Sixteen patients with recurrent aspiration pneumonia that could not be controlled by appropriate medical therapies. These patient, had no hope of recovering laryngeal function. Eight underwent laryngectomy, six underwent laryngotra-cheal separation and four underwent tracheocsophagcal anastomosis. After surgery, we evaluated the efficacy of the ther-apy and the patients' satistaciion with therapy.Belore and aftter surgery. the following clinical markers were examined to evaluate the efficacy of surgery: scores, of aspiration pneumonia, WBC, count, C reactive protein, erythrocyte sedimenta-tion rate, hemuocrit, body mans index, total protein, albumin, and the Barthel index, an indicator of daily activity. Fur-thermore, the grade of Depression and mood. and satisaction of patients and their carers among family members were scored using the Zung self-rating depression scale, a 20-picture tace scale, the visual analog scale, and feeding status. After surgical therapy.we confirmed that aspiration was prevented in fourteen patients of sixteen, and the state of inflam-mation and nutrition, the state of depression and mood were improved. Thirteen patients from sixteen were able to in-gest. a meal orally. The quality of life of patients with intractable aspiration was improved.

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[Purpose] In this paper, we report the results of studying the degree of reactive small round cell infiltration in the stroma as a prognostic indicator of maxillary sinus carcinoma treated with the kitasato method and the effect of preoperative irradiation at 8 Gy on infiltration in the stroma.
[Subjects] Out of 74 patients who had been treated with this method in the 27 years from 1976 to 2002. the following patients were enrolled in this study:(1) 17 patients from whom tissue specimens could be obtained with biopsies or probe antrotomies before preoperative irradiation. and (2) 10 patients from whom tissue specimens could he obtained after preoperative irradiation including those who survived five years and who died of a specific cause.
[Method] We classified the pattern of distribution of small round cell infiltration in the stroma into three degrees.(1)Stromal infiltration was compared before and after the operation to recognize the prognosis for each patient based on the pattern of distribution of small round cell infiltration in the stroma. (2) The correlation between the degree of stromal infiltration and prognosis was studied statistically.
[Results] (1) Both the patients with increased stromal infiltration and those postoperatively preserving a preoperative score of 2 + with irradiation at 8 Gy had a good prognosis. (2) The five year survival rate for patients was significantly higher in those with a score of 2 + for their tissue specimens.
[Conclusion] The Kitasato treatment method is effective and improves the QOL of patients with maxillary sinus carcinoma.The prognosis was good in the patients with increased or preserved stromal infiltration. The low-dose irradiation and chemotherapy used in combination seemed to be biological response modifiers.

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Falling accidents are a serious nocosomial problem, with balance disorders after the ingestion of hypnoties said to be a cause Based on the results of animal studies, it was postulated that this problem involves the muscle relaxation that is a pharmacological efect of benzodiazepines (BZP). No reports have, to our knowledge, been made of time-course changes in human in body balance after ingestion of hypnoties. Accordingly. we used quazepam (Doral'), a long-acting hypnotic considered to show comparatively weak musele relaxation, to study static balance after drug ingestion in human volunteers Briefly. informed consent was obtained from 8 healthy adults, then a gait analytic system (GangasH) was used to test static balance after drug ingestion Mann and Romberg tests). We also measured circulating drug concen-traion over time. Our results showed that balance disorders occurred after quazepam ingestion with an unstable posture particularly striking. Given the function of quazepam receptors, it is difficult to surmise that balance disorders after drug ingestion were due to the drug's muscle relaxation We surmised that inhibition from the central nervous system in connection with nerves awakening was involved. We found a strong correlation between the manifestation of balance disorders after drug ingestion and circulating drug concentration.

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Tracheostomy, frequently used to ensure airway maintenance, involves complications such as bleeding and pneumothorax. Major vessel damage is also a lethal complication that must be avoided. We report tracheostomy in a case of tortuous bracheocephalic artery. A 74-year-old female with slight dyspnea due to amyotrophic lateral sclerosis (ALS) referred for tracheostomy had a pulsating mass in front of the trachea, found in by magnetic resonance (MR) imaging and MR angiography to be a tortuous bracheocephalic artery. In surgery, the displaced bracheocephalic artery was confirmed between the sternothyroid muscle and lower pole of the thyroid gland. This vessel was carefully dissected, the thyroid gland was divided at the isthmus, and the anterior wall of the trachea was fenestrated in an inverted U shape. The flap created by fenestration protected the vcsscl wall and was sutured to the skin so the vessel would not be exposed to the tracheostoma.A tortuous major artery is not uncommon in the neck, and care should be taken to avoid damaging such a vessel during tracheotomy.

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In recent years. Streptococcus pneumoniae and Haetmophilus influenzae have acquired resistance to some drugs: as such, a therapeutic strategy in which penicillins (PCs) are primarily used is currently recommended for the treatment of pediatric upper respiratory tract infections. In 2000, we changed the primary drug used for such infections in patients visiting our hospital from cephems (CEPs) to PCs We examined the effect of this change on the detection rates of drug-resistant S pneumoniae (DRSP) and ampicillin (ABPC) resistant H. influenzae.
1. The subjects consisted of patients who had visited our hospital and received bacteriological examinations during 1999, 2001 or 2003 At the time of the examination, we questioned each patient regarding the medical institutions where they had received oral antibiotic therapy during the past year, how many antibiotic therapies they had received, and which antibiotics they had received. The number of patients who had only received antibioties, from our hospital was:37 out of 52 (71%) patient, in 1999. 80 out of 110 (73%) patients in 2001, and 50 out of 71 (70%) patients in 2003. The number of therapies in which only PCs, were, used was, significantly higher in 2001 and 2003 than in 1999. The number of therapies in which only CEPs were used was, lower in 2001 and 2003 than in 1999. We believe that this trend reflects our therapeutic strategy. Furthermore, the antibiotic therapies that patient, received at other hospitals were thought to have only a small influence on the detection rates of DRSP and ABPC resistant H._influenzae.
2. The detection rate for DRSP was 30% in 1995 and 60% in 1999 However, the detection rate for DRSP was 37% in 2001 and 39% in 2003 representing a significant decease from the detection rate in 1999. The detection rate for ABPC-resistant H. influenzae was 26%, in 1995 and increased slightly to 36% in 1999 However, the detection rate for ABPC-resistant H. influenzae increased significantly from 36% in 1999 to 59% in 2001 and to 71% in 2003. The reason for this trend is that PCs are considered to be less effective than CEPs against H. influenzae, even though they are more effective than CEPs against S pneumoniae.
3. We received the patients at our hospital Who required hospitahzation for the treatment of bacterial infections. In 1999, DRSP was detected in 2 of the 11 (18%) patients who required hospitalization. but no ABPC resistant H. influenzae strains were detected. ABPC resistant H. influenzae was detted in 3 of the 12 (25%) patient, hospitalized in 2001 and in 4 of the 10 (10%) patients hospitalized in 2003 Thus, the detcetion rate for ABPC, resistant H. infuenzae appears to be increasing.
4. Our findings, suggest that the number of DRSP isolates may increase when treatment policies focused on CEPs are employed, while the number of resistant H. influenzae isolates may increase when treatment policies are locused on PCs.
5. At present, guidelines focusing on the use of PCs for the treatment of pediatric upper respiratory tract infection are recommended, but standardizing the choice of antibiotics may cause the number of resistant bacteria to increase. When such guidelines are employed at medical institutions, attention should be constantly paid to trends in drug susceptibility. If an increase in one type of resistant bacteria is observed, flexible measures should be taken, without strict adherence to the guideline.

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