The purpose of this paper is to present diagnostic problems encountered with foreign wood fragment which have stayed a sufficient length of time become immersed in tissue fluid. A 47 year-old man initially had a wood fragment removed by a dentist. He suffered from trismus and continuous drainage from the stitch wound for about 6 months. Plain X-ray films, CT scans, and contrast dye studies with water soluble material gave negative results for foreign framents of wood. An exploratory operation revealed that swollen wood fragments penetrated into the skull base. A search for the basic data revealed that a wood fragment immersed in water had about the same absorption rate as human soft tissue. The authors recommend the use of oil soluble contrast dye in cases where there is suspicion of a long-stayed wood foreign-body which has had sufficient time to become immersed in tissue fluid.

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Alteration in cochlear blood flow is considered to be closely related to sudden sensorineural hearing loss, noise-induced hearing loss, or Meniere's disease. In this paper, the effect of Vinpocetine on cochlear blood flow was investigated by means of a laser Doppler method. Seven guinea pigs (280-620g) were used in this study. They were anesthetized with intraperitoneal injection of pentobarbital (30mg/kg), and tracheostomy was performed. The tympanic bulla was opened via a ventral approach and the basal turn of the cochlea was exposed by removing the mucosa. The experiment was carried out with spontaneous respiration, and cochlear blood flow and systemic blood pressure were determined. Vinpocetine induced an increase of cochlear blood flow in all of the guinea pigs. The changes of systemic blood pressure were much smaller than that of cochlear blood flow.

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The office closure method was performed on 49 ear drum perforations including 40 otitis medias and 9 traumatic ear drum perforations. The margins of the ear drum perforations were cauterized with 10% silver-nitrate, and Microspore Surgical Tape 3M was placed on the perforation as a patch. Twenty one of 40 otitis medias and all traumatic ear drum perforations were successfully closed. The office closure method should be considered as a useful treatment to repair ear drum perforations.

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Herpes simplex gingivostomatitis is commonly seen in infants and younger children but rarely in adults. A rare case of herpes simplex encephalitis following herpes simplex gingivosomatitis is reported here. A 28-year-old male, suffering from high fever, pain of the oral cavity and dysphagia for 5 days, was admitted to our hospital. An examination of his oral cavity revealed an acute gingivostomatitis due to the initial infection of herpes simplex virus (type 1). Two days later, he experienced a disturbance of consciousness and frequent tonic convulsions. Emergency treatnment was immediately performed. In the cerebrospinal fluid, pleocytosis (mainly lymphocytosis) and increased protein content were observed. The titer of the HSV antibody, serologically determined by the complement fixation reaction, was 1:32. The diagnosis of herpes simplex encephalitis was confirmed by the above mentioned clinical course and the findings of CSF. Thus, adenin arabinoside (Ara-A) therapy was planned and performed. This therapy proved successful and he recovered completely. No recurrence and sequera have been observed in the three years following treatment.

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To demonstrate endogenous androgen in normal human laryngeal mucosa, carcinoma and certain other lesions, 6 normal male epitheriums, 8 carcinomas, 10 polyps, hyperplasias and 4 heteromorphic epitherium tissues were processed for the histochemical demonstration of endogenous androgen by using the ABC immunohistochemical technique. Every carcinoma used in this study were moderately differentiated squemous cell carcinomas. The ABC method demonstrated a positive reaction in the nuclei of two male laryngeal carcinoma tissues and the laryngeal muscle. In the staining protocol employed, the other tissues gave negative reactions. The result showing positive reactions in nuclei were similar to those demonstrated by other sex hormone target organs in the literature. These results produced some evidence to suggest that human laryngeal carcinoma might be a target for androgenic steroids, and therefore implies that androgen plays an important role in the carcinogenetic process of normal laryngeal tissue and, for example, on the development and growth of laryngeal carcinoma.

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To our knowledge, a regimen of oral steroids, given on the basis of a gradually decreasing dosage, combined with thoroughgoing rest is the most effective of all treatment measures attempted so far to control attacks of Ménière's disease. Experiences indicate, however, that there have been cases in which nystagmus long persisted in defiance of such a combined therapeutic regimen or, which after once having been alleviated, recurred in repeated episodes apparently unamenable to any therapeutic means. Our recent research efforts have led us to discover that imipramine, an antidepressant, when used in such less manageable cases, may provide an adequate control of long-persisting or frequently recurring nystagmus. During the year of 1981 a total of 84 patients were admitted to our hospital to receive treatment for attacks of Ménière's disease. Of these, 34 (40%) were given imipramine after other treatment measures had failed to control nystagmus. In 28 (82%) of them, imipramine therapy proved to be effective in controlling attacks in 3 of the remaining 6 the drug had to be discontinued owing to side effects, such as a rise in blood pressure, nightmares and auditory hallucinations, while in the other 3 the drug therapy provided an inadequate control of nystagmus, although it was uncertain whether this therapeutic failure was due to an insufficient dose of the drug or to some other cause. Worthy of particular note was that patients who required the use of imipramine, when compared with those who did not, were more frequently in their fifties or sixties and complained more often of sleep disturbance and notably of severe stiffness of shoulders and back. The dosage of imipramine ranged from 10 to 120 mg, most often being 30 mg. All patients in our series who complained of insomnia were given a dose of amitriptyline bofore retiring. Amitriptyline alone did not produce a nystagmussuppressing effect as seen with imipramine. Of particular interest was the following distinct relationship indicative of the effectiveness of imipramine observed in imipramine-requiring patients: the earlier the start of imipramine therapy, the shorter the duration of hospitalization, while inversely the later the drug was instituted, the longer was the period of hospital treatment required. Imipramine is one of the drugs that are useful for the treatment of Ménière's disease. The effectiveness of the drug in this disease can probably be explained by its ability to relieve the depressed state of Ménière's disease patients that supposedly obstructs biological responses thus leading to the cure of lesions in the inner ear responsible for the disease.

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A case of malignant fibrous histiocytoma is reported. A 16-year-old male was referred to our hospital with a tumor of the left maxillary sinus which was invading the surrounding tissue and causing bone destruction. After radiotherapy, he received a total maxillectomy. However, two months later, local lesions recurred and lung metastasis was found. Although several kinds of chemotherapy and additional surgical operations were performed, he died from general emaciation after 10 months of treatment.

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Eighteen patients with chronic otitis media, middle ear cholesteatoma, and postoperative inflammatory diseases of the middle ear underwent high resolution computerized tomography (CT) and magnetic resonance imaging (MRI) before surgical exploration of the middle ear. Results showed that CT provides higher detail resolution in middle ear structures, but provides limited density resolution in displaying inflammatory soft tissue lesions. By contrast, MRI differentiates among soft tissue lesions such as fluid-filled spaces, granulation tissues, and cholesteatomatous debris. Cholesterin granulomas show a particularly characteristic signal pattern with a very high intensity area in both Ti and T2 weighted images. It is concluded that MRI is useful in differentiating soft tissue density masses when used in conjunction with CT in middle ear inflammatory diseases.

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Vocal function was compared in 29 patients who had undergone hemilaryngectomies in which a superiorly based sternohyoid muscle was used for glottic reconstruction. Four types of tissue were used to cover the muscle flaps: hypopharyngeal mucosa, labial mucosa, thyroid perichondrium, and cervical island skin flaps. The vocal function following hemilaryngectomy was evaluated and compared to a normal control group. The results are summarized as follows: 1) There were significant differences in MFR, intensity/flow ratio, MPT, and the highest tone of physiological Fo range between the hemilaryngectomy and the normal groups, 2) Psychoacoustic evaluations showed the voice to be rough, breathy, and/or strained in the hemilaryngectomy group; 3) Sound spectrographic analysis showed significant differences in fundamental frequency fluctuation extent and speed, amplitude fluctuation speed, amplitude falling time, relative level of igh harmonic components, and the relative level of noise for the hemilaryngectomy and control groups.

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Sixty-four patients with head and neck carcinoma were treated with induction chemotherapy consisting of Cis-platinum (CDDP), Vincristine (VCR) and Peplomycin (PLM)(COP therapy). The complete response (CR) rate was 15.6% (10/64), the partial response (PR) rate was 46.9% (30/64), and the overall response rate (CR+PR) was 62.5% (40/64). Background factors, such as sex, primary site of carminoma performance status (P. S.), pathological characteristics and administered dose of CDDP were analyzed for the patient resposiveness to COP therapy. The CR rate was higher in females than in males. Regarding primary site, complete responders were found most often in cases with mesopharyngeal carcinoma. A high overall response rate was found in patients with better P. S. and in cases whose histology showed well differentiated squamous cell carcinoma. Lower CR rate was detected in cases where less thas 50mg/m² of CDDP was administered, but the overall response rate (CR+PR) was not affected by the dose of CDDP. The outcome of PR to COP therapy was found within thirty days of the onset of treatment. Initial response to this chemotherapy was detected earlier in CR cases than in PR cases (P<0.05). Survival rate for induction chemotherapy was greater in CR cases than in PR cases (P<0.001).

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The utility of AD-1590 (A group) in pain after tonsillectomy was investigated with a multicenter collaborative double-blind design using indomethacin (I group) as a control drug. 1) A total number of 140 patients (71 A group and 69 I group) were treated. Out of 140, 133 (67 A group; 66 I group) were included in all evaluations and 7 (4 A group,; 3 I group) were partially evaluated. No significant bias was found in patient population or in characteristics between the two groups. 2) There was no significant difference in the analgesic effect of the first dose between the two groups. The improvement rate covering “≥ moderately improved” was 55.9% in the A group and 50.7% in the I group. 3) No significant difference was found in overall improvement between the two groups.“Moderately improved” and higher ratings accounted for 68.7% in the A group and 68.2% in the I group. 4) There was no significant difference in the incidence of side effects between the two groups. The incidence of side effects was 5.6% (4 out of 71) in the A group and 1.4% (1 out of 69) in the I group. 5) In the utility evaluation, there was no significant difference between the two groups. The utility rate covering “≥ useful” was 71.6% in the A group and 68.7% in the I group.

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11 cases of chronic purulent otitis media and 9 cases of acute exacerbation of chronic otitis media were treated with FOM tablets with the following results. 1. FOM tablets achieved a high overall efficacy rate of 65.0%. Bacteriologically, causative organisms were eradicated in 66.7% of cases. 2. Diarrhea was observed in 1 case. However, it was transient in nature and did not interfere with the continuation of treatment. It disappeared after completion of treatment. 3. Urinary rate was 65.0% and, especially in cases of chronic otitis media, a high utility rate of 81. 8% could be obtained. From these findings it is concluded that FOM tablets can be expected to be very effective in the treatment of purulent otitis media.

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