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Volume 56, Issue 1
Displaying 1-9 of 9 articles from this issue
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Review
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Hiroyuki Ito2005 Volume 56 Issue 1 Pages 1-9
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSTwo cases of upper airway obstruction by food were reported with the statistics of 11 subjects of upper airway obstruction by food for 22 years in our hospital.
The first subject was 53 year-old woman with bilateral putaminal bleeding. She suffocated during indirect laryngoscopy. The Heimlich maneuver was impossible to perform. It was because we could not make her get out the wheel chair immediately. A piece of pear was dislodged by fingers. The second subject was 49 year-old woman suffering from progressive neurological with mental retardation, of which diagnosis was unknown. She choked with a piece of pork, of which were dislodged by use of an aspirator. We have had 11 subjects with upper airway obstruction by food, 10 of them were upper airway obstruction. The subjects (9 men and 2 women) aged 44 to 68. All of them had physical and/or mental disorders. The causes were cerebral vascular, multiple atrophy, Wernicke-Korsakov syndrome, head injury and unknown neurological diseases. The upper airway foreign bodies were dislodged by forceps or finger sweep in 8 subjects. The patient with a lower airway foreign body was intubated to dislodge the foreign body by suction under intubation. The Heimlich maneuver was not performed in any cases.
Before dislodging the foreign body, we should diagnose the lesion of the occlusion by fingers. The operator insult the second and the third finger by the mouth into the hypopharynx, pressing the lateral wall of the pharynx laterally. When the operator touches the foreign body, he or she turns the finger toward the laryngeal surface of the foreign body and move it to the other side to keep airway. After keeping airway, he or she hangs out without picking it up. If he or she tries to pick it up, the airway will be occluded more completely. We can diagnose the airway obstruction and dislodge it simultaneously by this method, so called finger sweep or finger probe. In case of lower air way foreign body, keeping the air way is the first choice for example tracheostomy and puncture cricothyroido membrane by the use of large needles. Our data and domestic literal investigations showed that the Heimlich maneuver was scarcely performed at hospitals in Japan. It was not so effective as expected. When Heimlich maneuver and/or cardiopulmonary resuscitation is performed, examinations for their adverse effects on abdominal organs are recommended.View full abstractDownload PDF (1255K)
Original
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Shigeru Hirano, Kunihiko Nagahara, Sueyoshi Moritani, Shin-ichi Takagi ...2005 Volume 56 Issue 1 Pages 10-16
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSHypopharyngeal cancer is one of the most aggressive tumors in the head and neck region, with poor prognosis. Extended resection by pharyngolarygoesophagectomy is often required, which results in compromised quality of life. We have attempted to preserve the larynx even in advanced cases. The current study examined postoperative phonatory status after laryngeal preservation surgery.
Thirty-three cases were treated with laryngeal preservation surgery. Approximately 85% had advanced tumors. The whole larynx was preserved in 5 cases, while the larynx was partly preserved by partial laryngectomy in 13, hemilaryngectomy in 3, and near-total laryngectomy in 12.
About 75% of the cases showed good vocal outcome. Maximum phonation time and acoustic parameters appeared to worsen in the order of the partial, hemi-, and near-total laryngectomy groups. However, most cases achieved sufficient phonatory function at least in daily life.View full abstractDownload PDF (1724K) -
Tomoyuki Kurita, Kikuo Sakamoto, Hideki Chijiwa, Hirohito Umeno, Tadas ...2005 Volume 56 Issue 1 Pages 17-22
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSWe reviewed ten patients with congenital piriform sinus fistula treated between 1991 and 2004 at the Kurume University Hospital. The patients were seven boys and three girls of ages ranging from 2 to 11 years. The fistula was localized on the left side and was detected by either CT scan or barium roentgenogram. All cases had experienced neck abscess caused by the piriform sinus fistula. Surgical removal of the fistula was performed soon after the infection affecting the fistula had cured. Injection of pyoktanin blue through the opening of the fistula during direct esophagoscopy before surgery made it possible to distinguish the fistula from surrounding tissue without any difficulty. In our review of the ten cases, the thyroid gland of the same side had been removed together with the fistula. The clinical course after surgery was uneventful in all patients.View full abstractDownload PDF (1142K)
Case Report
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Kiyoaki Tsukahara, Ryoji Tokashiki, Hiroyuki Hiramatsu, Mamoru Suzuki2005 Volume 56 Issue 1 Pages 23-27
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSUnilateral laryngeal paralysis is a disease often encountered in daily otorhinolaryngological practice. A wide variety of surgical procedures have been applied. We herein report satisfactory results using direct pull of the lateral cricoarytenoid muscle. The subjects were seven patients who had been diagnosed with unilateral laryngeal paralysis at the Department of Otorhinolaryngology, Tokyo Medical University, between October 2002 and September 2003. All underwent direct pull of the lateral cricoarytenoid muscle. Maximum phonation time (MPT) and GRBAS scales before and after surgery were compared. MPT improved in all seven patients, and GRBAS scales improved in five patients including those with mild conditions. After surgery, the scales improved to G (0) in four and G (1) in one. These result suggest that direct pull of the lateral cricoarytenoid muscle may be applied widely to mild as well as severe cases, and is an effective procedure to treat unilateral laryngeal paralysis.View full abstractDownload PDF (960K) -
Shuji Yokoyama, Mutsumi Watanabe, Yasuhiro Tada, Makoto Kano, Kouichi ...2005 Volume 56 Issue 1 Pages 28-34
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSWe report a rare case of angioleiomyoma in the larynx. The patient was a 73-year-old male with no tumor-related complaint. During an operation for intestinal atresia, the anesthesiologist discovered a laryngeal tumor. Laryngoscopy revealed a tumor with smooth surface existing in the left aryepiglottic fold. The tumor touched the inside and the arytenoid area of the epiglottis and extended slightly over the vocal cord midline. Computed tomography showed the tumor to have clear boundaries, and to be internally uniform. MR imaging using gadolinium produced a clear, enlarged image of the tumor. The result of a histopathological exam performed after admission was suspicion of angioleiomyoma. Tracheostomy was performed under local anesthesia, and we attempted resection of the tumor by laryngomicrosurgery. However, because the tumor was large and there was much bleeding of the tumor, we ultimately resected the tumor through an external incision. Histopathology examination of the tumor specimen confirmed the presence of angioleiomyoma. This case suggests that when selecting the method of resection for angioleiomyoma, it is important to consider the possibility of tumor bleeding based on the tumor size and site, configuration of the tumor and clinical findings.View full abstractDownload PDF (1283K) -
Kohichi Yamauchi, Takehiro Karaho, Tetsuya Tanabe, Satoshi Kitahara2005 Volume 56 Issue 1 Pages 35-40
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSPTP has been widely used for medical packaging since the 1960's because of its convenience and durability, and as a result the number of patients with PTP foreign bodies in esophagus has increased.
We examined 13 cases of esophageal PTP foreign body patients treated in our department between 1993 and 2002.
In 12 cases, a rigid esophagoscope was used to remove the foreign body, and in only one case a flexible fiberoptic esophagoscope was used.
In general, when foreign bodies enter the stomach, we do not remove them but only observe ; but reports that PTP perforate the intestine have increased. We therefore examined and report on the latest methods for removal of foreign bodies.View full abstractDownload PDF (950K) -
Masatsugu Asai, Hideki Abe, Rinnosuke Wada, Aki Ishikawa, Yukio Watana ...2005 Volume 56 Issue 1 Pages 41-46
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSWe report a 13-year-old girl suffering from dyspnea caused by a large endotracheal fleshy granulation that developed after endotracheal intubation. Treatment was considered difficult because of the following conditions : the child's endotracheal cavity was narrower than that of adults ; narrowing of the anteroposterior tracheal diameter was observed as the sequela of tracheomalacia ; the fleshy granulation comprised approximately 50% of the trachea. Therefore, for surgery, we mainly used a polypectomy snare to facilitate resection of a large amount of the fleshy granulation, and supplementarily used KTP laser. To prevent ventilation disorder during surgery, resection was performed via two routes : an oral intubation tube measuring 6 mm in inner diameter, and a tracheotomy pore. The oral intubation tube was connected to an anesthetic instrument. A fiberscope and the polypectomy snare were fixed with tape and were inserted into the trachea through the intubation tube. Forceps for nasal surgery were inserted via the tracheotomy pore to hold the granulation through the loop of the snare, and the lesion was extirpated after cauterization and resection. Additionally, the residual granulation was vaporized with the KTP laser. The present case suggested the usefulness of a combination of polypectomy snare and KTP laser in resecting fleshy granulations. However, these instruments should be used cautiously to avoid complications such as burning.View full abstractDownload PDF (1234K) -
Norihito Kawasaki, Masahiko Taguchi, Haruhiko Nakamura2005 Volume 56 Issue 1 Pages 47-51
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSWe report on a case of small-cell lung cancer producing ectopic anti-diuretic and adrenocorticotropic hormones, simultaneously. The chief complaint was general fatigue. Localization of the primary tumor, in the right lower lobe bronchus involving the mediastinal lymph nodes, was diagnosed by chest CT. Definitive diagnosis was obtained by cytology bronchoscopically. The elevated serum anti-diuretic and adrenocorticotropic hormones decreased after chemotherapy. The findings in this case suggest that with cases of hyponatremia, we should differentially diagnose lung cancer accompanied by syndrome of inappropriate secretion of anti-diuretic hormone.View full abstractDownload PDF (751K)
Short Communication
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Tomoyuki Yoshida, Kazuhiro Nakamura, Nobuhiro Suzuki, Tsuyoshi Takenou ...2005 Volume 56 Issue 1 Pages 52-55
Published: 2005
Released on J-STAGE: February 17, 2006
JOURNAL RESTRICTED ACCESSPatients with head and neck cancers often require use of a tracheal cannula due to stenosis of the permanent tracheostoma following total laryngectomy. When placed in a permanent tracheostoma, however, a cannula that is designed for a multi-purpose tracheotomy frequently presents a problem.
To resolve this difficulty, we developed a straight cannula that fits most permanent tracheostomas. We achieved a straight design by removing the curvature of a single cannula cuffed tracheostomy tube (Koken Co., Ltd.). To facilitate installation by the patient without assistance, silicone was used because it is softer than similar conventional products. By making the cannula slightly larger across, it no longer needs to be immobilized with a strap.View full abstractDownload PDF (719K)
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