論文

This study evaluates the outcome and surgical stress associated with surgery for intractable aspiration. A retrospective review was conducted to compare the results between tracheoesophageal diversion and total laryngectomy. The operative time, intra-operative bleeding, time until drain removal, feeding conditions and surgical complications were compared between the two groups. Of the 19 patients, 31.6 per cent underwent tracheoesophageal diversion and 68.4 per cent received total laryngectomy. The operative time and drain insertion periods were statistically shorter in the tracheoesophageal diversion group, while the amount of intra-operative blood loss was smaller in the tracheoesophageal diversion group. The complication rate and the feeding conditions before and after surgery for the two groups did not show any statistically significant difference. Tracheoesophageal diversion was thus found to be a simple, safe, and reliable therapeutic modality for the control of intractable aspiration. Moreover, it induced less surgical stress than total laryngectomy.

A supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) consists of the resection of the whole thyroid cartilage and paraglottic space, while preserving the cricoid cartilage, the hyoid bone, most of the epiglottis and the arytenoids. Laryngeal reconstruction is achieved be suturing the cricoid cartilage and the hyoid bone. This procedure is mainly indicated for large T2 glottic carcinomas and provides a complete resection and laryngeal preservation without requiring a permanent tracheostomy. Although bilateral arytenoids are usually preserved to ensure better laryngeal function after CHEP, we unavoidably had to remove the arytenoid on the tumor-bearing side during a complete resection performed in a 56-year-old male with a rT2 tumor who had undergone radiation and demonstrated impaired vocal fold motion. Despite the resection of one arytenoid, the final laryngeal function proved to be satisfactory. CHEP should be utilized as an alternative surgical modality for conventional vertical partial laryngectomies or total laryngectomies. CHEP with the total removal of the arytenoid on the tumor-bearing side may be a useful laryngeal preservation procedure for the treatment of patients with glottic carcinoma associated with an impaired vocal fold motion or a fixed vocal fold.

We implemented a wearable system for detecting accelerations of the user's head while standing still for the purpose of developing a daily health care application. A 2- axis accelerometer was attached on the top of the user's head to separately detect faint accelerations in both the front to back and right to left directions. The total weight of the headset device is only 195 grams including a 9V NiMH battery. This paper presents the results of several experiments performed with the headset system. First, we observed healthy subjects under normal conditions and recorded typical accelerations in the range of 10-30 milli-Gs, which was sufficient to be detected by the system's sensitivity. We then performed numerical analysis on traces of acceleration patterns for a specific user in different conditions. From these analyses we found that the total length of 2-dimensional acceleration pattern trace and a high frequency spectrum (2Hz-10Hz) of right/left acceleration were related to the physical condition of the user. The wearable headset device can be carried to anywhere the user goes and the diagnosis of the wearer's physical condition only requires that the user stand still for 30 seconds, showing that this system can be used for daily health care monitoring.

Pneumomediastinum and cervical emphysema usually occur following esophageal or chest trauma. Rarely do they occur as a complication of childbirth, and only approximately 200 such cases have been reported in the literature worldwide. We describe a new case, and we review the clinical picture, pathophysiology, and management of these conditions. In view of the head and neck symptoms of pneumomediastinum and cervical emphysema during labor - which include dyspnea, cough, sore throat, pain on swallowing, and dysphagia - otolaryngologists might be consulted and should therefore be aware of these conditions in order to recognize and treat them.

Background: Cyclin D1 has been reported to be associated with poor prognosis in head and neck squamous cell carcinoma (HNSCC). Patients and Methods: FISH was performed on 58 patients. Thirty-two received neoadjuvant chemotherapy (NAC) as primary treatment and 21 with hypopharyngeal squamous cell carcinoma (HPC) received chemoradiotherapy. Results: CCND1 amplification was identified in 31 (53%) patients and the incidence was higher in HPC (p=0.0068). Four (31%) out of 13 patients with CCND1 amplification responded to NAC whereas the response rate in the non-amplified group was 79% (p=0.011). CCND1 amplification with a homogeneously staining region (HSR) was accompanied by cyclin D1 protein overexpression (p<0.0001). HPC showed HSR more frequently (p=0.033) and the survival rate of the subgroup with HSR was lower than that without (p<0.05). Conclusion: Detection of CCND1 amplification using FISH may be a useful marker of sensitivity to NAC and chemoradiotherapy for HNSCC.

We herein report on the hearing improvement obtained after tumor removal in a vestibular schwannoma patient with preoperative severe hearing loss and good otoacoustic emission. Hearing recovery after tumor removal is an uncommon occurrence. As a result, hearing preservation surgery is usually not performed for patients with severe hearing loss. However, patients with a good OAE seem to have a better chance to recover their hearing than those with a poor OAE, even if they have severe hearing loss. As a result, the cochlear function should be evaluated, especially regarding the OAE, before determining the indications for hearing preservation surgery.

Background: ONO-4817 is a novel matrix metalloproteinase (MMP) inhibitor which has a broad inhibitory spectrum for MMPs. We investigated the inhibitory effect of ONO-4817 on cervical lymph node metastasis of tongue carcinoma. Materials and Methods: HSC-3-M3, a cell line derived from human tongue carcinoma with high metastatic potential for lymph node, was used. The direct cytotoxicity of ONO-4817 was assessed by MTT assay and the gelatinolytic activity by gelatin zymography and film in situ zymography (FIZ). The inhibitory effect on lymph node metastasis was examined by orthotopic implantation model with nude mice. Results: ONO-4817 had no direct cyototoxicity on HSC-3-M3 cells. Gelatin zymography and FIZ demonstrated a suppression of MMP-9 activation and a marked inhibition of gelatinolysis. Additionally, a suppression of cervical lymph node metastasis was shown by therapeutic experiment. Conclusion: The MMP inhibitor, ONO-4817, is a candidate for adjunctive therapy of cervical lymph node metastasis in tongue carcinoma.

Objectives: In order to evaluate the effect of a medical administration for the sudden deafness patients, single-drug treatment for idiopathic sudden sensorineural hearing loss (ISSHL) was assessed at multi-centers participating in the Acute Severe Hearing Loss Study Group sponsored by the Ministry of Health, Labor and Welfare of Japan. Methods: The subjects consisted of ISSHL patients who were (1) 20 years of age or older, (2) diagnosed within 2 weeks after the onset of hearing loss, (3) showing a mean hearing level of 40-90 dB at five frequencies from 250 to 4000 Hz, (4) previously untreated, and (5) with normal for age in hearing of the opposite ear. The drugs used in this study were ATP, alprostadil, hydrocortisone and amidotrizoate, which were administered intravenously, and beraprost sodium and betamethasone, which were given orally. Two drugs were assigned to each center, one of which was selected according to the code hidden in envelopes and administered for 1 week. The treatment after the single-drug administration was conducted at the discretion of each center. The hearing gain and recovery rate at 1 week after the initiation of single-drug treatment and at 1 month or over when the hearing level was fixed, were evaluated based on the criteria for hearing recovery prepared by the Acute Severe Hearing Loss Study Group. Results: There was no statistically significant difference in the recovery rate among drugs either at 1 week after the initiation of single-drug treatment or at the time of fixed hearing level. At the time when the hearing level was fixed, a statistically significant difference in the complete recovery rate was detected only between amidotrizoate and beraprost sodium. Conclusion: From these results, we could not find any specific drugs recommended for ISSNHL. In evaluating the effect of the drugs, however, several problems in the clinical trial for ISSHL should be considered.

In cases of sudden deafness (SD), hearing recovery is generally assessed by classifying recovery into four degrees. To evaluate factors that may affect the prognosis for hearing recovery (e.g., hearing level at initial examination, days elapsed from onset of hearing loss to start of treatment) or drug efficacy, however, a quantitative method would be more advantageous. In the present study, therefore, the recovery rate was used as an index in investigating the prognosis and the efficacy of steroid treatment in 183 patients with SD first examined within 14 days after the onset of hearing loss during the period 1980-85. As with the degree of hearing recovery, the recovery rate was found to be favorable in those patients with good hearing at the initial examination, no vertigo, little difference in high-tone and low-tone hearing loss, and only a short lag between onset of symptoms and the initiation of treatment. This indicated that the recovery rate could be used as an index for the evaluation of hearing recovery in cases of sudden deafness. The efficacy of steroid treatment was evaluated in patients in whom the average of the hearing levels at five frequencies from 250 to 4000 Hz was 40-90 dB. No significant differences were found in either recovery rate or degree of recovery between those patients who received steroids and those who did not. This was believed to be attributable to the variety of pathological conditions involved in SD and to the influence of the other, non-steroidal drugs administered.

The relationship between vascular loops in the internal auditory canal and VIII nerve disorders was examined by performing pneumatic computerized tomographic (CT) cisternography in patients with idiopathic sudden deafness, idiopathic sensorineural hearing loss, and Meniere's disease. The incidence of vascular loops was higher in the diseased group than in the control group, viz. 19 of 61 cases (30% in the former, compared with only 6 of 88 cases (7% in the latter. The loops were classified as of Types I-IV according to the proximity to the fundus of the internal auditory canal. A large proportion of the loops found in the diseased group were classified as Type II or III. In most of the patients with vascular loops, the hearing loss was of the cochlear type, and in most cases, normal responses were obtained by the caloric test. Therefore, we concluded that vascular loops may be a possible cause of VIII nerve disorders and that this mechanism may involve circulatory disorder.

The clinical usefulness of Cefoperazone for the treatment of post-operative infections or prophylaxis was studied in patients with head and neck tumors. In some cases in which local application of an antibiotic was considered to be useful, Polymyxin B Sulfate was used concomitantly. Cefoperazone administration was clinically useful in 17 of the 18 patients enrolled in this study (very useful in 10, useful in 7) and only one patient failed to respond to Cefoperazone therapy. Adverse reactions or laboratory abnormalities possibly related to the therapy were seen in three patients. However, in one case, the adverse reaction could be attributed to the concomitantly administered anticancer agent, and in the other two cases, reactions were mild and transient.

In order to estimate the clinical values of the loudness balance test by pure tone audiometer as the objective method for evaluating tinnitus and to find out how we can use this method in the future, the results of the loudness balance test in 168 cases who complained of unilateral tinnitus were analyzed and presented in this study. Furthermore, in order to differentiate the tinnitus associated with endolymphatic hydrops and that of other causes, and to confirm the consistency and repeatability of the result of the loudness balance test by the pure tone audiometer, the loudness balance test was conducted before and after the oral administration of glycerol (glycerol loading tinnitus balance test). The test was performed in 44 confirmed cases of Meniere's disease and 10 of sensorineural hearing loss without fluctuation for a long duration. It was concluded that although by the loudness balance test with a pure tone audiometer the exact pitch of the tinnitus is not determined, much information about the tinnitus can be given. Also since there is no significant difference between the pitch of the tinnitus obtained by the pure tone audiometer and that by the Bekesy audiometer in most cases, and the loudness balance test by the pure tone audiometer is the easiest way to evaluate tinnitus clinically. This method has a meaningful and clinical value to evaluate the tinnitus objectively. After the glycerol administration several changes in the pitch and loudness of the tinnitus with or without changes of hearing were found in cases of Meniere's disease, but not in sensorineural hearing loss without fluctuation. The glycerol loading tinnitus balance test can be a good tool to differentiate the tinnitus associated with endolymphatic hydrops from that of the other causes, and therefore this test will be useful in the future as a new tinnitus test.

The tissues of the lateral wall of the cochlea, spiral ligament and stria vascularis, maintain homeostasis of the inner ear through the production of endolymph and regulation of cochlear blood flow. We examined the effects of purinergic agonists on the release of inositol phosphates (InsPs) in intact isolated lateral wall tissues of the Fischer-344 rat. After preincubation with myo-[3H]-inositol, stimulation with the P2 purinergic agonist ATP-γ-S resulted in a concentration-dependent increase in the formation of [3H]InsPs. The P2 purinergic agonist α,β-methylene ATP (AMP-CPP) was a weaker stimulant, and the P1 purinergic agonist adenosine was ineffective. These results are consistent;with the presence of P2y receptors and a purinergically controlled InsPs second messenger system in the cochlear lateral wall.