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The outcome of radiation therapy or surgery was studied retrospectively in 30 previously untreated patients with squamous cell carcinoma (SCC) of the lateral wall of the oropharynx. Twenty-two patients with tonsillar SCC and 8 patients with tonsillar pillar SCC were treated between 1978 and 1997 at the Jichi Medical School Hospital. The group consisted of 25 men and 5 women, aged 34 to 82 years (average, 63 years). In the tonsillar SCC group, lesions were T1 in 2 cases, T2 in 2, T3 in 13, and T4 in 5; 5, 3, 12 and 2 patients had NO, N1, N2, and N3 disease, respectively. In the tonsillar pillar SCC group, lesions were T2 in 5 cases, T3 in 2, and T4 in 1; 6 patients had NO, 1 had N1, and 1 had N2 disease. Fourteen patients were treated with radiation and 16 were treated with surgery, 14 of whom also received preoperative irradiation. Eleven patients in the surgery group underwent resection by a transoral approach and 5 underwent extended surgery with reconstruction. Disease-free survival rate at 3 years by the Kaplan-Meier method was 64% in the radiation group and 78% in the surgery group (not significantly different) in those with tonsillar SCC, and 67% and 82%, respectively, (not significantly different) in those with tonsillar pillar SCC. The surgical approach was transoral in patients with noninvasive T2 or T3 primary lesions. No local recurrence was observed. Transoral resection appears to be useful for treating noninvasive lateral wall SCC of the oropharynx.

Treatment with low-dose consecutive cisplatin (CDDP) was performed on six patients with recurrent and distant metastasis of head and neck squamous cell carcinoma. All patients were men, and their ages ranged from 64 to 86 years with an average of 75. Primary treatments were radiotherapy and surgery in three patients, chemotherapy and radiotherapy in two patients, and radiotherapy, regional chemotherapy and surgery in one patient. Two patients had laryngeal recurrent carcinomas, one patient had nasopharyngeal recurrent carcinoma, one patient had recurrent metastatic neck lymph node and two patients had distant metastasis (lung and brain). CDDP was administered over consecutive seven days, with a daily dose of 10mg/m2 as continuous drip infusion for 148 hours from day 1 to day 7. Four patients received two courses, while two patients received one course. The overall response rate was 33%, which was restricted to a partial response in two patients. These patients were still alive about one year after treatment. No toxic effect was observed. The present study indicated that low-dose consecutive CDDP was safe and efficacious for patients with recurrent head and neck squamous cell carcinoma.

Five of the nine patients in this series had incudostapedial joint separation, two had stapes fixation, one had incudostapedial joint separation and incus fixation, and one had a dislocated stapes foot plate that had no contact with the oval window.Autografts were used to reconstruct the discontinuity in six cases, and good results were obtained. Stapes surgery was done in three cases, and was successful in two cases.The etiology of the anomalies observed in these patients is discussed from the standpoint of temporal bone embryology.The results of pre-operative auditory function tests were evaluated. However, it was difficult to predict pre-operatively by auditory examination which type of ossicular anomalies the patients had.

Between 1974 and 1986, 54 cases of squamous cell carcinoma of the maxillary sinus were treated combing surgery, radiotherapy and regional chemotherapy simultaneously. Using UICC (1987) system, these 54 cases were classified into one Tl, four T2, thirty-three T3 and sixteen T4.The combined therapy consisted of 1) reduction operation followed by daily cleaning of the necrotic tumor mass ; 2) external irradiation with less than 30Gy ; 3) intra-arterial infusion of 5-fluorouracil (5-FU) and broxuridine (BUdR) ; and 4) final tumor resection under general anesthesia. As several modifications were made for the treatment procedure in 1979, the 54 cases were divided into two groups : Group A with 29 cases, which were treated before 1979 and Group B with 25 cases, which were treated after 1979.In this paper, the operative procedure, which we use for T4 cases is described. The first operation is performed after radiotherapy with about 10Gy and in this operation only the necrotic portion of the tumor mass is removed. The maxillary cavity is opened through the sublabial incision. This window is kept open and daily cleaning of the necrotic tumor mass is continued through the window. Three weeks after the simultaneous administration of radiation with 20Gy and 5 intra-arterial infusions of 5-FU and BUdR, the residual tumor is curetted thoroughly undergeneral anesthesia. Surgery is performed through the sublabial window which has been kept open after the reduction surgery. Removal of the residual tumor mass which extends to the ptery ygomaxillary fossa, nasopharynx, anterior and medial skull base can be performed without difficulty, provided that the tumor mass is removed in pieces. Tumors close to the dura mater, the optic nerve and the internal carotid artery are carefully dissected, using a microscope. The orbital contents and the hard palate, however, are preserved as much as possible. Although the dura mater as well as the orbital contents are widely exposed, these tissues are covered by healthy granulation tissues within 8 weeks without serious complications.The survival rates of the 54 cases estimated by the Kaplan-Meier method were 49% for Group A and 79% for Group B. When group B was divided into two groups according to T category (i.e. 15 cases of T3 and 10 cases of T4), the survival rates of Group B were 88% for T3 and 64% for T4. The patients have been living healthy without cosmetic nor functional disabilities after the treatment.

A case of Guillain-Barre syndrome in a 49-year-old male is described. The syndrome presented as tetraplegia with sensory impairment and the pre-icteric phase of acute hepatitis A. Both viral hepatitis and neurologic disturbances improved, although neurologic changes lasted for 3 months after the onset. HA IgM antibody in cerebrospinal fluid was first manifest with onset of neurologic symptoms. On the basis of this finding and some reports in the literature it seems possible that the Guillain-Barre syndrome may be related to the immunopathogenetic mechanism of hepatitis A virus infection.