The latest oto-surgery has gradually become to require accuracy and now is the time for it that necessary equipments for microsurgery and advanced capacity of surgical operations are absolutely essential. After stapes mobilization against otosclerosis, adding historical reviews on stapes fenestration, I have referred to the result of after -operation also stating the cases of my examinations. Patients of otosclerosis have been comparatively few, however, these treatments have obtained good results in our country as well. Besides stapes mobilization and stapes fenestration, adding stapes prosthesis, I haveincluded these in a concept of stapes surgery. Stapes prosthesis among these, is frequently indispensable to the case of tympanoplasty of chronic suppurative otitis media which abounds especially in our country. At present, we are under another examination on a method by polyethylene tube (one by schea). There are many unsuccessful cases for stapes prosthesis now, but I believe that a study toward this way is especially essential. I state that how stapes surgery has an important influence upon therapeutic results of after-operations of otosclerosis and chronic otitis media of today.
A mycological examination was carried out on 161 ears of cases of chronic perforative otitis media in which fungi infection was considered to affect the cure of middle ear condition. As a result, fungi infection was assertained in 29 ears (18.1%), and further study was made especially on candida infection which was revealed to be the most prominent in these cases. The results were as follows: 1. Candida was isolated from 22 of 29 ears above mentioned (79.8%). 2. Most of the cases from which candida was isolated were under 20 years of age. Candida infection was proved predominantly from spring to autum and in 12 ears it was proved strongly positive in the number of colonies in cultivation. 3. The character of discharge was mucopurulent, mucoid, purulent or serous. On the surface of the discharge from which candida was isolated, white, fine grains were observed in 9 of 15 ears. These white grains were considered to represent candida infection in those cases. The discharge was rather scanty and odorless. 4. The most common form presented a central, benign perforation, while a total perforation was also observed in several cases. 5. Bacteriological examination revealed Gram-negative bacilli in 54.5% and Staphylococci in 18.1%. A strain of the Staphylococci was resistent for chloromycetin. Concerning the antibiotics used before the examination, penicilline was used in 16 ears and chloromycetin was in also 16 ears. 6. Simple dry wiping of the tympanic cavity which could eliminate candida infection successfully in 5 cases did not give a curative effect in cases with eczematous change in the external auditory canal and/or with white grains in the discharge. On the other hand, use of Trichomycin and Marzonine was proved to give a curative effect on candida infection. Moreover, in 5 of these 15, disappearance of candida was followed by the cure of chronic otitis media itself. 7. As for the strain, candida albicans was isolated from 13 (59.1%), one of which proved to be virulent in examination on mice. Five of the 15 were thermostatic for 5 minutes heating at 56°C and 3 for 3 minutes at 57°C. 8. Immunological study was performed and the following results were obtained. 1) Compliment fixation reaction was negative in all of the cases. 2) Aggrutination reaction was positive under 160-fold. 3) Skin test was positive at a concentration of 0.2γ/cc 0.1γ/cc and 0.05γ/cc. 4) Precipitation reaction was also positive at a concentration of 500/cc, 250/cc and 125/cc. 9. An examination of curative effect of Marzonine and simple dry wiping pn experimental candida infection in rabbit gave almost the same results as the clinical ones above stated. Above all, Chloromycetin was proved to give rather a favorable effect on the development of candida. 10. As the route of candida infection in the tympanic cavity, the external auditory canal and Eustachian tube should be considered. 11. A few of the drugs generally used for external application in Otolaryngological clinic were proved to have bacteriostatic effectiveness for candida in Vitro. This fact might suggest that these drugs were valuable for the elimination of candida infection in clinical cases. 12. It would be reasonable to consider in these cases that candida infection was only a factor affecting the complete cure of middle ear condition and that it is essential to attempt further treatment in addition to the elimination of candida in the discharge.
1. We reported the two cases of medianfissure of nose. The first case: A boy (one year old). We have attained our purpose of the plastic operation by carring an incision on the nasal dorsum and approximating the alar cartilages in the midline with cutgut sutures. The second case: A girl having a considerably advanced fissure of nose. (shortly after birth). After having sutured the alar cartilages as in the first case and removed the surplus skin, we inserted a preserved cartilage of a leaf-type, and last, sutured the skin. However, as there occurred a suppuration, we have attained our purpose of the plastic operation by using a forehead skin flap secondarily. We have not found yet in medical literatures a case like the above that a plastic operation is carried at the early stage (which means right after one's birth). 2. Median fissures of nose are classified by the grade in its badness. 3. As the median fissures is in danger of giving the cases an obstruction in their social activities, it is considered that the plastic operation should be carried at the earliest possible according to each case.
In a 30-year-old woman who presented severe symptoms of wheezing, dyspnea and general weakness brought on by obstruction of the tracheo-bronchial tree due to tuberculosis, tracheotomy was performed with subsequent improvement of her general condition. She was able to take short walks outside the hospital one month later and improved to the extent that she was discharged from the hospital after 6 months. With shortening of the tracheal airway and active aspiration of secretions in the trachea made possible by the tracheotomy, it is believed that the vicious cycle created by the presence of the lower tracheal obstruction-obstruction of passage of air-respiratory volume decrease-increase, retention and difficulty in expectoration of secretion-dyspnea-general weaknessweakened respiratory movements-respiratory volume decrease-was broken, resulting in improvement of her general condition- In addition to the indications for tracheotomy which have hitherto been given, this case emonstrated the advisability of actively performing this procedure for the treatment as well as for prophylaxis in cases with respiratory obstruction due to secretions, regardless of the presence or site of stenotic lesions in the airway. The fact that tracheotomy is now being advocated and widely used in this sense in western countries is also mentioned.
On one hundred cases of empyema, classifying them into three groups; slight medium and serious, I have investigated their states of eyes of pre and after-operation. The result of which shows the following; one who has an ophthalmic trouble among these, slight-11.1%, medium-12.8%, serious-28.6%, and the former two have lessened after operation, but the serious have increased. The sight had a tendency of betterment a little after operation, but it was not remarkable. One who had a difference of right and left in a grade of protrusion of the eyeballs was recognized by percentage of 50 in the slight, 51.9 in the medium and 83.3 in the serious. The differences are within 1 mm. in the slight, 3 mm. in the medium and 6 mm. in the serious, and they increase gradually. Every case has progressed favorably after operation. The central scotom was proved by 6% in the slight, 14.5% in the medium and zero in the serious. This has disappeared or dimidished after operation. 3% of them have become wider and 4% of them have become narrower in a field of vision. On the fundus changes, hyperemy of the disk and opacity of retina around the disk were observed in a small number of cases, but it is not positive about the influence upon a disease in the nose.
Trostin, prepared from fresh bovine brain thromboplastin for the control of hemorrhages, was clinically tested on such otolaryngological operations as A, tonsillectomy B, Sinectomy C, total extirpation of the paranasal cancer D, Laryngectomy E, operation of the lingual cancer and F, palatoplastik and it was found Trostin was effective in shortening bleeding-time and in decreasing blood-sheed. Trostin appeared to be most effective 1 hour or so after its intravenous injection. Side effect was found in no case. It is desirable to be injected as slowly as possible. From these findings, Trostin is a potent and recommendable hemostatic to be used in otolaryngological operations.
Yamazaki and associates gave an epitome of the troach “Bradsol.” About 31 cases, which was experimentalized clinicaly in our department, our first result was described. This medicine was efficacious as well as foreign reports.