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101 巻, 8 号
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耳鼻科医としての対応石川 和夫2008 年 101 巻 8 号 p. 565-573
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーIt has become possible to make a diagnosis of small acoustic neuroma localized within the internal auditory meatus in the presence of normal or mild hearing impairment. From the viewpoint of functional preservation, it is deemed that a turning point has come in terms of the neurotologist's role in the management of patients with acoustic neuroma, especially in cases with small tumors. As a neurotologist, one is expected to locate the tumor while it is small, and follow the time-course of the tumor's growth and cochleo-vestibular symptoms, and then adopt the most beneficial treatment policy for the patient among the three treatment options of surgery, gamma-knife application, and follow up. To determine the optimal policy, one should take into consideration one's own experience, as well as the patient's social and familial background on an individual basis. When considering hearing preservation surgery, a middle cranial fossa approach could be the most promising and desirable. Some important check points for making a diagnosis of acoustic neuroma are also presented.抄録全体を表示PDF形式でダウンロード (6230K) -
佐々木 亮, 欠畑 誠治, 新川 秀一, 太田 修司2008 年 101 巻 8 号 p. 574-575
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (1823K) -
能美 希, 児玉 悟, 川野 利明, 吉田 和秀, 渡辺 哲生, 鈴木 正志2008 年 101 巻 8 号 p. 577-585
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーVaricella-Zoster virus infection sometimes causes multiple nerve paralysis. We report three cases of multiple cranial nerve paralysis due to Varicella-Zoster virus infection. The first patient, a 58-year-old man, presented with right otalgia, dysphagia and hoarseness. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment and right vocal paralysis. There was no facial palsy. He was diagnosed with VIIIth, IXth and Xth cranial nerve palsy. The second patient, a 60-year-old woman, presented with right otalgia, vertigo, right hearing loss, and dysphagia. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment, right canal paralysis and deviation of the tongue. Right facial palsy appeared on the 5th disease day. She was diagnosed with VIIth, VIIIth and XIIth cranial nerve palsy. The third patient, a 70-year-old woman, presented with right otalgia and dysphagia. There were painful vesicles on the right auricle and in the larynx, and clinical examination demonstrated soft palatine paralysis, right vocal cord paralysis and atrophy of the right sternocleidomastoid muscle. She was diagnosed with IXth, Xth and XIth cranial nerve palsy. Serum antibody titers for Varicella-Zoster virus were significantly elevated in all patients. All patients were successfully treated with intravenous or oral steroid and intravenous acyclovir.
Varicella- Zoster virus infection should be considered, particularly if unilateral cranial nerve palsy with pain is identified.抄録全体を表示PDF形式でダウンロード (6362K) -
柳内 充, 荒川 卓哉, 林 達哉, 原渕 保明2008 年 101 巻 8 号 p. 587-589
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーWe report the case of a 6-year-old girl with a small, round-shaped foreign body, composed of polyvinyl alcohol, in her right external auditory canal. This foreign body was originally a component of toy beads with which children are able to make variously shaped objects by sticking them together using water. Polyvinyl alcohol is a water-soluble polymer and is employed as an adhesive agent. In our case, it was not easy to remove it because it had fully adhered to her external auditory canal.
It is important to note that this kind of foreign body should not be attempted to be removed by water irrigation, as this would cause it to dissolve and stick to the tissue.抄録全体を表示PDF形式でダウンロード (3664K) -
中野 誠一, 山本 元久, 嶽村 貞治, 石丸 直澄, 宮崎 かつし, 田村 公一, 氷見 徹夫, 林 良夫, 武田 憲昭2008 年 101 巻 8 号 p. 591-597
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーWe reported three cases of Mikuhcz's disease. Mikulicz's disease was diagnosed by the following criteria: 1) symmetrical enlargement of the lacrimal and salivary glands lasting at least 3 months', 2) the lacrimal and salivary glands were microscopically involved in the infiltration of inflammatory cells, 3) sarcoidosis and other lymphoproliferative diseases were excluded. Three patients with Mikulicz's disease were all characterized by elevated IgG4 concentration in the serum and prominent infiltration of IgG4-positive plasmacytes in the minor salivary glands. On the contrary, there were no findings indicating sicca syndrome or anti-SS-A and SS-B antibodies, which characterize Sjögren syndrome. It is suggested that Mikulicz's disease is an IgG4-related plasmacytec disease, with a pathogenesis differing from that of Sjögren syndrome.抄録全体を表示PDF形式でダウンロード (6570K) -
石永 一, 有馬 忍, 湯田 厚司, 竹内 万彦, 間島 雄一2008 年 101 巻 8 号 p. 599-604
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーParotid carcinoma is relatively rare in head and neck cancer, and its treatment is still controversial because of its diverse histology.
A total of 37 cases of parotid carcinoma were treated in our hospital between 1991 and 2005. In terms of the therapeutic strategy, patients with low-grade carcinoma were treated by surgery alone with preservation of the facial nerves, whereas those with high-grade carcinoma underwent surgery with facial nerve resection and full-dose radiotherapy.
We performed neck dissection in only N+ patients. The 5-year, cause-specific survival rate in the 37 patients with parotid carcinoma was 67.5%, being 76.0% for those with low-grade cancer and 58.0% for those with high-grade cancer. Our study suggests that more extensive surgery is required for those with high-grade malignancy in order to improve the 5-year survival rate.抄録全体を表示PDF形式でダウンロード (714K) -
大峡 慎一, 楠威 志, 伊藤 伸, 横井 秀格, 古川 正幸, 池田 勝久2008 年 101 巻 8 号 p. 605-609
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーIngested foreign bodies are not unusual. In most cases, these foreign bodies are easily removed. We report a relatively rare case of a fish bone migrating into the parapharyngeal space, which was removed through a cervical incision. A 30-year-old-woman with a 3-week history of sore throat since ingesting a fish bone had complained of a left-sided neck mass and pain. The ingested fish bone penetrated the pharynx and migrated to the substernocleidmastoid muscle. Furthermore, a parapharyngeal neck abscess had formed. The fish bone was successfully removed via neck exploration and the patient recovered well.抄録全体を表示PDF形式でダウンロード (5317K) -
溜箭 紀子, 畑 裕子, 栗田 宣彦, 奥野 妙子2008 年 101 巻 8 号 p. 611-615
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーWe encountered two cases of multiple cranial nerve palsy involvement with varicella-zoster virus, where X cranial nerve palsy, more specifically vocal cord palsy, had recovered after prolonged progress. The patients were a 57-year-old female who complained of hoarseness and dysphagia and a 51-year-old male who complained of hoarseness, right hearing impairment and right facial palsy. The first patient had IX·X nerve palsy and the second patient had VII·VIII·IX·X nerve palsy. Both cases showed complete vocal cord palsy because of X cranial nerve involvement. In the first case, vocal cord palsy had persisted for eleven months, then recovered quickly during the twelfth month. In the second, vocal cord palsy recovered slowly over ten months. In case of X cranial nerve palsy due to varicella-zoster virus, we should consider that each case may show an individual recovery process with a widely varied time course.抄録全体を表示PDF形式でダウンロード (4384K) -
小宅 大輔, 岡田 智幸, 深澤 雅彦, 佐藤 成樹, 肥塚 泉2008 年 101 巻 8 号 p. 617-620
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーThis study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and miss-swallowing frequency in the prediction of food and liquid aspiration. Videoendoscopy was performed in Fourty-three patients. A four-level rating scale was employed to determine the severity of accumulated oropharyngeal secretions. On this secretion scale patients graded 0 and 1 could eat, but those graded 3 could not. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of the aspiration of food or liquid. The Results are discussed in terms of integrating this information with clinical bedside examinations.抄録全体を表示PDF形式でダウンロード (2301K) -
岩永 哲, 崎浜 教之, 吉田 晴郎, 田中 藤信, 高橋 晴雄2008 年 101 巻 8 号 p. 621-626
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーThe aim of this paper was to describe our surgical technique and retrospective review of the treatment of benign parapharyngeal tumors. We used a modified transcervical approach in twelve patients with large tumors. Pathological diagnose comprised 7 cases of pleomorphic adenoma, 4 cases of schwannoma, and 1 case of oncocytoma. The mean maximal tumor diameter was 4.8cm (range: 2.0-9.0cm) and the mean vertical distance from the skull base was 1.3cm (range: 0-3.5cm). The mean surgical time was 198 minutes (range: 104-369 minutes), and the mean blood loss was 82ml (range: 25-200ml). The average follow-up time was 37 months (range: 8-74 months) and there was no clinical or radiological signs of residual or recurrent tumor. The modified transcervical approach facilitates the removal of large tumors, but only in benign cases.抄録全体を表示PDF形式でダウンロード (5961K) -
神田 和可子, 細川 誠二, 山元 理恵子, 岡村 純, 土屋 松実, 大川 靖弘, 峯田 周幸2008 年 101 巻 8 号 p. 627-630
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーAccidental ingestion of foreign bodies is a common pediatric problem. Here we describe multiple foreign bodies (a screw and a bell) in the left bronchus and the small intestine of a 20-month-old child. After the ingestion episode, the patient was initially examined at the pediatric department of her local hospital. A screw was detected in the esophagus and a bell was detected in the small intestine. The patient underwent an endoscopic procedure under general anesthesia. However, the screw was not seen in the esophagus. Chest X-ray of the left side demonstrated that the screw was in the left bronchus. The patient was referred to our hospital, and underwent a removal of the screw under bronchoscopy. Fifty-one hours after ingestion episode, the bell was excreted.
Diagnosis of such cases requires the greatest care, because even if a foreign body is found in the gastrointestinal tract, there may still be another foreign body in the bronchus.抄録全体を表示PDF形式でダウンロード (4051K) -
川畑 隆之, 鳥原 康治, 直野 秀和, 松田 圭二, 河野 浩万, 東野 哲也2008 年 101 巻 8 号 p. 631-636
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーToxoplasmosis usually manifests as a cervicofacial lymphadenopathy in adults, and its manifestation as a parotid mass is very rare. In this article, we present the case of a 48-year-old with acquired intraglandular parotid toxoplasmosis which clinically mimicked a parotid gland tumor. We performed superficial parotidectomy, suspecting a malignant tumor. However, the postoperative histopathology, indicated toxoplasmic lymphadenitis. Serological tests revealed high levels of both IgM and IgG antibodies against Toxoplasma in the serum. We concluded that the disease was due to active infection with Toxoplasma gondii. Through the postoperative administration of specific antibiotic agents, the patient remained symptomatically well without signs of systemic or local toxoplasmosis. The infection was believed to have been transmitted via the patient's pet rabbit.抄録全体を表示PDF形式でダウンロード (4605K) -
伊藤 真人2008 年 101 巻 8 号 p. 638-639
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (332K) -
川本 将浩2008 年 101 巻 8 号 p. 640-641
発行日: 2008/08/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (302K)
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