Reconstruction of the tracheal wall is a difficult task for us head and neck surgeons after removal of thyroid carcinoma. Many techniques for the reconstruction have been reported in the literatures, and they are discussed in this paper. End to end anas-tomosis of the trachea is the most reasonable way to preserve the rigidity and elasticity that are essential for the trachea, and has been performed in many cases. In some cases, however, end to end asastomosis is not indicated because the defect is narrow or extends over the length of 5 tracheal rings. Staged reconstruction such as trough method can be used in these cases as an option for it. It is composed of the criation of lateral wall by transplanting a rib is followed by the anterior wall plasty using pieces of auricular cartilages with an anterior chest skin flap. Surgical techniques are reported in 3 methods of staged reconstruction. The author stressed that the lateral wall should be rigid enough to sustain the tracheal lumen, while the anterior wall should be elastic and proof against the traumatic force. Possibility of the use of artificial materials such as silastic mesh or collagen is also discussed.

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We investigated the effect of environmental toxic factor-formaldehyde and ultraviolet B (UVB)-on allergic reaction by using mouse bone marrow derived mast cell (BMMC). BMMC were obtained from the culture of Mouse bone marrow cell (BMC) in the RPMI-1640 medium containing WEHI-3 condition medium (culture medium) for 3-4 weeks. BMC were co-cultured with 0.2-2.5μg/ml formaldehyde for 3 weeks in the culture medium. Another BMC were irradiated UVB (300nm, 0.56-70 mJ/cm²) and cultured for 3 weeks in the culture medium.
Histamine content in, histamine release from and expression of IgE-receptors on membrane of BMMC treated with formaldehyde was significantly increased when compared with control. These results showed that BMMC cultures treated with fromaldehyde had altered biochemical and functional properties.
The percentage of alcian blue positive cell (BMMC) were decreased by UVB irradiation dosedependently. And UVB irradiation increased histamine content in BMMC and expression of IgEreceptors on membrane of BMMC. But decreased percentage of histamine release from BMMC that derived from low dose UVB radiated BMC. We considered that allergic reaction through the mast cell is suppressed by low dose UVB radiation and is promoted by high dose radiation.

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Reach of gargling liquid was observed in healthy 21 subjects (11 men and 10 women). The subjects, gargling with contrast medium (Baritop 120 ®) diluted with water, were examined by fluoroscopy. The examination was recorded by video tape recorder and digital image management apparatus.
We confirmed that gargling was devided into three types: fauces type in which gargling liquid reaches fauces, tongue root type in which gargling liquid reaches tongue root, and hypopharynx type in which part of gargling liquid reaches hypopharynx via vallecula. Of 21 subjects, 11 (52.4%) were fauces type, six (28.6%) were tongue root type, and four (19.0%) were hypopharynx type. To examine male and female separately, four subjects were fauces type, four were tongue root type, and three were hypopharynx type in male, besides, seven were fauces type, two were tongue root type, and one was hypopharynx type in female.
On the basis of this result, we concluded that effect of gargling differs depending on gargling types. Namely, tongue root and hypopharynx type were more effective than fauces type. In all three types, gargling liquid did not reach larynx. Consequently, gargling was not effective on laryngitis directly.

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Neurilemmoma is a benign tumor deriving from schwann cells. It is relatively uncommon that tumor occurs in the parapharyngeal space. Two cases of the parapharyngeal neurilemmoma are reported.
Case 1 was a 44-year-old woman who complained of a swelling about the right subaural region and the lateral r pharyngeal wall. CT and MRI showed a 40×30×25mm smooth-surfaced tumor at right parapharyngeal space. Preoperative diagnosis was neurilemmoma. The tumor was removed using cervical approach.
Case 2 was a 62-year-old woman who complained of a swelling at the left lateral pharyngeal wall. Imaging diagnosis revealed 50×40×35mm tumor at left parapharyngeal space adjacent to the deep lobe of the parotis. Preoperative diagnosis was benign parotid tumor. The tumor was removed using the cervical approach.
In both cases, histological diagnosis was neurilemmoma with Antoni type A+B. We could not determine which nerve it derived from in neither of the cases.

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In 1995, we experienced a marked prevalence of cedar pollinosis, which led us to further investigation for pollinosis in spring. To examine the actual condition, questionnaire were sent to the hospitals, in which 46 of them or 84% in the total, replied. In 1995, there were 7, 930 cases of cedar pollinoisis and 5, 995 cases of orchard grass pollinosis. According to the data obtained from our clinic for the past 6 years, the number of the patients with cedar and orchard grass showed antagonistic distribution in its relation, for example, cedar polliosis prevalence with faded incidence of orchard grass polliosis. Concern-ing to the relationship between the count of the cedar pollen and the number of the patients, these two items were in a direct proportion. More than half patients had visited hospitals before the accumulation of the pollen reached 50% of the total amount, that means a number of patients developed nasal allergy with few pollen in the beginining of the cedar season. In Ishikawa prefecture, orchard grass sometimes plays an important role for nasal allergy in late spring following cedar season.

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Hemangiomas of the larynx are thought to be rare.
A case of hemangioma of the larynx in a 81-yearold male is reported. The patient had no subjective symptom but he was pointed out laryngeal mass during GIF examination by a physician, then referred to our hospital.
We diagnosed the case as laryngeal hemangioma and performed sclerotic therapy under general anesthesia with Monoethanolamine oleate.
Sclerotherapy was effective in this case and there was no sign of recurrence during the 1 year after operation.

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In ordinary medical examination, otorhinolaryngologists rarely encounter patients with internal jugular vein thrombosis. We encountered two patients with this disease, which are reported in this paper.
Case 1 was a 41-year-old male who had undergone operation for cerebral aneurysm and was under postoperative monitoring. Left jugular vein thrombosis occurring with this patient was thought to be ascribable to cellulitis of the neck caused by propagation of inflammation from the wound of tracheotomy and to frequent central venous catheterization. Case 2 was a 57-year-old male. In this patient, the origin of left jugular vein thrombosis was judged to be spontaneous since he had no particular disease.
In both cases, diagnosis of jugular vein thrombosis was relatively easy because contrast CT findings included chracteristic ring-like enhancement, etc. In addition to CT imaging, angiograhy (especially intravenous digital subtraction angiography) was very useful for determining the thrombotic region, the degree of venous occlusion with thrombi, and others.
In Case 1, thrombotic left jugular vein was resected, but swelling of the left upper limb appeared later. This was due to new thrombosis thought to be caused by surgical procedure, and thrombosis was seen in a wide area extending from the left axillary vein to the central side. Fortunately, however, there were no clinical symptoms indicative of pulmonary embolism. In Case 2, anti-platelet therapy using ticlopidine hydrochloride was performed, which resulted in disappearance of thrombi in image diagnosis (contrast CT and MRI).
Through these two cases, we learned that much care must be exercised in surgical approach to internal jugular vein thrombosis since there is risk of causing serious complications, such as pulmonary embolism, in association with liberation of thrombi. A variety of underlying diseases may be present behind internal jugular vein thrombosis. Therefore, when this disease was suspected, appropriate tests, such as ultrasonic tomography, CT, MRI and angiography, should be performed as soon as possible, and the best approach selected.

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A retrospective study was made of 113 cases undergoing endoscopic endonasal sinus surgery under general anesthesia. Said time was 78.8 min in general anesthesia and 90.3 min in local anesthesia. Operation time was thus shorter in genaral anesthesia, and moreover there were no cases in which noticeable increase in the amount of hemorrhage of serious postoperative complications were observed. In the past, general anesthesia was employed in few sinus operations because it tended to cause larger amount of hemorrhage than local anesthesia. However, the technology of general anesthesiology and social set-ting have changed, and thus we think that general anesthesiology should be attempted more aggressively in endoscopic endonasal sinus surgery.

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Since the new simple myringoplasty after Yuasa's method was developed seven years ago, it has been applied to more than three thousand of cases of chronic otitis media with perforated eardrum. From the experiences of these operations, the following facts were apparent: 1) the recurrent aural discharge in the cases of chronic otitis media can almost be controlled by the simple closure of perforated eardrum by myringoplasty, 2) this simple method could be indicated not only for a small, central perforation but also for a big or a marginal perforation, 3) according to the long-term follow-up studies more than 6 months, the success rate for complete closure was 84.5% and this value can increase to 89.7%, if the postoperative condition with a very small hole in the drum can be also assessed to be clinically success, 4) this simple but reliable method can provide a lot of benefits for those who have an eardrum perforation with hearing loss and recurrent otorrhea.

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[in Japanese]

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[in Japanese]

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