Archives of oto-rhino-laryngology最新文献

Scanning electron microscopic examinations were carried out on the perilymphatic space bordering the round window in guinea pigs. A number of small vessels were found crossing free through the lumen of the scala tympani in this area. The larger number (5-10) of these capillaries are suspended between the bony cochlear wall and the terminal net of fibrocytes which covers the cochlear opening of the cochlear aqueduct and spreads onto the basal third of the round window membrane. Other capillaries (3-5) cross the lumen of the scala tympani from the outer cochlear wall to the modiolus. All of these capillaries have a thin endothelium and a very thin pericytic covering. These findings suggest that the capillaries crossing the perilymphatic space may give rise to a different chemical composition of the perilymph bordering the round window in comparison with the more upper parts of the scala tympani.

An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.

Ca2(+)-ATPase activity was studied ultra-cytochemically in the middle ear mucosa of the guinea pig. On electron microscopic examination, the most intense reaction was found on the microvilli. Reaction products were also observed on the cilia and around and between the secretory granules on the apical side of the cells in their secretory phase. The basolateral membranes contained few reaction products, while very little or no activity was found on the basal membrane.

The authors report their preliminary findings in a prospective study on the possible effects of different risk conditions present at birth on language acquisition and cognition. A multifactorial test was used to test normal children for normative values. This test was then administered to 186 at-risk babies and controls at 18 months of age. A noticeable difference in overall performance was observed only for preterm babies having an appropriate weight for their gestational age. However, significant results will only be available after evaluations are repeated when the children are 36 months old.

Laryngeal framework surgery for improving or changing the voice is a challenging development in phoniatric surgery. Basically two categories can be distinguished: (1) attempted medialization of the vocal fold, as for the treatment of paralytic dysphonias (arytenoid rotation technique and Isshiki's type I thyroplasty); (2) adjustment of the vocal fold's tension to produce changes in vocal pitch, as for the treatment of transsexuals or mutational dysphonia (cricothyroid approximation, Isshiki's type III thyroplasty and LeJeune's anterior commissure laryngoplasty). Both types of surgery are best performed with the patient under local anesthesia so that fine tuning of the voice is possible by monitoring the voice during the surgical procedure. The techniques of arytenoid rotation and Isshiki's type I thyroplasty are described in detail and the result of a combination of these procedures is illustrated by a case history of an aphonic patient with unilateral vagus nerve paralysis and subsequent severe incomplete glottal closure during phonation. In addition, the results achieved in several other patients are presented. Our current experience with laryngoplastic surgery and its variations is such that endolaryngeal Teflon or collagen injections are no longer used in our department. To date, we have seen no complications from the laryngoplasties and the voice results have been excellent.

The basic surgical guidelines for mastoid segment control are described in chronic ear disease. Dense cortical bone paté and mastoid tip bone chips are collected for possible obliteration of the surgical cavity produced. A meatally based musculoperiosteal flap is raised if "canal wall-down" surgery is anticipated. Mastoid bone surgery must be meticulous and the sigmoid, cerebellar and dural plates are first exposed. This is followed by a perilabyrinthine dissection. Tympanic or epitympanic surgery is connected with mastoidectomy as needed. All cavities are then obliterated.

We have reviewed the most recent 120 cases of acoustic neuromas operated upon in Bordeaux, France. In so doing, we have defined the strategy required to reach an accurate diagnosis as essentially comprising three stages. The first of these is to understand that the presenting symptom complex may be typical with progressive unilateral hearing loss, tinnitus, etc., or atypical with sudden hearing loss (10%), recovering facial paralysis (3.3%) or a Menière's syndrome (3.3%). Included in the first stage of diagnosis are audiovestibular investigations. An absent stapedial reflex was noted in 41% of our cases and an abnormality in vestibular testing in 95% of cases tested. These findings would be clear indicators to proceed to the second stage of the diagnostic strategy. This second stage comprises electric response audiometry consisting of auditory brainstem response (ABR) testing and electrocochleography (ECochG) employed as a filter for determining which patients should proceed to the third stage of testing. A combination of ABR and ECochG provides the clinician with results of high sensitivity and specificity. The false-negative rate for combined results in our experience has been less than 1%. The final diagnostic stage is radiological imaging, in particular using magnetic resonance imaging (MRI) with gadolinium contrast as the modality of choice. MRI is superior to CAT scanning, especially in the diagnosis of stage I intracanalicular tumors.

After tracing the vestibular nerve of the guinea pig with horseradish peroxidase (HRP), a conspicuous fiber bundle was found that passed to the ipsilateral cochlear nucleus. HRP-labeled fibers were seen to leave the descending vestibular nucleus at a level caudal to subgroup "y" in a lateral direction. Travelling close to the restiform body, the axons terminated at cells lying between the dorsal and posteroventral cochlear nucleus. These cells could be distinguished cytoarchitecturally from surrounding cells of the cochlear nuclei. Several electrophysiological investigations have assumed that there is a direct connection between the vestibular and the cochlear system. Compared to these, the fibers under consideration might be the morphological basis for such a "vestibulo-cochlear anastomosis."

Penetrating injuries of the anterior cranial fossa may result in permanent neurologic changes or even death if injuries are unrecognized and remain untreated. The diverse etiologies of such injuries are reviewed, as well as their diagnosis, treatment and prognosis.