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The primary treatment of nasopharyngeal carcinoma (NPC) has been external radiotherapy. Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare complication of irradiation therapy for a nasopharyngeal carcinoma. A 78 years old man had a history of NPC treated with radiotherapy in 1993. He was admitted to the hospital because of epistaxis. Angiography showed an ICA pseudoaneurysm pointing medially to the nasopharynx. Coil embolization of the ICA was performed, but cerebral infarction occurred. Internal carotid artery (ICA) pseudoaneurysms are an uncommon but potentially lethal condition. Angiography is the mainstay of diagnosis of the aneurysm and planning the embolization of the ICA. We should be more aware of this complication in NPC patients.

A 40-year-old man presented to our hospital with painful tumors in his left carotid space and left knee. He had no family history of neurofibromatosis type II (NF II), no history of hearing loss or vestibular problems, and no symptoms of NF I. Magnetic resonance imaging (MRI) of the head revealed no intracranial tumors including vestibular schwannoma (VS). MRI of the left carotid and left knee demonstrated T(1)-weighted mass lesions. They were excised and all of them were pathologically diagnosed as schwannoma. Thus, this case was diagnosed as definite schwannomatosis in reference to the diagnostic criteria.

The purpose of this study was to identify the factors that predict incomplete low-dose radioiodine remnant ablation (RRA) with recombinant human thyroid-stimulating hormone (rhTSH) and to report the adverse events associated with this treatment. Between 2012 and 2014, 43 consecutive patients with thyroid cancer received low-dose RRA with rhTSH after total thyroidectomy. We retrospectively investigated the adverse events during low-dose RRA and during diagnostic whole body scan (DxWBS) using rhTSH, and analyzed the rate of RRA completion and the associations between RRA completion and various clinical/pathological factors. Complete RRA was seen in 33 (76.7%) patients, and incomplete RRA was observed in 10 (23.3%). Patients with incomplete RRA had stronger neck accumulation of 131I than those with complete RRA (P

We present 21 surgical cases of malar bone fracture at our hospital between 1994 and 2005. Results showed a male predominance by 2.5 to 1 and the mean age of 45 years old. Arch fractureswere found in 12 cases, and body fractures were found in nine cases. Ten cases were complicated bymaxillary fractures. Patients with arch fractures were approached with a Gilles's temporal incision, intraoral incision, or direct incision on the arch. Patients with body fractures were approached witha lateral eyebrow incision, lower eyelid incision, intraoral incision, and/or direct incision on the arch.Titan plates were used for rigid fixation in 11 cases. For surgery, physicians should try to make smaller and fewer skin incisions for aesthetic satisfaction.

We examined 29 cases of blowout fractures (30 operations) in which repair surgery was performed at our department. There were 24 orbital floor fractures, 3 orbital medial wall fractures and 2 combined fractures of floor and medial wall. In subjective evaluation, the disturbance of eye movement was improved or cured in all cases. In subjective evaluation, the disturbance of eye movement evaluated by the Hess chart was significantly improved after the operation. The disturbance of eye movement at the first examination in the patients less than 19 years old was significantly worse than that in the patients more than 20 years old. The prognosis of eye-movement in cases of strong disturbance of eye movement at the first examination was significantly worse than in cases of weak disturbance at the first examination. The prognosis of eye-movement in cases with a linear fracture was significantly worse than in cases with a punched-out fracture. The prognosis in cases that were operated on within 9 days after injury did not differ from cases operated after 10 days. The decision to operate for blowout fractures could be made after an adequate observation period of more than 7-10 days.

Otorrhea of leaked cerebrospinal fluid and meningitis in a 33-year-old male originated from an encephalic herniation into the middle ear following traumatic temporal bone fracture. CT demonstrated a mixed-type fracture consisting of a longitudinal fracture and a posterior oblique fracture of the left temporal bone. The left tegmen tympani was broken into a bellows-like shape and a bone splinter from it had stuck in the epitympanum at the level of the incus body. Surgery via a middle cranial fossa approach confirmed penetration of the brain tissue between the incus and lateral semicircular canal. The diagnosis and management of this condition are discussed in the context of a literature review.

We experienced two cases of ossicular lesions in which three-dimensional (3D) images from multislice CT (MSCT) were useful in diagnosing the lesions. In the first case, the 3D images revealed an ossicular defect in the long process of the incus and the superstructure of the stapes in the middle ear. In the second case, discontinuity of the incudostapedial joint was revealed. The hearing level in both cases was improved by tympanoplasty. In the first case, besides the ossicular malformation, open-type congenital cholesteatoma was found in the middle ear during the operation. There is a possibility of residual recurrence of open-type cholesteatoma, so postoperative follow-up was necessary for the first case. Canal wall up tympanoplasty with posterior hypotympanotomy was performed in the second case. Since this procedure does not require managing the external auditory meatus or the tympanic membrane, it should be chosen in cases of normal tympanic membrane with traumatic ossicular chain discontinuity, such as the second case. In conclusion, reconstruction of 3D images by MSCT with 8 rows of detectors gave realistic and high-quality images of the ossicular lesions. The 3D images were useful for the surgeon's preoperative planning and for the patient's informed consent to the operation.

Tuberculosis in Japan has increased recently. Cervical tuberculous lymphadenitis is an extrapulmonary tuberculosis. We report a case of a 29-year-old woman who was 28 weeks pregnant, with cervical tuberculous lymphadenitis, which was diagnosed by tuberculin reaction and polymerase chain reaction test (PCR test) after delivery. The patient was treated with rifampicin (RFP), isoniazid (INH) and levofloxacin (LVFX) as antituberculous chemotherapy for a year, and was treated with INH and LVFX for the next half-year. The baby was treated with bacillus Calmette-Guerin vaccine (BCG vaccine) instead of antituberculous chemotherapy. The patient and the baby were making satisfactory progress. Although antituberculous chemotherapy should be done immediately when a pregnant woman is diagnosed with pulmonary tuberculosis, it should not be done immediately when the pregnant woman has cervical tuberculous lymphadenitis.

Gastroesophageal reflux disease (GERD) which includes otorhinolaryngologic symptoms is called laryngopharyngeal reflux disease (LPRD). GERD shows a high incidence in progressive systemic sclerosis (PSS) and mixed connective tissue disease (MCTD).Two cases of LPRD with collagen disease, MCTD and PSS, are reported. The chief complaints were globus sensation and hoarseness. Arytenoid swelling, vocal cord edema and interarytenoid pachydermia were found by laryngeal fiberscopy. The clinical symptoms and findings disappeared after administration of proton pump inhibitor (PPI).

Over the past few decades, various cortical regions in primates have been labeled as vestibular: area 2v, area 3, area 7, superior temporal gyrus and parieto-insular vestibular cortex (PIVC). These areas have reciprocal connections with each other and form an "inner circuit." The PIVC physiologically responds well to vestibular stimulation as well as visual and somatosensory inputs. It also morphologically receives projections from all other vestibular cortical regions. Thus these findings suggest that PIVC integrates multisensory information from different cortical areas. The PIVC may play a major role in the cortical vestibular system.We recorded neuromagnetic responses to visually-induced linear forward acceleration in humans using a 122-channel whole cortex neuromagnetometer. In the study, visual stimulation without vestibular stimulation induced activation in the PIVC in humans. Hence, it is suggested that the vestibular cortex not only receives vestibulr inputs from peripheral vestibular apparatus, but also produces vestibular sensation using other multi-model inputs.The monkey, cat and rat have homologous vestibular cortical system over species, which projects corticofugally onto the vestibular nuclei. These projections may play a role in an antagonistic coordination of involuntary oculomotor and skeletomotor movements during head movements or locomotion.

We present 35 cases of mandibular fracture treated at the Suita Municipal Hospital between 1994 and 2002. Results showed a male predominance by 2 to 1 and the highest occurrence of trauma in the 20-29 year age group (31%). Major causes of fractures were traffic accidents (52%), assaults (31%), and falls (17%). The most common fracture sites were, in descending order, the condyle (33%), parasymphysis (25%), angle (22%), body (10%), and ramus (10%). The cause of fractures in patients less than 30 years old is most likely due to traffic accidents and assaults, while that in patients over 30 years old is due to falls. Traffic accidents and falls significantly induce condylar fractures, while assaults significantly induce other fractures. Patients were treated with open reduction with titanium or biodegradable miniplates and screws (n = 30), maxillomandibular fixation alone (n = 2), conservative therapy (n = 1), or treatment at other hospitals (n = 2). The mean period for maxillomandibular fixation was 42 days. In 22 patients with more than 6 months of follow-up, 6 had complications: 4 had pain, 1 had deviation in mouth opening, 1 suffered from noise, and 1 from facial palsy. Patients with condylar fractures had a significantly high incidence of complications. We think that we should further decrease the period for maxillomandibular fixation, increase the application of biodegradable materials, and use methods for condylar fractures more appropriately.

We present here a case showing paradoxical convergence during lateral gaze. A 61-year-old female complained of dizziness when she saw horaizontally moving objects. She had a 20-year history of diabetes with retinopathy, nephropathy, and neuropathy.In an attempted leftward gaze, both eyes were transiently convergent for several seconds, disturbing ocular abduction. This paradoxical eye movement sometimes occurred in an attempted rightward gaze, and was accompanied with pupilary miosis. When one eye was covered, the other eye showed no disturbance in lateral gaze. Caloric vestibular stimulation induced conjugate eye movement in both directions. MRI did not show any lesion in her brain. These findings indicated that the gaze palsy in this case was due to covergent spasm (i.e., spasm of the near reflex). The convergent spasm appearing in attempted lateral gaze was successfully treated with baclofen, an agonist of GABA-B receptor. Its pathophysiology is unclear, but we supposed an increased excitability in the supra-oculomotor parts of the vergent eye movement system. A neural command to generate horizontal saccade simultaneously enters the vergent system, which may trigger the convergent spasm of this case.

Subjects visiting the Department of Otolaryngology at Suita Municipal Hospital reporting vertigo or dizziness numbered 664 women and 343 men from April 1999 to December 2000. As a city hospital, we play an important role in the diagnosis and treatment of acute vertigo or dizziness. The frequency of diagnosis of these cases was divided almost equally into 5 groups: (1) benign paroxysmal positional vertigo (BPPV) 23%; (2) suspected BPPV, 18%; (3) peripheral vestibular disorders other than BPPV, 22%; (4) disorders other than peripheral origin, 18%; and (5) undiagnosed, 19%. Based on our results, BPPV, other peripheral vestibular disorders, and disorders of other origins should be differentiated from the first screening. BPPV was most frequent and diagnosed by typical positioning nystagmus. Many other peripheral vestibular disorders were accompanied by nystagmus. It is also important to differentiate serious illnesses such as cerebrovascular disease (7%), space-occupying lesions in the posterior fossa (1.2%), and cardio-circulatory disease (3.6%).

We report two cases of actinomycosis of the neck, one acute and one chronic. The acute actinomycosis patient was a 63-year-old woman who complained of high fever, sore throat, and swelling of her neck on her first visit. Plain CT revealed gas-formation in the soft tissues of the left parapharyngeal space, the hyoid area and the cartilage thyroid area. We performed emergency tracheotomy and surgically drained her neck. No actinomycotic bodies were found microscopically in the surgically resected material, but cultures of the neck pus grew out actinomyces. A diagnosis of actinomycosis was made, and the patient was treated with administration of antibiotics, an ASPC drip infusion for about 7 weeks and oral BAPC for about 6 months, and the lesion was improved. The patient has been symptom-free for 4 years since the operation. The chronic actinomycosis patient was a 61-year-old woman who complained of swelling in the right submandibular region. Surgical resection was performed to exclude the possibility of a malignant tumor. Actinomycotic bodies were detected microscopically in the surgically resected material. The patient was treated with oral AMPC for about 6 months, and she has been symptom-free for 1 year since the operation.

UNOX System (high purity oxygen activated slugde process) have been adopted in various industrial field, especially in pulp and paper industries Japan. Over 30 plants are used for pulp and paper industries.In this paper, we report the new technologies concerning UNOX System such as new aerator, and treatment performance on board-paper waste, DIP waste, KP waste and KP waste plus EVA drain with the date of actual plants and treatability tests. We report that removal efficiency of not only BOD and COD but also even AOX and VOC are remarkable.

A 32-year-old man with Wernicke encephalopathy due to malnutrition is reported. The patient showed primary position upbeating nystagmus (PPUN) with severe ataxia and lateral gaze nystagmus. Neurootological examinations showed bilateral canal paresis, saccadic pursuit and disturbance of optokinetic responses. ABR revealed a prolongation of the I-III interwave interval, although his pure-tone audiogram was normal. Brain MRI demonstrated symmetrical high intensity areas on T2-weighted images in the periventricular regions of the third ventricle. MRI is a useful tool for the diagnosis of Wernicke encephalopathy in the early stages. After thiamine therapy, PPUN and ataxia gradually, but incompletely recovered, although lateral gaze nystagmus and the high intensity areas on MRI disappeared. These observations suggest that brainstem-cerebellar lesions contributed to the clinical manifestations of this case.

The etiology of sudden deafness is unknown, but ischemia of the inner ear is believed to be one of the major causes of sudden deafness. We administered Batroxobin for over 28 days at dosages of over 150 B. U., to 10 patients with sudden deafness. After this treatment, the hearing level improved significantly in 9 out of the 10 patients. The less satisfactory result in the one patient could be attributed to a failure in the control of his plasma fibrinogen levels. We believe that this therapy can be very effective, provided that the side effects of this therapy are well understood by both patients and the medical staff.The treatment of sudden deafness with Batroxobin is discussed in this report, based on our experiences with long term defibrinogenation therapy.

A rare parotid gland tumor, papillary cystadenocarcinoma, was diagnosed clinicopathologically. This tumor was classified for the first time by the world Health Organization (W.H.O.) in 1991. It was interesting that this tumor was characterized by cysts and papillary endocystic projections. The histogenesis is discussed.

Objective: The present study aimed to determine the time course and frequency patterns of transient low-tone air-bone gaps (ABGs) after canal plugging for intractable BPPV.Method: We investigated 8 patients with intractable BPPV who underwent canal plugging. Four cases had posterior semicircular canal type BPPV (pBPPV), and the other 4 had horizontal semicircular canal type BPPV (hBPPV). Pure-tone audiometries (PTAs) were performed before surgery and 7 days, 1 month, and 6 months after surgery.Results: The ratio of the number of patients with ABGs (+) was 100.0% (8/8) on the 7th day and 1st month postoperatively, and it was 0.0% (0/8) in the 6th month postoperatively. There were no significant differences in the time course or frequency patterns of ABGs between pBPPV and hBPPV.Conclusion: Our findings suggest that, during such a convalescence period, the plugged area might not be completely repaired yet and could still induce dizziness and low-tone ABGs, since enlarged vestibular aqueduct syndrome and sup...

Objective: To perform treatment with higher quality of life, we need to understand the psychological condition of each patient with vestibular schwannoma (VS). In the present study, we examined the pre-treatment mental status of patients with VS by using Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS).Method: Between 1997 and 2010, we enrolled and assigned 30 patients with unilateral VS in the present study. Before the treatment, we examined CMI and SDS to evaluate patients’ psychological condition and also sex, age, tumor size, hearing level in bilateral sides, CP%, and House-Brackmann score to learn patients’ backgrounds.Results: According to the data of CMI (>stage III, IV) and SDS (>40), psychological disturbances were pointed out only in 20.0% of patients with VS (6/30). VS patients with hearing deterioration (>30dB) in the contralateral side were significantly depressed (66.7%: 4/6) more than those with normal hearing (th/8th nerve function in the tumor side did not make any influ...

To search for prognostic predictors and reexamine the usefulness of electroneurography (ENoG) in predicting the prognosis of peripheral facial palsy using statistical methods.Prospective study.Tertiary referral center.Consecutive 142 patients with Bell's palsy and 26 with Ramsay Hunt syndrome treated with steroid plus antiviral agents.Multivariate analysis was used to identify which factors, including Yanagihara grading score and ENoG, predict better recovery. Receiver operating characteristic (ROC) curves were constructed for ENoG and grading score. The cumulative recovery rate by ENoG was calculated using Kaplan-Meier analysis. Recovery was defined as the improvement of grading score to 36 points or more (full score, 40) without synkinesis.Multivariate analysis revealed that Ramsay Hunt syndrome, the worst grading score and ENoG were the significant prognostic predictors. The area under the ROC curve for ENoG was broader than those for grading score, indicating that ENoG was superior to grading score in terms of accuracy for prognosis prediction. The ROC curve revealed that more than 85% degeneration on ENoG had the best specificity (77.8%) and sensitivity (71.4%) to predict nonrecovery. When ENoG was subjected to the analysis of cumulative recovery rate using Kaplan-Meier plots, patients with more than 85% degeneration on ENoG had significantly poorer prognosis.ENoG was the most effective factor for prediction of the prognosis of peripheral facial palsy, and more than 85% degeneration had the best specificity and sensitivity to predict nonrecovery.

Study Objective To investigate the analgesic efficacy of preoperative flurbiprofen on postoperative pain after tonsillectomy. Design Prospective, randomized, nonblinded, non–placebo-controlled study. Setting Municipal hospital. Patients Twenty-five ASA physical status I patients older than 20 years of age, who were scheduled for tonsillectomy. Interventions Patients were randomly allocated to two groups to receive preoperative intravenous (IV) 50 mg flurbiprofen (group F) or not (group C). Anesthesia was induced with IV propofol two mg/kg and maintained with nitrous oxide and sevoflurane. Measurements Pain scores at rest and at swallowing, intraoperative bleeding, vital signs during the postanesthetic period, interval until diclofenac sodium suppository rescue, and the total dose required for 12 hours postoperatively were all recorded. Main Results Pain scores at rest as well as those recorded after swallowing 30 minutes after tonsillectomy were significantly lower in group F than in group C. During the first postoperative 1.5 hours, significantly fewer patients in group F required rescue diclofenac suppository than did group C patients. However, total dose of required rescue during the postoperative 12 hours in group F did not significantly differ from that of group C. There were no significant differences in intraoperative bleeding or in any vital signs during the postanesthetic period either. Conclusion Preoperative flurbiprofen suppressed immediate postoperative pain after tonsillectomy. The analgesic effect, however, disappeared in a few hours and was insufficient for overnight pain relief.

Objective To evaluate the endoscopic transantral insertion of antral bone grafts into the orbit for repair of orbital floor defects. Design A retrospective analysis with a mean follow-up of 5.3 months. Patients Eleven patients who underwent surgical repair of orbital floor fractures. Setting Municipal hospital. Main Outcome Measures Preoperative and postoperative Hess screen tests and the presence of diplopia, enophthalmos, donor site complications, cosmetic deformity, infection, and graft extrusion. Results Subjectively, 3 patients with diplopia had complete resolution of their symptoms after surgery, and 8 patients had improvement of their symptoms. Objectively, 11 patients had significant improvement in the postoperative Hess area ratio compared with the preoperative Hess area ratio. In 1 patient with a floor defect measuring 2.5 cm, enophthalmos existed after surgery, but reoperation was not performed in this case because diplopia was improved. There were no donor site complications, cosmetic deformity, infection, or graft extrusion. Conclusions The endoscopic transantral insertion of antral bone grafts through the floor defect into the orbit is an effective technique that prevents injury to the lower eyelid, carries minimal donor site morbidity, and provides an optimal support function for the globe. It merits consideration in cases of orbital defects less than 2 cm in diameter.

Laryngeal tuberculosis is a rare entity and the disease related to laryngeal cancer is extremely rare. We describe a case of laryngeal tuberculosis in a 74-year-old man with a history of radiotherapy for laryngeal carcinoma four months earlier. Laryngoscopy demonstrated a white mass on the right vocal fold at the site carcinoma had previously occupied. Recurrence of the cancer was suspected, but the biopsy result showed histological features of tuberculosis. We discuss the derangement of the host's mucosal barrier by the malignancy as a contributing factor in secondary tuberculous infection. Tubercular bacilli may be reactivated due to the immunosuppression associated with the therapy.

Objective —To evaluate the complications, efficacy of surgical treatment and outcome in patients with the localized form of Wegener's granulomatosis (WG). Materials and Methods —We reviewed a series of 5 patients (3 males, 2 females; age range 22–67 years; mean age 44.6 years) with WG in the upper and lower respiratory tracts. Results —Aural, nasal and ocular complications were common in our patients. All patients responded to standard immunosuppressive treatment, and all surgical treatments had a favorable outcome in the remission stage. Although there was no life-threatening disease activity during the course of treatment, minor relapses occurred in three patients. Conclusions —Patients with localized WG may have a better outcome than those with systemic WG, but complications due to the disease or medication must be actively managed. Reconstructive surgery for patients with WG is safe and effective during the remission stage.

Our understanding of the pathomechanism of benign paroxysmal positional vertigo (BPPV) has improved dramatically. A type of BPPV featuring mixed torsional and vertical nystagmus induced by the Dix-Hallpike maneuver involves the posterior semicircular canal (P-BPPV). The other type of BPPV featuring horizontal nystagmus induced by spine-to-lateral head positioning involves the horizontal canal BPPV (H-BPPV). In complaints of vertigo or dizziness, 619 patients visited our department last year. Of these, 142 (23%) was had positional nystagmus consistent with a diagnosis of BPPV, 118 (19%) had no nystagmus but were suspected of BPPV due to vertigo episodes. BPPV was the most frequent diagnosis. H-BPPV was not rare, but accounted for 30% of BPPV. Of H-BPPV, 73% featured direction changing geotropic nystagmus, and 27% direction changing apogeotropic nystagmus. H-BPPV resolved faster than P-BPPV. Most cases caused by head trauma were P-BPPV. Transition between P- and H-BPPV was found in 6 cases. Women outnumbered men by about 3 to 2 in both P- and H-BPPV. Peak incidence was found in the those in their 60s and 70s, suggesting that the etiologies of both types of BPPV are essentially the same.

We examined the effects of amygdala lesion (AL) or hippocampal lesion (HL) on hypergravity-induced motion sickness in rats. Rats do not vomit, but the behavior known as pica, the eating of non-nutritive substances such as kaolin, can be used as an index of motion sickness. In the present study, hypergravity-induced kaolin intake and apomorphine-induced kaolin intake were measured before and after brain lesions. After AL, hypergravity-induced kaolin intake and the ratio of the hypergravity- to apomorphine-induced kaolin intakes were decreased. These results indicate that AL suppressed motion sickness more than pica behavior itself, suggesting that the amygdala plays an important role in the development of motion sickness in rats. Conversely, after HL, hypergravity-induced kaolin intake was increased, as was the ratio of the hypergravity- to apomorphine-induced kaolin intakes. These results indicate that HL aggravates motion sickness induced by hypergravity in rats, suggesting that the hippocampus counteracts motion sickness.

The importance of the vestibular apparatus in the development of motion sickness is widely accepted, although the role of the vestibular cerebellum remains controversial. We examined the effects of vestibular cerebellum lesion on the development of motion sickness in rats. Rats do not vomit, but the behaviour known as "pica", the eating of non-nutritive substances, such as kaolin, can be used as an index of motion sickness. A 2 h load of hypergravity induced pica in rats, indicating that they suffered from motion sickness. Pica was induced by hypergravity load even after surgical lesion to the bilateral cerebellar flocculus or to the cerebellar vermis. We concluded that the vestibular cerebellum was not essential in the development of motion sickness in rats.

Horizontal and vertical saccades were recorded and quantitatively analyzed with an infrared video recording system in 6 normal human subjects. Peak and mean saccade velocities increased exponentially as the amplitude increased. Peak velocity of horizontal saccade was significantly larger than that of vertical saccade (p less than 0.05, ANOVA test). On the other hand, duration and latency showed a linear relationship with saccade amplitude. Latency was constant (i.e. 0.21 s) irrespective of saccade amplitude in the regular eye tracking mode; however, latency slightly increased as the amplitude became larger in the randomized eye tracking mode. As a result, a slight positive correlation could be found between saccade amplitude and latency: r = 0.50 and 0.35 in horizontal and vertical saccades, respectively.

Positional nystagmus and body sway were measured for 8 hours following alcohol ingestion in 27 human volunteers. The intensity of positional alcohol nystagmus phase I (PAN-I) correlated well with blood alcohol concentration (BAC) along the time axis; the correlation coefficient between PAN-I and BAC 1 hour after alcohol ingestion was 0.62 (P less than .01). The minimum threshold BAC resulting in PAN-I was 0.23 mg/mL. Body sway was measured by stabilometry. The circumscribed area of posturography before and after alcohol ingestion was compared. Temporal changes in body sway and BAC were also closely correlated. The BAC threshold for increased body sway was estimated to be somewhere between 0.5 and 0.8 mg/mL, considerably higher than the threshold for PAN-I. Measurements of blood acetaldehyde, the dehydrated product of ethanol metabolism, showed no correlation with either the intensity of PAN or changes in body sway. The intensity of PAN and body sway measured at the time of peak BAC 1 hour after alcohol ingestion, however, showed significant positive correlation (r = .50, n = 25; P less than .01).

Recent studies have shown that when normal human volunteers are subjected to a sudden free fall, EMGs of truncal and limb muscles are activated due to the startle reflex originating in the otolith organs. In this study, muscle activities during sudden free fall and voluntary fall were recorded in 18 healthy human subjects. Monophasic or biphasic EMG responses could be recorded from all subjects during sudden free fall; the average latency of initial activity was 29.2msec (SD 3.5msec) in the orbicular oculi muscle, 67.7msec (SD 9.3msec) in the anterior tibial, 73.5msec (SD 9.2msec) in the gastrocnemius and 71.8msec (SD 9.4msec) in the soleus muscles. On the other hand, such initial activities did not appear in voluntary falls, and only activity which coincided with landing could be recorded. It is suggested that free fall stimulation can be used as a diagnostic tool in disorders of otolithic function.

The concentration of Latamoxef (LMOX) was determined by bioassay in surgical patients with sinusitis and chronic tonsillitis. One or two grams of LMOX was injected intravenously prior to tonsillectomy under general anesthesia and the Caldwell-Luc operation under local anesthesia.Concentrations of LMOX in the tonsil and maxillary bone were 12.7μg/g and 16.8μg/g respectively one hour after administration;and 9.4μg/g and 2.3μg/g respectively two hours after administration.The transfer ratio, the concentration in the tonsil to that in the serum, was about 20 percent. The tissue concentrations exceeded the antibacterial level of LMOX except for Pseudomonas aeruginosa.

Five patients with primary Cerebellar hemorrhage recovered about one month after the onset, without any surgical treatment. CT showed bleeding in and around the dentate nucleus in three patients and in the ventral vermis in two. All five had spinning vertigo or giddiness and vomiting, but cerebellar signs and other neurological symptoms were not common. Eye movement tests such as eye tracking, gaze nystagmus, positional nystagmus, optokinetic and caloric tests, suggested the possibility of central vestibular lesions. However, oto-neurological examinations alone could not provide the exact diagnosis.

Movements of the centre of gravity during 60 s of standing with eyes closed and eyes open were analysed before and after alcohol ingestion up to 8 h in 37 healthy human subjects. Blood alcohol and acetaldehyde concentrations (BAC and BAcHC) were measured simultaneously. Among the parameters analysed, area of posturogram was the most sensitive indicator; it increased to 3.8 times that of the control value at 60 min, after 3.5 ml/kg of ingested whisky (mean BAC of this group was 1.4 mg/ml), with the eyes open. The Romberg ratio, which denotes eyes closed relative to eyes open, remained constant. By contrast, there was little change in stabilometry in cases of 1.2 ml/kg of whisky ingestion (mean BAC at 60 min was 0.58 mg/ml). It is considered that body sway starts to increase when the BAC level exceeds 0.6 mg/ml on average; this value is only higher than the threshold of positional alcohol nystagmus. Correlation coefficients between BAC and each parameter of the stabilogram in the eyes open condition, such as area, X- and Y-axis diameters, and velocity of body sway, were 0.53, 0.45 and 0.48, respectively (p less than 0.01). There was no positive correlation between BAcHC and these parameters.

One hundred seventy-one maxillary carcinoma patients who survived more than 10 years after initial treatment were surveyed. Performance status was unrestricted in 35.1% of the patients, slightly restricted in 34.5%, moderately restricted in 21.1%, restricted in 7.0%, and very restricted in 2.3%. Radiation-induced cataracts on the affected side occurred in 100% of the patients treated with radiation. Good visual acuity was maintained in only 65.8% of the patients, even on the contralateral side. Fifty-five percent of the patients retained symmetric facial animation due to our policy of conservative therapy. Restricted mouth opening occurred in 32.2% of the patients, taking liquid diet in 21.1%, and middle ear effusion in 26.3%, which were closely linked to maxillectomy operation. This study suggests that avoiding excess radiation dosage, strict control of radiation field, adaption of two portals with 60 grades wedge pair filter, use of appropriate protectors, limiting removal at the maxillactomy, and postoperative care for trismus or tympanic effusion are necessary.