A total of 191 cases of laryngeal cancer were studied. All cases were treated at the Jikei University Hospital during the 10 years period from April 1976 to March 1986. There were 56 cases of supraglottic, 127 cases of glottic, and 8 cases of subglottic. To investigate the growth pattern, large tissue section were prepared from extirpated larynx which were classified 30 cases of supraglottic, 44 cases of glottic, and 5 cases of subglottic, during the 6 year period from January 1980 to March 1986. As to therapeutic results, cumulative survival rate for all cases was 79.5%(S. E. 3.2%) for 3 year and 72.3%(S. E. 3.8%) for 5 year. When classfied by diagnosis, 3-year cumulative survival rate was 61.9%(S. E. 7%) and 5-year survival rate was 39.6%(S. E. 8.7%) for supraglottic cancer, and the corresponding figures for glottic cancer were 87.0%(S. E. 3.1%) and 85.7%(S. E. 3.4%), respectively. In cases of supraglottic cancer, the growth pattern of cancer varied greatly according to its location and so were the therapeutic results. Three-year rude survival was 64.3% for cancers with the primary focus located in the false cords and 46.2% for those in the infrahyoid epiglottis (vestibular area). Therefore, it was difficult to obtain a good results by a uniform treatment method. Suitable method should be chosen individually according to the location of cancer. We consider it best to treat chiefly by radiotherapy the cases of unilateral cancer (T1a) located in the false cords, ventricle, vestibular area or epiglottis, while the other cases are best treated by surgical methods. Radical neck dissection is essential and bilateral neck dissection should be performed in cases where the focus is located in the midline. Cases of glottic cancer should be treated chiefly by radiotherapy when classified of stage as Stages I and II, and postiradiation observations should be made with chief regards on the anterior commissure and subglottic area. In cases showing invasion of cancer into the false cords or infraglottis total radiotherapy is not indicated. In cases of subglottic cancer, therapeutic results are poor when the lesion is in the midline below the anterior commissure. However, cases of stage I or more are best treated by a combination therapy of radiotherapy +operation. In these cases radical neck dissection should be performed thoroughly for the paratracheal lymph node. The anterior commissure plays a role as a barrier for invasion of cancer into the deeper layer, and two pathways of cancer invasion are produced above and under the barrier. When cancer invades cartilage, invasion starts from the callus portion and proliferation occurs within. Since cancer shows specific growth pattern in the callus differing from the primary lesion, due consideration should be exercised for handling of the unaffected side.
The present study was carried out using sequential frontal and sagital sections of temporal bones from 100 sides of human fetuses between 16 th and 36 th week of pregnancy. From the findings obtained, it was indicated that the process of genesis for the portion from the middle tympanic cavity to the antrum is different from that for the mastoid cells. In the growth of the portion from the middle tympanum to the antrum, which consists of a single sinus, a process different from that for the mastoid cells with complicated morphological characteristics is involoved. Namely, in the portion to the antrum the organ development as a cavity progress with fetal mesenchyma contained before entering of the epithelium from the auditory tube, and this process is characterized with enlargement of the cavity chiefly by absorption of existing bone rather than by active bone metabolism and bone formation. Moreover, as the genesis of middle ear in humans, the morphological formation of the otic capsule is completed until the middle phase of pregnancy. As the morphology of the middle ear cavity near it, there are mesotympanum, epitympanum and antrum. The growth process for the portion from the mesotympanum to the antrum is greatly affected by the morphology of the area around the oticcapsule which is situated whithin it. In the formation of the portion from the tympanum to the antrum, passive formation of pneumatic space in the predetermined portion through absorption of bone of the otic capsule and its surroundings is involoved. This is less affected by acquited changes even at the later stage of fetal development as compared to the mastoid cells with immatured growth. The genesis of the mastoid cells is considered to be determined by the following three elements.: 1) outward glowth of the temporal bone it self, 2) expansion of the existing pneumatic space due to bone metabolism within the temporal cells, and 3) the resulting advance of the epithelium into the pneumatic space associated with it. Formation of the cells progresses through the harmonous combination of each of these elements. When this harmony is broken, inhibition of the pneumatization occurs. Namely, the formation of the mastoid cells is characterized by the growth pattern dependent on active and rapid bone metabolism, in which each of these factors are involved. However, the above described three factors do not always show the essential harmonious growth. It appears that inhibition of the mastoid cells occurs when this harmony is broken. As an example, we observed in an experiment in pigs performed at our labonatory that inflammatory changes of the respiratory epithelium gave influences on subepithelial bone metabolism to inhibit growth and cause depressed pneumatization.
The olfactory epithelium was obtained, by using a biopsy instrument we devised, from a laryngectomized patient who had undergone laryngectomy about three years and eight months ago. Light and transmission electron microscopic observation of the specimen revealed normal thickness of the olfactory epithelium and without findings of atrophy. The epithelial structure was found to be normal; no degeneration was present in the supporting cells, olfactory cells or basal cells; and the submucosal tissue was found to be normal, too. There was no abnormality in microstructures such as the olfactory vesicles and olfactory cilia. These morphological observations and the data from clinical olfactory tests in the laryngectomized patient strongly indicated that disuse atrophy dose not occur in the olfactory epithelium of laryngectomized patients.
The eustachian tube has two types of clearance function, i. e. ciliary clearance and muscular clearance. The ciliary clearance is performed by the mucociliary transport system, while the muscular clearance is done by the tensor veli palatini muscle. Quantitative analysis of these two clearance function was made using five cats. The volume of the colored fluid (indigocarmine) to be discharged through the eustachian tube by mucociliary system or contractions of the tensor veli palatini muscle were measured. It was found that the muscular clearance can expel about six times as much fluid as the ciliary clearance does. The findings suggest that the muscular clearance is more effective than the ciliary clearance for the clearance of massive effusion.
Negative middle ear pressure induced by excretory function of eustachian tube was measured using fifteen cats. Under general anesthesia, a tube was connected to the bulla, whole space including middle ear and the tube was filled with physiological saline and the pressure of the space was measured with micro-tip pressure transducer (Miller PC-330 3F) which was hermetically connected to the tube. By the ciliary function, negative pressure of-25-233 (mean-134.8) mmH2O developed in 1-6 hours in nine ear, ., By the muscular pumping function (electril stimulation of tensor veli palatini muscle), negative pressure of-10-60 (mean-35) mmH2O developed with 10-20 times of stimulation within a few minutes in 6 ears. It is concluded that negative pressure in the middle ear develops in a short time merely by the excretory function of the eustachian tube when middle ear was filled with fluid.
Nineteen cases of tracheo-cutaneous fistula were seen between 1979 and 1984. These cases consisted of seven cases of cerebral vascular disease, four cases of head injury, two cases of pneumoia and a case of meningitis, drug allergy and brain tumor. The cases in their teens were four in their twenties, five; in their thirties, three; in their forties, four; in their fifties, three; in their sixties, one. Those under 10 and over 70 were not found. Fighteen cases were admitted at Kanagawa Rehabilitation Hospital for rehabilitation, and 10 of them were operated on. The duration of cannulation was 3 weeks at least and 1 year at most. In every case the thyroid cartilage and cricoid cartilage were intact. In one case an attempt was made to close its fistula, but failed. The other 18 cases were left as they were We obtained the conclusion that the main causes of tracheocutaneous fistula after tracheostomy were long-term cannulation and inadequate postoperative treatment.
Recent years have seen an increasing frequency in Japanese cedar pollinosis, which has become a social problem. This trend is true in Wakayama Prefecture. It is well known that the mechanism of onset of this disease is typical type I allergy involving Japanese cedar pollen and specific Ig antibody. Determination of the quantity of airborne Japanese cedar pollen in various parts of Wakayama Prefecture should be helpful in estimating the incidence of this disease and in taking preventive measures. Pollen sampling devices were installed on the roofs of representative hospitals in various parts of Wakayama Prefecture to determine the amount of airborne Japanese cedar pollen. This paper describes the results with some consideration of factors related the amount of airborne pollen.
A review is made on 426 sensori-neural hearing impaired children who visited the department of Oto-Rhino-Laryngology of Sapporo Medical School from April, 1, 1977 to May, 31, 1986. The following results were obtained. 1) We found no difference in incidence between males and females. (males: females=217: 209) 2) The number of bilateral hearing impaired children were 191, and unilateral impaired children were 235. (right side: left side=120: 115) 3) The peak of first visiting age was 6 years old. 4) We found that almost cases with bilateral sensori-neural hearing loss (severe type) were detected by 7 years old, with the peak at age three. 5) The number of unilateral hearing impaired cases that were found before age three was very few. 6) In bilateral severe hearing impaired children, 34% of cases were presumed as of hereditary, fetal, and perinatal origin. And the 4% of cases were presumed as acquired hearing impairement. The etiology of other cases was unknown. 7) It was more difficult to presume the causes of unilateral deafness than those of bilateral severe hearing impaired cases because unilateral hearing impaired children had less complaints than severe bilateral hearing impaired children did. We were able to presume the etiology in 25% cases of unilaterally deaf children. Mumpus was the principal cause that occupied 62.5% of aquired origins.
A bacteriological study was carried out on middle ear discharge in 239 cases of acute purulent otitis media. Two hundred and thirty strains (96.2%) of pathogenic bacteria were isolated from 239 cases with acute purulent otitis media. The most frequent organism found solitary was Staphylococcus aureus (28.3% of 230 strains) and next frequency was Streptococcus pneumoniae (20.4%) followed by Staphylococcus epidermidis (11.7%), Haemophilus influenzae (10.9%) Streptococcus pyogenes (3.5%), and Pseudomonas aeruginosa (6.5%). Streptococcus pneumoniae were frequently found in patients with paracentesis. However, Staphylococcus aureus was frequently found in patients with spontaneous perforation. The cases with mixed infection were 17 cases (8%) out of 213 cases, and Staphylococcus aureus was found in 64.7%. Especially, Staphylococcus aureus, Streptococcus pneumoniae and, Haemophilus influenzae were important pathogenic bacteria of acute purulent otitis media.
The effect of adenoidectomy on the treatment for OME has been evaluated by 6-months' research into the improvement of Eustachian tube function and chronic paranasal sinusitis of the children suffering from OME. The children who had undergone the treatment of adenoidectomy showed a marked improvement in the positive pressure equalizing function of the eustachian tube and their chronic paranasal sinusitis were also improved. But, on the other hand, as to the children treated without adenoidectomy, their eustachian tube function and chronic paranasal sinusitis were not improved. This result suggests that the improvement of chronic inflammation is one of the remarkable effects of adenoidectomy in the treatment of OME.
A case of an ameloblastoma of the lacrimal sac is reported. The patient, 46-year-old man, had complained of a swelling on the left inner canthus. Clinical examination showed a pale tumor in the left inferior nasal meatus. A partial maxillectomy was performed. The tumor extended from the lacrimal sac to the inferior nasal meatus through the nasolacrimal duct. Histopathological examination revealed ameloblastoma. Literature on the related subjects is reviewed.