The most frequent sleep problems are sleep-related breathing disorders, insomnia, excessive daytime sleepiness, and circadian rhythm disorder. In 2004, we treated 468 sleep disorder patients, at the Sleep Disorder Center, Shiga University of Medical Science Hospital. Forty-nine percent of the subjects were diagnosed as having sleep related breathing disorders, 22% as insomnia, 10% as rhythm disorders and 5% as having excessive daytime sleepiness. Insomnia is a common sleep-wake-related complaint, and sleeping pills are among the most commonly prescribed drugs in clinical practice. However, insomnia is a symptom that can be caused by various disorder's, many of which require specific therapies. One specific cause of insomnia in older adults is restless legs syndrome. This condition, characterized by an urge to move the legs, which is usually accompanied by sensations of discomfort and aggravations of symptoms by rest. Daytime sleepiness is a common complaint. Snoring, the use of hypnotic agents, sleep difficulties, irregular sleep-wake schedule and sleep deprivation are related to daytime sleepiness. Circadian rhythm sleep disorders have intrinsic and extrinsic subtypes: delayed sleep phase syndrome, advanced sleep phase syndrome and non-24-h sleep-wake syndrome. The underlying problem of circadian rhythm sleep disorders is that the patient cannot sleep when sleep is desired. Waking episodes may occur at inappropriate times; therefore, the patient may complain of insomnia or excessive sleepiness.

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When antineoplastic drugs are administered to a patient with impaired or unstable renal function, problems related to the dosage schedule may occur because of differences in pharmacokinetics between patients with normal renal function and those with renal dysfunction. We performed selective intraarterial infusion chemotherapy for a patient with maxillary squamous cell carcinoma who was undergoing hemodialysis for chronic renal failure. Cisplatin at doses of 50mg/body and docetaxel at doses of 20mg/body were administered via the maxillary artery twice at a one-week interval. The effect of intraarterial infusion chemotherapy was partial response. We could carry out the subsequential surgery and radiation therapy without severe adverse effects.

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The goal of surgical treatment for benign parotid gland tumors is to remove the mass completely without causing facial nerve palsy. In recent years, limited parotidectomy is becoming a new standard procedure for benign tumors, replacing superficial parotidectomy, and excellent results equal to the old procedure are being reported.
This study evaluates the postoperative results of 59 benign parotid tumors treated surgically between 1991 and 2001, then determined whether limited parotidectomy can become the new standard of surgical management for benign parotid tumor.
In 39 of the 59 patients, we investigated the frequency of local recurrence, Frey's syndrome and facial palsy. The histopathological diagnosis was pleomorphic adenoma in 17, Warthin's tumor in 15 and miscellaneous tumor including cyst, lymphoepithelial lesion or other lesions in 7, respectively. Twenty-one patients underwent partial parotidectomy, 10 enucleation and 8 superficial parotidectomy, respectively. The postoperative follow-up duration ranged from 3 to 14 years with an average of 7.54 years.
According to the results of this follow-up study, there was no recurrence with each surgical procedure. Frey's syndrome did not occur in any patient after partial parotidectomy compared to that in 3 patients (37.5%) after superficial parotidectomy. Four patients (19.0%) temporarily experienced in some degree of facial nerve weakness after partial parotidectomy.
From these results, partial parotidectomy is thought to be a new trend in the surgical treatment of benign parotid tumor.

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Since before Christ, Hippocrates' procedure was well known as a manual reduction procedure for acute temporomandibular joint (TMJ) dislocation. In this paper, the modified manual reduction procedure for acute TMJ dislocation is introduced.
First of all, the operator asks the patient to sit on the floor against the wall with his or her legs out straight. Then the operator stands facing the patient with his feet on either side of the patient's legs. The operator holds the patient's mandible with his thumbs on the bilateral occlusal surface of molar. Bilateral thumb pressure is exerted inferiorly and posteriorly. The operator leans his bodyweight forwards with straight arms when it is hard to replace the head of the mandible. After reduction of the mandible, it is common for the patient to bite the operator's thumbs. So the operator should move his thumbs outside of the teeth (to the oral vestibule). Restriction of mandibular motion for a few days is advisable.
Thirteen patients with acute TMJ dislocation underwent this manual reduction procedure. In all cases, the condylar head of the mandible was dislocated anteriorly.
The advantage of this manual reduction procedure is that even when the patient's muscle tension is strong and operator's physical strength is weak, it is not very hard to perform manual reduction of acute TMJ dislocation.

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We experienced a case of squamous cell carcinoma with sialolithiasis by metaplasia in the duct of a submandibular gland. A 58-year-old man was referred to our hospital to treat a mass in the oral cavity. There was a sialolithiasis in the proximal part of Wharton's duct. So, we removed the left submandibular gland. Metaplastic change was found in Wharton's duct with calculi, and, in the central part of the metaplasia, well differented squamous cell carcinoma was located. Neck lymph nodes were not swollen, so no further treatment was taken. There was no sign of reccurence. We studied the metaplasia rate in Wharton's duct in sialolithiasis patients who had been treated by submandibular gland removal in our hospital. About 90% of patients' metaplasia were found in areas with calculi. We thought that metaplasia in the duct was highly correlated with calculi, and that squamous cell carcinoma might occur on the basis of metaplasia.

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Conventionally, partial parotidectomy has been performed for benign parotid tumors. But, considering the fact that the possibility of Warthin's tumors becoming malignant is extremely small, it is questionable to treat Warthin's tumors and pleomorphic adenomas equally.
We have removed Warthin's tumors which exist in the tail of the parotid gland performing enucleation surgery under local anesthesia since 2002.
With enucleation surgery, there is no need to ligate vessels, use a drain or cut the great auricular nerve and the retromandibular vein. Furthermore, we can remove tumors dissecting along the tumor membrane carefully, without exposing the facial nerve. So, enucleation should be considered less invasive in comparison with partial parotidectomy.
With these advantages mentioned above, Warthin's tumor is expected to be increasingly treated with enucleation surgery from now on.

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Sometimes angioedema in the face, pharynx and larynx progresses so acutely that patient develops such difficulty breathing that it may become fatal. We report two cases of angioedema in the pharynx requiring tracheostomy. One case was caused by angiotensin converting enzyme (ACE) inhibitors that she was taking ACE inhibitors for hypertension and there was no rise of IgE in RAST and no decrease in C1-inhibitor. The other case was caused by oral allergy syndrome (OAS) with rising of IgE in RAST of soybean, radish, etc. that had been eaten just before swelling occurred.
The numbers of persons of advanced age are increasing, which in turn generates a higher the demand for ACE inhibitors. Recently, the incidence of allergic diseases has also been increasing. We suspect these circumstances will increase the incidence of angioedema caused by ACE inhibitors and OAS. It is important to check the patient's medication and meals to determine the origin and it is necessary for otorhinolaryngologists to recognize angioedema.

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IgA nephropathy is the most common type of glomerulonephritis, and is characterized by glomerular mesangial proliferation with predominant IgA deposition in the mesangial areas. Long-term observation showed that approximately 40% of patients with IgA nephropathy progress to end-stage renal failure after showing clinical manifestations for 20 years. In recent years, tonsillectomy in IgA nephropathy patients has become prevalent because the treatment has been found efficacious in improving renal survival.
We present a case report of IgA nephropathy for which renal transplantation was performed in a 40-year-old man. The patient developed IgA nephropathy that resulted in renal graft dysfunction. To prevent disease progression, he underwent tonsillectomy under general anesthesia. The tonsillar beds were edematous and fragile, and it was very difficult to coagulate the oozing from the tonsillar beds intraoperatively. An argon beam coagulator (ABC) was found to be very useful and safe for bleeding hemostasis. After tonsillectomy, the renal function was stabilized with steroid pulse therapy.
For patients progressing to end-stage renal failure, recurrent disease after transplantation remains a clinically important problem. Tonsillectomy may serve as both prophylactic and curative treatment for recurrent IgA nephropathy following renal transplantation.

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We report a case of a 47-year-old male with external auditory canal cancer with difficult diagnosis, successfully treated with chemoradiation therapy. The patient was treated for 5 years as cholesteatoma in another hospital. He presented a right auricular mass and bad smell. The size of the giant tumor mass was 10cm×6cm with a papillary surface. The right cervical lymph nodes were palpable. The diagnosis from the biopsy was squamous cell carcinoma (SCC). Because the tumor invaded the right internal carotid artery and skull base, the patient was treated with chemoradiation therapy. The therapeutic effect was Complete Response (CR) and the tumor has not relapsed for 2.2 years.

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Tumors arising in the parapharyngeal space are rare. We reviewed 13 cases of parapharyngral space tumors that had been operated on between 1999 and 2004, and investigated the preoperative diagnosis, method of operation, and complications after surgery. Computed tomography, magnetic resonance imaging and fine-needle aspiration cytology were very useful for preoperative diagnosis, judging the extent of involvement and localization, and assessing the pathology of the tumor in the parapharyngeal space. The pathological diagnosis of these tumors was pleomorphic adenoma (6 cases), neurilemmoma (5 cases), ganglioneuroma (1 case), and malignant pleomorphic adenoma (1 case). The cervical approach was the most common, and was used in seven cases. Other surgical approaches included the cervical approach with mandibulotomy (2 cases), cervical-parotid approach (2 cases), and parotid approach (2 cases). First bite syndrome (FBS) has recently been reported as a complication after surgical removal of parapharyngeal space tumors. We experienced 4 cases of FBS. Since FBS was very difficult to treat in these patients, it is necessary to be aware of this syndrome.

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We report clinical examinations of seven cases of Kimura's disease. Six patients were male and one patient was female. Patient ages ranged from 6 to 57. Three patients complained of swelling in the parotid region, two patients in the submandibular region, one patient in the zygomatic region and one patient in the cervical region. All patients demonstrated remarkable increase of eosinophils and serum IgE. Six patients were treated with medication and one patient was treated with surgical excision followed by radiation therapy. It is important to select an adequate method of treating Kimura's disease considering the benefits and limitations of various treatment methods.

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Agnathia literally means absence or severe dysplasia of the mandible. It is a rare expression of first brachial arch malformation. In the present case was detected polyhydramnios and the fetus demonstrated mandibular dysplasia on prenatal ultrasound diagnosis at 30 weeks of gestation. There were no signs of holoprosencephaly on prenatal MRI. At 36 weeks of gestation, cesarean section was performed. Immediately after birth the infant was tracheostomized. She has survived to infancy with tracheotomy.

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Cedar pollinosis is prevalent in Japan with a growing number of patients reporting increasingly severe symptoms each year. This study evaluated the clinical effect of treating patients with fexofenadine early in the cedar pollinosis season. Patients were divided into two treatment groups: early pollen season patients who consulted the clinic before the pollen season (Group 1); full pollen season patients who consulted the clinic after the start of the pollen season (Group 2). Both groups received fexofenadine HCI 60mg bid from the date of arrival in the clinic until pollen season end. Mean duration of treatment was 55.2 days (Group 1), 19.2 days (Group 2). Clinical efficacy was assessed based on changes in patient-reported symptoms [collected in daily diaries] and concurrent usage of other medications. Other assessments included measurement of eosinophil cationic protein (ECP), vascular endothelial growth factor (VEGF) and eotaxin concentrations in the nasal wash. Forty-nine patients were included in this study (Group 1: N=26; Group 2: N=23). Symptom and symptom-medication scores for Group 1 at weeks 2 and 4 (peak pollen season) were significantly lower (p<0.05) than those of Group 2. While both groups showed elevation of ECP, VEGF and eotaxin in the nasal wash during the peak pollen season, the elevation was lower in Group 1 (p=NS). This study showed that fexofenadine treatment prior to the pollen season reduced cedar pollinosis symptoms to a greater extent than commencing treatment after the start of the pollen season. This difference in efficacy may be linked to the inhibition of ECP and VEGF by fexofenadine.

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