IgA nephropathy (IgAN) is the most common form of glomerulonephritis worldwide. The progressive nature of this disease results in approximately 40% of IgAN patients experiencing end-stage renal failure (ESRF) within 25 years of diagnosis. To obtain a clinical remission of IgAN, we have used a combination therapy consisting of steroid pulse and tonsillectomy. In the present paper, the results of the retrospective investigation of the renal outcome in 329 patients having IgAN exceeding 36 month observation period were summarized.
1) The initial Scr level, histological score, tonsillectomy, and high dose methylprednisolone had a significant impact on clinical remission, but proteinuria, age, gender, levels of hematuria, blood pressure, conventional steroids, angiotensin converting enzyme inhibitors, and cyclophosphamide had no significant effect. 2) In patients without clinical remission, the Kaplan-Meier estimate of the probability of progressive deterioration was 21 ± 5% at 10 years. On the other hand, none of the clinical remission patients showed progressive deterioration, defined as a 50% increase in serum creatinine (Scr) from the baseline, during the observation period. 3) Repeat biopsies showed the complete disappearance of active glomerular lesion and a significant decrease in mesangial proliferation and tubulo-interstitial changes.
These findings indicate that intervention aimed at achieving clinical remission may produce encouraging results applicable to the management of patients with IgA nephropathy and that mesangial proliferation and interstitial changes in IgAN are reversible to a large extent.

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We reviewed 154 patients at 10 years after tonsillectomies and 37 patients without tonsillectomies.
1) Pharyngitis decreased to three times per year or less after the operation in 90% of the patients not older than 15 and in 84% of those 16 or older.
2) Pharyngitis decreased within one year after the operation in 80% of the patients not older than 15 and in 60% of those 16 or older.
3) Fevers decreased at least 2°C in 61% of the patients not older than 15.
4) In the patients who had had no tonsillectomies, the incidence of tonsillitis had decreased natually by the age of 11.4 years on average.
5) A high fever did not resolve spontaneously in the patients without tonsillectomies.
6) A tonsillectomy can be useful for recurrent tonsillitis, considering its social benefits.

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A postoperative course was reported for children under 3 years of age, who had had a history of recurrent tonsillitis. Remarkable effects was observed on 90% of the cases followed up at least for 5 years after tonsillectomy. Moreover, no negative symptoms were seen among them after the operation.
Nevertheless, after tonsillectomy congenital diseases were found in a few cases, or allergic diseases such as allergic rhinitis appeared. Although those are tendencies specific to infants, we must carefully observe them with considerations.
And it is well known that in infants, recurrent tonsillitis sometimes heals naturally. So it is considered that tonsillectomy for recurrent tonsillitis is indicated in infants beyond two and a half years of age.

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Autobipolar coagulation (BC) and argon plasma coagulation (APC) offer a new possibility for the tonsillectomy because of its accurate and effective hemostasis. BC provides pinpoint hemostasis, whereas APC makes a broad hemostasis with limited penetration depth of the coagulation zone. We report the efficacy of an electrotonsillectomy by the use of BC and APC compared with a conventional nonelectrotonsillectomy. A significant difference in operating time and in intraoperative blood loss occurred regardless of the ages of the operators. In conclusion, BC and APC offer an innovative new tonsillectomy method with significant reduced blood loss and surgical time.

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Tonsillectomy requires efficient intra- and postoperative hemostasis. The ultrasonically activated scalpel (UAS) uses high-frequency ultrasonic energy to perform tissue dissection and coagulation simultaneously.
In this study, we performed a comparative study to investigate the usefulness of the UAS in tonsillectomy. Twenty-seven patients undergoing tonsillectomy were examined in regard to intraoperative hemorrhages. We also investigated postoperative pain, quality of sleep, appetite, and QOL by using a visual analogue scale (VAS) for 7 days postoperatively. Six patients were operated on by the use of UAS alone, 6 were operated on by the use of UAS and an electrocoagulator, and the remaining 11 were operated on by the conventional method. In the UAS-alone group, 4 of the 6 showed no bleeding intraoperatively. As for postoperative pain, this group showed a significantly better score for 7 postoperative days. It also indicated a good score in the quality of sleep, appetite, and QOL for 7 postoperative days. We have found UAS to be safe and with advantages over conventional methods. The surgical technique and advantages of UAS are discussed.

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Surgical treatments such as uvulopalatopharyngoplasty (UPPP) or uvulopalatoplasty (UPP) have been reported to be effective for sleep related respiratory disorders. Recently, however, long-term evaluations have not been as good as expected. In the present study, we analyzed the data of 55 patients who had undergone surgery for sleep related respiratory disorders. All patients were analyzed with nocturnal polysomnography (PSG) before and soon after the surgery, and in 25 of them the evaluation was continued for more than 6 months after the surgery.
The mean apnea plus hypopnea index (AHI) in the 55 cases improved from 36.9±23.0 to 12.8±15.4. In 35 cases (63.6%), we discovered a 50% or greater reduction in AHI after surgery.
Twenty-five cases were available for study for 6 months or more, in which mean AHI improved to 18.0±15.0, from 38.6±21.0, with an improvement of 50% or more in 56.0% of the patients. The lowest SpO2 increased to 76.9±10.3%, from 64.6±13.1%.
We also report a case of severe restenosis of the nasopharynx after UPP. AHI was improved temporarily soon after the surgery, to 4.7, from 60.7; however, it rose again to 26.8 with a recurrence 3 years later.
Similar to other reports, the long-term results following surgery were not as good as had been expected. Moreover, several cases with complications or recurrence were found. Surgical treatment such as UPPP or UPP must therefore be selected very carefully, with consideration of the many interrelated factors involved in sleep related respiratory disorders.

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Radiofrequency volumetric tissue reduction (RFVTR) was applied to five male and four female patients with mild sleep apnea syndrome and simple snoring. Low-power radiofrequency energy was applied by a needle electrode to the soft tissue at the midline followed by two lateral injections at half the energy level. The procedure was repeated to a maximum of 3 times.
Eight of nine patients were satisfied with this new method, and their bed partners were also delight at the reduced bothersome snoring. Apnea-hypopnea index varied depend on the cases before and after surgery. All patients had pain after the surgery, but medication such as painkillers relieved their symptoms completely. No major complications occurred during the trial, for example, bleeding, infection, swallowing difficulty, speech deficits, or death. Mucosal ulceration on the oral surface of the palate occurred after 22% of the treatments (3 ulcerations after 18 total treatments). It was concluded that our 9 patients reported improvements in the elimination or lessening of snoring, with having relatively minimal side effects and discomfort, when the radiofrequency energy parameters described herein were used. A further study of using RFVTR will soon be conducted.

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For the assessments of the examination methods for patients with sleep-disordered breathing, we investigated examination methods that had been performed for patients with suspected sleep apnea syndrome at the departments of otolaryngology of university hospitals in Japan. There were seventy-one (82%) institutions in which some examinations had been performed. Sleep tests were performed in sixty three (88.7%) of them, and the test of Level IV, such as a continuous single-or dual-bioparameter recording monitor, were used in half. The decision of obstructive area through the airway was not performed in more than half the institutions. We suggest that the test of Level III, such as the modified portable sleep apnea testing, is recommended to diagnose sleep apnea syndrome, and the nasoendoscopy in diurnal sleep with diazepam is a suitable method of the decision of obstructive area.

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Tonsillectomy in adult patients is more difficult and needs a longer time to stop bleeding from the tonsillar bed than in pediatric cases because of a strong adhesion between the palatine tonsil and the connective tissue around the tonsil. With this in mind, we describe a new technique of tonsillectomy for adult patients by using a KTP laser. In KTP laser tonsillectomy, a KTP/532 laser beam is applied to tissue through the guide fiber inserted in the handpiece. The connective tissue around the tonsil is cut and simultaneously coagulated by KTP laser, resulting in an operation time shorter than required by conventional method. It is recommended that the surgeon directly observe the tonsillar capsule during surgery to prevent penetration into the tonsillar tissue or muscular tissue around the tonsil, and furthermore to stop bleeding immediately. The advantages of this procedure are therefore that there was a reduction in intraoperative blood loss and in average time for removing one tonsil. The disadvantage is that laser surgery appeared to lead to slow wound healing during the entire postoperative course. Considering safety and reliability during surgery, however, the KTP laser is useful for tonsillectomies on adult patients.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Ara-C has only limited activity against most of solid tumors, including head and neck squamous cell carcinoma. The reason for this is thought to be that the expression of cytidine deaminase, an enzyme which degrades ara-C, is high, whereas the expression of dCK, which phosphorylates ara-C, is weak in solid tumors. The present study demonstrated that adenoviral vector-mediated transduction of the dCK cDNA results in marked sensitization of head and neck squamous carcinoma to the cytotoxic effects of ara-C both in vitro and in vivo. These data suggest that the dCK/ara-C system may be a useful approach for gene therapy of squamous cell carcinomas of the head and neck.

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The inspection of the tongue is one of the important diagnostic methods in traditional oriental medicine. This diagnostic method is based on “the idea of organic whole, ” which is a fundamental concept of this medicine. The characteristics of the tongue that is a local part of the body show conditions of the whole body.
The parts of the tongue as a root, middle, edges, and tip reflect a functional situation of these organs: kidney, spleen, liver, and heart/lung, respectively, in terms of the physiological concept of the Oriental medicine. The color of the tongue's body and fur and the tongue's tension are influenced by the level of activity that is “yang.” The size and shape of the tongue and the thickness of its body and fur are influenced by the volume of body fluid that is “yin.”
These analyses of the tongue provide us with information for pathophysiological understanding that introduces us to a diagnosis and therapy. For example, the redness at the tip of the tongue indicates the existence of the extra heat in the lung or heart, or in both, which tends to cause a dry-type of inflammation in the mouth associated with sleeplessness. This should be treated with appropriate herbal medicines by cooling the lung or heart, or in both to reduce the extra heat. Other examples and a case study are mentioned in the text.

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