Inverted papilloma, although benign, recurs frequently and may become malignant, making definitive initial resection extremely important. We evaluated surgical procedures for recurrence and sites, with special reference to management of the orbital plate of the ethmoid and lacrimal bones, in 24 patients (32 cases) with inverted papilloma of the nasal cavity and paranasal sinuses undergoing surgical resection from 2000. Nine of the 32 showed recurrence, all around the ethmoid orbital plate. Up to 2002, recurrence was noted in 7 of 17 cases (41%), so we changed surgical selection criteria. Since 2003, we have conducted partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) in cases in which tumors adhered to the orbital plate, noting recurrences in only 2 of 15 cases (13%). A number of reports advocate endoscopic sinus surgery to minimize invasiveness for inverted papilloma, but partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases to reduce recurrent.

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Background: Birch pollen allergic patients often report oral and pharyngeal hypersensitivity to fruits and vegetables such as apples and peaches because of cross-reactivity. This phenomenon, called "oral allergy syndrome" (OAS), is sometimes accompanied by a systemic reaction and is considered to be an IgE-mediated allergy. We evaluated reciprocal relationships between food causing OAS using patient's reports and classified food in patients with birch pollen allergy. Methods: We interviewed 272 patients who had episodes of OAS and had IgE to birch pollen. Their mean age of the 198 women and 74 men was 34 years (15 to 65). We evaluated the reciprocal relationships between 14 foods frequently causing OAS—apples, peaches, cherries, kiwi, pears, melons, plums, strawberries, persimmons, tomatoes, grapes, watermelons, mangos, and bananas—classifying them by cluster analysis and kappa statistics. Results: The 14 foods were classified into rose-family and non-rose family. Rose-family fruits—apples, peaches, cherries, pears, plums, and strawberries—made a large cluster and were associated reciprocally. Melon and watermelon were associated. Melon and kiwi were not associated with rose-family fruits. Non-rose family foods—kiwi, melons, persimmons, tomatoes, grapes, watermelons, mangos, and bananas—made a large cluster and were partly associated. Conclusions: Foodstuffs causing OAS were classified into two groups based on patient's reports. Some clusters of foodstuffs were related.

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Methotrexate (MTX) has been increasingly administered to patients with rheumatoid arthritis (RA), resulting in methotrexate-associated lymphoproliferative disorder (MTX-LPD) in patients. We reported three case of rheumatoid arthritis (RA) undergoing methotrexate (MTX) therapy who developed MTX-LPD.
A 72-year-old woman treated with MTX since December 1997 (total dose 3684mg) presented with swelling of the right tonsil in October 2006, and diffuse large B-cell lymphoma was diagnosed by tonsil biopsy and positive EBER1. When MTX therapy was interrupted, the tonsil was shrank and chemotherapy was not necessary. She followed a good clinical course for 12 months. Two other patients treated with MTX for RA for several years presented with enlarged neck lymph nodes and were diagnosed with MTX-LPD. Neck lymph nodes shrank upon MTX withdrawal in several weeks . There have been no signs of recurrence in these cases and they followed a good clinical course. The oncogenic potential of MTX and RA is reviewed.

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