Hitoshi Tojima

Clinical evaluation of sizofilan as assistant immunotherapy in treatment of head and neck cancer.

Sizofilan (SPG), a simple glucan produced in a culture medium by Schizophyllum commune Feries, was used as an assistant immunotherapy in 15 patients with head and neck cancer. The cumulative 5-year survival rate was 86.7% in the SPG-treated group and 73.4% in the control group. Immunological parameters showed that the SPG group quickly recovered the cellular immunity damaged by radiation, chemotherapy and surgical procedure. SPG was found to be effective as an assistant immunotherapeutic agent in the treatment of head and neck.

Facial Nerve Enhancement in Gd-MRI in Patients with Bell's palsy

The diagnostic value of a contrast enhanced MRI in patients with Bells palsy was investigated. It was a characteristic finding that the internal acoustic meatal segment of the facial nerve was enhanced only on the affected side. The signal intensity ratio of the geniculate ganglion and the tympanic segment was significantly higher on the affected side than on the normal side. The severity of the facial palsy and the results of physiological examinations showed no relation to the results of MRI scans. Gd enhanced MRI thus appears to provide some useful findings for estimating the affected region of Bells palsy, whereas it is not considered to be valuable in the diagnosis of severity.

Gd-DTPA Enhanced MRI in Ramsay Hunt Syndrome

Ten patients with Ramsay Hunt syndrome underwent magnetic resonance (MR) scans. In many examinations, abnormal enhancement of the 7th nerve in the internal acoustic meatal segment through the mastoid segment was observed. Out of seven patients with cochlear and/or vestibular symptoms, only one showed abnormal enhancement of the 8th nerve, in addition to the 7th. The other 6 patients showed the same findings as in Bells palsy, showing no enhancement of the 8th nerve. This suggests that clinical symptoms have no relation to the results of MRI. Enhanced MRI is the most sensitive means of making differential diagnoses between Hunts syndrome and tumors, but it is impossible to detect all lesion sites corresponding to the symptoms in Hunts syndrome.

Facial Nerve Palsy in Children: Clinical Aspects of Diagnosis and Treatment

Eighty-two children with facial palsy aged less than 6 years were examined. Sixty-four cases, excluding patients with congenital and traumatic palsy, were distributed through the ages, but a predominant tendency to symptomatic palsy for cases aged less than 2 years was observed. Facial movement scoring was not practical in prognostic diagnosis in cases aged under 4 years, while ENoG was useful in all age-groups. Of 58 cases of acute peripheral facial palsy, 29 were observed clinically but given no treatment, 9 were given steroids, and 16 were given vitamins and other drugs. In the patients with acute peripheral facial palsy in whom a follow up study was performed, 56 cases (96.6%) showed complete recovery. The time of recovery was independent of treatment. Facial palsy in children is considered to have a good prognosis regardless of treatment. Steroid administration thus does not appear to be necessary in children with acute facial palsy.

Clinical Advantages of Electroneurography in Patients with Bell's Palsy within Two Weeks after Onset

One of the advantages of applying ENoG to patients with Bells palsy resides in its quantitative determinability for the axons which do not undergo wallerian degeneration. The relation between the ENoG value each day after onset and during the recovery process was investigated in 551 patients with Bells palsy within 2 weeks after onset in order to consider the diagnostic value of ENoG. It was discovered that ENoG on patients with Bells palsy makes it possible to reveal the extent of wallerian degeneration by 7 days after the onset of palsy. Accordingly, treatment of Bells palsy should be administered within the above 7 days; as early as 8 days after onset, exact prognostic diagnosis and judgment of therapeutic effect from ENoG values were concluded to be practicable.

Electrophysiological Study on the Pathology of Synkinesis after Facial Nerve Paralysis

By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves.

Deltopectral Flap for One-Stage Reconstruction of Pharyngocutaneous Fistulae Following Total Laryngectomy

Postoperative pharyngocutaneous fistulae are troublesome complications after total laryngectomy. To manage this complication, we devised an operative method consisting of a one-stage repair using a deltopectal flap. With this technique we can immediately cover both skin and pharyngeal defects. We have applied this method to 5 patients all of whom have successfully recovered their swallowing function.

Diagnosis and Treatment for Bell's Palsy Associated with Diabetes Mellitus

The method of detecting diabetes mellitus and estimating the diabetic control status in patients with Bells palsy, and the effect of high-dose steroid therapy for Bells palsy accompanied by diabetes were investigated. From October 1987, hemoglobin A1c (HbA1c) was introduced to detect diabetes in 288 out of 372 patients with Bells palsy, as a screening test for DM. Thirty-six diabetics with complete facial palsy were treated by high dose steroid therapy as described by Stennert. Hemoglobin A1c was useful in diagnosing diabetes and in assessing the diabetic control. Many patients under diabetic therapy kept their diabetes under good control. In cases of complete palsy, high-dose steroid therapy, at a cure rate of 97.4%, was highly effective in treating diabetes-accompanied Bells palsy.

Effects of Aciclovir in Ramsay Hunt syndrome

Nine patients with Ramsay Hunt syndrome were treated with Aciclovir and the effects of this treatment were observed for 6 months. The results were excellent in 5 cases, fair in 3, and poor in one case. Otalgia and auricular herpes was improved rapidly after the administration of Aciclovir. No severe side effect was observed in this study.

Effects of Aging on Hearing Results in Tympanoplasty

The effects of aging on the preoperative and postoperative hearing results of tympanoplasty were assessed in 642 patients with chronic suppurative otitis media (COM) or cholesteatoma (CHL). Analysis focused on the correlation between hearing results and age for each disease and type of tympanoplasty. Data were evaluated by calculating the regression line, mainly using second order polynomial regression analysis. Averaged air and bone conduction thresholds (PTA) in patients were appreciably poorer in younger patients and increased with age, compared with physiological hearing impairment in old age (presbyacusis). Regression lines for PTA of air and bone conduction in patients and for normal data (air conduction) separated from each other after the age of 30 and hearing impairment gradually accelerated with age. Means of air-borne gap, however, were almost the same in each age group, though hearing thresholds in individual patients were distributed widely. This was more dominant in patients who had undergone type III or IV tympanoplasty than those with type I tympanoplasty, and in patients with COM than with CHL. Labyrinthine function thus appears to be gradually aggravated with age in patients with chronic inflammatory ear disease. Patients with chronic otitis media should be thus recommended to undergo tympanoplasty at an early age.