Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
Volume 116, Issue 8
Displaying 1-16 of 16 articles from this issue
Review article
Original article
  • Junichiro Ohori, Mizuo Umakoshi, Keiichi Miyashita, Yoshiko Hayamizu, ...
    2013 Volume 116 Issue 8 Pages 947-952
    Published: August 20, 2013
    Released on J-STAGE: October 09, 2013
    JOURNAL FREE ACCESS
    The peritonsillar abscess (PTA) is one of the most common infectious diseases in the head and neck area and is treated with puncture, incision, or abscess tonsillectomy. In the present study, we performed a retrospective study for the patients who were diagnosed as having PTA on the basis of CT findings at the Kagoshima University Hospital between January 2007 and April 2012. The clinical characteristics were compared with the CT images and the indication of abscess tonsillectomy was discussed. In total, 145 patients (152 sides), mean age of 41 years (range: 5-80 years) were enrolled in the study. Patients having any surgical treatment such as puncture and incision before visiting our hospital were excluded. The CT findings revealed that PTA could be classified into two categories by the shapes of the abscess: the Oval type and Cap type. Further, the location of the abscess was differentiated superior and inferior, and classified into 4 categories: superior Oval type, superior Cap type, inferior Oval type, and inferior Cap type. The results showed that the number of the superior Oval type PTA was largest and followed by superior Cap type, inferior Cap type, and inferior Oval type in this order. When the CT classifications were compared with clinical findings, patients with the inferior Cap type abscess had laryngeal edema and airway obstruction more frequently than the other categories of PTA. Histological examination of the specimens obtained during surgery showed that the Cap type abscess tended to include more muscular tissue compared to the Oval type, indicating that inflammation might be more severe and wider in the Cap type than the Oval type. Those findings suggest that the inferior Cap type of PTAs need more intensive and reliable treatments such as abscess tonsillectomy.
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  • Fumiyuki Goto, Tomoko Tsutsumi, Kaoru Ogawa
    2013 Volume 116 Issue 8 Pages 953-959
    Published: August 20, 2013
    Released on J-STAGE: October 09, 2013
    JOURNAL FREE ACCESS
    Migraine-associated vertigo (MAV) is proposed as a new clinical entity on the basis of the assumption that the typical migraine and vertigo or dizziness have a common pathophysiology. Some of the patients with recurrent vertigo syndromes with unknown pathology may have MAV. We performed a retrospective study to clarify the clinical characteristics of MAV in the Japanese population. The following were considered as diagnostic criteria: (1) recurrent vestibular symptoms, (2) migraine headache as defined by the International Headache Society (IHS) criteria, (3) at least one instance of synchronization of a vertiginous attack with a migraine headache, (4) no associated unilateral hearing loss, and (5) absence of other diseases that may have caused vertiginous attacks. Of 552 patients with dizziness or vertigo, 46 (8.3%) were diagnosed as having MAV. A typical feature of this clinical entity is that migraine occurs before the onset of vertigo in women aged 30-40 years. Usually the attacks occur once in a year for 1 to 10 years. An attack lasts for 1-24 h and presents as vertigo and unsteadiness with simultaneous headache. The presence of hearing loss presents an important clinical dilemma. Whether the condition in patients experiencing hearing loss should be defined as MAV or not is still a matter for discussion.
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  • Atsuhiko Uno, Arata Horii, Takao Imai, Yasuhiro Osaki, Takefumi Kamaku ...
    2013 Volume 116 Issue 8 Pages 960-968
    Published: August 20, 2013
    Released on J-STAGE: October 09, 2013
    JOURNAL FREE ACCESS
    Objective: Gadolinium (Gd) contrast-enhanced MRI has recently been introduced to clinical practice to detect endolymphatic hydrops. However, since the image depends on the hardware, pulse sequence or the way of Gd administration, the protocol and the evaluating criteria for hydrops on MRI have not yet been standardized. In this study, we assessed the usefulness of the hydrops detection by MRI following the intratympanic or intravenous Gd administration methods, and compared these findings with the electrocochleography and glycerol test.
    Methods: MRI was taken in 27 patients with Meniere's disease or delayed endolymphatic hydrops. All patients had frequent episodes of vertigo attacks which were clinically considered as of unilateral ear origin. Two types of Gd administration were used; injection into the tympanic cavity in 17 patients or intravenous injection in 10 patients. Axial 2D-FLAIR images were obtained with a 3.0T MRI unit, 24 and 4 h after intratympanic or intravenous administration, respectively. The endolymphatic space was detected as a low signal intensity area, while the surrounding perilymphatic space showed high intensity with Gd contrast. Those cases in which low signal areas corresponding to the cochlear duct could be clearly noticed, were classified as cochlear hydrops. When the greater part of the vestibule was occupied by a low signal area in more than half of the images, it was classified as vestibular hydrops.
    Results: Endolymphatic hydrops was detected in 88% (15/17 cases) by the intratympanic Gd administration method, and 90% (9/10) by the intravenous method. In the contralateral ears, 20% (2/10) showed hydrops, detected by the intravenous method. ECochG and the glycerol test were difficult when the hearing of the patient was severely impaired. Positive results of EcochG and the glycerol test were obtained only in 15 and 6 cases, respectively. However, as far as the waves could be obtained, ECochG showed a high detection rate of 88% (15/17) in the affected ear. In those cases in which both MRI and EcochG could be obtained, including both ears, the results were matched in 78% (21/27ears).
    Conclusion: For the qualitative detection of hydrops, intratympanic and intravenous Gd administration methods were equivalent. Inner ear Gd contrast-enhanced MRI had higher efficacy in the detection of hydrops than the conventional tests.
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  • Yuki Sato, Masatsugu Masuda, Naoyuki Kohno
    2013 Volume 116 Issue 8 Pages 969-974
    Published: August 20, 2013
    Released on J-STAGE: October 09, 2013
    JOURNAL FREE ACCESS
    A 36 y/o female presented with the chief complaint of diarrhea and vomiting which had lasted for four days, and with a family history of suicide. The first general examination showed severe dehydration with hyponatremia. After admission, she was diagnosed as having isolated adrenocorticotropic hormone (ACTH) deficiency and mixed connective tissue disease, and the steroid replacement therapy was started with the dose equivalent to 7.5 mg/day of prednisolone (PSL). Three days later, she had right sensorineural hearing loss (SNHL). She was given 40mg/day PSL in addition to the steroid replacement therapy. On the next day, she developed a persecutory type of paranoid disorder, and then was given psychiatric medication. After tapering off PSL for SNHL, the delusion began to improve with psychiatric medication. Three weeks after the onset of SNHL, her hearing level had partially recovered. Ten months later, she did not show any psychic instability. A family history of psychosis and the present history of malnutrition and connective tissue disease are risk factors of steroid psychosis. It can develop even with 5 mg PSL if the patient has a risk factor. Careful medical history taking and knowledge about the steroid psychosis will prevent the severe side effects associated with steroid treatment.
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