巻号一覧
49 巻 (1998)
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49 巻, 5 号
選択された号の論文の9件中1～9を表示しています
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進 武幹, 高木 誠治1998 年 49 巻 5 号 p. 395-404
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーSensory information from the pharynx and larynx are essential to induce the sequence of protective reflexes of the upper airway, such as swallowing and coughing. The sensations received by the pharyngeal and laryngeal mucous are transmitted to the nucleus tractus solitarius (NTS) via the glossopharyngeal nerve (GPN) and the superior laryngeal nerve (SLN) .
The motor pattern for pharyngeal swallowing is quite stereotyped. Once swallowing has been initiated, no additional peripheral afferents are needed for its completion. This suggests that swallowing is produced by a central pattern generator (CPG), which is likely to be located in the medulla oblongata. The CPG is activated when the number of sensory impulses exceeds a certain threshold, which is modulated by the cortex through the corticobulbar tract.
Swallowing-related neurons (SRNs) were recorded systematically in the medulla oblongata of anesthetized cats. These SRNs received orthodromic inputs from the superior laryngeal nerve (SLN) and showed transient changes in their activity synchronous with swallowing. These neurons could be divided into three types : Type I SRNs are sensory-relay neurons from the SLN in the NTS ; Type II are interneurons located diffusely in the parvocellular reticular formation ventral to the NTS, which received oligosynaptic inputs from the SLN ; and Type III are motoneurons in the nucleus ambiguus. Some Type II neurons still showed a swallowing activity even after the animals were paralyzed, which suggests that they could be involved in the generation of swallowing outputs.
The threshold for triggering the CPG is influenced by output from the cerebral cortex. The region of the cortex related to swallowing is located in the rostral part of the orbital gyrus and sends output to the SRNs. This pathway modulates the threshold for the activation of the CPG and regulates excitability in the elicitation of swallowing.抄録全体を表示PDF形式でダウンロード (1593K) -
横井 茂夫1998 年 49 巻 5 号 p. 405-410
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーSuckling motions were investigated by recording the oral motions of normal infants suckling their mother's milk using ultrasonic tomographic images from below the mandibular foramen. The suckling motion was revealed to be a back and forth waving motion of the whole tongue, including the root of the tongue beginning from the tongue tip and extending to the epiglottis, and a peristalsis-like motion which fixes and presses the nipple and transports the emerging milk.
The oral motion around the tongue was also recorded with a small video camera built into a suction bottle, and the suckling motion was simultaneously using an instruments developed to measure the suckling pressure. The suckling motion of the tongue was revealed to be a peristalsis-like motion in which the tongue closely surrounds the nipple and the center of the tongue presses the palate first with the anterior part of the tongue and subsequently with the posterior part of the tongue. Up to the age of three months, the suckling pressure waveforms are regular, and suckling occurs as frequently as 80-90 per minute with a constant suckling pressure.抄録全体を表示PDF形式でダウンロード (2752K) -
-小児科の立場より-舟橋 満寿子1998 年 49 巻 5 号 p. 411-416
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーDysphagia often occurs in patients with cerebral palsy so severe as to have no head control or be unable to maintain a sitting posture. Abnormal muscle tonus causes various complications such as respiratory failure and gastrointestinal dysfunction. The primary brain involvement is non-progressive. However, with aging, these patients tend to suffer from the secondary progression of their complications, including dysphagia.
When a patient is clinically suspected of having aspiration, video-fluorography and laryngeal fiberscopy are indicated. Assessment of respiratory failure, gastroesophageal reflux (GER), and nutritional state is also needed. The following problems suggest that full oral feeding is inappropriate, and supplementary tube feeding should also be used: frequent lower respiratory infection (twice a year or more), silent aspiration, upper respiratory obstruction, GER, emaciation, and lethargy.
Treatment consists of rehabilitation of the swallowing function and implementation of tube feeding. Control of the posture, postural drainage of sputum, and preservation of the cough reflex are important to prevent concomitant respiratory failure. For cases intractable by medical management, surgical procedures such as laryngotracheal diversion and gastrostomy may be indicated.抄録全体を表示PDF形式でダウンロード (1098K) -
林田 哲郎1998 年 49 巻 5 号 p. 417-422
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーRecently, the birth rate has been decreasing. On the other hand, the incidence of high risk babies such as small for date babies, babies with cerebral palsy has become relatively high. Severe dysphagia and respiratory dysfunction in these patients often requires surgical intervention to prevent recurrent aspiration pneumonia and to avoid this vicious circle. Among the several procedures which can achieve this aim, tracheoesophageal diversion, first described by Lindeman in 1975, may be most suitable for younger patients with cerebral palsy according to our experience with 174 operated cases from April 1990 to March 1998. The operative technique is comparatively easier than that of total laryngectomy, and the larynx as well as the recurrent nerve is preserved. The need for this operation is now unexpectedly increasing, which may be due to the possibility of reconstruction of the laryngeal function and the small rate of post-operative complications, such as tracheoesophageal fistula.抄録全体を表示PDF形式でダウンロード (4513K) -
-93症例の臨床経過-巨島 文子1998 年 49 巻 5 号 p. 423-428
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーThe recovery of 93 patients from the acute phase of dysphagia with newly developed cerebral infarction is reported. The patients were divided into cases of pseudobulbar palsy and cases of bulbar palsy on the basis of MRI images of their brains. 78 of the patients, who had no medullary infarction, were diagnosed as having pseudobulbar palsy. The other 15, who suffered from lateral medullary infarction (so-called Wallenberg's syndrome) were diagnosed as having bulbar palsy. We studied their clinical courses by use of the laryngeal fiberscope and the barium swallow test. Within 4 weeks, 14 patients (15.1%) had recovered sufficiently to eat soft food, and within 4 to 12 weeks 60 patients (64.5%) had recovered to the same extent. However, in 19 cases (20.4%) severe dysphagia persisted for more than twelve weeks, even with intense rehabilitation. Of these, 4 suffered from medullary infarction and the other 15 had multiple lesions. Those patients with pseudobulbar palsy suffered a disturbance at the oral stage but maintained their pharyngeal movements, though they had difficulty in the transition from the oral to the pharyngeal stage. One patient with pseudobulbar palsy had widespread lesions in the lower motor cortex, which resulted in a disturbance at the pharyngeal stage. Those patients with bulbar palsy suffered disturbance to a series of pharyngeal movements, such as laryngeal elevation and pharyngeal constriction. In two serious cases, cricopharyngeal myotomy and laryngeal suspension were performed. In sum, neurological findings and MRI images of the brain are useful for the diagnosis of dysphagia and its prognosis at the acute stage of cerebral infarction.抄録全体を表示PDF形式でダウンロード (3145K) -
棚橋 汀路1998 年 49 巻 5 号 p. 429-435
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーAspiration and prolongation of the pharyngeal transit-time of a bolus become intractable problems in pharyngeal dysphagia caused by brain and/or brainstem stroke. Reconstruction of the swallowing function and the relief of aspiration are fundamental problems in the surgical management of pharyngeal dysphagia, the preservation of understandable speech and a normal airway without tracheostoma are also important. To date, several effective surgical procedures have been presented by many authors : cricopharyngeal myotomy, thyrohyoidpexia, laryngeal suspension, thyromandibular connection, laryngeal diversion and glottic closure. Indications for the respective surgical procedures are determined from videofluoroscopic and manometric examinations in which bolus transit-time, laryngeal closure, upward and forward motion of the larynx and the hyoid bone, opening of the pharyngoesophageal junction, relationship between aspiration and bolus transit (before, during and after swallowing) and swallowing pressure are measured and the patho-physiology of the dysphagia is evaluated.抄録全体を表示PDF形式でダウンロード (1292K) -
亀谷 隆一, 間中 和恵, 松永 英子, 鰺坂 涼, 中井 孝尚, 牧山 清, 久松 建一, 木田 亮紀1998 年 49 巻 5 号 p. 436-441
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーClinical features of acute epiglottitis were studied in 93 patients, 74 males and 19 females ranging from 19 to 78 years of age (mean age: 46.0 years), who had been admitted to our department over the last 10 years. The mean duration of illness was 2.3 days, and the mean period of hospitalization was 7.8 days. Then white blood cell count had increased to 16, 000/mm3 and their CRP to 9.8 mg/dl on average. A smoking habit was noted in 69 of the 93 patients (73.5%) . Thirteen patients (14.0%) had diabetes mellitus as an underlying disease. Forty-five patients (48.4%) had a prior history of therapy at other institutions. Airway control was required in 7 patients (7.5%) . It was suggested that acute epiglottitis develops rapidly, although it improves smoothly after appropriate therapy. It was also suggested that airway obstruction may occur in patients with associated diabetes mellitus or in those who visit a hospital within a couple of days after the onset of symptoms. Patients with acute epiglottitis often visit clinicians specializing in fields other than otolaryngology. Therefore, otolaryngologists should try to inform other clinicians about the clinical features of acute epiglottitis.抄録全体を表示PDF形式でダウンロード (1304K) -
Changes during the Breath Adaptation PeriodKazuhiko Shirota1998 年 49 巻 5 号 p. 442-450
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーThe breath adaptation period of newborns involves the switch from placental respiration to pulmonary respiration and remarkable respiratory-physiological changes. We made an acoustic analysis of the changes over time in neonate breath sounds as one of the objective indicators of such changes.
Using 30 children delivered transvaginally and 11 children delivered by caesarean section as subjects, breath sounds were recorded 2, 6, 12, 24, 48 and 72 h after birth, and frequencies were analyzed by a fast Fourier transform. From the power spectrum obtained, the percentage of the high frequency power at 500-700 Hz to the total power at 100-700 Hz (hereafter referred to as %500-700) was calculated for the study. In the children delivered transvaginally, %500-700 reached a peak 24 to 48 h after birth and tended to decrease gradually thereafter. The children delivered by caesarean section showed a peak 48 to 72 h after birth in many cases, although no fixed trend was seen. Various factors determine the frequency characteristics of breath sounds. Our study suggests that not only the influence of the discharge and the absorption of vesicular fluid, but also the lung compliance and changes in the functional residual volume, are involved with the changes in the frequency characteristics of the breath sounds of newborns from the period immediately after birth through the breath adaptation period.抄録全体を表示PDF形式でダウンロード (1299K) -
箕山 学, 田辺 正博, 田中 信三1998 年 49 巻 5 号 p. 451-457
発行日: 1998/10/10
公開日: 2010/10/20
ジャーナル フリーTwo patients with inflammatory stenosis of the subglottic larynx and upper trachea due to high tracheostomies underwent an open treated reconstruction. Stenosis was observed at the level of the cricoid cartilage in one case, and at the cricoid cartilage and upper trachea in the other case. In both cases, a partial defect of the cricoid cartilage was observed on a preoperative CT scan of the larynx.
Both patients were successfully treated using the “trough” method. In the initial stage, we created a trough after resection of the stenotic region through the laryngotracheal fissure. A stent formed from a silicon dental impression was inserted into the trough to maintain the wide patency of the laryngotracheal lumen. The trough was closed with a hinge flap internally and with an advancement rotation flap externally in one of the patients six months after the initial operation. In the other patient, the trough was closed with a sternohyoid myocutaneous flap internally and given an advancement flap externally four months after the initial operation.抄録全体を表示PDF形式でダウンロード (6396K)
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