巻号一覧
前身誌
105 巻, 9 号
選択された号の論文の17件中1～17を表示しています
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論説
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―ニカワ様鼻汁の本態は何か？好酸球は何をしているのか？―清水 猛史2012 年 105 巻 9 号 p. 803-812
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありAirway inflammation is associated with increased permeability and leakage of plasma coagulation factors, leading to activation of the coagulation system. We reported the detection of significant concentrations of thrombin and of the thrombin-antithrombin III complex in the nasal secretions of patients with chronic rhinosinusitis. We revealed that the thrombin and PAR-1 agonist peptide stimulated the secretion of PDGF, VEGF and MUC5AC mucin from cultured airway epithelial cells. We also found higher expressions of PDGF, VEGF and their receptors in nasal polyps, suggesting that thrombin-induced PDGF and VEGF may be involved in the formation of nasal polyps. Intranasal instillation of thrombin induced goblet cell metaplasia and mucus production in the rat nasal epithelium in vivo. These results indicate that sinonasal inflammation may be associated with activation of the coagulation system and that thrombin may play a crucial role in tissue remodeling, such as goblet cell metaplasia and formation of nasal polyps. Activated protein C (APC) and heparin are anticoagulant drugs used in clinical practice, and both possess anti-inflammatory activities. We also demonstrated that nasal administration of the anticoagulant drug APC or heparin may represent a new therapeutic strategy for the treatment of chronic rhinosinusitis.
To elucidate the roles of eosinophils in the pathogenesis of eosinophilic rhinosinusitis, eosinophil-epithelial interactions were examined by co-culture of the airway epithelial cell line NCI-H292 with the eosinophilic cell line EoL-1. Eosinophil-epithelial interactions significantly stimulated the secretion of PDGF, VEGF, MUC5AC, IL-8 and TGF-β from the epithelial cells. The EGFR tyrosine kinase inhibitor AG1478 inhibited the co-culture-induced secretion of MUC5AC, PDGF, VEGF and IL-8. Neutralizing antibodies directed against TGF-α or amphiregulin and the pan-metalloprotease inhibitor GM6001 inhibited the secretion of MUC5AC from the co-cultured epithelial cells. These results indicate that eosinophil-epithelial interactions stimulate tissue remodeling induced by PDGF, VEGF and MUC5AC mucin, probably mediated by EGFR transactivation via amphiregulin and TGF-α released from the epithelial cells.
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カラー図説
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宮田 遼, 近藤 敦, 関 伸彦, 白崎 英明, 坪松 ちえ子, 長屋 朋典, 氷見 徹夫2012 年 105 巻 9 号 p. 814-815
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありPDF形式でダウンロード (951K)
臨床
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晝間 清, 渡部 涼子, 新井 智之, 崎谷 恵理2012 年 105 巻 9 号 p. 817-820
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWe report on two cases of acoustic neuroma, which showed posterior semicircular canal (pSCC) type BPPV. As the canalith repositioning maneuver was effective, these cases were thought to be caused by canalolithiasis. This symptom was a peripheral vestibular disorder in the inner ear and was not a retrolabyrinthine disorder associated with the tumor in the internal auditory meatus. Our two cases were also accompanied by hearing loss on the affected side, so the common cochlear artery which supplies the cochlea and pSCC was thought to be the affected artery. Interruption of the blood supply in this artery seems to impair and yet not to totally destroy pSCC function. This may detach otoconia and cause pSCC type BPPV. An acoustic neuroma localized in the internal auditory meatus at the early stage, may influence the peripheral endo-organs in any way and mimic the symptoms of a peripheral vestibular disorder such as BPPV, before it will show paralytic nystagmus caused by the retrolabyrinthine neural disorder due to the progression of the tumor.
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大和谷 崇, 水田 邦博, 中西 啓, 瀧澤 義徳, 細川 久美子, 細川 誠二, 峯田 周幸2012 年 105 巻 9 号 p. 821-825
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありOsteoradionecrosis is most commonly caused by radiation-induced injury. We report on 3 cases of temporal bone necrosis that occurred after chemoradiotherapy for nasopharyngeal carcinoma performed more than 10 years previously. Case 1 was a 42-year-old woman who had nasopharyngeal carcinoma in 1991. The patient underwent chemoradiotherapy (70 Gy total) in 1991, and gamma knife irradiation (20 Gy) in 1998 for local recurrence. The bone in the posterior wall of the left external auditory canal began to be exposed in 2003. Otorrhea from the left ear increased and we found a skin defect and ulcer formation in the postauricular region. We performed radical mastoidectomy and debridement on April, 2010. The area of the defect was covered and filled in with a pedicle musculoperiosteal flap. The intra-aural skin became dry in 6 months, however, she lost consciousness due to a temporal lobe abscess and underwent an emergency operation on April, 2011. After operation, the patient recovered with no neurological symptoms and infections up to the present date. Case 2 was a 58-year-old man who had nasopharyngeal carcinoma in 2001. The patient underwent chemoradiotherapy (66 Gy total) in 2001, and X knife irradiation (15 Gy) 3 months later due to the remaining tumor. The left posterior ear canal wall collapsed and the tympanic membrane retracted with pooling epithelial debris appearing in 2007. Left facial nerve palsy was seen in December 2010. We performed a mastoidectomy on January, 2011. Cholesteatoma and necrotic granuloma with fragile bone filled the mastoid cavity, and a facial canal bone defect was seen. Bone necrosis with cholesteatoma and inflammatory granuloma was revealed by the pathological examination. The facial palsy improved after the operation. Case 3 was a 59-year-old man who had left abducens palsy with nasopharyngeal carcinoma invading the clivus. The patient underwent chemoradiotherapy (60 Gy total) in 2001, and X knife irradiation (24 Gy) 4 months later for the remaining tumor. His abducens palsy improved and he achieved a complete response to the treatment. Left otorrhea and perforation of the left tympanic membrane occurred in 2002, and the left external auditory canal had became stenosed over time. He had received head CT scan following a blow to his head, and it revealed a low density area in the left temporal lobe which suggested brain necrosis. No medical treatment has been performed for this because he had no clinical symptoms. The recent CT scan showed erosion of the sphenoidal and temporal bone, thickened soft tissue of the external auditory canal, and thinning of the bone around the carotid artery in the upper pharyngus.
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北村 貴裕, 松代 直樹, 鎌倉 武史, 梶川 泰2012 年 105 巻 9 号 p. 827-833
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWegener’s granulomatosis is known to be a systemic necrotizing, granulomatous vasculitis that mainly affects the upper and lower respiratory tracts and the kidney.
We report on a case of suspected Wegener’s granulomatosis with intractable otitis media and facial palsy. A forty-year-old woman suffered from intractable otitis media coexisting with facial palsy. C-ANCA was positive. A nasal biopsy was performed, but it did not show vasculitis. The patient was therefore treated with steroid hormones and immunosuppresants as a case of suspected Wegener’s granulomatosis. The combination therapy was effective, and her facial palsy resolved in four months, but her severe hearing loss remained. It is difficult to diagnose this disease with the current diagnostic criteria.
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長谷川 陽一, 山本 悦生, 老木 浩之, 田邉 牧人2012 年 105 巻 9 号 p. 835-840
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWe report herein on 2 of multiple cholesteatomas combined with attic cholesteatoma. Microscopic examination of the tympanic membrane and CT scan of the temporal bone indicated attic cholesteatoma in each case. Surgical exploration demonstrated the presence of another cholesteatoma and there was no epithelial continuity between the lesion and the attic cholesteatoma.
In both cases, it is probable that the cholesteatoma of the mastoid antrum and attic cholesteatoma were unrelated. In case 1, chronic inflammation may have obstructed the tympanic isthmus and the pars flaccida was retracted secondarily. In case 2, both lesions may have been congenital and one of them perforated the tympanic membrane and appeared to be acquired cholesteatoma.
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生駒 亮, 荒井 康裕, 丹羽 一友, 高橋 優宏, 梶原 良介2012 年 105 巻 9 号 p. 841-846
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWe experienced a case of childhood acute myeloid leukemia diagnosed with facial palsy. The facial palsy fully recovered following the chemotherapy for the acute myeloid leukemia at an early stage. It might be the case we otolaryngologists can sometimes experience acute leukemia with otologic symptoms. It is important that we see the patients with otologic symptoms from this point of view.
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石田 良治, 関 伸二2012 年 105 巻 9 号 p. 847-850
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありMedial Meatal Fibrosis (MMF) is a rare disease which cause obstruction in the medial portion of the external auditory canal due to proliferation of fibrous tissue. We experienced two cases of MMF.
Case 1 was a 64-year-old woman with bilateral hearing loss, and Case 2 was a 57-year-old woman with left hearing loss. A surgical procedure was performed in both cases. The fibrous tissue was totally removed and the bony canal was covered with a skin graft during the surgery. In both cases, postoperative hearing improved, and no reccurence has been observed.
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久松 建一, 工藤 逸大, 高根 智之, 牧山 清, 平井 良治2012 年 105 巻 9 号 p. 851-857
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありIn fifty-six patients with sleep-disordered breathing (SDB), including obstructive sleep apnea-hypopnea syndrome (OSAHS), upper airway resistace syndrome (UARS), snoring and excessive daytime sleepiness, the nasal resistance was measured preoperatively with rhinomanometry using the anterior method. All 56 patients (ages ranging from 21 to 73, 48 men and 8 women), underwent endonasal rhinoplasty (ER) consisting of a septoplasty and bilateral submucosal inferior turbinectomy with posterior nasal nerve resection, and bilateral partial middle turbinectomy. Three months later, the postoperative effect of the ER was evaluated using polisomnography with or without electroencephalography, the Epworth sleepiness scale (ESS) and rhinomanometry. In cases with both bilateral or ipsilateral nasal resistance over 0.35 Pa/cm3/s ER was highly effective in alleviating OSAHS, UARS, excessive daytime sleepiness and improvement of respiratory events during sleep. The high effectiveness of ER for SDB suggests increased nasal resistance during sleep greatly affects the pathophysiology of SDB.
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大原 賢三, 岸部 幹, 片山 昭公, 國部 勇, 片田 彰博, 林 達哉, 原渕 保明2012 年 105 巻 9 号 p. 859-862
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWe report a case of laryngitis caused by accidental insecticide inhalation. A 73 years old man was referred to our hospital because he was unable to take anything by mouth due to sore throat. Laryngoscopy revealed marked white lesion from the larynx to the trachea. Detailed questionnaires revealed his insecticide inhalation 4 days ago. The insecticide contained 50.0% organic phosphorus and 25.9% xylene. He didn’t have organophosphate and xylene poisoning symptom. But he was affected with laryngitis caused by acid. Because solvent of insecticide was acid.
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宮野 一樹, 物部 寛子, 安原 一夫, 戸島 均2012 年 105 巻 9 号 p. 863-868
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありIt has been proposed that primary dermal melanoma is a subtype of melanoma confined to the dermis and/or subcutaneous fat that histologically simulates metastasis but is associated with an unexpectedly prolonged survival.
We report on a case of malignant melanoma in the temporal muscle. A 63-year-old woman seen for a mass in her left temporal legion noticeable while masticating, was diagnosed as having malignant melanoma based on the cytological and immunohistochemical findings. However physical and imaging examinations showed no evidence of metastatic melanoma and no EWS-ATF1 fusion transcript specific for clear cell sarcoma was detected. This case was disease-free over 2 years after the operation. We therefore consider that this case was a primary dermal melanoma.
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濱本 隆夫, 平川 勝洋, 竹野 幸夫, 立川 隆治2012 年 105 巻 9 号 p. 869-873
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありHemorrhage from a tracheo-innominate artery fistula as a result of tracheal cartilages necrosis is a highly lethal complication after tracheostomy. We experienced a case of this hemorrhage and performed brachiocephalic artery ligation. To prevent the hemorrhage, we need frequently to check the position of the tracheostomy tube and cuff pressure. Early recognition and expeditious treatment are essential for survival. When we find any signs of a hemorrhage, we have to consider the option of brachiocephalic artery ligation as preventive treatment.
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坂東 伸幸, 後藤 孝2012 年 105 巻 9 号 p. 875-881
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありWe report on two cases of a fistula of the first branchial cleft. A 15-year-old female complained of swelling and tenderness of the temporal, postauricular and parotid gland regions. A large abscess revealed on a CT scan was incised and drained immediately. After the patient had left the hospital, we identified secretion from the external ear canal following pressure to the postauricular region, prompting us to consider the existence of a fistula of the first branchial cleft, opening onto the canal. We extracted the fistula located in the temporal and postauricular region and extending to the parotid gland deep lobe, after identification of the main trunk of the facial nerve. A 5-year-old male complained of swelling and tenderness of the parotid gland region. As the formation of the abscess recurred repeatedly, he underwent surgery. The fistula was located in the parotid gland superficial lobe and had adhered firmly to the cartilage of the external ear canal. After identification of facial nerve we extracted the fistula. After surgery, neither facial nerve palsy nor recurrence has been identified in either case.
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兵 行義, 福辻 賢治, 舘 俊廣, 田中 浩喜, 雑賀 太郎, 粟飯原 輝人, 原田 保2012 年 105 巻 9 号 p. 883-890
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありStevens-Johnson syndrome (SJS) is a potentially fatal disorder characterized by high fever, widespread blistering exanthema with mucosal involvement and is characterized by sudden apoptosis of keratinocytes leading to erosion of the mucos membrane. Epidermal detachment of the less than 10% of the total body surface area is typical within this spectrum of epidermal necrolysis. SJS is associated with lifethreatening dermatological conditions that are characterized by mucosits erosions. The underlying etiology is almost invariably secondary to drugs.
We report herein on two cases of SJS associated with carbamazepin and allopurinol. A 76-year-old man with dyspnea was admitted to our hospital. He was diagnosed as having SJS due to carbamazepin which he had taken 1 month previously. A 75-year-old woman with a sore throat was admitted to our hospital. She was diagnosed as having SJS due to allopurinol which she had taken 3 weeks previously. We advised clinicains to pay careful attention to the fact that SJS has various symptoms. It is necessary for us to confirm which medicine the patients had previously taken.
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薬物
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赤澤 幸則, 我那覇 章, 近藤 俊輔, 関 沙織, 鈴木 幹男2012 年 105 巻 9 号 p. 891-895
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証ありLevofloxacin (LVFX) 500 mg in tablet form, one of the fluoroquinolone antibiotics, has recently become available in Japan, and is rapidly absorbed and extensively distributed into various tissues. In the present study, we try to clarify whether LVFX could prevent surgical site infection (SSI) in clean-contaminated middle ear surgery. LVFX was administered to each patient without otorrhea 2 to 4 hours before middle ear surgery. Although one of 40 cases (2.5%) developed SSI, the infectious lesion immediately disappeared with the administration of additional LVFX. There were 2 cases with mild adverse reaction, i.e. slight liver dysfunction and diarrhea. The drug concentrations in the middle ear and in the serum were simultaneously investigated 3 to 4 hours after LVFX administration in 5 patients. The LVFX concentration in the middle ear was 1.23 times higher than the serum concentration. From the above observations, we concluded that LVFX has adequate ability enough to prevent SSI in clean-contaminated middle ear surgery.
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研修ノート
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出島 健司2012 年 105 巻 9 号 p. 896-897
発行日: 2012年
公開日: 2012/09/01
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エラータ
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2012 年 105 巻 9 号 p. 0-
発行日: 2012年
公開日: 2012/09/01
ジャーナル 認証あり耳鼻咽喉科臨床第105巻第3号 宮本真理子著「IgG4関連疾患としてのミクリッツ病，慢性硬化性顎下腺炎（キュットナー腫瘍）の血清学的および臨床病理学的検討．耳鼻臨床105：3；267～276」におきまして，本文中に誤りがございましたので，下記のごとく訂正致します．
著 者
271頁3行目
（誤）ミクリッツ病は24例に高IgG4血症を認め，平均1245.2±1869.5（SD）mg/dl（P＝0.0221）
（正）ミクリッツ病は24例に高IgG4血症を認め，平均816.9±712.4（SD）mg/dl（P＝0.0221）抄録全体を表示PDF形式でダウンロード (91K)
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