Helical CT scanning of laryngeal deviation.

OBJECTIVE: To evaluate helical computed tomography (CT) scanning in patients with laryngeal deviation. MATERIALS AND METHODS: Five patients with laryngeal deviation and three control subjects underwent helical CT. The laryngeal deviation was idiopathic in one patient and acquired in four. Three-dimensional (3D) images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial images were reconstructed for assessment. RESULTS: The thyroid cartilage was inclined and twisted to the right in three patients, inclined to the right and twisted to the left in one patient, and inclined to the left and twisted to the right in one patient. The infero-posterior part of the thyroid cartilage, and the cricoid and arytenoid cartilages were shifted to the left in four patients. The vocal cords were at the level of C4 approximately C4/C5 in two patients, C4/C5 in one, C4/C5 approximately C5 in one, and C5 approximately C5/C6 in one. In four patients, inclination of the laryngeal cavity to the right may have induced left false vocal cord protrusion. The levels of the two false vocal cords differed in all patients. When the inclination and twisting were corrected on the computer, 3D images of the laryngeal cartilages of the patients became almost the same as those of the control subjects, except for slight deformity of the thyroid cartilage. The width of the right and left thyroid alae was measured on the computer, and was almost equal in all patients. 3D airway surface models of the left hemilarynx resembled those of the right hemilarynx when the angle of view was changed on the computer. CONCLUSION: Three-dimensional images of the laryngeal cartilages and bones, 3D airway surface models, and sequential coronal and axial CT scans were obtained using helical CT. This method allows the 3D observation of laryngeal deviation, and viewing of images from various directions on the computer was useful to understand the characteristics of laryngeal deviation.

Immunocytochemical distribution of the c-H-ras protein in nasal polyps: localization to the terminal bars.

OBJECTIVE: This study was performed to investigate the role of proto-oncogene products, c-H-ras and c-erbB-2, in the pathophysiology of nasal polyps. METHODS: An immunocytochemical investigation of the expression of proto-oncogene products of c-H-ras and c-erbB-2 was performed on 16 nasal polyps and 15 nasal mucosa specimens. RESULTS: The c-H-ras protein was found to be localized to the terminal bars of apical cells of the epithelium in 11 of 16 nasal polyps and in seven of 15 nasal mucosa. Localized staining at the terminal bars for the c-H-ras protein was significantly more frequently observed in glandular-cystic type than in edematous type nasal polyps. Such localized staining was significantly more frequently seen in polyp specimens with invaginated epithelia than in those with no invaginated epithelium. Our findings confirmed that the c-erbB-2 protein was mainly localized to the plasma membrane in all samples. CONCLUSION: These results suggest that the c-H-ras protein localized to the terminal bars plays an important role in the pathophysiology of glandular-cystic type nasal polyps and that it may be related to invagination of nasal polyp epithelium.

Inflammatory cells in nasal mucosa and nasal polyps.

OBJECTIVE: Since some controversy exists concerning the frequency of inflammatory cells in nasal polyps, we have compared the frequency of tissue inflammatory cells (lymphocytes, neutrophils, eosinophils and plasma cells) including 11 kinds of lymphocyte subsets in the same specimens of nasal mucosa and nasal polyps. METHODS: Histopathological observations and flow cytometric analyses were performed on eight mucosal specimens of the inferior turbinates of patients with nasal polyps and on 13 polyp specimens. RESULTS: Nasal polyps contained significantly more eosinophils, neutrophils and plasma cells than nasal mucosa, and EG2+ cells (activated eosinophils) were significantly more frequent in nasal polyps than in nasal mucosa. Flow cytometric analysis showed that there were no significant differences in the frequencies of lymphocytes and lymphocyte subsets (CD1+, CD2+, CD3+, CD5+, CD7+, CD4+, CD8+, CD10+, CD19+, CD20+ and HLA-DR+ cells) including CD4/8 ratios between nasal mucosa and polyps, though, both nasal mucosa and polyps contained significantly more lymphocytes than eosinophils, neutrophils or plasma cells. The T cell lineage (CD2+, CD3+, CD5+ and CD7+ cells) was found in high frequency and B cell lineage (CD10+, CD19+ and CD20+ cells) in low frequency in both nasal mucosa and polyps. The frequency of HLA-DR+ cells (most of which were activated T cells) was not significantly different between nasal mucosa and nasal polyps. CONCLUSION: Histopathological and flow cytometric analyses were performed on the composition of inflammatory cells in nasal mucosa of the inferior turbinates and in polyps from the same patients. The elevated numbers of activated eosinophils, neutrophils and plasma cells in nasal polyps compared with nasal mucosa suggest that inflammatory processes play important roles in the pathophysiology of nasal polyps. The frequencies of lymphocytes and lymphocyte subsets were not significantly different between these two tissues.

A case of multiple symmetrical lipomatosis (Madelung's disease).

Multiple symmetrical lipomatosis (Madelung's disease) is a rare disease with multiple symmetrical unencapsulated fatty accumulation diffusely involving the neck, the shoulders and the upper extremities (Kohan et al. Otolaryngol. Head Neck Surg. 1993;108:156-159). We describe a 48-year-old Japanese man with a history of alcoholism and liver cirrhosis who reported gradually enlarging masses in his cervical region for 4 years. MRI revealed large masses suggesting lipomas in the neck. The patient underwent a two-stage lipectomy. This patient is the 13th case reported in Japan since 1978, though over 200 cases have been reported since 1846 in Europe, most of them from the Mediterranean (Kitano et al. ORL 1994;56:177 180; Kaku et al. Endocrinol. Diabetol. 1997;4:103-106).

Arterial blood gas abnormalities in patients with dizziness.

Arterial blood gases were analyzed in 121 patients with dizziness. Sixty-one showed arterial blood gas abnormalities in the dizziness period. An increase in bicarbonate was seen in 57, increases in both bicarbonate and arterial carbon dioxide pressure in 8, and a low arterial oxygen pressure in 22 patients. The frequency of the abnormalities was significantly higher in those with central-peripheral diseases than in those with Meniere's disease. Arterial blood gases were also checked at random in the remission period in 22 patients. The frequency of dizziness recurrence was significantly higher in patients with the abnormalities in the remission period than in patients without them. These results indicate that approximately half of the patients with dizziness tend to have arterial blood gas abnormalities in the dizziness period. It is suggested that arterial blood gas abnormalities cause temporary vestibular dehabituation that increases the frequency of dizziness in central-peripheral diseases and Meniere's disease.

On the frequency of thyroid diseases in outpatients in an ENT clinic.

The prevalence of thyroid diseases was studied in the ENT department of Kobe Teishin Hospital. Between January 1990 and June 1994, 6,348 outpatients (3,004 women and 3,344 men) visited the ENT department with problems of ear, nose, and throat. Among them 114 patients (82 women and 32 men) were revealed to have thyroid diseases (1.8%). The prevalence of thyroid diseases increased in patients over the age of 40 (4.6% for 40-80 year aged women, 1.6% for 40-80 year aged men). The male/female ratio was about 1:2.7. There was no subjective symptom in 86.8% of the patients. The prevalence of Hashimoto's thyroiditis was 53.5%, nontoxic diffuse goiter 16.7%, cyst(s) 8.8%, adenoma 7.0%, nontoxic nodular goiter 4.4%, subacute thyroiditis or acute exacerbation of Hashimoto's thyroiditis 4.4%, Graves' disease 1.8%, thyroid carcinoma 1.8%, adenomatous goiter 0.8%, and primary hypothyroidism 0.8%. Visible goiter was observed in only 5 patients and 93% of the patients had palpable but not visible thyroids. Therefore, it is important to palpate the thyroid gland during examination of the neck not only in women but also in men. Hashimoto's thyroiditis is thought to be increasing in frequency and is becoming a more important disease in the ENT clinic.

Effect of experimental acidosis on nystagmus in rabbits.

Vertigo related to acidosis in Meniere's disease has been reported. This study was undertaken to ascertain whether acidosis has any effect on vertigo. Since patients with Meniere's disease usually show unilateral vestibular dysfunction, unilateral intratympanic injection of streptomycin sulfate (SM) was used to induce unilateral vestibular dysfunction in rabbits. Intratympanic SM injections induced vestibular destruction and elicited severe spontaneous nystagmus and ataxia. Then symptoms of acute vestibular upset gradually subsided and eventually disappeared completely. Three weeks after SM injections, in compensated rabbits, NH4Cl injection or CO2 inhalation was used to induce acidosis. Intravenous NH4Cl injection or CO2 inhalation induced nystagmus and ataxia again. In normal rabbits, no nystagmus was induced by NH4Cl injection or by CO2 inhalation. These results suggest that acidosis might be a cause of recurrence of vertigo in patients with unilateral vestibular dysfunction.

The influence of daily electrical stimulation of the amygdala on optokinetic nystagmus in rabbits.

To clarify the role of the amygdala in optokinetic nystagmus (OKN), the following experiment was carried out. Electrical stimulation, using 0.1-ms, 200-Hz pulse waves of 100 microA over a 30-s period, was performed once daily for 10 days to the amygdala of rabbits (medial or lateral area). Daily electrical stimulation of the medial area of the amygdala caused a significant increase of OKN frequency in rabbits.

Use of micro-sliced homograft cartilage plates in tympanoplasty.

We described our experiences in the use of micro-sliced septal cartilage homografts in tympanoplasty. The cartilage plates (0.1-0.5 mm thick) previously prepared with our method by use of a dermatome were used for the three purposes 1) to reconstruct the attic wall defect, 2) to prevent the retraction of the grafted fascia in myringoplasty, and 3) to prevent the displacement of the columella and the retraction of the grafted fascia in columella-type tympanoplasty. There have been no postoperative infections or extrusions in our 142 cases. These cartilage plates are considered to be very convenient in tympanoplasty.

Clinical evaluation of a knee-ankle-foot-orthosis for hemiplegic patients.

The KAFO described provides hemiplegics with effective and dynamic ambulation, because of its light weight, easy application, reasonably located genucentric knee and ankle joints, together with the flexibility of thigh and lower leg cuffs and arch support. The flexibility of this orthosis permits proper torsion of thigh and lower leg cuff. After application of the KAFO, hemiplegics become able to extend or flex their hip or knee joints in a wide range of motion. As the result of these characteristics, hemiplegics can ambulate smoothly and effectively in the KAFO as described in the results and practical investigations.