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A 55-year-old man presented with progressive pain and expanding swelling in his right neck. He had no history of trauma or infectious disease. The patient had undergone chiropractic manipulations once in a month and the last manipulation was done one day before the admission to our hospital. On examination by laryngeal endoscopy, a swelling was found on the posterior wall of the pharynx on the right side. The right piriform fossa was invisible. CT revealed hematoma in the posterior wall of the right oropharynx compressing the airway tract. Aneurysm-like enhanced lesion was also seen near the right common carotid artery. Ultrasound imaging revealed a fistula of approximately 1.2 mm at the posterior wall of the external carotid artery and inflow image of blood to the aneurysm of a diameter of approximately 12 mm. No dissection or stenosis of the artery was found. Jet inflow of blood into the aneurysm was confirmed by angiography. T1-weighted MR imaging revealed presence of hematoma on the posterior wall of the pharynx and the aneurysm was recognized by gadolinium-enhancement. We performed emergency surgery to remove the aneurysm while preserving the patency of the external carotid artery. The pin-hole fistula was sutured and the wall of the aneurysm was removed. Histopathological assessment of the rissue revealed pseudoaneurysm. The patient was discharged after 12 days without deficit. Progressively growing aneurysm of the external carotid artery is caused by various factors and early intervention is recommended. Although, currently, intravascular surgery is commonly indicated, direct surgery is also feasible and has advantages with regard to pathological diagnosis and complete repair of the parent artery.

Human growth hormone (hGH) is a single chain, 22 kd-protein with two intramolecular disulfide bonds. The hGH gene is located on chromosome 17 at band q22-q24 and has four introns separating five coding exons. The expression of hGH is restricted to the pituitary and regulated by GHF-1 which binds to the hGH promoter acting in concert with several other more ubiquitous DNA binding proteins. The secretion of hGH is regulated by GH releasing hormone (GRH) and somatostatin. GRH controls GH synthesis by stimulating transcription of GH mRNA while somatostatin determines the timing and amplitude of GH pulses. Pulsatile GH secretion is influenced by a number of neurogenic, metabolic and hormonal factors.

Neo-adjuvant chemotherapy with CDDP combination was introduced into the treatment of advanced head and neck cancer. Twenty-three patients with s.c.c of head and neck were given combination chemotherapy consisting of CDDP, VDS and 5-FU before surgical treatment in our department. CR and PR of this trial in all patients were 4 and 35%, respectively. The WBC nadir occurred around 2 weeks later, but all the patients recovered prior to the next cycle or surgical treatment. Renal dysfunction, nausea, vomiting and depilation were generally mild. VDS is useful as one of the neo-adjuvant drugs for the treatment of head and neck cancer. Long-term observation in connection with this treatment is required.

Sixty-three ears of 49 patients with serous otitis media were treated making use of butterfly ventilation tube in our 4 hospitals and 1 private office. The average time from intubation to extubation was 9 months and the longest case was 33 months. Main complications were infection and spontaneous extubation. The rate of hearing improvement after tympanostomy was more than 80% in all cases. The frequency of the most improvement was observed in 1kHz on the average. It was cleared that the butterfly ventilation tube was easy to use for the wide age patients and at any clinics. It was concluded that the butterfly ventilation tube was useful as a long-term ventilation tube.