological findings, which also showed partial destruction of the capsule by lymphocyte infiltration. The cervical lymph nodes became enlarged by the 3rd week after surgery, and the axillary and lng-uinal lymph nodes enlarged by the 5th week after surgery. Histopathological and immunohistological studies demonstrated that the enlarged lymph nodes were due to a T cell type non-Hodgkin's malignant lymphoma. Lymphoma cell infiltration in the resected Warthin's tumor was also confirmed. Chemotherapy proved ineffective, and the patient died from the tumor. Warthin's tumor is usually benign; however, caution should be observed when the tumor shows a tendency to enlarge rapidly, as this may be indicative of malignant transformation of the Warthin's tumor or a combined malignant tumor.
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Shinichi Takeuchi, Hironori Akizuki, Hiroyuki Hiramoto
1999 Volume 1999 Issue Supplement101 Pages
199-203
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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A patient with limited Wegener's granulomatosis (WG), who developed nasal involvement before the active generalized symptoms appeared, is reported. A 48 year-old male presented with a complaint of nasal pain resistant to treatment for 3 months. A diagnosis of early stage WG was made based on a positive finding of circulating antineutrophil cytoplasmic antibodies (C-ANCA). The pathognomonic diagnosis of WG had not been confirmed by repeated biopsies of the nasal mucosal lesions. Although a combination of prednisolone plus cyclophosphamide (CY) therapy greatly improves the prognosis in patients with generalized WG, this treatment may be too aggressive for patients with limited WG because of unfavorable drug side effects such as an increased occurrence of infection and cancer of the urinary bladder. In contrast, the risk of toxicity from methotrexate (MTX) appears to be less than CY, and thus MTX was provided instead. Daily systemic treatment with methotrexate and sulfamethoxazole-trimethoprim and methylprednisolone resulted in a marked improvement in the nasal symptoms within weeks. This treatment regimen is an alternative to the conventional and more aggressive immunosuppressive therapy, and may be useful for patients whose illnesses are not immediately life-threatening.
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Tsuneo Matsuda, Kazuhiro Sakamoto
1999 Volume 1999 Issue Supplement101 Pages
204-209
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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A seventy three year-old man with hoarseness visited our hospital. A physical examination revealed a pedunculated tumor 5 mm in diameter originating from the posterior margin between the ventricle of the larynx and the right vocal fold of the larynx. The tumor was removed by laryngomicrosurgery. The histopathological findings from the tumor were suggestive of a malignant fibrous histiocytoma.
The literatures were reviewed, and it appears that only 16 cases of such lesions of the larynx have been reported overseas, and that only 8 cases have been reported in Japan. International reports have shown that this tumor tends to recur and to metastasize to distant organs. However, our case has had a good prognosis since the surgery, and most of the other cases in Japan have also had a good prognosis.
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Haruhiko Shizuku, Ikuji Kawata, Sonoji Hine, Yohii Hori, Junji Koda
1999 Volume 1999 Issue Supplement101 Pages
210-214
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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A midline mandibulotomy was performed on two patients in order to resect parapharyngeal space tumors. One patient was a 65 year-old woman diagnosed as with a monomorphic adenoma, and the other was a 48 year-old man diagnosed as with a carcinoma in pleomorphic adenoma. Despite the disadvantages associated with a midline mandibulotomy, including the esthetics and postoperative occlusion disorders, this procedure was indicated for both patients because this is a useful technique for removing large, highly-vascularized, and malignant tumors due to the large surgical field of this method.
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Masahiro Ando, Tatsuya Ishida, Seizo Ooyama
1999 Volume 1999 Issue Supplement101 Pages
215-220
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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The case of a 7 year-old boy with a mastoid cyst which manifested an occipital headache is presented. The cyst had exterded from the mastoid cavity to the posterior cranial fossa and was compressing the right cerebellar hemisphere. A plain CT scan showed a smoothly marginated mass in the temporal bone. We could not determine the details of the mass because it was isodense with the brain parenchyma, but on MR imaging the mass could be clearly differentiated from the cerebellum because of a signal difference. MR imaging showed the characteristic findings of a cholesterol cyst on T
1 and T
2-weighted images. The hyperintense appearance of this cholesterol granuloma on T
1 and T
2-weighted images was very useful in differentiating it from other lesions.
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Seizo Ooyama, Tatsuya Ishida, Masahiro Ando
1999 Volume 1999 Issue Supplement101 Pages
221-224
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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Laryngeal tuberculosis, once a common disease, has become quite rare after the introduction and use of specific antibiotic therapy against tuberculosis. In contrast to the pre-chemotherapy era, the clinical presentation of laryngeal tuberculosis is now changing. The case of a 79 year-old woman with laryngeal tuberculosis is described. The patient presented with a chief complaint of hoarseness of four months duration, and had granulomatous changes in her right false vocal fold. Biopsies for the histological diagnosis were performed, and laryngeal tuberculosis was suspected. Finally, the diagnosis was established by the identification of Mycobacterium tuberculosis in the sputum and a tissue sample. The granulomatous lesion responded well to treatment with anti-tuberculous chemotherapy. Granulomatous lesions of the larynx should alert the otolaryngologist to consider laryngeal tuberculosis in the differential diagnosis.
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Shinichi Nakagawa, Katsuhiko Nakamura, Junji Koda, Hirofumi Tanamoto, ...
1999 Volume 1999 Issue Supplement101 Pages
225-233
Published: February 25, 1999
Released on J-STAGE: November 27, 2012
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Fifty patients with chronic sinusitis were treated with rokitamycin (RKM), a 16-member macrolide, for durations ranging from 2 to 12 weeks. Improvement in both subjective symptoms and objective findings increased with the progress of the treatment. After 12 weeks of treatment, the improvement rates for 5 subjective symptoms ranged between 56.5-85.7%, and the rates for 5objective findings ranged between 56.3-77.8%, the overall efficacy rate was 52.8%. The average efficacy rate on the final day of observation was 50.0%, and the rate for patients who had 3 or more of the symptoms at the start of the treatment was 53.8% on the final day of observation. The rates of improvement on the radiographic findings were 59.4%-66.7% for the maxillary sinuses and 64.3-70.0% for the ethmoidal sinuses. With regard to safety, there were 6 cases of abnormal laboratory data, including 4 cases of abnormal hepatic function and 1 case each of elevated amylase and occult blood in the urine. It was concluded from these results that RKM therapy is as useful as other 14member macrolides in the treatment of chronic sinusitis.
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