巻号一覧
48 巻 (1997)
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48 巻, 3 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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山下 耕太郎, 石井 甲介, 佃 守1997 年 48 巻 3 号 p. 211-215
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーThe anterior and posterior macula flava are located at the anterior and posterior ends of the vocal folds. The macula flava have a peculiar structure with dense elastic fibers, but their functions are unknown.
The physiologic properties of the macula flava are thought to be determined by the alignment and distribution of collagen and elastic fibers.
We studied the three dimensional arrangement of collagen and elastic fibers in the macula flave of the human vocal fold by scanning electron microscopy after dissolving the cellular elements and the collagen fibers with a 90% formic acid treatment and, also, digesting the cellular elements and the elastic fibers with a 10% sodium hydroxide treatment.
This study revealed that the anterior macula flava consists of lumps of fine collagen fibers and fine elastic fibers, detached from the thyroid cartilage, whereas the posterior macula flava consists of thick bundles of collagen and elastic fibers running longitudinally and connecting directly to the arytenoid cartilage.
It was speculated that the anterior macula flava have a massive mixed structure composed of collagen fibers and elastic fibers which run separately in the vocal ligamentum, to form the fulcrum apart from the thyroid cartilage.
Furthermore, the posterior macula flava have a structure corresponding to the longitudinal strong force.抄録全体を表示PDF形式でダウンロード (4982K) -
石田 春彦, 岩江 信法, 天津 睦郎1997 年 48 巻 3 号 p. 216-220
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーAntigen-presenting cells (APCs) are considered to be initiators of the allergic reaction, and Langerhans cells and macrophages are APCs found in the human nasal cavity. We studied the distribution of Langerhans cells and macrophages in human laryngeal mucosa.
Mucosal specimens were obtained from four normal larynxes that were resected due to carcinoma of the mesopharynx or oral cavity. Sections were prepared from the epiglottis, vocal cords, subglottis and the arytenoid portion of the larynx. Langerhans cells and macrophages were investigated immunohistochemically using antibody S-100 protein for the Langerhans cells, CD68 for the macrophages, and the antihuman HLA-DR antibody as an MHC-class II antigen.
Langerhans cells were more abundant than macrophages in the epiglottis and arytenoid portions. In contrast, in the subglottis macrophages were more common than Langerhans cells. Few Langerhans cells or macrophages were seen in the mucosa of the vocal cords. MHC-class II antigens were present in most of the Langerhans cells and macrophages.
These findings suggest that Langerhans cells and macrophages function as APCs in the human larynx. Langerhans cells are present in the squamous epithelium of the larynx, except in the vocal cords, and macrophages are present in the ciliated columnar epithlium.抄録全体を表示PDF形式でダウンロード (7538K) -
森脇 計博, 奥村 隆司, 川嵜 良明, 有賀 秀治, 佐野 光仁, 久保 武1997 年 48 巻 3 号 p. 221-226
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリー33 cases of subglottic stenosis were treated at the authors' clinic over 13 years (1982-1994). Most of these 33 cases were due to long-term endotracheal intubation and tracheostomy. We operated on 20 of these cases with subglottic stenosis. After these operations, systemic administration of antibiotics and local inhalation of steroids were essential. T-tubes were more effective in selected cases, combined with the surgical procedure. Recently, laser have been used as one treatment technique. This may become a very useful tool, if indications are selected properly. We have experienced three severe complications in spite of the treatment. An obstruction of a T-tube developed due to sputum, a removed T-tube accidentally, and a trachea was burn by KTP laser. Finally, we report on a new device named the L-tube that removes some of the deficiencies of the T-tube.抄録全体を表示PDF形式でダウンロード (700K) -
成功率と嚥下機能への影響因子について森 一功, 坂田 一成, 平野 実, 清川 兼輔, 矢永 博子, 田井 良明, 藤田 博正1997 年 48 巻 3 号 p. 227-233
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーSeventy-four patients who had undergone free jejunal autografts for head and neck reconstruction were reviewed to determine what might be necessary to increase the success rate of this technique. The success rate of these free jejunal autografts was 96 percent and as a whole 88 percent of these patients could resume an oral diet eighteen days after operation on average.
Patients who had developed a fistula or total necrosis of the grafted jejunum frequently showed hyperglycemia or tachycardia immediately after operation. Endothelial damage to the vessels and/or impairment in peripheral circulation were thought to be one of the causes of these complications, suggesting that it is advisable to strictly monitor blood sugar and heart rate after such operations.
Patients whose distal anastomoses had been irradiated postoperatively frequently showed stricture at the distal anastomoses. It was thought to be due to the edema during irradiation and cicatricious stenosis after irradiation, suggesting that these patients should undergo dilatation frequently.抄録全体を表示PDF形式でダウンロード (798K) -
藤本 保志, 松浦 秀博, 田山 二朗, 中山 敏, 長谷川 泰久1997 年 48 巻 3 号 p. 234-241
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーThis paper reports on the development of an improved method for testing the swallowing function (The Swallowing Ability Seale) which has been designed to assess dysphagia after therapy for oral and oropharyngeal cancer. The instrument consists of a 2-step questionnaire: an MTF score and a dysphagia score. The MTF score is a simple and practical assessment tool consisting of three subscales: 1) Method of intake, 2) Time of intake, and 3) Food. The dysphagia score is an assessment tool for defining patients' anatomic or physiologic swallowing disorders. The scale was administered to 23 oral and oropharyngeal cancer patients. The dysphagia score significantly decreased after wide dissection of the tongue, and clearly distinguished between differences in ability before and after rehabilitation. We also found a correlation between the MTF score and the dysphagia score. The results indicated that the scale is reliable and sensitive to functional differences across a broad spectrum of oropharyngeal dysphagia after therapy for oral and oropharyngeal cancer.抄録全体を表示PDF形式でダウンロード (890K) -
唐帆 健浩, 大前 由紀雄, 田部 哲也, 羽生 耀子, 村瀬 優子, 北原 哲, 井上 鐵三1997 年 48 巻 3 号 p. 242-248
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーThe head-rotation maneuver during swallowing has been reported to reduce the occurrence of aspiration in some dysphagic patients. This study examined the effects of head rotation on pharyngeal swallowing in healthy subjects. A helical CT scan was used to study the anatomical change of the pharynx in three volunteers performing the head-rotation maneuver. Further, videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. The helical CT scan revealed that the piriform sinus formed a fusiform shape on the rotated side, and a funnel shape on the opposite side. The videofluoroscopic study revealed that head rotation swallowing lateralizes the bolus away from the rotated head. The pharyngeal manometric study indicated that the pharyngeal peak pressures significantly increased on the side of the head rotated during pharyngeal swallowing. The pharyngeal pressures opposite to the side of the head rotation were not affected but a significant decrease in the upper esophageal sphincter (UES) resting pressure was noted. We concluded that head rotation swallowing in normal subjects not only alters the bolus pathway but also increases the function of pharyngeal clearance, and therefore UES dynamics.抄録全体を表示PDF形式でダウンロード (6258K) -
野々山 勉, 原田 輝彦, 大川 親久, 鵜飼 幸太郎, 坂倉 康夫1997 年 48 巻 3 号 p. 249-255
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーA statistical study was made of 69 cases of tracheo-bronchial foreign bodies treated at our clinic during the 16 years from 1978 to 1994. Fifty-five cases (80%) were under 3 years of age and 38 cases (55%) were one-year-old babies. The foreign bodies were found in the right bronchus in 24 patients, in the left bronchus in 32 patients, and in the trachea in 6 patients. Of the various kinds of foreign bodies removed, peanuts predominated (34 cases, 49.3%). The foreign bodies were removed by means of a ventilation bronchoscope under general anesthesia. Most of the cases were treated within a few days successfully. However, the longest period of lodgement was 87 days.抄録全体を表示PDF形式でダウンロード (818K) -
池田 元久, 渡辺 勇1997 年 48 巻 3 号 p. 256-260
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーA 54-year-old male suffering from an epidermoid cyst of the vocal cord and a 55-year-old male suffering from a vocal cord polyp accompanied by glottic sulcus underwent surgical treatment. According to the histopathological findings of the first case, we agreed with Bouchayer's opinion, namely, that this type of sulcus looked more like an epidermoid cyst which had opened at the surface of the vocal cord than a true replication of epithelium to form a sulcus. In the second case, the patient had been aware of his husky voice since childhood. He visited our hospital this time because his dysphonia had become worse lately. It is already known that a glottic sulcus is sometimes associated with cordal epidermoid cysts or polyps, and the diagnosis of these three diseases is usually difficult because of the lack of characteristic clinical signs besides voice trouble. It is important to record the clinical history of patients with voice disorders very carefully, and to perform a careful endoscopic and/or laryngoscopic examination when we are consulted by patients with persistent husky voice.抄録全体を表示PDF形式でダウンロード (4149K) -
井口 芳明, 小川 克二, 山本 一博, 加藤 幸子, 小野 雄一, 鐵田 晃久1997 年 48 巻 3 号 p. 261-264
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーA case of a large epiglottic cyst is reported. The patient was a 66-year-old woman who complained of a tumor in the pharynx and dyspnea. She was found to have a large mobile cystic mass in her mesopharynx. When she lay down, the mass entered the laryngeal lumen and she complained of dyspnea. We performed tracheostomy for general anesthesia and prevention of bleeding. The mass was removed under direct laryngoscopy using a WEERDA laryngoscope. The mass had a wide steal, but it could be removed completely. Histological examination revealed an epidermoid cyst, the wall of which was lined with squamous epithelium.抄録全体を表示PDF形式でダウンロード (4409K) -
吊り上げ胃管上端を一時的に盲端にした症例千々和 圭一, 森 一功, 藤浦 仁美, 平野 実, 清川 兼輔, 田井 良明, 藤田 博正1997 年 48 巻 3 号 p. 265-270
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーRecently, reconstruction using free jejunum autograft is usually performed after resection of hypopharyngeal and cervical esophageal carcinomas. Furthermore, when a tumor extends down into the thoratic esophagus, reconstruction is performed with the use of a jejunal autograft and a gastric tube after total pharyngo-laryngo-esophagectomy. However, sometimes primary reconstruction is impossible given the general condition of a patient and the condition of the reconstructed tissues.
Such a case with a hypopharyngeal carcinoma was discussed. A 77-year-old male underwent total pharyngo-laryngo-esophagectomy, but primary reconstruction of the pharynx was impossible since an upper part of his gastric tube had poor blood supply. Therefore, the upper end of the gastric tube was closed and embedded in the patient's neck after the blood supply was supercharged using microvascular anastomosis between the left gastroepiploic artery and the left transverse cervical artery. A gastric tube stoma was made at the neck after postoperative radiation therapy of 54 Gy. After these staged operations, a final reconstruction of the pharynx was made with the use of a pectoralis major myocutaneous flap. The postoperative swallowing function of the patient showed no problems, and no recurrent tumor was detected. This result suggests that this staged operation procedure is effective and should be applied in similar, limited cases.抄録全体を表示PDF形式でダウンロード (6021K) -
工藤 典代, 飯田 由美子, 佐内 明子1997 年 48 巻 3 号 p. 271-276
発行日: 1997/06/10
公開日: 2010/02/22
ジャーナル フリーSix infants with upper airway obstruction were discussed. Their disease were severe laryngomalacia, trachea-laryngomalacia, subglottic stenosis of the larynx and choanal atresia associated with Crouzon syndrome. They were treated with long term intratracheal intubation for more than 2 months. Three of them had systematic complications.
We succeeded in decannulation with 3 of these patients after long-term intubation, though the others needed tracheotomies. Their average body weight was about 6000g and the average age was 4 or 5 months, when the decannulation was performed.
The three infants who needed tracheotomies had systematic complications. In particular all of them had the GER (gastro-esophageal reflex).
We concluded that the appropriate time for decannulation and tracheotomy in infants is when they are 5 or 6 months old and their body weight about 6000g.
Unless decannulation is successful, because of the severe upper airway stenosis, a tracheotomy is necessary for such patients.抄録全体を表示PDF形式でダウンロード (1187K)
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