Sachiko Tomioka

Bone destruction due to the rupture of a cholesteatoma sac. A pathogenesis of bone destruction in aural cholesteatoma

Severe bone destruction in a cholesteatoma is one of the characteristic clinical features. To clarify the mechanism of bone destruction in cholesteatoma, the matrix of cholesteatoma and the attached bone, obtained during middle ear surgery, was observed by light microscope. Rupture of the epithelial lining in a cholesteatoma and the escaping contents (keratin), which gave rise to intense characteristic granulations in subepithelial tissue, were found. Furthermore bone destruction was always found at the site of subepithelial tissue of cholesteatoma. From these facts, the escape of contents from the sac of cholesteatoma into the subepithelial layer is considered to be an important factor in the mechanism of bone destruction.

Organic Acids and Anaerobic Microorganisms in the Contents of the Cholesteatoma SAC

Organic acids in the contents of the cholesteatoma sac from 28 cases were studied by gas chromatographic technique. Five volatile fatty acids (acetate, propionate, isobutyrate, butyrate and isovalerate) and lactate were detected in large amounts, which may lower the pH of the cholesteatoma content. These acids were considered to be derived from products of anaerobic microorganisms. Therefore, the contents from 12 cases were cultured anaerobically in a glove box. Obligate microorganisms were identified in 92% of the cases and Peptococcus, Bacteroides, and Clostridium species were frequently isolated. In vitro, such obligate anaerobes produced various organic acids from the cholesteatoma content. Facultatives such as Staphylococcus aureus and Proteus mirabilis produced acetate in the content under aerobic and anaerobic conditions, whereas no organic acid was produced by Pseudomonas aeruginosa. Organic acids in the cholesteatoma content could be fermentative products made by the microorganisms, anaerobes and facultatives, which use the content as a substrate for acid production.

ABR Audiometry in the Diagnosis of Cerebellopontine Angle Tumors

Auditory brain-stem responses (ABR) examination with simultaneous lobe-vertex (L-V) and membrane-vertex cm-v) recording was performed in 34 ears with cerebellopontine angle tumors. The detectability of wave I was better in M-V recording than in L-V recording, whereas L-V recording exhibited better detectability of wave V. ABR waveforms were classified into three groups, and the relations between the waveforms and the size of tumor or the degree of hearing loss were analyzed. Positive finding in ABR were obtained in 25 out of 34 ears in the present study. It was stressed that this dual recording in ABR was extremely useful in the diagnosis of cerebellopontine angle tumors.

Foreign bodies in the tracheobronchial tree

ZusammenfassungZwischen 1966 und 1974 wurden 110 Fremdkörper im Tracheo-Bronchialbaum unter Allgemeinnarkose und Beatmungsbronchoskopie entfernt. Die Methode hat sich auch bei Kindern bewährt. Bei der Hälfte der Fälle handelt es sich um Erdnüsse. Die Fremdkörper fanden sich vorwiegend im rechten Hauptbronchus. Nur bei Kindern unter sechs Jahren war der linke Hauptbronchus bevorzugt.SummaryDuring the period from 1966 to 1974, 110 cases of foreign bodies in the tracheobronchial tree were treated in our clinic using the ventilation bronchoscope under general anesthesia, and good results were obtained. Upon reviewing the case records, the ventilation bronchoscope was evaluated to be safe even for infants.Of the 110 cases, male predominance was 2 to 1, and 76 infants were under 3 years of age. Although, various types of foreign bodies were removed, almost half of the cases involved peanuts. Generally, the right bronchus was obstructed more frequently than the left. However, in children under 6 years of age, this tendency was inverted especially in 53 cases involving peanuts. The relationships between the age factor and the location of the foreign bodies are discussed.

Study of a simultaneous lobe-vertex and membrane-vertex recording technique in auditory brainstem response.

The study of a simultaneous lobe-vertex and membrane-vertex recording in auditory brainstem response was performed in normal adults and in patients suffering from brainstem disorders. It was demonstrated that in normal subjects the detectability of waves I and V depends on the site of the recording electrodes and there is no statistical difference between the two recording methods in the latencies of the two waves. We reported 3 typical cases that illustrate the value of this recording method in the detection of the cochlear nerve or the brainstem disorders.