Tetsuzo Inouye

Effects of Head Rotation on Pharyngeal Function during Normal Swallow

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

Inhibition of head and neck metastatic and/or recurrent cancer by local administration of multi-cytokine inducer OK-432.

The multi-cytokine inducer OK-432 is a pulverized preparation of the low-virulence SU strain of Streptococcus pyogenes of human origin. A reduction of the tumour mass in the OK-432-injected areas was observed in 11 out of 13 patients with metastatic and/or recurrent head and neck cancer. Complete response (CR), partial response (PR) and minor response (MR) were noted in six, three and two cases respectively. OK-432 local administration therapy could create a new strategy for cancer therapy.

Experimental Cholesterol Granuloma Histopathological and histochemical studies

The authors have induced experimentally middle-ear effusions and cholesterol granulomas one month and later after tubal obstruction in squirrel monkeys. Cholesterol crystallization has occurred frequently in the middle-ear fluids of three-and six-month-animals, and, typical cholesterol granulomas were noted in four of the eight middle ears of six-month-monkeys. The shape and size of the cholesterol crystals were variable, depending upon the surrounding cells of fluid. In middle-ear effusion, the crystals formed rather large rectangular structures, which tended to become smaller and thinner, as the granulomas developed. The granuloma containing cholesterol crystals was rich in various oxidative and hydrolytic enzymes. The large cells surrounding the crystals show intense-to-strong enzyme activity and probably play a phagocytic role in the developing and healing processes of the granuloma.

Laser surgery for allergic and hypertrophic rhinitis.

Laser surgery, which is one type of surgical treatment for allergic and hypertrophic rhinitis, was investigated basically and clinically. The basic investigation showed morphological changes in the nasal mucosa before and after laser surgery. Before laser surgery, hyperplasia of the mucous epithelium, thickening of the basement membrane, edema of the lamina propria mucosa, eosinophilic infiltration, and enlargement of the nasal glands were noted. After laser surgery, the nasal mucosa was covered with 1) epithelium that was squamatized or cuboidal and/or 2) columnar epithelium that was stratified. Granulation-like tissue or cicatricial tissue was found in the lamina propria mucosa. Clinically, we performed laser surgery in 204 cases. Regarding the short-term results, laser surgery was effective in 87%. In the long term, the short-term results persisted in 81% of cases treated for sneezing, 78% for nasal discharge, and 76% for nasal obstruction. From these results, we concluded that laser surgery was a useful surgical treatment for allergic and hypertrophic rhinitis.

Laryngeal closure at the level of the false cord for the treatment of aspiration.

A new procedure for aspiration which closes the larynx at the level of the false cords is reported. This method is not harmful to the vocal folds and maintains arytenoid movement, thus preserving phonatory function. With the advance of the operative technique for aspiration and swallowing rehabilitation, patients who have recovered from aspiration can be helped. Our procedure can be recommended for such cases.

The fine surface view of the human adult eustachian tube

The distribution pattern of ciliated cells and goblet cells in the mucosa of the normal adult human eustachian tube has been determined by means of SEM. In general, the density of the ciliated cells decreased from the pharyngeal to the tympanic orifice, and from the tubal floor to its roof. Most ciliated cells possessed about 100-200 cilia, and the average length of the cilia was approximately 8 mu. It is interesting to note that their number and length had a tendency to diminish towards the tympanic orifice of the tube. The ciliated epithelial cells at the tubal floor and lower parts of the walls undoubtedly play an important part in providing an active mucociliary mechanism, as in other parts of the upper respiratory system.

Lymphangiectatic fibrous polyp of the palatine tonsil. A report of three cases.

Three cases of lymphangiectatic fibrous polyp of the palatine tonsil are reported. The polyp arose from the upper pole of the tonsil in two cases and from the middle-to-lower part in one case. They were all asymptomatic until the polyps grew larger. The polyps were removed, with or without the tonsil. The pertinent literature is reviewed.

Distinctive increases in HLA-DR+ and CD8+57+ lymphocyte subsets in Wegener's granulomatosis.

Lymphocyte subset abnormalities have been observed in a series of patients diagnosed with Wegeners granulomatosis (WG). Fifteen patients with WG were evaluated for lymphocyte subset abnormalities by two-color immunofluorescence flow cytometry. The WG group showed a decrease in CD4+ cells and an extraordinary increase in HLA-DR+ cells. The average percentages of HLA-DR+ cells of the normal group and WG group were 11.0 +/- 4.0 and 40.5 +/- 13.9% (CD3+HLA-DR+ = 20.3 + 9.4%). Within the CD8 family, CD8+57+, CD8+38+ and CD8+HLA-DR+ cells were markedly elevated. Our findings differ from other series which reported that the lymphocyte subsets in the peripheral blood of patients with WG were normal.

Primary Squamous Cell Carcinoma of the Middle Ear Invading the Cochlea A Histopathological Case Report

This report describes the histopathological changes in the temporal bone of a 71-year-old man who died of meningitis and epidural abscess complicated by primary squamous cell carcinoma of the middle ear. The present case is unusual and differs somewhat from previously reported cases of the primary squamous cell carcinoma of the middle ear in three respects: 1) an extensive invasion of the cancer into the membranous labyrinth, 2) cholesterol deposits in the cochlear spiral canal, and 3) presence of ossifying labyrinthitis. Among these findings, extensive involvement of the inner ear by cancer destroying the lower part of the otic capsule is particularly unusual. It is assumed that squamous cell carcinoma overcame the biological resistance to neoplastic infiltration which probably exists in the otic capsule and the membranous labyrinth.

Amelanotic Melanoma Metastatic to the Epiglottis

Metastasis of melanoma in the head and neck region is often reported but the report of amelanotic melanoma metastatic to the epiglottis is an extremely rare entity. This paper describes a patients previously treated for cutaneous amelanotic melanoma who developed metastatic tumour involving his epiglottis. This legion was successfully excised by a intra-oral approach combined with KTP/532 laser surgery. The paper also describes the diagnostic evaluation, management, operative technique and DNA analysis of this rare case.