To better understand the effect of the neck reflex on optokinetic nystagmus, experiments were carried out using rabbits. Rabbits were suspended in air with none of their limbs touching the ground, while being surrounded by a full-field optokinetic drum. The drum was rotated counterclokwise at 60/s. The horizontal eye movement was recorded by electronystagmograph with the animals in three posturs consisting of: 1) the initial posturs, head ad trunk aligned along the same body axis, 2) trunk rotated clockwise by 60 with the head stationary, and 3) the trunk rotated counterclockwise by 60 with the head stationary. The speed of the slow phase of nystagmus was significantly faster in the second posture than in the initial posture, but it was significantly slower in the third posture than in the initial posture. The recordigs were repeated after the upper cervical nerve roots were sectioned unilaterally. No effects of trunk rotation on the speed of the slow phase were seen when the side of a cervical nerve section was extended. These results indicate that smooth following eye movements are influence by the neck reflex. This reflex becomes accelerated as the head turns in the same direction as the visual field, whereas it is inhibited when the headturns in the opposite direction. The proprioceptors of the extended neck appear to account for the effects observed in the examined experimental animals.

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To assess the effectiveness of myringoplasty in children, a retrospective study was done on 35 traditionally performed myringoplasties and 38 simple myringoplasties using the Yuasa method. The success rate was 86% in the traditional group and 63% in the simple myringoplasty group. After performing the second myringoplasty on 14 ears, the overall closure rate was 94% and 92%, respectively. A relationship was observed between the surgical technique and the successful outcome in the simple myringoplasty group. We concluded that placing the graft using either the overlay method or plug myringoplasty after a circular resection of the edge of the performation followed by exfoliation of the squamous epithelium was an effective procedure for performing simple myringoplasty.

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Nodular fasciitis is a rare benign lesion which rarely occur in the head and neck. We herein report a case of nodular fasciitis in a 24-year-old male who initially noticed a nodule in the submental region. The mass was surgically removed and diagnosed to be nodular fasciitis. At 10 months postoperatively, there has been no sign of recurrence.

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We reviewed 48 patients with squamous cell carcinoma of the mesopharynx, especially 38 patients with lateral wall type who were initially treated in our department between 1982 and 1999. The overall survival rate of such lateral wall type mesopharyngeal carcinoma was 43%. According to the UICC system (1987), the five-year survival rate was 100% for stage I, 100% for stage II, 69% for stage III, and 29% for stage IV. The survival rate for stage IV cases was significantly lower than the other stage cases. We reviewed low -dose CDDP chemotherapy group (n=7), the surgical therapy group (n=19) and the radiotherapy alone group (n=7). The five-year survival rate was 69% for chemotherapy, 36% for surgical therapy, and 29% for radiotherapy alone. The chemoradiotherapy group had a better survival rate than the radiotherapy alone group. Regarding the local recurrence rate, the lymph node recurrence rate, and the salvage rate, we compared these rates between the surgical treatment group (n=19) and the radiation therapy group (n=19), however, no significant difference was observed between the two groups.

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A 70-year-old woman with a huge primary mucocele in the maxillary sinus is herein presented. She suffered from left exophthalmos and double vision. The CT and MRI findings from the left expansive cystic lesion in the left maxillary sinus accompanied by an extensive bone defect in the medial and inferior orbital walls. Endoscopic sinus surgery was carried out under local anesthesia. The serous secretion within the mucocele was removed, and large openings were made in the middle and inferior meatus. The postoperative course was uneventful. The literature on primary mucocele in the paranasal sinuses was also briefly reviewed.

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We evaluated the clinical efficacy of Pocepullan, a Japanese cedar pollen allergen-pullulan conjugate, compared with Torii extract of Japanese cedar pollen in a multi-center randomized open parallel study. The participants were allergic to the pollen, which was confirmed in an interview where they indicated that symptoms appeared or were exacerbated in the dispersion season of Japanese cedar pollen. They scored more than class II of the RAST (radioallergosorbent test) or tested positive on a skin test. A total of 124 subjects, ranging from 15 to 64 years of age, were assigned to the pocepullan or the Torii extract group. The efficacy was evaluated based on the degree of improvement from 1997 to 1999. The Torii extract group was found to be significantly superior to the pocepullan group in terms of improvement. This result was possibly obtained due to the significantly higher incidence of discontinuations and dropouts in the Torii extract group. When all the subjects, including those who discontinued or dropped out were taken into account, no significant difference was observed between the two groups. Although equivalence was not proved, both groups appeared to show a com- parable efficacy. In terms of safety, in the Torii extract group, an adverse event was noted due to what was assumed to be an anaphylactic reaction, and its causative relationship with the extract could not be denied. The incidence of adverse events was significantly lower in the pocepullan treatment group than in the Torii extract group. The results obtained so far suggest that pocepullan was comparable in efficacy but superior to Torii extract in safety and the speed it reaches a maintenance dose. In the specific immunotherapy of Japanese cedar pollinosis, pocepullan is therefore considered to be potentially beneficial for both patients and doctors.

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We evaluated the efficacy and safety of pocepullan, Japanese cedar pollen allergen-pullulan conjugate, against Japanese cedar pollinosis in a long-term trial. The participants who had been on medication but who were not undergoing immunotherapy were also enrolled as a reference group. Immunotherapy with pocepullan was started after the end of the pollen dispersion season in 1995 and was continued until the beginning of the season in 1999. The symptom-medication score as calculated from the data obtained from the patients' diaries was suppressed significantly more in the pocepullan group than in the reference group during the immunotherapeutic period from 1997 to 1999 (p<0.001). In particular, the decrease in medication score was significant in 2000, one year after the therapy had been completed. A survey was also conducted in the pollen dispersion season of 2000. The questionnaire mainly dealt with the quality of life of the patients, such as their impressions and subjective evaluation of their symptoms during the pollen dispersion season. The survey suggested that pocepullan continued to be efficacious even after the end of immunotherapy. The efficacy rate is the ratio of subjects in whom the effects of pocepullan were rated higher than “efficacious” and was 59/77 (76.7%, 1996), 40/59 (67.7%, 1997), 38/47 (80.9%, 1998), and 22/32 (68.8%, 1999) for each year. The degree of pollen dispersion, which varies each year, also has some influence on the efficacy rates. In 1996, 21 adverse events were reported in 13 subjects (14.8%). In 1997, 1998 and 1999, 1.5%, 1.7% and 8.8% of the subjects showed adverse events, respectively. However, no serious adverse events were reported during the study.

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A multi-center open trial was conducted to evaluate the efficacy and safety of pocepullan against Japanese cedar pollinosis on a larger scale. The participants were confirmed to be allergic to pollen based on an interview in which the participants indicated that symptoms appeared or were exacerbated in the dispersion season of Japanese cedar pollen. The subjects ranged from 15 to 64 years of age and scored more than class II in RAST (radioallergosorbent test) or tested positive on the skin test. A total of 140 subjects participated in the trial with 83 after the season of 1997 and 57 after that of 1998. Pocepullan was graded as effective in 68.4% of the subjects in 1998 and in 71.1% of the subjects in 1999. The results were comparable to those of a pollen extract used previously for immunotherapy trials. On the other hand, a causative relationship with pocepullan could not be denied in 15 of the 137 cases of adverse events (10.9%). One case experienced an adverse effect which was considered to possibly be due to an anaphylactic reaction. As a result, precautions should be taken (e. g. dose reduction) when patients are not in good health. The results obtained so far show that pocepullan, Japanese cedar allergen conjugated with pullulan, is potentially useful as a specific immunotherapeutic agent with a superior safety and a comparable efficacy when compared with the current allergen ex- tract presently in widespread use.

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Gastro-esophageal reflux disease (GERD) is caused by exposure of acid to esophagus, and defined by the presence of esophageal mucosal break and/or symptoms, which lead to impair quality of life. Thus GERD is classified into endoscopy-ositive GERD and endoscopy-negative GERD. Heartburn is major symptom as annoyance of daily life. However, GERD has various symptoms, patients with non -cardiac chest pain, chronic cough, pharyngitis and laryngitis are thought to be associated with occurrence of gastro-esophageal reflux. Recently, GERD is increasing in Japan caused by westernized of dietary habit, increasing of aged population, acid output and H. pylori negative population. Step down therapy; initial PPI treatment is superior strategy for GERD, of its efficacy and cost-effectiveness. Now in Japan, long-term maintenance therapy using PPI is approved, and expected that many patients can be treated with appropriate therapy.

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