Masaru Shirato

Computer Analyses of Rohrer's Coefficients

In the field of respiratory physiology computers have been used for theoretical and automatic analyses of the test results. The purpose of this paper is to clarify whether computers are available in measurement of the nasal resistance. The nasal cavities, simulated by an acryl resin model, were ventilated at various volumes and speeds. The pressure and flow changes were recorded by a data recorder and analyzed by a minicomputer according to the prescribed situations. Rohrers formula P = K1V+K2V2 and its modification R = K1+K2V were used for calculation of K1 and K2. The calculated values differed significantly when sampling was made on a particular part of the respiratory excursion or sampling time was extraordinarily prolonged. They were also different from the ordinary values when too slow or too rapid ventilatory speed was applied. It was concluded that more than twenty samplings were necessary at regular intervals in a normal inspiratory or expiratory phase. Too slow and too rapid respiration should be avoided because of functional limitations of the measuring apparatus.

Chondrosarcoma of the Larynx; A Case Report.

A 65-year-old female had complained of hoarseness and malaise in the larynx for two years. Indirect laryngoscopic examination revealed a lightgrey mass in the right posterior part of the subglottic area. Vocal cord movement was good bilaterally. Cervical lymph nodes were not palpable. Excision of the mass was carried out by a laryngofissure approach. The mass arose from the right posterior lamina of the cricoid cartilage. A cricoid cartilage defect extending for about half its circumference was reconstructed with the use of costal cartilage. Histopathological examination showed low-grade chondrosarcoma. Postoperative laryngeal collapse or stenosis were not found.

Treatment of postoperative hypoparathyroidism with activated vitamin D3.

We report here the effect of activated vitamin D3 (Vit. D3) in postoperative hypoparathyroidism. We performed 42 total thyroidectomies and 43 sub-total thyroidectomies from 1978 to 1989.Hypoparathyroidism occurred in 36 patients (85.7%) after total thyroidectomy and 5 (11.6%) after sub-total thyroidectomy. We treated 18 of these patients with Vit. D3 only (43.9%) and 21 with Vit. D3+calcium (51.2%) orally. Treatment with Vit. D3 only is easier and more useful than that with Vit. D3 + calcium in controlling the serum calcium level of patients with hypoparathyroidism.We should monitor not only the serum calcium level but also the serum albumin to determine the real serum calcium level.With Vit. D3, which we prescribed in doses of 0.5-6.0μg (mean: 2.47±1.45μg) per day, we could control the serum calcium level well in patients with postoperative hypoparatyroidism without a high calcium level in the urine.It is probably concluded that Vit. D3 treatment alone is adequate for postoperative hypoparathyroidism patients, who have normal calcium uptake from the digestive tract, and it is the easiest and safest way to control the serum calcium level.

Osteocalcin and multiple scanning X-ray photodensitometry (MD/MS) for postoperative hypoparathyroidism treated with vitamin D3.

In order to rule out low-grade osteoporosis in postoperative hypoparathyroidism patients treated with activated vitamin D3, we examined (1) the midportion of parathyroid hormone (M-PTH, relatively stable compared to other PTH), (2) osteocalcin (osteoblast producing Gla protein), (3) multiple scanning X-ray photodensitometry (MD/MS method, using X-ray film of secondary metacarpal bone with alminium steps).Sixteen patients were examined: 13 of a series of 45 who had had total thyroidectomy and 3 of a series of 49 who had had subtotal thyroidectomy. In spite of normal serum calcium levels, 9 patients were diagnosed as osteoporosis by the MD/MS methods. Increasing of the vitamin D3 dose reduced the lower-grade osteoporosis in these patients within 3-4 months.It is concluded that osteocalcin and the MD/MS methods are useful in demonstrating mild osteoporosis in patients with postoperative hypoparathyroidism, in spite of normal serum calcium levels. We can monitor the doses of vitamin D3 during long term therapy with the use of these examinations.

Adenocarcinoma of sublingual salivary gland; A case report.

A 40-year-old woman complained of a painless mass in the left side of the floor of the mouth. A 2×2cm round, smooth, nontender mass was palpable on the left side of the floor of the mouth; it was fixed to the symphysis of the mandible. No cervical lymph nodes were palpable. T2-weighted MRI scan of the tumor showed smooth margins and a heterogeneous signal. A contrast-enhanced CT scan showed a slightly enhanced mass lesion. Radionuclide scanning with 67Ga showed a hot tumor. Radiography revealed a malignant tumor originating in a minor salivary gland or a sublingual gland. Microscopic examination of the tumor showed adenocarcinoma.Radical neck dissection was combined with resection of the left side of the floor of the mouth and of the internal margin of the mandible. The surgical defect was reconstructed with a rectus abdominis musculocutaneous flap.Postoperative evaluation of mastication and articulation was good. The patient had no evidence of recurrence one year after surgery.

Correlation between nystagmus and body sway induced by caloric stimulation.

To clarify the difference between the vestibulo-ocular system and the vestibulospinal system, we analyzed the relationship between nystagmus and body sway induced by caloric stimulation. The subjects were 8 healthy males who were asked to maintain an upright standing position with eyes closed on the platform. Caloric stimulation was applied to the right ear with cold water (20°C). Eye movement was recorded by electronystagmography. Body sway was analyzed from the output of the X and Y axis components from the platform.1) Increase in the amplitude of body sway corresponded closely with nystagmus intensity during caloric stimulation.2) The parameters of left-right body sway were significantly positively correlated with the parameters of nystagmus.3) No difference was observed in the velocity of body sway in either axis.4) The directionality of body sway still remained after the caloric nystagmus had disappeared.These results indicate that unilateral caloric stimulation has two effects on body equilibrium. One is a direct stimulus of the labyrinth which induces postural deviation during caloric stimulation. The other is a disturbance of the postural control system which induces body oscillation. The latter effect persists even after caloric nystagmus has disappeared.

Postural Deviation Evoked by Caloric Stimulation During Upright Standing in Man

To understand a disequilibrium of the peripheral vestibular disorders, we tried to analyze the body sway evoked by unilateral or bilateral caloric stimulation with warm and cold water systematically. As for postural deviation, the results of our study are summarized as follows. Unilateral warm stimulation evokes heterolateral and anterior postural deviation. Unilateral cold stimulation evokes homolateral and anterior postural deviation. Bilateral warm stimulation evokes posterior postural deviation. Bilateral cold stimulation evokes anterior postural deviation. Therefore we consider that there are several patterns of static disequilibrium of upright posture in the peripheral vestibular disorders.