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104 巻, 12 号
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論説
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鮫島 靖浩, 湯本 英二原稿種別: 論説
2011 年 104 巻 12 号 p. 833-844
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありDysphagic pathophysiology in laryngeal paralysis is reviewed among 193 subjects with laryngeal paralysis alone and concomitant with vagal, glossopharyngeal, and/or hypoglossal nerve palsy. The latter had severer dysphagia and aspiration than those with unilateral laryngeal paralysis alone. In addition to glottal incompetence, factors such as failed or insufficient pharyngeal bolus transport and the initiation of the swallowing reflex were key factors in swallowing difficulty and aspiration. An analysis of videofluoroscopic swallowing studies and flexible endoscopic swallowing evaluation suggested that bolus retention in the hypopharynx after swallowing and delayed initiation of the pharyngeal phase are major causes of penetration and aspiration.
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カラー図説
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―舌骨付胸骨舌骨筋弁と内視鏡の使用―波多野 篤原稿種別: カラー図説
2011 年 104 巻 12 号 p. 846-847
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありPDF形式でダウンロード (1250K)
臨床
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川田 晃弘, 神田 幸彦, 隈上 秀高, 原 稔, 道祖尾 弦, 高崎 賢治, 髙橋 晴雄原稿種別: 臨床
2011 年 104 巻 12 号 p. 849-854
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありNew born hearing screening was started on a trial basis in Japan in 1997.
Community-based newborn hearing screening started in Nagasaki prefecture in October 2003. We investigated 45,924 infants who underwent universal newborn hearing screening from October 2003 to March 2008.
Ninety-four to ninety-six percent of neonates in Nagasaki prefecture were screened in from 2005 to 2008. The referral rate after the screening process was 0.5–0.7%. The incidence of hearing loss was 0.15–0.20%.
We compared the age in lunar months of the screened and non-screened infants at the time of diagnosis, intervention, fitting of the first hearing aid, and the age of cochlear implantation. The age at the time of diagnosis (p<0.0001), intervention (p<0.0001), fitting of the first hearing aid (p<0.0001), and the age at which cochlear implantation was performed (p=0.0025<0.01) were significantly lower in the screened infants.
These results show that universal new born hearing screening is very useful for early detection of, and intervention for infants with hearing loss.
The integration of medical, educational, and social assistance is very important for infants diagnosed as having hearing loss after newborn hearing screening.
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柳田 三洋子, 柳田 正巳, 菱田 圭祐, 脇田 賢治, 加古 伸雄, 近藤 由香2011 年 104 巻 12 号 p. 855-858
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありWe report on a 58-year-old female with inner ear anomalies associated with recurrent meningitis. During surgical treatment, severe cerebrospinal fluid leakage through a bony defect in the stapedial footplate was observed after the stapes was removed. Intralabyrinthine obliteration with the temporal muscle fascia was performed and the oval window was sealed with an auricular cartilaginous chip. No sign of meningitis has occurred after the operation.
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佐藤 哲也, 大石 直樹, 武井 泰彦, 甲能 直幸2011 年 104 巻 12 号 p. 859-863
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありAdvances in broad-spectrum antibiotics are enabling general physicians and pediatricians to treat acute middle-ear infection without otolaryngologists’ intervention. Most such subjects also recover without serious complications. Middle-ear infection remains potentially life-threatening, however, due to potential infectious intracranial complications, requiring surgery by otolaryngologists. We report two cases of acute pediatric mastoiditis following acute otitis media. Both had been initially treated by pediatricians and administered several antibiotics. One subject had masked mastoiditis when first seen and the other serious complications involving intracranial infection thought due to comorbid congenital cholesteatoma. Both were treated successfully with mastoidectomies followed by intravenous antibiotic therapy.
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鈴木 良, 平海 晴一, 山本 典生, 坂本 達則, 伊藤 壽一2011 年 104 巻 12 号 p. 865-869
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありA 52-year-old woman with persistent cerebrospinal-fluid otorrhea after repeated surgery and radiosurgery for cranial base chordoma noticed otorrhea after the last surgery. Skull-base reconstruction by neurosurgeons did not stop otorrhea completely. Cisternoscintigraphy showed persistent leakage.
Middle ear obliteration and closure of the external auditory canal successfully terminated otorrhea.
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中山 雅博, 田渕 経司, 西村 文吾, 原 晃2011 年 104 巻 12 号 p. 871-876
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありEwing’s sarcoma, a malignant primary bone tumor typically occurring within the pediatric or adolescent extremities or pelvis, is extremely rare in its primary cranial form. Recent immunohistochemical, molecular, and genetic studies have characterized Ewing’s sarcoma lineage as a primitive neuroectodermal tumor (PNET). We report a case of primary temporal bone Ewing’s sarcoma. A 19-year-old woman admitted with left temporal swelling was found in open biopsy to have Ewing’s sarcoma as confirmed by immunohistochemistry. The tumor was surgically removed and the wide surgical temporal bone defect was successfully reconstructed with a titanium mesh plate and an anterolateral thigh flap. The woman then underwent chemotherapy. Neither local recurrence nor distant metastasis has been seen in the 32 months since surgery. Adequate surgical resection and chemotherapy are thus vital in managing temporal bone Ewing’s sarcoma. Titanium mesh plates are also useful in reconstructing defect in surgical malignant tumor treatment.
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佐々木 崇博, 竹中 幸則, 森鼻 哲生, 喜井 正士, 猪原 秀典2011 年 104 巻 12 号 p. 877-880
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありUndifferentiated sarcoma in the sinonasal cavity is extremely rare. Only one case in the maxillary sinus has been reported, so far. We report herein on a case of undifferentiated sarcoma of the nasal septum. A 73-year-old male suffering from left epistaxis was referred to our department. Clinical examination revealed a tumor of the nasal cavity. Histological examination of the biopsy indicated the diagnosis of sarcoma. The tumor was resected under general anesthesia. With HE staining, immunohistochemical staining and the molecular genetic method, we diagnosed the tumor as an undifferentiated sarcoma. The postoperative course was uneventful. There have been no signs of recurrence.
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小泉 敏三, 家根 旦有, 細井 裕司2011 年 104 巻 12 号 p. 881-886
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありParanasal sinus osteoma may be treated surgically when the lesion is large and symptomatic, and shows significant invasion. We report the case of a 47 mm ethmoid sinus osteoma with orbital invagination. The lesion was resected in minimally invasive endonasal surgery.
A 79-year-old man was diagnosed with an ethmoid sinus osteoma, so-called “orbital osteoma”, that had partially penetrated the anterior orbital internal wall. In endoscopic endonasal surgery under general anesthesia, the fixed osteoma in the middle meatus, including orbital invagination, was slowly and continuously mobilized to expand the movable range within the nasal cavity. To reduce volume, the osteoma was cut in two using an otological drill. After the columella—the mobile part of the nasal septum—was incised transversely to enlarge the external nostril, individual parts of the osteoma were removed through the enlarged nostril.
The surgery detailed here shows how a large paranasal sinus osteoma, conventionally requiring exonasal incision, is resectable with minimal invasion via endoscopic endonasal surgery.
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橘 智靖, 中田 道広, 小河原 悠哉, 松山 祐子, 阿部 郁2011 年 104 巻 12 号 p. 887-892
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありThe parotid tumor has various histopathological findings, and in many cases, it is also difficult to make a diagnosis preoperatively. A clinical study was performed on 153 cases of benign parotid tumor surgically resected between 1994 and 2010. The most common tumor was pleomorphic adenoma, followed by Warthin’s tumor. We compared the preoperative diagnosis based on fine-needle aspiration biopsy with the final diagnosis. We also evaluated any postoperative complications. The predictive value for a specific histologic diagnosis was 94.4% for pleomorphic adenoma, and 94.6% for Warthin’s tumor. The diagnostic accuracy for the histologic diagnosis was 85.9% for pleomorphic adenoma, and 81.5% for Warthin’s tumor. Following the operations, facial paresis occurred in 31 (20.3%) cases, salivary fistula in 9 (5.9%) cases, Frey’s syndrome in 2 (1.3%) cases, and infection in 2 (1.3%) cases. We considered that fine-needle aspiration biopsy was very useful for the surgical management of benign parotid tumors.
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鈴木 久美子, 武田 英彦, 熊川 孝三2011 年 104 巻 12 号 p. 893-897
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありIgA nephropathy (IgAN) is the most common cause of glomerulonephritis in Japan. About 40% of IgAN cases proceed within 20 years to end-stage renal failure and dialysis. Of subjects undergoing renal transplantation, however, 40–60% suffer from recurrent IgAN, becoming a serious clinical problem.
Several recent reports have noted the efficacy of tonsillectomy against recurrent IgAN, although cases remain few and efficacy in long-term prognosis unclear.
We retrospectively studied 6 recurrent IgAN subjects undergoing tonsillectomy before or after renal transplantation for 21–68 months (mean: 54.3 months).
Of these, 5 undergoing tonsillectomy before or soon after renal transplantation showed highly improved urinary findings. Only 1 subject undergoing tonsillectomy 2.5 years after renal transplantation showed no improvement. We did not find any other related factors determining prognosis.
Our findings suggest that tonsillectomy is effective in treating recurrent IgAN. Tonsillectomy should be done soon before or after renal transplantation.
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小笠原 徳子, 百島 尚樹, 菊池 慶介, 長屋 朋典, 村上 昌雄, 菱川 良夫, 吉岡 巌2011 年 104 巻 12 号 p. 899-903
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありSoft tissue tumor is a rare disease in the head and neck regions which is difficult to diagnose and treat. We report on a case of unresectable soft tissue tumor in the head and neck.
The patient was a 41-year-old man who noticed some swelling on the right side of his neck which had started three months prior to presenting. A tumor was found in the right neck surrounding his common carotid artery which was judged unresectable because of its location and size. The differentiated diagnosis between a synovial sarcoma and a malignant peripheral nerve sheath tumor (MPNST) was difficult. The patient underwent carbon ion radiotherapy as an initial treatment in the Hyogo Ion Beam Medical Center. There was a partial response from the tumor in his neck tumor, but it metastasized to the lung and bone and the patient died of pulmonary failure nine months after the initial treatment.
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―平成19年の二次・三次救急を要した患者の割合について―山川 秀致, 中島 逸男, 今野 渉, 深美 悟, 平林 秀樹, 春名 眞一2011 年 104 巻 12 号 p. 905-909
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありWe place a doctor on duty 24 hours a day. Our hospital is in the third group of hospitals, which are the highest ranked emergency medical institutions, supplying emergency medical services ranging from the first to the third level. However, only a few third aid patients are conveyed to our hospital.
We performed a clinical, statistical review of 2,737 cases referred to our department between January and December, 2007. Their age range was from 0 to 95 years (average age: 21 years) and the proportion of males to females was 1.25 to 1. Many patients were referred to or visited our department in December and January at the end and beginning of the year and in May at ‘Golden Week’ holidays. Half of the patients were children from 0 to 9 years (51.6%).
Cases of acute otitis media decreased in summer, but these cases exhibited the highest prevalence almost throughout the year. Cases of epistaxis increased in winter and a foreign body increased in summer. The number of vertiginous patients had no change throughout the year. Cases of acute otitis media generally occurred in children, and cases of epistaxis were specifically diagnosed in the elderly.
Inflammatory diseases such as tonsillitis and peritonsillar abscess developed predominantly in patients in their 20’s. Ninety percent of the patients having visited our department took medical advice from a nearby doctor or were discharged home. Those patients who were referred to our department on a continually consistent basis comprised 7.8% and those who were admitted in an emergency comprised only 3.1%. Their most frequent diagnoses were inflammatory diseases.
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機器
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徳丸 裕, 羽生 昇, 進藤 彰人, 加我 君孝, 藤井 正人原稿種別: 機器
2011 年 104 巻 12 号 p. 911-916
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありSurgery of parotid gland and parapharyngeal tumors is one of the most common operations and identification and functional preservation of the facial nerve are considered to be important procedure in these operations. We developed a special mosquito clamp for facial nerve monitoring during dissection. This clamp is connected to a Nerve Integrity Monitoring System (NIM-Response® 2.0, Medtronic USA). By using this clamp, we can always monitor the facial nerve function during tissue dissection without the stimulating probe. We report herein on the clinical usefulness of the monitoring mosquito clamp and NIM system to preserve the facial nerve function in 10 cases of parotid gland and parapharyngeal tumor. Facial nerve function was well preserved in all cases, thus this monitoring clamp and NIM system are very useful for the preservation of facial nerve function during parotid and parapharyngeal tumor surgery.
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研修ノート
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三輪 正人原稿種別: 研修ノート
2011 年 104 巻 12 号 p. 918-919
発行日: 2011年
公開日: 2011/12/01
ジャーナル 認証ありPDF形式でダウンロード (308K)
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