Squamous metaplasia of the nasal mucosa in arsenic-exposed patients was investigated using Papanicolou's staining. Eighty-six cases with arsenic exposure were examined and 88 cases with no arsenic exposure were studied as a control group. Smears from the nasal septum were stained using Papanicolou's method, and examined for evidence of squamous metaplasia. Twenty-three of the 86 cases with arsenic exposure (27%), and 14 of the 88 cases with no arsenic exposure (16%) showed evidence of squamous metaplasia. There were no statistically significant differences between the two groups. Within the control group, however, there was a significant difference between the smoking and non-smoking cases. Squamous metaplasia was observed in 9 of the 30 cases who smoked (30%), but only in 5 of the 58 cases (9%) who did not smoke.

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Isshiki Thyroplasty Type I is a common operative procedure performed to improve hoarseness or misdeglutition caused by unilateral recurrent laryngeal nerve paralysis. Measurement of the fenestration during this operative procedure, however, may be troublesome to the surgeon. We devised a simple method to measure the fenestration by applying a fragment of silicone mesh. This method was very easy to perform and enhanced the speed and precision of the procedure.

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Two cases of deep neck infections are reported. Case one was a 50-year-old female who had complained of sore throat, trismus, and swelling of the left cheek and neck. Parapharyngeal abscess secondary to acute tonsillitis was suspected based on the clinical symptoms and CT scan. Intravenous antibiotics and drainage of the abscess using an external approach successfully treated the infection. Case two was a 70-year-old female who presented with swelling of the neck, dyspnea, and unconsciousness. An emergency tracheotomy was performed, revealing foul smelling purulent discharge. An abnormal shadow was seen on the chest x-ray, and right pleural effusion or pyothorax was suspected. Thoracentesis released purulent discharge, but did not improve the condition. The patient died of cardiovascular and renal failure twelve hours after admission, probably due to septic shock. Deep neck infections are rare, and antibiotics have greatly reduced the incidence and resulting complications. When a deep neck infection does occur, it may spread rapidly and lead to lethal complications, so prompt surgical drainage of the abscess and chemotherapy of anaerobic pathogens are required.

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Pre-and postoperative cellular immunity in 64 cases of head and neck cancer was investigated using counts of total lymphocytes, T-lymphocytes, and CD4 (cluster of differentiation 4) positive subsets. CD8 (cluster of differentiation 8) positive subsets were low three days postoperatively, but improved after one month. PHA (phytohemagglutinin) blastoformation depression was detected in twenty patients pre-and postoperatively. In 55% of the patients with depressed PHA blastoformation, recurrent cancers were observed several months after PHA (phytohemagglutinin) blastoformation disturbance was detected. It is suggested that monitoring postoperative lymphocyte activity may play a role in detection of head and neck cancer recurrence.

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Cellular immunity of 64 patients with head and neck cancer was examined pre-and postoperatively. Patients were divided into two groups according to the blastoformation by phytohemagglutinin. No statistical differences were found between the phytohemagglutinin blastoformation-depressed group and the normal group for sex, age, operating time, blood loss, blood infusion, or immunosuppressive acidic protein value. But the phytohemagglutinin blastoformation-depressed group encompassed more advanced cases, and cases with mesopharynx and hypopharynx carcinoma. Alcohol was shown to be a carcinogenic factor in hypopharynx carcinoma, It is suggested that alcohol may account for the depression of postoperative Cellular immunity.

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Two cases of rhinolithiasis are herein reported. In the first case, a Yellow-brown mass in the left nasal cavity of a 28-year-old female was removed in a piecemealy fashion under a local anesthesia while the uncleus could not be found. In the second case, an operation revealed a bad smelling black-brown mass in the right maxillary sinus of a 80-year-old male. A histopathological examination of the calculi revealed that the problem was caused by a fungus ball. We analyzed 153 similar cases of rhinoliths previously reported in the Japanese literature and also discussed the origin of these rhinoliths.

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Cervical cystic hygromas (lymphangioma) are rare among adults. We treated an adult patient with cervical Cystic hygroma. A 62-year-old male patient complained of a left cervical mass. CT, MRI and Ultrasound findings suggested a cystic lesion. In particular, MRI proved to be the most effective method for estimating the nature and number of Cystic hygroma lesions. Surgical treatment was performed by an excision. During the operation, a cyst capsule was ruptured, but we were still able to excise it completely. The patient has since been progressing favorably with no indication of recurrence. As far as we know, this case is the oldest reported case of cervical Cystic hygroma in Japan. A surgical excision is the most effective approach in the treatment of Cystic hygroma, however, it is important to note that a complete removal of cervical lymphangiomas in children may be difficult because of an insinuation of the tumor into the adjacent neck structures. In cases with an incomplete removal, recurrence is therefore common. In contrast, lymphangiomas in adults are generally encapsulated masses and can usually be excised completely. We succeeded in performing a complete removal in our case. We also make a brief review of similar cases in the literature.

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We analyzed the epidemiologic factors of Japanese cedar pollinosis using high school students residing in three regions with a different volume of pollen by means of an allergic questionnaire and the measurement of both IgE and HLA. The results were as follows: The allergic clinical symptoms were proportional to the volume of pollen. However, the production of IgE was influenced not only by the volume of the pollen but also by the amount of air pollution (an extrinsic factor) and other generic factors (intrinsic factors).

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A 26-year-old man who was suffering from aspergillosis of the paranasal sinuses (the maxillary, followed by the ethmoid and sphnoid) was treated by the irrigation method of diluted amphotericin B solution from a counter opening of the inferior nasal meatus. This patient has not since experienced a recurrence for twenty months. In addition, a 42-year-old female and a 63-year-old female were suffering from an inflammation of the unilateral maxillary sinus. Later, a fungus ball was found to be stopped up in the ostium. After removing the fungus ball, the inflammation of the maxillary sinus was cured. Neither of the two females have since experienced any recurrence for almost two years.

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Eight cases of deep neck infection were treated during the ten-year period from 1982 to 1991. Two patients out of eight had diabetes mellitis while one had been administered steroid therapy because of his rheumatoid arthritis. An emergency tracheotomy and surgical drainage were performed on these patients because of an abscess formation in the deep neck and a swelling of the epiglottis, which caused dyspnea, had all been recognized. In particular, in one patient who had diabetes mellitus, the abscess formation had extended so widely to the back bilateral axillae and mediastinal cavity that the surgical drainage from these areas was performed through the neck. For diagnosis and treatment of this disease, the following modalities are considered to be necessary; 1) computerized tomography 2) surgical procedures should be used whenever possible 3) extensive spectral antibiotics should be administered for protection against anaerobic bacterial infections 4) It is important to adequately treat complications that decrease the self-defense ability and are considered to prolong the infection.

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A case of ceruminous adenocarcinoma which arose in the external meatus of the right ear of a 74-year-old male is herein reported. The tumor was localized within the confines of the middie third of the external auditory canal and its malignancy was suggested by both cytology and a CT scan. The lesion was treated by a wide Iocal excision. At 54 months after the operation there is still no evidence of either recurrence or distant metastasis.

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The nasal bacterial carriages in 160 staff members who were employed at our hospital were screened. Methicillin resistant S. aureus (MRSA) was identified in 8 nurses of which one had a nasal allergy, while another demonstrated sinusitis. Six nurses were treated with nasal irrigation using a physiological saline solution once a day for 7 days or more. After the treatment four of the 6 nurses became free from MRSA within 7 days, while the one with a nasal allergy eventually became free of MRSA within 14 days. The subject with sinusitis, however, needed more than 2 weeks to overcome MRSA.

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Outpatients with chronic sinusitis were divided into 3 groups by the envelope method, and 1ml of 2-fold, 4-fold, and 20-fold dilutions of Broncasma Berna were administered into the nasal cavity using a jet type nebulizer twice a week for 4-8 weeks. The efficacy and safety of the aerosol therapy were compared according to the dose.
1. Concerning the subjective symptoms, rhinorrhea improved significantly in all groups. Marked or moderate improvements were observed in 33% of the 2-fold dilution group, 64% of the 4-fold dilution group, and 31% of the 20-fold dilution group.
2. Conceming the objective symptoms, improvements were observed in the volume of nasal secretion in the 20-fold dilution group and the quality of nasal secretion in the 4-fold dilution group. Marked or moderated improvements were observed in 17, 36, and 15% of the 2-fold, 4-fold, and 20-fold dilution groups, respectively.
3. The treatment was considered to be either very useful or moderately useful in 33% of the 2-fold dilution group, 46% of the 4-fold dilution group, and 15% of the 20-fold dilution group, while it was found to be at least slightly useful in 75%, 91%, and 77%, respectively.

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