Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
Volume 22, Issue 2
Displaying 1-8 of 8 articles from this issue
  • Ryozo Asai
    1971 Volume 22 Issue 2 Pages 49-51
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    Laryngoplasty ia a surgical technique for repairing of a defect or deformity and for restoring of function of the larynx. In this paper, the author dealt with the laryngoplasty performed on the laryngectomized patients, and discussed on the problems of postoperative aspiration of food or a salivary flow into the trachea. Out of 41 patients received Asai's method, 37 patients had the aspiration problems. Aspiration is one of the embarrassing problems after laryngoplasty and may have been a cause of pneumonia which is sometime fatal, and the author suggested that for the prevention of aspiration of food the patients must learn to press on the pharyngeal fistula externally on the anterior neck during food intake.
    Aspiration of a flow of saliva into the trachea or the reflected swallowing of saliva through the pharyngeal fistula is another type of aspiration problems, but fortunately in the most cases an amount of salivary flow is unexcessive and it will be removed by a cough. The author investigated the tracheal mucous membrane in the patients with the pharyngeal fistula and found that aspiration of saliva into the trachea may have prevented driness of the mucous membrane of the respiratory tract.
    In the author's series of laryngoplasty, two patients developed pneumonia possiblly due to aspiration of food or fluid. The followings are suggested as the postoperative regimen for the patients with laryngoplasty:
    1. Regular check-up as done for the laryngectomized patient.
    2. Give a full knowledge of aspiration problems to the patient, and instruct him how to apply a pressure on the anterior neck during food intake.
    3. Prevention of pulmonary complication by X-ray study of regular interval
    The author also stressed a necessity of development of a new technique in laryngo plasty for the protection of aspiration of food or saliva
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  • Keisuke Amoo, [in Japanese]
    1971 Volume 22 Issue 2 Pages 52-57
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    For the last ten years, there has been a remarkable progress in the artificial ventilator treatment in every field in the hospital, so that a long term artificial ventilation is now practical and indication for it has expanded in numbers of diseases. Concurrently, many problems inherent to it have appeared in front.
    These problems consist of two parts. First problem is concerned with a choice of the most suitable measure to secure the airway of the patient with respiratory failure. Measures include orc-endotracheal, naso-endotracheal intubation and tracheostomy. They should be evaluated in terms of the followings: promptness and risk in establishing them, how long they will be needed, easiness in fixing the tabes in right position, and in maintaining them patent and clean, probable difficulties encountered when discontinuing or re-establishing them and comfort of the patient. Needless to mention, misplased or occuluded tubes in the trachea can be lethal. Therefore, once the patient is intubated, whatever the measure might be, frequent and close observation is mandatory.
    Second problem is concerned with humidification of the airway. Intubation, bypassing the physiological humidifying apparatus, i.e. the upper respiratory tract, causes drying out the mucus membrane of the lower respiratory tract which leads to the depressed function of the cilia. This in turn leads to accumulation of sputum in the periphery of the lungs, then the lungs tend to become atelectatic and are rendered to get infected. So, the humidity must be supplemented by a humidifier or a nebulizer. Frequent suctioning in the trachea with a catheter in order to fascilitate excretion of the sputum is also mandatory, Unfortunately, it is painstaking to do the tracheal suction in an aseptic way. Besides, the most common cause of death of the patient under long term artificial ventiltion is pulmonary infection. To gain specimen of tracheal aspirate for organism to culture and to take chest film once evervday if possible, are the recommended measures prevent or find the infection in early stage.
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  • Takeo Sato
    1971 Volume 22 Issue 2 Pages 58-72
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    The recent advancement in the management of the laryngeal cancer has raised the overall cure rate to over 75%, which is uniquely high as a cancer cure rate. The number of laryngectomees going back to the society with various handicaps increases each year. The rehabilition of these people is an urgent problem.
    There are four problems in rehabilitation. The first is the management of problems related to the use of a new air way. The others are the rehabilitation of voice, mental rehabilitation and the management of the senile diseases.
    The department of otolaryngology, the university of Osaka has a laryngectomees' association, which consists of about 700 patients. These laryngectomees were questioned about the physical complaints. Besides the loss of speech, their complaints included intolerance of hot foods, aerophagia, difficult sipping, anosmia, tracheal bleeding in winter, abdominal blowing, frequent breaking wind, difficult straining, stenosis of tracheal stoma and urticaria.
    I). The most important problem of all is a tracheal bleeding in winter. The typical finding of tracheo-bronchitis sicca hemorrhagica diffusa is the obstruction of the trachea and the bronchi due to an accumulation of blood crusts. Endoscopic removal of crusts is necessary. Patients should be instructed to maintain an adequate temperature and humidity to the air way.
    II). The speech rehabilitation is the most important for laryngectomees. In Japan, Tapia's artificial larynx is widely used as an excellent substitute. Some improvements need to be directed for the easier use by begginers. The conventional type has to be raised from the tracheal stoma during each inspiration. The new type revised by us has an inspiratory valve in such a way that patient can inspire without releasing the pipe from the tracheal stoma.
    Of course, the ideal substitute for normal voice is esophageal speech. To obtain the data for the more effective way of teaching esophageal speech, the mechanism of speech was studied using X-ray cinematography in 50 patients with esophageal voice. The relation of esophageal speech to respiration was studied using an indicator, which showed the direction of air current during respiration. The direction thus recorded is shown as a line in the films.
    The author could obtain some additional informations from the present study, by correlating the air intake to the phase of respiration. The modes of air intake are best classified into these five types; injection during inspiration, direct inhalation without injection independent of respiration, injection during expiratory phase and combined type of inhalation and injection.
    The shape of the pseudoglottis can be classified into these five types; simle form, simple form with subglottic space, larynx-like form, multiglottic form and incomplete form.
    From the proficiency of speech, which was evaluated phonetically, the author summarized that good esophageal voice is produced by
    1). air intake by injection during inspiration,
    2). pseudoglottis formation by simple form or simple form with subglottic space, and
    3). ejection of air by uniform contraction of the lower esophagus and“squeezing up”contraction of the upper esophagus.
    III). The mental rehabilitation of laryngectomees is an urgent problem in the social and clinical aspects, too, They can not laugh and speak emotionally. Doctors must lead them to be going back to the society with the normal mental condition.
    IV). In the management of the diseases of old age of the laryngectomees, there are several important problems. The most cardinal of them is the early diagnosis of lung metastasis and double cancer in other organs. Laryngectomees should be instructed to maintain a comfortable circumstances with an adequate temperature and humidity in winter.
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  • H. Tachiiri, [in Japanese], [in Japanese], [in Japanese], [in Japanese ...
    1971 Volume 22 Issue 2 Pages 73-77
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    Since 1949 we have been working on periodical examination for a large group of over 700 patients who underwent the total laryngectomy due to laryngeal cancer and have spoken by means of esophageal speech method or with a speech instrument.
    It was planned with a purpose of following studies:
    a) Estimation of general organic and functional conditions of such senile patients and guidance or controle of personal life.
    b) Detection of local recurrence or metastases to other organs, especially to the lung, in early stage.
    c) Influencet of inhalation through the stoma of the trachea on the lung.
    d) Roentgenologic analysis of phonation and speech mechanism by means of cinematography.
    e) Relation between abnormal speech methods and condtions of G-1-tract.
    For b) and c) we have used all sorts of roentgen examination technics, such as plain and contrast, including high-voltage and direct magnification radiography, which make us possible to interprete various abnormalities of lung markings, especially of vascular shadows. Results obtained, concerning about b) and c) are as follows:
    1) Recurrences or lung metastases of laryngeal cancer were chiefly concentratrated within 5 years after operation, particularly frequent in the first 2 years.
    2) Primary lung cancer of any other organs, for example, stomach, intestine or kidney, were revealed in relative higher incidence.
    3) Changes of bronchopulmonary system were found in various forms and grades:
    (i) chronic and recurrent inflammation,
    (ii) fibrotic changes, above all, of interstitial tissues, which leds to abnormalities of vascular shadow, such as irregular running course, unbalanced calibre and/or irregular contour, and
    (iii) emphysema.
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  • Ikuichiro Hiroto
    1971 Volume 22 Issue 2 Pages 78-81
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    After the removal of the trachea with malignant struma, the new trachea was created with a pedicle skin flap of the neck based on the clavicular portion. The skin incision was made lateral downward from the left upper end of the curved horizontal incision for the strumectomy in such a way as the breadth of the skin flap corresponds with the length of the circumference of the trachea, and the skin was peeled off under the platysma.
    In the first case which the membraneous portion of the trachea was preserved, the median margin of the skin-flap was sutured to the membraneous portion. Then, the skinflap was rotated and its upper margin was sutured to the lower end of the larynx and its lateral margin to the membraneous portion of the trachea on the opposite side. This new trachea covered with a skin on the anterior neck.
    In the second case which the trachea was entirely removed, the lower portion of the median margin of the skinflap was first sutured to the posterior part of the end of the trachea. After that, its median and lateral margins were sutured together and the tube was created so as to face the skin inward. The upper end of this tube was connected to the lower end of the larynx.
    A small opening remained on the lower end of the new trachea, because the bilateral recurrent laryngeal nerve paralysis existed in both cases. This tracheostoma may be secondarily closed after the dyspnea is controled.
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  • Yasuhiko Hashimoto, [in Japanese], [in Japanese], [in Japanese], [in J ...
    1971 Volume 22 Issue 2 Pages 82-89
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    Endoscopic findings of chronic bronchitis syndrome were classified into five types, and histochemical and electron-microscopic studies were performed in tissues obtained from mucous membrane of the bronchi of these cases. From the intensive study on the mucus producing cells, it was evident that cough and difficulty expectoration followed by difficulty breathing were caused by disorder or dysfunction of the secretory system of goblet cells and grandular cells.
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  • Hikonojo Iwamoto, Hazime Aramaki, Mariko Azumi, Masako Aramaki
    1971 Volume 22 Issue 2 Pages 90-94
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    We have recently experienced 2 cases of calcification of the common carotid artery with cancer of the left palatine tonsil and cancer of the larynx respectively.
    In case 1, a 70 year old male, a pulsating tumor became palpable on the left side of the neck 2 months after operation. Metastasis to lymph nodes was suspected and lymphadenectomy was attempted. Since the tumor was hard and stone-like and proved to represent induration of the arterial wall itself, it was left untouched to take its own course. On the plain X-ray picture of the neck, a picture of calcification was noted at the site of the tumor.
    In case 2, also a 70 year old male, a hard tumor was palpated as in case 1, immediately above the common carotid artery, in the internal carotid artery, during the operation. Plain X-ray films taken postoeratively revealed calcification.
    Since both of these cases had cancer, lymph node metastasis was first suspected. During operations in the aged, calcification due to tumors should be remembered as one of the vascular anomalies along with aneurysm and tortuosity of the carotid artery.
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  • Ryo Takahashi, Tadashi Hinohara, Tatsumi Shiraki, Norisuke Hayashi
    1971 Volume 22 Issue 2 Pages 95-99
    Published: April 10, 1971
    Released on J-STAGE: October 20, 2010
    JOURNAL FREE ACCESS
    A 59 years old man with carcinoma of the larynx and the upper esophagus was treated by 6, 000 rad of Liniac therapy preoperatively, and underwent total resection of the tumor with a satisfactory post-operative progress.
    Six months later the patient had the secondary reconstruction of the upper esophagus utilized with a large skin flap from the anterior chest wall according to Watson's technique with an excellent result.
    This reprot is to describe the surgical technique.
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