The tonsil, a frequent site of infection, presents various clinical problems in our practice. It is, at the same, time an immune organ, which functions to help prevent infections. Although inflammation of the tonsil can usually be controlled by antibiotics, frequent tonsil infection may induce ill effects systemically. There are extensive fundamental studies in regard to the morphology and functions of the tonsil. However, the results and knowledge from such studies have not been fully applied to the clinical management of the disease yet. The author considers that clinical application of fundamental knowledge will be one of the most important aspects of future studies on the tonsil. Two of the most important questions that should be answered are; 1. Why tonsillitis recurs so frequently. 2. What are the clear and scientific criteria for indications for tonsillectomy.
It is almost a century since the speciality of rhinology developed as a branch of surgery in Europe. The histories of the departments of otolaryngology in some old universities in Japan are as old as that of rhinology itself. The Japan Rhinologic Society was founded in October 1962, when the first general meeting was held in Nagano city. There have been remarkable advances in new techniques and the knowledge of rhinology during the past 20 years. Among many subspecialities within the Japan Otorhinolaryngological Society, the Japan Rhinologic Society has the greatest number of members reflecting the fact that we have had more patients with nasal and sinus dissases than patients with aural or pharyngolaryngeal diseases. The number of participants in the Annual General Congress of the Japan Rhinologic Society has been increasing steadily and the future of the society portends to be even more prosperous. I believe that the Japan Rhinologic Society is larger than any other rhinologic society in any other part of the world. The author outlines the history of the Society and expresses his view for the future of the Society.
The authors treated 38 patients with malignancies of the tonsil by irradiation during the period 1974 to 1979 at the Jikei University Hospital. However, the definitive pathological diagnosis of the malignancy had been confirmed from small pre-irradiation biopsy specimens in only 9 cases. Repeated biopsies were required in some cases, together with the removal of adjacent lymph nodes for confirmation of the diagnosis. Irradiation had to be started before obtaining a conclusive diagnosis in the cases with swallowing or respiratory distress. In Japan, 70 percent of malignancies of the tonsil are malignant lymphoma where diagnosis is often difficult because of concurrent inflammation of the tonsil. The authors concluded that cooperation of the otolaryngologist, radiotherapist, medical oncologist and pathologist is essential in order to improve the accurary of pathological diagnosis and the results of subsequent treatments.
The authors reviewed the cases of aspergillosis of the paranasal sinuses which were seen at the Jikei University Hospital (11 cases) during the period from January 1976 to August 1981 and which appeared in the Japanese literature (34 cases) as to clinical features, diagnosis, etiology and treatments. The clinical features were as follows: 1) in all cases aspergillosis of the paranasal sinuses occurred unilaterally, 2) a necrotic granulation mass was often seen in the middle nasal meatus, 3) bone erosions or defects were often seen in the medial wall of the maxillary sinus, 4) most of the patients were middle aged, 5) the signs and symptoms included postnasal discharge, toothache, headache, nosebleed, nasal obstruction, nasal discharge and pain of the face. The diagnosis can usually be obtained by clinical and histopathological examinations. In a few cases which can not be differentiated from malignancy an exploratory sinusotomy should be done. Etiological factors may be classified into systemic, local and parasite factors. Since aspergillosis, almost in all cases, occurs unilaterally it seems that the local factors are of primary importance and the systemic and parasite faccors are of secondary. It is assumed that Aspergillus fumigatus enters into the nasal cavity and proliferate around the fontanelle. The treatment of choice is irrigation of the maxillary sinus or surgical removal of the lesion.
The main drawback of one hand ligation in surgery is the slackening of the first tie during the preparation for a second. In order to overcome the drawback the author used a double tie in the first tying. Although this method requires some practice to perform smoothly it is a very useful and quick technique once learned by a surgeon.