A taste sensor with global selectivity composed of several kinds of lipid/polymer mem-branes has recently been developed for transforming information on taste substances into electric signals. These signals are then analyzed by computer . The sensor output shows different patterns for chemical substances which have different taste qualities such as salt-iness and sourness, and shows similar patterns for chemicals with similar taste. The sensor responds to the taste itself, because taste interactions such as synergistic and suppression effects can be acurately reproduced. The sensitivity, reproducibility and durability of the taste are superior o those of the human taste sense. Moreover, human sensory expressions can be quantified using this taste sensor.

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We evaluated the changes and positive rates (using Nosaka's criteria) of body temperature (BT), peripheral white blood cell count (WBC), and erythrocyte sedimentation rate (ESR) by the provocation test of tonsils in patients with focal tonsillar infections in comparison with healthy controls.
The results were as follows. 1) BT and WBC increased even in healthy controls during the provocation test on tonsils. 2) No significant differences in WBC were seen between any groups with secondary diseases and the controls. 3) Some significant increases in BT and ESR were seen in patients with rheumatoid arthritis (RA) and chronic lowgrade fever (LGF).4) No significant differences in the positive rates of tests were seen between patients with pustulosis palmoplantaris (PPP) or sternocostoclavicular hyperostosis (SCCH) and the controls. 5) The positive rate of BT in patients with RA was higher than that in the controls. 6) Though the positive rate of ESR in patients with IgA nephropathy, RA or LGF was also higher than that in the controls, it was lowest among the three parameters. 7) Trials to change the positive standard of BT or WBC did not result in our discovery of better diagnostic benefits.
These results indicate that the provocation test of tonsils used routinely in Japan has poor diagnostic value as a focus test without any fundamental corrections.

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Streptococcus (S.) pyogenes, S. pneumoniae, and nontypable Haemophilus influenzae (NTHi), are common pathogens for tonsillitis. These bacteria are considered normal flora of the palatine tonsil and appear to colonize more frequently in children with recurrent tonsillitis (RT) even during healthy status. The immune response against such bacteria is one of the important determinants for elimination of potential pathogens and for the development of RT. We measured serum IgG antibody levels to various bacterial antigens by enzyme-linked immunosorbent assay in children with or without RT. The antibody level to whole cell antigens of S.pyogenes was not different between children with and without RT. However, the antibody levels to LTA of S.pyogenes, to capsular polysaccharides of S.pneumoniae, and to P6 outer membrane protein of NTHi, were significantly lower in younger children (≤ 6 y.o.) with RT than in age-matched children without RT. A high serum antibody level to whole cell antigens of S.pyogenes was significantly associated with increased antibody levels to lipoteichoic acid (LTA) of S.pyogenes in children without RT, however this association was never found in children with RT. These results suggest that selectable immunologic derangements against the bacterial antigens being targets for bactericidal antibodies and/or being homogenous among strains from common pathogens for tonsillitis may be associated with recurrence of tonsillitis in such children.

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To clarify the pathogenesis of tonsilogenic palmoplantar pustulosis (PPP) we investigated fibrinolytic activity from the viewpoint of chronic inflammation and abnormal immune reaction.
Firstly fibrinolytic activity of isolated lymphocyte from both tonsil and peripheral blood was determined before and after 7 days' incubation using the fibrin plate method. In patients with PPP, increased fibrinolytic activity of both tonsillar and peripheral lymphocyte was noticed which persisted even after 7 days' incubation. After removal of tonsils, fibrinolytic activity decreased to near normal levels but did not change to a suppressive level as was the case in normal healthy subjects and in patients with non-focal chronic tonsillitis.
Secondly, we carried out the provocation test by means of direct ultra-short wave stimulation to tonsil in patients with PPP, and examined the changes in fibrinolytic activity of the circulating blood. Before stimulation, the tissue plasminogen activator (t-PA) level was higher than that of normal. After stimulation, fibrin degradated products (FDP) tended to increase remarkably from the normal level in the positive provocation test group with PPP.
These remarkably increased fibrinolytic states suggest the important roles in the development of palmoplantar pustulosis of prolongation and modification of chronic inflammatory process in relation to the production of abnormal antigenic substances.

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Palmoplantar pustulosis (PPP) consists of leukotactic inflammation on the skin of the palms and soles. Psoriasis is another example of a leukotactic skin disease. Both disorders are often induced after oral bacterial infection (focal infection). Immunoreaction to highly homologous heat shock (stress) proteins with Mr 65 kD (HSP65) from microorganisms, as well as host humans, has been suggested in immunological abnormalities involved in autoimmune and hypersensitivity disorders. Such disorders include rheumatoid arthritis, systemic insulin-dependent diabetes mellitus, Behcet's disease and Kawasaki disease. We compared antibody level to HSP65 in PPP, as well as psoriasis, especially in correlation with oral infectious foci. Antibody to purified recombinant-HSP65 of Mycobacterium leprae was analyzed with enzyme-linked immunosorbent assay (ELISA) and Western blotting.In patients with PPP, anti-HSP65 IgG level in the blood plasma was 0.170±0.079 in ELISAexpressed as OD492 nm, and showed a mild increase compared to the normal control group (0.080±0.032).PPP with tonsillar or periodontal infection demonstrated a significantly high level of anti-HSP65 IgG (0.230±0.065, p<0.001), while PPP without suspected infectious foci showed relatively a low level (0.139±0.066).A similar correlation was observed in. psoriasis. All patients showed only a slight increase in anti-HSP65 IgG (0.111±0.053).However, a significant increase (0.178±0.032, p<0.001) occured after psoriasis of acute guttate-type (PGA) induced by tonsillar infection, but not in psoriasis vulgaris (PV) (0.101±0.053) and generalized psoriasis pustulosa (PP) (0.087±0.025). Western blotting confirmed specific immunoreaction bands to HSP65 in the blood samples. Possible staphylococcal infection in the oral cavity was suggested by an additional ELISA assay to staphylococcal antigen: anti-staphylokinase IgG showed a significant increase in PPP with infectious foci (0.110±0.028, p<0.01) compared to the normal group (0.039±0.014), while PPP without infectious foci showed only a mild chanqe (0.060±0.017. p<0.05). Immunomodulatory, probably immunopotentiating, roles of HSP65 of bacterial and host cells are assumed in the triggering mechanism by focal infection during development of leukotactic inflammation in PPP and psoriasis.

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Chemiluminescence revealed a lowering of phagocytotic activity of neutrophiles in most patients with palmoplantar pustulosis (ppp). A macrophage migration inhibition test with some bacterial antigens suggested that lymphocytes might be sensitized to bacterial antigens, resulting in urovocation of cellular immunity.
Immunohistochemical staining was positive for IL6, IL8 and TGF-αin kerationcytes of specimens biopsied from the skin lesions in patients with psoriasis. However, staining was negative or weakly positive in patients with ppp.Thess findings indicated differences in pathomechanisms between ppp and psoriasis. Therefore, ppp and psoriasis should be regarded as different disorders.

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We studied the effects of tonsillectomy as well as the prognostic factors on 47 patients (21 males and 26 females) with IgA nephropathy (IgAN). All patients were followed-up for more than 6 months (with the average of 29 months) after the tonsillectomy. The average age at tonsillectomy was 30.1 years old.
The postoperative remission rates were 61.7% (29/47) in proteinuria and 44.7% (21/47) in hematuria. The remission rates decreased after long-term (more than 2 years) follow-up.
Patients with minor and focal segmental nephrotic lesions showed a significant higher remission rate due to proteinuria than patients with advanced nephrotic pathology. The remission rate due to proteinuria was lower in patients showing a positive result in the tonsillar provocation test than in patients showing a negative result. The age of onset of IgAN, the period of time from the onset of IgAN until the tonsillectomy operation, and the creatinine clearance rates of the patients showed no significant statistical differences.

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We investigated the change of IL-6 and macrophage colony stimulating factor (M-CSF) concentration in the serum and urine of patients with IgA nephropathy and of patients with chronic tonsillitis who underwent the tonsil stimulating test or a tonsillectmy. Serum M-CSF concentration did not change after the tonsil stimulating test and the tonsillectomy. Three days after the tonsil stimulating test, urine M-CSF concentration was higher in the patients with IgA nephropathy compared with that in the patients with chronic tonsillitis. Urine IL-6 and M-CSF concentration was high in the IgA nephropathy patients with sever glomerular proliferation compared with the patients with mild glomerular proliferation occurring 2-7 days after the tonsillectomy. We concluded that urine IL-6 and M-CSF may be useful makers for investigating the influence of tonsils on glomerular injury in patients with IgA nephropathy.

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The method to evaluate the oral stage of the swallowing has not been established yet, because of its motor pattern complexity. We consider that the pressure in the oral cavity and pharynx during swallowing can be measured to by an index of the oral stage and the pharyngeal stage, respectively. In this study, we used a new instrument for evaluating the swallowing function which can measure intraluminal pressure of the oral cavity and pharynx simultaneously. In addition, we examined oro-pharyngeal bolus transit disorder by measuring oro-pharyngeal coupling time (OPCT).
The following results were obtained from the data of 26 normal subjects and 21 patients with dysphagia. The mean time of OPCT for normal sublects was 0.34±0.12 sec (mean±SD, n=26), which differed significantly (p<0.01) from that of patients with dysphagia 0.54±0.15sec (mean±SD, n=21). This study reveals that OPCT is Proloned in patientl with the oro-pharyngeal bolus transit disorder, due to the lack of bolus driving.

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Post-treatment oral symptoms were investigated in patients with oral cavity or pharynx cancer using a visual analogue scale (VAS). Evaluations were done after more than 6 months of treatment. Questionnaires measured degree of intraoral dryness, taste, mucosal sensation, movement of the tongue and disorders in oral phase swallowing. In this study, we examined 41 patients and evaluated their individual salivary flow for saliva production compared with 34 normal control subjects.
The patients were divided into three groups depending on their treatment as follows: Group A, 8 tongue cancer patients (T17 and T21) treated without radiation therapy but with a Nd- Yag laser; Group B, 6 mouthfloor carcinoma patients and 12 tongue cancer patients (T2 10 and T3 8) treated with surgery combined with 32-44 Gy preoperative radiation, and Group C, 15 patients who received more than 50 Gy radiation to the major salivary glands but did not has surgery.
The results of the VAS analysis are as follows:
1) The oral symptoms of all patients, except one, could be evaluated by the VAS questionnaires
2) Patients in group A had good swallowing function without xerostomia.
3) Patients in group B had swallowing disorders which resulted from dysfunction of tongue movement in addition to oral dryness.
4) In group C patients, severe oral dryness caused swallowing disorders.
The above results indicate that a reduction in salivary flow as well as in tongue movement after treatment results in disorders of oral phase swallowing. In this study, we considered VAS to be very useful for discriminating the changes in oral symptoms.

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Reconstruction of hard palate and soft palate defects is difficult because of structural and functional problems. Palatal prostheses are often required to enable speech and swallowing; however, maxillary and midface defects with or without orbital involvement are disfiguring and disabling problems especially in elderly cancer patients. Elderly patients, or those with compromised vision, often find these appliances cumbersome and difficult to manage. To help obviate these problems, a one-stage method of immediate palatal reconstruction was developed to obturate the palate and restore facial contour. This technique is a one-stage reconstruction of the palate and accompanying defects of the midface and maxilla which obviates the need for cumbersome palatal appliances. Free flaps in combination with microvascular surgery are now used universally to repair these defects. In order to reconstruct the palate, primarily after the radical removal, the author employs three the following three types of free flaps: rectus abdominis myocutaneous flap, latissimus dorsi myocutaneous flap, and forearm flap.To prevent drooping of the flap, muscle and fascia of the flap are needed to suture the zygomatic site.

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Swallowing function after surgery and primary reconstruction was investigated in 57 patients with tongue cancer and in 9 patients with anterior oral floor cancer. To evaluate the swallowing function, we employed a questionnaire interview, pharyngoesophagography, and measurement of swallowing pressure.
The following conclusions were obtained:
Swallowing function tends to depend on the extent of tongue and mandible resection.
In total glossectomized patients, preserving the larynx, primary laryngeal suspension and cricopharyngeal myotomy was necessary for preservation of aspiration.
In total glossectomized patients who had total laryngectomy, reconstruction of the simple wide passway of food was best suited for easiest transit of liquid food from the mouth into the esophagus.
Postoperative swallowing was relatively good in two-thirds of glossectomized patients. As for swallowing function, the reconstructed tongue or oral floor must be prevented from impeding the movement of residual tongue in these cases.
Swallowing function after hemiglossectomy or partial glossectomy was satisfactory comparing to that of the preoperative state.
Swallowing function, after pull-through operation for anterior oral-floor cancer, was apparently poor in the case of tongue resection in addition to segmental mandibular resection.

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In order to minimize functional and esthetic disturbances caused by extensive postoperative maxillofacial defects, the following points are recommended. 1. For hard palate defects. prosthetic restoration is preferable whereas most soft palate defects should be repaired surgically by means of composite reconstruction including bone and soft tissue to promote functional recovery. 2. The mandible is reconstructed precisely using metal plates, bone, and a thin skin flap.3. The tongue and oral mucosa are reconstructred by means of thin, highly mobile skin flap.4. Most facial defects, excepts those in the orbital region, should preferably be repaired surgically. Orbital defects as well as defects of the auricle and nose can be restored by prosthetic means. We have carried- out functional reconstructive surgery by free tissue transfer as first choice for the oral and maxillofacial region.
A total of maxillofacial defects 612 patients with underwent treatment. The site of treatment was the maxilla in 202 cases (33%), the mandible in 172 cases (28%), the tongue and mouth floor in 27 cases (4%) and the face in 98 cases (16%); 116 free tissue transfer operations, including 64 forearm flap and 31 vascularized iliac crest operations.

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In the present studies, we examined the biopsied materials of malignant lymphoma originating from the head and neck regions using histological analyses of HE, immunostain B and Tcells, and gene analysis of immunogloblin light and heavy chain, T cell receptor β, γ chains by Southern blot.
Finally, we diagnosed the five malignant lymphomas of seven cases.
Gene analyses seemed to have a lower rate of correct diagnosis than histological diagnosis in this study. However, this included the possibility of rapid detection of the first gene rearrangement without the detection of histlogical change of malignant lymphoma.
In the diagnosis of malignant lymphoma, it was necessary that we critically diagnosed in not only these studies but also other laboratory data and the clinical course.

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MATERIALS
Eleven patients with squamous cell carcinoma of the anterior wall of the mesopharynx treated in our hospital from 1985 through 1996 were reviewed.
METHODS
We analysed the treatment method, results of treatment and survival rate. We divided the 11 patients into various stages according to the UICC system (1987).
RESULTS
The patients consisted of 10 males and 1 female. The mean age was 56.3 years. One patient was in stage I, 3 in stage II, 3 in stage III, and 4 in stage IV. Patients in the advanced stage represented 64% of the total.
The survival rate was 54.5% . Ten patients were treated with radiation therapy, 8 with surgery, and 8 with chemotherapy. Stage I and stage II cases were treated with radiation therapy only, with 1 patient experiencing a local recurrence who treated by a salvage operation. Advanced cases were treated with combination therapy consisting of intravenous chemotherapy using CDDP or CBDCA and 5-fluorouracil, linac x-ray irradiation, extensive resection and primary reconstruction. The 5 cases that died were all advanced cases, the 6 surviving cases were 4 early cases, 1 stage III case and 1 stage IV case.
The causes of treatment failure were distant metastasis in stage III and local failure in stage IV.
CONCLUSION
In order to improve the results of therapy in advanced cases, further combination therapy and more extensive resection are thought to be necessary.

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Extracorporeal Shock Wave Lithotripsy (ESWL) was performed on six patients with sialolithiasis of the submandibular gland. In three patients, satisfactory results were obtained. However, in the other three patients, results were unsuccessful. Reasons for this failure are as follows; 1) The patient was not able to assume the proper head position for ESWL for sialolithiasis. 2) The flow of saliva was not enough to discharge crushed stones. 3) Stones were too large to be crushed by ESWL. 4) Technical skills of the operator were unsatisfactory due to insufficient training. The authors, however, emphasize that ESWL is an excellent method for sialolithiasis at the point of minimal invasion. Therefore, it is expected that demand for ESWL for sialolithiasis will increase, and so we have to establish indications and safety standards for this method as soon as possible.

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The antibacterial activities of benzylpenicillin (PCG) alone or in combination with herbal medicines, Jyuzen-Taiho-Toh (JTT), Hotyu-Ekki-Toh (HET) and Tohki-Rikuoh-Toh (TRT), were examined against penicillinase (PCase)-producing H.influenzae using an agar dilution method. All of the combinations of PCG and each herbal medicine enhanced the activity of PCG against PCG- resistant H.influenzae; the minimum inhibitory concentration (MIC) value was decreased two fold. Each herbal medicine alone did not show antimicrobial activity and the PCase inhibitory activity of each herbal medicine was assayed to confirm its positive synergic result. Each tested herbal medicine inhibited PCase, wish JTT showing the strongest activity in comparison with TRT and HET.
In this investigation, the extracts of herbal medicines, JTT, TRT and HET, were found to possess not only synergistic activity against PCase- producing H.influenzae, but also to possess inhibitory activity against PCase prepared from the strains. The active substance in the extracts which inhibits the PCase has not yet been purified. Further studies are needed to demonstrate the mode of inhibition and to determine its practical usefulness.

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The subject in our study on tonsillectomy were 31 patients (13 males and 18 females). The average age at the tonsillectomy was 31.0 years. The average period of observation was 93.1 months. We studied the effects of tonsillectoy by urinalysis, and by measuring serum Cr, IgA, ASLO levels both one year and five years after the tonsillectomy operation. The renal histology was classified into four groups according to criteria for deciding convalescence from IgA nephropathy.
An improvement of urinary findings occurred in 48% of the cases one year after the operation; 52% of the cases improved after five yeare. This indicates that the improvement in urinary findings occurred over a paratively long period. The rate of effective tonsillectomy, including improvement in renal function, was in 48% of cases after one year; this rate was 39% of cases after five years. This suggests that the effectiveness of tonsillectomy decreased as renal function deteriorated.
Tonsillectomy had no effect on the group of patients whose serum Cr had been very high. Therefore, the group of patients whose serum Cr had been over 2.0 mg/dl and who had suffered from renal falure, should have been excludid from this study. After considering the effective rate of tonsillectomy and the changes of serum Cr, We concluded that the operation should be performed on patients an early stage of renal histology. However, in the group of advanced stage that the renal function was normal, tonsillectomy in IgA nephropathies possibly prevented aggravation of the renal function.

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Our study population included 15 patients who had stomato-pharyngeal disease. Twelve patients were clinically suspected to have a Peritonsillar Abscess (PTA). In actual fact, eleven patients had PTA and one patient had peritonsillitis. Another three patients were clinically suspected to have tongue tumors; of these, two patients actually had carcinomas and one patient had leukoplakia. All patients were subjected to a transoral sonographic examination using a RTfino apparatus (Yokogawa Medical Systems) equipped with a MZ 6.5MHz probe.
In all patients with PTA and tumors of the tongue, the existence of stomato-pharyngeal disease was demonstrated.
The present study showed that transoral sonography can be useful in the diagnosis of stomato-pharyngeal disease.

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Salivary duct carcinoma is an uncommon malignant tumor that occurs in the major salivary gland. It resembles ductal carcinoma of the breast.
We present a case of a 75-year-old man with salivary duct carcinoma of the right parotid gland. The patient was treated with preoperative irradiation and a right total parotidectomy with right radical neck dissection was done followed by postoperative chemotherapy. The autopsy revealed metastasis of bilateral lungs, paratracheal and para-aortic lymph nodes, and invasion of the right thyroid gland and right common carotid artery region.

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