Tsuyoshi Yoshihiro

A case of bilateral eosinophilic granuloma in the temporal bone

We present a case of bilateral eosinophilic granuloma in the temporal bone in a 47-year-old woman, who visited our hospital with a headache and a feeling of occlusion in her left ear. Her left tympanic membrane was slightly turbid and pure tone audiometry revealed mild left sensorineural deafness. CT disclosed a shadow of soft tissue in the left mastoid antrum and mastoid cells, which was indicative of marked destruction of the bone. Because MRI findings led us to suspect otitis media cholesteatoma, a mastoidectomy was performed. The mastoid antrum and mastoid cells were filled with easily bleeding granulation, and there was a wide range of bone deficit in the posterior cranial fossa. Histopathologically, the granulation tissue was an eosinophilic granuloma. Her postoperative clinical progress was good and she was discharged. However 2 months after discharge, she had a feeling of occlusion in the right ear and CT revealed a shadow in the right mastoid antrum and cells. Therefore, right tympanoplasty was performed and the same findings as in the left ear were obtained. A histopathological diagnosis of eosinophilic granuloma was made again. To date, there has been no recurrence.

A Case of Cat Scratch Disease

We present a case of cat scratch disease. The patient was an 18 year-old female with no history of cat scratches, although she kept five cats. She noticed lymph node swelling in the right subparotid region. A malignant lymphoma was suspected, so the mass was surgically removed. Histopathologically, focal granulomatous lesions with necrosis were found in the subparotid lymph node. The necrosis was surrounded by a layer of epithelioid cells. The diagnosis of cat scratch disease was made on the basis of the clinical and histopathological features.

Congenital Cytomegalovirus Infection and Sensorineural Hearing Loss

Cytomegalovirus (CMV) is the most common cause of congenital viral infection with a reported incidence of 0.29-0.42% of live births. Bilateral and unilateral sensorineural hearing loss of varying degrees has been reported in children with symotomatic and asymptomatic congenital CMV infections. In this paper, case studies from three infants with hearing impairments diagnosed by pediatricians as symptomatic congenital CMV infections are reported. The follow-up hearing assessments were performed by ABR and pure tone audiography. According to their ABR thresholds, the three cases had severe, severe and moderate bilateral sensorineural hearing impairment, respectively. We administered acyclovir and anti-CMV r-globlin, and the ABR thresholds of all three cases improved. However, in two cases, delayed progressive hearing loss and vestibular impairment were found.

Parapharyngeal Space Tumors; A Clinical Study of 7 Cases.

A 67-year-old man was admitted to our hospital because of general fatigue and pancytopenia. The patient had a past history of total laryngectomy for cancer of the larynx at age 64. Following that operation Tegaful 642.0g was administered for about three years. Hematological examinations revealed a hemoglobin of 7.6 g/dl, a white cell count of 2300/μl, and a platelet count of 34000/μl. A diagnosis of myelodysplastic syndrome (RAEB-t) was made from bone marrow, which contained myeloblasts and atypical cells, and peripheral blood cells (65%). A chromosomal banding study of the bone marrow cells was normal. We speculated that the preceding adjuvant chemotherapy was probably related to the occurrence of myelodysplastic syndrome.

Myelodysplastic Syndrome Occurring after Adjuvant Chemotherapy for Laryngeal Cancer.

A 67-year-old man was admitted to our hospital because of general fatigue and pancytopenia. The patient had a past history of total laryngectomy for cancer of the larynx at age 64. Following that operation Tegaful 642.0g was administered for about three years. Hematological examinations revealed a hemoglobin of 7.6 g/dl, a white cell count of 2300/μl, and a platelet count of 34000/μl. A diagnosis of myelodysplastic syndrome (RAEB-t) was made from bone marrow, which contained myeloblasts and atypical cells, and peripheral blood cells (65%). A chromosomal banding study of the bone marrow cells was normal. We speculated that the preceding adjuvant chemotherapy was probably related to the occurrence of myelodysplastic syndrome.

Olfactory Neuroblastoma with Intracranial Invasion; A Case Report.

A 40-year-old female was operated on for nasal polyps, but the tumor had extended already into the cranial space. Olfactory neuroblastoma was diagnosed. After chemotherapy we conducted transnasal dissection for the skull base lesion and performed craniotomy for the intracranial one. Postoperative irradiation of 50 Gy was given. Although no local recurrence or distal metastasis has been continuing found during the four years since treatment, careful follow up is necessary because of the high rate of local recurrence.

Bacteriological Study and Observation by the Scanning Electron Microscope of the Tips of the Intraarterial Catheters

Bacteriological studies and observation by the scanning electron microscope of the tips of the intraarterial catheters were made on patients with malignancies of the head and neck who were treated by intraarterial injection. Seven of the 28 samples (25 %) were positive bacterial contamination, but no clinical symptoms of infection developed at all. There were two achromobacter xylosoxidans, 2 staphylococcus epidermidis, 2 propionibacterium acnes and one pseudomonas cepacia. Positive bacterial contamination (Pseudomonas cepacia) was seen in ony 1 of the 9 patients who were compelled to remove the intraarteral catheters. Scanning electron microscopic findings of the tips, and the inside catheters showed granular and fern-like materials, but none showed bacteria. Predominant peaks of Na, Cl, P, S levels were detected by an X-ray microanalyzer. In conclusion, no relationship was observed between the trouble of tubing and the bacterial contamination, but care should be paid to avoid the contamination.

A Case of Cholesteatoma Otitis with Vertigo

A case of cholesteatoma otitis with vertigo is reported. The direction of nystagmus was changed with the passage of days. Thus, the judgement of the semicircular canal condition is important to observe the nystagmus. Concerning hearing, its level decreased and improved. Infection might have affected the inner ear. After recovery of infection, its function recovered.