Tetsuo Takahara

A method for the histopathological analysis of the temporal bone and the eustachian tube and its accessory structures.

A very important contribution to the study of otitis media, one of the diseases most often seen in pediatric patients, is the collection processing, and study of the specimens of the temporal bone and the entire eustachian tube. During the last few years, we have collected, processed, and studied 100 such specimens, and through these experiences our technique has become refined. We now have some important suggestions for otologists interested in the histological study of otitis media as well as in the pathology of the eustachian tube and its relation to middle ear abnormalities. This report details the most successful method for the study of eustachian tube abnormalities and their relationship to middle ear effusion.

Lymphoma Invading the Anterior Eustachian Tube Temporal Bone Histopathology of Functional Tubal Obstruction

The temporal bones of a man with poorly differentiated lymphocytic lymphoma, who had had a bilateral conductive hearing loss and incomplete left-sided facial palsy, were obtained. Sections were prepared for histologic study by staining with hematoxylin and eosin and were examined under the light microscope. The left temporal bone showed marked tumor cell involvement, not only of the lateral part of the cartilaginous portion of the eustachian tube (ET) where the tensor veli palatini muscle had been partially destroyed, but also in the anterior part of the temporal bone. A serous middle ear effusion was present, but the lumen of the ET was unaffected by tumor or inflammation. The pathological findings in the right temporal bone were similar to those in the left, although the cartilaginous part of the ET and its surrounding structures were not available for study. The pathogenesis of otitis media with effusion appeared to be secondary to functional ET obstruction, due to the dysfunction of the tensor veli palatini muscle as a result of the tumor destruction. This case is the first to be reported in which functional ET obstruction, secondary to tumor invasion of the active muscle dilator of the ET, has been histologically confirmed.

Radiochemotherapy for non‐Hodgkin's lymphoma in palatine tonsil

From January 1966 to December 1980, 367 cases of non‐Hodgkins lymphoma (NHL) were autopsied at Kobe University Hospital. The rate of extranodular type was 76.7% and the most common site of origin was the palatine tonsil. Of 133 patients with NHL in the palatine tonsil, at the Kobe University Hospital 110 were treated. All of the patients were treated by irradiation. Sixty‐one patients were treated by irradiation alone. Forty‐nine patients were treated in addition with conventional chemotherapy using vincristine, cyclophosphamide, endoxan a, and prednisolone. In 14 of 49 patients, adjuvant immunochemotherapy using a Streptococcus pyogenes (OK‐432) was added at maintenance dose in combination with induction radiochemotherapy. The survival curve of the patients treated by radiochemotherapy is better than that of the patients treated by irradiation alone. The survival rates at 0 to 1, 1 to 2, and 2 to 3 years for the patients treated by radiochemotherapy were 81.5, 66.3, and 59.0%, respectively, significantly higher than those of the radiotherapy group. The 5‐year survival rates of the radiotherapy group were 50.2% for Stage I and 26.5% for Stage II patients. The rates increased to 78% and 41.8% by radiochemotherapy. The extranodal NHL of Stage II also frequently develops into the advanced stage and adjuvant chemotherapy is necessary for such patients.

Frequency and localization of congenital anomalies of the middle and inner ears: a human temporal bone histopathological study

This study investigated congenital anomalies occurring in the middle and the inner ears, with particular attention to their features, localizations, and frequencies. One hundred human temporal bones obtained from 73 individuals, aged 31 gestational weeks to 39 years, each of whom had anomalies of the middle ear and/or inner ear, were used for this study. The temporal bones had been removed at autopsy, fixed, dehydrated, embedded in celloidin, and sectioned horizontally or vertically at 20 microns. Every 10th horizontal section or every 20th vertical section was stained with hematoxylin and eosin, mounted and studied under a light microscope. In the middle ear the structure most often found to be anomalous was the facial nerve; in the inner ear it was the lateral semicircular canal. The implications of the anomalies observed are discussed as they relate to fetal development, dysfunction of the ear, and clinical interpretation of diagnostic radiological studies.

Medical Treatment of Bell's Palsy

Infusion therapy using low-molecular dextran in combination with high-dose cortisone was modified from Stennerts original protocol and indicated in 50 cases of Bells palsy. The effects of infusion were compared with the outcome in 36 cases treated by orally-administered steroids and vasodilators. In the case of incomplete palsy, the recovery rate was excellent regardless of the mode of treatment. If the palsy is not progressive, it is not necessary for patients with this condition to have infusion therapy. In the case of complete palsy, 95% of those with normal nerve excitability (NE) experienced complete recovery when treated by infusion. However, only 71% of this group experienced complete recovery when treated with oral administration. In the group with diminished or absent NE, complete recovery was obtained in 58% of the patients treated with infusion, whereas only 18% recovered completely when given oral administration. Thus, the recovery rate increased sharply in the case of infusion therapy. Therefore, the above-mentioned method of infusion therapy is indicated in cases of complete or progressively incomplete Bells palsy except in those cases where its use is contra-indicated for some other reason.

Metastatic Squamous Cell Carcinoma in the Neck Invading the Facial Canal —A Case Report—*

The results of histopathologic examination of the temporal bone of a 71-year-old woman with squamous cell carcinoma of the tonsil and ipsilateral facial palsy are presented. The right temporal bone was directly involved by metastatic spread of the primary lesion to the right upper cervical lymph nodes. Tumor cells had invaded the canal of the facial nerve, the chorda tympani nerve, and the stapedius muscle, as well as the air cells in the mastoid region. However, although tumor cells had infiltrated the facial canal to a considerable distance from the metastatic tumor mass, the facial nerve had not been infiltrated. Slight degeneration of the facial nerve, however, was observed and appeared to have been caused by compression by the tumor.

SEVENTEEN YEAR'S EXPERIENCE IN THE TREATMENT OF CARCINOMA OF THE MOBILE TONGUE

Two hundred and forty-two patients with squamous cell carcinoma of the mobile tongue were reviewed. Most of them were initially treated by irradiation and then treated surgically for salvage. Cervical node metastases were frequently developed during or after the initial therapy. The patients in the advanced stage showed poor prognosis due to uncontrolled cervical node metastases and/or local recurrence. In the patients with no initial cervical node involvement, better local control and less frequent incidence of subsequently developed cervical node metastases were observed in the group treated by surgery than in those treated by irradiation. In the patients with initial cervical node involvement, no significant difference was noted in the survival yielded by either treatment modality. In advanced carcinoma, combined treatment with radiotherapy and surgical therapy seemed to give better results than with either radiotherapy or surgical therapy alone in this study.

Primary tuberculosis of the nasal cavity

A woman, aged 43, came to the out-patient department complaining of progressive right nasal obstruction and epistaxis. Nasal examination showed granulomas with crusts in the bilateral Kiesselbach areas and anterior end of the right inferior turbinate. We took this tissue for biopsy, and sections showed tuberculosis of the nasal mucosa.She had no past history of pulmonary tuberculosis and X-rays of the chest and sinuses were reported normal. Whole-body examination showed no other suspected tuberculous focus. She was cured by general chemotherapy only using streptomycin, INAH and RFP. She has been followed up for the past two years and is symptom-free, with no local or general signs of recurrence.

The effectiveness of combination therapy (irradiation and chemotherapy) for malignant lymphoma in the palatine tonsill

1. 口蓋扁桃悪性リンパ腫の放射線単独治療群の1年から4年までの生存率は, 64%, 47%, 36%, 34%であったが, 放射線化学療法併用群では82%, 66%, 60%, 49%と生存曲線は有意に上昇が認められた.2. 実測生存率による0～1年, 2～3年で放化群の生存率が有意に高かった.3. Stage I では放単群と放化群の生存率に有意差を認めなかった.4. Stage II では0～1年, 2～3年の観察期間で放化群の生存率は放単群に比較して, 有意に高かった.5. Stae III, IVでも放化群の生存期間の延長が認められた.6. Lucus-Collins の分類では Non-T Non-B の生存率が最も良く B-cell lymphoma, T-cell lymphoma でも他領域の悪性リンパ腫に比較して予後は良好であった.