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Volume 58 (2007)
- Issue 6 Pages 519-
- Issue 5 Pages 433-
- Issue 4 Pages 365-
- Issue 3 Pages 301-
- Issue 2 Pages 85-
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Volume 58, Issue 6
Displaying 1-12 of 12 articles from this issue
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Original
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Kazuhiro Nakamura, Nobuhiko Isshiki, Tetsuji Sanuki, Noriaki Nagai, Hi ...2007 Volume 58 Issue 6 Pages 519-526
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSThe incidence of right vocal fold paralysis is lower than that occurring on the left. The higher incidence of left vocal fold paralysis can perhaps be explained by the fact that a greater portion of the recurrent nerve is located on the left. The current study focused on the characteristics of and surgical approaches taken in cases of vocal fold paralysis that occurs on the right side.
Of the 110 patients with unilateral vocal fold paralysis who received surgical therapy at Isshiki Clinic : Kyoto Voice Surgical Center between 1994 and 2006, 35 (22 males and 13 females ; ages ranging from 17 to 75 years, with a mean of 49.4) with paralysis on the right side were selected. The causes for paralysis were : thyroid surgery (16 cases), surgery for cervical vagus neurinoma (5), idiopathic paralysis (3), surgery for neurinoma of the mediastinal vagus nerve (3), brain tumor (3) and surgery for esophageal cancer, head injury, and surgery of the cervical vertebrae (one each).
For surgical procedures, arytenoid adduction (AA) was employed for cases with a wide glottic slit and thyroplasty type 1 (type 1) for those with a narrow glottic slit. When the glottic slit was wide with atrophy, AA was combined with type 1. The vocal folds were shifted medially to those undergoing AA, type 1 or AA + type 1, and we tried cricothyroid approximation testing. For the 10 patients who exhibited voice improvement, thyroplasty type 4 (type 4) was added. It was suspected that the background conditions of paralysis resulted in insufficient functioning of the cricothyroid muscle in these 10 patients. To evaluate the voice before and after surgery, maximum phonation time (MPT) and the AD/DC ratio were determined.
The postoperative MPT improved in all except for one case whose test results were unchanged. The AC/DC ratio also increased in all except one.
When failure of the cricothyroid muscle is suspected in cases of unilateral vocal fold paralysis, correcting the glottic slit is not sufficient ; tension should be added to the vocal fold in the anterior and posterior directions. First, the vocal fold is shifted medially by applying AA, type 1 or AA + type 1 ; then, having monitored the patient's voice, a combination with type 4 should be considered as an intra-operative option.View full abstractDownload PDF (804K) -
Shigeru Kasugai, Shoji Watanabe, Yoshihiro Akazawa, Takashi Otsuka, Hi ...2007 Volume 58 Issue 6 Pages 527-532
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSThis study reports statistic results for 237 cases of esophageal foreign bodies during 21 years from 1985 to 2005, which indicated shifts in both foreign body types and their removal method. The mean age was 49.5 years old, with a range from 8 months to 91 years (90 males, 147 females). Most esophageal foreign bodies consisted of press-through-packages (PTPs) (37.6%), fish bones (24.5%), coins (13.1%) or artificial teeth (8.0%). Coins, which had accounted for a large percentage in previous reports, were third in frequency in the present study. In age distribution, there were two peaks : one with children under 10 years old, the other in persons over 50 years old. Especially in children, coins accounted for a high percentage. PTPs, fish bones, artificial teeth and pieces of meat, in that order, were most prevalent in older people. These foreign bodies were lodged at the cricoid narrowing (84.4%).
Removal of the foreign bodies was attempted using direct esophagoscopy under general anesthesia in 79.7% of the cases (187 of 237). However, since 2003 removal by endoscopy for the upper digestive tract has been increasing gradually up to 82.9% (29 of 35 cases). We postulate that the change in removal method from direct esophagoscopy to endoscopy owes to progress in devices equipped with endoscopy.View full abstractDownload PDF (415K)
Case Report
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Tsuyoshi Nakamura, Hideto Saigusa, Iichirou Aino, Kimihiro Okubo2007 Volume 58 Issue 6 Pages 533-536
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSRecently, patients with chronic obstructive pulmonary disease (COPD) have been increasing in Japan. Inhalation of anti-cholinergic drugs can be used for medical therapy for COPD because of their effectiveness without use of other concomitant medications and major general complications. We report a case of xero-laryngitis induced by use of a long-acting type anti-cholinergic inhaler (tiotropium bromide hydrate).
A 60-year-old male had been complaining of difficulty in phonation and hoarseness for 2 months. Laryngoscopic findings revealed xero-laryngitis with incrustations on the inter-arytenoid mucosa and posterior regions of the bilateral vocal folds. Detailed medical interview indicated that the patient had been administrated a long-acting type anti-cholinergic inhaler (tiotropium bromide hydrate) for COPD since 10 weeks earlier. After we stopped the administration of the anti-cholinergic inhaler, laryngoscopic findings demonstrated that his voice recovered completely within about one month.View full abstractDownload PDF (356K) -
Miwako Kimura, Takaharu Nito, Noboru Hagino, Niro Tayama2007 Volume 58 Issue 6 Pages 537-544
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSRelapsing polychondritis (RP) is a comparatively rare disease which systemically affects organs containing collagen, such as cartilage tissue, the eyes and skin. Diagnosis must be made from its clinical manifestations. In this study, we reported two cases that suffered from RP with subglottic stenosis. Case 1 was a 60-year-old female who complained of hoarseness. Laryngoscopic findings showed polypoids of the bilateral vocal folds and subglottic stenosis. At the same time, she revealed auricular chondritis. Pathological findings from the auricular cartilage were RP. Steroid pulse therapy was performed and her respiratory symptom was improved. Four months later, she complained of dyspnea and revealed severe subglottic stenosis. A tracheotomy was performed and her airway was controlled by a soft silicone tracheal stoma retainer. Case 2 was an 18-year-old male who complained of hoarseness and dyspnea on exertion. Laryngoscopic findings showed incomplete paralysis of the right vocal fold and severe circumferential subglottic stenosis. A tracheotomy and biopsy from the tracheal cartilage were performed. Pathological findings in the tracheal cartilage showed chondritis. Steroid pulse therapy was performed and his airway was controlled by a soft silicone tracheal stoma retainer. These two cases both complained of dyspnea and ultimately required a tracheotomy. For RP, respiratory tract chondritis was a critical problem and airway management was important.View full abstractDownload PDF (675K) -
Kiminori Sato2007 Volume 58 Issue 6 Pages 545-551
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSVideoendoscopes have a small charge-coupled device (CCD) chip built into the tip that provides a clear image. This report concerns office-based cervical esophageal foreign body extraction using a transnasal videoendoscope.
Two types of videoendoscopes (with and without a working channel for irrigation, air insufflation and forceps) were used. The diameters of the videoendoscope tips were 5.3 mm and 4.1 mm.
The advantages of this intervention were as follows. 1) Videoendoscopes presented clear dynamic color images on a color video monitor and provided excellent resolution and recording, and thus yielded high diagnostic accuracy and fine intervention. 2) The videoendoscope diameter was relatively small and resulted in less discomfort to the patient. 3) Patients could be treated in a supine position on a procedure chair at the otolaryngology outpatient clinic, which obviated sedation or general anesthesia. 4) Pernasal endoscopy allowed the doctor to treat patients who had a strong gag reflex. 5) Good image documentation on the color video monitor allowed the physician to carry out safe intervention. A disadvantage of this procedure was that extraction of some varieties of foreign bodies was limited.
Cervical esophageal foreign body extraction using a transnasal videoendoscope is a reliable procedure that has widened the indications for office-based endoscopy.View full abstractDownload PDF (636K) -
Buichirou Shin, Hideki Chijiwa, Yoshimi Miyajima, Hirohito Umeno, Tada ...2007 Volume 58 Issue 6 Pages 552-555
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSWe experienced a case of esophagus adenocarcinoma located in the cervical esophagus. A 76-year-old female was admitted to the hospital because of an abnormal sensation in the throat. Endoscopic examination revealed a round protruded lesion covered with normal esophagus mucosa in the cervical esophagus. An esophagogram showed a polypoid lesion 4cm in diameter as a complete defect of the cervical esophagus. The cytological diagnosis was adenocarcinoma. As treatment, cervical esophagostomy, bilateral modified radical neck lymphnode dissection, and reconstruction using free jejunum was performed. Microscopic examination showed well differentiated adenocarcinoma. The fact that most of the tumor was located in the submucosa and the invaded proper muscle layer was covered with normal squamous epithelium, suggested that the adenocarcinoma derived from the submucosal esophageal gland. These findings indicate that as most primary esophageal adenocarcinomas stem from the esophageal glands, they are to be differentiated from benign submucosal tumors of the esophagus.View full abstractDownload PDF (389K) -
Takahiro Kimura, Junichi Okubo, Haruo Hirakawa2007 Volume 58 Issue 6 Pages 556-560
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSForeign bodies in the trachea or bronchus are highly dangerous and need to be treated immediately and appropriately. Most foreign bodies are removed by rigid bronchoscope or flexible bronchoscope. Some foreign bodies, however, are difficult to remove. We report our experience with removal through a tracheostoma.
The patient was a 56-year-old male with a past history of cerebral infarction and hemorrhage. He was receiving feeding mostly via percutaneous endoscopic gastrostomy (PEG), but a modicum of oral feeding was also possible. One day, he aspirated a large piece of meat and severe dyspnea occurred. We found it in contact with the carina and thought it was too large to pass the subglottic region by rigid or flexible bronchoscope. We prepared a percutaneous cardiopulmonary support system (PCPS) for acute respiratory obstruction. We performed a tracheotomy and were able to remove the blockage through a tracheostoma while maintaining spontaneous breathing without use of PCPS.View full abstractDownload PDF (458K) -
Toshifumi Tomioka, Tomohito Fuke, Tomotaka Miyamura, Hiroyuki Yamada2007 Volume 58 Issue 6 Pages 561-567
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSAdvanced age thyroid cancer which often involves metastasis and invasion to the near organs, is referred to as “high-risk cancer.” Basic dyspnea is particular soon lowers the QOL of these patients, is called for proactive radical surgery. Two patients (about 80 years old) were operated for advanced age cancer. Both presented invasion to the recurrent laryngeal nerve and aero tract. We tried to preserve the recurrent laryngeal nerve microscopically, but ultimately failed to do so. In consideration of postoperative hoarseness, aspiration and their advanced age , thyroplasty type I was performed simultaneously. In both cases, postoperative hoarseness was not severe. Both cases could take oral nutrition without aspiration early after surgery. We think simultaneous thyroplasty typeI offer enough merit for advanced age high-risk cancer because a long prognosis cannot be expected.View full abstractDownload PDF (698K) -
Yutaka Saitou, Hiroshi Morikawa, Hideki Hirabayashi, Koutarou Baba, Sh ...2007 Volume 58 Issue 6 Pages 568-573
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSWe experienced two cases of descending necrotizing mediastinitis (DNM). On the day of admission, they underwent surgical drainage and mediastinal drainage through a thoracic approach. Case 1 was a 79-year-old female without any underlying diseases who developed an abscess deep in the neck. She was treated with combined antibiotics, but the abscess advanced to the mediastinum on CT scan. Case 2 was a 70-year-old female who had diabetes mellitus. Cervical drainage and antibiotics treatment had been performed at another hospital, but however, the abscess remained and expanded to the mediastinum on CT scan. In both cases, we performed incision and cervical drainage and transthoracic drainage on the same day and both cases survived. After the operations, we performed aggressive therapies such as cervical and transthoracic drainage combined with broad-spectrum antimicrobial therapy and transcervical continuous drainage and irrigation of the abscesses. Our findings show that early and aggressive surgical drainage through a thoracotomy is very important for treating DNM.View full abstractDownload PDF (512K) -
Hirohisa Takayanagi, Manabu Komori, Tsuguhisa Nakayama, Tomoaki Yonemo ...2007 Volume 58 Issue 6 Pages 574-581
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSSpontaneous pneumomediastinum (SPM) is relatively uncommon. but the number of reported cases has increased recently because of the improving performance and spreading adoption of computed tomographic scans. We experienced six cases of spontaneous pneumomediastinum over the past three years. All were healthy men with an average age of 16 years (range : 13 to 21 years). None of them had causal disease. In four patients, the cause of the evoked episode was exercise. In the other two, the cause was unknown. All patients were treated conservatively with bedrest and administration of antibiotics and they recovered without any complications.
Including our cases, we reviewed and discussed 220 cases with spontaneous emphysema reported in the Japanese literature during the past 20 years.View full abstractDownload PDF (771K)
Glossary
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[in Japanese], [in Japanese]2007 Volume 58 Issue 6 Pages 582-583
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSDownload PDF (205K) -
[in Japanese]2007 Volume 58 Issue 6 Pages 584-586
Published: 2007
Released on J-STAGE: December 25, 2007
JOURNAL RESTRICTED ACCESSDownload PDF (279K)
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