The author carried out an animal experiment using rabbits in order to observethe state of the circulation and vascularization of tubed pedicle flaps to serve as an aidfor judging the most suitable time for transplantation. A pigment (Chinese ink) was directly introduced into the vessels, so as to observe the state as objectively as possible. This paper deals with the results obtained. Using 84 rabbits, 2 tubes of 3 cm in breadth and 4 cm in length were preparedon the back of such animal. On the 14th day after constructing the tubed flap, one end was detached and after another 14 days the other end was cut. At the completion of the flap and after the first and second detachment, a vasodilating agent was administered and the effect was comparedwith that of the control group. In other words ink-Ringer's solution was perfused into tubes after preparation, primary removal and secondary one and each tube was cut and observed after 2, 4, 6, 8, 10, 12, and 14 days. In addition, in the tubes removed, the change of vessels especially at the part of implantation was pursued time-coursely. The results obtained were as follows: 1. Distinct new-formation of vessels was already noticed after 48 hours at the implantation part of the primary removal. Dilatation and new-formation of vessels showed a decreasing tendency with a peak on the 6 th day both in the control and the K (+) groups. On the 12th day almost cured state was observed. 2. When the ends of a vessel on the tube side and a vessel of the recipient tissue were in touch, they connected without delay by opening the cut-ends. 3. When a vessel on the tube side and cut-end of vessel of the recipient tissue were closely situated but not touching a path was formed through the red cells and fibrinsbetween the two ends. This path formed later a tube with endothelial cells. 4. A newly formed vessel in the recipient tissue connected with a vessel of the tube. 5. It was found that a vasodilating agent worked effectively for circulation within the tube and the implantation part and for new formation of vessels; resulting in earlierhealing by about 2 days. 6. It was experimentally proved that the process of healing can be shortened by the use of a vasodilating agent at the final detachment of the flap.
A histoanatomical study of the frontal bone was undertaken using a total of 61 human frontal bones (74 sides) obtained from widely scattered ages ranged from 5 months to 80 years of age in order to investigate the process of pneumatization in the frontal sinus and causes of recurrent frontal sinusitis. 1. Although no frontal sinus was seen to be present in the fetal frontal bones, there observed extensions of submucous connective tissue into the medullary space, which wasconsidered as a preparatory state for the formation of the frontal sinus. When the rudiment of the frontal sinus contacts the anterior table of the frontal bone, it created a shallow pit which later developed to a sinus. The author observed the shallow pit first in a 2-year-old girl and a completed frontal sinus fi rst in a 4-year-old girl. 2. The process of development of the frontal sinus is characterized by a boneabsorption on the mucosal side and the formation of bone on the opposite side. The bony plate at the roof of the frontal sinus has many small ducts in it communicating the sinus cavity to the marrow space. Through the small ducts extends the submucous connective tissue as far as the marrow space. Transformation of the bone tissue is takenplace under the mucosa and the epthelial layer. Development of the frontal sinus is usually seen, accordingly, toward the direction of the bone marrow. 3. Anterior development of the frontal sinus is usually seen between the age of 25 and 35. So-called frontal pneumosinus seems to be produced by unusually active anterior development of the sinus. 4. Development of the frontal sinus after middle age was characterized by proliferation of submucous connective tissue into the small ducts toward the marrow space thenfollowed by absorption of the bony tissue. It is not certain that how the proliferation of the connective tissue induce bony absorption in the frontal bone. Development of the frontal sinus appeared not to cease at about the age of 20as previously considered. The author observed osteoclasts in a 29-year-old female with moderate frontalsinus development at the roof of the frontal sinus, in a 38-year-old male with a well developed frontal sinus and in a 70-year-old male at the wall of the small ducts. These findings would indicate that the development of the frontal sinus although very slow continue to one's life. 5. In two frontal bones with well developed frontal sinuses, a small cavity that connecting the frontal sinus to the marrow space was found. This small cavity had a similar anatomical relation to that of the antrum which communicate the middle ear to the mastoid. Proliferation of submucous connective tissue was also seen extending from the frontal sinus to the medullary space in these cases. Such findings may be considered as one of the characteristics of a well developed frontal sinus. In routine frontal sinusectomy, these connective tissues in the small cavity and small ducts are unable to be removed radically the remaining tissue may proliferate to create finally so-called regenerated sinus. 6. Three of the frontal bones with underdeveloped sinuses showed arborescent type development of the frontal sinus. In those bones small ducts extended into the medullary space through which submucous connective tissue was seen to reach the marrow sapce. Frontal sinusectomy if performed on such sinuses the nasofrontal duct will inevitably obstructed to produce various symptoms including unexplained headache, or in some cases recurrent frontal sinusitis, muco or pyocele of the frontal sinus. 7. The author discussed other causative factors of the recurrent frontal sinusitis. 8. Discussion was made about the six cases of osteoma encountered in the frontal sinus.
The authors studied hearing acuity of school children in secluded parts of Hokuriku District, 1. Of 1, 431 school children studied, hard of hearing was found in 81 children or 5.7 per cent. 2. No significant difference was seen in different age groups. 3. Most of them had low grade hearing loss not exceeding 30 db. Severe hearing loss more than 50 db. was seen in three or 0.21 per cent. 4. Among the hard of hearing children, sensorineural type of hearing loss was seen in 58.0 per cent, conductive type in 14.3 per cent, and combined type in 27.7 per cent. 5. 54.3 per cent of hard of hearing children were not aware of their hearing impairment. 6. A relation was seen between the extent of hearing impairment and the school records. 7. A positive relation was confirmed between adenoid vegetation and hearing impairment.
A 55-year-old male with a fragment of free necrotic thyroid cartilage in the larynx which caused severe dyspnea and hoarseness is reported. The patient had a history of tele-Cobalt irradiation (7120/8 weeks) for glottic cancer (T2N0M0), which resulted in perichondritis and 4th grade postirradiation lesion (Takeda). Laryngofissure revealed an obstruction of the subglottic space by a free necrotic thyroid cartilage. All the symptoms disappeared afterremoval of the necrotic mass.
Ketamine, an intravenous anesthetic, which was hitherto considered to be not adequate for anesthesia in bronchoesophagoscopy was used in 6 esophagoscopy cases, 11 bronchoscopy and 4 direct laryngoscopy cases all with good results. The overall results were summarized as follows: 1. Satistactory depth of anesthesia was obtained in all cases by use of Ketamine 0.7-1.0 mg per kilogram of body weight intravenously. 2. Laryngospasm or bronchospasm was effectively evaded by a combined use of mucosal anesthesia. 3. Contracture of the masseter muscle, which was seen in almost all cases did not present any particular difficulty as the mouth was kept open during the introduction of the agent into the vein 4. Premedication of thiethylperazine, atropine sulphate and diazepam successfully depressed the complications after the endoscopic examination. 5. Repeated examinations on one patient was not encountered by any difficulties as the patients did not have any discomfort in the preceding examination. The authors concluded that intravenous anesthesia by Ketamine was very availing for both doctors and patients.
The authors treated 24 patients with nine different infectious diseases in Otolaryngology with Cephalexin given orally. Of the 24 cases treated the efficacy of the agent was judged as markedly effective in 18 cases, effective in 3 cases, slightly effective in 2 cases and ineffective in one case. No significant side effect was seen in any of the cases. The authors concluded that the antibiotic can be used for acute infections in otolaryngology with excellent results.
Ketophenylbutazone (KETAZON) known as a non-steroid anti-inflammatory drug, has been administered in diseases such as rheumatoid arthritis, gout and others. The anti-inflammatory effects of the Ketophenylbutazone in laryngeal diseases were tested by us in 35 patients. The drug was given by mouth, 600mg/day for adults and 300 mg/day for children. The effects in 20 patients with acute and chronic laryngitis were as remarkable as those reported in some studies. In 15 patients who were subjected to laryngomicrosurgery, the drug was given after surgery for 2-4 weeks and satisfactory responses were obtained. Another advantage of this drug was that no side effect was observed in any of the 35 cases even with long term usage. Ketophenylbutazone appears to be an effective drugs in the patient with laryngeal inflammation after laryngomicrosurgery.