A record of the employment of the pectoralis major myocutaneous flap is presented, and a basic technique of its clinical use for reconstructive surgery of the head and neck is discussed. Some revisions in the technical details of the operation have resulted from the author's own experiences. The pectoralis major myocutaneous flap has become the main material in reconstructive surgery of the head and neck, though only two years have passed since it was successfully applied. It is expected that through further experience the flap will come to be applied not only for augmentation of tissues in the defect described hut also for a functional reconstruction of the affected muscles.
The cochleas of 25 guinea pigs were exposed to carbon dioxide laser irradiation for.the duration of 0.4 to 1 second at 4 to 32 watts. Animals were killed immediately or 30 minutes after the irradiation. The damages were examined histopathologically. When 7 males were applied there was considerable damage to both the bony and the membraneous labyrinth. The bony capsule of the cochlea was found scorched and perforated. The underlying cochlear lateral wall around the perforation was destroyed. The cells composing the stria vascularis and spiral ligament were swollen and partially vacuolated. Reissner's membrane and the organ of Corti had disappeared completely. With increased laser intensities the lesions were found extending deep into the modiolus of the cochlea. The cochlear lateral wall, organ of Corti, Reissner's membrane and spiral limbus were severely destroyed. The spiral ganglion cells were also involved. An increase in vascular permeability was also noted in the areas of the irradiated labyrinth. In order to abolish the functionof the labyrinth by laser it was found necessary to expose the membranous labyrinth, which may induce local infection. More experimental studies must be done before laser can be safely used in human ear surgery.
Since the first report of ligation of the internal maxillary artery for control of nasal bleeding by Seiffert (1928) the procedure has been widely accepted, while recently clipping has become more common than ligation because of its convenience. The authors performed clipping of the internal maxillary artery in 18 cases out of 122 cases with nasal bleeding who were hospitalized at the university hospital during the period from October 1971 to June 1979. The results were successful in all cases except one. Hypertension appeared to be the cause of bleeding in most of the cases, while the bleedings were mostly from the posterior part of the nasal cavity. The authors discuss the techniques in the procedure, its indication, and its merits, and drawbacks in comparison with those in ligation and in superselective arteriographic embolization.
In 25 patients who underwent tonsillectomy or tonsillectomy and adenoidectomy serum globulin levels were measured within 20 hours pior to and after operations for comparison. In most of the cases no significant pre-and post-operative changes were noted, while the changes appeared greater in children who underwent tonsillectomy and adenoidectomy than in the adults who underwent tonsillectomy only.
A rare case of leiomyoma in the pharyngeal portion of the tongue in a 65-years-old female is reported. The patient complained of bloody sputum and sensation of foreign body in the pharynx. The tumor was walnut-sized and was found to occupy almost the entire pharyngeal space. It was removed surgically by medial pharyngotomy. Histopathological examination revealed a vascular leiomyoma. Neither recurrence nor metastasis was seen one year after the operation. Two possible origins of leiomyoma are 1) migration of embryonal tissue and 2) leiomatous neoplasm originaing from the wall of a blood vessel, papilla of the tongue or remnants of the thyroglossal duct. The origin of this tumor was assumed to be either the blood vessel or the thyroglossal duct from the histological findings, site of the tumor and its development.
The flexible bronchofiberscope can be introduced through various routes such as pernasal, peroral, per-intratrachialtube or per-solid bronchoscope. Although the pernasal method has not been accepted generally by intersists or general surgeons for various reasons such as difficulty in introduction, inconvenience in repeating the introduction or in securing the airway, rhinologists find no difficulty in pernasal introduction in almost all instances. Pernasal introduction renders good fixation and easy handling of the scope and, at the same time, allows observations of the upper airway and the lower airway in the same procedure. The authors. report the technique and discuss the advantages and shortcomings of this method.