To study the effects of superselective intraarterial chemotherapy with low-dose CBDCA, Pirarubicin, and concurrent radiotherapy on head and neck cancer, we compared primary cancer response and histopathological effective grades in 66 patients (more than T2) divided into radical and preoperative radiotherapy groups. The radical group (n=33) showed a 75.7% response in primary cancer, i.e. 54.5% complete remission and 21.2% partial remission. The preoperative group (n=33) showed 39.4% complete remission when the histopathological effective grade was higher, and 57.6% partial remission when the grade was lower. Cancer response was better in the oral cavity, mesopharynx, and hypopharynx than in the parasinus. In the preoperative group, 5-year overall survival was 84.4% when the effective grade was higher, and 29.4% when the grade was lower. Survival differed significantly (P<0.01) between higher and lower grades. Additional postoperative therapy is thus essential in patients with lower grades of histopathological effectiveness.

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We report horizontal canal BPPV (HC-BPPV) targeting its pathophysiology, the affected side, and the function of the horizontal semicircular canal, together with a review of the literature.
Subjects were 13 patients with HC-BPPV visiting our vertigo outpatient clinic at Nara medical university hospital and a related hospital in the 2.5 years from January 2000 to June 2002.
Subjects were classified into 7 with canalolithiasis and 6 patients of cupulolithiasis after a neurotological examination. CP was positive in 54% of all patients, 71% of those with canalolithiasis, and 33% of those with cupulolithiasis.
To determine the affected side in HC-BPPV, we used the affected side by using the law of Ewald in canalolithaisis patients and the detection of a neutral diminishing nystagmus in cupulolithiasis patients. CP positive in caloric testing indicated insignificant dysfunction of the horizontal semicircular canal in canalolithiasis patients compared to that in cupulolithasis patients. The mechanism behind caloric nystagmus was thought to be a convection of endolymphatic fluid interrupted consequently by an otolith in the semicircular canal in canalolithiasis patients.
In contrast, CP was positive in cupulolithiasis patients regarded as having no convection of endolymphatic fluid.
The mechanism causing a difference in caloric test results between canalolithiasis and cupulolithiasis patients thus requires a larger patient population and further examination to be conclusive.

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An important pathway of gene transcriptional inactivation is hypermethylation at the CpG islands of promoter regions. Some tumor suppressor genes have been reported to harbor promoter hypermethylation in head and neck cancer. We studied DNA hypermethylation of 4 genes in 42 cases of primary head and neck cancer. We applied methylation-specific PCR for p16, RAR-β, RASSF1A, and Fhit genes. Hypermethylation was detected at p16 in 43%, at RAR-β in 40%, at RASSF1A in 12%, and at Fhit in none of the cases. Hypermethylation of at least one gene was detected in 26 (62%) of the 42 cases. No significant correlation was seen between methylation status and clinicopathological findings or prognosis.
Hypermethylation of several tumor-associated genes plays an important role in tumorigenesis of head and neck cancer. We discuss clinical implications and their application.

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Bilaterality in acute low-tone sensorineural hearing loss (ALHL) is more generally recognized than that in idiopathic sudden sensorineural hearing loss. Subjects were 274 patients diagnosed with ALHL based on criteria of a study group of the Ministry of Health, Labor and Welfare of Japan, i.e., total of 3 low-tone hearing of 70dB or more and, a total of 3 high-tone hearing of 60dB or less, and treated at the departments of otolaryngology at Yamanashi University and Suwa Central Hospital. ALHL involving bilateral ears symptoms and/or bilateral hearing impairment conforming to diagnostic criteria was selected and summarized. Clinical ear symptoms, clinical test results, and hearing levels (total 3 low tone-hearing, 1kHz, and total of 3 high-tone hearing) were statistically analyzed. We also reviewed Japanese clinical reports of ALHL that include bilateral cases.
In 32 cases (11.7%) of 274 cases, both ear symptoms and hearing impairment were bilateral. In 22 (8.0%) of the 274, bilateral ear symptoms were present, but showed unilateral hearing loss conforming to diagnostic criteria. Another 22 (8.0%) out the 274 reported unilateral ear symptoms, but hearing tests indicated bilateral ALHL. A total of 76 cases (27.7%) of the 274 had bilaterality in either ear symptoms or hearing loss. Our review indicated that 9.0% (162 of 1803) ALHL patients were bilaterally affected, possibly indicating that ALHL includes a larger number of bilateral cases than currently assumed, if the opposite side were given a especially detailed clinical interview.
Statistical analysis (Mann Whitney test, P<0.01) of hearing of unilateral cases indicated that 3 low-tone hearing was more affected than 3 high-tone hearing, even on the normal side. These results indicate that ALHL tends to be bilateral, possibly due to the mechanism of pathogenesis, and also that the mechanism may include both local and general conditions. This more closely resembles Meniere's disease than idiopathic sudden sensorineural hearing loss. Both sides of bilateral cases were not usually the same in hearing patterns, glycerol test results, or prognosis. A statistically significant difference (Mann Whitney test, P<0.01) in total of 3 low-tone hearing was seen between worse and better sides in bilateral cases. The degree of disease on both sides in bilateral cases thus was not always the same. Bilateral cases may result from both the influence of general conditions such as fatigue, stress, and lack of sleep and local conditions such as pathogenesis of endolymphatic hydrops that may cause differences in both ears. No clear difference was seen in clinical symptoms, hearing levels, and clinical examination, e.g., Schellong and glyceol tests, between unilateral and bilateral cases. Bilateral cases had a poorer prognosis (lower complete recovery ratio; x² test P<0.01) than unilateral cases. Our results indicated that cautious evaluation of opposite ear is necessary in diagnosis, treatment, and prognostication of ALHL.

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Drop attacks are sudden falls without concurrent vertigo whose etiology may be unknown. Drop attacks are also associated with cardiac, cerebrovascular, psychogenic, and vestibular disorders, in addition to seizures. Vestibular-based drop attacks without loss of consciousness can occur in patients with Meniere's disease. We present 2 cases of drop attack in patients with Meniere's disease. Case 1, a 65-year-old man, experienced 4 such attacks and case 2, a 55-year-old woman, experienced 20 within 2 years of Meniere's disease onset. Case 1 enjoyed spontaneous remission. In case 2, selective serotonin reuptake inhibitor (SSRI) administration suppressed attack frequency. Anxiety may predispose individuals to drop attack. Etiologically, inadequate stimulation of otolith organs may induce a sudden vestibulo spinal reflex that, in turn, causes sudden falls. To correctly diagnose drop attacks, the patient must exhibit sudden falls, and transient ischemic attack should be carefully ruled out.

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Streptococcal toxic shock-like syndrome (TSLS) is known to progress rapidly into septic shock and have a high mortality of 40%. We report a rare case of neck infectious disease caused by Group A hemolytic streptococcus pyogenes. A 65-year-old man. hospitalized for eyelid swelling and dyspnea suffered shock, dyspnea, and pressure reduction on the day he was hospitalized and died of multiple organ failure 18 days later. Despite treatment with antibiotics, tracheostomy, immunoglobulin, etc. We suspected that he had been infected via a laceration of the external auditory meatus. Accurate diagnosis followed by prompt, radical treatment is essential if TSLS is to be treated successfully.

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