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103 巻, 4 号
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論説
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伊藤 彰紀原稿種別: 論 説
2010 年 103 巻 4 号 p. 291-301
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありNeurovascular compression syndrome (NVCS) involves neuropathy due to intracranial blood vessels compressing the cranial nerves. NVCS of the eighth cranial nerve is less reportedly established as a clinical entity than that of the fifth and seventh cranial nerves. We report 17 cases of NVCS of the eighth cranial nerve and their clinical features.
Clinical symptoms and test findings among our subjects indicated that (1) most were aged more than 65 years, (2) were unilateral, (3) had intermittent tinnitus, (4) suffered attacks lasting a few seconds dozens of times a day, (5) experienced dizziness concomitantly with tinnitus, (6) aggrevated tinnitus and dizziness when tilting the head toward the affected side and looking downward (positional tinnitus, positional dizziness), (7) heard specific tinnitus sounds such as crackling differing from those in cochlear tinnitus, (8) had mild or no hearing loss, (9) were diagnosed with retrocochlear hearing disturbance due to an interpeak latency delay between waves I and III of the auditory brainstem response (ABR), (10) often had no nystagmus or canal paresis (CP), (11) were found in constructive interference steady state magnetic resonance imaging (CISS MRI) to have compression of the eighth cranial nerve by the vertebral artery (VA) or the anterior inferior cerebellar artery (AICA), (12) rarely had concomitant facial spasms, and (13) had tinnitus and dizziness markedly suppressed by carbamazepine.
With the number of elderly individuals continuing to increase, cases of NVCS due to arteriosclerotic changes in cerebral blood vessels are expected to increase, making it necessary to consider NVCS in elderly subjects with dizziness, tinnitus, and hearing loss.
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カラー図説
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河野 浩万原稿種別: カラー図説
2010 年 103 巻 4 号 p. 302-303
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありPDF形式でダウンロード (598K)
臨床
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安藤 健一, 水田 啓介, 山田 南星, 久世 文也, 青木 光広, 伊藤 八次, 林 真也, 大宝 和博原稿種別: 臨 床
2010 年 103 巻 4 号 p. 305-310
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありMiddle-ear carcinoma is very rare, and primary radical surgery followed by adjuvant radiotherapy is held to give better survival than radical radiotherapy alone. If resection produces no cure, chemoradiation may be attempted but curability using conventional external irradiation is low.
A 56-year-old woman with unresectable advanced middle-ear carcinoma was found in computed tomography to have irregularly enhanced soft tissue filling the right external auditory canal, middle ear cavity, and mastoid, and diffusely destroyed temporal bone. The tumor had destroyed the carotid artery bone canal. Enhanced magnetic resonance imaging showed diffusely thickened posterior fossa dura mater. She was treated successfully with conventional external irradiation and subsequent stereotactic irradiation combined with chemotherapy. Stereotactic irradiation thus proved extremely effective against local residual and metastatic bone lesions.
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門川 洋平, 宇高 毅, 因幡 剛, 平木 信明, 大久保 淳一, 鈴木 秀明2010 年 103 巻 4 号 p. 311-315
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありWe report a case of vascular leiomyoma of the nasal cavity. A 90-year-old woman visited our hospital because of recurrent epistaxis, and she was found in fiberscopy and computed tomography to have a well-defined spherical submucosal mass in the left nasal vestibule. The lesion showed low intensity in T1- and intermediate intensity in T2-weighted magnetic resonance imaging, with homogeneous intense gadolinium enhancement. The tumor was excised in a transnasal approach using an ultrasonic scalpel. Histopathological and immunohistochemical findings yielded a definitive diagnosis of venous vascular leiomyoma.
Vascular leiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft-tissue mass arising in the submucosal tissue of the nasal cavity.
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細川 誠二, 八木 悠樹, 岡村 純, 瀧澤 義徳, 峯田 周幸2010 年 103 巻 4 号 p. 317-321
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありInfection patterns of Chlamydia trachomatis, a major sexually transmitted disease (STD), have expanded, perhaps due in part to more liberal life styles, to include the oral cavity and pharynx. A 22-year-old woman seen for a nasopharyngeal tumor, throat pain, left nasal obstruction, and blood in the sputum was found in indirect fiberscopy to have a tumor of the left pharyngeal wall. Conputed tomography and magnetic resonance imaging of the neck showed a nasopharyngeal mass not greatly so enhanced. Tumor biopsy yielded a pathlogical diagnosis of an inflammatory cell mass. The woman had been treated elsewhere for cervititis after her last menstruation period, but serum IgM and IgG evaluations for C. trachomatis had not strongly associated the nasopharyngeal mass and inflammation with C. trachomatis infection. Immunohistological nasopharyngeal biopsy indicated C. trachomatis, for which she was treated using Clarithromycin (CAM) at 400 mg/day, which yielded a complete response. Our results showed erythromycin (EM), clarithromycin (CAM) and minocycline to be effective in treating chlamydial infection.
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因幡 剛, 宇高 毅, 門川 洋平, 平木 信明, 大久保 淳一, 鈴木 秀明2010 年 103 巻 4 号 p. 323-327
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありChurg-Strauss syndrome (CSS) is a systemic vasculitic disorder affecting small blood vessels of the upper and lower respiratory tract. Subjects with CSS often have otorhinolaryngological manifestations, but clinical characteristics have not been detailed. We report a case of CSS associated with chronic hypertrophic eosinophilic sinusitis.
A 66-year-old man treated for bronchial asthma and seen for a 1-month history of nasal obstruction was found in physical and radiological tests to have chronic pansinusitis with nasal polyposis. Clinical laboratory tests showed marked peripheral blood eosinophilia (35%, 3080/μl). When conservative treatment was ineffective, the patient underwent endoscopic transnasal polypotomy. Surgical specimens histopathologically showed conspicuous eosinophilic infiltration consistent with chronic hypertrophic eosinophilic sinusitis. His postoperative clinical course was uneventful. Three months later, he developed purpura of the extremities and general fatigue with deteriorated of peripheral blood eosinophilia (58%, 11020/μl). The defintive diagnosis was CSS. He was administered steroid pulse therapy-methylprednisolone of 1,000 mg/day for 3 days followed by tapered doses-combined with transoral cyclophosphamide. Following complete remission, he remains currently free of theh disease.
Chronic hypertrophic eosinophilic sinusitis morbidity has been increasing in the last decade, and diagnosticians must be aware that this prevalent sinusitis may be a manifestation of a rare condition such as CSS.
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唐木 將行, 星川 広史, 石井 玄吾, 森 望2010 年 103 巻 4 号 p. 329-334
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありAspergillosis, a fungal infection generally acquired by inhaling airborne spores (conidia) of the ubiquitous mold Aspergillus, may cause symptomatic infection such as allergic aspergillosis in young atopic subjects, aspergillomas also called fungus balls, and invasive aspergillosis typically seen in debilitated or immunocompromised subjects. A 71-year-old man who had undergone chemoradiotherapy for malignant lymphoma 12 years earlier was seen for a visual disorder and pain. It was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have a right orbital apex lesion but no paranasal sinus abnormalities. Based on a diagnosis of optic neuritis without a histopathological diagnosis, we started systemic steroid therapy, which only worsened his symptoms. Endoscopic endonasal orbital apex biopsy conducted afterwards for a definitive diagnosis found that the visual disorder was caused by invasive fungal infection, underscoring the importance of pathological examination.
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小河 孝夫, 大脇 成広, 清水 猛史2010 年 103 巻 4 号 p. 335-341
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありOlfactory neuroblastoma, a malignant tumor arising from the olfactory epithelium, is treated combining surgery and radiotherapy. Many reports have also cited the effectiveness of chemotherapy.
We report a case of olfactory neuroblastoma in a 64-year-old-man responding well to chemotherapy. Computer tomography and magnetic resonance imaging showed a large mass in the bilateral nasal cavity, maxillary sinus, and ethmoid sinus with a clinical Kadish staging score of stage B. After 2 cycles of cisplatin and irinotecan chemotherapy and additional radiotherapy of 60 Gy, endoscopic resection achieved a complete pathological response. No recurrence was noted in the 20 months after diagnosis, and he died of pancreatic cancer.
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比良野 彩子, 愛場 庸雅, 久保 武志, 中野 友明, 和田 匡史2010 年 103 巻 4 号 p. 343-348
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありWe report a case of maxillary hematocele with idiopathic thrombocytopenic purpura (ITP). A 45-year-old man seen for nasal bleeding and cheek swelling had not benefitted from treatment elsewhere, since his nasal cavity tumor continued growing, and concomitant bleeding from treatment induced canine fossa and left cheek fistula perforations. Magnetic resonance imaging of the tumor showed varied intensities in the lesion. Computed tomography showed bone destruction from nonuniform tumor enhanement, suggesting maxillary hematocele.
We transfused high-dose γ globulin and p. concentrate and ligated the external carotid artery preoperatively to control bleeding and resected the tumor completely using Weber's incision. The definitive pathological diagnosis was hematocele and tissue granulation. We suspected that the hemorrhagic trend due to ITP was related the hematocele.
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永谷 群司, 鈴木 秀明, 森 貴稔, 小泉 弘樹, 大久保 淳一, 大淵 豊明, 若杉 哲郎, 寳地 信介, 宇高 毅2010 年 103 巻 4 号 p. 349-356
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありWe clinically analyzed 48 consecutive retrospective cases of parotid carcinoma initially treated between 1988 and 2007. Subjects were 30 males and 18 females ranging from 5 to 85 years old (average: 57.9 years). Of the 12 histological types seen, the most common was mucoepidermoid carcinoma, seen in 12 subjects (25.0%). We studied their survival based on 5 potential prognostic factors-stage, T stage, neck metastasis, facial nerve palsy, and malignancy grade-together with features of mortality and recurrence.
Overall 5-year disease-specific survival was 71.2% and 10-year survival 54.9%.
Survival rates were significantly lower in stage IV and high-grade malignancy groups than in stage I-III and low-grade malignancy groups. T stage, neck metastasis, and facial nerve palsy tended to compromise survival. Recurrence developed in 2 subjects, in whom significant recurrence risk factors were stage III-IV (particularly, stage IV), T3-4, and high-grade malignancy. Of 18 deaths, causes were distant failure in 11 and local failure in 5. None died of nodal failure.
Analysis of these prognostic factors is important in selecting appropriate surgery and in determining indications for postoperative radiotherapy and chemotherapy, leading to better treatment outcome in those with parotid carcinoma.
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―粘膜疹の有無による病態の考察―重見 英男, 黒田 芳信, 鈴木 正志2010 年 103 巻 4 号 p. 357-361
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありThe 2 types of laryngeal disorder related to varicella zoster virus infection are differentiated by the presence or absence of mucosal spots. We report a case of herpes zoster localized in the right laryngeal mucosa.
A 71-year-old woman having 2-days history of severe pain on swallowing without satisfactory response to an antibiotic was found in laryngeal fiberscopy to have laryngeal mucosa on the right side with white coating. Vocal cord movement was intact. She was diagnosed with laryngeal zoster bread on hemilateral mucosal eruptions accompanied by severe pain. The day after taking acyclovir, generalized zoster without itching or pain appeared on the anterior and posterior head, chest, abdomen, and back. Laryngeal mucosal spots and generalized zoster disappeared without sequelae within 4 to 5 days.
A review of the literature showed that almost all laryngeal disorders without mucosal eruption included laryngeal palsy and other cranial or cervical nerve injury. Laryngeal disorders with mucosal spots are divided into those with laryngeal palsy and other nerve injuries and those with intact vocal cord function.
We concluded that laryngeal disease without mucosal spots results from neuropathy due to intracranial or cranial basement disorders. We also concluded that laryngeal disorders with mucosal spots and normal vocal cord movement result from direct herpes zoster virus invasion through the upper laryngeal nerve from the nodosal ganglion.
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水田 啓介, 山田 南星, 久世 文也, 加藤 久和, 青木 光広, 伊藤 八次2010 年 103 巻 4 号 p. 363-372
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありApproaches to pterygopalatine and infratemporal fossa lesions are numerous because they are relatively surgically inaccessible. We report 9 cases of pterygopalatine and infratemporal fossa lesions. We treated 2 subjects with benign schwannoma using transmaxillar sinus and orbitozygomatic approaches. We used resection without facial skin incision, assuming that presurgical intraarterial embolization and navigational use was important in removing tumors safety with minimal invasion. One case involved lower infratemporal fossa adenoma. We used a mandibular swing for en block removal. We treated 3 with recurrent palatal carcinoma using maxillary swing. In 2 with lesions extending laterally to the parapharyngeal space, mandibular swing was added to maxillary swing. We treated 1 with recurrent chordoma in the infratemporal fossa using maxillary swing to preserve postoperative function and facial form. We treated 2 with massive infratemporal fossa tumors using an infratemporal approach. One of these 2 had a massive tumor invading the maxilla, necessitating maxillectomy with a Weber incision. We concluded that surgical approaches with wide access to safety must be used to resect tumors completely in those with malignancies
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櫟原 崇宏, 河田 了, 森 京子, 萩森 伸一, 竹中 洋2010 年 103 巻 4 号 p. 373-378
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありCystic lymphangioma, a vascular anomaly considered to be a lymph sac derived from the fetal jugular vein remaining as a mass, is frequently noted in the lateral natal neck. It is classified as a vascular malformation by the International Society for the Study of Vascular Anomalies (ISSVA). While most cases are asymptomatic, it may grow into an unwieldy mass. We report a case of cystic lymphangioma and abnormal subclavian vein distribution incidentally identified during trauma treatment.
A 2-year-old boy, with left supraclavicular fossa swelling, had fallen from a 120 cm height in a park and struck his left shoulder, which was left untreated due to the absence of pain. His family noted a slowly growing left supraclavicular fossa mass the following day. When first seen, he had a 30×40 mm mass in the left supraclavicular fossa. Palpation indicated a smooth, slightly soft, undulating, surface a cystic lesion containing a septum. Computed tomography (CT), magnetic resonance imaging (MRI), ultra sonography (US) needle aspirate of the cyst was bloody and malformation of the left subclavian vein distributing in the left supraclavicular region was noted. The mass was excised due to its rapid growth, together with part of the platysma muscle to which the mass strongly adhered. The two blood vessels entering the mass, were ligated and excised en bloc with the mass, which was diagnosed pathologically as cystic lymphangioma. No recurrence has occurred in the 4 years since surgery.
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榊 優, 佐伯 忠彦, 松本 宗一, 渡辺 太志2010 年 103 巻 4 号 p. 379-386
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありWe reviewed 42 cases of deep neck abscess drained surgically or treated conservatively between February 2001 and August 2008, based on age, gender, primary focus, main symptom, abscess location, systemic disease, pathogenic bacteria, hospital treatment, hospitalization length, complications and long-term hospitalization.
Of the 42, 26 were men and 16 women aged 14 to 80 (central age: 54.5 years). Abscess was caused most by tonsil inflammation (38.1%). Main symptom were sore throat (54.8%) and neck swelling (35.7%). Abscesses were found in the supra- and infrahyoid region in 30 cases and extended to the mediastinum in 2. Of the 42, 14 (33.3%) had hypertension and 11 (26.2%) diabetes mellitus (DM). Inflammation was due to aerobic bacteria (mainly Streptococcus milleri) in 23 cases (54.8%) and to anaerobic bacteria (mainly Peptostreptococcus) in 11 cases (26.2%).
Flexible fiberscopic examination was important in evaluating pharyngeal and laryngeal mucosal disorders and enhanced computed tomography was useful in both diagnosis and postoperative observation. Of the 42, 38 required surgical drainage and 4 were cured using needle aspiration and antibiotics. Of the 38 undergoing surgery-tracheostomy was required in 22. Hospitalization for those with tracheostomy and DM was longer than in those without these factors. Complications included 2 cases each of, mediastinal abscess, sepsis, disseminated intravascular coagulation (DIC), acute renal failure, severe pneumonia, upper digestive tract bleeding and swallowing disorder.
Early surgical drainage and intravenous antibiotic administration are thus essential for treating deep neck abscesses.
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久松 建一, 牧山 清, 平井 良治, 岸 博行2010 年 103 巻 4 号 p. 387-394
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありWe propose a new screening judgment on the effectiveness of multilevel staged surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS) using polysomnography without electrocephalogaphy, the Epworth sleepiness scale (ESS), and SF36v2 questionnaires on quality of life (QOL). Subjects numbered 24 with sleep-disordered breathing, including 20 with OSAHS, who underwent coblation-assisted uvulopalatopharyngoplasty (UPPP) and optional endonasal rhinoplasty consisting of bilateral submucosal inferior turbinectomy and septoplasty to reduce negative pharyngeal pressure three months before or after UPPP. Three months after each operation, the postoperative effect was evaluated using polysomnography without electroencephalography, ESS, and QOL. Apnea-hypopnea, apnea, hypopnea, ESS, and QOL indexes all improved significantly, as did snoring measured on a visual analog scale. Combined endonasal rhinoplasty and coblation-assisted UPPP mutually increased effectiveness even in moderate and severe OSAHS and sleep-disordered breathing together with snoring and/or daytime sleepiness.
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研修ノート
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大脇 成広原稿種別: 研修ノート
2010 年 103 巻 4 号 p. 396-397
発行日: 2010年
公開日: 2010/04/01
ジャーナル 認証ありPDF形式でダウンロード (441K)
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