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Mycobacterium marinum is a free-living nontuberculous mycobacterium that is widely distributed in freshwater and seawater around the world. Granulomatous skin infection from M. marinum in people who are exposed to fish or aquatic environments is a rare condition known as fish tank granuloma. The granuloma mainly occurs on the skin of the upper limb, in a few cases on the face, and rarely in the nasal cavity. We describe a case of M. marinum infection that presented as a nasal cavity mass. A 57-year-old woman who was receiving infliximab for psoriatic arthritis visited our hospital with a complaint of right nasal obstruction. A granulomatous mass with an irregular surface was found in the anterior part of the right nasal cavity. Tissue biopsy revealed granulation tissue. Since the application of steroid ointment did not reduce the size of the mass, the tumor was resected under local anesthesia, and the base was cauterized. The pathological finding was an inflammatory granuloma with negative Ziehl–Neelsen staining. The granuloma recurred 3 months after resection. The interferon-gamma release assay (IGRA) test was positive, and therefore, a mycobacterial tissue culture test was performed because of suspected nasal tuberculosis, which identified M. marinum. The nasal cavity mass disappeared 2 months after the administration of minocycline, followed by clarithromycin, and subsequent discontinuation of infliximab. M. marinum infection can cause an intranasal mass. IGRA and the mycobacterial tissue culture test are useful for diagnosis. As in this case, the nasal lesion may be excised as an inflammatory nasal granuloma, and therefore, there may be many more “hidden” cases of M. marinum infection. If nasal granulation is present, the possibility of M. marinum infection should be considered.

With the objective of identifying the factors affecting the nasal resistance in patients undergoing sinus surgery, we evaluated the data of 95 patients with chronic sinusitis who underwent endoscopic sinus surgery (ESS) between 2015 and 2018 at our hospital. We determined the nasal resistance by rhinomanometry and also patients' sensation of nasal obstruction before surgery and 3 months after the ESS. In total, 49 bilateral and 46 unilateral ESS procedures were performed, including ESS alone, ESS + septoplasty, and ESS + septoplasty + conchotomy. In addition, the surgical cases were classified into single sinus or polysinus surgery, and groups with or without polyps. We compared the nasal resistance and degree of change in the nasal resistance among the groups. The same comparisons were also conducted separately in cases with nasal resistance levels of >0.25 Pa/cm3/s. Nasal resistance improved following the ESS in both the bilateral and unilateral cases. In almost all the subgroups, the nasal resistance improved following ESS with the exception of the ESS with septoplasty group with nasal resistance levels of >0.25 Pa/cm3/s. The degree of change in the nasal resistance was not significantly different between the ESS alone, ESS + septoplasty, and ESS + septoplasty + conchotomy groups. Similarly, the degree of change in the nasal resistance was also not significantly different between the single sinus and polysinus surgery or between patients with and without polyps. Furthermore, there were no differences among the above groups of patients with >0.25 Pa/cm3/s either. The patients' sensation of nasal obstruction improved following the ESS. The nasal resistance measured by rhinomanometry was weakly correlated with the sensation of nasal obstruction prior to the ESS; however, the nasal resistance following the ESS and the degree of change of the nasal resistance following the ESS were not correlated with the sensation of nasal obstruction or the degree of change in the sensation of nasal obstruction. Future studies are needed for a precise clarification of the factors that affect nasal resistance.

Gardner syndrome with odontogenic sinusitis is rare but should be suspected in patients with multiple osteomas of the skull and facial bones, excess teeth, impacted teeth, and odontomas. Early diagnosis and treatment of GS may improve prognosis.

The usefulness of nasal irrigation for chronic rhinosinusitis is recognized, and it is widely used as a topical treatment after endoscopic sinus surgery (ESS). Generally, there are few complications due to nasal irrigation, and it is recognized as a highly safe treatment. There are no reports of nasal septal perforation due to nasal irrigation. The objective of this study was to describe three cases of nasal septal perforation occurring during self-nasal irrigation after ESS. Case patient 1 was a 38-year-old woman who was admitted to our hospital with a complaint of nasal obstruction. Based on a diagnosis of chronic rhinosinusitis and allergic rhinitis, we performed bilateral ESS and bilateral inferior turbinectomy. At discharge, we instructed the patient in how to perform self-nasal irrigation twice a day at home. At the time of the third visit after discharge, a black crust had adhered to the bilateral anterior nasal septum. Crust formation continued at the same site, and nasal septal perforation was seen two and a half months after the operation. The other two cases showed similar courses. Postoperative nasal irrigation can cause nasal septal perforation. We need to educate patients on proper nasal irrigation and regularly check the nasal septum.

Chemical burns of the paranasal sinus are rare; therefore, assessment methods for treatment of and prognoses for the exposure site are unknown. We experienced a case in which a hydrochloric acid burn of the paranasal sinuses caused irreversible tissue damage. Computed tomography is useful for identifying the exposure site and assessing tissue damage over time. Identification of the exposure site and proactive washing are recommended for patients with chemical burns of the paranasal sinuses. Laryngoscope, 131:E2490-E2493, 2021.

Most maxillary sinus papillomas are confirmed when they have extended beyond the nasal cavity and are rarely found while localized in the maxillary sinus. We experienced two cases of localized papilloma in the maxillary sinus. Case 1 was a 69-year-old man with a localized left maxillary sinus lesion detected during a routine imaging examination. As the lesion was likely to be papilloma, we recommended that the patient undergo diagnostic surgery, which he refused. He experienced bloody rhinorrhea 1 year and 9 months after the first visit, and computed tomography (CT) showed increased lesions and bone destruction. Histological examinations revealed squamous cell carcinoma ex inverted papilloma. He died 5 years after the first visit. Case 2 was a 46-year-old woman in whom positron emission tomography/CT showed a localized right maxillary sinus lesion. Tissue biopsy results indicated oncocytic papilloma. Endoscopic resection was performed later. On an imaging examination, sinonasal papilloma was determined accidentally to be a localized lesion of the maxillary sinus. A detailed interpretation of the CT scan was useful in estimating sinonasal papilloma. Tissue biopsy or diagnostic surgery should be performed when sinonasal papilloma is suspected during appropriate image evaluation.

When evaluating nasal obstruction, conventional measurements of nasal patency do not necessarily correspond to a patient's subjective symptoms. The aim of this research is to seek an objective evaluation method by establishing computational modeling for nasal patency measurements.We created a computer-generated geometrical model of the nasal cavity from computed-tomography scans of an adult male, presented a computational modeling method for evaluating the nasal patency in the deep-breathing state, and simulated numerically the airflow within the nasal cavity in the natural- and deep-breathing states.During inhalation in the natural-breathing state, the airflow was higher in the center of the nasal cavity and lower in the upper and lower portions, with the airflow characteristics being associated with the nasal functions. In the deep-breathing state, the computed nasal patency was compared with that measured experimentally by rhinomanometry. The quantitative accordance between computation and experiment was unsatisfactory, but the qualitative tendencies were similar.Through natural- and deep-breathing computations, the roles and functions of the olfactory region, nasal valve, and middle and inferior meatuses were evaluated from the flow patterns and pressure, with correlation to the nasal resistance and physiology. Above all, from the deep-breathing computation using the present computational modeling, it was deduced that the pressure difference is essential for determining the nasal sites at which the nasal resistance was produced. Thus, numerical simulation with computational modeling is potentially an objective method for evaluating nasal obstruction.

Thesauri for science and technology information are increasingly used in bibliometrics and scientometrics. However, the manual construction and maintenance of thesauri is costly and time consuming, thus, methods for semi-automatic construction and maintenance are being actively studied. We propose a method that expands an existing thesaurus with specified terms extracted from the abstracts of articles. Specifically, we assign the terms to specified subcategories by clustering a word vector space, then determine the hyponyms and hypernyms based on their relations with terms in the sub-categories. The word vectors are constructed from 177,000 IEEE articles archived from 2012 to 2014 in the Scopus dataset. In experiments, the terms were correctly classified into the Japan Science and Technology thesaurus with 70.8% precision and 75.4% recall. In future, we will develop a semiautomatic thesaurus maintenance system that recommends new terms in their proper relative positions.

入院治療を望まない高齢者頭頸部癌患者に対して，初回治療として外来TS-1単剤治療をおこない，投与方法と有害事象，治療効果について検討した。対象と方法：65歳以上の前治療のない頭頸部扁平上皮癌患者8例（平均73.8歳），ほとんどがステージIVAであった。病状を十分に説明の上，患者，家族の希望により本治療を選択した場合のみを対象とした。投与量は体表面積あたりの推奨投与量の67％から100％まで，投与方法は4週投与2週休薬から2週投与2週休薬まで，それぞれ症例に応じて変更した。投与期間は1ヶ月から2年（現在継続投与中を含む）までである。結果：治療効果はCR 1例，PR2例，SD2例，PD3例であった（奏効率38％）。生存期間は4ヶ月から2年。Grade 4以上の白血球減少，Hb低下を1例，Grade 3の食欲不振を2例に認めた。3例はQOLを維持して1年以上の在宅療養ができた。67-80％の低用量の抗癌剤でPRやSDを維持した症例もあり，高齢者に対する治療としてはTumor Dormancy Therapyとしての長期投与も有用と考えた。

進行下咽頭癌や声門下癌の根治手術時に，傍気管リンパ節の郭清とともに甲状腺，副甲状腺の全摘あるいは亜全摘をおこなうことがある。術後性副甲状腺機能低下症に対して，腸管におけるカルシウム吸収促進を期待して，活性型ビタミンD製剤を投与し，血清カルシウム濃度の調整がおこなわれる。カルシウム製剤の投与は血中，尿中カルシウム濃度の大幅な上昇をきたすことがあり，腎機能に対する悪影響が懸念される。われわれは副甲状腺機能低下症例に活性型ビタミンD3製剤であるファレカルシトリオール（フルスタン®）を投与し，その効果を検討した。対象は癌術後の副甲状腺機能低下症13症例である。ビタミンD3製剤をアルファカルシドールからファレカルシトリオールに変更し，投与前，投与中の血清，尿中カルシウムなどを指標に，併用するカルシウム製剤とファレカルシトリオールの投与量を調整した。13例中1例は副甲状腺機能が回復したため中止し，残り12例全例でカルシウム製剤を中止できた。これらの症例の血清カルシウム値は正常で，テタニー症状もない。ファレカルシトリオールの長時間作用と強力な小腸カルシウム吸収促進作用は，術後性副甲状腺機能低下症のカルシウム濃度の調整に有効にはたらき，過剰なカルシウム負荷を防ぐことができ，重篤な有害事象もみられなかった。

Although hemangioma is a benign tumor that is generally treated surgically, preoperative treatment is often required for hemangioma in the nasal cavity or paranasal sinuses because a good visual field is difficult to achieve with heavy blood flow, increasing the risk of massive hemorrhage. Super-selective embolization is widely accepted as the treatment of choice to control hemorrhage during surgery for vascular tumors.A 43-year-old woman complained of unilateral nasal obstruction and nasal bleeding. A hemorrhagic tumor was found in the left nasal cavity. The pathologic diagnosis was capillary hemangioma. Embolization was performed prior to surgery to minimize bleeding. Selective catheter embolization was performed with NBCA (N-butyl-2-cyanoacrylate), which was introduced into the distal branch of the sphenopalatine artery.Radical surgery was planned for a few days after embolization, but it was postponed because Moya-Moya disease was found during angiographic study. The tumor gradually decreased in size after angiography and selective embolization of the feeding arteries. We were able to resect the tumor by the transnasal route with endoscopy 69 days after embolization. Total blood loss during the operation was 10ml.In general, radical surgery is performed within 1 week after preoperative embolization because a long waiting period after embolization increases the risk of recanalization and collateral vessel formation. When we use long-acting embolic material and embolize the distal branch of the feeding artery, we may be able to perform minimally invasive surgery by waiting for a longer period after embolization.

We studied the influence of sleep restriction on standing posture in 10 healthy volunteers (6 men and 4 women), aged 19 to 24 years (mean, 21.4 years), with normal hearing and vestibular function and no history of leg trauma. They were examined under three conditions: in the morning after sleeping well, in the morning after remaining awake all night, and in the afternoon after remaining awake all night. Each subject was asked to stand on a stabilimeter fixed on a platform attached to a rotating device. We examined the stability of each subject's stance while the platform was stationary and while it was rotating clockwise at a speed of 60 deg/s. At the same time, they underwent a test of mental arithmetic for 20 minutes (Uchida-Kraepelin test). The total length of traces of the center of pressure and its perturbation area, when they were measured while the platform was stationary, was significantly (p

To elucidate spatial orientation and posture regulation under conditions of microgravity.Coriolis stimulation was done with five normal subjects on the ground (1 g) and onboard an aircraft (under conditions of microgravity during parabolic flight). Subjects were asked to tilt their heads forward during rotation at speeds of 0, 50, 100 and 150 degrees/s on the ground and 100 degrees/s during flight. Body sway was recorded using a 3D linear accelerometer and eye movements using an infrared charge-coupled device video camera. Flight experiments were performed on 5 consecutive days, and 11-16 parabolic maneuvers were done during each flight. Two subjects boarded each flight and were examined alternately at least five times.Coriolis stimulation at 1 g caused body sway, nystagmus and a movement sensation in accordance with inertial inputs at 1 g. Neither body sway, excepting a minute sway due to the Coriolis force, nor a movement sensation occurred in microgravity, but nystagmus was recorded.Posture, eye movement and sensation at 1 g are controlled with reference to spatial coordinates that represent the external world in the brain. Normal spatial coordinates are not relevant in microgravity because there is no Z-axis, and the posture regulation and sensation that depend on them collapse. The discrepancy in responses between posture and eye movement under conditions of microgravity may be caused by a different constitution of the effectors which adjust posture and gaze.

A rare case of PTP foreign body in the larynx is reported. The patient was a 58-year-old female who complained of foreign body sensation in the throat and cough without dyspnea. She did not remember swallowing a PTP. The PTP was safely removed from the larynx by direct laryngoscopy under neuro lept analgesia. Three months after removal, contact granuloma occurred on the bilateral posterior vocal cords. It was controled by steroid inhalation and tranilast. The methods of anesthesia and operation are discussed.

To detect the effect of microgravity on vestibular responses, we conducted Coriolis stimulation experiments at 1 G and μ G. Five men with vision occluded were asked to tilt their head forward while rotating at 100 degrees/sec. Postural changes were recorded by a 3D linear accelerometer, and the distance of upper body movement was derived from recordings of linear acceleration. Eye movements were recorded by a CCD camera. For a second period after commencing head tilt, the upper body moved 10 cm in the direction of inertia input at 1 G, but it moved to the opposite direction at μ G, i.e., 4 cm in the direction of inertia force. Nystagmus peak slow-phase velocity immediately after head tilt and its attenuation process did not differ between 1 G and μ G. The strength of movement sensation and the severity of motion sickness were far weaker at μ G than at 1 G. It was concluded that inertia input is valid to induce postural and sensation responses only when the external reference is given Z axis by gravity. Vestibular ocular response may be maintained at μ G because the head reference is valid even after the external reference becomes arbitrary.

Patients with head and neck malignancy who visited Tokai University Hospital over seven years were statistically surveyed. Six hundred and eighty-three patients were newly registered in this period. The most frequent primary lesion was the larynx (29.3%), followed by the hypopharynx (20.6%), oral cavity (11.9%), oropharynx (11.9%), and nose and paranasal sinus (8.6%). About two-thirds of the patients had advanced cancers. The patients were referred from adjacent regions, most frequently from the Shonan area. Referred patients with malignancy were increasing each year. The trends in head and neck cancers and the treatment modality were discussed. After the opening of a new hospital building in 2006, a further increase in the number of referred patients and operations is expected.

We herein report a case of traumatic fracture of the stapes accompanying vestibular window rupture with perilymph fistula, and its diagnosis and surgical procedure were discussed. In the present case, a direct force through the external auditory canal damaged not only the ossicular chain but also the vestibular window. On the exploratory tympanotomy, the complete dislocation and fracture of the stapes with a relatively huge rupture was confirmed. Perilymph fistula was repaired with a connective tissue graft, which was inserted between disrupted vestibular window and the long process of the incus. Vestibular dysfunctions disappeared within 3 days, and a satisfactory audiologic result was obtained one month after surgery.

We herein describe a case of accessory parotid gland tumor, including diagnosis and surgical approach. The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. It has secondary duct empting into the Stensen's duct. The accessory parotid gland exists in 21-61 % of individuals. However, the appearance of an accessory parotid tumor is rare, with a reported frequency of 1-7.7 % of all parotid gland tumors. Surgical resection is the treatment of choice for the accessory parotid gland tumor. It is important to identify the buccal branch of the facial nerve to avoid injury to the facial nerve. The tumor in our case was surgically resected without facial nerve injury. The histopathological diagnosis was pleomorphic adenoma.

The airway management and anesthesia maintenance during the laryngoscopic surgery is essential for a safe operation. For the benign laryngeal obstructive disease such as a large mass or a foreign body of the upper airway, it is difficult to secure the airway. Sometimes they might be hazardous and potentially lethal. We present two cases of a large laryngeal polyp and a laryngeal foreign body of pressthrough-package (PTP). They were successfully operated on with laryngomicrosurgery under neuroleptanalgesia (NLA) without intubation. The choice of the operation and airway management were discussed.