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The local field ion emission properties of helium and neon around a step edge atom of W(112) were examined at liquid nitrogen temperature using a micro-probe hole field ion microscope combined with a pulse-counting analysis. We have analyzed the mapped field ion densities obtained for both imaging gas atoms at their respective best local image voltages based on the formula for tunneling barrier strength and have evaluated the dipole moment of polarized adatom as well as the local field enhancement factor at the adatom site. We found that the dipole moments of helium and neon adatoms showed the same value, although the best local image field acting on the helium adatom is much higher than that on the neon adatom. We also found the same magnitude of local field enhancement factors for both noble gas field adsorptions. These results imply that the key to the best local image condition is the tunneling barrier field variations above the adatom. The vital role of the imaging gas atoms is to form an optimum dipole moment to create an ideal electric field distribution for the best local image appearance at each atom site depending on the different chemical nature of adatom species.

The local field ion densities of W(112) surface have been observed using a micro-probe hole field ion microscope combined with a pulse counting analysis. The mapped field ion densities clarified the anisotropic emission property within a single bright spot of a surface W atom site at a step edge. Based on the most relevant formula for tunneling barrier strength provided by B. Halpern and R. Gomer, we derived the local "across-atom" barrier field variations in the same step edge area. We found that the location of maximum barrier field strength is noticeably shifted towards the step side, rather than being on the top of the substrate surface atom site. The result indicates that the locus in which most highly promoted field ionization events take place is much smaller than previously estimated because of the extremely localized barrier field produced by the field adsorption of helium imaging gas atom.

Tin-free, photoinduced electron transfer promoted reductive radical cyclization reactions of allyl 2-bromoaryl ethers in the presence of NaOH in 2-PrOH were found to take place efficiently to give 3-methyl-2,3-dihydrobenzofurans. In contrast to conventional radical cyclization reactions that employ AIBN/Bu 3 SnH in benzene, the new method utilizes NaOH and 2-PrOH that are both readily available and benign. Consequently, the newly developed photochemical process serves as a versatile and environmentally friendly method for carrying out aryl radical cyclization reactions.

Objective:This study aimed to investigate the function of tissue plasminogen activator in the olfactory epithelium of mice following neural injury.Method:Transmission electron microscopy was used to study the changes in the morphology of the olfactory epithelium 1–7 days after surgical ablation of the olfactory bulb (bulbectomy).Results:Prior to bulbectomy, a uniformly fine material was observed within some regions of the olfactory epithelium of mice deficient in tissue plasminogen activator. At 2–3 days after bulbectomy, there were degenerative changes in the olfactory epithelium. At 5–7 days after bulbectomy, we noted drastic differences in olfactory epithelium morphology between mice deficient in tissue plasminogen activator and wild-type mice (comparisons were made using findings from a previous study). The microvilli seemed to be normal and olfactory vesicles and receptor neuron dendrites were largely intact in the olfactory epithelium of mice deficient in tissue plasminogen activator.Conclusion:The tissue plasminogen activator plasmin system may inhibit the regeneration of the olfactory epithelium in the early stages following neural injury.

Objective Eosinophilic otitis media (EOM) is characterized by the extensive accumulation of eosinophils in the middle ear mucosa and middle ear effusion and is usually associated with bronchial asthma. Eosinophilic otitis media patients show gradual or sudden deterioration of hearing. In our previous study, we reported that high-tone loss was more frequently found and more severe in EOM patients than in control patients with chronic otitis media. These findings suggest that not only bacterial infection but also eosinophilic inflammation in the middle ear may damage the inner ear. The present study was performed to determine whether eosinophilic inflammation is indeed related to deterioration of bone-conduction hearing level (BCHL). Patients Fifty-five ears of 28 patients with EOM associated with bronchial asthma were included in this study. Middle ear effusion (MEE) samples were collected from all the patients, and the concentrations of eosinophilic cationic protein (ECP) and immunoglobulin E (IgE) were measured by fluorescence enzyme immunoassay. The BCHLs at 2 and 4 kHz for the worse-hearing ear of each patient were correlated with the concentrations of ECP and IgE. Results The concentration of IgE in MEE significantly and positively correlated with BCHL at 2 and 4 kHz. The ears with a higher concentration of ECP in MEE also tended to show deterioration of BCHL at 4 kHz. Other clinical risk factors for BCHL deterioration were male sex, long duration of EOM, association with bacterial infection, severe inflammatory changes of the middle ear mucosa, and high serum IgE concentration. Conclusion Eosinophilic-inflammation-related substances such as ECP and IgE are closely related to the deterioration of BCHL at high frequencies. Particularly, IgE concentration in MEE is a good indicator of BCHL elevation. We should always pay attention to the hearing acuity of EOM patients with the risk factors.

We report two cases of otitis media positive for antimyeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated with facial palsy. Case 1: A 73-year-old man treated for 3 months for bilateral otitis media with effusion had left facial nerve palsy and deteriorated bone conduction hearing in both ears. Blood analysis showed elevated MPO-ANCA to 134 EU. Case 2: A 66-year-old woman treated for about one year for bilateral otitis media with effusion and fluctuating mixed hearing loss had bilateral facial nerve palsy and a blood test positive for MPO-ANCA at 67 EU. Both were diagnosed with otitis media caused by ANCA-related vasculitis. After prednisolone and cyclophosphamide administration for half a year, blood test results were negative for MPO-ANCA. Both recovered almost completely from facial nerve palsy and bone conductive hearing loss partially improved except in one hearing-impaired ear. ANCA-related vasculitis of the temporal bone should thus be considered in those with intractable otitis media and deteriorated bone conduction hearing before the occurrence of facial palsy.

Conclusion: Glucocorticoid (GC) administration enhanced apoptotic changes in mature olfactory receptor neurons (ORNs). GC administration may enhance regeneration of olfactory epithelium (OE). Objectives: The mechanism underlying olfactory epithelial cells turnover involves apoptosis replaced by new ORNs. On regeneration of OE, we evaluated the apoptotic changes in OE. Our aim was to corroborate the enhancement of apoptosis of ORNs induced by GCs that are generally administered locally or systemically to patients with olfactory dysfunction. Materials and methods: For the in vitro study, we established cultured murine ORNs. Triamcinolone acetonide was added to culture supernatants. ORNs were then cultured for another 2 weeks. In the in vivo study, triamcinolone acetonide was administered to mice 5 or 10 times. The mice were dissected 3 days after the final injection, and the olfactory regions were removed and embedded in paraffin. All samples were examined by immunohistochemical staining and the TdT-mediated dUTP-biotin nick-end labeling (TUNEL) method. Results: Glucocorticoid receptor (GR) expression of cultured murine ORNs was observed among ORNs at the mature stage. Expression of GRs by murine OE was localized on mature ORNs and supporting cells. Administration of GC to both cultured ORNs and mice resulted in proportions of apoptotic cells that were significantly higher than those in the control groups.

Eosinophilic otitis media (EOM) is characterized by the extensive accumulation of eosinophils in the middle ear mucosa and middle ear effusion and is usually associated with bronchial asthma. EOM patients show gradual deterioration of hearing and sometimes become deaf suddenly. However, there have been no systemic studies of bone conduction hearing level (BCHL) of patients with EOM.Seventy-one ears of 38 patients with EOM associated with bronchial asthma were included in this study. For controls, 65 ears of age-matched 60 patients with chronic otitis media (COM), who underwent tympanoplasty, were similarly studied. The BCHLs at 250, 500, 1,000, 2,000 and 4,000 Hz of EOM patients were compared with those of COM patients, and the clinical risk factors for the deterioration of BCHL in EOM were analyzed.Two patients became profoundly deaf unilaterally after the onset of EOM. High-tone loss was more frequently found and more severe in EOM patients than in COM patients. The clinical risk factors for high-tone loss were older age, male sex, presence of pathogens, and condition of the middle ear mucosa.High-tone hearing loss and profound hearing loss were frequently associated with EOM, suggesting that inflammatory products of the middle ear invade the inner ear via the round window to cause inner ear damage. To prevent the deterioration of BCHL, the control of eosinophilic inflammation and bacterial infection is mandatory.

Transmission electron microscopy was used to study the responses of the supporting cells of the olfactory epithelium at 1-5 days after surgical ablation of the olfactory bulb (bulbectomy). In intact olfactory epithelium, lamellar smooth endoplasmic reticulum and rod-shaped mitochondria were distinctly observed in the supporting cells. On the first day after bulbectomy, bending of the microvilli and an increase in the smooth endoplasmic reticulum were observed. Cristae of the mitochondria became obscure, and the density of the mitochondrial matrix decreased. On the second day after bulbectomy, the number of microvilli decreased, broad cytoplasmic projections that contained cytoplasmic organelles protruded into the luminal side, and the mitochondria were swollen. On the fifth day after bulbectomy, microvilli seemed to be normal and some cells had large cytoplasmic projections that protruded toward the lumen of the nasal cavity. Within the cytoplasmic projections of the supporting cells, a large lamellar and reticular-shaped smooth endoplasmic reticulum was evident. Mitochondria exhibited almost normal morphology. The current findings demonstrate that morphological changes occur in the supporting cells after bulbectomy. This new evidence hypothesizes that these changes represent events that contribute to the regeneration of the olfactory epithelium after bulbectomy.

Group A streptococci may cause a variety of infections, some of which are severe and may be lifethreatening. Patients affected by severe invasive group A streptococcal infection may develop a syndrome characterized by circulatory insufficiency with multiple organ failure, namely, streptococcal toxic shock-like syndrome (TSLS). Here, we report a case of streptococcal TSLS originating from the left neck. A 70-year-old man was referred to our hospital with a diagnosis of deep neck and mediastinal infection. Debridement of his left neck and drainage of anterior and posterior parts of the mediastinum were immediately performed. As Group A streptococci were detected from the effusion and blood, he was diagnosed as having streptococcal TSLS. Intensive systemic care involving long-term administration of penicillin G in addition to drainage of the infection helped him recover from TSLS. He underwent further debridement twice to control local infection. Early diagnosis of and surgical intervention for TSLS are mandatory. Subsequently, appropriate supportive treatment of vital organ dysfunction and administration of penicillin as the antibiotic of choice represent the cornerstones of the management of this syndrome.

Interleukin-6 (IL-6) is a multifunctional regulator of immune response and hematopoiesis. Recently, it has been reported that expression of IL-6 is correlated with prognosis in various cancer patients. In this study, we investigated whether the proliferation and invasion potential of head and neck squamous cell carcinomas (HNSCCs) were influenced by IL-6. All HNSCC cell lines, HEp-2, HSC-2, HSC-4, and SAS, were tested by reverse transcription-polymerase chain reaction (RT-PCR) and expressed the IL-6 receptor (IL-6R), and glycoprotein 130, which is responsible for signal transduction. HEp-2, HSC-2, and HSC-4 also produced IL-6. IL-6 inhibited the proliferation of HSC-2 and SAS, but the invasion potential of all the cell lines increased. Moreover, IL-6 down-regulated soluble IL-6R expression. Anti-IL-6R antibody abrogated the inhibited proliferation and increased invasion induced by IL-6. IL-6 stimulation also induced the extracellular regulated protein kinase 1/2 activation and increased vascular endothelial growth factor release. These results suggest that IL-6 can directly influence cell proliferation and the invasion potential as the first step of tumor metastasis.

Chronic sinusitis with eosinophils easily recurs after endoscopic sinus surgery. The condition is usually complicated by asthma, and many eosinophils are present in the sinus mucosa. One conservative treatment method is the administration of glucocorticoids locally or systematically. To evaluate the efficacy and tolerability of intranasal fluticasone propionate for the treatment of chronic sinusitis with eosinophils, seven patients with chronic sinusitis with eosinophils were treated over a 12-week period using a fluticasone propionate aqueous nasal spray (800 microg per day in each nostrilz). The Symptons of 7 patients, especially nasal discharge and nasal obstructions, improved and an expanded air space was observed on paranasal CT images. The percent of drug systemically available after intranasal administration varied by less than 1% for intranasal fluticasone propionate. Therefore, even if intranasal fluticasone propionate is administerved at double the usual dose, it is unlikely to cause systemic side effects. Fluticasone propionate aqueous nasal spray at double the usual dose is effective for the treatment of chronic sinusitis with eosinophils.

Fibrovascular polyps of the esophagus are extremely rare. A 52-year-old woman had the sensation of food sticking in her throat for 3 weeks. Examination revealed a polypoid lesion within the esophagus that extended from the pyriform sinus to the distal esophagus above the gastric cardia. With the patient under general anesthesia, the stalk of the lesion was cut through the rigid laryngoscope; however, the tumor could not be retrieved through the mouth. Large biopsies of the lesion were taken. The remaining lesion was later passed in the fecal matter. Pathological findings were consistent with the features of fibrovascular polyps.

Sulfide, oxide, and amphibole in MME (mafic microgranular enclaves) in the young Kurobegawa Granitic Pluton (2 Ma) indicate that their textural and mineralogical features are characteristic of progressively oxidized magnetite-series granitoids. Hydrous mafic magma intruded into the chamber from the bottom and fragmented to form MME, subsequently vesiculated and floated through the chamber. The MME generally have sharp fine chilled margins and show no in situ mixing between the MME and the host granite. Amphibole, an early phase together with sulfides and plagioclase, began to crystallize just after the mafic magma intruded into the chamber bottom (10 km in depth) and then continued to crystallize as the MME floated. Amphibole shows strongly patchy zoning from brownish green pargasitic core to pale green magnesio-hornblende rim, with a systematic decreasing in Fe2+/(Fe2++Mg) with AlIV decreasing toward the rim. Early sulfide precipitation followed by late -stage magnetite formation and the simultaneous decreasing in Fe2+ during amphibole crystallization were resulted from progressive oxidation of iron in minerals. Transformation of sulfur species from SO2 to H2S probably oxidized iron in the minerals in this hydrous magma on cooling, as suggested in previous models for large sulfur supplies and magma oxidation in subduction related volcanisms.

To better understand the roles of NeuroD, a member of the basic helix-loop-helix transcription factor family, during the differentiation of olfactory receptor neurons, we studied the expression of NeuroD in developing and aging mouse olfactory epithelium (OE). During embryonic period, NeuroD expression is confined in the basal compartment of OE. During neonatal period, NeuroD expression is detected in the middle compartment and in the basal compartment of OE. In the adult, the number of NeuroD expressing cells in the basal compartment significantly decreased, while the NeuroD-positive cells in the middle compartment was maintained throughout lifetime. This dual phase expression pattern of NeuroD suggests multiple roles of NeuroD in the neurogenesis of ORNs.

Our object was to clarify changes in epidermal growth factor (EGF) occurring in the olfactory epithelium with aging. We investigated the changes in EGF in the murine olfactory epithelium with aging by an immunohistochemical method. We examined six mice at each of the following stages: embryonal (embryonic days 14 and 16), neonatal (postnatal days 1 and 7), adult (postnatal weeks 5 and 12), and aged (postnatal years 1.5–2). The olfactory epithelium of each mouse was stained with anti-EGF polyclonal IgG using an immunohistochemical method. EGF were observed in the whole layer of the olfactory epithelium at all stages. The mesenchyme under the epithelium was stained in the embryonal stage, and the circumference of the olfactory gland cells was also stained, although weakly, in the adult stage. We believe that EGF contribute to cell proliferation, growth and turnover of the olfactory epithelium. However, the decrease in EGF was less than expected in the aged mice.

Objective:We report an extremely rare case of maxillary haemangioma.Method:Case report and review of the literature concerning haemangioma arising from the nasal cavity and paranasal sinuses.Results:Maxillary haemangioma is rare and sometimes requires wider resection than nasal haemangioma if a large tumour is found. We present a case of maxillary haemangioma in a 37-year-old Japanese woman, which was completely resected by pre-operative embolisation and endoscopic sinus surgery.Conclusion:Our findings suggest that if a large maxillary haemangioma is diagnosed pre-operatively, the treatment of choice is pre-operative embolisation followed by endoscopic sinus surgery, in order to avoid the surgical complications associated with wide resection.

The authors report a very rare case of pleomorphic adenoma in the epiglottis. A 46-year-old man complained of “unclear voice”. Initially he was diagnosed with an epiglottic cyst after laryngoscopy, lateral X-P, and CT. We performed a puncture of the tumor through a laryngoscope, and determined that this disease was not a cyst, but a tumor. Biopsy and tracheotomy was performed. Pathological diagnosis of the tumor was Pleomorphic adenoma. After 10 days, tumor resection was performed by pharyngotomia mediana suprahyoidea under general anesthesia.For the diagnosis of pleomorphic adenoma in the larynx, biopsy is essential. It might be necessary to perform the biopsy several times because pathological diagnosis of pleomorphic adenoma in the larynx is not easy.To treat pleomorphic adenoma of the larynx, surgical resection is primarily recommended. Determination of the method of the surgical approach depends on the tumor size. When the tumor is smaller than 2cm, surgery with a laryngoscope is recommended. However for larger tumors, a skin incision should be made.

Glucocorticoids (GCs) are commonly prescribed for treatment of olfactory dysfunction. However, the effects of GCs on olfactory epithelium are not well known. We investigated the effects of high-dose GCs on proliferating cells of olfactory epithelium. Five adult male rats (300 g) received a single daily subcutaneous dose of vehicle containing 0.3 mg dexamethasone (DEX) for 9 days (DEX+ group), and a control group received vehicle alone (DEX– group). We compared sections from the Two groups for numbers of Ki67-positive cells. The mean number of Ki67-positive cells per 500 olfactory epithelial cells was 9.6 for the DEX+ group and 58 for the DEX– group (significant difference). We conclude that high-dose GC suppressed proliferation of olfactory epithelium. We suggest that high-dose GC suppresses cytokines and growth factors, resulting in secondary suppression of proliferating ability.

A case of bilateral vocal cord abductor paralysis in a patient with Parkinson's disease was reported. The patient was a 71-year-old male suffering from Parkinson's disease for four years. He developed dysphagia and stridor while walking one year ago. The authors filmed his larynx using a fiberscope during breathing, phonation and the pharyngeal reflex, and its movements were observed. The bilateral vocal cords showed severe bowing and were fixed in the midline. On inspiration, the vocal cords moved laterally only slightly. But once the pharyngeal reflex was evoked, just after the upward movement of the larynx and the strong adduction of bilateral vocal cords had ceased, the vocal cords moved laterally quite rapidly, and a near-complete abduction was soon achieved. Vocal cord abduction to such a degree was not observed during respiration at rest or during deep inspiration.The fact that the potential for vocal cord abduction was preserved casts a doubt on an explanation of bilateral vocal cord abductor paralysis as atrophy of the nucleus ambiguus or as atrophy of the posterior cricoarytenoid muscle. Instead, we consider that our findings imply a rigidity of the laryngeal musculature and a simultaneous contraction of both the abductor and adductors, as contributing factors to the midline fixation of the vocal cords.

Twenty-one patients with paranasal sinus disease were studied with magnetic resonance imaging (MRI) and CT: two with acute in Hammatory sinus disease, seven with chronic inflammatory sinus disease, four with squamous cell carcinomas, two with papillomas, one with malignant lymphoma, and five with mucoceles. In a few cases, no characteristic MRI abnormalities were detected. The distinction between paranasal tumor and in Hammatory mucosa was almost seen in MRI through clearness of periphery, homogeneity of structure, signal intensity, and enhancement by Gd-DTPA. However, there were some exceptions.CT was useful mainly for bone details, and MRI for soft tissue, so CT and MRI provide different information. The use of both CT and MRI is recommended for the correct diagnosis of paranasal sinus disease. CT should be used initially and MRI should be a secondary examination.

Dewaxing of gray cotton fabric is an important operation in the dyeing process, Instead of the conventional wet scouring process, oxygen low temperature plasma treatment was applied to gray cotton fabric. The low temperature plasma treatment was useful technic to remove the surface cotton wax. In order to confirm the practical effect, two kinds of cotton fabric which were treated with the conventional scouring and the low temperature plasma processes, were processed subsequently bleaching, mercerizing, dyeing, and finishing under the same conditions. The qualities of both fabrics were almost the same, but it seems likely that the consumptions of chemicals, water, and energy by low temperature plasma process are much less than those of conventional one. The scouring time by conventional process was reduced to one twentyth by the low temperature plasma process.

Two patients with primary malignant lymphoma (non-Hodgkin's lymphoma) extending bilaterally into nasal cavities and paranasal sinuses were examined by plain X-ray films, CT, and MRI.Plain X-ray films showed diffuse, uniform bilateral opacification of ethmoid cells and maxillary sinuses, which might lead to a misdiagnosis of chronic sinusitis. The only abnormal finding was bone destruction of the medial orbital rim; it was considered very important not to overlook this finding to avoid misdiagnosis.Moth-eaten or permeating bone destruction of the nasal septum was found on CT and confirmed by MRI, which showed several very low intensity (no signal) regions dotted along the nasal septum. We conclude that less marked bony wall destruction and apparent mass formation on both sides of the bony wall are characteristic findings of sinonasal malignant lymphoma.

Acute suppurative sialoadenitis is now rare because of the progress of antibiotics. Four patients with acute suppurative Sialoadenitis visited our clinic. Three had parotitis, and one had submaxillary gland infection.All four patients were 70-80 years old. One of them had leukemia. Staphylococcus aureus was isolated from three patients.It is difficult to differentiate between acute suppurative sialoadenitis and salivary gland malignant'. We recognize various images in CT scans of acute suppurative sialoadenitis, from tumor formation to total salivery gland swelling, so differentiation is difficult by CT scan.We examined one patient with MRI, and we noted a great increase in the signal level of the salivary gland, which indicated inflamation and a low signal level which indicated abscess. MRI is considered to be useful for the differentiation between acute suppurative sialoadenitis and salivary gland malignancy

Formation of cysts in the paranasal sinuses is common but in the mastoid cavities, it is rare. A 49-year-old female had a primary cyst in a mastoid cavity. Operation confirmed that the aditus was completely obliterated by the cyst wall and a cholesterol granuloma. There was no communication between the mastoid cavity and the epitympanic cavity. The etiology of mastoid cysts has been uncertain, but obstruction of the air ventilation in the middle ear space at the aditus is thought to play an important role in the etiology. Mastoid cyst is diagnosed by aspiration of the cyst, but it is important to differentiate it from meningoencephalocele and meningocele protruding into the mastoid cavity. Radiologic imaging, especially CT and MRI, should be done before the aspiration.

High resolution computed tomography (HRCT) of the temporal bone has enabled us to diagnose inner ear anomalies easily. Otorhinolaryngologists will be able to diagnose Mondini type malformation more frequently. A 55-year-old female visited us because of hearing loss and vertigo. Pure tone audiograms revealed bilateral deafness. Bilateral Mondini type inner ear malformations were observed in the HRCT of the temporal bone. Her family history revealed that there were five women with severe hearing impairment. We perform temporal bone HRCT and audiograms on three women with impaired hearing and a woman with normal hearing in her family. Pure tone audiograms of three women revealed nearly bilateral deafness and temporal bone HRCT showed bilateral Mondini type inner malformations similar to one another. The CT of the woman with normal hearing showed completely normal findings. Autosomal dominant inheritance was suspected because of the family history.

Most patients with bilateral vocal cord paralysis have a fairly satisfactory voice, but their airway is usually compromised. A 26-year-old female had dyspnea and bilateral vocal cord paralysis since resection of a meningioma in November, 1981. In April, 1984, she had a tracheotomy because of increasing dyspnea. One year later, we tried to close her tracheostoma naturally but failed because of dyspnea. In May, 1987, the posterior third of the right vocal cord was vaporized by laser irradiation, but the airway was not improved enough and the tracheostoma could still not be closed. In June, 1989, we tried endoscopic laser arytenoidectomy to provide a good airway. This method, selected because of her fixed arytenoid cartilage, was successful in a restoring her airway and she is doing well without a cannula, 3 months after laser treatment.Endoscopic laser arytenoidectomy should be useful in the treatment of bilateral vocal cord paralysis, especially with fixed arytenoid cartilage.

Bilateral parotid gland tumors are uncommon. We report the first known case of pleomorphic adenoma on the left and monomorphic adenoma on the right. Histologically, the left tumor had the typical features of a pleomorphic adenoma. There were many areas of epithelial tumor cells associated with typical myxoid areas. In the right tumor, the trabecular pattern contained epithelial tumor cells, and neither myxoid nor chondroid components were seen. The diagnosis was trabecular adenoma. Among bilateral parotid gland tumors, Warthins tumor is the most common, and pleomorphic adenoma is very rare. We review the literature on bilateral pleomorphic parotid gland adenomas and discuss the reason for their rarity.

We describe two cases of metastatic brain stem tumors diagnosed by otorhinolaryngologists. Although metastatic brain stem tumors are rarely encountered in otorhinolaryngology clinics, their possible presence must always be kept in mind. The first patient was a 64-year-old male with left facial palsy. Neurootological examinations revealed bilateral medial longitudinal fasciculus syndrome and left gaze disturbance. Neuroradiological, CT and MRI examinations showed lesions in the brain stem and around a lateral ventricle. These lesions were diagnosed to be metastatic from lung carcinoma. The second patient was a 56-year-old male with bloody otorrhea from chronic external otitis caused by atomic bomb burns. His optokinetic nystagmus response was found to be abnormal, and he also numbness of the right hand and of the skin around the mouth. A brain stem tumor was demonstrated by CT scan. At autopsy, a brain stem tumor was found metastatic from a lung carcinoma which had been resected two years before his death.

The endoscopic diagnosis of congenital ectopic gastric mucosa in the cervical esophagus has recently become possible.However, symptoms have rarely been attributed to its presence.We treated a 45-year-old woman with isolated ectopic gastric mucosa in the cervical esophagus who had complained an abnormal sensation in the throat for one year.Physical examination was normal and her esophagogram was negative, but esophagoscopy revealed an area of reddish raised mucosa, about 5mm in diameter, arising from the antero-lateral wall of the cervical esophagus.Histological examination of the biopsied specimen showed columnar epithelium consistent with gastric mucosa.Since the endoscopic treatment, the patient has been asymptomatic without any medical treatment.Ectopic gastric mucosa has the potentiality of malignant transformation to adenocarcinoma.Therefore, endoscopic examination of the cervical esophagus is indicated in the evaluation of persistent abnormal sensation in the throat.

To evaluate the systemic effects of intranasal steroid drops in patients with dysosmia.Intranasal steroid drops were administered for 12 weeks to 23 patients with dysosmia, and their plasma cortisol and adrenocorticotropic hormone (ACTH) values were measured before and after treatment. Improvement in dysosmia was judged based on the standerd olfactory test and the patients' symptoms.The post-treatment plasma cortisol levels ranged from 0.1 to 25.0 microg/dl (5.4 +/- 5.9 microg/dl), and the posttreatment plasma ACTH levels ranged from 5.0 to 55.0 pg/ml (13.8 +/- 11.7 pg/ml). After treatment, the 23 cases were divided into two groups: 14 cases (60.9%) with a decline in cortisol and/or ACTH level, and 9 patients (39.1%) with normal plasma cortisol and ACTH levels. Improvement in dysosmia was found in 4 patients (28.6%) in the former group and 4 patients (44.4%) in the latter group. The difference in percentage of patients who improved was not significant between the groups.We conclude that the direct topical effect of intranasal steroid drops on the olfactory mucosa may have been the principal reason for the improvement in the patients' dysosmia.

Objectives: We sought to clarify the relationship between the outcome of recurrent laryngeal nerve paralysis with the characteristics of the thoracic aortic aneurysm and the surgical procedure used in each patient. Methods: Nine patients who developed recurrent nerve paralysis (nonsurgical paralysis) due to a thoracic aortic aneurysm alone and 14 patients who underwent artificial vessel replacement for thoracic aortic aneurysm and developed recurrent nerve paralysis postoperatively (surgical paralysis) were evaluated. Results: In the patients with nonsurgical paralysis, the aneurysms were similar in size to those of other patients who underwent surgery of the thoracic aorta and were invariably located near the aortic arch. Aneurysm shape was not associated with nerve paralysis. Surgical paralysis was alleviated in two patients. Surgical paralysis was observed in 9% of those who underwent surgery of the thoracic aorta. Vocal cord mobility recovered in 4 of the 11 patients with surgical paralysis who underwent follow-up. Symptoms were alleviated by rehabilitation in many patients who did not recover vocal cord mobility. The positions of the artificial vessel anastomoses are thought to be closely related to the outcome of paralysis. Conclusion: Recurrent nerve paralysis reduced not only the patient's quality of life but also survival by leading to disorders including aspiration pneumonia. Therefore, early rehabilitation should be performed, and surgical treatment should be considered, if necessary, for patients with recurrent nerve paralysis.

Mucoceles of the paranasal sinuses cause progressive distension of the bony walls and induce compressive symptoms. Although rare, cases of massive intracranial extension have occurred. We believe that an endoscopic transnasal approach is the best choice for such huge mucoceles because it is the least invasive and can provide an adequate surgical field of view for wide marsupialization. However, the results of long-term follow-up after endoscopic transnasal surgery have not been reported. This study was designed to evaluate prospectively the postoperative course of patients with intracranially extended mucocele. In the last 5 years, we have operated on four patients with intracranially extended mucocele. Although postoperative scanning is not recommended routinely after surgery for inflammatory disease, we followed up two patients who consented by using magnetic resonance imaging (MRI) along with endoscopy. Dural descent to the original skull base plane necessitated long periods of follow-up, lasting 18 and 5 months, respectively. On the mucocele wall mucosa, which had been smooth during surgery, polyps and granulations developed after surgical drainage and lasted for a considerable time. Although endoscopic transnasal opening of mucocele is a method of choice, we recommend follow-up of such patients for long periods, at least until the frontal skull base dura returns to its original position.