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105 巻, 5 号
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論説
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山中 昇原稿種別: 論説
2012 年 105 巻 5 号 p. 407-412
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありCurrently, the evidence-based medicine, EBM, has become essential in every field of medicine and many clinical guidelines have been developed based on the high-quality evidence. Such evidence has usually classified into 6 levels according to the quality of the studies. A meta-analysis of randomized controlled trials is considered as the highest level of evidence. The meta-analysis, however, has several pit-falls that we should keep in mind. The pit-falls are Simpson’s paradox, the selection bias, the publication bias, and the geographical bias. In the clinical setting of otolaryngology, it is not always possible to obtain a high level of evidence for conventional clinical treatments such as myringotomy, sinus puncture and aspiration, aeration of the Eustachian tube for the treatment of otitis media with effusion, and so on. Since these treatment modalities have no high-level of evidence, should we therefore stop performing them? No. We should have a further look at these treatments as “good practice points (GPP)”. Otolaryngological specialists should play an important role in combining high-quality evidence and GPP to seek the optimum treatment approach for each patient.
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カラー図説
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楠 威志原稿種別: カラー図説
2012 年 105 巻 5 号 p. 414-415
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありPDF形式でダウンロード (606K)
臨床
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小林 賀子, 河口 幸江, 小川 恭生, 大塚 康司, 西山 信宏, 鈴木 衞原稿種別: 臨床
2012 年 105 巻 5 号 p. 417-422
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありWe analysed 29 children diagnosed as having facial nerve paralysis at the Departments of Otorhinolaryngology or Pediatrics of Tokyo Medical University Hospital between January 2000 and December 2009. The most common cause was Bell’s palsy (18 cases). The other cases were Ramsey Hunt’s syndrome (5 cases), congenital (4 cases), traumatic (1 case) and otitis media (1 case). Only ten patients were able to undergo electroneurography (ENoG) and those children were all over six years old. The results of ENoG were from 12% to 62.2%. Even when the ENoG score was low, the clinical outcome was good. There was no relationship between the ENoG score and the prognosis in this study. All patients except those with congenital facial palsy were treated with steroids, and the palsy improved in all of them.
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倉田 奈都子, 川島 慶之, 古宇田 寛子, 角 卓郎, 得丸 貴夫, 岸根 有美, 喜多村 健2012 年 105 巻 5 号 p. 423-429
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありWe report the clinical course of 7 subjects with nasal extranodal natural killer/T-cell (NK/T) lymphoma (ENKL—6 men and 1 woman, aged 34-71 years—) treated between 2007 and 2010. Most had necrotic nasal cavity lesions that prevented an accurate pathological diagnosis. Definitive pathological diagnoses were obtained from 1 to 12 months after symptom onset (mean: 7.0±4.2 months). The mean time for taking biopsies was 2.6±1.7 months, and specimens required for diagnoses numbered 8.3±7.6. Subjects suspected of malignant lymphoma at initial biopsy required less time and fewer specimens for definitive diagnosis than those with a diagnosis suspected for other than malignant lymphoma. Based on Ann Arbor staging classification, 4 of the 7 were classified as stage I, 2 as stage II, and 1 as stage IV. One each in stages I and II attained remission, 2 in stage I are undergoing treatment, and one each in stages I and IV died during treatment. Early diagnosis is thus a critical factor in determining the prognosis of those with extranodal NK/T lymphoma. Our results suggest the importance of otolaryngologists to biopsy non necrotic tissues and to ensure clinical evaluation enabling prompt pathological diagnosis.
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西田 明子, 福島 英行, 三好 拓志, 前谷 俊樹, 金井 理絵, 窪島 史子, 山本 季来, 辻 拓也, 金丸 眞一2012 年 105 巻 5 号 p. 431-435
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありIntraosseous hemangiomas are rare, comprising only 0.5% to 1% of all osseous neoplasms. The most common locations are the vertebral column and the skull bones; nevertheless, the maxillary bone is quite a rare location and only a few cases have been described in the literature thus far.
We describe a case of a 48-year-old woman who was referred to our hospital with a suspected maxillary tumor incidentally discovered on (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging performed during a general medical examination. Computed tomography (CT) demonstrated a 3 cm bony tumor with a honeycomb appearance occupying the left maxillary sinus. Complete surgical resection via the Caldwell-Luc procedure was performed for the purpose of diagnosis and treatment. Histological examination revealed that the tumor was an intraosseous cavernous hemangioma originating from the maxillary bone. Although preoperative angiography and embolization were not performed, intraoperative-blood loss was minimal. No recurrence has been seen in a follow-up period of 3 years.
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飯塚 崇, 岡田 弘子, 畠 将晃, 村田 潤子, 池田 勝久2012 年 105 巻 5 号 p. 437-440
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありAcute invasive fungal sinusitis frequently occurs in immunocompromised hosts suffering from diabetes mellitus, liver diseases, using steroids or antibiotics and in the elderly. Invasive fungal sinusitis can destroy bones, muscles and tissues and cause orbital and cranial complications, and increases the mortality rate. Recently, however, antifungal drugs have been reported to be effective against invasive fungal sinusitis. We report on a patient with acute invasive fungal sinusitis who died from drug-related side effect.
The patient was 72-year-old man who had diabetes mellitus, hepatitis C and cerebral infarction. He complained of right visual loss. He was treated with steroids, but his visual activity decreased. He was referred to our hospital because of the presence of an invasive soft tissue density in the right sphenoid sinus on CT imaging. We performed an endonasal endoscopic biopsy to confirm the diagnosis. The diagnosis was invasive paranasal aspergillosis. He was treated with antifungal drugs, but he died of liver failure caused by the drugs. In the case of an underlying disease, it is necessary to pay special attention to drug-associated side effects.
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濵本 真一, 兵 行義, 宇野 雅子, 秋定 健, 原田 保2012 年 105 巻 5 号 p. 441-446
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありBasal cell adenocarcinoma (BCAC) of the salivary glands is rare low grade malignant tumor. They were categorized in the second version of the classification of salivary gland tumors by WHO in 1991.
A 58-year-old female presented with a complaint of a right parotid mass. A benign tumor was suspected, but the histological diagnosis was BCAC by superficial lobectomy of the right parotid gland. Tumor cells were observed near the surgical margin, radiotherapy was given post-operatively. There was neither local recurrence nor metastasis during 8 months of follow-up.
In general BCAC is recognized as a low grade tumor with a favorable prognosis, while long-term follow-up is needed because of occasional recurrence.
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細川 誠二, 武林 悟, 岡村 純, 瀧澤 義徳, 細川 久美子, 大和谷 崇, 峯田 周幸2012 年 105 巻 5 号 p. 447-451
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありThe ameloblastoma is one of the odontogenic tumors, with its particular origin in the mandible. We encountered a patient who had pulmonary metastases after the treatment of a recurrent ameloblastoma of the maxilla.
A 68-year-old man was referred to our institute with recurrent nasal bleeding and a nasal cavity tumor in 2004. The mass was resected as a biopsy and the diagnosis based on the histopathological findings was an ameloblastoma. The patient subsequently underwent a total maxillectomy with surrounding tissue and skin grafting.
Five months after the initial resection, multiple masses were noticed in the bilateral lungs. A left lower lobectomy was performed, and the histopathology revealed recurrent metastases from the ameloblastoma of the maxilla. One year and five months after the lobectomy, the patient’s condition is good with no evidence of disease.
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服部 佳世子, 平野 滋, 楯谷 一郎, 曽我美 遼, 伊藤 壽一2012 年 105 巻 5 号 p. 453-456
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありWe report a case of Kawasaki disease mimicking a retropharyngeal abscess. A boy aged 7 years and 11 months was hospitalized after 4 days with a high fever and cervical lymphadenopathy. Contrast-enhanced head and neck computed tomography (CT) showed a low-density lesion in the posterior pharyngeal space. Having all 6 clinical criteria for Kawasaki disease on hospital day 2, the boy was treated with γ-globulin, ibuprofen, and antibiotics, which gradually alleviated all clinical signs.
An abscess-like retropharyngeal lesion is considered a manifestation of Kawasaki disease. Cervical lymphadenopathy is the presenting symptom in only 12% of subjects with Kawasaki disease, and may significantly delay diagnosis. It is therefore important when examining a child with a retropharyngeal abscess to consider the possibility of Kawasaki disease.
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加藤 明子, 池嵜 祥司, 田畑 貴久, 若杉 哲郎, 永谷 群司, 鈴木 秀明2012 年 105 巻 5 号 p. 457-461
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありThe pyriform sinus fistula is a rare anomaly that derives from the third, fourth or fifth pharyngeal pouch, and may cause recurrent anterior neck abscesses and/or suppurative thyroiditis. A 16-year-old male presented with acute left anterior cervical swelling. Endoscopic examination showed pus pooling in the left pyriform sinus, and computed tomography (CT) revealed an irregular-shaped abscess in the left anterior cervical region. From these findings, a pyriform sinus fistula was suspected. The patient was treated with antibiotics, and the acute inflammation subsided temporarily. Videofluoroscopy and CT after gastrografin® deglutition were then performed. The latter clearly depicted the fistula arising from the left pyriform sinus extending down to the left thyroid lobe. The patient underwent transcervical resection of the fistula including a partial thyroidectomy. Immediately prior to resection, the fistula was stained by injecting crystal violet solution through the opening in the pyriform sinus using a curved laryngoscope. The fistula was readily identified intraoperatively by the injected stain, and successfully resected. The patient showed temporary vocal cord paralysis of the affected side, which recovered within 2 months after surgery. No recurrence has been seen in 8 months of follow-up. We would like to stress that CT combined with contrast medium deglutition is a powerful means to enable a definitive diagnosis of this anomaly and could thus be useful in planning a surgical procedure.
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小泉 敏三, 家根 旦有, 成尾 一彦, 細井 裕司2012 年 105 巻 5 号 p. 463-469
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありSarcoidosis, a systemic disease of unknown pathogenesis, involves granulomatous lesions forming in various organs. Although it commonly affects the chest, lungs, eyes, and skin, it is rare in the pharynx and/or larynx. The few cases of pharyngeal and/or laryngeal sarcoidosis recently reported mostly discuss the acute clinical course, leaving the long-term chronic course unstudied.
We report the case of a 51-year-old woman with pharyngeal and laryngeal sarcoidosis having a clinical course exceeding 16 years. Chiefly reporting ongoing throat pain and dyspnea, she was followed-up for chronic laryngitis by an ENT specialist for 16 years. Her first visit to our clinic showed slightly hypertrophic tonsils and distinctive laryngeal tissue swelling from the epiglottis to the arytenoids. Tonsillar and epiglottic lesions biopsied under local anesthesia yielded a histological diagnosis of sarcoidosis. Ensuring systemic examinations showed no other organs to be complicated by sarcoidosis except for the pharynx and larynx.
Oral steroids administered for 3 weeks, were ineffective due to the chronic stage, although pharyngeal and laryngeal lesions improved gradually after 2 years of continuous follow-up without medication.
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上田 勉, 宮原 伸之, 河野 崇志, 濱本 隆夫, 立川 隆治, 工田 昌也, 平川 勝洋2012 年 105 巻 5 号 p. 471-476
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありWe experienced a patient who required a high-dose opioid for pain control, a 39-year-old male who was diagnosed as having primary small cell carcinoma of the larynx. He received concurrent chemoradiotherapy with cisplatin plus etoposide, and achieved a complete response. Four months later, multiple bone and distant metastases became evident. He was treated with concurrent platinum-based chemotherapy and an opioid, NSAIDs, adjuvant analgesics, radioactive strontium and palliative radiotherapy for management of the pain associated with the bone metastases. The pain gradually became stronger, and we increased the opioid dose up to 16680 mg/day in terms of oral morphine. Finally the pain was successfully managed until his death.
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山原 康平, 隈部 洋平, 田中 信三, 平塚 康之, 和田 忠彦, 山田 光一郎2012 年 105 巻 5 号 p. 477-481
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありPrimary tracheal cancer is very rare and a tumor obstructing the airway is an emergency difficult to manage. We report a case of primary tracheal cancer requiring surgery using percutaneous cardiopulmonary support (PCPS). A 68-year-old man was referred of severe dyspnea and squamous cell carcinoma obstructing the subglottic laryx found in bronchoscopy. Computed tomography (CT) showed a tumor extending from the cricoid cartilage to the third tracheal ring. We diagnosed tracheal cancer because most of the lesion was in the tracheal wall. Because dyspnea was getting worse, we performed emergency surgery. PCPS was established before tracheostomy for airway management. We performed total wide-field laryngectomy with the inferior margin located at the seventh tracheal ring. Using PCPS helps keep the operation uneventful and successful.
Despite postoperative chemoradiotherapy, mediastinal lymph node and lung metastases 8 months post-operatively led to the man's death 15 months later. PCPS is very simple and easy to control, and has proven very effective in cases of severe airway stenosis.
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久場 潔実, 徳永 英吉, 大崎 政海, 原 睦子, 肥田 修, 中島 正己, 木下 慎吾, 森 美穂子2012 年 105 巻 5 号 p. 483-487
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありWe present a case of post methicillin-resistant Staphylococcus aureus (MRSA) infectious acute glomerulonephritis following cervical esophagus cancer surgery. Despite the subject's MRSA infection being treated successfully by antibiotics infusion, continuous hemodilution, and direct hemoperfusion with a polymyxin-absorbed immobilized column, hematuria, proteinuria, and serum creatinine gradually increased. Kidney biopsy showed rapidly progressive glomerulonephritis. This clinical course and examination findings yielded a diagnosis of post-MRSA infectious acute glomerulonephritis. Symptoms were gradually alleviated by steroid administration.
Post-MRSA infectious acute glomerulonephritis, a new disease, typically presents as rapidly progressive glomerulonephritis with nephrosis. It usually develops after malignant tumor surgery and especially, after MRSA infection sepsis. This disease must therefore be considered in the differential diagnosis of subjects with postoperative MRSA infection who show elevated hematuria and proteinuria, and worsening renal function. If nephritis progresses despite antibiotic treatment, steroid administration should be considered.
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機器
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菊池 恒, 西野 宏, 笹村 佳美, 福嶋 敬宜, 市村 恵一原稿種別: 機器
2012 年 105 巻 5 号 p. 489-494
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありRecently, partial glossectomy is likely to be chosen for early tongue cancer. In our hospital, we have used the CO2 laser or electrosurgery for this procedure, but post-operative pain was severe and, as a result, oral intake was hampered.
So as to lessen the postoperative pain, we experimented with a coblation system in partial glossectomy for early tongue cancer and got a good healing course. We would like to report on a case together with the pathological findings. A 34-year-old woman complained of glossal pain. She had a small mass at the right side of the tongue. Biopsy revealed squamous cell carcinoma. Under the clinical diagnosis of a tongue cancer (T1 N0 M0) the patient underwent a partial glossectomy using the coblation system (Evac 70®) under general anesthesia. Postoperative pain was milder than that associated with electrosurgery. The pathological examination revealed that, in descending order, tissue damage was electrosurgery>CO2 laser>coblation system. Partial glossectomy for early tongue cancer using a coblation system seems to be a useful operation for reducing post-operative pain.
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研修ノート
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小川 恭生原稿種別: 研修ノート
2012 年 105 巻 5 号 p. 496-497
発行日: 2012年
公開日: 2012/04/27
ジャーナル 認証ありPDF形式でダウンロード (219K)
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