[in Japanese]

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[in Japanese]

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Pediatric sleep apnea patients shows irregular breathing, snoring, sleep apnea and retraction of the anterior chest during sleep. Snoring is considered to indicate the upper airway stenosis and the respiratory effort during sleep. Nasal obstruction and tonsillar hypertrophy are the main causes which induce sleep related breathing disorder in children, because they are obligatory nasal breather due to anatomical structure. Pediatric cases usually indicate sleep apnea symptoms. Although the number of the sleep apnea is less, but the continuously elevated respiratory effort induces the same symptoms as adults. We can diagnose precisely the elevated respiratory effort if we measure the intra-esophageal pressure during sleep in pediatric cases.
Main symptoms of the pediatric cases are mouth breathing, sleepiness, irritability, chest deformity which are expressed as adenoid face appearance. Sleep-wake rhythm disturbance are frequently observed such as late and forced awakening in the morning, long naps in the afternoon and late and forced bedding at night. Careful attention must be made when we diagnose pediatric sleep related breathing disorder.

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[in Japanese]

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[in Japanese]

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We investigated the indications for tonsillectomy in patients with IgA nephropathy based on the longterm results of treatment and the prognostic factors that can predict the effect of tonsillectomy for the prevention of renal failure.
Subsequently, indication criteria for tonsillectomy in patients with IgA nephropathy were proposed based on the contents we investigated. They are as follows.
1) IgA nephropathy is definitively diagnosed by evaluating the renal glomeruli at renal biopsy.
2) Tonsillectomy is indicated for patients with Grade I to III renal pathology and with a serum creatinine level of 2.0 mg/dl or less at renal biopsy. However, even among patients with Grade IV or with aserum creatinine level more than 2.0 mg/dl at renal biopsy, surgery should be considered in the absence of contraindications for tonsillectomy, such as renal hypofunction, when they want to undergo surgery and informed consent is obtained.
3) Medical history includes deterioration of urine findings at tonsillitis or acute upper respiratory inflammation.
4) As local findings of the palatine tonsil, buried tonsils and attachment of pus plugs to the tonsillar crypt are observed.
5) Positive findings, especially positive urine findings (hematuria), are detected on tonsillar provo cation test.
Items 1) and 2) are essential. Items 3) to 5) are reference items, as no previous study meets the evidence.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Obstructive sleep apnea (OSA) is characterized by nocturnal collapsing of the upper airways. Consequently complete cessation of breathing or reduced breathing phases appears. OSA is a widespread disorder affecting up to 11% of the male and up to 6 % of the female population. It is associated with serious consequences such as myocardial infarction, stroke, hypertension and traffic accidents. Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea syndrome (OSAS). Long-term compliance rates do not exceed more than 60 to 70 %. Other options like surgical procedure exist. But only one surgical procedure won't be successful in cases of moderate and severe OSA because one surgery will enlarge the airway only at one location. Alternative multi-level surgeries are of interest, combining procedures at the level of the base of tongue and the soft palate in order to stabilize the whole upper airway like the CPAP-ventilation. Several multi-level surgery concepts exist. Our multi-level surgery based on the hyoid suspension with the combination of a radiofrequency therapy of the tongue base brings out the effectiveness of this concept. With this concept we achieve a success rate of 57.6 %; this result situates us at the average level of the cited multi-level surgery studies. With this success rate this protocol can replace the CPAP mask especially in cases with CPAP intolerance or decline

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We introduced a new treatment for hypogeusia, and reported the results and future issues of this treatment in 38 patients. We developed topical injection of a steroid to the oral floor adjacent to the lingual nerve;we administered this procedure 3 times every two wk, and evaluated the treatment response 6 wk after treatment. The pretreatment and posttreatment means on an electric taste function test were 28.0 dB and15.0dB, respectively, showing improvement. In patients with normal serum zinc levels, the pretreat ment mean was 28.2dB, and was improved to 13.7dB after treatment, whereas in patients with a decrease in the zinc levels, the pretreatment and posttreatment means were 27.2dB and21.5dB, respectively. Therefore, we performed this procedure in patients with normal zinc levels, suggesting that it is less effec tive at these levels, but initially administer substitution therapy with zinc to patients with a decrease in the zinc level, and performed this procedure when they did not respond. To date, this procedure has been performed in more than 50 patients;however, no serious side effects have occurred. To confirm the effica cy of this procedure, data should be collected from a larger number of patients.

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Objectives: To clarify problems about treatment for oropharyngeal cancer . Patients & Methods: From 1971 to 1998, 264 patients with oropharyngeal squamous cell carcinoma were treated at Cancer Institute Hospital, Tokyo. Early tumor was irradiated 60 Gy. Advanced tumor was irradiated 40 Gy followed by surgical treatment when the primary site remained or followed by full dose radiation when it disappeared clinically. Results: Cause-specific 5-year survival was stage I, 100 %, stage II, 85 %, stage III, 76 %, stage IV, 43 % (T4, 28%, N3, 25%), tonsil, 68%, tongue base, 59%, soft palate, 71%, and pha ryngeal wall, 22%. Total laryngectomy was performed for 45 % of all operative patients and 76 % of the operative patients with tongue base cancer . Frequencies of double cancer were 22.7% for oropharyngeal cancer. Conclusion: Treatment for the cases with T4, or N3, or tongue base left much room for improve ment.

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Adenoidectomy is a the common surgery in the pediatric population and is one of the operations we otolaryngologists should master first. Traditionally the operation was performed with the curette or adenotome under no visualization, but alternative techniques using various surgical tools have been reported. We performed adenoidectomy using suction diathermy.
Of the 14 patients who underwent adenoidectomy, 9 were male and 5 were female, with ages ranging from 3 to 13 years (mean age, 5.8years). Five patients underwent adenoidectomy alone. Adenoidenctomy were performed on 8 patients and 1 patient, with tonsillectomy and inferior turbinate ablation respectively.
Under general anesthesia, the patient is placed in the supine position and a Crow-Davis mouth gag is used for retraction of the mandible. Two Nelaton catheters are inserted into the nares out the oropharynx and their proximal ends are clamped to elavate the soft palate. A 70°endoscope is introduced into the oral cavity and the adenoids or other nasopharyngeal structures are examined under direct visualization on the video-monitor. 10 French Valleylab Handswitching Suction Coagulator E2610-6 is used with its tip bent to an appropriate angle and the tip is inserted within the adenoid pad. The current is applied for several seconds, and simultaneously the probe tip is gradually withdrawn. The repetition of this procedure can excise the adenoid tissue and the operation is complete when the choana and the nasopharyngeal outline are visible.
The operative time was about 10 minutes and the blood loss was minimal. Two complications, OME (otitis media with effusion) and local infection, were seen in 1 patient and 3 patients, respectively.
We conclude that the suction diathermy adenoidectomy under endoscopy visualization is a useful technique, particularly for re-operative cases in which the adenoid hypertrophy extends to the choana.

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We describe a case of a 44-year old female complaining of gustatory rhinorrhea from Childhood in which gustatory stimuli caused bilateral excessive and watery nasal secretion . This disorder was presumably caused by faulty regenerated parasympathetic nerve fibers reaching the nasal mucosa or, possibly, by a congenital condition. Nasal pretreatment with an anti-cholinergic drug clinically blocked the positive sugar-induced rhinorrhea, indicating that gustatory rhinitis is produced by foods that stimulate atoropineinhibitable muscarinic receptors (probably on submucosal glands). Although the syndrome can be treated prophylactically by use of topical atoropine, she preferred radical therapy and the resection of the posterior nasal nerve was performed through the middle meatus under endonasal endoscopic management. The resection of the nerve on both resulted in an almost complete inhibition of sugar-induced rhinorrhea without serious complications. Although this disease is not life-threatening, it is socially disturbing to patients and surgical therapy is one modality of treatment.

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The objective of this study was to define our policy of the surgical treatment for T2 tongue cancer with regard to (1) how to resect the primary lesion, (2) indication of preventive neck dissection, and (3) indication of reconstruction.
We retrospectively analyzed 95 patients (T1: 25, T2: 41, T3: 25, T4: 4) with previously untreated tongue cancer between 1986 and 2000. Thirty-three patients of T2 tongue cancer were treated between 1986 and 1997, and they were classified into two groups (early T2 stage: ≤3cm, late T2 stage: >3cm) according to the maximum diameter of the primary lesion, and analyzed for cervical lymph node metasta sis. A rate of pathological neck lymph node metastasis was 2/8 (25 %) in early T2 stage, and 8/11 (72.7 %) in late T2 stage. A rate of secondary neck metastasis was 4/17 (23.5 %) in early T2 stage, and 9/16 (56.3 %) in late T2 stage. A rate of non-salvage case of secondary neck metastasis was 1/4 (25 %) in early T2 stage, and 6/9 (66.7 %) in late T2 stage.
These findings suggested that the wait-and-see policy was better for the early T2 patients and that preventive neck dissection was indicated for late T2 patients, which influenced a change in our policy after 1998. They also suggested that the indication of reconstruction was for patients with a stage of late T2, because we believed in principle of en-block resection by the pull-through method with a specimen of neck dissection and a primary lesion.
Forearm flap has been mainly used during this period, but anterior lateral thigh flap has been recently used in most of the cases because the donor side wound looks better . We thought that anterior lateral thigh flap was one of the useful flaps in reconstruction of T2 tongue cancer.

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[in Japanese]

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