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前身誌
106 巻, 9 号
選択された号の論文の16件中1～16を表示しています
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論説
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大久保 公裕, 後藤 穣2013 年 106 巻 9 号 p. 769-775
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありWe introduce evidence for the efficacy of allergen immunotherapy, including sub-cutaneous immunotherapy (SCIT) and sub-lingual immunotherapy (SLIT), which are used internationally now. There is not the exact methodology established methodology, but a lot of succesful case reports, so SCIT is still used in Japan. The effect is large enough by the proper SCIT method form its evidence including the meta-analysis data. However, judging from the care setting in Japan, various problems still need to be resolved. Therefore, the SLIT approach, which appears to be the more easy-to-adopt approach, has received much attention inotherco-untries. Comparison of these two currently used routes for immunotherapy is still much debated. There are a large number of patients and doctors that are willing to the safer SLIT in Japan. Practical use of SLIT for pollinosis caused by Japanese cedar pollen is expected to be introduced in 2014.
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カラー図説
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中平 光彦2013 年 106 巻 9 号 p. 776-777
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありPDF形式でダウンロード (668K)
臨床
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狩野 有加莉, 下郡 博明, 菅原 一真, 樽本 俊介, 山下 裕司2013 年 106 巻 9 号 p. 779-781
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありCongenital cholesteatoma of the external auditory canal is a rare disease. We report a 3-year-old male child with congenital cholesteatoma of the left external auditory canal. A white mass existed at 10-12 o’clock of the canal. In computed tomography (CT) of the temporal bone, a low-density lesion was located in contact with the tympanic membrane, but not clearly invaded the middle ear cavity. Treatment consisted of removal using an endoscope. At the 7-month postoperative follow-up there was no evidence of any relapses. We discuss herein the indication of surgery for congenital cholesteatoma of the external auditory canal.
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北野 雅子, 竹内 万彦2013 年 106 巻 9 号 p. 783-789
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありKeloids and hypertrophic scars often present difficulties in treatment. Patients have cosmetic and psychological problems from the shape, pain and itching, so keloids are referred to as a ‘psycological malignant tumor’. We herein present a case of an auricular keloid of 25 mm in diameter which developed from a pierce hole. The tumor was treated with surgical excision, postoperative irradiation (16Gy/4fr) and oral administration of tranilast. At ten months after the treatment, no recurrence of the keloid has been seen. Excision should be carefully performed to give perfect obliteration followed by precise suture closure. Postoperative irradiation is effective for prevention of recurrence. Optimal total doses and fractions have been discussed in many papers, and we should treat on the basis of the fact that auricular keloids tend to relapse more than ear lobe keloids. Many treatments for keloids and hypertrophic scars have been reported, but the combination of the above therapeutic approaches is necessary to treat keloids and hypertrophic scars successfully and obtain a better therapeutic result. It is important to keep in mind that keloids tend to recur and need long term follow up.
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平川 治男, 西 康行, 渡部 泰輔, 多田 誠, 上田 勉, 佐々木 淳2013 年 106 巻 9 号 p. 791-795
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありExtraskeletal osteosarcoma (ESOS) is an extremely rare malignancy arising from the soft tissue. The predominant site of origin of ESOS is the lower limbs, the thigh. ESOS arising in the head and neck region is extremely rare. This is the first report of ESOS of the ear, to the best of our knowledge. We describe a case of ESOS arising from the subcutaneous tissue in the cartilaginous external acoustic meatus.
A 53-year-old man consulted our ENT department in the end of May 2009, complaining of inability to insert a cotton bud into the external acoustic meatus. Examination revealed an elastic-hard tumor arising from the posterior wall of the meatus, occluding the cartilaginous meatus. The eardrum was intact. Plain CT of the temporal bone showed calcification of the lesion arising from the meatus. There was no evidence of bone involvement. Biopsy performed in the middle of July revealed suspected chondrosarcoma. At the beginning of August, an operation was performed; the tumor was removed en bloc with the surrounding tissues including a part of the auricular cartilage, the temporal periosteum, and the meatus skin. Pathological examination confirmed the diagnosis of ESOS. At present, the patient is still alive with no evidence of recurrence of the disease.
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金村 亮, 合田 正和, 神村 盛一郎, 中川 英幸, 宇高 二良, 田村 公一, 武田 憲昭2013 年 106 巻 9 号 p. 797-802
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありWe report herein on a case with pyoderma gangrenosum in the nasal root associated with ulcerative colitis. Pyoderma gangrenosum is characterized by progressive skin necrosis and is often associated with chronic bowel inflammatory diseases such as ulcerative colitis and Crohn’s disease. Although it bears a clinical resemblance to self-destructive abscesses or bacterial infection of the soft tissues, no bacteria and non-effects of antimicrobial agents were observed and the drainage of the abscess and debridement of necrotic tissue is contraindicated in patients with pyoderma gangrenosum. The treatment of the underlying disease is also effective for the treatment of pyoderma gangrenosum. In the present case, a steroid and mesalazine were effective for both the pyoderma gangrenosum and ulcerative colitis.
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生駒 亮, 坂根 さやか, 丹羽 一友, 折舘 伸彦2013 年 106 巻 9 号 p. 803-808
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありWe report herein on our experience of a case of IgD multiple myeloma with cavernous sinus syndrome and an orbital tumor. Left blepharoptosis and left eye movement disorder were observed associated with the cavernous sinus syndrome. The orbital tumor was biopsied using the endoscopic endonasal transparanasal technique and was diagnosed as an IgD multiple myeloma. The left blepharoptosis and left eye movement disorder recovered fully following ROAD-IN therapy. Based on our experience we believe that the endoscopic endonasal transparanasal technique could be applied as an approach to orbital lesions.
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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 9 号 p. 809-816
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありSquamous cell carcinoma of the submandibular gland is an extremely rare salivary gland cancer ranging from 0.015 to 0.045 percent of all head and neck cancers, and is associeted with a poor prognosis. Granulocyte-colony stimulating factor (G-CSF) producing tumors also have a poor prognosis. This type of tumor produces G-CSF itself, which promotes tumor growth, thereby potentially accelerate the clinical progression of the disease through an additional synergic effect. The present study describes our experience in treating a patient who was thought to have a G-CSF-producing squamous cell carcinoma of the submandibular gland.
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河合 保典, 寺田 友紀, 宇和 伸浩, 佐川 公介, 貴田 絋太, 阪上 雅史2013 年 106 巻 9 号 p. 817-821
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありAmyloidosis is a condition in which amyloid, a specific protein with a fibrous structure, is deposited extracellularly. We report herein on a case of localized amyloidosis of the tongue. A 50-year-old female presented with a small mass on the dorsal tongue. Histopathological examination revealed that tumor was formed by amyloidosis containing an amyloid protein, ALκ protein. It is classified as systemic or localized amyloidosis according to the degree of spread of the disease. Examination of the whole body showed no sign of amyloid deposit in other organs.
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平賀 幸弘, 黄 淳一2013 年 106 巻 9 号 p. 823-829
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありTwo patients of IgG4-related Mikulicz’s disease (IgG4-RD) with Progressive Transformation of Germinal Centers (PTGC) arising in the submandibular glands are reported.
The patients were a 58-year-old male and 39-year-old female who fulfilled the clinico-pathological diagnostic criteria for IgG4-RD, including (1) markedly elevated serum IgG4 level, (2) bilateral swelling of the submandibular and lachrymal glands, and (3) microscopic finding of an IgG4+/IgG+ plasma cell ratio of more than 40% in the germinal centers.
Histopathologically, PTGCs are characterized by hyperplastic germinal centers composed of mantle zone lymphocytes and remnant of large germinal center cells with follicular lysis.
Complete resection is the only treatment for PTGC. However, in patients with IgG4-RD, administration of a corticosteroid might be recommended and efficacious. Because of the possibility of recurrence or malignant transformation after surgery or other treatments, close follow-up is mandatory.
To the best of our knowledge based on a thorough search of the literature, there is only one report other than ours of PTGC arising in the submandibular glands in a patient with IgG4-RD.
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吉田 卓也, 東野 正明, 河田 了, 栗栖 義賢, 辻 求2013 年 106 巻 9 号 p. 831-835
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありThe accessory parotid gland tissue has been described as salivary tissue adjacent to Stensen’s duct that is distinctly separate from the main body of the parotid gland. It is said that approximately 21% of human parotid glands have an accessory component.
We report herein on a case of an accessory parotid gland tumor in the left mid-cheek. A 35-year-old woman presented with over 20-year history of a slowly growing and painless tumor in the left mid-cheek. The diagnosis of a pleomorphic adenoma arising from the accessory parotid gland was suggested based on the examination of MRI findings and fine needle aspiration cytology. The following surgical approaches for removing mid-cheek masses have been reported: a direct incision over the mass; the intraoral approach; and the standard parotidectomy approach. We chose s-shaped incision approach which allows safe preservation of the facial nerve, although it requires a large skin incision. This approach has advantages of providing a wide operation field to preserve the facial nerve and avoiding enucleation of the pleomorphic adenoma. After removal of the tumor, despite the appearance of slight transient facial nerve weakness in the buccal region, there were no other postoperative complications.
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坂根 さやか, 生駒 亮, 丹羽 一友, 折舘 伸彦2013 年 106 巻 9 号 p. 837-841
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありA 54-year-old woman complained of anterior neck pain. Computed tomography showed a calcification at the base of the tongue. Her symptoms had appeared just after a meal, so we suspected that the calcification was from a foreign body. Direct laryngoscopic extirpation was performed under general anesthesia. We diagnosed the condition as lingual tonsil lithiasis, because the calcified body was composed mostly of calcium phosphate.
The etiology of palatine and lingual tonsil lithiasis is discussed with reference to the literature.
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石永 一, 大津 和弥, 宮村 朋孝, 竹内 万彦2013 年 106 巻 9 号 p. 843-846
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありWe performed a retrospective review of 1265 surgical procedures performed at our department between January 2007 and December 2011. We identified 20 patients with post-operative hemorrhage in head and neck surgery. The procedure most often complicated by wound bleeding was parotidectomy (6.5%), followed by laryngectomy (3.9%). Symptoms of hemorrhage developed within was obsevued 12 hours in 85% of the patients. However, delayed hemorrhage, more than 24 hours after the operations, in two cases. In our study, two cases of laryngeal edema were found after re-operation, with tracheostomy necessitated in one case.
Careful hemostasis and early recognition with immediate intervention are required to prevent severe complications after head and neck surgery.
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進藤 彰人, 徳丸 裕, 藤井 正人2013 年 106 巻 9 号 p. 847-851
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありWe report the case of a patient who developed complex regional pain syndrome type I, after operation for tongue cancer. A 62-year-old male underwent excision for tongue cancer, followed by reconstruction, using a left free forearm flap. Nine re-operations were required after the primary operation. Two months after the first operation, the patient complained of pain and swelling in his left hand, which spread from his left hand to the upper part of the arm and also to the right side. The range of motion of both shoulders was limited. An x-ray of the hands showed bone atrophy, thermography showed coldness, and the hand grip was weak. Based on the findings, the patient was diagnosed as having complex regional pain syndrome type I. He was started on medication and rehabilitation. The symptoms have improved slowly, and at present, 3 years after the diagnosis, most of the symptoms have disappeared, except for the left hand being numb, and the patient is able to lead an ordinary life.
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研修ノート
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北原 糺2013 年 106 巻 9 号 p. 852-853
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありPDF形式でダウンロード (568K)
メディカル・エッセイ
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―第二編：優先権の主張と先行―飯沼 壽孝2013 年 106 巻 9 号 p. 855-858
発行日: 2013年
公開日: 2013/09/01
ジャーナル 認証ありTwo claims of priority to Menière’s report are evaluated. The first claim was from Deleau who officially corresponded with Gaz.méd. immediately after Menière’s oral presentation.
Deleau’s claim was based upon the classical idea of SYMPATHY.
This idea had already been rejected by the Academy in 1837, thus Deleau’s claim was invalid. The second was from Pirquet who wrote in his textbook in 1865, that what Menière reported had a long time ago been confirmed by both Saissy and Pirquet. When we checked the original monographs by both of them, although some similarities in the labyrinthine lesions as shown by autopsies were seen, the alleged patients had shown none of the symptoms matched with Menière’s. Thus, Pirquet’s claim is unreliable. The third was not a claim, but the conclusions of the famous experiments by Flourens in 1830. In the fifth paragraph of his conclusions, Flourens declared that the similar symptoms observed by various human maladies would be elucidated based upon his experiments related to the lesions of the semicircular canals. This had unfortunately escaped Menière’s citation.
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