巻号一覧
45 巻, 1 号
選択された号の論文の12件中1～12を表示しています
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気道確保を必要とした症例について井口 芳明, 設楽 哲也, 高橋 廣臣, 八尾 和雄, 古川 浩三, 石井 豊太, 稲木 勝英1994 年 45 巻 1 号 p. 1-7
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーOne hundred seven cases of acute epiglottitis in Kitasato University Hospital over 21 years (1971-1991) were reviewed. Fifteen of these required intubation or tracheostomy to keep the air way open. The clinical features of all these cases, and especially the cases which had been treated for air way preservation, were reported. Edematous swelling of the epiglottis, arytenoid and aryepiglottic fold revealed by indirect laryngoscopy in these cases were classified as follows: swelling of the epiglottis in three grades, high in cases with invisible vocal cords, low in cases with visible vocal cords, and moderate in intermediate cases and swelling in the arytenoid and aryepiglottic fold in two grades (positive and negative). Dyspnea usually appears in patients with swelling of the high grade in the epiglottis, or with swelling of the arytenoid or aryepiglottic fold抄録全体を表示PDF形式でダウンロード (862K) -
横山 貴康, 本間 裕, 岩切 裕昌, 小林 吉史, 野中 聡, 海野 徳二1994 年 45 巻 1 号 p. 8-12
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーIn this study, we tried to analyze the role of the larynx during coughing. To do this, the activities of the intrinsic laryngeal and major respiratory muscles and the changes in intratracheal pressure were recorded during coughing in both nontracheotomized and tracheotomized conditions.
Experiments were carried out using non-anesthetized decerebrate cats. EMGs were recorded by means of bipolar electrodes made from thin (50μm) stainless steel wires implanted into the diaphragm (DIA), the rectus abdominis muscle (RA), the thyroarytenoid muscle (TA) and the posterior cricoarytenoid muscle (PCA). The intratracheal pressure was recorded using a micro-tip catheter pressure transducer. To evoke coughing, a stainless steel wire was inserted through a pin-hole in the trachea, and mechanical stimuli were applied at the tracheobronchial mucosa.
The mechanical stimuli consistently evoked a series of coughs. During coughing in both the non-tracheotomized and tracheotomized conditions, the TA, PCA, DIA and RA muscles exhibited burst discharges with a fixed pattern and intratracheal pressure increased up to 80cmH2O. However, the onset of the discharge of the RA muscle during coughing in the tracheotomized condition was significantly earlier than that in the non-tracheotomized condition. These results suggest that the function of the larynx during coughing is not only to ensure the closure of the airway, but also to modulate the phases of the respiratory muscle activity.抄録全体を表示PDF形式でダウンロード (639K) -
吉藤 美佳, 毛利 光宏, 木西 實, 天津 睦郎1994 年 45 巻 1 号 p. 13-21
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーDuring the past 16 years, we have been performing tracheoesophageal (TE) fistulization for the purpose of voice restoration following total laryngectomy. The principle behind this technique is to divert the exhaled pulmonary air through the TE fistula into the esophagus and the hypopharynx where the vibration can occur. It is generally accepted that a prominence is formed on the retropharyngeal wall during conventional esophageal and TE phonation. This retropharyngeal prominence has been generally understood to be synonymous with the “neoglottis” or “pseudoglottis, ” since it has been thought to be responsible for the vibratory source.
The purpose of this study is to clarify the relationship between the retropharyngeal prominence and the neoglottis during TE phonation. Fifteen patients who had undergone TE fistulization at the time of laryngectomy were subjected to radiographical examination and manometry in the gullet. Both of these were performed during TE phonation of a sustained vowel/a/.
In lateral neck X-rays, we measured the supero-inferior length where the retropharyngeal prominence came into contact with the anterior wall during phonation. The mean length thus measured was 12.3mm. It was significantly shorter than the 35.4mm of the retropharyngeal prominence.
The intraluminal manometry was carried out by drawing a microtransducer slowly from the esophagus to the mesopharynx through the vibratory source. The obtained pressure with or without a vibrating wave varied depending on the location of the measurement, i. e., 1) high pressure without vibration; 2) high pressure with fine vibration; 3) an abrupt pressure drop with a large amplitude of vibration; 4) pressure at the baseline level with fine vibration; and 5) pressure at the baseline level without vibration. The manometry performed under fluoroscopy in 4 patients revealed that a zone showing an abrupt pressure drop with a large vibration amplitude was included in the contact segment. This zone was regarded as the neoglottis. The mean length of the neoglottis as judged by the manometry was 7.6mm, which was shorter than that of the contact segment in the X-ray examination.
From the above results, it was confirmed that the neoglottis as the vibratory source was formed on a very limited extent of the retropharyngeal prominence during TE phonation.抄録全体を表示PDF形式でダウンロード (2671K) -
Hirokuni Yoshimura, Jun Shinada, Takamasa Koh, Yoshiaki Abe, Akira Ish ...1994 年 45 巻 1 号 p. 22-29
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーFifteen patients with central type early or semi-early lung cancer (including 4 with in situ cancer and 1 with N1 disease) were analyzed with respect to symptoms, sputum cytology, chest roentgenogram, bronchoscopy, surgical procedures and resected specimens. 7 patients had no evidence of disease on the chest roentgenogram (Group I) and 8 demonstrated an abnormal shadow, which was either a segmental (or subsegmental) pneumonia-like shadow or a shadow of a segmental (or subsegmental) atelectasis (Group II). 3 patients in Group I were diagnosed by sputum cytology and had no symptoms. The other patients complained of either hemoptysis, persistent cough or symptoms of pneumonia. All of the patients underwent bronchoscopy, which was successful in localizing their tumors. The findings of this bronchoscopy for central type early lung cancer were (1) surface infiltrative disease, (2) tiny nodules, and (3) nodular tumors. The first two findings tended to be characteristic of the tumors in the Group I patients, and the third finding was peculiar to the Group II patients. More patients in Group I seemed to have early disease than in Group II. The 5-year survival rate of the 15 patients with central type early lung cancer has been 90.9%. They can expect favorable postsurgical survival at present regardless of accompanying variables. We emphasize the importance of chest X-ray findings and bronchoscopic findings in the diagnosis of central type early lung cancer.抄録全体を表示PDF形式でダウンロード (5097K) -
川端 五十鈴, 木場 玲子, 岡村 浩一郎, 増田 成夫1994 年 45 巻 1 号 p. 30-35
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーA case of mucoepidermoid carcinoma of the larynx is reported. A 69-year-old man visited our clinic complaining of hoarsness of approximately 10 months' duration. Laryngeal examination revealed a tumorous mass on the undersurface of the right vocal cord and complete fixation of same-side vocal cord. An excisional biopsy was performed under laryngomicrosurgical techniques. The pathology report diagnosed a mucoepidermoid carcinoma of high grade malignancy. The patient underwent radiotherapy in doses of 30Gy. After radiotherapy, total laryngectomy, right radical neck dissection and left conservative neck dissection were performed. However the patient died 6 months later from distant metastasis.
Among malignant tumors of the larynx, mucoepidermoid carcinoma is extremely rare. Only 9 cases of this tumor have been reported in the Japanese literature, and this is the 10th case in Japan. The pertinent literature was also reviewed.抄録全体を表示PDF形式でダウンロード (5563K) -
川井田 政弘, 桜井 淳, 岡崎 睦, 猪狩 武詔, 福田 宏之, 甲能 直幸1994 年 45 巻 1 号 p. 36-40
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーA case of intractable aspiration in a patient with spinocerebellar degeneration was reported. The patient was a 54-year-old woman suffering from spinocerebellar degeneration for about five years. She developed dysphagia, aphonia and dyspnea with the breakdown of the normal protective function of the larynx. She was admitted in our hospital where tracheostomy was performed ;the tracheal separation and tracheoesophageal diversion were successful. We then discussed these surgical procedures for intractable aspiration in patients with progressive neurologic disease, such as spinocerebellar degeneration, from the viewpoint of quality of life.抄録全体を表示PDF形式でダウンロード (5376K) -
原田 竜彦, 井上 貴博, 加納 滋, 行木 英生, 向井 万起男1994 年 45 巻 1 号 p. 41-44
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーA case of a giant laryngeal polyp causing dyspnea and acute pulmonary edema was reported. This is only the second such case reported in the literature.
The patient was a 57-year-old man who had a sudden onset of both inspiratory and expiratory dyspnea with coughing at the midnight. His glottis was obstructed intermittently by a giant polyp with a pedicule near the anterior commissure on the left vocal cord. Chest X-rays at admission showed fluffy shadows in the lower right lung field. Tracheotomy was immediately performed. Blood gas analysis revealed hypoxemia (pO2:52.5mmHg, pCO2:34.6mmHg) even 6 hours after the tracheotomy, and chest X-rays showed pulmonary edema. On the third day in hospital, the polyp was resected in laryngomicrosurgery under general anesthesia. The data from a blood gas analysis and chest X-rays became normal on the sixth day in hospital. The tracheostoma was able to close spontaneously without any trouble.
We hold the same opinion as Kollef's opinion that, in cases of partial or intermittent upper airway obstruction, pulmonary edema develops before improvement in the obstruction, whereas it occurs after relief of the obstruction in cases of complete obstruction. In our case, the chest X-ray at the patient's visit to the hospital supports this opinion.
The mechanisms underlying pulmonary edema caused by airway obstruction were also discussed.抄録全体を表示PDF形式でダウンロード (5359K) -
井上 貴博, 原田 竜彦, 大平 達郎, 菅家 稔1994 年 45 巻 1 号 p. 45-49
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーA 57-year-old man was observed by his physician to have an embedded denture in his esophagus. He was referred to our hospital for further examination and treatment.
A chest X-ray showed a denture lodged in the lower thoracic esophagus. Initially, we attempted to remove the denture with a rigid esophagoscope under general anesthesia, but we were unable to identify it perhaps because of the low visual capability of the rigid esophagoscope. However, we were later able to extract the denture with a flexible fiberscope.
The next morning the patient complained of dyspnea. Since the chest X-ray presented a bilateral pneumothorax, thoracic drains were implanted. Then, because the chest X-ray demonstrated pleural effusion in the evening, an esophagogram was taken immediately which revealed two esophageal perforations.
Though a perforated esophagus generally constitutes a surgical emergency, a conservative treatment was selected because the perforations were infectious.
Intensive care, during which antibiotics and thoracic irrigation were administered, saved the patient's life.抄録全体を表示PDF形式でダウンロード (4232K) -
南 有紀, 家根 旦有, 田中 治, 宮原 裕, 松永 喬, 中井 寛明1994 年 45 巻 1 号 p. 50-53
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーA 1-year and 9-month old boy visited Nara Medical College Hospital with wheezing after eating chestnuts. Since a foreign body was not detected by the plain chest X-ray and chest CT films, we decided to use MRI. A chestnut appeared as a high signal in T1-weighted imaging of the left main bronchus.
It is sometimes difficult to diagnose radiolucent foreign bodies in the lower respiratory tract, and such cases are often peanuts in infants. It is thought that MRI will be useful in detecting nuts in such cases.抄録全体を表示PDF形式でダウンロード (2418K) -
中田 道広, 岡野 光博, 竹久 亨, 小林 照和1994 年 45 巻 1 号 p. 54-60
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーWe have seen two cases of tracheal diverticulum, a comparatively rare disease, which are reported here.
Case 1 was a 36-year-old male whose main complaint was bloody sputum. A diverticulum was found on the right dorsal side 2cm above the tracheal branching region by bronchial fiberscopy. Tracheal cartilage rings and a membranous area were present in the lumen, and a congenital tracheal diverticulum was diagnosed.
Case 2 was an 80-year-old female with coughing and sputum as the main complaints. In laryngofiberscopy, a diverticulum was found on the right dorsal side 3cm subglottically. The aperture was expanded and sacciform, and acquired tracheal pulsion diverticulum was diagnosed.
In both cases, the course of the disease is being observed conservatively.
We discussed 28 cases of tracheal diverticulum reported in the Japanese literature.抄録全体を表示PDF形式でダウンロード (5719K) -
緒方 憲久, 鮫島 靖浩, 浅井 栄敏, 増山 敬祐, 石川 哮1994 年 45 巻 1 号 p. 61-64
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーRecently we have seen a case of bronchial foreign body with pneumothorax, which has been reported in only a few cases in Japan.
A 14-month-old male had begun to suffer from coughing and dyspnea on March 28, 1993. X-rays showed a pneumothorax of the left lung. Constant air aspiration from the left pleural cavity by the insertion of a catheter resulted in marked improvement. However, his pneumonia and slight fever did not improve in spite of the continuous use of antibiotics. Aspiration of a foreign body was highly suspected, and the patient came to our clinic on April 23, 1993. X-rays indicated emphysema and a shift of the mediastinum toward the right. Direct bronchoscopy was performed with a ventilation bronchoscope. A seed of a Chinese citron was found at the left main bronchus. After the seed was removed, the symptoms disappeared and no complications were observed.抄録全体を表示PDF形式でダウンロード (2836K) -
森田 裕人, 片桐 史郎, 吉村 博邦1994 年 45 巻 1 号 p. 65-67
発行日: 1994/02/10
公開日: 2010/02/22
ジャーナル フリーWe sometimes see bleeding from the site of biopsy (brushing or curettage) during bronchoscopic examinations. If bleeding occurs after a biopsy, brushing or curettage from peripheral lung lesions, it is often difficult to insert the biopsy forceps, brushes or curette again in the proper part of the bronchus. Therefore we perform biopsies, brushing or curettage through a radiopaque catheter which is inserted through the channel of a fiberscope in advance using a jointed brush or curette as a guide under fluoroscopy. Using this catheter, we can easily repeat brushing, curettage and biopsies accurately and quickly.抄録全体を表示PDF形式でダウンロード (2353K)
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