Mikrovibration (体表面微細振動) の研究が日本ほど盛んに行なわれている国は他になく, その日本の科学雑誌に寄稿するのは喜びにたえない. さて, こゝでは生理学的および技術的問題点を取り上げてみたい.
Mikrovibration (以下MVと略す) は温血動物のみにみられる全身的の不断の微細振動であると定義することができよう. これは肉眼的な振動と比較され, Miner Tremor (稲永, 1959) とかphysiologischer Tremor (Stuart, et al. 1963) と呼称された. だが Tremorというのは一定条件 (寒さ, 興奮) で起こる生体の反応や脳疾患 (パーキンソン氏病) で起こるものであり, MVは生涯間断なく続くものである. しかもこれは生体の反応でなく, 永続的な筋活動である. 従つてTremorというよりMVと命名する方が妥当である. それで私は「MVとは温血動物のみにみられ, 全身に存在する永続的な振動で, 健康成人は7～14cpsの周波数をもつものである」と定義する.
生物学的問題: MVの生物学的機能はまだ不明である. しかし体温保持と筋緊張が問題となる. 運動神経を切断された四肢ではMVが消失する (菅野, 1957) ことから, これは筋線維の収縮によつて生ずるといえる. またMVは温血動物のみに存在することから, 永続的筋収縮によつて体温を保持するに必要な熱量が生産されていることと関係があると思われる. 身体の弛緩状態および睡眠中は筋肉の活動電流は認められない (Buchthal, 1958). だがその場合でも存在する収縮性筋トーヌスはいかなる機構でなされているかという問題が生ずる. 冷血動物の筋トーヌスはいわゆる遅速線維-温血動物にはみられない-の収縮によつて生ずるようである (Reichel, 1960). また組織と体液のリズミカルな振動が生体の化学的作用に無関係とは思われない. これらの点に大きな意義を有すると考えられるMVの力学的力は, 鉛板による測定実験で, 意外に大きいことが判明した.
MVのもう一つの生物学的作用は迷路の受容器の刺激にある. 三半規管の内リンパ液がMVによつて一定の振動をなしていて, そこに存在する受容器は常に刺激されていると考えられる. その刺激が中枢へ伝えられることによつて, 人間は安静時でも方向知覚を保持するのであろう. この仮説の証明のために, 平衡障害患者と正常人で比較実験が行なわれ, 前者では周波数は高く, 振幅は小さいことが実証された (永淵, 1966). この仮説から次のことが考えられる. すなわちMVを欠く冷血動物は温血動物に比較して, 迷路から体位についての情報が少なく, そのため平衡維持が困難であろう. このように考えると, MVは系統発生学にも意義をもつてくる. 温血であることもMVによつて初めて生ずることから, 哺乳動物や鳥類に重要な二つの器官-体温と平衡調節-は系統発生史上ほぼ同時期に現れたといえる.
MVの発生に二つの仮説-心搏説と筋原説-がある. 心搏説 (Brumlik, 1962, Buskirk & Fink, 1962) によると, MVは心搏動による身体の共振であると述べている. だがMVは死後数分間認められる (Rohracher, 1954, 菅野, 1957, 吉井, 1965). 実際には心搏の影響をMVから完全に分離することは出来ない. MVの機構は筋原説でうまく説明出来る. 各運動神経線維は多くの筋線維を支配しており, 個々の筋線維が, それぞれ収縮を行なうと周囲に振動を及ぼし, それが綜合されて一つの持続的な微細運動を形成する. 菅野 (1957) と吉井 (1963) は動物実験で頸部脊髄を切断してもMVは存続することを証明した. 脊髄反射が筋線維の収縮に大きな役割を果していることは明らかである. 菅野は脊髄後根を切断すると, その領域の MVは一時増大したあと消失することを証明した. このことから菅野と福永 (1960) はMVの発生に脊髄反射が関与していると述べている. MVの発生機序には脊髄反射以外に中枢支配も考えねばならない. 温度が低下すると, MVの周波数は増加し, それによつて筋肉内の熱量が産生される. この調節は非常に正確に行なわれており, その中枢は視床下部にある. この中枢と筋収縮との間には, 脊髄の運動細胞, ガンマ運動神経, 筋紡錘が関与している.
低温ではMVの周波数は高い成分が優位となり, 振幅は減少する (Rohracher, 1954, 1958). だがこの逆の事実が発見された. すなわち人体のMVは冬でその周波数が高く夏で低いという実験結果である. また温帯地方の住民は寒帯地方の住民よりMV周波数は高い (日本人とオーストリア人の比較実験). この説明はまだなされていない.
技術的問題: 技術的に最も困難なことはMVの正確な測定である. Marko (1959) は光学的にMVを可視出来るように試みた. 他には電気力学的にこれを把握しようと工夫されている. MVが正絃波振動であれば正確に測定出来るが, 実際は複雑なので正確な測定は困難である. MV測定の理想は, ピツクアツプが小さくて軽いこと, そして振幅と周波数を積分せずに正確に記録出来ることである. 現在はまだこれがないので, 加速度型ピツクアツプと積分装置で測定しなければならない. MVはこの他, 筋活動の本体, 臨床医学的応用, 更に筋活動に必要なエネルギーと体温との関係等の問題をもつている.

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In this report, the authors classified the middle ear cholesteatoma as follows;
1) attic cholesteatoma
2) tensa cholesteatoma
3) cholesteatoma behind the intact tympanic membrane
4) implantation cholesteatoma
a) flap cholesteatoma
b) postoperative mastoid cholesteatoma
Five cases of postoperative mastoid cholesteatoma were presented. About these cases, the conditions that was suitable for occurrence of cholesteatoma were discussed.
The authors mentioned that postoperative mastoid cholesteatoma, though generally not observed as common cholesteatoma, was of the same nature as common cholesteatoma.
It was mentioned that when the accelerating factors existed, exfoliation of epithelium occurred and postoperative mastoid cholesteatoma grows in the same mechanism as common cholesteatoma.
In conclusion, the authors suggested that postoperative mastoid cholesteatoma could be one type of the postoperative cholesteatomas.

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Plastic surgery for 2 cases of atresia nasi anterior following burns was presented. In the first case of widespread cicatrical atresia, the opening of naris and the formation of ponticulus were simultaneously performed, used with both pedicle flaps from the atresia region and free split skin flap transplanted between the naris and the upper mouth lip. In the second case of simple atresia, three forked incision was carried out at the closed membrane of the naris and three pedicle skin flaps were transplanted inside of the raw face of vestibulum nasi after the cicatricial tissue was removed.

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The patient was male 21 year-old-farmer who had been suffered from nasal obstruction, rhinorrhea, headache and dullness. Malfomation of the right ear, saddle nose, atrophic rhinitis and anosmia were observed.
The plastic operation opening the choanal atresia was done through the transpalatinal method under the general anesthesia. The choanae were obstructed with the membranous connective tissue, which were histologically composed of the fibrous tissue, glandular structure, striated muscles, nervous tissue, etc, but the osseous tissue and cartilage tissue were not found anywhere in the sections.
By the operation, the remarkable improvements of speech and hearing were obtained.
At present, one year after the operation, the patient has no trouble and no complaint about breathing through the nose.

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It often happens that when a surgical operation is carried out on the basis of radiographical findings by contrast medium “Moljodol”, so called,“X.-M. F. T.(X-ray Mucous Menbrane Test)”. On clinical symptoms, the case in question is found to be entirely free from abnormalities in respect to pathologic-histological operation findings. Namely, such cases are rare encountered, which, although normal, are considered, backed by various examinations, as resulting sinusitis.
Among 100 cases inspected in 1966 regarding the excretory functions in the supra-maxillary cavity by the contrast medium, Nakano (the author) reports to have found 3 cases (3%), in which no abnormalities at all were detected in the cavity mucosa.
The author has conducted examination of these cases in which no organic abnormalities were observed, as a result, has reached the conclusion that this particular disease, while very much similar to sinusitis, is not actually sinusitis, therefore, should be treated as an absolutely separate disease. The author suggests that this disease results probably from an unbalanced movement of the cavity mucosa, unbalanced secretory functions with automatic nerve, accordingly, wishes to propose that the name of “Maxillo-Sino-Pathie” be adopted for these groups, to report these cases under this name.
Hoping that the patients will not be treated by unnecessary operations in future.

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The author succeeded to obstruct the obsolete nasal septum perforation in 3 cases, in which the different ways of closing technique were tried.
In the first case, whose mucous layer was able to be loosened, a part of the cartilage was moved to the space of perforation.
In the second case, two pieces of mucous layer from the inferior turbinate were patched on both sides of the septum, after the margin of perforation was excoriated.
In the third case, one side of the mucous layer was successfully loosened, which was made the flap to close the perforation, while the other side of it was excoriated and patched with a piece of mucous layer from the inferior turbinate.
After that some pieces of unguent gauze tampon were used for fixing the mucous layer.

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A case of neurilemmoma of the tongue in a 19-year-old female was reported. The patient complained of the tumor in the tongue, speech disorder and dysphagia at the time of admission.
The tumor was removed without difficulty under general anesthesia.
The tumor measured 4.2×2.5×2.6cm in dimensions and weighed 15g. Histopathological examination revealed well vascularized neurilemmoma, which was made up of so-called type “A” and type “B” tissues and had a large degeneration cavity.
The patient has been released from her suffering without any recurrence 3 months after the operation.

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Coins are most frequent esophageal foreign bodies. They usually lodge in frontal position due to the proper shape of the esophagus.
The author reported here a rare case of an esophageal foreign body a coin lodging in sagittal position.
The patient was an 11 year old boy. About 90 minutes before his visit on the author's clinic, he, playing a magician, inserted a coin (10 yen) deep into the hypopharynx, mistakenly swallowed it, and complained of chest-pains. Roentgenographically, the coin seemed to lodge at the first narrow in sagittal position.
This rare position was confirmed by esophagoscopy (with 1.0×18cm Killian's esophagoscope) and the coin was extracted with Robert's forceps.
In the case of this age, a foreign body 2.5cm in diameter such as that of a 10 yen coin is easy to pass through the esophagus. The sagittal position in this case seemed to be attributed to the condition that the patient inserted a coin intentionally deep into the hypopharynx.

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The author has treated the tympanic symptoms of ear-drums with perforation caused by closing of the eustachian tube. The following conclusions were obtained:
1) It was found that there were two types of the tympanic symptoms due to closing of the eustachian tube: the one was that by the negative pressure of the tympanum, and the other was that by some other causes.
2) Therefore, the tympanic inflation helped in stabilizing the air pressure in the tympanum as well as in reducing the tympanic symptoms by effecting the various parts of the middle ear.

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The authors reported two rare cases of a foreign body.
The first case was 31 year old male who was pierced on the left palpebular conjunctiva by the cap of ball-pen which had been kept in his left breast pocket when he fell in the course of rock climbing. The cap was left in the right maxillary sinus through the nasal cavity.
A day later of his visiting the authors' clinic, Caldwell-Luc operation was performed. The cap which penetrated his left orbit and nasal septum and stopped in the right maxillary sinus was successfully removed after cutting off the lateral bony wall of the maxillary sinus.
The second case was a 5 month old female baby. When she was playing she was accidentally covered with tulcum powder all over the face and inhaled the powder. Soon dyspnea occurred. She was sent to the authors' clinic without delay, and undertook the bronchoscopy. Her trachea and bronchus were filled with white mass. The authors tried to remove it as much as possible, but could not do it completely from the peripheral bronchus.
Unfortunately, two days later dyspnea increased, and she died.
The authors reflected that we should have learned how to treat such an unusual case.

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The authors reported two cases of otogenic brain abscess which manifested themselves after radical operation of cholesteatoma.
These cases called latent brain abscess were cured soon after the temporal lobe abscess was opened.
Mortality of brain abscess was decreased but shows a high ratio even now. Diagnostics and new method of treatment were further discussed.

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Three cases of delayed decannulation in infant were reported and discussed. A one year and three months old boy who had been troubled for one month by delayed decannulation. In this case, a special short cannula (Fig.) was successfully used for purpose of the maintenance of normal air passage. The stimulation to the trachea and the bend of tracheal cartilage are avoidable by using this cannula.
In other two cases, eleven months old boy and two years old boy, delayed decannulation was cured by removing tracheostoma to the suitable position.
Delayed decannulation occurs easily in infants because of their narrow air passage. The subsidence of tracheal cartilage and the presence of granulation tissue in the trachea make the air passage narrower. Therefore, it is important to avoid the above mentioned factors.

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