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104 巻, 6 号
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論説
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北野 博也原稿種別: 論説
2011 年 104 巻 6 号 p. 391-396
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありRecently, robotic technology in the surgical field has become more widespread. However, in the field of head and neck surgery, robotic surgery has been limited because of spatial and technical limitations. The technical and optical advantages of a new robotic instrument, the da Vinci S system, enable us to perform robotic surgery in head and neck field. In this article, I discuss the advantages and disadvantages of robotic surgery using the da Vinci S system for head and neck surgery.
Robotic thyroid surgery using the robotic approach has been developed mainly in Korea. In Korea, robotic thyroidectomy using a gasless, transaxillary approach is a common technique. Many papers about robotic thyroidectomy using the da Vinci S system have been published in which the technical advantages of the robotic approarch in the cosmetic results have been discussed4)-6).
Another feasible approach in the head and neck region is the transoral robotic surgery (TORS) for mesopharyngeal and midline skull base tumors. This technique has been developed mainly by Weinstein and his colleagues. This new robotic surgical instrument, the da Vinci S system, is compact in comparison with the previous types. Therefore, robotic surgery via the oral cavity has become possible. Weinstein et al. mentioned in their paper that multiple institutions have shown that transoral robotic surgery programs can be successfully established yielding excellent clinical outcomes7).
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カラー図説
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松田 秀樹, 高橋 優宏, 佃 守原稿種別: カラー図説
2011 年 104 巻 6 号 p. 398-399
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありPDF形式でダウンロード (578K)
臨床
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大和田 聡子, 山本 昌彦, 鈴木 光也, 吉田 友英, 野村 俊之, 池宮城 慶寛, 重田 芙由子, 田村 裕也, 岸 雅彦原稿種別: 臨床
2011 年 104 巻 6 号 p. 401-408
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありA 66-year-old man visited our Medical Center at the end of June, 2009 with an approximately 3 week history of general fatigue, feeling depression and dizziness. First, general and neurological examinations were performed, but there were no abnormal findings. Within 1 week after the first examination, the patient's family noticed that he was talking and acting strangely. These symptoms rapidly worsened, and he was admitted on July 1st. At that time, he showed the cerebellar ataxia such as the poorness of the finger to nose test and wide based gait. Diffusion-weight imaging (DWI) Magnetic resonance imaging (MRI) showed a high intensity change in the right side of the cerebral cortex and basal ganglia but no remarkable change in the cerebellum except for slight atrophy. Electroencephalography showed a typical periodic synchronous discharge. Based on the above findings, the patient was diagnosed as having probable Creutzfeldt-Jacob disease (CJD).
We performed neuro-otological examinations on the 9-10th July. They showed bilateral gaze evoked nystagmus and ataxic pursuit, diminished optokinetic nystagmus, and the disappearance of visual suppression on a caloric test. By the end of July, following the rapid development of dementia and generalized myoclonus, the patient became bedridden. By mid-August, he had become akinetic and mute. Based on our neuro-otological evaluation the final diagnosis was CJD. In the early period of onset of CJD, the cerebellar ataxia was not reflected on the MRI findings, but this diagnosis was suggested by the abnormal eye movement. Dizziness is one of the initial signs of CJD, so otorhinolaryngologists should bear CJD in mind if a patient shows symptoms of cerebellar ataxia
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渡邊 毅, 髙橋 晴雄, 田中 藤信, 奥 竜太, 北岡 杏子2011 年 104 巻 6 号 p. 409-413
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありWe report a case of unilateral inner ear malformation that presenting with recurrent meningitis and bilateral deafness. A 8-months-old boy with congenital left-side hearing impairment, diagnosed in newborn screening, suffered bacterial meningitis twice within 7 months of birth, becoming bilateral totally deaf there after. Temporal bone computed tomography (CT) indicated left-side inner ear malformation, Mondini dysplasia, and a cerebrospinal fluid (CSF) fistula. CSF from a stapes footplate defect was repaired surgically. Cochlear implantation was successful in the right ear 3 months after the first operation. In the 14 months since the second operation, he has had no bacterial meningitis and has begun speaking two-word sentences. Early diagnosis and prompt surgical intervention are thus crucial in avoiding meningitis sequelae.
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水越 彬文, 平海 晴一, 山本 典生, 坂本 達則, 伊藤 壽一2011 年 104 巻 6 号 p. 415-418
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありMastoiditis is one of common suppurative complications of acute otitis media, which sometimes induces severe intracranial complications. We report on a case of mastoiditis accompanied with sigmoid sinus thrombosis.
A 12-year-old girl presented with repeated otalgia and aural discharge in her right ear which had persisted for 2 months. Computed tomography (CT) examination revealed a defect of the lateral wall of the sigmoid sinus with stenosis. The patient underwent total mastoidectomy. She has been alive without neurological manifestations for 7 months, and the sigmoid sinus has been enlarged without anticoagulation therapy.
The development of antibiotics has decreased the frequency of mastoiditis, although the mastoiditis without clinical symptoms has been reported in recent years. CT examination is a decisive diagnostic tool to classify the mastoiditis as incipient or coalescent, to detect intracranial complications, and to determine the type of therapy. Thrombophlebitis is one of the life threating intracranial complications of mastoiditis, but if it is localized in only one hemisphere and has no neurological manifestations, it can be followed without surgery.
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菊池 恒, 中村 謙一, 石川 敏夫, 笹村 佳美, 市村 恵一2011 年 104 巻 6 号 p. 419-425
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありOrbital complications in sinus infections occur due to the anatomical proximity of the paranasal sinuses and orbit. Delayed diagnosis and treatment may involve unfavorable morbidity and mortality. We report 10 cases—7 men and 3 women—of acute rhinosinusitis and acute exacerbation of chronic sinusitis complicating orbital symptoms in the last 5 years. Mean age at consultation was 64.6 years (54-75). Seven had undergone previous sinus surgery. The posterior ethmoid and sphenoid sinus were mainly affected. Mean preoperative visual acuity of 0.07 became 0.53 postoperatively. Restricted eye movement occurred in 1 case of good recovery. Of antibiotics, second- or third-generation cephem was used in 8 cases and carbapenem in 2. Corticosteroids were administered by pulse therapy in 5 and by tapering schedule in 4. Visual recovery occurred in 7. Unrecovered cases were likely to receive delayed surgery. We recommend initial 3-day steroid pulse therapy in subject with decreased vision, discontinued on vision recoveries. Pulse therapy should be continued in case of incomplete or poor recovery.
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津田 武, 西池 季隆, 川島 貴之, 村田 潤子, 喜井 正士, 田村 学, 猪原 秀典2011 年 104 巻 6 号 p. 427-433
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありWe clinically examined 32 subjects—25 men and 7 women (median age: 65 years)—with inverted nasal and paranasal sinus papilloma seen between 1997 and 2010. Krouse classification confirmed, 6 as T1, 7 as T2, 18 as T3, and 1 as T4. The 31 subjects with T1, T2 and T3 underwent surgery, and the remaining T4 subject chemoradiation. Recurrence occurred in 6 of the surgical cases (recurrence rate: 19%). Reducing post operative recurrence requires that magnetic resonance imaging and computed tomography, identify tumor origin and extent and that endoscopic examination confirm total surgical excision.
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永野 広海, 馬越 端夫, 川畠 雅樹, 早水 佳子, 大堀 純一郎, 吉福 孝介, 黒野 祐一2011 年 104 巻 6 号 p. 435-440
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありAlthough parotid duct obstruction may cause recurrent painful gland swellings, bilateral parotid duct stenosis is rare.
Sialendoscopy enables the ductal system to be seen directly, allowing more precise diagnosis of idiopathic gland swelling particularly in stenosis.
We report 2 cases involving painful bilateral parotid gland swelling and stenosis. A 61-year-old man with type II (right and left-side) stenosis, and a 35-year-old man with type II (right-side) and III (left-side) stenosis. Both were confirmed in sialendoscopy.
Sialendoscopy enables stenosis to be directly and precisely assessed for planning effective treatment.
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松木 崇, 宮本 俊輔, 永井 浩巳, 岡本 牧人2011 年 104 巻 6 号 p. 441-446
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありMumps, a common pediatric illness, most often exhibits bilateral parotid swelling, but may involve numerous complications, including laryngopharyngeal edema, which is poorly covered in the literature. From 2005 to 2009, we treated four adults for mumps-related laryngopharyngeal edema. Together with salivary gland swelling, subjects reported laryngopharyngeal discomfort such as sore throat and foreign body “presence” triggering edematous laryngopharyngeal change detected in laryngoscopy. Immediate intravenous steroid hormone administration helped prevent airway obstruction, avoiding tracheostomy. Severe dyspnea and tracheostomy have been reported. Adult mumps cases should thus prompt attention for laryngopharyngeal edema.
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赤澤 吉弘, 渡辺 昭司, 春日井 滋, 向出 光博, 大塚 崇志, 及川 貴生, 三上 公志, 肥塚 泉2011 年 104 巻 6 号 p. 447-453
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありIn the present study, 37 patients with advanced laryngeal carcinoma (stage III and IV) were analyzed, who had been treated at St. Marianna University, School of Medicine between 1996 and 2007, based on the modified TNM classification by the international union against cancer (UICC, 6th edition, 2003). Before the modification of the TNM classification, total laryngectomy (TL) was our strategy of treatment for T3 and T4 patients. Those patients who refused TL received radiotherapy (low-dose concurrent chemoradiotherapy or radiotherapy alone). Five out of 16 cases in T3 who were classified under the 6th edition belonged to T2 under the previous edition, which made the treatment of T3 more difficult. The 5-year cause-specific survival rate of all cases was 63.9%, 81.3% in stage III, 46.8% in stage IV, 90.9% in the glottic type and 50% in the supraglottic type. A particularly significant difference was seen between these latter two types (p<0.05). Comparing the radiotherapy group and the TL group, the survival rate of T3 patients was 85.7% in the TL group and 67.5% in the radiotherapy group, which was not significant. In T4 patients, the survival rate was 20% in the radiotherapy group and 100% in the TL group (p<0.05). In the T3 and T4 patient radiotherapy groups, high-dose concurrent chemoradiotherapy should be used to improve the 5-year survival rate.
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森 祐輔, 辻 純, 安里 亮, 神田 智子, 本多 啓吾, 牛呂 幸司, 渡邉 佳紀2011 年 104 巻 6 号 p. 455-459
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありHemophilia is conventionally monogenic causing hemorrhagic symptoms due to decreased or deficient factor VIII. Acquired hemophilia (HA), however develops clinical hemophilic analogous symptom when auto antibody factor VIII or IX develops. This rare disorder, which causes pharyngeal hemorrhage has not been reported in Japan insofar as we know until our case. An 83-year-old Japanese woman seen for acute pharyngalgia and hematemesis lasting two months. Required emergency tracheotomy for hematoma airway narrowing, but bleeding persisted, after an operation. We finally diagnosed her condition as acquired hemophilia because of aberrant bleeding, prolonged coagulation time (APTT), and decreased factor VIII and inhibitor-positive factor VIII. For inhibitor removal and hemostasis, we administered prednisolone (PSL), factor VIII concentrates, and genetic recombination activated factor VII (rFVVII). Factor VIII inhibitor showed loss than start of therapy in two months and follow-up has proceeded hemorrhage-free as of this writing.
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研修ノート
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本間 明宏原稿種別: 研修ノート
2011 年 104 巻 6 号 p. 460-461
発行日: 2011年
公開日: 2011/06/01
ジャーナル 認証ありPDF形式でダウンロード (281K)
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