巻号一覧
前身誌
106 巻, 11 号
選択された号の論文の16件中1～16を表示しています
- |<
- <
- 1
- >
- >|
論説
-
肥後 隆三郎2013 年 106 巻 11 号 p. 967-975
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありHead and neck cancer patients often exhibit swallowing disturbance after treatment, which is a major cause of morbidity and reduced quality of life. Thus, the posttreatment swallowing function should be appropriately evaluated in head and neck cancer patients. We first of all present herein the results of postsurgical swallowing function using a combination of videofluorography (VF) and manometry in 14 patients with head and neck cancer, consisting of 8 oral cavity cancer patients, 4 oropharyngeal cancer patients, and 2 hypopharyngeal cancer patients. Oropharyngeal swallowing pressure after partial resection of the mandible without reconstruction of the bony segment defect decreased compared with the normal control. VF and manometric examination revealed that partial resection of the mandible without reconstruction of the bony segment defect had a negative effect upon swallowing function. The oropharyngeal swallowing pressure markedly decreased in patients with oropharyngeal cancer after surgery, and no significant differences were observed in the hypopharyngeal swallowing pressure between oropharyngeal cancer patients and normal control. The tongue base should be reconstructed to compensate for decreased oropharyngeal swallowing pressure. Although hypopharyngeal cancer patients who underwent partial resection of the hypopharynx showed a marked decrease in their hypopharyngeal swallowing pressure, they could take food orally 6 months after treatment. Partial pharyngectomy with preservation of the larynx is a good procedure for selected patients. In addition, we discuss swallowing function after concurrent chemoradiotherapy (CCRT). Although swallowing disturbance was observed in about 40% of the patients treated with CCRT, dysphagia in these patients was minimal and could be managed with rehabilitation and dietary intake modification. Existing disease, such as cerebral infarction and respiratory dysfunction, tended to result in posttreatment swallowing disturbance after CCRT. Swallowing function after larynx-preserving reconstruction in elderly patients is also reviewed. Microsurgical reconstruction of pharyngeal and oral defects was thought to be a safe procedure even in patients over 80 years of age with performance status 0 or 1.
抄録全体を表示PDF形式でダウンロード (587K)
カラー図説
-
小島 博己2013 年 106 巻 11 号 p. 976-977
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありPDF形式でダウンロード (951K)
臨床
-
西元 謙吾, 谷本 洋一郎, 荻田 幹夫, 松崎 勉2013 年 106 巻 11 号 p. 979-984
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありPatients with carcinoma of the middle ear usually have a poor prognosis even after multidisciplinary treatment. We describe the rare case of a patient with bilateral middle ear carcinoma who was treated by stereotactic radiosurgery using the Cyberknife, and remained tumor free for more than five years after the therapy.
The patient was sorely afflicted with persistent left otorrhea despite having undergone surgery for bilateral chronic otitis media and was diagnosed (confirmed by histopathological examination) as having carcinoma of the middle ear on the left side. FDG-PET imaging revealed accumulation in the right side ear also, however, the diagnosis of right middle ear carcinoma was finally made after five months by histopathological examination.
He underwent stereotactic radiosurgery using the Cyberknife on two occasions, had no remarakable complications, and survived without tumor recurrence for more than five years. We suggest that stereotactic radiosurgery using the Cyberknife may be useful for the treatment of middle ear carcinoma, especially bilateral middle ear carcinoma, because of the reservation around the restriction by the surrounding organs.
抄録全体を表示PDF形式でダウンロード (5849K) -
田崎 彰久, 本田 圭司, 鎌田 知子, 畑中 章生2013 年 106 巻 11 号 p. 985-990
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありWegener’s granulomatosis is characterized by necrotising granulomas of the respiratory tract, renal failure and necrotisingangitis. We report herein on a case of a 53-year-old man who presented with visual disturbance of the right eye. He had also presented with visual disturbance one year previously, and underwent endoscopic sinus surgery at another hospital. We considered that the visual disturbance was caused by a sinus cyst. Although we performed endoscopic sinus surgery, the patient’s visual loss did not improve. About one month after the surgery, bilateral visual disturbance and nasal septum perforation appeared, the p-ANCA titer was elevated, and pachymeningitis became apparent, but the left paranasal sinus was intact. Finally we diagnosed that the visual loss was due to pachymeningitis based on Wegener’s granulomatosis, and we therefore administered predonisolone and cyclosporin. The eyesight in the patient’s right eye was still poor but his left eyesight recovered.
抄録全体を表示PDF形式でダウンロード (2074K) -
加藤 智久, 糟谷 憲邦, 竹澤 公美子, 清水 猛史2013 年 106 巻 11 号 p. 991-995
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありGanglion cyst in the head and neck region is rare. We describe a case of ganglion cyst in the retropharyngeal region in a 79-year-old man. The patient complained of an uncomfortable feeling in the throat while swallowing. On physical examination, a submucosal mass was found in the posterior pharyngeal wall. Computed tomography and magnetic resonance imaging revealed a 16×13×12 mm cystic mass protruding into the pharynx. A well-circumscribed cystic mass was completely removed by surgery via the transoral approach. The histological diagnosis was ganglion cyst. The postoperative course was uneventful and follow-up has revealed no recurrence until date, more than 2 years since the surgery.
抄録全体を表示PDF形式でダウンロード (1263K) -
植木 雄志, 高橋 奈央, 佐藤 邦広, 髙橋 姿2013 年 106 巻 11 号 p. 997-1000
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありThe clinical data of 56 patients with hypopharyngeal squamous cell carcinoma who were seen between 1991 and 2011 were evaluated at our department. The overall 5-year disease-free survival rate was 43.6%. The survival rates in the patients with stage I (n=3), stage II (n=13), stage III (n=3), stage IV (n=37) disease were 66.7%, 83.8%, 0%, and 31.4%, respectively. Among the patients with stage III/stage IV disease, the survival rate in those who underwent surgery (n=8) was 83.8%, while that in those who underwent concurrent chemoradiotherapy (CCRT) (n=30) was only of 22.3%. The survival rate in patients who underwent adjuvant chemotherapy with S-1 (n=16) was 46.3%, and that in patients who underwent adjuvant chemotherapy without S-1 (n=24) was 20.5%. These results suggest that surgery plays a very important role in the treatment of advanced hypopharyngeal carcinoma and that appropriate adjuvant chemotherapy improves the outcome in these patients.
抄録全体を表示PDF形式でダウンロード (480K) -
渡邉 佳紀, 安里 亮, 辻 純, 神田 智子, 本多 啓吾, 辻村 隆司, 森 祐輔2013 年 106 巻 11 号 p. 1001-1007
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありMucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma which arises from a complex organization of mucous membranes and lymphoid tissues. Such lymphomas have been reported as occurring in the head and neck region, including the major salivary glands, thyroid gland and the Waldeyer ring, but there are no reports on hypopharyngeal MALT lymphomas in Japan. We encountered a very rare case of hypopharyngeal MALT lymphoma that we were able to treat with curative resection via the endoscopic transoral surgery.
抄録全体を表示PDF形式でダウンロード (1035K) -
呉 奎真, 樽谷 貴之, 井門 謙太郎, 立川 隆治, 竹野 幸夫, 工田 昌也, 平川 勝洋2013 年 106 巻 11 号 p. 1009-1013
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありWe experienced the case of a 56 year-old female with malignant lymphoma of the larynx. She presented with a 4-month history of hoarseness of the voice. Examination revealed a tumor in the right false cord. Laryngeal biopsy obtained under direct laryngoscopy yielded the pathological diagnosis of inflammation. A second biopsy was performed through a cervical incision, and the pathological diagnosis was revised to B-cell lymphoma. The patient was treated by R-CHOP therapy, i.e., standard CHOP regimen plus rituximab, which produced a complete response. Thus, the laryngeal tumor was well-controlled by treatment.
抄録全体を表示PDF形式でダウンロード (2265K) -
齊藤 雄, 萩原 晃, 小林 賀子2013 年 106 巻 11 号 p. 1015-1021
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありWhile hemangioma is a common neoplasm in the head and neck region, it rarely occurs in the larynx. Herein, we report a case of laryngeal hemangioma that occurred in the arytenoid region. The patient was a 33-year-old woman who presented with the chief complaint of throat discomfort. Endoscopy showed a tumor in the larynx of blue-violet color with an irregular surface, occupying the arytenoid region bilaterally. Bolus of food was confirmed in the right pyriform sinus. CT confirmed the presence of the tumor in the arytenoid region bilaterally. Some calcification was observed within the tumor. On MRI, the tumor was visualized as an iso-intensity on T1-weighted images and as a hyperintensity on T2-weighted images. We performed direct dissection under laryngomicroscopic observation. During the operation, it was difficult to see the entire tumor within the same visual field under the laryngomicroscope. The tumor was diagnosed histopathologically as a cavernous hemangioma. There are several reports of the necessity of an external incision with tracheotomy in cases with giant tumors. Dissection under a laryngomicroscope, without tracheotomy and the attendant dysfunction of vocalization and swallowing, is a better option for the treatment of cavernous hemangioma.
抄録全体を表示PDF形式でダウンロード (1266K) -
谷山 岳司, 杉山 智宣, 荒木 真美佳, 福喜多 晃平, 山田 弘之, 畠山 好央, 小山 真司, 細井 裕司2013 年 106 巻 11 号 p. 1023-1026
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありBetween 2002 and 2011, we treated 18 cases of cervical lymph node metastasis from cancer of unknown primary origin. The subjects were 15 men and 3 women, ranging in age from 45 to 83 years (mean: 65.5 years). The histopathological tumor types were squamous cell carcinoma (15 cases), mucoepidermoid carcinoma (1 case), adenocarcinoma (1 case), and undifferentiated carcinoma (1 case). The largest metastatic lymph nodes were located in the upper deep cervical region in 16 cases. For histologic diagnosis of the metastatic lymph nodes, FNAB (fine needle aspiration biopsy) was conducted in 14 cases and open biopsy in 4 cases. Neck dissection was performed in 17 cases, of which 14 also received postoperative radiotherapy. The overall 5-year survival rate in this study was 63.6%. For the control of metastatic lymph nodes and minute tumors at the primary site, combination therapy consisting of neck dissection and chemoradiotherapy is desirable.
抄録全体を表示PDF形式でダウンロード (337K) -
増田 理佐, 若杉 哲郎, 永谷 群司, 大淵 豊明, 鈴木 秀明2013 年 106 巻 11 号 p. 1027-1032
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありCases of branchiogenic carcinoma that strictly comply with the diagnostic criteria are rare. Human papillomavirus (HPV)-positive oropharyngeal carcinomas often manifest themselves as large and cystic lymph node metastases with a tiny primary lesion, mimicking branchiogenic carcinoma. We report herein on a case of branchiogenic carcinoma that was considered to be associated with HPV.
A 69-year-old man was referred to our department with a 2-week history of right-sided cervical swelling. Computed tomography revealed a multicystic mass measuring 35 mm in diameter in his right neck. The mass contained a small solid region, and a lymph node was seen anteroinferiorly to the cystic mass. Although a fine needle aspiration biopsy showed no malignancy, significant accumulation (SUVmax=5.3) was seen in the solid region of the mass on FDG-PET. We suspected lymph node metastasis, but failed to find a primary lesion with endoscopic and imaging examinations. The patient then underwent a biopsy of the lymph node, which turned out in frozen section analysis to be metastatic squamous cell carcinoma, suggesting cancer of an unknown primary. Conservative neck dissection (levels II-IV) was subsequently performed. The histopathological diagnosis was squamous cell carcinoma arising in a lateral cervical cyst. Immunohistochemically, the tumor was positive for p16, indicating the association with HPV. In order to examine for the presence of HPV-related cancer of the oropharynx, resection and histological examination of the palatine and lingual tonsils was performed, but no malignancy was detected. Under a definite diagnosis of branchiogenic carcinoma, the patient received postoperative concurrent chemoradiotherapy with carboplatin. He has been free from disease for 16 months after treatment.
To the best of our knowledge, this is the first case report on a p16-positive branchiogenic carcinoma. The relationship between the carcinogenesis of the lateral cervical cyst and HPV infection is unknown, and remains to be investigated.
抄録全体を表示PDF形式でダウンロード (1365K) -
―Voice Handicap Index（VHI）日本語改定版および Voice-Related Quality of Life（V-RQOL）日本語版を用いて―上前泊 功, 芦澤 圭, 中山 雅博, 田中 秀峰, 西村 文吾, 田渕 経司, 和田 哲郎, 髙橋 邦明, 原 晃2013 年 106 巻 11 号 p. 1033-1038
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありEsophageal speech, electric larynx and tracheoesophageal speech have been used for substitute speech in patients after laryngectomy. However, there have been no studies comparing them in terms of QOL. Twenty-four cases of laryngeal carcinoma or hypopharyngeal carcinoma treated with a total laryngectomy with or without reconstruction at the University of Tsukuba Hospital from 1998 to 2012 were clinically analyzed. Ten patients had tracheoesophageal speech and fourteen patients had esophageal speech. The patients with tracheoesophageal speech consisted of 9 males and 1 female ranging in age from 49 to 83 years old (mean age 61.1). On the other hand, the patients with esophageal speech consisted of 14 males ranging in age from 65 to 80 years old (mean age 70.0). All patients in the two groups answered two kinds of questionnaire, namely, the Voice Handicap Index (VHI) revised edition and the Voice-Related Quality of Life (V-RQOL) Japanese edition.
The conversation acquisition rates of the patients with tracheoesophageal speech and the patients with esophageal speech were 90.9 and 42.8%, respectively, and the acquisition rate was significantly higher in the patients with tracheoesophageal speech. The total VHI scores of the patients with tracheoesophageal speech and the patients with esophageal speech (average±standard deviation) were 60.5±17.2 and 78.9±17.8 points, respectively, and the total V-RQOL scores of the patients with tracheoesophageal speech and the patients with esophageal speech (average±standard deviation) were 54.1±15.9 and 32.7±19.1 points respectively. The results strongly suggested that a high QOL was observed with both evaluations in patients with tracheoesophageal speech. Thus, tracheoesophageal speech might be effective for vocalization in alaryngeal patients from the point of view of their QOL.
抄録全体を表示PDF形式でダウンロード (471K) -
渡邊 毅, 田中 藤信, 奥 竜太, 宗 謙次, 髙橋 晴雄2013 年 106 巻 11 号 p. 1039-1044
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありA 66-year-old female patient with spinocerebellar degeneration and long-term incorrect placement of a central venous catheter was referred to our hospital with persistent fever and right neck swelling.
Preoperative computed tomography (CT) showed the misplacement of catheter, which was inserted through the right subclavian vein but had turned upward into the upper internal jugular vein causing intravascular thrombosis. A deep neck abscess was also found around the catheter tip. The patient was diagnosed as having central venous catheter-related infection. As the catheter could not be extracted, we performed neck dissection under general anesthesia. The internal jugular vein was identified in the middle of the abscess cavity. Inside the venous lumen filled with the abscess fluid and thrombosis, we found the catheter tip. The catheter was carefully removed without bleeding. Postoperative treatment was effective, and the patient eventually recoverd fully.
Thus, it is important to recognize that long-term incorrect placement of a catheter may cause deep neck abscess and internal jugular vein thrombosis.
抄録全体を表示PDF形式でダウンロード (883K)
薬物
-
岡本 美孝, 鈴木 五男2013 年 106 巻 11 号 p. 1045-1057
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありBackground: Intranasal glucocorticoids effectively and safely alleviate the symptoms of allergic rhinitis, but treatment options from this drug class are still limited for the Japanese pediatric population. Objective: To evaluate the efficacy and tolerability of mometasone furoate nasal spray (MFNS) at a once-daily dosage compared with a placebo spray (placebo) in Japanese children with perennial allergic rhinitis (PAR). Methods: In this randomized, double-blind, multicenter study, subjects aged 5~15 years with PAR were randomly assigned to MFNS or the placebo for 2 weeks. The once-daily morning dosage of MFNS was 100 μg (50 μg per nostril) in subjects aged 5~11 years and 200 μg (100 μg per nostril) in those aged 12~15 years. The primary end point consisted of change from baseline in the total nasal symptom score (TNSS) at week 2 or discontinuation. Other efficacy end points included investigator-assessed measures of individual nasal symptoms, interference with daily activities, and global improvement. Results: Of the 333 randomized subjects, 330 completed the full 2 weeks of treatment. The between-treatment difference in TNSS at week 2 or discontinuation indicated the superiority of MFNS vs the placebo (P<0.0001). Scores for individual symptoms, interference with daily activities, and global improvement were significantly superior with MFNS vs the placebo at week 1 and week 2 or discontinuation. The overall incidence of adverse events was similar between MFNS (30.5%) and the placebo (36.3%), and all adverse events were mild to moderate. Conclusions: MFNS provided effective and rapid relief for PAR in a Japanese pediatric population while exhibiting tolerability similar to that of the placebo.
抄録全体を表示PDF形式でダウンロード (795K)
研修ノート
-
角田 篤信2013 年 106 巻 11 号 p. 1058-1059
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありPDF形式でダウンロード (358K)
メディカル・エッセイ
-
―第四編：臨床統計報告―飯沼 壽孝2013 年 106 巻 11 号 p. 1061-1063
発行日: 2013年
公開日: 2013/11/01
ジャーナル 認証ありSeven aural statistical reports, in which either Menière’s disease, Menière’s symptoms, or Menière’s symptom complex were included and classified, are analyzed. The incidences of these three Menière’s disease-related affections are distributed between 0.1–2.5% of the total aural lesions. As to the prognosis of deafness, Habermann’s two reports (1881) from Prague are available, and in 17 cases, the deafness was totally incurable, as Menière had already so reported in 1861.
抄録全体を表示PDF形式でダウンロード (183K)
- |<
- <
- 1
- >
- >|