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前身誌
102 巻, 8 号
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論説
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湯本 英二2009 年 102 巻 8 号 p. 601-613
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありThe author reviewed the development of laryngeal framework surgeries for the treatment of severe hoarseness due to unilateral vocal fold paralysis. The improvement of breathy hoarseness after surgery is usually archieved by various types of framework surgery, including intracordal injection, type I thyroplasty, arytenoid adduction, and their modifications. However, a significant number of patients do not recover their “normal” voices after surgery. It is hoped that laryngologists will develop a novel method through which such patients can recover their “normal” voices. Such a method should be able to give the immobile vocal fold median location, as well as volume and mucosal viscoelasticity symmetrical with those of the unaffected vocal folds. The author believes that arytenoid adduction combined with a type of reinnervation technique will satisfy these requirements.
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カラー図説
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松下 友, 上田 祥久, 松田 洋一, 中島 格2009 年 102 巻 8 号 p. 614-615
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありPDF形式でダウンロード (890K)
臨床
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北島 明美, 肥塚 泉2009 年 102 巻 8 号 p. 617-622
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありWe experienced a case of cerebellar infarction with vertigo. A 39-year-old male complained of vertigo and a slight headache. There was no significant nystagmus or cranial sign on the first day. CT was also normal. After two days, he was admitted to the hospital because his consciousness became unclear. At that time, CT and MRI showed cerebellar infarction involving the postero-inferior cerebellar artery. His consciousness became clear and he showed almost no impairment after treatment. Angiography revealed dissection of the vertebral artery. The clinical signs of cerebellar infarction are occasionally similar to those of inner ear disorders. In such cases, neurological and neuro-otological examinations are important in distinguishing cerebellar infarction from inner ear diseases.
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古宇田 寛子, 角 卓郎, 角田 篤信, 喜多村 健2009 年 102 巻 8 号 p. 623-627
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありIn patients with Ménière’s disease, compliance with the physician’s instructions regarding medication and the clinical efficacy of medication were compared between two isosorbide preparations (oral solution and jelly). Each subject took two preparations in a cross-over fashion. The jelly was significantly superior to the solution in terms of easier carriage and storage as well as simplicity of ingestion. When patients were stratified by history of isosorbide treatment and drugs taken first on this cross-over study, results did not differ significantly. Comparison of clinical efficacy between the two preparations did not demonstrate any significant inter-group differences in terms of severity of dizziness, pure tone threshold level, compliance during the study period, or amount of drug taken.
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佐藤 克郎, 髙橋 姿2009 年 102 巻 8 号 p. 629-633
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありSix cases of nasopharyngeal carcinoma involving patients under 30 years old treated in our department were clinically evaluated. The ages of the cases ranged from 14 to 29 years old (median: 19 years old). Four cases (67%) were male and 2 (33%) were female. Histopathologically, 5 cases (83%) were poorly differentiated squamous cell carcinoma (SCC), and a single case (17%) was adenocarcinoma. Chief complaints were hearing loss in 4 cases (67%), cervical swelling in one case (17%), and nasal obstruction in one (17%). The clinical stage was Stage I in the adenocarcinoma case, Stage IVA in 4 SCC cases, and Stage IVB in the remaining SCC case. SCC cases were treated by concurrent chemoradiotherapy followed by adjuvant chemotherapy. The adenocarcinoma case was treated by transpalatal resection followed by postoperative radiotherapy. Since the most common chief complaints were ear symptoms, observation of the nasopharynx should be performed for otitis media with effusion patients, even when the patient is young. For squamous cell carcinoma of the juvenile nasopharynx, aggressive chemoradiotherapy similar to the treatment strategy for older patients was considered to result in a favorable prognosis. For adenocarcinoma arising in the posterior wall of the nasopharynx, surgical resection followed by postoperative radiotherapy was considered to be an appropriate treatment strategy. In the treatment of pediatric nasopharyngeal carcinoma cases, motivation to perform the complicated treatment in cooperation with the department of pediatrics seemed to be important.
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重見 英男, 鈴木 正志2009 年 102 巻 8 号 p. 635-638
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありOnly one bleeding point is typically seen in the local mucosa in most cases of nasal bleeding. We report here a rare epistaxis case suspected of multiple bleeding points on unilateral nasal cavity. A 64-year-old male had a one-week history of chance left-sided epistaxis. Multiple mucosal eruptions were seen on the inferior and middle turbinates and nasal septum of the left nasal mucosae. A dark brown mass was recognized near the frontal recess and removed. This mass was determined to be a live nasal leech. This patient had an history of leech exposure three months earlier while bathing in natural hot spring.
Patients with a nasal foreign body usually have symptoms of foul-smelling purulent secretion and nasal stiffness with mucosal swelling. These symptoms are the result of rejection reactions by neutrophills against the foreign body. However, this reported case had no such symptom. This finding was supported that a live leech moves around the nasal cavity to escape human immune reactions.
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都築 建三, 深澤 啓二郎, 竹林 宏記, 岡 秀樹, 西村 雅史, 阪上 雅史2009 年 102 巻 8 号 p. 639-643
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありThis study reviewed the clinical features of patients with paranasal sinus diseases initially demonstrating ophthalmologic manifestations. Between April 1995 and March 2008 (13 years), we performed sinus surgeries in 100 patients with paranasal sinus diseases presenting with ophthalmologic symptoms at Hyogo College of Medicine. There were 54 men and 46 women, aged 56.0 years (10-86 years). The diagnosis was based on the preoperative findings of ophthalmologic, endonasal and radiological examinations, and operative findings. The patients were followed-up for 6 months or more after surgery. Patients with symptoms due to tumor or trauma were excluded in this study. Majority of them (64/100 patients, 64%) were initially referred to ophthalmologists. Of the 100 patients, loss of visual acuity was most frequently observed in 39 patients (39%). Other ophthalmologic symptoms were eyelid swelling (27%), ocular pain (24%), diplopia (19%), constriction of the visual field (9%), exophthalmos (11%), epiphora (7%), pressure behind the eye (7%), external ophthalmoplegia (2%), and ptosis (2%). Symptoms associated with paranasal sinus cysts were mostly found in 65 patients (65%) with compression of the adjacent orbita, those occurring in bacterial sinusitis in 33 patients (33%), and those in fungal sinusitis in 2 patients (2%). Forty patients (40%) were diagnosed with rhinogenic optic neuropathy. Major lesions were observed in the posterior (35%) and anterior (32%) ethmoid sinus. For treatment, an intranasal approach (endoscopic sinus surgery, ESS) was performed in 89 patients (89%), whereas an external approach was required in 11 patients (11%). During the postoperative course, reoperation (ESS) was required in 3 patients (3%) because of recurrence in the sphenoid sinus, whereas the other 97 patients followed an uneventful course. In conclusion, pre- and long-term postoperative observation by not only otolaryngologists but also ophthalmologists is recommended in order to perform minimally invasive surgery and avoid recurrence.
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小野 倫嗣, 横井 秀格, 小池 泉, 田崎 京子, 加瀬 香, 芳川 洋, 池田 勝久2009 年 102 巻 8 号 p. 645-650
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありA 51-year-old man had a chief complaint of left epistaxis and orbital pain. Anterior rhinoscopy showed a tumor in the left nasal cavity. CT showed a mass in the left ethmoid sinus, and the nasal septum and skull base showed thinning. Ga cintigraphy showed accumulation only in the left nasal cavity. Thereafter, MRI showed a mass with acute intracranial invasion occurring two-week with a period. We biopsied the nasal tumor, and the diagnosis was SNEC. Because the tumor acutely extended to the intracranial space, the patient developed convulsion. We performed treatment for convulsion with glyceol, rinderon and phenytoin. After radiotherapy with cyberknife effectively reduced the size both of the primary lesion and intracranial lesion, abdominal CT detected liver metastasis. The patient is currently receiving chemotherapy with irinotecan and cisplatin.
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石田 芳也, 林 達哉, 金井 直樹, 小林 祐希, 朝日 淳仁, 和田 哲治, 原渕 保明2009 年 102 巻 8 号 p. 651-657
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありMalignant lymphoma of the larynx is very rare with a reported incidence of less than 1% of all laryngeal malignancies. A case of laryngeal non-Hodgkin's lymphoma (diffuse large B cell type) in an 89-year-old female is reported.
At the initial consultation, the patient had complained of abnormal sensation in the pharyngolaryngeal region that had persisted for a few days. Endoscopic examination demonstrated a supraglottic mass with a smooth surface. The histopathological diagnosis was diffuse large B cell lymphoma. There was no other evidence of lymphoma anywhere except a regional lymph node. The patient was diagnosed as having clinical stage IIEA and treated with 30 Gy's irradiation alone because of her poor performance status. Six months after the initial treatment, tumor recurrence occurred in the right tonsil and treated with chemoradiotherapy that was 3 courses of CHOP and 30 Gy's concurrent radiotherapy followed by 4 courses of R-CHOP. There was no recurrence observed for 8 months after completion of the last therapy.
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石川 正昭, 渡邉 佳紀, 平野 滋, 神田 智子, 田村 芳寛, 安里 亮, 伊藤 壽一2009 年 102 巻 8 号 p. 659-666
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありMetastasis in the thyroid gland (MT) is clinically rare, although it is increasing in number. We report three cases of MT. All cases showed a rapidly-growing mass in the neck, and were diagnosed by fine-needle aspiration biopsy. The first case was a 63-year-old man who had been treated for hepatocellular carcinoma (HCC) with chemotherapy and interferon for one year. MT was treated by thyroidectomy. He died due to primary recurrence 2 years later, but had remained free of recurrence in the neck.
The second case was a 48-year-old woman, who complained of dysphagia and dyspnea. One year earlier, she had received postoperative chemotherapy for breast cancer. She underwent total thyroidectmy and died six months later due to generalized metastasis from breast cancer. There was no local recurrence in the neck.
The third case was a 60-year-old woman, who had been diagnosed colon cancer three years earlier, and had been treated by a surgical resection and chemotherapy. She had also been treated for lung metastasis. MT was found after detection of brain metastasis. She underwent thyroidectomy. After the procedure, she was transferred to another hospital for additional chemotherapy and was lost to follow-up.
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奥田 匠, 永原 國彦, 森谷 季吉, 本多 啓吾, 安慶名 信也, 矢間 敬章2009 年 102 巻 8 号 p. 667-671
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありIt is extremely rare to develop metastasis of differentiated thyroid carcinoma to the axillary lymph nodes, non-regional lymph nodes. The metastasis is likely lymphogenous because of patients showing metastasis only in the axilla without other distant metastasis. Four of 924 patients with differentiated thyroid carcinoma who underwent curative resection in our institution and Kyoto Medical Center showed metastasis to the axilla (0.43%) during the follow-up until July, 2008 from April, 1981. The patients were aged 61-73 years old, 2 with well-differentiated and 2 poorly-differentiated papillary carcinoma, 1 male and 3 female, with 1 already having distant metastasis at a different site when axillary metastasis became clear. Furthermore, each patient had a history of neck dissection of the ipsilateral VI regional lymph nodes prior to axillary metastasis. Concerning the origin of axillar metastasis, it was previous reported that lymphatic communication is present between the cervical and axillary lymphatic clutches. When orthodromic lymphatic flow is blocked by either previous neck dissection or metastasis around the venous angle, the lymphatic system may go against the flow. The postoperative course and prognosis are presented together with the viewpoint of QOL.
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宮田 耕志, 福島 英行, 藤木 暢也, 本多 伸光, 前谷 俊樹, 西田 明子, 木谷 芳晴, 足立 恒道, 辻村 美佳, 三好 拓志2009 年 102 巻 8 号 p. 673-678
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありMetastasis of leiomyosarcoma to the neck is very rare. To our knowledge, metastasis to both the thyroid and parotid glands has not been reported.
We report a case of retroperitoneal leiomyosarcoma metastatic to the thyroid and parotid glands. A 60-year-old woman was referred to Kitano Hospital. She had been treated for retroperitoneal leiomyosarcoma 4 years previously, and metastasis to the lung and thigh had occurred 2 years later. Metastatic lesions in the bilateral lobes of the thyroid gland and right parotid gland were treated by surgery, mainly to prevent the airway from narrowing as a result of the thyroid lesion. After the operation, she developed recurrence in the abdominal region and she was treated in other hospital. Recurrence of the thyroid lesion was not seen until her death 9 months after the operation.
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―鎖骨窩法10例の経験と吊り上げ式腋窩アプローチ法の試み―金泉 秀典, 吉崎 智一2009 年 102 巻 8 号 p. 679-684
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありFrom July 2006 to October 2007, we performed video-assisted neck surgery (VANS) via a subclavicular approach in 10 patients with thyroid tumor. Seven had benign follicular tumor, and three had papillary carcinoma. All cases underwent hemithyroidectomy. One case of papillary carcinoma underwent additional central neck dissection (D1). The mean operating time was 207 min, and the mean blood loss was 70 ml. Transient recurrent laryngeal nerve palsy was noted. However, postoperative bleeding was not observed. To improve the esthetic outcome, we applied a new method: a skin lifting axillary approach. We applied this method to a 27-year-old female patient with benign follicular tumor showing no postoperative complications. The axillary scar was not visible when the ipsilateral arm was in its natural position. This new method is a feasible procedure with esthetic benefits, and may offer a practical alternative for patients requiring sugical removal of the thyroid gland.
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中山 雅博, 田渕 経司, 大久保 英樹, 待木 健司, 原 晃2009 年 102 巻 8 号 p. 685-687
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありHemophilia A is an X-linked hereditary disease. We describe herein a patient with multiple fractures of the facial bones, who was diagnosed with hemophilia A during treatment. A 15-year-old boy presented with multiple fractures of the facial bones at Hitachi, Ltd. Mito General Hospital. He underwent a repair operation for the fractures. Severe epistaxis recurred after the operation, and he was referred to Tsukuba University Hospital for further evaluation and treatment. On admission, laboratory testing revealed prolonged activated partial thromboplastin times (APTT) and decreased activity of factor VIII, which led to a diagnosis of hemophilia A. Administration of a coagulation factor VIII product prevented bleeding. The clinical phenotype is not always the same among hemophilia patients, thus, the possibility of previously undetected hemophilia has to be considered when treating unexpected severe bleeding.
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薬物
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兵 行義, 増田 勝巳, 原田 保, 吉弘 剛, 文珠 正大, 小坂 史郎, 柴田 大, 西田 直樹, 與田 茂利, 舘 俊廣, 宇野 雅子 ...2009 年 102 巻 8 号 p. 689-697
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありLoratadine, which blocks the peripheral H1 receptor, is a long-acting antihistamine with minimal sedative effects when given at the recommended dose. This present study was undertaken to evaluate the effectiveness of loratadine in patients with Japanese cedar pollinosis, using the Japan rhino-conjuctivitis quality of life questionnaire (JRQLQ).
The subjects consisted of 189 patients who consulted our hospitals and clinics during the peak pollen exposure season in 2007 (between Feburary 26 and March 10). The patients were divided into two groups; patients who had taken loratadine once daily prior to entering this study were classified as the treated group (n=65), while patients without any previous treatment were classified as the non-treated group (n=124).
The results showed that the nasal symptoms in the treated group were milder than those in the untreated group, and that furthermore, the treated group could maintain a good quality of life.
In years with extensive scattering of Japanese cedar pollen, prophylactic treatment with loratadine is effective, safe and should be considered when choosing a strongly effective drug for prophylactic treatment
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研修ノート
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竹内 裕美2009 年 102 巻 8 号 p. 698-699
発行日: 2009年
公開日: 2011/04/09
ジャーナル 認証ありPDF形式でダウンロード (249K)
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