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Volume 59, Issue 1
Displaying 1-12 of 12 articles from this issue
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Review
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Yoshinori Nakagishi, Yuji Morimoto, Masanori Fujita, Noriko Morimoto, ...2008 Volume 59 Issue 1 Pages 1-11
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSBackground Airway stenosis in childhood is resistant to conventional treatments. We examined whether photodynamic therapy (PDT), which is one of the less invasive therapeutic modalities, is effective for airway stenosis. Methods Airway stenosis rabbit models were made by scraping the mucosal membrane of the trachea. After the stenosis-induced rabbits were intravenously administered with Photofrin, the tissue concentrations of Photofrin were measured. The stenosis-induced animals were treated by PDT using Photofrin, and then bronchoscopic examination was repeatedly carried out to observe the status of tracheal stenosis. Results Photofrin concentration in the granulation tissue was four-times higher than that in the intact trachea and 10-times higher than that in the other examined tissues. PDT ameliorated the degree of airway stenosis and reduced respiratory stridor. Conclusions Photofrin preferentially accumulated in lesions of airway stenosis and PDT was effective for relief of airway stenosis. These findings suggest that PDT has potential as a novel therapeutic method for airway stenosis originating from granulation tissue.View full abstractDownload PDF (673K)
Original
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Nobusuke Hohchi, Sinya Tachibana, Masahiro Katsuno, Taketoshi Nogaki, ...2008 Volume 59 Issue 1 Pages 12-18
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSDuring the seven-year period from 1999 to 2006, we experienced 64 cases of acute epiglottitis that required inpatient hospital care at the Department of Otorhinolaryngology of Kanto Rosai Hospital. 42 cases were male, and 22 female, with ages ranging from 12 to 77 and the average age being 47.5 years. The average time from the onset of symptoms to the initial medical examination was 3.8 days. Sore throat was the most common symptom and was observed in 60 cases (94%), followed by odynophagia in 57 cases (89%), with respiratory discomfort observed in 18 cases (28%). We administered antibiotics in all cases, and steroids were concomitantly applied in 59 cases (92%). A tracheostomy was performed in 6 cases (9.4%), leading to survival in all cases. We compared the smoking history, presence of diabetes, and BMI (Body Mass Index) between the tracheostomy group and the non-tracheostomy group, but only a comparatively limited history of smoking or diabetes was found in the tracheostomy group, thus showing a significant difference in comparison to the non-tracheostomy group. Cases involving epiglottic cysts were more likely to have had a prolonged period of hospitalization. The overall local findings of epiglottitis in which swelling of the arytenoids was found, in addition to swelling of the epiglottis, were therefore considered to be important in the evaluation of severity.View full abstractDownload PDF (562K) -
Kazuhiro Nakamura, Nobuhiko Isshiki, Tetsuji Sanuki, Hideaki Kanazawa, ...2008 Volume 59 Issue 1 Pages 19-28
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSThyroplasty type 3 (TP3) is a surgical technique for reducing the anteroposterior diameter of the thyroid cartilage. The operation results in relaxation of the vocal folds, a low-pitched speaking fundamental frequency (SFF), and improvement of laryngeal efficiency.
Major indications include treatment for non-responders to voice therapy of a high-pitched SFF associated with vocal cord atrophy or mutational voice disorder, and breathy voice caused by hypertonic vocal folds. In this study we assessed pre- and post-surgical voice, laryngeal efficiency, and surgical technique in patients who underwent TP3.
The 19 patients who underwent TP3 at the Isshiki Clinic, Kyoto Voice Surgical Center, between 2001 and 2006 were eligible for evaluation in this study. These included 17 males and 2 females ranging in age from 18 to 73, with a mean age of 48.7 years. Surgery was performed for diagnosis of vocal fold atrophy in 8 cases, mutational voice disorder in 4 cases, sulcus vocalis in 3 cases, a combination of vocal fold atrophy and sulcus vocalis in 2 cases, gender identity disorder in 1 case, and because the patient desired a low-pitch voice in 1 case. Pre- and post-surgical SFF were measured in all subjects, and the AC/DC ratio was calculated in the 10 subjects treated since June 2004.
All operations were performed under local anesthesia. TP3 was performed bilaterally in 10 cases, and unilaterally in the other 9 cases. A combination of thyroplasty type 1 and TP3 was performed in 12 cases with vocal fold atrophy and glottal slit.
A satisfactory voice was achieved in all patients. TP3 was performed on a total of 29 sides, with face-to-face treatment of cartilage fixation on 24 sides and by overlapping on 5 sides. The mean width of cartilage resected on the 24 sides using the face-to-face method was 2.4 mm. In the bilateral group, pre- and post-surgical SFF decreased from a mean of 43.0 semitones (196.0 Hz) before surgery to 35.4 semitones (127.8 Hz) after surgery, and in the unilateral group it decreased from 42.9 semitones (198.4 Hz) to 37.7 semitones (149.3 Hz). The mean AC/DC ratio was 36.7% before surgery and 52.1% after surgery.
TP3 was useful as a surgical treatment to lower pitch and resulted in voices that were satisfactory to the patients. It was also effective in improving laryngeal efficiency, since most subjects showed improvement in their AC/DC ratio. The pitch-lowering effect was greater in the bilateral group than in the unilateral group.View full abstractDownload PDF (810K)
Case Report
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Masayuki Tomifuji, Akihiro Shiotani, Koji Araki, Kazuhisa Moro, Asako ...2008 Volume 59 Issue 1 Pages 29-35
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSA 57-year-old male presented with chief complaint of foreign body sensation in his throat. On video hypopharyngoscope, a tumorous lesion was found in the lateral wall of the piriform sinus. At first biopsy, pathological findings revealed poorly differentiated squamous cell carcinoma. The patient underwent a partial pharyngotomy and unilateral neck dissection for hypopharyngeal squamous cell carcinoma (T2N1M0). Pathological findings showed small cell carcinoma of the hypopharynx. Metastasis of the small cell carcinoma was also found in a cervical lymph node. The treatment regimen for small cell lung cancer was used. Concomitant chemoradiotherapy (CDDP+VP-16) was performed postoperatively. Adjuvant chemotherapy (CDDP+VP-16) was not performed due to prolonged bone marrow suppression. A half-year after the operation, multiple lung metastasis and cervical lymph node metastasis were found. The patient underwent two courses of chemotherapy (CDDP+VP-16), but the tumor gradually grew. He died one-and-a-half year after surgery. Small cell carcinoma is a high-grade malignancy which metastasizes easily. Indications for surgery are limited. Chemoradiation and adjuvant chemotherapy are recommended.View full abstractDownload PDF (584K) -
Koji Inagaki, Koichiro Saito, Yutaka Isogai, Takuji Takaoka, Takekatsu ...2008 Volume 59 Issue 1 Pages 36-41
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSFiberscopic laryngeal surgery can be performed with local anesthesia and is of great advantage for treating patients suffering jaw or neck insufficiency for direct laryngoscopy. This surgical strategy is also suited to treat patients in poor physical condition for general anesthesia, or to treat laryngeal lesions requiring removal of the tracheal tube for enhanced viewing. To perform this minimally invasive laryngeal surgery, it is indispensable for the surgeon to reduce the danger of hemorrhage and not to err when excising the lesion during surgery. Fiberoptic electrocautery has been reported to be a simple and safe alternative to achieve removal or debulking of lesions, reducing the danger of hemorrhage during endobronchial surgery by flexible bronchoscope.
We report a case of laryngeal giant granuloma treated endoscopically using electrocautery snare with local anesthesia. This 36-year-old female patient underwent surgery to treat mandible prognathism by endotracheal intubation. The patient developed phonation insufficiency 7 weeks after surgery and was diagnosed to have laryngeal granulomas at the posterior glottis. Glottic closure was interrupted by the right giant granuloma during phonation. Although the giant granuloma was resistant to conservative therapy and required surgical removal, this patient could open her mouth no greater than 2.6 cm, making direct laryngoscopy impossible.
Endoscopic surgery was carried out as an alternative approach using trans-nasal and trans-oral flexible fiberscopes simultaneously to manipulate the electrocautery snare and grasping forceps, respectively. The giant granuloma was firmly grasped by the grasping forceps and removed successfully using electrocautery without any complication. Dual fiberscopic surgery using electrocautery may be a useful technique to achieve safe and immediate removal of laryngeal lesions.View full abstractDownload PDF (441K) -
Sachio Tsuda, Hirohito Umeno, Shunichi Chitose, Tadashi Nakashima2008 Volume 59 Issue 1 Pages 42-47
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSWe experienced a rare case with laryngo-tracheal manifestation of papillomatosis. The patient was a 28-year-old male who complained of spitting tissue pieces, hemosputum and dyspnea. Fiberscopic examination as well as MRI revealed the presence of a papilloma in the subglottis 1 cm from the vocal cord and a 3 cm sized, fragile papilloma 4 cm from the vocal cord. As treatment, the tracheal papilloma was resected with tracheal rings 2 to 6 and closed by end-to-end anastomosis. The laryngeal papilloma was vaporized by YAG laser. There were no postoperative complications such as subcutaneous emphysema, vocal cord paralysis or laryngeal edema. The postoperative state of the patient has been uneventful without any recurrence.View full abstractDownload PDF (459K) -
Toru Matsuura, Yuichi Majima2008 Volume 59 Issue 1 Pages 48-51
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSSpontaneous mediastinal emphysema with cervical emphysema is relatively rare. A 17-year-old patient with a sore throat admitted for pharyngeal pain was found by chest X-ray and CT to have air in the intramediastinal and right cervical regions. Laboratory data and laryngoscopic examination were negative. The patient had no underlying disease and was diagnosed with spontaneous mediastinal emphysema. Bed rest and antibiotics cured the emphysema within 10 days. There has been no recurrence 6 months after the spontaneous mediastinal emphysema.View full abstractDownload PDF (415K) -
Yoshinori Shitara, Shigebumi Tanaka, Yasunori Ishibashi, Takeshi Yoshi ...2008 Volume 59 Issue 1 Pages 52-55
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSWe report a case of sleeve resection of the trachea through median sternotomy incision with wrapping of thymic tissue. A 26-year-old female who complained of sudden dyspnea was transferred to our hospital on suspicion of bronchial asthma attach. Examination revealed a tracheal adenoid cystic carcinoma. We performed mobilization of the trachea through median sternotomy incision and sleeve resection of the trachea 4cm (5-rings) in length. The stump was reconstructed by end-to-end anastomosis and the anastomotic site was wrapped using thymic tissue. Neither laryngeal release nor release of hilum was performed. Flexion of the neck was maintained for two weeks. We extubated on the 8th post-operative day and the patient was discharged ambulatory on the 30th post-operative day. Mobilization of the trachea, wrapping of the anastomotic site with thymic tissue and flexion of the neck are a useful and safe procedure for tracheal sleeve resection.View full abstractDownload PDF (368K) -
Tadashi Hara, Hideo Shimada, Osamu Chino, Takayuki Nishi, Yoshifumi Ki ...2008 Volume 59 Issue 1 Pages 56-59
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSA 71-year-old woman who had undergone an esophagectomy for benign esophageal stenosis reconstructed by gastric tube through the anterior portion of the sternum, and who had been on medication for lumbago with NSAIDs, was admitted to our hospital complaining of skin redness and oozing of blood in the anterior portion of the gastric tube. The skin redness and oozing of blood were caused by perforation of a gastric tube ulcer. The patient was treated by stoppage of the NSAIDs, eating restraint, hyperalimentation and proton pump inhibitor. The gastric tube ulcer gradually improved and the patient left the hospital. Two months later, however, the patient went into hospital again because of gastric tube ulcer perforation. The patient was treated by the same therapy with the first admission. The gastric tube ulcer gradually improved, but after the patient resumed eating, the gastric tube ulcer worsened. Infection of H. pylori was negative. Endoscopic examination revealed a surgical staple at the floor of the gastric tube ulcer. We diagnosed that the staple had caused the recurrence of the gastric tube ulcer, so we removed it. After that, the gastric tube ulcer improved swiftly and there has been no subsequent recurrence.View full abstractDownload PDF (370K) -
Keiko Hasegawa, Michiro Kawakami, Yoshitsugu Nimura, Tetsuya Terada, T ...2008 Volume 59 Issue 1 Pages 60-64
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSIn recent years, in the field of head and neck surgery the discovery rate of papillary microcarcinomas has been increasing thanks to progress in neck echo and other equipment. However, treatment of microcarcinomas has not yet achieved a uniform perspective. Here, we report on a case of papillary carcinoma of unknown origin.
We also examine some literature pertaining to treatment of occult thyroid cancer.View full abstractDownload PDF (416K)
Glossary
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[in Japanese]2008 Volume 59 Issue 1 Pages 65-67
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSDownload PDF (291K) -
[in Japanese]2008 Volume 59 Issue 1 Pages 68-69
Published: February 10, 2008
Released on J-STAGE: February 25, 2008
JOURNAL RESTRICTED ACCESSDownload PDF (239K)
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