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Volume 50 (1999)
- Issue 6 Pages 579-
- Issue 5 Pages 519-
- Issue 4 Pages 463-
- Issue 3 Pages 391-
- Issue 2 Pages 217-
- Issue 1 Pages 1-
Volume 50, Issue 4
Displaying 1-9 of 9 articles from this issue
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Keiichi Chijiwa, Kazunori Mori, Hirohito Umeno, Tadashi Nakashima1999 Volume 50 Issue 4 Pages 463-469
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSFrom 1977 to 1996, 199 patients (167 males, 32 females) with a mean age of 66 years having previously untreated supraglottic carcinoma underwent curative treatment at the Kurume University Hospital. In this paper, the sites of extension were examined, and their influence upon the frequency of neck metastasis and distant metastasis were analyzed.
The overall, five-year survival rate as determined by the Kaplan-Meier method was 75.6%. With respect to invasive site, for patients with subglottic and piriform sinus invasion, the five-year cause-specific survival rates were 59.7% and 41.4%, respectively. The 5-year local control rate of the tumor was 81.7%, and for patients with lesions confined to the supraglottis was 88.3%. The frequency of neck metastasis for patients with lesions invading the lateral wall of the oropharynx and piriform sinus were 78% and 89%, respectively. The frequency of distant metastasis in patients with lesion invading the piriform sinus was 36%. These results suggest that chemotherapy may be neccessary for cases with tumors invading the piriform sinus.View full abstractDownload PDF (815K) -
Seiji Takagi, Kuniyoshi Tsuda, Motohiro Sawatsubashi, Shinji Ootani, T ...1999 Volume 50 Issue 4 Pages 470-475
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSMost esophageal ruptures may be ascribed to instrumental lesions, and the rise in the number of esophageal ruptures in recent years is due to the increasing use of diagnostic endoscopy. Rupture of the hypopharynx and esophagus is a hazardous disorder which is generally lethal if untreated.
We recently surgically treated a case of parapharyngeal abscess caused by hypopharyngeal injury during flexible fiberesophagoscopy. Early diagnosis and treatment are of decisive importance to the prognosis. The triad pain, fever and emphysema are disorder's most important symptoms. Plain radiography and a CT of neck and chest are mandatory to reveal the site, extent and nature of any mediastinal abscess secondary to neck infection. A CT scan is also useful for postoperative observation.
Perforation of the cervical esophagus is often treated surgically, but conservative management under strict supervision provides equally good results. In its early stage, perforation of the thoracic esophagus should be treated with emergency surgery involving suturing of the perforation and trans-thoracic drainage of the mediastinum. Suturing is impossible in the later stages. Trans-thoracic drainage of the mediastinum and pleura should be sufficiently carried out.
Irrespective of the local treatment, all forms of esophageal rupture should be treated with a large dose of antibiotics, fasting, introduction of a gastric tube and the sufficient administration of fluids, electrolytes and calories.View full abstractDownload PDF (2275K) -
Akihito Watanabe, Masao Hosokawa1999 Volume 50 Issue 4 Pages 476-480
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSRecrrent laryngeal nerve paralysis in patients who undergo esophagectomy with three-field lymph node dissection causes not only hoarseness but also dysphagia.
During the year from January 1997 to December 1997, sixty-two patients with carcinoma of the thoracic esophagus underwent three-field lymph node dissection at Keiyukai Sapporo Hospital. Postoperatively, eight patients (11.6%) suffered from recurrent laryngeal nerve paralysis. As far as the incidence of the recurrent nerve paralysis is concerned, lymph node metastasis and the location of the primary lesion do not make any statistical difference. Five patients with recurrent laryngeal nerve paralysis recovered spontaneously within 3 months. The other three patients needed intracordal injection therapy using atelocollagen.View full abstractDownload PDF (2568K) -
Hiroyuki Yamada, Akihiko Katoh, Hajime Ishinaga1999 Volume 50 Issue 4 Pages 481-485
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSRecently, we have performed microvascular anastomoses in the reconstructive surgery of the esophagus: 3 cases at the Department of Surgey of Yamada Red Cross Hospital, and 3 cases at the Department of Surgery of Saiseikai Matsusaka Hospital. In these 6 cases, a gastric pull-up technique in 3 cases, a colonic pull-up technique in 2 cases, and a pedicled jejunum technique in 1 case were performed to reconstruct the esophagus.
Microvascular anastomoses were performed in the cervical region in all 6 cases; for the artery alone in 1 case, the vein alone in 1 case, and for both vessels in 4 cases.
Major complications (except for the minor leakage in 1 case) were not observed, and the reconstructions by organ transfer were successful.
Microvascular anastomoses in the cervical region for adjuvant circulation is safe and easy, bacause the cervical region has many adequate vessels for anastomoses and is a stable in terms of respiratory movement.
For head and neck surgeons, participation in a team operation of the thoracic esophagus is important and necessary in order to be able to examine the laryngeal findings and detect double cancers in the head and neck regions.View full abstractDownload PDF (670K) -
Kazue Manaka, Norihisa Hamada, Yoshiharu Watanabe, Akinori Kida1999 Volume 50 Issue 4 Pages 486-491
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSFrom 1992 to 1996, we have experienced 14 cases with tracheo-bronchial foreign bodies. 8 of these were males (57%), and the age of 9 cases (64%) was under 2 years. Foreign bodies were found in the right bronchus in 9 cases, and in the left bronchus in 4 cases, and in the larynx in one case. The most common foreign body was a peanut (6 cases). 8 out of the 14 cases were treated by means of ventilation bronchoscopy under general anesthesia. In 8 out of the total 14 cases, the presence of a foreign body was clearly determined. In 3 cases, foreign body was revealed by chest X-rays, in 4 cases foreign body was detected by digital subtraction fluorography, and one case was seen under the vocal cord with the fiberscope. We were convinced of the presence of foreign bodies in 4 other cases, because of the fact that pneumonia, atelectasis, pulmonaly emphysema and check valve sign were found in the chest X-rays. Although we could not identify the presence of a foreign body in 2 cases, we performed an operation because the patients' respiratory conditions were poor. Whenever we doubted the presence of a foreign body from the signs and symptoms, we should conduct an operation even if the presence of them could not be confined.View full abstractDownload PDF (4727K) -
Kazuhiro Yamamoto, Masatoshi Hirayama, Hiromi Nagai, Jun Yamanaka, Mak ...1999 Volume 50 Issue 4 Pages 492-497
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSWe reported 2 cases of cervical injury due to knives and summarized 6 cases who were treated at our hospital. Generally, in this type of injury, the epithelial wound is small. However, one should pay attention to the fact that the wound is likely to reach a deeper layer. It is crucial to properly ascertain the degree of injury and initiate treatments as soon as possible. For the past 15 years, 6 cases with cervical injury due to knives were treated at our hospital. Some wounds reached the trachea and some damaged the esophagus. Four out of 6 cases were attempted suicides. Such cases generally have a background of mental problems. It is important to pay more attention to evaluating the extent of wounds when the patient is unconscious and the wounds are multiple.View full abstractDownload PDF (5324K) -
Hajime Ishinaga, Akihiko Katoh, Hiroyuki Yamada1999 Volume 50 Issue 4 Pages 498-501
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe development of preoperative diagnosis for thyroid cancer has restricted the surgical indication for benign thyroid disease, but surgical management should still be performed for hyperthyroidism, enlarged thyroid tumors and so on. Also, it is possible to diagnose for thyroid papillary carcinoma preoperatively, but it is difficult to do so for follicular carcinoma. Therefore, we must operate for some solitary tumor cases in order to rule out the latter type of cancer. In this study, we evaluated the thyroid patients treated in our department and proposed indications for benign solitary thyroid tumor.
Between 1989 and 1998, 555 patients with thyroid disease were treated in our department. 204 cases were benign, and 351 showed thyroid malignancy. 185 cases were benign thyroid nodules, and 17 were follicular carcinoma. In this study, the tumors that were large in size were found to be follicular carcinoma more frequently. We concluded that a case with a solitary tumor≥40-50mm should undergo a thyroid operation for the purpose of ruling out follicular carcinoma.View full abstractDownload PDF (559K) -
Masahiro Mikami, Shinichi Ishimoto, Niro Tayama1999 Volume 50 Issue 4 Pages 502-507
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSChronic pulmonary disease of the elderly caused by frequent aspiration has been recognized in the recent Japanese literatures. We report an elderly case with cerebrovascular disease who had long-term bronchial foreign bodies and had been treated for “asthma” for years. He was taken to an emergency room because of a dyspnea which occurred at breakfast. Fiberscopy showed a bean-like foreign body in his right main bronchus. Using ventilation bronchoscopy, we removed not only this pulse but a piece of fish vertebra from his right main bronchus and another older one coated by granulation tissue from his left superior lobar bronchus. A chest x-ray of this patient showed a diffusely scattered nodular shadow in the right lower lung field; this finding resembled that of diffuse aspiration bronchiolitis (DAB). He showed a multiple brain infarct on MR imaging. A low signal-intensity area in the white matter of the left supra orbital gyrus on T1 weighted image might be related to his characteristic aspiration. We assumed the fine crackle in his lung fields and his continuous productive cough had been caused by frequent aspiration. In the elderly, some patients could have latent aspiration but be incorrectly diagnosed as asthma or other pulmonary diseases. When we meet elderly patients with moist rale and productive cough, we must consider the possibility of chronic pulmonary disease caused by aspiration. There is a need to develop for testing and treating methods for these patients.View full abstractDownload PDF (6245K) -
Toshio Ogoshi, Kazuhiro Kawano1999 Volume 50 Issue 4 Pages 508-512
Published: August 10, 1999
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSWe report a case in which the laryngeal mask airway (LMA) was useful for pediatric flexible bronchoscopy under general anesthesia.
A two-year-old girl was admitted to our hospital with the chief complaint of recurrence pneumonia and atelectasis. Anesthesia was induced with eithsevoflurane in 50% oxygen. Suxamethonium chloride was used for control ventilation.
A size-2 laryngeal mask (ID 8mm) was then attached. The mask permitted the use of a fiberoptic bronchoscope with an external diameter of 3.2mm. Because of inadequate ventilation, the insertion of a 5.05mm, external diameter, fiberoptic bronchoscope for suction was not successful. Much pulurental mucus was observed in the left main bronchus, but tracheomalasiadid was not observed.
However, we could make a full examination of the larynx, trachea and bronchial tree.
In this case, throughout the bronchoscopy, adequate controlled ventilation could be achieved easily without excessive air leaks or airway resistance.
We believe that this is a safe and useful technique for flexible fiberoptic bronchoscopy under general anesthesia, especially in pediatric cases.View full abstractDownload PDF (4187K)
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