Severe respiratory viral infectious diseases, such as SARS and highly pathogenic avian influenza H5N1, have recently emerged mainly in the Asian countries. Measures for preventing health crises in this region are now required. The Global Outbreak Alert and Response Network (GOARN) has been organized as a common surveillance network system to detect the outbreak of infectious diseases rapidly, and to identify their causes. GOARN involves a technical collaboration among existing institutions and networks whereby human and technical resources are pooled for rapid identification, confirmation and response to outbreaks of international importance. The objectives of GOARN are to combat the international spread of such outbreaks, ensure that appropriate technical assistance reaches affected states rapidly, and contribute to long-term epidemic preparedness and capacity building. A network system for supplying skilled personnel to the affected area is required to respond swiftly to outbreaks of infectious diseases. The author proposes pre-registration of doctors and nurses skilled in infection control after training by WHO in each country before the occurrence of any outbreak of infectious disease. In case of an outbreak, the registered members will be rapidly sent to the affected area, and will be able to develop necessary preventive measures in coordination with WHO. Preparedness for the outbreak of infectious diseases as described above will minimize the spread of international infectious diseases in each region, and can play an important role in health crises in the future.

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Positron emission tomography (PET) is an imaging technique utilizing radioisotopes. Most radioisotopes used for nuclear medicine imaging procedures decay by releasing energy as gamma rays. These photons are detected by gamma cameras using either the planar or SPECT mode. Other radioisotopes decay by positron emission. The high-energy photons are emitted at 180 degrees to each other and detected simultaneously by opposing detectors on the PET scanner. The image quality of PET is better than a gamma camera image. Today the field of PET is growing exponentially because it facilitates detection of cancer throughout the body without pain. The clinical uses of FDG-PET are to distinguish a benign from a malignant tumor, to determine the staging, to detect distant metastasis and/or recurrence, to evaluate the effectiveness of treatment response, and to estimate the prognosis. Since 2002 the Japanese government approves reimbursement of FDG-PET costs under the national health insurance program for ten types of tumor. Currently there are many PET centers engaged in cancer screening all over Japan. PET centers require a cyclotron unit with many staff members to serve as radiopharmacists. FDG-PET is not an all-around method for tumor imaging, and we have to diagnose images with consideration of normal distribution of F-18 FDG in the body and reference to morphological images. The development of PET/CT and new radiopharmaceuticals promises to play an important role in routine tumor imaging in the coming years.

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In the majority of cases, hypopharyngeal cancer is asymptomatic until it reaches the advanced stage, which accounts for the high incidence (70-80%) of advanced cases of hypopharyngeal cancer at initial diagnosis. However, endoscopic screening in high-risk patients, such as those with squamous cell carcinoma of the upper aerodigestive tract, may contribute to early detection of hypopharyngeal cancer. In our hospital, patients with esophageal cancer received periodic otolaryngological screening for head and neck cancer. The purpose of this study was to determine whether periodic otolaryngological screening before and after treatment of esophageal cancer is effective in detecting early stage hypopharyngeal cancer.
A total of 1,790 consecutive patients with esophageal cancer were treated at Keiyukai Sapporo Hospital between May 1995 and December 2003. Of these, 80 patients had additional primary hypopharyngeal cancer. Sixty-three patients were diagnosed as having hypopharyngeal cancer by periodic otolaryngological screening, prior to which they had no subjective symptoms of hypopharyngeal cancer or lymph node involvement. The clinical stage distribution of these hypopharyngeal cancers was as follows : stage I, 43 ; stage II, 14 ; stage III, 3 ; stage IV, 3. Patients with stage I or II hypopharyngeal cancer comprised 90.5% of the 63 patients, which was rather higher than the reported incidence of early cases.
Our findings demonstrated that periodic pharyngolaryngoscopy screening in patients with esophageal cancer can provide early detection of hypopharyngeal cancer.

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Hypopharyngeal cancer has been reported to be frequently associated with cancer of the esophagus, and the rate of the double cancer is thought to be from 30% to 40%. When treating esophageal double cancer, we have to consider the balance among radicality, prognosis and QOL. The indication of esophagectomy and gastric pull-up in esophageal double cancer is thought to be from 10% to 20% because superficial carcinoma of the esophagus is high in frequency. Hypopharyngeal cancer has a propensity to spread in the submucosa far away from the main tumor. The submucosal spread is frequently blamed for the high incidence of local recurrence. Lymph flow in the pyriform sinus and posterior wall cancer moves upward to the oropharynx. Because the submucosal spread is an invisible lesion, the superior margin should be resected adequately, applying frozen section biopsy in the pyriform sinus and posterior wall cancer. Bilateral neck dissection is often performed even in cases of clinically negative necks, because it is histologically proven that occult metastasis to the cervical lymph nodes occurs in as many as 30-40% of the cases reported. It is therefore necessary to diagnose metastatic nodes carefully before an operation in the case of performing a prophylactic neck dissection. Ultrasonography is more reliable than CT or MRI for evaluating lymph node metastases. However, it is often difficult to detect the number of positive lymph nodes by ultrasonography. Indication of prophylactic neck dissection for hypopharyngeal cancer has to be rendered carefully because of the high metastatic rate and limitations of preoperative diagnosis.

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The role of concurrent chemoradiotherapy in the management of hypopharyngeal cancer was discussed. In controlled clinical trials, CDDP-based concurrent chemoradiotherapy showed benefit in survival compared to radiation alone for the patients with inoperable hypopharyngeal cancers. At the same time, concurrent chemoradiotherapy demonstrated benefit in organ preservation compared to radiation followed by salvage surgery for patients with operable hypopharyngeal cancers. In the Japanese literature, the overall survival rate with concurrent chemoradiotherapy exceeds 50%. At our institution, CDDP and 5FU administered concurrently with radiation yielded local tumor disappearance in 55% of the resected specimens, thus suggesting the possibility of organ preservation. The 5-year disease-specific and overall survival rates were 56% and 51%, respectively.

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We investigated the present status of sick house syndrome and/or chemical sensitivity in Japan. Both clinical and basic studies have been supported by a grant from the Japanese Ministry of Health, Labor and Welfare during the past five years. The disease is induced by a chronic low-dosage exposure to hazardous environmental chemicals such as formaldehyde, toluene, volatile organic compounds (VOCs), and organophosphate compounds, such as chlorpirifos. A significant lesion was found in the central nervous system. The patients may have a genetic vulnerability to certain chemicals. Objective tests of the central nervous system including the autonomic nervous system helped to establish the diagnosis of those patients. Tests checked for abnormal pupil reaction to light examined by infrared videopupillography, defective smooth pursuit ocular movement, hyper- or hypo-function of smell, abnormal functional MRI followed by suspected chemical loading and reduced or elevated blood circulation of the brain etc. helped the diagnosis. Measurement of indoor chemicals is also helpful to establish the diagnosis. From those objective tests, patients were positive, therefore, psychological suspicion was excluded. Early diagnosis as well as treatment of patients are urgent and necessary together with avoidance of hazardous environmental chemicals.

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Both sick house syndrome (SHS) and chemical sensitivity (CS) are ill-defined disorders in humans attributed to exposure to indoor volatile organic compounds. The upper respiratory airway has mainly three functions : intake, defense and nervous reception. It is thought that chemical materials cause development of unpleasant symptoms by poisoning or by allergic or neurological reaction. We studied the olfactory function of SHS and CS patients. However, we found no significant differences in either olfactory threshold or olfactory contrast between the patients and normal controls. These results show that patients with SHS do not have hypersensitivity to odor stimulation and may have something otherwise at work in their central pathway. Further examinations including other nervous systems are needed to resolve the correlation between sensitivity in the upper respiratory airway and symptoms of SHS patients.

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To investigate the mechanism of bronchoconstriction by formaldehyde (FA), we examined the effect of FA on airway epithelial ion transport in guinea pigs. We investigated the mechanism by which formaldehyde induces bronchoconstriction and increases airway hyperreactivity in guinea pigs with experimental asthma, and evaluated the efficacy of several drugs. As a clinical study, we also investigated the effect of formaldehyde inhalation on respiratory function and airway hyperreactivity in students practing dissection, and evaluated the efficacy of disodium cromoglycate (DSCG, Intal^TM).
The increment of short circuit current (Isc) was 9.42±2.84 μA/cm² after a FA challenge of 12.5 mg/m³. DPC, DSCG, Ouabain and H-89 attenuated this increase in Isc. After a challenge with FA of 12.5 mg/m³, cAMP increased significantly. FA also activated PKA, but this activation was inhibited by PKA inhibitor H-89. Inhalation of 10 ppm of formaldehyde caused a significant increase in lung resistance. Pretreatment with DPC, H-89 and DSCG led to significant inhibition of the increase in lung resistance.
The student's PEF on leaving the anatomical laboratory was decreased by 8.9% as compared with that on entering the laboratory. Inhalation of DSCG significantly ameliorated the decrease of PEF to 2.7%. Students with asthma showed increased airway hyperreactivity after the dissection classes, but this increase in hyperreactivity could be prevented by inhalation of DSCG from the sixth week.
These findings suggest that formaldehyde induces activation of intracellular cAMP and PKA, and stimulates irritant receptors in the airways through electrophysiologic changes due to activation of the Cl channel, and that bronchoconstriction is caused by a response mediated via neurotransmitters such as acetylcholine, substance P, and neurokinin A.
These results suggest that DSCG is effective against bronchoconstriction and enhanced airway hyperreactivity due to inhalation of formaldehyde.

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In recent years allergic diseases have been increasing, especially allergic rhinitis and bronchial asthma, which are chronic inflammatory disorders of the airways. Risk factors for airway hyperresponsiveness can be classified into host factors and environmental factors. Exposure to allergens such as domestic mites, fungi, animal allergens, formalin and photochemical smog (nitrogen oxides, ozone) are recognized as major environmental factors. Both indoor and outdoor irritants which contribute to environmental change become injurious to humans, animals and plants paralleling our socioeconomic condition. In children who are exposed to maternal smoking, there is evidence that exposure to tobacco increases their risk of developing asthma and wheeze. Therefore initiation of appropriate solutions is important for successful management and prevention of allergic diseases.

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We reviewed the medical records of 89 patients who underwent fiberoptic bronchoscopy (FB) for unexplained hemosputum or hemoptysis to determine the various causes. Our patient population was predominantly male and elderly with a history of smoking. The most common complication of hemoptysis was hypertension. Chest X-rays showed 35 patients (39.3%) with normal findings. By contrast, there were only 16 patients (18.2%) with normal findings on chest CT. Bleeding was recognized by FB in 36 cases (40.4%), and the likelihood of visualizing active bleeding or its site was higher with early FB versus delayed FB. Idiopathic hemoptysis (40.4%), bronchiectasis (21.3%), and bronchogenic carcinoma (16.9%) accounted for the majority of the causes of hemoptysis. Two of 15 patients with bronchogenic carcinoma had a normal chest X-ray.
We conclude that the following patients with hemosputum or hemoptysis should be examined using FB : (1) all patients with any abnormal findings on chest X-ray or chest CT, (2) patients over 40 years old with significant smoking history even without abnormal findings on chest X-ray, (3) patients with hemosputum or hemoptysis lasting more than one week.

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Purpose : The purpose of this study was to evaluate bronchoscopic hemostasis and bronchial artery embolization (BAE) as treatments for patients with hemoptysis.
Methods : 138 patients (98 men and 40 women, ages 16-91) with hemoptysis were treated by use of bronchofiberscopy and BAE at our Department over the past 5 years. All patients underwent bronchofiberscopy within 48 hr of active bleeding to determine the bleeding site. The value of these medical treatment was evaluated.
Results : The causes of hemoptysis in these patients were bronchiectasis (82 cases), tuberculosis (12 cases), and lung cancer (12 cases). Bronchoscopic hemostasis was performed for 56 patients, and brought about desirable effects such as primary hemostasis. Indications for BAE were determined by the findings of bronchial arteriogram. BAE was performed for 49 patients, and brought about desirable effects such as hemostasis. About 50% of the patients had a relapse after bronchoscopic hemostasis. BAE resulted in an immediate cessation of hemoptysis in 46 of the initial 49 patients (93%). Long-term control of bleeding was achieved in 42 of the initial 49 patients (85%).
Conclusion : The principal treatment for hemoptysis is hemostasis and treatment of the underlying disease. Our study findings suggested that bronchoscopic hemostasis and BAE bring about desirable effects such as primary hemostasis. The effect of bronchoscopic hemostasis is only temporary, however and another treatment is required. The solid judgement of indication for bronchoscopic hemostasis and BAE is important to the success of hemostasis.

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A control of hemoptysis has been achieved with bronchoscopic techniques, bronchial artery embolization (BAE), or lung resection. The best medical treatment has been chosen for each. In our hospital, BAE was selected as the preferred the medical treatment for hemoptysis. BAE was carried out in 60 patients between 1997 and February 2004. Although transient chest discomfort was recognized in three patients, there were no complications relevant to BAE. There was bronchiectasis with the basic disease in 21 patients. The number of those well controlled after one BAE was 48 patients (80%), while after two BAE, 9 patients (15%) obtained well-controlled hemoptysis. BAE was not successful in controlling hemoptysis in 3 patients. Among them 2 are being observed and one patient was administered separation of the bronchial artery and resection of the lower right lobe. Presently we are configuring 3-dimensional images of the bronchial artery according to imaging CT, considering of the form of the metallic coil, and introducing IVR-CT/angio system etc., for improvement in the results of and prevention of complications with BAE.

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[Introduction] Surgical treatment for hemoptysis caused by inflammatory pulmonary diseases was discussed on the basis of clinical data at Fukujuji Hospital. [Materials and Methods] Forty-seven cases were surgically treated for massive airway bleeding over a span of 14 years. Results were evaluated and several problems studied. [Results] About half of the cases involved pulmonary aspergillosis, and the next were chronic bronchitis with or without nontuberculous mycobacterial infection. In 36 cases pulmonary resections bigger than segmentectomy were performed to the responsible foci, and in 12 of these cases pneumonectomies were carried out. In these pulmonary resections the morbidity rate was rather high but the mortality rate was as low as 2.8%. All ceased bleeding successfully immediately after the operation. In 11 cases resections were not indicated because of their opportunistic conditions. These were intervened palliatively with non-resected operations such as cavernotomy. In 8 cases hemoptysis disappeared postoperatively, but 2 cases died from uncontrolled airway bleeding in the early postoperative days. Among the cases of aspergillosis, non-resectable cases were rather more frequent than in other inflammatory patients. [Conclusion] Surgical treatments for hemoptysis caused by inflammatory pulmonary diseases were effective to control bleeding. In particular, radical pulmonary resection bigger than segmentectomy had a high success rate, but its morbidity rate was also relatively high. Therefore, in emergency situations, pulmonary resection should be indicated carefully in compromised cases. Surgical treatments should be used together with conservative ones such as bronchial arterial embolizations as much as possible.

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Bleeding of the otorhinolaryngology area was explained according to location : the nose, mouth, pharynx, larynx or cervical part of the trachea and explained. In addition, we discussed blunt laryngeal trauma, where outward symptoms and findings can often be mild compared to severe interior findings, thus making it impossible to reach an appropriate and prompt diagnosis and administer early treatment.
We examined a case of innominate artery fistula in a 24-year-old female who was under the control of a cuffed tracheal cannula after tracheostomy. Repeated excessive aspiration caused infection from tracheal granulation, which led to injury of the innominate artery.

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Acute pharyngotonsillitis is one of the most common infectious diseases. The disease is cured within several days to one week by treatment with NSAIDs and/or oral antibiotics, but a guideline for diagnosis and treatment of acute pharyngotonsillitis has not yet been established. European and American guidelines are directed at family practicians. In the guidelines, serious cases are expected to be referred to otolaryngologists. Recently, the Guideline Committee of Japan Stomato-Pharyngology Society proposed that severity of the disease be assessed by a scoring system consisting of symptoms/signs and local findings and the disease be treated according to the severity score. In addition, the committee proposed a guideline for tonsillectomy for recurrent tonsillitis, in which the medical circumstances and economics of Japan and the patient's QOL and compliance of a patient are all taken into consideration. This report introduces part of the guideline for acute pharyngotonsillitis proposed by the Guideline Committee.

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