Diagnosis and treatment of the so-called malignant granuloma of the nose is discussed in a study of 27 cases. This gangrenous condition consists of two diseases, one reticulum cell sarcoma, the other Wegener's granulomatosis. However, a few cases with undefined clinical and histological features remain neither to be distinguished. But these cases will be certainly classified into either of the two in near future.
Differential diagnosis of the two diseases is as follows. In Wegener's granulomatosis, 1) superficial and bilateral lesions of the nasal cavity, 2) frequent involvements in the middle ear, larynx and trachea without lesions of the face, 3) rare involvement in the pharynx, 4) round shadow or cavity formation in X-ray of the lung, 5) increase in the serum globulin value, 6) giant cell granuloma and vascular changes in histological findings, and 7) renal or respiratory failure in the terminal stage are noticed.
In reticulum cell sarcoma, 1) destructive and unilateral lesion of the nasal cavity, 2) occasional facial lesion with bony destruction, 3) involvements in the soft palate and in the pharynx without lesions in upper respiratory tract, 4) occasional pneumonia, 5) normal serum globulin value, 6) non-specific granulation or sarcomatous changes in the histological findings, and 7) pneumonia, extensive destruction of the nasal lesion and cachexia in the termination are found.
It is widely agreed that irradiation is the most promising therapy for reticulum cell sarcoma and that the use of steroids is most effective for Wegener's granulomatosis. However, when the diagnosis is not definitely decided by the initial biopsy and clinical findings, it is emphasized that combined irradiation therapy with the use of steroids, antibiotics and occasional blood transfusion should be performed at early stage of the disease and further biopsies and clinical examination must be carried out for the differential diagnosis. Prognosis of the malignant granuloma of the nose is fairly good in our cases. Fifteen of 27 cases are alive (55%). Five years survival ratio is 58% in fourteen cases of Wegener's granulomatosis, 50% in ten cases of reticulum cell sarcoma and 0% in three cases which were not differentially diagnosed.

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The authors described a simple procedure for the electrocoagulation of the sphenopalatine foramen for the treatment of nasal allergy. After a short description of related local anatomy, the instrument and the procedure of electrocoagulation were given.
The tip of the coagulation electrode consists of platinum plate 1.0cm in length, 0.4 cm in width and 0.4mm in thickness. After adequate surface anesthesia, the electrode was inserted into the sphenopalatine foramen which was situated in the lateral wall of the nasal cavity close to the posterior end of the middle turbinate. The electric power of about 9 watts was used for the coagulation. The degree of coagulation was determined by observing the smoke which rose from the nostrils.
The results of coagulation therapy in 7 cases were satisfactory; complete relief in one case and remarkable relief in six cases in which the prescription of antihistamines had become unnecessary. The authors recommend that this prosedure is worth while trying prior to the transantral Vidian neurectomy.

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Forty-three cases of unilateral exophthalmus met in our clinic between 1962 and 1971 were investigated statistically. In these cases, cyst of the paranasal sinuses, especially that of the frontal and/or ethmoidal sinus, was the most frequent cause of exophthalmus: thirty-one cases had cysts of the paranasal sinuses. Malignant tumors were relatively rare in our cases. Twenty cases of cysts of the paranasal sinuses were examined ophthalmologically, and visual lesion was found in 70% of the cases and 65% of the cases presented retinal lesions. Fundiscopic examination revealed retinal striae in six and retinal amotio in five cases, which resulted from the cyst. After the sinus operation, the visual lesion and the retinal lesions were improved in most cases. In treating cyst of the paranasal sinus, surgical removal of the cyst has been generally regarded as the best way. In some cases, however, it is a better method to open the cyst to the nasal cavity without removing the cystic wall and with remaining a drainage tube in the cystic cavity. The importance of careful observations of eye symptom and of early treatment of the causative disease was emphasized.

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The benign rhabdomyoma is one of the most infrequent benign tumor types composed of striated muscle cells. The literature does not yield more than 16 cases, if one excludes the cardiac rhabdomyoma which is quite different from the present entity. These tumors in the literature were located more often in the tongue, pharynx and larynx than in other anatomical sites.
The present report deals with an additional case of a pharyngeal rhabdomyoma upon which histological and ultrastructural studies and chemical analyses concerning the lipids were performed. This particular tumor consisted of polygonal, frequently vacuolated cells having abundant finely granular and deeply acidophilic cytoplasm. Cross striations were demonstrated in a few cells. Electron-microscopy revealed rod-like bodies and cross-sectioned M bands of the myofilament. Chemical analyses of this tumor showed the lipid pattern resembling that of the normal skeletal muscle.

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Phonation time in fortissimo, mesoforte and pianissimo were measured in varying pitches with a level recorder.
“Phonation capacity” was obtained by integration of voice intensity with phonation time. Examinations were performed in 6 healthy subjects, 3 males and 3 females, and the following results were obtained.
1.“Phonation time” in fortissimo showed the minimum value compared with the value of mesoforte or pianissimo phonation in various pitches.
2.“Phonation capacity” was diminished and showed a remarkable decrease in fortissimo phonation during the register transition.

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The author reported a case of esophageal foreign body (dental prosthesis) removed by the technique of thoracotomy. The case was a 61-year-old female complaining of odynophagia after swallowing a dental prosthesis by mistake. X-ray examination of the thorax showed a foreign body having four sharp clasps.
Removal of the foreign body under direct esophagoscopy failed, because it bit esophageal membrane firmly. Second trial using X-ray fluoroscope was done without any success. Therefore thoracotomy was performed under general anesthesia. Opening the thorax, there was a hematoma around the broncho-aortic constriction of the esophagus and the two clasps of the prosthesis perforated the esophagus. After removal of the foreign body, treatment with antibiotics, continuous drainage to the pleural cavity and oxygen tent were continued to avoid mediastinitis and lung collapse. The patient was discharged without complications on the 24th-day after the admission.

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Fifteen cases of chronic otitis media were investigated by delayed hypersensitivity skin test and isolation of candida albicans was performed. Three incurable cases out of fifteen showed manifested reaction to skin test and candida was found in these three cases. The authors think that otitis media candidiasis may be diagnosed by delayed type skin test and isolation.

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A 40-year-old woodcutter had an ear injury by a tiny piece of a twig which stack into his external auditory canal during his work. Conservative treatment showed no effect on the sensation of vertigo and vomitting, and a transsection of the chorda tympani was finally performed with marked success in the improvement of the sick sensation.
In this case the following three points were discussed.
1. Even a small external force may cause inner ear injury.
2. Gaze nystagmus to both sides was observed in this case which evidently showed a lesion in the vestibular endorgan. This observation implies that gaze nystagmus to both sides is not always caused by central lesion.
3. Transsection of the chorda tympani can be available for the cure of peripheral vertigo (e. g. inner ear injury) as well as for that of Meniere's disease.

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Twenty-five patients with vertigo were treated with intravenous injection of xylocaine. Twenty-four patients of them had vertigo of peripheral origin and another one was diagnosed as central origin. The male patients were injected 3ml. of 2% xylocaine diluted with 20ml. of 20% glucose solution. The females were injected 2ml. of 2% xylocaine and the same amount of glucose solution.
Positional nystagmus of fourteen cases (56%) was vanished or decreased in its scale or frequency after the first injection. The positional nystagmus was observed again in the next day of the injection, but it seemed smaller and weaker. Repeated injection of xylocaine showed increased effect on positional nystagmus (84%). Vertigo, headache and tinnitus disappeared together with nystagmus. There were no complications by the injection of xylocaine.

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Diphenidol is a new antivertigo drug with potent protective actions against apomorphine-induced emesis.
In order to investigate the effects of Diphenidol, changes of subjective symptoms and equilibrium function were observed after 4 weeks application of Diphenidol. Six of ten cases with Ménière's desease and five of seven cases with vestibular neuronitis obtained good relief. No undesirable side-effect was noted. A few discussions about the mechanism of Diphenidol were made.

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