巻号一覧
46 巻 (1995)
- 6 号 p. 447-
- 5 号 p. 361-
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46 巻, 5 号
選択された号の論文の11件中1～11を表示しています
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進 武幹, 梅崎 俊郎1995 年 46 巻 5 号 p. 361-368
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーIn general, esophagography with a VTR system, electromyography and measurement of the pressure of the digestive tract are used for evaluation of the swallowing function. In previous reports, a time lag in the movement of the bolus has been pointed out in many patients with dysphagia. However, a standardized time reference for this lag has not been clarified in most cases.
A new concept for evaluating dysphagia is introduced in this study to clarify the pathophysiology of swallowing disorders. The movement of the bolus is referred to as a“phase, ”and the time progress of the patterned output from the medullary swallowing center is referred to as a“stage. ”It can, therefore, be considered that dysphagia occurs when the time lag between the phase and the stage exceeds the physiologically permissible limits.
Standard points for the phase and the stage were determined separately from an analysis of the esophagogram using a VTR system and normal volunteers, and the time lag between the two points was measured in patients with dysphagia. We also devised a new instrument to evaluate the swallowing function which could record simultaneously the pressure of the oral cavity and that of the pharynx and the air flow rate. These methods were useful for detecting the delay in the initiation of pharyngeal swallowing which is observed in patients with dysphagia caused by lesions of the corticobulbar tract.抄録全体を表示PDF形式でダウンロード (2881K) -
吉田 哲二1995 年 46 巻 5 号 p. 369-374
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーAspiration resulting from swallowing disorders can be classified into four types. This classification is helpful for selecting an appropriate surgical treatment for the aspiration as well as for difficulty in swallowing.
Type I: In this type, aspiration ccurs when the larynx is elevated and closed during swallowing. It results from an incomplete laryngeal closure.
Type II: Here aspiration takes place when the larynx descends and opens at the end of the second stage of swallowing. This type aspiration results from a weak propelling force and/or a strong resistance at the entrance to the esophagus. The weak propelling can be attributed to an incompetent velopharyngeal closure, disturbances of tongue movement and/or a weak pharyngeal peristalsis.
Type III: Aspiration occurs in both the rising and falling phases of the larynx.
Type IV: This type is observed in those patients who are unable to execute the movements of the second stage of swallowing. The inability for the second stage movements seems to be caused by one of the following two factors: a severe paralysis of the swallowing muscles and strong inhibitory stimuli to the swallowing center of the medulla oblongata. The latter is observed in those patients who would have a very severe aspiration if their swallowing center allowed them to swallow. In this type, the bolus is transported from the mouth to the pharynx by gravity and weak tongue movements. The larynx closes as a reflex action but does not present the type of rising and falling movement by executed in the normal second stage. When the larynx opens, the bolus in the pharynx enters the airway.抄録全体を表示PDF形式でダウンロード (4098K) -
菅間 康夫1995 年 46 巻 5 号 p. 375-379
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーAspiration pneumonia is caused by materials inhaled into the lower respiratory tract, such as gastric juice or food particles. In adults, most of the patients have a swallowing disturbance such as bulbar palsy or a consciousness disturbance as well as a reduced cough reflex.
Acute aspiration pneumonia caused by gastric juice is sometimes referred to as the“Mendelson syndrome”, which is a chemical injury to the broncho-alveolar epithelium and vascular endothelium. Food particles from the oral cavity or stomach, which are usually contaminated with resident bacteria from the oral cavity or pharynx, subsequently cause bacterial infections and sometimes even lung abscesses. One kind of chronic aspiration pneumonia which is similar to diffuse pan-bronchiolitis (DPB), is called diffuse aspiration bronchiolitis (DAB), is due to continuous small amount of aspiration.
It is important to diagnose aspiration pneumonia immediately and to start its treatment at an early stage.抄録全体を表示PDF形式でダウンロード (5722K) -
伊藤 裕之, 冨田 昌夫, 上出 洋介, 加藤 孝邦1995 年 46 巻 5 号 p. 380-386
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーConservative treatments of dysphagia can be divided into three categories: the correction of postures, and the indirect and the direct exercise for dysphagia. Abnormal postures of the patients deteriorate into dysphagia and also disturb the expectoration of phlegm. The first step in the conservative treatments is correction of the posture when it is necessary. The second is the indirect exercise for dysphagia. Physical therapy, and sometimes speech therapy, are performed on the dysphagia in the first and second stages of deglutition, but they are not effective in relieving the insufficiency of the esophageal sphincter. The enlargement of the esophageal sphincter by the use of a balloon catheter is useful in cases of the incomplete insufficiency of the esophageal sphinctor without other disorders of deglutition. The complete closure of the esophageal sphincter is not indicated for this method. The intermittent oral catheter insertion method by Kisa has been reported as being useful as the training of dysphagia. Also, respiratory exercises for the expectoration of phlegm are necessary to prevent complications to the respiratory organs before direct exercise.抄録全体を表示PDF形式でダウンロード (6368K) -
田山 二朗1995 年 46 巻 5 号 p. 387-393
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーWe report on surgical treatments for aspiration that results from functional dysphagia.
The surgical techniques can be classified into functional operations and radical operations. The functional operations support the injured function of swallowing and aim at oral feeding with no aspiration. We would need to divide the airway from the feeding tract in order to prevent aspiration in patients who complained of severe aspiration. In these cases, we might do the radical operations that could close the larynx or separate trachea and the esophagus.
The radical operations can be divided into two types in view of laryngeal preservation.
Before an operation, we need a detailed analysis of the patient's swallowing functions with fluolography, electromyography and so on. We should select one of these methods taking into account the causes of the dysphagia, the basic diseases, age, prognosis for the swallowing function, and the patient's wishes and/or life style. Finally, we should emphasis the importance of a functional analysis of a patient's swallowing before any operation, and the possibility for rehabilitation after operation.抄録全体を表示PDF形式でダウンロード (6010K) -
阿部 直1995 年 46 巻 5 号 p. 394-398
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーVomiting is a complex reflex that is centrally programmed and involves a sequential and coordinated contraction of many different muscles, such as the gastrointestinal smooth muscle, the upper airway muscles, and the muscles involved in respiration. The respiratory muscles are important contributors to vomiting. The abdominal muscles, parasternal intercostal muscles, and costal part of the diaphragm contract phasically during vomiting to increase abdominal pressure and aid expulsion. Compared with breathing at rest, the relative phase of the diaphragm and abdominal muscles changes so that during vomiting both the inspiratory and expiratory respiratory muscles contract together to assist expulsion. During CO2 rebreathing, electrical activity and shortening increase in the costal, medial crural, central crural, and lateral crural regions of the diaphragm, compared to breathing at rest. However, during vomiting, (1) both shortening and EMG activity significantly increase compared to the resting state in the costal segment; (2) lateral crural shortening does not increase in spite of a significant increase in EMG activity; (3) the medial crural lengthens without any increase in EMG activity; and (4) the central crural diaphragm shows a significant biphasic length change, with initial shortening followed by lenghthening. A strong coordinated interaction between the brain stem centers responsible for the control of respiration and of vomiting is suggested.抄録全体を表示PDF形式でダウンロード (2514K) -
関口 利和1995 年 46 巻 5 号 p. 399-405
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーGastroesophageal reflux (GER) is a phenomenon usually observed in normal subjects. Most healthy individuals reflux gastric contents into their esophagus, and this is called physiological reflux. These episodes occur in the postprandial period; are short lived; rarely cause other symptoms; and almost never occur at night.
In contrast, another kind of GER is called pathological GER, and this causes other symptoms and diseases.
The lower esophageal sphincter (LES) function contributes largely to GER.The mechanisms of GER can be classified into three types: 1) the transient LES relaxation; 2) intraabdominal pressure transients, and 3) spontaneous free GER.
The first is usually observed in healthy subjects. The latter two mechanisms are associated with a low resting LES pressure.
Pathological GER includes a high rate in the latter two mechanisms.
GER increases postprandially, possibly secondary to gastric distention.抄録全体を表示PDF形式でダウンロード (2624K) -
全国PTP食道異物報告集計岩田 重信, 小林 由充子, 高須 昭彦, 内藤 健晴, 森 茂樹, 井畑 克朗, 浦野 誠, 岩田 義弘, 横山 尚樹1995 年 46 巻 5 号 p. 406-418
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーA statistical study was made of 51 cases of PTP (press-through-pack) among 186 cases of foreign bodies in the esophagus at our clinic and of 635 cases obtained from reports in Japan between 1974 and 1994. The results were as follows.
1) Our series included 21 males and 30 females aged from 15 to 87 years (mean age: 62.7 years). The incidence of PTP for all cases of esophageal foreign bodies was 27.5%.
2) The sites of the PTP were the cervical esophagus (51.0%), the middle esophagus (37.3%), and the lower esophagus (11.6%). However, between males and females, the rate of incidence was higher in the cervical esophagus in females than in males.
3) The annual incidence gradually increased from 10.9% (1976) to 44.8% (1994) compared to other esophageal foreign bodies.
4) Bleeding and edematous swelling of the esophageal mucosa were observed in all cases during operations. Some revealed granulation around the foreign bodies without perforation.
5) Treatments were performed under open tube esophagoscopy under general anesthesia, except in one case.
6) 635 cases were obtained from reports in Japan. Their ages ranged from 9 to 92 years, and females showed a higher incidence of PTP than males. Also, annual incidence increased in older persons, especially in females.
7) To avoide the PTP esophageal foreign bodies, the forms and materials of PTP were discussed from the veiwpoint of medical institutes, pharmacologists and patients.抄録全体を表示PDF形式でダウンロード (5616K) -
Masato Takase1995 年 46 巻 5 号 p. 419-432
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーThe author carried out a comparative study of various forced expiratory volume measures focusing on childhood asthma, in search of the best indicator of airway obstruction in children. The measures compared included percent predicted values of forced vital capacity, forced expiratory flow between 25% and 75% of vital capacity, forced expiratory volume in t= 0.5, 0.6, 0.7, 0.8, 0.9, 1.0 seconds, written as %FVC, %FEF25-75%, %FEVt and FEVt%, which denoted the percentage ratio of FEVt to FVC.
Standardized spirometry was performed using a 9-liter, water-sealed spirometer. Predicted values were calculated by means of regression equations, using the power function of standing height, which were derived from 432 healthy subjects consisted of 232 males and 200 females between 9 and 14 years of age. A total of 240 asthmatic subjects, subdivided into equal groups A and B, and composed of even age and sex distributions, were selected from a larger group of children with physician-diagnosed asthma. Group A had been asymptomatic for the past year, while group B had been symptomatic. Between-group differences for various measures were quantified by means of the Mann-Whitney U-test. Using the lower end of a 95% confidence limit for each measure calculated for the healthy subjects by sex, the abnormality rates on the different measures were compared between the healthy and the asthmatic subjects, as well as between groups A and B by a chi-square test.
In conclusion, FEV1.0% proved to be the most powerful single measure for the detection of mild airway obstruction in attack-free asthmatic children. The rates of abnormality revealed by FEV1.0% were 47.5% for group A and 70.0% for group B. The use of FEVt% with shorter time periods did not increase the sensitivity. FEV1.0% was constant within the age-range studied, but about 2% higher in females than in males. Although, the mean absolute difference between the healthy and the asthmatic subjects was largest at %FEF25-75%, it fell behind FEV1.0% in terms of discriminatory power because of its larger data variance.抄録全体を表示PDF形式でダウンロード (2410K) -
平田 思, 夜陣 紘治, 田頭 宣治, 青木 正則, 田村 千春1995 年 46 巻 5 号 p. 433-436
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーA case of mucoepidermoid carcinoma of the larynx was reported. The patient was a 55-year-old man who had complained of hoarseness for five months. A biopsy from a tumor of left vocal cord revealed a moderately differentiated squamous cell carcinoma. Although the tumor lesions disappeared with chemotherapy (CDDP 100mg) and radiotherapy (liniac 66 Gy) 10 months later, there was a recurrence at which time a total laryngectomy was performed. The final pathologic diagnosis was mucoepidermoid carcinoma of the larynx. Mucoepider moid carcinoma originating in the larynx is extremely rare. Only 11 cases have been reported in the Japanese literature. Our case was initially diagnosed as squamous cell carcinoma.抄録全体を表示PDF形式でダウンロード (2721K) -
伊藤 裕之, 久保田 彰, 森山 寛1995 年 46 巻 5 号 p. 437-442
発行日: 1995/10/10
公開日: 2010/10/20
ジャーナル フリーThis report deals with a case of dysphagia induced by the irradiation of a malignant lymphoma of the neck. The patient was a 55-year-old male with dysphagia who had undergone irradiation to the neck for a malignant lymphoma ten years previously. The dysphagia that had gradually worsened in ten years made him enable to eat and drink orally. He often contracted by pneumonia. On first examination, atrophic changes were observed in the soft palates, and the epiglottis, and the improvement of the tongue was bilaterally impaired. These findings were diagnosed as the causes of the dysphagia. A barium study showed that the movement of the tongue and the pharynx were impaired. The barium was aspirated. A plain X-ray film of the mandible showed ostitis. The impairment of the tongue movement was due to bilateral hypopharyngeal nerve palsies induced by the irradiation. Laryngeal suspension and cricopharyngeal myotomy were not suitable because they could have aggravated the radiation necrosis of the thyroid cartilage which will be expected in the future. A total laryngectomy, which sacrifies the phonation, was out of the question, because the patient's dysarthria was not so hard to understand. He was instructed in the self-insertion of a feeding tube to get enough nutrition, the physical therapy of the lung with the aid of his wife to prevent aspiration pneumonia. The loss of phonation lowers the QOL of such patients. In the cases with dysphagia which do not recover with surgical treatments, rehabilitation should mainly stress the conservation of phonation and the prevention of pneumonia to maintain the higher QOL of patients.抄録全体を表示PDF形式でダウンロード (4747K)
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