jibi to rinsho
Online ISSN : 2185-1034
Print ISSN : 0447-7227
ISSN-L : 0447-7227
Volume 6, Issue Supplement3
Displaying 1-4 of 4 articles from this issue
  • Masato Nishi
    1960 Volume 6 Issue Supplement3 Pages 183-199
    Published: March 01, 1960
    Released on J-STAGE: May 10, 2013
    JOURNAL FREE ACCESS
    In order to know, whether it is advisable or not to resect a plica triangularis in case of tonsillectomy, I have made a clinical and pathohistological study using 12 pieces of specimen taken from patients ranging from 9 to 56 years old.
    1) The lymph follicles in the plica triangularis (hereafter P. t. for short), which are in most cases the size of a grain of rice or half and 3 or 4 in number, lie scattered or congregated and a big follicle possesses a fovella approximately in its center.
    2) The lymphatic tissue of P. t. is indeed in construction similar to the palatine or lingual tonsil, but what distinguishes it from the palatine tonsil is the way of congregation of the follicles as well as the fact that it is not covered with a capsule, while it is different from the lingual tonsil in that there are fewer mucilage glands just under the follicle.
    3) In comparison with the P. t. of a senior, that of a junior is larger in breadth and so is the follicle both in number and size. Therefore, the follicle in the P. t. of a junior is larger and as one grows older it seems to be more and more reduced in size.
    4) The pathological changes of the P. t. are the same as those of the palatine tonsil, but they are in general very slight as compared with the latter.
    5) Against a narrow P. t. the follicle in a broad one is larger both in number and size. The broad one can be seen in the female more often than in the male, in the junior than in the senior, in a person without a focal infection than in one with it and in the shallow fossa tonsillaris superior than in the deep one. The pathological changes are in high degree in the broad P. t.
    6) Between the resected side of the P. t. and the non-resected regarding the afterbleeding and pain after tonsillectomy and the healing state of wound due to operation there were not particular differences observed.
    7) If the P. t., especially the well-developed one, be left unresected at the time of tonsillectomy, it may sometimes enlarge itself in a compensatory way afterward, and cause an inflammation or even an abscess. The well-developed P. t. should be therefore, as completely as possible resected.
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  • Tsuyoshi Inoue
    1960 Volume 6 Issue Supplement3 Pages 200-228
    Published: March 01, 1960
    Released on J-STAGE: May 10, 2013
    JOURNAL FREE ACCESS
    Nach dem zweiten Weltkrieg ist dem Japaner die Möglichkeit wieder gegeben, durch den eigenen japanischen Himmel einen Flug zu machen, und man kann also neuerdings eine durch das Flugzeug bedingte eigentümliche Mittelohrschädigung überall sehr oft stattfinden sehen. Deswegen habe ich vor kurzem betreffs der durch den Sturz in der Unterdruckkammer nach Sasaki experimentell hervorgerufenen Aerolesio des Mittelohres des Menschen über deren Erkrankungsprozess, klinische Befunde, Therapie, Prophylaxis u. a. berichtet. Rund 80 Personen wurden mir zum Versuche zur Verfugung gestellt und der Sturzversuch in der Unterdruckkammer erstreckte sich auf etwa 100 Fälle.
    Der Versuchsverlauf sowie die Resultate sind folgendermassen nur kurz zusammenzustellen
    1) Beim Sturzversuche wurde eine eiserne Unterdruckkammer nach Sasaki in Gebrauch genommen. Die Unterdruckkammer, deren Rauminhalt 3.87 m3 beträgt, ist als Leistungsfähigkeit mit der Steiggeschwindigkeit von ca. 5 Minuten pro 3000m Höhe und der Sturzgeschwindigkeit von ca. 30 Sekunden pro 3000m Höhe versehen.
    2) Die Bestimmung der Durchgangigkeit der Tuba auditiva erfolgte unter Mitverwendung der Valsalva-Perlmanschen Methode, der Pneumophonmethode nach van Dishoeck sowie der Tubenkatheterisation und danach liessen sich dreierlei Typen von der Norm, Stenosenbereitschaft und Stenose unterscheiden.
    3) Nach meinen Betrachtungen über labile und stenosierte Zustände der Tuba auditiva (Stenosenbereitschaft und Stenose) an je 50 Versuchspersonen mit Tonsillitis chronica oder Deviatio septi nasi liess sich eine Anomalie der Tubendurchgängigkeit resp. in einem hohen Satz von ca. 50% feststellen, und durch die operative Entfernung der betreffenden Krankheiten erholte sich die Tubendurchgätigigkeit resp. bei über-60%.
    4) Indem man subjektive und objektive Befunde an 54 von den samtlichen 108 Ohren, in denen Adie experimentelle Aerolesio des Mittelohres entstand, zusammenfassend beurteilte, konnte man diese in den Typ I (leichteste Falle), Typ II, Typ III und Typ IV (schwerste Falle) einteilen und der Trommelfellbefund wurde mit Skizzen dargestellt.
    Aus dem Entstehungsmechanismus betrachtet, scheint es in der Tat angebracht, wie Prof. Sasaki behauptete, die vorliegende Krankheit als “Aerolesio des Mittelohres” zu bezeichnen.
    An 54 Fallen (108 Ohren) mit Hals-Nasen-und Ohrenkrankheiten f uhrte ich Sturzversuche in der Unterdruckkammer nach Sasaki durch (Hohe von 2000 m; Sturzgeschwindigkeit von 500 m pro Minute; man liess den zu Untersuchenden zweimal alle 30 Sekunden einen Schluckakt machen).
    54 Ohren, in denen die experimentelle Aerolesio des Mittelohres entstand, setzten sich wie folgt zusammen: Typ I 37, Typ II 12, Typ III 4, Typ IV 1. Von anderer Seite wurden aber 54 Fälle (108 Ohren) nach der Prufung vor dem Beginn des Versuches in Bezug auf die Tubendurch-gängigkeit eingeteilt wie folgt: Norm 77 Ohren, Stenosenbereitschaft 30 Ohren und Stenose 1 0hr. Unter den betreffs der Tubendurchgängigkeit normalen 77 Ohren wurden 31 Ohren von der Aerolesio des Mittelohres befallen, und zwar erkrankten daran die Personen mit den 2 vorgeschil- derten Krankheiten, Tonsillitis chronica und Deviatio septi nasi, am meisten, d. h. in 23 Fällen. Unter 31 Ohren mit der Stenosenbereitschaft oder Stenose der Tuba auditiva wurden 23 Ohren von der Aerolesio des Mittelohres befallen, von denen gerade 21 Fälle mit den 2 letztgenannten Krankheiten zu tun hatten.
    Unter den betreffs der Durchgängigkeit der beiden Tuben normalen 32 Fällen (64 Ohren) erkrankten 12 Fällk (12 Ohren) nur einseitig an der Aerolesio des Mittelohres und unter diesen 12 Fällen (12 Ohren) waren Schleintsekfete in der Tiefe des Nasenritchenrautnes neunmal (9 Ohren) zu finden.
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  • Tsuneo Motomori
    1960 Volume 6 Issue Supplement3 Pages 229-253
    Published: March 01, 1960
    Released on J-STAGE: May 10, 2013
    JOURNAL FREE ACCESS
    With reference to 60 cases of malignant tumor in the field of otorhinolaryngology, which were treated in our clinic from 1957 to 1959, the feature of metastasis to the cervical lymph nodes was pathohistologically examined by the author. Hitherto, the cervical lymph nodes have been assumed to be an area with a predilection for recurrence after total laryngectomy carried out under the diagnosis of malignant tumor in the field of otorhinolaryngology.
    With regard to the radical neck dissection as a method of preventing and treating the metastasis to the cervical lymph nodes, the author has made a pathohistological study by tumor group, making clear its significance as well as the feature of metastasis of each group of tumors. Add to this, the postoperative results were referred to.
    1) In patients without clinically palpable cervical lymph nodes, who were submitted to a prophylactic neck dissection with the removal of malignant tumor, microscopically positive nodes were found in 12 out of 34 cases (35.2%). According to this pathohistological fact, the prophylactic neck dissection with laryngectomy must be performed even in case of no palpable nodes, in order to prevent the recurrence of the disease in the cervical lymph nodes.
    2) In patients with clinically palpable cervical lymph nodes, the metastasis of malignant tumor to the cervical lymph nodes was microscopically proved to be negative in 5 out of 26 cases of therapeutic neck dissection (19.2%). The metastatic tumor had perforated through the capsule of lymph nodes, and invaded the adipose tissue around them. Therefore, in order to prevent the recurrence of the disease in the cervical lymph nodes, the combined radical neck dissection with laryngectomy must be performed in all patients with clinically palpable cervical lymph nodes, because the exstirpation of lymph nodes only of up to this day seems to be insufficient.
    3) Regarding the cancerous growth, the frequency of metastasis to the lymph nodes in case of prophylactic neck dissection was as follows: cancer of the tongue 1 case (100%), cancer of the larynx 5 out of 15 cases (33.3%), cancer of the upper jaw 5 out of 15 cases (33.3%), while in cases of cancer of the lower jaw, cheek and palate there was microscopically no metastasis observed.
    4) Regarding the cancerous growth, the frequency of metastasis to the lymph nodes in case of therapeutic neck dissection was as follows: cancer of the larynx 9 cases (100%), cancer of the upper jaw 1 case (100%), cancer of the tongue 1 case (100%), cancer of the pharynx 1 case (100%), cancer of the cervical part of esophagus 2 out of 4 cases (50%) and cancer of the palate 0 case (0%). As for the. sarcoma, the frequency of metastasis in this case was as follows: sarcoma of the upper pharynx 1 case (100%), sarcoma of the middle pharynx 2 cases (100%), sarcoma of the lower pharynx 2 cases (50%) and sarcoma of the upper jaw 1 case (0%).
    5) Six years and four months have passed since the radical neck dissection and hyopreepiglolaryngectomy (IWAMOTO) were adopted by us for the first time, during which, in comparison with the past results, we have been making a fine record in operation with the recurrence rate of 16.9% and with the death rate of 10.3%.
    6) Not only in the presence of a high-degree cancer infiltration into the oral and pharyngeal cavity in case of cancer of the upper jaw, but also in case that there is any doubt of the infiltrative proliferation of cancer into the orbit, the prophylactic neck dissection must be performed, when the patient is in a more advanced stage of cancer infiltration than an early stage.
    7) In case of a high-degree external cancer (cancer of the larynx) as well as of a high-degree cancer of the lower pharynx and esophagus, I should like to emphasize the radical neck dissection on both sides of the neck.
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  • Kensuke Hisaki
    1960 Volume 6 Issue Supplement3 Pages 254-282
    Published: March 01, 1960
    Released on J-STAGE: May 10, 2013
    JOURNAL FREE ACCESS
    The author studied statically and dynamically, the general functional status of the autonomic nerve in patients of Ménière's disease in the intermittent period of the attacks of vertigo and further the etiopathogensis of the disease.
    (A) The functional status of the automonic nerve in the statical condition of patients of Ménière's disease when they are not stressed.
    1) The psychosomatic studies on Ménière's disease.
    The functional status of the autonomic nerve has a close relation to the individual character and mental condition, and further the existence of the autonomic center in the lymbic system of the cerebral cortex has been made clear in recent years. The author investigated the psychosomatic aspects of Ménière's disease in 214 items, and compared them with the controls using the Cornell Medical Index Health Questionnare (CMI) which was made by K. Brodman and the clinical reliability of which was ensured by K. Fukamachi (Table 2, 3. Fig. 2, 3).
    i) Significant differences between the Ménière and the control groups were revealed by the following questions. In Ménière's disease, the following complaints due to the autonomic imbalance were observed: pressure or pain in the head, stiffness in the shoulders or the neck, thumping of the heart, cold hands or feet even in hot weather, stubborn coughs following colds, liability to severe colds. From this it is conseivable that these might become one of the etiologic factors of Ménière's disease in the middle ear. Besides, the patients of Ménière's disease have suffered from liver or gall bladder trouble oftener than the controls. This confirmed the report of K. Kubo that the functional disorder of the liver would become one of the predispositions of the nerve deafness.
    ii) The discriminative chart by Fukamachi (Fig. 1) made by the statistical method was used to classify patients of Ménière's disease into four groups; normal, provisionally normal, provisionally neurotic and neurotic. The percentage of each type showed the similar ratio to the other psychosomatic diseases such as bronchial asthma and essential hypertension. Ménière's disease lay between neurosis and the normal.(Table 3. Fig. 3)
    iii) From above facts, it was made clear that Ménière's disease was a psychosomatic disease, and the author concluded that the therapy of Ménière's disease required not only the somatic but psychic consideration with reference to the judgment of the discriminative chart.
    2) The measurement of the activity of serum cholinesterase.
    In five cases out of twelve, the fall of the activity of serum cholinesterase was observed, and it showed that it would mean parasympathetic predominance.
    3) The measurement of electrolytes in the serum (Na, K, Ca).
    The results with 18 patients of Ménière's disease in the intermittent period of the attacks of vertigo were in the normal range.
    4) The measurement of 17-Ketosteroid (17-KS) in the urine was made considering the part played by the adrenocortical hormones in the defense mechanism of the living body.
    The fall of 17-Ketosteroid in the urine was observed in five cases out of ten, and one feature of Ménière's disease as an adaptation disease was confirmed and an intimate interrelation of the neuro-hormones was suggested. The fact that the fall of 17-KS was rare in males as compared with females seems to be due to the possibility of 17-KS secreted from the testicles in males having masked the deficiency of the 17-KS from the adrenal glands.
    5) The measurement of the functional status of the autonomic nerve by Wenger's method.
    The measurement was undertaken about the following seven articles.
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