Human papilloma virus (HPV) genome, a circular double-stranded DNA moleculs with approximately 8, 000 base-pairs, is suspected to be one of the etiological factors in laryngeal benign and malignant tumors. In the present review article, a close relationship between HPV infection/expression and laryngeal tumors is addressed.
HPV-6/11 infection is well known to cause juvenile-onset laryngeal papilloma. We have detected HPV-11 DNA/mRNA signals and/or papilloma virus genus-specific common antigen in all samples of adult-onset multiple laryngeal papilloma (AMLP), providing direct evidence of the association of HPV-11 infection and AMLP. Recently, several molecular biological studies using polymerase chain reaction have detected HPV-16 DNA in laryngeal squamous cell carcinomas (20%-54%). We found one laryngeal carcinoma in which the HPV-16 transforming genes, E6 and E7, were expressed. The HPV-16 long control region was active in cultured laryngeal epithelial cells (HLEC cells) from vocal cords, indicating that HLEC cells are target cells for HPV-16 gene expression. Moreover, HLEC cells could become immortalized by transfection with HPV-16 DNA (HLEC-16 cells).
A modified in vivo implantation system showed that HLEC-16 cells form epithelium which resembles precancerous lesions, such as severe dysplasia. These results suggest that, although the exact mechanism remains to be elucidated, HPV-16 infection may play an important role in laryngeal multistep carcinogenesis.

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Twenty three patients (26 ears) with congenital ossicular malformations were treated in our department from 1982 through 1993.
Malformations of the stapes were the most common, especially fixation of the stapes footplate. Two or more malformations were noted in 10 ears.
Of the 15 ears with ossicular chain fixation 11 (73.3%) showed a so-called stiffness curve in the standard audiometric examination. On the other hand, only 4 of the 8 ears (50.0%) with ossicular discontinuity showed a flat hearing curve.
Postoperative hearing was improved up to 30dB (JIS standard) or less in 16 ears (61.5%). There was no significant difference in the postoperative hearing between those with ossicular fixation and those with ossicular discontinuity.

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Two cases of facial paralysis of central nervous system origin are reported. One patient had the supranuclear type and the other the nuclear type of facial paralysis. The supranuclear type of left facial paralysis was due to a metastatic brain tumor (3×2cm) in the precentral gyrus of the right frontal lobe of a 67-year-old male. The original tumor was anaplastic squamous cell carcinoma of the lung. Although the lower portion of the left side of his face showed slight paralysis, the upper portion showed normal movement because of the double innervation of the upper portion of the face from both crossed and uncrossed corticobulbar fibers. The nuclear type of facial paralysis was due to a large epidermoid cyst located in the fourth ventricle of a 52-year-old female. The tumor was assumed to have depressed the right facial colliculus in the floor of the fourth ventricle resulting in the nuclear type of moderate right facial paralysis with normal stapedial reflex and normal gustatory function.

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There have been many reports of inverted tooth in the nasal cavity. However, most of them were supernumerary tooth with abnormal configurations. Our patient was a 65-year-old woman who complained of nasal discharge. A white mass was found in the left nasal cavity. This tooth-like mass was removed surgically through a labiogingival incision under general anesthesia. The inverted tooth had almost the configuration of a normal premolar tooth. Thus, it was not a supernumerary but an inverted normal tooth.

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In a 59-year-old female with Sjögren's syndrome, xerostomia and xerophthalmia had started in 1982, and lymphadenopathy of the cervical nodes and sore throat appeared in 1991. Biopsies were taken from the swelling in the nasopharynx and the cervical node. The pathological diagnosis was “pseudolymphoma”. We started chemotherapy with a steroid. The lesions shrank remarkably during one week, but five months later, the swellings enlarged and did not respond to steroid therapy. Biopsy of the nasopharynx was performed again. The pathological diagnosis was “malignant lymphoma”. We started chemotherapy with “CHOP”. The lymphoma disappeared and has not recurred.

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The clinical courses of 30 patients with malignant salivary gland tumors were studied. Histological examination showed 18 high grade and 12 low grade malignant tumors.
Twenty patients (8 with high-grade and 12 with low-grade malignant tumors), had a good outcome after surgical treatment only. None had metastasis, and only one had any infiltration of the surrounding tissues. The other 10 patients died of local tumor recurrence or distant metastasis despite aggressive surgery, including sacrifice of the facial nerve or removal of adjacent skin plus postoperative radiotherapy or chemotherapy. The patients with a poor outcome had high grade malignant tumors with infiltration of surrounding tissues or cervical lymph node metastasis. These results show that pathological characteristics and clinical stage are the very important factors in the clinical outcome after surgery for malignant tumors of the parotid gland.

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We treated three patients with chronic sialoadenitis of the submandibular gland (the so-called Küttner tumor). Immunological abnormalities were detected in all three, but they were different from those of Sjögren's syndrome. It is conceivable that Küttner tumor is caused by an immunological abnormality and not by sialoliths. In one of the three patients, the Küttner tumor developed into Mikulicz disease, suggesting that these two diseases have the same pathogenesis. In one of the three, pulse therapy with a steroid was effective in reducing the symptoms and the swelling of the submandibular gland.

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Only a few cases of dermoid cyst in the floor of the mouth have been reported. We treated a patient with a dermoid cyst as large as a fist who had had no treatment for a long time.
A 25-year-old man who complained of trouble swallowing. CT and MRI revealed a large cyst in the floor of the mouth. The cyst was removed surgically under general anesthesia. It was 9cm×6cm in size and included sebaceous glands and keratinous material demonstrated by histopathological examination.
We report this case and review the literature.

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To elucidate the mechanism of tongue swallowing which is closely related to snoring and obstructive sleep apnoea, the distance between the root of the tongue and the posteior wall of the hypopharynx was measured in paired radiograms in the lateral projection obtained under two conditions in each of the following four situations:
(1) upright and supine positions with mouth closed (35 patients); (2) with closed and opened mouth in the supine position (78 patients); (3) the jaw occluded and not occluded in the supine position with the mouth shut (57 patients); and (4) the same situation as (3) but nasal breathing required (43 patients).
The incidence of a narrowed hypopharynx (i. e., tongue swallowing) in each latter condition was 57.1% with situation (1) and 45.6% with situation (3) while it was significantly higher (p<0.001) with situation (2)(89.7%) and situation (4)(85.7%).
When the relationship between varying conditions and measurements was examined by the paired-T test, situation (1) with t=0.37 and situation (3) with t=0.34 showed a negative statistical significance, whereas situation (2) with t=9.46 and situation (4) with t=9.35 were positive (p<0.01).
The results indicate that opening the mouth is factor contributing most to tongue swallowing and that sustained nasal breathing during sleep is very important in the treatment and prevention of snoring and obstructive sleep apnoea.

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We reviewed the clinical records of eighty patients with recurrent laryngeal nerve paralysis who were examined at our outpatient clinic during the past 6 years and 3 months (1986. 1-1992. 3). Eight cases of recurrent laryngeal nerve paralysis caused by endotracheal intubation for general anesthesia were clinically investigated.
The presumed caused of this paralysis were as follows: 1, Aging. 2, Poor general status (anemia, hypoalbuminemia, bleeding and transfusion during surgery). 3, Inadequate head and neck position. 4, Local circulatory disorder due to an overinflated cuff pressure, inadequate intratracheal tube size and position. 5, The influence of abdominal surgery.
A very high rate of recovery (87.5%) was observed in patients with laryngeal nerve paralysis.

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Recurrent Laryngeal nerve paralysis was studied in 156 patients seen in our clinic from 1987 to 1992. There were 92 males and 64 females. The age distribution showed a peak at 60 years in men and at 40 years in women. The paralyzed left vocal cord was in 83 patients, the right in 42, and both cords in 29. The paralysis was paramedian in 53, median in 52 and intermediate in 20. The cause of the palsy was surgery in 76 patients (thyroidectomy in 41, intrathoracic surgery in 24, and intubation in 11), brain damege in 6, intrathoracic disease in 21, neck disease in 11, and idiopathic in 43.
The incidence of recurrent laryngeal nerve paralysis in Japan was determined from a survey of 5832 cases reported by several different clinics. Recurrent laryngeal nerve paralysis ranged from 0.36% to 1.04%, mean value in 0.63% of all new outpatients. Post operative recurrent laryngeal nerve paralysis accounted for 41.1%: thyroidectomy 14.7±5.7%, intrathoracic operation 10.3±3.2%, and post-intubation palsy 6.7±2.4%. The non-surgical causes were idiopathic 33.2±11.8%, and malignant tumors of the neck or chest 16.2±9.4%.

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We have treated one adult with multiple and one with isolated laryngeal pa-pillomatosis. The former, a 27-year-old male was not controlled with the combination of laser surgery and local injection and systemic administration of α-IFN, but he was cured by local injections of six million units of β-IFN combined with laser surgery. The latter, a 44-year-old male was cured by local injections of three million units of β-IFN and resection. The results indicate that local laryngeal injection of β-IFN is useful in the treatment of laryngeal papillomatosis.

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A very rare case of adenosquamous carcinoma of the larynx is reported. A 61-year-old male complained of hoarseness for one year. A small tumor with an obscure margin was found on his left vocal cord. The histological diagnosis of the biopsied tumor was squamous cell carcinoma. After irradiaton with 66Gy, the tumor vanished, but recurred six months later at the primary site. Total laryngectomy with neck dissection was performed. The ultimate diagnosis of the extirpated tumor was adenosquamous carcinoma. There was one lymph node metastasis which consisted of adenocarcinoma only in the left paratracheal region. The patient has shown no evidence of recurrence five months after the surgery.

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Cystic parathyroid adenoma is rare. This report presents a 48-year-old female with primary hyperparathyroidism caused by cystic parathyroid adenoma.
She was found to have hypercalcemia on laboratory examinations performed in the Department of Internal Medicine of our hospital during a search for the cause of her vertigo. Further examinations indicated a functioning parathyroid cyst. Ultrasonography and MRI scan showed that the cystic portion was sharply demarcated from the solid portion of the lesion in a parathyroid gland. The high level of plasma PTH decreased to normal after removal of the enlarged parathyroid gland. Histological examination demonstrated a secondary pseudocyst resulting from cystic degeneration of a parathyroid adenoma. Twenty-seven cases of functioning parathyroid cysts reported in the Japanese literature are reviewed. The clinical features and histological evidence of functioning parathyroid cyst are discussed.

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Castleman's lymphoma is an uncommon disease of benign lymphnode hyperplasia which usually affects the mediastinum. We recently treated a 63-year-old female with the plasma cell type of Castleman's lymphoma of the neck.
It is very difficult to diagnose Castleman's lymphoma preoperatively. There have been no reports of fine needle aspiration biopsy (FNA) of this lymphoma. We perfomed FNA in this patient and found plasma cells without atypia. This finding was consistent with the plasma cell type of Castleman's lymphoma.

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The effects of preoperative Sizofiran (SPG) administration on cellular immunity in regional lymph nodes were studied in patients with head and neck cancer and compared with the effect on circulating lymphocytes in peripheral blood. SPG enhanced im-munological activities in the regional lymph nodes, as shown by increased cytotoxic activities of the effector cells and increased helper T lymphocytes and effector cells in the lymph nodes. The tumor-involved lymph nodes treated with SPG contained significantly fewer cytotoxic effector cells with decreased cytotoxic activities and fewer helper T lymphocytes than did uninvolved lymph nodes treated with SPG. The LAK cells derived from the regional lymph node, especially from the tumor-uninvolved nodes which were previouly treated with SPG were thought to have higher cytotoxic activities than those not treated with SPG.

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Epstein-Barr Virus (EBV) is associated with a number of lymphoid malignancies. However, the malignancy showing the most consistent association with the virus is undifferentiated Nasopharyngeal Carcinoma (NPC).
Underlying the viral involvement in these EBV-associated diseases appears to be the capacity of EBV to transform the growth of human B cells, a phenomenon most easily studied in vitro where experimental infection of resting B lymphocytes leads to cellular activation and to the growth of permanently virus-transformed lymphoblastoid cell lines.
EBV not only induces growth transformation of human B lymphocytes, but has more recently been shown to enhance B cell survival under suboptimal conditions in which growth is inhibited.
The interplay between EBV infection and expression of cellular genes has important implications for the pathogenesis of virus-associated malignant disease. We are now studying the possible involvement of FcERII/CD23 and ADF in the enhancement of cell survival under suboptimal conditions.

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We evaluated the clinical effect of Tsumura Shin'i-Seihai-To (TJ-104), a Kampo medicine, in patients with chronic sinusitis with nasal polyps. The subjects of this study were 45 patients aged 12-81 years, who received Shin'i-Seihai-To 7.5g p. o. per day for 12 weeks. The clinical effectiveness was graded according to 4 parameters. Subjective symptoms, objective signs other than nasal polyps, the size of nasal polyps and X ray signs. The patients' Sho was determined from their answers to an easy questionnaire.
The effect of Shin'i-Seihai-To was first examined in all patients before their Sho was known. Then the patients were divided into a Jitsu & Ghukan-Sho group in which Shin'i-Seihai-To was effective and a Kyo-Sho group in which was not effective, and the two groups were compared.
It is concluded that Shin'i-Seihai-To had the effect on improvement of subjective symptoms and reduced the size of nasal polyps. Furthermore, the improvement in objective signs was significant in relation to Sho.

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Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.
In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.
X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.
Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.
These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.

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