Operative findings in recurrent cholesteatomas that followed intact canal wall tympanoplasty are often suggestive of invagination of the canal skin into the non-ventilated cavity. Animal experiments using rabbits to produce a similar condition revealed active proliferation of the epithelial cells of the canal wall. The obstruction of the tympanie isthmus in a chronically inflamed ear appeared to play an important role in the early stage of the development of cholesteatoma. Radiological findings that inflammation of the mastoid cavity brings about depression of normal pneumatization have been seen both in pigs and children. All of the above finidngs in both clincal and experimental studies were suggestive of the fact that many cholesteatomas in man are due to invagination of the epithelial layer into the non-ventilated middle ear or associated clefts.
ABR (Auditory Brain Stem Response) waves and pure tone thresholds were examined in adults (from 21 to 42 years old), advancing aged (from 65 to 82) and high advancing aged (from 90 to 100). The number of subjects examined was 69. The results are as follows 1. The ABR waves in the advancing aged and high advancing aged revealed the same positive pattern as those in adults. 2. The threshold in 3 kHz on the pure tone audiogram and the threshold in appearance of ABR I, III, V waves are elevated (P<0.05) gradually as age increased. 3. The peak latency of ABR I, III, V waves evoked by the same auditory click has a tendency to be prolonged as age increased.
The authors report four cases of monocytic angina, a subtype of infectious mononucleosis often characterized by angina, remittent fever, systemic lymphadenopathy, splenomegaly, hepatomegaly, rash and formation of pseudomembrane on the pharyngeal mucosa. EB virus was shown to be the cause of this disease by Henle and Niederman in 1968. The patient with this disease can be treated on a primary care basis after malignant diseases, e.g. leukemia and malignant lymphomas have been ruled out by various methods.
The author describes the incidence of otitis media with effusion in the handicapped children at an institution in Sendai Japan. The majority of 135 pupils were found to have thick cerumen in the external auditory canal. The incidence of otitis media with effusion was found to be 30% in preschool children, 9.9% in primary school children and 7.1% in junior high school children. A case of aural cholesteatoma was found in a primary school child who underwent tympanoplasty.
A 15-year-old girl presented with adverse complications, e. g. stifness of the neck, disturbance of consciousness and right IX, XII nerve palsies because of a neuroblastoma in the epipharynx. We treated her with high dose fractionation and short interval radiotherapy (total doses of 27.0 Gray in 16 days): She showed a remarkable improvement without severe adverse radiation side effects. The above experience led us to the concept of emergency irradiation for a case of oncologic emergency. We concluded emergency irradiation should be applied as follows. 1) Emergency irradiation should be indicated for a case of oncologic emergency such as upper respiratory obstruction. 2) The optimum dose is about 3.0 Gray at a time and total doses should be within 15.0-20.0 Gray. 3) The optimum interval is 7-10 days. We report a case of oncologic emergency and a concept of emergency irradiation, which may be called oncologic emergency irradiation (O. E. I.).
In patients with chronic sinusitis, the severity of paranasal lesion on each side may often differ even in the same patient. This may be in some way related to the difference of morphology of each side of the nasal cavity as a local factor. In a case of chronic sinusitis the morphology of the nasal cavity and the degree of aeration of each sinus were evaluated by taking 12 frontal sectional roentgenographic films. In this case, the disease of one ethmoidal sinus and that of the contralateral maxillary sinus were more severe than those observed in the other sinuses. We designated such lesions as diagonal lesions tentatively. In the maxillary sinus, the disease of the sinus on the concave side of the nasal septum was often found to be more severe than that of the convex side. This is assumed to be a result of long standing physiological disturbances in respiration due to the resultant hypertrophy of the lower turbinate. On the other hand, severe disease of the ethmoidal sinus on the convex side may be due to mechanical disturbances of ventilation or drainage of the sinuses.
We hereby report a case of cardiorespiratory arrest caused by stellate ganglion block. A 70-year-old man, complaining of sudden hearing impairment in his left ear visited our hopital. He was disgnosed as having sudden deafness of the left ear, and received left stellate ganglion block with 3 ml of 2% Carbocaine. On the fourth block immediately after withdrawal of the needle, his respiration and pulse became undetectable. Cardiac massage was given immediately, and he recovered within a few minutes. Among the causes of cardiorespiratory arrest caused by stellate ganglion block, four possibities may be raised. 1) anaphylatic shock by Carbocaine injection, 2) injection with the anesthetic into the left vertebral artery, 3) injection of the drug into subarachnoidal space, 4) irritation by the procedure of the vagal nerve. In this case, irritation of the vagal nerve is considered to be the most probable cause among the above as was suggested by his clinical course. Stellate ganglion block is thought to be a simple procedure and is easily performed in many hospitals. However, it should be done by well-trained physicians with knowledge of cervical anatomy and enough experience. In addition, resuscitation equipment should always be available when performing this procedure.
A case of nasopharyngeal teratoma in a female newborn is reported. This tumor was readily removed by a snare without any type of anesthesia. The teratomas are generally tridermal tumors, but dermoid tumors of the nasopharynx which are bidermal in nature are frequently called nasopharyngeal teratoma. In the present case, the tumor consisted of the skin, fat tissue, connectve tissue, cartilage and mixed glands. On one hand, these tumors are often called by the term “epignathus” or “hairly polyp”. The pathogenesis of this rare tumor is still uncertain. Symptoms vary according to the size and the site of the tumor, but difficulty in swallowing and breathing has often been reported. There is usually little bleeding following a surgical removal, and no recurrence of this type of tumor has been described in Japan.
The authors presented a program for the microcomputer with which to diagnose vertigenous diseases. BASIC language was used for the program so it can be used for other computers. The agreement of doctor's diagnosis and computer diagnosis was 39% for the first disease and 60.9% for the first three diseases, after correction they were 69.6% and 87% respectively. Computer diagnosis of vertigenous diseases can be a supplementary means in the diagnosis for extra-speciality physicians.