昭和46年1月から昭和50年12月までの慢性中耳炎患者542症例において, 耳漏中の検出菌に対する薬剤感受性試験の成績を検討した.
(1). 黄色ブドウ球菌では, 近年における各種薬剤の感性率の下降がみられた. この傾向は特にPCG, ABPCおよびマクロライド系薬剤において顕著であった. また多剤耐性化の傾向も強まってきた. 一方, SBPC, CER, GMには依然, 高い感性率を示していた.
(2). 緑膿菌では, 従来の報告同様, 高い感性率を示したものはGMとCLであり, この2剤の近年の耐性増加傾向はみられなかった. またSBPCも比較的高い感性率を示していた.
(3). Proteus 属に関しては, P. mirabilis はSBPC, CER (CEX) およびGMに, P. inconstans はSBPCのみに高い感性率を示し, CER, GMには耐性株が多かった.
(4). 慢性中耳炎の治療にあたっては, まず細菌検査および薬剤感受性試験を実施することが大切である.また治療中も,菌交代現象を考慮して, 細菌検査が必要である.

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Tragal cartilage graft tympanoplasty was performed on 23 ears in which previous tympanoplasties or radical mastoidectomy had been unsuccessful. The operation was limited to ears having an aerated cavity around the Eustachian tube orifice and the patent tube. There was granulation tissue with or without cholesteatoma in the athelectatic posterior half of the tympanic cavity and the mastoid. After re-exploring the mastoid cavity, all the residual air cells were eradicated using a diamond bur, and white healthy cortical bone was exposed in all dimensions of the cavity. Pathology around the stapes was cleared but the mucosa in the tympanic cavity remained untouched. The facial buttress and the bony posterior ear canal were lowered as much as possible. If superstructure of the stapes was missing, the cartilage prosthesis was placed on the footplate. The tragal cartilage was fashioned to fit the tympanic annulus anteriorly and the facial canal posteriorly and was placed to seal the tympanic cavity exactly. In five ears, the mastoid cavity was obliterated by an anterior pedicle temporalis muscle flap. The follow-up study from one to seven years confirmed that the smoothly surfaced mastoid cavity dried perfectly in all ears. There was neither adhesion nor a retraction pocket. Epithelial debris or crust was scanty. In 13 ears, postoperative hearing remained within 30dB, and in 8 ears it improved more than 15dB. In two ears, hearing deteriorated more than 15dB postoperatively. Our experiences have proved that the use of the tragal cartilage is beneficial for recostruction of the middle ear in selected cases in which reoperation was required and its advantages are; (1) accessibility in the operative site, (2) availability in an adequate amount, (3) excellent contour and thickness, (4) adequate stiffness and elasticity, and (5) excellent survival capacity without producing tissue reaction and adhesion.

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Removal of the posterior canal wall and broadening of the tympanic annulus were carried out in hopes of attaining a complete elimination of inflammation and cholesteatoma.
The technique was designed so that an antrum cavity and tympanic annulus with a cartilage plate would result. This cartilage plate divided the large excentrated mastoid cavity into two parts, namely reconstructed antrum and residual cavity exposed to the external canal.
A well ventilated middle ear space can be rebuilt using this procedure.

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A Japanese male aged 57, complaining of sudden facial palsy on the right side, was diagnosed preoperatively as “cholesteatoma”. During exploratory tympanotomy a large tumor was found along the Fallopian canal. The histological examination of the tumor revealed facial neurinoma. Difficulty in diagnosis of facial neurinoma was discussed from the viewpoint of the coexistance of cholesteatoma. A search of the literature failed to reveal a report of a similar case.

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Carcinosarcoma, showing simultaneous presence of malignant epithelial and non-epithelial elements, is rare and verification of this diagnosis requires detailed histopathological examination. We observed both malignant epithelial and non-epithelial elements in each tumor of two cases in the maxillary sinus and larynx, using light and electron microscopy.
The first case was found in a 66-year-old female. Under diagnosis of malignant maxillary tumor, she was treated by irradiation, chemotherapy, cryosurgery and surgery, but death followed with a metastases to the cervical vertebra and cervical lymphnodes.
Non-epithelial elements were composed of interlacing bundles and whorls of atypical spindle cells. Under electron microscopy, the cytoplasm revealed an abundant rough endoplasmic reticulum. The intercellular spaces contained varying amounts of collagen and flocculent material. Epithelial elements were islands of tumor cells in the stroma. Under electron microscopy, tonofibrils and desmosomes were noted.
The second case concerned a 78-year-old male. Under a diagnosis of malignant laryngeal tumor, total laryngectomy was successfully performed. On the surface layer of the tumor mass, well differentiated squamous cell carcinoma was noted, while in the subepithelial tissue, interlacing bundle of many atypical spindle cells and a few giant cells were confirmed as fibrosarcoma cells since the morphological character of fibroblasts was evident.
Thus the combined use of electron and light microscopes using different stains is required for the diagnosis of carcinosarcoma.

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The theory that cellular immunity may be the principal component of the defense mechanism against cancer in the living body is generally supported.
That T-cells play a leading role in this cellular immunity appears to be likewise supported.
However, the investigations previously performed by many authors have been done with T-cells from the peripheral blood. If immunity to cancer should exist, lymphocytes in the blood in cancerous tissue or tissue around the cancer (local blood) could possibly provide more pertinent information than that of peripheral blood. Thus, we compared T-cell values between blood obtained from tumor or tissue around the tumor at operation of the maxillary sinus (local blood) and peripheral blood in 15 cases with untreated maxillary cancer. As a result, the T-cell value in local blood was higher than that in peripheral blood, the difference being significant. In a similar study done on 16 patients with sinuitis, (controls), there was no difference between local and peripheral blood.
According to observations of eight patients with maxillary cancer, in whom local blood could be collected during the therapeutic course, there was a tendency for the difference in T-cell value between local blood and peripheral blood to decrease with the progress of the treatment in those in whom the tumor had regressed or disappeared.

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頭頸部外傷例の中で, 頸部または腰部痛を有し, これがめまい・平衡失調の原因をなしていると考えられる症例に, Muscalm を投与し, 次の事実を知った. (1) Muscalm は四肢のしびれ感をのぞいて種々の愁訴に有効に作用することがわかった. その中でも, 悪心, 嘔吐, 頸部・項部痛, 頭重感, 頸部及び肩凝り, めまい, 四肢の振戦, 頭痛, 腰部痛などの愁訴には有効であった. なお, めまい愁訴の好転は平衡機能異常の改善と大略平行した. (2) 頸部・腰部痛とめまい・平衡失調の変動のあいだには正相関がみられた.
この成績を基として, 次の考えを述べた. 頭頸部外傷例にみられる各愁訴, とくにめまい・平衡失調や自律神経症状に対して本薬剤が有効に作用するのは, (1) 本薬剤が頸部・腰部深部受容器と関係のあるγ系の活動性を是正し, その部の深部受容器の活動性充進が正常化する. (2) かくして, これに対応する中枢機構 (視床下部, 脳幹, 小脳) の機能の改善がもたらされた故と考えられる.

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1. 35例の頭頸部扁平上皮癌 (新鮮例16, 二次例19例) にNK-631投与を行い, 39.4%の有効率を得た. 新鮮例での有効率は56.3%であった. 従来のBLMとほぼ同等の効果とみる.
2. 投与法としては, NK-631 10mg (BLM 15mg と等力価) 週3回筋注法が主なものであった.
3. 投与量は新鮮症例に対しての平均は 92.5mg, 二次例では130.5mgであった.
4. 新鮮例にあっては, およそ100mg以内で後続治療に引継ぐことが肝要であろうと思われた.
5. 原発巣に対する治療は, 外向性発育を示す口腔癌に適応が大きい.
6. 組織像の経時的推移では, 7例中3例にIII度以上の効果をみたが, 投与量とは必ずしも平行しない.
7. リンパ節転移巣に対する効果は, 7例中2例に有効であり, そのうち1例は一時的縮小をみたが, 休薬で再増殖を示し, 1例は頸部廓清術で組織学的効果II_bを証明した.
8. 副作用は, BLMに時として見られる様な重篤な肺線維症が, 臨床上ならびに剖検上にも認められず, この点BLMより遥かに安全性が高いと評価された.
9. 放射線や手術と併用して治療効果を高め, あるいは再発率を低下させるか否かは, 今後なお検討すべき課題である.
10. 特に高齢者の口腔癌治療に当っては, Ra針治療を回避する手段として, NK-631に凍結外科を組合せることにより, 侵襲の少い治療法となることができれば幸いである.

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1) 東北大学百万ボルト電顕室に設置されたJEM1000を用いて, 超高圧電子顕微鏡の内耳組織観察への応用法につき, (a) 切片の厚さ, (b) 染色方法, (c) 連続切片法の可能性, の諸点を中心に検討した.
2) 切片の厚さについては, 加速電圧1000kVで600nm～1000nmが最も良い解像の得られる範囲であることがわかった.
3) 超高圧下では, 600nm以下の超薄切片に, しばしばコントラストの低下や試料損傷等が生じた.
4) 1000nm以上の厚い切片では, 細胞小器官等の重複像や, 電子密度の増加があり, 像質の低下がみられた. しかし, 遠心性・求心性神経終末の鑑別等は行うことができた.
5) 厚切片の染色法について文献的に検討した. 内耳のように, リンパ腔の占める領域の極めて大きい組織においては, block 染色を行わなくても十分な染色性が得られることがわかった. われわれは, 酢酸ウラン・酢酸鉛の二重染色法を行った. 染色時間は, 酢酸ウランアルコニル液 (7分), 酢酸鉛水溶液 (10分) であった.
6) 厚切片による「連続切片法」は極めて利用価値の高い研究方法になり得ることを確認した.

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蝸牛軸に腫瘍浸潤のある症例を, 神経細胞変性による難聴, 蝸牛微小循環障害の病理を解くモデルとして観察した.
内耳有毛細胞は, ラ線神経節細胞の消失している場所に一致して変性していた.
腫瘍細胞が Rosenthal 管内に侵入しただけでは血管条, ラ線靱帯に変化は認められなかったが external radiating arteriole が圧迫されていると考えられる浸潤高度の部位にのみ血管条の変化がみられたので internal と external radiating arteriole が独立しているという Lawrence の説を支持する所見である.

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This study was undertaken to evaluate the inner ear damage risk of chlorhexidine applied directly to the middle ear in cases of otological disinfection. The effects of this drug applied to the round window niche were investigated not only regarding the various electrical phenomena in the cochlea but also on the morphological findings in cochlea of guinea-pigs. Using a microelectrode, the endocochlear DC potential, the intracellular negative DC potential and the cochlear microphonics were recorded from the basal turn of the cochlea. After application of the drug, the cochlear microphonics showed a marked decline, at first among all electrical phenomena in the cochlea, and then a subsequent decrease of endocochlear DC potential. The deleterious effects of the drug on these potentials were irreversible and progressive, and they reached a magnitude of 10 to 5% of the pre-drug level 30 minutes after the application. The magnitude of the negative DC potential in the organ of corti also began to decrease from about 20 to 30 minutes after the application. In the morphological examination, no remarkable change was observed in the organ of Corti under scanning electron microscope, while the decrease of microvilli and the swelling of cell bodies were evident on the surface of marginal cells of the stria vascularis.
It is well known that cochlear microphonics are generated from the hair cells, while the origin of the endocochlear DC potential probably is in the stria vascularis. From this point of view, although no histological changes were evident on the organ of Corti, it may be concluded that the earlier decline in the amplitude of cochlear microphonics indicates hair cell lesions induced by drug application, and the subsequent decrease of endocochlear DC potential suggests the delayed lesion in the stria vascularis.
Consequently, it must be considered that the topical use of chlorhexidine induces inner ear lesion.

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