日本気管食道科学会会報
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
42 巻, 3 号
選択された号の論文の12件中1~12を表示しています
  • 大前 由紀雄, 田中 英一, 北原 哲, 小倉 雅実, 井上 鐵三
    1991 年 42 巻 3 号 p. 237-243
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    The laryngeal elevation is one of the most basic activities in the normal swallowing. It allows the esophageal sphincter to open by shifting the laryngeal structure anteriorly and superiorly. Dysphagia and aspiration may be caused by reduced laryngeal elevation.
    We presented a technique to maintain the permanently elevated larynx for treatment of dysphagia caused by trauma or surgical resection of head and neck. Four cases diagnosed as insufficient laryngeal motion were treated by laryngeal suspension and by cricopharyngeal myotomy in order to allow swallowing function. To evaluate the effect of surgery, we compared the position of the thyroid notch pre and post operatively. Three cases undergone antero-superior laryngeal suspension became capable of eating orally. One case showed no change in swallowing due to insufficient suspension. This result showed that for the cases of dysphagia caused by reduced laryngeal elevation, the combination therapy we performed was useful for rehabilitation of dysphagia.
  • 高木 健三, 山木 健市, 佐竹 辰夫, 鈴木 隆二郎
    1991 年 42 巻 3 号 p. 244-250
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    Nocturnal and early morning wheezing is very common in patients with bronchial asthma, but the mechanism has not been clear yet. Therefore, we investigated the circadian changes of cyclic AMP, cyclic GMP, catecholamine, histamine and serotonin in plasma sampled from inpatients with bronchial asthma and from normal subjects as a control. The level of plasma cyclic AMP was highest at 4: 00 p. m. and lowest at 4: 00 a. m. (P<0.005) in control group whereas the level of plasma cyclic AMP was highest at 12: 00 noon and lowest at 4: 00 p. m. in patients with bronchial asthma. The level of plasma histamine was significantly higher (P<0.001) in asthmatics than normal subjects at midnight. The level of plasma cyclic GMP and serotonin were higher in asthmatics than normal subjects, but that of plasma norepinephrine and dopamine were lower in asthmatics than normal subjects. Plasma epinephrine level in asthmatics was highest at 4: 00 p. m. and lowest at 4: 00 a. m. (P<0.05). Our study suggests that nocturnal asthma may be, at least in part, caused by a circadian fall in plasma epinephrine and release of histamine and thereby results in bronchoconstriction.
  • 本多 一至, 柳田 とも子
    1991 年 42 巻 3 号 p. 251-254
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    Serum thyroglobulin (Tg) level was examined pre- and post-operatively in 57 patients with various thyroid tumors. Serum Tg level decreased significantly post-operatively in the carcinoma cases (P<0.001) and in the adenoma cases (P<0.05). In cases of carcinoma, the serum Tg level increased again with the recurrence or metastasis of the carcinoma. Therefore, to measure the level of Tg in post operative following up patients with carcinoma is useful to detect the recurrence or metastasis of the tumor.
  • 酒井 昇, 本間 明宏, 犬山 征夫, 大橋 正實, 石川 順一, 内藤 広行, 小林 良二
    1991 年 42 巻 3 号 p. 255-258
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    A case of malignant lymphoma of the larynx in a 10-year-old female is reported with a review of literatures. Our case was youngest in the Japanese reports. Biopsy of the right false cord and left ventricle was performed and histological examination revealed malignant lymphoma (diffuse lymphoma, medium sized cell type). The clinical stage of this patient was IE and successfully treated with combined chemotherapy (CHOP) and radiation (40 Gy).
  • 山口 幹夫, 山下 利幸, 武田 直也, 近藤 昭男, 小池 靖夫
    1991 年 42 巻 3 号 p. 259-263
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    Three cases of laryngeal allergy were reported. A 21-year-old female had a 7-month history of persistent dry cough, sneeze and nasal discharge. Both a 32-year-old male and a 58-year-old female had a 2-month history of abnormal sensation in the throat. The arytenoid region in these 3 cases was swollen and pale in color. Antiallergic drug (Azelastine hydrochloride) was administrated for all cases, and their complaints completely disappeared. The clinical finding, such as“swollen and pale”in the arytenoid region was remarkably improved in all cases.
  • 吉田 友英, 長舩 宏隆, 谷野 徹, 高橋 博文, 小田 恂, 亀田 典章, 蛭田 啓之, 和田 昌士
    1991 年 42 巻 3 号 p. 264-267
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    A case of mucoepidermoid carcinoma of the larynx is reported. The patient was a 63-year-old man who had suffered from sore throat for nine months. By physical examination, swelling in the right epiglottis and arytenoid was noted. Histopathological findings of the specimen showed a mucoepidermoid carcinoma (low grade malignancy). The patient had chemotherapy and radiotherapy. Among malignant tumors of the larynx, mucoepidermoid carcinoma seemed to be extremely rare. Only seven cases of the laryngeal mucoepidermoid carcinoma including this case have been reported in our country. A pertinent literature was reviewed in this paper.
  • 大島 渉, 中尾 美穂, 高田 憲, 松本 真吏子, 河田 了, 寺薗 富朗, 紀平 晋也
    1991 年 42 巻 3 号 p. 268-272
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    Total laryngopharyngectomy is common in the treatment for most of hypopharyngeal cancer. Reconstructive surgery was performed byusing of a pedicled pectoralis major myocutaneous flap to the two male patients in our hospital. Additional operation of making a tracheoesophageal shunt was performed at the same time for the purpose of voice restora tion. Both of the two patients speak well in comparatively short period after the operation. It is well known that acquirement of esophageal voice after total laryngopharyngectomy is very difficult. Therefore, it is very significant to perform laryngopharyngectomy and reconstructive surgery for voice restoration at the same time.
  • 太田 勇司, 仲野 祐輔, 足立 晃, 永安 武, 森永 真史, 新宮 浩, 田川 努
    1991 年 42 巻 3 号 p. 273-277
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    We experienced a case of a cervical tracheal stenosis caused by irradiation of the neck lymphnodes after mastectomy. We treated a 43-year-old female with right breast cancer (T3N1MO stage lila) who underwent standard radical mastectomy (Br+Ax+Mj+Mn) on May 1984, and had a 60Co irradiation of 50 Gy to axillar, parasternal and supraclavicular areas, for two months after surgery. She had complained of severe stridor and dyspnea since February 1985, and subsequently suffered from a pneumonia in the left lower lobe. She was admitted to our hospital and undergone steroid inspiration. A silicone T-tube was inserted into the trachea. Her symptoms had inproved for two years, but a tracheo-esophageal fistula and pneumonia developed. We performed a resection of a tracheo-esophageal fistula. She died following to suddenly massive hemorrhage from tracheo-bracheochephalic artery fistula on the 7 postoperative days.
  • 市村 恵一, 加瀬 康弘, 山根 雅昭, 田中 利善
    1991 年 42 巻 3 号 p. 278-283
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    We have treated 6 patients with tracheostomal stenosis for the last 5 years. Permanent tracheostomata were created during total laryngectomy in 5 adult patients, and during laryngotracheal separation in a pediatric patient with congenital multiform arthrogryposis. In most cases, stenosis occurred in a month or two after the surgery, while it developed when systemic skin rash occurred in 2 patients whose stomal size had been stable for a fairly long time.
    Stomal stenosis can be defined as a scar contracture developed along a circular suture line. Therefore the surgical strategy against the stenosis of stoma should be the same as that of general scar formation in the skin. Taking this into account, the two following policies can be selected: One is Z-plasty and its modification or transposition of local flaps only to reposition and relax the line of contracture. The other is a complete removal of the cicatrical tissues to eradicate the lesion. If any contributing factors to stenosis remain, the choice should be the former. Therefore, we have employed the interposition of four paired triangular flaps regardless of stomal configuration. However, there seems to be no satisfactory solution at present against stomal stenosis due to hypertrophic scars or keloids. Systemic approach considering precipitating factors of stenosis is essential.
    An ideal stoma does not necessarily mean a wide one. Patients in this study have insisted the adequate size of 14-20 mm vertically and 12-18 mm horizontally, which is almost the same diameter as the trachea. The critical size where every adult patient has complained to be dyspneic was less than 10mm×8mm.
  • 濱田 薫, 長 澄人, 藤村 昌史, 福岡 和也, 徳山 猛, 成田 亘啓, 今井 照彦, 渡辺 裕之, 松田 成器
    1991 年 42 巻 3 号 p. 284-288
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    A 60-year-old man was admitted to a hospital with infarction of the brain stem. Tracheostomy was done and he had breathed through a cuffed tracheal canula for five months. And then, he suffered from suffocation due to growth of polyp like granulation tissue when the canula was exchanged. We tried pure ethanol injection via a flexible bronchofiberscopy to the granulation tissue. The airway obstruction was improved. We thought intratumoral ethanol injection was one of the useful treatment for unfavourable development of the granulation after tracheostomy.
  • 飯田 順, 中島 久美, 堤 康一朗, 岩武 博也, 南 定, 竹山 勇
    1991 年 42 巻 3 号 p. 289-292
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    The authors report the results of transcutaneous silicone injection in 8 cases of unilateral vocal cord paralysis who complained of hoarseness. In order to medialize the vocal cord, injection was done to outside of the vocal cord through the cricothyroid space under local anesthesia. This procedure was successful in improvement of phonatory function in most cases. Transcutaneous silicone injection is recommended in unilateral vocal paralysis case, especially who are unable to undergo general anesthesia.
  • 大森 英生, 池田 稔, 大木 光義, 鴫原 俊太郎, 山口 英夫
    1991 年 42 巻 3 号 p. 293-296
    発行日: 1991/06/10
    公開日: 2010/10/20
    ジャーナル フリー
    In many cases of radiolucent foreign bodies in the airway of infants, diagnosis is difficult. The diagnostic method has been mainly to detect Holzknecht's sign through conventional radiography. However, it has been difficult to obtain highly reliable information for detecting foreign bodies or determining the site of the foreign bodies by this diagnostic method alone.
    The recently developed digital radiography utilizes digital signals which are converted from X-ray energy to get clear images. The image processor which consists of a high speed computer, mathematically integrates the signals to visualize the spacific site. Digital fluorography, in particular, is widely applied clinically in vascular radiography in the form of digital subtraction angiography. The authors applied digital fluorography to two infants cases of radiolucent foreign bodies (peanuts) in the airway. The results suggested that the method could be usefully applied to diagnose foreign bodies in the airway and to detect the sites of the foreign bodies.
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