Renal biopsy and cytodiagnosis of nasopharygeal semears were performed in nineteen children with chronic nephritis or nephrotic syndrome. Basophilic cells were found in nasopharyngeal smears in eighteen subjects. RAST scores of house dust, mite and several food antigens were examined in 17 subhects and 47.1% of them showed positive. These results suggested that renal diseases such as chronic nephritis or nephrotic syndrome were related to allergic mechanism whether RAST is positive or not.
1) A total of 102 children under three years of age, underwent adenoidectomy between May 1977 and June 1990. The youngest patient Adenoidectomy alone was done on most of the children under one year of age. Among children from 1 to 2 years of age, half received adenoidecwas 6 months old. Three times as many boys as girls underwent surgery.tomy only and the other half adenotonsillectomy. However, among cases between 2 and 3 years of age, the number of adenotonsillectomies was significantly greater than that of adenoidectomies alone. 2) The number of adenoidectomies of younger children has recently been inreasing and the average age ot patients has been falling. We have performed adenoidectomies on children under one year of age since 1986. 3) It is difficult to diagnose adenoid hypertrophy with only X-ray films. We prefer to use sedative drugs and/or fiberscopy and/or contrast medium. 4) We consider the degree of upper airway stenosis and adenoid hypertrophy to be the most important factors in deciding whether or not to perform adenoidectomy.
First Dept. of Pediatrics, Dokkyo Univ. School of Medicine, Tochigi We made the new classification of hypertrophy and/or swelling of palatine tonsils in inspection. and tried the palpation of possible lower parts of the palatine tonsils on 234 allergic patients. We then tried to find out the association with palpation and inspection of the palatine tonsils which were serially observed. When they cought cold, their palatine tonsils changed the size both in inspection and palpation. In palpation, we could find tenderness and change of hardness of tonsils. When they were not infected, the grade more than II of tonsilar hypertrophy in inspection and palpation was 50% in the patients of younger than 11 years old. When they were infected, on the other hand,80% of them showed grade II or III. When they were not infected,90% of the adult patients showed grade O or I. Even though they cought cold, showed little change in grade. The same change could be obserbed in palpation. Though the palpation of possible lower parts of the palatine tonsilsis is very useful to catch change of tonsils, it is necessitated to evidence that the tumors would actually he lower parts of palatine tonsils.
Fifty-six children who underwent adeno-tonsillectomy were evaluated by the occurrence preoperative and postoperative apnea episodes and a questionnaire after the operation. Pathologic apnea during sleep was observed preperatively in 42.9% of the children, and disorders concerning respiration, inflammation, and deglutition were noted more frequently in these children than in those showing no pathologic apnea. After operation, there was an improvement of 100% in the occurrance 72% in frequent sore throats and 82.5% in difficulty of swallowing, in the patients who complained of these conditions preoperatively. The indications of adeno-tonsillectomy must be evaluated in the case of patients with abnormal respiration during sleep and problematic deglutition.
We studied the clinical course of tonsillar focal infection in children. In children, the majority of secondary diseases were allergic purpura and chronic low grade fever. Improve ratio of secondary diseases were 70.0% in operative cases, and were 89.5% in nonoperative cases. The correct ratio of diagnosis of tonsillar provocation test by irradiation of ultra-micro waves were 52.2%. We think that the diagnosis of tonsillar focal infection is required to re-examination.
158 cases of adenotomy and tonsillectomy in children during 1989.4-1990.5 were reported.30% of them were under 4 years of age, and 80% of them were under 7 years of age. Boys were 100cases and girls 58 cases. Chief complaints were sleep apneas in children under 3 years of age, and in 2-7 years old, snores and nasal obstractions. Half of 5-6 years old children had hearing disturbans due to otitis media with efusion (OME), and children over 7 years old had mostly recurrent tonsillitis. Most children under 3 years old of age were preoperatively diagnosed as sleep apnea syndrome (SAS) due to adeno-tonsillar hypertrophy,5 and 6 years old children had OME, and cases over 7years old were mainly diagnosed as recurrent tonsillitis. In cases with general complication, especially in infant with mental retardation or cromosomal anomaly, respiratory disturbance of sleep apnea tended to be in a serious condition, cases of SAS due to adeno-tonsillar hypertrophy are necessary to undergo an operation of adeno-tonsillectomy.
Accuracy of six different procedures, Jerger formula (Jerger), Niemeyer-Sesterhenn formula (NS), Baker-lilly formula (B-L), broad-band noise regession by Hyde (Hyde I), multiple regression on broad-band noise by Hyde (Hyde II) and bivariate plotting method by Silman et al. (B-P), used in predicting hearing level from the stapedial reflex threshold data were compared from 63 normal hearing and 66 hearing-impaired ears. As results, none of both predictors suggested by Hyde was accrurate for clinical use. With each formula of Jerger, N-S and B-L, hearing level was correctly predicted in more than one half of all ears. However, the three formulae showed a low rate (23~35%) in accuracy predicting a mild or moderate loss. With the B. P, no method accurately estimated magnitude of hearing loss while maintaining a high proportion (ca.85%) of separation from normal hearing ears with the hearing-impaired on the basis of position on the bivariate graph. Among these methods, the Jerger suggested to be adequate to predict normal hearing for younger children, and the B. P was particularly useful in identifine simulation in adults as well as functional deafness in elder children.