Yasushi Matsumoto

Cholesteatoma in the petrous apex

Six patients with extensive cholesteatoma in the petrous pyramid are reported. All patients had a facial palsy of long duration. In five patients with a history of otitis media, radiographic examinations and surgical explorations revealed chronic inflammatory changes in the middle ear, which suggested that the cholesteatoma in the petrous pyramid was associated with a preceding otitis media. Only in one patient, without a past history of otitis media, was the cholesteatoma assumed to be of congenital origin. The cholesteatoma was totally removed in five patients using a translabyrinthine approach and in one by a middle cranial fossa approach. Control of middle ear infection, obliteration of the mastoid petrosal cavity, and facial nerve repair were supplementary but significant surgical problems.

A fatal case of fungal endocarditis of the tricuspid valve associated with long-term venous catheterization and treatment with antibiotics in a patient with a history of alcohol abuse

We report a fatal case of fungal (candidal) endocarditis of the tricuspid valve with clinico-pathologically interesting findings following and associated with candidal pneumonia during long-term central venous catheterization (CVC) for intravenous therapy and long-term treatment with antibiotics for bacterial and fungal infection in a patient with a history of alcohol abuse. We review the literature on fungal cardiac infection related to long-term catheterization and alcohol abuse, and discuss the pathogenesis.

A case of Ehlers-Danlos syndrome associated with cleft lip and palate.

A case of the Ehlers-Danlos syndrome associated with cleft lip and palate is presented. This is the first reported case with cleft lip and palate. The cleft palate in our case was successfully repaired by palatoplasty (push-back operation). The aetiology, clinical features and surgical problems of this syndrome are discussed.

Gadolinium·DTPA·Enhanced MRI in Facial Palsy

We evaluated the specificity of facial nerve enhancement on magnetic resonance imaging (MRI) using contrast agent gadolinium-DTPA (Gd-DTPA) for the diagnosis of facial nerve lesions.

Gadolinium-enhanced MR imaging in Bell's palsy. A preliminary report.

We carried out magnetic resonance imaging (MRJ) in 3 cases of Bells palsy. Case 1 was a 43 y. o. male, case 2 was a 21 y. o. female and case 3 was a 64 y. o. male. The diagnosis was in complete: Bells palsy. Tl-weighted images (TR500/TE25-33) were taken before and after the intravenous administration of Gd-DTPA (0.1mmol/kg) using 0.5 Tesla superconductive type MRI 3, 8, and 11 days respectively after the onset. In the ipsilateral intratemporal facial nerve, enhancement of signalintensity was seen in the geniculate ganglion in casel, in the mastoid portion in case 2, and in the labyrinthine portion and geniculate ganglion in case 3. The possibility of imaging the facial nerve in Bells palsy was demonstrated, and the diagnostic significance of Gd-enhanced MRI was discussed in this preliminary investigation.

Acoustic tumors; Gadolinium-DTPA enhancement in MR imaging.

Magnetic resonance imaging (MRI) was performed in 21 patients with clinical and histologic diagnoses of acoustic tumor with 0.15 Tesla and 0.5 Tesla whole body image scanner (Hitachi G-10, G-50). Eleven patients were evaluated by MRI before and after an intravenous injection of 0.1mmol/kg of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA). Contrast enhancement was seen in all cases. The degree of enhancement was greater with T-1 weighed images such as saturation-recovery (500/20-30) and inversion-recovery (2000/500/20) than with T-2 weighed images such as spin-echo (2000/20-60) sequences. The differentiation of tumor parenchyma from the cystic portion is easier with Gd-DTPA enhancement. After enhancement there was a reduction of measured T-1 value in all measured cases while no significant change was seen in T-2 value. No short time side effects were encountered and no significant change was seen in blood urea, creatinine, electrolytes, liver function tests, blood coagulation or urinalysis after injection of Gd-DTPA. Although much more work will be required to evaluate this contrast agent, Gd-DTPA is a promising MRI contrast enhancer for the clinical assessment of acoustic tumor.

Hyperacusis in Bell's palsy.

It has been generally accepted that stapedial muscle dysfunction is the cause of hyperacusis in Bells palsy. However, the acoustically evoked stapedial reflex (AR) revealed by the tympanometric test is not always negative in patients with hyperacusis. The AR was negative in 64.7% of our 278 patients with Bells palsy of recent onset, while only 19.1% complained of hyperacusis. In order to explain this discrepancy, the auditory tests, Bekesy audiometry, ABLB, SISI test and ABR, were carried out in 13 selected patients. No evidence of retrocochlear disturbance was found.Although the underlying pathophysiological mechanism of hyperacusis has remained uncertain, we could not exclude the possibility of a false negative AR measured by conventional tympanometry or the contribution of tensor tympani muscle function when hyperacusis and AR results are contradictory.