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Volume 51 (2000)
- Issue 6 Pages 405-
- Issue 5 Pages 345-
- Issue 4 Pages 297-
- Issue 3 Pages 229-
- Issue 2 Pages 61-
- Issue 1 Pages 1-
Volume 51, Issue 3
Displaying 1-9 of 9 articles from this issue
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Original
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Kazuhito Tanaka, Masahumi Suzuki, Seiichi Shinden, Toshihiko Ohba, Aki ...2000 Volume 51 Issue 3 Pages 229-236
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSA total laryngectomy was conducted to prevent intractable aspiration in ten cases of amyotrophic lateral sclerosis and three cases of multiple system atrophy. Such patients eventually lose their articulating function, and if left untreated, we feared that our patients would suffer asphyxiation and repeated aspiration pneumonia due to accidental aspiration. If treated by a surgical procedure, on the other hand, it can be anticipated that a patient's life expectancy will be at least one year. Therefore, our patients all agreed to undergo a total laryngectomy.
The postoperative recovery was uneventful, and every patient was eventually permitted to try oral feeding. Oral feeding became viable for an extended period in six patients, while the others needed nasogastric or gastrostomy tube feeding for a maintenance of adequate nutrition. With the possibility of aspiration eliminated, these patients were able to eat and sleep without fear. Many extended their sphere of activities and improved their QOL.
The present experiences revealed that among the surgical procedures to separate the airway from the digestive tract to prevent intractable aspiration in progressive degenerative neuron diseases, a total laryngectomy produces a reliable effect and therefore should be recommended.View full abstractDownload PDF (686K) -
Toshiyuki Katoh, Masaru Iwata2000 Volume 51 Issue 3 Pages 237-243
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSWe investigated oropharyngeal candidiasis in patients with bronchial asthma treated with inhaled beclomethasone dipropionate (BDP). The detected rate of Candida in the oropharynx in these asthmatic patients was 33.3%, which was significantly higher than that in control subjects. This rate significantly depended on the frequency of the inhalation of the BDP (p <0.05), but there was no correlation with the inhalation dose per either time and day. The term of administration of the inhaled BDP tended to be longer in the Candida positive cases, and there was a significant correlation between the term of administration and the amount of Candida detected (r =-0.67, p <0.05). Although it is considered that gargling after inhalation and the use of spacers are effective in preventing oropharyngeal candidiasis, the detected rates of Candida were 33.3% in both patients who either gargled and used spacers and those who did not. The patients who understood the reason why the spacers and gargling were necessary accounted for just 85.2% of the total, in spite of the education efforts of the medical staff.
In conclusion, a decrease in the number of inhalations of BDP per day may be effective in preventing oropharyngeal candidiasis, and various ways to increase the understanding of patients are needed for education pertaining to gargling after inhalation and the use of spacers.View full abstractDownload PDF (478K)
Case Report
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Shinichi Kageyama, Toshihiro Mori, Eiji Yumoto, Seiji Kawakita2000 Volume 51 Issue 3 Pages 244-248
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSA 21-year-old male underwent a left hemithyroidectomy and left arytenoid adduction for left recurrent laryngeal nerve (RLN) palsy with thyroid cancer by endotracheal intubation under general anesthesia. Immediately after the operation, dyspnea without stridor appeared. A flexible fiberscopic examination and laryngeal tomography showed an impairment in the abduction of the right vocal cord. The right RLN palsy improved after 2 weeks with the use of vitamin B12 and a peripheral vasodilator. Although an electromyographic examination could not be performed, we diagnosed partial vocal cord paralysis primarily caused by a disorder of the posterior branch of RLN following endotracheal intubation on the basis of the clinical course and laryngeal tomography.View full abstractDownload PDF (969K) -
Hajime Takeshita, Mitsuru Furukawa2000 Volume 51 Issue 3 Pages 249-252
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSA 23-year-old male with tracheomalacia suffering from dyspnea due to laryngeal tumor consulted at our clinical office. He had suffered repeated convulsions and was using anticonvulsant drugs (phenitoin, clonazepam, sodium valproate). He was severely handicapped both mentally and physically. He had undergone extra-tracheal fixation and had been intubated with a T-tracheotomy tube through the tracheostoma. The laryngeal tumor extended from the cricoid cartilage and pressed against the T-tracheotomy tube. Thus, his airway through the tracheotomy tube was stenotic. His larynx was extirpated under a Percutaneous Cardiopulmonary Support System (PCPS). PCPS is useful to operate in cases that pose airway intubation difficulties.View full abstractDownload PDF (595K) -
Kousei Takeda, Ichiro Morita, Michiya Satoh, Masatoshi Horiuchi, Tsuka ...2000 Volume 51 Issue 3 Pages 253-256
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSSwallowed objects may be true esophageal foreign bodies, such as coins, dentures, press-through-pack etc., and several methods has been used for the removal of esophageal foreign bodies. We experienced a case of a successful Fogarty occlusion catheter extraction of a piece of glass from the upper thoracic esophagus.
The patient was a 34-year-old male, who swallowed broken pieces of a whisky bottle for suicide. The thoracic CT and esophageal fluoroscope showed the shadow of a foreign body in the upper thoracic esophagus, and surgery was performed under general anesthesia. We tried to remove the foreign body with a rigid esophagoscope and forceps, but it was firmly affixed to the esophageal wall. We inserted a Foley catheter over the foreign body with a pair of forceps, but it was too short and allowed insufficient expansion of the balloon for removing the foreign body. Therefore, we inserted a Fogarty occlusion catheter over the foreign body with the forceps, inflated the balloon on the gastric side, and drew out the catheter together with the foreign body. No complications occurred.
We disccussed the usefulness of a Fogarty occlusion catheter for the removal of an esophageal foreign body in this paper.View full abstractDownload PDF (598K) -
Takayuki Sejima, Kosuke Ishii, Tomoko Ogawa, Hidetaka Tanaka, Keiichi ...2000 Volume 51 Issue 3 Pages 257-261
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSSleep apnea syndrome is frequently associated with multiple system atrophy, for example olivopontocerebellar atrophy (OPCA), and sometimes causes the sudden death of such patients.
A 60-year-old man with olivopontocerebellar atrophy was admitted to Jichi Medical School Hospital. With the progress of his disease, heavy snoring and apnea attacks were observed during sleep. Vocal cord movements were analyzed by laryngofiberscopy during both wakefulness and sleep induced by intravenous administration of diazepam. While waking-laryngofiberscopy showed a normal movement of the vocal cords, sleeping-laryngofiberscopy showed an obvious paradoxical movement of the vocal cords, where the vocal cords abducted during expiration and adducted during inspiration. To prevent choking, a tracheostomy was done. After the tracheostomy, the vocal cord movements got worse during both wakefulness and sleep.
Paradoxical movement of the vocal cords appears to be caused by the following : 1) a disorder of the respiratory center in the medulla oblongata, 2) a decrease of CO2-sensitivity in chemical receptors during sleep, and 3) an abnormal tension of the intralaryngeal muscles. Tracheostomy should be considered in such patients, but there is still room for further study on the indications for the operation.View full abstractDownload PDF (622K) -
Hajime Ishinaga, Akihiko Kato, Hiroyuki Yamada2000 Volume 51 Issue 3 Pages 262-265
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSRecurrent laryngeal nerve (RLN) paralysis is a major complication after thyroidectomy. Immediate reconstruction of the RLN is proposed in such cases.
Four cases underwent concurrent recurrent laryngeal nerve reconstruction at our department between 1997 and 1998.
Nerve transfer was performed in three cases and the great auricular nerve and the ansa cervicalis were chosen as nerve grafts. Direct anastomosis of the ansa cervicalis to the peripheral end of the RLN was conducted in one case. Both procedures resulted in a good post-operative status, and hoarseness and mis-swallowing in no cases were observed.
The operated-side vocal cords in all cases were observed to be fixated at the paramedian portion, without atrophy. The average maximum phonation time (MPT) was 14.5 seconds, and this was longer than that in cases who had not undergone reconstruction of the recurrent laryngeal nerve (their average MPT was 8.9 seconds).
We concluded that an immediate reconstruction of the RLN should be disirable for cases who need a nerve resection in a thyroid operation.View full abstractDownload PDF (304K) -
Takashi Hiramatsu, Masami Ohnishi, Michinori Murai, Kouichiro Asano2000 Volume 51 Issue 3 Pages 266-272
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSIn 1998, we had three patients with gas gangrene of the neck. All of the patients complained of dyspnea. They received surgical drainage by two skin horizontal incisions, under endotracheal general anesthesia, antibiotics and an IVH for general management.
Case 1 was a 62-year-old man with diabetes mellites and multiple metastases of prostal cancer. He died two days after admission. Case 2 was a 63-year-old woman with diabetes mellites, and case 3 was a 75-year-old man. These patients recovered without skin necrosis, but they had a tracheostomy and a swallowing disturbance about one month after surgery. The swallowing disturbance caused their mental states to be unstable.
These findings suggest that we should probably undertake emergency tracheostomy, if a patient complains of dyspnea, and take into consideration the problem of a possible swallowing disturbance at recovery, and that two horizontal skin incisions are useful for surgical drainage of gas gangrene of the neck because the lower incision is available for tracheostomy.View full abstractDownload PDF (1500K)
Short Communication
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Satoshi Kitahara, Etsuyo Tamura, Taichi Furukawa, Yuhko Matsumura2000 Volume 51 Issue 3 Pages 273-276
Published: June 10, 2000
Released on J-STAGE: January 27, 2009
JOURNAL RESTRICTED ACCESSWhen suturing within the larynx under laryngomicrosurgery, a long time is required because of the limited range of motion of most forceps. However, suturing under direct laryngoscopy has not yet been established as a fundamental technique, probably because of its uncommon nature. We designed a new sutural instrument on the basis of the idea that the great difficulty of making notches within the larynx can be overcome by making them outside the laryngoscope and transferring them to the target point.
We believe that laryngoscopic surgery can be improved if sutures within the larynx can be effected without trouble.View full abstractDownload PDF (823K)
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