巻号一覧
45 巻 (1994)
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45 巻, 6 号
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岸岡 睦子, 原田 輝彦, 加藤 昭彦, 清水 猛史, 鵜飼 幸太郎, 坂倉 康夫1994 年 45 巻 6 号 p. 419-423
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーFrom 1983 to 1992, 16 cases of airway stenosis have been treated with the silicone T-tube in our department. The ages of the cases ranged from 4 months to 74 years. Seven cases were male, nine were female. The causes of the stenosis varied. In infants, congenital stenosis and prolonged intubation were the major causes, while blunt traumas to the neck and traumatic or prolonged endotracheal intubation were the major ones in adults. The most common location of the lesion was subglottic or in the tracheal stoma. The size of the T-tube varied with age from 5 to 13mm in diameter. The period of the T-tube insertion ranged from 7 days to 62 months (average: 17.1 months). In 10 cases, the tubes were successfully removed. Five cases have been followed up. One case died from asphyxia because the tube was dislocated into the trachea at home. As progress in emergency medicine and medical techniques has increased the incidence of airway stenosis, treatment including use of the T-tube is increasing its importance.抄録全体を表示PDF形式でダウンロード (4354K) -
小野 良祐, 平野 裕志1994 年 45 巻 6 号 p. 424-431
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーBronchoscopic brachytherapy is a new technique presently being investigated for the treatment of cancer involving the tracheobronchial tree.
This paper reports on the potential application of bronchoscopic brachytherapy to the local treatment of cancer of the respiratory tract.
Bronchoscopic brachytherapy was performed on 8 patients with roentgenographically occult lung cancer after biopsies proved malignant lesions of the trachea and bronchus in each case. These patients came to the National Cancer Center Hospital during the period from September 1992 to December 1992.
Among these 8 cases of malignant lesions of the trachea and bronchus, 5 malignant lesions of the bronchus were diagnosed by bronchoscopic ultrasonography prior to the bronchoscopic brachytherapy, and these 5 patients have completed at least three courses of this therapy carried out by means of a videobronchoscope.
Among the 8 cases of malignant lesions of the trachea and bronchus, complete remission was obtained in 7 cases.
Of the 8 patients, the death of one patient was caused by amyotrophic lateral sclerosis, while the remaining 7 patients have survived for 13-15 months (14.1 months on average) to date, without showing recurrence or metastasis.
As for the complications involved in this treatment, only a light degree of excessive secretions was observed, and there was no abcess formation in any of the cases.抄録全体を表示PDF形式でダウンロード (7774K) -
村岡 秀樹, 海老原 秀和, 石川 紀彦, 小松崎 篤1994 年 45 巻 6 号 p. 432-436
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーAbnormal sensations in the laryngopharynx (ASL) are the most common initial symptom of patients with hypopharyngeal cancer (HPC). We investigated ASL in 41 patients with HPC and the following results were obtained. The initial symptoms of 12 patients are ASL, and 11 of these 12 patients later complained of other serious symptoms, such as cervical nodal swelling, swallowing pain and persistent throat pain, when diagnosed as HPC at our clinic. Four patients in this series suffered from ASL for over 12 months before a diagnosis was made as HPC. Nevertheless, the exact relationship between ASL of long durations and HPC is not certain. There are many outpatients who complain of ASL, but most of these show no abnormal findings in routine examinations. However, careful observation and long-term follow-ups of patients complaining of ASL are essential, since ASL many be an early sign of HPC.抄録全体を表示PDF形式でダウンロード (2225K) -
頸部外切開を要した咽頭異物の1例長山 郁生, 丸山 裕美子, 嶋田 武文1994 年 45 巻 6 号 p. 437-441
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーA case of a fish bone stuck in the pharynx and reaching the danger space was reported. The patient, 60-year-old female, swallowed a fish bone, resulting in a retropharyngeal abscess. A CT scan showed a marked swelling of the retropharynx with a fish bone located near the center of this swelling. After treatment with steroid hormones and antibiotics for 5 days, the patient recovered from her symptoms. An endoscopic examination was performed to detect the fish bone but failed to find it. Then the patient underwent surgery to extract the fish bone by external incision. During this operation, it was difficult to detect the foreign body because it had escaped from the retropharyngeal space where was expected to be. Finally, it was found in the danger space. From this, it was concluded that the fish bone had penetrated the pharyngeal muscle and alar fascia, sticking in the danger space. After the operation, the patient was found to have a pharygeal fistula because of salivary secretion from the drainage. With drainage of the retropharyngeal space and intravenous hyperalimentation, the fistula improved about one month later.抄録全体を表示PDF形式でダウンロード (4873K) -
韓 相善, 北村 溥之, 宮田 耕志, 金子 賢一, 安里 亮, 平野 滋1994 年 45 巻 6 号 p. 442-444
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーWe recently treated a 59-year-old male case with Forestier's disease who complained of hoarseness. X-ray examination revealed severe ossification of the anterior bodies of C3, C4 and C5. Fiberscopy also revealed a left vocal cord palsy. We concluded that the cause of the patient's hoarseness was not recurrent laryngeal nerve paralysis, but arytenoid fixation due to inflammation.抄録全体を表示PDF形式でダウンロード (2327K) -
鈴木 雅一, 益田 慎, 菊池 信幸, 設楽 仁一, 石塚 洋一1994 年 45 巻 6 号 p. 445-450
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーA thirty-year-old female with relapsing polychondritis was reported. The first symptom was redness and swelling of the bilateral auricles, then hoarsness and dyspnea followed after a half month.
The case was followed for one year and three months. Dyspnea was caused by ankylosis and the edema of the bilateral vocal cords. Another causative factor was the stenosis of the main trachea. During the follow-up period, a saddle nose occured. The redness and swelling of the auricles, pain in the chest and upper and lower limb joints relapsed.抄録全体を表示PDF形式でダウンロード (8031K) -
その予後規定因子としての気管脆弱性市村 恵一, 田山 二朗, 丹生 健一, 田中 利善, 村上 泰1994 年 45 巻 6 号 p. 451-455
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーIt is difficult but challenging to care for the airways of patients who are severely handicapped both mentally and physically. Tracheostomy is usually selected when conservative procedures are no longer effective. However, tracheostomy itself can cause swallowing problems. The most reliable management procedure for aspiration is an operation through which the laryngeal function is sacrificed such as total laryngectomy or laryngotracheal separation. Aspiration can be well controlled with this technique. However, in some patients who undergo such procedures airway stenosis develops, which finally causes their death. Tracheal stenosis may devolop due to the following factors; 1) scar formation resulting from granulation tissues produced by the cuff or tip of nasotracheal tubes or tracheostomy tubes; 2) posterior compression by the thoracic vertebrae due to their abnormal arrangement, such as scoliosis and loss of physiological kyphosis, which is related to the poor posture caused by the primary disease; or 3) a fragile tracheal structure. Two cases, an 11-year-old girl with spastic cerebral palsy and a 4-year-old boy with arthrogryposis multiplex congenita, who developed permanent tracheostoma followed by tracheal stenosis were presented. The former died from massive intratracheal bleeding due to the rupture of the brachiocephalic artery, and the latter died from inflammatory airway obstruction. Tracheomalacia in the severely handicapped should be regarded as a prognostic factor against surgery to stop aspiration, and therefore it must be checked before surgery.抄録全体を表示PDF形式でダウンロード (674K) -
設楽 仁一, 鈴木 雅一, 石塚 洋一1994 年 45 巻 6 号 p. 456-461
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーA case of obstructive sleep apnea syndrome (OSAS) in children was reported. A 6-year-old boy visited our hospital complaining of obesity, snoring and sleep apnea. His body weight was 79.6kg, and his height was 133.6cm. Weight control, tonsillectomy and adenoidotomy was performed, after which his symptoms improved remarkably. The tonsills were 8.0g at both sides, and the adenoids were 2.0g. A polysomunograph was performed on the pre- and post-operative days. Since the operation, respiration has been regular, and the air flow was increased. Snoring has decreased remarkably. The patient's apnea index (A. I.) dropped from 16.2 to 3.2, and the SaO2 improved.抄録全体を表示PDF形式でダウンロード (6081K) -
福山 智子, 湯田 厚司, 山田 弘之, 原田 輝彦, 坂倉 康夫1994 年 45 巻 6 号 p. 462-466
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーWe report a case of esophageal perforation caused by a piece of glass in a 34-year-old woman suffering from sudden severe pharyngeal pain. We found a foreign body lodged at the esophageal wall 4cm below from the first esophageal constriction upon X-ray and flexible fiberscopic examination. The foreign body was removed using a rigid esophagoscope 39 hours after swallowing. The foreign body was an equilateral triangular piece of glass whose side was 30mm. Immediately after the foreign body was removed, we found an esophageal perforation, subcutaneous emphysema and pneumomediastinum. The perforation was closed using an external approach. The patient showed improvement after the operation.抄録全体を表示PDF形式でダウンロード (6047K) -
大塚 健司, 木田 亮紀, 遠藤 壮平, 中里 真帆子, 蜂須賀 久喜, 森本 理香, 長田 宏巳1994 年 45 巻 6 号 p. 468-477
発行日: 1994/12/10
公開日: 2010/02/22
ジャーナル フリーAn 80-year-old female, who had undergone total thyroidectomy and bilateral modified neck dissection after a diagnosis of thyroid papillary carcinoma with neck lymphnode metastasis, was revealed through a post-operative chest CT examination to have a lung mass instead of old pulmonary tuberculosis. The diagnosis of lung adenocarcinoma was made by a percutaneous needle biopsy. The patient expired five months after the thyroid operation without undergoing any intensive treatment, partly because of her age. The final diagnosis determined by autopsy was primary lung carcinoma metastatising to the thyroid gland and to the neck lymphnodes.
According to information collected from 57 reported cases in Japan, primary lesions involving thyroid metastasis can be broken down as follows: kidney in 21 cases, lung in 7 cases, stomach in 6 cases, breast in 5 cases, esophagus in 4 cases, rectum in 3 cases; and the skin, uterus, ovary, villus, thymus, pancreas, larynx and an unknown location in one case each.
The absence of calcification, as well as a rapid growth and a significant increase in the tumor marker in the serum are findings which suggest metastatic thyroid carcinoma. The prognosis for patients with metastatic thyroid carcinoma is generally poor. However, long survivals after radical thyroid surgery have been reported in the literature. Thus, treatment modality should be individualized according to the patient's status and the tumor's grade and degree of extension.抄録全体を表示PDF形式でダウンロード (9029K)
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