In 54.2% of glasses inadequate frame are prescribed and in 70.9% of glasses lenses of incorrect dioptor are prescribed in Japan. Especially 31.9% of glasses are corrected over 1.0 diopter. It is noteworthy that most of them are prescribed without ophthalmological medical care. Incomplete subjective examination and no objective examination are the major causes for the prescription of these inadequate glasses in Japan. In subjective examination of refractive anomalies binocular fogging and checking astigmatism under fog are indispensable to avoid accommodative spasm. Not only refractometer but retinoscopy is also necessary for objective examination.
Using new subjective method (subjective method 2) instead of ordinal method (method 1) we can obtain fairly good accordance between total astigmatism and corneal astigmatism. Correlation coefficient between total astigmatism and corneal astigmatism is only 0.006 by using method 1, but 0.496 by using method 2, i.e., the latter indicates fairly good correlation. Therefore, ophthalmometry is also necessary to prescribe good glasses, especially in the cases whose axis of total astimatism do not coincide with that of corneal astigmatism.
Dioptor of prescribed glasses is not always consistent with the result of refractive examinations. Using the test for near vision and binocular vision, and observations of whole clinical course, a major error of making inappropriate glasses might be abolished. we call this 4-dimensional prescription.
In Japan, 36% of total populations are using glasses and population using glasses for far vision will be ca 22 millions (20.5%). As described above, about 30% of these, i.e. 6.6 millions of people are using markedly inadequate glasses. This relates closely to the fact that 76.9% of glasses which must be prescribed under ophthalmological medical care, has been made only by opticians who have no official licenses.

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The immunohistochemical study was done on the distribution of S-100 protein and Neuron Specific Enolase (NSE) in olfactory mucosa and the results were compared between the man, the monkey, the rabbit and the rat. Rabbit antisera against rat NSE and bovin S-100 protein were used for Avidin-Biotin Complex immunohistochemical procedures. α and β subunit of S-100 protein was also used for the study.
NSF positive cells were present in the human olfactory mucosa. S-100 positive cells were present in the rabbit olfactory mucosa. S-100-α-subunit positive cells were present in the rabbit olfactory mucosa.

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Auditory brainstem responses (ABR) were recorded in 36 normal adult ears.
1. The standard deviations of latency of each response were found to be less than 0.20 msec at click intensity of 75 db SL.
2. The shapes of the wave IV-V complex were classified into 5 different patterns, but the variations in the shapes of the wave IV-V complex were not clinically significant.
3. The intertest differences of the wave V latency were found to be less than 0.10 msec in 32 ears of 35 ones(91%). Those of wave I-V interval were less than 0.10 msec in 31 ears of 35 ones (88%).
4. It should be abnormal, when the interaural difference of the wave V was more than 0.4 msec or when that of wave I-V interval more than 0.45 msec.

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Tinnitus was influenced by psychic factors and its treatment was evaluated in 135 patients with persistent tinnitus (111 had perceptive hearing loss and 24 did not). The parameters evaluated were “tenacity to the tinnitus” and “satisfaction to the improvement”.
Twenty-five of 135 patients had tinnitus only by misapprehension due to a certain psychic reaction. In these cases, it was unable to verify the presence of tinnitus by any kind of the test for tinnitus.
The degree of the tenacity to tinnitus was different in each case, regardless of the sensation level of tinnitus and it had various influences on the satisfactions to the improvement of medications. In the patients with severe tenacity, they felt either full or no the satisfactions, and in the patients with moderate tenacity, various degree of the satisfactions were obtained in cases of slight improvement, while the satisfaction and the improvement by treatment were parallel in the patients with slight tenacity.
Thus, these observations strongly suggests that it is very important to consider various psychic factors especially the tenacity when one treats the patients with tinnitus.

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The treatment of tinnitus by means of transtympanic infusion of 4% Xylocaine is not a new topic, having already been reported by others. However, this method is not common at present.
From January 1983 through March 1984 using this method the authors treated 50 patients (70 ears) suffering from tinnitus, and obtained good results. Judging from this efficacy, we would like to make this way of treatment popular.
The detailed method of anesthetizing the inner ear is described in this paper. It is also mentioned that the efficacy of this treatment can be predicted before the application of infusion based on the results of audiometry and caloric test. That is, the cases with a slight hearing loss and a normal caloric response show a favorable result in their treatment of tinnitus.

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Our experience in treating patients with trigeminal neuralgia is reported and current concepts of its pathogenesis and treatment is presented.
Seventy-four patients with trigeminal neuralgia were treated at our hospital between 1976 and 1983. Sixty-three patients could be controlled successfully with medication and/or trigeminal nerve block. In 11 patients surgical treatment was carried out. Among them 9 patients underwent suboccipital craniectomy, and operative findings were as follows. In 7 patients causative lesions were found (5 C-P angle tumors, 1 vertebrobasilar aneurysm and 1 adhesive arachnoiditis). In 2 cases trigeminal nerve root seemed intact, and trigeminal rhizotomy was carried out. Other 2 patients underwent trigeminal rhizotomy by subtemporal approach. Operative results were satisfactory in all cases.
The pathogenesis of trigeminal neuralgias has been controversial, but recently mechanical compression on nerve root at its entry zone by aberrant vessels (vascular cross-compression) is believed to be causative in majority of patients with this disease. As for its treatment, microvascular decompression by suboccipital craniectomy has been proposed and developed by Janetta, and now this procedure is widely accepted. Though our cases do not include typical microvascular decompression, candidates for such operation should exist in medically controlled group. If any of these patients become refractory to medical treatment, posterior fossa exploration should be necessary for vascular decompression.
We believe patient: with this disease should be treated medically at first, and surgical treatment is restricted to patients who are refractory to medication or in whom causative lesions are discovered by preoperative examinations such as CT scan and angiography.

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A case of Maria Amat's phenomenon was presented. A 75 year old man had right facial palsy of ten year's duration. Functional recovery had been almost complete, but there were associated movements among the facial muscles.
He showed contraction of the right orbicularis oculi muscle synchronizing with the facial muscle contraction. Electromyographic study showed that abnormal facial synkinesia was an intrafacial associated movement.
As a similar synkinesia is caused by paradoxical levator inhibition, it is very important to do electromyographic study for exact differential diagnosis. A 75 year old man proved to be Mann Amat's pheno menon with electromyographic evidence.

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The recent increase in the proportion of elderly persons among patients seen at the Department of Dentistry of Kanazawa National Hospital led us to conduct a survey of disease states and contents of treatment in those elderly patients for the year of 1982. The results were summarized as follows:
1. Of entire 1412 patients seen during that year, 261 (113 male, 148 female), or 18.5%, were above 60 years of age. 2. Of these 261, 161 (62%) visited the hospital directly and 100 (38%) on referral. Among these latter 100 patients, 79 were referred to us from other departments of the same hospital and the remaining 21 from outside. Most frequently the referring physician was an internist. 3. Chief complaints at the time of first examination were masticating trouble relating to denture in 38% of the elderly patients, pains in 36%, caries (indolent) in 12%, swelling in 6% and others in 8%. 4. At the time of first examination 163 (62%) had a single or multiple non-dental diseases, with 32% of them suffering from cardiovascular diseases and 17% from digestive diseases. 5. Ninety-four patients (36%) had been operated on, with 41% of them for digestive diseases and 14% for neoplasms. 6. One hundred and twelve patients (43%) had a history of illness treated by non-operative measures, the overall incidence of such diseases being 152. 7. Average numbers per person of untreated decayed teeth D, treated decayed teeth F, healthy teeth T and lost teeth M were 2, 4, 7 and 19, respectively; M was increasing with advancing age. 8. Forty-three % of the elderly patients were affected with periodontal diseases; as the affected teeth were lost, the disease per se was terminated, while the incidences of gingivitis and collapsing periodontal diseases decreased with advancing age. 9. As regards the contents of treatment given, 151 patients (58%) received prosthesis and the remainder 127 (49%) were treated surgically, with the ratio of open to closed treatment being 2:1 in terms of frequency. Conservative treatment was given in 75 (29%). 10. The duration of treatment averaged 6.2 days, being 1-4 days in 52%, 5-8 days in 23%, and 9-33 days in 25% of patients. 11. In 112 patients (42.9%) treatment was covered totally by insurance. An overall study was further made by taking account of all these findings together.

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Two rare cases of metastatic tumor found in the head and neck region are reported.
Case 1; A 47-year-old female with a history of hepatoma operated on 2 years before was referred to our clinic because of a gingival mass. The biopsy showed histology of metastatic hepatoma. The gingival mass disappeared by radiotherapy. However, the patient died of the lung and brain metastases 4 months later. Autopsy revealed complete healing of hepatoma and no tumor cells were detected even by microscopic examination.
Case 2; A 67-year-old female visited our clinic because of a mass with soreness in the right ala of the nose. Because the mass seemed like as nasal furuncle, antibiotics was given initially which did not improve the condition. One week later, advanced gastric cancer was found by upper G-I series which was performed because of the complaints of anorexia and weight loss of one year duration. Then, the biopsied nasal mass was diagnosed as the metastatic tumor of gastric cancer. Exploratory laparotomy was done, but the primary lesion was inoperable. Although chemotherapy was given postoperatively, the patient died of peritonitis carcinomatosa 6 months later. Autopsy was not granted, but clinically no metastasis except that in the nose was seen anywhere.
When a mass lesion is seen in the head and neck region, we have to keep our minds also on rare metastatic tumors described in this paper.

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A case of a 70-year-old female with inferior syndrome of the red nucleus (Claude's syndrome) was reported.
She complained of right blepharoptosis and impairment of equilibrium and gait, which developed on November 20, 1982.
On admission, neurologic examination revealed complete paralysis of the right oculomotor nerve and the cerebellar symptoms of the left extremities. She stood wide-based and unsteady, and walked with leftward deviation, and eventually fell down. Hemiplegia and involuntary movements were absent.
CT scanning revealed a lesion in horizontal, sagittal and frontal planes, with a small low density area in the region involving the right red nucleus of the midbrain.
These clinical symptoms and signs were diagnostic of Claude's syndrome.
Only a few cases of Claude's syndrome have been reported in Japan, and a very few cases with lesions demonstrated by CT scan as in this case have been reported. The cause in this case was occlusion of the middle cerebral branch of the posterior cerebral artery.
The patient has run a favorable prognosis: the cerebellar symptoms have disappeared, and only slight oculomotor palsy and blepharoptosis remained.

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A 37-year-old woman with a family history of Alport's syndrome was reported. Her initial symptom was bilateral hearing loss, which occurred at the age of 7. Proteinuria was discovered at the age of 17. At age 32, ptosis of the upper lids developed, which was followed by weakness of extremities, gait disturbances and urinary incontinence. On admission she was emaciated severely and showed proximal dominant muscular atrophy and weakness in all extremities. Prominent ptosis and severely limited eye movement in all directions without paralysis of the intra-ocular muscles were recognized. She was deaf completely and deep reflexes in all extremities were diminished or absent. She could walk without a support, but showed truncal ataxia. Laboratory examinations revealed abnormal findings in GTT and high level of serum CPK. Brain CT scan showed a marked decrease in density in the cerebral white matter, resembled to that seen in patients of leukodystrophy, but EEG was normal and no mental deterioration was found. Biopsied muscle showed intermingled findings of the neurogenic and myogenic changes without ragged-red fibers, and no mitochondrial abnormality was found on an electronmicroscopical examination.
In references of Alport's syndrome, we could not find the case with ptosis and/or external ophthalmoplegia. And many symptoms and findings seen in this case resembled closely to those of Kearns-Shy syndrome (KSS). Therefore we would report this case as KSS-like syndrome without a mitochondrical abnormality with a family history of Alport's syndrome.

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Six patients developed sudden onset of hearing loss after being exposed to acoustic trauma.
Administration of steroids, low molecular weight dextran and stellate ganglion block were done for treatment.
Of 6 cases, hearing acuity recovered completely in 1 case, markedly improved in 2 cases, slightly in 2 cases and 1 remained unchanged.
The author concluded that early adequate treatment might be more effective to ricover the hearing loss in acute acoustic trauma.

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A case of von Willebrand's disease with repetitive postoperative bleeding is reported. A 4-year-old boy was scheduled for tonsillectomy and rdenoidectomy under general anesthesia. Physical examination findings were within normal limits and laboratory data reve aled no abnormalities except for slight prolongation of the bleeding time (5 min by Duke's method). His past history and family history were non-contributory. Although there was no bleeding tendency during operation, nasal bleeding began after he returned to the ward. Operations for hemostasis had to be done three times over the following two weeks. After that, his past history was re-examined and it was clarified that he had had frequent epistasis and had a episode of difficulty of hemostasis after extraction of the tooth. Further laboratory examinations revealed that both he and his mother were the patients of von Willebrand's disease. This case tells us that a careful examination of history is very important.
In the pre-operative preparation of a patient suffering from von Willebrand's disease, it is important to select a time for surgery and to infuse cryoprecipitate before operation. During operation fresh whole blood must be used for blood transfusion. Hypothermic anesthesia and use of aspirin should be avoided.

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Intermaxillary fixation utilizing teeth is widely used for mandibular fixation during bone graft. When teeth cannot be used as a fixed source, however, extraoral fixation is frequently employed with a variety of apparatus and fixation approach is subsequently devised. Extraoral fixation permits a firm fixation, but has some demerits that the patient's discomfort is considerably great because the apparatus protrudes beyond the face, often requiring a removal procedure.
In the present study, a resin splint was fixed to the jaw using circumzygomatic suspension and piriform fossa suspension for the maxilla and using circumferential wiring for the mandibula, followed by intermaxillary fixation using a hook attached to the individual resin splints. This approach was clinically applied to two cases and favorable results were obtained.
This method has the following advantages compared to the conventional extraoral fixation:
1) No special equipment is required.
2) Removal operation is not needed.
3) It gives less uncomfortable feeling during fixation.
4) The maintenance of proper occlusion is easily obtained, because the resin splint can be immediately utilized as a denture after completion of the fixation.

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A 65 year old man first noticed painless gingival swelling in his anterior mandibular region approximately one year before. Later the swelling gradually increased in size.
Oral examination revealed a 30×25mm gingival lesion on the labial and lingual alveolus, that was located in the region from the right lateral incisor to the left first premolar and its surface was smooth and not ulcerated. The lesion was not tender and hard like bone in consistency. There were no signs of inflammation and the contiguous teeth were neither mobile nor tender on percussin.
The panoramic radiograph showed a large, circumscribed, radiolucency and the margin was irregular. It was located in the area between right lateral incisor and left first premolar, where numerous, irregular-shaped bone trabeculare were scattered and it produced a soap bubble or a honey-comb appearance that was uncommon radiographic findings of ameloblastoma of the mandible. The roots of left lateral incisor and canine teeth were inclined and estranged by the expanding tumor, but the resorption of root was not observed. The tumor was excised with the marginal resection of the mandible.
Microscopic examination disclosed nests and islands of stratified squamatous epithelium in fibrous stroma. The surface of the islands showed a palisading arrangement of columnar or cuboid cells. In some areas, there were polyhedral cells resembling the stellate reticulum and cystic spaces in the center of islands which appeared to be odontogenic in origin.
The pathologic diagnosis was ameloblastoma type I by Miyazaki-Arai's classification.
During a follow-up of two years and six months, there have been no evidences of a recurrence.

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It is well known that the relapses of lepromatous or borderline cases of leprosy occur even after the patients are treated sufficiently and regularly and followed-up carefully for several years.
In this article the author presents four cases of leprosy. Three of them are relapsed cases of lepromatous leprosy. The treatment of these three cases was analyzed and the inducing factors for the relapse were discussed. One of them was a suspected case and the result of the smear of the skin was discussed with reference to the early signs of the relapses.
Three cases, one male and two female cases, had some new skin lesions in 1983, one case in spring and two in autumn. One patient was treated at irregular intervals before the relapse occurred and the treatment was already discontinued due to anemic condition with general weakness in one case. In one case any noticeable changes were seen during the course of the treatment. The remaining case did not have a clinical manifestation of the relapse up to the present time but recently the smear examination of the skin for the acid-fast bacilli repeatedly demonstrated slight positive tests in this case.
The subjective signs were characterized by the swelling of the face, nasal obstruction, some erythematous patches with itching of the trunk and extremities. Sleepiness with general fatigue would be one of the most special and noticeable signs of the relapses.
Objectively, a mild or moderate degree of infiltration in the face and various sizes of a few or several erythematous patches on the trunk and the extremities were usually observed.
The causes for the relapses are usually inconsistency and insufficiency of the treatment. At present, in Japan, most patients are cured and the guidelines for the treatment were established, but it should be noticeable that after the long period of negative acid-fast bacilli a few cases have the possibility of the relapses especially in the lepromatous cases. From this point of view, it should be emphasized that the careful and repeated observation must be done even for the cases whose treatment has stopped for a long time after a sufficient and long-term, regular treatment. For these reasons, the above mentioned characteristic signs shouid be very carefully observed and noticed by the physicians, paramedical staffs and family of the patients.

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