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Superselective intra-arterial chemotherapy, which can provide local control and laryngeal preservation, is safe and useful for preserving pharyngeal and laryngeal functions.To evaluate superselective intra-arterial chemotherapy in terms of the contribution to survival and laryngeal preservation in squamous cell carcinoma (SCC) of the anterior oropharyngeal wall.A total of 51 patients with SCC of the anterior oropharyngeal wall received intra-arterial administration of docetaxel at 60 mg/m(2) and cisplatin at 60 mg/m(2) anterogradely, followed by intravenous continuous infusion of 5-fluorouracil at 750 mg/m(2)/day over 120 h starting on day 2. Neck lymph node metastases were treated by neck dissection.The 5- and 10-year survival rates of the 51 patients were 72.8% and 66.4%, respectively. The 5-year survival rates of patients with T2, T3, T4a, and T4b cancer were 100%, 88.7%, 41.9%, and 33.3%, respectively. The 5- and 10-year laryngeal preservation rates of the 51 patients were 63.4% and 30.0%, respectively. The 5-year laryngeal preservation rates of patients with T2, T3, T4a, and T4b cancer were 100%, 75.2%, 23.6%, and 33.3%, respectively. No irreversible side effects, complications, or sequelae were reported.

Patients who received concurrent chemoradiation therapy or radiation therapy alone were followed over a long term. The complete response (CR), 10-year survival, and 10-year larynx preservation rates were 87.5%, 95.3%, and 75.1%, respectively. Statistically, concurrent chemoradiation therapy contributes to laryngeal preservation but not to the survival rate.To determine the additive and synergistic effects of anticancer chemotherapy combined with chemoradiation therapy for squamous cell carcinoma (SCC) of the glottic larynx.Eighty-nine patients with untreated T2N0M0 SCC of the glottic larynx were included. Thirty-two patients received treatment cycles consisting of intravenous cisplatin (CDDP) on day 1 (80 mg/m(2)) and intravenous 5-fluorouracil (5-FU) over 120 h on days 2-6 (600 mg/m(2)/day) every 4 weeks. Radiotherapy was delivered by a 4 MV linac X-ray machine at a dose of 66 Gy. Fifty-seven patients received radiotherapy alone.After chemoradiation therapy, the overall response, CR, 10-year survival, and 10-year larynx preservation rates were 100%, 87.5%, 95.3%, and 75.1%, respectively. Side effects included leukopenia, neutropenia, mucositis, and dermatitis. Seven patients (21.9%) required salvage surgery. Pathological findings confirmed that the treatment regimen caused marked cancer tissue degeneration. Histologic examination of surgical specimens suggested that the safety margin for partial laryngectomy was 4 mm from the gross tumor.

Concurrent chemoradiation therapy with docetaxel (DOC) at a dose of 10 mg/m(2) twice a week contributed to laryngeal preservation.To determine laryngeal preservation following concurrent chemoradiation therapy with DOC.A total of 141 patients with untreated T2N0M0 squamous cell carcinoma of the glottic larynx were included in the study. The treatments were either radiation therapy alone or DOC intravenously administered at a dose of 10 mg/m(2) once or twice a week during radiotherapy with 4 MV linac X-ray (total of 66 Gy for 33 days).The response and CR rates were 100% and 90.5% in the once-weekly combination group, and 100% and 97.6% in the twice-weekly combination group, respectively. The 5-year survival rates were 76.8% in the once-weekly combination group and 96.8% in the twice-weekly combination group. The 5-year laryngeal preservation rates were 83.8% in the once-weekly combination group and 97.6% in the twice-weekly combination group. The most common side effects were mucositis, dermatitis, and alopecia. The patients who received DOC twice a week showed more severe cancer tissue degeneration, and pathological examination of serial sections indicated that the safety margin for partial laryngectomy was considered to be 3 mm from the gross tumor with good glottal closure.

Vascular tumors are divided histologically into vascular lesions on the surface of the body, i.e. hemangiomas, and vascular malformations which have normal endothelial cells but manifest structurally abnormal vascular proliferation. Vascular malformations are often encountered in the head and neck region. We studied patients who underwent laryngoscopic surgery in our department for vascular malformations of the larynx.Direct laryngoscopic surgery was performed under general anesthesia. The mucosa surrounding the vascular malformation was stripped and resected. The vasa vasorum were treated with an Ho:YAG laser. We reviewed five patients who had received laryngoscopic treatment in the larynx region during the past two years.Histopathologic examination of the removed tumor tissues revealed venous malformation in four cases and lymphatic malformation in one case. The postoperative course was uneventful with neither hemorrhaging nor other complications, and none of the cases showed any recurrent disease up to the present.Our experience suggests that the laryngoscopic surgery provides minimal surgical intervention and can be applied to a wide range of age.

Objective:Only a few benign tumours of the middle ear have been reported to lead to the development of facial palsy. Here, we describe a patient with middle-ear cavernous lymphangioma and facial palsy.Study design:Single case study.Patient:A 61-year-old man presented with left-sided hearing impairment and incomplete left facial palsy. A tumour was confirmed to be occupying the epi- to mesotympanum and to be joined to the facial nerve. The tumour was removed along with facial nerve tissue, which was resected at its horizontal portion, and the remaining facial nerve was fixed by end-to-end anastomosis. Complete facial paralysis occurred after the operation, but the patient's House–Brackmann grade gradually improved to grade III. Post-operative histopathological examination revealed infiltration of the lymphangioma into the facial nerve tissue, together with mild neural atrophy of the facial nerve.Conclusion:These findings suggested that tumour invasion was the cause of facial palsy in this patient.

Facial nerve paralysis associated with middle ear cholesteatoma, although well known, is only occasionally encountered and its clinical features and management have been evaluated in only a few studies. We studied its clinical features associated with facial paralysis. Subjects numbered 20 [15 males and 5 females] from 3-82 years old (mean: 42.6 years) with facial nerve paralysis due to middle ear cholesteatoma undergoing surgery between 1990 and 2008. After cholesteatoma lesion resection, a limited area of the fallopian canal in which facial nerve edema or redness was evident was opened, although the epineural sheath was not incised for nerve decompression. Initial paralysis was incomplete in 13 (65%). Paralysis onset was sudden in 16 (80%). The facial paralysis outcome was favorable in 14 (70%). Facial paralysis outcome was largely favorably, although poor outcomes were observed in cases with petrosal cholesteatoma and in those undergoing surgery ≥2 months after paralysis onset.

We report a rare pediatric case of congenital cholesteatoma initially manifesting as facial paralysis. A 3-year-old boy seen for acute facial palsy had developed left facial paralysis on January 4, 2008, undergoing predonisolone therapy by a local pediatrician from January 10. Upon referred on March 5, facial palsy was a severe Grade V in House-Brackman classification. Middle-ear computed tomography showed soft tissue filling the mastoid antrum through the epitympanic recess to the tympanic cavity. Endoscopic examination identified swelling of the tympanic membrane and a yellowish-white tumor of the tympanic cavity. Based on a diagnosis of congenital cholesteatoma, he underwent surgery under general anesthesia on June 27. The cholesteatoma lesion occupied the tympanic cavity, extending to the aperture of the mastoid antrum. In staged surgery, the exposed facial nerve in the tympanic cavity appeared hyperemic and adjacent to the cholesteatoma lesion. Postoperatively, facial paralysis improved incompletely remaining in Grade III in House-Brackmann classification.

Multiple sclerosis patients sometimes complain of vertigo as one of their symptoms. We experienced a case in which vertigo was seen as the chief complaint. MRI and neurootological examinations led to the diagnosis that the vertigo was caused by recurrent multiple sclerosis lesions of the posterior cranial fossa. We then considered five earlier multiple sclerosis patients who had vertigo. Their pure tone audiogram and caloric tests were almost normal. However, neurootological examinations ETT, OKP and gravicorder showed abnormalities. Therefore, in addition to MRI T2 and T2 FLAIR image examinations, neurootological examinations are valuable for diagnosis, especially in order to detect posterior cranial fossa lesions.

We report a case of Hunt syndrome with the primary complaint of lower cranial nerve paralysis. The patient experienced not only lower cranial nerve paralysis, but also, finally, paralysis of the facial nerve. The patient was a 68-year-old woman. She came to the hospital complaining of herpetic vesicles around the right ear and pain, vertigo, and hoarseness, but there was no facial palsy. Hydrocortisore sodium succinate and acyclovir were administered intravenously.Twelve days after, she developed right facial palsy. Prednisolone and Valaciclovir hydrochloride were orally administered. Fifty Four days after disease onset, the function of all cranial nerves recovered completely.A review of the Japanese literature revealed 44 cases of Hunt syndrome with multiple cranial nerve palarisis from 1954-2005. In our case, the development of right facial palsy occurred later than all other symptoms. The late-onset facial palsy was only 5 cases and rare.

The clinical and surgical findings of this study indicated advanced cholesteatoma in many patients with facial paralysis. The outcome of facial paralysis was good. Poor outcomes were observed in cases with petrosal cholesteatoma and in those who underwent surgeryor = 2 months after the onset of paralysis.To investigate clinical features of cholesteatoma associated with facial paralysis.Sixteen patients with facial paralysis due to middle ear cholesteatoma were reviewed. After removal of the cholesteatoma lesion, a limited area of the fallopian canal, that in which facial nerve edema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed.Initial paralysis was incomplete in 11 patients (69%). The onset of paralysis was sudden in 12 patients (75%). Labyrinthine fistulae (n = 9; 56%) and bone destruction in the cranial fossa (n = 10; 63%) were frequently observed. Six patients (38%) were totally deaf due to labyrinthitis. The outcome of facial paralysis was good in 13 patients (81%). Patients who underwent surgeryor = 2 months after the onset of paralysis frequently had a poor outcome. Paralysis was not improved in two cases with petrosal cholesteatoma.

Objective: To show the significance of various factors when predicting the outcome of facial nerve paralysis. Design: Retrospective chart review. Setting: Nihon University Itabashi Hospital in Tokyo. Subjects Four hundred sixty-seven patients with facial paralysis who visited the hospital within 14 days of disease onset. Methods: The failure rate of complete recovery was studied for each of these nine factors: sex, age, varicella-zoster virus (VZV) infection as the cause of paralysis, initial severity of paralysis, number of days from onset of paralysis to the beginning of medical treatment, nerve excitability test (NET), stapedial reflex, lacrimal secretion, and severity of facial paralysis 1 month after onset. These factors were analyzed by logistic regression. Results: Logistic regression clarified that age, VZV infection, NET response, loss of stapedial reflex, and the state of paralysis 1 month after the onset had statistical significance for the prognosis of facial paralysis. The poor recovery rate was greater than 50% in the patients who exhibited abnormal responses on NET or failed to attain recovery to grade III or better during the 1-month period after the onset of paralysis. These findings were therefore considered as high risk factors for the prognosis. The poor recovery rate was between 25% and 50% in patients who were 50 years or older or whose initial grading of paralysis was V or worse. These findings were classified as moderate risk factors. Patients with VZV-caused paralysis and loss of stapedial reflex had poor recovery rates of below 25%, and these were classified as low risk factors. Conclusion: It is possible to predict the prognosis of facial paralysis on the basis of several clinical findings. NET response, severe initial paralysis, age 50 years or older, and, as a second-stage factor, severity of facial paralysis 1 month after the onset were found to be especially important factors for predicting the prognosis of facial paralysis.

A 58-year-old man presents with bilateral total ophthalmoplegia caused by malignant lymphoma in the cavernous sinuses. He reported right retrobulbar pain and diplopia; however, corticosteroid therapy was not effective. After admission, right total ophthalmoplegia progressed to bilateral involvement within a few days. From biopsy of the ethmoidal sinus and axillary lymph nodes, non-Hodgkin's lymphoma was diagnosed. Chemotherapy was started immediately, and non-Hodgkin's lymphoma was completely remitted within 3 months. Bilateral total ophthalmoplegia also improved; however, tonic pupils became prominent in both eyes. Paraneoplastic effects of non-Hodgkin's lymphoma may be responsible for the tonic pupils.

In 96 patients who visited our hospital with glossodynia, we conducted gustatory tests, measured serum zinc and copper levels, examined lingual papillae using biomicroscopy, conducted psychological tests and investigated the effectiveness of treatments directed at the cause of dysgeusia. Gustatory test results showed that 43 (44.8%) of the patients had dysgeusia, which was mild in 62.8%, moderate in 30.2% and severe in 7.0%. By giving higher priority to treatment of dysgeusia than to glossodynia, pain disappeared or was relieved and gustatory sensation improved in 27 (62.8%) of these 43 patients. Overall, pain disappeared or was improved in 65 (67.7%) cases. When treating glossodynia, it is important to diagnose the cause of pain and to give higher priority to treating that cause. The clinical efficacy of treatment for glossodynia will be improved when the presence or absence of dysgeusia is diagnosed early in the course of treatment.

We treated five patients with Hunter's glossitis following total gastrectomy. The major complaints of the patients were taste disorder and abnormal glossal sensation. In all five cases, the patient's tongue was red and smooth, and laboratory testing showed the presence of macrocytic anemia and decreased serum concentration of vitamin B12 (cyanocobalamin). Gustometry was carried out in four cases and the results documented the presence of taste disorder. All five patients were treated by administration of vitamin B12, which led to improvements in the appearance of the tongue, the patients' subjective complaints and the results of taste testing. When patients present with a red, smooth tongue, Hunter's glossitis (which can easily be improved by administration of vitamin B12) should be considered in the differential diagnosis.

Objectives: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. Methods: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8±0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. Results: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. Conclusions: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Fifty five cases with middle ear cholesteatoma which were performed second look and revision surgery were studied. In those cases, at the first operation, the posterior wall of the external auditory canal was reconstructed after canal down mastoidectomy. At the second operation, in 27 cases, the reconstructed posterior wall was totally removed, again, for investigation of residual cholesteatoma. In 26 cases, partial removal near to the epitympanum and the tympanic cavity was enough for inspection of the residual cholesteatoma. As the part was reconstructed with small cartilage, it was not complicated to remove it. At the second surgery, reconstruction of the mastoid cavity and the posterior wall was performed in 37 cases, and in 16 cases, the mastoid cavity was obliterated because of its severe pathological changes. After the second surgery, small bony absorption of the reconstructed posterior wall was observed in two cases, and abnormal findings of the eardrum were recognized in 10 cases. However, no cases were needed for frequent management or additional surgery. Improvement of hearing was succeeded in 100% of the cases with type I, 60% with type III and 30% with type IV tympanoplasty.

We report a rare case of benign mesenchymoma with carpal tunnel syndrome.The patient was a 37 year old female who presented complaining of numbness of the right index. When she came to our hospital in November 1996, an ambulatory tumor was palpable at the carpal tunnel. She had sensory disturbance and numbness in the median nerve area. The distal motor latency was 5.1 msec. Roentgenogram did not show tumor. In magnetic resonance imaging (MRI), tumor showed high intensity in T2 image. In December 1996 surgery was performed. The histology of this tumor was benign mesenchymoma.

Clinical examinations were performed on 16 elderly patients (over 90 years of age) who were treated surgically during the past 2 years and 9 months for femoral neck fracture. Patients aged over 90 account for 15.7% (16 cases) of the population aged over 65 (102 cases). Cardiac failure was the most frequent preoperative complication. Principal complications seen during operation were hypotention and arrythmia. 9 patients regained walking ability and 7 could move by wheelchair.Walking ability afteroperation was lower than before trauma, but no patients remained bedridden. 8 of the 13 patients who lived in their own homes befor trauma could return. But 1 patient needed to stay in a health care facility, while 4 patients had to be taken to other hospitals.Early surgical treatment and early postoperative rehabilitation are also important for preventing complications and improving the quality of life in elderly patients (over 90). We felt the need to prepare the patients to return back to their normal lives after hospitalization.

We experienced one case of dislocation of the inner head in biporal hip prosthesis caused by the wear of the HDP liner. The case, a 82 year-old woman with left femoral neck fracture was treated with biporal hip prosthesis, without self-centering mechanism, approximately 11 years ago. She had severe pain in her left hip while sitting down on her heels, and was unable to walk. Roentogenogram of the hip revealed extreme varus position of the outer head and dislocation of the inner head in bipolar hip prosthesis. Surgical exploration revealed the outer head that was fixed in the varus position, hyperplastic granulation in acetabulum, and manifest wearing of all inner HDP liners. This suggested that the wear occurred due to impingement between the stem neck and outer head fixed in the varus position. In conclusion, we should follow-up carefully after operation for a long period of time, and help the patient resume proper daily activities.

Diagnosis and treatment of taste disorders are challenging because the disorder can only be determined by the awareness of the patient. Hence, these disorders still require comprehensive evidence. We conducted a randomized, placebo-controlled double-blind study to investigate the effect of polaprezinc, a zinc-containing agent, in 219 patients with either zinc deficiency-inductive or an idiopathic taste, disorder. As a result, the zinc-treated arm experienced a statistically significant improvement against the placebo-treated arm in the perceptible threshold scores of the filter-paper disk method 8 weeks after the administration of the investigational drug. Moreover, the effect lasted for 4 weeks after discontinuation of the drug. However, the effective ratios based on the initial criteria were 55.6% in the treatment group and 43.2% in the placebo, where no statistical significance was recorded. Sex and degree of depression could be two of the potential factors to explain this discrepancy. Furthermore, the effect was not significant among male patients and patients with a high depression score based on the Self-rating Depression Scale (SDS) test. These results indicate that determining the symptom among such patients remains undisclosed. Whereas, in approximately 77%, or 168 patients with "normal" SDS scores and with completely impaired taste qualities, the ratio of effective cases reached 60.9% in the zinc-treated group, the ratio of the placebo-treated group reached 39.5%, resulting in a statistical significance. This may be partly because of a problem in the adaption of male subjects to the gustatory analyses, especially to the identification of saltiness and sourness. Care must also be taken regarding the depressive state of patients when diagnosing and treating taste disorders. Taste disorders caused by depression may not be cured by zinc supplementation due in part to the fact that the symptom is based on a mental issue, and due in part to the conservative responding bias generated by the depression itself, which may inhibit accurate and precise diagnosis of the disorder. In conclusion, administration of a zinc agent is effective for patients with taste disorders, provided selection of appropriate patients is performed, and that proper examination and evaluation are conducted. The present study also indicated that examining depressiveness based on the SDS scores and investigating disturbance of each taste quality using the filter-paper disk method are recommended for the diagnosis and determination of the treatment effect of a taste disorder.

Superselective intra-arterial chemotherapy is a safe and useful treatment that preserves the vocal, swallowing, and feeding functions of the larynx in T3 cancer supplied by the superior laryngeal artery and T4a cancer not extending beyond the thyroid cartilage.To evaluate the outcomes of superselective intra-arterial chemotherapy for squamous cell carcinoma of the glottic larynx.Sixty-four patients with squamous cell carcinoma of the glottic larynx underwent treatment of the primary tumor using induction chemotherapy with two cycles of intra-arterial docetaxel and cisplatin, plus continuous intravenous infusion of 5-fluorouracil for 120 h starting on day 2; followed by two cycles of concurrent chemoradiation therapy. Residual neck lymph node metastases were treated by neck dissection.The overall 5- and 10-year survival rates were 70.4% and 62.9%, respectively. The 5- and 10-year survival rates were 96.3% and 89.9%, respectively, in the 29 patients with T3 cancer, and 50.4% and 44.1%, respectively, in the 35 patients with T4a cancer. The overall 5- and 10-year laryngeal preservation rates were 71.0% and 60.6%, respectively. The 5- and 10-year laryngeal preservation rates were 92.5% and 87.4%, respectively, in patients with T3 cancer, and 48.6% and 35.6%, respectively in patients with T4a cancer. No irreversible adverse effects were reported.

To determine the plasma endothelin level in the acute stage in patients with Bell palsy (based on the hypothesis that endothelin, which is a potent vasoconstrictor, may play a role in the mechanism of the onset of facial nerve paralysis and in view of the fact that the etiology of Bell palsy is still a maze of unknowns).The study involved 62 patients with the acute stage (tested within 10 days of onset) of Bell palsy (i.e., idiopathic acute peripheral facial paralysis) and an additional 36 healthy persons who served as control subjects. To determine the content of endothelin, 2 ml of plasma samples was collected from each subject. Endothelin-1 was extracted and analyzed by a radioimmunoassay by using anti-endothelin-1 antibody.Nihon University Itabashi Hospital, a referral and institutional center in Tokyo, Japan.The patients who were suffering from Bell palsy exhibited a statistically significant (P.01) increase in the endothelin level compared with that in the 36 normal control subjects. An age-matched comparison (ranges, 20-29 years and 30-39 years) of patients with Bell palsy with normal control subjects revealed a significant difference between the normal group and the group with Bell palsy in the plasma endothelin level for both age groups that were tested (P.01). The mean value of the endothelin level in patients with Bell palsy was maximal on day 5, and the percentage of patients with abnormally elevated endothelin levels was 100% from days 6 to 9.Endothelin, which has potent vasoconstrictive effects, may contribute to the pathogenesis of the microcirculatory impairment that occurs in patients with Bell palsy, mainly by promoting secondary ischemia.

An 8-year-old boy was admitted to Ehime University Hospital, Ehime, Japan, for the further investigation of a 5-month episode of gross hematuria accompanied by lower abdominal pain. Magnetic resonance imaging revealed a solid tumor measuring 3 cm in diameter of the bladder wall. Cystoscopy demonstrated a red, wide-based, nodular tumor situated on the dome of the bladder. Histological examination of tissue taken at hot biopsy showed fibrolipoma. In consideration of potential malignancy, a partial cystectomy was carried out after informed consent was given. Histological examination of the resected specimen showed it to be cavernous hemangioma.

Synovial osteochondromatosis is a benign disease of synovial tissue, most commonly affecting the knee and elbow joint, and is rarely found in the hip joint. We report a case of synovial osteochondromatosis of the hip joint.A 39-year-old man was admitted to Fukuoka University in November 1993 with a 2 year history of pain of the right hip joint. On admission, motion of the right hip joint was slightly restricted. Roentgenography of the right hip joint revealed expansion of the joint cavity. Arthrography of the right hip joint showed a honeycomb shadow. We performed arthrotomy using the Smith-Petersen approach, taking care not to dislocate the femoral head because of the potential hazard of necrosis associated with this. Many loose bodies and synovial tissue were removed and postoperatively, the patient did well. Six months postoperatively he had no pain and little disability, and radiographs showed no evidence of recurrence.

Between 1993 and 1994, twenty-six hip arthroplasties were performed on 25 patients using the Impact Modular Hip System. This system maintains the entire femoral neck by allowing the resection to be made at the head/neck junction. By saving the femoral neck, minimal bone is removed. It also permits the entire implant to rest within the neck region where it can obtain unsurpassed rotational stability and transfer physiological load along the trabecular path. Preoperative diagnosis was osteoarthritis of the hip in 19 hips, avascular necrosis of the femoral head in 2, and miscellaneous in 5. The JOA hip score averaged 56.5 points before surgery. The average age of the patients at the time of surgery was 62.5 years, ranging from 42 to 85 years. Postoperatively, there were no major complications such as postoperative infection or dislocation. All patients were followed for more than 4 months (mean 10.4 months). The JOA hip score averaged 89.4 points after surgery. More than 80% of the hips were rated as having an excellent or good result and there were no poor results.

A 61-year-old male developed left otitis media and left peripheral facial nerve paralysis. One month later right otitis media and right peripheral facial nerve paralysis occurred. ATL cells were found in the peripheral blood, and anti-ATL associated antigen was demonstrated by the serological examination. The cerebrospinal fluid contained ATL cells, but no ATL cells were found in the granulation tissue removed from the middle ear cavity.

Optokinetic nystagmus (OKN) and after-nystagmus (OKAN) show different responses depending on the direction of gravity with respect to the head and body. In 13 normal healthy persons (10 experimental and 3 control subjects), we studied the OKAN evoked by horizontal and vertical stimuli, in upright, side-lateral, and repeated upright positions along a time course of more than 6 h. The results showed continuous modifications of OKAN, the degree increasing with time. Lateral tilt produced different effects on the intrinsic vertical and horizontal optokinetic oculomotor systems.

Superselective intra-arterial chemotherapy, which enables local control and laryngeal preservation, is a safe and useful therapy for preservation of nutrition, speech, and swallowing functions.To improve the laryngeal preservation rate in patients with hypopharyngeal piriform sinus squamous cell carcinoma by superselective intra-arterial chemotherapy.Fifty-seven patients received anterograde intra-arterial administration of docetaxel and cisplatin, and two courses of intravenous continuous infusion of 5-fluorouracil as a neoadjuvant chemotherapy over 120 h starting on day 2. Concurrent chemoradiotherapy was administered from the third course to control the primary cancer. Remaining neck lymph node metastases were treated in principle by neck dissection.The 5- and 10-year survival rates were 68.5% and 58.9%, respectively. The 5-year rates by the T classification were 96.0% (10-year rate, 88.6%) in T3, 48.1% in T4a, and 16.7% in T4b. The 5- and 10-year laryngeal preservation rates were 65.2% and 62.4%, respectively. The 5-year rates by the T classification were 92.4% (10-year rate, 87.6%) in T3, 36.2% in T4a, and 16.7% in T4b. No irreversible side effects, complications, or sequelae were reported. Superselective intra-arterial chemotherapy showed superior laryngeal preservation as well as high survival rates, particularly in T3, and was considered a useful therapy.

Patients who received concurrent chemoradiation therapy with carboplatin were followed up on a long-term basis. In 25 patients treated with carboplatin at an AUC of 2.0 mg/ml, the complete response (CR), 10-year survival, and 10-year larynx preservation rates were 96.0%, 91.1%, and 75.2%, respectively, and the safety margin for partial laryngectomy was 4 mm from the gross tumor.To perform long-term follow-up of the therapeutic outcomes of concurrent chemoradiation therapy and salvage surgery to determine the additive and synergistic effects of anticancer drugs combined with chemoradiotherapy.Fifty male patients (aged 33-76 years) with untreated T2N0M0 squamous cell carcinoma of the glottic larynx were included. Carboplatin was intravenously administered once a week for 4 weeks. Radiotherapy was delivered by an external beam of 4 MV linac X-ray (total = 66 Gy).The AUC 1.5 combination group showed overall response, CR, 5-year survival, 10-year survival, 5-year larynx preservation, and 10-year larynx preservation rates of 100.0%, 68.0%, 83.4%, 77.0%, 75.2%, and 75.2%, respectively. The AUC 2.0 combination group showed corresponding rates of 100%, 96.0%, 95.7%, 91.1%, 82.9%, and 72.7%, respectively. The most common side effects of grade 3 or more were leukopenia, neutropenia, and mucositis (stomatitis), and all were reversible. Thirteen patients (52.0%) in the AUC 1.5 combination group and nine patients (36.0%) in the AUC 2.0 combination group required salvage surgery. Histologically, concurrent chemoradiation therapy with carboplatin caused more severe cancer tissue degeneration. Pathological examinations indicated that the safety margin for partial laryngectomy was 4 mm from the gross tumor.

A long-term study was carried out on 57 patients treated with radiation alone who had T2N0M0 squamous cell carcinoma of the glottic larynx. The response and survival rates were satisfactory, but the complete response (CR) and the larynx preservation rates showed a need for improvement. Thirty-four patients underwent salvage operations and a safe margin for the partial laryngectomy was evaluated by histopathological examination of serial sections of the surgical specimen.Although the effectiveness of combined chemoradiation therapy in the treatment of head and neck cancer has been reported, the facts remain unclear. The purpose of this study was to analyze the long-term outcomes of radiation therapy alone for T2N0M0 squamous cell carcinoma of the glottic larynx, i.e. the survival rate, the larynx preservation rate, and the reality of salvage operations. This is expected to contribute to an understanding of the synergistic effects of anticancer drugs used in combined chemoradiation therapy, the use of which will be expanded in the future. The reason for this is that the radiation source, radiation field, and radiation dose are nearly identical for patients with T2N0M0 squamous cell carcinoma of the glottic larynx.The subjects were 57 patients with untreated T2N0M0 squamous cell carcinoma of the glottic larynx. There were 55 males and 2 females. Their ages ranged from 31 to 86 years. The 4 MV Liniac X-ray external beam radiation therapy was carried out via two-dimensional horizontal opposing ports, 2 Gy per dose, five times a week with a total of 66 Gy.In 57 patients, we observed CR in 33 patients, partial response (PR) in 20 patients, no change (NC) in 4 patients, and progression disease (PD) in none of the patients. The response rate was 93.0% and the CR rate was 57.9%. The survival rates (Kaplan-Meier method) were: 5-year survival rate of 88.5% and 10-year survival rate of 73.5%. The larynx preservation rates (Kaplan-Meier method) were: 5-year larynx preservation rate of 60.4% and 10-year larynx preservation rate of 50.1%. The main side effect of grade 3 or more was only stomatitis in four patients, all of which were reversible changes (CTCAT v3.0 JCOG/JSCO). Salvage operation was required in 34 (59.6%) of 57 patients, 10 patients underwent partial laryngectomy, total laryngectomy was performed in 3 of the 10 patients following the partial laryngectomy, and 27 patients (47.4%) underwent total laryngectomy. The surgical specimens were serially sectioned at a thickness of 4 μm and examined histopathologically and compared to the macroscopic findings at surgery. The safe margin for partial laryngectomy was considered grossly to be 5 mm from the edge of the tumor.

We treated two patients with nasal tuberculosis. One was a 58-year-old female who visited our clinic because of right nasal obstruction and bleeding. Mild swelling of the inferior turbinate and a bloody nasal discharge were observed. Mycobacterium tuberculosis was cultured from the nasal discharge. Biopsy of the mucous membrane of the inferior turbinate showed a granuloma with epithelioid cells. The other was a 59-year-old female who visited us with complaints of right nasal obstruction, purulent nasal discharge, and frontal headache. Granulation, bleeding and crust attachment were observed on the right concha nasalis inferior and the nasal septum. Mycobacterium tuberculosis was cultured from the nasal discharge. Both patients had strongly positive Mantoux tests. Chest X-ray films showed evidence of old tuberulosis but no active pulmonary tuberculosis. Both patients were treated mainly with streptomycin and other anti-tuberculous drugs with satisfactory results.

An immunohistochemical investigation was conducted on infiltrating lymphocytes in submandibular glands removed from three cases with unspecific chronic sclerosing sialadenitis of the submandibular gland (unspecific CSSS) which has been described for the first time by Küttner. A high degree of lymphocyte infiltration was recognized and formation of lymphatic follicles was observed. In particular, activated B cells were predominantly observed in that part of the lymphatic follicles which was equivalent to germinal centers. In the T cell subset, the helper/inducer T cells displayed significant dominance over suppressor/cytotoxic T cells, and were distributed in the dark peripheral zone of the follicles. The distribution pattern of these lymphocytes seemed to be similar to antigenically stimulated lymph nodes and it was recognized that the unspecific CSSS could be a site of exceedingly active local immune responses. The authors believe that these findings support the view that unspecific CSSS (Küttner tumor) is an immune disorder.

We expeienced a case of rapid bone absorption of the femoral neck. A 55-year-old female who had been treated with oral medications for nearly thirty years for schizophrenia, was injured in a fall. She complained of right coxalgia, but fracture of the femoral neck was not diagnosed by anteroposterior radiograph in the local orthopaedic clinic. The pain didn't improve and she visited our hospital 50 days after the injury. Radiographs showed abnormal bone absorption of the femoral neck. The authors consider that the rapid bone absorption in this case was partly due to the mental disorder.

The clinical results after arthroscopic synovectomy in 24 knees of 14 RA patients with chronic synovitis were reviewed. The follow-up period ranged from 2 to 55 months, with an average of 32 months. The operated knee joints were divided into early synovectomy (Larsen's grade 0, 1, 2) and late synovectomy (Larsen's grade 3, 4, 5). Compared with preoperative findings, pain and swelling was on the whole improved. In early synovectomy, pain and swelling was improved in 11 of 13 knees and the effect was expected to remain for 3 to 5 years. In comparison, in late synovectomy, pain and swelling was improved in 5 of 9 knees (56%) within 3 years after surgery, with none achieving a good result after more than 3 years. This procedure seems to be indicated in early grade patients and appears to provide significant time saving in late grade patients.

Objective: Examine changes in the expression of taste receptor genes in patients who had loss of taste and those who had phantogeusia.Method: The subjects of this study consisted of 51 patients with loss of bitter taste and 43 patients with phantogeusia. The control group consisted of 24 subjects. We took specimens by scraping their foliate papillae. T2R family and TAS2R family gene expression was detected using RT-PCR and electrophoresis.Results: The patients with loss of bitter taste showed a significant decrease in the frequency of expression of taste receptor genes T2R8 (P = .002), 10 (P = .001), 13 (P = .003), 16 (pTAS2R40 (p48 (P = .007) compared with the control group. The frequency of gene expression of TAS2R42 (P = .008) and T2R3 (P = .033) were significantly increased in patients with phantogeusia.Conclusion: Expression of some genes was decreased in patients with loss of taste, while expression of other genes was increased in patients with phantogeusia. It was suggested that conflicting changes...

Consecutive daily low-dose S-1 therapy was less toxic and its efficacy was not inferior to the conventional administration schedule. Consecutive daily low-dose S-1 chemotherapy appears to be a treatment option for patients in whom it is difficult to continue the conventional administration schedule of S-1 due to adverse events.To evaluate the safety and efficacy of consecutive daily low-dose S-1 therapy in an adjuvant setting.This study investigated 52 patients with absence of local residual tumor, lymph node metastasis or distant metastasis after radical treatment for advanced head and neck squamous cell carcinoma. After receiving informed consent from patients, half of the usual dose of S-1 was administered daily for 2 years. The safety, feasibility, and efficacy of this approach were evaluated.Hematologic toxicity was seen in 51 of 52 patients (98.1%), but grade 3 hematologic toxicity was found in only 2 patients (3.8%). Nonhematologic toxicity was observed in 15 patients (28.8%) and all were grade 1. Forty-three patients (82.7%) were able to complete the chemotherapy for 2 years without dose reduction. The 3-year disease-free survival rate and 3-year survival rate were 82.6% and 94.0%, respectively.

We experienced methrtrexate (MTX) therapy at a low dose level of 1, 25-7.5mg/week in 10 refractory RA patients with an uncontrollable inflammatory process, and studied its indication and effects. Eight of these 10 patievds began to show an improved Lansbury index value about 4 weeks after the initiation of drug therapy. Among the components of the Lansbury index a definite improvement was noted in morning stiffness, srasping power and the joint score, while the erythrocyte sedimentation rata improved slightly. No efficacy side effects occsred in one of 10 patients with the elevation of the transaminase serum level. The results of this therapeutic trial with MTX indicate that a favorable response can be expected even at a low dose level of 2.5mg/week or below in those patients with refractory RA whose treatment by gold sodium thrimalate, auranofin, bucllamine, D-penicillamine and or steroids has not been effective.

Of patients with RA of the elbow treated by synovectomy in our department, 10 (12 elbows) in whom postoperative follow-up observations were feasible, were evaluated for the results of the operative treatment. They consisted of 3 males (5 joints) and 7 females (7 joints) with a mean age of 63.2 years and a mean follow-up period of 4 years. The affected synovium was removed through a longitudinal skin incision laterally. During the follow-up period, we noted relief of pain, improvement of the ranges of elbow flexion and extension, forearm supination and pronation in almost all the patients. An improvement of ADL was also prominent with the restoration of the patients' abilities to comb their hair with their hands, to eat and to hold Something. The results of the operation were thus quite gratifying with a definite improvement achieved in the range of motion of the joint and also of ADL.

A case of suppurative arthritis by Serratia Marcescen was reported.The patient was a sixty-seven years old male who complained of pain and swelling in his right hip.Roentgenographically in this case, destructive changes in the femoral head and acetabulum had been obsered within short duration. Especially disappearance of the femoral head had been observed within about three weeks.Serratia Marcescens was verified in bacteria culture from joint fluid and synovial tissue.Focal curettage and medication of Astromycin 400mg/day and Flomoxef sodium 2g/day for about a month post-operation, were administered, and thereafter his symptom and laboratory data, including C-reactive Protein and erythrocyte sedimentation rate, were improved.He was satisfied with the result of our treatment though using the hip brace.

The effect of a zinc-containing compound, Polaprezinc, was shown to clinically improve the disease conditions of idiopathic taste disorders with no serious side effects in a well controlled double-blinded clinical study.The purpose of the present study was to evaluate the efficacy and safety of a zinc-containing compound in the treatment of patients with idiopathic taste disorders, including patients with low serum zinc, by a Good Clinical Practice (GCP)-compliant, randomized, placebo-controlled, double-blind, multi-center clinical study.A group of 109 patients suffering from taste disorders was assigned into placebo and three treatment groups. Each group of patients was given either placebo (n=28), or 17 mg (n=27), 34 mg (n=26) or 68 mg (n=28) of oral zinc, Polaprezinc preparations, daily for 12 weeks.The group of patients given 68 mg zinc showed a significant improvement in their gustatory sensitivity compared with the placebo group. The most common side effects observed were increase in serum triglyceride and serum alkaline phosphatase, decrease in serum iron, and some gastrointestinal incidents, although they were not serious.

Fifty four patients with a frozen shoulder, in which closed manipulation was done, were examined as to their clinical results.Further, 33 of them were examined by arthrography and articular capacity of the shoulder.We performed manipulation and operative procedures for the frozen shoulder in patients who had not responded to conventional conservative modalities such as antiinflammatory drugs, steroid injections, nerve block and physical therapy.In cases that the articular capacity in the shoulder was more than 12ml, or expansion of rotator interval region was held comparatively in the scapular Y view of arthrography, in less than 11ml, a full range of motion was obtained by closed manipulation under general anesthesia.As to the manipulation procedure, care should be taken not to do forced manipulation and manipulation should be done as gently as possible.Post operative management is most important in determining the prognosis of the patients.The key is to maintain the shoulder at an elevated position and to resume exercise therapy at an early stage.

Acyclovir, an antiviral agent, was administered to six patients with Ramsay Hunt syndrome, which induced complete facial paralysis and consulted within one week of the onset of facial paralysis. Complete recovery of paralysis was noted in four patients. The remaining two patients with incomplete recovery were in their fifties or older, and one of the two patients had shown no response to the nerve exitability test (NET) on the paralyzed side.In the present study, the effect of acyclovir on the prognosis of facial paralysis of Ramsay Hunt syndrome was relatively favorable.

Objectives:To determine the characteristics of causative factors of taste disorders amongst the elderly, and to examine the therapeutic effect of a zinc agent, taking into account age-related factors.Subjects:A total of 408 patients with taste disorders were divided into three groups by age: 49 years or younger, 50 to 64 years old, and 65 years or older.Results:The incidence of taste disorders caused by drug administration and systemic disease were significantly higher in the elderly group. A serum zinc concentration of 69 µg/dl or lower was found in 33 per cent of the elderly group, significantly more (p Conclusions:In the elderly, the incidence of taste disorders caused by drug administration or systemic disease was significantly greater compared with other age groups. The curative effects of zinc administration were not observed to be influenced by age.