A 70-year-old man, who had a sudden onset of a severe allergic reaction after consuming strawberries, is herein reported. The mucosa of the oral floor showed severe erosion, and a marked edema was found in his submental and bilateral submandibular triangles. He also had a past history of angioedema presumably due to the presence of angiotensin converting enzyme (ACE) inhibitor. These results suggest that immunological process may be involved in the pathogenesis of ACE inhibitor-induced angioedema.

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We report a case of intestinal Behcet's disease in a male whose chief complaints were sore throat and fever. A 25-year-old man presented with multiple stomatitis, genital ulcers and erythema of the extremities. Based on these symptoms, he was thus suspected to have Behcet's disease on the first visit. He began to complain of pain of in the ileocecal region one day after admission, which gradually increased and analgesics had no effect. An X-ray examination of the chest revealed a perforation of the digestive organ, as a result, an emergency operation was performed at the same day. We recognized a perforation at the ileocecal region and numerous ulcers around it. We diagnosed the patient to have intestinal-Behcet's disease and treated him with steroids after the operation. The various symptoms consequently disappeared soon thereafter, and he has not shown any clinical signs of recurrence for one year postoperatively.

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We experienced a relatively rare case of a cervical neurinoma that extended to the left submandibular region. The patient was a 73-year-old woman who complained of a tumor in her left submandibular region with no neural symptoms. The CT and MRI findings showed a tumor that was extended from the cervical spine to the left anterior cervical region. We performed a successful total resection of the tumor. She has had no post-operative neural symptoms and the MRI findings three months post-operatively revealed no tumor reccurrence.

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We report a case of cervical lymphadenopathy caused by toxoplasmosis. The patient was a 26-year-old female and visited our clinic because of multiple right neck lymphadenopathy. A CT scan showed multiple right posterior cervical lymphadenopathy. The results of fine needle aspiration cytology showed class II disease. Histologically, the excised lymph node was characterized by follicular hyperplasia with clusters of epithelioid histocytes. The serological titer against toxoplasma was high. Based on these results, we diagnosed this lymphadenopathy to be toxoplasmosis. After treating the patient with acetylspiramycin for 4 weeks, the lymphadenopathy disappeared. Toxoplasmosis is a disease caused by an infection with the obligate intracellular parasite Toxoplasma gondii. An acute infection acquired after birth is asymptomatic but frequently results in the chronic persistence of cysts within the tissues of the host. Toxoplasmosis has many clinical subtypes: lymphadenopathy, encephalitis, chorioretinitis, dissemeinated toxoplasmosis and congenital toxoplasmosis, etc. Toxoplasmic lymphadenitis generally involves the lymph node in the head and neck regions without any systemic symptoms. There are various diseases which present with an enlargement of the cervical lymph nodes including benign or malignant tumors, infectious diseases and sarcoidosis. Therefore, a careful and definite differential diagnosis must always be done in such cases.

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The patient was a 36-year-old female hospitalized with massive hematemesis and intense pain of the larynx and chest. Translucent white-cord-like substances were vomited up during the initial examination. The pathological findings showed the substances to be a superficial layer of the esophageal mucosa, consisting of squamous epithelium. The cast was clean, uniformly grayish-white, parchment-like and quite free from any offensive odors. The patient recovered rapidly and completely. A superficial esophageal cast itself is rare but almost all cases tend to be accompanied with pemphigus vulgaris. The simple superficial esophageal cast accompanied with massive bleeding in this case is thus considered to be a very rare finding.

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We report a rare case of a cyst which occurred at the base of the tongue in an adult. A 29-year-old female was seen as an out-patient with the chief complaint of an abnormal sensation in the pharynx and larynx. Laryngoscopy showed a tumor at the base of the tongue which was pushing the epiglottis backward. Both CT and MRI evaluations revealed a cystic lesion located in the middle of the base of the tongue. The cyst was totally removed by an external incision, and we did not recognize any cord connected to the cyst during the operation. The histopathological examination disclosed the wall of the cyst not to be covered with any epithelium at all. No clinical signs of recurrence of the cyst have been noticed for about one year after the operation. Most cysts occurring at the based of the tongue tend to be classified as diseases originating from the thyroid gland. We also compared any differences between similar infant and adult cases and the histological findings from a median cervical cyst.

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We evaluated the efficacy of pre-seasonal Nd: YAG laser therapy for the treatment of birch pollinosis. Fifty-nine birch pollinosis patients underwent Nd: YAG laser therapy for a 10-month period before the start of the birch pollen season in 1998. The nasal symptoms in the patients curing the 1998 birch pollen season (post-laser nasal symptoms) were then compared with the nasal symptoms observed during the 1997 birch pollen season (pre-laser nasal symptoms). The birch pollen count was higher in 1998 than in 1997. The post-laser symptoms were milder than the pre-laser symptoms. These results suggest that the Nd: YAG laser therapy therefore effectively reduced the severity of nasal symptoms in patients suffering from birch pollinosis.

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In our previous study we reported that the patients with Japanese-cedar pollinosis suffered from a substantial interference in their QOL. In this study, we compared the QOL scores in Japanese-cedar pollinosis patients both in-season and out-of-season using the SF-36 questionnaire. All 242 patients who visited four clinics in Osaka from March 9 to 14, 1998, were enrolled in the in-season study. For the out-of-season study, the same questionnaire was mailed to all enrolled patients in the last half of July 1998. The response rate by mail was 71.5% (173/242). Lower scores in terms of all sub-scales were observed in the female subjects in both seasons. The QOL score was also lower in the subjects with combined conditions compared with those without combined conditions in both seasons. The QOL scores decreased according to age in-season. Out-of-season, however, the subjects under 29 years of age showed the lowest scores regarding BP, VT, RE and MH. The reason for this was unclear, but the finding was nevertheless an interesting one. In general, the out-of-season QOL scores were higher than the in-season scores, especially regarding mental components. From these results, the patients with Japanese-cedar pollinosis were thus found to show a low QOL in-season while most tended to show a significant recovery out-of-season.

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To examine the treatment for pollen disease in response to the general pollen count, we administered suplatast tosilate only to patients with Japanese cedar pollenosis both before and after the start of the pollen season in 1998, in which the pollen count was expected to be small. In 1999, in the the pollen count was expected to be large, suplatast tosilate was administered throughout the pollen season and steroid nasal drops were also concomitantly used after the start of the pollen season. The inhibitory rate of the symptoms in total was 63% in 1998 and 75% when steroid nasal drops were administered in combination with suplatast tosilate after the start of the pollen season in 1999. It was thus considered to be necessary to develop a treatment method to counter the start of the pollen season. When the effect of this treatment regimen on the clinical symptoms was examined, the inhibitory effect on nasal obstruction was found to be the highest. Five patients were treated with suplatast tosilate over two consecutive seasons. Three patients who responded well to suplatast tosilate in the first season also responded well in the second season in spite of the increase in the pollen count. This finding seems to suggest that some patients may thus demonstrate a high sensitivity to suplatast tosilate.

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