Kiichiro Taguchi

Characterization and management of deep neck infections

A retrospective review was conducted of 91 patients with deep neck infections to determine the pattern of clinical disease and formulate a management plan. The spaces involved, as determined by clinical, radiologic, and operative findings, were the peritonsillar space (72 patients), parapharyngeal space (eight patients) submandibular space (seven patients), retropharyngeal space (one patient) superficial space (one patient), anterior visceral space (one patient), and visceral vascular space (one patient). Of the 19 patients who did not have a peritonsillar space infection the origin of the infection was found in eight; four of these were odontogenic. Thirty-eight patients required surgical drainage of the abscess. Five patients underwent tracheotomy due to increasing dyspnea. One patient with diabetes mellitus and a past history of myocardial infarction died of unknown cause. All other patients had an uneventful recovery without major complications. The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.

Gait intiation in bilateral vestibular loss

OBJECTIVE Gait initiation is a transient procedure between orthostatic posture and steady-state locomotion and includes anticipatory anteroposterior (AP) and lateral movements. Commands for this task are located in some levels of brain stem, which modulates activity of central pattern generator in the spinal cord. The purpose of this work was to explore the role of the vestibular system in this voluntary stepping. METHODS Six patients with chronic bilateral vestibular loss (BVL) were measured by means of a large force plate (70 cm x 120 cm ) and the displacement of the center of pressure (COP) during gait initiation was calculated. Measurement parameters comprised maximum distance (MD), velocity (MV) in the AP and lateral direction as well as for pre-, first- and second-step stages, and the angle of the COP trajectory. RESULTS For all stages, BVL patients registered lower values for both MD and MV in the AP direction than did normal subjects. In the lateral direction, however, neither MD nor MV in BVL patients showed any difference from those of normals. The step angle of the COP trajectory was obviously reduced. CONCLUSION These results suggest that in the AP direction, the vestibulospinal pathway can influence the locomotor related neural circuits, including the central pattern generator and supraspinal levels, by means of modifying the velocity and step length in order to stabilize the trunk. On the other hand, the control mechanism in the lateral direction may be different from that in the AP direction.

Computed tomographic findings in peritonsillar abscess and cellulitis

The differentiation of a peritonsillar abscess from peritonsillar cellulitis, although difficult on physical examination, is required in order to determine the appropriate treatment. Peritonsillar cellulitis can be treated with antibiotics alone, while a peritonsillar abscess should be drained. Computed tomography (CT) of the neck is often performed to identify the formation of a deep abscess in the neck, but is rarely used to diagnose peritonsillar infections. We report a patient in whom CT was a useful diagnostic tool for distinguishing peritonsillar abscess from peritonsillar cellulitis.

Computer Calculation Of Movement Of Body'S Center Of Gravity

The movement of the bodys center of gravity was calculated in normal subjects and in vertiginous patients by using a strain gauge platform system and a ditigal computer. The total length of the loci traced by the center of gravity in 40 normal subjects during normal standing for 1 minute was 52.0 +/- 18.5 cm with eyes open, and 81.5 +/- 52.3 cm with eyes closed. The ratio of the total length with the eyes closed compared with that with the eyes open during normal standing for 1 minute was 1.56 +/- 0.56. The time course of the length of the locus was calculated every 10 seconds, and characteric curves were obtained. The dependability of this test appeared to be fairly accurate and the usefulness of this technique for the diagnosis of vertiginous or ataxic diseases is recommended.

Cerebral evoked response to auditory stimuli in young children during sleep.

Recent developments in the averaging technique with electronic computers have provided possibilities for objective measurement of hearing in young children utilizing the auditory evoked response as an index of hearing. Numerous investigations have been reported on the audiometric application of the evoked response in young children. Most of the authors recorded the response in the waking state of subjects. 4 ,5 ,7 , l O.12 J4 .1 9 However, in waking children under five years of age, test trials are often unsuccessful because of their body movements or their refusal to wear electrodes. Many of the children in this age range require sedation for successfully completing the test and obtaining reliable results.

Spectral Analysis of Body Sway

The frequency spectrum of the center of gravity in normal subjects while standing was recorded by using a platform-strain gauge system and a digital computer. Individual differences of the spectral patterns resulted in the classification of three types. Averaged divisional frequency of each type was calculated in the range below 1 Hz in which the main change between the values with eyes open and those with eyes closed appeared as the frequency shift.

Reliability and validity of late vertex-evoked response audiometry.

In order to evaluate the current visual scoring technique in the late vertex-evoked response audiometry (ERA), the detectability of the response, errors in judgment, consistency between scorers and test-retest reliability were studied in adults and young children in waking and sleeping states. In waking adults, ERA proved to be a quite reliable and valid method for testing hearing objectively. On the contrary, a marked inconsistency was found in the appearance of the response in children during sleep. From a clinical standpoint, ERA in waking adults and sleeping children should be regarded as two substantially different methods.

Changes with aging in head and center of foot pressure sway in children.

To quantitate the development of equilibrium in children, we investigated movements of the head and of the center of foot pressure (COF) in standing subjects, using a cephalograph, a force measuring platform, and a technical computer. We studied 126 subjects, 105 healthy children, aged 4-18 years, and 21 adults, aged 20-28 years. Each subject stood with their feet together on a platform for 60 s each with eyes open or closed. The area and total length of head and COF movements decreased with increasing age, and were significantly greater in children under 12 years than in adults. The ratio of the lengths of head to COF movements was significantly larger in children under 9 years than in adults. The ratio of the anteroposterior to lateral movement of COF was also larger in children under 9 years. These observations suggested that body sway in children was not only larger than that in adults, but different in nature.

Relationship Between the Heads and the Body's Center of Gravity During Normal Standing

An apparatus for the recording of head movements has been developed and a basic study was performed to determine the normal values of head movement and to estimate the significance of the head movement as a righting reflex. The locus traced by the head closely resembled that of the center of gravity, though shorter in overall length. The head also moves more slowly than the center of gravity. The phase delay of its movement was observed during standing with eyes closed. These results suggest that the heads movement is controlled by the bodys center of gravity and that the latter moves in order to keep the head steady, maintaining the eyes in normal position.

Clinical Significance of Head Movement While Stepping

Head movement of normal subjects and patients with peripheral vestibular disorders while stepping was recorded using three accelerometers, a multi-channel telemeter and a microcomputer. The head movement registered from normal subjects was stable at a stepping speed of 1.2 or 1.4 steps/sec. Patients with peripheral vestibular disorders (except for BPPV) showed significantly greater head movement values in all three directions and smaller ratios of anteroposterior component to lateral component in the head movement, as compared with those of normal subjects.