The clinical and bacteriological data of 61 cases of the acute otitis media were presented. The bacteriological correlation between the middle ear and the nasopharynx and oropharynx was studied; all of the cases were subjected to the studies on bacteria of the ear and of the nasopharynx and the oropharynx. The results are as follows: 1) Sixty-four strains of bacteria were isolated from 61 middle ear effusions. Streptococcus pneumoniae was 64% of the strains, H. influenzae was 19%, beta-hemolytic streptococcus was 6 % and Staphylococcus aurous was 11%. 2) There were 70 strains of potential pathogen isolated from the nasopharynx. Streptococcus pneumoniae was _??_9%, H. influenzae was 19%, beta hemolytic streptococcus was 6 % and staphylococcus aureus 16%. 3) There were 67 strains of potential pathogen isolated from oropharynx. Streptococcus one_??_moniae was 50%, H. influenzae was 15%, beta-hemolytic streptococcus was 15%, staph.oerccus aureus was 19% and Klebsiella pneumoniae was 1.5%. 4) The b_??_ correlations between the ear and the nasopharynx are as follows: Complete agreement, 72% of the cases; partial agreement, 20%; and disagreement, 8%. 5) The bacteriologic correlations between the ear and the oropharynx are as follows: Complete agreement, 42% of the cases; partial agreement, 26%; and disagrrment, 25%. 6) There is an extreme difference in the agreement rate between the nasopharynx and the oropharynx. Statistically, Chi-square test showed that the nasopharynx has a greater similarity to middle ear than the oropharynx in bacteria at the .05 level of significance. 7) The coincident rate of bacteria between middle ear and nasopharynx are as follows: Streptococcus pneumoniae, 97% of cases; H. influeuzae and beta hemolytic streptococcus, 100%; and staphylococcus aureus, 20%.
Statistical observation of 226 cases of head and neck tumors, during the period of April, 1973, when Department of Ear, Nose and Throat was commenced, through March, 1978, was done at the Department of Otolaryngology, University Hospital of the Rytikyfis, College of Health Science, Okinawa. The head and neck tumors were found in approximately 4. 0% of all the ENT patients in each year. The number of the patients and the locations of the malignant tumors were as follows: 38 cases(16.8%) in the oral cavity, 76 cases(33.6%) in the pharynx, 53 cases(23.5%) in the larynx, 42 cases (18. 6%) in the nasal and paranasal cavities, 2 cases (0.9%) in the acoustic organs and 15 cases (6. 6%) in the other head and neck region. The statistical details of malignant pharyngeal tumors were as follows: 1) Epipharyngeal tumors were found in 18 cases (23.7%), oropharyngeal tumors in 38 cases (50. 0%) and laryngopharyngeal tumors in 20 cases (26. 3%) out of total 76 cases. Epipharyngeal tumors (18 cases) occupied 8. 0% of the malignant head and neck tumors. 2) The ratio between males (14 cases) and females (4 cases) was 3.5 and 1. 3) The age was distributed from 20 to 66 years. Its incidence had two peaks. One was in the second decades and the other was in the fifth to sixth decades. The average age was 39.8 years, which was younger than that of other malignant tumors. 4) Nasal symptoms were noted in 36.8% of all initial symptoms of the malignant epipharyngeal tumors, aural symptoms in 23.7%, cranial symptoms in 21.0%, cervical symptoms in 15.8% and pharyngeal symptoms in 2.6%. Cervical lymphadenopathy was found in 66.7% of the patients, unilaterally in 10 subjects (83.3 %) and bilaterally in 2 subjects (16.7%). 5) Cranial nerve symptoms were noted in 3 cases. 6) The primary tumor sites were the posterior superior wall of the epiphrynx (10 cases, 55. 6%), lateral wall (7 cases, 38. 9%), anterior wall (0 cases, 0%) and unknown (1 cases, 6.6%). 7) Histopathologically, carcinomas were found in 19 cases (83. 3%), mostly squamous cell carcinoma, and sarcomas were found in 3 cases (16.7%), mostly reticulum cell sarcoma. 8) According to TNM classification (UICC) and stage classification (The American Joint Committee), 3 cases (16.7%) were in stage I, 2 cases (11, 1%) in stage II, 5 cases (27.8%) in stage III, 7 cases (38. 9%) in stage IV and last one (5. 6%) was unknown. The advanced stages of III and IV were seen in 12 cases (66.7%). 9) Most patients were treated by external radiation (mainly cobalt 60 irradiation), chemotherapy and immuno-chemotherapy. 10) The 3 year crude survival rate in 9 patients with malignant epipharyngeal tumors was approximately 44.4%.11) Okinawa Prefecture is closely located to Formosa, where numerous cases of malignant epipharyngeal tumor are found. However, the incidence of malignant epipharyngeal tumors in Okinawa Prefecture was less than in Formosa.
A rare case initially diagnosed as nasopharyngeal angiofibroma in an old patient and later diagnosed as pseudotumor by the careful histological and clinical observation was reported. A 60-year-old male who had a long-standing history of chronic sinusitis was found having anasopharyngeal tumor in the right nasal cavity and an ossified polyp in the left. Resection of the tumor was performed under local anesthesia, and the tumor was diagnosed as angiofibroma by both operative findings and histological examinations. However, as the case had following characteristics: (1)the old age of the patient, (2)the long-standing history of chronic inflammation, (3)a coincidence with the histological findings in both nasal cavities, namely, ossification of a part of the tumor in the right cavity and the similar findings to angiofibroma around the ossification in the left cavity, the tumor was concluded to be pseudo-tumor probably caused by inflammation. In diagnosing nasopharyngeal angiofibroma in the aged patients, the possibility of pseudo-tumor should be carefully investigated.
Of 12 normal subjects, influences of breath, holding, rebreathing, hyperventilation and exercise on nasal resistance were observed. Decrease of nasal resistance was induced by breath holding, rebreathing and exercise. Increase of nasal resistance was induced by hyperventilation. These changes were statistically significant. These changes of nasal resistance were considered to be induced by the changes of P02 and/or PCO2.
Most of the investigations about immune potential of peripheral blood lymphocytes in cancer patients up to now have been studied with non-specific or tumor specific qualitative mitotic responses in vitro. In order to study immunological responsiveness quantitatively, virus plaque assay devised by B. R. Bloom was applied to determine immune potentials of the patients with head and neck cancer and the normal subjects. It has been reported that by this method the number of activated lymphocytes with a mitogen or antigen could be enumerated. Using this method, the number of Concanavalin A (Con A)-activated lymphocytes in cancer patients was examined. The cancer patient consisted of non-Hodgkin malignant lymphoma (7 cases), lingual cancer (6 cases), laryngeal cancer (5 cases), and miscellaneous (6 cases). The number of virus plaque forming cells (VPFC) activated by Con A was subtracted from that of VPFC without Con A. The subtracted number (AVPFC) in the cancer patients (- 1538 ± 3197, mean ± SD) was significantly smaller than that of 11 normal cases (9727 ± 9009) and 7 cases of benign diseases (12537 ± 23228). The number of AVPFC in the cancer group was generally small regardless to the difference of the primary region of cancer, TNM classification, clinical stage, and the pathological findings. There was no correlation between the number of VPFC and that of peripheral blood lymphocytes in the cancer patients. The advantages of virus plaque assay for immunological investigation in cancer patients were emphasized.
The immunocompetence of patients with malignant lymphoma was examined and compared to that of patients with cancer in head and neck. The following is a conclusion obtained. 1) There was no aggravation of general condition in either patient before the treatment. 2) Patients with malignant lymphoma did not show the elevation of serum Ig-G level and serum-inhibitory factors detected in patients with cancer. The increase of a2-globulin in patients with malignant lymphoma was not so significant as in patients with cancer. 3) The cellular immunocompetence in patients with malignant lymphoma was impaired more markedly than in patients with cancer. Number of peripheral lymphocyte was decreased much the same, but PPD skin test, PHA skin test and PHA-induced lymphocyte transformation test were suppressed more markedly in patients with malignant lymphoma. 4) The depressed cellular immunocompetence in these two disease might be caused by different mechanism. It is strongly suggested that the humoral factors may play a role in patients with cancer and cellular factors in patients with malignant lymphoma for the depressed immunocompetence. 5) In the treatment of patients with malignant lymphoma, follow-up examinations of immunocompetence are required and immunotherapy is more necessary than in patients with cancer.