巻号一覧
31 巻 (1980)
- 6 号 p. 417-
- 5 号 p. 355-
- 4 号 p. 285-
- 3 号 p. 199-
- 2 号 p. 79-
- 1 号 p. 1-
31 巻, 2 号
選択された号の論文の17件中1～17を表示しています
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石橋 康1980 年 31 巻 2 号 p. 79-85
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーThere have been very few reports on recurrent nerve paralysis in children in Japan. In the present paper, clinical findings, etiology and managements of recurrent nerve paralysis in children are discussed based on the experiences on 24 cases (11 males and 13 females) who were seen at the author's clinic during the last 10 years from 1970 to 1979.
In most of the cases, recurrent nerve paralysis occurred within one month after birth. Bilateral paralysis was seen in 5 cases, while the remaining 19 had unilateral paralysis. Diagnosis was made through laryngeal examinations by means of either direct laryngoscopy or laryngofiberscopy. Symptoms consisted of stridor, various degrees of dyspnea, weak cry and hoarseness.
It was most characteristic for recurrent nerve paralysis in infant that respiratory distress was frequently observed. Etiologies of paralysis were: cardiovascular diseases in 5 cases (ventricular septal defect, 4; myocarditis, 1), surgery for congenital lesions in 5 cases (esophageal lesion, 2; cardiovascular lesion, 2; lymphangioma of the neck, 1) and the pressure of a neck tumor in 1 (thyroglossal duct cyst). In 1 case, meningomyelocele associated with hydrocephalus was considered to be the cause of paralysis. The remaining 12 cases were considered to be idiopathic in origin.
For the relief of respiratory distress, intubation was necessitated in 2 cases, and tracheotomy was done in 1 case. Respiratory distress disappeared within six months in the vast majority of the cases. Hoarseness and weak cry also disappeared or improved within a few months.抄録全体を表示PDF形式でダウンロード (1868K) -
柴崎 晋1980 年 31 巻 2 号 p. 86-97
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーThe observation was attempted to clarify the more detailed morphological and functional significances of the non-ciliated cells in the airway epithelium of animals. Small-sized mammals such as mice, rats and bats were used in this study, and the non-ciliated cells were usually observed in all over the airway epithelium in these animals.
Non-ciliated cells were devided into two different types, i. e., the endocrine type and exocrine type.
Endocrine type cells may be identical to the so-called brush cells and other related cells which were initially reported by Rhodin and Dalhamn (1954), on account of their morphological characteristics that are equipped with well-developed filament bundles, glycogen granules and many closely packed micrcvilli protruding from their apical surface into the lumen. All of these type cells generally contained many dense granules of smaller size which were released into the connective tissue layer under the epithelium. No synapse-like contacts between these cells and the intraepithelial nerve fibers were observed.
Exocrine type cells were found to exist not only in the terminal bronchioles but in the trachea and other thicker part of the airway epithelium. These cells contained a lot of both types of ER and scarce secretory granules of seromucous in nature. In such animals, neither discernible well-defined glands in the connective tissue layer of the entire airway nor typical goblet cells in the epithelium were observed. Thus, such non-ciliated cells may concern with the production of lubricating material in the epithelium in these animals.抄録全体を表示PDF形式でダウンロード (17683K) -
井上 鉄三1980 年 31 巻 2 号 p. 98-102
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーA bolus passes through hypopharynx then to proceed to the entrance of esophagus where the second stage of deglutition commences.
Should a bolus passes down to the larynx, one must investigate the cause of the trouble, and one can employ the various methods of study of dysphagia as follows.
1. X-ray fluoroscopy with spot-photography.
2. Cineradicgraphic investigation.
3. Intra-luminal continuous pressure study.
4. Electromyographic investigation of the muscles involved.
5. Combination of electromyography and cineradiography.
6. High speed, ninety flames or more, thirty-five mm cineradiography.
7. Investigation of innervation by horse-radish method.
One must use one or more of methods mentioned above to investigate dysphagia.
X-ray examination with fluoroscopy and spot photography is the first step of whole studies. This can tell you much about the swallowing, and no one can go further study without X-ray fluoroscopy.
Cineradiography in high speed i s far advantage for investigation of dysphagia because this speed of cineradiography can pick up the more precise motility of the esophagus than one can see by his bear eyes. For example, various kinds if irregular contractives can be picked up by this methods.
It is worth while doing intra-luminal pressure study in various spots of esophagus to be measured, this can give further information about deglutition especially in second and third stages.
Combination of electromyography and cineradiography has some limitation to its location though, this gives the most precise information about dysphagia.
Horse-radish percxidase method has been applied for few years to lcalize the centers of all motor activities of fibers. This method should be carried cut more in future to determine the various centers of efferent fibers.
The investigation of dysphagia depends upon the method of research mentioned above and one can choose whatever method he has in his own hand.
One of the surgical treatments of dysphagia is to severe and cut the cricopharyngeus muscle fibers and thyropharyngeous muscle fibers. This is effective for the certain types of dysphagia though, on the other hand, one should observe what does a nature do for the treatment.抄録全体を表示PDF形式でダウンロード (628K) -
竹中 榮一1980 年 31 巻 2 号 p. 103-108
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーThe patients with chief complaints of defective laryngeal and pharyngeal clearance must be examined by the following radiologic examinations:
1) High voltage lateral and frontal views are effective to find out soft tissue masses.
2) Contrast enhanced radiographs and Ba meal adhesive radiographs must be used to detect contours and defects.
3) Selective angiographs via external carotid, thyroid and truncus cervical arteries are sometimes effective.
4) CT images dramatically demonstrate head and neck lesions with infiltrating areas. Thus, these are helpful for the treatment of malignant diseases.
5) Radioisotope tests in some cases are useful to differentiate malignant diseases.
6) X-ray cinefluorographs with 35mm cine film and CsI image intensifier are most effective to analyse defective deglutition and find out the organs and parts involved.
Cinefluorographic findings of each phase of the patients with head and neck tumours and neuromuscular diseases are discussed in relation to deglutition disorders.抄録全体を表示PDF形式でダウンロード (6737K) -
松尾 裕1980 年 31 巻 2 号 p. 109-115
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーA radiocinematographic study of deglutitory movements in patients with various neuromuscular disorders yielded the following findings:
1) In patients with hemiplegia due to encephalomalacia or brain tumor, there is no particular complaint of misswallowing. However, because the contractile force of the pharyngeal muscles ipsilateral to the paralysis is weak, barium meal passes through the pharynxalong the paralysed side above the epiglottis, which is pulled toward the healthy side, becoming asymmetric. Thus, hemiplegic patients are hemiplegic in deglutitory movements also and are ready to misswallow.
2) In patients with Wallenberg's syndrome in whom there is a paralysis of the pharyngeal muscles ipsilateral to the brain lesion, the bolus passes through the paralysed side of the pharynx, the epiglottis being asymmetric in configuration. Observed contractions of the cricopharyngeus muscle seem to suggest that this striated muscle is governed by the dorsal nucleus of vagus nerve.
3) In patients with amyotrophic lateral sclerosis the Passavant's bar is formed to a very modest extent by contraction of the palatopharyngeal sphincter. The barium which enters the vestibule of larynx is likely to be swallowed because of a weak action of the larynx to expel it out into the food passage.
4) In patients with myasthenia gravis elevation of the soft palatine becomes insufficient on repeating deglutitory movements, leading to an almost complete failure of the nasopharyngeal space to close.
5) In patients with cerebellar disorder, the contractile force of muscles involved in deglutition is kept normal but there is an impairment of co-ordination of their movements (ataxia), which is a possible cause of misswallowing.抄録全体を表示PDF形式でダウンロード (12747K) -
吉田 操1980 年 31 巻 2 号 p. 116-120
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーAspiration during operation is rare. It occurs mostly by an inadequate tracheal intubation. We had two such cases in the last five years. Removal of aspirated substances from bronchial trees through bronchofiberscope was effective in treatment of such a condition.
Aspiration occurs rather frequently following surgery of the thoracic esophagus. Postoperative aspiration was noted in 18 cases (2.4%) among 758 resections of esophageal carcinomas. In general the patients with postoperative aspiration had a tendency to delay peroral food intakes. The patients with excellent postoperative course usually started peroral food intakes on the 11th postoperative day, those with slight aspiration on the 15th postoperative day, those with moderate aspiration on the 20th postoperative day and those with severe aspiration on the 30th postoperative day respectively. Total parenteral or enteral nutrition was indispensable for management of most patients. All cases with severe aspiration and 14% with slight or moderate aspiration developed bronchopneumonia after they had discharged from the hospital. Prophylactic cares should be taken in their home life.
Recurrent nerve paralysis is one of causes for postoperative aspiration. Eighty-nine percent of patients with postoperative aspiration showed recurrent nerve paralysis and 69% of postoperative recurrent nerve paralyses caused varying degrees of aspiration after surgery of the thoracic esophagus. The postoperative deviation or traction of the cervical esophagus may be a cause of aspiration.
There are many cases of esophagobronchial fistula formation. Esophageal contents are easily aspirated into bronchial trees, and subsequently aspiration pneumonia occurs. Results of 14 esophageal bypass operations for esophageal fistulas were discussed. Aspiration of esophageal contents was completely prevented by this type of operation. However, the prognosis of patients depended on severity of the tumor.抄録全体を表示PDF形式でダウンロード (5393K) -
小宮山 荘太郎1980 年 31 巻 2 号 p. 121-125
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーA great many investigations of human pharyngoesophageal motility have been concerned with the motor activity induced by swallowing actions. The methods utilized in such investigations were mainly roentgenoscopic studies, electromyographic observations and graphic registration of contractions by intraluminal recording instruments (swallowing pressure).
The method of measuring the swallowing pressure in the pharyngoesophagus has been used as an open-tubed kymographic system. Recently, a satisfactory method that is able to get accurate recording of pressures in the esophagus has become available. A miniature straingauge manometer using 4 diode transducers was developed for clinical measurement of the pharynuoesonhaueal intraluminal pressure.
In this study, variations of pressure in the pharynx and cervical esophagus at swallowing were observed in a group of normal subjects and a group of patients with swallowing dis orders.抄録全体を表示PDF形式でダウンロード (2431K) -
末梢臓器における誤嚥の Mechanism佐藤 文彦1980 年 31 巻 2 号 p. 126-133
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーAspiration may be caused by a variety of inco-ordination of swallowing.
In this experimental design, a physiologic and biomechanical method for observation of the laryngopharyngeal motion was devised. That is, electromyographic observations of the laryngeal and pharyngeal constrictor muscles, measurement of glottic preseure and measurement of tensile force by laryngeal elevation were made in fully conscious and slightly anesthetized animals.
These electromyographic and biomechanical observations of normal deglutition in the dog were characterized by a co-ordinated pattern of sequent three motions; laryngeal elevation, laryngeal closure and transportation of the bolus.
Experimentally, aspiration was brought about by cutting superior laryngeal nerve, recurrent laryngeal nerve, vagal nerve and hypoglossal nerve.
In the series of bilaterally sacrificed internal branch of the superior laryngeal nerves, the electrical phasic activity of the intrinsic laryngeal muscles and laryngeal closure were delayed about 90msec. during swallowing in slightly anesthetized condition, and in the series of bilaterally sectioned recurrent laryngeal nerves, degree of the laryngeal closure was markedly disturbed (34%). And also, degree of the laryngeal elevation at swallowing was 48% in the series of bilaterally sectioned hypoglossal nerves.
From these experimental observations, mechanism of aspiration was described and discussed in clinical relation to aspiration.抄録全体を表示PDF形式でダウンロード (1018K) -
木内 宗甫1980 年 31 巻 2 号 p. 135-137
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーAspiration is frequently encountered in clinical medicine. In order to properly appreciate it, an adequate radiographic visualization of the pharynx during the second stage of swallowing is required. This is demonstrated best on the lateral view. In some cases, however, routine conventional procedures are often found inadequate because of the rapid sequence of events in the region during deglutition. For this reason, it may be helpful to use cinefluorographic analysis in obtaining a detailed information of the mechanisms involved in this phenomenon.
This phenomenon results from multiple causes, but it is possible to classify them into two main groups, local structural lesions and neurogenic diseases. In these lesions, which block mechanically the adequate closure of the laryngeal aperture or inhibit functionally the normal closing actions of the aspiration barrier, some of barium are aspirated. Aspiration may also occur if there is prolonged stasis and pooling of barium in the pharynx, because barium may overflow the aditus.
It should be pointed out that this phenomenon is frequently accompanied with other radiographic abnormalities. They consist of: (1) hesitancy in initiating a swallow; (2) asymmetrical deglutition; (3) pharyngeal laxity; (4) pharyngeal stasis; (5) return of barium from the oropharynx to the oral cavity; (6) nasal regurgitation; (7) abnormalities of the upper esophageal sphincter relaxation. When this sign is found along with these functional disorders of deglutition, and if neurogenic disorders can be excluded, development of local structural lesions involving the pharynx, larynx and cervical esophagus is strongly suspected.抄録全体を表示PDF形式でダウンロード (3190K) -
逆行性軸索輸送法 (HRP法) による研究吉田 義一, 平野 実1980 年 31 巻 2 号 p. 138-140
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーThe motoneurons innervating the cricopharyngeal muscle of cats were identified by utilizing retrograde axonal transport of horseradish peroxidase (HRP).
HRP was injected into the cricopharyngeal muscle in eight cats, the thyreopharyngeal muscle in four cats and the rostral part of esophagus in four cats.
After injection of HRP into the cricopharyngeal muscle, HRP-labeled motoneurons were found in the ipsilateral retrofacial nucleus and the rostral part of the nucleus ambiguus.
The labeled neurons were most frequently observed through the levels between the rostral part and middle part of rostrocaudal extent of the inferior olivary nucleus.抄録全体を表示PDF形式でダウンロード (1815K) -
椿 康喜代1980 年 31 巻 2 号 p. 141
発行日: 1980/04/10
公開日: 2010/02/22
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田頭 宣治1980 年 31 巻 2 号 p. 142
発行日: 1980/04/10
公開日: 2010/02/22
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延髄外側症候群 (Wallenberg 症候群) 症例森川 謙三1980 年 31 巻 2 号 p. 142a-143
発行日: 1980/04/10
公開日: 2010/02/22
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田中 英一1980 年 31 巻 2 号 p. 143-144
発行日: 1980/04/10
公開日: 2010/02/22
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1980 年 31 巻 2 号 p. 145-158
発行日: 1980/04/10
公開日: 2010/02/22
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1980 年 31 巻 2 号 p. 159-176
発行日: 1980/04/10
公開日: 2010/02/22
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1980 年 31 巻 2 号 p. 177-193
発行日: 1980/04/10
公開日: 2010/02/22
ジャーナル フリーPDF形式でダウンロード (3597K)
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