[in Japanese]

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The zinc preparation polaprezinc is approved for treating gastric ulcers and its safety confirmed. To clarify its efficacy against taste disorder, we studied its effects on histopathological epithelial tongue changes and taste bud cell cycle regulation in zinc-deficient rats, an animal taste disturbance model.
Exp. I; Four-week-old SD rats were placed on 4-week zinc-deficient diets. During the ensuing 4 weeks, polaprezinc was administered orally at doses of 0, 1, 3 and 10mg/kg/day with zinc-deficient diets. The tongue was histopathologically studied. Exp. II; Histopathological time courses of 0, 1, 2, 3 and 4 weeks was studied in 3mg/kg groups of polaprezinc.
Parakeratosis was observed in rats on the zinc-deficient diet and 1mg/kg polaprezinc but not in these administered 3 and 10mg/kg of polaprezinc. The ratios of keratinizing epithelium, including parakeratosis, in the outer and inner circumference of circumvallate papilla increased in zinc-deficient rats - these increases reversed in rats administered polaprezinc. Proliferating antigen-positive taste bud cells decreased in zinc-deficient rats - the decrease reversed in those administered polaprezinc. Based on time-course observation, cellular taste bud proliferation recovered to normal after 2 weeks of polaprezinc administration and parakeratosis normalized after 3 weeks of administration.
Polaprezinc thus ameliorated parakeratosis and decreased taste bud cell proliferation caused by zinc deficiency. These effects may involve mechanisms underlying taste disorder improvement in animal models. These results suggest that zinc plays a significant role in taste organ morphology and function of, and that polaprezinc is efficacious in treating taste disorder.

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Background: In Japan, sanitary masks have proven useful in ameliorating common cold symptoms, but scientific findings remain largely to be defined.
Subjects and Methods: We randomly allocated 72 subjects with common colds at our medical institutes to 2 groups—32 wearing sanitary masks on a 24-hour basis until symptoms had completely disappeared and 40 (control group) wearing masks during daytime alone. Over a 1-week course, subjects filled out symptom questionnaires daily before bed and after rising. We then compared clinical effects on a visual-analog scale for sore and dry throat, cough and sputum, and cold contraction.
Results: Statistically, subjects with 24-hour mask wear got well more quickly (p<0.05) than those in the control group, and cough and sputum scores were significantly reduced (p<0.05).
Conclusions: Sanitary-mask wear during sleep appears to reduce common cold symptoms.

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To determine long-term trends in subjects with taste disorder, we reviewed the clinical statistics of 1,594 -565 men and 1,029 women- treated for taste disorder between 1992 and 1999, and between 1999 and 2009. Subject numbers, age and gender distribution, serum zinc, and disorder cause were investigated yearly.
Those showing a gradual yearly increase, particularly among older subjects, had shifted from their 50s to their 70s in the 18 years observed. Due to difficulties in diagnosis, 58% of subjects were judged “idiopathic”. “Zinc deficiency” was the most common ascertained cause, with “drug induced” playing an important role in increasing subject numbers. Serum zinc in subjects gradually decreased with year.
These results suggest that increased in subject numbers with taste disorder depend on social problems such as progressive population aging, decreased zinc uptake due to changing diet, and drug abuse.

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We studied gender-based sleep-disordered breathing (SDB) status in 300 subjects-212 men and 88 women aged≥65-focusing on the apnea hypopnea index (AHI), body mass index (BMI), and form feature, comparing subjects to 1019 subjects aged<65. We noted increased the depressed pharyngeal function, or “loosening” in those aged≥65, together with decreased BMI and increased AHI. This apparently “natural”-rather than disease-based-progression should therefore be considered as a potentially useful screening aspect, when evaluating “elder” SDB.

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We report outcomes and evaluations in 10 cases of pediatric cleft palate involving severe velopharyngeal incompetence accompanying palatine tonsillar hypertrophy surgically treated by push-back, pharyngeal flap construction and plastic surgery. Cases evidenced no improvement from speech therapy and concomitant tonsillectomy for palatine tonsillar hypertrophy. Surgical treatment for velopharyngeal incompetence may induce obstructive sleep apnea and tonsillectomy induce hypernasality. Indications for combining such surgery must thus be critical and informed consent appropriate before execution. Fortunately, our cases showed satisfactory velopharyngeal competence and no sleep apnea aggravation postoperatively. We therefore cannot overemphasize that indications for combined surgery be strict and preoperative informed consent be applicable and based on the awareness of potential disadvantages.

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Background: To clarify typical posttonsillectomy urinary findings in subjects lacking IgA-producing germinal centers, we studied pathological tonsillar findings in IgA nephropathy and changes in urinary findings by perioperative and 6 months after tonsillectomy.
Methods: Subjects undergoing tonsillectomy after 3 of steroid-pulse therapy courses and those who undergoing tonsillectomy after long-term oral-steroid treatment were divided into 2 groups based on the presence or absence of tonsilar germinal centers. They were tested for urinary findings early postoperative by period and 6 months after tonsillectomy.
Results: In the steroid-pulse therapy group, among those with poor urinary findings 3 days after tonsillectomy, those with germinal centers tended to have improved urinary findings, compared to those without these centers, 6 months after tonsillectomy. In the oral steroid group, those with germinal centers had poor urinary findings early after tonsillectomy, but findings had improved in 6 months after tonsillectomy. Of those without germinal centers, 3 had poor urinary findings 3 days after tonsillectomy, although 2 showed improvement 6 months after tonsillectomy compared to baseline.
Conclusions: Our steroid pulse group results suggest that germinal center presence or absence relates to tonsilar involvement in IgA nephropathy development, oral steroid group results suggest that those with poor early postoperative urinary findings have in sufficient renal function to cope with IgA release.

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Alveolar soft-part sarcoma (ASPS) is a very rare tumor. ASPS of the tongue tends to occur in childhood and radical resection is the only treatment. Prognosis is relatively good if the primary site is resectable, because this tumor grows slowly and recurrence rate is low. We report a case in a three-year-old girl referred to our department with an episode of oral bleeding. Bleeding during surgery was controlled by preoperative arterial embolization and minimal tumor resection was performed by estimating the extension of tumor invasion from intra-arterially delivered pigment-containing material. Despite successful primary lesion treatment, lung metastasis found at presentation recurred after initial surgical resection, warning of a depressing prognosis.

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Over 80% of subjects we treat for IgA nephropathy show clinical remission after bilateral tonsillectomy and steroid pulse treatment when their serum creatinine is below 1.2. One problem among those without clinical remission is the residual tonsil. We conducted revision tonsillectomies in 24 with IgA nephropathy showing residual tonsils and persistent abnormal urinary findings following tonsillectomy and steroid pulse treatment. Within 5 months postoperatively, 84.6% showed clinical remission, indicating the importance of considering the residual tonsils if tonsillectomy and steroid pulse treatment do not bring IgA nephropathy remission. In residual tonsil detection, revision tonsillectomy should be done immediately due to its effectiveness in attaining clinical remission.

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To determine gonococcal and chlamydial infection routes, we compared oropharynx and genital gonococcal infection and chlamydial infection test results against questionnaire answers on profession and sexual partner in 250 subjects-169 women and 81 men-seen at a sexually transmitted infection (STI) clinic from September 2008 to January 2009.
The 162 (96%) women consisted of commercial sex workers (CSW) and 7 (4%) were non-CSW. Of CSW testing positive in oropharynx to genital results with gonococcal and chlamydial test, 27 (17%) to 11 (7%) had gonococcal and 25 (15%) to 54 (33%) chlamydial disease. Of non-CSW, positive cases numbered 1 to 2 for gonococcal and 0 to 4 for chlamydial disease.
The sexual partner suggested source of STI by the questionnaires is from male indicated sexual partners included 61 (75%) CSW, 13 (16%) private partners such as wife or girlfriend, and 5 (6%) nonexclusive or accidental partners. Two (2%) did not answer. The percentage (number of CSW/number of all positive male subjects) of CSW estimated 89% (16/18) as the source of pharyngeal gonococcal infection, 93% (37/40) genital gonococcal infection, 100% (2/2) pharyngeal chlamydial infection, and/or 77% (10/13) genital chlamydial infection in male subjects. A small number of male subjects had gonococcal or chlamydial infection transmitted by private partners.

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We retrospectively reviewed 71 cases of previously untreated tongue carcinoma from 2003 to 2009. Lymph node metastasis of tongue carcinoma in T1 cases were 5/31, T2 19/24, T3 7/11, and T4 4/5. In T2N0, late cervical metastasis was high, but surgery saved 8/9 cases. In T3/T4, unaffected side metastasis was high. indicating that in T3N(+)/T4, elective neck dissection should be considered.

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Fanconi anemia (FA), a chromosomal instability disorder with high-frequency pediatric aplastic anemia, carries a high risk for solid cancer, e.g., squamous cell cancer. We report a case of tongue cancer associated with FA. A 37-year-old woman, diagnosed with aplastic anemia at age 3, was referred for suspected tongue cancer, diagnosed as right-side tongue-edge cancer T2N0M0 stage II, undergoing partial glossectomy. Six months postoperatively, metastasis had developed to the upper-right and deep-internal jugular lymph nodes. Despite the compromised host, prophylactic cervical dissection may thus be best considered in cases of FA, because of the highly-carcinogenic property.

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Elderly nursing homes residents often experience swallowing problems associated with subsequent respiratory disorders. We conducted videoendoscopy in 14 subjects 6 men and 8 women ranging 54-97 years old (mean: 80.1 years) at two such homes. All used wheelchairs and had been diagnosed with dementia. Among them, 9 had cerebrovascular disorders, 3 neuromuscular disorders, and 1 collagen disease. At examination, 8 had a history of fever and sputum likely due to aspiration. We modified meals to prevent aspiration in 6 cases (42.9%), after which aspiration symptoms subsided. We found endoscopy effective in detecting potential aspiration in the elderly, particularly in those with dementia. The active participation of Otolaryngologists should take part in endoscopy in the elderly, even in home-visits.

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Pemphigus vulgaris (PV), an uncommon autoimmune disease forming cutaneous and mucosal blisters and sores, is difficult to diagnose early due to its varied pathological changes and initial symptoms. In the PV case we report here, an 80-year-old woman reported pain upon swallowing due to laryngeal edema-rare as an initial symptom. Once laryngeal edema had disappeared, treatment-resistant oral mucosal sores and epistaxis appeared and gradually worsened. Mucosal lesion biopsy confirmed the PV diagnosis. Antidesmoglein-3 and antidesmoglein-1 autoantibody serum levels increased, but no skin lesions occurred in the roughly two months before definite diagnosis. Corticosteroid treatment controlled symptoms and antidesmoglein autoantibodies. Mucosal lesions should thus prompt consideration of likelihood systemic disease early on with a view forward immediate diagnosis and treatment.

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We report a case of mediastinal emphysema following dental treatment in a 44-year-old man seen for pharyngeal and chest pain after the left mandibular third molar was extracted. Computed tomography confirmed emphysema. He was hospitalized to treat high fever, increased white blood cell counts and high c-reacted protein. We injected dripenem intravenously to avoid mediastinitis following emphysema. He was discharged on hospital day 5. Mediastinal emphysema is a rare dental treatment complication requiring early diagnosis and infection control to ensure a positive outcome.

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