[in Japanese]

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The author, at the beginning, illustrated diseases of regulating mechanism of the brainstem: epilepsy of brainstem origin, diencephalosis, mesencephalosis and medioencephalosis, discussing his own data and those of other researchers. Correlation between clinical characteristics and EEG was stressed, and certain. EEG abnormalities: paroxysmal bilateral slow dysrhythmia or paroxysmal bilateral spike and wave complex and 6-14 c/s positive spike pattern, were regarded as the most available indicator of diseases of regulating mechanism of the brainstem. Dysrhythmic vertigo: one of epilepsy of brainstem origin, was dealed in this paper, and the author tried to describe an outline of this disease.
Out of 234 patients with main complaints of recurrent attacks of dizzy state consulted in our clinic in the previous two years, 79 cases: 38 of dysrhythmic vertigo, 15 of epilepsy (grand mal and petit mal) and 26 of Menier's syndrome served this study because of their established symptomatology. Dizzy state of the former two is considered to be of central origin and that of the latter as a symptom of peripheral Cotogenic and vestibular) origin. Investigations were carried out to find out symptomatological and clinical differences between these three diseases.
Age of the onset: 11-55 with the average of 28.9 in dysrhythmic vertigo, 5-32 with the average of 17.3 in epilepsy and 12-55 with the average of 30.3 in Menier's syndrome, showed younger age of the onset of the patients' dizzy state in epilepsy. Features of dizzy state were examined and three categories were settled: vertigo, dizziness and black-out. Frequencies of these three in each of the diseases: 9 vertigo, 26 dizziness and 21 black-out in dysrhythmic vertigo (38 cases), none of vertigo, 9 dizziness and 8 black-out in epilepsy (15 cases) and 16 vertigo, 19 dizziness and 8 black-out in Menier's syndrome (26 cases), showed that vertigo was most correlative to Menier's syndrome while black-out was relatively rare in this syndrome, and that in epilepsy vertigo was neglected. Duration of attacks of dizzy state: a moment to several seconds in 17 cases and several minutes in 3 of dysrhythmic vertigo, a moment to several seconds in 5 and several minutes in 2 of epilepsy, and a moment to several seconds in 3, several minutes in 5, several hours in 5 and several days in 1 of Menier's syndrome, suggested that duration of attacks was much shorter in dysrhythmic vertigo and epilepsy than in Menier's syndrome. Some symptoms and signs were detected at the intervals between the attacks otogenic ones such as deafness, tinnitus, feeling of ear-stenosis and otalgia, ophthalmologic ones such as nystagmus, blurred vision, dimness of vision, double vision, flimmerscotoma, blind spot and photophobia, and those which might be originated from vestibular insufficiency such as arm deviation, positive stepping test, deviated gait and Romberg or Mann phenomena. Distributions of these three kinds of symptoms and signs were compared in the three diseases, showing no significant difference, but Menier's syndrome only had a considerable density in the symptoms and signs of otogenic nature, no matter whether the patients' dizzy state was vertigo, dizziness or black-out. Recurrent or habitual headache at the intervals of the attacks of dizzy state was registered in 61% of the cases of dysrhythmic vertigo, 27% of those of epilepsy and 38% of those of Menier's syndrome, and dysrhythmic vertigo was considered to be most correlative with recurrent headache (dysrhythmic headache).

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I have observed clinically the 215 cases of laryngeal cancer treated in the Otolaryngological Clinic of Kyushu University during 9 years from August, 1957 to July, 1966. There were 192 male and 23 female patients among them and the ratio of male to female was 8.4: 1. The range of age was from 38 years old to 84 years old and its distribution was as follows: 38-39 years old 2 cases (0.9%), 40-49 years old 16 cases (7.4%), 50-59 years old 58 cases (27%), 60-69 years old 96 cases (44.7%), 70-84 years old 43 cases (20%).
In the prognosis, 55 cases (25.6%) of the all cases died (24 died from laryngeal cancer and 21 from other diseases). The total survival ratio was 74.4%, the 5-year survival ratio being 69%.
The next table shows the analysis of the results according to the treating method.
_??_

The T. N. M. classification was done on the all cases and its conclusions were as follows.
1. Radiation therapy was most effective for the T1N0 group of glottic cancer. Especially, the interstitial radium-irradiation (Sasaki's method) which was carefully indicated proved 100% curability.
2. Partial resection was effective against the confined supraglottic cancer.
3. Laryngectomy was very effective for the T1N0 and T2N0 groups, but there were many recurrence cases in the T3N0_group. So T3N0 group should be treated not only by laryngectomy but by prophylactic neck dissection.
4. Laryngectomy combined with prophylactic neck dissection was effective for the T3N0 group, and the T4N0 group should be treated by some more strong and combined therapy.
The second subject of my clinical study is as follows. Radio-isotope Au¹⁹⁸ of 100μc was injected in the mucous membrane of the various sites of the larynx and in the submucous soft tissue of the ventricular band of 10 cases who were over 50 years old, on the supposition that the cancer invaded the various sites deeply, and the condition of lymphatic stream from the larynx to the cervical lymph nodes was examined by multiscintigram.
The results were as follows
1. Radio-isotope Au¹⁸⁹ clearly transferred to the deep cervical lymph nodes of the injected side in the most sites of the larynx.
2. In the arytenoid radio-isotope Au¹⁹⁸ transferred to the bilateral cervical lymph nodes. So the neck dissection should be exercised not only on the affected side, but the prophylactic neck dissection should be done on the other side, when the arytenoid region suffered from cancer, even if it was unilateral.
3. In the ventricular band the transference of radio-isotope Au¹⁹⁸ showed different when I injected in the depth of 3 and 5mm in one side of it. The radio-isotope Au198 injected there clearly transferred to the bilateral cervical and tracheal lymph nodes. The dissection of the tracheal lymph nodes should be done, not to mention the bilateral neck dissection, in the cases whose cancers developed deeply, though it was unilateral supraglottic cancer.
For that reason, clinically the T. N. M. classification is much more useful than many other classifications in the past.
This classification is the one in which much consideration was paid to the site and extent of the lesion, but not sufficiently to the depth of it.
Actually, it may be very difficult to make a clinical diagnosis about the deep development of cancer, and there is much room left for improvement at this point.

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Histochemical demonstrations of lipoid, succinic dehydrogenase and phosphorylase were done in the intrinsic laryngeal, the heart, the diaphragm and the femoral muscles of the dog.
The results obtained were as follows:
1). The intrinsic laryngeal muscles were chiefly composed of two kinds of muscle fibers, i. e. the one which shows a high enzymatic activity of succinic dehydrogenase and an intense affinity to Sudan Black B and the other which gives very low activities of them. The former corresponds to the red muscle fiber and the latter to the white fiber. Besides these muscle fibers, there exist a few muscle fibers of intermediate type which show a moderate enzymatic activity.
2) The distribution ratio of the red muscle fibers to the white was approximately 1: 1 in every intrinsic laryngeal muscle, while it was 1: 1.5 in the femoral muscle.
3) In general, the peripheral parts of the muscles were predominant in white fibers, while the central parts in red ones. In the thyroarytenoid muscle, the distribution ratio of the red muscle fibers to the white was approximately 1: O.9 in the central parts and 1: 2.3 in the peripheral parts.
4) The activity of phosphorylase was high in the femoral muscle, medium in the intrinsic laryngeal muscles and low in the diaphragm and the heart muscle.
5) The function of the intrinsic laryngeal muscles is considered more tonic than that of the femoral muscle and more phasic than that of the heart and the diaphragm muscle.

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41 year old male, a case of foreign body in the right maxillary sinus was reported.
The material of foreign body was dental instrument, a broach. He was treated twice in his right maxillary carious teeth, first 28 years ago (1939), and secondly 15 years ago (1952). Without any symptom the broach had been left in the maxillary sinus as long as 15 years, and was fortuitously detected at hospital when he complained of headache.
Many cases of the maxillary sinus foreign body were reported, but few in which it was left for such a long time as in our case.

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Primary amyloidosis is a rare disease of unknown cause, but the amyloidosis of the tongue is not infrequently seen in the primary type.
The author regarded a case of amyloidosis of the tongue roported here as of the primary tumor-forming type.
A 53 year-old male developed many masses, approximately 1×0.5×0.3 cm. in size, in the anterior dorsal surface of the tongue and in the left-side buccal mucosa about 10 months prior to his death. He had complained of a slight difficulty in swallowing. The diagnosis was established by the Congo-red stain preparations of the biopsy specimen taken from the tongue. The autopsy revealed the deposits of amyloid in part of the small intestine and in the masses of the subcutaneous tissue layer of the chest and the hip, each mass being approximately 2cm. in diameter. Pyelonephritis, the increase of plasma cells in the bone marrow and the early-staged cancer of the pancreas were also observed.

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Eosinophilic granuloma (Kimura's disease) occurring in the parotid gland of a 37 years old male and its histopathological findings were examined.
Histologically the lesion can be separated from Letterer-Siwe disease, Hand-Schüller-Christian disease and Eosinophilic granuloma of the bone (Otani & Ehrlich) on account of the appearance of many prominent lymphatic nodules in the former case, in which develope germinal centers not only in the parotid gland but in the adjacent soft tissue.
It seems to be an interesting and important fact that the disease has never been reported about Europeans and Americans.

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Primary nasal carcinoma is rare, and only 32 cases have been reported in the domestic literature. A case of primary nasal septal carcinoma which occurred in a 45 year old man was reported.
His chief complaint was nasal obstruction and epistaxis. The patient had extirpation of the carcinoma under maxillotomy (Menker's method) and received Cobalt irradiation (5000r) after the operation. Histological examination revealed that it was adenocarcinoma.
No recurrence of the carcinoma was noted in 2 years after the operation.

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Mittels “ectite”, ein Methyl-Cystein-Hydrochlorid, wurde die chronische Sinusitis erfolgreich behandelt. Bei 20 von 24 Fallen, bei welchen nur dieses Mittel verabreicht wurde, verbesserten sich die objektiven und subjektiven Beschwerden deutlich. Bei 8 Fällen war der Erfolg ausgezeichnet, bei 4 Fallen gut, während er bei 8 Fällen etwas geringer war. Bei 4 Fallen konnten wir keine Besserung feststellen.
Durch die Verabreichung von “ectite” in Verbindung mit verschiedenen konservativen Operationen, welche die Nasenhöhle durchgängig machten, konnten wir bei 3 Fällen ausgezeichnete Erfolge erzielen.
Bei 3 Fällen, bei welchen das Mittel nach der Radikaloperation verabreicht wurde, haben wir eine Verkürzung der Behandlungsdauer festgestellt.
Bei allen Fällen gab es keine Nebenwirkungen.

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The fine structural changes in the cochleas of guinea pigs, acoustically stimulated with or without vitamin B₁ administration, were observed under an electron microscope.
The observations were performed on the intermediate zone of the outer and inner hair cells, the nerve endings at the base of the outer hair cells and the myelinated nerve fibers in the osseous spiral lamina. The correlation between the structural changes by acoustic stimulation and the effects of vitamin Bi administration in relation with these changes were examined.
All the experimental animals of the first group were exposed to white noise at 110 phon without vitamin B₁ administration. The exposure time ranged from 15 min. to 24 hrs. In the second group the animals were given vitamin B₁ (10mg/day, for 7 days, intraperitoneally) and then were exposed to white noise as well as in the first group.
Immediately after the noise exposure, the cochleas were removed and fixed in glutaraldehyde and osmium tetroxide, dehydrated with aceton and then embedded in Epon 812. Ultrathin sections which were cut out of the blocks and stained with uranylacetate and then with lead hydroxide were examined under a HU-10A electron microscope.
The structural changes observed were as follows:
1. In the intermediate zone of the outer hair cells, some of the smoothsurfaced endoplasmic reticulums along the cell membrane showed swelling, their lamellae increasing in number and their lamellar arrangement coming out of order. Mitochondria in this zone began to swell and degenerate in the long exposed animals (over 6 hrs.). These changes were found to be more dominant in the group without vitamin Bi administration.
2. In the intermediate zone of the outer hair cells, some kinds of cell particles, all regarded as lysosomes, were found. With the shortly exposed animals (within 60 min.), electron dense inclusions in the cell particles appeared thicker in proportion to the exposure time. On the other hand, with long exposed animals (over 6 hrs.), these electron dense inclusions were found thick if vitamin B₁ was administered, while with the animals without vitamin B₁ administration, they were found remarkably thin.
3. In the intermediate zone of inner hair cells, structural changes were less noticeable than in that of the outer hair cells.
4. In the non-vesiculated (afferent) nerve endings at the base of the outer hair cells, the mitochondria showed swelling and degeneration in the long stimulated animals (over 6 hrs.), without vitamin Bi administration.
5. In the axon of myelinated nerve fibers in the osseous spiral lamina of some long exposed animals (over 6 hrs.), extraordinary membranous structures were found.
6. As finding of great interest, in the intermediate zone of outer hair cells of the two of all the experimental animals, a group of virus-like particles was discovered.

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