In our daily practice, we often encounter patients with a chief complaint of hemoptysis. It has been on these patients that we took aggressive approaches by doing bronchoscopies to locate the hemorrhagic sites. During the bronchoscopies the lesions were recorded by photographs and movies. Total of 190 cases, 116 of which were already reported previously for hemoptysis, were bronchscoped and the results were analyzed for literature review and discussion. It was shown that our statistical results were quite different from the reports made by others, impling that a previous concept hemoptysis indicate tuberculosis was to be discarded. Discrepancies of the results were presumably due to the facts that age of the reports made, hospitals, specialities of the reporters, diseases treated by such specialists, diagnostic methods and quality of laboratory examinations were all different. It was our impression that etiologies of the hemoptysis were changing, namely from tuberculosis to acute or chronic bronchitis and lately to malignant tumors and/or circulatory disturbances. These days laboratory examinations have been so refined that causes of so-called spontaneous hemoptysis begin to be settled. Therefore, specific treatments can be established readily and the better results are expected.
Chronic frontal paranasal sinusitis is one of the challenging ailment in ENT field. Earlier Tato, Bergara and Goodale have reportedly treated the frontal sinusitis by filling the sinus by autogenous fat or iliac bone. We have been filling the sinus by deproteinized heterogenous bone (Kiel Bone). Clinical and animal experiences have been accumulated. This filling material (Kiel Bone) was originally developed by Maatz and Bauermeister in West Germany by deproteinizing the calf bone with hydrogen peroxide. In animal experiments, the Kiel Bone was filled into the frontal (or maxillary) sinus of the dogs (or monkeys). The animals were sacrificed in a certain periods for histologic examination of the filling material. In 20 days bone regeneration was already recognized and the newly grown bone with rafts were observed in 110 days. No foreign body type reaction was demonstrated. Clinically the material was packed into 82 chronically inflammed frontal paranasal sinuses of 51 patients. Postoperative course was uneventful on all patients but 5 who developed infections. The infections took place in 6 sinuses of the 5 patients. This indicated 90.2% success rate on the patients treated and 92.7% success rate on the sinuses treated. The infections occured 9.8% of the patients treated and 7.3% of the sinuses treated. Causes of the failure were presumed to be remaining mucosa left by untrained surgeons and the infection during and after the operations. The fact that no immunologic reaction was responsible for the failure was proved by clinical and pathological investigations. Postoperative pneumatization of the sinuses was observed on only 2 patients (3.9%). This figure was apparently less than 22.7% of the re-pneumatization following the classical frontal sinus operations. However, these figures are not lightly to be compared because averge follow up periods are only one year and 8 month (the longest is 4 years so far). The histologic examinations of the clinical cases showed satisfactory results. From these results, the frontal sinus filling operation using the Kiel Bone is considered to be practical procedures However for the stisfactory clinical result, indication should be thoroughly evaluated, because the time honoured intra-nasal or extra-nasal operations (preferably combined by osteoplastics of the anterior wall) are still good procedures. The indications of the frontal paranasal sinus filling operation using the Kiel Bone are; 1) cases in which permanent patency of the ductus naso-frontalis is not expected, 2) recurrent frontal sinusitis, 3) giant sinus which is likely to cause local deformity postoperatively. Main advantages of the Kiel Bone graft to the autograft are;1) easy preservation and sterilization, 2) supplies are unlimited, 3) shorter operative time, 4) less pain to the patient, 5) ischemic necrosis of the filling material needs not to be worried.
Complaints mentioned by patients with chronic paranasal sinusitis not always correspond to their objective findings. Therefore such complaints often make us think of neurotics or of imbalance of the autonomic nervous system. The patients with chronic paranasal sinusitis were classified on the basis of these neuropsychiatric complaints. It was found that the patients who had no nasal operation of any type in the past were neurasthenic and the patients who already received operative treatments of the nose were hypochondriac. These patients were further studied using Cornell Medical Index about their complaints. The results were; non-operative patients had more psychosomatic complaints than normal healthy individuals, while the operatively treated patients were strongly hypochondriac and 70% of them were neurotic. From these results, it was shown that the operations were largely responsible for the hypochondriac states of the patients and that psychological aspect of each patient should fully understood by Cornell Medical Index prior to the treatment.
A case of lipoid proteinosis (Urbach-Wiethe Syndrome), which was found on a 57 year-old female, was presented. Her symptoms were untypical enough to have us suspect the tumor arising from the floor of the mouth. The clinical signs and symptoms, ENT manifestations in particular, were reviewed and so were the literatures.
Intracranial injury and injuries to the lamina papyracea and optic canals can be considered as severe complications of operation for chronic paranasal sinusitis And prognosis of the optical canal injury is poor in general. In order to prevent such complications and to proceed the operation at ease, skulls and X-ray films taken from 3 directions were studied to improve the operative approach to the ethmoid sinus and for the bettel exposure. The trans maxillary-sinus approache to the ethmoid sinus appeared to result in poor visualization because of inevitable dead angle. Therefore the ethmoid sinus should preferably be reached by other route. In author's view the tiansnasal approach is the most advantageous route to the ethmoid sinus.
We selected the 10 cases 18 sides indicating polypous variation of chronic paranasal sinusitis and injected acid-muco-polysaccharide, specially chondroitin-sulfuric acid (5% chondron 2ml) to the above each case for 10 days every day, we observed the above progress mainly from the point of the view of nasal-inside and also from the point of subjective symptom, the result of which shall be summarized as follows; 1) About the all cases, efficiency was 70%. Almost all of them, the progress was good in accordance with the observation of one month after injection. 2) The improvement of polypous variation at the portion injected started mostly after the injection of third time. Namely the moisture was disappeared, the brightness was decreased, the contraction to the hard state was made and the variation into the yellow-brown-red-brown colour was started. At the latest, from the 6th-7th time, the above variation became certain. 3) A little later than the view of narsal-inside, the subjective symptom is being improved. At first the narsal obstruction and watery narsal discharge were decreased. Even in case the improvement of the view of narsal-inside is unable to recognize, sometimes we had the occations to observe the improvement of subjective symptom. 4) Even in case the improvement of subjective symptom and the portion of injection was observed, it seems to be difficult to see the improvement by the exploratory puncture of the maxillary sinus and roentgenological inspection. 5) The relation between the efficiency and age-together with sex-distinction was unable to see by the observation of this time. 6) It seems to be significant to make proper use of antibiotic together with enzyme in accordance with the situation of each case. 7) The secondary reaction was perfectly unobserved.
A case of angioblastoma developing in the oral cavity, which was believed to be quite rare, was reported along with histopathologic discussion. The patient was a 38 year-old male who noticed a small lump of the buccal mucosa after an accidental bite. The tumor reportedly became larger. At the time of initial examination, the tumor was thumb tip in size, hard in consistecy and appeal ed to be adhesrve to the adjacent tissues. Incisional biopsy was performed for tissue diagnosis. In view of the pathology reportangioblastoma in suspicion-, a complete excision was done. Final tissue diagnosis was also Angioblastoma. Grossly the removed tumor was pale white in hue and was a little different from the other angiomas in appearance. Histologically, however, the tumor was confirmed to be angioblastoma, since the tumor cells were observed in the canliculi and the cells were of endothelial origin. Literatures were reviewed.
A new type of handy operative microscope has been developed. In place of the Stand and the Arm of the previous microscope, a sliding arm is installed. Weight of a magnifier attached to the tip is balanced by a spring coil, so that the magnifier can be moved at ease to any direction by a singe touch. The magnifier is exchangeable and any of the otologic scopes-Neitz binocular scope and illuminator, Sturz binocular scope and/or Nagashima binocular scope can easily be mounted. This microscope can also be used for postoperative dressing change and for observation of the wound healing.