Fifty three patients with advanced head and neck cancer (T4) who visited Kumamoto University Hospital during the periods through 1981 to 1985 were analysed. Distribution of the affected site was as follows, 13 cases of the tongue and oral floor, 10 of the hypopharynx, 8 of the larynx and the thyroid gland, 7 of the mesopharynx, 4 of the nasal cavity and paranasal sinus. 2 of the salivary gland and 1 of the epipharynx. Ten out of 53 cases are alive without recurrence. These 10 cases were consisted of the tongue and oral floor, the larynx and tyroid gland. The prognosis was correlated with the N number. The cases which could not be initiated by operation were all died. In the present report, we emphasized that the operation should be employed as possible in advanced cases of head and neck cancer.

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Immunotherapy utilizing the adoptive transfer of autologous tumor and lymphokine activated killer (ATLAK) or lymphokine activated killer (LAK) cells in conjunction with recombinant interleukin-2 (rIL-2) was applied to 7 patients in head and neck cancer. A large amount of peripheral blood lymphocytes were obtained by leukapheresis using a Haemonetics V50 pheresis system. ATLAK or LAK cells were administrated systemically (intra venous) or locally in conjunction with rIL-2. Fever, nausea or vomiting and weight gain were the side effects of adoptive immunotherapy. Eosionophilia was also observed 6 out of 7 patients, although all side effects resolved without any treatment.
The therapeutic potential of infusion of in vitro stimulated autologous immune cells requires further investigation.

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At the out-patient clinic during the years of 1985 and 1986, 179 sets of X-ray films by Waters' view were obtained by pediatric patients with the clinical diagnosis of chronic sinunitis. These films were analyzed as to the angle of positioning by the image, the degree of lesions (slight, moderate mucosal thickenings and diffuse opacity) and the indistinct finding of the bony walls of the maxillary sinus.
When films were prepared with the routine positioning angle of 45 degrees to the OM plane, the angle as evaluated by the images upon the films tends to be excessive in most of the cases especially in small children. By small childen at the age of 3-4, the positioning angle should be modified and reduced to 20-25 degrees, and the angle is adjusted up to the age of 10 when the routine 45 degrees will be restored. Excessive angle will give rise to the seemingly increased opacity of the maxillary sinus. X-ray findings in children's sinusitis are symmetrical in 70% of cases. The bony walls the sinus will be increasingly indistinct as the degree of the lesions advances, 16.2% in the slight, 47.8% in the moderate and 72.0% in the severe degrees, respectively.
In the radiological diagnosis of sinusitis in children, when the possibilities of malignancies and complications were clinically excluded, a single Waters' view will be sufficient up to the age of 4-6, and Caldwell's view will be added from the age of 7-9. Ultrasonography in A-mode will aid in
reducing exposure to X-ray and in follow-up studies.

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Two patients (a 15-year-old boy and a 12-year old girl under observation more than 10 years, respectively) with monostotic fibrous dysplasia in temporal bone were reported.
1. Both patients similary suffered from unilateral conductive deafness due to remarkable narrowing by the lesion.
2. Both patients underwent a modified radical mastoidectomy, and gained better hearing.
3. Ultrastructural findings of these lesions were approximately identical in their surgical specimens which had been taken twice in each patient.
a) Hyperplastic lesion consists of premature production of bone trabeculae and fibrous tissue where myoblast-like cells scatter.
b) Monocyte-like cells closely situated along the premature trabeculae suggesting bone absorption in the trabeculae.

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Seventeen cases of carcinoma of the hypopharynx and the cervical esophagus who had been treated from 1979 to 1982 at Kitasato University Hospital were investigated retrospectively. Fourteen of them were advanced cases.
Nine patients were alive for more than five years. Seven were alive with no evidence of the disease, one was alive with reccurrent disease in the cervical lymph nodes and could not be followed up after five years.
Six patients died of original disease, in addition to them, one died suddenly of unknown cause after eleven months and one died of gastric cancer after 39 months. No evidence or original disease was seen in the latter two.
Five-year survival rate was 53% (9/17) in total cases and 69% (9/13) excluding two cases died of other causes and two who refused the surgical therapy.

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An enquete survey on 106 sudden deafness patients was undertaken with the object of comparing the criteria for prognosis with the patient's own subjective sense of improvement. The results of the inquiry disclosed that subjective improvement in hearing was generally worse than criteria for prognosis, and that comprehensive subjective improvement was even worse. General agreement was noted between criteria for prognosis and the subjective improvement in the "cured" and "unchanged" groups, whereas the agreement was minimal in the "markedly improved" group. This may imply that the "markedly improved" group comprises the most contradictory cases. There was a statistically significant correlation between the subjective improvement and stabilized hearing level, but no significant correlation was noted between subjective improvement and the range of hearing level improvement. This may indicate that the patient tends to judge his prognosis by the degree to which his hearing has improved rather than the degree by which his hearing has improved. These results appear to support some of the arguments against the current criteria for prognosis which were first determined by the Committee on Sudden Deafness of the Ministry of Health and Welfare and are now widely used in Japan.

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The follow-up study and a functional evaluation of T-E shunt operation were reported. The subjects included in this study were 25 patients who underwent T-E shunt operation in the authors department from 1980 to 1987. The surgical procedure mainly used was a modified version of the Amatsu method as reported previously.
Methods of the functional evaluation consisted of voice analysis using a Phonatory Function Analyzer (Nagashima PS-77), a preoperative pulmonary function test and proximal esophagography by means of video disk dynamic imaging.
Postoperative evaluation revealed that T-E shunt was successful in 19 cases (76%), while unsuccessful in 6 cases. The latter group consisted of 3 cases with surgical closure due to severe aspiration and 3 cases with spontaneous closure due to infrequent use of the shunt. Voice analysis of 15 cases disclosed satisfactory phonatory function except 1 case. In these 14 cases sound pressure level exceeded 75dB and maximum phonation time was longer than 5 seconds. It was found that those case with poor pulmonary function in vital capacity and FEV1.0 showed poor voice function. An X-ray study revealed a varying degree of leakage through the T-E shunt. In most cases, the leakage occurred immediately after Ba bolus passed the level of the shunt portion, when the residual Ba in the esophagus leaked through the shunt. A case with narrow pharyngeal space failed to produce good voice. It was concluded that a T-E shunt operation shuld be avoided if: (1) a postoperative narrowing of pharyngeal space is expected, (2) pulmonary function is poor and (3) the patient is reluctant to use the T-E shunt.

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Preoperative CT images of 96 cases (104 sides) of postoperative cysts of the maxilla, seen between 1982 to 1987, were analyzed as to their modes of distribution in the maxilla.
Three scanned planes, i. e., middle inferior meatus level, superior inferior meatus level, and middle meatus level (each level in 0.5cm distance) were included in the study.
The distribution were classified into four groups by the combination of the bony destruction seen in both medial and posterior sinus walls. In the middle inferior meatus level, the group only with medial wall destruction, accounts for about 40%.
As a general tendency, cysts localize in the central portion of sinus. Polycystic cysts, however, tend to occupy the whole sinus. The expansion of anterior sinus walls decreases as the upper level approachs, and polycystic cysts show more expansion rate than single cysts.

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Mucociliary clearance of the respiratory tracts is one of the major defense mechanisms against infection in the airways. The ciliostasis may cause the dysfunction of the mucociliary clearance. The purpose of this study was to evaluate the effect of S-carboxymethylcysteine (SCMC) on nasal ciliary activity using the photoelectric method. Nasal ciliated epithelium of chickens which were infected to Newcastle disease virus were used. Each specimen was placed in a Dvorac-Stotler culture chamber containing Hank's balanced salt solution. SCMC and its metabolites, Smethylcystein sulfoxide and SCMC sulfoxied were perfused through the chamber with the concentrations of 10, 40, 80, and 160 micrograms/ml. The ciliary activity was observed with a phase-contrast
microscope connected to a photometer. The results are followings.
1) Nasal ciliary beat frequencies (CBF) of infected chickens were significantly less than those of controls.
2) The CBF of chickens 7 days after inoculation increased significantly after administration of 40, 80 and 160 micrograms/ml of SCMC.
3) The CBF of the chickens 4 days after inoculation were poorly responsible to the drugs.
4) S-methylcystein sulfoxed seemed to be more effective than SCMC sulfoxed on the activation of cilary beat.

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Congestion and decongestion of the nasal mucosa are induced by many factors, including the spontaneous nasal cycle, changes in the breathing pattern, posture, temperature, humidity, and exercise. Among these, exercise is considered to have an intensive effect on nasal patency. The effect of exercise on nasal patency was assessed in 70 children (aged six to 15 years) and 92 adults (aged 16 to 38 years). Five children were normal. 15 had allergic rhinitis, and had asthma. There were 26 normal adults, and 66 adults had allergic rhinitis. All patients performed a six-minute treadmill exercise test. Nasal resistances were measured at a pressure of 1.0cm water by anterior rhinomanometry before and immediately after exercise, as well as 5, 10, 15, 20, 25 and
30 minutes after exercise. The FEV₁ was also determined in children. Exercise-induced decreases in nasal resistance were observed in all subjects immediately after exercise; the decrease was marked in patients with allergic rhinitis. Nasal resistance values immediately after exercise were comparable in normal subjects and in those with allergic rhinitis. In patients with allergic rhinitis and asymmetrical skeletal abnormalities of the nose, exercise reduced the difference between the right and left nasal resistance values observed initially; however, a difference remained. In general, nasal resistance began to recover about five minutes after exercise. However, post-exercise nasal resistance values tended to be higher than pre-exercise levels, espe-
cially in patients with allergic rhinitis. Extreme increases in nasal resistance, ie, "exercise induced nasal obstruction, " were observed in 15 of 66 (23%) adults and 6 of 15 (40%) children with allergic rhinitis and in 18 of 50 (36%) children with asthma. In children with asthma, there was no significant correlation between the occurrence of "exercise-induced nasal obstruction" and "exercise-induced asthma". None of the normal subjects experienced "exercise-induced nasal obstruction."
"Exercise-induced nasal obstruction" is indicative in clarifying the congestion process of allergic nasal mucosa reacting to non-specific stimuli.

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The vestibulo-ocular reflex (VOR) and optokinetic response (OKR) act conjointly in stabilizing retinal images under natural conditions. Recent observations have established that the VOR is plastic and adaptive in nature. It has been reported that the visual and vestibular inputs are integrated in the vestibular nucleus, since some of the vestibular nucleus neurons respond to both vestibular and optokinetic stimulation. This suggests that the elements responsible for the VOR gain changes are located in a part of the vestibulo-ocular pathway that is shared with the OKR system. The principal aim of the present study was to investigate the effect of adaptive VOR gain changes on the OKR system in human subjects.
The horizontal OKR induced by a full-field optokinetic drum rotating at constant angular velocities of 30, 60, 90 and 120 deg/sec as well as the VOR gain in the dark using horizontal pendular oscillations of frequency 0.25-Hz and angular amplitude 30 degrees observed. The subject then wore horizontal vision reversal prisms or magnifying spectacles (×2) and was subjected to sinusoidal oscillations for one hour. After removing the optical devices, the VOR and OKR gain were measured again in a similar fashion.
The VOR gain in the dark was reduced significantly from 0.58±0.14 to 0.37±0.08 after reversal vision. The OKR gains at 30, 60, 90 and 120 deg/sec before reversal vision were 0.94±0.97, 0.92± 0.07, 0.83±0.12 and 0.67±0.13, respectively. After 1 hour of reversal vision, the OKR gains at the same stimulus velocities were 0.83±0.11, 0.77±0.09, 0.68±0.11 and 0.54±0.14, respectively. There
was a statistically signficant difference in the OKR gains before and after 1 hour of reversal vision. This result indicates that the variable gain element affected by wearing vision reversal prisms is common to both the VOR and OKR systems.
The VOR gain increased from 0.47±0.09 to 0.62±0.08 after 1 hour wearing magnifying spectacles. However, no significant differences were noted between the OKR gains before and after wearing spectacles. Under the present experimental conditions, the increased VOR gain induced by magnifying spectacles manifested no effect upon the OKR gain control. The reason for this disparity is, however, not clear, although reports by previous investigators suggest that decreases in adaptive VOR gain produce a greater effect on OKR gain than increases, and that the effect of VOR gain changes upon OKR gain control tend to appear at high rather than low optokinetic stimulus velocities.

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The clinical significance of different chemical mediators in nasal allergy was investigated. For this purpose, nasal provocations were carried out in patients suffering from nasal allergy involving house dust, using serial increasing doses of antigen and chemical mediators such as histamine, LTD₄, PAFand PGD₂. The nasal responses induced were evaluated by counting the number of sneezings and by quantifying the nasal secretion and nasal airway resistance. The threshold concentrations of the chemical mediators for positive response were found to be 4.7± 9.9μg/disc for antigen, 10^3.2±^0.9μg/ml for histamine, 2×10^-1.4±^0.7μg/ml for LTD4 and 10^1.4±^0.4μg/ml for PAF. The provocation employing 100μg/ml of PGD₂ showed no responses.
Both antigen and histamine produced sneezings and increased nasal secretion as well as nasal airway resistance. Both LTD4 and PAF induced increases of nasal secretion and nasal airway resistance but no sneezing. The increases in nasal secretion were not significantly different between antigen and histamine provocations. Histamine produced nasal secretion more than LTD₄ (P<0.01), and LTD₄ did more than PAF (P<0.01). The increasing rates of nasal airway resistance were not significantly different among histamine, LTD₄ and PAF provocation.
The doses of PAF and PGD₂ used in the present study seemed to be too large for them to be released in vivo by antigen provocation. Therefore, histamine and LTD₄ are considered to play the most important roles in producing the symptomes of nasal allergy.

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