The authors report their experience in which long-standing convergence disturbance in six patients, which had not responded to various ophthalmological treatments, has been improved within 7 to 10 daysafter intranasal sinusectomy, and also another experience in which convergence disturbance in some cases alleviated temporarily after trigeminal ganglion blocking. After studying these cases the authors conclude: 1) Convergence seems to be controlled by the trigeminal nerve 2) The oculomotor nerve receives rami of sympathetic nerve from the cervical sympathetic plexus through the ophthalmic branch of the trigeminal nerve These sympathetic fibers in the oculomotor nerve may have an inhibitory function on convergence. 3) The trigeminal nerve may affect the convergence by inducing headheaviness or headache in the persistent stimulative state of the nerve.
Automatic analysis of the rate and amplitude of potential changes in the frontalis, orbicularis oculi and orbicularis oris muscles has been conducted on 23 patients with facial palsy following the method of Fitch and Willison. As a control group, muscles of the normal side in seven post-operative facial palsies were studied. The total number of direction reversal of the potential changes from positive-going to negative-going and vice versa (T) and total amplitude (A) which counted the total amplitude pulses generated whenever the potential level had changed by 100y V were measured. There were no differences in T and A/T in three facial muscles. Reliability of T and A/T was evaluated twice with an interval of at least more than one month in the non-paralyzed side of the ten patients with unilateral peripheral facial palsy. These results indicated that T and A/T showed poor test-retest reliability. In serial testings of T and A/T in paralyzed sides clinical recovery and findings in automatic analysis coincided only in patients showing rapid recovery. This tendency was more remarkable in the orbicularis oculi muscle than in the orbicularis oris muscle. Changes in T and A/T were gradual in patients showing a slow recovery process-over one month. Reasons for the poor reliability of this method were discussed.
The authors report three recent cases of mandibular cyst and they stress the importance of preservation of the normal configuration of the mandible as well as its function in the rreatment. Tumors and cysts of the mandible may be derived from dental cause or from systemic diseases. It is also underlined that an dequate knowlege of dental radiology and of anatomy and pathology of the mandible are necessary for accurate diagnosis, adequate treatment and proper reconstruction of the mandible.
The authors report a 2lyear-old male case who had been suffering from repetitive vomiting which lasted for 2 weeks. X-ray examination of the chest done by a local pediatrician revealed a small round foreign body in the esophagus which moved occasionally on swallowing. The patient was transferred to the author's hospital, where the foreign bodiy was removed successfully by esophagoscopy under general anesthesia. The foreign body turned out to be a small pachinko-ball. The patient, however, continued to vomit even after removal of the foreign body. Subsequent barium swallow study showed a stricture of the cardia accompanied with marked swelling of the esophageal space above that level. Although the authors have to rule out congenital esophageal stricture in this case for the confirmation of diagnosis, examinations and the manifestations suggested cardiospasm, which is a rare disease. The removed esophageal foreign body was a small metal ball which would have easily passed a normally dilated esophagus. Retention of an unusually small foreign body in the esophagus might indicate the possibility of an underlying abnormality of the esophagus.
A 57-year-old male who complained of retrosternal pain was sent to our hospital by an otolaryngologist. Esophagoscopy attempted under local anesthesia was unsuccessful. The next day he complained of slight dyspnea and a fever, A chest X-ray revealed pleuritis and mediatinitis. A second trial under general anesthesia revealed a press-through-pack in the esophagus, which was successfully removed. Postoperative esophagograms showed a fistula shadow, and the shadow did not disappear till the 34-postoperative day. A press-through-pack has rigid and sharp edges, so when it lodges in the esophagus it requires cautious treatment.
A go stone was removed from the cervical esophagus of a 15-month-old child using a Foley catheter under esophagoscopy and general anesthesia. A go stone foreign body is rare. It is exceedingly difficult to remove without a specially designed forcceps because of its shape and slippery surface. As such forceps were not available the authors used a Foley catheter, which was found useful and safe.