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106 巻, 8 号
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論説
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氷見 徹夫, 高野 賢一, 関 伸彦, 森山 亜由美, 山本 元久, 高橋 裕樹2013 年 106 巻 8 号 p. 671-682
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありIgG4-related disease (IgG4-RD) is a novel clinical disease entity characterized by elevated serum IgG4 concentration and tissue infiltration by IgG4-positive plasma cells. IgG4-RD may be present in a certain proportion of patients with a wide variety of diseases. Representative diseases are considered as Mikulicz’s disease, autoimmune pancreatitis and retroperitoneal fibrosis. Although IgG4-RD forms a distinct, clinically independent disease category and is attracting strong attention as a new clinical entity, many questions and problems still remain to be elucidated, including its pathogenesis, the establishment of diagnostic criteria, and the pathogenic role of IgG4. We discuss herein the results of recent studies and provide an overview of IgG4-RDs in the head and neck regions, including Mikulicz’s disease, Küttner’s tumor, Riedel thyroiditis, IgG4-related rhinosinusitis, IgG4-related infraorbital nerve swelling, all of which show IgG4 involvement in their pathogenesis.
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カラー図説
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岡本 美孝2013 年 106 巻 8 号 p. 684-685
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありPDF形式でダウンロード (982K)
臨床
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坂田 俊文, 大庭 哲, 中川 尚志2013 年 106 巻 8 号 p. 687-691
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありAs suitable practice guidelines have not yet been established for acute low-tone sensorineural hearing loss (ALHL), many doctors feel unsure about making a diagnosis based on their own methods for judgment. We administered questionnaire surveys on the conditions surrounding ALHL diagnoses to otolaryngologists in the Fukuoka area in Japan for the purpose of sharing medical practice-related information and to identify controversial issues. The results showed that suspected cases of ALHL had been treated as certain cases. During the year-long survey period, it was also estimated that about 50% of the total diagnosed patients completed treatment within 2 months, about 30% continued treatment for 2 months or more, and about 20% elected to discontinue treatment. For the treatment drug, isosorbide was used less frequently than steroids. When making a diagnosis, doctors did not limit themselves to diagnostic criteria, and aggressively tried to treat symptoms as ALHL when that was the suspected diagnosis. As criteria for determining the end of treatment, the survey results showed that treatment was sometimes concluded despite instability in either subjective symptoms or hearing impairment, and that it was sometimes concluded based on the patient’s wishes. Half of the patients referred from another hospital did not have actual written referrals, and some patients dropped out of treatment on their own accord, suggesting that some patients were concerned about the course of ALHL.
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濵本 真一, 兵 行義, 田中 浩喜, 舘 俊廣, 森田 倫正, 福島 久毅, 原田 保2013 年 106 巻 8 号 p. 693-697
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありKawasaki disease (KD) is an idiopathic systemic vasculitis common in infants and children that affects predominantly small and medium-sized extraparenchymal muscular arteries. KD manifests various clinical symptoms, of which coronary aneurysms are the most important complication. However, the association of sensorineural hearing loss with KD is rare. A 7-year-old girl with KD was referred to our department with a chief complaint of hearing loss. In her hearing test, she showed a high degree of bilateral sensorineural hearing loss. Although the patient was treated with steroid pulse therapy (methylprednisolone), her hearing level deteriorated. Two weeks after steroid therapy, a slight improvement was seen. Thereafter, the patient started to use hearing aids. About one year has elapsed since the onset of hearing loss, but her hearing level has not improved.
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遠藤 芳彦2013 年 106 巻 8 号 p. 699-704
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありHereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant disease that is characterized by repetitive nasal bleeding with familial occurrence, and is frequently associated with difficulty in treating the nasal bleeding. We treated cases of refractory nasal bleeding, consisting of 4 cases of hereditary hemorrhagic telangiectasia and one case of renal cell carcinoma, metastasized to the paranasal sinus, on an out-patient basis with local injection of the esophageal varices sclerosing agent, polidocanol. Following injection sclerotherapy in all five cases, the frequency of nasal bleeding decreased. Since this procedure was able to be performed on an out-patient basis without requiring hospitalization, it was useful in improving patient QOL.
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芦澤 圭, 田渕 経司, 田中 秀峰, 廣瀬 由紀, 原 晃2013 年 106 巻 8 号 p. 705-710
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありThe glomangiopericytoma (a sinonasal-type hemangiopericytoma) is a rare tumor arising from the pericytes surrounding capillaries and shows variable malignant potential. We describe herein a case of a 60-year-old female with a glomangiopericytoma of the nasal cavity. After preoperative embolization, it was successfully treated with endoscopic excision. Histological examination showed multiplication of short spindle-shaped cells which reacted to immunostaining for α-smooth muscle actin. She had an uneventful postoperative course and remains well 12 months after surgery, without any tumor recurrence. Endoscopic surgery can be considered an effective treatment for the resection of this tumor type, when the tumor base can be visualized and the disease extent accurately defined.
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秋山 貢佐, 米崎 雅史, 後藤 理恵子, 唐木 將行, 星川 広史, 森 望2013 年 106 巻 8 号 p. 711-715
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありA 67-year-old man presented with left nasal obstruction and mucopurulent discharge. CT showed shadows at his left sinuses, and implant extension into the left maxillary sinus cavity with an osteolytic lesion around that equivalent to the left side maxillary second molar. Our diagnosis in this case was left maxillary sinusitis related to a dental implant, and we performed endoscopic sinus surgery with implant extraction. Postoperatively, a complication involving sinonasal inverted papilloma (IP) was diagnosed with a histopathological examination. Residual lesion or recurrence has not occurred so far and all patient symptoms disappeared during the follow-up period. Dental implants are widely used and their use is increasing rapidly. On the other hand, cases of maxillary sinusitis caused by inadequate dental implant treatment have been reported. IP is one of the most frequent sinonasal benign tumors, and there are various differential diagnoses, including antrochoanal polyp, and odontogenic maxillary sinusitis. We should keep in mind that IP may occur in unilateral nasal polypoid cases, including cases suspected as being odontogenic maxillary sinusitis. Such masked lesions might not be detected if the treatment is performed by an oral surgeon alone; therefore, we think it is important that oral surgeons and otolaryngologists should make the diagnosis and perform the treatment together.
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地村 友宏, 永野 広海, 黒野 祐一2013 年 106 巻 8 号 p. 717-721
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありPemphigus is an intractable disease of the oropharyngeal mucosa and is classified into vulgaris and foliaceus. The incidence is relatively low and early diagnosis of pemphigus vulgaris is difficult due to the clinical and pathological diversity of this disease.
We report herein on a case of mucosal dominant pemphigus vulgaris occurring in the oropharyngeal and laryngeal mucosa. A 73-year-old woman complaining of a blister on oral mucosa visited an otolaryngologist and was diagnosed as having stomatitis. Despite standard treatment, the lesion did not improve and skin erosion was observed. The patient then visited a dermatologist and was referred to the dermatology department of our hospital with the diagnosis of pemphigus vulgaris. Since she complained of a sore throat, swallowing pain and hoarseness, she was asked to have an examination at our department.
Local examination showed multiple erosion in the oropharyngeal and laryngeal mucosa. A lower lip biopsy was performed and the anti-desmoglein antibody titer in the serum was examined. The histopathological findings were consistent with pemphigus vulgaris and an increased anti-desmoglein antibody 3 titer was observed. The patient then underwent corticosteroid treatment and her symptoms remarkably improved. Although pemphigus vulgaris is rarely seen by otolaryngologists, it is suggested that pemphigus vulgaris should be considered as one of the differential diagnosis when intractable stomatitis is observed.
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橘 智靖, 中田 道広, 小河原 悠哉, 松山 祐子, 阿部 郁, 藤澤 真義, 内野 かおり, 深澤 元晴, 宇野 欽哉2013 年 106 巻 8 号 p. 723-728
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありThe histopathology of submandibular gland tumors is varied, and in many cases, it is also difficult to make a diagnosis preoperatively. A clinical study was performed on 38 cases of submandibular gland tumor surgically resected between 1995 and 2011. There were 33 benign and 5 malignant tumors. The most common benign tumor was pleomorphic adenoma (97.0%). Three of the 5 malignant tumors were low-grade mucoepidermoid carcinomas, and two were adenoid cystic carcinomas. We compared the preoperative diagnosis with final diagnosis. We considered that fine-needle aspiration (FNA) biopsy was very useful for the surgical management of submandibular gland tumor, and in malignant cases, the use of both FNA and frozen section biopsy (FSB) could improve the precision of the preoperative diagnosis. We performed supraomohyoid neck dissection in patients with clinically negative neck metastasis, and total neck dissection in patients with clinically positive neck metastasis. Postoperative radiotherapy was performed in patients with perineural invasion, a narrow safety margin, high-grade malignancy, multiple neck metastasis and extranodal extension. Following extirpation of the submandibular gland and tumor, facial paresis occurred in 8 (27.6%) cases. We compared postoperative complications following the non-identified method with the identified method. Facial paresis occurred in 1 (5.9%) cases following the non-identified method, and occurred in 7 (50.0%) cases following the identified method. Our results suggested that the non-identified method was safer and more useful in preventing postoperative complications following extirpation of the submandibular gland and associated tumors.
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山戸 章行, 服部 賢二, 真貝 佳代子2013 年 106 巻 8 号 p. 729-732
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありWe experienced a case of bilateral chylothorax following left neck dissection. The patient was a 70-year-old woman. For cancer of the left side of tongue base, the tongue was totally resected and reconstructed with a pectoralis major muscle flap. At the same time, a left modified radical neck dissection was performed. We found intraoperative chyle leakage, so we ligated the thoracic duct and covered it with muscle. The next day, the patient complained of dyspnea, and chylothorax was observed at both sides. Conservative treatment, such as thoracostomy tube placement, perenteral nutrition, and percutaneous administration of octreotide improved the chylothorax. Tissues around the thoracic duct should be carefully handled during neck dissection. When post-operative respiratory discomfort is found, chylothorax must also be carefully taken into consideration.
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横田 陽一, 内藤 祐介, 上田 奈津子, 滝脇 正人, 白戸 弘道2013 年 106 巻 8 号 p. 733-737
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありPapillary and follicular carcinomas arise from thyroid follicle cells, whereas medullary carcinoma originate in parafollicular cells. Since the origin of these tumor types differs, their coexistence within the same thyroid gland is rare. Mixed medullary follicular cell carcinoma is a tumor in which a follicular tumor (papillary carcinoma or follicular carcinoma) and medullary carcinoma are intermingled in the same tumor, and is furthermore considered to be a very rare disease. We report herein on a case of mixed medullary follicular cell carcinoma in which high serum Carcinoembryonic antigen (CEA) levels offered adiagnostic method.
A 66 year-old woman was introduced to our hospital with high CEA levels, and a tumor of left thyroid lobe with involvement of multiple lymph nodes of the left supraclavicular fossa was discovered on CT images. We operated on the tumor under the diagnosis of a medullary carcinoma based on the high CEA and calcitonin levels. The postoperative pathology result was mixed medullary follicular cell carcinoma. Both CEA and calcitonin levels quickly normalized after the operation, and at the time of writing no recurrence of the tumor has been seen.
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田中 浩喜, 兵 行義, 與田 茂利, 宇野 雅子, 粟飯原 輝人, 原田 保2013 年 106 巻 8 号 p. 739-746
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありDeep neck infections arising in the cervical interfascial space from odontogenic and pharyngotonsillar origins are infectious diseases which we have commonly encountered in our daily practice. In very rare cases these can lead ultimately to mediastinitis (called descending necrotizing mediastinitis). In such progressive case to mediastinitis the mortality rate is high, currently reported to reach around 40%. We experienced two cases of mediastinitis due to deep neck infection in patients having no underlying systemic diseases (diabetic and others including immunocompramised conditions). Prompt surgical drainage via the cervical and mediastinal approach is essential for the treatment of patients with descending necrotizing mediastinitis and these treatments can determine the prognosis in these patients. We must try to treat these diseases as promptly as we can with surgical drainage. Computed tomography also will help us to decide on an early diagnoses and evaluate abscesses or aerogenic images during the post-operative process.
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大原 賢三, 和田 哲治, 森合 重誉, 金井 直樹, 原渕 保明2013 年 106 巻 8 号 p. 747-751
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありMost penetrating neck injuries (PNIs) in Japan involve stab wounds. Such neck injuries are increasing through urban violence, and also include deliberate self-harm. Neck injuries penetrating the platysma or sternocleidomastoid muscle are rare.
We report herein on a 27-year-old man with a direct injury of the right common carotid artery as the result of a suicide attempt, who was able to leave the hospital with no complications.
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川田 晃弘, 宮本 佳人2013 年 106 巻 8 号 p. 753-758
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありWe experienced a case of HIV infection diagnosed at the Department of Otorhinolaryngology. The patient was a 53-year-old male who came to our clinic complaining of intractable stomatitis and angular cheilitis. Oropharyngeal candidiasis was found. He had recurrent episodes of herpes zoster. He was therefore examined for a possible immunodeficiency. He was serologically tested for HIV and was found to be positive with Western blotting. The laboratory tests for syphilis were also positive. Since the incidence of HIV and AIDS in Japan has increased gradually, otolaryngologists will get more opportunity to examine HIV positive patients. Physicians should pay attention to patients who present with HIV-associated manifestations. Early diagnosis of HIV infection could assist patients to receive appropriate treatments and prolong their lives.
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研修ノート
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大脇 成広2013 年 106 巻 8 号 p. 760-761
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありPDF形式でダウンロード (297K)
メディカル・エッセイ
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―第一編：発表直後の反応―飯沼 壽孝2013 年 106 巻 8 号 p. 763-766
発行日: 2013年
公開日: 2013/08/01
ジャーナル 認証ありRather early articles published soon after Menière’s oral presentation on February 12, 1961 were summarised and discussed. Signol & Vulpian’s article supported both Flourens’ and Menière’s articles based upon a cock which suffered from a head injury after fighting with another. The neural phenomena were confirmed by the autopsy.
Brown-Sequard’s article is against Menière based upon the animal experiments and autopsies. He insisted that injury to the acoustic nerve gave rise to spasm, vertigo, and other cerebral syptoms. Hillairet’s article is agaist Menière based upon a case of chronic otitis accompanied with necrosis of the pyramid with a large polyp. Although he suggests the action reflex upon the cerebellum and peduncles, the article depends on quotatins with hypotheses, and the evidense is lacking. As a supplement, the two manuscripts by Menière for the application of the position formerly owned by the late Itard are introduced with Menière’s signature.
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