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Solitary fibrous tumors (SFT) are uncommon neoplasm that arises in most cases from the pleura. SFT has been rarely observed in the head and neck, but SFT of the paranasal sinuses is especially rare, with 39 previously reported cases to date including those reported in this abstract. Herein we describe three cases of SFT in the paranasal sinuses that were successfully treated endoscopically. Two of the three cases involved patients with no previous history of SFT. The lesion of one of the patients was pathologically diagnosed as SFT preoperatively, but the other was diagnosed as an angiogenic tumor without any biopsies. The tumors were completely resected after arterial embolization by a transnasal endoscopic procedure. The third case involved a 43-year old man, who had undergone medial maxillectomy through a lateral rhinotomy incision to resect SFT four years and seven months before. The tumor relapsed intracranially and, therefore, a craniotomy procedure followed by endoscopic skull base surgery was performed. Radiation therapy was performed postoperatively because the recurrent tumor was pathologically identified as malignant SFT, which had been classified benign at the time of the first resection. All three patients are presently alive with no evidence of disease.

We report herein two cases of allergic fungal rhinosinusitis accompanied by bone destruction of the adjacent nasal sinuses. The first case involved a 21-year-old man who presented with left exophthalmos. Computed tomography (CT) showed soft tissue lesions in the left paranasal sinuses and destruction of the left lamina papyraceae, as well as infiltration of the lesion into the orbit. In the second case, a 39-year-old man, CT showed bone destruction of the skull base and medial wall of the left orbit. In both cases, total serum immunoglobulin (Ig)E level was >1000 IU/mL and fungus-specific IgEs were increased. Fungal hyphae were identified within the mucus on histopathological examination in both cases; however, no fungal invasion of the mucosa was apparent. Final diagnosis was allergic fungal rhinosinusitis (AFRS) in both cases. AFRS is a relatively new disease concept that was proposed in the early 1980s, with disease characteristics very similar to eosinophilic rhinosinusitis. Occasionally, AFRS must be differentiated from malignant disease or invasive fungal rhinosinusitis, so an understanding of the clinical features is important.

Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops.

Single-stage reconstruction of the pharyngoesophagus with a free jejunal graft is considered standard surgical treatment for hypopharyngeal cancer. We reviewed postoperative cervical CTs in 72 of 136 consecutive patients (1982-2002) undergoing this therapy in our department. Of these, 29 (40%) showed mesenteric lymph node swelling (> 10mm) in grafts. Most swelling is considered reactive, but 1 patient showed pathological metastasis in fine-needle aspiration cytology (FNA). When metastasis is clinically suspected in imaging study and other examinations, FNA should be done carefully with guided ultrasound echo-imaging, to avoid damaging vascular grafts and necrosis of the jejunal graft.

We clinically studied 31 cases of parapharyngeal space tumor treated between 1988 and 2002, and compared histological findings and preoperative diagnosis. Pleomorphic adenoma was the predominant tumor, accounting for 35.5%. Schwannoma and paraganglioma were next at 26.6%. In determining pathological diagnosis, fine needle biopsy and imaging were useful. Important factors in imaging diagnosis are inspecting the degree of enhancement in CT or MRI, investigating the existence of flow void on MRI, and discriminating whether the origin is pre- or post-styloid.

Fabry's disease is a genetic disorder caused by the absence of alpha-galactosidase (alpha-Gal), the gene of which is carried on the long arm of the X chromosome. This enzymatic defect leads to an accumulation of glycosphingolipids in the plasma and lysosomes of endothelial, perithelial, and smooth muscle cells, especially involving those of the cardiovascular, renal and cerebrovascular systems. We report one male case of Fabry's disease with renal deterioration. A 36-year-old man who was a classic case with acroparesthesia, angiokeratoma, and hypohidrosis from 10 years of age, was diagnosed to be a hemizygote of Fabry's disease at 27 years as a result of severe decreased alpha-Gal activity of his peripheral white blood cells. This patient was found to have a point mutation of a G to A transition in exon 1. In May, 1989, he was reported to have proteinuria with normal renal function and admitted to our hospital due to renal deterioration in September, 1993. Laboratory examinations revealed a serum urea nitrogen of 65 mg/dl and creatinine value of 6.9 mg/dl. Urinary protein excretion was 3.9 g/day and urinary sugar was negative. On the renal biopsy specimens, light microscopic examinations revealed multiple sclerosing and collaptic lesions in glomeruli without severe tubulo-interstitial damage, but with stenotic change of the small arteries and arterioles. Electron microscopic examinations revealed a large number of electron dense deposits in the tubules. We diagnosed this case as Fabry's disease with chronic renal failure, however the pathogenesis of this renal progressive deterioration remained obscure. In this case, degenerative changes in the renal vessels due to Fabry's disease may be associated with rapid deterioration in renal function.

A group study of chemotherapy for head and neck squamous cell carcinoma, using CDDP, THP and PEP, was carried out on 32 cases at the department of Otolaryngology, University of Tokyo, and 7 affiliated hospitals. The combined chemotherapy, which we call "PTP therapy", consisted of 30 mg/m2 of THP on day 1, 70 mg/m2 of CDDP on day 2, and 5 mg/body/day of PEP on 4 successive days. The overall response rate was 78.1% (CR: 15.6%; PR: 62.5%). No major side effect was observed in any case. PTP therapy is useful in neoadjuvant chemotherapy.

We studied 50 patients with acute low-tone sensorineural hearing loss (ALHL) who were examined at the Department of Otolaryngology, University of Tokyo, and followed up for 18 months or more. We investigated the prognosis of hearing loss within 3 months after onset, rate of recurrence during long-term follow-up, interval between the first and the second episodes of hearing loss or between onset and the time when the diagnosis of Meniere's disease was made, and factors affecting prognosis. The results were as follows. 1. Within the initial 3 months of follow-up, hearing loss continued to fluctuate in 5 patients. In the remaining 45, hearing returned to normal in 34, improved without returning to normal in 6, showed no marked change in 4, and became worse in one. 2. In long-term follow-up, the recurrence of hearing loss without vertigo occurred in 16 patients, and 5 others were eventually diagnosed as having Meniere's disease. The average interval between the first and second episodes of hearing loss was 9.2 months, and the diagnosis of Meniere's disease was made an average of 27 months after onset. 3. Recurrence was not significantly related to the initial prognosis of hearing loss. 4. Within the initial 3 months of follow-up, the prognosis of hearing loss was significantly better in patients whose hearing loss at 1 kHz was within 20 dB, and tended to be better in females and in patients attending within one week of onset. Long-term follow-up showed that the rate of recurrence was significantly lower in patients aged 40 years or more, and tended to be lower in patients who visited the hospital within one week of onset or whose hearing loss at 1 kHz was within 20 dB. 5. There were no significant differences between patients with single and recurrent attacks with respect to sex, subjective symptoms, and results of the glycerol test and electrocochleography. ALHL tends to recur without any relationship to the initial prognosis of hearing loss. Since it is still difficult to predict whether or not hearing loss will recur, long-term follow-up is necessary even in patients with good initial prognosis.