A case of Wernicke encephalopathy following hyperalimentation without thiamine is reported. Retrocochlear deafness and such classic symptoms as opthalmoplegia and ataxic gait were observed. The MR findings were also considered to be useful for an early diagnosis of Wernicke encephalopathy. In response to the administration of thiamine both deafness and almost all of the ocular signs were observed to gradually improve. On the other hand, ataxia and lateral gaze nystagmus remained. The lesions observed in both vestibular nuclei may be attributable to the residual ataxia. A pure tone audiometer test showed almost normal hearing, while both speech discrimination tests showed poor scores. ABR revealed a slight prolongation of the unilateral III-V interwave intervals. Therefore, lesions around the inferior colliculus in the upper brainstem may account for this type of retrocochlear deafness. It is thus necessary to pay close attention to the onset of retrocochlear deafness as a potential sign of Wernicke encephalopathy.

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A case of objective tinnitus, which could be either activated or inhibited voluntarily in a 22-year old female, in herein reported. The tinnitus, which manifested itself as a clicking sound with a peak energy spectrum of 2.2 kHz. She could control the tinnitus voluntarily until a rate of a maximum of 150/minute. A depression of the eardrum, a pressure decrease in the auditory meatus and low compliance value in the impedance audiometry were all observed in synchronization with the tinnitus. However it was not thought that a stapedius is related to the tinnitus because of an increasing of the compliance value due to a stapedial reflex. Based on the above findings, it was suggested that the tinnitus may have originated due to an opening in the auditory tube.

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It is well known that an intact false vocal cord is structured by a pseudostratified columnar epithelium for the most part and the tip of the false vocal cord is stratified by a squamous epithelium in part. The lamina propria mucosae is composed of connective tissue with collagen fibers and glandular laryngae. A case of severe hypertrophic false vocal cord was observed. Some specimens of this false vocal cord were surgically obtained, and then compared with the control specimens taken from 3 patients of approximately the same age. In this case of hypertrophic false vocal cord, multiplying collagen fibers of the lamina propria mucosae and relatively atrophic glandular laryngeae were observed.

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We treated 240 patients with an abnormal sensation in the throat. 141 cases had organic disease while 99 cases had none. Most of the cases due to inflammation and malignancy of the pharyngolarynx complained of either pain or the abnormal sensation of a foreign body in the region of the hyoid bone or thyroid cartilage. Many cases without any organic disease complained of an obstructive or foreign body sensation in the tracheal region. The clinical effects were excellent in the cases who had no psychogenic background, and good in the cases who had a psychogenic background but no other organ symptoms. However, the clinical effects were not so good in cases who had a psychogenic background and other concurrent symptoms.

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An 80-year-old man had received irradiation (40 Gy) and a partial pharyngotomy and total laryngectomy for hypopharyngeal cancer(T 2 N 1 M 0) 6 years and 6 months previously. The patient thereafter spoke with an artificial pneumatic larynx (Tapia). He recently began to complain of oral pain and was diagnosed as having oral cancer(T 2 N 0 M 0). Oral cancer was treated with irradiation (50 Gy) and has since been well controlled. We suspect that in addition to heavy drinking, the continuous stimulation of the artificial pneumatic larynx was the most likely carcinogenic cause of the oral cancer. The oral cancer was not considered to have been radiation induced because no radiated field for hypopharyngeal cancer was observed in the oral cavity.

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Two cases of malignant melanoma of the nasal cavity and paranasal sinuses are presented.
Case 1: A 69-year-old-male presented with a right nasal obstruction. A CT scan showed a mass in the right nasal cavity, as well as in the maxillary and ethmoid sinus. Biopsy specimens from the tumor showed a characteristic picture of malignant melanoma. Chemotherapuetic treatment was carried out and the tumor remarkably decreased in volume. However, a tumor remnant still remained in the right nasal cavity and ethmoid sinus. Thus, we repeated the same regimen. Thereafter, the patient status gradually deteriorated, and he eventually died four months after admission.
Case 2: A 70-year-old man was admitted with right intermittent epistaxis. A tumor was found locally in the right nasal cavity. The tissue diagnosis was malignant melanoma. The patient underwent surgery as the primary treatment. After six weeks, the tumor recurred. The patient was operated on and underwent chemotherapy. In spite of all therapies, the patient died 17 months later.
Regarding the pathological anatomy, we recognized metastasis in many organs in case 2, but no difinite difference in the tumor cell type was observed between case 1 and case 2. The clinical and pathlogical features of malignant melanoma of the nasal cavity and paranasal sinuses are also discussed regarding differences in the tumor cells

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Wegener's granulomatosis is a rare disease that is defined by the triad symptoms of (1) granulomatous necrotizing processes in the upper and/or lower respiratory tract,(2) generalized vasculitis, primarily of the small arteries and veins, and (3) focal necrotizing glomerulitis. While following the course of this disease, we encountered a 46-year-old male with Wegener's granulomatosis in whom we observed subglottic stenosis. We performed a tracheostomy because of the risk of potential distress. The patient was treated with corticosteroids after a tracheostomy, and is presently in remission.

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Two cases of an inverted tooth are herein reported. Case 1 was a 13-year old boy who complained of right facial swelling. A tooth-like mass was found in the maxilla on X-ray, and was surgically removed. Case 2 was a 36-year old man who complained of nasal discharge and cacosmia. A tooth-like mass was found in the left nasal cavity, and was removed via the nostril. Both masses were found to be supernumerary canine-like teeth. The literature on inverted teeth in Japan was also surveyed and analyzed.

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Küttner's tumor is caused by chronic fibrosing sialadenitis, which consists of a fibrous swelling of the salivary glands, especially the submandibular glands, and usually occurs in middle-aged men. No definite view on the etiology of Küttner's tumor exists and there is also still as yet no clear definition of this condition. We herein report 2 patients diagnosed as having Kuttner's tumor who demonstrated a fibrous enlargement of the salivary glands. In case 1, ⁶⁷Ga tumor scintigraphy showed an accumulation in the parotid gland as well. In case 2, we also found a hard fibrous lesion in the sublingual gland that eventually disappeared after 7 months. Both patients showed a slight reduction in the submandibular gland swelling and the lesion also tended to show increased hardness. Further follow-up studies of this disease are thus called for based on immunological analyses.

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Laboratory and clinical studies were carried out to evaluate the effectiveness and safty of L-627 in the treatment of otorhinolaryngological infections. The following results were obtained:
1. The L-627 concentrations in the paranasal tissue after an intravenous administration of 300 mg were 0.44-1.57μg/g in the mucous membrane of the auris media at from 55-120 minutes, 0.20-2.66μg/g in the mucous membrane of the maxillary sinus at 52-140 minutes, 0.28-1.6μg/g in the tonsillar tissue at 60-120 minutes.
2. The clinical efficacy rates were 69.2% for the otitis media, 91.3% for sinusitis, 83.3% for tonsillitis, 82.6% for peritonsillar abscess, while demonstrating an overall efficacy rate of 81.9%.
3. The MIC90 values of L-627 against isolates from patients with otorhinolaryngological infections were found to be 0.05μg/ml against S. pyogenes, 0.1μg/ml against S. aureus (MSSA), 0.2μg/ml against CNS, S. pneumoniae and Enterobacteriaceae, 0.78μg/ml against Streptococcus sp., Haemophilus sp. and P. aeruginosa 3.13μg/ml against other NE-GNR, 50μg/ml against S. aureus (MRSA), 100μg/ml against Corynebacterium sp.
4. Bacteriological efficacy evaluations demonstrated eradication rates of 87.2% for monomicrobial infections with gram-positive organisms, 93.3% for those with gram-negative organisms, 83.3% for those with anaerobic organisms and 78.3% for polymicrobial infections, while showing an overall eradication rate of 85.7%.
5. Side effects occured in 3 of 133 patients (2.3%), including 2 cases of rash and one case of diarrhea. Abnormal laboratory findings were observed in 5 of the 107 patients (4.7%)that were elegible for the evaluation.

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TO-193 is a topical agent which sticks to fibrinogen, thrombin and aprotinin upon collagen sheet. The clinical efficacy of TO-193 has already been reported in otorhinolaryngological surgery. The clinical efficacy was evaluated in the following two categories: the closure of a perforated tympanic membrane and local hemostasis. Nine ears from 9 outpatients with tympanic perforations were treated with the closure method using TO-193. The complete closure of the perforation or pinhole perforation within 8 weeks were 56%, and some contractions of the perforation within 8 weeks were 44%. No patient showed any contractions of the perforation. TO-193 was used as a hemostatic treatment for another 9 patients undergoing tonsillectomy, nasal and paranasal sinus surgery and surgery of the oral cavity, when some bleeding was observed after conventional hemostatic treatment (such as ligature, suture or electrical coagulation). The successful rate of effectiveness was 89%. With respect to safety, none of the 18 patients showed any evident side effects. Therefore, TO-193 is considered to be useful for the closure of a perforated tympanic membrane and hemostatic treatment.

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Otorhinolaryngological clinical infections were conducted on Tazobactam/Piperacillin (TAZ/PIPC), in which Tazobactam (TAZ), a novel β-lactamase inhibitor was combined, on patients with otitis media sinusitis, tonsillitis, peritonsillitis and peritonsillar abscess. Among the 159 cases administered TAZ/PIPC, 139 cases were found to be evaluable for its clinical efficacy and included 36 cases with otitis media, 32 cases with sinusitis, 33 cases with tonsillitis and 38 cases with peritonsillitis-peritonsillar abscess, respectively. The clinical efficacies against each disease were as follows: otitis media 75%, sinusitis 91%, tonsillitis 91% and peritonsillitis-peritonsillar abscess 92%, respectively. In the case of monomicrobial infection, the bacteriological responses against gram-positive bacteria, gram negative bacteria and anaerobic bacteria were 95%, 87% and 100%, respectively, while in the case of polymicrobial infection it was 94%, with an overall response of 94.3%. The overall bacteriological response against each strain was 96.0% while it was 91.2% against g-lactamase producing strains. Adverse events were observed in 7 out of 156 cases (4.5%). Abnormal laboratory findings were observed in 13 out of 137 cases (9.5%). Based on the above findings, Tazobactam/Piperacillin (TAZ/PIPC) is thus considered to be highly useful in the treatment of otorhinolaryngological infections.

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