Report 1. On the Disturbances of the Microcirculation, especially on Sludge Phenomena.
Microscopic study on the disturbances of the microcirculation in vivo in the conjunctival vascular beds was performed before tonsillectomy in 205 cases and after tonsillectomy in 130 cases.
Results obtained were as follows:
1) Morphological changes such sas considerable constriction and dilatation, tortousity, reduction of blood flow, spasm, stasis, ecchymosis, ishemia and muddy appearances were much more frequently found in the cases with tonsillar focal infection.
2) Sludge phenomena were found in 78.2% in tonsillitis chr. focalis, whereas in 32.4% in tonsillitis chr. simplex.
3) After tonsillectomy sludge phenomena (S. p) certainly decreased in 64.8% of tonsillitis chr. focalis following to some objective improvements, whereas in 22.0% of tonsillitis chr. simplex.
4) A slight, however certain influences in blood sludges were observed in half out of 50 cases examined, according to the increase of vasomotor reflex caused by cold stress.
5) Through electron microscopic study, sludged erythrocytes in 5 cases were compared with those of relatively haelthy two (one quite normal, the other tonsillitis chr. simplex).
a) By bloch's method, marked coatings on the surface of sludged erythrocytes were proved in all of 5 cases.
b) By ultra thin slice method, certain string-like shadows were more frequently observed in sludged blood instead of the coatings just above related, while normal and healthy red cells revealed electron-microscopically no morphological changes.
Report 2. On Sludge Test
In order to study sludge phenomena in vitro on a slide glass, sludge test (S. t) was examined before tonsillectomy in 204 cases and after tonsillectomy in 126 cases.
Results obtained were as follows :
1) Before tonsillectomy, S. t wasre positive in 78.2% of tonsillitis chr. focalis, whereas in 27.9% of tonsillitis chr. simplex.
2) After tonsillectomy blood sludging subsided in 57.7% and enhanced in 8.5% of tonsillitis chr, focalis, whereas in 22.0% and in 12.2% in tonsillitis chr. simplex.
3) Sludge phenomena in vitro, as for S. t, had more than 80% related with that in vivo.
4) S. t was highly related with B. S. R. (especially with 30 mts R.)
5) At low temperature (0°-4°C) S. t was considerably enhanced, whereas at high temperature S. t was sometimes enhanced or sometimes subsided. S. t was also influenced according to the changes of colloidal medium.
6) S. t positive means clinically dysproteinaemia and the test is available for a screening test.
Report 3. On Dermal Capillary Resistance
Dermal capillary resistances were examined before tonsillectomy in 184 cases and after tonsillectomy in 125 cases.
Results obtained were as follows:
1) In 58.8% of tonsillitis chronica simplex and in 81.0% of tonsillitis chronica focalis, capillary resistance before tonsillectomy was lower than normal value.
2) As for tonsillar systemic diseases, capillary resistances of nephritis patients (17) indicated 118±15.9mmHg (negative pressure) before tonsillectomy, but after tonsillectomy moderately improved (153, 1±17.41nmHg); slight fever (20) from 146.2±21.7mmHg to 193±14.4mmHg, rheuma (43) from 123.3±8.0mmHg to 153.1±17.4mmHg. tonsillitis chronica simplex from 158.0±15.8mmHg to 171.8±13.5mmHg.
3) Capillary resistences of S.p and S. t positive groups were more fragile than those of S. p and S. t negative groups.
4) Petechial test showed similar results to those with Miyao's apparatus.

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Antistreptolysin-O titer (AST) was measured in the 107 patients of tonsillitis chronica simplex (control group) and focalis.
The influence of tonsillar ultra-short-wave irradiation and hyaluronidasemassage upon AST was observed for 24 hours after provocation. And the influence of tonsillectomy in the each group upon AST was observed more than one month after the operation.
Results obtained were as follows:
1. The increase of AST (more than 250 units) was shown in 35.5% in patients of control group, and in 57.1% in tonsillitis chronica focalis.
2. The increase of AST was observed in 70.8% for 24 hours after provocation by tonsillar ultra-shortwave irraditation and in 66.7% for 24 hours after provocation of tonsillar hyaluronidase-massage (tonsillitis chronica focalis).
3. Following tonsillectomy, AST showed a difinite decrease (88.0%) in the patient of tonsillitis chronica focalis who had shown an increase of AST.
4. Antistreptolysin reaction, especially with the provocation, showed much significance in diagnosis and evaluation of prognosis of tonsillar focal infection.
The blood plasma protein fraction was measured in the 87 patients who were affected by tonsillitis chronica simplex (control group) and focalis.
The influence of tonsillar ultra-shot-wave irradiation and hyaluronidasemassage upon the fraction was observed 24 hours after provocation. And the influence of tonsillectomy in the each group upon the fraction was observed more than one month after the operation.
The results were as follows:
1. Decrease in Albumin and increase in γ-Globulin of the fraction were more characteristic in patients with tonsillitis chronica focalis than in control group.
2. Due to tonsillar ultra-short-wave irradication, the fraction showed a definite decrease in Albumin and increase in γ-Globulin, while no remakable changes of the fraction were seen by the provocation of tonsillar hyaluronidasemassage.
3. Both increase in Albumin and decrease in γ-Globulin of the fraction was seen after tonsillectomy.

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To disclose the association of tonic asymmetry with vestibulospinal disturbance "Arm-Tonns Reaktion" (A. T. R) was observed in normal 30 cases and 100 patients. Results obtained were as follows:
1) all of normal cases showed "negative" in A. T. R.
2) Thirty-three percent of cases with vertigo showed "positive" in A. T. R. But this per centage was by far small as compared with the rate of abnormality in Nystagmus.
3) To elevate the positive rate of A. T. R, the tonic asymmetry induced by vestibular stimulation was observed. The method to stimulate vestibular apparatus was same as "Nystagmus Cupulometry", the auther called this method "Tonic Cupulometry" By Tonic cupulometry the positive rate of A. T. R coulde be elevated about 20%.
4) Most of the positive reactors showed descendence of the arm on the affccted side.
5) To disclose the nature of tonic asymmetry induced by vestibular disturbance, E. M. G of m. biceps brachi. and m. triceps brachi in meniere's disease were studied. "K-T curve" of both m. biceps brachi and m. triceps brachi of on healthy side were normal, but only m. t. b. on affected side was abnormal. From this result, the nature of Vestrbular tonic asymmetry was considered to be due to hypotomns of extensor muscle on the affected side.

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The influence of nasal turbinate upon the physical growth and the sexual development of the domestic fowl was observerd by feeding nasal turbinate and its extract. Both the group fed by turbinate of hog and the control group fed by pork showed the similar result of high increasing rate of the general physical growth such as weiht, length of legs and teil-pluma, while the group fed by turbinate of sow showed the less increasing rate of them. The group fed by turbinate of sow showed the less atrophy of comb, wattle as sexual characters of the fowl just after castrated, then the more development of them than the other similar two groups. Little difference was observed between three groups as for the rate of development of the length of toe and spur.
From the results above mentioned, some substance to check the general physical growth and to develop the sexual characters should be expected to be in nasal turbinate.
Part 2. Changes in Endocrine Organs.
In the part one of this paper, author expected some substance in nasal turbinate to check general growth and to develop sexual characters.
Histological finding of various endocrine organs of the domestic fowl mentioned in the part one was studied and weight was measured to find out the mechanism of this change.
Weight of thyroid gland, thymus and suprarenal body of the group fed by turbinate of sow was measured less than that of the other two groups. The rate of the weight of thyroid gland and thymus to the whole body showed little difference betweenn three groups, while suprarenal body of the group fed by turbinate of sow showed a little higher than the other two groups and slight hypertrophy of the body was noticed.
Histological study of hypophysis, suprarenal body and thyroid gland showed a little difference between the group fed by turbitnae of sow and the other two groups. On the other hand, epiphysis and thymus showed no different histological finding between three groups.
From the result above mentioned, it seemed like that the histological finding of various endocrine organs was modified by feeding nasal turbinate and its extract and then physical and sexual development was affected consequently.

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Histological observations of 388 cases of the mucous membrane obtained from the maxillary sinus during operations was made. First, the findings of acute exacerbrations were separated from those of chronic findings.
Then, from a morphologic standpoint of epithelium of the mucous membrane, duct system of glands, and gland tissues; a classification was attempted as follows; 1) Chronic atrophic sinusitis a) Metaplasic form b) Cystic form c) Follicular form d) Fibrous form e) Simple form 2) Chronic hyperplastic sinusitis 3) Chronic hypertrophic sinusitis
As a result of these observations the hypertrophic form was of relative recent change and hyperplastic form was seen to be progressive degree. Those with repeated acute exacerbation of chronic inflammation was seen to progress to the atrophic form. Chronic irregular structral picture can be surmised as arising from chages in the arterial wall, fibrosis, elastic and muscular thickening of the venous wall together with the formation of cysts and lymphatic follicles.
In one case a histological picture similar to that of Aschoff bodies in rheumatic heart disease was seen which was of great interest.

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A Statistical Observation of clinical materials was made on 255 cases of all tumors experimenced in the Department of Oto-Rhino-Laryngology, Musosoino Red Cross Hospital in the last ten years (1950-1959).
1) The tumor was seen in 0.3% of total cases.
2) Seventy-three cases were benign, 105 cases were malignant and 77 cases unknown.
3) A percentage of male and female was 57% and 43% respectively.
4) The highest incidence of all tumors was seen among those in the 4 th or 5th decade.
5) The incidence was highest in the pharynx and tonsils, being 24.3% The tumor of ears was only 4.7%.
6) The order of the benign tumors were as follows. i) oral caity ii) nasal cavity iii) paranasal sinus iv) ear v) larynx vi) pharynx vii) tonsils viii) tvachea and esophagus
7) The order of the malignant tumors were as follows. i) pharynx ii) tonsils iii) nasal cavity iv) paranasal sinus v) trachea and esophagus vi) or al cavity vii) larynx viii) ear.
8) The cancer was seen in 70 cases, among which cancer of paranasal sinus (male 45 cases and female 25 cases)
9) The Sarcoma was seen in 32 cases, among which sarcoma of pharynx and tonsils was seen in 84%.

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The iron bound law in surgical treatment for cancer, i. e. complete removal of cancer including normal surrounding tissue was applied to the therapy for the upper jaw cancer by the author and the expected results were achieved. Namely, the maxillary bone, the muscles of mastiction with the temporal muscles, and the orbital contents were resected en bloc without splitting the upper jaw with cancer, and further the greater part of the roof of the frontal sinus, that of the orbita, that of the ethmoidal sinus, the median wall of the temporal fossa, and the roof of the sphenoidal sinus, all of which formed the bony base of the skull, were removed to explore the meninges and thus the bony walls surrounding the tumor were completely removed.
After these procedures, cleaning of the temporal fossa, pterygopalatine fossa and muscles of mastication as well as the ethmoidal sinus was perfectly conducted under direct vision.
Continual drainage of cerebrospinalfluid was induced by an incision of the meninges in the anterior cranial fossa in order to prevent postoperative meningism and meingitis.
This method of operation was employed in 35 patients with uppe jaw cancer who visited the Department of Otolaryngology, the Faculty of Medicine, Keio University from 1953 till 1959.
The 5-year survival rate was 40%. The extent of indication of this operation method, however, is very wide and can be applied to cancer even involving the muscles of mastication or the base of the skull, which has been considered to be inoperable before, except the cases with poor general condition.
In other words, it can be undertaken almost unconditionally so long as the general condition permits.

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It is rare to find giant cell epulis at the Oto-Rhino-Laryngological clinic. The authors have experimenced case of giant cell epulis which was seen in 49-years-old male.
This walnut size tumor was protruted from the gum of the second and third moral teeth of the right upper jow.
Histologically this tumor was originated from the periodontium of the above-mentioned teeth and many giant cells were found in the fibrous connective tissue.
These giant cells seemed developed from these fibrocyte cells. This finding suggest us that this giant cell epulis could be a new growth instead of granulation due to inflamation.

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