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108 巻, 12 号
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論説
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―頸部リンパ節結核を中心に―井口 広義2015 年 108 巻 12 号 p. 887-895
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありAccording to Japan’s tuberculosis statistics, in 2014 the incidence rate of tuberculosis (TB) per 100,000 people was 15.4, and the death rate from TB per 100,000 people was 1.7. Although the incidence rate of TB in Japan has decreased year-on-year, from 18.2 in 2010 to 17.7 in 2011, 16.7 in 2012, and 16.1 in 2013, the rate still remains high compared to that in other developed countries, and Japan is ranked as an intermediate-burden country. There are very large regional differences in the incidence rate of TB, with high incidence rates in urban areas such as Osaka (36.8), Nagoya (23.2), and Tokyo (21.2); in contrast, the lowest incidence rate is 8.1 in Nagano. Additionally, the proportion of new TB patients amongst the elderly population is still high. Although pulmonary TB (PTB) is the most common type of TB, extrapulmonary manifestations are also seen. Otolaryngologists encounter extrapulmonary TB (EPTB) most commonly as cervical tuberculous lymphadenitis. The 47 cases of head and neck TB that we have seen in the past 10 years consist of 30 cases of cervical lymph node TB (63.8%), 12 of laryngeal TB (25.5%), 3 of parotid gland TB, and 2 of middle ear TB. Because TB can manifest itself in many different ways, otolaryngologists who deal with upper respiratory diseases should always be aware of the possibility of TB in clinical practice. The concurrence rate of active PTB in patients with cervical tuberculous lymphadenitis is not high, while laryngeal TB, although a less common form of head and neck TB, frequently occurs in conjunction with active PTB. Head and neck cancer is one of the high risk conditions for the development of TB, and otolaryngologists should be aware of the risk of secondary TB development in patients with head and neck cancer.抄録全体を表示PDF形式でダウンロード (892K)
カラー図説
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都築 建三2015 年 108 巻 12 号 p. 896-897
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありPDF形式でダウンロード (974K)
臨床
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平川 治男, 西 康行2015 年 108 巻 12 号 p. 899-904
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありA 69-year-old female patient visited our clinic with the complaints of dizziness, recurrent otorrhea from the left ear, and worsening tinnitus. She had undergone Bondy’s operation on the left ear in her childhood. A granulomatous lesion was detected in the left mastoid antrum 7 years and 9 months after her first visit to our clinic. The first biopsy showed mild dysplasia with dyskeratosis. A second biopsy repeated 8 months later revealed well-differentiated squamous cell carcinoma. Temporal bone CT and MRI showed the temporal bone tumor almost invading the intracranial region. Superselective intra-arterial chemoradiotherapy was administered. However, two months after this therapy, partial resection of the temporal bone was performed because of suspected residual tumor. However, histopathology revealed no viable carcinoma cells within the resected specimen. The patient has shown no signs of recurrence until now, a year after the operation. Retrospective CT evaluation showed that the CT performed 2 years and 9 months before the appearance of the granulomatous lesion showed a slight thickening of the soft tissue in the mastoid antrum. In conclusion, it must be borne in mind that carcinoma can arise from chronic otitis media, and repeated biopsy should be performed in patients with suspected carcinoma. Temporal bone CT and otoscopy at regular intervals are recommended, so that the early signs of carcinoma development are not missed. In addition, our experience suggests that superselective intra-arterial chemoradiotherapy might possibly control advanced squamous cell carcinoma of the middle ear without surgery.抄録全体を表示PDF形式でダウンロード (848K) -
若本 陽子, 山崎 博司, 岡野 高之2015 年 108 巻 12 号 p. 905-911
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありFracture of the stapes following head injury is thought to be clinically less common than displacement of the incus or disarticulation of the incudostapedial joint. We present a case of traumatic fracture of the stapes due to an indirect force without dislocation of the incudostapedial joint.
A 52-year-old male was referred to our hospital complaining of hearing loss on the left side four weeks after a traffic accident that had led to the patient sustaining multiple intracranial injuries with disturbance of consciousness. He recovered with conservative treatment and subsequently became aware of hearing loss in the left ear. A pure-tone audiogram showed a 70-dBHL conductive hearing loss with a 40-dB air-bone gap. Temporal bone computed tomography (CT) revealed disarticulation of the incudomalleolar joint and displacement of the stapes. After exploratory tympanotomy, we found disarticulation of the incudomalleolar joint, and fracture of both the stapedial crura, however, the incudostapedial joint and the footplate of the stapes were intact. Six months after type IV tympanoplasty, the patient achieved air-bone gap closure to within 15 dB.
In the present case, the incudostapedial joint was preserved, while the patient had sustained considerably forceful head injury that caused multiple intracranial injuries and dislocation of the ossicles, which is a rare form in indirect trauma of the ossicular chain. In addition, multiplanar reconstruction images of temporal bone CT allowed us to accurately diagnose the pathology of the ossicular chain in the patient.抄録全体を表示PDF形式でダウンロード (1163K) -
中田 吉彦2015 年 108 巻 12 号 p. 913-918
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありLigature of the external carotid artery (LECA) is a very effective and final method of choice in patients with excessive post-tonsillectomy hemorrhage. I report herein on the case of a 26-year-old woman who underwent LECA for an excessive post-tonsillectomy hemorrhage. Her tonsillectomy had been performed under general anesthesia for habitual angina eight days previously. In the early morning of the 8th postoperative day sudden and excessive bleeding occurred and the patient went into shock. Immediate LECA was performed under general anesthesia. The bleeding was stopped promptly and completely. Subsequently, a tracheostomy and a blood transfusion were performed. The patient was discharged 21 days after the LECA without any severe complications.抄録全体を表示PDF形式でダウンロード (517K) -
藤井 悠策, 岩田 知之, 横井 久2015 年 108 巻 12 号 p. 919-923
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありSolitary fibrous tumor (SFT) is a benign tumor originating from the mesenchyme. While many cases of SFT arising from the serosa, such as the pleura and peritoneum, have been reported, this tumor is relatively rare in the field of otorhinolaryngology. In this article, we report the case of a SFT arising in the nasal vestibule in a female patient.
The patient was a 61-year-old female in whom a SFT was discovered inside the left nasal cavity. Contrast-enhanced CT imaging revealed a heterogeneously enhancing tumor lesion in the nasal cavity. MRI showed a tumor with a uniformity of internal anatomy measuring 3 cm in diameter. On T2-weighted images, the tumor was visualized as a hyperintensity, showing uniformly strong enhancement with gadolinium. Under general anesthesia, the tumor was removed via a gingival incision. On histopathology, the tumor was partially lined by ciliated epithelium and was composed of spindle cells lacking atypia within a subepithelial fibrous framework. Some vitrifications of vasodilatation were also noted. Immunohistochemistry revealed positive staining of the tumor for CD34 and bcl-2, along with positive staining of the tumor margin for SMA and desmin. Based on the above findings, the tumor was diagnosed as SFT. After the operation, the patient has been under outpatient follow-up, and until now, 12 months since the operation, there has been no evidence of recurrence or transfer of the tumor.
Recurrence or transfer of nose/paranasal sinus SFT has not been reported to date in Japan. Complete removal of the tumor by surgery was successfully accomplished in both the previously reported cases. The first surgical removal was considered to be an important indicator to assure a favorable prognosis.抄録全体を表示PDF形式でダウンロード (788K) -
塚谷 才明, 道岸 隆敏, 横山 邦彦, 辻 志郎, 兼田 美紗子, 長谷川 博紀, 吉崎 智一2015 年 108 巻 12 号 p. 925-930
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありINTRODUCTION
The purpose of this study was to investigate the postoperative complications of thyroid surgery.
METHODS
The medical records of 206 consecutive patients who underwent thyroid surgery between April 2008 and February 2015 at our hospital were reviewed. The data of 166 patients with thyroid carcinoma (162 papillary, 1 follicular, 2 poorly differentiated, 1 anaplastic), 27 patients with benign follicular nodule, 7 patients with hyperthyroidism (6 Graves’ disease, 1 Plummer’s disease), and 3 patients with chronic thyroiditis were analyzed. Mainly, the incidences of recurrent laryngeal nerve (RLN) palsy, postoperative hemorrhage and hypoparathyroidism were evaluated.
RESULTS
Permanent RLN palsy occurred in 3 patients (1.5%); one of these 3 patients had a prior history of thyroid surgery, and the operator failed to identify the RLN in the severely scarred tissues. In another, with an extra-laryngeal RLN branch, the surgeon mistook the posterior branch as the main trunk of the RLN. Transient RLN palsy occurred in 7 patients (3.4%). No patient developed RLN palsy after the introduction at our facility of non-continuous laryngeal nerve monitoring during the operation.
Four patients (1.9%) developed postoperative hemorrhage necessitating reoperation; of these 4 patients, 3 had large follicular nodules.
Permanent hypoparathyroidism occurred in 3 of the 47 patients (6.4%) who underwent total thyroidectomy.
CONCLUSIONS
We reconfirmed the frequency of postoperative complications following thyroid surgery at our facility, and found them comparable to the results reported from other facilities.抄録全体を表示PDF形式でダウンロード (314K) -
平岡 政信, 武田 早織, 山本 良一, 山内 一真, 保富 宗城, 山中 昇2015 年 108 巻 12 号 p. 931-936
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありParathyroid cysts are comparatively rare, and are often difficult to differentiate from thyroid cysts preoperatively. Therefore, a definitive diagnosis of parathyroid cysts can be made only after surgery in most patients. We report two cases of parathyroid cysts. Parathyroid cysts are classified as functional or non-functional, depending on whether the patient exhibits features of hyperparathyroidism or not. Both of our cases reported here were classified as having non-functional cysts. It is difficult to distinguish parathyroid cysts from thyroid cysts based on the clinical and radiological findings alone. It has been reported that analysis of the cyst contents obtained by cyst puncture under ultrasonographic guidance may be a useful technique for accurate diagnosis of parathyroid cysts. Puncture and ethanol injection are good treatment alternatives for this benign disease.抄録全体を表示PDF形式でダウンロード (591K) -
栢野 香里, 鯉田 篤英, 松本 幸江2015 年 108 巻 12 号 p. 937-943
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありWe report a patient with metachronous bilateral malignant melanomas in the nasal cavity and paranasal sinuses that were attributed to submandibular lymph node metastasis.
A 65-year-old female visited our hospital with a left submandibular mass. She was diagnosed as having a left submandibular gland tumor, and surgery was performed. The histological diagnosis was lymph node metastasis from a malignant melanoma. Neither the primary lesion nor other metastatic lesions were detectable by CT, MRI, or FDG-PET. However, visual examination confirmed the presence of a black mass (approximately 1 mm in diameter) at the anterior edge of the left inferior nasal concha and blackish brown pigmentation of the mucosa of the left common nasal meatus tectorium. The primary origin was considered to be the nasal cavity. Endoscopic tumor resection and left neck dissection were performed through a left lateral rhinotomy incision. Histopathological examination revealed multicentric melanoma at the anterior edge of the left inferior nasal concha and mucosal interstitium of the maxillary sinus. No metastasis was detected in the dissected lymph nodes. The patient was diagnosed as having malignant melanoma, pT3pN1M0, stage IVA. Three cycles of adjuvant chemotherapy (DAV therapy: DTIC, ACNU, VCR) were administered. Sixty-two months after the surgery, a black lesion appeared in the right olfactory cleft. Biopsy was performed, and recurrence of malignant melanoma was confirmed. The tumor was endoscopically resected through a right lateral rhinotomy incision. Melanoma lesions were observed in the right anterior ethmoid and right sphenoid sinuses. Three cycles of adjuvant chemotherapy (DAC-Tam therapy: DTIC, ACNU, CDDP, TAM) were again administered. At present, 89 months after the surgery, the patient remains free of recurrence or metastasis.
Malignant melanomas, even small ones, can metastasize early to the lymph nodes. Since they are sometimes multicentric, an examination of the entire body and extensive resection with an adequate safety margin, such as total resection of the sinonasal mucosa, are necessary.抄録全体を表示PDF形式でダウンロード (1047K)
研究
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―放射線単独および他の化学放射線療法との比較検討―永野 広海, 宮本 佑美, 井内 寛之, 地村 友宏, 馬越 瑞夫, 牧瀬 高穂, 川畠 雅樹, 宮下 圭一, 原田 みずえ, 宮之原 郁代 ...2015 年 108 巻 12 号 p. 945-950
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありObjective: The aim of this study was to evaluate any acute adverse effects of cetuximab with radiotherapy (bioradiotherapy: BRT) on head and neck compare a to radiotherapy and chemoradiotherapy (CRT, using CBDCA, CDDP, TPF therapy) for head and neck cancer.
Materials and Methods: We treated 18 patients (13 men and 5 women) with squamous cell carcinoma of oral cavity, larynx, oropharynx, nasopharynx, or hypopharynx. The median age was 64.4 years (range, 43–80 years). Patients received BRT (cetuximab: first time, 400 mg/m2/day, second time, 250 mg/m2/day). The neutrophil cell count, weight loss, stomatitis and dermatitis were compared to CRT.
Results: There was no significant difference in the incidences of weight loss in BRT compared with radiotherapy (P=0.71) and chemoradiotherapy (CBDCA: P=0.71, CDDP: P=0.36, TPF therapy: P=0.36). There was no significant difference in decrease of the neutrophil cell count in BRT compared with radiotherapy (P=0.06). There were statistically significant decreases of the neutrophil cell count in BRT and chemoradiotherapy (CBDCA: P=0.02, CDDP: P=0.05, TPF therapy: P=0.005). There were no significant differences in the incidences of stomatitis in BRT compared with radiotherapy (P=0.13) and chemoradiotherapy (CBDCA: P=0.10, CDDP: P=0.19). There was a statistically significant difference in the incidence of stomatitis in BRT compared with chemoradiotherapy (TPF: P=0.03). There were no significant differences in the incidences of dermatitis in BRT compared with radiotherapy (P=0.89) and chemoradiotherapy (CDDP: P=0.14, TPF: P=0.53). There was a statistically significant difference in the incidences of dermatitis in BRT compared with chemoradiotherapy (CBDCA: P=0.03).
Conclusion: The frequency of acute adverse event of BRT and radiotherapy was the same. BRT was more safe compared with another form of chemoradiotherapy.抄録全体を表示PDF形式でダウンロード (864K) -
五島 史行2015 年 108 巻 12 号 p. 951-954
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありIt is common to see patients with hidden depression and anxiety complaining of somatic symptoms. These patients are labeled as having “psychosomatic disorder”. The percentage of patients diagnosed as having psychosomatic disorders differs among institutes. Among patients presenting to the otolaryngology department of general hospitals, 2–30% are estimated to suffer from psychosomatic disorder. These patients often have depression or anxiety and it is necessary for the otolaryngologist to have the skills to handle these symptoms as a primary care physician. The treatment options include antidepressants, anti-anxiety drugs, and sleeping pills. This study was conducted to investigate the rates of prescription of these drugs in the department of otolaryngology of general hospitals. In all, 19 (18.4%) doctors prescribed antidepressant drugs, fewer than the numbers of doctors prescribing sleeping pills and anti anxiety-drugs. These drugs were prescribed for the symptom of dizziness or tinnitus. Among the reasons for the low rate of prescription of antidepressant drugs are the fear of adverse reactions and poor knowledge of the prescribing information about the drugs among the doctors. The findings reveal that doctors at the department of otolaryngology seldom have the skill to handle patients with depression. It is necessary for otolaryngologists to equip themselves with the skills to treat patients with psychosomatic disorders.抄録全体を表示PDF形式でダウンロード (419K)
研修ノート
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佐々木 亮2015 年 108 巻 12 号 p. 956-957
発行日: 2015年
公開日: 2015/12/01
ジャーナル 認証ありPDF形式でダウンロード (409K)
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