Eight occult primary carcinomas were reported and discussed clinicopathologically. Cancer of the nasopharynx, thyroid gland and biliary duct are occasionally lanthanic. Approximately twenty per cent of masses in the neck are metastasis of cancer. Extirpation of the pathological lymph node which will represent the lesion in the neck should be of most importance to make the exact diagnosis for the patient.
As the occult primary tumor is usually small and has no local sign, general physical examination of the whole body and scintigram are necessary. Even if the cervical metastasis of cancer was found, the adequate and radical treatment should be given without resignation because the patient has some possibility to survive for long period. Generally, radiation therapy for primary cancer in the head and neck and radical neck dissection for cervical metastasis are employed.

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Auditory and vestibular functions were examined in 9 children who had been suffered from hyperbilirubinemia of the newborn infancy. Two of them had athetoid cerebral palsy. Two children had moderate bilateral sensorineural deafness. Their audiograms showed a characteristic shape. The hearing loss below 1000 Hz was mild and that above 2000 Hz was severe. Temporary threshold shift was seen. Vestibular function tests revealed no abnormality. Histopathological observations were performed in an autopsized neonate who died 72 hours after the birth due to severe kernicterus. Marked degeneration was seen in both dorsal and ventral cochlear nuclei. Similar changes were found in the vestibular nuclei, the hypoglossal nuclei and the cerebellum. Degeneration of the dorsal nucleus of vagus was slight. The olivary nucleus and the cerebral cortex appeared to be intact. Hearing loss following hyperbilirubinemia of the newborn infancy is mainly attributed to lesions in the cochlear nuclei.

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Two cases of the carotid body tumor are reported. The first case was a woman, aged 35, who complained of swelling in the right side of the neck with bleaching of the same side of the face during physical exercises. The tumor was removed surgically. In this report, it is written briefly about this case because it had already been reported in Otolaryngology (Tokyo), 1973.
The second case was a woman, aged 36, who had swelling in the right side of the neck. The tumor was resected and 1,800 gm of blood was lost from the common carotid artery, which was repaired.
The most significant sign of the two cases was the tumor with pulsation in the submandibular region. The carotid angiography showed clear view of the tumor. The difficalties in surgical manipulation of the tumor are pointed out and indications for surgical treatment are discussed.

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A 48-year-old female suffered from severe nausea and vomitting for one week before the admission. She showed signs as follows;
1) Spontaneous vertical nystagmus appeared upon gaze upward and horizontal nystagmus appeared upon gaze to right and left. 2) Directional preponderance to right was shown by caloric test. 3) Left and downward optokinetic nystagmus was not observed when the stimulations were given. 4) Severe ataxia was shown. The patient could not keep Romberg's posture even with open eyes. 5) Dysdiadochokinesis was found in her right arm. 6) Paresis of abduction of left eye ball, left facial paresis and left trigeminal paresis were seen. 7) Spinal fluid, ophthalmoscopic finding and the internal auditory meatus were normal.
As a treatment, intravenous injection of Théraptique was performed for-one month. All symptoms were mended after four months from the onset.
Incomplete obstruction of the left anterior inferior cerebellar artery by thrombus is suspected as pathogenesis of this case, because the limit of cerebral nerves which became paretic showed the region of this artery. However, the labyrinthine artery is commonly a branch of the anterior inferior cerebellar artery, and it is contradictory that the patient showed almost normal labyrinthine function. The hearing of the patient was in normal level. The vestibular signs did not occur from the vestibule but from the vestibular nuclei.
We think that the left labyrinthine artery of this patient did not branched from the anterior inferior cerebellar artery but from the posterior inferior cerebellar artery or one of double branches of the anterior inferior cerebellar artery. According to the anatomical investigations, it is said that such a case is not so rare.

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Der 1896 von Küttner beschriebene Tumor, Küttner-Tumor genannt, ist eine unspezifische entzündliche Anschwellung der Speicheldrüse, die am häufigsten im Mannesalter etwa ab 40 Lebensjahren an der Submandibularspeicheldrüse vorkommt.
Die von den Verfassern in den letzten Jahren behandelten Fälle bestanden auch aus 53 jährigen, 42 jährigen bzw. 53 jährigen Männern, die alle mit der Submandi- bularanschwellung unser Ambulatorium besucht haben.
Als Ursache können bei diesen Fällen die chronische Infektion der Mundhöhle und die Konkrementbildung (bei den 2. u. 3. Fällen) vermutet werden.
Die GröBe jedes exstirpierten Tumors betrug 30×40×17mm, 55×85×25mm (einschlieBlich der Sublingualdrüse) bzw. 42×30×20mm und sie wogen 10.5g, 31g bzw. 18g. Histologisch war jedes Tumorgewebe eine chronische sklerotische Sialadenitis.

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Vibrations of the intact and perforated tympanic membranes of the fresh dog's cadaver were studied by the high speed motion film. The auditory bulla was exposed preserving the tympanic membrane, ossicles, tympanic muscles and tendons. The picture was taken from the side of the tympanic membrane. Vibrations of the tympanic membrane with 250 to 1000 Hz tone stimuli above 100 dB SPL were analyzed by a film motion analyzer. Vibrations of the intermediate zone of the membrane was greater than that of the central and peripheral zones. Vibrations of the anterior superior quadrant was greater than that of the anterior inferior quadrant in the dog. This difference was marked with low tone stimulations. A small perforation at the anterior inferior quadrant greatly decreased the vibration of the tympanic membrane with 250 to 500 Hz tone stimuli. The decrease in vibration amplitudes was greater at the anterior superior quadrant.

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The effect of furosemide upon the endocochlear DC potential (EP) was studied. The injection of furosemide in 10mg/kg body weight caused an increase of EP and then a gradual decrease. With the injection of 20mg/kg body weight of furosemide the EP decreased, recovered within 1 hour and then decreased.
Following the initial injection of 20mg/kg of furosemide the second injection of 20mg/kg of furosemide was administered at two hours. EP decreased, recovered incompletely and then decreased to less than 5mV. Two of seven cases caused a depression of EP and a gradual recovery close to 0 mv within 1 hour following the second injection of 20mg/kg of furosemide. The initial depression of EP caused by 20mg/kg of furosemide would depend upon the suppression of active sodium transport in the stria vascularis.
The second depression of EP caused by 20mg/kg of furosemide would be due to the histological changes in the stria vascularis. The variation of EP caused by furosemide was similar to that of CM. Therefore the hearing loss caused by furosemide appeared to be dependent upon the changes of the endolymphatic ion composition by suppression of active sodium transport in the stria vascularis and by damage in the stria vascularis.

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The effect of prednisolone upon the cochlear microphonics was studied by means of differential electrode technics.
With the injection of prednisolone in the dosage of 2mg/kg body weight the CM caused a slight depression and a recovery within 1 hour.
With the injection of prednisolone in the dosage of 10mg/kg body weight the CM caused a slight depression to 82% of the initial value in the 30th minute followed by a recovery within 2 hours or a gradual depression to 67.3% of the initial value in the 30th minute without a recovery within 2 hours and 20 minutes.
It is apparent that the depression of the CM caused by prednisolone would be due to the decrease in the concentration of sodium and the increase in the concentration of potassium in the endolymph.
Prednisolone would promote the sodium reabsorption in the endolymph in the stria vascularis and cause a decrease in the endolymphatic sodium concentration.
It was suggested that the disorder of the pituitary-adrenal cortical system is also allowed to be regarded as one of causes which produce Menier's disease or sudden deafness supposed to be developed by the abnormality of the inner ear fluids.

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Ten years follow-up studies of 269 cases of chronic tonsillitis and 205 cases of rheumatic heart disease were performed to investigate the effect of tonsillectomy after a long period of time. In the cases of chronic tonsillitis, effects of tonsillectomy and subjective symptoms were examined with questionnaires and the results were related to the preoperative findings of the tonsils. In the cases of rheumatic heart disease, effects of tonsillectomy upon cardiac symptoms were investigated in connection with depedency of the heart disease upon habitual angina, the preoperative states of the tonsils, erythrocyte sedimentation rates before tonsillectomy, c-reactive protein, and electrocardiogram.
The results obtained were as follows:
(1) In the cases of both chronic tonsillitis and rheumatic heart disease, subjective symptoms such as pharyngeal pain, headache and frequent occurrence of common cold or fever were improved after tonsillectomy in most cases. However, abnormal sensation or dryness of the throat was improved less frequently after the surgery.
(2) In 50% of cases with chronic tonsillitis that showed no improvement of subjective symptoms, especially of pharyngeal pain, there were injection and swelling of follicles on the posterior pharyngeal wall.
(3) Tonsillectomy for chronic tonsillitis newly produced abnormal sensation or dryness of the pharynx in 27% and 23% of the cases respectively.
(4) In chronic tonsillitis, subjective symptoms were improved more in the cases with non-hypertrophied tonsils than in those with hypertrophied tonsils. In the patients with rheumatic heart disease, no significant relation was found between the size of the tonsils and the effects of tonsillectomy on cardiac symptoms.
(5) In chronic tonsillitis, the effects of tonsillectomy on subjective symptoms did not differ between the tonsils with pus in the crypts and those without pus. In rheu- matic heart disease, improvements of cardiac symptoms were obtained more frequently in the cases with pus in the tonsillar crypts than those without pus.
(6) In cases with habitual angina related to the occurrence and aggravation of rheumatic fever, tonsillectomy produced more frequent improvements of cardiac symptoms than in cases in which rheumatic fever had not been related to habitual angina.
(7) Cardiac symptoms in rheumatic heart disease were more frequently improved in the cases with favorable results of laboratory examination, ESR of 10mm or less before tonsillectomy and or negative reaction of CRP after tonsillectomy than in the cases with abnormal test results.
(8) In the cases that had received heart operation as well as tonsillectomy, the cases that had tonsillectomy prior to heart operation presented more frequent improvements of cardiac symptoms than the cases that had tonsillectomy after heart operation.
(9) In 34.5% of rheumatic heart disease improvements in electrocardiograms were observed.
The results in the present investigation suggest that tonsillectomy for focal infection such as rheumatic heart disease should be intensively indicated.

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A modified neuroleptanalgesia was employed in numerous clinical procedures such as, tonsillectomy, radical operations on chronic paranasal sinusitis and operations for postoperative maxillary cyst etc,(in 51 cases). The method of modified neuroleptanalgesia was used 0.15-0.2mg/kg of droperidol and 0.5-1.0mg/kg of pentazocine, which were injected intramuscularly. Pain during operation was markedly decreased by above method and suppresion of vomiting reflexes after the operation was remarkable. Blood pressure and pulse rate were stable throughout the operation and respiratory depression was clinically insignificant. Therefore, it was concluded that this method of modified neuroleptanalgesia was an useful anesthesia for operation in the field of ear, nose and throat.

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[in Japanese]

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