In his twilight years, painter VINCENT VAN GOGH (1853-1890) was often attacked by paroxysms of illness and he committed suicide after treatment of one and a half years' duration. GOGH'S ailment has been considered as a mental disease but the author, from an otological viewpoint, reviewed his letters, behaviors and works and reached a conclusion that GOGH probably was plagued by MÉNIÈRE's disease.
I. The reasons for diagnosing him to have MÉNIÈRE'S disease.
1) There was vertigo.
In his letters, GOGH often complained that he was frequently having dizzy spells.“Vertigo was felt with me always.”(j'avais toujours des vertiges, W4)“The vertical tremors began attacking me since early this month.”(le tangage, qui a accompagné le commencement de ce mois-ci. 546)“Having so frequent attacks of vertigo, ”(ayant si souvent le vertige, 605)“An attack of vertigo comes on in the long run.”(c'est à avoir le vertige. 638)
2) There was a recruitment phenomenon.
The following sentence is well describing the existence of recruitment. This explanation was made by GOGH by observing his inmates of the mental hospital but at the same time it can be interpreted as recollecting his own experiences.“The acoustic nerve of the man probably is so hypersensitive that he feels he can even hear voices and words that echo in corridors.”(il crois entendre des voix et des paroles dans l'echo des corridors, probablement parce que le nerf de l'ouis est malade et trop sensible, 592)
3) Stomach got upset while attack was on.
GOGH often wrote in his letters that due to bad stomach conditions while attack was persisting, he couldn't eat at all (569, 602a, 606). This could be considered as gastric symptoms that occur during an attack of MÉNIÈRE's disease.
4) Attacks were of seasonal occurrence and had precipitating causes.
The first attack on GOGH began in December 1888 and exactly one year later, that was in December 1889, there was a relapse. Also in July 1889, a severe attack struck him and in July 1890 he killed himself. One of the causes of his suicide was thought to be the recurrence of attacks or its prognostication. In other words, one can see a fairly distinct quality of being seasonal in GOGH'S attacks (Fig. 1). On many occasions fatigue stemming from painting and travelling could be considered as a precipitating cause of his attacks.
Attacks having a quality of being seasonal and demonstrable precipitating causes are known to be one of the characteristics of MÉNIÈRE's disease.
II. Puzzles involving GOGH that can be explained by MÉNIÈRE'S disease theory.
1) Why did GOGH cut his ear lobe?
It was a puzzle why GOGH, with his own hands, cut through his ear lobe. However, supposing GOGH was plagued by MÉNIÈRE's disease and he cut it off in trying to escape from distressing symptoms of aural stuffiness, tinnitus and recruitment accompanying attacks, this can be well understood.
2) In the center of his painting entitled “The starry night”(212, Fig. 2) are depicted stars as if they are floating from left to right like whirling waves. If the stars can be seen like this, it might have been when an attack of MÉNIÈRE'S disease was on with the occurrence of horizontal-rotatory nystagmus. It is conceivable that GOGH compounded in this painting the impression of the stars he saw when he was struck by the attack.

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Toluidine blue is metachromatic dye belonging to the thiazine group. Toluidine blue staining has been used for detection of exact area of carcinomatous invasion. The cases for this study related to the period from 1974 to 1978, during which a total of 151 microlaryngoscopies were performed by the same doctors group.
Though the 64 specimens seeming to be non-malignant under simple micolaryngoscopic view, their histological features exposed 50 non-malignant specimens (78%), but 14 specimens (22%) of malignant histological reports.
Out of 87 specimens looked like malignant tissues under microlaryngoscopic view, their histological features showed the 69 (79%) malignant results, but the 18 (21%) specimens of non-nalignancy. Agreement of the histological-microlaryngoscopic views was shown at the rate of 78.8% (119/151).
On the other hand, histological features exposed 59 (84%) malignancy though the 70 specimens seeming to be malignant by positive staining reaction with toluidine blue.
Out of 48 specimens reacted to be negative by toluidine blue staining, their histological features showed the 48 (100%) benign results. Agreement of the histological-microlaryngoscopic views was shown at the rate of 90.7% (107/118). Histological features of the giving positive staining reaction, no matter how their outlooking with an aid in the microlaryngoscopic views seeming normal lesions, included 3 specimens of carcinomas in situ and 1 specimen of severe dysplasia.
Toluidine blue seemed to be useful for detection of carcinoma in situ, determination of the lesion of biopsy, detection of multifocal carcinoma and adequate choice of treatment of laryngeal cancer.

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In this paper, a surgical procedure of parotidectomy preserving the facial nerve with retrograde preparation technique was described. The skin incision is given the shape of “S” around the auricle. The temporal branch of the facial nerve was searched out on the zygomatic arch at first. Then the nerve was preparated in a centripetal direction to the trunk of facial nerve. Having reach the trunk of facial nerve the other branches were preparated in a centrifugal direction between the upper and lower lobe of parotid gland. The advantages of this method are as follows:
1. As the most of parotid tumor locates at the lower part of the parotid gland, it is possible to reach the trunk of facial nerve without a manipulation of tumor.
2. As the temporal branch locates on the zygomatic arch superficially, it is very easy to find out the branch.
3. Communicating branch of auriculotemporal nerve to facial nerve is cut simultaneously preventing the salivary fistula and Frey's syndrome.
4. As the temporal branch supplies no important facial muscles, the methcd reported is safer than the other method which starts from buccal or mandibular branch.

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This paper presents usefulness of CO₂ laser in treating ameloblastoma. The patient was a 14-year-old boy who had developed ameloblastoma in the right molar region of the mandible. The tumor was 4cm×3.5cm×1cm in size and presented a cauliflower-like appearance. Marginal mandibulectomy was indicated. Prior to the dissection of bone, the portion of the tumor protruding out of the mandible was removed with laser irradiation, which caused only 10 ml of bleeding. This procedure was helpful in visualizing the margin of the tumor and assured adequate extent of removal in marginal mandibulectomy.

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For surgical precedures of stroboscopic microsurgery of the larynx, a monitoring system with acoustic analysis of patient's voice obtained during the operation has been developed.
In this system, coefficient of variation of the fundamental frequency (Fcv) of the voice for periodicity and the ratio of averaged difference of amplitude and effective in-put level are obtained. The result is displayed on a monitor display and also printed out by digital printer.
The results of normal cases of 6 males and 6 females are as follows;
1) In male group, Fcv of /a/ is 0.73% and that of /e/ is 0.72%
2) In female group, both Fcv of /a/ and /e/ are 1.00%.
3) Larger score is obtained in female group than in male group while no difference between /a/ and /e/ is obtained.
4) In male group, Vsus of /a/ is 21.15% while that of /e/ is 17.47%.
5) In female group, VSUB of /a/ is 16.48% while that of /e/ is 12.52%. 6) Smaller score in female group and also in /e/ is shown than in male group and in /a/.
Pre-and post-operative phonatory examinations as sustained vowels in 40 clinical cases with various laryngeal lesions were performed. In addition, voices obtained through a direct laryngoscope were acoustically analyzed pre-and post-operatively while vibratory patterns were simultaneously observed by use of a laryngostroboscope.
The results are as follows;
1) The score of Fcv of voices through a direct laryngoscope is larger than that of voiced vowels.
2) In regard to estimation of phonatory funtion of the larynx, there is no significant difference between an acoustical analysis by this system and a stroboscopic observation of vibratory patterns.
3) It is revealed that there is significant relationship between phonarory functions immediately after the operation and that of long thrm after the operation.
In addition, for 15 clinical cases, this system has been employed as a monitoring system for functional microsurgery of the larynx.
We would say that for this system it is very important to perform anesthetic procedures and extension of the larynx resorablly in order to obtain good voices abaiable for acoustic analysis.
It seems most likely that the operation may be accomplished when the score of Fcv reaches under the level of 1.7% and Vsus is under 30% while the stroboscopic vibratory pattern is normally restored.
By use of this system, prevision of the result of the operation can be obtained.

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