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109 巻, 4 号
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論説
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星川 広史2016 年 109 巻 4 号 p. 221-229
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありThe imaging of specific molecular targets associated with cancer can be expected to allow earlier diagnosis and better management of oncology cancer patients. Positron emission tomography (PET) is a highly sensitive non-invasive technology that is ideally suited to clinical imaging of cancer biology. 2’-Deoxy-2’-18F-fluorodeoxy glucose (FDG) PET is now widely used for the diagnosis of malignant tumors and assessment of the therapeutic response. However, FDG is also metabolized at sites of inflammation and in other physiologically reactive organs, so that development of newer imaging probes with specificity for cancer are needed. The amount of DNA synthesis is a measure of cellular proliferation, and increased cellular proliferation is a feature of cancer. Thymidine analogs, 3’-deoxy-3’-18F-fluorothymidine (FLT) and 4’-[methyl-11C]-thiothymidine (4DST), have been introduced as stable cell proliferation imaging agents. Our recent researches have shown that FLT and 4DST PET show high sensitivity for the detection of head and neck cancer, despite the low uptake level of the tracers. In regard to assessment of the therapeutic response, FLT PET during treatment and early follow-up has the potential to predict therapeutic responses, with the ability to discriminate residual tumors from inflammatory changes. Volume-based parameters of pretreatment 4DST-PET can provide important prognostic information in patients with head and neck cancer.
A depth-of interaction (DOI) detector is a key device to obtain any significant improvement of the sensitivity while maintaining high spatial resolution. DOI measurement also has the potential to expand the field of application of PET, because it allows for more flexible detector arrangement.
New molecular imaging probes have also been developed for visualization of the brain and nervous system functions. Future applications are expected to allow analysis of the functions of sensory areas and diagnosis of sensory nerve disorders.抄録全体を表示PDF形式でダウンロード (1179K)
カラー図説
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千年 俊一2016 年 109 巻 4 号 p. 230-231
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありPDF形式でダウンロード (778K)
臨床
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鬼頭 良輔, 森 健太郎, 北野 友裕, 宇佐美 真一2016 年 109 巻 4 号 p. 233-238
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありCisplatin (CDDP) is widely used as an effective antineoplastic drug for cancers of various organs, and is also known to cause ototoxicity. In this study, we report on the incidence of and factors related to CDDP-induced hearing loss, and the time-dependent change of the hearing level among these patients.
Twenty patients with head and neck cancers treated with chemoradiotherapy using CDDP in our institution were enrolled and analyzed. As chemotherapy, three cycles of concurrent CDDP were administered on weeks 1, 4, and 7 of radiotherapy. Pure-tone audiograms were performed before and 1 week after each course of administration of the CDDP. Adverse events including hearing impairment were assessed through the National Cancer Institute Common Toxicity Criteria (NCI CTCAE) v4.0.
The incidence of hearing loss was 45% in this patient group (Grade1 was reported in 6 patients, and Grade2 was reported in 3 patients). Hearing thresholds at 8 kHz were remarkably worse than at any other frequencies. Furtheremore, hearing loss related to creatinine increased and the white blood cell count decreased.
These results indicate that there were individual differences, for example drug metabolism-related factors, related to CDDP-induced hearing loss.抄録全体を表示PDF形式でダウンロード (305K) -
稲垣 洋三, 神崎 晶, 岩崎 聡, 山田 浩之, 渡部 高久, 大石 直樹, 小川 郁2016 年 109 巻 4 号 p. 239-246
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありWe participated in a clinical trial for a hearing aid system in Japan, “Verification of the efficacy and safety of the middle ear implant MVS (Medel Vibrant System) in conductive and mixed hearing loss”. We present a report of a case that we encountered in our department.
MVS is a Vibrant Soundbridge® (VSB) middle ear implant device that is approved and is in wide use in Europe and the United States. It has been shown to have the potential to provide a high level of acoustic clarity and sound quality. Also, as compared to conventional hearing aids, there is no howling and the distortion frequency is lower. An additional advantage is the excellent transient response.
The patient was a 33-year-old woman, with a history of bilateral hearing loss from birth, who was under observation whilst wearing a hearing aid. In an attempt to improve her hearing, we admitted her to our hospital. Based on the diagnosis of middle ear malformation and mixed hearing loss on both sides, we performed bilateral tympanoplasty. Since the hearing improvement following this procedure was poor on the right side, we prescribed a hearing aid. However, the patient did not adapt satisfactorily to this device. Four years after the initial diagnosis, we performed VSB middle ear implant surgery using the round window stimulation method, placing the transducer in the round window. The postoperative results were good. The speech inspection noise levels in both ears under a free-field, silent setting were 60 dBHL 85%, and 50 dBHL 100%. Thus, the postoperative course was good, the patient’s satisfaction level improved and no adverse events occurred.
VSB is likely to be a useful tool in rescue surgery for refractory middle ear cases. Also, it is useful as a standard rescue procedure in difficult hearing aid cases. In practice, otologic procedures are intended to improve the QOL and meet requirements in both diverse cases and individual patient conditions. Therefore, dissemination of VSB as one of the treatment choices for improving hearing loss is expected in the future.抄録全体を表示PDF形式でダウンロード (1043K) -
森川 大樹, 瀬尾 徹, 速水 康介, 宮下 美恵, 村本 大輔, 磯野 道夫, 土井 勝美2016 年 109 巻 4 号 p. 247-250
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありInverted teeth in the nasal cavity are a rare clinical entity. We report herein on a case with resection via the endoscopic endonasal approach. A mass in the left nasal cavity was incidentally found in a 1-year-old boy at the local otolaryngologist, and the infant visited our department, suspected as having a nasal tumor. Anterior rhinoscopy indicated a peduncular lesion with partial calcification 3 mm behind the cutaneomucous transition site of the left nasal cavity. CT imaging indicated a mass with soft tissue density in the left nasal vestibule. We speculated an ectopic tooth or a teratoma including tooth tissue. We subsequently endoscopically removed the tumor via the endonasal approach under general anesthesia. The post-operative finding was an inverted ectopic tooth in the nasal cavity. Early diagnosis and treatment are required to prevent concomitant nasal symptoms.抄録全体を表示PDF形式でダウンロード (381K) -
上野 春菜, 脇坂 尚宏, 吉崎 智一2016 年 109 巻 4 号 p. 251-256
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありA 60-year-old male patient developed purpura in the bilateral lower limbs and renal dysfunction during the treatment of a peritonsillar abscess. We consulted the dermatologist and nephrologists. They suspected anaphylactoid purpura and purpura nephritis because of the progress of the disease and the pathologic findings of skin biopsy. Steroid therapy was useful to control the appearance of the purpura, and angiotensin-converting enzyme inhibitor and antiplatelet therapy had an effect on the decrease of urinary protein.
Cases of anaphylactoid purpura are rare in the elderly. Arthritis and abdominal symptoms are less serious and frequent, but renal dysfunction and recurrence of purpura are more serious and frequent in comparison to younger patients. We consider that it is important to treat anaphylactoid purpura with cooperation between dermatologists and nephrologists.抄録全体を表示PDF形式でダウンロード (1177K) -
込田 薫, 濵田 昌史, 関根 基樹, 金田 将治, 山本 光, 大上 研二, 飯田 政弘2016 年 109 巻 4 号 p. 257-261
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありC1 inhibitor (C1-INH) is a protein that adjusts complement functions and thereby controls the blood coagulation system, and its qualitative or quantitative abnormality can recurrently produce local edema. We report herein on a case of angioedema due to C1-INH deficiency which presented with airway stenosis resulting in dyspnea and was successfully treated with lyophilized human C1-inactivator concentrate (Berinert® P).
Our case was a 45-year-old female who had been suffering from swelling of her face and limbs for 15 years. She was referred to our hospital because of persistent swelling of the lips and eyelids even after having the administration of steroids. We gave her an intravenous drip of 300 mg hydrocortisone and 5 mg antihistamine at the first visit because she only presented with face edema. However, dyspneic attacks developed several hours later, and therefore she revisited our emergency room. Laryngoscopy revealed her respiratory tract was constricted by mucosal swelling at the level of the meso-hypopharynx. Readministration of 200 mg hydrocortisone failed to improve her symptoms, and we switched to the administration of Berinert® P because the C4 serum level was observed to be clearly lower. Her breathing disorder improved immediately after this application, and laryngopharyngeal edema had disappeared by the next morning. C1-INH activity demonstrated a low value afterwards, which finally led us to a diagnosis of angioedema due to C1-INH deficiency. We maintain follow-up with the administration of 3000 mg/day of tranexamic acid.
Angioedema due to C1-INH deficiency can be differentiated from other types of angioedema through the low value of complements and C1-INH activity, and C4 is recommended as a screening test. When we see a patient with serious edema especially in the upper airway, angioedema due to C1-INH deficiency should always be kept in mind because we can avoid an unnecessary tracheostomy with the immediate use of Berinert® P.抄録全体を表示PDF形式でダウンロード (621K) -
小村 さやか, 渕上 輝彦, 中屋 宗雄2016 年 109 巻 4 号 p. 263-267
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありRecently, intracapsular enucleation has been reported as the standard treatment of neurogenic tumors arising from the cervical sympathetic region. In the present study, we performed intracapsular enucleation for two neurogenic tumors derived from the sympathetic chain. Case 1; A 61-year-old female who presented with an asymptomatic cervical mass. Based on the imaging findings, we suspected a neurogenic tumor and performed intracapsular enucleation. Histopathologic examination revealed a schwannoma. After surgery, transient Horner’s syndrome was observed. Case 2; A 32-year-old female consulted for a 10-year history of the left cervical mass. There was no neural deficit. From the imaging findings, and the presence of café au lait spots on the body trunk, the lesion was suspected as being a neurogenic tumor. Intracapsular enucleation was performed, and a histopathologic examination revealed a neurofibroma. Postoperative palsy did not occur. In spite of the same surgeon employing the same method in both the above cases, postoperative palsy occurred in the former, but did not in the latter. Postoperative nerve palsy can sometimes occur, even if intracapsular enucleation was performed. Therefore, adequate preoperative informed consent is required.抄録全体を表示PDF形式でダウンロード (707K) -
原田 みずえ, 大堀 純一郎, 黒野 祐一2016 年 109 巻 4 号 p. 269-274
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありWe experienced a case of maxillary carcinoma in which pancytopenia occurred after concurrent chemoradiotherapy (CCRT). The patient was a 68-year-old man. He had complained of right cheek pain one and a half months previously, and consulted a nearby otolaryngologist. CT imaging of the paranasal sinus demonstrated an abnormal shadow with bone destruction of the right maxillary sinus anterior wall. The patient was suspected as having maxillary cancer and was referred to our hospital. PET showed high accumulation in the right maxillary sinus and the lesion was diagnosed as a maxillary carcinoma (squamous cell carcinoma, T2N0M0, Stage II) by biopsy under local anesthesia. The patient underwent CCRT using 80 mg/m2 of carboplatin (CBDCA). However, combination therapy with CBDCA was stopped after seven times administration since platelet marker decreased to 28,000. Radiation alone treatment was subsequently continued to 70 Gy. On the day after completing radiation, the patient was diagnosed as having pancytopenia and he also suffered from Methicillin-resistand Staphylococcus auerus infection-mediated pneumonia, pharyngitis, and sinusitis. After three months of intensive treatment, he had almost recovered. However, CT and PET imaging showed multiple metastasis and he died two months later.抄録全体を表示PDF形式でダウンロード (859K) -
―超音波エコーと細胞診を用いて―毛利 武士, 寺田 友紀, 宇和 伸浩, 佐川 公介, 阪上 雅史2016 年 109 巻 4 号 p. 275-280
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありWhen determining the treatment plan for thyroid tumors, aspiration cytology is considered as an important test due to its high accuracy. However, surgery is often performed for cases with imaging findings suggestive of thyroid cancer, even if aspiration cytology clearly rules out malignancy. In the present study, we compared the relationship of the postoperative pathologic diagnosis with the preoperative ultrasound results to examine factors that are useful for differentiating between benign and malignant tumors. Our study included 97 patients diagnosed as having non-malignant tumors (Papanicolaou class I–III) by preoperative cytology, who underwent thyroidectomy during the 11-year period from January 2002 to December 2012. Subjects were divided according to the postoperative histopathology into the benign group (n=79) and the malignant group (n=18). The two groups were compared in terms of the maximum tumor diameter, preoperative serum thyroglobulin level, preoperative Papanicolaou classification, age, gender, and the ultrasound findings (presence/absence of border irregularity of the gland and presence/absence of microcalcifications). The preoperative cytological specimen adequacy rate was 94.9% (186 out of 196 specimens). In the benign group, thd preoperative cytology was class I in 12 patients, class II in 61 patients, and class III in 6 patients. In the malignant group, the cytology was class I in 1 patient, class II in 10 patients, and class III in 7 patients. The malignant group had significantly more class III cases and cases showing irregular borders of the gland on ultrasound.
In the future, abnormal findings other than those examined in the present study should also be examined in detail.抄録全体を表示PDF形式でダウンロード (366K) -
桑原 幹夫, 横堀 有紀, 二宮 洋, 近松 一朗2016 年 109 巻 4 号 p. 281-286
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありAlthough traumatic injuries caused by crossbows are rare in Japan, some of these may be life-threatening. We describe herein a-22-year-old man who attempted to commit suicide with a crossbow. The patient shot himself in the neck with a crossbow and was taken to hospital by ambulance. Computed tomography (CT) scans revealed a crossbow bolt entering anterior border of the sternocleidomastoid muscle, involving the carotid space, and passing through the posterior region of the neck. The crossbow bolt had been shot into the neck, penetrated the internal jugular vein and worked as a tamponade so that further bleeding was prevented. We successfully removed the crossbow bolt using the purse-string suture technique and reconstructed the internal jugular vein. The postoperative course was uneventful other than a temporary vocal cord paralysis. In cases of neck injuries, careful evaluations of the vascular structures are indispensable to prevent unexpected bleeding.抄録全体を表示PDF形式でダウンロード (833K)
研修ノート
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小河 孝夫2016 年 109 巻 4 号 p. 288-289
発行日: 2016年
公開日: 2016/04/01
ジャーナル 認証ありPDF形式でダウンロード (218K)
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