More than a decade ago, genetic analyses could be performed by a limited number of specialist. Therefore, the technology was far from clinical application at that time. With the remarkable progress in gene analysis in recent years, however, a variety of genetic tests have already been applied clinically and have become necessary for the diagnosis of certain malignant tumors, infections and so on. However, genetic tests are not fully used in clinical practices because of persistent uncertainties as whether such tests will be covered by national health insurance and which items should be tested. Under these conditions, this report addresses malignant lymphoma, hereditary medullary thyroid carcinoma, tuberculosis, and hereditary deafness, for which genetic testing has already been applied clinically, in order to explain genetic testing that a general medical institution can contract out to a clinical testing company.

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Arnold-Chiari malformation is a rare congenital condition characterized by varying degrees of downward displacement of the cerebellar tonsils, inferior cerebellum or medulla through the foramen magnum. Diagnosis of Arnold-Chiari malformation is not difficult due to the characteristic primary position downbeat nystagmus and a variety of cerebellar signs. Recently using magnetic resonance imaging (MRI), diagnosis of Arnold-Chiari malformation is more easy, but the degree of neurological disorder in the cerebellum and brainstem are not clarified without neuro-otological examination. We analyzed the eye movement using electro-nystagmograph in two cases of Arnold-Chiari malformation (one case is 14 old female and the other case is 54 old female) and discussed the differences of neuro-functional disorder between two cases that can not be discriminated by MRI techniques only.

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Microscopic polyangitis (MPA) is one of the systemic vasculitis syndromes, including polyarteritis-nodosa and allergic granulomatosis angitis, which are characterized by clinical evidence of blood vessel inflammation that produces ischemic changes in various organs. Here we report a patient who showed bilateral fluctuating sensorineural hearing loss and diagnosed as having microscopic polyangitis. A 71-year-old woman visited our hospital complaining of redness on the nasal tip and alas. One week later she noticed tinnitus and hearing loss in the right ear, and then hearing of both ears fluctuated and responded well to the administration of predonisolone. She was suspected of having an autoimmune disease because she complained of numbness of fingers and erythema of the face. By close examination, she was diagnosed as having microscopic polyangitis and was given predonisolone and cyclophosphamide. Her bilateral hearing has been stable and MPO-ANCA became negative after the therapy. The sensorineural hearing loss in MPA may be caused by necrotic or inflammatory vasculitis in the inner ear. We should pay attention to the association of an autoimmune disease such as MPA in cases of fluctuating or repeated sensorineural hearing loss responding well to the administration of steroids.

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We treated 2 patients for traumatic optic neuropathy. Visual acuity remained unchanged following high-dose corticosteroid therapy in both patients. They underwent optic nerve decompression under endoscopic control. One patient with preoperative visual acuity of 0.01 showed an improvement of visual acuity and expansion of visual field. The other was blind preoperatively and did not show any improvement postoperatively. Other authors reported that improvement of vision occurred in approximately half the patients who had no light perception prior to surgery. Therefore, optic nerve decompression can be an option in the treatment of traumatic optic neuropathy, if vision worsens or remains unchanged even after the patient is treated with high-dose corticosteroid therapy.

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Lipoma is a common neoplasm in the head and neck region, but it rarely occurs in the parotid gland, constituting about one percent of all salivary gland tumors. We encountered three cases of parotid lipoma in our hospital over the last ten years, which originated from superficial (2 cases) and deep (one case) lobes. Tumors were completely excised in all three cases, and none of them has recurred for 3-9 years to date. Lipoma is easily diagnosed on preoperative imaging study including CT and MRI and by its typical pathological findings. However, pathological diagnosis was difficult in a 49-year-old woman, with atrophic change of the parotid gland due to aging, accompanied by hyperplasia of the adipocyte, which mimicked lipomatosis.

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We experienced two cases of leukoplakia of oral cavity that were induced by pipe smoking. The first patient, a 62-year-old-male, complained of oral dysesthesia. The leukoplakia was found in the palatum durum on the left side, in the inner surface of the gingiva (right maxillodental first molar). He had smoked pipe tobacco for about 10 years. The second patient, a 59-year-old male, complained of pain in the oral cavity. The leukoplakia was found in the left palatum durum and gingiva (left maxillodental second molar, bilateral mandibulodental second molar). He had smoked pipe tobacco for about 15 years. Their leukoplakia was excised by CO₂ laser.
The shape of the pipe's lip was related to the locations where leukoplakia was found. A perfect match of leukoplakia location to the place where the pipe's lip contacted suggested the pipe smoking as the cause of the disease.

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We report a case of autonomously functioning thyroid nodule (AFTN) with papillary microcarcinoma in a 74-year-old woman. She complained of a right anterior neck mass, and presented with hyperthyroidism. Computed tomography and magnetic resonance imaging of the thyroid showed a nodule measuring 2.5×2cm in the right lobe and a nodule measuring 5×4.5cm in the left lobe. The left lobe nodule was hyperfunctioning on Tc-99m imaging. On the other hand, the right lobe nodule showed uptake on delayed T1-201 imaging and was suggested to be malignant. Fine needle aspiration biopsy using ultrasonography was class V (papillary carcinoma) for the right lobe nodule and class II for the left lobe nodule. The patient underwent total thyroidectomy and right regional neck dissection. Histopathological examination revealed two papillary microcarcinomas (each 5mm in diameter) surrounded by nodular hyperplasia in the right lobe, nodular hyperplasia in the left lobe, and right pretracheal and paratracheal lymph node metastasis. Since it is not rare for cancer to be associated with AFTN, care must be taken to obtain an accurate diagnosis in such cases and surgery is the treatment of choice for AFTN.

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A rare case of papillary carcinoma of the thyroid with systemic sarcoidosis is reported. A 63-year-old woman who had had operations for recurrent papillary carcinoma of the thyroid four times visited our department complaining of a lump in the right neck. Further examination revealed enlarged lymph nodes in the bilateral neck, the upper mediastinum and the bilateral hilum of the lung. Fine needle aspiration biopsy of the right cervical lymph node yielded papillary carcinoma. Serum lysozyme and ACE levels were beyond normal limits. She underwent bilateral neck dissection, and histopathological examination revealed papillary carcinoma in the right cervical lymph node and sarcoidosis in the left. Gallium scintigram performed after the operation showed uptakes in the upper mediastinum and the bilateral hilum of the lung. A tuberculin test was negative. We finally diagnosed her illness as recurrent papillary carcinoma of the thyroid in the right cervical lymph node, and systemic sarcoidosis in the left cervical, upper mediastinal and bilateral hilar lymph nodes. It seems very difficult to preoperatively differentiate thyroid carcinoma and sarcoidosis co-existing in the cervical lymph nodes. The management of cervical lymphadenopathy in thyroid carcinoma should not be changed because of the presence of sarcoidosis, and a neck dissection should be performed.

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Ulceration recognized after radiotherapy is refractory and difficult to cure.
Here we report a successful case of pinch grafting (split thickness skin graft) for intractable ulcer which occurred after radiotherapy for laryngeal cancer.
Although pinch grafting is inferior to full thick skin grafting in cosmetic appearance, it is such a simple and easy method that even beginners can get good results with few complications and good epithelialization.
We consider pinch grafting is very effective treatment for the following case, which had poor blood circulation within the transplantation floor, and uncertainty whether the graft would take root firmly or not.
With those advantages mentioned above and physically little sacrifice, pinch grafting is expected to be adopted increasingly from now on.

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‹Background› In the field of otolaryngology-head & neck surgery, antimicrobial agents are administered in order to prevent perioperative period infections caused by mainly Gram-positive coccus such as Staphylococcus aureus or Staphylococcus epidermidis. Short-period administration of penicillin or 1^st generation cephems antibiotics are recommended for clean/clean-contaminated operations. For a short operation, a single administration within 30 minutes from the start of operation is considered sufficient. However, in Japan it is administered as a customary practice for several days after the operation in many cases.
‹Purpose› Oral antimicrobial agent azithromycin (AZM, Zithromac^®) was administered in order to prevent postoperative infection in patients who underwent clean/clean-contaminated operations in the field of otolaryngology-head & neck surgery, and its efficacy was examined.
‹Patients and method› Of patients who underwent clean/clean-contaminated operations in the operation room of the Department of Otolaryngology, Hokkaido University Hospital from April 2003 to November 2004, patients who underwent minor or intermediate operations for mouth, pharyngolarynx, trachea, or neck were selected. Patients who had experience of irradiation, or past history of surgical site infection, or those who were considered to have a high risk of infection due to systemic complications and to whom a doctor in charge judged it appropriate to intravenously infuse antimicrobial agents, were excluded.
‹Results› Three hundred patients were administered, and of these, violation of the treatment occurred in 2 patients (0.6%). Postoperative infection occurred in 8 (2.4%) Some of them had medical problems, or past histories of MRSA infection, or operations of the head and neck area.
‹Conclusion› In clean/clean-contaminated operation in the field of department of otolaryngology-head & neck surgery, intravenous antimicrobial injection is commonly used to prevent postoperative infection, but these results suggest that a sufficient effect can be achieved by 3-day-administration of the oral antimicrobial agent AZM.

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We report 26-year-old female whose cervical lymph node became swollen, accompanied by aggravation of systemic lupus erythematosus (SLE) symptoms. Histologically, the lymph node showed necrosis with a geographic pattern, and increments in the macrophages and histiocytes preying upon the apoptotic lymphocytes. The clinical and pathological findings were consistent with histiocytic necrotizing lymphadenitis (HNL). Recently, however, it has been considered that histological finding of HNL in an SLE patient indicates that the lymphadenitis is related to SLE (lupus lymphadenitis). Thus, the present case was diagnosed as lupus lymphadenitis. Steroid administration to improve the SLE symptoms was also effective for lymphadenitis. The present case indicates that cervical lymphadenitis associated with an autoimmune disease, such as SLE, is occasionally difficult to differentiate from HNL, and suggests that treatment of the primary disease is important to improve disease-associated lymphadenitis.

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