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100 巻, 6 号
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加瀬 康弘2007 年 100 巻 6 号 p. 407-416
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーWhile the majority of blowout fractures result in favorable outcomes regardless of treatment, few cases of poor outcome inevitably occur, and treatment for these cases remains an important issue. In the present study, we describe the pathology of blowout fractures and the treatment for cases of diplopia, based on our own 250 patients and recent literature.
Clinical conditions that result from blowout fractures and are involved in the onset mechanism of diplopia primarily include herniation of soft tissue, swelling caused by bleeding or infiltration of exudates, and extraocular muscle damage. Extraocular muscle damage includes mechanical damage resulting from impaction at the fracture site, as well as varying degrees of damage to the muscle itself.
Factors related to the prognosis of diplopia include children, constriction of extraocular muscle, and severe diplopia, and these factors are often mutually related. In addition, early surgery is indicated for patients to whom these factors apply. Although indication for surgery is determined on an elective basis for other patients, certain clinical conditions can be expected to be resolved by waiting, as follows: swelling of soft tissue around extraocular muscles resolves at around 2 weeks, mild damage (such as concussion and contusion) to extraocular muscle resolves at 1-2 months, and severe damage (fibrosis due to Volkmann contracture) to extraocular muscle resolves at around 6 months to over a year. The treatment of blowout fractures requires accurate determination of the clinical conditions of each patient and treatment should be selected accordingly.抄録全体を表示PDF形式でダウンロード (3267K) -
河田 了2007 年 100 巻 6 号 p. 418-419
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (2999K) -
渡辺 知緒, 横田 雅司, 伊藤 吏, 阿部 靖弘, 青柳 優2007 年 100 巻 6 号 p. 421-427
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーTo investigate the effect of steroids and PGE1 in the treatment of sudden sensorineural hearing loss, we examined 145 patients who were treated between 1993 and 2000. Forty-one patients were treated with high doses of steroids (group A), fifty-six patients were treated with high doses of steroids and PGE1 (group B), and forty-eight patients were treated with conventional doses of steroids and PGE1 (group C). Using follow-up audiograms obtained one month after the initial treatment, recovery rates were compared among these three groups. The overall recovery rate of group B (72%) was higher than those of groups A (44%, p<0.05) and C (61%). The recovery rate of group B was especially greater in the 50 and older age group, in patients who started the treatment within 7 days from the onset of hearing loss, and in patients without vertigo. The recovery rate of group C was significantly higher in patients less than 50 years old when the treatment was started within 7 days from the onset of hearing loss. These results suggest that both high doses of steroids and PGE1 may play important roles in therapy for sudden sensorineural hearing loss in patients aged 50 and older. High doses of steroids may not have beneficial effects on sudden sensorineural hearing loss in younger patients.抄録全体を表示PDF形式でダウンロード (965K) -
浜 雄光, 越知 康子, 芝野 忠寿, 浅野 純志, 安田 誠, 広村 弥生, 久 育男2007 年 100 巻 6 号 p. 429-433
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーWe report a 50-year old man with chronic sinusitis with frontal sinus cyst showing intracranial development. He complained of swelling in the medial angle of the right eyelid. Preoperative CT and MRI demonstrated a right frontal sinus cyst and ethmoid-maxillary sinusitis. The frontal sinus cyst compressed the right frontal lobe of the cerebrum, but no symptom was accompanied by frontal lobe impairment. Under general anesthesia, the frontal sinus cyst and sinusitis were accessed by intranasal ESS. We gently fenestrated the wall of the frontal sinus cyst with a microdebrider and drained the cystic component. The patient has been event free with no recurrence for 15 months postoperatively.抄録全体を表示PDF形式でダウンロード (7012K) -
荻原 仁美, 湯田 厚司, 山口 素子, 田中 睦子, 宮本 由起子, 服部 玲子, 今井 裕, 間島 雄一2007 年 100 巻 6 号 p. 435-439
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーWe report four cases of lingual tonsillar MALT (mucosal associated lymphoid tissue) lymphoma. The cases consisted of a 68-year-old woman, a 60-year-old woman, a 55-year-old woman, and a 75-year-old man. The clinical stages of these cases were IIA, IA, IV (invasion to bone marrow) and IA, respectively. As some types of lingual tonsillar MALT lymphomas show hypertrophy of the lymphoid tissue but not a mass, it is not easy to make a diagnosis of MALT lymphoma only by fiberscopic findings. Furthermore, the small size of biopsy specimens or tissue damaged by forceps can show a false negative consult.
Repeat biopsies are sometimes required for a definitive diagnosis. It is important to take large biopsy specimens with little damage, and to discuss well with pathologists.抄録全体を表示PDF形式でダウンロード (5727K) -
出原 啓一, 大西 将美, 野々田 岳夫, 大橋 敏充2007 年 100 巻 6 号 p. 441-445
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーThrombophlebitis of the internal jugular vein caused by head and neck infection has become a rare disorder due to the development of antibiotics. We treated a patient with thrombophlebitis of the internal jugular vein considered to have been caused by peritonsillar abscess. The patient was a 33-year-old male who consulted us due to swelling and severe pain of the neck after remission of peritonsillar abscesses. CT and ultrasonography were useful for the diagnosis. This patient was successfully treated by antibiotics and fluid infusion, but concomitant anticoagulant therapy might have also been an appropriate strategy. This case suggests the need to consider thrombophlebitis of the internal jugular vein in patients complaining of swelling and pain in the neck after head and neck infection.抄録全体を表示PDF形式でダウンロード (4248K) -
太田 亮, 林 達哉, 長門 利純, 駒林 優樹, 片田 彰博, 坂東 伸幸, 荻野 武, 今田 正信, 青木 直子, 原渕 保明2007 年 100 巻 6 号 p. 447-454
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーSynovial sarcoma is a mescenchymal malignancy which accounts for approximately 10% of all soft tissue sarcomas. It usually occurs in the lower limbs of young adults, and only 3% of all synovial sarcomas involve the head and neck region. As the incidence in the head and neck region is very low, only 11 cases with endolaryngeal localization have been reported in the world. We report a case of synovial sarcoma of the larynx.
The patient was a 50-year-old man, complaining of swallowing difficulty. The tumor existed in the left arytenoid and pyriform sinus. Histological diagnosis obtained by biopsy was synovial sarcoma.
As total laryngectomy as a initial treatment was refused, superselective arterial infusion of high-dose cisplatin with concurrent radiotherapy was performed. The effect of the treatment was insufficient after four trials of arterial infusion at one-week intervals and 40Gy radiation. He finally consented to undergo total laryngectomy. No recurrence has been observed for 18 months after surgery.抄録全体を表示PDF形式でダウンロード (13013K) -
森 幸威, 兵 行義, 宇野 雅子, 粟飯原 輝人, 秋定 健, 原田 保2007 年 100 巻 6 号 p. 455-461
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーA mucosa-associated lymphoma (MALT) is a tumor of lymphoid tissue involving the mucosa. Histopathological examination revealed a marginal zone B-cell lymphoma of MALT type. MALT lymphomas are low-grade lymphomas found mainly in the stomach and intestinal tract. Oto-rhino-laryngologically, MALT lymphomas have rarely been reported in the salivary gland. To the best of our knowledge, there have been reported only four cases in the minor salivary glands. Our patient was a 71-year-old woman with discomfort in the mesopharynx. Initially, we suspected malignant lymphoma. Such a tumor must be immediately enucleated. The pathological diagnosis was MALT lymphoma occurring in the minor salivary glands. The treatment was four courses of CHOP, rituximab and radiotherapy. About two years have passed since treatment, and there has been no recurrence.抄録全体を表示PDF形式でダウンロード (8206K) -
福家 智仁, 富岡 利文, 宮村 朋孝, 山田 弘之2007 年 100 巻 6 号 p. 463-465
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーFine needle aspiration cytology (FNA) is a non-invasive and cost-effective examination for the diagnosis of cervical tumors. Therefore FNA is useful for diagnosis of malignant lymphoma with cervical lymphadenopathy, yielding good accuracy and specificity. There were a few false-negative results, and open biopsies were necessary for diagnosis in these cases. This approach resulted in an increased rate of immediate diagnosis and in a decreased rate of unnecessary open biopsy.抄録全体を表示PDF形式でダウンロード (471K) -
小河 孝夫, 花満 雅一, 小川 富美雄, 柴山 将之, 園田 聡, 鈴木 幹男, 清水 猛史2007 年 100 巻 6 号 p. 467-472
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーCervical schwannoma arising from the vagus nerve is relatively uncommon. During the last six years, we treated three cases of cervical schwannnoma arising from the vagus nerve, that were effectively diagnosed by MR imaging. We performed complete resection of the tumor in one case and intracapsular resection in the other two cases, however, postoperative nerve palsy occurred in every case, causing mis-swallowing and hoarseness. Mis-swallowing improved within one month without treatment, but hoarseness persisted longer. Finally, medialization of the vocal cords was a successive treatment to improve hoarseness.抄録全体を表示PDF形式でダウンロード (5716K) -
近藤 英司, 北村 嘉章, 陣内 自治, 秋月 裕則, 由良 いづみ, 中川 英幸, 中川 伸一, 佐野 暢哉, 武田 憲昭2007 年 100 巻 6 号 p. 473-483
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーWe report two cases of invasive aspergillosis of the head and neck regions. One patient was a 56-year-old male with invasive aspergillus sinusitis. The other patient was a 14-year-old boy with aspergillus mastoiditis after bone-marrow transplantation. Both cases were inoperable because of vascular invasion by aspergillus, and treatment with antifungal agents was discontinued due to severe side effects. A novel triazole voriconazole (VRCZ) was then used for salvage therapy and successfully treated invasive aspergillosis in both cases. VRCZ is an effective and well tolerated agent to treat invasive aspergillosis of the head and neck regions.抄録全体を表示PDF形式でダウンロード (15619K) -
Fスケール問診票による検討朝倉 光司, 本間 朝, 大國 毅, 山崎 徳和2007 年 100 巻 6 号 p. 485-490
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーTo evaluate the role of gastroesophageal reflux disease (GERD) in patients with globus pharyngeus, we performed a study with a simplified questionnaire for evaluation of GERD, e. g. a frequency scale for symptoms of GERD (FSSG).
Patients experiencing a lump in the throat without local pathological findings and those with chronic hypertrophic laryngitis showed significantly higher FSSG score than those with other ear, nose or throat disorders. The response rate to anti-acid treatments (H2 receptor blockade or proton pump inhibitor) were 28.6% in patients with FSSG scores below 7 points (n=14), 56.5% in those with scores between 8 and 14 points (n=23), and 85.7% in those with scores above 15 points (n=21). After treatments, FSSG score significantly decreased in responders (n=34, 16.8±1.00 vs 7.15±0.668, p<0.0001), but not in non-responders (n=12, 12.6±1.65 vs 11.3±1.71, ns).抄録全体を表示PDF形式でダウンロード (2149K) -
矢部 はる奈, 五島 史行, 林 賢, 國弘 幸伸, 小川 郁2007 年 100 巻 6 号 p. 491-495
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーIt is not easy to treat patients with intractable Meniere's disease. Intratympanic injection of gentamicin or steroid is one option. The other is a surgical procedure like endolymphatic shunt surgery. Middle ear pressure treatment using the Meniett device, which has not been approved by the Japanese government is widely accepted in foreign countries. We had a chance to use this Meniett device under approval of the ethic's committee of Hino Municipal Hospital since September 2004. ‹Methods› Four patients with intractable Meniere's disease who suffered intensive vertigo attack for more than 5 months with conservative medical treatment were employed in the study. Ages ranged from 67 to 72, with 3 females and 1 male. After a ventilation tube was inserted under local anesthesia, treatment with the Meniett was performed 3 times a day at home. ‹Results› Two patients improved and 2 slightly improved concerning vertigo attacks. One showed no change, 1 experienced a worsening, and 2 showed slight improvement concerning the hearing level. ‹Conclusion› The Meniett device is less invasive and may be suitable for elderly patients who prefer conservative treatment. The mechanism involved in the reduction of vertigo attacks is not clear so far, but we speculate that middle ear pressure may suppress serum vasopressin (antidiuretic hormone) secretion and thereby reduce endolymphatic hydrops. It is necessary to accumulate treatment data with the Meniett in Japan to obtain official approval by the government.抄録全体を表示PDF形式でダウンロード (2120K) -
梅田 悦生2007 年 100 巻 6 号 p. 497-504
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーInfectious gastroenteritis caused by Norovirus which broke out in November 2006 has infected more than three million patients within a two-month periode. Their symptoms varied from severe diarrhea, vomiting and fever to digestive disorders due to a slight flu. The author, an otolaryngologist, has examined numerous flu patients who complain of various symptoms and always bears in mind that digestive disorders might result from Norovirus. Warnings of this kind are found in some clinical reports. The present paper suggests that otolaryngologists should be aware that their patients with flu symptoms might have gastroenteritis caused by Norovirus.抄録全体を表示PDF形式でダウンロード (2571K) -
水田 啓介2007 年 100 巻 6 号 p. 506-507
発行日: 2007/06/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (307K)
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