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104 巻, 8 号
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論説
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山岨 達也原稿種別: 論説
2011 年 104 巻 8 号 p. 533-540
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありMitochondrial DNA lesions are closely associated with sensorineural hearing loss in approximately 70% of the three most common mitochondrial disorders: MELAS, MERRF, and CPEO. After reviewing mitochondrial DNA and inner ear disorders, we discuss the putative mechanism of deafness. We then detail clinical features associated with 1555 A-to-G substitution in the 12S ribosomal RNA gene, focusing on the possibility of this gene damaging protein synthesis, since muscular degeneration is observed similar to that in other mitochondrial encephalomyopathies. We next describe clinical auditory and vestibular dysfunction and temporal bone histopathology associated with 3243 A-to-G substitution in transfer RNA (tRNA)Leu(UUR) gene. We also discuss how to prevent deafness progression and the cochlear implantation role in subjects with mitochondrial DNA lesions.
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カラー図説
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水田 啓介, 西堀 丈純, 青木 光広原稿種別: カラー図説
2011 年 104 巻 8 号 p. 542-543
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありPDF形式でダウンロード (812K)
臨床
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中野 淳, 小川 徹也, 西村 邦宏, 前原 一方, 平山 肇, 植田 広海原稿種別: 臨床
2011 年 104 巻 8 号 p. 545-551
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありCerebrospinal fluid (CSF) hypovolemia is characterized by orthostatic headache, loss of CSF, and diffuse pachymeningeal gadolinium enhancement on MRI. The audiometric finding that has so far been associated with CSF-hypovolemia is sensorineural hearing loss. We report the case of a 52-year-old woman with bilateral mixed hearing loss in CSF-hypovolemia. She complained of headache upon rising, nausea, and bilateral earfullness. Her MRI showed a diffuse pachymeningeal gadolinium enhancement with decreased ventricle size, indicating CSF-hypovolemia. Her tympanic membranes were normal and tympanograms were type A, but her audiogram showed bilateral mixed hearing loss. Her audiogram also showed a normal air-conduction threshold and hyper sensitivity to bone conduction (−10, −15 dB), and an air-bone gap remained after she recovered from the CSF-hypovolemia. The original air-bone gap had apparently developed into mixed hearing loss as a result of the sensorineural hearing loss with CSF-hypovolemia. In this case, a wide cochlear aqueduct may have acted as a third mobile window in the inner ear, resulting in an air-bone gap and hypersensitivity to bone-conducted sound stimuli. Moreover, this third window may have been related to the onset of sensorineural hearing loss with CSF-hypovolemia. The air-bone gap in this case should perhaps be called “pseudo-conductive loss”.
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林 千江里, 古川 正幸, 春山 琢男, 奈良林 修, 飯塚 崇, 池田 勝久2011 年 104 巻 8 号 p. 553-557
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありMeningioma, which usually occurs in the intracranial fossa, occurs only extremely rarely in temporal bone. Tumors extending to the mesotympani are so similar that differentiating between meningioma and paraganglioma is very difficult. We report a case preoperatively diagnosed as glomus jugulare involving radical dissection, but determined postoperatively to be jugular foramen meningioma. Although the subject’s postoperative condition remains satisfactory, follow up must include collaboration with the neurosurgeon. It cannot be emphasized enough that jugular foramen meningioma must be diagnosed from characteristic radiological findings and differentiated from paraganglioma.
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西元 謙吾, 松崎 勉, 早水 佳子, 大堀 純一郎, 牧瀬 高穂, 黒野 祐一2011 年 104 巻 8 号 p. 559-563
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありEctopic pituitary adenoma of the sphenoid sinus is rarely encountered by general physicians and otolaryngologists. Recently this disease has been identified using CT, MRI, and other imaging examinations. Ectopic pituitary adenomas of the sphenoid sinus are considered to be benign and slow-growing with mild or no symptoms. On the other hand, primary sphenoidal carcinoma is also a rare disease, the chief complaint for which is usually headache or nasal bleeding as a result of invasion around the organs. CT and MRI imaging cannot differentiate sphenoidal carcimona from ectopic pituitary adenomas of the sphenoid sinus. A diagnosis of ectopic pituitary adenoma of the sphenoid sinus may be suspected when a patient has slight complaints such as slight headache, regardless of the findings of imaging examinations. Histological examinations are necessary for the differential diagnosis of the ectopic pituitary adenomas of the sphenoid sinus and sphenoidal carcimona. The prognosis of an ectopic pituitary adenomas of the sphenoid sinus is good if the adenomas are removed by surgery.
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加瀬 香, 小野 倫嗣, 楠 威志, 池田 勝久2011 年 104 巻 8 号 p. 565-568
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありWe report a case of maxillary dentigerous cyst associated with a supernumerary tooth. A 10-year-old boy was seen for left cheek swelling. Computed tomography (CT) and magnetic resonance imaging (MRI) of the paranasal sinuses showed left unilateral maxillary sinus opacification for an aberrant tooth and associated cystic formation. Endonasal endoscopy was used for middle and inferior meatus antrostomies and removing the tooth and cystic contents. The boy recovered without complications and has shown no sign of recurrence in the 1.5-year follow-up since surgery.
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三木 健太郎, 折田 頼尚, 能勢 聡一郎, 銅前 崇平, 平井 美紗都, 野山 和廉, 中井 貴世子, 浜家 一雄2011 年 104 巻 8 号 p. 569-573
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありSarcoidosis is a multiorgan granulomatous disease of unknown pathogenesis, which may involve any region of the human organs. It most commonly affects the lymph nodes in the chest, lung, eye, and skin. Although involvement of structures within the head and neck region has been well documented in the literature, isolated laryngeal sarcoidosis is rare. A 57-year-old woman presented discomfort of her throat. We found edematization of the epiglottis with no other abnormalities. Based on the results of a biopsy and diagnosis by exclusion we concluded that this case might be isolated laryngeal sarcoidosis. The patient responded well to treatment with low-dose prednisolone without recurrence.
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早水 佳子, 黒野 祐一2011 年 104 巻 8 号 p. 575-580
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありHyalinosis cuits et mucosae is a rare autosomal recessive disorder characterized by a hoarse voice and skin and mucosal changes. Beaded papules along the eyelid margins and infiltration of the oral mucosa are characteristic findings. In 1994, the disorder was mapped to a locus on chromosome 1q21, and pathogenic mutations were identified in the extracellular matrix protein (ECM)1 gene, which encodes the glycoprotein ECM1. We report a case of hyalinosis cuits et mucosae. The case was a 17-year-old woman. Her chief complaint was a hoarse voice since birth. She exhibited papular thickening of the upper and lower eyelids and nodules with generalized skin thickening. The skin of her hands, elbows, and knees showed signs of hyperkeratosis. And the mucosae of her pharynx, tongue, soft palate, tonsils and lips were infiltrated. She had an abnormal ECM1 mutation assumed to be a feature of this disease. In addition, she had an abnormality in exon 8 of ECM1: To our knowledge, this is the first report in Japan of an abnormality in exon 8 of ECM1. No substantial changes, in the patient's condition have been observed, and the patient continues to be followed-up.
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松村 麗, 李 昊哲, 西川 周治, 峰晴 昭仁, 荒木 倫利, 河田 了2011 年 104 巻 8 号 p. 581-584
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありWe report a case of 31-year-old man with acute pancreatitis associated with hypercalcemia as the first manifestation of primary hyperparathyroidism due to benign parathyroid adenoma. After initial, conservative treatment, intact PTH and serum calcium levels improved, which is followed by adenoma resection. Although parathyroid-adenoma-induced hypercalcemia is known to be associated with acute pancreatitis, the medical entity is very uncommon. The pathophysiology of hypercalcemia-induced acute pancreatitis is poorly understood despite proposed mechanisms. Because parathyroid adenoma with hypercalcemia is common, the relationship between hyperparathyroidism and pancreatitis or ossifying fibrosis requires better clarification.
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西川 仁, 日高 浩史, 石田 英一2011 年 104 巻 8 号 p. 585-590
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありDeep neck abscess is relatively rarer in children than in adults. During a one-year period, we experienced 3 cases of deep neck abscess in children who were treated with surgical drainage. Two of the three cases, in which contrast enhanced computed tomography (CE-CT) showed an abscess internal to the carotid artery, were treated using an intraoral approach. The treatment rate using an intraoral approach in our hospital was higher among children than among adults, consistent with a previous report. We confirmed that a deep neck abscess in children could more often be treated using an intraoral approach because of the specificity and secondary abscess formation from lymphogenous infection. We consider that CE-CT is useful in terms of detecting the positional relation to the great vessels and to select the best surgical approach.
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薬物
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山中 昇, 杉田 麟也, 鈴木 賢二, 横山 道明, 林 泰弘, 眞田 文明, 藤原 久郎, 渡邊 敬, 田渕 富三原稿種別: 薬物
2011 年 104 巻 8 号 p. 591-605
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありIn pharmacokinetic and clinical studies of once daily 500 mg levofloxacin (LVFX) in adults with acute otitis media or acute rhinosinusitis, we assessed disease severity and LVFX efficacy using scoring based on local findings and clinical symptoms.
The LVFX tissue concentration of 2.25 to 5.83 hours after single 500 mg administration was 6.010±2.477 μg/g (mean±SD) in the maxillary sinus mucosa, with a tissue/plasma concentration ratio of 1.51±0.43. The clinical efficacy (test of cure) was 100% (13/13) in acute otitis media and acutely exacerbated chronic otitis media, 85.1% (63/74) in acute rhinosinusitis, and 90.9% (10/11) in acutely exacerbated chronic rhinosinusitis. Bacteriological eradication was 94.9% (37/39) in acute rhinosinusitis and 100% in acute otitis media (4/4) and acutely exacerbated chronic rhinosinusitis (3/3). Adverse reactions, all mild to moderate, occurred in 33.6% (38/113). Side effects, but no serious or clinically significant event, occurred in 22.1% (25/113).
In conclusion, LVFX once daily 500 mg p.o. entered well into maxillary sinus tissue and appears useful in treating otitis media and rhinosinusitis. Data confirmed that scoring was very useful in deciding appropriate otitis media and rhinosinusitis treatment.
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研修ノート
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武井 泰彦原稿種別: 研修ノート
2011 年 104 巻 8 号 p. 606-607
発行日: 2011年
公開日: 2011/08/01
ジャーナル 認証ありPDF形式でダウンロード (241K)
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