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Volume 52 (2001)
- Issue 6 Pages 431-
- Issue 5 Pages 369-
- Issue 4 Pages 299-
- Issue 3 Pages 229-
- Issue 2 Pages 59-
- Issue 1 Pages 1-
Volume 52, Issue 2
Displaying 1-26 of 26 articles from this issue
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Contribution
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Yasushi Murakami2001 Volume 52 Issue 2 Pages 59-65
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSMore than 50 years have elapsed since The Japan Broncho-esophagological Society was founded in 1949, and this November the last annual meeting of the society for this century was held in Hiroshima. The occasion of this meeting was a well-timed opportunity to look back upon the remarkable progress made in this century in bronchoesophagology. Bronchoesophagology is supported by professionals in various disciplines, and its progress results from their cooperation. In this report, remarkable advances in each area were summarized, and problems to be considered in the 21st century were discussed.View full abstractDownload PDF (725K)
Symposium 1:Stenting for Tracheo-esophageal Stenosis
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H. Kato, M. Yamakido2001 Volume 52 Issue 2 Pages 66-67
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Norio Aoyama, Junji Minamide, Hiroyoshi Koizumi2001 Volume 52 Issue 2 Pages 68-74
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSThe effects and problems of metallic stents were clinically examined in 32 patients with advanced esophageal carcinoma for the period from May 1996 to May 2000 at the Kanagawa Cancer Center. Chemotherapy and/or radiation therapy were performed in 30 of these patients. They were 24 patients (75%) with esophageal stenosis and 8 patients (25%) with tracheoesophageal fistula caused by esophageal carcinoma before stenting. We used a covered Ultraflex in 27 patients, an uncovered Ultraflex in 4 patients, and a Wallstent in one patient. Metallic stents were successfully implanted in all patients in our series. But the tracheoesophageal fistula in one patient was could not be intercepted completely after placement of the metallic stent. An improvement in oral intake was seen after stenting in 30 patients (93.8%). Leaving the hospital was possible in 14 patients (43.8%). The median survival of all patients after placement of the metallic stent was 54 days. The following device-related complications were seen: migration of the stent in four patients (12.5%), bleeding after stenting in one patient, and esophageal perforation in one patient were seen. Tumor ingrowth was recognized in two patients (6.3%). Moreover, hemorrhages (hematemesis and hemoptysis) near death were seen in 12 patients (37.5%). The majority of the causes of the bleeding in them were due to tumor factors.View full abstractDownload PDF (2569K) -
Hideo Shimada, Osamu Chino, Takayuki Nishi, Hikaru Tanaka, Yoshifumi K ...2001 Volume 52 Issue 2 Pages 75-81
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSEsophageal stent insertion is useful as a procedure for terminal cases such as those with inoperable advanced cancer or esophagobronchial fistula. We are trying to use stents especially with patients complaining of dysphagia who do not have an expected long survival to improve their QOL.
We studied the timing of the use of SEMS and evaluated the effects of additional therapy.
SEMS were indicated in 23 cases from April, 1994. The causes of unresectability was as follows: 16 cases due to tumor, 4 due to tumor and the general condition of the patients, 3 due to general condition. The location of the main lesions were Ut in 10 cases, Mt in 10 cases, Lt in 3 cases. Longitudinal size ranged from 6 to 12 cm (mean: 9.3 cm). Concerning the timing of the SEMS induction, stents were inserted before or after the beginning of treatment in 11 cases, and after treatment in 12 cases, SEMS allowed oral intake just after insertion and improved QOL without complications.
SEMS insertion can be expected to maintain oral intake during therapy and prevent aspiration in patients with oral dilatation of the esophagus before stenosis. Moreover, CT was considered necessary before and after insertion of stents to detect the tracheal deviation and compression by tumors— especially in cases with cancer located in Ut— and evaluate to effects of additional therapy.View full abstractDownload PDF (1853K) -
Kinya Furukawa, Jituo Usuda, Akihiko Suzuki, Akihiko Ogata, Hideaki Sh ...2001 Volume 52 Issue 2 Pages 82-87
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSAirway stentings for tracheobronchial stenosis have been performed at our institution to reconstruct the tracheobronchial lumen and improve pulmonary function and quality of life in patients with end-stage lung. We have had patients who underwent insertions of more than 2 stents using a combination of stent types. We have demonstrated the utility of combination stenting for severe endobronchial stenosis from our experience.
From 1985 to May 2000, we performed stenting in 125 cases of central airway stenosis (malignant: 98 cases, benign: 27 cases). Nd-YAG laser vaporization, balloon dilatation, argon plasma coagulation and/or core-out were performed to dilate the bronchial lumen before stenting. T-tubes, Dumon stents, self-expandable metallic stents (SEMS) and Dynamic stents were all used. All stentings were performed under a fluoroscope. A rigid bronchoscope was used for all of the Dumon stents and some of the SEMS.
The number of combination stentings was 20 cases (male: 14, female: 6) out of a total 125 cases (16.0%). A total of 45 stents were placed in these 20 cases. Nineteen out of these 20 cases had malignant stenosis (lung cancer : 10, esophageal cancer: 6, Mets: 3). Four cases of tracheal-esophageal fistula were observed. One case of benign stenosis was bronchial malacia. Synchronous insertions totaled 13, metachronous 5, and synchronous and metachronous 2.
SEMS were selected in 17 out of the 20 cases (85.0%) because of its procedural ease. A rigid bronchoscope was used for stent insertion in 80.0% of the cases because of severe and complicated stenosis. A Nd-YAG laser was used in 37.8% (17/45 stents). Improvement of QOL and lung function were obtained after the stentings (PS: 3.3 to 2.0, Hugh-Jones:4.1 to 2.7, PaO2 : 79.7 to 84.7 torr in room air, %VC : 77.6 to 84.7%, FEV:1.0% : 61.0 to 63.6%, PF : 2.13 to 2.73 liters/s).
Reconstruction of tracheobronchial stenosis with combination stenting is a very useful modality for end-stage lung patients with severe central airway stenosis and improves pulmonary function and quality of life. Each type of stent has its benefits and demerits, and therefore selection of a stent or stents should be made only after careful consideration of the characteristics of different stents and the type of tracheobronchial stenosis.View full abstractDownload PDF (469K) -
Teruomi Miyazawa, Yasuo Iwamoto, Yuka Miyazu2001 Volume 52 Issue 2 Pages 88-92
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSWe opt to use the stent best indicated in specific situations. Further implantation of the same stent and/or the additional implantation of a different stent is sometimes needed.
Between July 1991 and July 2000, we performed combination stenting as an emergency procedure in 24 patients with life-threatening tracheobronchial stenosis at Hiroshima City Hospital. Symptomatic relief of dyspnea was achieved in 88% of our patients.
Combination stenting seems to be especially indicated in certain complicated situations, e.g., diffuse stenosis, long stenosis, bilateral bronchial stenosis, and stenosis with fistula.View full abstractDownload PDF (1111K) -
T. Yasukawa, T. Fujisawa, S. Yoshida, M. Suzuki, Y. Sekine, K. Shibuya ...2001 Volume 52 Issue 2 Pages 93-94
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Symposium 2:Current Status and Remedies for Foreign Body Sensation in the Throat
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Y. Koike, S. Komiyama2001 Volume 52 Issue 2 Pages 95
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Haruhiko Ishida2001 Volume 52 Issue 2 Pages 96-100
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSForty-three of 55 patients with cedar pollinosis experienced some laryngeal symptoms. Thirty-four of the 43 cases were diagnosed as having laryngeal allergy in the cedar pollen season of 1997, and the remaining nine cases as suspected laryngeal allergy. Thirty-seven of the 43 complained of abnormal sensation in the larynx, and arytenoid edema was observed in 18 of these. Anti-allergic drugs improved the laryngeal symptoms in 27 of the 34 cases diagnosed as having laryngeal allergy.
Six of the 42 patients who had abnormal sensation in their larynx were diagnosed as having laryngeal allergy, and laryngeal examination showed arytenoid edema in five of these. Four of the six cases should additional allergic factors such as a past history of allergic disease, positive specific IgE, peripheral blood eosinophilia, and eosinophilia in nasal smears.
Laryngeal allergy is thus one of the diseases to be considered in the differential analysis of patients who complain of an abnormal sensation in the larynx.View full abstractDownload PDF (391K) -
Hiroshi Ozawa, Kazutomo Kitajima, Hideyuki Kataoka2001 Volume 52 Issue 2 Pages 101-105
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSRecently, more people come to see otolaryngologists complaining of an abnormal sensation in the throat. We have carried out screening examinations in 315 cases of abnormal throat sensation. Laboratory examinations revealed low serum Fe 15%, low F-T3 19%, low F-T4 12%, antimicrosomal antibody positive 13%, antithyroglobulin antibody positive 18%, abnormal ultrasound findings for the thyroid gland under ultrasonographic examination 42%, abnormality under hypopharyngo-esophagography 10%, and osterophytes in a cervical x-ray. Thyroid disorders are one of the causative organic diseases of abnormal sensations in the throat. In this screening examination, relatively many cases had an abnormality of the thyroid gland. In the case of patients who had an abnormal sensation especially in the thyroid gland, more hypothyroidism, and more positive antimicrosomal antibodies and antithyroglobulin antibodies were observed. Also, there were increased abnormal findings under ultrasonographic examination of the thyroid grand. Therefore, the relation between abnormal sensation in the throat and thyroid disorders is strongly suggested in these cases. Thus, examination of the thyroid gland is a necessary part of the screening examination for abnormal sensations in the throat.View full abstractDownload PDF (416K) -
Yuichiro Kuratomi, Yasuo Takeda, Sohtaro Komiyama2001 Volume 52 Issue 2 Pages 106-113
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSTo investigate the characteristics of abnormal throat sensations in patients with carcinomas, the symptoms and clinical histories of 275 patients with mesopharyngeal, hypopharyngeal, and supraglottic carcinomas were examined. Thirty-two percent of the patients came to hospital with throat pain, which was the most frequent symptom in our study. Twenty percent of the patients came with cervical mass, and 16% with abnormal throat sensations or hoarseness.
The patients with abnormal throat sensations had less advanced primary diseases, especially in the case of hypopharyngeal carcinomas. Few characteristic abnormal sensations were found in the patients with these carcinomas. Most of the patients with throat pain showed slight swallowing pain, which was similar to the pain seen with foreign bones in the throat. It was noted that patients had abnormal throat sensations or throat pain in areas related to the location of their primary tumors.
The average interval from the appearance of abnormal throat sensation to the first examination was 2 months. Among our carcinoma patients, 20% of the patients with abnormal throat sensations or throat pain did not come to hospitals until they recognized other symptoms such as cervical masses or hemosputum. In addition, 20% of the patients with these carcinomas were initially diagnosed as upper respiratory tract infections and given medicines thus. It is very important for the early detection of mesopharyngeal, hypopharyngeal and supraglottic carcinomas to inform the general public and physicians in various medical fields about the possible characteristic symptoms of these carcinomas.View full abstractDownload PDF (890K) -
Kuniyoshi Tsuda2001 Volume 52 Issue 2 Pages 114-119
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSPatients with abnormal sensations in the throat complain of various unusual feelings. However, a majority of these can not explain the exact quality and location of their feelings. In this study, I injected cholera toxin B (CTB) and fast blue (FB) into two anatomically different, but adjascent sites: the mucosa of the arytenoid region and the entrance of the esophagus, respectively, and observed labeled cells in the vagal ganglia to clarify the sensory mechanism of the nervous system at the ganglion level. The labeled cells as shown by CTB or FB were distributed within the jugular and nodose ganglia. A small number of the cells in the jugular ganglia were double-labeled. A majority of the labeled cells were a median or small size. These results suggest that the arytenoid region of the larynx and the entrance of the esophagus are anatomically distinct sites but not strictly separated in the sensory nervous system, and that the main sensory receptors in these sites are the nerve endings of the Aδ-or C-fibers, which are not highly specialized. Therefore, it is understandable that the specification of the quality and location of the stimuli is difficult at these sites.View full abstractDownload PDF (638K) -
Kensei Naito2001 Volume 52 Issue 2 Pages 120-124
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSIn recent years, laryngeal allergies have been on the increase in Japan. Laryngeal allergy patients often complain of a foreign body sensation of the larynx and a persistent cough. We investigated the clinical features of these two symptoms shown by laryngeal allergy patients. The cough in laryngeal allergy patients was characteristically prolonged and non-productive responding well to an H1-blocker or the local use of steroids. Hypersensitivity to capsaicin in laryngeal allergy patients was also observed. The expressions of the foreign body sensation of the larynx in patients suffering from laryngeal allergy were various: i.e. itching, dryness, tingling, phlegmatical sensation and perception of a contracted throat. Anti-allergic therapy for the most part did not ameliorate these laryngeal symptoms.View full abstractDownload PDF (426K)
Symposium 3:Management of Advanced Thyroid Cancer
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A. Kida, K. Nagahara2001 Volume 52 Issue 2 Pages 125-126
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Yasuhisa Hasegawa, Hidehiro Matsuura2001 Volume 52 Issue 2 Pages 127-132
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSMost patients with differentiated carcinomas of the thyroid have an excellent prognosis. Some cases, however, show postoperative local recurrence or extensive metastasis, and a few consequently have an unfavorable outcome. Many investigators have attempted to discover the major factors responsible for these prognostic differences for cases of thyroid carcinomas. The purpose of this paper is to clarify the high-risk group based on prognostic factors. Between January 1980 and December 1990, 135 patients with papillary and follicular thyroid cancer successfully underwent operations at the Aichi Cancer Center Hospital, Nagoya, Japan. The Kaplan-Meier method was used to estimate overall survival as a function of time, and survival differences were analyzed by the Log-rank test. In univariate and multivariate analyses using the Cox proportional hazards model, we used sex, age, clinical TNM classification, differentiation, and extracapsular extension as variables. Of these, sex, age and extracapsular extension made significant independent contributions. We also describe the significant association of tumor relapse and unfavorable outcome with extracapsular extension and age above 55 years. These factors, therefore, appear to be useful for predicting relapse and making a prognosis in patients with differentiated thyroid cancer.View full abstractDownload PDF (697K) -
Kazuyasu Nakao2001 Volume 52 Issue 2 Pages 133-136
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSIn patients with advanced thyroid cancer a combined resection of the surrounding invading organs with local radicality may be useful in terms of both QOL and survival.
For the past 20 years we have performed such operations in 48 patients with differentiated thyroid cancer. Out of these, circumferential resection of the trachea with end to end anastomosis was carried out in 39 patients. The result was a 10 year survival rate of 67.7%. Esophageal resection and reconstruction was performed using ileal interposition in 2 patients and a forearm skin in one patient. Resection of the common carotid artery and reconstruction with an artificial graft was performed in 2 patients. In order to preserve the larynx, a T-tube was used in 3 patients with bilateral palsy. Permanent hoarsness remained in 21 out of 38 patients.
Combined resection of cancerous organs is a useful method for patients with advanced thyroid cancer.View full abstractDownload PDF (356K) -
Takashi Yoshidumi, Mitsuru Ebihara, Bunsuke Satake, Takashi Hirao, Tak ...2001 Volume 52 Issue 2 Pages 137-144
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSLong term results of treatment for 53 patients with stage III, IV differentiated thyroid cancer (47 with papillary carcinoma, 6 with follicular carcinoma), treated at Gunma Cancer Center Hospital, were reviewed. The ten-year cumulative survival rate of 44 cases treated with surgery was 84%. Only one patient out of 34 cases who underwent hemilobectomy had a recurrence in the remaining lobe of her thyroid gland. Total laryngectomy was performed on two patients. Prognosis for the patients with distant metastasis was poor, but locoregional recurrence was not an obstacle to long term survival.
Treatment results for 30 patients who underwent thyroidectomy combined with resection of the tracheal wall at the National Cancer Center Hospital were discussed. The surgical procedure was fenestration following partial resection of the trachea or laryngeal wall in all cases. Peroral alimentation was achieved in all patients on the 7th day (median) after surgery. Closure of the tracheal defect was obtained in 25 patients. Pathological examination revealed a positive margin in 13 patients, and clinical recurrence at the surgical margin was observed in only two cases.
In summary, distant metastasis occurred in 15 patients, and all of the seven patients who died from their disease had distant metastasis. The ten-year cumulative survival rate of all patients was 67%.View full abstractDownload PDF (575K) -
Minoru Kinishi, Mutsuo Amatsu2001 Volume 52 Issue 2 Pages 145-148
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSAmong a variety of reconstructive procedures for establishing respiratory continuity following circumferential resection of the cervical trachea, an end-to-end anastomosis is the most physiological method of reconstructing the airway with its full diameter and mucociliary function.
Reducing the excessive tension at the anastomosed site is generally achieved by mobilizing the lungs and lower tracheal segment upward and by releasing the upper airway downward. However, little attempt at reducing excessive tension across the suture line by suspending the distal tracheal segment toward the proximal one has been reported in the literature. This paper describes a procedure for suspending the distal segment of the trachea across the suture line using the bilateral sternal flaps of the sternocleidomastoid (SCM) muscle from its superior attachments. A successful primary anastomosis without excessive tension was achieved in 5 patients with this method.
By transecting the bilateral sternal heads of the SCM muscle at the tendinous portion, which includes the periostium attached to the sternal head of the SCM muscle at the sternum, the bilateral sternal muscle flaps are freed to suspend the distal tracheal segment from each mastoid tip. The sutures are placed through the full thickness of the sternal muscle flap, including its tendinous portion and the sternal periostium, and then placed in a downward direction through the full thickness of the lateral wall of the seventh distal tracheal ring below the cut margin (Fig. 2). It is important that these sutures include the tendinous portion of the sternal muscle flap, the sternal periostium attached to the sternal head, and the lateral cartilaginous tracheal wall in order to ensure the suspension of the distal tracheal segment.View full abstractDownload PDF (339K) -
Katsuhiro Hirakawa, Koji Yajin, Takaharu Tatsukawa2001 Volume 52 Issue 2 Pages 149-153
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSAnaplastic carcinoma of the thyroid is one of the most aggressive neoplasmas encounterd in humans. A poor prognosis for this disease is well known, and death sometimes occurs within a few weeks after detection. Eight cases with anaplastic carcinomas out of 100 thyroid cancers were treated at the Department of Otorhinolaryngology, Hiroshima University during 1990∼1999. Of the 8 patients, 5 had resection with curative intent. At 2 years after treatment, only one patient is still alive. This patient underwent extended operation including total lobectomy, pharyngo-laryngectomy and esophagectomy with reconstruction using gastric transposition. Histopathological examination of resected specimens revealed anaplastic carcinoma within the papillary carcinoma. The other 7 patients died of their disease one to eight months after the first treatment. The treatment of anaplastic carcinoma is still controversial. Results of chemotherapy adopting cisplatin, G-CSF and multi-drug therapy have improved, and extended operations have been reported with better results than patients treated without operation. Although curative extended surgical treatment in patients with localized disease requires careful consideration because unsuccessful resection may lead to an advanced stage of the disease, it has been reported that adequate resection of tumors can cure some carcinomas with anaplastic changes. Unfortunately, during the past recent decade, advances in the treatment of this disease have been nominal. Considering quality of life, further study is needed to establish the most effective treatment of anaplastic thyroid carcinoma.View full abstractDownload PDF (871K)
Panel Discussion:Carcinoma of Hypopharynx and Cervical Esophagus—Up-to-Date Status of Treatment Conserving Function—
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M. Okamoto, H. Takahashi2001 Volume 52 Issue 2 Pages 154-155
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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S. Kishimoto, S. Ebihara, R. Hayashi, M. Saikawa, W. Ohyama, T. Haneda ...2001 Volume 52 Issue 2 Pages 156
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Y. Okamoto2001 Volume 52 Issue 2 Pages 157
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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T. Yoshida2001 Volume 52 Issue 2 Pages 158-159
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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K. Yoshino2001 Volume 52 Issue 2 Pages 160-161
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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Luncheon Lecture
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K. Haruma2001 Volume 52 Issue 2 Pages 162-164
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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T. Inamatsu2001 Volume 52 Issue 2 Pages 165-167
Published: April 10, 2001
Released on J-STAGE: August 25, 2008
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