Hideo Higashitsuji

Submandibular salivary pH as a diagnostic aid for prognosis of facial palsy.

The present paper aims at introducing a new method of testing the function of the chorda tympani with the aid of submandibular salivary pH. This method has several advantages: (1.) it enables the measurement of the function of only the paralyzed side; (2.) it accurately predicts the outcome of facial palsy at an early stage; and (3.) the method is simple and inexpensive.

Treatment of Tongue Cancer with Reference to Long-term Follow-up

1. 昭和41年より同55年までの15年間に天理よろづ相談所病院耳鼻咽喉科で治療した口腔舌扁平上皮癌症例は36例であった. その男女比は1.6対1, 平均年令は58.3才であった.2. 全症例の5年実測生存率は, 49%であった. 女性および高令者の成績は不良であった.3. stage 分類と生存率は正相関した. 特に, 頸部リンパ節転移の有無は予後に大きく影響した.4. 術前照射群の成績は手術単独群のそれより不良であった. これに対し, 術後照射群での成績は手術単独群のそれを上回って良好であった.

Role of the Proprioceptors of the Extrinsic Eye Muscles in the Maintenance of Body Equilibrium in Response to Optokinetic Stimulation

視運動刺激下の身体平衡維持に外眼筋深部受容器の果す役割を明かにするたために, 次の検索を行った. すなわち, 外眼筋麻痺 (核上性) を伴う頭頸部外傷例を対象とし, 麻痺眼へ prism 装着を行い, その眼筋の低下した深部受容器活動性を促進, 鼓舞するよう操作した場合, 視運動刺激に対する眼反射と脊髄反射がどのように変動するかを観察し, かつ両者の相関を検討した. この際, 眼球運動と身体の平衡状態 (立直り反射) をそれぞれ眼振電計と重心動揺計で測定記録した. 得られた成績は次の通りである.(1) prism 装着によって視運動眼振はかなりの率で変動を示した. すなわち, この眼振の発現が促進されたもの53%, 眼振発現に有意の変化のなかったもの21%, 却って眼振の抑制がみられたもの26%である.(2) 同時記録した重心動揺曲線と視運動眼振発現状況の間には次のような相関がみられた. すなわち, prism 装着で眼振の出現が活発となるものは重心動揺曲線が安定化し, 立直り機能改善を示唆する所見が得られる傾向が強かった. これに対し, prism の装着で眼振の発現が却って抑制されたものでは, 重心動揺の度が増大し, 立直り機能の低下がうかがわれる傾向が示された.(3) 視運動刺激で誘発されるめまいとこの刺激でおこる眼反射, 脊髄反射の変化の間には一定の相関がある. すなわち, 眼振の抑制と重心動揺の増大がおこるとめまいが出現又は増強する傾向があり, 両者間に平行関係のあることが判った.これまでの報告や自験を参照し, 以上の成績より次の結論をのべた.1. 視運動刺激に対して眼球及び身体の平衡機能が円滑に発揮されるためには, その前提として外眼筋深部受容器と網膜の機能的協応が成立している必要がある. 従って, 外眼筋麻痺例にしばしば出現する視運動性めまいの背景には, 上記の2つの器官の協応の破綻があり, それに由来して眼筋, 躯幹, 四肢筋の機能失調がおこり, それを土台にめまいが生ずる.2. 眼球の非動化を行わず, 外眼筋深部受容器活動性を prism で変化させて視運動眼振や視運動脊髄反射を観察する方法は, 従来の研究方法にくらべてより生理的であり, 新しい研究分野の開発に役立ちうる.

Progressive Bilateral Perceptive Deafness due to Unknown Causes

Sixteen patients with progressive bilateral perceptive deafness due to unknown causes were examined using various hearing tests and equilibrium tests with the following results.1. Among the 11 patients examined 11 showed inner ear deafness and 3 showed inner ear deafness combined with retrocochlear one.2. With reference to the appearance and progress of deafness, the deafness of this type was divided into the following two:One was frequently observed in younger patients under twenty and was characterized by the tendency that bilateral deafness which appeared simultaneously and deteriorated equally, showed gradual, high-tone hearing loss. Thus, the hearing loss in these patients tended to be similar in pattern. i) between the first and the last examinations and ii) between the right and the left ears. Furthermore, the deafness of this type was rarely accompanied by vertiginous attacks.The other was frequently found in older patients, of above twenty and was characterized by the tendency that deafness of both ears did not appear simultaneously and did not deteriorate equally. Furthermore, the deafness of this type was sometimes accompanied by vertiginous attacks in anamnesis.3. Among the 16 patients examined, 4 showed fluctuating hearingloss. Furthermore, one of the 3 patients who underwent the glycerol test showed a positive sign. From the above mentioned findings the following conclusions were drawn:(1) There may be differences between the 2 groups of patients, younger and older with regard to the etiological factors of the progressive bilateral perceptive deafness due to unknown causes, although both groups showed inner ear deafness. The deafness in the former group may be induced by congenital factors and may be regarded as a kind of premature presbyacusis. In contrast, the deafness in the later may be induced, at least partly, by acquired factors.(2) Some patients showed findings suggestive of the existence of labyrinthine hydrops. These are valuable in considering the mechanism and treatment of the deafness of this type.

Ectopic Thymic Tissue in the Neck

In 1971 an ectopic solid thymus gland of the neck was first reported in Japan. Since then only a few individual case reports have been published. This article presents one such patient who was recently found and reviews the literature. The embryology of ectopic solid thymus glands and thymic cysts in the neck is also discussed.

Clinical Evaluation of Ultrasonic Examination on Thyroid Tumors

For the diagnosis of thyroid tumors, palpation, X-ray, RI-scintiphoto and biopsy have been employed. They are, however, insufficient for the determination of the characteristics of tumors, but also cause several side effects, such as spreading tumor cells and haemorrhage.In order to obtain more accurate information about thyroid tumors without any serious side effects, we employed B-mode ultrasonography to evaluate 223 patients with thyroid tumors. In 84 of the 223 patients tested, the correlation was examined between the results of ultrasonography and the histological findings.The results obtained were as follows:(1) On the basis of the presence or absence of echo within tumor pictures, the tumors were classified into the following 3 types, i. e., solid, cystic and mixed. The solid type tended to be malignant. In contrast, in the case of the cystic type, tumors tended to be benign with a few exceptions.(2) On the basis of echo structures within tumor pictures, the tumors were divided into the following two types, i. e., coarse and non-uniform or fine uniform. The latter echo has been considered to be indicative of benignity. However, the present examination revealed that in 45% of the tumors with the latter echo malignancy was proved histologically.(3) On the basis of marginal echo structure between tumors and the surrounding tissues, the tumors were classified into the following two types, i. e., smooth and irregular. In the case of the latter type, tumors tended to be malignant.In contrast, in the case of the former type, tumors tended to be benign with a few exceptions. There were nine patients with malignant tumors, four with cysts and five with encapsulated tumors.From these findings, we conclude that the classification of ultrasonographic echoes described in (1) and (3) are valuable in determining the characteristics of thyroid tumors.

Ear Surgeries of the Well-pneumatized Temporal Bones

10年の間隔をもつ2時期に行われた手術耳の含気度を比較し, 最近, 含気度良好耳の手術が増加していることを示した.この差は炎症経験の有無による日本人の側頭骨含気化に年代差が生じたのではなく, masked mastoiditis の増加によるものと推論した.

A Report on 31 Patients with Nasopharyngeal Carcinoma with Special Reference to the Results of Treatment

1) 昭和41年4月から昭和54年10月までの間に当科に入院加療を見った上咽頭悪性腫瘍は39例あり, そのうち癌腫は31例であった. これらの症例について統計学的観察を行い, 次の成績をえた.2) 男性20人, 女性11人で男性に多く, その平均年令は50.3才であった.3) 初発症状は, 耳症状, 鼻症状, 頸部腫瘤, 頭痛, 脳神経症状の順に高かった. また, 経過中脳神経症状を示した症例は14症例あり, そのうち第V, 第VI脳神経の症状が多かった.4) 初発症状発現から初診までに要した期間は, 6ヵ月以内が19人66%である. 初診時にほとんどの症例で診断がついた. 但し, 1症例では初診2ヵ月後にはじめて確診しえた.5) 扁平上皮癌が15症例, リンパ上皮腫が8症例, 未分化癌が8症例で, 31症例中23症例は Stage IV に属した.6) 治療は放射線療法を主体とし, これに化学療法を併用することが多かった. 治療効果を高めるため, 症例によっては抗癌剤の動脈潅流や口蓋開窓術, 頸部廓清術を加えた. その結果, 3年粗生存率は62.5%, 5年粗生存率は33.3%となった.7) 遠隔転移は, 肺, 骨に多く, 院内死亡例10例のうち3例は内頸動脈破裂が直接の死因であった.

Lateral Cervical Cyst and Fistulae of the First Bronchial Cleft Origin

Lateral cervical cysts and fistulae of the first branchial cleft origin are relatively rare disorders. Approximately 61 cases have been reported in the international literature. Recently we surgically treated 3 such patients.Case I. A 2 yr. old boy presented a chronic left submandibular sinus and a history of a left cervical abscess which had been incised 4 months previously. The fistulous tract was extirpated on 9. 24. 1976. The tract extended from a point below and in front of the angle of the jaw, upwards, to end blindly at the external auditory canal. The upper part lay deep to the facial nerve. On microscopy of the specimen, the sinus was seen to be lined with skin accompanied by cartilage.Case 2. A 1 yr. old girl developed an abscess at the angle of the left jaw during a period of 3 months. There was a fistula at the floor of the external auditory canal. The sinus tract was excised on 5. 11. 1977. The tract extended from the angle of the jaw, upwards, to the floor of the auditory canal. The upper part lay deep to the facial nerve. The tract was found to be lined with skin and accompanied by cartilaginous tissue.Case 3. A 6 yr. old boy presented a history of recurrent meatal and postauricular swelling. The cyst was excised on 10. 7. 1976. The cyst covered the mastoid process and extended deep along the floor of the auditory canal. The tract ended in a blind sac superior to the facial nerve. The cyst was lined with keratinized squamous epithelium.