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104 巻, 9 号
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論説
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兵頭 政光原稿種別: 論説
2011 年 104 巻 9 号 p. 609-615
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありRecently, swallowing disorders have increasingly become a critical clinical issue. The aims of treatment for dysphagic patients are focused on the recovery of oral alimentation and prevention of aspiration pneumonia. Rehabilitation and surgical interventions have been the basic treatment strategies. In addition, pharmacologic treatment options have been developed over the last two decades. Substance P plays an important role as a neurotransmitter for inducing the swallowing or cough reflex. Angiotensin converting enzyme inhibitors, dopamine agonists, and capsaicin facilitate local accumulation of substance P, therefore, they upregulate the impaired swallowing reflex. Many recent reports have described that these pharmacotherapeutic approaches could reduce the risk of pneumonia. Our clinical study showed that capsaicin administration for a month improved decreased pharyngeal contraction and upper esophageal sphincter function. Also, anti-platelet therapy with cilostazol, traditional Chinese medicine (Hange-Koboku To), and olfactory stimulation with black pepper oil and menthol were reported to prevent pneumonia, especially in the elderly. However, many of these reports lack sufficient evidence, and additional studies are warranted. Botulinum toxin injection into the cricopharyngeal muscle has a direct effect on various types of dysphagia by blocking sustained contraction of the upper esophageal sphincter. It can be an alternative treatment instead of cricopharyngeal myotomy. Influenza or pneumococcal vaccination were reported to be beneficial and recommended for elderly disabled patients at high-risk for pneumonia, but its efficacy is still the subject of discussion. In conclusion, although pharmacologic treatment for dysphagia is a novel research topic, it has a great possibility as an efficient therapeutic option for numerous patients with swallowing disorders. Further studies are necessary.
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カラー図説
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吉田 友英, 重田 芙由子, 山本 昌彦原稿種別: カラー図説
2011 年 104 巻 9 号 p. 616-617
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありPDF形式でダウンロード (786K)
臨床
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北村 貴裕, 鎌倉 武史, 松代 直樹, 古川 雅史, 梶川 泰原稿種別: 臨床
2011 年 104 巻 9 号 p. 619-623
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありOur study of 677 cases of idiopathic sudden sensorineural hearing loss (ISSNHL) related to posttreatment recovery yielded the following results:
1) Most subjects—36.8%—had horizontal hearing loss
2) V character hearing loss curve was highest at 61.7% and lowest in high tone, near total deaf, and total deaf.
3) We classified 6 hearing loss types into 4 prognostic types—good for V character, intermediate for horizontal and reverse V, poor for high tone and near total deaf, extremely poor for total deaf.
4) Good recovery—a hearing level improvement of ≥30dB—was relatively high in near total deaf hearing loss.
5) Total deaf hearing loss had the highest vertigo at 68.4%.
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高木 大樹2011 年 104 巻 9 号 p. 625-629
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありLectin family member galectin-7 contributes to different events associated with pluristratified epithelial differentiation and development. Proteomic analysis during middle ear cholesteatoma surgery showed galectin-7 to be a specific protein in cholesteatoma. Detected in the cholesteatoma matrix but not in middle ear mucosa, galectin-7 may be a useful marker of cholesteatoma residue in immunofluorescent staining since such residue is considered a major cholesteatoma recurrence factor.
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早水 佳子, 黒野 祐一2011 年 104 巻 9 号 p. 631-636
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありOncogenic osteomalacia, a rare paraneoplastic syndrome, is due to excess renal phosphate excretion caused by recently discovered osteomalacia, which occurs as a result of fibroblast growth factor (FGF)-23 secreted by mesenchymal tumors such as hemangiopericytoma. FGF-23 is involved in controlling phosphate (P) and calcium (Ca) metabolism.
We report a case of oncogenic osteomalacia with hypophosphatemia induced by FGF-23 production in nasal hemangiopericytoma. A 58-year-old man seen for 19-month-long whole-body pain was confirmed in computed tomography (CT) to have a tumorous mass extending to the right middle turbinate. Hemagiopericytoma was determined pathologically by biopsy, necessitating surgery and blood vessel embolization. The man’s symptoms disappeared promptly postoperatively. Pathology results after were positive for FGF-23 in immunostaining. The man has had no relapse, after excellent results in the 26 months since surgery. We discuss clinical features, diagnosis, and treatment and provide a review of the literature.
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西村 邦宏, 伴野 真哉, 土屋 吉正, 池田 篤彦, 稲川 俊太郎, 小川 徹也, 植田 広海2011 年 104 巻 9 号 p. 637-641
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありNasopharyngeal carcinoma in children is rare, and treatment lies mainly in chemotherapy and radiation due to the complexity of nasopharyngeal anatomy.
We report a case of pediatric nasopharyngeal carcinoma treated by induction chemotherapy followed by IMRT and adjuvant chemotherapy. An 11-year-old boy was diagnosed with nasopharyngeal carcinoma. We planned the following treatment; initial induction chemotherapy with CDDP and 5FU to reduce the tumor volume as much as possible, then radiation therapy using IMRT to spare parotid gland function and reduce the adverse effects of radiation therapy. Finally, adjuvant chemotherapy was administered 4 times. There are no signs of recurrence 26 months after completion of therapy and no complaints of thirst.
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油井 健宏, 岩田 義弘, 加藤 久幸, 岡田 達佳, 櫻井 一生, 内藤 健晴2011 年 104 巻 9 号 p. 643-646
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありWe reported a case of pediatric thyroid carcinoma. A 10-year-old girl seen for dyspnea on exertion due to bilateral laryngeal paralysis. This was found to have a thyroid tumor in preoperative computed tomography (CT) examination of bilateral laryngeal paralysis. It was diagnosed with papillary carcinoma in fine needle aspiration cytology. We undertook left thyroid lobectomy with isthmus and left side neck dissection. Tracheostomy and glottic dilation was performed to improved dyspnea after thyroid lobectomy. The tumor was diagnosed as poorly differentiated carcinoma with invasion beyond the thyroid capsule, and multiple cervical lymph node metastases were diagnosed histopathologically. Dyspnea was improved by glottic dilation and the tracheosoma could be closed postoperatively. The girl remains alive without recurrence in the 2 years and 6 months since surgery.
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牛呂 幸司, 安里 亮, 辻 純, 神田 智子, 本多 啓吾, 渡邉 佳紀, 森 祐輔2011 年 104 巻 9 号 p. 647-652
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありLiposarcoma commonly occurs in the lower extremities and retroperitoneum, but rarely in the mediastinum. We report a rare case of primary mediastinal liposarcoma treated surgically. A 77-year-old man seen for an asymptomatic superior mediastinal mass found in magnetic resonance imaging had been exposed to radiation in the atomic bombing of Hiroshima.
The large lobulated mass had surrounded and displaced major vessels and the trachea. The encapsulated mass was removed surgically, and the final pathological diagnosis was well-differentiated liposarcoma.
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薬物
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橘 智靖, 中田 道広, 小河原 悠哉, 松山 祐子, 阿部 郁原稿種別: 薬物
2011 年 104 巻 9 号 p. 653-656
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありSalivary fistula is an uncommon parotid surgery complication. We report a case of prolonged postoperative salivary fistula. Minocycline injection effectively prevented severe complications in refractory salivary fistula. Minocycline has been used in sclerotherapy for chylous fistula following neck dissection, thyroid cyst, parathyroid cyst, etc, and found to be useful in preventing prolonged complications.
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山中 昇, 杉田 麟也, 鈴木 賢二, 横山 道明, 林 泰弘, 眞田 文明, 藤原 久郎, 渡邊 敬, 田渕 富三2011 年 104 巻 9 号 p. 657-666
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありIn pharmacokinetic and clinical studies of once daily 500 mg levofloxacin (LVFX) in adults with acute pharyngotonsillitis, we assessed disease severity and LVFX efficacy using scoring based on local findings and clinical symptoms.
The LVFX tissue concentration of 2.58 to 4.12 hours after single 500 mg administration was 7.791±1.686 μg/g (mean±SD) in the palatine tonsil, with a tissue/plasma concentration ratio of 1.66±0.20. The clinical efficacy (test of cure) was 95.0% (19/20). Bacteriological eradication was 100% (7/7). Adverse reactions, all mild to moderate, occurred in 28.6% (6/21). Side effects, but no serious or clinically significant event, occurred in 4.8% (1/21).
In conclusion, LVFX once daily 500 mg p.o. entered well into palatine tonsil tissue and appears useful in treating acute pharyngotonsillitis. Data confirmed that scoring was very useful in deciding appropriate acute pharyngotonsillitis treatment.
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研修ノート
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肥後 隆三郎原稿種別: 研修ノート
2011 年 104 巻 9 号 p. 668-669
発行日: 2011年
公開日: 2011/09/01
ジャーナル 認証ありPDF形式でダウンロード (372K)
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