Ikuo Inokuchi

Effect of and Indication for Tonsillectomy in IgA Nephropathy

Although more than 20 years have passed since the initial report of IgA nephropathy, the etiology of this disease is still unclear. Some reports suggest that the tonsil is an important etiological factor. We performed tonsillectomy on 26 patients with IgA nephropathy associated with chronic tonsillitis, and followed up the patients for two years after the operation to evaluate its clinical effect on this disease. Twelve patients (efficacy rate 46%) showed distinct improvement in urinary findings after the operation, although the efficacy rate went down as renal injury advanced. Serum IgA levels decreased significantly after the operation both in patients who improved and in those who did not; the decrease was especially evident in patients who had high levels of serum IgA before tonsillectomy. In 4 patients who improved, the level of circulating immune complex (CIC) was extremely high before, and decreased significantly after, the operation. One patient suffered renal failure three years after tonsillectomy. When renal injury has advanced to the clinically apparent degree, as occurred in this patient, tonsillectomy is absolutely contraindicated. In reaching a decision as to whether tonsillectomy is indicated in mild cases, the change in the number of erythrocytes in urinary sediments may be a sensitive parameter of the tonsillar provocation test.

Evaluation of facial palsy by moiré topography index.

We investigated the usefulness of moiré topography for evaluating facial nerve function in 51 patients with facial palsy and 10 normal volunteers. This method visualizes the shape of objects in three dimensions. We devised three moiré indexes as a simple method of quantifying the severity of facial palsy: the nasolabial groove moiré index, the oral angle moiré index, and the inner canthus moiré index. We compared the results obtained by the moiré indexes with findings obtained using the House-Brackmann grading system and found that they were highly correlated. These three moiré indexes included all the standard factors of the House-Brackmann grading system, allowing us to develop the total moiré index.

Evaluation of facial palsy by Moiré topography.

To evalute facial nerve function, several visual assessment methods have proposed by May, Yanagihara, Stennert, House, Brackman, among others, and the score method is widely accepted as a simple and useful method for examination to evaluate roughly the degree of facial palsy. However, it is difficult to capture fine changes with the score method when precise evaluation is required, and it is limited as a form of objective and reporducible assessment. Therefore, it is not a very suitable method to follow up the process of the recovery in facial nerve palsy.

Temporal Bone Pathology in Congenital Anomalies of the Oval Window and the Facial Nerve

Temporal bones of six infants with congenital ear anomalies were examined for abnormalities of the oval window and facial nerve. These temporal bones were classified into two groups according to the degree of malformation: group A, those with atresia or absence of the oval window; and, group B, those with hypoplasia of the stapes and annular ligament. Group A, consisting of five ears, were associated with severe middle ear anomalies such as the abnormal course of the facial nerve and absence of the stapes. In group B, consisting of seven ears, the stapes were present and the facial nerve presented minor anomalies such as obtuse angulation at the first genu, central migration of the geniculate ganglion cells, ectopic muscles and a wide bony dehiscence of the facial canal around the oval window. Probable origin of the anomalies in group A could mainly be due to maldevelopment of the facial nerve during an earlier embryonal period while that of group B could have developed after the ninth week of the fetal period and are mostly localized along the second branchial arch.

Hearing immaturity found by ABR and its clinical impact on otoneurological evaluation

Auditory Brainstem Response (ABR) is the most reliable and most frequently used procedure to evaluate audiological conditions in early infancy. However, several reports have demonstrated that developmental change in the central nervous system may affect the results of ABR in audiological evaluations. We examined statistically the reliability of ABR for the diagnosis of profound deafness in early childhood according to our experience over the past 12 years of follow-up in our facility. Subjects included 371 children among 1,041 children who were admitted to Kanariya-Gakuen (institute for pre-school deaf children) from April 1985 to March 1997. These children were examined with ABR to determine their hearing levels. In five cases with an abnormal hearing threshold determined by ABR and other audiological tests, repeated examinations carried out during a 5- to 6-month follow-up period revealed that they had normal hearing. Three of these children had been diagnosed previously with mental retardation and the remaining two were infants < 5 months old. The specificity and sensitivity of ABR were calculated as 97.3% and 100%, respectively. The predictive value of a positive result was 94.7%. There remains the possibility of a false negative for such cases, although the rate seems to be very low (< 0.2%).

Dynamic evaluation of facial palsy by moire topography video: second report

By using moire topography video, the feature of facial expression can be well analyzed. The dynamic change of moire strips pattern enables the observation of facial movement in three dimensions and contributes to the better evaluation of patients with facial palsy. Using this method, several special features on the facial expression of patients with facial palsy were demonstrated.

Evaluation of facial palsy by moire topography

Society of Facial Research is used frequently. It is of great value clinically, but the method has several weak points concerning objective and quantitative assessment. This study uses moire topography to solve these problems. mA moire camera, FM3013, of the lattice irradiation type was used for measurement of the face. Five moire photographs were taken: at rest, wrinkling the forehead, closing the eyes lightly, blowing out the cheeks and grinning. The degree of facial palsy was determined by the Asymmetry Index (AI) as a measure of the degree of facial deviation. Total AI was expressed as the average AI based on calculations of the measurement in 5 photos. Severe paralysis is represented by an AI of more than 20%. Partial paralysis has a range of 20-8%. Nearly normal is judged to be less than 8%. Ten normal individuals are measured as control and show an AI of 3% or less. Moire topography is useful in assessing the recovery process because it has the benefit of making the site and grade of palsy easily achieved by the AI and the deviation in its patterns. The authors propose that the moire method is better for an objective and quantitative evaluation than the societys method.

A Case of Malignant Schwannoma in the Nasal Cavity.

A 68-year-old woman consulted our clinic exhibiting a bilateral nasal obstruction which had lasted for 2 months. Anterior rhinoscopic examination revealed the presence of necrotic tumor which was raised from the posterior portion of the right nasal cavity or epipharynx. Since only slight tumor reduction was obtained through 40Gy of radiotherapy, surgical excision was done endonasaly using an endoscope. Intra-operative findings indicated that the tumor was raised from the posterior portion of the right inferior turbinate. En bloc resection was carried out, but viable tumor cells were exposed at the surgical margin. An additional 30Gy of post-operative radiotherapy and lateral nasal wall resection using a lateral rhinotomy approach were carried out. Moreover, right neck dissection was done for right cervical lymph node metastasis.Surgical excision with a wide margin is the most desirable method of treatment for this kind of tumor. Though this method is difficult to carry out in the head and neck region, we suggested that excision with marginal margin combined with radiotherapy could produce good results.

Efficacy of the Canalith Repositioning Method for Treatment of Benign Paroxysmal Positional Vertigo.

Canalith repositioning methods have been designed to release free floating canalith from the posterior semicircular canal back into the utricle to treat benign paroxysmal positional vertigo (BPPV). Treatment by Semonts liveratory maneuver, one of these methods, was compared to treatment by medication only.Seven of 10 patients (70%) treated with the liveratory maneuver showed improvement within a week. Conversely, only 1 of 10 patients (10%) showed improvement within a week when treated with medication only.Accordingly canalith repositioning should be the first choice of treatment for BPPV.

The Use of Steroid Therapy for Bell's Palsy; A Proposal.

Based on the pathophysiology of Bells palsy, Stennert employed a high dose of steroid plus lowmolecular weight dextran, and reported a high cure rate. This report was undertaken to evaluate the effects of intermittent corticosteroid pulse therapy on Bells palsy.Sixteen patients with Bells palsy who had complete facial paralysis were enrolled. The treatment performed was intermittent corticosteroid pulse therapy, given between January 1993 and May 1995. In our intermittent corticosteroid pulse therapy protocal, methylprednisolone sodium succinate, low-molecular weight dextran, ATP and vitamins were also used in combination.The cure rate of this therapy was 87.5%, and no side effects were observed during the treatment. Therefore, this therapy was considered to be very effective in curing Bells palsy.