Masanori Morimoto

A Comparison of the Furosemide and Glycerol Tests for Meniere's Disease

The feasibility of furosemide test for the detection of endolymphatic hydrops has previously been discussed (Authors, 1973, 1975). The glycerol test also has been reported as being effective for the same purpose but only in Meniere patients with fluctuating hearing loss (Klockhoff & Lindblom, 1966). In 48 patients with Menieres disease, both the furosemide test (F-test) and the glycerol test (G-test) were performed on 51 ears including 3 cases of bilateral involvement. The average value of urine volume in the F-test was significantly greater than that for the G-test. The decrease in tinnitus was 40% in the former, 45% in the latter. The F-test yielded a positive rate of 73%, and the G-test, 45%. The results were thus: positive in the both tests, i.e., F+: G+ were 17 (33%); F+: G-, 20 (39%); F-: G+, 6 (12%), and both negative, F-: G-, only (16%). The side effects of the F-test were nil, but those of the G-test were as follows: headache (29%), nausea (4%), and increase in tinnitus (9%). The response increase of the hydropic labyrinth caused by the two kinds of systemic dehydration over-lapped in part and differed in part, as a result of the differing diuretic mechanisms and their respective affinities to the cochlea and the vestibulum. The furosemide test may be based on the action of the vestibular response type, which is caused by natriuretic dehydration accompanying the more sensitive response increase in caloric-induced nystagmus, while the glycerol test may be based on the action of the cochlear response type, owing to osmotic diuresis manifested as hearing shift. The correlation between labyrinthine hydrops and dehydration was discussed and it was concluded that these double test were quite adequate methods for choice of treatment of not only unilateral Menieres disease in its various stages but also in bilateral involvements.

THE FUROSEMID TEST FOR MENIERE'S DISEASE

In a previous report it was suggested that intravenous administration of furosemid followed by a comparative caloric test (the furosemid test) could be utilized for detection of endolymphatic hydrops (Kitahara et al., 1973). As a result of the further application of the furosemid test upon 161 patients with vertigo, positive results were observed in 80% of patients with typical Menières disease, 6% of atypical Menières disease, 42% with labyrinthine syphilis and 27% with sudden deafness. In patients with labyrinthitis, results were negative. It is thus concluded that the furosemid test provides positive evidence for determining the etiology of vertigo.

Effects Of Cholinergic Agonists And Antagonists On Nucleus Vestibularis Lateralis Unit Discharge To Vestibular Nerve Stimulation In The Cat

Unit discharge in nucleus vestibularis (NVL) was studied in locally anesthetized cats. The mean firing rate +/-S.E. of spontaneous unitary discharges of NVL neurons was 19.8+/-0.9 Hz and that of spinal-transected animals was 18.0+/-1.6 Hz. The mean firing rate of these neurons in animals with cerebellum ablation and the administration of scopolamine in a dose of 0.5 mg/kg i.v. was relatively low. After administration of physostigmine in a dose of 25 mug/kg i.v. the firing rate was enhanced. The effects of physostigmine were antagonized by scopolamine. About 95% of NVL neurons activated by single electrical shocks to the ipsilateral vestibular nerve showed regular firing following administration of physostigmine. These neurons changed to a gamma distribution at lambda=2 following administration of scopolamine.

A new folded pharyngeal flap, preliminary report

In an attempt to minimize postoperative scar contracture and shrinkage after a pharyngeal flap operation, a folded flap operation was devised. This operation was performed on 14 patients with velopharyngeal inadequacy. A superiorly-based flap was elevated from the posterior pharyngeal wall and was folded with the mucosa outside. The flap-velum connection was made through raw surfaces produced on each lateral ridge of the flap and the two penetrating incisions on the sides of the soft palate. In none of the cases did detachment of the flap or any other complications occur. This rather simple technique which aims to prevent scar contracture of the flap will permit further elaboration of the flap design-depending on the extent of velopharyngeal incompetence.

Responses of Single Neurons of the Vestibular Nuclei to Lateral Tilt and Caloric Stimulation in the Intact and Hemilabyrinthectomized Cats

Responses of unitary discharges of the vestibular nuclei to lateral tilt and caloric stimulation were studied in the unanesthetized encephale isole preparations of intact and hemilabyrinthectomized cats. The responses of firing rate of 93 units to lateral tilt were classified into 5 groups: increased type. (increase with lateral tilt to either or both directions), decreased type (decrease with lateral tilt to either or both directions), reversed type-I (increase with ipsilateral and decrease with contralateral tilt), reversed type-II (decrease with ipsilateral and increase with contralateral tilt), and refractory type (refractory with lateral tilt to both directions). The most dominant pattern of the responses to lateral tilt was the decreased type (60.2%). On the other hand, more than half of the vestibular units (61.3%) showed reverse changes in frequency to caloric stimulation with cold and warm water. Two main types of units were localized in the vestibular nuclei: one increased the frequency in respo...

Effects of chlorpromazine and diazepam on neuronal activities of the lateral vestibular nucleus in cats

SummaryThe effects of chlorpromazine and diazepam on vestibular neuronal activity were studied in gallamine immobilized cats. Chlorpromazine depressed all the P, N1 and N2-waves of field potentials in the lateral vestibular nucleus evoked by electrical stimulation of the vestibular nerve. Diazepam also reduced the amplitude of postsynaptic components (N1 and N2-waves), while the presynaptic one (P-wave) was slightly increased. Chlorpromazine suppressed the spontaneous as well as the increased vestibular neuronal firing following stimulation of the vestibular nerve. Diazepam enhanced the increased vestibular neuronal firing excited by the nerve stimulation and had no effect on the spontaneous unitary discharges.

Restoration of voice after laryngeal surgeries

Some aspects of speech deficiency in Japanese‐speaking patients who had undergone surgeries for laryngeal malignancy were studied. Surgical procedures included reconstructive surgeries after total laryngectomy and conservation surgeries. A series of listener‐judgments and some acoustic analyses of speech were made. The recorded voices of the patients were more or less hoarse. The median speaking pitch varied greatly from patient to patient, and often assumed an unusual value. The average articulation score for five Japanese vowels was computed for each subject. The score varied from patient to patient, and was thought to be useful in quantitatively evaluating speech quality. It was shown that certain glottal consonants such as /h/ can be affected by laryngeal surgeries. It was emphasized that the larynx should be regarded not only as a generator or a vibrator, but also as an articulator which produces consonants. The listening tests also revealed that the intonation pattern of Japanese two‐syllable nouns can be influenced by laryngeal surgeries, and that distinction among certain words may become impossible as a result. This type of speech problem may require serious consideration in some language environments.

Meniere's Disease and Diphenidol

In 24 patients with Menieres disease, chemotherapy using Diphenidol (l,l,-diphenyl-4-piperidino-l-butanol hydrochloride), a non-phenothiazinic antiemetic agent, was carried out using the double-blind technique in the cross-over design. The prevalence and intensity of symptoms at the three stages were recorded every three weeks according to fixed scales which were graded: vertigo, unsteadiness, tinnitus, nausea, headache, and shoulder stiffness. The hearing was measured by tone audiometry. Equilibrium function tests were also performed every three weeks and these included the electro-nystagmographical procedure to determine caloric response and the ARG-Tilt tests. Both symptoms and the results of equilibrium function tests, showed a higher incidence of improvement during the period of Diphenidol administration than during that of placebo. The difference was statistically significant with respect to vertigo, dizziness or unsteadiness, and general condition subjectively, as well as caloric response and ARG-...

Indication and the results of pharyngeal flap operation

SummaryIndication for pharyngeal flap operation was discussed particularly from the following 3 viewpoints; diseases and factors responsible for velopharyngeal incompetence, and the extent. Aerodynamic (pressure-flow) techniques now in use at our clinic were described, which permit objective evaluation of the degree of velopharyngeal incompetence. For the factor analysis of velopharyngeal incompetence, new X-ray techniques-cineradiography of the lateral pharyngeal wall movement and objective evaluation of velar mobility by double exposure technique were found to be of clinical value.On the basis of pre- and postoperative findings of 30 pharyngeal flap cases, the followings were emphasized. 1.Speech results after pharyngeal flap depend not only on the surgery but also greatly on the other factors such as faulty habits of articulation.2.The flap operation should be performed before 10, or at latest before 15 years of age.3.If a patient with velopharyngeal incompetence has no faulty habits of articulation, speech should generally be improved to an acceptable level by pharyngeal flap operation.ZusammenfassunqDie Indikation für die Pharynxlappenoperation ist teilweise von folgenden drei Gesichtspunkten diskutiert werden: Krankheiten und Faktoren, die verantwortlich sind für die Gaumensegelschwäche und deren Ausdehnung. Aerodynamische, jetzt in unserer Klinik gebräuchliche Techniken, die eine objektive Bestimmung des Grades der Gaumensegelinsuffizienz ermöglichen, werden beschrieben. Für die Faktoranalyse der Gaumensegelschwache fanden wir, daß neue Röntgentechniken wie Röntgenkinematographie der Bewegung der lateralen Pharynxwand und objektive Ausmessung der Gaumensegelbeweglichkeit durch Doppelbelichtung von klinischem Wert sind.Aus der Grundlage von prä und postoperativen Befunden von 30 Pharynxlappenfällen wird folgendes betont: 1.Das Sprachresultat hängt nicht allein vom chirurgischen Eingriff ab, sondern auch weitgehend von anderen Faktoren, wie dem Charakter des Sprachfehlers.2.Die Operation sollte möglichst vor dem 10. Lebensjahr, jedenfalls aber vor dem 15. Lebensjahr durchgeführt werden.3.Wenn ein Patient mit Gaumensegelschwäche keine fehlerhafte Sprachgewohnheit hat, wird die Sprache im allgemeinen zu einem akzeptablen Niveau durch die Operation verbessert.

Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients

BACKGROUND AND PURPOSE Intravenous nicardipine is generally used to treat hypertension in acute stroke patients but is associated with frequent phlebitis. We aimed to identify the incidence and risk factors of phlebitis in such patients. METHODS The incidence and risk factors of phlebitis were investigated in 358 acute stroke patients from July 2014 to June 2015. RESULTS In total, 138 patients received intravenous nicardipine. Of 45 (12.6%) phlebitis patients in 358 acute stroke patients, 42 (93.3%) were administered nicardipine, which was significantly associated with phlebitis occurrence (P < .01). Other candidate risk factors of phlebitis of acute stroke patients in univariate analysis were intracerebral hemorrhage (P < .01), nicardipine injection to paralyzed limbs (P = .023), dilution of nicardipine with normal saline (P < .01), higher maximum flow rate of nicardipine (7.2 ± 4.1 mg/h versus 1.6 ± 3.1 mg/h; P < .01), and higher maximum concentration of nicardipine (271.5 ± 145.0 µg/mL versus 37.6 ± 75.0 µg/mL; P < .01). The only statistically significant independent factor following multivariate logistic regression analysis, according to the optimal cutoff values defined from receiver operating characteristic curve analyses, was the maximum concentration of nicardipine greater than 130 µg/mL (OR 57.9; 95% CI 21.5-156; P < .01). A gradual decline of pH below 4.3 was observed when the concentration of nicardipine solution increased to greater than or equal to 130 µg/mL in vitro. CONCLUSIONS Nicardipine-related phlebitis is frequently observed in acute stroke patients and is significantly associated with administration of a maximum concentration of nicardipine greater than 130 µg/mL.