Naoya Takeda

Clinical Studies on Roxithromycin Treatment of Chronic Sinusitis.

Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.

Clinical Study of Laryngeal Cancer

One hundred and nine cases of laryngeal cancer were treated between 1987 and 1997 in the Department of Otorhinolalyngology at Obihiro Kousei Hospital. The average age of the patients was 65. 4 years old, and the male to female ratio was 21: 1. Based on histopathological diagnosis, 108 cases were reported as squamous cell carcinoma and one case was reported as spindle cell carcinoma. There were 15 cases of supraglottic carcinoma, 91 cases of glottic carcinoma and 3 cases of subglottic carcinoma. There were 33 cases in stage I , 35 cases in stage II, 22 cases in stage III and 19 cases in stage J Y. The five-year survival rates of the patients for stages I to IV were 100%, 90%, 66% and 65% respectively.

Two Cases of Hemangioma in the Nasal Cavity with Preoperative Embolization

Embolization was performed in two cases of angioma in the nasal cavity prior to surgery in order to minimize the amount of bleeding. In case 1, the injected embolizing substance (Ivalon) was insufficient, because the amount of bleeding during surgery was as much as 500 ml. Higher dosage of injected substance, however, sometimes leads to less bleeding and higher risk of complication. Since the optimum amount of injected substance has not been discussed further investigation of the standard injectable level should be carried out. In case 2, the amount of bleeding was very little. Thus, embolization is useful as a method of peroperative blood loss prophylaxis in some cases.

The Efficacy of Hemitonsillectomy and Adenotomy in Treatment of Upper Airway Obstruction in Children

Adenotonsillectomy is frequently performed on children with upper airway obstruction, since the most common cause is adenotonsillar hypertrophy. Removal of a minimal amount of tonsil tissue may be immunologically better, however, removal of a wider area may be necessary to enlarge the airway sufficiently. Based on the foregoing, removal of the palatine tonsil on only one side and adenotomy (hemitonsillectomy and adenotomy: HTA) was performed in 6 cases of upper airway obstruction in patients under 5 years old. Five of these cases underwent nocternal polygraphic recordings before and one week after HTA. Airflow, thoracic movement, mesopharyngeal pressure and oxygen saturation were simultaneously monitored and the following results were obtained: the maximum amplitude of mesopharyngeal pressure remarkably decreased, and the minimum oxygen saturation increased to a normal range postoperatively. Although all cases had good long term courses, two, both 5 years old, complained of snoring and sleep apnea again 30 or 37 months after HTA. On physical examination, the remaining palatine tonsils had hypertrophied while pharyngeal lymph follicles had not hypertrophied. Funnel chest, which had been observed in one of the 2 cases before HTA, had already completely disappeared. On polysomnographic examination, recurrence of upper airway obstruction was demonstrated. The remaining palatine tonsils were removed and thereafter the 2 cases improved both clinically and on the polygraphic test. The remaining 4 cases were investigated by questionnaires, which showed that they had no recurrence 5 to 39 months postoperatively. Pigeon chest, which had been observed in one of the 4 cases before HTA, had slightly improved. These results suggest that HTA is valuable for preservation of immunological function,