巻号一覧
前身誌
102 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
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論説
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―聴衆参加型セミナー「小児滲出性中耳炎の治療戦略」の結果報告―飯野 ゆき子, 林 達哉, 名倉 三津佳, 髙橋 晴雄2009 年 102 巻 2 号 p. 77-86
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありA luncheon seminar entitled “Treatment strategy for otitis media with effusion (OME) in children” was held at the 70th Annual Meeting of Practica Oto-Rhino-Laryngologica in Nagasaki in June 2008. The seminar consisted of one moderator, two speakers and approximately 100 participants. The moderator and the speakers presented some typical cases of OME and asked clinical questions regarding the treatment of OME in children. Each question had four or five answers, which were prepared beforehand. The participants chose one answer among them using an analyzer keypad. The number of participants choosing a specific answer was immediately analyzed and the results were shown. We selected the treatment strategy that was supported by the majority of participants as the first-line treatment, and proceeded to the next question. Finally, the treatment algorithm for OME was established by consensus. Each treatment or management strategy was compatible with evidence-based treatment of OME in children. Therefore, we would like to propose this algorithm as a medical guideline for the treatment of OME in children.
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カラー図説
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西窪 加緒里, 兵頭 政光, 岡田 昌浩, 羽藤 直人2009 年 102 巻 2 号 p. 88-89
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありPDF形式でダウンロード (552K)
臨床
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松吉 秀武, 蓑田 涼生, 増田 聖子, 梶原 薫子, 湯本 英二2009 年 102 巻 2 号 p. 91-97
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありIt is rare for a malignant tumor to be diagnosed when tinnitus and dizziness are with initial symptoms. We experienced a case diagnosed internal auditory canal metastasis of lung cancer. The patient was a 39-year-old woman. Left-sided tinnitus and dizziness appeared, and she consulted our hospital. Pure tone audiometry identified left sensory neural hearing loss at a high frequency. She was diagnosed with sudden deafness, and, in spite of steroid therapy, her hearing ability and symptoms subsequently aggravated. We located a tumor in the left internal auditory canal by MRI, and diagnosed the case as otological symptoms caused by the metastasis of lung cancer to the internal auditory canal by PET-CT. This is the first report in Japan where by the metastasis of lung cancer has been found to be the main reason for otological symptoms. When hearing impairment shows further exacerbation in spite of treatment, we should consider a tumor of the internal auditory canal in the differential diagnosis.
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青木 光広, 水田 啓介, 安藤 健一, 山田 南星, 伊藤 八次, 二木 良孝2009 年 102 巻 2 号 p. 99-102
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありWe report a 46-year-old man with bacterial meningitis and left cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (common cavity type). Left tympanotomy showed granulation over the stapes and water-like otorrhea, and the stapes was separated from the thickened incus long arm. A partial defect was present in the stapes foot plate, and removal of the stapes led to pronounced leakage of CSF. We therefore packed the vestibule with fascia and small pieces of auricular cartilage tightly and then positioned the cap of the vestibule with fascia and fibrin glue. He has remained well and free from meningitic symptoms for two years after the operation. Our case indicates that the occlusion of the vestibule with fascia and auricular cartilage should be considered even in cases without a history of meningitis.
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長谷川 賢作, 武田 真紀子, 國本 泰臣, 矢間 敬章, 夜陣 真司, 北野 博也2009 年 102 巻 2 号 p. 103-108
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありIn the surgical wound classification of the CDC Guidelines, the surgical field in middle ear surgery is often classified as “clean-contaminated” or “contaminated”. We investigated the occurrence of postoperative infections, including surgical site infections (SSIs), by performing bacteriological examinations immediately after surgery in patients who underwent middle ear surgery in our hospital. The investigation was conducted in 67 patients (29 males and 38 females) who underwent tympanoplasty between October 2005 and March 2007. As an antibacterial agent, PIPC was administered twice daily for 5 days starting immediately before to after surgery. Bacteriological examinations were performed using ear discharge specimens collected preoperatively and also using specimens collected by draining the mastoid antrum on the 1st to 3rd postoperative days and specimens scraped from the external ear canal on the 5th postoperative day. As a result, in most patients the microorganisms identified preoperatively were not detected in the mastoid antrum by the 3rd postoperative day. In the present clinical research, there were 5 patients judged to have developed SSI and 1 patient with a nonsurgical site infection (pneumonia). Since the mean hospitalization period for patients without SSI in our hospital was 10.9 days, it is considered that local and systemic conditions become stable within about 1 week after surgery.
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―Bell麻痺，Hunt症候群を中心に―星 参, 櫻井 弘徳, 矢沢 代四郎, 中嶋 大介, 清水 猛史2009 年 102 巻 2 号 p. 109-114
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありA statistical analysis was performed involving 1,513 patients with facial nerve palsy treated at the Department of Otorhinolaryngology, Shiga University Hospital between 1978 and 2007. There were 1,055 cases of Bell's palsy and 198 cases of Hunt's syndrome. In 427 cases of Bell's palsy and 96 cases of Hunt's syndrome, the outcomes of treatment were analyzed on classifying them into three groups by age: under 15, between 16 and 59, and over 60 years old.
The recovery rates following treatment for Bell's palsy and Hunt's syndrome were 94.0 and 73.9%, respectively. Hunt's syndrome demonstrated a poorer prognosis than Bell's palsy, as already documented in the literature. Patients over 60 years old showed a poorer recovery compared to those under 59 years old in both Bell's palsy and Hunt's syndrome.
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―その基本病態を中心に―金川 英寿, 菅原 一真, 橋本 誠, 御厨 剛史, 綿貫 浩一, 山下 裕司2009 年 102 巻 2 号 p. 115-119
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありWe reported a case of psammomatoid ossifying fibroma of the sinonasal tract. The patient was a 39-year-old woman complaing of a swelling of the right cheek. MRI and CT demonstrated a large mass (48×30×40 mm) with a heterogeneous contrast effect. The mass was diagnosed as a benign tumor based on a biopsy performed in the outpatient clinic. Therefore, the tumor was dissected by endoscopic sinus surgery. After the surgery, the tumor was diagnosed as a psammomatoid ossifying fibroma by histological analysis. Psammomatoid ossifying fibroma shows an invasive growth pattern, although the tumor is categorized as benign. The tumor may remain in the skull base. Thus, we are planning a Subsequent operation as radical surgery. Psammomatoid ossifying fibroma of the sinonasal tract is very rare.
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倉田 奈都子, 野口 佳裕, 杉本 太郎, 伊藤 卓, 岸本 誠司2009 年 102 巻 2 号 p. 121-125
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありThe accessory parotid gland is a solitary salivary gland separate from the main parotid gland. Although it is recognized in 21-56% of individuals, the incidence of accessory parotid tumor is relatively rare. We report a 57-year-old male with pleomorphic adenoma arising from an accessory parotid gland. The patient had suffered from a gradually growing mass with no pain in his right cheek for six years. CT scans showed a well-circumscribed, 24×19-mm solid tumor lying on the masseter muscle. Fine needle aspiration revealed a cytological finding of pleomorphic adenoma. Considering the clinical course, radiological and cytological findings, pleomorphic adenoma of the accessory parotid gland was highly suspected. At surgery, a standard incision for parotid tumor was made and extended superiorly. Buccal branches of the facial nerve were detected at the anterior edge of the parotid gland. Total removal of the tumor with excision of the accessory parotid gland was performed. The pathological diagnosis was pleomorphic adenoma. Slight paresis of buccal branches resolved two months after surgery. No recurrence has occurred during 20-month follow-up. We recommend a standard parotidectomy approach that is safe and has cosmetic benefits for the surgical management of neoplasms arising from accessory parotid gland tissue.
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浜口 清海, 池上 聰, 森田 直子2009 年 102 巻 2 号 p. 127-130
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありCarcinosarcoma (true malignant mixed tumor) of the parotid gland is an extremely rare tumor that is composed of both carcinomatous and sarcomatous components. We report a case of a 67-year-old woman with a carcinosarcoma of the left parotid gland. The patient had a parotid tumor showing enlargement for 3 months, and the tumor was resected. Histological examination showed carcinosarcoma, which contained undifferentiated carcinoma as a carcinomatous component and chondrosarcoma as a sarcomatous component. Because this tumor is very aggressive and has a high frequency of recurrence and metastasis, she underwent total parotidectomy with facial nerve resection, left radical neck dissection, and postoperative radiotherapy. After the postoperative radiotherapy, she underwent facial nerve reconstruction. She was alive without recurrence or metastasis at the 12-month follow-up, but we need to continue long-term close follow-up.
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大髙 隆輝, 坂東 伸幸, 小林 祐希, 東谷 敏孝, 太田 亮, 高原 幹, 安部 裕介, 片田 彰博, 林 達哉, 原渕 ...2009 年 102 巻 2 号 p. 131-137
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありSalivary duct carcinoma (SDC) is a high-grade aggressive malignancy originating from the salivary gland, which was first described by Kleinsasser et al. in 1968. We reported here three cases of salivary duct carcinoma in the parotid gland.
The first patient was a 66-year-old male, who presented with a mass in the left parotid region. The patient underwent superficial parotidectomy followed by radiotherapy. The second patient was an 85-year-old female, who presented with parapharyngeal extension. She underwent total parotidectomy with mandibulotomy and upper neck dissection. The third patient was a 76-year-old male. He underwent total parotidectomy with resection of the facial nerve and neck dissection. After surgery, he was treated with radiotherapy.
These three patients were not diagnosed as having SDC before surgery and are currently alive without recurrence or metastasis despite differences in treatment. When we analyzed 61 patients in the Japanese literature, patients with SDC showed an extremely poor prognosis. Moreover, the English literature also showed a poor prognosis and predictive factors included sex, tumor size and neck lymph node metastasis. Therefore, radical surgery with neck dissection and radiotherapy followed by complete follow-up is important to treat patients with SDC.
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山田 光一郎, 土師 知行, 佐藤 進一, 田村 哲也, 本吉 和美, 小澤 一之, 山口 浩志, 本多 啓吾, 辻村 隆司2009 年 102 巻 2 号 p. 139-143
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありWe report a very rare case of an esophageal diverticulum following anterior cervical fusion. A 58-year-old woman underwent 2-level anterior cervical fusion with allograft and anterior plating. Postoperatively, she complained of dysphagia such as discomfort during swallowing and was diagnosed with an esophageal diverticulum based on barium swallow study. It was decided to excise the diverticulum via an external approach. In a discussion with the patient, the plate was also removed by orthopedists. The patient made a good recovery and she has remained symptom-free to date.
An esophageal diverticulum following anterior cervical fusion is a very rare complication. We found only 7 cases of esophageal diverticulum following anterior cervical fusion in the English literature.
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成尾 一彦, 細井 裕司, 笹井 久徳, 鎌倉 綾, 黒川 雅史, 宮原 裕2009 年 102 巻 2 号 p. 145-152
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありWe encountered three cases of advanced deep neck abscess extending to the mediastinum. Delayed diagnosis and inadequate mediastinal drainage are the primary causes of a high mortality rate. In all three cases, there were delays in referral to the ENT department to diagnose the deep neck abscess extending to mediastinum because of chronic renal failure requiring hemodialysis, Alzheimer's disease and cerebral vascular dementia, respectively. Computed tomography was very useful to diagnose and analyze the infected compartments.
After diagnosis, we underwent surgery as soon as possible with the cooperation of thoracic surgeons. To drain the mediastinum, we chose thoracoscopic drainage, mediastinoscopic drainage and conventional thoracotomy, respectively, according to the site of abscess and general condition of the patient. In all cases, immediate postoperative management was performed in the intensive care unit and postoperative progress was satisfactory. If deep neck abscess is suspected, adequate diagnosis and immediate surgical procedures are necessary.
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薬物
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森 繁人2009 年 102 巻 2 号 p. 153-162
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありJapanese cedar pollinosis is the most common seasonal rhinoconjunctivitis in Japan. Nasal and ocular symptoms often interact with each other, however, the nose and eyes are often treated independently, and their responses to treatment are also evaluated independently in many cases.
This study was designed to assess the efficacy of combined administration of the oral and ophthalmic formulations of antihistamine olopatadine hydrochloride, when administration was started before pollen season or after the onset of symptoms. Patients who received pre-season treatment had significantly lower scores for the following outcome measures than those who began olopatadine therapy after allergic symptoms appeared: nasal congestion, nasal discharge, total nasal symptom score, and itchy eyes. Even starting oral and ophthalmic olopatadine after the onset of symptoms resulted in a significant improvement in all nasal and ocular manifestations within two days. These findings suggest that the comprehensive treatment of the nose and eyes with a combination of oral and ophthalmic olopatadine is extremely beneficial in patients with Japanese cedar pollinosis. Although this therapy provides immediate symptomatic relief, it is recommended to start both formulations before pollen season.
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研修ノート
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折舘 伸彦2009 年 102 巻 2 号 p. 164-165
発行日: 2009年
公開日: 2010/07/17
ジャーナル 認証ありPDF形式でダウンロード (456K)
耳鼻咽喉科処置の有用性
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髙橋 淳人, 庄司 和彦2009 年 102 巻 2 号 p. 166-167
発行日: 2009年
公開日: 2010/07/17
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