1. After in vitro stimulation with respiratory syncytial virus (RSV), various cytokines were detected in supernatant of tonsil cell cultures. These may play a protective role during RSV infection. However, apoptotic cells were numerous in cultures with high concentrations of RSV . Although the exact mechanisms of the induction of apoptosis could not be determined, cytokines seemed to play a role.
2. Epstein-barr virus (EBV) genome was present in high consentrations in enlarged tonsils as demonstrated by specific polymerase chain reaction assay (PCR). To examine the role of EBV in the suppression of apoptosis in hypertrophy of the tonsils, we designed the primer pairs specific for latent membrane protein (LMP)-1 encoding regions for amplification of divergent sequences using PCR. The PCR-amplified products from EBV genome-positive tonsil cells were analyzed by the single- strand conformation polymorphism method, but no specific mutation for the hypertrophy could be detected.

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It is now known that the genus Chlamydia comprises four species: Chlamydia psittaci, Chlamydia trachomatis, Chlamydia pneumoniae and Chlamydia pecorum.
C. pneumoniae has been implicated as a significant cause of acute respiratory disease, including pharyngitis, tonsillitis and sinusitis. Although C. trachomatis is well recognized as the most frequent cause of sexually transmitted diseases, less is known about otolaryngeal infection in adults.
In this study, we evaluated the prevalence of antibodies to C. pneumoniae and to C. trachomatis with a microimmunoifluorescence test (Micro-IF) of 506 healthy individuals living in the Tokyo area. Prevalence rates for IgG antibodies to C. pneumoniae and to C. trachomatis were about 50% and 15%, respectively.
Serological studies of 97 patients with pharyngitis or tonsillitis showed that 12 (12.4%) had acute antibody to C. pneumoniae (IgG titers of ≥512 and/or IgM titers of≥16) and 3 (3.1%) had acute antibody to C. trachomatis (IgM titers of≥16).
The clinical features observed in patients with Chlamydial infection were not as severe as in patients with Group A streptococcal infection.
We also evaluated the sensitivty of C. pneumoniae and C. trachomatis to three macrolide agents and ofloxacin. The ranges of MICs of these antibiotics for C. pneumoniae and C. trachomatis were 0.16μg/ml-0.5μg/ml, showing that these are the effective drugs for the treatment of Chlamydial infection.

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The purpose of this study is to investigate the clinical features in the older patients with oral cavity cancer and to discuss suitable management in these patients . We analyzed the clinical data of 160 oral cavity cancer patients who visited our department during the last 20 years. A questionnaire was sent to 46 tongue cancer patients to evaluate their post-surgical status (swallowing and speaking). Twenty- nine of them had been treated with laser excision and 17 with radical tongue resection followed by reconstruction with pectoralis major myocutaneous flap.
The patients' average age was between 50 and 60 years at the time of surgery and did not increase during the past 20 years. The number of female patients, however, rose conspicuously during the past 10 years, perhaps because of the increased amount of smoking and drinking among females. Aged patients (>60) visited us on an average of 5 .3 months after the onset of symptoms, while the younger ones (<60) did so on an average of 3 .8 months. Answers to the questionnaire showed that neither the younger nor the older patients treated with laser surgery had much of a functional problem. Serious functional problems, however, occurred and persisted in some of the patients who had radical excision.
Although there are some characteristics showed by aging, each oral cavity cancer patient has different individual features. Therefore, it is important to manage the oral cavity cancer patient according to one' s individual feature.

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An in vivo study was performed to evaluate the use of laser beam for the fragmenta tion of salivary stones. In accordance with the absorption and reflection spectra of sections of salivary stones, optimal fragmentation was achieved with a pulsed dye laser with a pules width of 1. 4μm and a wave-length of 504nm. Further studies on particle size were conducted, and a new “sialioendoscope” technique was developed. Six patients with sialolithiasis of the submandibular gland were treated. Under continuous endoscopic monitoring laser- induced shock wave lithotripsv was performed.
In one patients complete fragmentation and removal of the salivary stones was achieved and in another 50-70% fragmentation was performed and salivary flow was restored. This approch to laser lithotripsy of salivary stones with endoscopic monitoring represents a novel method that permits treatment on an outpatient basis under local anesthesia with little inconvenience to the patient.

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In a series of 93 subjects with various oral symptoms (ex.; xerostomia, glossodynia, recurrent stomatitis, sticky mouth, etc.), 53 without xerogenic diseases or xerogenic medications were evaluated quantitatively by ^99m Tc-pertechnetate scintigraphy for agerelated changes in salivary flow. The uptake rate at rest and the excretion rate after stimulation were calculated by an analysis of the time- activity curves for the parotid and submandibular glands. Age- related salivary flow changes in males could not be evaluated because there were only 6 male patients. Forty- seven females were divided into four age-groups: 10 in the 5th decade, 13 in the 6th, 15 in the 7th, and 9 in the 8th. Both resting and stimulated parotid saliva flow rates decreased gradually with age, but the differences were not statistically significant. The resting and stimulated submandibular flow rates did not change with age. Thus, there appears to be a difference of agerelated changes on saliva flow rates between the parotid and submandibular gland.

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This report focuses on hypertrophied palatine tonsils in the air column of the pharynx. Hypertrophy of the tonsils was evaluated in 10 children, 3 to 7 years of age, with obstructive sleep apnea (group SA) diagnosed by polygraph sleep studies and 5 age- matched controls with chronic glomerulonephritis (group non-SA). Both groups had small to middle- sized adenoids.
We evaluated three items: the size of the tonsils according to Mackenzie' s classification and the degree of projection of the tonsils during the gag reflex, the clinical symptoms obtained by parental questioning, and the lateral view of soft tissues of the neck high kilo voltage beam X-ray films.
1) Nine of the 10 children in the SA group had third degree hypertrophied tonsils wich touched each other during the gag reflex .
2) Seven of the 10 children in the SA group and only 1 of the 5 children in the non- SA group had dysphagia . All of the children in the SA group and 4 of the 5 in the non- SA group snored during sleeps.
3) On the lateral X- rays of the upper airway in all of the children in the SA group the distance between the dorsal surface of the tonsils and the posterior pharyngeal wall was less than 4mm . In 2 of the 5 in the non-SA group it was 1-4mm and in 3 it was more than 5mm. Five of the 10 children in the SA group had tonsils with the inferior surface below the upper edge of the epiglottis, while in all the non- SA group the inferior surface was above the edge of the epiglottis.
We conclude that those findings are very important in the evaluation of children with sleep disorders who are not clearly defined by questioning the parents.

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in the past 4 years, bilateral tonsillectomy was performed in 100 patients with IgA nephropathy in the department of otolaryngology of Sendai Red Cross Hospital . They have been followed for at least 6 months after surgery.
The results of urinalysis are as follows:
1) By 6 months after tonsillectomy, proteinuria had disappeared in 63% and hematuria in 34% of the patient.
2) Patients with mild or moderate renal pathology had higher postoperative remission rates than did those with advanced renal patholgy.
3) Patients with larger palatine tonsils had higher remission rates of proteinuria and hematuria.
4) Higher remission rates were observed in patients with a short interval between the onset of IgA nephropathy and tonsillectomy.
The effectiveness of tonsillectomy in patients with IgA nephropathy is discussed.

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We described a patient who recovered from acute respiratory distress syndrome and multiple organ failure following acute tonsillitis. He was a 35-year-old male who developed acute tonsillitis followed by peritonsillar, retropharyngeal and mediastinal abcsesses complicated with septic shock, acute respiratory distress syndrome and multiple organ failure. Mixed infection was suspected as the cause of the tonsillitis, and anaerobic bacilli resistant to the antibiotics used probably caused secondary infection.
Immediate and appropriate therapy with CLDM, CAZ and IPM/CS was effective along with prompt surgery; retropharyngeal, supraclavicuar and submandibular incisions. Tracheotomy was especially useful in the drainage of purulent exudates in the prevertebral space and upper mediastinum as well in the improvement of pulmonary ventilation.
Intermittent mandatory ventilation was performed for ten days. Constant hemodynamic monitoring with a Swan- Ganz' s catheter and the timely application of hemodialysis were main contributors to the successful treament of this patient.
A multidisciplinary approach by various specialists is essential in the treatment of this kind of patient

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We have been studying contingent negative variation (CNV) elicited by electrical taste stimulation as the warning stimulus. In this study, we examined the characteristic waveform and tried to determine whether or not we could evaluate electrical taste objectively.
Stimuli were applied for 100 msec or 500 msec with a bipolar stainless steel electrode disc that was held gently in contact with the tongue by a specially constructed fixture. The imperative stimulus was a pure tone of 1 kHz at 60 dB and the interstimulus interval of paired stimuli was 2000 msec. The CNV was recorded in 25 normal subjects with the stimulus at an intensity of 40 μ A, and the evoked potential (P300) in response to the electrical taste stimulation was recorded simultaneously, at the F _z, C_z and P _z sites.
Under cooperative conditions, the late components of CNV were recorded in all 25 subjects, and the P300 components were recorded in 18 of the 25 at the C_z site and in 12 of 13 subjects at the P _z site. The early components of CNV, however, were recorded in 8 of the 25 at the C_z site.
To determine whether this examination could evaluate electrical taste objectively, we asked normal subjects to ignore the electrical taste stimulation and to respond only to the pure tone as the imperative stimulus. This was performed by 9 subjects with the P300 evoked electrical taste stimulation under cooperative conditions. Although the amplitude of the P300 decreased, it was detected clearly by 8 subjects. The late component of CNV was detected by 3 subjects. The early component of CNV was detected by the 2 subjects who had already noted this component under cooperative conditions.
In conclusion, it was possible to evaluate electrical taste objectively in normal subjects in whom the P300 components were evoked by electrical taste stimulation.

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Sleep related breathing disorder (SRBD) is a modern concept applied to various diseases in which there is abnormal ventilation during sleep.Simple snorers and patients with obstructive sleep apnea syndrome (OSAS) are included.in this concept of breathing disorders caused by stenosis of the upper airway during sleep.
However, the causes of stenosis of the upper airway have not yet been elucidated. Narrowing of the upper airway during arousal is thought to be a major factor.
Therefore, we examined the faucial size in patients with SRBD, simple snorers and patients with OSAS, who had faucial stenosis.
The subjects were 53 healthy individuals, who were on the medical staff or received routine examinations at Saiseikai Nakatsu Hospital between August 1990 and July 1992 and 20 patients treated in the outpatient otolaryngology department of Osaka Medical College Hospital between August 1992 and August 1994.
With mesopharyngometry, anatomical characteristics were evaluated in normal controls, SRBD patients with low esophageal pressure (Pes) and SRBD patients with elevated Pes.
Anatomical differences were found between normal controls and patients with SRBD. Patients with elevated Pes had significantly narrower fauces than did the normal controls or those with low Pes. Thus, deterioration in patients with SRBD could be due to faucial stenosis.

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Changing the position during sleep is a simple treatment for obstructive sleep apnea. The present study was performed to evaluate the effect of sleeping posture on obstructive sleep dyspnea. Fifty-five patients who complained of snoring or obstructive sleep apnea underwent day-time polysomnography with the use of zopiclone. Their mean age was 47.0 years (range 26 to 78 years). Their mean body mass index (B.M.I.) was 26.3kg/m² (range 16.7 to 32.6kg/m²). Polysomnography was carried out with simultaneous monitoring of upper airway pressure in the posterior epipharynx (Pepi) mesopharynx (Pmeso), hypopharynx (Phypo) and esophagus (Peso). The site of obstruction during sleep was determined from the pressure gradients among the 4 sensors. The subjects were categorized as follows: group A, 18 patients who showed a reduction of Peso of 50% or more in the lateral position; group B, 25 patients whose Peso was reduced less than 50%; group C, 12 patients who did not show any improvement in the lateral position.
Pmeso, Phypo and Peso were lower during sleep in the lateral decubitus position than in the supine position. As the Peso in the lateral decubitus position improved, the apnea plus hypopnea index and lowest SaO₂ level were significantly corrected. The B.M.I. of group A was lower than that of groups B and C. Group A had a single site of obstruction. It seems probable that the effect of position on respiratory disturbances during sleep is influenced by the grade of obesity and the site of obstruction.

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Biopsies from 19 adult patients with acute tonsillitis suspected of being of viral origin (9 males and 10 females, with a mean age of 24.5 years) were examined immunohistochemically for viral antigens with the avidine-biotin peroxidase complex method with the use of anti-HSV 1 and anti-HSV 2 monoclonal antibodies and six types of anti-EBV antibodies.
In hematoxylin and eosin stained sections from two patients multinucleated cells and intranuclear inclusions had the histopathologic appearance of HSV infection. Viral antigens were detected in eight immunoperoxidase-stained biopsies; three were HSV 1, was HSV 2, four were EBV. In the two H-E spacimens with histopathologic changes suggested HSV infection, HSV 1 was found in one and HSV 2 in the other.
We compared the results of tissue staining and the titers of HSV and EBV antibodies in paired sera from the same patients. The two patients whose biopsies showed HSV 1 or HSV 2, did not have high HSV 1 or HSV 2 antibody titers. Of the patients with EBV positive biopsies, three had paired sera tests. In one of them a diagnosis of first infection by EBV was made from the rise in antibody titers, but the other two had no rise. Moreover, a first infection by EBV was diagnosed serologically in one patient with a negative immunoperoxidase stained biopsy.
In patients with acute tonsillitis suspected of being caused by HSV infection, immunohistochemical staining is useful in the determination of the type of HSV. In the diagnosis of acute tonsillitis due to EBV not clear that the immunoperoxidase method is better than other methods of detection of EBV.

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Usually positive standardization of parameters in tonsillar provocation tests is expressed, for example, as “increase of ESR by 9 mm or more” . Such an expression is not valid, however, without the following hypothesis: the degree of focal infection of the tonsils is in directly reflected by changes in parameters of the tonsillar provocation test.
We evaluated statistically the sensitivity of several parameters in the test of tonsillar provocation by indirect irradiation with ultra microwaves. The objective parameters were body temperature, erythrocyte sedimentation rate (ESR) and white blood cell count (WBC).
Body temperature and ESR were accurate indices in some secondary diseases, but WBC was the most changeable parameter and not an accurate index in most secondary diseases.
In evaluations of diagnostic tests of focal infection, of the tonsils strict attention must be paid to the parameters used in tonsillar provocation tests.

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To determine the most effective surgical method, we observed and identified the constricted palato-pharyngeal area of patients with sleep apnea syndrome. The constricted area was evaluated by naso-endoscopy under sedation before and after surgical treatment in 25 patients with breathing disorder during sleeping. In 18 of them, the diagnosis was simple velopharyngeal obstruction, further divided into two types, antero-posterior and lateral. The antero-posterior type is characterized by swinging of the soft palate back and forth, and the lateral type by approximation of the lateral pharyngeal walls. Eight of the 18 patients examined had classified in the former type of obstruction, which responded to simple UPPP. However, simple UPPP was not effective in the other 10, who had the later type of obstruction. An additional operation to remove the redundant tissue in the lateral and posterior parts of the pharynx significantly reduced the apnea in 5 of the 10 spatients.

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A total of 49 patients (24 males and 25 females) with oral papillomas were investigated clinically and virologically during the 17 years from 1977 to 1994. Their ages ranged from 14 to 83 years (median 44 years). Dysplasia was found in one patient, one patient developed leukoplakia after 5 years, and another patient developed squamous cell carcinoma after 2 years.
Human papillomavirus (HPV) genomes in oral papillomas were identified with the use of the vira type^TM in situ hybridization (ISH) method . Of the 49 patients, two (4.1%) had a positive reaction to the omni probe. But neither could not be identified HPV genomes. In our study, of 16 patients with laryngeal papillomas, seven (43.7%) had a positive reaction to the omni probe. And in five of them were identified, HPV genomes types 6, 11 and 18. We conclude that HPV is a less common cause of oral papillomas than of laryngeal papillomas.

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DNAs isolated from seven squamous papillomas and one condyloma acuminatum of oropharyngeal region were Southen hybridized with a mixed probe of HPV 2a, 5b, 6b, 11, 16, 18, 57 and 58 under low- stringent conditions. HPV DNA was detected in a tonsillar condyloma acuminatum but not in seven squamous papillomas. The pattern of cleavage of HPV DNA by restriction endonucleases from the condyloma acuminatum corresponded to that of HPV type 6.
These date may indicate that squamous papilloma is less closely associated than condyloma acuminatum with HPV. We conclude that histopathological differentiation between the two papillomas is necessary because of the heterogeneity of the etiological association of HPV in oropharyngeal papillomas.

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In recent years much attention has been paid to the sleep apnea syndrome. Over 90% of the patients with sleep apnea syndrome have the obstructive type. Enlarged tonsils and adenoids can cause obstructive sleep apnea sundrome in children. For them adenotonsillectomy is very effective, but we had a patient whose apnea was not improved by adenotonsillectomy.
A 4-year-old boy had had snoring, stridor, and difficulty breathing during sleep for two years. He underwent endotracheal intubation because of apnea and unconsciousness at another clinic and was referred to our hospital. The apnea and unconsciousness were not improved by endotracheal intubation. Examination of the pharynx revealed hypertrophied tonsils and adenoid. The white blood cell count was 14, 000. Arteial blood gas analysis showed increased carbon dioxide and decreased oxygen. Brain MRI, CSF examination, and EEG showed no abnormality except for an old infarction in the left putamen. On the fourth hospital day an adenotonsillectomy was performed, but the apnea continued. He was referred to the pediatric department, where doxapram administration dramatically reduced his apnea.
This clinical course suggests that the sleep apnea syndrome in this patient was of the mixed type. Although there were no significant intracranial findings to explain his sleep apnea syndrome, his apnea might be due to some disorder of central respiratory control.

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We report our experience with nasal CPAP therapy which greatly reduced severe sleep apnea of a 7-year-old boy with Laurence-Moon-Biedle syndrome.
When he was 2 years old, a diagnosis of Laurence - Moon - Biedle syndrome was made. From the age of 4 he became obese and at the age of 7 frequently experienced severe sleep apnea after a common cold.
He was first seen at our hospital in respiratory arrest and with an oxygen saturation of under 25% . We gave him emergency treatment.
His body weight was 195% of expected weight and he had enlarged adenoids and tonsils, which caused obstructive sleep apnea. His chest film showed 77% CTR with heart failure.
Immediately he was transferred to the ICU and received nasal CPAP, which greatly reduced sleep apnea and improved his general condition.
One week after the start of nasal CPAP treatment his CTR was 60% . So we could perform adenotonsillectomy without any trouble.
Since the operation he has experienced no sleep apnea even without nasal CPAP.

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A 25-year-old man complained that when he turned his head he heard an abnormal sound on the right and pain on the left side of the front of his neck . With the fluoroscopy and videotape recording, the authors found that the abnormal sound arose when the right greater cornu of the hyoid bone rubbed against the right transverse process of cervical vertebra III. The pain seemed to be caused by the left greater cornu' s stimulation of the surrounding soft tissues. Three-dimensional reconstruction of CT imaging was useful in demonstrating the three-dimensional relationship of the right greater cornu of the hyoid bone and the right transverse process of cervical vertebra III and in planning treatment . Both part greater cornu were removed surgically, and the abnormal sound and the pain disappeared. He is making good progress without any difficulty in swallowing.

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