Masahiko Kubo

Application of Mucodyne to Chronic Sinusitis.

The therapeutic effect of S-carboxymethyl cystein (S-CMC, Mucodyne®) was examined in 54 patients with chronic sinusitis. A dose of 1500mg/day of S-CMC was administered to the patients for 4 weeks, and its effectiveness was evaluated at the end of treatment.1) The overall efficacy rate was 78.7% and the efficacy rate for good responses was 46.8%.2) An adverse reaction was noted in only one patient (1.9%).

A clinical study of norfloxacin in the treatment of otitis media.

1) Norfloxacin was given to 53 patients with otitis media. It was effective in 95.0% of those with acute suppurative otitis media, and in 63.6% of those with acute exacerbation of chronic otitis media.2) Cultures showed elimination of bacteria in 92.3% of those with acute suppurative otitis media, and in 62.5% of those with acute exacerbation of chronic otitis media.3) The antibacterial activity of Norfloxacin was excellent against both gram-positive cocci and gram-negative rods.4) No side effect was noted except for diarrhea in one patient.These results indicate that Norfloxacin is a useful antibacterial agent in the treatment of otitis media.

Effect of combined use of sulpiride and tiaramide HCl on abnormal sensation in the throat.

The majority of patients with abnormal sensation in the thoat have a history of an upper respiratory tract infection, increased apprehension, cancerphobia, depression, etc. Therapy of such patients with an anti-depressant plus an anti-inflammatory agent is expected to be effective.The authors administered Sulpiride (150mg/day) and Tiaramide HCl (300mg/day) for two weeks to 114 patients with abnormal sensation in the thoat and evaluated the results. Side effects, such as abdominal symptoms, drowziness or headache, were reported by 9 patients (8%) including 3 patients in whom the medication had to be suspended. The therapeutic effect of the medication was evaluated in the remaining 111 patients at the end of the first and second week of administration and one week after the termination of treatment. It was considered to be effective when the abnormal sensation improved subjectively by 50% or more. The combined therapy was effective in 56% of the 111 patients within one week, in 72% in two weeks and in 73% in three weeks. The therapy was more effective in patients with depressive state and/or mild inflammation in the throat.

Sensation of a lump in the throat elicited by atropine sulfate injection.

Several investigators have reported a considerable number of patients suffering from dryness of the oral cavity or throat along with abnormal sensation in the throat. It is necessary to clarify whether hyposalivation or decreased airway fluid is the cause of abnormal sensation in the throat.The authors investigated the occurrence or increase of the sensation of a lump in the throat after intramuscular or subcutaneous injection of atropine sulfate (0.5 mg).The subjects were 105 patients with various kinds of otolaryngeal diseases. Five of them reported the occurrence and one reported the increase of the sensation after the injection. Four of these 6 patients were females and 5 were over 50 years of age.It is quite certain that hyposalivation or decreased airway fluid can cause the sensation of a lump in the throat.

Massive antiemetic therapy with metoclopramide for cisplatin-induced emesis.

Large doses of metoclopramide as an antiemetics were administered to 9 patients recieving cisplatin (CDDP) (50mg/m2) for head and neck cancers. Metoclopramide, 2mg/kg was administered four times intravenously on the first day of CDDP therapy and once a day on days 2-7. Neither emesis nor nausea occurred in 8 of the 9 patients (89%). Side effbcts were minimal: mild sleepiness(66.7%)and diarrhea(22.2%). It is concluded that the antiemetic effect of intravenous metoclopramide in large amounts can prevent cisplatin-induced emesis.

Chondrosarcoma of the epipharynx in a patient with thyroid cancer.

The patient was a woman, aged 41, who had complained of abnormal sensation in the pharynx for about 2 weeks. CT scan disclosed a low-density mass in the epipharynx with extention to the parapharyngeal space and the prevertebral space. Surgical removal was performed via the oral route. A thyroid cancer with cervical node metastasis was detected during tracheostomy. The tumor of the epipharynx was chondrosarcoma histologically.Cartilaginous tumors of the epipharynx are rare. Moreover, chondrosarcomas of the head and neck region associated with a second primary neoplasm are extremely rare and only one case has been described before the present report.

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.

Analysis of Deaths from Laryngeal Cancer

The authors reviewed 26 patients with laryngeal cancer who were treated in our clinic and died of the disease within 5 years after initial treatment in the period from 1961 to 1980 and analysed their therapeutic problems.Of the 26, 16 were classified as the supraglottic type, 5 as the glottic, 1 as the subglottic and 4 as the transglottic. The male to female ratio was 7.7:1. In 13 cases (50%), the initial treatment was thought to be carried out radically. Local recurrence after irradiation was controlled to a certain extent by total laryngectomy and metastasis to the cervical node after total laryngectomy was also treated by neck dissection. The average interval from initial treatment to death was 16.7 months.The main causes of poor results were thought to be the following:1) The lesion was more extended than was realized, 2) radiatian was unsuccessful in patients whose disease may have been curable by surgical treatment, 3) insufficient surgical field for the larynx and/or neck, 4) tumors were too advanced, 5) aged patients for whom radical treatment was not indicated, 6) patients refusal of surgical treatment.

A Case of a Sewing Needle Foreign Body in the Pharyngeal Wall

A case of a pharyngeal foreign body was reported with a review of the literature. A 19-year-old woman voluntarily swallowed a sewing needle. Though the foreign body was invisible in the pharyngeal region, X-ray examination revealed a concealed needle in front of the second cervical vertebra. Under general anesthesia with tracheotomy, the patient was placed in the supine position, with the head excessively extended. The concealed needle in the suspected area which was surrounded by Ligaclips® on three points was confirmed by an image amplifier. The needle was removed from the posterior wall of the pharynx perorally. The psychiatrist pointed out that she was irritable and emotionally unstable.We analyzed 49 cases of foreign bodies in the pharynx and esophagus treated in the Department of Otolaryngology, Mie University Hospital during the period of 1975-1980, as well as 5 cases of concealed needles in these areas reported in the Japanese literature.