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前身誌
107 巻, 7 号
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論説
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土井 勝美2014 年 107 巻 7 号 p. 509-519
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありSummary: Middle ear implants (MEIs) such as VSB® (Vibrant soundbridge), BB® (Bonebridge), and the BAHA® osseointegrated implant for bone conduction (Bone-anchored hearing aid) are attractive and alternative treatments for patients with conductive, sensorineural, and mixed hearing loss who do not benefit from, or who choose not to wear, conventional hearing aids (HAs). Recent studies suggest that MEIs and BAHA can provide better improvements in functional gain, speech perception, and quality of life than HA, while there certain risks associated with the surgery should be taken into consideration, including bleeding, wound infections, facial nerve or chorda tympanic nerve damage, dysfunctions of the middle and inner ears and future device failure/explantation. Some types of MEI furthermore may involve restricted access to MRI scans. In the future, it is likely that there will be an increasing population even in Japan that will meet the new criteria for these implantable hearing devices. However, the long-term efficacy and safety of these devices should be established.抄録全体を表示PDF形式でダウンロード (1893K)
カラー図説
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伊藤 真人2014 年 107 巻 7 号 p. 520-521
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありPDF形式でダウンロード (618K)
臨床
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秋山 貢佐, 後藤 理恵子, 唐木 將行, 星川 広史, 森 望2014 年 107 巻 7 号 p. 523-527
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありAn 83-year-old woman was referred with right-side nasal obstruction. The CT scan showed a 60×45×43 mm mass arising from the nasal septum. MRI imaging indicated a smooth and encapsulated mass partial cystic formation involving 30×30×24 mm. A pre-operative definitive diagnosis could not be made despite two biopsies. We performed an endoscopic intranasal operation in combination with a midfacial degloving approach. The post-operative final diagnosis was pleomorphic adenoma (PA) of the nasal septum. Nasal septal PA is exceedingly rare, and only a few cases of giant PA tumor have been reported previously. In this case, we could achieve complete en bloc excision via minimal invasive surgery without facial skin incision. Intranasal PAs have a pathologic feature which seems to be composed of higher epithelial and lower stromal components than PAs of the major salivary glands. The possibility of PA should be kept in mind when assessing nasal cavity tumors that are rich in epithelial constituents. Sometimes small cysts are formed in PAs, while a cyst large enough to be recognized macroscopically is rare. This is the first case report of a nasal septum PA accompanied with cyst formation.抄録全体を表示PDF形式でダウンロード (675K) -
平澤 一浩, 大塚 康司, 伊藤 博之, 上田 百合, 白井 杏湖, 鈴木 衞, 永井 義幸, 加藤 紀和, 櫻井 衛2014 年 107 巻 7 号 p. 529-533
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありIntranasal steroids are widely used to treat olfactory disorder, and are known to have fewer side effects than systemic steroids. However, there are some reports that intranasal steroids have induced adrenal insufficiency, even when the steroid dosage is appropriate.
We encountered a case of secondary adrenal insufficiency after using intranasal betamethasone for olfactory disorder within the usual dosage. In this case, we were not aware of instructing the patient not to swallow the steroid which had dripped into her pharynx. Thus, a large amount of steroids which had passed through her nasal cavity might have been absorbed in the oropharyngeal mucosa and also ingested. That is possibly the main cause of developing adrenal insufficiency.
Recently, Toki-shakuyaku-san, a traditional Chinese medicine, has started to be used for olfactory disorder after a cold. Because of its minimum side effects, it may be safely used for patients with the risk associated with steroid use.抄録全体を表示PDF形式でダウンロード (581K) -
山内 一真, 保富 宗城, 河野 正充, 乾 晃造, 安井 紀代, 早田 幸子, 戸川 彰久, 山中 昇2014 年 107 巻 7 号 p. 535-540
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありPyogenic granulomas are a benign vascular tumor of the skin and mucous membranes commonly affecting the oral cavity, and less commonly the nasal cavity. Their etiology is unknown, however, pyogenic granulomas have been closely related to pregnancy. We report herein on a 31-year-old pregnant woman with a rapidly growing hemorrhagic lesion within the nasal cavity, which required pre-operative embolization and subsequent endonasal excision under general anesthesia after delivery of a child. In this report, we discuss the clinical figures, radiological and histological characteristics of pyogenic granulomas, and their treatment strategy.抄録全体を表示PDF形式でダウンロード (1026K) -
大塚 康司, 清水 雅明, 柴田 元子, 岡吉 洋平, 荒木 進, 小川 恭生, 北村 剛一, 鈴木 衞2014 年 107 巻 7 号 p. 541-545
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありSarcoidosis is a multisystem granulomatous disorder of unknown origin. Sarcoidosis can affect the nasal mucosa and result in acquired nasolacrimal duct obstruction that induces epiphora and dacryocystitis. We report herein on a 41-year-old man with nasolacrimal duct obstruction secondary to sarcoidosis. He had pulmonary sarcoidosis when he was 22-year-old. He underwent septoplasty and turbinectomy for nasal obstruction at the age of 29. Histopathological examination showed non-caseating epithelioid granuloma resulting in nasal sarcoidosis. Epiphora in both eyes developed and an endoscopic-dacryocystorhinostomy was performed bilaterally at the age of 41. His nasal cavity was deformed and the mucous membrane was hypertrophic. We used a navigation system and a 25G light guide to establish orientation. A 2.5 mm diamond bur was used for the dacryocystorhinostomy. A Nunchaku-type silicon tube was inserted successfully in the left side, but was inserted only half way in the right side. The left and right tubes were removed a month and 3 months after surgery. The symptoms of the left eye disappeared after one year but the symptoms of the right eye remained.抄録全体を表示PDF形式でダウンロード (508K) -
松澤 真吾, 長谷川 雅世, 原 真理子, 新鍋 晶浩, 金沢 弘美, 吉田 尚弘, 飯野 ゆき子2014 年 107 巻 7 号 p. 547-551
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありIgG4-related disease is considered to be a systemic disease characterized by a high serum IgG4 level and IgG4-positive plasma cell infiltration into the organs of concern. In the head and neck regions, Mikulicz disease has come to be associated with IgG4-related diseases. We report herein on five cases of patients with IgG4-related disease with bibliographic consideration. Patients with this disease, but showing only the swelling of the salivary glands, may be treated conservatively with only careful follow-up. However, when serious systemic symptoms such as pancreatitis occur during the clinical course of a case of IgG4-related disease, early diagnostics and follow-up in consultation with other specialists are recommended.抄録全体を表示PDF形式でダウンロード (604K) -
上田 奈津子, 久世 文也, 水田 啓介, 西堀 丈純, 青木 光広, 伊藤 八次2014 年 107 巻 7 号 p. 553-556
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありThere are several reports showing the effect of a somatostatin analog in postoperative chylous leakage after gastrointestinal surgery and thoracic surgery. We treated a case with a postoperative refractory chylous leakage with a somatostatin analog. The patient was a 63-year-old man. We performed lymph node resection including the venous angle for metastatic cervical lymph node recurrence from tongue cancer. We performed conservative treatment with a ban on food and drink per os, total parenteral nutrition and applied local pressure to the neck chylous leakage. Because the neck chylous leak reached 1321 ml per day, we carried out thoracic duct ligation on the 3rd day after surgery. The chylous leak decreased temporarily after surgery, but increased again to 925 ml per day. Chylous leakage was stopped after the administration of a somatostatin analog for 5 days. We considered that the use of the somatostatin analog in addition to conservative conventional treatment and surgical treatment is one possible strategy to deal with postoperative refractory chylous leakage.抄録全体を表示PDF形式でダウンロード (503K) -
戸田 直紀, 神村 盛一郎, 堀 洋二2014 年 107 巻 7 号 p. 557-562
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありWe experienced a case of a subglottic intubation granuloma. A 75-year-old woman had been intubated for 8 days for treatment of acute myocardial infarction. The process was uneventful and she was discharged. However, about four months later, she had a severe attack of dyspnea and she was transported to the emergency department of our hospital. An endoscopic examination revealed a subglottic mass which occupied almost the whole subglottic space.Immediately intubation was performed, and subsequently we performed a tracheotomy. Microlaryngeal surgery or laryngofissure are popular for the surgical approach to subglottic tumors, but we performed endoscopic surgery via the tracheostoma using forceps and endoscopes usually used for sinus surgery. We resected a 2 cm subglottic tumor the histological assessment of which was a granuloma. We think that endoscopic surgery via a tracheostoma is very useful for subglottic and proximal tracheal lesions. We hope the technique will be applied for a variety of indications and will develop in the foreseeable future.抄録全体を表示PDF形式でダウンロード (624K) -
近藤 俊輔, 硲田 猛真, 中原 啓, 榎本 雅夫, 赤澤 幸則, 鈴木 幹男2014 年 107 巻 7 号 p. 563-567
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありWe experienced two cases of immediate allergy due to anisakis.
Case 1: A 30-year-old man ingested a boiled mackerel, two hours after which he developed urticaria and dyspnea. Six hours later, these symptoms had diminished. He consulted our hospital several days after that. He had three urticaria episodes after ingestion of mackerel. Serum Immuno CAP was positive for anisakis, but negative for mackerel or sardine.
Case 2: A 71-year-old woman ingested a boiled flatfish for dinner. The next morning she noticed pharyngeal edema and dyspnea. She came to our hospital and one day after treatment with steroids and antibiotics, her symptoms had resolved. Serum Immuno CAP was positive for anisakis.
These two cases show that, patients diagnosed as having a fish-related or idiopathic allergy should be examined for evidence of Anisakis-induced allergy.抄録全体を表示PDF形式でダウンロード (423K) -
木村 光宏, 片岡 真吾, 淵脇 貴史, 田村 優希江, 清水 保彦, 青井 典明, 佐野 千晶, 川内 秀之2014 年 107 巻 7 号 p. 569-577
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありDeep neck abscesses represent an emergency otolaryngological disease. We analyzed 25 patients with deep neck abscesses treated in our hospital between 1998 and 2009. The mean age of the patients was 58.9 years. We investigated the age, primary focus, extension of the abscess, treatment, causative bacteria and prognosis.
The cause of the deep neck abscesses was pharyngeal infection in 9 cases (36%), odontogenic infection in 5 cases (20%), peritonsillar abscess in 3 cases (12%), and a foreign body (fish bones) in 3 cases (12%). Each case of deep neck abscess was classified according to the degree of extent of infection diagnosed with CT imaging. The abscesses were localized in the upper neck space above the hyoid bone in 10 cases, extended to the lower hyoid bone in 8cases, and extended to the mediastinum in 7 cases.
As regards causative bacteria, there was a mixture of aerobic and anaerobic bacteria-related infection in 11 cases (44%). Severe single aerobic infection was seen in 9 cases(36%), and Streptococcus pyogenes (S. pyogenes) was seen in 4 cases (16%). Progression to the mediastinal space occurred in 4 cases of the mixed infection type and in 3 cases of S. pyogenes infection.
As for the sensitivity of the causative bacteria to antibacterial drugs, the anaerobic bacteria demonstrated 89% resistance to penicillin. It was thought that anaerobic bacteria produced β lactamase.
Our treatment principle for deep neck abscesses is hospitalization, followed by incision and drainage of the abscess and intravenous administration of a wide spectrum antibacterial agent.
Though there serious cases have been reported such as descending necrotizing mediastinitis and/or necrotizing fasciitis, all 25 cases we treated were successfully cured without any severe complication.抄録全体を表示PDF形式でダウンロード (1128K)
研修ノート
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酒井 修2014 年 107 巻 7 号 p. 578-579
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありPDF形式でダウンロード (332K)
メディカル･エッセイ
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―第十二編：書物でみる胃性めまい―飯沼 壽孝2014 年 107 巻 7 号 p. 581-585
発行日: 2014年
公開日: 2014/07/01
ジャーナル 認証ありIn Part 12 of this series, descriptions of vertigo in general were the main objects and stomachic vertigo was investigated in relation to vertigo in general. Galen quoted from Archiges that sympathy of the gastric opening with the brain caused vomiting and spasm. The regime of Salerno University (1480) recorded that most sympathies arose from the lesions in the stomach, liver, spleen and uterus. Other Medieval books of Willis (1684) and De La Mettre (1761) are minimally divergent from the ancient ideas. Herz (1791) described systematically and succeeded to escape from the ancient ideas. Double (1817) made several precise observations of signs and symptoms. Finally, Dejerine (1914) made a very important leap forward in that his book on neurology is still a classical must-read book. His impression of stomachic vertigo is that occasional excitations of both sensory and motor systems might give rise to types of vertigo which have nothing to do with the stomach. The year of 1861, when Menière’s labyrinthine vertigo was established, is the year which is literally evolutional for the idea of vertigo based on thousands of years of history.抄録全体を表示PDF形式でダウンロード (618K)
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