A retrospective clinical study was conducted involving 95 patients with laryngeal cancer treated in our department between 2005 and 2011. The subjects consisted of 90 males and 5 females. The average age was 64.4 years old. As to the origin subsite, the glottis accounted for 74 (77.8%), the supraglottis in 20 (21.1%), and the subglottis in 1 (1.1%). The clinical stage according to the 2002 UICC TMN classification system was I in 36 cases (37.9%), II in 20 (21.1%), III in 16 (16.8%), and IV in 23 (24.2%).
The 5-year overall survival rate was 95.2% in stage I patients, 93.3% in stage II, 76.2% in stage III, and 63.2% in stage IV.
Relief medical treatment was performed for 11 patients among 13 patients in whom recurrence was noted with survival, and five patients were in the state of survival without desease.

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We reviewed prospectively collected data of patients with maxillary sinus squamous cell carcinoma who had been given superselective intra-arterial cisplatin and concomitant radiation (RADPLAT) at Hamamatsu University School of Medicine, University Hospital between 2004 and 2011 to assess the effectiveness and safety of this therapeutic approach.
Twenty-six patients underwent conventional radiation (60-66 grays) with 5 to 6 weekly infusions of intra-arterial cisplatin (100-120 mg/m²) and systemic sodium thiosulfate neutralization. Twenty-one patients (80.8%) of the 26 patients had T4 disease. Of these 26 patients 8 were treated with Induction chemotherapy (systemic chemotherapy or superselective intra-arterial cisplatin) followed by RADPLAT, whereas the other 18 did not receive any pretreatment before RADPLAT. We performed salvage surgery only for three of nine patients in whom residual cancer was confirmed or who had local recurrence after RADPLAT.
After a median follow-up period of 20 months, the 2-year overall survival rate was 76.2% for all patients. The local control rate and the progression-free survival rate were 61.9% and 51.9%, respectively. In terms of eyeball preservation, five patients lost their visual function during the observational period. Three patients received cisplatin via the ophthalmic artery to reduce tumors which had deeply infiltrated the orbit or ethmoid sinus and who had become blind. Salvage radical maxillectomy with orbital exenteration was conducted for two patients. Five patients experienced grade 3 or 4 toxicity. Arterial infusion had to be discontinued in two patients because of cerebral infarction and severe colitis.
Short-term follow-up results in our hospital suggest that RADPLAT could be applied effectively to advance the treatment of maxillary sinus squamous cell carcinomas. However, we must recognize that RADPLAT has potential risks regarding cerebrovascular accidents and other serious adverse effects and the late onset side effects are as yet unclear.

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We studied nasopharyngeal carcinoma (NPC) patients treated in hospitals in Hamamatsu University School of Medicine during the period from 2000 to 2011. A total of 41 cases (male: 30, female: 11) were analyzed epidemiologically, histologically, and clinically in this study. The age of the patients ranged from 19 to 86 years, with a mean age of 56 years. On the basis of the World Health Organization (WHO) histological criteria, 12.2% of the patients were classified as WHO I, 48.8% as WHO II, and 39% as WHO III. Tumor staging showed that 2.4% belonged to stage I. 24.4% to stage II. 41.5% to stage III, and 31.7% to stage IV. The five-year survival rate for all patients was 78.0%, and those for stage I+II, III, and IV were 90.9%, 61.9%, and 76.9%, respectively.
Although NPC is a radiosensitive and chemosensitive tumor, a substantial number of patients develop local recurrence or distant metastases. For patients with locoregional advanced disease, it is well known that conventional radiotherapy is insufficient in terms of both the local control rates and distant metastases. New techniques of radiation and new combined radiotherapy and chemotherapy modalities have been evaluated in numerous clinical trials in recent years. The purpose of this article was to review the current knowledge in terms of the management and outcome of patients with NPC.

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The level of incidence of patients with oropharyngeal cancers increased from 1998 to 2010. The purpose of the present study was to investigate therapeutic strategies for oropharyngeal cancers based on an examination of clinical outcomes in our department. The study subjects comprised 69 patients with oropharyngeal cancers treated in our hospital from January 2007 to December 2011. Overall survival was examined with the Kaplan-Meier survival curve. Subsite, stage, treatment (surgery group vs radiation and chemotherapy group) and prognosis were reviewed retrospectively. Overall survival was 59.9%. The overall survival was not associated with any difference in the tumor size (T1 and T2 vs T3 and T4), lymph node status (N0 vs N+), stage (I, II and III vs IV), subsite, or treatment. As for the treatment, overall survival of the surgery group was 62.1%, while that of the radiation and chemotherapy group was 76.8%.

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Based on the 5 years from January 2007 to December 2011, a retrospective study was performed on 76 patients (group A) with hypopharyngeal squamous cell carcinoma treated in our department, 72 males and 4 females, median age 67 years (ages ranging from 45 to 83 years). Four cases were in stage I, 10 in stage II, 10 in stage III and 52 in stage IV. As for the primary treatment, 34 of 76 patients were treated with surgery, and 42 patients were treated with chemoradiotherapy (CRT) or irradiation alone. The 3-year disease-specific survival rate (Kaplan-Meier method) was 63.3%, and there was clearly a poor prognosis for Stage IV patients. We compared the results with those from 144 patients with squamous cell carcinoma of the hypopharynx who were treated from 1978 to 2002 (group B) that was previously reported by our hospital. The rates of the 3-year survival for patients from group A and group B were 60% and 46%, respectively. CRT for hypopharyngeal cancer was thought not have enough strength, and the introduction of the neoadjuvant -chemotherapy will be considered in patients with locally advanced disease. Hypopharyngeal cancer is often to be found in advanced cancer at the time of treatment, and it is necessary to determine the risk and treat appropriately. However, further investigation is required on new therapeutic strategies for advanced hypopharyngeal carcinoma.

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Sixty-two patients with oral cancer, treated in our department over the 7-year period between 2005 and 2011, were reviewed. The median age was 67.0 years. The primary site of oral cancer was the tongue in 36, gingiva in 10, oral floor in 8, buccal mucosa in 6, and the hard palate in 2. The 3-year survival rate analyzed with the Kaplan-Meier method was 72.4%, 71.4%, 83.3%, and 55.8%, respectively for stages I, II, III, and IV. The 3-year survival rate by site was 70.1%, 66.7%, 62.5%, 66.7%, and 50.0%, respectively for the tongue, gingiva, oral floor, buccal mucosa, and hard palate. Next, we analyzed 28 tongue cancers primarily treated with surgery regarding pathological lymphatic vessel invasion, vessel invasion, and neural invasion. With respect to the vessel and neural invasion, the survival rate of non- and low invasion group was significantly higher than in the moderate and high invasion groups.

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The parotid gland carcinoma is an infrequent tumor, which has various histological characteristics.
In the 20-years from 1993 to 2012, we treated 42 subjects with parotid gland carcinoma. Twenty-nine patients (69.0%) were male, and 13 patients (31.0%) were female. The mean patient age was 62.3 years, ranging from 19 to 91 years. In pathological analysis, the histological diagnoses were as follows: mucoepidermoid carcinomas in 11 patients (26.2%), salivary duct carcinomas in 11 (26.2%), acinic cell carcinomas in 6 (14.3%), adenoid cystic carcinomas in 3 (7.1%), and 2 (4.8%) with squamous cell carcinomas and basal cell carcinomas, and low-grade cribriform cystadenocarcinoma. Only two cases undergoing fine-needle aspiration biopsy were preoperatively diagnosed as having the exact pathology. The local control depend upon the pathological grade of the tumor. The 5-year and 10-year survival rates were 60.3% and 25.8%, respectively, with Kaplan-Meier analysis. The main finding of this study was that radical resection is a reasonable approach and postoperative radiotherapy is helpful for parotid gland carcinomas of the head and neck.

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The present study subjects comprised 88 thyroid cancer patients treated in our hospital from July 2001 to November 2011. We investigated clinical considerations in these subjects, such as age, sex, tumor stage, pathological examination results, and the treatment regimen. The average age was 61 years old, and the sex ratio was 1:2 (M:F). Patients aged 45 and below accounted for 19.3% of the total population. The sensitivity of thyroid fine needle aspiration cytology (FNAC) was 72.7%. The overall survival was examined by the Kaplan-Meier survival curve and the overall 5 year survival rate of all cases (88 cases) was 85.2%. The 5 year survival rate of papillary carcinoma (77 cases) was 88.3%. Recurrence and metastases were seen in T3N1, T4 band N1b cases. The 5 year survival rate was especially bad for undifferentiated cancer and squamous cell carcinoma.

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We have treated 19 patients with cervical metastases of unknown origin over the past 7 years. The clinical stage distribution was as follows: N1, 2; N2a, 4; N2b, 7; N2c, 2; N3, 4. The histopathological diagnoses of the cervical lymph nodes were as follows: squamous cell carcinoma in 12, adenocarcinoma in 2, and others in 5. Five patients were found to have a subsequent primary tumor. Primary tumor sites were as follows: tonsils, larynx, hypopharynx, cervical soft tissue, and lung. Of the 19 patients, 13 patients underwent neck dissection. The overall survival in this study was 61.8%.

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We investigated 166 patients who underwent cochlear implantations in our department in the period from March 1993 to April 2012. Forty-nine patients (29.5%) were children and 117 patients (70.5%) were adults. The most frequent causative diseases were progressive sensorineural hearing loss, congenital hearing loss, sudden deafness, postoperative hearing loss and meningitis. Twenty of the 166 patients (12.0%) experienced postoperative complications. Complications consisted of skinflap infection in 5 patients (3.0%), electrode extrusion in 4 patients (2.4%), electrode slip-out in 3 patients (1.8%), device failure in 2 patients (1.2%), facial spasm in 1 patient (0.6%) and facial palsy in 1 patient (0.6%). Of those complications, 13 patients (7.8%) received revision surgery. Before implantation, we should inform patients and their family about the risk of complications, and make a real effort to avoid such complications.

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We present herein a report on 3 cases of congenital cholesteatoma of the tympanic membrane. A white mass was seen at the tympanic membrane in all cases. One female patient was admitted with complaints of a white mass in the left ear canal. In the other patients, white masses were incidentally discovered by otolaryngologists. Surgical explorations revealed cholesteatomas of the tympanic membrane. Congenital cholesteatomas of the tympanic membrane are relatively rare. Although the pathogenesis of congenital cholesteatomas of the tympanic membrane is still unclear, an embryologic origin was suspect.

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The nerve fibers running inside the organ of Corti were studied in the cat cochlea with scanning electron microscopy (SEM). In the present study, we used thick serial sections which were cut from temporal bones embedded in celloidin. The tunnel spiral bundle, tunnel radial fibers, tunnel basilar fibers, outer spiral bundle and nerve endings on outer hair cells were seen as previously reported. In addition, numerous radial fibers which emerged from the habenula perforata were seen beneath the inner hair cells. An inner spiral bundle was also seen in this area. It has been difficult to show nerve fiber types with SEM examination, because the region containing these fibers does not possess an open space such as the tunnel of Corti and Nuel’s space. Nerve fibers in this area were clearly visualized by using the thick serial section method for SEM.

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Immunocytochemical localization of the GTP-binding protein G_s in the rat vestibular organs was investigated using a post-embedding immunogold method with an antibody raised against the C-terminus of the α-subunit of G_s. In the crista ampullaris and the utricle, labeling was detected on the deeply infolded basolateral membrane of the dark cells, but not on the luminal membrane. No labeling was detected on transitional cells or on wall cells facing the endolymph. The present observation provides a detail of hormonal regulation of vestibular organs, which in turn regulate ion transport and fluid homeostasis in the vestibular endolymph.

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Purpose: Photodynamic therapy (PDT) induced singlet oxygen (¹O₂) can cause rapid necrosis of solid tumors. Using a new near-infrared photomultiplier tube system, the ¹O₂ production was monitored in real-time for HSC-3 tongue cancer cells and in vivo tissue, and the relationship between the ¹O₂ production and anti-tumor effects was investigated.
Experimental Design: Using 5-aminolevulinic acid (5-ALA), ¹O₂ generation was induced with a variety of laser parameters (fluence and irradiation) in vivo. During this time, tumor death was evaluated. Based on the ¹O₂ production, the optimal irradiation conditions and the long-term outcome were investigated on a subcutaneous tongue cancer model over 90 days.
Methods and Results: The ¹O₂ production showed a strong correlation with the laser output in a dose-dependent manner. At high laser output, the ¹O₂ levels were high and caused gradual but strong anti-tumor effects, whereas at low laser outputs, the ¹O₂ levels were low and the anti-tumor effects were rapid but superficial. We then performed PDT in an experimental tongue cancer model at an irradiance lower than 150 mW/cm², which was identified in the first part of the study as the optimal irradiance value based on the ¹O₂ production. Within the 90 days post PDT, PDT-induced hemorrhagic necrosis was observed in 8 mice out of 10 within 5 days. In the other 2 mice, no sign of necrosis was seen until 25 days after PDT. The tumor volume of the PDT group continued to decline except for 2 mice which showed some slight growth over 70 days after PDT. In the control group, tumor size increased dramatically over 70 days.
Conclusions: The present studies established ¹O₂ levels as an indicator for optimal irradiation during PDT, and showed a relationship between the ¹O₂ production and the photodynamic effects. Although 5-ALA mediated PDT showed a strong anti-tumor effect on larger subcutaneous tongue tumors, it might be more effective for small tumors of oral cavity.

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Fine needle aspiration biopsy (FNA) has been adopted as a simple and cost effective method for cytological studies of head and neck tumors. Recently fine needle nonaspiration biopsy (FNNA) has been reported to provide better specimens. In the present study, we compared the efficacy of the two techniques. During a 2-year period, 92 cytological examinations were conducted in patients with head and neck tumors. Biopsy sites studied included thyroid tumors (n=63), lymph nodes (n=25) and salivary gland tumors (n=4). Fine needle biopsies were performed in each lesion with 23-gauge needles, and results were analyzed by a single pathologist. Specimens from 9 patients (9.8%) were inadequate with both techniques. Six (7.3%) of 83 were insufficient specimens with FNA and 5 (6.0%) of 83 with FNNA. Insufficient specimens were obtained at 4 (7.2%) and 2 (3.6%) of 55 thyroid tumors, and 2 (8.3%) and 3 (12.5%) of 24 lymph nodes with and without aspiration, respectively. All specimens from salivary gland tumors were sufficient for diagnosis. The causes of insufficient specimens were blood contamination in the thyroid tumor with FNA and some amount of cellular material in the lymph node with FNNA. No statistically significant difference was noted in diagnostic yield between the two techniques. We concluded that FNNA is equal to FNA in the cytological studies in head and neck tumors. Double sampling may reduce inadequacy rates to low levels and be useful as a routine policy.

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Waardenburg syndrome (WS) type 1 is an autosomal dominantly inherited disorder characterized by hypopigmented iridis, dystopia canthorum, hair hypopigmentation and sensorineural hearing loss. WS type 1 is caused by mutations of PAX3, in which approximately 70 mutations have identified worldwide.
A 66-year-old male was referred to our hospital with the complaint of bilateral hearing loss. He showed bilateral hypopigmented iridis, dystopia canthorum and profound sensorineural hearing loss. Though he had no family members with characteristic features of WS, he was diagnosed as having WS type 1 on the basis of the clinical findings. The mutation analysis of the patient revealed a novel insertion mutation c.239_240insA (p.His80GlnfsX33) in PAX3.
Though we could not perform a segregation analysis due to the difficulties of collecting family samples, we estimate that the presence of WS in our current patient was caused by a de novo PAX3 mutation. As the cause in a few patients with WS type 1 has been reported to be de novo PAX3 mutations, it might be necessary to remember that all patients with WS type 1 have not inherited the disease in an autosomal dominant manner.

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Eruption of a tooth into the nasal cavity is a rare clinical entity. We report herein on 2 cases of inverted teeth in the nasal cavity. Case 1: A 2-year-old boy was brought to our department because of a tooth-like body in the left nasal cavity. He complained of rhinorrhea and coughing. Case 2: A 70-year-old man was brought to our department because of purulent granulation tissue in the left nasal cavity. He complained of left nasal bleeding, yellow rhinorrhea and an unpleasant smell. Those patients were both successfully managed with endoscopic sinus surgery. These masses were confirmed to be a tooth following histopathological examination. Early diagnosis and treatment are important to prevent affected patients suffering from such nasal symptoms.

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We report herein on 42 cases of paranasal sinus mycosis treated surgically in our hospital between January 2005 and March 2012. The patients (17 males and 25 females) had ages ranging from 36 to 84 years (average 62.2 years). Thirty-nine patients had mycosis in the unilateral maxillary sinus, two in the bilateral maxillary sinus and one in the sphenoid sinus. In the CT findings, there were 33 cases with hypertrophic change of the sinus wall, 32 cases with partial calcification in the sinus and 14 cases with partial bone destruction of the sinus wall. Endoscopic sinus surgery was undertaken in 40 cases, and the Caldwell-Luc procedure in 2 cases. In all cases the condition was diagnosed with pathological examinations. Aspergillus was detected in 35 cases, Candida in 3 cases, and the causative fungus could not be identified in 4 cases. The prognosis was good in 35 cases, and the other 6 cases needed additional treatments or surgery.

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A case of olfactory neuroblastoma is reported herein. A 59-year-old man visited our hospital with right nasal drip and chronic cough in November 2001. An examination revealed a tumor in his right nasal cavity, the surface of which was smooth and dark white. The patient did not have any visual acuity difficulties and the cervical lymphnodes were not swollen. The patient underwent surgery for a nasal tumor in December 2001. Based on the pathological findings, we made a diagnosis of olfactory neuroblastoma with a clinical Kadish staging score of stage A.
The patient was treated with 57.6 Gy carbon-ion beam therapy, and became free from disease. Eight years later, a right upper neck metastasis was discovered with elevation of serum NSE levels. Subsequently, the tumor was removed completely with neck dissection.
The patient has been followed up periodically and to date no recurrence of the tumor has been observed. The measurement of the serum NSE level seemed to be useful for diagnosis of recurrence in patients with olfactory neuroblastomas.

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We experienced a case of bilateral sudden severe sensorineural hearing loss with vertigo in a 33-year-old woman.The pure tone average (PTA) at 500 Hz, 1 kHz and 2 kHz was 68.75 dB on right side and 72.5 dB on left side. Her hearing level improved for a short time although she had no particular treatment. She was strongly positive for anti-nuclear antibodies, and was previously weakly positive for an anti-cardiolipin antibody. Two months previously, in another hospital, she had therefore undergone low-dose steroid and anti-thrombus treatment under the suspected diagnosis of anti-phospholipid antibody syndrome (APS), although there had been no past history of thrombosis. After first improving, she has had repeated incidents of hearing loss and various constitutional symptoms, which have however not yet resulted in a definitive diagnosis. We believed that this inner ear disorder was related to an autoimmune disease.

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Carcinoids (neuroendocrine tumors) are common in the gastrointestinal tract, respiratory tract, and lungs. There have been several reports of carcinoid tumors of the middle ear and larynx, but they are rarely found in the head and neck. We present herein on a case in which a tumor of the external auditory meatus was excised and diagnosed as a carcinoid tumor.
Case report: A 37-year-old male presented with earache of the left ear. A preliminary examination of the ear revealed a tender spherical swelling on the upper anterior wall of the external auditory meatus. Targeted CT imaging of the temporal bone showed a globular, 5 mm maximal dimension mass of soft tissue located against the tympanic membrane in the left external auditory meatus, with no obvious bone damage or spread to the tympanic cavity. The tumor was removed through a postauricular incision and biopsied. The pathology report found cord-like structured tumor cells under the external auditory meatal skin; immunohistochemical stains were positive for synaptophysin, CD56, and chromogranin A and negative for CD7, CD20, S-100. In addition, MIB-1 expression was approximately 4%. Based on these results, the mass was diagnosed as a well-differentiated neuroendocrine tumor consistent with a carcinoid tumor. As carcinoids of the hearing organs are rare, it was suspected that this was the result of metastasis, and the patient was given a full-body CT and referred to a pulmonologist and gastroenterologist. A thorough examination was conducted with MRI, GIF, and CF, and no abnormalities were found; the patient was then observed long-term. After one year, a thorough internal follow-up examination found no suspected primary tumors. One year after surgery, an internal ear examination was normal, and a CT showed no obvious signs of recurrence in the tympanic cavity or the area surrounding the external auditory meatus.

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We report herein on a case of refractory otitis media due to a congenital pre-auricular fistula communicating with the mastoid antrum. The patient was a 12-year-old female with middle-ear anomalies. The pre-auricular fistula was removed, and a tympanoplasty was performed. The fistula communicated with the mastoid antrum. Because of the combination of the branchial fistula and hearing loss, our suspected diagnoses was branchio-oto-renal syndrome and we performed genetic tests.

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Relapsing polychondritis (RP) is a comparatively rare chronic inflammation which occurs in systemic cartilage such as the auricula, nose and trachea. Those tissues become denatured and are irreversibly destroyed. RP is more commonly seen in the case of middle-aged patients, and is treated with steroids and immunosuppressants. We report herein on a case of RP that developed in a 16-years-old male. The patient showed various symptoms such as respiratory tract inflammation, auricular chondritis, saddle nose, vertigo, and hearing loss. He was diagnosed as having RP one month after the onset, but the disease proved recalcitrant even with repeated steroid pulse therapy and the use of several kinds of immunosuppressant. We have found RP very difficult to treat in this patient because his symptoms are aggravated with doses of predonisolone less than 27.5 mg.

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A 72-year-old woman with diabetes mellitus and many dental caries was admitted with a deep neck phlegmon. On the third day of being treated with antibiotics, she complained of chest compression. Electrocardiography showed ST-segment elevation in the precordial leads. The cardiologist diagnosed the patient as Takotsubo cardiomyopathy based on both the typical findings of echocardiography in which the base of the left ventricle was hyperkinetic and the remainder of the left ventricle akinetic, and coronary angiography which did not demonstrate significant stenosis. The patient was treated in the Intensive Care Unit (ICU). One day later, computed tomography (CT) showed that the phlegmon had progressed to form a widespread abscess including the parapharyngeal space, a condition that is potentially life-threating. Takotsubo cardiomyopathy requires avoiding stress because it could cause a cardiogenic shock. However, the widespread deep neck abscess needed prompt surgical drainage. After a full discussion with the cardiologist and anesthesiologists, surgical drainage was performed under general anesthesia. Although congestive heart failure and pulmonary edema occurred during the perioperative period, intensive care including the use of diuretic and atrial natriuretic peptide (ANP) improved the patient’s condition. Abnormal left ventricular movement disappeared on the 18^th day. The patient was discharged from the hospital on the 35^th day.
Takotsubo cardiomyopathy has gained attention since recent studies pointed to a close relationship between stress and the condition. We should therefore be familiar with the characteristics of this disease because there is a chance we will encounter it in daily practice.

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Patients with Hunter syndrome have progressive deposition of glycosaminoglycans in the soft tissue of the throat and trachea, and tend to have a big tongue and coarse facial features. The deposition is thought to be responsible for airway obstruction. We report herein on a 20-year-old man with Hunter syndrome with dyspnea, whose airway obstruction became severe with stenosis of his trachea and bronchus. He was treated with insertion of a metallic stent which improved his airway symptoms for several months. Unfortunately, although he had planned to have a stent operation for his narrow airway, he suddenly died from cardio-respiratory arrest before he could have the operation.

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We often come across cases of peripheral facial palsy, most of which can be cured with medication. We report herein on a case of breast cancer, found in a patient with recurrent facial palsy. A seventy-year-old female with facial palsy was cured once, but a few weeks later, facial palsy occurred again. We suspected a tumor as the cause of the recurrent facial palsy. We examined the patient with temporal bone CT and head MRI imaging and found a mass region with bone destruction on images of the temporal bone. When we did an excisional biopsy under general anesthesia, we unexpectedly identified the mass as a locally advanced breast cancer. Finally the patient was diagnosed as having a peripheral facial palsy caused by a metastatic tumor from breast cancer.
Breast cancer associated with facial palsy is rare, but when the facial palsy recurs or occurs slowly, with facial spasm or with otitis media with effusion, we should consider the existence of a tumor, especially metastatic tumor from breast or lung cancer.

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Otolaryngologists are often requested to operate in the case of primary hyperparathyroidism which is almost always derived from a parathyroid adenoma and parathyroid hyperplasia. The diameter of such lesions is usually about 10 mm, based on the literature. We report herein on a surgical procedure we performed for a giant parathyroid adenoma. A 67-year-old man with bilateral lower limb pain, weakness and dysbasia was referred to Fujinomiya City General Hospital from a clinic in the city. Physicians diagnosed him as having primary hyperparathyroidism and a parathyroid tumor with various examinations, and requested us to extirpate the tumor. We performed a left inferior parathyroidectomy. The tumor measured 75×50 mm, weighed 70 g and was pathologically diagnosed as adenoma. Based on the data from various Japanese references, the tumor was considered as a giant parathyroid adenoma in Japan.

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Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep neck infection and has a high mortality rate. Therefore, we need rapid diagnosis and treatment. The reported strategies for DNM treatment have stressed the need for surgical management and adequate antibiotic administration. We experienced one case of DNM with a deep neck abscess. The patient was a 52-year-old male with acute epiglottitis, so we started antibiotic administration, and although the epiglottitis and inflammatory response were getting better, chest pain and dyspnea gradually occurred. We therefore performed CT scan imaging which showed signs of a gas forming abscess in both the neck and anterior mediastinum. Transcervical mediastinal drainage was performed by otolaryngologists and thoracic surgeons. In spite of the operation, the patient’s respiratory condition was getting worse, and a second operation was required via thoracotomic drainage. We should take account of gas-forming abscess as a severe case, therefore we considered a more extended drainage area and performed an additional operation. CT imaging is very useful for determining whether to perform surgery, including transcervical, mediastinal, or thoracotomic drainage.

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In 2001, Hamano and others reported elevation levels of serum IgG4 in autoimmune pancreatitis patients who demonstrated lymphoplasmacytic infiltrates and sclerosis in the pancreas. IgG4-related disease is a recently recognized systemic syndrome characterized by various systemic disorders，mainly occuring in exocrine tissue. A pathological organizational diagnosis of IgG4-related disease is easily managed with biopsy of the mandibular gland. We report herein on our experience with three cases of IgG4-related disease.

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Adenotonsillar hypertrophy is the most common cause of airway obstruction and sleep disordered breathing (SDB) in children. SDB in children is frequently associated with growth impairment. We report herein on a short-statured 4-year-old boy with SDB who underwent adenotonsillectomy (T&A). The following variables were evaluated before and after the operation in this patient: height, weight, serum levels of insulin-like growth factor-1(IGF-1) and insulin-like growth factor binding protein-3(IGFBP-3), bone age, the apnea hypopnea index (AHI), the attention-deficit hyperactivity Index-IV (ADHD-RS-IV), and a questionnaire regarding QOL. Serum levels of IGF-1 and IGFBP-3 increased after the operation. That also ameliorated all the other variables with the exception of bone age. These results indicated improvement of SDB after T&A might be related to amelioration of growth impairment in children.

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Japanese cedar pollen is the most common antigen responsible for allergic rhinitis in Japan. Antihistamine medication is commonly applied to reduce the symptoms of allergic rhinitis. Benifuuki is a kind of Japanese green tea with a high O-methylated catechin content. It was demonstrated to have an anti-allergic effect on allergic rhinitis in an animal model. The purpose of the present study was to demonstrate the effect of Benifuuki on allergic rhinitis induced by Japanese cedar pollen. We studied the difference between the effect of Benifuuki and Yabukita (normal green tea without O-methylated catechin as a placebo) green tea. The two kinds (Benifuuki and Yabukita) of Japanese green tea were prepared for the patients with cedar pollinosis. The subjects comprised 104 Japanese cedar pollinosis patients, who were requested to drink tea 2 times a day following instructions on how to make the tea. The effect of the two types of tea was evaluated with immunological examinations, blood sampling, rhinomanometry and questionnaires concerning allergic symptoms before beginning this study and every month from January 2009 until April 2009 for four months up to the end of the Japanese cedar pollen season. Both the Benifuuki and Yabukita beverages were effective for the improvement of nasal obstruction, with the greater effect seen from the Benifuuki beverage. Taking the Benifuuki beverage before the onset of cedar pollinosis offered a constantly better result for nasal obstruction month by month and it was effective even taking the tea after the cedar pollen season had started. Improvement of such symptoms as sneezing and watery rhinorrhea was demonstrated in subjects taking the Benifuuki beverage, and improved activities of daily living were also observed in these subjects. Nowadays Japanese green tea is recognized as one of the alternative medicines, and is common healthy drinking seen worldwide with no side effects. Benifuuki was proved to have a high potential to alleviate nasal obstruction in Japanese cedar pollinosis patients. The Benifuuki beverage was considered to be a beneficial way to control allergic rhinitis induced by cedar pollen.

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Benifuuki is a Japanese green tea containing O-methylated catechin, which has the potential to alleviate allergic rhinitis. For the peak Japanese cedar pollinosis season, patients used paper tissues impregnated with Benifuuki green tea extract to reduce the allergic response. This approach was effective for low level cedar pollen exposure, however, it was not enough to reduce the allergic reaction in the peak of the scattering season. Treatment with medication, including medicated tissues, is a common way for pollinosis patients to manage their activities of daily living well under pleasant conditions for low to medium levels of Japanese cedar pollen, but this approach had difficulty in controlling the allergic reaction when the levels of Japanese cedar pollen were high.
Side effects associated with some medications, such as tiredness, weariness, sleepiness, and dry mouth were often observed among allergy patients. Most patients want to take medication without side effects. The Benifuuki beverage is one of the beneficial ways to alleviate allergic rhinitis. Various ways of using tissues impregnated with Benifuuki extract were tried, such as wiping the areas around the nose with the tissues, blowing the nose, or putting the Benifuuki tissues into a mask also impregnated with the Benifuuki beverage.
Tissues with the Benifuuki extract assisted with a combination of the Benifuuki beverage itself proved to be a safe and more effective way to treat the allergic response to Japanese cedar pollinosis, but the need to develop a new strategy remains.

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Allergic rhinitis caused by scattering of pollen from the Japanese cedar tree is very common in Japan, lasting from the beginning of early February up to end of April in the Kikugawa area. Most of the patients complain of sneezing, watery rhinorrhea and nasal obstruction. These symptoms are induced by the large amount of pollen released by the Japanese cedar trees, and the scattering of the pollen is regulated by a number of weather conditions such as outside temperature, wind and rainfall. The purpose of this study was to investigate the factors which could influence Japanese cedar pollen scattering. For this purpose, the information on the pollen was provided by a pharmaceutical company and the weather conditions were provided by the Meteorological Agency. All data were recorded into a computer for statistical analysis. High peaks of cedar pollen were recorded three times during the cedar pollen season in 2009. The wind was often observed blowing from the Tenryu Area. Cedar pollen was carried not only from the Tenryu Area, which is famous for its Japanese cedar forests, but also from the surrounding mountain area. We found that a couple of days of cold temperature five weeks before a cedar pollen peak influenced the blooming of the cedar flowers and hence the production of cedar pollen. Each peak of cedar pollen proved to be coincident with the aforementioned weather situation. The scattering of cedar pollen was not correlated with the outside temperature, rainfall, humidity or the length of the daytime. The ability to forecast the timing of Japanese cedar pollen scattering to affected patients was thought to be important to allow preparation to minimize the allergic reaction to the cedar pollen. On the clinical side, the forecast of cedar pollen scattering promotes smooth patient care.

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In a retrospective clinical evaluation of serious bacterial infections, we reviewed 26 cases – 15 males and 11 females from 4 to 76 years old (median: 37.5) – treated with drip infusion of antibiotics without hospitalization at 7 months from January to July, 2007. The indications for drip infusion of antibiotics were acute tonsillitis in 9 cases, peritonsillitis in 6 cases including 2 cases with abscess formation, lymphadenitis of the neck in 3 cases, acute epiglottitis (stage I and III), laryngeal edema and acute laryngopharyngitis in 2 cases, and acute subglottic laryngitis and perichondritis of the auricle in one case. In a private clinic, observation of the laryngopharynx with a flexible endoscope fitted with a CCD (Charge–coupled device) image sensor and palpation of the neck were indispensable to the diagnosis of these diseases often complicating acute laryngopharyngitis and/or lymphadenitis of the neck. After earlier detection of these disease, the rate of treatment-completion without hospitalization in this one private clinic for drip infusion of antibiotics with or without corticosteroid complemented with oral antibiotics was 88%. Injected antibiotics were CTRX (Ceftriaxone Sodium) in 5 cases, PIPC (Piperacillin Sodium) in 6 cases, FOM (Fosfomycin Sodium) in 11cases, and PIPC combined with FOM in 4 cases of critical infection. A single dose of corticosteroid in 11 cases with severe inflammation was 300 mg or 600 mg of hydrocortisone sodium succinate. With the good cooperation between hospitals and clinics, improving the treatment-completion rate in clinics could have contributed to reduce not only the burden on hospital doctors but also the medical expenditure.

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The middle ear negative pressure hypothesis and the migration hypothesis have been quoted as two major etiological theories for middle ear cholesteatoma. Various infections in the outer ear canal and the tympanic membrane may cause middle ear mucosal infection and bone destruction in the similar way as middle ear infection does. One acute infant case and another quiescent adult case are presented herein in support of the eardrum infection hypothesis.

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For 10 years from 1995 to 2005, 2281 cases of vertigo were studied in my private clinic. For diagnosis, taking the detailed present history, examinations of nystagmus, body equilibrium and hearing were done. The recent tendency of vertigo patients showed increase in accordance with the aged. The marked increase was seen in female. The majority of the diseases was benign paroxysmal positional vertigo. As the background of vertigo, sleep disorder and various stresses were considered. As many patients were referred to my clinic from physicians, the importance of collaboration with various medical fields for the treatment of vertigo was emphasized.

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