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102 巻, 9 号
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論説
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大畑 敦, 菊地 茂, 重田 恵一, 田中 是, 田原 篤2009 年 102 巻 9 号 p. 701-708
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありDeep neck infection (DNI) is an emergent otolaryngologic disease. We examined 69 patients, 52 males and 17 females, with DNI, who were treated in our hospital between 1995 and 2004. The mean age of DNI patients is 50.0 years old and peak incidence is in the sixth decade. Twenty patients suffered from diabetes mellitus (DM). The primary lesion of DNI was found in the tonsils in 34 cases, the oral cavity in 16 cases, the pharynx in 12 cases, and other regions in 7 cases, respectively. Among 69 DNI patients, infection remained in the suprahyoid region in 31 cases, whereas it extended to the infrahyoid region in 33 cases and to the mediastinum in 5 cases.
The titer of serum C-reactive protein (CRP) and the duration of admission were considered parameters of DNI severity. CRP was significantly higher and the duration of admission was significantly longer in elderly patients, in patients with DM, and in patients with infrahyoid and mediastinal DNI, whereas no significant difference was found between males and females, and among the primary lesions. Therefore, we consider that age, DM, and the extension of DNI are important factors determining the severity of DNI.
We also refer to the etiology, diagnosis, treatment and complications of DNI.
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カラー図説
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善浪 弘善, 高橋 壽彦2009 年 102 巻 9 号 p. 710-711
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありPDF形式でダウンロード (780K)
臨床
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中西 啓, 岩崎 聡, 今井 篤志, 林 理佐子, 水田 邦博, 峯田 周幸2009 年 102 巻 9 号 p. 713-718
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありPendred syndrome and nonsyndromic hearing loss with enlarged vestibular aqueduct (NSEVA) are caused by mutations of SLC26A4, which encodes Pendrin. In this report, we present two cases with a bilaterally enlarged vestibular aqueduct detected by high-resolution computed tomography (HRCT), with both showing SLC26A4 mutations.
Case 1 was a 56-year-old female with a complaint of bilateral progressive hearing loss. Pure tone audiometric examination revealed bilateral sensorineural hearing loss, and HRCT detected a bilaterally enlarged vestibular aqueduct. Diffuse enlargement of the thyroid was noted on ultrasound examination with a euthyroid state. Mutation analysis of SLC26A4 identified c.2168A>G (p.His723Arg) homozygously.
Case 2 was a 9-year-old girl with bilateral hearing loss detected in a school hearing screening test. Audiometric examination showed conductive hearing loss in the right ear and mixed hearing loss in the left ear, with severe hearing loss at low tones, and HRCT identified a bilaterally enlarged aqueduct. Ultrasound examination of the thyroid gland was within the normal range for the size. Her paternal grandmother and father also had bilateral hearing loss, in whom HRCT could not detect an enlarged vestibular aqueduct. Mutation screening revealed that the patient showed c.2168A>G homozygously and her father showed c.2168A>G heterozygously.
Clinical evaluation and the results of mutation analysis suggested that case 1 was likely to have typical Pendred syndrome. Case 2 showed mutations of SLC26A4, bilateral hearing loss severe at low tones, and a family history of hearing loss involving her grandmother and father, indicating that the case may differ from those diagnosed with typical NSEVA or Pendred syndrome, and this should be examined closely.
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東野 正明, 川上 理郎, 長谷川 恵子, 伊藤 加奈子, 峰晴 昭仁2009 年 102 巻 9 号 p. 719-722
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありWe report the case of a 53-year-old woman with meningeal carcinomatosis who presented with a unilateral facial nerve palsy. The patient had been followed with malignant lymphoma at the department of blood internal medicine of our hospital. We treated as Bell's palsy, and carried out steroid treatment. But 1 week later, swallowing disorder and diplopia appeared, and magnetic resonance imaging (MRI) showed that abnormal enhancement of the cerebral pia mater. Finally she was diagnosed as meningeal carcinomatosis by cerebrospinal fluid cytology. Consideration of the possibility of meningeal carcinomatiosis is necessary when diagnosing facial palsy in a patient with a history of malignant tumor.
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椋代 茂之, 萠拔 陽子, 浅野 純志, 安田 誠, 浜 雄光, 素輪 善弘, 西野 健一, 久 育男2009 年 102 巻 9 号 p. 723-729
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありHemangioma is a benign tumor that originates from vascular tissue of the skin, mucosa, bone, muscles and glands. Hemangioma arising in the soft tissue is common in the head and neck region, but intraosseous hemangioma of the skull or facial bones is rare, particularly in the nasal bone.
We treated a 60-year-old woman with primary hemangioma of the nasal bone. X-ray of the nasal bone revealed a sunburst appearance, and CT of the nasal bone showed honeycomb appearance. Surgical excision and reconstruction with a cartilage graft were performed. Postoperative pathological study revealed it to be a cavernous hemangioma. There has been no recurrence of the tumor for 1 year.
When we treat nasal tumor, hemangioma of the nasal bone should be included in the differential diagnosis. Considering its benign nature, observation is often preferred, but surgical excision should be performed when it has a mass effect, hemorrhage, and cosmetic problems.
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勝野 雅弘, 橘 伸哉, 谷 康寛, 渡辺 尚彦2009 年 102 巻 9 号 p. 731-736
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありIt is generally known that sphenoid sinus diseases gives rise to ophthalmological symptoms. We report a case of multiple cranial nerve disorder due to cholesterol granuloma of the sphenoid sinus. A 73-year-old man complained of reduced vision of the right eye, right blepharoptosis and headache. We diagnosed him with multiple cranial nerve disorder due to a cystic lesion of the sphenoid sinus based on MRI and CT findings. On the same day, an emergency operation was performed involving endoscopic sinus surgery. After the operation, the patient gradually recovered from the symptoms. A part of the cyst wall was pathologically composed of cholesterol granuloma. Cholesterol granuloma of the paranasal sinus is rare. Our search of the literature on cholesterol granuloma of the paranasal sinus revealed only 35 cases. We thought that emergency surgery is necessary for multiple cranial nerve disorder due to a sphenoid sinus disease.
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水田 啓介, 藤井 恵子, 山田 南星, 久世 文也, 青木 光広, 伊藤 八次2009 年 102 巻 9 号 p. 737-741
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありPatients with metastatic regions of carcinoma of the salivary gland have been treated with chemotherapy. Cisplatin, adriamycin and cyslophosphamide are the most active agents against adenocarcinoma-like salivary gland tumors; however, response rates to these agents have been low. Chemotherapy with carboplatin and paclitaxel is used for non-small cell lung cancer. It has been reported that the combination of carboplatin and paclitaxel was effective in some patients with recurrent or metastaic salivary gland malignancies. Weekly low-dose carboplatin and paclitaxel has been reported to have good activity with acceptable toxicity. A 47-year-old patient underwent total parotidectomy for carcinoma ex-pleomorphic adenoma of the parotid gland. He developed multiple lung metastases 5 months later. The lung metastases did not response to CAP (cisplatin, adriamycin, cyslophosphamide) and we therefore began administration of carboplatin and low-dose paclitaxel. One cycle of treatment consisted of carboplatin at an area under the curve of 1.5 and paclitaxel at 80 mg/m2 on days 1, 8 and 15 on a 28-day cycle. After 6 cycles of this treatment, lung metastases partially responded while maintaining good QOL.
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山村 一彦, 森田 一郎, 甲斐 智朗, 佐藤 道哉2009 年 102 巻 9 号 p. 743-746
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありThe presence of a fish bone in the aerodigestive tract is a common phenomenon in the ENT Department. It is removed easily by an endoscopic procedure, but sometimes can cause complications such as deep neck infection.
Herein, we report the case of a fish bone with a tubal structure stuck in the pyriform sinus. A 71-year-old woman presented with complaints of progressive odynophagia and dysphagia following dinner 1 day earlier. An axial computed tomographic scan of the neck showed a 3-cm-long and linear hyperdense projection pointing to the pyriform sinus and submucosal emphysema. Rigid laryngoscopy with the patient under general anesthesia, which was performed on the day of presentation, showed a fish bone with a tubal structure in the pyriform sinus but no pus-like material. It was removed, but a retropharyngeal abscess was soon formed. The patient recovered fully soon after subsequent surgical drainage through the cervical incision.
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大野 覚, 中谷 宏章, 弘瀬 かほり, 松本 昇, 伊藤 悟志, 山西 伴明, 西岡 明人, 小川 恭弘2009 年 102 巻 9 号 p. 749-754
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありWe report the results of superselective intra-arterial CDDP infusion with radiotherapy for 12 patients with hypopharyngeal carcinoma, compared with 66 patients mainly treated surgically before 1999.
In the former treatment group, 47 patients received extensive radical surgery with laryngectomy. In this group, the 5-year cause-specific survival rate was 43.5% and the laryngeal preservation rate was 28.8%.
Superselective intra-arterial infusion was performed at a dose of CDDP 100 mg/m2 per one or two weeks in combination with irradiation. In this group, the 5-year cause-specific survival rate was 64.8% and the laryngeal preservation rate was 41.7%. A complete response was achieved in 9/12 (75%), and a partial response was achieved in 3/12 (25%) at the primary site.
For the treatment of hypopharyngeal carcinoma, superselective intra-arterial CDDP infusion with radiotherapy is a very effective method.
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籠谷 領二, 物部 寛子, 戸島 均2009 年 102 巻 9 号 p. 755-759
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありWe experienced two cases of bleeding from a small aneurysm developed in an epiglottic vallecula. In the first case, bleeding was controlled by lingual artery embolization. In the second, the aneurysm was cauterized under general anesthesia in addition to embolization. In the head and neck region, aneurysms in the carotid artery, superficial temporal artery, thyroid artery and lingual artery have been reported in the past. Venous aneurysm has developed in the internal jugular vein, external jugular vein and retromandibular vein. There have been a few cases in which bleeding from a small aneurysm was critical in the oropharyngeal region. We consider that embolization and cauterization without delay are important in cases presenting with active bleeding from a small aneurysm.
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金川 英寿, 堀池 修2009 年 102 巻 9 号 p. 761-766
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありCastleman’s disease was first reported by Castleman et al. in 1954 as localized large benign hyperplastic mediastinal lymph nodes histologically characterized by hyperplasia of lymphoid follicles and capillary proliferation with endothelial hyperplasia. We report a case of Castleman’s disease of the neck. A 38-year-old woman complained of front neck swelling of about 20 year duration. Front neck swelling was scadually increasing, so she visited a local hospital. Neck echo demonstrated a mass in the front neck. The mass was not diagnosed before the operation. The tumor was surgically resected at our hospital. After surgery, the tumor was diagnosed as hyaline vascular type of Castleman’s disease. Postoperatively, the patient is very well with no recurrence for 18 months.
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吉福 孝介, 宮下 圭一, 黒野 祐一2009 年 102 巻 9 号 p. 767-772
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありCarotid body tumor (CBT) is a rare disease, with previously reported cases only numbering about 150 in Japan. Although the tumor is known to be a benign neoplasm, ten percent of reported cases were malignant. So, surgical resection is recommended for the treatment of CBT. However, the surgery is not always straightforward and management of the carotid artery is one of the key points of surgery. We report herein a case of CBT that required reconstruction of the internal carotid artery.
A 28-year-old man visited our hospital complaining of hoarseness and a swelling in his left neck.
Computed tomography (CT) and magnetic resonance imaging (MRI) showed a hypervascularized tumor involving the common carotid, internal, and external carotid arteries. The balloon Matas test showed sufficient cerebral blood flow, suggesting the safety of scarification of the common carotid and/or internal carotid artery without vessel grafting.
In order to make a definite diagnosis, a biopsy was performed under local anesthesia. The pathological examination demonstrated typical findings of CBT.
Although complete removal of the tumor was attempted without resection of the carotid artery, the tumor had invaded the vessel wall and could not be removed from the carotid artery. After simple clamping of the internal and common carotid arteries, the tumor was dissected together with the carotid arteries in 30 minutes. Then, vascular reconstruction was performed using the saphenous vein to avoid complications due to the blockade of the carotid artery. The patient was discharged without any brain damage 20 days after surgery.
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川田 仁美, 佐藤 豪, 阿部 晃治, 武田 憲昭2009 年 102 巻 9 号 p. 773-779
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありMost patients with plasmacytoma demonstrate a generalized disease at diagnosis such as multiple myeloma (MM). However, 3-5 percents of patients with plasmacytoma present with either a single bone lesion, or less commonly, a soft tissue mass, of monoclonal plasma cells: solitary plasmacytoma of bone (SPB) or extramedullary plasmacytoma (EMP). Moreover, SPB has a high risk of progression to MM.
We report a 65-year-old female with SPB that only involved the skull base bone. She complained of discomfort of the throat for one month and endoscopic examinations showed a submucosal tumor of the nasopharynx. The tumor was biopsied by an endoscopic transnasal approach with the navigation system under general anesthesia. Resected tumor tissue showed monoclonal proliferation of CD138-positive plasma cells with lambda light chain expression in the cytoplasm. Although a small M protein was present in serum, CT, MRI and FDG-PET demonstrated that the osteolytic lesion arising from the clivus of the skull base bone gave rise to a submucosal tumor of the nasopharynx without skeletal lesions and other related organ or tissue impairment. Bone marrow did not contain monoclonal plasma cells, which is not consistent with MM. Finally, we diagnosed the patient as having SPB, but not EMP, without complication of MM.
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今泉 光雅, 西條 聡, 鈴木 輝久, 佐藤 和則, 佐藤 聡, 大森 孝一2009 年 102 巻 9 号 p. 781-785
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありCarcinoma with an unknown primary site accounts for 1-5% of all head and neck carcinomas. Herein, we report a case of a 76-year-old female who presented with left cervical swelling. Lymph node biopsy was performed in her left neck, yielding a pathological diagnosis of “cervical metastasis of a poorly differentiated squamous cell carcinoma”.
This patient underwent various examinations, including positron emission tomography (PET), but no primary site was found. We eventually diagnosed her with primary unknown carcinoma. Radical neck dissection was performed, followed by a total of 50 Gy of postoperative whole neck radiotherapy. After the completion of treatment for the cervical metastasis, we diagnosed her with uterine cervical cancer based on lymph node swelling in the area of the iliac artery and aorta. Chemoradiotherapy was performed in the Department of Obstetrics and Gynecology of our hospital. The tumor size was reduced, and the patient has survived for 12 months to date.
If various images including PET show lymph node swelling in the retroperitoneum, the possibility of a gynecological disease should be considered.
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文珠 正大, 秋定 健, 粟飯原 輝人, 兵 行義, 原田 保2009 年 102 巻 9 号 p. 787-791
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありDeep neck infection is a serious life-threatening infection that spreads in the spaces surrounded by the cervical fasciae. We report a case of deep neck infection in an infant. The patient was a 15-month-old boy who was brought to a nearby pediatrician with chief complaints of right neck tenderness and fever. Deep neck infection was diagnosed based on the results of computed tomography, cervical incision and tracheotomy was performed under general anesthesia and subsequent intravenous antibiotic administration was conducted after the operation. He recovered in about 2 weeks with the disappearance of deep neck abscess.
In conclusion, early diagnosis and surgical drainage are important for the management of deep neck infection. For infants, we must consider abscess incision not only performed orally but also external cervical incision.
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研修ノート
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須納瀬 弘2009 年 102 巻 9 号 p. 792-793
発行日: 2009年
公開日: 2011/05/11
ジャーナル 認証ありPDF形式でダウンロード (429K)
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