In these days, endoscopic surgery become a common technique for use in various organs, especially in treatment of biliary tract disease. Rapid evolution of laparoscopic surgery, due in part to development of new instruments and machines, has made it possible to cure neck diseases.
In 1998, we started minimally invasive endoscopic surgery for treatment of benign tumors in the neck. Most difficult problem of endoscopic surgery for the neck region is pneumomediastinum that is brought by insufflation using to make working space. Our new technique basically enabled to performe endoscopic neck surgery without insufflation. Concequently, the potential risk of insufflation-related complication was disappeared.
In this review, we report our new technique of minimally invasive endoscopic surgery for neck masses using neck region lifting method.

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The present study was designed to investigate seasonal changes in immune responses to Japanese cedar (Cryptomeria japonica (CJ)) pollen allergens in humans with CJ pollinosis. Peripheral blood samples were collected from eighteen patients with CJ pollinosis before and after the CJ pollen season (April 2000, January 2001, April 2001 and September 2001). Seasonal changes in not only IgE responses but also T cell proliferative responses were analyzed before and after CJ pollen season. Two patterns of seasonal changes in immune responses among pollinosis patients were apparent. In one pattern, immune responses at the T cell and IgE level are induced during the pollen scattering season and decrease gradually after the season ends, as reported previously (variable group). In the second pattern, the immune responses do not decrease and are maintained until the next pollen season (continuous group). Patients in the latter group suffer from CJ pollinosis for long periods of time and their nasal symptoms appear earlier than in the variable group. DNA typing of HLA-class II antigens revealed that the genotype frequency of DPB 1*0501 was higher in pollinosis patients, but no difference was observed between the variable group and the continuous group. In conclusion, this study suggests that early nasal symptoms in CJ pollinosis patients are the result of immune responses that have been maintained at a high level since the last pollen season.

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Our department has been treating patients with tongue cancer since 1946. Until the early 1980 s, treatment for primary lesions consisted mainly of a small dose of radium irradiation, regardless of the clinical stage. The approximate 5-year survival rate for progressive tongue cancer with a staging of greater than T 3 was as low as 20.3% (N =137) between 1946 and 1970. Irradiation methods have since improved, and the resection-reconstruction method using a deltopectral skin flap had been introduced. In addition, a trend has emerged towards performing surgical treatment and reconstructions using a greater pectoral muscle skin flap. As a result, the approximate 5-year survival rate for T 3+ T 4 tongue cancer improved to 37.0% (N =40) for the period between 1971 and 1980.
In 1982, a reconstruction technique using a free skin flap with the goal of reconciling the preservation of function and an improvement in the clinical results was established. Treatment protocols have changed drastically since then, making it possible to perform an extended resection while maintaining the swallowing function. As a result, the approximate 5-year survival rate for T 3+ T 4 tongue cancer has improved to 51.6% (N =126).
This paper describes the clinical outcome for stage III and IV progressive tongue cancerstreated mainly by surgery over the past twenty years. The subjects included 192 cases of stage III or IV squamous cell carcinoma of the tongue ; all of the subjects underwent radical operations between January 1981 and December 1999. The approximate 5-year survival rate (disease-specific survival rate) for stage III cancers was 65.3% (71.8%) (N=123), while that for stage IV cancers was 38.2% (40.0%) (N =69). The 5-year primary lesion control rate according to T classification was as follows : T 1, 100%, T 2, 83.8%, T 3, 81.7% ; and T 4, 77.4%. The 5-year neck control rate was 77.1%.
Our department, in principle, usually administers external irradiation at a dosage of 40 Gy. We histologically reclassified biopsied specimens of primary lesions according to the efficacy of preoperative irradiation and studied the relation between preoperative irradiation and the clinical results. The appearance rate was 40% (53/132) in the group that was an responsive to irradiation and 60% (79/132) in the group that was responsive. The difference in the primary lesion-neck control rates and the approximate survival rates of the two groups was significant (p <0.05). Some cases responded to irradiation treatment even at a dosage of 40 Gy. These results suggest that preoperative irradiation is an effective adjuvant therapy in the treatment of progressive tongue cancer, since there is a limit to the improvement in clinical results that can be obtained by surgical treatment alone.

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Polysomonography is useful for assessing the severity of sleep breathing disorder, including obstructive sleep apnea hypopnea syndrome. The clinical condition is difficult to understand completely, however, based on the apnea hypopnea index (AHI) alone, however, and longitudinal change of shape in the upper airway must be clarified. Most diagnoses of obstructive sites in the upper airway were diagnosed statically, so we attempted to assess changes in upper airway shape using dynamic magetic resonance imaging (MRI), emphasizing the movement of tongue and lower chin, to analyze the relationship between AHI.Subjects were 62 patients with sleep breathing disorder examined by nocturnal polysomnography and dynamic MRI, assessing the change of shape in the upper airway. We concluded that : the group whose rotation angle of the tongue exceeded 6° and that the group whose distance of lower chin movement was longer during sleep than while awake were severe cases.

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The effects of Harmonic Scalpel surgery on the inferior turbinates of 35 patients with perennial allergic rhinitis were studied. At least 1 year after surgery, the percentages of patients in whom sneezing, nasal discharge, nasal obstruction and quality of life had improved were 56%, 66%, 71% and 79% respectively. The quality of life of younger patients, in particular, significantly improved after surgery. Harmonic Scalpel surgery is an effective treatment for perennial allergic rhinitis.

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Audiometry and measurement of 2 otoacoustic emissions-transiently evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) -were done over time in patients with sudden deafness, and the relationship between the prognosis of hearing and the detection of otoacoustic emissions was evaluated. Results showed that at a low wavelength band of 1, 000 Hz, there was strong involvement of TEOAE, whereas at a high wavelength band of 4, 000 Hz, involvement of DPOAE was slightly higher compared to TEOAE. These results show some degree of agreement with findings reported to date in the literature. Measurement of otoacoustic emissions has been said to have little usefulness in estimation of the prognosis of sudden deafness.
However, sudden deafness can be classified based on audiograms. Supplemental measurement of the 2types of otoacoustic emissions, TEOAE and DPOAE, presents the advantage of providing additional information. We surmised that simultaneous measurement of TEOAE and DPOAE has value since it enables objective judgment of the site of injury in the inner ear and generates clinically useful information.

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[in Japanese]

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