動物における聴覚障害の研究は一つの大きな目標を持つている. それは聴力検査や電気生理的指標を用いて, 聴覚機能に対する傷害を決定する事である. 人間により行なう事の出来ない様な方法で病理組織学的なデータが得られるのであるから, 臨床的にも大きな価値を持つている. それによって実際に患者を観察する事によって立てた仮説を実証する事が出来る. 又日常の診断の過程では得られない聴覚機能の新知見が得られるであろうし, 期待しなかった様な例外も発見出来るかも知れない. 私はこ～で末梢性損傷に関する知見をもう一度見なおしてみたいと思う.
末梢性損傷の影響を見るよい方法の一つに, 神経細胞活動の電気生理的記録法がある. Fig. 1に正常な動物の蝸牛反応の入出力曲線を示す. 注目しなければならないのは直線部分で, 刺激が大きくなるにつれて蝸牛反応も大きくなる. しかし最大に達し, それを過ぎると直線性を失なう. 更に蝸牛反応最大値は周波数によつて異なる. Fig. 1の点線で示した曲線は, 動物に永久的な聴力損失をもたらす刺激を与えた際の蝸牛反応で, 二つの変化が認められる. 第1に蝸牛反応の最大値の低下と第2に高周波数領域での直線部分の右偏位である. 直線部分が本質的に互いに平行的に保たれているのに, 蝸牛反応の大きさののび率が増加しないのは興味がある. レクルートメントのある患者に見られる音の大きさの異常に急激なのびは, 蝸牛反応曲線における傾斜の増加に現われているのではないと思われる. 勿論, 蝸牛反応は損傷された耳の機能をほんの一部しか現わしていない. 蝸牛反応と聴検で得られたデータとの間に有意な関係を見つけたいのであるが, 残念ながら同一の動物でそれを得る事は極めて困難である. 何故ならば, 長期間電極を挿入しておく事は正円窓に近い所を除いては困難だからである.
Simmons and Beattyの研究によると, 強い音響負荷により永久的な損傷を与えた動物では正円窓から得た蝸牛反応はそこから数ミリメートル離れた部位の病変しか表わしていない事が明らかになつている. その結果, 聴力検査で得た聴力損失と蝸牛反応の損失の間の相関々係は16, 000サイクル以下では極めて弱いものとなる.
障害された部位に分離電極を挿入して蝸牛の損傷を詳しく測定する方法もあるが, 今迄にそれと聴力検査のデーターを一緒に出した人はない.
末梢障害の研究には三つの一般的な考えがある. 第一は, 普通聴力検査で得たオージオグラムはコルチ器損傷の極めて優れた指標となる. 第二に, 神経のみを損傷した際はオージオグラムには限られた変化として現われる. 第三に, 純音弁別閾値は末梢の損傷をそのま～反映するものではないという事である. もう少し深く考えて見ると, 蝸牛障害と聴検結果は極めてよく一致する. 基底膜上で最大の反応を示す点と, 10g目盛りで表わした周波数とはよく一致する. 即ち周波数のオクターブ変化は基底膜上の一定の距離で移動している. 第8神経の蝸牛の部分を切断してもそれが不完全であれば, 神経節細胞の消失と聴覚閾値は殆んど関係がない. Fig. 7は螺旋神経節細胞の35～100%が消失した猫のオージオグラムであるが正常である. この事から純音シグナルを感じ得るには, ほんの数本の神経エレメントがあればよいと推定される.
神経線維がある長さで完全になくなれば勿論閾値は影響を受ける. 然しそれがある限られた範囲であれば, 可成りひどい損傷でも聴力損失を伴わない場合があり得る. 以上の事から次の二つの解釈が成り立つ. 第1 に単一のシグナルを感知するのに必要とされる以上の, 多数の役に立つ神経線維が存在する. 第二にシグナルの感知は残つている神経線維群の活性度の変化にもとつくものである. 臨床経験上でも神経損傷を受けた患者が正常オージオグラムを示す例がある.
内耳の病的な状態は, 純音オージオグラムよりも弁別検査によつてはつきりするものであるから, 我々は猫を使つて一連の聴覚弁別能の研究を行なつた. しかしこの種の実験には非常な時間を費すし, 逃避条件反応法を用いた猫は非常に神経質になり, それ以後の実験が出来なくなる. そのため, 別のグループの猫を準備して行つた結果がFig. 8と9に示されている. 蝸牛に可成り重篤な病変があつても周波数と強さの弁別には異常なかつた. これは純音弁別検査でも不充分であつて, 臨床で用いる語音聴力検査の様なものを考案しなければならない. 更にもつと多量の情報を提供して臭れる様な高等な動物を使う必要が生じて来る. 我々は現在, 猿を用いて実験を行なつているが, これは未解決な聴力障害のよき指標となるものと期待される.

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The malignant epipharynx tumor is a relatively rare disease, which occurs oftener in Orientals, especially in Chinese. It is noticeably difficult for treatment and the prognosis is very bad. In this report the author made observations on 72 cases of malignant epipharynx tumor, which were brought into postmortem exa mination in Japan with the special reference to the state of their metastasis.
1. Visceral metastasis was seen in 37 cases (69.8%) among 53 of cancer. The site of metastasis were mainly in bone, liver and lung. While, visceral me tastasis was 8 (47.0%) among 17 of sarcoma, and chiefly in spleen and adrenal gland.
2. Lymphonode metastasis was 36 cases (67.9%) among 53 of cancer and 12 cases (70.6%) among 17 of sarcoma. The site of metastasis in both cases were mainly in cervical lymphnodes. But sarcoma showed the general tendency of having distant metastasis, such as in the hilus of the lung, retroperitoneal space, the intermesenteric lymphonodes and so forth.

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A study was made of the distribution of neutralizing antibodies against adeno virus type 3, in sera of patients with chronic tonsillitis in Kumamoto district during the period from October 1963 to August 1965. Neutralizing antibody titer was regard from 1: 4 to 1: 16 and antibody titer which showed higher than 1: 4 serum dilution (positive) found in 42.2% of 415 patients with chronic tonsillitis, and less frequently in a control group of 64 persons without chronic tonsillitis (26.5%). The antibodies were more frequently seen in patients with both adenoid and chronic tonsillitis (61.9%) than in patients only with adenoid (35.2%).
104 cases with chronic tonsillitis and positive antibodies received tonsillectomy, of them a decrease in the titer was observed in 30 cases (28.8%) one month after tonsillectomy. However, adenotomy produced a decrease in the titer in only 3 cases out of 16.
Neutralizing antibodies against Adenovirus type 3 were found in the tonsil extracts in 5 out of 21 cases which showed positive antibodies in sera. The anti bodies in sera were found more frequently in patients with focal chronic tonsillitis than in those with simple chronic tonsillitis. Of systhemic diseases, the antibo dies were found most frequently in patients with slight fever, but percentage of positive (1: 4<) antibodies was about the same in the other systhemic diseases.

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Tympanoplasty has been carried out for a long time, but techniques of the operation are still under discussion, e. g., kinds of grafting and procedures on mastoid cavity and ossicular chain to be chosen.
Many reporters say that the rate of success is poor in Wullstein's Type III and IV. Because, in these types the operated ear gets smaller tympanic cavity, and new eardrum is prone to adhere to the promontory. Therefore, many devices are presented about columella formations.
Here, tissue adhesives (Biobond) were used for rebuilding of the damaged ossicular chain. By the use of Biobond incudomalleolar-, incudostapedial joint or handle of the malleus were attached to head of the stapes. And good results were obtained in eight cases.
Points of excellence of this method were:
1) easy procedure, 2) rapid and firm adhesion, 3) no toxicity, 4) little tissue reaction, 5) no need to sterilize newly, and 6) feasibility of cleaning out hidden side of the affected ossicles.

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The statistical observations of congenital malformation of the external ear was recorded here. The prevent material consisted of 651 subjects having 773 malde veloped ears, which were found in 29000 outpatients examined at the Department of Otorhinolaryngology of Kyushu University Hospital from 1960 to 1965.
The frequency of each kind of maldeveloped ear was: fistula auris congenita 196 patients (251 ears), microtia 174 (192), atresia auris congenita 161 (184), accessory auricle 66 (78), pocket ear 30 (38) and the others 24 (30)(Table 2). The sex distribution of the subjects was: 410 males and 241 females. There was distinct male preponderance, especially in microtia and atresia auris congenita (Table 3). The sides affected were: 340 right-sided, 189 left-sided and 122 bilateral. Unilateral defect was preponderent mainly in microtia and atresia auris congenita (Table 3). The frequency of the patients who had malformed ear visit ing our Department for one year made no difference.
(1) fistula auris congenita: 113 male and 83 female cases; 91 right-side, 50 left-side and 55 bilaterally affected. Locations of fistula: crural, 166 patients; preauricular, 19; helicine, 9; and the others, 2 (Table 3, 7).
(2) microtia: the total number of patients observed was 174 (192 ears) ; males 122, and females 52. 105 right-side, 51 left-side, and 18 bilaterally affected. The preponderances in male and unilateral cases were distinct.
We divided our subjects into five groups. In determining the degree, the gradation of Marx was followed. Degree I cases, consisting of 5 ears, included subjects with auricles which are normal in all the characteristic features except in their extraordinarily small size. In Degree II, to which 46 subjects belonged, part of the characteristic features of an auricle was lost. Degree III included 132 subjects with distinctly malformed auricles. The cavum conchae did not exist and most of the cases were lacking the auditory canal. Degree IV consisted of 9 subjects. At this stage the auricle was very defective, showing only its trace, often a malformed lobule. Degree V was anot i a (Table 8).
(3) atresia auris congenita: the total number of patients was 161 (184 ears) ; male 116, female 45. 91 right-side, 47 left-side and 23 bilaterally affected. As in microtia, distinct male and unilateral preponderances were observed. Atresia mostly accompanied microtia. The patients were divided into three groups. Degree I: high grade stenosis. Degree II: the canal was almost lost, only a hol low. Degree III: complete atresia which was the commonest (Table 3, 10, 11).
(4) accessory auricle: the patients were composed of 34 males and 32 fema les. 27 right-side, 27 left-side and 12 bilaterally affected. It was very interest ing that an accessory auricle (over-development) and microtia (arrested develop ment) appeared in the same patient both and on the same side or each on the respective side (Table 3, 9).
Malformed ear was often accompanied with cleft palate, hare lip, facial hemiatrophia and facial paralysis (Table 5). There was no relationship discover ed between the month of birth and the congenital malformation of an external ear (Table 4, 6). In the course of reporting the statistical studies, hereditary factors and phenocopy were taken into account.

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The authors reported here a case of Teratoma occurring in the epipharynx of a new born infant who had a cleft palate. Twenty cases, including this case, of epipharynx teratoma have been reported in Japan, and the four cases of them were complicated by the cleft lip. In this case the tumor with a pedicle occurred on roof of the epipharynx and the posterior margin of the nasal septum. It filled the cleft of the plate and was swollen into the oral cavity. This elastic tumor was smooth and light yellowish brown on the surface, capsuled with the epithe lium containing hair, hair-roots, sebaceous glands and some cartilage. It was removed operatively with little bleeding under general anesthesia.

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Wegener's granulomatosis is a rare, fatal disorder. of obscure etiology. It is pathologically characterized by necrotizing granulomatous lesions of respiratory tract, generalized arteritis and focal glomerulonephritis. In the present communi cation two autopsy cases of Wegener's granulomatosis that we encountered recently are briefly described.
In the first case of a woman, aged 57, signs of generalized disease appeared just after the radical middle ear operation, which took a fulminating course of 56 days after the operation. Her autopsy revealed typical characteristic findings of Wegener's granulomatosis.
In the second case, a woman, aged 33, was treated vigorously with steroids in the early stage of the disease when she was suffering from the inflammation of the upper respiratory tract and had a prolonged course of 8 years. Histopatho logical findings in autopsy presented unusual pathologic changes modified probably by steroids and secondary infection, and generalized angitis was relatively mild. This case was regarded as an atypical form of Wegener's granulomatosis.
Similar disorders included in the categories of arteritis and granulomatous disease are mentioned and discussed.

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The authors reported a case of Silver-Protein allergy. The case was a 47 years old man who had complained of nasal discharge and nasal obstruction. Severe symptoms, such as tachypnea, palpitation, erubescene on the face and itch of the body were founded after nasal treatment. The provocation test of Silver-Protein solution showed positive reaction and similar symptoms.
The assertion made by Dr. Taro Takemi,“We are entering into a new age of advanced health and accordingly, safety education is a thing of vital necessity for safe-guarding our health before we have our health basically destroyed and actually contract a disease” should be a target of universal concurrence and res pect.
For the sake of such safety education and in order to prevent an onset of the so-called “Iatrogenic disease”, liable to be induced by medicines and also, for the purpose of guarding the patient from another sensation of disagreeableness when receiving medical treatment, the necessity of a record (provisionally named), containing the patient's past experiences on his reactions to the medicines, would be conceived.
The patient, who is over-sensitive to a medicine, should then be requered to submit the record to his physician when receiving a treatment from him.
The present writer is especially desirous that this procedure be adopted for actual practices in medicine.

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A man, aged 54 years, had a silent tumor of the palate during 37 years, that was recently found to be partially malignant. The patient was treated by trans oral maxillectomy and ⁶⁰Co-radiation therapy.
Since 1907, 98 in-patients who had the palate tumors were treated in our clinic and their half was carcinomas and 19 cases were mixed tumor patients. The clinicopathological examination and statistical analyses of the mixed tumors (or endotheliomas) were performed.

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Rinderon A solution, containing steroid and antibiotics, was applied to acute and chronic otitis media, 13 and 12 cases respectively. Rinderon A ointment was used for 7 cases with eczema of the external ear.
The result was satisfactory in 92.3 96 of 13 cases with acute otitis media, in 83.3 % of 12 cases with chronic otitis media and in all cases with eczema of the external ear. One case of acute otitis media became free from symptom in only four days and other eight cases within one week.

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