Eight guinea pigs were given by the pressures from 1 ATA to 2 ATA for 3 seconds and subsequently 2ATA to 1ATA for 2 seconds in the atmospheric chamber. Four animals (A group) were sacrificed immediately after the pressure experiment and the remaining four (B group) were 15 weeks after the experiment. Varying degrees of hemorrhage and edema were found in the middle and inner ears of the A group animals. In the cochlea of the A group animals hemorrhage was observed in the perilymphatic spaces and tissues, especially in the scala tympani and its surrounding perilymphatic tissues such as the lower spiral ligament and the osseous spiral lamina. There was a slight edema in the stria vascularis in some animals. In the B group animals, however, no erythrocytes were detectable in the perilymphatic spaces and tissues of the cochlea. There was a marked atrophy of the organ of Corti and the stria vascularis. No rupture of Reissner's membrane, cochlear window membrane and basilar membrane was noted either in A or B group of the guinea pigs. Morphological changes of the organ of Corti may be caused by both direct physical action and indirect influence of the blood circulatory disturbance on the membranous labyrinth.
Vascular loops were found by air CT cisternography in 7 of 68 patients suspected of having acoustic neuromas. The vascular loop was found to be projected into the internal auditory canal in only one of the 7 patients. This patient alone exhibited the symptoms and findings of Meniere's disease. In the other 6 patients, the vascular loop was found in the vicinity of the internal auditory meatus. In 2 of these patients, the chief complaint was unrelated to the vascular loop. One had a round window membrane rupture, which was confirmed surgically, while the other had Recklinghausen's disease without cochlear symptoms or vertigo. This patient was suspected of having a tumor at the fundus of the IAC. The other 4 patients had progressive sensorineural hearing loss, the onset of which had occurred as sudden deafness in 2 patients. Widening of the internal auditory canal was seen in 2 patients, while increased latency of wave V in the ABR was observed in 1 patient. These results indicated that symptoms are sometimes caused by neurovascular cross-compression between the vascular loop and the eighth cranial nerve. It will be necessary to further study their cause-and-effect relationship in the future by neurotological examinations using such techniques as air CT cisternography.
The level of carcinoembryonic antigen (CEA) was determined in 69 patients with cancer of the larynx and 20 patients with cancer of the hypopharynx. Malignancies were histologically 88 squamous cell carcinomas and one carcinoma in pleomorphic adenoma. The CEA level higher than 5.0ng/ml was considered to be positive. Eleven of 69 (16%) patients with cancer of the larynx and 4 of 20 (20%) patients with cancer of the hypopharynx were positive. The low positive sensitivity of CEA indicated a lesser diagnostic value in cancer of the larynx and hypopharynx. In cancer of the larynx, there was no significant correlation to the clinical stage in the determinations of CEA. The CEA titer elevated with the recurrrence or distant metastasis of the malignancies. It seems that the CEA determination is valuable for monitoring the presence of possible metastasis.
We compared relations between methods of anesthesia and bood loss in 20 patients with chronic nasosinusitis (40 sinus sides), each of whom underwent operations on one sinus side under hypotensive anesthesia and on the other under conventional normotensive anesthesia. The patients who had the first operation under hypotensive anesthesia and the second one under conventional normotensive anesthesia were assigned to A group. The patients who had the first and the second operations in reversed order were assigend to B group. C group consisting of the patients who underwent the operation under local anesthesia was made the control group. As a result, in the A group the mean total blood loss was 227 ml with the mean minute volume 8.8ml/min under conventional normotensive anesthesia, under hypotensive anesthesia the former was 84.4ml with the latter 3.5ml/min. The B group showed that the mean total blood loss was 223 ml with the mean minute volume 4.9ml/min under conventional normotensive anesthesia and that the former was 140ml with the latter 3.3ml/min under hypotensive anesthesia. In both A and B groups, the mean blood loss diminished under hypotensive anesthesia from under conventinal normotensive one. Comparison between the results of the A and B groups and the C group demonstrated that conventional normotensive anesthesia produced larger blood loss than did local anesthesia but that there were no differences in blood loss between under hypotensive anesthesia and local anesthesia.
Although its incidence is rare, tuberculosis of the parotid gland presents clinical significance in differential diagnosis of parotid tumors. This is a report on four cases of tuberculosis of the parotid gland. Case 1 is a 41-year-old female who presented with a swollen left parotid gland associated with local pain, redness of the overlying skin and swelling of cervical lymph nodes. Case 2 is a 51-year-old female who showed a swollen left parotid gland without pain or swelling of cervical lymph nodes, but with adhesions of the overlying skin. Case 3 is a 56-year-old female who was found to have a swelling of the left parotid gland with mild local pain and without adhesions of the skin or swelling of the cervical lymph nodes. Case 4 is a 16-year-old female who manifested swelling of right parotid gland without pain, adhesions, tenderness or swelling of the regional lymph nodes. In each of the four cases tuberculin test was positive, but chest radiographs were negative. Retrospectively, image examinations indicated some signs of inflammation in every case. The diagnosis was confirmed in each case by histopatholgical examination.
A case of 77-year-old man with basal cell carcinoma in the middle part of the nose, which was removed and then repaired with septal flap and skin transplantation is reported. The septal flap is transferred to the defect and sutured to the edge of nasal mucous membrane. In the septal flap, the mucoperichondrim of its outside is removed and free skin graft is placed onto the septal cartilage. This method has two advantages when compared to that of Kazanjian's. 1) The lining of the nasal cavity representsmucous membrane. 2) Septal flap and skin graft can be placed in one-stage operation.