Hemoglobin concentration (IHb) in the human nasal mucosa was measured as an indicator of mucosal blood volume with a spectrophotometric analyzer, and nasal blood flow (BF) was measured with a laser speckle flowmeter.
IHb and BF in the nasal mucosa, so f t palate, and posterior wall of the mesopharynx were compared. In normal subjects, both IHb and BF were highest in the nasal mucosa.
IHb and BF in patients with various pathological conditions were compared. IHb in the nasal mucosa was higher in patients with chronic sinusitis and those with chronic pharyngitis, and lower in those with allergic rhinitis and those with abnormal sensation in the throat. BF in the nasal mucosa was higher in patients with chronic pharyngitis, and lower in those with allergic rhinitis, chronic sinusitis, or abnormal sensation in the throat. IHb in the soft palate showed no significant differences on the basis of pathological condition, and BF in the soft palate was higher only in patients with allergic rhinitis. IHb in the posterior wall of the mesopharynx was higher in patients with chronic pharyngitis, and BF there was higher in patients with chronic pharyngitis and in those with allergic rhinitis.
IHb was measured before and after total laryngectomy, and was found to d ecrease following operation. Nasal resistance and IHb were measured simultaneously; it was found that some normal subjects showed cyclic changes in nasal resistance and IHb. Simultaneous measurement of bilateral nasal IHb showed that some normal subjects showed cyclic changes. It was considered that the change of nasal blood volume was the main cause of these nasal cycles. IHb increased during hyperventilation or upon changing from a supine to lateral position, and decreased during breathholding, during mental exertion or upon changing from a supine to sitting position.
The influenc e of drugs on IHb was studied. IHb was increased by administration of methacholine, histamine, or substance P, and was decreased by administration of tetrahydrozoline, phenylephrine, or oxymetazoline.
It is concluded that measurement of both IHb and BF is useful in assessing mucosal microcirculation in the human nose, and that IHb level reflects blood volume in capacitance vessels.
Mucosal blood volume and oxygen saturation in the human vocal fold
Yamaguchi M, Koike Y.
Acta Otolaryngol(Stockh) 110:300-8,1990.
With a newly developed spectrophotometric analyzer we were able to measure hemoglobin (Hb) concentration and its oxygen saturation in the human vocal and ventricular folds. Studies were made on 30 subjects including 18 normal controls. In laryngomicrosurgery under general anesthesia, measurements were made with a fiber probe touching the laryngeal mucosa. Results were as follows: In normal mucosa of the vocal fold, the mean value of IHb was 40 and the ISO2 was 55, while in that of the ventricular fold, the mean values were 74 and 56, respectively. Thus, in spite of the influence of general anesthesia, the mucosal blood volume was lower in the vocal fold than in the ventricular fold. The mean value of IHb was 30 in the vocal fold polyps, 122 in the vocal fold nodule, 43 in the polypoid degenerations, 17 in the vocal fold cyst, 62 in the granuloma, 6 in the sulcus vocalis and 19 in the hyperkeratoses. This method is considered useful for objective and quantitative analysis of pathological conditions in the vocal fold.
山口 幹夫, 阿河 邦治, 兼竹 博之, 小池 靖夫, 加島 健司
The purpose of this study is to evaluate the blood volume and blood flow in human tympanic membrane.
Hemoglobin concentration (IHb) and oxygen saturation of hemoglobin (ISO2) were measured in 71 ears by using a tissue spectrum analyzer. Blood flow (Flow level) was measured in 40 ears by using a laser speckle flow meter. By using two fiber optic probes, these three parameters were measured in the tense part of the tympanic membrane.
A comparison was made between the measurements made with fiber probe touching the tympanic membrane and the measurements not touching it. Between two measuring patterns, there was no significant differentiation in three parameters, so we took non-touching tequnique.
IHb and Flow level had reproducibility between the first and second recordings. But ISO2 did not have clear reproducibility.
In normal tympanic membrane, IHb and Flow level were not significantly correlated (r=0.52).
IHb was 16±1.3 (Mean±SEM) in nomal cases, 17±4.6 in otitis media with effusion and 104±22.8 in acute otitis media. Flow level was 0.7±0.07 in nomal cases, 0.6±0.07 in otitis media with effusion and 2. 2±0.37 in acute otitis media.
It is considered that the measurement of hemoglobin concentration by using tissue spectrum analyzer and the measurement of blood flow by using laser speckle flow meter are useful in the studies of the pathophysiology of human tympanic membrane. tympanic membrane, blood flow,
Key words : otitis media with effusion, tissue spectrum analyzer, laser speckle flow meter
山口 幹夫, 立花 文寿, 兼竹 博之, 山下 利幸, 小池 靖夫
The purpose of this study is to compare mucosal blood flow with mucosal blood volume in human larynx. Subjects were two men who had vocal fold polyps. In laryngomicrosurgery under general anesthesia we measured hemoglobin concentration (IHb) by using spectrophotometric analyzer and measured mucosal blood flow (BF) by using laser speckle flow meter. In normal mucosa of the vocal fold, the mean value of IHb was 25.5 and the mean value of BF was 4.6, whereas in that of the ventricular fold, the mean value of IHb was 72.3 and the mean value of BF was 2.4. The IHb value was lower in the vocal fold than in the ventricular fold, while BF was higher in the vocal fold than in the ventricular fold. In the region of telangiectatic polyp of the vocal fold, IHb was 88 and BF was 4.1. IHb was 17 and BF was 2.0 in the region of gelatinous polyp. Both IHb and BF had higher value in the telangiectatic polyp than in the gelatinous polyp. It was considered reasonable for vocal fold vibration that blood flow was high and blood volume was low.
ヒト喉頭粘膜血液量 −組織ヘモグロビン量と血流速度の同時測定の試みー 喉頭2：95-98.1990.
(パネルディスカッション 鼻粘膜における自律神経の生理的役割-血管系を中心に- 司会 東京医科歯科大学 長谷川誠)
Local effects of adorenarine on blood flow and blood volume in the nasal mucosa
Yamaguchi M, Mabuchi A and Koike Y
山口 幹夫, 木下 道子, 嶋田 高明, 堀 洋二, 山下 利幸, 大津 信也, 石谷 保夫, 石田 達也, 小池 靖夫, 馬淵 厚至, 近藤 昭男, 兼竹 博之
An investigation of microcirculation in the ear, nose and throat was performed.
Hemoglobin concentration which indicates blood volume in tissue was m easured with a spectrophotometric analyzer. Blood flow was measured with a laser Doppler flowmeter and a laser speckle flowmeter.
Normal ran g es of hemoglobin concentration and/or blood flow in the ear drum, the inferior turbinate, epipharynx, mesopharynx, soft palate, vocal fold, ventricular fold and the arytenoid region were studied. It was useful for differential diagnosis of pathologic conditions to compare these with normal ranges.
The continuous measurement of hemoglobin concentration and/or blood flow in the nasal mucosa and the finger tip in humans was performed. Continuous measurement of hemoglobin concentration and blood flow in the middle ear and the laryngeal mucosa of guinea pigs was performed. The effects of drugs on the autonomic nervous system and the microcirculation were subjectively analyzed.
山口 幹夫, 山下 利幸, 兼竹 博之, 小池 靖夫
The measurement of mucosal blood flow is important for assessing condition in the nose, pharynx, larynx and middle ear. Recently the measurement of mucosal blood flow has been made very accurate by the development of new methods of measurement (e. g. Laser-Doppler flowmeter, RI clearance method, spectrophotometric analyzer).
Earlier works on the assessment of mucosal blood flow in the nose, pharynx, larynx and middle ear are reviewed.
山下 利幸, 山ロ 幹夫, 石谷 保夫
We examined the effects of local hyperthermia by humidified aerosol at 43°C on blood flow in the epipharynx using a spectrum analyzer. We measured the blood flow in patients with epipharyngitis, abnormal sensation in the throat, before and after nasal hyperthermia, as well as in healthy subjects.
Epipharynx blood flow was high in the ep i pharyngitis group, and was decreased by local hyperthermia. Local hyperthermia normalized epipharynx blood flow in the group with abnormal sensation in the throat. In some patients abnormal sensation in the throat disappeared or decreased after local hyperthermia; therefore, this treatment appears to be useful.
兼竹 博之, 山口 幹夫, 山下 利幸, 武田 直也, 小池 靖夫
To the best of our knowledge little if any information is available concerning human laryngeal mucosal blood volume presumably because the larynx is an anatomical position which renders the measurement of blood flow there difficult. With the advent of a reflectance spectrophotometer, however, studies of tissue blood flow have been facilitated to a great extent. As a result, attempts have been made to determine mucosal blood volume in various organs and tissues including the gastric mucosa.
Recently, an ultra-thin fiber probe (1.8m min diameter) for measurement of tissue blood volume has been developed. Using a laryngeal flexible fiberscope attached with this newly developed probe in the opening for the forceps, an attempt was made to measure laryngeal mucosal blood volume by the method of reflectance spectrophotometry, determining IHb and ISO2 the former of which is a parameter of hemoglobin in the tissue blood vessels and the latter, a parameter of hemoglobin oxygen saturation in the tissue blood vessels.
IHb of the vocal folds is significantly low, about half those of the false folds and arytenoid region, whereas ISO2 is significantly higher in the false folds and arytenoid region than in the vocal folds. The hemodynamics in the vocal folds as a high-speed vibrator are specific, unlike in other laryngeal regions.
We have plans to determine laryngeal tissue blood volume at more sites so as to investigate the laryngeal tissue distribution of blood volume in greater detail. Furthermore, tissue blood volume in morbid conditions will also be determined for information which will be of value in clinical applications.
山口 幹夫, 石谷 保夫, 馬淵 厚至, 山下 利幸, 小池 靖夫
The present study was undertaken to investigate laryngeal microvascular reactivity to histamine in normal guinea pigs.
Twelve guinea pigs were sedated with intraperitoneal sodium pentobarbital, a fissure was made in the larynx, and the intra-laryngeal space was opened. A probe of a spectro-photometric analyzer was placed lightly on the mucosa of the vocal fold and fixed.
Hemoglobin (Hb) concentration and oxygen saturation of Hb were measured continuously by reflectance spectrophotometry; 10μl of isotonic saline was dropped on the laryngeal mucosa in the controls, and 10μl of histamine (104μg/ml) on the mucosa of the experimental animals.
The results were as followed; 1) Visual inspection after histamine provocation showed laryngeal mucosal swelling and dilatation of the microvessels. 2) After histamine provocation, Hb concentration increased (p<0.01) and oxygen saturation of Hb decreased (p<0.01). 3) After saline dropping, these two parameters showed no significant change.
Thus, histamine caused swelling of the laryngeal mucosa and increased the mucosal blood volume. This method is useful for observing allergic reactions in the laryngeal mucosa.
山口 幹夫, 山下 利幸, 武田 直也, 近藤 昭男, 小池 靖夫
Three cases of laryngeal allergy were reported. A 21-year-old female had a 7-month history of persistent dry cough, sneeze and nasal discharge. Both a 32-year-old male and a 58-year-old female had a 2-month history of abnormal sensation in the throat. The arytenoid region in these 3 cases was swollen and pale in color. Antiallergic drug (Azelastine hydrochloride) was administrated for all cases, and their complaints completely disappeared. The clinical finding, such as"swollen and pale"in the arytenoid region was remarkably improved in all cases.
第8回喉頭アレルギー研究会. 21, 1992.
山下 利幸, 山口 幹夫, 石谷 保夫, 小池 靖夫
A case of laryngeal allergy was reported. A 38-year-old female presented to the Department of Otolaryngology, the University Hospital of Tokushima with a two-year history of abnormal sensation in the throat. The abnormal sensation was frequently associated with cough, sneeze, nasal discharge and eye itching. The arytenoid regions were slightly swollen and pale in color. A screening prescription for abnormal sensation in the throat, consisting of Bromazepam (2mg) 3T and Lysozyme chloride (270mg), was administrated for two weeks without any effect. A provocation test revealed allergic reactions of the mucosa of the arytenoid region to mite allergen : Following application of mite allergen, infiltration of mast cells was histologically observed in the mucosa. Azelastine HCl was effective.
山下 利幸, 山口 幹夫, 武田 直也, 嶋田 高明, 堀 洋二, 立花 文寿, 記本 晃治, 竹内 紳一, 加島 健司, 木下 道子, 阿部 晃治, 田村 公一, 石谷 保夫, 小池 靖夫, 布村 進作, 近藤 昭男
喉頭アレルギーの病態については不明な点が多い. 喉頭は解剖学的にアプローチ困難な部位であり, しかも呼吸にとって重要な役割を果たしている. このことにより局所におけるアレルギーの検査が容易でなく, 実地臨床の場で診断に苦慮することも多い.
われわれは実験動物を用いた喉頭アレルギーモデルを作製した. さらに抗原粒子の喉頭粘膜への付着の可能性の有無およびヒスタミンの喉頭粘膜血流量に及ぼす影響について検討した. その結果動物において喉頭にアレルギー反応が存在しうるという結論を得たため臨床的な検討を行った. 臨床的に喉頭アレルギーが疑われる患者に対し, 抗アレルギー剤の投与を行い, 症状, 所見の改善を認めた. また一例において誘発反応を行い, 組織学的にアレルギー反応をとらえた. これらの結果を踏まえて喉頭アレルギーの存在を確認するとともに, 簡便に診断できるクライテリアの確立が喉頭アレルギー診療に寄与すると思われた.
山口 幹夫, 宇高 二良, 竹内 紳一, 加島 健司, 記本 晃治, 石田 達也, 小池 靖夫, 武市 佳代子
We examined three important quantitative parameters to evaluate the sleep disturbances in children.
The subjects were 46 children who had sleep disturbances such as sleep apnea, snoring and sternal retraction. They were examined with an all night polysomnography which included mesopharyngeal pressure, arterial oxygen saturation, air flow, thoracic movement, and snoring sound. We obtained Apnea Index, Sleep Oxygen Desaturation Index (SOD Index) which stood for the average percentage of reduction from arterial O2 saturation during sleep and mesopharyngeal pressure amplitude (MPA) which stood for the maximum negative pressure amplitude under the obstructed portion in the upper airway.
In 44 cases of obstructive sleep apnea, the relationship among three parameters was investigated with correlation with chest deformity.
The following results were obtained:
(1) The correlation between Apnea Index and SOD Index (r=0.732, P<0.001) was more (1) The correlation between Apnea Index and SOD Index (r=0.732, P<0.001) was more significant than that between Apnea Index and MPA (r=0.371, P<0.01) and than that between Apnea Index and MPA (r=0.585, P<0.001).
(2) By evaluating Apnea Index and MPA, two types were identified. The one had high values of both Apnea Index and MPA. The other had low values of Apnea Index (below 5 points) and high values of MPA.
(3) MPA had a significant differentiation (P<0.01) between chest deformity cases and no-chest deformity cases. However, neither Apnea Index nor SOD Index had a significant differentiation.
It was considered that MPA was useful for one of the quantitative parameters to evaluate the sleep disturbance in children.
Chubby Puffer Syndromeの一例
武市 佳代子, 山口 幹夫, 石田 達也, 仁木 宏
The cause of upper airway obstruction in most children is adeno-tonsillar hypertrophy; however, obesity can be the cause as in Pickwickian syndrome.
The present case with complaints of loud snoring and sleep a pnea, was a 6-yearold girl who weighted 39 Kg. Her tonsils and adenoids were remarkably enlarged. The maximum mesopharyngeal pressure amplitude during sleep was 68 cmH2O. Because of upper airway obstruction and obesity, she was diagnosed as having the "Chubby Puffer" syndrome. After adenotonsillectomy, her symptoms were relieved. The suspected mechanism of upper airway obstruction in our case was adenotonsillar hypertrophy.
大津 信也, 山口 幹夫, 石田 達也
竹内 紳一, 山口 幹夫, 石田 達也, 大津 信也
大津 信也, 記本 晃治, 竹内 紳一, 山口 幹夫, 石田 達也
馬淵 厚至, 山口 幹夫, 石田 達也, 宇高 二良, 加島 健司, 武市 佳代子
石田 達也, 木原 浩文, 山口 幹夫, 宇高 二良, 武市 佳代子
Palygraphic recordings during spontaneous nocturnal sleep were made in four men, three of whom (age range, 35 to 62) had obstructive sleep apnea and one (age, 25) who had no apneic episodes. Continuous recordings were made simultaneously of finger arterial blood pressure, air flow, thoracic movement and mesopharyngeal pressure amplitude. One man with severe obstruction underwent tracheotomy and uvulopalatopharyngoplasty. He was studied again after surgery.
1. When ventilation resumed, the blood pressure of the three patients with obstructive apnea rose. During apneic episodes, the blood pressure of two patients with severe obstruction gradually fell, while the blood pressures of one patient with mild obstruction was not reduced.
2. One patient with severe obstruction showed irregular waves of blood pressure.
3. One patient with severe obstruction, who was studied twice, had remarked fluctuations in blood pressure preoperatively and reducted and stable blood pressure postoperatively.
4. The man with no apneic episodes showed transient elevations in blood pressure without periodicity.
These results demonstrate that blood pressure is affected by repetitive obstructive apnea and that measurement of continuous finger arterial pressure is clinically useful and totally harmless.
One of the causes of abnormal sensation in the throat is psychological. We selected 7 patients in whom it appeared that psychosomatic or neurotic tendencies triggered for abnormal sensation in the throat. We used frontal muscle electromyographic biofeedback for relaxation therapy and autogenic training; the abnormal sensation disappeared or decreased in 6 patients.
Measurement of mesopharyngeal pressure in patients with obstructive sleep apnea
Koike Y, Takeichi K, Ishida T, Yamaguchi M, Ohtsu S.
Adv Otorhinolaryngol. 1992;47:260-6.
山下 利幸, 山口 幹夫, 立花 文寿, 谷口 雅彦, 兼竹 博之, 小池 靖夫
Sensory stimuli to the larynx evoke a laryngeal adductor reflex mediated by the brain stem via superior and recurrent laryngeal nerve. There are some reports that abnormal laryngeal reflex results in disorders of phonation and respiration. The clinical use of Larynx-evoked Brain Stem Response (LBR) as a research tool to study polysynaptic reflex pathway is considered to have a great advantage. The purpose of this report is to review the literature concerning LBR and to speculate the clinical application of LBR. In present time, there are detailed reports of LBR about validity of response, latencies, generator sources, on cat. However, there are a few reports of adaptation for use in humans.
立花 文寿, 武田 直也, 山下 利幸, 石谷 保夫, 石田 達也, 小池 靖夫, 近藤 昭男, 竹内 紳一, 山口 幹夫, 兼竹 博之
We reviewed 94 patients with laryngeal cancer who were treated at Tokushima University Hospital during the 7 years between January 1982 and December 1988. The male/female ratio was-8: 1. The 94 patients included 51 (54.2%) with glottic cancer,37 (39.4%) with supraglottic cancer, and 6 (6.4%) with subglottic cancer.
According to the 1978 UICC TNM classification system,22 patients (23.4%) were in stage I,22 (23.4%) were in stage II,26 (27.7%) were in stage III, and 24 (25.5%) were in stage IV.
The five-year survival rate was 66.4% for patients with laryngeal cancer (stage I,87.2%; stage II,63.3%; stage III,63.5%; and stage IV,50.0%),77.3% for patients with glottic cancer (stage I,87.5%; stage II,100.0%; stage III,76.9%; and stage IV,14.8%), and 54.7% for patients with supraglottic cancer (stage I,83.3%; stage II,40.0%; stage III,30.0%; and stage IV,60.4%). For patients with subglottic cancer, it was 66.7%.
We had 2 cases of supraglottic cancer which were classified as T1 lesions according to the 1987 UICC system, althrough they were T4 lesions according to the 1978 UICC system.
石田 達也, 小池 靖夫, 石谷 保夫, 幸田 純治, 武田 直也, 嶋田 高明, 堀 洋二, 岡田 修治, 馬淵 厚至, 日根 其二, 山口 幹夫, 大津 信也, 川田 育二, 平本 博之, 阿部 律子, 阿河 邦治, 酒巻 孝一郎, 小佐 井真, 近藤 昭男
In a series of 191 patients with chronic paranasal sinusitis 54.4% had foreign-body sensation in the throat (FBST). Roxithromycin (RXM) was administered for about 2 months. The post-arytenoid area was examined for pus and the patients were divided into the following three groups: 1) pus present but disappeared with treatment (35 patients); 2) pus present both before and after treatment (9 patients); 3) no pus either before or after treatment (60 patients). Group 1 had much higher rates of recovery from nasal symptoms and efficacy rates than did group 2. The FBST scores of group 1 patients improved with treatment (4.02→3.04), but there was virtually no change in group 2 (3.53→3.64).
These results indicate that FBST can be induced by postnasal discharge in patients with chronic paranasal sinusitis and can usually be reduced by treatment with appropriate antibiotics.
石田 達也, 小池 靖夫, 石谷 保夫, 幸田 純治, 武田 直也, 嶋田 高明, 堀 洋二, 岡田 修治, 馬淵 厚至, 日根 其二, 山口 幹夫, 大津 信也, 川田 育二, 平本 博之, 阿部 律子, 阿河 邦治, 酒巻 孝一郎, 小佐 井真, 近藤 昭男
Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.
In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.
X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.
Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.
These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.
石田 達也, 記本 晃治, 高石 司, 阿部 律子, 平賀 智, 川田 育二, 山口 幹夫, 阿河 邦治, 酒巻 孝一郎, 小池 靖夫
耳鼻咽喉科領域感染症44例に対して, ASPCを投与し, 同薬剤の臨床効果ならびに安全性を検討した. その結果, 臨床症状, 所見からは, 主治医判定で98%, 委員会判定で86%という高い有効率が得られた. またとくに急性扁桃炎・咽喉頭炎症例においては外来投与で良好な成績が得られた. 副作用は1例も認められなかつた.
上記症例のうち5例に細菌学的検査を施行した. 全例においてASPCの有効菌種であるグラム陽性菌が検出され, 薬剤投与後には委員会判定で100%の有効率が得られた.
以上より, ASPCは非セフェム系の優れた抗生剤の一つであり, 扁桃炎・咽喉頭炎をはじめとする耳鼻咽喉科領域感染症に対して優れた臨床効果を有し, かつ安全性にも富んだ薬剤であると考えられた.
立花 文寿, 石谷 保夫, 石田 達也, 小池 靖夫, 岡田 修治, 山口 幹夫, 大津 信也, 高石 司, 平賀 智, 阿部 律子, 川田 育二
Oxatomide was administered to 78 patients (total 86 ears) with otitis media with effusion for four weeks after myringotomy, and its effectiveness and safety were evaluated. The rate of clinical efficacy was 47.7% (marked effect, 15.1%; moderate effect, 23.3%; slight effect, 9.3%). The appearance of the tympanic membrane was improved in 40.7% of the ears. There was improvement in 34.2% of the ears on the pure tone audiogram and in 36.9% on the tympanogram. A side effect was observed in 1 patient (1.3%), but it was mild and no treatment was required. On the basis of these results, oxatomide was judged to be effective in the treatment of otitis media with effusion.