[Airway management in a patient with lower lip squamous cell carcinoma after radical surgical resection].

General anesthesia was scheduled in a patient who had undergone radical surgical resection because of his lower lip squamous cell carcinoma. His oral area had been reconstructed drastically and this pathological change indicated difficulties of mask fitting, mask ventilation and laryngoscopic intubation. Before induction of general anesthesia, we performed fiberbronchoscopic transnasal awake intubation. The patient's condition was stable during both intubation and operation. At the end of anesthesia, the tracheal tube was removed after the patient had become fully awake and had recovered completely from neuromuscular brockade. In conclusion, it is important to evaluate and recognize the difficult airway preoperatively. When this is suspected, awake intubation should be chosen to secure and guarantee the airway.

[Propofol anesthesia for a patient with insulinoma].

We experienced the anesthetic management of a 47-year-old woman with insulinoma. Removal of the tumor was performed under propofol, nitrous oxide, and epidural anesthesia. We tried the continuous infusion of glucose to maintain normal blood glucose level and to avoid intraoperative hypoglycemic event. The blood glucose and immunoreactive insulin (IRI) level were measured intermittently. After the removal of the insulinoma, the IRI level decreased rapidly to the normal range. In this case, neither hyperglycemic nor hypoglycemic episode was observed. The perioperative course was uneventful. Propofol has not been shown to significantly affect the release of insulin and glucose regulation. This case suggests that under the condition of continuous glucose infusion and blood glucose monitoring, propofol is an useful anesthetic agent for a patient with insulinoma.

Unusual case of plasma cell tumor with monoclonal gammopathy of the sino-nasal cavity and clavicular bone.

A rare case of extramedullary plasmacytoma in the sino-nasal cavity is presented. During a prolonged clinical course, the tumor has recurred several times after irradiation, chemotherapy and surgery, and presented in the clavicular bone as well. Immunohistochemical staining of each tumor showed IgA kappa phenotype, and immunoelectrophoresis of the serum showed overproduction of IgA with kappa light chains. Although an elevation of serum IgA persists, the patient has remained well without evidence of overt multiple myeloma.

[Evaluation of turnover of olfactory epithelium in mice by using anti-BrdU monoclonal antibody].

Among nerve cells of vertebrates, the olfactory elements are uncommon in their capacity to turnover and to be replaced after injury. An autoradiographical and morphological observation has shown that degenerated olfactory nerve cells are reconstituted by a new population of neurons which originate from basal cells. However, an autoradiographic method requires a special isotope institute and it takes a long time for the final specimen to observe. Recently, a rapid technique without the radioisotope has been alternatively developed in which a thymidine analogue, 5-bromo-2'-deoxyuridine (BrdU), is incorporated into replicating DNA and subsequently localized using a specific monoclonal antibody. In the present study, cell dynamics of olfactory mucosa in mice were investigated by means of immunohistological technique. The results were as follows. 1. The labelled elements were concentrated at the basal layer of the epithelium, which were observed 5 hrs after the first injection of BrdU. 2. At 15 days after administration of BrdU, the labelled elements were located in the mid-layer of the epithelium, where can be recognized as the compartment of nerve cells. 3. After 30 days, the labelled cells disappeared from the epithelium. It indicates that the period of turnover in the olfactory epithelium of mice is within 30 days. 4. Fifteen days after axotomy of the olfactory nerves, two stained patterns which were numerously or sparsely labelled regions were observed. The former is considered that immature neurons predominantly exist, and the latter is the area which mature neurons abundantly locate. It is considered that this immunohistological approach is useful for the observation of the turnover of the olfactory epithelium.

Inhibitory effects of kampo medicine on Epstein-Barr virus antigen induction by tumor promoter.

We have investigated the possible interaction of Japanese Kampo medicine; Shosaiko-to with Epstein-Barr virus (EBV) induction by TPA (12-O-tetra-decanoyl-phorbol-13-acetate) in EBV-genome harboring cells. The effect of ether extract of Shosaiko-to was also studied on the induction of EBV by superinfection with EBV from P3HR-1 cells (P3H-EBV). Concomitant treatment of EBV-latently-infected cells (Raji and A2L/AH) with TPA and ether extract resulted in effective inhibition of EBV-antigen induction. However, in the experiments to test the influence of ether extract on EBV induction by superinfecting Raji cells with P3H-EBV, ether extract did not affect the percentage of EBV-antigen-positive cells. These data indicate that Shosaiko-to is effective to inhibit antigen synthesis induced by chemical promoters without affecting EBV-antigen induction after superinfection.

[Experimental study on the effect of the topical application of steroids on olfactory disturbance in mice].

Although the topical treatment with steroids is the widespread method for olfactory disorders in human, the reports are limitted to clinical observations. The aim of this report is to evaluate the effect of topically applied of steroids in mice on the repairing course by the experimental olfactory disorders caused by zinc sulfate. The olfaction of mice was estimated by the record of behavioral task, using Cycloheximide, commonly used as repellent in rodents. When mice taste Cycloheximide for the first time, immediately the mice experience a very disagreeable taste leading to the simultaneous memory of the odor of Cycloheximide. Those who once experienced the taste and odor of Cycloheximide, will avoid simply by the odor next time. Two bottles were offered to mice, one containing distilled water and the other 0.01% Cycloheximide. When the mouse drank the distilled water, the response was interpreted as a correct response. When the Cycloheximide solution was chosen, an error. Twenty four mice were tested at ten times during a 10-minute trial, and the rates of correct response were counted. From the next day after the treatment of zinc sulfate, nasal application of 0.1% beta-methasone (group A), or nasal application of distilled water (group B) were applied to each group of twelve mice for five days. The results were as follows. 1. In the first experiment, the correct response was 85% (group A), and 80.8% (group B), however at the second trial, all responses were correct.(ABSTRACT TRUNCATED AT 250 WORDS)

Three cases of inter-sterno-costo-clavicular ossification associated with tonsillar infection.

Three cases of inter-sterno-costo-clavicular ossification (ISCCO) associated with chronic tonsillitis are reported. Two cases had additional symptoms of pustulosis palmaris et plantaris (PPP). All the patients underwent tonsillectomy. The histological changes of the palatine tonsils of case 1 and case 2 were characterized by so-called focal small lacunar ulcers and periarteriolar fibrosis (onion-skin lesion). Some multinucleated giant cells were observed in case 2. Following tonsillectomy, symptoms in the clavicular region and the PPP improved. It is possible to consider that ISCCO is caused by focal tonsillar infection.

Agenesis of the cervical internal carotid artery.

Total or segmental agenesis of the internal carotid artery is a rare anomaly. The cervical portion of the internal carotid artery was absent in the right side of the patient who was carried out radical surgery due to recurrent oropharyngeal cancer. Post-operative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Otolaryngologist-Head and Neck surgeon should know such a vascular anomaly and avoid a disastrous result on dividing the external carotid artery.

[Expression of an Epstein-Barr virus early antigen and cell fusion].

Superinfection of Raji cells with Epstein-Barr virus (EBV) derived from P3HR-1 (P3H-EBV) leads to syncytium formation. Studies using inhibitors of DNA and protein synthesis suggest that the fusion-inducing factor belongs to the early antigen of virus-specified proteins. Induction of early antigen (EA) in Raji cells by using various chemicals also leads to syncytium formation. However, A2L/AH hybrid cells, which were prepared by fusion between epithelial cells of adenoid origin and lymphocytes transformed by B95-8 virus, could not be superinfected with P3H-EBV. But, the syncytium formation was observed when EBV-EA was induced by chemicals in A2L/AH cells. It was considered that the synthesis of viral protein in superinfected Raji cells is essential for fusion and that the viral genes, inducible in Raji and A2L/AH cells by treatment with chemicals code for the necessary functions that lead to syncytia formation.

[Suppressive effect of CDDP on induction of the Epstein-Barr virus antigen synthesis by n-butyrate].

n-Butyrate has been shown to induce Epstein-Barr virus (EBV) antigen synthesis in certain EBV genome-carrying lymphoblastoid cell lines. We have studied the effect of cis-dichloro-diamine-platinum (CDDP) on induction of EBV antigen synthesis not only by n-butyrate treatment of the EBV producer, P3HR-1 cells, but also by superinfection of EBV to the EBV non-producer, Raji cells. Simultaneous treatment of the cells with n-butyrate and CDDP or MMC blocked VCA and EA induction, but no suppressive effect was observed by the treatment of the cells with n-butyrate and Ara-C. The induction of EBV antigens was also observed in EBV-superinfected Raji cells, even in the presence of DNA synthesis inhibitor, CDDP or MMC. From these results, we discussed the mechanisms of the EBV antigens synthesis in EBV latently infected cells.

Epstein-Barr virus (EBV) infection by cocultivation of fibroblast-dominant cell line and EBV-transformed lymphocytes.

A long-term cell culture epitheloid cell line (NPC-F/L) was established from the fibroblast-dominant cell line derived from nasopharyngeal carcinoma tissue by cocultivation with an Epstein-Barr virus (EBV)-transformed lymphoblastoid cell line of adenoid origin. The cells were investigated by karyotyping, by immunofluorescent testing for EBV-associated nuclear antigen (EBNA), early antigen (EA), and viral capsid antigen (VCA) and by a light microscopy. The cells were shown to be epithelial not only by morphology but also by immunocytochemical staining with monoclonal antibody to cytokeratins and they expressed EBNA and EA but not VCA. The cells developed histologically undifferentiated squamous cell carcinoma when inoculated subcutaneously into the back of athymic nude BALB/c(nu/nu) mice, which were similar to the human tumors from which the fibroblastoid cell line was established. The presence of EBNA in touch smears prepared both from the biopsy tissue of human and nude mice was demonstrated. Karyotyping analysis indicated an aneuploid chromosome with a model number of 74.

Electro-olfactogram (EOG) in olfactometry.

The electro-olfactogram (EOG) is a potential originated in olfactory epithelium evoked by odorous stimulation, which has been demonstrated and termed by Ottoson (1959). In order to ascertain the clinical application of EOG, we attempted to record similar potentials in human subjects. In some preliminary experiments using rabbits, it was quite easy to produce Ottoson's findings. In human subjects, however, there were sometimes great technical difficulties owing to the hidden anatomical position of the olfactory epithelium. Then we utilized Olympus selfoscope endoscopy for placing and retaining the electrode to the olfactory portion precisely and safely, with a tube for sending airborne odor. As results, we succeeded in recording negative spike discharge similar to Ottoson's findings. We examined a total of 27 nasal cavities in 22 patients with peripheral olfactory disorders and 11 nasal cavities in 12 patients with central olfactory disorders. The positive EOG rate in patients with peripheral or central olfactory disorders was 28 and 69%, respectively. Moreover, the positive rate was decreased in proportion to the degree of olfactory disorders in chronic rhinosinusitis. No positive EOG was observed in anosmic nasal cavities, while it was 68% in normal persons and resulted in an equal value to anosmia group caused by the damage of central olfactory pathway. From these results, it is considered that the positive EOG study is the only method which provides objective finding for the differential diagnosis of anosmia caused by disorders of olfactory epithelium or disorders of central olfactory tract.

[Combination chemotherapy with cisplatin and UFT malignant tumors of the head and neck--experimental study of human nasopharyngeal carcinoma (A2L/AH) xenografted to nude mice].

Combination therapy with cis-platinum (CDDP) and UFT was examined with human nasopharyngeal carcinoma (A2L/AH) implanted in nude mice. The tumor growth of A2L/AH was inhibited in the group administrated UFT 20mg/kg, but was not in 10mg/kg group in comparison with the control group. An inhibition rate (IR) of the tumor growth was 80.2 and 21.3% respectively. The group received CDDP (5mg/kg, q7d X 3, 2mg/kg, q7d X 3 and 1 mg/kg, qd X 6) by i. p. injection, resulted in 75.2, 37.4 and 23.1% inhibitions respectively. While, the response rate in the group treated with CDDP (1 mg/kg, qd X 6) and UFT (10mg/kg) showed a synergistic effect (IR; 66.3%) which was higher than in the group administrated CDDP (2mg/kg, q7d X 3) and UFT (10mg/kg) (IR; 58.3%).

Importance of unilateral examination in olfactometry.

Hyposmia, the decreased sense of smell, and anosmia, the loss of sense of smell, may be unilateral or bilateral. If the olfactory acuity examined by means of bilateral test is normal, olfactory disorders are not found; unilateral examination is therefore necessary for definite evaluation of olfactory acuity. As evidence, 7 cases out of 94 patients with chronic rhinosinusitis and 6 cases out of 12 patients who received the surgery of anterior cranial fossa showed definite different olfactory threshold between nasal cavities, and there were no patients who recognized the diminished sense of smell in spite of unilateral high olfactory threshold. Additionally, we have experienced that a patient with brain tumor was diagnosed by the help of unilateral olfactory test. We thus strongly recommend the unilateral olfactometry as a method for simple and reliable test in clinical measurement of the sense of smell.

Usefulness of word table for the quantitative evaluation of the recognition threshold in children's olfactometry.

In the quantitative evaluation of the recognition threshold in smell test, the influences of subjects' age, intelligence, and experience are unavoidable in expressing the nature of smell, especially in children. In order to avoid such individual differences, a word table has been designed in our clinic. In this study, we employed a word table for children's quantitative evaluation of the recognition threshold, and found that T & T olfactometry performed with use of a word table showed a greater reliability compared to the test without use of a word table. The use of a word table for children's olfactometry is also considered to be an easily administered procedure.

Significance of intravenous olfaction test using thiamine propyldisulfide (Alinamin) in olfactometry.

The significance of intravenous olfaction test in olfactometry was studied by injection of thiamine propyldisulfide (Alinamin) intravenously. An original solution of Alinamin is a thiol-type derivative of vitamin B1, and releases a mercaptan smell (garlic smell) in expired air when it arrives at the olfactory epithelium via the nasopharynx. In the intravenous olfaction test (Alinamin test), the latent time which is a period between the initiation of injection and recognition of garlic smell, and duration time which is a period between the recognition and disappearance of smell are measured. Our results indicated that latent time is influenced by olfactory acuity and duration time depends on olfactory adaptation phenomenon. Central olfactory disorders were highly suspected in hyposmia patients with duration time of less than 15 sec, and nonresponders in Alinamin test always showed poor prognosis in the recovery of olfactory acuity. It was considered that the Alinamin test is useful not only for estimating the degree of olfactory disorders, but also for differential diagnosis of impaired lesions and olfactory prognosis.