Esophageal web in Plummer-Vinson syndrome.

In Plummer-Vinson syndrome, esophagography often reveals a web at the anterior wall of the cervical esophagus. The pathogenesis of the esophageal web and the cause of dysphagia in this syndrome were investigated radiographically, endoscopically, manometrically, and histologically. It was considered that the web seen in the esophagogram may have been formed due to the restriction of dilation of the esophageal wall, which results from repetitive inflammation and the subsequent healing process. Dysphagia in this syndrome may be explained by a decrease in swallowing power. Iron deficiency anemia may play the main role in the above histological changes and the resulting decrease in swallowing power.

Adult T-cell leukemia/lymphoma originating in the paranasal sinus.

A case of adult T-cell leukemia/lymphoma (ATLL) occurred in a 60-year-old woman who had a disturbance of right eye movement and visual acuity. She was born and lived in southwest Japan, an endemic area of ATLL. Rhinoscopic and roentgenologic examinations revealed a mass in the ethmoidal and sphenoidal sinuses. Histologic examination showed a diffuse lymphoma (a medium cell type with T-cell properties). The ATL (adult T-cell leukemia) cells (abnormal multi-lobed lymphocytes) were found in the peripheral blood. Human T-cell leukemia virus type I antibody was found to be 320 times positive. Based on the above findings, the patient's condition was diagnosed as ATLL, and she was treated by chemotherapy. However, the patient died due to general prostration seven months after the onset of the disease. The literature on this disease is summarized.

Swallowing function following hypopharyngeal reconstruction with the pectoralis major musculocutaneous flap.

Swallowing function was studied in three patients following the pectoralis major musculocutaneous reconstruction of the hypopharynx and cervical esophagus after extensive resection for hypopharyngeal cancer. Fluoroscopy and endoscopy revealed the formation of a sphincter-like ring at the proximal end of the remaining intact esophagus. This ring may act to prevent reflux from the lower esophagus, although its sphincteric power is weak. Manometric testing showed that no swallowing pressure was produced in the reconstructed gullet; therefore, bolus propulsion at the pharyngeal stage occurs mainly by gravity. Follow-up studies on swallowing indicate a minimum length of the suture line of 11 cm in order to prevent esophageal stenosis due to anastomotic stricture at the distal mucocutaneous junction.

[Subclinical swallowing disorder in patients with abnormal sensation in the throat].

Measurement of swallowing pressure was done in 75 patients who complained of abnormal sensation such as obstructive sensation, difficulty in swallowing, etc. in the throat without noticeable cause. Abnormal swallowing pressure curves were observed in 33 patients (44%), and 76% of them showed abnormal elevation of the pressure at the hypopharyngeal or cervical esophageal region. These results indicated that subclinical swallowing disorder, particularly abnormal high swallowing pressure, can be a possible cause of their complaints. The author assumed that abnormal elevation of swallowing pressure is due to hypertonicity of the hypopharyngeal and cervical esophageal muscles. By the animal experiments using dog, a muscle relaxant, eperizone hydrochloride, revealed to change muscle tonus of the hypopharyngoesophageal muscles. Intravenous administration of the drug decreased swallowing pressure and prolonged the relaxation time of the cricopharyngeal muscle. Clinically the muscle relaxant showed to be effective in ameliorating the complaint of the patients with abnormal high swallowing pressure at the hypopharyngeal or cervical esophageal region. Based on the above results, the author proposed that the clinical entity, hypopharyngeal-cervical esophageal hypertonicity, causes a subclinical swallowing disorder leading to the abnormal sensation in the throat.

[Clinical studies on acute otitis media in infants less than one year old].

Epidemiological and bacteriological studies were made on 164 infants less than 1 year old with acute otitis media (OMA) treated at the Department of Otorhinolaryngology, Matsuyama Red Cross Hospital between January 1991 and December 1993. The patients consisted of 101 males (61.6%) and 63 females (38.4%). Compared with the general population in Matsuyama city, the preponderance of male patients with OMA is statistically significant at the level of P = 0.05. In infants less than 1 year old males are likely to be more susceptible to OMA than females. One hundred and four patients among the 164 (63.4%) were referred by pediatricians. Fever was the most common symptom (57.9%) and the next was otorrhea (19.5%). Between the patients younger than 6 months (younger group) and those 6 months old or older (older group) there were epidemiological differences which were statistically significant at the level of P = 0.05. The older group contained 128 patients (78.0%) and the younger group 36 (22.0%). The difference in incidence between the two groups indicates that infants 6 months old or older are more susceptible to OMA than those younger than 6 months. In the older group 76.6% of the patients had bilateral OMA, while in 38.9% of those in the younger group the OMA was bilateral. In infants 6 months old or older bilateral involvement and, in contrast, in infants younger than 6 months unilateral involvement was more frequent. The period needed to cure OMA was confirmed for 179 ears of 106 patients. For 80 (44.7%) of the 179 ears the period extended beyond 4 weeks. Seventy-five of the 80 ears were those of patients in the older group. OMA in the older group tended to be more resistant to treatment. The middle ear secretion of 117 ears was examined bacteriologically. Specimens were collected from middle ear effusion of 99 ears following myringotomy and from otorrhea in 18 ears. Cultures of 68 specimens were positive for one species of bacteria and 13 cultures yielded two species. Streptococcus pneumoniae, Staphylococcus epidermidis and Haemophilus influenzae were the three most common microorganisms in middle ear effusion. But it was considered that S. spidermidis was not pathogenic and was a result of contamination. In otorrhea S. aureus was frequently found. No difference in the results of bacteriological study was noted between the two groups. Transplacental IgG1 and IgG2 antibodies to S. pneumoniae and H. influenzae are known to decrease after birth and their serum levels are lowest between ages 6 months and 1 year. Then the serum levels of the immunoglobulins increase gradually with active production until age 4 years. The incidence and period of restitution of OMA in infants less than 1 year old in the present study seem to reflect the above Change in the serum levels of IgG1 and IgG2 mentioned. Based on the above results emphasis is placed on close cooperation between the otolaryngologist and the pediatrician in the treatment of OMA in an infant less than 1 year old. Particularly careful follow-up is important in patients in the older age group because they tend to be more susceptible to OMA and the disease is more resistant to treatment.