Mycoplasmal infection is a frequent cause of chronic respiratory tract disease in domestic animals and fowls; and in man one of the causes of colds and aggravation of chronic infection of the respiratory tract. Recent interest in this infection prompted this study of its effects or pathogenicity in chronic rhino-sinusitis. Mycoplasma has also been found in the discharge from respiratory tract mucosa over relatively long periods and is considered a possible factor contributing to the chronicity of infections of the respiratory tract.
Methods:(1) A culture, employing standard rabbit serum, was prepared using specimens obtained from the maxillary sinuses and middle nasal meatus of healthy persons, of patients operated for chronic sinusitis, and of patients with acute exacerbation of chronic sinusitis and isolation and identification of mycoplasma made.
(2) Sero-immunological examination was performed with complement fixation and indirect hemagglutination tests to determine the titer of antibodies to M. pneumoniae.
Results and Summary:(1) In patients operated for with chronic sinusitis, non-pathogenic M. salivarium and M. orale type I, were isolated from the middle nasal meatus in 4 of 98 patients (4.1%) and from the maxillary sinus mucosa in 1 of 40 patients (2.1%).
(2) M. salivarium and M. orale type I were isolated from the middle nasal meatus in 7 of 106 patients (6.5%) with acute exacerbation of chronic sinusitis. Pathogenic M. pneumoniae was not found in any of the patients. As the same species of mycoplasma were isolated from the mucous membrane of the oropharynx in all 7 patients, it appeared that the mycoplasmal infection of the chronically inflammed sinus mucosa was due to contamination from the oropharynx.
(3) No mycoplasma was observed in the middle nasal meatus of 168 healthy persons without respiratory tract infection. Thus, mycoplasma does not appear to be present in the normal fl ora of healthy paranasal sinuses.
(4) Although M. salivarium and M. orale type I are considered non-pathogenic, various toxic phenomena suggestive of a low virulence were observed. With reduced local resistance to infection or the use of antibiotics, the possibility of opportunistic mycoplasmal infection by these species is therefore possible.
(5) In 1969 a significantly higher number of patients with acute exacerbation of chronic sinusitis (11.5%) showed a high titer of complement-fixing antibodies, as compared with healthy individuals (4.1%) (chi-square test, p =0.05). In the same year a higher titer of indirect hemagglutinating antibodies was found in the sinusitis group than in the control group (chi-square test, p=0.01).
(6) No significant difierence in age distribution of healthy individuals with antibodies to M. pneumoniae was observed. As high titers of antibodies were present in healthy individuals only in 1969 and not in 1971, it is surmised that an endemic outbreak of infection by M. pneumoniae occurred in the Tokyo area in that year.
(7) The significance of mycoplasmal infection as one of the principal factors responsible for exacerbation of chronic sinusitis in endemic areas of infection by M. pneumoniae is suggested by the results of the sero-immunological studies.

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A survey of patients with head and neck malignant tumors who visited our Otorhinolarygological Department at Kanazawa University Hospital during the period from 1963 to 1971 and did not return after the initial visit was conducted.
The survey was in 3 parts, the first survey consisting of those who were seen in the period from 1963 to 1965, the second from 1966 to 1968 and the third 1969 to 1971.
The patients with malignant tumors in each period were listed, and questionnaries were sent to them concerning the reason for their failure to return, the subsequent course of their disorder, profession, income, present address and so on.
The answers were received from 76 among 146 patients. In analysing these answers, the following results were obtained:
There were more patients with tumors in the digestive tract such as oral cavity, tongue, pharynx or esophagus, than those with tumors of the respiratory tract such as the nasal and paranasal cavities or the larynx.
About forty per cent were being treated at other hospitals or clinics, while about sixty per cent died without effective treatments.
As to the reasons of their failure to return, about sixty per cent preferred to being treated at other hospitals or clinics neaer to their houses.
More than one half of the patients were living in rural or fishing districts.
More than a half of the patients had expired.

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Symphalangism is a rare malformation of the hands or feet and is characterized by the absence of the proximal interphalangeal joints of the finger and fusion of the talus and navicular bones of the foot.
This condition is inherited as an autosomal dominant and is often associated with conductive deafness which is caused by the bony fusion of the stapes to the oval window.
The Symphalangism associated with strabismus and impairment of hearing is also described but the simultaneous occurrence of these three anomalies is quite rare, and only two cases, of these malformations in a mother and her daughter, were reported by E.S. Vesell.
The authors found three cases of symphalangism associated with strabismus and hearing loss in grandmother, father and son, and the possibility of a single gene producing the three malformations was discussed. The authors feel that it is difficult to conclude that the associated anomalies such as conductive deafness and strabismus are expressions of the symphalangism gene.

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Five cases of rhinitis medicamentosa due to the excessive use of nose drops were reported together with the histopathological findings obtained from partially resected inferior nasal turbinates. These findings were similar to non-specific rhinitis. Degeneration of ciliated epithelium with squamous metaplasis, thickening of the basement membrane, small lymphocytic infiltration of slight to moderate degree in the tunica propria, fibrosis, and mild thickening of the larger blood vessels wall were noted. Eosinophilic infiltration was insignificant. It was suggested that the sustained and excessive use of the topical vasoconstrictors either caused stasis of the ciliary movement by altered viscosity of the mucous blancket or sustained stimuli to the alpha receptors in the nasal mucosa giving rise to ischemic edema of the tissue.
The treatment consists in the correction of the lesions which initiated the excessive use of nose-drop and in the cessation of the use of the topical vasoconstrictors.

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A case of lingual carcinoma occurred in a 81-year-old female who had frequent episode of stomatitis ophthosa is reported.
Local findings, when referred initially to our clinic, were characterized by a leukoplakia on the left side of the tongue showing tumorous changes.
Histopathological diagnosis of the lesion revealed acanthosis of the epithelium.
Small round cell infiltration was seen without any specific changes.
The patient was followed once or twice a month for 6 months, when she complained of local tenderness.
The second biopsy showed carcinoma in situ. The treatment consisted in local radium irradiation and systemic administration of 5-FU, MMC, and endoxan, which showed a favorable effect on the course of the disease.
The author suspected that the sustained local stimulation by a new artificial denture might have caused a chain of changes: leukoplakia acanthosis and carcinoma in situ.

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The authors previously reported the clinical effect of MS-antigen in the treatment of nasal allergy as tested by a double blind test, where d-chlorpheniramine maleate was used as the placebo. The results were summarized that although no significant difference in the effectiveness was proved between the two groups immediately after the conclusion of the treatment, a significant difference was observed 4 weeks after the conclusion of treatment (P<0.05).
The authors recently, 3-4 years after the previous test, conducted a follow-up study on the 71 cases which were judged effective in the previous test.
Of the 71 cases, 43 cases (25 cases in MS-antigen group and 18 cases in placebo group) were located.
The continuance of the effect after 3-4 years was confirmed in 44% or 11 cases out of 25, and 17% or 3 out of 18 in the placebo group, which was proved significant statistically (α=0.06).
It was also revealed that relapse of the nasal symptoms in the MS-antigen treated group was seen within 20 months after the conclusion of the treatment and none relapsed after 21 months.

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