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103 巻, 1 号
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論説
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北尻 真一郎, 伊藤 壽一2010 年 103 巻 1 号 p. 1-4
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありTreatment options for sensorineural hearing loss (SNHL) are very limited, and most of the patients cannot be cured. The pathophysiology of SNHL is poorly understood because the biopsy of the human inner ear is impossible. This is one of the major reasons why development of a treatment strategy for SNHL is difficult. iPS cells from hereditary deafness patients have the potential to differentiate into inner ear cell under experimental conditions, and their phenotypes are expected to reveal the pathophysiology of SNHL. These iPS-derived cells with deafness mutations can also be applied to screening for the development of a treatment approach to rescue the phenotype.
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カラー図説
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伊藤 真人2010 年 103 巻 1 号 p. 6-7
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありPDF形式でダウンロード (828K)
臨床
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大塚 尚志, 大塚 千久美, 米澤 久司, 館田 勝, 石島 健, 佐藤 宏昭2010 年 103 巻 1 号 p. 9-13
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありSuperficial central nervous system siderosis is a very rare disease related to hemosiderin deposits in the brain, brain stem, cerebellum, and spinal cord due to chronic subarachnoid hemorrhage. Clinical findings are progressive bilateral sensorineural hearing loss, cerebellar ataxia, and pyramidal tract signs. A 62-year-old woman exhibited vertigo, worsening tinnitus, unstable gait, and spontaneous Bruns-like horizontal nystagmus. A central nervous system disorder was suspected due to the vertical vector that emerged when the woman looked upward. Magnetic resonance imaging (MRI) showed a low-intensity rim in T2-weighted imaging enveloping the brain and spinal cord surface.
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三橋 拓之, 栗田 知幸, 上田 祥久, 松田 洋一, 伊藤 信輔, 中島 格2010 年 103 巻 1 号 p. 15-20
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありMalignant external otitis (MEO) is an uncommon, invasive and, sometimes, mortal disease that is mainly caused by pseudomonal infection of the external auditory canal. MEO frequently involves the base of the skull, multiple cranial nerves and the meninx. Recently, the mortality rate of this disease has decreased due not only to the use of antipseudomonal antibiotics, but also to the availability of Burow’s solution and hyperbaric oxygen therapy (HBO). We have experienced 5 cases of MEO which were treated between 1999 and 2007 at Kurume University Hospital. All patients were male and their mean age was 73 year-old. As a complication, 4 cases had diabetes. Four cases had facial palsy due to MEO. All cases had received administration of antibiotics and an antifungal agent. Diabetic patients had been treated with insulin to control the blood sugar. Three patients had been treated with surgical debridement and the use of Burow’s solution. In one case, MEO was well controlled with HBO and the intravenous administration of alprostadil alfadex (PGE1), but the recurrence was severe and the patient died. Despite combination treatment, four of the 5 cases died of meningitis due to MEO. In a patient with diabetes who was treated using Burow’s solution, an antifungal agent, and insulin, the MEO was cured and the patient has been alive for 18 months. As a local treatment, Burow's solution is effective against MEO. As adjuvant treatments, HBO and administration of PGE1 may be effective against MEO.
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正木 義男2010 年 103 巻 1 号 p. 21-25
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありI report on a case of an idiopathic bone defect of the external auditory canal. A 62-year-old female patient presented with tinnitus and aural fullness in her right ear during biting. I confirmed the projection of the anterior wall of the external auditory canal during biting, and the projection was retracted when she opened her mouth. Computed tomography examination revealed a partial defect of the anterior wall of the bony external ear canal. I thought that this defect was caused by the failure of the foramen of Huschke to close during development.
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―耳鼻咽喉科医および皮膚科医からみた考え方―吉崎 智貴, 高原 幹, 上田 征吾, 東谷 敏孝, 原渕 保明2010 年 103 巻 1 号 p. 27-33
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありToday, pustulosis palmaris et plantaris (PPP) is widely accepted to be one of the tonsil-related diseases because tonsillectomy is quite effective in curing this condition. In addition, many fundamental findings have been reported which suggest that the tonsil plays a key role in the pathogenesis of PPP. However, criteria for the operation for PPP have not been established yet, so a common opinion of tonsillectomy for PPP has not been obtained from both dermatologists and otolaryngologists. In this study, we conducted a questionnaire survey to determine the current situation of tonsillectomy for PPP. Questionnaires were sent to otolaryngology and dermatology departments of the university hospitals in Japan. The results revealed that a deep relation between PPP and the tonsils was recognized by many otolaryngologists, however, the majority of dermatologists seemed to feel that the tonsils played a small role in the pathogenesis of PPP. To reduce the perception gap regarding the relationship between PPP and the tonsils among otolaryngologists and dermatologists, criteria regarding tonsillectomy for PPP need to be established.
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石田 晃弘, 小池 修治, 那須 隆, 野田 大介, 石井 健一, 青柳 優2010 年 103 巻 1 号 p. 35-40
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありLaryngeal adenoid cystic carcinoma is rare disease. We report herein on a case of adenoid cystic carcinoma arising in the subglottic region of the larynx. A 52-year-old female presented with a 2-month history of progressive dyspnea during exercise. Endoscopic examination of the larynx revealed a submucosal mass lesion in the subglottic area. An excisional biopsy was performed using the laryngofissure technique. The pathological diagnosis was cribriform type adenoid cystic carcinoma. The patient underwent total laryngectomy with bilateral neck dissection (Level 2-4) and postoperative radiation therapy. She has been alive without locoregional recurrence and distant metastasis for 18 months.
We discuss herein the clinical and pathological features of adenoid cystic carcinoma of the larynx as well as reviews of the reported cases in the literature. Up to the present, only 22 cases including our case have been reported in Japan. For the patients with adenoid cystic carcinoma of the larynx, long-term follow-up is essential because of the possibility of delayed recurrence or metastases.
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工藤 毅, 鎌田 英男, 二宮 洋, 安岡 義人, 古屋 信彦2010 年 103 巻 1 号 p. 41-45
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありThe purpose of the surgical treatment of the frontal sinus cyst is to widen the obstructed naso-frontal sinus duct. In our department during the past 8 years, 15 patients were treated surgically with silicon tube drainage. We made three kinds of tube, type A, B and C. Depending on the intraoperative findings, the silicon tube was cut to fit the naso-frontal duct and sinus. The average intubation period was 46 months. The A type of tube was firmly placed in the naso-frontal duct. The B and C types also did not slip out spontaneously, but were safely removed after surgery. These 3 types of silicon tube have proved useful for the treatment of frontal sinus cysts.
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金川 英寿, 堀池 修, 増満 洋一, 橋本 誠, 山下 裕司2010 年 103 巻 1 号 p. 47-52
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありNon recurrent inferior laryngeal nerve is an anomaly explained by the process of nerve and blood vessel development from the embryologic branchial arch associated with the anomalous origin of the right subclavian artery from the aortic arch. We report a case of non recurrent laryngeal nerve found during thyroid surgery. Recurrent laryngeal nerve injury is a major complications of thyroid surgery that occurs easily in the presence of non recurrent inferior laryngeal nerve. Thyroid surgery, thus repuires particular awareness of this possibility.
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稲垣 洋三, 大石 直樹, 藤峰 武克, 藤井 良一, 齊藤 秀行, 小川 郁2010 年 103 巻 1 号 p. 53-57
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありSkull-base and parapharyngeal tumors require intricate treatments due to its anatomic complexity, variations in histological type, and the site often involves the presence of critical blood vessels and nerves. Diagnostic imaging and fine-needle aspiration cytology are thus essential. We report a case of skull-base meningioma extending to the parapharyngeal space in which we made a definitive diagnosis by biopsy (as grade I) and took a wait-and-see approach.
A 52-year-old woman had complained of a headache since June 2006 and was seen in the neurology department at our hospital in July. A tumor from around the left jugular foramen to parapharyngeal space was revealed by magnetic resonance imaging (MRI) and she was referred for consultation to the neurosurgical department and our department. It was difficult to establish the diagnosis from the clinical manifestation and diagnostic images due to the tumor's complicated anatomy, therefore it was confirmed by biopsy instead of cytology. It can be said that biopsy is useful to determine therapeutic measures for the skull-base meningioma because it is less invasive and can verify a histological type compared with the complete removal of the tumor.
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酒井 あや, 辻 裕之, 下出 祐造, 宮澤 徹, 石政 寛2010 年 103 巻 1 号 p. 59-64
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありCongenital bronchogenic sac cysts result from primitive foregut maldevelopment. Although they occur predominantly in the chest, they have been reported as extrathoracic lesions. Bronchogenic cyst diagnosis relies on lesion histology and location. We review our experience on the diagnosis and management of a 39-year-old man with pathologically proven bronchogenic cyst.
The cyst was surgically resected. Histologically, the cyst consisted of ciliated columnar epithelium, smooth muscle, and mucus glands, yielding a definitive diagnosis of bronchogenic cyst. This is the 18th case reported in the Japanese literature of a cervical bronchogenic cyst. In conclusion, congenital bronchogenic cysts may occur in the adult necks and should be considered in the differential diagnosis of cystic cervical masses.
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矢吹 健一郎, 佃 守, 谷垣 裕二, 池田 陽一, 愛甲 健, 小山 主夫2010 年 103 巻 1 号 p. 65-69
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありWe report on a case of complex regional pain syndrome (CRPS) type I. A 27-year-old woman underwent lymph node biopsy of the neck to confirm a diagnosis of histiocytic necrotizing lymphadenitis. Four days after the biopsy, she complained of hyperpathia and limited range of motion on the thumb, forefinger and middle finger of the right hand. She was diagnosed as having CRPS with thermography and treated with glucocorticoid, mecobalamin, and nonsteroidal anti-inflammatory drugs (NSAIDs). The symptoms disappeared within a month and no relapse was seen.
CRPS is a disorder of the extremities that is characterized by pain, swelling, limited range of motion, vasomotor instability, skin changes, and patchy bone demineralization. It frequently begins after an injury, surgery, or vascular events, e.g., myocardial infarction or stroke. Tonsillectomy and free forearm flap can cause CRPS.
Two types of CRPS have been reported: type I corresponds to patients with CRPS without a definable nerve lesion. Type II which was formerly termed causalgia refers to cases with a definable nerve lesion. The pathogenesis of CRPS is still unclear. CRPS might be caused by the formation of an abnormal reflex arc between the sympathetic nervous system and peripheral vascular components after a causative event.
The diagnosis of CRPS is difficult, however, symptoms such as characteristic pain including allodynia and hyperpathia, and altered skin temperature are helpful. Autonomic testing such as thermography and bone scintigraphy are also useful.
Prevention and early diagnois are important to treat CRPS. Therefore careful examination and a good understanding of CRPS are recommended.
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―鼓膜形成術における新素材―松田 洋一, 栗田 知幸, 上田 祥久, 伊藤 信輔, 中島 格2010 年 103 巻 1 号 p. 71-75
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありThe simple underlay myringoplasty has evolved, enabling it to be performed more easily and safely. However, this procedure needs fibrin glue that is made from donated blood. Furthermore, a skin incision is necessary to take the subcutaneous connective tissue graft. There are some reports regarding the methods of using a collagen sheet or chitinous substance membrane as a substitute for the subcutaneous connective tissue graft. However, no report has appeared regarding a myringoplasty using a membrane made from the patient’s own blood. The aim of this study is to establish the procedure of less invasive myringoplasty from the aspect of safety using autologous blood from the patient.
We have developed a procedure to make the autologous fibrin membrane and gel. We evaluated the histological stability of the fibrin membrane and gel using image analysis equipment. The density of the fibrin fiber was measured at the time of production, after 24 hours, 48 hours, 72 hours, 1 week, and 2 weeks. Welch’s t-test was used for the statistical analysis.
The fibrin membrane had less microscopic changes even at the 2-weeks assessment. There was no statistically significant difference between the density of the fibrin membrane fiber and the fascia at 2 weeks. In contrast, the fibrin gel had melted and disappeared at 1 week.
It is thought that the fibrin membrane might produce a scaffold for the regeneration of the tympanic membrane as a substitue for the subcutaneous connective tissue or fascia. These results indicate that myringoplasty using the fibrin membrane could be a safer and less invasive procedure.
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薬物
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―スコアリング・システムを用いた重症度評価とその臨床効果―山中 昇, 保富 宗城, 戸川 彰久, 竹井 慎, 河野 正充2010 年 103 巻 1 号 p. 77-84
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありIn recent years, high prevalence penicillin-resistant Streptococcus pnenumoniae (PRSP) strains and β-lactamase non-producing ampicillin-resistant Haemophilus influenzae (BLNAR) strains have been reported the treatment of acute otitis media (AOM) in children. Between September 2005 and March 2006, we performed a clinical efficacy study on Tebipenem-pivoxil (TBPM-PI) in children with acute otitis media.
We assessed the severity of disease by using a scoring system based on symptoms and tympanic membrane changes, and a clinical efficacy study was carried out using the improvement in the score results cross linked in a table together with symptoms and TM findings and the objective grading of the physician in charge.
16 patients were enrolled in this study, ages were from 0 to 5 years old, with a median age of 3.50 years. S. pneumoniae, H. influenzae, and M. catarrhalis were detected as causative bacteria. The doses of TBPM-PI administered to children with AOM were 4 mg/kg b.i.d (10 cases) or 6 mg/kg b.i.d (6 cases) for seven days. The overall efficacy rates of TBPM-PI for AOM according to the clinical efficacy judged by the scoring system and the grading of attending physicians were 90.5% and 100%, respectively. The eradication rate of pathogens at the end of treatment was 4/4. Based on our results, the present study strongly suggested that TBPM-PI would be an effective antimicrobial agent against moderate to severe AOM. Moreover, the scoring system was very useful for the decision making regarding the appropriate treatment regimen of AOM.
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―単回および反復投与による第I相試験―奥田 稔2010 年 103 巻 1 号 p. 85-98
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありDexamethasone cipecilate (NS-126C), a new steroid nasal spray in powder form, is effective in once-a-day administration. We conducted a placebo-controlled, double-blind phase I clinical study in single administration at 50 μg, 100 μg, 200 μg, or 400 μg and repeated administration at 200 μg or 400 mg once a day for 14 days in healthy adults to determine NS-126C safety and pharmacokinetics.
An analysis of subjective symptoms, objective findings, anterior rhinoscopy, laboratory tests, adrenal function tests, physical examination, throat or nasal fungal tests, and nasal ciliary function tests showed only 1 adverse event for which a causal relationship to the study drug could not be ruled out, i.e. 1 case of mild throat discomfort in 1 subject given the drug at 100 μg in the single-dose study. No adverse effect on adrenal function was observed.
In pharmacokinetic examination, plasma levels of the unchanged drug and its principal metabolite, DX-17-CPC, and the level of unchanged drug in urine were less than the quantitation limit of <16 pg/ml in all subjects. DX-17-CPC was detected in urine at and after 120 hours from initial administration in the repeated-dose study, but was low in concentration at less than 3 times the quantitation limit.
These findings confirmed the safety of NS-126C at 400 μg, once a day, for 14 days, with only extremely low levels of systemic exposure demonstrated.
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研修ノート
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青木 光広, 出原 啓一2010 年 103 巻 1 号 p. 100-101
発行日: 2010年
公開日: 2011/06/15
ジャーナル 認証ありPDF形式でダウンロード (352K)
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