Recently, laryngotracheal injuries caused by traffic and industrial accidents are increasing. And also the cases of the difficulty of decanulation are increasing. There are some methods as the therapeutic measures for the difficulty of the decanulation. For example, the direct anastomosis of the trachea to trachea and the trachea to larynx, the excision of the stenosed granulation and scar tissue and the reconstruction by the implantation of the skin and the mucosa are mentioned. Bryce tried the reconstruction of the trachea by so-called “Trough method” deviced by himself to this condition. The f irst stage of this method is the excision of the stenosed tissue and the formation of the trough-like laryngotracheal space which opens outwards. The secondstage is the covering and the closure of the opening of the trough by the pedicle skin flap which is moved to the place from the chest or neck. Two cases which are treated with this method and had good results are reported.

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Twenty-seven children, suffered from chronic otitis media was treated surgically. In the case of tympanoplasty the discharge was ceased 1-2 months after Operation, and postoperative hearing was successful in 83% in simple chronic otitis media and 40% in cholesteatoma. This result was approximately equal to adults'.
we pronounced that if a case was indicated, tympanoplasty should be done as soon as possible, because the irreversible change in children was little.

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Three cases of polyneuritis cranialis were treated at our clinic during the past few years.
The case 1 was a 31-year-old female who had developed paralysis of the left vagus and accessory. The case 2 was a 59-year-old female who had had neuropathy of the right glossopharyngeal and vagus nerves. In these two cases, disphasia and hypernasality were complained of. The case 3 was a 48-year-old female who had developed palsy of the left facial and recurrent laryngeal nerves. Her complaints were facial palsy and hoarseness. All the three patient were treated chiefly with stellate block and steroid hormone. The neuropathy completely disappeared within one month in all cases.

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The syndrome of stapes fixation and proxismal symphalangism was described in a 9-year-old female. Audiometry revealed similar bilateral conductive deafness(air conduction levels showed 60 dB). As deformities of the middle ear, no junction between the crural arch and the foot plate and fixation of the foot plate were obserbed. Stapedectomy was performed and postoperative hearing was satisfactory.

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Three cases of the pendulous tonsil were reported. The pendulous portion of the tonsil was found to be formed by outgrowth of the tonsillar tissue from the upper pole of the tonsil. There were several inflammatory aspects on three pendulous por-tions. The formation of the lymphatic tissue was incomplete and most of its nodules were of the disturbance type. In the dilatated tonsillar crypts there found a lot of desquamated horny epithelial cells, fibrin and discharge of the plugs. Lymphocytes and neutrophil leukocytes infiltrated in the peripheral parts. There was cystic change in the third case. In three cases the parenchyma of the tonsil was atrophic and damaged. In addition, these inflammatory changes developed gradually in our cases. The author considers that the chronic irritation due to the infection caused such for-mation.

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A case(56-year-old male)of a thorotrast granuloma developing about 20 years after cerebral angiography was reported. In 1950 the angiography was performed in another hospital, and in 1968 the patient noticed hoarseness and tumor of right cervical region. The percentage thorium residue by scintilation counter showed high level. In 1973 the operation was performed in general anesthesia, and the tumor revealed to be thorotrast granuloma by histological examination.
Thorotrast is a colloidal solution of thorium dioxide, which is a radioactive opaque substance used for a multitude of diagnostic purpose in radiology. It has a half-life of 1.4×10¹⁰ years and shows frequently the fibrotic and granulomatous changes occurring from the accidental extravascular injection. In addition, there are many reports of carcinomatous changes on reticuloendothelial system, especially primary liver malignancy.

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A case of neurinoma from the deep lobe of the right parotid gland is presented. The patient was a 41-year-old Japanese woman complaining of painful lump in the right parotid region of 2 months duration.
On clinical examination, the mass was suspected as a mixed parotid tumor undergoing malignant changes. It was extirpated without showing any apparent connection with the facial nerve. The tumor was well encapsulated, measuring 4.4×3.3×2.0cm and weighing 13g. The histological section of the tumor showed a typical neurinoma, demonstrating Antoni A and B types of cell pattern.

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A 42-year-old gravida II developed both ears deafness, tinnitus, rotatory vertigo and vomiting of acute onset. She was at 8 weekes' gestation. Audiological and caloric testing showed left ear total perceptive deafness right ear moderate deafness and depressed labyrinth function. Two months after abortion audiological and caloric examination revealed a slight recovery of hearing and labyrinth function.
The deafness associated with pregnancy would be due to an increase in progesterone which acts to the vascular stria and causes a decrease in the concentration of sodium and potassium in the endolymph by promoting the absorption of both ions in the endolymph or which causes a cerebrovascular occlusion of the vertebrovascular arterial system.

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A 41-year-old man experienced headache, polydipsia and polyuria about ten years ago. He complained of loss of libido and visual disturbance about nine years ago. He was treated with irradiation over the pituitary. In December 1972, he developed bilateral hearing loss and tinnitus.
In July 1973, it became hard for him to wear trousers. He complained of blurred vision and headache and was referred to the hospital. The x-ray of his skull revealed calcification behind the pituitary. The angiography of the vertebral artery yielded the obstruction of the sinus rectus and sinus transversus dextra.
His audiogram and caloric examination showed bilateral sensory-neural deafness and disturbed vestibular function.

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Klinische Berichte über Fälle von Fremkörpern in der Keilbeinhöhle sind in Japan sehr selten. Die Verfasser sind neulich einem solchen interessanten Fall begegnet. Es handelte sich urn eine 41-jährige Frau mit Hirntumor, die in der chirurgischen Klinik aufgenommen war. Zur Untersuchung der Speiseröhre vor derOperation des Hirntumors wurde ein 2 cmlanges Stück des Nélaton-Katheters, das miteinem Vinyl-Tubus verhältnismäßig locker verbunden war, vondem behandelnden Arzt versehentlich in die Tiefe der rechten Nasenhöhle eingeführt. Obwohl der Chirurg den Verlust des Nélaton-Katheter-Stückes bemerkt hatte, behandelte er die Patientin diesbezüglich nicht, da sieüber keine Beschwerden geklagt hatte.
Bei der postoeprativen okzipitonasalen sowie seitlichen Röntgenaufnahme des Selladels wurde der deutliche Schätten des Fremdkörpers zufällig in der Keilbeinhöhle gefunden. Der Fremdkörper war quer auf dem hinteren unteren Boden der Keilbeinhohle gelegen. Der Fremdkorper konnte schlielßlich mit großer Muhe mittels eines Bildverstärkers von der rechten Nasenhöhle aus herausgenommen werden, obwohl die Verfasser transmaxillar sowie intranasal die Keilbeinhöhle öffneten.
Das Stück desNélaton-Katheters war 2, 1cm langund hatte einen Durchmesser von 0, 4cm.

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Among the patients suffering otogenic vertigo, 78.4% had coincidentally chronic tonsillitis. Causative relationships between both conditions were suspected, and tonsillectomy was performed on some patients. These patients who had undergone tonsillectomy became responsive to the supplemental drug therapy for the vertigo better than the patients whose tonsils could not be removed for some reason, but not so much as the patients with the normal tonsils.
Otogenic vertigo is assumed as a kind of symptomatic manifestation of the circulatory disturbances in the inner ear. These circulatory abnormalities will be accompanied by simultaneous circulatory changes in small vessels of the bulbal conjunctiva which is easily subjected to photomicroscopic observation. A FSC microscope prepared for microcirculation research was used to take pictures and movies of the vessels. Sludging phenomenon of blood components in the conjunctival vessels was often observed in the patients who had otogenic vertigo and concomitant chronic tonsillitis. A provocative stimulation on the tonsils with the ultra-short wave developed or aggravated the sludging in 21.1 % of the vertigo patients with the normal tonsils, in 58.2% of the patients of chronic tonsillitis without vertigo, and in 73.3% of the patients with both the vertigo and chronic tonsillitis. The sludging phenomenon due to the provocation became most intense after 30 minutes in 26.6 % andafter 3 hours in 53.3% of the patients who had new development of, or aggravation of the sludging. Besides the sludging, 59.1% of these patients showed abnormal reaction of the conjunctival small vessels, mostly vascular constriction. In only a few cases vascular dilatation or both dilatation and constriction were observed.
Annulation on the tonsils was tried by injecting Impletol on 3 patients who had sludging. Suppression of the sludging occurred very markedly in onepatient, slightly in another, 30 minutes after the injection and lasted for 3 hours, but not at all in the remaining one. Tonsillectomy suppressed the occurrence of the sludging in the patients with the vertigo and chronic tonsillitis. Deducting from the conjunctival vascular changes observed in chronic tonsillitis or those induced by the provocation on the tonsils, it is speculated that chronic tonsillitis will aggravate vascular disturbances in the inner ear through either allergic reaction or disorders of peritonsillar autonomic nerves, and may lead to otogenic vertigo.

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Fundmental investigation with a new Penicillin derivative, Sulfobenzyl penicillin (SB PC) were performed with the results which may lead to the following conculsion.
1) In vitro antibacterial activity: The minimal inhibitory concentration of SB PC was measured by an agar plate dilution method. The MIC of SB PC against 37 strains of coagulase positive staphylococcus aureus isolated from otorrhoea was distributed over a range of 0.78 to 50mcg/ml, with a peak being observed particularly at 6.25 mcg/ml. Further more, the MIC against of 37 strains of pseudomonas aeruginosa, eschirichia coli, klebsiella pneumoniae and proteus mirabilis was 1.56 to≥100mcg/ml.
2) Concentration in blood: The maximal level reached 14.3mcg/ml on the average 30 miniutes after a single intramuscular injection of 500mg of SB PC to healthy adults, and the level was still 0.9mcg/ml 6 hours after the intramuscular injection.
3) Concentration in tissues: SB PC activity was demonstrable at the concentration of 1.4mcg/g in a human palatine tonsilla and 0.88mcg/g in mucous membrane of maxillary specimen one hour after the intramuscular injection of 500mg. The serum concentration of SB PC were then 6.3 to 8mcg/ml.

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