Search

A case is presented of an infant who presented with foreign bodies in bilateral external auditory canals. Battered child syndrome was defined in 1962 by Kempe et al. as nonaccidental attack or injury repeatedly inflicted upon children by persons caring for them. Otolaryngologists are rarely in a position to diagnose and initiate management of child abuse presenting as injury to the head and neck area. The number of reported cases of child abuse has increased dramatically over the past several years and it is likely that physicians will examine such cases and be unaware of the fact that the child is being abused.

A clinical study of papillomas in the nose and paranasal sinuses was performed. A total of 17 cases of papilloma was seen at our clinic during the last 11 years and they consisted of 14 males and 3 females with a mean age of 57.9 years. The combination of MRI and CT scan was more useful than CT scan alone to distinguish between papillomas and chronic sinusitis. The recurrence rate was 29%.

Forty previously untreated patients with nasopharyngeal carcinoma treated for 18 years from 1981 through 1998 at the Mie University Hospital are reviewed. The male to female ratio was 2.3:1. The most frequent chief complain was cervical mass. More than half of the patients were classified into stages IIB or III. Until 1988, patients were treated mainly with radiotherapy, but the results were unsatisfactory. Since 1992, to decrease the occurrence of locoregional relapse and/or distant metastasis, we have used pirarubicin, cisplatin and peplomycin alternating with radiation, two cycle of chemotherapy alternating with two courses of radiation (30 Gy each after the first and second chemotherapy cycle). The chemotherapy consisted of pirarubicin, 30mg/m2/day on day 1, cisplatin, 50mg/m2/day on day 2 and peplomycin 5 mg/day on day 3-6, all given intravenously. The 5 years survival rate of 13 patients who recieved this new trearment was 61.5%. We conclude that alternative chemoradiotherapy is necessary for a better prognosis of nasopharyngeal carcinoma.

Cefixime (CFIX) was administered to 22 patients with acute otitis media, 43 patients with acute exacerbation of chronic otitis media, 27 patients with acute paranasal sinusitis and 14 patients with acute exacerbation of chronic paranasal sinusitis.1. It was effective in 81.0 00 of those with acute otitis media, in 54.$ % of those with acute exacerbation of chronic otitis media, in 65.400 of those with acute paranasal sinusitis, and in 100.0 % of those with acute exacerbation of chronic paranasal sinusitis.2. Bacteriological studies showed an elimination rate of 59.5% (47/79).3. No side effect was noted.4. The above results indicate that CFIX is a very useful antibiotic in the treatment of otitis media and paranasal sinusitis.

Incipient symptoms of multiple myeloma usually include such symptons as pain, anemia, malaise, and loss of body weight. A case of multiple myeloma occurring as a buccal mass is reported. The patient was a 65-year-old female. She visited our hospital complaining of a buccal mass with tenderness. A 4×4cm mass was observed the left buccal region. From CT and MRI findings, our preoperative diagnosis was a osteocartilaginous tumor. The buccal tumor with adjacent bone was removed surgically. Post-operative histological examination revealed proliferating plasmacytes in the tumor, and a pathological fracture in the right clavicula two days after the operation. The final diagnosis was multiple myeloma (IgA-κtype).

From 1990 through 1998, 143 patients with laryngeal cancer were treated in our department. Of the 143 patients, 94 had glottal, 43 had supraglottal, and 6 had subglottal cancer. The 5-year survival rate in patients with laryngeal cancer was 90.0% for stage I, 81.3% for stage II, 77.9% for stage III, and 42.6% for stage IV. The 5-year survival rate was 86.5% for glottal, 55.9% for supraglottal and 66.7% for subglottal cancer patients. The laryngeal preservation rate was 90.4% for stage I, 60.5% for stage II, 21.4% for stage III and 28.1% for stage IV.A loco-regional recurrence occurred in 24 of 143 patients (16.8%). The salvage rate for these patients was 45.8% (11/24). Six of 11 patients who died of primary disease and nodal failure (including 2 stomal recurrences) had supraglottic stage N carcinoma.In conclusion, laryngeal preservation surgery should be recommended in the early stages of cancer after radiation failure and local recurrence. It is recommended to dissect the anterior compartment including the delphian lymph node, pretracheal, and parathyroidal nodes bilaterally for patients with laryngeal tumors that have significant anterior subglottic extension, tumors arising in the subglottic region, or advanced tumors arising in any region, especially the supraglottis.

Epiglottal cysts in the larynx are not rare, but a standard resection method has not yet been established. We reported a new device and technique for resection of epiglottal cysts. According to usual laryngomicrosurgery, we approached the cyst by means of Karl Storz's direct laryngoscope and used scissors and forceps for laryngomicrosurgery. We treated the cyst wall with the scissors and forceps while they were electrified by an electrotome. Epiglottal cysts were removed easily, rapidly, and completely, and the hemostasis was easily obtained.This “electrolaryngomicrosurgery” is an idea resembling that of Columbus' egg; however, it makes resection of epiglottal cysts easy and certain.

A 7-year-old girl with CHARGE association is reported. This patient exhibited coloboma, tetralogy of Fallot, retarded development, ear anomaly and deafness, which fulfiled the criteria of CHARGE association. Pure tone audiography showed bilateral moderate conductive hearing loss. CT of her temporal bone revealed normal cochlea and hypoplastic bilateral semicircular canals. She was unresponsive to cold water stimuli in the caloric test. As an ossicular chain anomaly was suspected, an exploratory operation was carried out on her right ear. The stapes lacked its anterior crus and footplate, which was considered to be the cause of her conductive hearing loss. This disease is not rare and otorhinolaryngologists should consider this condition when examining young patients with deafness and ear anomalies.

The effect of emedastine difumarate after antigen challenge was investigated on nasal passage patency and the number of inflammatory cells in the nasal secretion of allergic rhinitis patients. The results showed that the change in nasal passage patency after 8 weeks of emedastine difumarate administration was significantly inhibited 30 minutes after the antigen challenge. No significant changes in the number of inflammatory cells in nasal secretion was observed during the acute or late phases.

We have treated 159 patients with laryngeal cancer over the past 15 years (Jan. 1, 1977 to Dec. 12, 1991). Of these 159 patients, 14 suffered from T3 glottic carcinoma and 13 from T3 supraglottic carcinoma; the histological diagnosis in every case was squamous cell carcinoma. The average age of the patients was 63.3 years and the male-female ratio was 13 to 1. The 5-year cumulative survival rate was 77.9% for T3 glottic carcinoma and 23.1% for T3 supraglottic carcinoma. Among the cases of glottic carcinoma, 6 patients underwent total laryngectomy. Five patients were treated by total laryngectomy and radiation, and 3 patients received radiation only. We were able to achieve primary site control in 10 of 14 cases. Among the cases of supraglottic carcinoma, 3 patients underwent total laryngectomy, 8 patients were treated by total laryngectomy and radiation, and 1 patient received radiation only. We were able to achieve primary site control in 5 of 8 cases who received laryngectomy and radiation, but were unable to in patients treated with laryngectomy without radiation therapy. Recurrences were found to appear more in cervical lymph nodes in both glottic and supraglottic carcinomas. In 13 cases with supraglottic carcinoma, 7 patients had recurrences sites in cervical lymph nodes. We concluded that elective neck dissection may be indicated for the treatment of T3 supraglottic laryngeal carcinoma.

The canalith repositioning procedure is designed to relocate free-floating otoliths from the posterior semicircular canal back into the utricle, thus relieving the patient of bothersome, often long-standing vertigo. We treated ten cases of benign paroxysmal positional vertigo using the canalith repositioning procedure. On follow-up, 7 patients were free from dizziness, 2 had improved significantly and one patient remained unchanged. This procedure is simple and cost-effective. We highly recommend this procedure for the treatment of benign paroxysmal positional vertigo.

From January 1990 to June 1995, nasal and/or sinus surgery was performed on 21 children with chronic sinusitis. There were 9 males and 12 females aged 5 to 15 years, with an average age of 11.3 years. Ten children received a polypotomy alone, and functional endoscopic sinus surgery was performed on 13 patients. Three patients underwent a Caldwell-Luc operation. The follow-up information was gathered by questionnaires mailed to all 21 patients and all of the patients replied. The mean follow up period was 32 months. Before the surgery, nasal obstruction was the most predominant symptom and rhinorrhea was the second. Of the 21 patients, 18 patients (85.7%) had complete resolution of their symptoms, and when questioned as to whether their surgical therapy had been successful, 16 patients (76.2%) recorded positively.In 9 of the patients, we performed rhinoscopic and X-ray examinations 28 months after the operation. Endoscopic sinus surgery was performed on 5 patients (8 diseased sides), and a polypotomy was performed on 4 patients (6 diseased sides). In this study, we found that endoscopic sinus surgery was more effective than the polypotomy. We conclude that endoscopic sinus surgery is effective in the treatment of chronic sinusitis in children.

A 58-year-old woman was referred to our department because of globus. X-ray examination, real-time ultrasonography, CT, and MRI were performed. A parathyroid tumor was revealed at the back of the left lobe of the thyroid. A functional parathyroid adenoma was suspected based on the results of a fine needle aspiration biopsy and high serum levels of both calcium (12.4mg/dl) and PTH (2800pg/ml). The patient subsequently underwent surgery. During surgery a parathyroid tumor was removed and the histological diagnosis was benign parathyroid adenoma.

From May 1991 to December 1993, 667 patients underwent surgery under general anesthesia in our department, and 37 of them received blood transfusions during 13 different surgical procedures. Radical resection with reconstruction for oropharyngeal carcinoma caused the largest amount of blood loss. The Hb value was less than 10g/dl in 59%, and the Ht was lower than 27% in 38%. The blood loss was greater than 30% of the total circulating blood volume as predicted from the height and weight of 48% of the 37 patients. In the total group of 667 patients, blood loss of more than 600ml (criteria for transfusion) occurred in 33 patients; six of them did not receive blood transfusion. We introduced the concept of MSBOS (Maximum Surgical Blood Order Schedule) and found from the data of the present study, of the values of MSBOS in several surgical procedures that blood loss of more than 600ml occurs in 80% of the patients. We estimate that the amount needed for replacement is eight units for oropharyngeal cancer (radical resection with reconstrution) and six units for cancer of the tongue (radical resection with reconstrution).

Three Patients, all male, with squamous cell carcinoma of the external nose were treated: primary cancer of the nasal vestibule, direct invasion from cancer of a lacrimal gland, and distant metastasis from lung cancer. They all underwent total rhinotomy. The first died of renal failure before treatment was completed. For the other two, facial prosthesis were made from silicon color-matched to the facial skin. Facial prosthesis is considered to be advantageous in that the operated wound can be observed carefully and frequently so as to discover recurrence at an early stage. As facial prosthesis can be provided quickly after surgery and is suitable for follow-up of the operated area.

Most of the patients with hypopharyngeal cancer had advanced stage lesions (III or IV). This may account for the poor prognosis. We investigated the process of diagnosis in 45 patients treated in our clinic during the past nine years. In 32 of them (71%) advanced disease was diagnosed before treatment. The interval between the onset of initial symptoms and the definite diagnosis before treatment ranged from less than one month to more than 12 months (average of 5.1 months). After the first medical examination, nine of the 45 patients required more than three months before diagnosis of hypopharyngeal cancer was comfirmed. At the first visit for consultation about the initial symptoms, 32 patients visited an otolaryngologist, and 13 patients visited an internist or a general surgeon. Three patients who were older than 74 years and complained of pharyngo-laryngeal discomfort were included in the above group of nine patients receiving a late diagnosis. The present study indicates that it is empirically feasible to diagnose or rule out hypopharyngeal cancer in elderly patients complaing of abnormal sensation in the pharyngo-laryngeal portion. Since hypopharyngeal cancer in the early stage is not easily detectable in the usual manner, such as indirect laryngoscopy or hypopharynx fluoroscopy, endoscopy with a well-equiped fiberscope and biopsy or cytology should be conducted periodically, if signs suggest the presence of hypopharyngeal cancer.

Three hundred and twenty eight patients with allergic rhinitis were treated with Azelastine chloride. Nasal symptoms were improved in 77.7% of those allergic to Japanese cedar pollen, in 89.1% of those with housedust allergy, and in 87.3% of those allergy to both Japanese cedar pollen and housedust. The clinical effects were examined for at least two weeks after the initial administration. Side effects were seen in 2.2% of the patients. These data indicate that Azelastine is a good medicine for the treatment of allergic rhinitis.

We used tizanidine hydrochloride, a muscle relaxant, and dihydroergotoxine mesilate, an activator of central nervous system function, as basic drugs in the treatment of 48 patients with tinnitus (25 males and 23 females, aged 25 to 82 years).Usual amounts of the two drugs were administered daily alone or in combination with other drugs for 2 to 31 weeks, and the clinical effect was evaluated by analyzing subjective tinnitus and accompanying symptoms before and after treatment.Loudness, continuousness and distress of tinnitus, and headache and shoulder stiffness as accompanying symptoms were reduced significantly after treatment (p

This study was desiged to determine the effectiveness of Tsumura Shin'i-seihai-to (TJ-104), a Kampo medicine, in chronic sinusitis. The subjects of this study were 30 patients aged 19 to 80 years, who received TJ-104 7.5g p. o. per day for four weeks.The general effectiveness of TJ-104 On subjective symptoms and rhinoscopic observations was 69.0%.Nasal mucociliary clearance (ST) was determined by the saccharin method in 28 subjects before (week 0) and four weeks after the start of the administration (week 4). At week 0, ST was within the normal range in 15 patients, and was retarded in 13 patients. At week 4, ST was signiflcantly better than at week 0 in those patients whose ST was retarded before treatment (p

We have treated 100 patients with abnormal sensation, such as a lump or choking, in the throat without using any medicine for 3 weeks. We classified the effectiveness of psychotherapy into 4 groups: markedly effective (the initial abnormal sensation was reduced by 80% or more), moderately effective (more than 50% but less than 80%), slightly effective (more than 20% but less than 50%) and not effective (less than 20%) at the end of 1, 2 and 3 weeks of treatment.1) The average reduction of the initial sensation was 29% at 1 week, 35% at 2 weeks and 38% at 3 weeks. The marked and moderate effectiveness rates were, respectively, 9% and 27% at 1 week, 17% and 27% at 2 weeks, and 25% and 20% at 3 weeks.2) The present psychotherapy seemed to be effective for the following patients: more than 50 years of age; without any occupation; with symptoms other than throat discomfort; those who responded well to previous medication for throat discomfort; not cancerphobic; less than 6 months since onset; complaining of discomfort higher than the hyoid bone; those with a choking sensation; not very neurotic by psychiatric tests.The results indicate that psychotherapy for this condition is not very effective if total cure is the goal and that it should not be the first choice of treatment. On the other hand, these data obtained from psychotherapy can provide a good reference for determining the effectiveness of various drugs in the treatment of abnormal sensation in the throat as long as the same criteria are used for the classification of effectiveness.

The therapeutic effect of S-carboxymethyl cystein (S-CMC, Mucodyne®) was examined in 54 patients with chronic sinusitis. A dose of 1500mg/day of S-CMC was administered to the patients for 4 weeks, and its effectiveness was evaluated at the end of treatment.1) The overall efficacy rate was 78.7% and the efficacy rate for good responses was 46.8%.2) An adverse reaction was noted in only one patient (1.9%).

Angiofibromas are histologically benign tumors, but clinically they often appear to be malignant because of their rich vascularity, so that massive bleeding may occur during surgery. Therefore, it is necessary to select a surgical technique with only slight bleeding and with a wide view enabling resection of the tumor en bloc.A 13-year-old male patient with a giant angiofibroma involving his nasopharynx, pterygopalatine fossa, and infratemporal fossa was treated here. We tried to resect the tumor en bloc without a skin incision. Le Fort I osteotomy was performed after embolization of the feeding artery of the tumor. The tumor was resected en bloc with little bleeding. There were no postoperative complications. We think that Le Fort I osteotomy is the most desirable technique for resecting angiofibromas with a wide view of the operative area.

The patient was a 62-year-old male with the complaint of hoarseness. He had had partial cystectomy for carcinoma of the bladder 8 years earlier and resection of a basal cell carcinoma of the left auricle 2 years earlier.Laryngeal carcinoma was diagnosed (T2N0M0), and he was treated with irradiation (60Gy). During the course of irradiation for the laryngeal carcinoma, a general examination revealed that he had liver carcinoma.After the irradiation, a left lobectomy of the liver was performed for hepatocelluler carcinoma. He is alive and well without any evidence of disease 15 months after partial hepatectomy.In this case the serum was positive for anti HTLV-I (ATLA) antibodies.It was suggested that HTLV-I might be involved in the development of these 4 malignancies.

We used the Cornell Medical Index Health Questionnaire (CMI) and the Maudsley Personality Inventory (MPI) to collect medical and psychological data from 35 males (42-78 years of age; average 62.5) and 15 females (20-76 years of age; average 54.7) with malignant head and neck tumors immediately before hospitalization for treatment of the tumors at Mie University Hospital and just before discharge from the hospital. There were 10 nose and paranasal, 8 oral, 8 pharyngeal, 14 laryngeal, 6 thyroid gland tumors and 4 others. The period of hospitalization was 1 to 13 months, average 3.3 months.1) Somatic and psychological complaints registered on the CMI were significantly lower after treatment (p

Without following the traditional diagnostic procedure based on oriental medicine, we administered an oral Kampo (traditional Chinese herbal) medicine, Tsumura Saiboku-to (7.5g/day), daily for 2 weeks to 108 patients with abnormal sensation in the throat, such as a lump or choking.After excluding 8 patients, 4 with unpleasant side effects and 4 who discontinued the medication, we evaluated the efficacy at the end of the first and second week of administration and one week after the termination of treatment in 38 males and 62 females. The medicine was considered to be very effective when the abnormal sensation improved subjectively by 80% or more, moderately effective if improvement was 50% to 80%, slightly effective if it was 30% to 50% and not effective if less than 300.The respective effectiveness rates were 22%, 32%, 11% and 35% at the end of the first week; and 35%, 33%, 12% and 20% at the end of the second weed; and 43%, 30%, 7% and 20% at the end of the third week. Further analysis of the data suggests that this medicine is more effective for females than males, for younger patients and those over 50, for non-drinking than habitually drinking patients, for those not previously treated, for those without cancer phobia, for those treated within one month after the start of abnormal sensation, for those with the sensation higher in the pharynx, and for those with lower neurotic scores on psychological tests.Side effects were reported by 6 (6%), 4 of whom stopped the medication: 4 had gastrointestinal symptoms and 2 had dry mouth and/or throat.From the point of view of western medicine, the effectiveness of Saiboku-to on abnormal sensation in the throat is good enough. It would probably be even better if administered after a selection based on diagnosis according to the concepts of oriental medicine.

A clinical study was conducted on a consecutive series of 147 patients with laryngeal cancer treated at the Department of Otorhinolaryngology, Mie University Hospital, during the 9 years from 1981 to 1989.1. There were 138 males and 9 females with a ratio of 15:1. Most of the patient (87.8%) were 50 to 70 years of age.2. According to the TNM classification of malignant tumors proposed by the UICC (1987), there were 85 (57.8%) glottic tumors, 47 (32.0%) supraglottic, 5 (3.4%) subglottic and 10 (6.8%) without a distinguishable site of origin (transglottic).3. The rates of recurrence after initial treatment were 10.9%, 20.9%, 31.0% and 27.3% for T1, T2, T3 and T4 patients, respectively.4. The presence or absence of lymphnode metastasis during the period of initial treatment showed no correlation with either later recurrence or later distant metastasis.5. Analysis by Kaplan-Meier's method showed 5-year survival retes of 80% for glottic, 55% for supraglottic, 69% for subglottic and 62% for transglottic tumors. The overall 5-year survival rate was 62%.

Diagnostic procedures in oriental medicine are quite different from those in western medicine because of the difference in basic concepts of medicine. From that oriental point of view, it is claimed that Saiko-ka-ryukotsu-borei-to (Chaff-Hu Jia-Long-Gu-Mu-Li-Tang), like other Kampo prescriptions, should be selected after a diagnostic procedure based on oriental medicine for more effective treatment of patients with abnormal sensation, such as a lump or choking in the throat. However, it is not easy for physicians trained in western medicine to learn these procedures.In this study, we used the Cornell Medical Index Health Questionnaire (CMI) as an aid for selecting patients for whom Saiko-ka-ryukotsu-borei-to is supposed to be effective, and we evaluated its actual clinical usefulness. Eighty-nine male and 50 female patients with abnormal sensation in the throat were classified as normal (Area I), almost normal (Area II), slightly neurotic (Area III) and neurotic (Area IV) by Fukamachi's method, and normal (Type I), autonomic nerve dysfunctioning (Type II), neurotic (Type III) and psychosomatic (Type IV) by a modification of Abe's analysis of CMI responders. In addition, we chose 13 questions (Saiko-ka-ryukotsu-borei-to Sho questions) from the CMI list which are supposed to be very important from the oriental medicine point of view for selecting Saiko-ka-ryukotsu-borei-to. According to their answers to the 13 questions, the patients were placed in 3 groups: supposedly good, supposedly moderate and supposedly poor responders.Tsumura Saiko-ka-ryukotsu-borei-to® (7.5g/day) was given orally for 2 weeks and the clinical effect was evaluated 1, 2 and 3 weeks after the start of treatment. When the abnormal sensation as evaluated subjectively by the patient was reduced by more than 50%, treatment was considered to be effective. Evaluation of the answers to the CMI and of the effectiveness of the medicine revealed the following:1) In both male and female patients, improvement increased gradually and was highest at the end of the 3rd week.2) Among the male patients, those in Area I or Type I were the best responders, while among the female patients those in Area I or Type I were the worst responders.3) As expected, good responders of both sexes had much higher effective rates at the end of each week than did poor responders.These results indicate that an analysis of the answers to the CMI questionnaire is very useful for predicting the efficacy of Saiko-ka-ryukotsu-borei-to in patients with abnormal sensation in the throat.

The patient was a 48-year-old woman with a retropharyngeal abscess. She had a sore throat after digesting a fish. No fishbone was detected at the first hospital she visited, therefore, she was treated with antibiotics and steroids until one was observed by CT scan. Eight days later, she was referred to our hospital. The fishbone was removed orally from the posterior pharyngeal wall under a general anesthesia. Three days after the operation, she had a fever and a non-productive cough. CT scan revealed a retropharyngeal abscess and drainage was performed. The abscess subsided and she was discharged 10 days later.

Using the Cornell Medical Index-Health Questionnaire (CMI) and the Maudsley Personality Inventory (MPI), we surveyed abnormal sensation in the throat (AST) in 258 in-patients with otorhinolaryngeal diseases at Mie University Hospital.Patients with pharyngeal, laryngeal, or thyroid disease had a higher incidence of AST than did those with nasal or other diseases. There was a significant relationship between AST and a history of upper respiratory tract diseases. CMI scores revealed that 13.6% of the patients were classified as manifestly neurotic, and more patients with AST were neurotic (48.5%) than those without AST (18.2%).

The authors treated 494 patients with abnormal sensation in the throat, such as a lump or a choking sensation, who had visited Mie University Hospital or its related hospitals from April 1985 to June 1989. The effects of various drugs for this condition were analyzed and the therapeutic response was compared in two groups : one was composed of patients with continuous complaints (continuous group), the other of patients with periodic complaints (periodic group). The purpose of this study was to determine whether patients with continuous complaints were more resistant to various kinds of medication and had more serious pathological conditions than those with periodic complaints.1) Placebo, lysozyme chloride (anti-inflammatory agent) and dosulepin hydrochloride (anti-depressant) were apparently effective for patients in the periodic group. Especially, with lysozyme chloride, there was a statistically significant difference in the complete cure rates of the two groups. Therefore, when we treat this condition with placebo or anti-inflammatory or anti-depressant drugs, continuous discomfort of the throat is much more severe than periodic discomfort.2) Tiaprofenic acid (an anti-inflammatory agent with peripheral analgesic effect) and Saiboku-to (Chinese herbal medicine) were equally effective in the two groups. Therefore, we cannot say that continuous complaints indicate a more severe condition of pharyngeal discomfort when these two drugs are used.3) Minor tranquilizers were much more effective in the periodic group than in the continuous group during the period of administration. However, within a week after the termination of the drug, a high rate of recurrence was noted in the periodic group, and final complete cure rate of this group was inferior to that of the continuous group. Therefore, when we treat this condition with minor tranquilizers, the periodic discomfort of the pharynx should be considered to be more serious than continuous discomfort.The present study has shown that continuous pharyngeal discomfort is not always more serious than periodic discomfort. The severity of this condition may depend on the therapy chosen. We should be careful in the assessment of the severity of the pharyngeal discomfort.

Comelian® (dilazep dihydrochloride) was used for six months to treat 80 patients with Meniere's disease, and its effectiveness in preventing attacks of vertigo and its safety were evaluated.1) The average number of definitive spells per month was reduced significantly (p>0.001) from 1.45±0.21 (Mean±S. D.) for six months before the start of treatment to 0.65±0.12 during the six month treatment.2) The maximum interval between definitive attacks was prolonged significantly (p

Ameloblastoma is a tumor believed to originate from odontogenic tissues and is generally considered to be benign. However, it often recurs postoperatively and in a few case malignant changes have been reported.Recently we treated a 75-year-old female with an ameloblastoma spreading from the center of the mandible to the left zygomatic bone. She had first noticed the tumor more than 10 years earlier. The only symptom was asymmetry of the face.The tumor was removed along with the left half of the mandible. Although reconstruction was not performed, her postoperative course was uneventful without dysfunction of mastication or speech.

We studied 28 cases of orbital blowout fracture treated in Department of Otorhinolaryngology, Mie University Hospital, from January, 1984 to March, 1989. There were 23 male patients and 5 female patients ranging from 7 to 59 years of age (average, 21.7 years). In the majority of cases was the present injury occurred during fighting. Vertical double vision was in 50%. The degree of double vision was evaluated before and after surgery and classified as severe, moderate, or mild. Double vision was evaluated before surgery, at the time of extubation of the balloon catheter, and about 3 months after surgery. Improvement was better when surgery was performed within two weeks after the injury. These patients also showed better improvement of other injuries postoperatively. Good postoperative improvement was also seen in patients with a negative preoperative forced duction test. Balloon catheter placement in the maxillary sinus for two weeks is considered to be adequate.

Mao-bushi-saishin-to extract capsules, a kampo preparation, was administrated orally to 21 patients with perennial nasal allergy who met a definite set of criteria. The dosage schedule was 3 times a day (6 capsules/day) for 4 weeks. The overall efficacy, safety and usefulness were evaluated.(1) Efficacy was rated “excellent” or “good” in 35.0% and “fair” or better in 60.0% after 2 weeks of treatment and 57.9% and 68.4%, respectively after 4 weeks of treatment.(2) Sneezing, nasal discharge, nasal provocation test, and nasal mucus eosinophil count showed statistically significant improvement after 4 weeks of treatment.(3) The medication was rated “useful” or “very useful” in 52.4% of the cases and “slightly useful” or better in 66.7%.(4) The only side effect was skin rash in two patients.These results indicated that this preparation is useful for the treatment of nasal allergy.

Hange-koboku-to is a Kampo medicine which is supposed to be effective for abnormal sensations, such as a lump or choking, in the throat. Some authors, including the present authors, have investigated clinically the relationship of its efficacy and the severity of the patients' neurotic condition. No complete agreement, however, has been reached. Some have reported that non-neurotic patients respond better to this medication, but others do not agree. No study has been done yet on the relationship between the efficacy of Hangekoboku-to and autonomic nerve dysfunction. The purpose of this study is to determine whether there is any relationship between the effect of Hange-koboku-to and psychosomatic conditions classified with a newly developed method (modification of Abe's method) using the Cornell Medical Index-Health Questionnaire Analysis which places patients into four categories: normal, autonomic nerve dysfunctioning, neurotic and psychosomatic (autonomic nerve dysfunctioning+neurotic).Ninety-six female patients with abnormal sensation in the throat were classified by a modification of Abe's method into the 4 groups mentioned above and treated with Tsumura Hange-koboku-to (7.5g/day) for 2 weeks. The clinical effectiveness was evaluated 1, 2 and 3 weeks after the start of medication. A reduction of the abnormal sensation, evaluated subjectively, of more than 80% was considered to show excellent effectiveness. The number of patients reporting excellent effectiveness increased gradually to a peak at the end of the 3rd week, indicating that in some patients further improvement occurred after the termination of medication. The percentages of patients reporting an excellent effect in the 3rd week were 49%, 29%, 45% and 37%, respectively, in the normal, autonomic dysfunctioning, neurotic and psychosomatic groups.The diagnostic procedures of the oriental medicine are quite different from those of western medicine because of the difference in basic concepts. Our results indicate that psychosomatic evaluation of patients by a modification of Abe's method is helpful for physicians trained in western medicine, who do have little knowledge of oriental diagnostic procedures, for determining whether Hange-koboku-to might be useful in the treatment of individual patients.