Hiroyuki Nishioka

Chondrosarcoma of the ethmoid sinus extending to the anterior fossa

A 27-year-old women with chondrosarcoma of the ethmoid sinus extending to the anterior fossa had initial symptoms of blurred vision on the left and slight proptosis. Neuroradiological examination, however, disclosed that the tumor extended not only to the anterior cranial fossa, but also to the orbit, nasal cavity, and maxillary sinus. It is difficult to predict the biological behavior of chondrosarcoma by means of histological examination. The effectiveness of radiotherapy, chemotherapy, or both is also a matter of controversy. Clinical aspects of chondrosarcoma are briefly discussed.

Clinical study of abnormal sensation in the throat.

The authors treated 853 patients with abnormal sensations, exclusive of pain and difficulty in swallowing, in the throat from Aug. 1981 to May 1985. There were 363 males and 490 females (1:1.3). At the time of diagnosis, the majority of the patients were in the 3rd, 4th and 5th decades of life. The sensations, 72% of which were located in the middle of the neck, projected mostly (88%) on the level between the hyoid bone and the suprasternal fossa and were strongly felt during empty swallowing by 60% of the patients. In most of the patients, the hematological examination, chemical analysis of blood and serological test were within normal limits. When the answers of the patients to the Cornell Medical Index-Health Questionnaire were analysed by Fukamachis method, 33% of the patients were classified as normal, 33% as almost normal, 25% as slightly neurotic and 9% as neurotic. The Maudsley Personality Inventory, however, revealed that the decreased score of the lie scale correlated significantly with the increased score of the neurosis scale. No hypopharyngeal malignancies have been detected so far in the patients in this study.

Effect of Metharmon-F in middle-aged female patients with abnormal sensation in the throat.

咽喉頭異常感を主訴として受診した中高年婦人53例をメサルモン®-F (3錠/日×14日間) を単独で用いて治療し, 以下の成績を得た.1. 副作用は5例 (9.4%) に出現し, うち4例は休薬を余儀なくされた.2. 効果判定が可能であった49例のうち, 自覚的に異常感が50%以上改善した (著効+有効) 例の占める割合は, 投薬開始後1, 2および3 (投薬終了後1) 週目で, それぞれ39%, 49%, 51%であった. それが80%以上改善した (著効) 例の占める割合は, それぞれ8%, 31%, 35%であり, 著効率が比較的高いことと十分な効果が得られるまでに日数を要したことが特徴的であった.3. 層別化してみると, 30, 60才例が40, 50才例に比し, 随伴症状を有さない例が有する例に比し, 当科受診前に治療を受けたことのない例が既治療例に比し, 肥満度の低い例が高い例に比し, 月経が順調か閉経後5年を越えた例が月経不順や閉経後5年以内例に比し, 自己を楽天的と評価した例が苦労性とした例に比し, 発症後1ヶ月以内に治療を開始した例がそれ以上を経て開始した例に比し, 心理ならびに性格検査で神経症的傾向が低い例や逆に著しく高い例が幾分神経症的傾向が窺われる例に比し, また, 外向的と考えられる例が内向的と思われる例に比し良好な治療成績を示した.内分泌異常により咽喉頭異常感が発現あるいは増悪する可能性があることを文献的に考察し, 本症例に対して体内ステロイドバランスを調整してやることを目的とした治療を施してやることは有意義であると結論した.

A Clinical Examination of Malignant Tumor of the Palatine Tonsil

From 1961 to 1980, 45 patients with malignant tumor of the palatine tonsil were treated at the Department of Otolaryngology, Mie University Hospital. Of these, 12 patients were cancer and 33 sarcoma.Tonsillar cancer predominantly affected the male, whereas sarcoma was found in the male and female almost equally. The age distribution of tonsillar cancer was uniform, while there were two peaks in the fourth and seventh decades of life for tonsillar sarcoma. Eighty-three percent of cancer was squamous cell carcinoma, and all the sarcoma cases were malignant lymphoma of which 94% were reticulum cell sarcoma. Seventy-five percent of carcinoma were stage III or IV, while 94% of malignant lymphoma were stage I or II at the time of diagnosis. Sore throat was the most commonly encountered chief complaint for both carcinoma and malignant lymphoma. Three patients (25%) of those with carcinoma and four (12%) malignant lymphoma patients complained of a lump in the neck.All the patients with tonsillar malignancy underwent radiation therapy, and chemotherapy was also used in nine patients (75%) with carcinoma and 19 (58%) with malignant lymphoma. Crude survival rates for tonsillar cancer was 64% for 1 year, 20% for 2 years, 11% for 3 years and 0% for 5 years, and for malignant lymphoma of the palatine tonsil it was 45% for 1 year, 40% for 2 years, 37% for 3 years and 22% for 5 years.Although both carcinoma and malignant lymphoma had poor prognosis in this study, the preliminary results of combined radiation and chemotherapy for malignant lymphoma were encouraging. It was found that the total radiation dose of 5, 000-7, 000rads for carcinoma and 4, 000-6, 000rads for malignant lymphoma of the palatine tonsil was satisfactory in this study.

A Clinical Study of Dysosmia

A consecutive series of 107 patients with dysosmia in the Department of Otolaryngology, Mie University Hospital during the four years from 1974 to 1977 was studied clinically. The pernasal olfaction test with exponentially diluted odors of five kinds (beta-phenyl ethyl alcohol, cyclotene, iso-valeric acid, gamma-undecalactone and scatol), which had been standardized by the task group for olfaction in Japan, was employed for evaluating the olfactory acuity of the patients. Of the 107 patients, 76 were anosmic, 23 were hyposmic and 8 were parosmic. Pathogenesis of dysosmia were analysed by the patients history and symptoms, rhinoscopic and radiographic findings of the nose and the intravenous olfaction test, and could be classified into the four groups of respiratory disturbance (R), peripheral nerve disturbance (P), combination of respiratory disturbance and peripheral nerve disturbance (R+P) and central nervous disturbance (C). There were 20 patients with R, 14 with P, 53 with R+P and 20 with C. For patients with R or R+P, therapy with nasal drops containing steroid solution was conducted while the patient was lying supine with the head bent far backward. By this treatment, 85% of the patients with R and 75.5% of those with R+P were improved. However, there were no efficacious therapies for patients with C or P.

Seven Cases of Malignant Lymphoma of the Nose and Paranasal Sinuses

This paper deals with seven patients with malignant lymphoma of the nose and paranasal sinuses. They included six males and one female aging from 30 to 70 years. Of the seven patients, the maxillary sinus was thought to be the site of origin in four patients, the sphenoidal sinus in one and the nasal cavity in three. The most frequent histopathological type in this series was reticulum cell sarcoma, but one was lymphosarcoma and another was unclassifiable.According to the criteria of the Ann Arbor classification, two patients were in stage I, two in stage II, two in stage III and one in stage IV. Cheek swelling and epistaxis were the most common chief complaints in six patients. They did not present particularly characteristic clinical symptoms. Cobalt-60 or Linac teletherapy was delivered in a total dose of 1600-6000rads. In addition, non-scheduled chemotherapy including 5-FU, COP, BONP or VEMP was given. In five out of the seven, the initial response to this therapy was favorable. In these patients, 83% (five of the six) died within 16 months of diagnosis and only 14% (one of the seven) survived for five years. With this dismal experience in mind, three principles are proposed for the management of patients with malignant lymphoma of the nose and paranasal sinuses. These consist of (1) exact staging of the disease, (2) planned protocol adjusted to the stage for the therapy and (3) irradiation combined with chemotherapy for patients in stage II.

Congenital Choanal Atresia

A case of bilateral congenital choanal atresia is presented. The patient was a 16-year-old girl who had suffered from thick, mucoid discharge and complete nasal obstruction since birth. Although she gradually learned to breathe through her mouth, she often encountered respiratory distress with cyanosis in the early stages of life. A diagnosis of choanal atresia was made when a catheter failed to pass through the nose into the pharynx. The nasopharyngography confirmed the posterior nasal obstruction.Surgical correction was performed by a transpalatine approach under general anesthesia. Following exposure of the posterior choanal region via the transpalatine approach, the membraneous tissue which occluded the choanae was excised. Silicon tubes were left inserted into the opened choanae for 2 weeks. No remarkable complication has been observed postoperatively. The choanae are still open and the patient breathes satisfactorily through her nose.From 1923 to 1979, 45 cases of congenital choanal atresia have been reported in the Japanese literature. These cases are analyzed in terms of sex, laterality, type and concomitant anomalies. Our present report is the 45th case of congenital choanal atresia to be reported in Japan.