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Biomedical subjects

M Hirano

Publications and source records attributed to M Hirano.

At least 883 records · Page 49Linked to original sources
PubMedDate not supplied

Topographic arrangement of motoneurons innervating the suprahyoid and infrahyoid muscles. A horseradish peroxidase study in cats.

The topographic arrangement of motoneurons innervating the muscles which participate in the rostrocaudal movement of the larynx was studied in cats by means of the horseradish peroxidase (HRP) method. After HRP injection into these muscles, all labeled neurons were found in the nuclei of the brainstem and cervical nerves (C1, C2) ipsilaterally. The mylohyoid and anterior digastric motoneurons were seen in a cluster in the medial part of the rostrocaudal area of the motor trigeminal nucleus. Within the medial part of the nucleus, the mylohyoid motoneurons were located ventrally and the anterior digastric motoneurons dorsally. The posterior digastric neurons were situated in the accessory facial nucleus, the stylohyoid neurons in the ventral aspect of the facial nucleus, the geniohyoid motoneurons in the ventral aspect of the hypoglossal nucleus, and the thyrohyoid motoneurons in the lateral aspect of the hypoglossal nucleus and the dorsomedial part of the ventral horn cells of C1. The HRP-labeled neurons of the sternohyoid and sternothyroid muscles were observed in the central portion of the ventral horn cells of C1 and C2.

Animals↗
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Symptom improvement of spastic dysphonia in response to phonatory tasks.

It has been acknowledged that for many patients with spastic dysphonia, reflexive phonation remains essentially free of the spasticity that characterizes this disorder. The purpose of this paper is to document the extent to which various phonatory tasks change the patient's voice. We retrospectively reviewed 37 patients with spastic dysphonia evaluated at the Center for Communication Disorders of Lenox Hill Hospital, New York, between 1977 and 1981. The patients' responses to various phonatory tasks were observed. These tasks were grouped into the following ten categories: noncommunicative vocalization, primitive communication, speech superimposed on noncommunicative phonation, communicative phonation with varied mode of vocal fold vibration, normal communicative phonation with unusual pitch, normal communicative phonation with unusual emphasis, normal communicative phonation with normal laryngeal adjustments, use of the vocal folds in an artistic manner, speech in which normal auditory feedback was eliminated, and speaking with whisper which was not associated with vocal fold vibration. The results are summarized as follows: 1) whispered speech always resulted in an improvement of the symptom, in most cases markedly; 2) there was a tendency for a task that was more effective in reducing spasticity to be reduced in communicative function; 3) there was a tendency for a task that was more effective in reducing the spasticity to deviate more from the normal mode of phonation; and 4) there were some patients in whom an improvement occurred with elimination of auditory feedback.

Adult↗
PubMedDate not supplied

Strobofiberscopic video recording of vocal fold vibration.

We describe our current system for strobofiberscopic video recording of vocal fold vibration and our early clinical experiences. The advantages of the strobofiberscopic video system over the strobotelescopic video systems are 1) the range of subjects is wide, and 2) the patient can phonate while maintaining normal head position during examination.

Adolescent↗
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Posterior glottis. Morphological study in excised human larynges.

Two sets of investigations were conducted with excised human larynges. The glottis was closely observed and photographed from above and below in three conditions: neutral, adduction, and abduction. The structure surrounding the posterior glottis was histologically investigated in the same three conditions. The results are as follows. The structure surrounding the posterior glottis consists of three portions: the posterior wall of the glottis, the lateral wall of the posterior glottis, and the cartilaginous portion of the vocal fold. During vocal fold adduction, the posterior part of the larynx closes completely not at the glottis but at the supraglottis, resulting in formation of a conic space in the posterior glottis that can be viewed only from below. The posterior glottis accounts for approximately 35% to 45% of the entire glottic length and 50% to 65% of the entire glottic area. The mucosa of the posterior glottis has ciliated epithelium. The lamina propria consists of two layers. The posterior glottis can be regarded as a respiratory glottis.

Adult↗
PubMedDate not supplied

Deglutition following supraglottic horizontal laryngectomy.

In order to determine factors that may contribute to deglutition problems following supraglottic horizontal laryngectomy or its modified techniques, clinical records of 38 patients were studied. Contribution of the following factors was investigated: age; sex; tumor classification; radical neck dissection; extent of and symmetry in removal of the aryepiglottic folds, arytenoid cartilages, and false folds; removal of the base of the tongue, hyoid bone, and a part of the vocal folds; extent of removal of the epiglottis and thyroid cartilage; cricopharyngeal myotomy; and some complications and concomitant diseases. The results suggest that removal of the arytenoid cartilage and asymmetrical removal of the false folds contribute to deglutition problems. We conclude that the standard supraglottic horizontal laryngectomy associated with surgical approximation of the larynx to the base of the tongue and cricopharyngeal myotomy does not usually cause serious deglutition problems. When the arytenoid cartilage is removed, reconstruction of the structure is required for the prevention of severe aspiration.

Aged↗
PubMedDate not supplied

Vocal function following hemilaryngectomy.

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.

Adult↗
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Histopathologic study of carcinoma of the hypopharynx: implications for conservation surgery.

A total of 38 specimens obtained by laryngopharyngectomy were subjected to a whole organ section study. Of the 38, 31 were pyriform sinus (PS), three were postcricoid (PC), and four were posterior wall (PW) carcinomas. The results were as follows. 1) The thyroid cartilage was involved much more frequently than the other laryngeal cartilages. 2) Joint involvements were infrequent. 3) The interarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles frequently were invaded by PS carcinomas, whereas PC carcinomas frequently involved the interarytenoid and posterior cricoarytenoid muscles. 4) The recurrent laryngeal nerve (RLN) was involved in all PC T3 cases, but RLN involvement was rare in PS cases. 5) Involvements of the paraglottic space and periarytenoid region were closely related to fixation of the larynx on the affected side (hemilarynx) in PS carcinomas. 6) Neither hemilarynx fixation nor PS apex involvement was a reliable landmark for determining the exact extent of laryngeal involvement. 7) Conservation surgery could have been employed in 18 of the 38 cases.

Humans↗
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Computed tomography in determining laryngeal involvement of hypopharyngeal carcinoma.

In 22 patients with hypopharyngeal carcinoma, the extent of laryngeal involvement was estimated preoperatively by means of computed tomography and visual inspection including mirror examination and fiberscopic and strobofiberscopic video recordings. All patients underwent laryngopharyngectomy, and the surgical specimens were subjected to a whole organ section study. The results of the preoperative evaluations were related to the histopathologic findings. Computed tomography was reliable for the estimation of paraglottic space involvements. It was also useful in detecting carcinomatous invasion into the preepiglottic space and aryepiglottic fold, but there were some false positives for these structures. It was not always reliable in assessing invasion of the laryngeal cartilages. It provided a very accurate estimation of involvement for the thyroarytenoid muscle and a considerably accurate assessment for the lateral cricoarytenoid and interarytenoid muscles and the recurrent laryngeal nerve. It was useful in detecting involvement of the posterior cricoarytenoid muscle, but there were a fair number of false positives. For the cricothyroid muscle, the estimation based on CT was not very reliable. Some erroneous judgments on CT were corrected in a comprehensive evaluation that included visual inspection.

False Negative Reactions↗
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A study of endotoxaemia in patients with primary biliary cirrhosis.

Hepatic reticuloendothelial function may be diminished in patients with primary biliary cirrhosis. Endotoxin concentrations in peripheral blood and in the superior mesenteric vein were measured, by the beta-glucan sensitive, factor-free, endotoxin-specific limulus assay, in patients with primary biliary cirrhosis and liver cirrhosis (non-PBC cirrhosis). Endotoxaemia was detected in the peripheral blood of seven out of nine patients (78%) with asymptomatic primary biliary cirrhosis, but in only two out of thirteen patients (15%) with non-PBC cirrhosis. The endotoxin level was significantly higher in the earlier stages of primary biliary cirrhosis than in the later stages (P < 0.05). The endotoxin level in superior mesenteric vein blood was significantly lower in patients with primary biliary cirrhosis than in patients with non-PBC cirrhosis. Peripheral endotoxaemia in patients with primary biliary cirrhosis may be due to the diminished capacity of the hepatic reticuloendothelial system, for phagocytosis of endotoxin.

Endotoxins↗
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Examination of visceral perception and gastric tone by gastric stimulation using air inflation during endoscopy.

This study investigated the assessment of visceral perception and gastric tone using insufflation during endoscopy. The intragastric pressure was measured during insufflation in 16 patients with gastro-oesophageal reflux disease, 25 patients with functional dyspepsia and 24 normal controls, using a pressure transducer inserted through the forceps aperture until gastric symptoms appeared. The intragastric pressure at the visceral perception threshold, the time to threshold and the time-pressure curve gradient were measured. The visceral perception threshold was significantly reduced in the functional dyspepsia group compared with the normal controls. Balloons were also inserted into the duodenal bulbs of 10 normal controls to investigate the effect of efflux of air into the duodenum; the measured parameters were not influenced by inflation and deflation. These results suggest that it is possible to assess visceral perception and gastric tone by measuring changes in intragastric pressure, using gastric stimulation by insufflation during endoscopy.

Aged↗
PubMedDate not supplied

Peripheral T-cell lymphoma: clinicopathologic analyses of 25 cases.

Twenty-five patients with peripheral T-cell lymphoma (PTCL) were analyzed to assess clinicopathologic features of the disease and were classified according to the newly proposed histologic classification for T-cell lymphomas to study the correlation between histology and survival, if any. Histologic diagnoses were: Lennert's, 1; T-zone, 1; pleomorphic, small, 1; pleomorphic, large, 1; angiocentric, 4; pleomorphic, medium, 5; immunoblastic, 5; angioimmunoblastic, 7. Patients with PTCL were noted to be endowed with clinicopathologic factors known to adversely affect survival, such as advanced stage (92%), B symptoms (56%), liver involvement (56%), multinodal disease (52%), elevated serum LDH (48%), and so on. Response to therapy was poor. CR was obtained in 30% of patients with advanced disease with a 50% relapse rate. Median survival for the 25 patients was 13 months. No correlation was found between morphologic subtypes and survival.

Actuarial Analysis↗
PubMedDate not supplied

Arrangement of motoneurons innervating the intrinsic laryngeal muscles of cats as demonstrated by horseradish peroxidase.

After HRp injection into the posterior cricoarytenoid (PCA), the thyroarytenoid (TA), the lateral cricoarytenoid (LCA) and the interarytenoid (IA) muscles, labeled neurons were identified in the nucleus ambiguus ipsilaterally. The motoneurons for the cricothyroid muscle (CT) were found ipsilaterally in the retrofacial and ambiguus nuclei. The labeled cell columns of PCA, TA, LCA and IA were situated more caudal than that of CT in the order of PCA, TA, LCA and IA. In the nuc. ambiguus, the motoneurons of CT showed compact form and were located in the ventral part, those of PCA were aggregated and occupied the middle part, those of TA were scattered and were seen in the dorsal part, and those of LCA and IA were sparse and were recognized widely in the nucleus.

Animals↗
PubMedDate not supplied

Histological structure of vocal fold lamina propria in foetal larynx.

Previous investigations of vocal fold lamina propria in adult human larynx have revealed a highly specific organization and distribution of the connective fibres. The authors tried to elicit the developmental characteristics of that process using a material of foetal larynxes, ranging in foetal age from 13 to 23 weeks. The specimens were embedded in paraffin and then serially sectioned in both horizontal and vertical plane. The specific technique of differentiating elastic fibres from collagen fibres was utilized. The distribution and organization of connective tissue in foetal vocal fold lamina propria differed from that in adults and no straight elastic fibres were demonstrated as the first sign of later differentiation.

Connective Tissue↗
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Somatotopic representation of the laryngeal motoneurons in the medulla of monkeys.

Following HRP injection into the cricothyroid (CT), posterior cricoarytenoid (PCA), thyroarytenoid (TA), lateral cricoarytenoid (LCA), and the interarytenoid (IA) muscles, most of the labelled neurons were observed ipsilaterally in the nucleus ambiguus (Amb), whereas a few labelled cells were also recognized in the reticular formation. The labelled cell column for CT extended from a level near the rostral end of the inferior olivary nucleus (IO) to a level caudal to its middle part. The labelled cell columns of PCA, TA, LCA and IA were located between the level rostral to the middle of IO and that of the caudal end of IO. These findings agree with our previous studies on cats. However, in the transverse plane, CT motoneurons were arranged in annular fashion around the Amb. Motoneurons of PCA were located in the medial part, those of TA in the lateral part, and those of LCA and IA in the middle part of the Amb. These findings differ from our findings in cats, described elsewhere.

Animals↗
PubMedDate not supplied

Macula flava in the vocal fold of human fetus.

The histological analysis of fetal vocal folds (in humans) in serial horizontal sections revealed a dense cell accumulation at the anterior and posterior ends of the vocal fold. Macula flava posterior was identified in all analysed specimens and macula flava anterior in those older than 18 weeks. Maculae flavae are composed of mesenchymal immature cells which gradually originate from cartilaginous cells of the arytenoid or mesenchymal immature cells of the anterior commissure tendon. Macula flava posterior presents the continuation of the arytenoid and there is no delineation between macula flava anterior and anterior commissure tendon. Since macula flava posterior extends its protrusion to the place of the most intensive connective tissue organization (which begins already in fetal life), it has been concluded that both maculae have an important influence to the specific organization and differentiation of connective tissue in the lamina propria of the fetal vocal fold.

Fetus↗
PubMedDate not supplied

Acoustic analysis of pathological voice. Some results of clinical application.

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.

Aged↗
PubMedDate not supplied

Ageing of the vibratory tissue of human vocal folds.

Sixty-four human larynges ranging in age between 70 and 104 years were investigated histologically. The results were incorporated into our previous data for younger age groups. Discussion was focused on the mucosa around the vocal fold edge. The following tendencies were observed with ageing: (1) the membranous vocal fold shortens in males; (2) the mucosa thickens in females; (3) the cover of the vocal fold thickens in females; (4) edema develops in the superficial layer of the lamina propria in both sexes; (5) the intermediate layer of the lamina propria thins and its contour becomes deteriorated in males; (6) elastic fibers in the intermediate layer become less dense and atrophy in males; (7) the deep layer of the lamina propria thickens in males; (8) collagenous fibers in the deep layer become denser and fibrotic in males. The degree of these geriatric changes vary from individual to individual.

Aged↗