The incidence of multiple primary cancer in the head and neck region has increased year by year. Of the 131 cases of cancer of the mesopharynx or hypopharynx treated in our hospital between 1986 and 2001, 38 had multiple primary cancers by December 2002. Esophageal cancer had developed in 13 patients with cancer of the hypopharynx and in 4 patients with cancer of the mesopharynx. Seven of the ten patients with simultaneous esophageal cancer and cancer of the mesopharynx or hypopharynx were treated by radiation in 4 cases, by pharyngolaryngoesophagectomy followed by pull-up gastrotomy in 3 cases. Sake index was significantly higher in the group with cancer of the mesopharynx or hypopharynx associated with esophageal cancer than in the group without any secondary primary cancer. Endoscopic examination with Lugol staining should be routinely performed for early detection of second primary esophageal cancer, before and after treatment of head and neck cancer.

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Among patients whose chief symptom is olfactory disturbance, occasional cases have been shown not to have anosmia, based on the results of T&T olfactometry, despite having no reaction or an obscure reaction to the Alinamin test. These cases include many that cannot be explained by the interpretation that the olfactory sense is absent because the closure of the posterior nasal foramen prevents odor elements from reaching the olfactory fissure. To characterize the clinical patterns of these cases, cases shown not to have anosmia according to T&T olfactometry were divided into cases that had no reaction to the Alinamin test and those that had an obscure reaction. These two groups were then classified according to cause, remaining olfactory element, subjective symptoms and clinical results and a comparative study was performed. When classified into normal or abnormal groups, cases with no reaction to the Alinamin test generally belonged to the abnormal group. These two groups cannot be regarded as belonging to the some category in many respects, including causative disease, remaining olfactory element, and clinical results. Even if a patient has an abnormal Alinamin test result, the patient's condition is not necessarily inucurable, and medical treatment may provide same benefits.

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Postoperative maxillary multilocular cysts are a difficult disease to diagnose and treat. Nine cases of postoperative maxillary multilocular cysts with 3 or more cysts on one side were reviewed. A combination of CT and MRI is useful for precise counting and localization of the cysts. Endoscopic sinus surgery (ESS) was performed in 7 cases, and both Caldwell-Luc operation and ESS was performed in the other 2 cases. We classified the lesions into 3 types ; vertical, horizontal, and mixed, to decide on the surgical procedure and to assess the outcome. Postoperative maxillary cysts that were located far from the nasal cavity closed regardless of which surgical procedure was used. One patient was developed copious bleeding while operation, so it is necessary to consider dislocation of artery because of maxillary deformation. However it is difficult to decide which cyst causes symptoms, a review of a series of cases was generally uneventful. Therefore we consider that cysts should be opened as much as possible.

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We studied the relationship between acoustic neuroma and detection of otoacoustic emission (OAE) in three patients with this disorder by (1), measurement of transiently evoked OAE (TEOAE) and (2) measurement of distortion-product OAE (DPOAE). In two of the three, OAE was detected in the frequency range for which sensorineural hearing loss was found by standard audiometry. Most cases of hearing loss in patients with acoustic neuroma consist of a mixture of inner ear hearing loss and retrocochlear hearing loss, and the intensity of OAE is not uniform. No significant correlation is associated between acoustic neuroma and detection of OAE, but successful detection of OAE, as in our patients, leads to a possibility that the severity and location of inner ear disorders can be surmised. If we consider the advantages of OAE detection noninvasively and simply, this becomes a clinically useful examination.

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We report three cases of sphenoid sinus retention cyst with headache treated in our department in which clinical improvement was achieved by surgery. Retention-cysts most commonly occur in the maxillary sinus, and they are infrequent in other paranasal sinuses. However, since no symptoms develop in the majority of cases, surgery is not performed. All 3 of our patients complained of headaches, and a CT scan revealed a cyst shadow in the sphenoid sinus on one side. We performed Endoscopic Sinus Surgery (ESS) by opening the sphenoid sinus and aspirating the cyst with a microdebrider, etc. The recovery process was good in all three cases, the headaches resolved, and no recurrences have been detected on CT scans. Based on these results, the retention cysts of the sphenoid sinus were concluded to have caused the headaches, and we concluded that surgical treatment must be considered in patients with headache. We considered the choices of surgical approaches to the sphenoid sinus lesion alone, dividing the approaches to the sphenoidal sinus into routes via the olfactory cleft, from the upper concha, the anterior ethmoid sinus in the middle meatus, and the posterior ethmoid sinus in the superior meatus.

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Angiomyolipoma is a benign tumor that most commonly forms in the kidney and is sometimes associated with tuberous sclerosis. Here we report a rare case of angiomyolipoma of the nasal cavity. A 56-year-old male patient presented with a firm swelling in his right nasal vestibule. A CT scan revealed a mass in the right nasal vestibule without bony destruction. The patient had no clinical signs of tuberous sclerosis. The tumor was completely extirpated via a transoral approach, and the diagnosis of angiomyolipoma was confirmed histopathologically. The patient has remained free from disease for eight months since the surgery.

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Rapid advances in genomics have led to a paradigm shift in biological investigation. The number of studies using the genomics tools such as microarray technology is logarithmically increasing. Here, I introduce some successful genomic studies in relation to allergic diseases. In human beings, the immune system developed as an ingenious device for defending against frequent attacks by microbes. Therefore, our immune system seems to have become deranged in our recent, unprecedented hygienic environment. It is now necessary to understand the total functional elements comprising the immune system, not just a single molecule present in an immunocyte working in our immune system.

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