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105 巻, 1 号
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論説
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楯谷 一郎, 伊藤 壽一原稿種別: 論説
2012 年 105 巻 1 号 p. 1-5
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありEvolution of a surgical device can sometimes set a new trend in the history of surgery. It is well recognized that the development of the surgical microscope generated new fields in surgery, such as neurosurgery, temporal bone surgery, and phonosurgery. Also, the spread of the flexible and rigid endoscope in the 1990s produced functional endoscopic sinus surgery as well as laparoscopic surgery, video-assisted thoracoscopic surgery, and arthroscopic surgery, which enabled early diagnosis and minimally invasive surgery. In this paper, we review recent and novel surgical devices, such as navigation systems, narrow band imaging technique, three-dimensional endoscope systems, and especially, robotic surgical systems, and discuss the future of surgical devices.
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カラー図説
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中村 学, 堤 康一朗, 田中 泰彦, 肥塚 泉原稿種別: カラー図説
2012 年 105 巻 1 号 p. 6-7
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありPDF形式でダウンロード (632K)
臨床
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鬼頭 良輔, 宇佐美 真一原稿種別: 臨床
2012 年 105 巻 1 号 p. 9-14
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありIn recent years, several studies have been reported on the relationship between oxidative stress and various disorders including some inner ear disorders such as noise-induced hearing loss, drug-induced ototoxicity and age-related hearing loss.
In this study, we investigated oxidative stress in 39 patients with sudden sensorineural hearing loss (SSNHL) using Free Radical Analytical System 4 (FRAS4). We compared the oxidative stress levels at before treatment to the levels at one and four weeks after treatment.
The oxidative stress level with SSNHL exhibited higher values than the upper limit of the normal value. Furthermore after treatment, oxidative stress levels decreased in most of the patients. Next, we evaluated the relationship between oxidative stress levels and hearing recovery grades. In the patient group with complete and marked recovery, the oxidative stress levels before treatment were higher than the levels in the patients group with slight recovery and no recovery. No statistical significance was observed in the oxidative stress levels evaluated at after treatment between those two groups.
Our findings suggest that SSHNL is related to oxidative stress at the onset period, and the oxidative stress levels before treatment can predict the hearing prognosis in the SSHNL patients.
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岡崎 健, 都築 建三, 岡 秀樹, 澤田 暁宏, 岡田 昌也, 竹林 宏記, 佐伯 暢生, 三代 康雄, 阪上 雅史2012 年 105 巻 1 号 p. 15-20
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありWe report a case of severe epistaxis resulting in an unfortunate clinical course. A 35-year-old man seen for bilateral nasal obstruction, a top-heavy feeling, and general fatigue was found to have bilateral swollen nasal mucosae and a completely obstructed nasal airway. Sinonasal X-ray showed the pansinuses to be occupied. Nasal treatment caused such immediate excessive bilateral epistaxis. Disturbance of consciousness occurred. The bleeding could not be arrested completely even under general anesthesia. Astriction was done using anterior packing and posterior balloon tamponade. Perioperative blood examination showed thrombocytopenia, disseminated intravascular coagulation (DIC), electrolyte abnormality, hepatic dysfunction, and overwhelming acidosis, requiring that the man be managed in the intensive care unit (ICU), where he also suffered hemophagocytic syndrome and multiple organ failure (MOF). The diagnosis from bone-marrow biopsy and flow cytometry was aggressive natural killer (NK) cell leukemia (ANKL). Despite chemotherapy with steroids, etoposide, and L-asparaginase, he died of hemorrhagic pneumonia one month after the final diagnosis. Given such nasal symptoms with a worsening general condition due to latent blood dyscrasia, blood examinations should be done even before attempting nasal treatment.
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―内視鏡手術と抗真菌薬治療の著効例―宇野 敦彦, 村田 潤子, 西池 季隆, 西村 洋, 今井 貴夫, 太田 有美, 池田 勝久, 猪原 秀典2012 年 105 巻 1 号 p. 21-26
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありWe present herein on two cases of fungal rhinosinusitis infiltrating the adjacent structures. The first case was zygomycosis in the sphenoid sinus infiltrating the superior orbital fissure and clivus, developed in an old but immunocompetent female. Endoscopic sinus surgery followed by systemic administration of liposomal amphotericin B (L-AMB) rapidly relieved the symptoms of severe headache and high fever. The accompanying abducens palsy also recovered 3 months after the treatment. The second case was aspergillosis extending into the orbit and cavernous sinus in a 66 years old male with diabetes mellitus. While L-AMB treatment showed limited effect, alteration to voriconazole and micafungin administration dramatically improved the signs and symptoms. Oral administration of voriconazole was continued for 4 months until negative serum βD glucan confirmed. These two cases were successfully treated with endoscopic surgery and antifungal agents, but invasive fungal rhinosinusitis remians a challenging clinical state for otolaryngologists. Treatment plans should be based on the histological identification of the causal fungus.
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東谷 敏孝, 岸部 幹, 小林 祐希, 高原 幹, 片山 昭公, 國部 勇, 坂東 伸幸, 片田 彰博, 林 達哉, 野中 聡, 原渕 保明2012 年 105 巻 1 号 p. 27-32
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありSquamous cell carcinoma of the nasal cavity and paranasal sinuses is comparatively common, while nonsquamous cell carcinoma—adenocarcinoma and salivary gland-type carcinoma—is rare. We examined reports in Japanese about nonsquamous cell carcinoma of the nasal cavity and paranasal sinus after 2000 finding adenoid cystic carcinoma to be most common followed by adenocarcinoma, and mucoepidermoid carcinoma.
We retrospectively analyzed 8 patients (2 men and 6 women, median age: 67.5 years) with salivary carcinoma of the nasal cavity and paranasal sinuses between 1990 and 2009. Primary sites were the maxillary sinus in 4, ethmoidal sinus in 2, and nasal cavity in 2. Pathology included adenocarcinoma in 4, adenoid cystic carcinoma in 3, and mucoepidermoid carcinoma in 1. T classification was T2 in 3, T3 in 3, and T4a in 2. No lymph node or remote metastases were seen. Stage II accounted for 3, stage III for 3, and stage IVA for 2. Surgery was done in all 8 cases-surgery alone in 3, surgery and radiotherapy in 4, and 1 with adenoid cystic carcinoma by combined surgery, radiotherapy, and chemotherapy.
None of the 8 showed postoperative recurrences or metastasis, and all survived primary treatment.
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―地域住民における潜在的味覚低下に関する調査―永野 広海, 黒野 祐一2012 年 105 巻 1 号 p. 33-40
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありBACKGROUND: No studies have reported subclinical hypogeusia in the general community. Therefore, we investigated the relation between subclinical hypogeusia and several lifestyle diseases.
METHODS: The study population consisted of 515 patients (191 men, 324 women; mean age, 71 years old; age range, 21 to 97 years) who were referred to the Department of Internal Medicine at Kashima and Nagahama Hospital. Taste function was measured using a paper impregnated with salt crystals, Salsave®.
RESULTS: Subclinical hypogeusia was present in 102 of the 515 patients; this group had a mean age of 78.9 years old and an age range of 48 to 95 years old. Statistical analyses indicated that the frequency and severity of subclinical hypogeusia is significantly higher in men (p=0.001), in the aged (p=0.004), in patients using numerous medications (p=0.005), in hypertensive patients (p=0.005), and in diabetic patients (p<0.001). However, hyperlipidemia (p=0.84) and hyperuricemia (p=0.16) were not significantly associated with subclinical hypogeusia. Thirteen (46.4%) of the 28 patients in the chronic heart failure group had subclinical hypogeusia. The frequency and severity of subclinical hypogeusia were significantly greater in the chronic heart failure group than in the hypertension group or in the diabetic-hypertension group (p<0.001).
CONCLUSIONS: Taste acuity is partially impaired in men, in the aged, in patients using numerous medications, in hypertensive patients, and in diabetic patients. Our results suggest that subclinical hypogeusia should be recognized as a common disease with older people in the general community.
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青井 二郎, 小森 正博, 西窪 加緒里, 兵頭 政光2012 年 105 巻 1 号 p. 41-46
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありFibromatosis is a fibroproliferative lesion characterized by aggressive local invasion without regional or distant metastases, the absence of cytologic evidence of malignancy, and a high rate of recurrence. Infantile fibromatosis is a rare disease entity. We report herein on the case of an infant in whom the parotid tumor was growing aggressively, and present some discussion regarding the treatments for infant cases compared with adult cases.
A one year and 9 months boy was referred to us for diagnosis and surgical treatments because a right parotid mass had continued to grow for two weeks even though he was taking an antibiotic for what was diagnosed as acute parotitis. The tumor measured 32×30 mm with a smooth surface, was elastic hard and immovable. On the contrary, neither facial palsy, lymph node metastases nor tenderness was found. On imaging examinations, the tumor was identified in the deep lobe of the parotid gland. A surgical resection of the tumor was carried out with preservation of the facial nerve. Histopathological examination showed diffuse proliferation of spindle cells without abnormal mitosis and necroses. Immunohistochemistory of β-catenin revealed the spindle cells were fibroblasts. Finally, taking into account the age and the location of the tumor, the final diagnosis was infantile fibromatosis, destmoid-type. The patient was followed up in our clinic and no recurrence was observed one year after the operation.
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今里 圭, 加藤 明子, 橋田 光一, 若杉 哲郎, 永谷 群司, 田畑 貴久, 武永 芙美子, 寳地 信介, 鈴木 秀明2012 年 105 巻 1 号 p. 47-51
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありRhabdomyoma, a benign soft tissue tumor most often seen in the heart, rarely occurs elsewhere. We report a rare case of rhabdomyoma of the larynx. A 50-year-old man with a 3-year history of hoarseness was found in endoscopic examination and computed tomography to have a well-defined lobulated submucosal right arytenoid mass extending to the false vocal cord. It showed slight contrast enhancement, intermediate intensity in the T1-weighted magnetic resonance imaging (MRI), and intermediate to partially high intensity in T2-weighted MRI. We conducted tracheostomy and direct laryngoscopy biopsy. The histopathological diagnosis was rhabdomyoma, and the tumor was resected via lateral pharyngotomy. The man developed a recurrent tumor and underwent reoperation 4 months after the first surgery, but no further recurrence has been seen in 19-month follow-up. We bibliographically review clinical characteristics, diagnosis, and treatment of rhabdomyoma.
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雪辰 依子, 廣瀬 正幸, 津田 武, 阪上 雅史, 佐野 光仁2012 年 105 巻 1 号 p. 53-58
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありInfantile hemangioma usually resolves spontaneously, making observation the therapy of first choice. Infantile hemangioma in the airway may, however, require immediate intervention. Medical and surgical treatment over the year has included systemic and local administration of steroids, chemotherapeutic agents (vincristine, interferon-α, etc), endoscopic laser excision, open surgical resection, temporary tracheotomy and, most recently, propranolol management.
A five-month boy with stridor and retractive breathing since the age of 38 days was treated with oral predonisolone, which initially relieved symptoms. Symptoms recurred as predonisolone administration was being tapered off. Intralesional triamcinolone injection was conducted under laryngoscope and oral propranolol administered. Airway symptoms disappeared 10 days post operatively.
Intralesional triamcinolone injection and oral propranorol administration were very effective in this case, with no side effects observed. Oral propranolol administration is thus expected to become the first choice in treating infantile hemangioma due to its minimal side effect.
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松本 秀, 渡辺 太志, 佐伯 忠彦, 能田 淳平2012 年 105 巻 1 号 p. 59-64
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありWe report three cases of brachial plexus schwannoma. Subjects were a 28-year-old man with upper-limb pain in right lateral neck palpation, a 62-year-old woman with right supraclavicular fossa mass, and a 37-year-old man with left lateral neck mass. Magnetic resonance imaging (MRI) showed all three to have neurogenic tumors, originating in the brachial plexus, subsequently resected intracapsularly under general anesthesia. Histopathological examination showed tumors in one case to be mixed Antoni A and B schwannoma and in two to be Antoni A. Postoperatively all three developed paresthesia or sensory deficit and two upper-limb motor weakness that improved within 1 month. The Semmes-Weinstein monofilament test was useful in evaluating the preoperative and postoperative upper-limb sensory deficit. The postoperative period remains complication-free as of this writing.
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池田 賢一郎, 嶋根 俊和, 林 武史, 秋山 理央, 卯月 彩, 杉本 茜, 小林 斉, 三邉 武幸, 洲崎 春海2012 年 105 巻 1 号 p. 65-69
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありAngiosarcoma is a rare but highly aggressive tumor tending to occur on the scalp and face in elderly subjects. Some reports suggest that trauma, neck dissection, and radiotherapy may induce it.
We report a case of angiosarcoma originating in the internal jugular vein of a young man.
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荻原 仁美, 湯田 厚司, 西田 幸平, 小川 由起子, 北野 雅子, 竹内 万彦2012 年 105 巻 1 号 p. 71-75
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありCherubism is a painless nonneoplastic bone disease characterized by clinically bilateral symmetrical jaw enlargement. Mandibular and/or maxilla generally manifestation in childhood gradually increases until adolescence. Few cases have been reported in Japan, and only comparatively more in Europe. Genomic DNA sequence mutation of the SH3BP2 gene has been identified in subjects with cherubism, with familial occurrence reported in most cases. We report a case of nonfamilial cherubism in an 11-year-old Japanese girl diagnosed by mandibular deformities, computed tomography, magnetic resonance imaging, and pathological examination. We are taking a wait-and-see approach due to her age the grade of the lesion.
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機器
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菊池 恒, 長谷川 雅世, 笹村 佳美, 市村 恵一原稿種別: 機器
2012 年 105 巻 1 号 p. 77-82
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありPreserving the recurrent laryngeal nerve (RLN) during neck surgery such as thyroidectomy is a requirement met by surgeons. However, the RLN is sometimes difficult to identify due to congenital or tumor-based reasons.
To demonstrate the pros and cons of nerve integrity monitoring (NIM) in such identification, we report 5 cases, 3 in which the RLN was safely identified and 2 in which it was not.
Cases 1 to 3 yielded satisfactory results using NIM. Even an aberrant run of the RLN its identification was easy with NIM.
Case 4 involved a left pyriform sinus fistula. Because the hypopharynx was operated on from the oral cavity, electromyography sensor tube slipped off, making NIM instable. The problem was thus oral cavity manipulation.
Case 5 involved a huge benign thyroid tumor due to which we expected the RLN to run aberrantly and mistakenly cut the RLN. NIM was still positive even after ablation possibly because of distal fiber stimulation.
Due to the very real possibility of injuring the RLNs, surgeons should therefore keep this possibility in mind.
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研修ノート
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寺田 哲也原稿種別: 研修ノート
2012 年 105 巻 1 号 p. 84-85
発行日: 2012年
公開日: 2012/01/01
ジャーナル 認証ありPDF形式でダウンロード (377K)
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