日本耳鼻咽喉科学会会報
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
92 巻, 2 号
選択された号の論文の15件中1~15を表示しています
  • 隈上 秀高, 松村 高洋, 青木 真二
    1989 年 92 巻 2 号 p. 165-168
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    A case of amyloidosis localized in the nasopharynx was reported. The patient was a 62-year-old female who complained of persistent nasal obstruction.
    The gross appearance of this tumor showed a thumb-sized red-yellowish mass, in part covered with white coating.
    The systemic amyloidosis was excluded by several clinical examinations including rectal biopsy.
    Histopathological examination revealed diffuse deposits of homogeneous eosinophilic substances. A polarized microscopic examination by congo-red stain showed that deposit's substances were amyloid. A typical amyloid fibril was observed under electron microscope.
    The mass was removed with Beckmann adenotome. Bleeding was minimal.
  • ことにT4症例の治療法について
    森田 守, 宮田 守, 五十嵐 丈人, 藤本 泰幸, 井上 耕, 中村 良博, 大島 清史
    1989 年 92 巻 2 号 p. 169-175
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Between 1974 and 1986, 54 cases of squamous cell carcinoma of the maxillary sinus were treated combing surgery, radiotherapy and regional chemotherapy simultaneously. Using UICC (1987) system, these 54 cases were classified into one Tl, four T2, thirty-three T3 and sixteen T4.
    The combined therapy consisted of 1) reduction operation followed by daily cleaning of the necrotic tumor mass ; 2) external irradiation with less than 30Gy ; 3) intra-arterial infusion of 5-fluorouracil (5-FU) and broxuridine (BUdR) ; and 4) final tumor resection under general anesthesia. As several modifications were made for the treatment procedure in 1979, the 54 cases were divided into two groups : Group A with 29 cases, which were treated before 1979 and Group B with 25 cases, which were treated after 1979.
    In this paper, the operative procedure, which we use for T4 cases is described. The first operation is performed after radiotherapy with about 10Gy and in this operation only the necrotic portion of the tumor mass is removed. The maxillary cavity is opened through the sublabial incision. This window is kept open and daily cleaning of the necrotic tumor mass is continued through the window. Three weeks after the simultaneous administration of radiation with 20Gy and 5 intra-arterial infusions of 5-FU and BUdR, the residual tumor is curetted thoroughly undergeneral anesthesia. Surgery is performed through the sublabial window which has been kept open after the reduction surgery. Removal of the residual tumor mass which extends to the ptery ygomaxillary fossa, nasopharynx, anterior and medial skull base can be performed without difficulty, provided that the tumor mass is removed in pieces. Tumors close to the dura mater, the optic nerve and the internal carotid artery are carefully dissected, using a microscope. The orbital contents and the hard palate, however, are preserved as much as possible. Although the dura mater as well as the orbital contents are widely exposed, these tissues are covered by healthy granulation tissues within 8 weeks without serious complications.
    The survival rates of the 54 cases estimated by the Kaplan-Meier method were 49% for Group A and 79% for Group B. When group B was divided into two groups according to T category (i.e. 15 cases of T3 and 10 cases of T4), the survival rates of Group B were 88% for T3 and 64% for T4. The patients have been living healthy without cosmetic nor functional disabilities after the treatment.
  • 耳小骨奇形3症例の報告
    船井 洋光, 沖田 渉, 堀内 康治
    1989 年 92 巻 2 号 p. 176-182
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Intraoperative auditory brainstem responses (ABRs) were monitored in 3 patients undergoing middle ear surgery for congenital ossicular anomalies. It was investigated whether this technique was capable of providing useful information to the operating surgeon.
    After the induction of anaesthesia and intubation, standard disc electrodes were attached to the vertex (active), ipsilateral mastoid (reference), and forehead (ground). These electrodes were draped out of the surgical field. The general anaesthesia was maintained by inhalation of enflurane. Stimulus intensity was decreased from 80 dBnHL in 10 dB steps until no response was obtained. Thus latency-intensity functions for wave V of ABR were obtained.
    First (A) recording was performed before the incision. The tympanomeatal flap was then elevated and the bony annulus overloading the oval window was drilled out. This enabled to visualize and confirm the anomalies of the ossicles. Before reconstructing the ossicles, the tympanomeatal flap was returned to its normal position and second (B) recording was obtained.
    During the reconstruction, recordings (C1, C2, ...) were repeated as indicated. Then it was confirmed whether the effective reconstruction was obtained for auditory function.
    The results suggest that latency of wave V was significantly decreased when the effective reconstruction of the ossicular chain was done. Latency-intensity function is shifted to the left of A and B functions.
    Intraoperative auditory assessment using ABR in the reconstructive surgery for the ossicular chanis is promising in providing useful information for auditory function and in predicting postoperative hearing improvement.
  • 安藤 英樹, 寺田 修久, 戸川 清, 今野 昭義
    1989 年 92 巻 2 号 p. 183-188
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    It is generally accepted that abnormal autonomic responsiveness may contribute to the pathogenesis of hyperesthetic rhinitis. Histologically, in the nasal mucosa, cholinergic fibers are found close to blood vessels, but are particularly numerous around the glands. Adrenergic fibers are found mainly around the vascular structures. Physiological and pharmacological studies demonstrate that parasympathetic hypersensitivity causes hypersecretion, and sympathetic hyposensitivity causes vasodilatation. α1-adrenergic receptor function is dominant for this vasodilatation.
    Using radioligand binding techniques, it has been found that there is an increased number of muscarinic cholinergic receptors and a decreased number of α1- and β-adrenergic receptors in patients with nasal allergy, while the binding affinities do not change.
    In this report, using radioligand binding techniques, we investigated the relationships between the number of receptors and the degree of the hyperreactive nasal symptoms in patients with hyperesthetic rhinitis.
    The results are as follows.
    1. The number of muscarinic cholinergic receptors of human nasal mucosa in patients with hyperesthetic rhinitis was related significantly (P <0.01) to the degree of hypersecretion induced by methacholine and frequency of blowing nose estimated from allergy diary.
    2. There was no relationship between frequency of sneezing and the number of muscarinic cholinergic receptors.
    3. The number of α1-adrenergic receptors was related significantly (P<0. 05) to the degree of swelling of nasal mucosa induced by methoxyamine.
    Judging from these results, it was assumed that pathogenesis of hyperreactive nasal symptoms may be associated at least partially to the changes of number of autonomic nerve receptors in the nasal mucosa.
  • 古川 仭, 加藤 千維子, 上出 文博, 梅田 良三
    1989 年 92 巻 2 号 p. 189-193
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    n-Butyrate has been shown to induce Epstein-Barr virus (EBV) antigen synthesis in certain EBV genome-carrying lymphoblastoid cell lines. We have studied the effect of cis-dichlorodiamine-platinum (CDDP) on induction of EBV antigen synthesis not only by n-butyrate treatment of the EBV producer, P3HR-1 cells, but also by superinfection of EBV to the EBV non-producer, Raji cells. Simultaneous treatment of the cells with n-butyrate and CDDP or MMC blocked VCA and EA induction, but no suppresive effect was observed by the treatment of the cells with n-butyrate and Ara-C. The induction of EBV antigens was also observed in EBV-superinfected Raji cells, even in the presence of DNA synthesis inhibitor, CDDP or MMC. From these results, we discussed the mechanisms of the EBV antigens synthesis in EBV latently infected cells.
  • 成長および運動負荷による影響
    籾山 安弘
    1989 年 92 巻 2 号 p. 194-206
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    In terms of the nozzle active anterior rhinomanometry, nasal resistance was measured in 297 school children and students with no history of nasal and respiratory diseases (151 males and 146 females), aged 6 to 17 years. Nasal resistance was evaluated at rest and after physical exercise.Single master two-step test was employed as physical exercise. Then, the relationships among the nasal resistance, age and the effect of exercise were studied.
    Subjects were divided into four groups by means of nasal resistance at rest and their response to the physical exercise : the age of 6 to 8, 9 to 11, 12 to 14 and 15 to 17 years.
    1) Nasal resistance at rest
    From 6 to 8 years, nasal resistance was very high. This high value may be due to the large anatomical size of their adenoid. From 9 to 11 years, the older the age was, the smaller the nasal resistance became. The difference between mean values of the nasal resistance of 9 and 11 year old children was statistically significant. However, from 12 to 14 years, nasal resistance once increased and then decreased again during this particular period. This chronological change of resistance may be contributed to the discrepancy of the anatomical maturation of the nasal structure. That is, the nasal turbinates seems to develop prior to the growth of the nasal frame work. Therefore nasal air passage may relatively be narrow until the nasal frame work is well developed. This transient increment of nasal resistance was statistically significant. Thereafter, from 15 to 17 years, nasal resistance was continuously decreased and approaching to the adult value.
    2) Effect of physical exercise
    From 10 to 14 years, nasal resistance was significantly decreased after physical exercise.From 6 to 7 and 15 to 17 years, changes after exercise were unpredictable. This may be attributed to the prematurity of the autonomic nervous system in 6 to 7 years and the instability of autonomic control in 15 to 17 years. These results suggest that the autonomic nervous system gives much influence to the regulation of the nasal resistance.
  • 過性脳虚血発作惹起動物による実験的研究
    三好 敏之
    1989 年 92 巻 2 号 p. 207-220
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Patients with transient ischemic attack (TIA) in the vertebrobasilar artery more often complain of disturbance of equilibrium, such as vertigo or dizziness, than of auditory disorders, such as hearing impairment or tinnitus.
    The author induced TIA in rabbits by injecting adenosine diphosphate (ADP) into the right vertebral artery.
    Observations of rotatory nystagmus have shown that a peak level of directional preponderance appeared 1 minute after injection of ADP (0.3mg/kg b.w.) and continued for more than 4 minutes.
    On the other hand, the amplitude of auditory brainstem responses (ABRs) presented no significant changes following the injection of ADP (0.5mg/kg b.w.). However, greater amounts of ADP (1.0 and 2.0 mg/kg b.w.) were found to reduce the amplitude of ABR-waves, although significant reduction was observed for only less than 1 minute. This change was represented by flattening of the later part of the waves, with the first wave much less affected.
    Electrocochleogrm (E. Coch. G.) have also demonstrated a transient reduction in amplitude 10seconds after injection of ADP (4.0mg/kg b.w.) with correspondingly rapid recovery. In cases of hypertension due to noradrenaline load or trimethaphan -induced hypotention, reduced amplitudes were more profound and continued longer, returning to its normal range within 1 minute.
    Differences in susceptibility between the equilibrial system and auditory system in TIA of the vertebrobasilar artery are discussed.
  • 服部 琢, 丹羽 英人
    1989 年 92 巻 2 号 p. 221-227
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Evaluation of clinical application of evoked oto-acoustic emission (OAE) as an objective cochlear function test was studied in normal hearing subjects, retrocochlear and cochlear deafness cases. In normal hearing subjects, OAE responses showed good reproducibility while the minimum detectable level of OAE varied between subjects. We found that the interaural difference of minimum detectable level of OAE is the best indicator of cochlear damage. As both OAE and ECochG originate from the hair cells, we compared the behavior of OAE and ECochG in cases with retrocochlear deafness. We found that OAE exhibited the same behaviour as CM in ECochG in these cases. In cases of cochlear deafness, in spite of the recovery of the hearing thresholds to within normal levels, the minimum detectable level of OAE remained at an average of about 4. 4dB higher as compared to normal hearing subjects. This demonstrates that a minimal cochlear damage likely to go undetected by pure tone audiometry is detected by OAE measurement. We conclude that OAE must be added to the growing list of tests in the objective assessment of cochlear function.
  • 嶽 良博, 垣内 弘
    1989 年 92 巻 2 号 p. 228-232
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Sixty strains of S. pneumoniae isolated from the patients with upper respiratory tract infections were immunologically classified by use of Danish type/group specific antisera. The percentages of S. pneumoniae serologically defined were 23. 3% for Group 23, 20. 0% for Group 19, 13. 3% for Group 6, 10. 0% for Type 3, 3. 3% for Type 4, 3. 3% each for Type 9 and 18, and 1. 6% for Type 14. It was confirmed that in case of acute otitis media Group 19 and Type 3 were characteristic showing 30. 0% and 13.4%, while rhinosinusitis were highly related to Group 23 of S. pneumoniae. An additional analyses revealed that Type 3 of S. pneumoniae were mostly found in the patients over 50 years old, though the patients under 5 years old were related to Group 19.
  • 木村 仁, 山口 秀樹, 鄭 正舟, 奥平 唯雄, 河野 淳, 飯塚 尚久, 今給 黎守慶, 船坂 宗太郎
    1989 年 92 巻 2 号 p. 233-238
    発行日: 1989/01/20
    公開日: 2008/07/30
    ジャーナル フリー
    As a clinical test, direct observation of the middle ear should be ideally performed without any surgical intervention such as myringotomy. This paper reports a newly invented superfine fiberscope which makes it possible to insert through the eustachan tube, and direct views of the middle ear structures on normal subjects and patients. The patients were of a small cholesteatoma and traumatic dislocation of the ossicular chain. All of them were tested with local anesthesia in outpatient clinic.
    This superfine fiberscope was of great value in observing of middle ear structures as a diagnostic instruments, as that no surgical intervention was necessary in the procedure.
  • 秋山 育代
    1989 年 92 巻 2 号 p. 239-245
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    The effects of ethyl alcohol on vestibulo-ocular reflex (VOR) and gaze functions were investigated in normal adults.
    Twelve normal adults were administered whisky at the rate of 1.0ml/kg (ethyl alcohol 0. 43g/kg), so that the mean peak concentration of breath alcohol amounted to 0.15mg/l.Before and after alcohol administration, the subjects underwent sinusoidal rotation tests with an amplitude of 40°and frequencies of 0.2-0.85Hz and eye tracking tests of unidirectional motion at 30°-70°/sec.For the rotation test, 7 subjects were examined at the dose of 0.65g/kg ethyl alcohol.
    The following results were obtained.
    1. The mean value of VOR gain under the condition of performing mental arithmetic in the dark was not significantly altered by alcohol. However, the magnitude of change in VOR gain showed a highly significant correlation with the gain before drinking; whereas small values were enlarged and large values were suppressed by alcohol.
    2. The accuracy of spacial gaze fixation was scarcely affected by alcohol, even at the dose of 0.65g/kg.
    3. Visual fixation on a head-fixed target (fixation-induced suppression of VOR) and smooth pursuit were significantly impaired by alcohol.
    4. The present study indicated that VOR is regulated even in the dark by both gaze stabilizing functions, i.e., spacial gaze fixation and smooth pursuit.
  • 中溝 宗永, 鎌田 信悦, 内田 正興, 横田 美幸, 佐藤 之俊, 荒牧 元
    1989 年 92 巻 2 号 p. 246-252
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    We encountered a case of catecholamine-secreting carotid body tumor which has never been reported in Japan. The patient was a 20-year old man, who complained of a mass located at the right neck and hypertensive symptoms such as loss of consciousness at extension of the neck, fatigability, etc. Carotid angiography and computed tomography (CT scan) revealed a carotid body tumor. Before operation, a mild hypertension was noted, serum and urinary levels of norepinephrine showed abnormal increase, and phentolamine test was positive. After the tumor was dissected by a surgical procedure associated with carotid reconstruction, blood pressure and norepinephrine levels clearly trended to decrease and phentolamine test returned to negative.
    Histopathologically, the tumor was a paraganglioma with so-called " organoid " pattern. The tumor was not chrornaffin, but the presence of neurosecretory granules was confirmed under electron microscope.
    In one-year follow up after the operation, no sign suggestive of " latent " or newly arising paraganglioma was noted in assay of catecholamines in serum and urine, nor on adrenal CT scan.
  • 坂井 聡子
    1989 年 92 巻 2 号 p. 253-259
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    We determined nasal peak flow using a peak flowmeter with a face mask (PALROD peak expiratory flowmeter) and nasal airway patency with an anterior rhinomanometer (Nihon Koden MPR-1100) at a minimum time interval in the same individual. We compared the values obtained by two kinds of measurements to evaluate the usefulness of the peak flowmeter for nasal airway patency.
    In this study, the nasal patencies were experimentally changed and measured in 30 patients using a-1 stimulant spray and in 25 patients with nasal allergy using nasal provocation of antigens.We also measured the natural circadian changes of nasal patency in 21 patients with nasal allergy and in 18 normal persons every two hours from 8:00 A.M. to 8:00 P.M. and from 9:00 A.M. to 9:00 P.M., respectively.
    As a result, we found close correlations between percent change of the peak flow and the nasal airway patency measured after spraying a-1 stimulant (r=0.699, p<0.01), after antigen provocation (r=0.585, p<0.01), and during circadian change (r=0.464, p<0.01 in normal persons and r=0.251, p<0.05 in allergy patients).
    In conclusion, peak flowmeter is handier and cheaper than rhinomanometer and is useful in evaluating the effect of vasoconstrictors and nasal provocation on nasal patency and in measuring the circadian changes of nasal patency.
    Since nasal secretion in the nose affects the measurement of peak flow, it should be removed a much as possible immediately before the flowmeter is used.
  • 美しい音色は狭められた声門間隙により吹奏される
    向井 將
    1989 年 92 巻 2 号 p. 260-270
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
    Historically, the concern of wind instrumentalists has been diaphragm control and embouchure.Laryngeal movement during " blow " has been overlooked or neglected by wind musicians. It has been said that musical tone has to be produced by the resonances of the player's air column by opening his larynx during blow.
    In the present study, fiberscopic observations of the larynx during blow revealed that musical tones were played with adducted vocal cords. Narrowed glottis appeared to control the airflow of the blow. Persons who could not make musical tone blew with open glottis. Vibrato was also made by rhythmic open and narrowing movements of the glottis. The authors concluded that the larynx regulates the airflow of the " blow ". The authors postulated that the embouchure might be important as the receptor of the airflow rather than controlling the movement for "blow".
  • 白幡 雄一
    1989 年 92 巻 2 号 p. 292-295
    発行日: 1989/01/20
    公開日: 2008/03/19
    ジャーナル フリー
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