Taste disorder commonly suffered by the elderly is expected to increase as society ages. Although some causes have been suggested, many remain to be clarified. Clinical guidelines are expected to aid in clarification and treatment. In preparing guidelines, we found three well-studied pathogenetic factors responsible for the disorder: mineral deficiencies, drugs, and systemic diseases.

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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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[in Japanese]

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[in Japanese]

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Concurrent chemoradiotherapy (CCRT), an emerging treatment modality in advanced squamous cell carcinoma of the hypopharynx, has proven efficacious and useful in functional preservation. We evaluated CCRT efficacy and toxicity using cisplatin/5FU, cisplatin or docetaxel to stage II-IV hypopharyngeal squamous cell carcinoma based on the medical records of 63 consecutive subjects (Stage IV: 84.2%, III: 6.3%, II: 9.5%) treated from 2003 to 2009. The chemoradiotherapy response was “complete” in 62.9% and “partial” in 33.9%. Three-year overall survival was 59.7%. The frequency of significant grade 3 and 4 toxicities was 29.0% with neutropenia, 38.7% with mucositis, 27.4% with dysphagia, and 37.1% with nausea. Hematological toxicity was minimal and no treatment-related deaths occured. Concurrent chemoradiotherapy for hypopharyngeal carcinoma is considered tolerable and achieves overall survival comparable to other surgical modalities, warranting further study of this approach as a viable alternative.

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[in Japanese]

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Tonsillectomy long used in treating IgA nephropathy (IgAN) was rarely done: before the tonsillectomy was combined with steroid pulse therapy (TSP). Evidence has accumulated even in randomized controlled studies strongly indicating TSP efficacy, especially in the early stage. TSP has thus become a first line treatment for achieving clinical remission.

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A questionnaire for determineing tonsillectomy status in tonsil-related disease treatment was sent to university hospital dermatology, nephrology, and pediatrics departments in Japan.
Among the 9.4% of subjects with pustulosis palmaris et plantaris (PPP) referred by dermatologists to otolaryngologists for possible tonsillectomy, 52.5% were actually treated by tonsillectomy, which 40% of the dermatology departments surveyed stated was effective. Of the 30.1% of those with IgA nephropathy referred by nephrologists and 12.0% referred by pediatricians, over 90% were treated by tonsillectomy. This treatment was stated to be effective by 90% of the nephrology departments and 70% of the pediatrics departments in over half of the subjects thus treated.
Although results showed tonsillectomy to be widely accepted in effectively treating IgA nephropathy, many dermatologists seem to feel that the tonsils played only a small role in such cases. This means that education efforts about tonsillectomy effectiveness must be increased.

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Kawasaki disease, an idiopathic vasculitis predominantly in infants and children under age 4, manifests various clinical symptoms, of which coronary aneurysm is the most important complication. Since the formation is related to prognosis, prompt diagnosis and treatment are essential. We report a case of Kawasaki disease accompanied by fever and painful left-neck swelling difficult to differentiate in diagnostic imaging from infectious disease. A 3-year-old boy seen for left-neck swelling, neck pain, and fever, had a history of Kawasaki disease. He had been seen at the pediatric department of a nearby hospital with a fever of 38°C that persisted from June 8, 2011. Cefditoren pivoxil (CDTR-PI) was prescribed for bilateral neck swelling and increased inflammatory reaction confirmed by hematology. On the following day (June 9), he was seen at our hospital for a 40°C fever and worsening cervical swelling, and was referred to our department for differentiation from infectious disease. At admission, examination detected redness and swelling of the left palatine tonsil and surroundings, a 35mm in diameter swelling of the left upper deep neck, and a 1.5cm swelling of the right cervical lymph node. Hematology indicated marked inflammatory reaction with WBC of 22,780/μg (Neutro 86.5%) and CRP of 12.8mg/dL. Diagnostic imaging by ultrasonography and CT showed aggregated bilateral swelling of the cervical lymph nodes, suggesting acute suppurative cervical lymphadenitis and acute left peritonsillitis. Drip infusion of ceftriaxone (CTRX) 1,300mg started on June 9 did not improve, physical or hematological condition. Hyperemia of the bulbar conjunctiva and enhanced coronary artery wall brightness in echocardiography were noted from June 12, yielding a diagnosis of Kawasaki disease recurrence. Antibiotics were discontinued and gamma globulin begun, rapidly resolving, fever and cervical lymph node swelling and improving clinical findings.
Our case of Kawasaki disease accompanied by fever and painful left-neck swelling was difficult to differentiate from infectious disease in diagnostic imaging. Kawasaki disease should thus be considered when antibiotic-refractory swelling of the cervical lymph node develops in children.

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BACKGROUND: Recent outbreaks of highly pathogenic avian influenza in Asia and the spread of the disease worldwide highlight the need to redefine conventional immunization approaches and establish effective mass vaccination strategies in the face of global pandemics. Transcutaneous immunization (TCI), a novel route vaccination uses topical vaccine antigen application on the skin.
METHODS: TCI was done in BALB/c mice with or without microneedle array pretreatment using cholera toxin (CT). Immunogenicity was evaluated by measuring CT-specific IgG and CT-specific IgG1, IgG2a IgG2B IgG3, IgM, IgA , and secretory IgA antibodies with ELISA.
RESULTS: TCI with microneedle array pretreatment resulted in a 225-fold increase in CT-specific serum IgA levels compared to TCI. TCI with or without microneedle array pretreatment showed CT-specific secretory IgA in nasal washings, saliva, lung washing and facilities. TCI with microneedle array induced a much stronger immune response than that without microneedle array and IgG1 response was marked in TCI, suggesting that the TCI immune response shifted in the Th2 direction.
CONCLUSIONS: These results suggest that TCI may be a simple, non invasive way to induce systemic and mucosal immune response.

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Coblation tonsillectomy appears more promising than conventional tonsillectomy in preventing postoperative pain. Coblation tonsillectomy is reported, however to cause more postoperative bleeding than conventional tonsillectomy and followed a learning curve. To clarify the situation, we compared postoperative bleeding between the two types of tonsillectomy. Postoperatve bleeding occurred in 7.1% of coblation and 5.5% of conventional tonsillectomy, with no statistically significant difference between groups. A learning curve was seen in individual coblation surgeons, although the postcoblation bleeding frequency appeared to be the same as in conventional tonsillectomy. Coblation tonsillectomy also involved less postoperative pain. Given these results, we have found coblation tonsillectomy to be very useful.

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We report 2-year postoperative outcomes in 5 subjects with IgA nephropathy in transplanted kidneys who underwent tonsillectomy combined with steroid pulse therapy at Kochi Health Sciences Center. Evaluation was based on urinary occult blood, urinary protein, eGFR, and renal pathological findings. Each parameter was compared to preoperative findings. All subjects showed negative results for urinary occult blood and qualitative urinary protein tests, while 1 had abnormal results in a quantitative urinary protein test. One subject's eGFR was worse than preoperatively, considered due to chronic transplant rejection.
These results demonstrate the sustained effectiveness of the above therapy over 2 years, comprehensively accounting for hematuria resolved early on postoperatively in all subjects. No recurrence had been observed in the 2 years after surgery.

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Pyriform sinus fistula, a congenital form from the hypopharynx, often causes acute suppurative thyroiditis and neck abscess among young subjects. We clinically examined 6 cases of pyriform sinus fistula treated surgically from 2005 to 2011. All subjects had the fistula on the left side.
During surgery we inject pyoktanin into the fistula opening under direct laryngoscopy. We then confirm fistula staining in the surgical area and conduct fistulectomy with hemithyroidectomy or partial fistulectomy without hemithyroidectomy. We confirmed fistula staining in four of five subjects under the above conditions. The postoperative course was uneventful in all cases and no recurrence was noted.

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We examined the formal diagnosis of sleep-disordered breathing (SDB) in senior citizens, that is 301 subjects-213 men and 88 women-aged 65 and over. We then compared apnea hypopnea index (AHI), body mass index (BMI), and form feature by gender to that in subjects under age 65. Although “loosening” was increasingly seen among those 65 and older and severe AHI group, age and AHI were not correlated. In senior citizens' SDB, lower pharynx and “loosening” were increasing regardless of gender, suggesting the possibility of severe SDB. Although “loosening” was difficult to rate objectively, diagnosis is comparatively easy and was found to be useful in the screening of elder SDB.

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Synchronous pleomorphic adenoma (PA) and Warthin's tumor (WT) in the unilateral parotid gland are extremely rare. We report two such cases.
Case 1; A 60-year-old man had a 3.2×4.8cm tumor in the upper portion of the left parotid gland and another 2.4×1.9cm in the lower portion. Scintigraphy showed ₉₉TcO₄ accumulation in the lower tumor. Pathological study showed the upper tumor to be PA and the lower one to be WT.
Case 2: A 65-year-old man had with a 3.5×4cm tumor in the left parotid gland showing ₉₉TcO₄ accumulation. MRI showed a small nodule in addition to the tumor. The larger tumor was WT, and the smaller one was PA.
The case that accepted a different composition type ipsilaterally is extremely rare. We may not be given a diagnosis only with images such as MRI or the CT. It is desirable we use FNA and ₉₉TcO₄ accumulation, and to make a general decision.

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A 35-year-old man had repeated tonsillitis and knee arthritis after tonsillitis. After tonsillectomy, however, his knee swelled only once, and never thereafter. Reactive arthritis caused by group A streptococcus is also called poststreptococcal-reactive arthritis. In this case, tonsillectomy effectively ended reactive arthritis.

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Lingual tonsil hypertrophy may cause a lump sensation and sleep disorder. The usefulness of lingual tonsillectomy using coblation has been reported outside of Japan. We report our experience with lingual tonsillectomy using coblation for lingual tonsil hypertrophy and yielding a good postoperative course. A 69-year-old woman with lingual tonsil hypertrophy reporting a “lump” sensation in the throat and snoring underwent conservative treatment without effect. We conducted lingual tonsillectomy using coblation, after which her subjective symptoms decreased. Tongue base excision using coblation can thus be seen as a surgical option in obstructive sleep apnea syndrome.

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