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前身誌
103 巻, 10 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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―いかに個別治療を選択するか―植田 広海原稿種別: 論説
2010 年 103 巻 10 号 p. 891-898
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありThe goal of middle-ear cholesteatoma surgery is two-fold—a safe, dry, trouble-free ear and good hearing. No single surgical strategy is optimal in all cases, however, necessitating an individualized approach—and a standard for surgical selection.
We reviewed middle-ear ventilation and tympanoplasty techniques. Cholesteatoma recurrence is a major problem following closed tympanoplasty, requiring ventilation created from the mesotympanum to the mastoid cavity and promoting mastoid reaeration. If a ventilation route cannot be constructed posto-peratively, open tympanoplasty should be considered.
In attic and antrum aeration in preoperative computed tomography (CT), we selected closed tympanoplasty. For such cases without attic and antrum aeration, planned tympanoplasty was selected. In those older than 60 years or with poor Eustachian tube function, open tympanoplasty with or without soft-wall external ear canal reconstruction was selected rather than planned staged tympanoplasty. Postoperative residual cholesteatoma was seen in 19 of 185 ears (10.3%), but no recurrent cholesteatoma.
Individual hospital staffs should thus prepare and review a standard individualizing cholesteatoma surgery.
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カラー図説
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小池 修治, 那須 隆, 石田 晃弘, 野田 大介原稿種別: カラー図説
2010 年 103 巻 10 号 p. 900-901
発行日: 2010年
公開日: 2010/10/01
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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林 裕史, 新正 由紀子, 朝戸 裕貴, 加我 君孝原稿種別: 臨 床
2010 年 103 巻 10 号 p. 903-907
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありIn treating congenital microtia and atresia, we conduct simultaneous external canal plasty, tympanoplasty, and auricle elevation with plastic surgeons about 6 months after auricleplasty by only plastic surgeons. The results are good both cosmetically and functionally.
We report 13 cases in which hearing did not improve satisfactorily after surgery using postoperative high-resolution computed tomography (HRCT) of the temporal bone.
Lateral healing was seen in 9 (69%), new bone proliferation in 3 (23%), malpositioning of a cartilage block in 2 (15%), and both lateral healing and malpositioning of a cartilage block in 1 (7.6%).
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山戸 章行, 北原 糺, 今井 貴夫, 土井 勝美, 猪原 秀典2010 年 103 巻 10 号 p. 909-913
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a case of medial meatal fibrosis, a rare external auditory canal condition, in which hearing improved postoperatively. A 60-year-old woman had undergone surgery and 6-month follow up. Extrinsic stimulus-induced fibrosis was attributed to her daily swimming. External auditory meatus inflammation was quite moderate, so the external ear canal skin was preserved, the removed thickened subdermal connective tissue removed, and the bony external ear canal drilled to enlarge the meatus diameter. We confirmed hearing improvement and no fibrosis recurrence. Medial meatal fibrosis may thus be treated satisfactorily with surgical intervention.
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五島 史行, 矢部 はる奈, 小川 郁2010 年 103 巻 10 号 p. 915-920
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありHeadaches is classified as primary and secondary, with secondary originating in head and neck conditions, the most important etiology being acute sinusitis. Headache due to mucosal contact, rarely encountered by otorhinolaryngologists, is an important secondary headache, whose criteria are defined by the International Classification of Headache Disorders to include intermittent pain localized in the periorbital and medial canthal or temporozygomatic regions, evidence that pain is attributable to mucosal contact and the presence of mucosal contact in the absence of acute rhinosinusitis, obtained using clinical examinations, nasal endoscopy, and/or computed tomography (CT). After mucosal contact is surgically corrected pain usually disappears permanently within 7 days. We reviewed mucosal contact headaches in 63 subjects undergoing nasal or paranasal surgery from April 2007 to March 2008. Of those 7 were diagnosed with headaches due to contact points in nasal mucosa, ranging from canthal to the temporozygomatic. The most common contact, between the middle turbinate and nasal septum, was seen in 6 of the 7. Surgery eliminated symptoms in 4 and ameliorated them in 3 indicating effective headache management. Subjects with severe headaches or localized periorbital and medial canthal pain regions, mucosal contact involvement is ruled out when CT allows no lesions. When mucosal contact headache is suspected, however surgery should be considered as a last resort.
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吉福 孝介, 馬越 瑞夫, 大堀 純一郎, 黒野 祐一2010 年 103 巻 10 号 p. 921-926
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a case of subperiostereal orbital abscess and discuss surgical effectiveness. An 8-year-old girl seen for acute sinusitis and subperiostereal orbital abscess reported left-eyelid swellings visual disturbance, and diplopia. Computed Tomography (CT) findings showed low-density medial orbital area suspected of being an abscess, necessitating emergency endoscopic sinus surgery (ESS) and removing the lamina papyracea. This was followed by intravenous antibiotics and steroid therapy. She recovered fully without complications, and was discharged on a 7 day hospitalization.
We found surgery to be effective in treating subperiostereal orbital abscess if conservative therapy proves ineffective. To successfully treat visual disturbances due to paranasal sinus disease, early diagnosis is also important.
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井上 俊哉, 岡崎 はるか, 永田 基樹, 湯川 尚哉, 藤澤 琢郎, 鈴木 健介, 友田 幸一2010 年 103 巻 10 号 p. 927-930
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a case of pharyngolaryngoesophagectomy and free jejunal transfer in a subject with local hypopharyngeal cancer recurrence after full-dose chemoradiotherapy. Reliable tissue transfer was also needed for early postoperative ambulation and oral ingestion. We planned the jejunal flap including two pairs of jejunal arteriovenous grafts and anastomosed them to the recipient vessel with the double-pedicled arteriovenous jejunum. The postoperative course was excellent. This approach proved useful in such severe cases with systemic complications despite longer operating time and restrictions on recipient vessels.
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陣内 進也, 金子 賢一, 原 稔, 佐藤 智生, 髙橋 晴雄2010 年 103 巻 10 号 p. 931-934
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a case of pharyngeal fishbone requiring transcervical surgery. A fishbone was clearly identified by 3-dimensional computed tomography (3D-CT). A 67-year-old man complaining a sore throat after eating fish. The fishbone was located in the extrapharyngeal space between the hyoid bone and tongue. After a submental transcervical incision, the foreign body was easily found in the genioglossus muscle and removed. We found 3D-CT to be very useful in diagnosing and determining foreign body's surgical orientation.
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岩垣 俊憲, 平岩 真希子2010 年 103 巻 10 号 p. 935-939
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありTo evaluate risks and difficulties of inflammatory adult tonsillectomy, we reviewed 64 cases—33 prospective and 31 with acute inflammation—of subjects over 15 years old undergoing tonsillectomy between June 2004 and December 2009. No difference was seen between groups in postoperative hemorrhage, surgery time, or postoperative oral intake resumption. Twenty-one of the inflammatory tonsillectomy group had peritonsillar abscesses. Eight were diagnosed accidentally in surgery. We concluded that inflammatory tonsillectomy was comparatively safe and shortered hospitalization.
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橋本 健吾, 武藤 俊彦, 児島 雄介, 西川 奈見2010 年 103 巻 10 号 p. 941-945
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a rare case of neurofibroma of the larynx.
A 65-year-old man suffering from hoarseness from about 2004, that had become severe by the end of 2007 was found in laryngoscopic examination to have a huge polyp bilaterally involving the vocal cords. The tumor, removed in laryngomicrosurgery, pathological by involved humorous spindle cells accompanied by myxomatous components and positive for NSE and vimentin in immunity dyeing. The histopathological diagnosis was neurofibroma.
Because no family history or cafe au lait spots or neurogenic tumors were recognized, it was thought to be solitary onset.
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―二次性副甲状腺機能亢進症における手術治療―細川 清人, 花本 敦, 滝本 泰光, 伊東 真人2010 年 103 巻 10 号 p. 947-951
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありBackground: Total parathyroidectomy raises problems in preoperatively identifying and intraoperatively locating all parathyroid glands. In 2007, we prepared 1% methylene blue injections that led to a favorable outcome. Subjects and Materials: Twelve subjects with secondary hyperparathyroidism indicated for total parathyroidectomy based on the Japan Society for Dialysis Therapy guidelines were treated. Methods: Methylene blue at 5 mg/kg of body weight was bottled in 100 ml of normal saline and administered intravenously over 30 to 60 minutes after subjects were anesthetized or as surgeons required. Results: Dye use enabled four glands in 10 cases and 5 glands in 1 to be removed, compared to 4 glands identified preoperatively in just 3 cases. Surgery lasted from 92 to 242 minutes. Serum iPTH, calcium, phosphorus levels were reduced in all cases. Conclusions: Injecting 1% methylene blue enabled successful parathyroid-grand removal in many cases without serious side effects.
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―下咽頭小細胞癌例の報告とともに―物部 寛子, 籠谷 領二, 戸島 均2010 年 103 巻 10 号 p. 953-960
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありExtrapulmonary small-cell carcinoma (EPSCC) is clinically underrecognized and optimal management remains illusive. Although head and neck EPSCC tends to involve early widespread dissemination and poor prognosis, recently reported favorable outcomes have used concurrent chemoradiotherapy in limited-stage disease. We report an EPSCC case of arising in the hypopharynx successfully treated by induction chemotherapy followed by concurrent chemoradiotherapy. To clarify EPSCC clinically, we retrospectively reviewed clinical courses of all EPSCC records between 1999 and 2008 in a single-institution series.
The 14 subjects identified had primary sites at the gastrointestinal tract in 5, uterine cervix in 3, genitourinary system in 2 and at the gallbladder, liver, hypopharynx, and an unidentified primary lymph node in one case each. Of the 14, 2 cases had stage I, 2 cases had stage II, 4 cases had stage III, 5 cases had stage IV in tumor-node-metastasis (TNM) classification. Stage IV subjects usually underwent platinum-based chemotherapy, to which 25% showed partial response (PR) and 75% progressive disease (PD) with median overall survival (OS) of 114.0 days, or 16 weeks. Of stage III or lower subjects, 75% underwent surgery and 62.5% chemotherapy. OS was 1244.0 days or 3.7 years and 2-year survival rates was estimated at 87.5%. Survival duration differed significantly between those in stage III or lower and those in group IV. Age significantly affected survival time in the Cox proportional hazard regression model. Brain metastasis was uncommon in this series, despite the absence of prophylactic cranial radiation. Further studies are needed to improve and clarify the clinical EPSCC course.
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駒林 優樹, 浅野目 充, 北南 和彦, 吉田 眞子, 片山 昭公, 原渕 保明2010 年 103 巻 10 号 p. 961-965
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありWe report a case of anaplastic thyroid carcinoma of the left lateral cervix. A 72-year-old woman undergoing surgery for a left neck mass behind the internal jugular vein was found pathologically to have anaplastic carcinoma with partial papillary thyroid carcinoma. Although ultrasonography and computed tomography showed no tumor in the thyroid gland, we conducted total thyroidectomy. No carcinoma was detected pathologically in the specimen and no recurrence was seen two years after treatment. These findings are insufficient, however, to diagnose either occult thyroid carcinoma or ectopic thyroid carcinoma.
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機器
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小森 正博, 下分 章裕, 柳原 尚明, 樫葉 恵子, 表原 慶典, 貞本 昌規原稿種別: 機 器
2010 年 103 巻 10 号 p. 967-969
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありAnesthesia is required in ear surgery e.g., to remove polyps and cholesteatomas, insert ventilation tubes or conduct myringoplasty. With surface anesthesia often unsatisfactory and penetrative anesthesia, e.g., with an iontophoresers not usable in tympanic membrane perforation, local anesthetic injection may also cause fear and anxiety about pain in subjects or limit the operative field due to external auditory canal swelling. To overcome these shortcomings, we found it helpful to use an electric dental injector in otologic practice.
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研修ノート
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羽藤 直人原稿種別: 研修ノート
2010 年 103 巻 10 号 p. 970-971
発行日: 2010年
公開日: 2010/10/01
ジャーナル 認証ありPDF形式でダウンロード (344K)
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