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108 巻, 7 号
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論説
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香取 幸夫2015 年 108 巻 7 号 p. 501-505
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありSurgical procedures for prevention of intractable aspiration have been established and performed in patients with severe dysphagia. In this review, typical methods, namely, epiglottic tube-plasty, laryngotracheal diversion, glottal closure and narrow-field laryngectomy are introduced. Postoperative vocal loss is an anticipated demerit in this series of surgeries, however, the patients become free from life-threating pneumonia. In addition, oral intake will become possible in many cases. The surgeries for preventing aspiration described here should be considered more widely for patients with recurrent intractable pneumonia.抄録全体を表示PDF形式でダウンロード (553K)
カラー図説
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山下 拓2015 年 108 巻 7 号 p. 506-507
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありPDF形式でダウンロード (809K)
臨床
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藤 さやか, 竹野 幸夫2015 年 108 巻 7 号 p. 509-516
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありTo reveal the clinical characteristics of pediatric acute rhinosinusitis in the intermountain region, we performed nasal culture bacteriological tests and examined the background factors and the efficacy of treatments.
We collected retrospectively the bacteriological test results, patient background factors, and histories of antibiotic use for 106 pediatric outpatients with acute rhinosinusitis who had undergone nasal culture tests at the Shobara Red Cross Hospital between April 2011 and January 2012. We analyzed the relationship among these factors, the risk of emergence of resistant bacteria, and the therapeutic outcome (cure group/resistant group).
There were 67 males and 39 females and the median age was 33.5 months. There were 23 mild cases, 77 moderate cases, and 6 severe cases. We obtained 55 Moraxella catarrhalis strains, 54 Haemophilus influenzae strains, and 29 Streptococcus pneumoniae strains in all 157 strains. These three bacterial species accounted for 88% of all. There were 21 strains of β-lactamase non-producing ampicillin resistant (BLNAR) and 13 strains of penicillin intermediate S. pneumoniae (PISP). Earlier age (5 years and under) was a significant risk factor for the emergence of resistant bacteria unlike in the case of group nursing. The therapeutic outcomes of each severity level were 21/2 (mild), 51/26 (moderate), and 2/4 (severe), respectively. The moderate and severe cases were significantly more resistant to treatment than mild cases. With regard to the moderate cases, both the group of administration of penicillin antibiotic by mouth and non-administration antibiotic group were significantly more resistant to treatment than the group of administration of cephem antibiotic by mouth. Earlier age, group nursing, and presence or absence of resistant bacteria did not affect the severity level and therapeutic outcome unlike in the case of administration of antibiotics.
It is important for antimicrobial treatment of pediatric acute rhinosinusitis to use antimicrobials properly according to the scoring system along with an understanding of the clinical background.抄録全体を表示PDF形式でダウンロード (446K) -
石井 秀将, 羽嶋 正明, 津村 薫, 河野 崇志, 岩田 和宏2015 年 108 巻 7 号 p. 517-523
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありWe retrospectively evaluated 13 cases of orbital fracture in children younger than 15-year-old treated at Hiroshima City Asa Hospital from 2006 to 2012. Seven cases (53.8%) had nausea and vomiting immediately after the injury due to activation of the oculo-vagal reflex. Coronal-view computed tomographic images showed that the inferior wall was fractured in 10 cases. Among them, two cases (20%) had the punched-out type of fracture, three cases (30%) had open-door type fracture, and five cases (50%) had linear-type fracture. All of the five cases with linear-type fracture required urgent surgical intervention. In all cases, gaze impairment was relieved after the operation, however, minor residual diplopia persisted in the three cases who showed the “missing rectus sign” on the preoperative CT. Pediatric orbital fracture is a true surgical emergency. Early diagnosis and surgical repair are crucial.抄録全体を表示PDF形式でダウンロード (927K) -
木村 寛, 將積 日出夫2015 年 108 巻 7 号 p. 525-529
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありMixed connective tissue disease (MCTD) is a collagen disease of unknown origin characterized by the combination of the symptoms similar to systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and positive anti-U1-RNP antibody. We herein report on the case of a 62-year-old female who first presented with left dysgeusia, together with numbness of the left cheek. After an otorhinolaryngological examination she was examined in the neurological department. The neurological examination clearly showed left trigeminal sensory neuropathy in the maxillary and mandibular nerves. Additionally, in this examination Raynaud’s phenomenon, swollen hands, and sclerosis of the fingers were also found. The laboratory examination showed leucopenia and positive anti-U1-RNP antibody. These clinical manifestations and laboratory findings are consistent with a diagnosis of MCTD. The trigeminal sensory neuropathy is also associated with MCTD. We suggested that the left dysgeusia and numbness of the left cheek were due to trigeminal sensory neuropathy. The above symptoms were treated, but failed to improve. We suggested that MCTD should be considered in the differential diagnosis when a patient complains of unilateral dysgeusia and numbness of the cheek. To the best our knowledge, in Japan, our case is the first otorhinolaryngological report on dysgeusia due to MCTD.抄録全体を表示PDF形式でダウンロード (348K) -
長谷川 博紀, 室野 重之, 吉崎 智一2015 年 108 巻 7 号 p. 531-534
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありPyriform sinus fistula is a rare disease that is associated with recurrent suppurative thyroiditis and neck abscess. However, it is difficult to remove the fistula radically. Furthermore, patients, especially children, need to tolerate the burden of emotional and physical stress. Recently, chemocauterization of the internal opening of the fistula using trichloroacetic acid (TCA) was reported as a safe and reliable treatment procedure for this disease.
Here, we report the case of a 13-year-old girl who was diagnosed as having a right pyriform sinus fistula and was treated by chemocauterization with TCA. The internal opening of the fistula could be easily observed under a laryngoscope, which allowed the chemocauterization to be performed without any difficulty. No complications were observed during or after the procedure.
Until date, 15 month since the treatment, the patient remains free of recurrence. Based on our experience, we suggest that chemocauterization with TCA is a useful and safe treatment for pyriform sinus fistula.抄録全体を表示PDF形式でダウンロード (434K) -
小野 麻友, 大脇 成広, 清水 猛史2015 年 108 巻 7 号 p. 535-539
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありWe describe herein a case of bilateral arytenoid dislocation caused by self-extubation in a 17-year-old man. He was injured in a motor vehicle accident. He had convulsions, and the emergency medical technician performed intubation. By the time he arrived at our hospital, self-extubation had occurred, and we intubated again.
Four days after the extubation incident, the patient complained of hoarseness and coughing. A fiberoscopic examination revealed immobile bilateral vocal cords in the dilated position and the vocal cords were under tension. Bilateral arytenoid dislocation was suspected from the fiberoscopic and CT findings.
Using a laryngo-microsurgery approach, we raised his bilateral arytenoids using a balloon catheter filled with 2 ml water. After the operation, his vocal cords regained mobility and his voice recovered completely.抄録全体を表示PDF形式でダウンロード (494K) -
原田 博之, 篠原 尚吾, 藤原 敬三, 末廣 篤, 岸本 逸平, 桑田 文彦, 内藤 泰2015 年 108 巻 7 号 p. 541-547
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありIn East Asians, a strong association has been reported to exist between a past or current history of facial flushing after a small dose of alcohol (flushers) and heterozygosity for inactive aldehyde dehydrogenase-2 (ALDH2); furthermore, individuals with the latter have been shown to have a higher relative risk of alcohol-related oral and esophageal cancers as compared to individuals with wild-type ALDH2 alleles.
The purpose of this study was to examine whether flushers with oral or/and pharyngeal squamous cell carcinoma might also at a higher risk of synchronous or metachronous cancers of the upper gastrointestinal (UGI), and to clarify the relationship between the risks associated with flushing and those associated with alcohol and smoking.
This is a retrospective study conducted using a questionnaire and medical chart review. We sent a questionnaire to 240 patients or families of patients treated for head and neck squamous cell carcinomas (HNSCCs) from 2004 to 2011, to determine if the patients had a past or current history of flushing after a small dose of alcohol, and also whether they were habitual smoker or drinkers; the 121 patients or their families who replied were enrolled in this study. In addition to being classified as flushers or non-flushers, the patients were dichotomized into heavy smokers (≧10 pack-years) and non-heavy smokers, and into heavy drinkers (consumption of ≧20 g of alcohol per day) and non-heavy drinkers. We evaluated the relationships among these factors and the occurrence of second primary cancers in the UGI tract.
Flushers showed a higher incidence of second primary cancers (22% v.s. 11% in 5 years), although the difference was not significant. Univariate analysis showed a higher hazard ratio in heavy drinkers than in flushers or smokers, however, this was also not statistically significant. Multivariate analyses showed that a history of flushing was associated with a higher hazard ratio than drinking or smoking habit, however, the difference were not significant.
A simple interview about the drinking habit and history of facial flushing after a small dose of alcohol may be useful for identifying patients at high risk for HNSCC.抄録全体を表示PDF形式でダウンロード (524K) -
鈴木 学, 櫟原 新平, 東野 正明, 寺田 哲也, 河田 了2015 年 108 巻 7 号 p. 549-554
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありAn 85-year-old woman was referred with a left-side pre- and infra-auricular mass. She had no complaints such as pain and facial paresis with the exception of the large mass. In the past history, she had undergone four operations for a parotid gland tumor. The CT scan showed a 110×80 mm mass arising from the parotid gland. MRI imaging indicated a smooth and encapsulated mass. The pre-operative diagnosis was a large pleomorphic adenoma of the parotid gland. In the intraoperative findings, the tumor was located in the deep lobe and some branches of the facial nerve were sacrificed to remove the tumor. The extirpated tumor was 12 cm in diameter and weighed 570 g. Based on the histopathological findings, the tumor was diagnosed as pleomorphic adenoma without malignant change. Early operative removal of the tumor should be performed as much as possible in case of pleomorphic adenoma of the parotid gland due to the possibility of malignant change and the increasing size of the tumor.抄録全体を表示PDF形式でダウンロード (895K) -
岡 直人, 寺田 友紀, 宇和 伸浩, 佐川 公介, 毛利 武士, 貴田 紘太, 岡 秀樹, 美内 慎也, 森川 朋子, 阪上 雅史2015 年 108 巻 7 号 p. 555-559
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありApocrine carcinomas are a rare condition. In this report, a case of an apocrine carcinoma (AC) of the inferior eyelid is described.
A 55-year-old male patient was examined for right exophthalmos without diplopia, oculomotor dysfunction, or vision and visual field disorders. A tumor was identified in the right nasal cavity, and on palpation, the right inferior eyelid was indurated, and there was no palpable lymphadenopathy in the cervical region. AC was diagnosed by biopsy and immunostaining for GCDFP-15. A tumorectomy and reconstructive surgery were performed. No additional treatment was performed because the tumor margin was pathologically negative. We initially followed the patient postoperatively, but the patient on his own accord declined further examination. After three years of absence, the patient returned to our facility with the chief complaint of right cervical swelling. A fine-needle aspirate of the cervical swelling showed an adenocarcinoma. Because this tumor was a recurrence, the patient underwent a right modified radical neck dissection (m-RND). After two years of follow-up, a left cervical swelling was identified. He underwent a left m-RND and received titanium silicate chemotherapy for 6 months. However, brain metastasis was diagnosed on contrast-computed tomography. Chemotherapy was planned, but he died before receiving treatment.抄録全体を表示PDF形式でダウンロード (823K) -
上村 明寛, 朝日 淳仁, 野村 研一郎, 原渕 保明2015 年 108 巻 7 号 p. 561-568
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありWe report herein on a rare case of a solitary fibrous tumor in the anterior neck. A 45-year-old man visited our hospital with the chief complaint of a mass of the anterior neck. CT scan and MRI revealed that the inside of the tumor had a solid pattern. Fine needle aspiration cytology showed no malignant cells. Because the tumor had increased in size compared to the CT findings of 7 years previously, we removed the tumor. Based on the pathological examination, the tumor was diagnosed as a solitary fibrous tumor. Immunohistochemical staining was positive for CD34, vimentin, and the NAB2-stat6 fusion gene. Solitary fibrous tumors originated from the anterior neck have been relatively rare.抄録全体を表示PDF形式でダウンロード (855K) -
山浦 明日香, 田畑 貴久, 若杉 哲郎, 池嵜 祥司, 大久保 淳一, 永谷 群司, 鈴木 秀明2015 年 108 巻 7 号 p. 569-574
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありHypopharyngeal cancer is the second most common of the head and neck cancers in Japan. We retrospectively analyzed 77 fresh cases of hypopharyngeal cancer who were treated in our department between 2005 and 2013. They were 69 males and 8 females, aged 49 to 81 years with an average of 65.3 years.
Our treatment protocol was as follows: For T1/2 cancers, hyperfractionated radiotherapy with concurrent daily carboplatin (25 mg/m2) was performed. Responders at 30–40 Gy continued receiving chemoradiotherapy to a total of 72 Gy whereas nonresponders underwent surgery. For T3/4 cancers, 1–2 courses of induction chemotherapy (docetaxel 60 mg/m2 [day 1], cisplatin 60 mg/m2 [day 1], and 5-fluorouracil 600 mg/m2 [days 1–5]) were performed. Responders of T3 patients and good responders of T4 patients were then given chemoradiotherapy whereas the other T3/4 patients underwent surgery after induction chemotherapy.
The overall 5-year crude and disease-specific survival rates determined by the Kaplan-Meier method were 58.0% and 68.1%, respectively. The survival rates were significantly higher in patients at stage II/III than in those at stage IV. The overall laryngeal preservation rate after primary treatment was 58.4%. The laryngeal preservation rate was significantly higher in patients of T1/2 than in those of T3/4 (T1: 100%, T2: 93.3%, T3: 53.3%, T4: 25.8%). The survival rate of T3/4 patients did not differ between the laryngeal preservation and removal groups.
The overall survival and laryngeal preservation rates could be improved by the early detection of hypopharyngeal cancers and by altering the treatment protocol for advanced cancers.抄録全体を表示PDF形式でダウンロード (484K)
研修ノート
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阿部 晃治2015 年 108 巻 7 号 p. 576-577
発行日: 2015年
公開日: 2015/07/01
ジャーナル 認証ありPDF形式でダウンロード (504K)
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