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Volume 62 (2011)
- Issue 6 Pages 511-
- Issue 5 Pages 433-
- Issue 4 Pages 377-
- Issue 3 Pages 315-
- Issue 2 Pages 63-
- Issue 1 Pages 1-
Volume 62, Issue 3
Displaying 1-10 of 10 articles from this issue
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Original
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Hiroyuki Ito, Takakuni Kato, Hideki Nagatomo, Tatsushi Nukazawa, Hajim ...2011 Volume 62 Issue 3 Pages 315-321
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSThis report provides with statistical analysis of surgical prevention for intractable aspiration pneumonia (SPIA) and SPIA's indication. We have performed SPIA in 20 subjects during the recent 10 years. Seventeen patients had undergone previous tracheostomy and gastrostomy. Two simultaneously underwent gastrostomy and SPIA.
The subjects were 4 cases of cerebral palsy with mental retardation;3 of multiple system atrophy (MSA), 2 each of progressive nuclear palsy, spinocerebral atrophy II (SCAII), corticobasal degeneration and parkinson disease;and 1 each of parkinsonian syndrome, dementia with Lewy body, traumatic brain injury, traumatic cervical spinal cord injury and undiagnosed neurological disease. Laryngectomy was performed on 14 subjects. Montgomery's laryngeal closure with simultaneously bilateral arytenoidectomy was performed on 6 subjects.
Bedridden patients due to progressive neural diseases, cerebral palsy or cerebral vascular disorders have an indication of requiring tracheotomy due to aspiration pneumonia;however, patients who require tracheotomy due dyspnea from bilateral vocal cord palsy arising from MSA or SCA are excluded from this indication.
SPIA enables bedridden patients to survive longer and improves their QOL and that of their spouses and/or parents who care for them;however, aging and diseases of the spouses and/or parents make it difficult to continue patient care over the long term. New measures are required.View full abstractDownload PDF (657K) -
Akiteru Maeda, Hirohito Umeno, Shunichi Chitose, Hiroyuki Mihashi, Tad ...2011 Volume 62 Issue 3 Pages 322-328
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSWe performed a clinicopathological study of 13 transglottic carcinomas experienced in our hospital. Invasion to the thyroid cartilage and artenoid cartilage was found in 77% of the cases. Invasion of the cricoid cartilage was found in 55%. In histopathological analysis, invasion of the preepiglottic space (PES), paraglottic space (PGS) and cricoid area (CA) was found in 31%, 100%, and 77%, respectively. PGS and CA were the most important laryngeal spaces in terms of transglottic carcinoma. As preservation of the larynx was difficult due to laryngeal cartilage invasion, a total laryngectomy was performed in all cases.View full abstractDownload PDF (3339K) -
Masashi Takemura, Keiichirou Morimura, Yushi Fujiwara, Kayo Yoshida2011 Volume 62 Issue 3 Pages 329-337
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSWe compared the clinicopathological factors of cases in which salvage esophagectomy was performed after definitive chemoradiotherapy (dCRT) with those of cases in which esophagectomy was performed without preoperative therapy. In this study, we reviewed the surgical procedures, postoperative complications and survival statistics between 21 patients undergoing salvage esophagectomy (S group) and 187 patients undergoing esophagectomy (NS group) without preoperative therapy, from January 2003 to December 2009. The operative procedures of both groups were not significantly different. The duration of operation of the S group was significantly shorter than that of the NS group, but the amount of blood loss did not differ. The incidence of anastomotic leakage was found to be higher in the S group. No patients demonstrated tracheal necrosis or hospital mortality in the S group. Recurrent diseases were found in 11 cases. One- and 3-years survival rates were 80% and 63.2%,respectively. In the S group, the prognosis of cases with Stage IV or lymph node metastasis before CRT was significantly poorer than the other cases. The thoracoscopic approach in salvage esophagectomy was a safe and feasible option. However, the rate of anastomotic leakage was high, and a procedure conducive to preservation of the tracheal blood flow is needed in salvage esophagectomy. Long-term survival was expected in only selected patients, even among patients after curative salvage esophagectomy.View full abstractDownload PDF (2138K) -
Takashi Nasu, Shuji Koike, Daisuke Noda, Akihiro Ishida, Takanari Goto ...2011 Volume 62 Issue 3 Pages 338-344
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSBackground : Early enteral nutrition through jejunostomy is well recognized as a potential method for decreasing perioperative complications in esophageal surgery. To date, the efficacy of early enteral feeding through jejunostomy has not been evaluated in head and neck surgery. We conducted a retrospective study to assess the efficacy of early postoperative enteral feeding through jejunostomy in patients with head and neck cancer who underwent free jejunal reconstruction surgery, compared to postoperative total parenteral nutrition.
Methods : Between 2007 and 2009, 15 patients underwent a jejunostomy after harvesting a free jejunal flap and were provided enteral alimentation through the jejunostomy one day after surgery. For the control group, 15 patients on postoperative total parenteral nutrition between 2004 and 2006 were selected. The differences between the two groups with respect to recovery rate of serum albumin level after surgery, total dosage of albumin preparation for 2 weeks after surgery, changes in total lymphocyte count, postoperative complications, and indications of infection were analyzed.
Results : In the enteral feeding group, average recovery rates of serum albumin level at postoperative days 7, 15, and 30, were higher than in the control group. Total dosage of albumin preparation for 2 weeks after surgery in the enteral feeding group was significantly low compared to the control group. Total lymphocyte counts at postoperative days 7, 15, and 30 were significantly decreased in comparison to preoperative values in both groups. At postoperative day 7, total lymphocyte counts in the enteral feeding group were significantly higher than in the control group, which means that enteral feeding may prevent decrease in the total lymphocyte count in the early postoperative period. Postoperative complications in the enteral feeding group were fewer than in the control group. In particular, there were no surgical-wound infections or digestive system complications in the enteral feeding group. Duration of antibiotic therapy and duration of fever in the enteral feeding group were significantly reduced in comparison to the control group.
Conclusion : Early postoperative enteral feeding through jejunostomy in patients with head and neck cancer is efficient and safe in the postoperative period.View full abstractDownload PDF (508K) -
Machiko Fujita2011 Volume 62 Issue 3 Pages 345-348
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSWe studied epipharyngeal lesions in 43 patients with acute group A streptococcal pharyngo-tonsilitis, seen between July 2008 and October 2010. We performed epipharyngeal endoscopy and bacteriological examinations of the epipharyngeal mucosa including bacterial culture and the rapid antigen detection test. Endoscopically, 35 patients (81%) exhibited acute epipharyngitis with some degree of white coating. Group A streptococcal infection was confirmed in 21 (81%) of the 26 patients who underwent smear bacteriology of the epipharyngeal mucosa. Patients with acute group A streptococcal pharyngo-tonsilitis typically have acute epipharyngitis also.View full abstractDownload PDF (1194K) -
Keigo Takagi, Yoshinobu Hata, Shuichi Sasamoto, Shoji Takahashi, Fumit ...2011 Volume 62 Issue 3 Pages 349-354
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSBackground : Tracheal invasion including tracheal bifurcation due to esophageal cancer can sometimes cause serious complications of the airway, but such cases sometimes improve quickly following chemoradiation treatment. The absolute indications for stent replacement in the airway for this disorder and the optimal choice of stent are herein discussed.
Methods : Between 1992 and 2010, 28 patients with airway stenosis, including 7 patients with esophago-tracheal fistula, were treated by placement of various stents;namely, 12 patients received Dumon stents, 3 patients had Dynamic stents, 10 patients were given Ultraflex stents, while 3 other patients were treated without the use of stents.
Results : 1)Severe dyspnea in the supine position was observed, which mainly originated from invasion to the membranous portion of the trachea. 2)Airway patency was maintained after stent replacement, although the median survival time of such cases was only 4 months. 3)Three patients with severe dyspnea who could lie in a supine position recovered after undergoing chemoradiation treatment without stent replacement. 4)No cases of stent removal were observed after chemoradiation treatment.
Conclusions : Chemoradiation treatment for esophageal cancer was found to be effective for the management of airway disturbances, and thus the absolute indications for stent replacement are restricted to patients who cannot lie in a supine position due to severe impairment of ventilation during radiation therapy, as well as patients presenting with tracheobroncho-esophageal fistula. Concerning stent selection, a metal stent should be the first choice for tracheal stenosis due to its ease of insertion, because there is no substantial difference between silicone and metal stents regarding the treatment of tracheal stenosis. However, it is important to note that a silicone Y stent is useful for the treatment of tracheal bifurcation.View full abstractDownload PDF (826K)
Case Report
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Kenji Noda, Satoru Kodama, Kanako Noda, Masashi Suzuki2011 Volume 62 Issue 3 Pages 355-359
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSLaryngeal tuberculosis (LTB) presently accounts for only 0.1-0.2% of all newly diagnosed tuberculosis (TB) cases in Japan. Patients with LTB are thus rare, but they are occasionally encountered in our outpatient department. We recently experienced a case and considered problems in ambulatory practice relating to LTB.
A 52-year-old male presented with hoarseness. He was referred to our hospital with diagnosis of a subglottic tumor by a local otolaryngologist. Laryngoscopy revealed a white necrotic mass at the left vocal cord and subglottis. Based on the results of histological and sputum examinations, he was diagnosed as LTB. We referred him to a special hospital for treatment.
In otorhinolaryngology outpatient clinics, many factors increase the risk of TB infection since LTB is an aerially transmitted disease. For example, patient coughing is frequently induced by laryngeal endoscopic examination. In the current case, no other newly infected patient of TB was detected. However, sufficient infection control precaution was not taken in ambulatory practice. Adequate infection control precaution should be taken with patients who are suspected of being infected with TB. We have started historical management of endoscope disinfection. We are now able to trace any person in contact with an infected patient of TB via endoscopy or airbone route in the endoscopy room.View full abstractDownload PDF (2250K) -
Takashi Tsujimura, Tomoyuki Haji, Shinichi Satou, Kazuhiko Minami, Tos ...2011 Volume 62 Issue 3 Pages 360-364
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSEx utero intrapartum treatment (EXIT) is a life-saving procedure for fetal airway obstruction performed without prolapsing the umbilical cord during birth. This report presents a case of branchial arch syndrome that was successfully treated by an EXIT procedure. A 29-year-old female, gravida 2, para 2, was referred to our hospital because ultrasonographic examination at 28 weeks gestation detected a fetus with severe facial malformation. A fetal MRI revealed aplasia of the maxilla and hypoplasia of the mandibular. The images indicated that the airway would be obstructed at the time of delivery, and the patient underwent a Caesarean operation and tracheostomy by an EXIT procedure at 37 weeks 0 day gestation. The operation was started under general anesthesia, and the fetal head and right shoulder were delivered. A tracheostomy was then performed in the fetus while preserving the fetal circulation, and it was thereby possible to maintain an adequate airway. Real-time ultrasonographic monitoring of umbilical blood flow and prompt operation are important during the EXIT procedure, and therefore an otolaryngologist must cooperate closely with the obstetrician, pediatrician and anesthesiologist during all surgical procedures.View full abstractDownload PDF (724K)
Glossary
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[in Japanese], [in Japanese]2011 Volume 62 Issue 3 Pages 365-367
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSDownload PDF (1542K) -
[in Japanese], [in Japanese]2011 Volume 62 Issue 3 Pages 368-369
Published: June 10, 2011
Released on J-STAGE: June 25, 2011
JOURNAL RESTRICTED ACCESSDownload PDF (684K)
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