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109 巻, 3 号
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論説
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朝蔭 孝宏2016 年 109 巻 3 号 p. 147-154
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありWe carried out this study to clarify the treatment outcomes and problems associated with induction chemotherapy (using taxotere, cisplatin and 5-FU [TPF therapy]) in patients with hypopharyngeal or oropharyngeal cancer. The data of a total of 83 patients with hypopharyngeal cancer (including 14, 29, 23 and 17 patients with T1, T2, T3 and T4 disease, respectively, and 61, 13 and 9 patients with pyriform sinus (PS), posterior wall (PW) and postcricoid (PC) involvement) and oropharyngeal cancer (including 1, 7 and 25 patients with stage II, stage III and stage IV disease, respectively, and 26, 6 and 1 patients with side wall, front wall and upper wall involvement) were analyzed retrospectively. The main therapies employed in the patients with hypopharyngeal cancer were as follows: transoral surgical resection plus radiation therapy for T1 disease, radiation therapy, induction chemotherapy and partial resection for T2 disease, induction chemotherapy, radiation therapy and pharyngo-laryngoesophagectomy for T3 disease, and pharyngo-laryngoesophagectomy plus induction chemotherapy for T4 disease. The 5-year larynx preservation rates in the patients with T1, T2, T3 and T4 disease were 100%, 73%, 39% and 35%, respectively. Our strategies yielded improved larynx preservation rates without adversely affecting the survival rates. However, the treatment method for T3 disease needs to be improved, because a large number of recurrences and deaths due to the primary disease were encountered in this patient group. The feasibility, incidence of neutropenia, response rate, and 3-year disease-specific survival rate in the induction chemotherapy group were 70%, 88%, 82% and 73%, respectively. A statistically significant difference in the 3-year disease-specific survival rate was seen between the p16-positive and p16-negative patients in the induction chemotherapy group: while the rate was 100% in the p16-positive patients, it was only 51% in the p16-negative patients (p = 0.004).抄録全体を表示PDF形式でダウンロード (523K)
カラー図説
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金谷 洋明, 今野 渉, 春名 眞一2016 年 109 巻 3 号 p. 156-157
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありPDF形式でダウンロード (1089K)
臨床
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梅原 毅, 渡辺 真世, 袴田 桂, 大嶋 吾郎, 鈴木 克佳, 岩永 健, 山口 裕貴, 新井 宏幸, 喜夛 淳哉, 佐原 聡甫, 林 泰 ...2016 年 109 巻 3 号 p. 159-166
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありFunctional hearing loss is often misdiagnosed as sensorineural hearing loss, and patients may be forced to receive unnecessary treatment. In this study, we examined the clinical characteristics of children with functional hearing loss. A total of 37 children with functional hearing loss (55 ears) diagnosed over the past 7 years were enrolled. The subjects comprised 8 boys and 29 girls, with an average age of 10.7 years (range, 5–17). While 7 of these children were found incidentally to have hearing loss during school health examination, the remaining 30 children visited our hospital with symptoms. Twenty-one children had functional factors, and 16 children were not conscious of their hearing loss. Interestingly, almost a half of the children (51.4%) had only unilateral hearing loss. Pure-tone audiometry showed moderate-severe horizontal-type hearing loss in most cases. In self-recording audiometry by Bekesy, 47% of the ears showed Jerger type V, a unique, but not specific, finding, in cases of functional hearing loss. All children showed normal response in the stapedius reflex (SR) test and auditory brainstem response (ABR). ABR was most useful and SR was useful as a screening test for functional hearing loss. Boys and children with unilateral hearing loss showed a good prognosis, which was not dependent on the severity of the hearing loss.抄録全体を表示PDF形式でダウンロード (1098K) -
後藤 真一, 長岐 孝彦, 白崎 隆, 太田 修司, 松原 篤2016 年 109 巻 3 号 p. 167-170
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありWe report herein on a case of a copepod parasite identified in the left nasal cavity. An 80-year-old woman visited our hospital with a chief complaint of delusions of parasitosis of the nails, skin, and nasal cavity. A foreign body that looked like a worm was detected in the left nasal cavity and removed. This appeared to be a parasite called a copepod. The patient was diagnosed by the mental health department as having skin delusional parasitosis due to dementia. Although the route of infection to the nasal cavity is unknown, there is a possibility that the patient inserted the copepod into the nasal cavity herself, to justify her symptoms of delusions of parasitosis.抄録全体を表示PDF形式でダウンロード (368K) -
齋藤 善光, 宮本 康裕, 明石 愛美, 阿久津 征利, 藤田 聡子, 三上 公志, 春日井 滋, 中村 学, 赤澤 吉弘, 谷口 雄一郎, ...2016 年 109 巻 3 号 p. 171-176
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありHyoid bone syndrome is a disease caused by an abnormality in the apparatus hyoideus, indicated by a variety of symptoms such as a feeling of discomfort in the pharyngolarynx, neck pain, a clicking sound when twisting the neck, etc. We report on two cases of hyoid bone syndrome accompanying an excessively long greater cornu of the hyoid bone.
Case 1 consulted the hospital with the excessively long of discomfort when swallowing along with a clicking sound when swallowing from several years prior. The greater cornu of the hyoid bone on both sides was found to be long upon neck CT, in addition to approaching the transverse process of the fourth cervical vertebra. Case 2 became aware of neck pain from 1 year prior and consulted the hospital due to exacerbation of the symptoms. The excessively long greater cornu of the hyoid bone was observed on both sides of neck on CT imaging, with the greater cornu of the hyoid bone approaching the transverse process of the third cervical vertebra. From the above, the patient was diagnosed with hyoid bone syndrome accompanying an excessively long greater cornu of the hyoid bone on both sides, with prominent improvement in symptoms observed when partial resection of the bilateral greater cornu of the hyoid bone was carried out, yielding good results.
Although such cases may be diagnosed as pharyngolaryngeal paresthesia, when symptoms are observed over a long period of time and the complaint is strong and clear, an in-depth examination including imaging testing is required. Moreover, it was believed that resection of the greater cornu of the hyoid bone is a useful treatment for hyoid bone syndrome.抄録全体を表示PDF形式でダウンロード (592K) -
小林 徹郎, 庄司 和彦, 堀 龍介, 児嶋 剛, 岡上 雄介, 藤村 真太郎, 奥山 英晃2016 年 109 巻 3 号 p. 177-181
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありA 67-year-old patient who had been diagnosed as having an esophageal foreign body and had undergone an unsuccessful endoscopic removal at a different hospital was referred to our department. Esophageal rupture, cervical emphysema and a cervical abscess associated with a foreign body between the hypopharynx and the cervical esophagus caused by unintentional ingestion of a partial denture were diagnosed on close examination. The partial denture between the hypopharynx and the cervical esophagus was removed through a cervical incision. The patient made good progress without having any serious complications. We recommend foreign body retrieval through a cervical incision when an endoscopic approach is difficult.抄録全体を表示PDF形式でダウンロード (754K) -
藤本 知佐, 田村 公一, 武田 憲昭2016 年 109 巻 3 号 p. 183-188
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありAn 80-year-old male patient with multiple laryngeal chondromas is reported. Bilateral thyroid cartilage masses were identified incidentally on CT. The masses remained constant in size over a two-year follow-up period, however, pharyngolaryngeal endoscopy at the end of two years showed submucosal swelling of the false folds of the larynx. A mass lesion measuring 15 mm in diameter in the right lamina of the thyroid cartilage was surgically resected by the cervical approach under local anesthesia. Histopathological examination showed mild proliferation of chondrocytes without nuclear atypia in a hyaline cartilage matrix, based on which the diagnosis of laryngeal chondroma was made. Another mass measuring 7 mm in diameter found in the left lamina of the thyroid cartilage was left unresected and will be followed up.抄録全体を表示PDF形式でダウンロード (702K) -
芦澤 圭, 松岡 伴和, 石井 裕貴, 森山 元大, 増山 敬祐2016 年 109 巻 3 号 p. 189-194
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありPurpose: To retrospectively assess the safety profile of chemoradiation (CRT) with S-1 for oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC).
Patients and methods: Forty-two patients were treated with CRT between April 2004 and March 2014. Definitive radiotherapy was delivered up to a total dose of 60–70 Gy. The patients received 2 courses of S-1 (60–100 mg/day) for 2 weeks followed by 2 weeks of rest while receiving radiotherapy.
Results: Nine patients with stage I or II were treated with CRT alone. Patients with stage III or IV were treated with either induction chemotherapy (IC) with docetaxel, cisplatin, and fluorouracil (TPF) following CRT with S-1 (n=26) or CRT with S-1 alone (n=7). Of these, 92.9% completed the full CRT course. The overall complete response rate was 76.2% (CR: 32, PR: 7). The five-year disease-specific survival rates (DSS) for stages I and II were 100%, and for stages III and IV were 55.1%/58.3% (oropharyngeal/hypopharyngeal). The five-year DSS for patients with stage III or IV who had radical surgery during the same period was 64.6% (n=24). No significant differences were noted in the results between the survival outcomes of CRT (with or without IC) and surgery. Grade 3 and 4 oral mucositis frequently occurred during the CRT regardless of CRT alone or CRT followed IC. However, there was no treatment-related death, and all patients, with the exception of one, received the full radiotherapy.
Conclusion: CRT with S-1 appeared to be a well-tolerated and acceptable regimen even in combination with TPF IC.抄録全体を表示PDF形式でダウンロード (335K) -
谷上 由城, 北村 守正, 平野 滋, 楯谷 一郎, 岸本 曜, 石川 征司, 森田 真美, 中平 真衣, 伊藤 壽一2016 年 109 巻 3 号 p. 195-201
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありPapillary thyroid carcinoma progresses slowly and carries a relatively good prognosis. However, invasion of important adjacent structures, such as the recurrent laryngeal nerve, trachea and esophagus, worsens the patient’s QOL. While cases of thyroid carcinoma invading the trachea are sometimes encountered, cases of advanced thyroid carcinoma are raraly encounterd in which tracheal intubation is impossible. While performing surgery in these cases, sufficient consideration should be given before the operation to methods for maintaining the airway.
Herein, we report a case of thyroid carcinoma invading the trachea, in which tracheotomy needed to be performed under extracorporeal membrane oxygenation (ECMO). A 70-year-old woman presented to a neighborhood doctor with a history of difficulty in breathing. CT showed severe tracheal invasion by a thyroid carcinoma, and the patient was referred to our hospital. A PET-CT revealed its metastases in the lung, liver, and bones. Biopsy of the tumor invading the trachea revealed the diagnosis of papillary carcinoma. Because the airway stenosis was severe, usual tracheal intubation, as well as usual tracheotomy and mediastinal tracheotomy, was difficult. Therefore, we incised the first and second tracheal rings not invaded by tumor and carried out intubation through the tracheotomy stoma. We used ECMO in anticipation of airway obstruction due to bleeding, and were therefore able to maintain the airway. Thereafter, we performed total thyroidectomy, D3c neck dissection, and tracheal fenestration. After the operation, radioactive iodine therapy was administered and the fenestrated trachea was closed by staged operations.抄録全体を表示PDF形式でダウンロード (960K) -
永野 広海, 馬越 瑞夫, 地村 友宏, 黒野 祐一2016 年 109 巻 3 号 p. 203-209
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありAcute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, however, mortality from this disease remains as high as 30–40%.
A 5X-year-old man presented to the ENT service with a 3-month history of discomfort in the pharynx. Based on the findings of endoscopy and positron emission tomography/computed tomography (PET/CT), the patient was diagnosed as having oropharyngeal carcinoma (T4aN2cM0). Two cycles of TPF chemotherapy (docetaxel, cisplatin and 5-fluorouracil) were administered, which led to no reduction of the tumor size. Therefore, radiotherapy was combined with administration of cetuximab (bioradiotherapy: BRT).
BRT was associated with an enhanced severity of mucositis, resulting in aspiration. The respiratory function deteriorated gradually, and eventually, the patient was diagnosed as having ARDS. Artificial non-invasive positive pressure ventilation (NPPV) was initiated, along with administration of neutrophil elastase inhibitor (sivelestat) and methylprednisolone (1 mg/kg). In response to the treatment, the respiratory function gradually improved and the patient could be weaned off NPPV on the 14th day.抄録全体を表示PDF形式でダウンロード (872K) -
伊藤 佳史, 鈴木 海斗, 岩橋 大輔2016 年 109 巻 3 号 p. 211-217
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありNeuroendocrine tumors is a generic term for tumors arising from neuroendocrine cells. In the present study, we encountered a patient with a Grade 3 laryngeal neuroendocrine carcinoma with liver and bone metastases who was successfully treated with a small cell lung cancer (SCLC) regimen. We report herin on this case with a review of the diagnosis, classification, and management of neuroendocrine tumors. Classically, neuroendocrine tumors have their own classification by the organs involved, and in some previous studies, the histopathology has been inconsistent with the clinical course. Then, in 2010, the WHO advocated a new pathological classification, whereby neuroendocrine tumors were to be stratified into 3 groups: Grade (G) 1, G2 and G3 based on the mitotic count and Ki67 index. A previously reported series of high-grade neuroendocrine tumors were equivalent to G3, and some reports have described that SCLC treatment was given. In our case, the patient was also treated as an SCLC patient, and the response of the primary lesion was evaluated as complete response (CR). Currently, 18 months have elapsed since the completion of therapy, the patient enjoys satisfactory levels of QOL without recurrence. We believe that this classification would be of assistance in discussion about prediction of the prognosis and statistical treatment.抄録全体を表示PDF形式でダウンロード (899K)
研修ノート
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肥後 隆三郎2016 年 109 巻 3 号 p. 218-219
発行日: 2016年
公開日: 2016/03/01
ジャーナル 認証ありPDF形式でダウンロード (381K)
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