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1 はじめに 工場や倉庫,住宅など低層構造物の耐風設計,ある いは高層ビルなど大規模建築物周りの風環境アセスメ ントなどにおいて,地表面近くの風速分布,乱れの強 さ,ガストファクターなど,自然風の性状を把握する ことは重要である。日本建築学会の建築物荷重指針・ 同解説(以下,荷重指針)では,地表面付近の風速の 性状が複雑であり,地表面粗度の影響を大きく受ける ことや,これまでに報告された実測例が少なく不明な 点が多いことより,周辺の地表面の状況に応じて定ま るある高さ Zb以下の範囲においては,平均風速,乱れ の強さを一定値としている。また,それ以上の高さで は,地上高さ Z の指数関数として与えている。したが って,これに基づいて算定した場合,Zbより低い構造 物の風荷重や地表面付近の平均風速を過大に評価して いることも多いと考えられる。 筆者らは,地表面粗度の状況が異なる複数の場所に おいて,地上高さ 10m までの 2 ないし 3 高度における 風速の観測を行う機会を得た。本報告は,それら実測 結果に基づき,地表面近くの風の性状について検討し

Muscle tension dysphonia (MTD) is a voice disorder associated with abnormal laryngeal posture or glottic configuration induced by excessive contraction of the laryngeal muscles, and supraglottic contraction is one of the characteristic findings in MTD. In recent study we investigated the changes in laryngeal findings and voice quality and the association between them in the course of voice therapy for MTD with supraglottic contraction. The effects of voice therapy on the laryngeal and the vocal findings were assessed by two rating methods: the MTD score and the conventional GRBAS scores and both scores were gradually improved. Of the two components of supraglottic contraction, false vocal cord compression was more curable than anterior-posterior compression at the aryepiglottic level. Little correlation was found between the scores at the first examination, but significant associations (p0.05) were found between the differences of MTD score and G/R/S scores but not B/A scores before and after the series of voice therapy. These results suggest that supraglottic contraction is a crucial factor worsening voice quality and that MTD score is useful to assess the efficacy of voice therapy for MTD.

学校教師における嗄声の現状について調査するため, 3年間に公立学校共済組合直営の病院の人間ドックを利用した公立学校教師利用者11413名について検討を行った.アンケート調査により, 全公立学校教師利用者の924人 (8.5%) が「声がかすれる」という訴えを有することが判明した.さらにそのなかで, 実際に耳鼻咽喉科を受診し, その結果音声障害と診断されたのは180人であった.その音声障害疾患の内訳は, 多い順で, 声帯結節が85人 (46%) , muscle tension dysphonia (以下MTD) は34人 (20%) , 慢性声帯炎21人 (11%) , 声帯ポリープ8人 (4.4%) であり, 前2疾患について検討したところ, 声帯結節群のほとんどが女性で, 一方MTDの群においては男性が優位であり, 明確な性差が認められた.両疾患の年齢分布とも母集団とほぼ同様に50歳代をピークとしていた.喫煙との関連についての検討の結果, 男性の声帯結節の群のみでそのほとんどが喫煙者で構成されており, 喫煙と男性教師における声帯結節の形成の問に関連があることが示唆された.以上の結果は, 今後の学校教師に対する音声疾患の治療のみでなくその予防のために意義のある情報と考えられる.

muscle tension dysphonia (以下MTD) は, 発声時に, 喉頭の筋肉の過剰な緊張が原因で喉頭内腔が押し潰されることによる発声の異常のことを意味しており, 喉頭の内視鏡検査では, 仮声帯の過内転, 披裂部の喉頭蓋基部への前後方向への圧迫の所見を示す.また, 音声訓練による治療が奏功しやすいといわれている.しかしながら, 音声訓練が実際に喉頭所見を改善するか否かということについては不明であった.われわれは, 経鼻ファイバースコープ検査より, 持続母音発声時の喉頭内3部位の圧迫の程度から算定する「MTDスコア」を開発し, MTD症例に対する音声訓練の治療効果を明らかにするために, 治療経過を通じてのMTDスコアの変化について検討した.対象症例は, 男性25例, 女性6例であり, 年齢分布では60代後半にピークを認めた.問診による発症に先行するエピソードの解答は多様であった.音声訓練による治療の経過において, 全31例中24例で, 音声訓練の回数を経るにつれて, 経時的に過緊張発声障害スコアの減少が認められた.そのなかの21例においては, スコア0となり, 同時に嗄声の消失が認められた.3例においては, 数度の増悪の後, 最終的にスコア0となった.残りの4例は不変または増悪した.結果として, MTDに対して, 音声訓練による治療が有効であることが強く示唆された.

A convenient technique for evaluating the wind environment around buildings in wind tunnel tests has been developed. Infrared thermography and a knowledge-based system are applied to this technique. The evaluation system developed in this study can be used effectively at an early design stage of a tall building development, e.g., when the cross sections and/or the arrangement of buildings are examined from the view point of the pedestrian-level wind environment.

The purpose of this study is to develop a method for assessing the comfort of an open-air environment, based on a questionnaire answered by inhabitants of urban areas. Eighty-nine inhabitants of three cities in the northern part of Japan and 18 inhabitants from the suburb of Tokyo responded to the survey. The dependence of comfort judgement on various meteorological factors was studied by using multivariate regression analysis. To construct a comfort environment assessment model, the focus was on a discomfort ratio, which represents what percentage of the inhabitants feels uncomfortable under certain ambient conditions.

The maxillary mucosae of chronic sinusitis patients were observed by transmission and scanning electron microscopy. Although the epithelium was severely damaged by the chronic inflammation and the ciliated cells and goblet cells were degraded and had peeled off, most of the basal cells survived at the surface of the mucosa. The surviving basal cells extended their cytoplasmic processes toward each other and finally covered the bare surface of the mucosa. Cells having a few cilia and many microvilli were occasionally observed. Immunohistochemistry for PCNA (proliferating cell nuclear antigen) was also performed. The nuclei of many basal cells in the nonciliated area and those of a few ciliated cells were positive for PCNA. These findings suggest that the maxillary mucosa of chronic sinusitis has the ability to regenerate and that basal cells play the role of precursors to ciliated cells.

Thirty-eight patients with major salivary gland tumors who underwet surgery in our clinic were studied during a 6 year period from 1991 through 1996. The tumors arose in the parotid gland in 33 patients and in the submandibular gland in 5 patients. The histopathological diagnosis was benign in 32 patients and malignant in 6 patients.The most common benign tumor was pleomorphic adenoma (15 cases). The prevalence of adenolymphoma in the parotid gland in this study was higher than in previous reports, and all patients with adenolymphoma were male. All patients with malignant tumors have remained free of recurrence.

We report two cases of plunging ranula and one of dermoid cyst of the submandibular region. A 30-year-old female presented with a painless swelling in the right submandibular region. A clinical diagnosis of plunging ranula was made, and the patient underwent surgical excision. The cyst was extirpated with the sublingual and submandibular glands. The other plunging ranula was in a 46-year-old female. The cyst was extirpated with the left submandibular gland through a surgical incision in the left submandibular region. There has been no recurrence in either case.A 17-year-old female presented with a swelling in the left submandibular region. CT and echography revealed a large cyst in the floor of the left side of the mouth. Under general anesthesia, the cyst was removed surgically. The histopathological diagnosis was dermoid cyst.

Infections constitute a high percentage of the diseases treated in the field of otorhinolaryngology. We examined the efficacy and safety of Banan® and the trends of the organisms causing infections in 300 patients. A total of 262 strains of organisms were detected and S. aureus was predominant. The efficacy rate of Banan® was 89.5% for acute infections, 62.8% for chronic ones, and 76.5% overall.Side effects occurred in 2.7% of the patients and the majority of them were gastrointestinal disorders.Thus, we concluded that this drug was useful in the field of otorhinolaryngology.

We investigated cefepime, a newly developed parenteral cephem antibiotic, in the treatment of otorhinolaryngological infections. Cefepime was injected intravenously in a total of 26 patients, 1.0g-2.0g for 2-8 days. The infections were otitis media 4, paranasal sinusitis 6, tonsillitis 13, other infections 3.The clinical response was excellent in 6, good in 14, fair in 5, no response in 1. The efficacy rate (excellent + good) was 80.0%. Especially in tonsillitis, the efficacy rate was very high (100%). The efficacy rate was higher for acute than for chronic infections.Of a total of 29 cultured bacteria, 24 were eliminated. The eradication rate was 92.3% excluding 3 strains whose bacteriological response was unknown. The eradication rate was over 90% for gram positive and gram negative bacteria.The tissue levels of cefepime were higher in the maxillary sinus mucosa than in the palatine tonsil.

Twenty-nine patients with nasopharyngeal carcinoma (NPC) with skull base or intracranial involvement were analyzed by high-resolution computed tomography (CT). We divided the path of the primary tumor spread into six directions from the nasopharynx. The most common direction of spread was the anterior region, and the second most common was the posterolateral region. Recently, high resolution CT has been used for the diagnosis of the nasopharynx. T-staging of NPC was made according to the International Union Against Cancer (UICC) TNM classification system, depending on clinical findings and conventional radiograph examinations (not including CT). CT images were valuable for detection of the primary tumor involvement of the skull base region in NPC. Furthermore, bone target CT images were better for searching for subtle bony changes. Therefore, we recommend that CT should be used in T-staging of NPC systematically. When CT is used as one of the staging criteria, some patients with NPC with subtle bony changes will be upstaged.

The concentration of Cefoperazone (CPZ) in the soft tissues (mucous membrane of the pharynx, trachea and lymph node) and wound exsudates in patients undergoing major head and neck surgery was measured by high-pressure liquid chromatography.CPZ (4g) was infused over a 4-hour period. Simultaneous samples of serum and soft tissues were collected in 14 patients at 2 to 4 hours during infusion. CPZ (2g) was administered intravenously twice a day on the following day.Mean levels of CPZ in the mucous membrane of the pharynx and trachea and lymph node were 67.2μg/g, 36.0μg/g, 35.8μg/g, respectively. Excretion of CPZ into wound exsudates through the catheter was observed in 12 patients. Mean levels of CPZ in the wound exsudates were 80.7μg/ml (day 1), 35.5μg/ml (day 2), 42.5μg/ml (day 3).Clinical use of CPZ in 28 patients undergoing surgery showed no postoperative infection.Our experience showed that CPZ was particularly useful in prophylaxis for otolaryngological surgery.

Nocardia-CWS (N-CWS) was examined for adjuvant-immunotherapeutic effectiveness in patients with head and neck malignancies whose tumour mass has diminished after radical operation and/or radical irradiation.The evaluation of effect of N-CWS was done with comparing between the nonrecurrent rate of patients who had been injected N-CWS and that of patients who had not injected under randomized control study.The subjects comprised 36 patients who were given N-CWS injections. They completed both their therapeutic courses and subsequent 6-month or more observation periods in or before April, 1979. The control patients numbered 35 and matched for disease and severity.The rate of sufficient control, as difined by the rate of no local recurrence of tumour mass or metastasis after radical treatment in the subjects and control patients, was 75% (27/36) 71% (25/35), respectively, at 6 months; 61% (17/28) and 41% (9/22) at 12 months; and 50% (11/20) and 25% (3/12) at 18 months.The patients on N-CWS were better controlled than the reference patients by ca 20%, and these findings clearly showed the excellent immunotherapeutic effectiveness of the agent.

1. 頭頸部粘膜に発生した悪性黒色腫30例を報告した. 原発部位別では鼻腔20例, 上顎洞1例, 硬口蓋6例, 上咽頭1例, 扁桃1例, および眼球結膜1例であった. うち25例は新鮮症例, 5例は二次例であった.2. 悪性黒色腫の病理組織学的診断は光顕的にメラニン顆粒を認めないと難かしくなり, 自験例では8例 (27%) において無色素性黒色腫であった.3. 悪性黒色腫の経過は多様であり, 短期間に終るもの, 長期間生存し得るもの, 晩発性の再発例, 自然退縮例など様々である. 自験例の新鮮例25例の予後は5年生存率16%, 10年生存率11%であった.4. 著者の治療方針は手術可能な程度に限局した症例では術前照射5000rad, 根治的切除術, 両側予防的頸部廓清術を行い, 免疫療法として Nocardia-CWS の局所注射ないし皮内注射を2～3年間続ける. 手術不能例では可能な限り, 放射線治療, 凍結手術, レーザ手術, Nocardia-CWS の局所注射を継続する.

1967年から1982年までに大阪大学耳鼻咽喉科, 放射線科を受診した中咽頭癌患者212名のうち, 重複癌が24名にみられ, その24名の重複癌患者について検討し, 以下の結果を得た.1) 発生頻度は, 中咽頭癌患者全体の11%にみられ, すでに報告されている下咽頭と並び, 中咽頭も重複癌が多い.2) 年齢, 性差は, 中咽頭癌患者全体と比較し差がない.3) 第1癌と第2癌の発生間隔については, 1年以内の同時発生が25%にみられ, 8割が7年以内にみられた.4) 部位の組合せでは, 喉頭が8例, 食道5例, 胃4例, 以下, 下咽頭, 舌がつづき, 呼吸器, 上部消化器との組合せが多い. また, 中咽頭の発癌の亜部位は, 軟口蓋9名, 扁桃7例と多かったが, 中咽頭癌はもともと扁桃に最も多いので, 発生頻度としては, 軟口蓋, 中咽頭後壁に多い.5) 組織学的には, 扁平上皮癌どうしの組合せが63%と多い.6) 放射線癌と考えられるものが5名にみられた.

In recent years, elderly patients with cancer of the head and neck region have been increasing. However, it is not rare that treatment of these cases is impeded by the patient's general condition, complications, environments and advancing age. In 31 fresh cases of cancer of the head and neck region who visited our department at the age of 80 years or more during the past ten years, we analyzed the problems encountered during treatment. These 31 cases accounted for 4.6% of the total 696 cases of head and neck cancer treated at our department over the past ten years. They consisted of 26 males and 5 females. The primary site of cancer was the larynx in 12 cases, the oral cavity in 8 cases, the hypopharynx in 5 cases, the nasal and paranasal cavities in 4 cases, the rhinopharynx in 1 case and the parotid gland in 1 case. We applied radiation therapy to 17 cases, surgical treatment to 5 cases, radiation+surgical treatmentto 1 case and palliative treatment to 8 cases. Primary control was achieved in 19 cases (83%). We think that radical treatment should be actively applied even to elderly patients unless it is impossible.

Lethal mid-line granuloma (LMG) is a clinical term, and it is histologically composed of Wegener's granulomatosis (WG), polymorphic reticulosis (PR), and malignant lymphoma (ML). WG is an inflammatory disease, and PR and ML are considered to represent a neoplastic proliferation of lymphoreticular cells. In the present report, a nation-wide study on LMG in Japan is compared with a study from the UK, to examine differences in frequencies of each disease in Eastern and Western countries. A total of 340 cases of LMG were examined. On the basis of histological and clinical findings, these cases were categorized as 68 WG, 129 PR, 92 ML, 44 chronic inflammation not specified, and 7 other related conditions. The crude frequencies of WG, PR, and ML per 100,000 outpatients of ENT clinics in Japan and England were 4, 8 and 6, respectively and 8, 4 and I, respectively. The predominance of malignant lymphoproliferative diseases to WG in Japan (3.5:1) was in marked contrast to the situation in the UK (1:1.6). A review of the pertinent literature suggests a clustering of malignant lymphoproliferative diseases of the nose among Mongolian ethnic groups.

上顎洞2例, 鼻腔, 上咽頭, 扁桃各1例に発生したカルチノイド腫瘍の5症例を報告した. 嗜銀染色, 電子顕微鏡的観察で神経分泌顆粒を認め, この診断を得たが, いわゆるカルチノイド症状を示したものはなく, 血中尿中にも生化学的活生物質を認めなかった.頭頸部のカルチノイド腫瘍はその性質が胸腹部発生のものとは異なっていることより, この腫瘍をより広義な表現である Apudoma と称する方が適当である.

From 1967 through 1982, one hundred and seventy six patients with squamous cell carcinoma and anaplastic carcinoma of oropharynx were treated at the Departments of Otolaryngology and Radiology, Osaka University Hospital.All cases were initially treated by external radiation therapy. Recurrent cases were treated by various kinds of treatment, such as surgery, interstitial iradiation or external radiation. Surgical treatment was most effective in the management of recurrent cases.Local lesions were controlled in 77 cases by the initial radiation alone. Out of 99 recurrent cases, 25 cases were treated by surgical procedures, of which 14 cases were successfully controlled. Local control rate by radiation therapy was found to decrease as the size of the tumor increases. Local control rates according to T stage were T1: 60%, T2: 51%, T3: 32%, T4: 0%.Radical radiation therapy can be curative in the early stages while preserving function, whereas, surgery alone, or in combination with radiation therapy should be performed in advanced stages.

From 1967 through 1980, fifty four patients with tonsillar carcinoma were treated at Osaka University Hospital. The male to female ratio was 3. 5 : 1. The age was distributed from 26 to 82 years. The majority of patients were in their sixties and seventies. According to the TNM classification (UICC 1978), twelve cases were in T1, 22 cases in T2, 19 cases in T3 and 1 case in T4. Cervical metastasis were found in 36 patients (67%) at first examination. Radiation therapy was performed as the initial treatment on all of the patients. Various kinds of treatment such as surgery, re-radiation, Radium implantation, and chemotherapy were used with the radiation failure cases. Among them, surgical salvage was the most effective. The five and ten year accumlated survival rates were 49% and 36% respectively.

Three patients had a painless mass in the parotid (two patients) or submandibular regions (one patient). These patients were 70, 66, and 65 years of age, respectively. One patient was male and the other two were female. No symptoms suggesting the presence of autoimmune sialadenitis had been noticed, although one patient suffered from rheumatoid arthritis. Histologic study showed that small atypical lymphoid cells with slightly irregular and indented nuclear contours proliferated diffusely and secondary lymph follicles were distributed at random among them. These findings are similar to those that we recently reported for intermediate lymphocytic lymphoma (ILL) of the thyroid gland arising in patients with autoimmune thyroiditis. A high frequency of ILL among our series of salivary lymphomas (three of nine cases) is discussed.

A case of malignant fibrous histiocytoma (MFH) in the right maxillary sinus is reported. Patient was a 30-year-old male, and was diagnosed as pleomorphic type of MFH by biopsy before therapy. The tumor shrunk and changed into xanthoma-like tumor after radiotherapy. A case like the present case has not been reported previously in the literature.