巻号一覧
前身誌
107 巻, 9 号
選択された号の論文の13件中1～13を表示しています
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論説
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鈴木 秀明, 小泉 弘樹, 北村 拓朗, 寳地 信介, 大淵 豊明, 橋田 光一2014 年 107 巻 9 号 p. 665-671
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありThe mechanism of bone resorption in middle ear cholesteatomas has been investigated over the past century. In the early and middle periods of the last century, bone resorption by cholesteatomas was explained by pressure exerted on the bone, which is currently rejected by most researchers. Since the 1980s, a diversity of cytokines, chemical mediators, and enzymes have been detected in cholesteatoma tissue, and presumed to be candidates that play pivotal roles in bone resorption in cholesteatomas. Among the candidates, interleukin-1α, tumor necrosis factor-α, and prostaglandin E2 have been most thoroughly investigated. In the 2000s, many researchers vigorously studied the regulation of osteoclasts by the RANKL/RANK/OPG system in connection with the above inflammatory products. However, the presence and participation of osteoclasts still remain unclear in human cholesteatoma lesions. Most recently, we reappraised bone resorption by acid lysis, which was first proposed in the 1950s. Hypotheses on the mechanism of bone resorption in middle ear cholesteatomas were comprehensively reviewed.抄録全体を表示PDF形式でダウンロード (391K)
カラー図説
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志賀 英明, 山田 健太郎, 山本 純平, 寺口 奏子, 三輪 高喜2014 年 107 巻 9 号 p. 672-673
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありPDF形式でダウンロード (561K)
臨床
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―伝音難聴と感音難聴，それぞれの効果と有用な評価法について―射場 恵, 熊谷 文愛, 熊川 孝三, 三澤 建, 武田 英彦2014 年 107 巻 9 号 p. 675-683
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありThe bone-anchored hearing aid (BAHA) has been used since 1977, and is currently approved for a variety of bilateral hearing loss categories including conductive hearing loss, and mixed hearing loss. The BAHA is also approved for patients with unilateral hearing loss, and this entity occupies one-third of the total number of cases.
In Japan, however, the BAHA has not been approved for patients with unilateral conductive hearing loss and single sided deafness (SSD), because no significant effect could be confirmed based on the results of a prior multi-center clinical study.
In the present study, we re-evaluated the effectiveness of BAHA for the patients with unilateral conductive hearing loss and SSD by adding new test conditions of a speech recognition test in noise and the sound localization test to those tests which were used in the multi-center clinical study.
The results of the speech recognition test in the patient with SSD showed a decrease of 16% in the score with BAHA in noise (+10 dB signal-to-noise ratio) compared in cases without BAHA, when noise was presented on the side of the patient’s poor ear and speech was presented on the side of better ear. On the other hand, in patients with unilateral conductive hearing loss, the score with BAHA increased 2% compared in cases without BAHA.
As to the result of the sound localization test, in the patient with SSD, the mean absolute error (MAE) was 45° with BAHA and 52.5° without BAHA. On the other hand, in the patient with unilateral conductive hearing loss, the MAE was 26.1° with BAHA and 36.9° without BAHA.
In other words, the effectiveness was reversed for each of the pathological conditions in the present study. We think that these results are derived from the difference of the subject’s having only one functioning inner ear in SSD but having bilateral functioning inner ears in unilateral conductive hearing loss. Therefore, the effectiveness of BAHA should be evaluated separately in patients with unilateral conductive hearing loss and SSD even in cases showing similar hearing disturbance.抄録全体を表示PDF形式でダウンロード (1144K) -
平川 治男, 多田 誠, 渡部 泰輔, 西 康行2014 年 107 巻 9 号 p. 685-688
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありSupplied-air hood respirators are used when working with abrasive blasters. The hood covers the head, neck, and upper torso, and usually includes a neck cuff. Clean air is delivered by a compressor through a hose leading into the hood. The hood is not tight-fitting. Sufficient air is provided to maintain a slight positive-pressure inside the hood relative to the environment outside the hood. In this way, an outward flow of air from the respirator will prevent contaminants from entering the hood. This positive-pressure inside the hood exerts pressure on the skin but does not usually cause subcutaneous emphysema. However, we report herein on a case of subcutaneous emphysema of the face caused by using a supplied-air hood respirator. The lift developed by the airflow between the face and the hood possibly induced the subcutaneous emphysema in spite of the positive-pressure inside the hood.抄録全体を表示PDF形式でダウンロード (608K) -
三澤 建, 武田 英彦, 熊川 孝三2014 年 107 巻 9 号 p. 689-696
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありThe middle meatal mucosa, uncinate process, infundibulum, superior meatal mucosa and sphenoethmoidal recess are the most common sites of origin of polyps. Polyps originating from the mucosa of the nasal septum are rare. We report herein on a case of bilateral nasal polyps originating from the nasal septum.
Case report: A 39-year-old woman visited our hospital complaining of nasal obstruction. The patient had lateral nasal septal polyposis which filled nasal vestibule.
She had a history of perennial allergy rhinitis and asthma. Computed tomography (CT) showed nasal septal polyposis filling the nasal pathway without bone destruction.
She was treated with a corticosteroid nasal spray, oral antihistamine therapy and oral clarithromycin therapy for 3 months but without any improvement in her symptoms.
As nasal septal polyps are a rare entity and the potential of malignant disease was considered, we performed a biopsy. Nasal polyps with an inflammatory response were diagnosed based on the histopathological examination. Endoscopic surgery was performed using a microdebrider under general anesthesia.
After surgery, the patient was treated with oral antihistamine therapy, oral steroid therapy and a corticosteroid nasal spray. At 2 weeks postoperatively, she discontinued the oral steroid use. At 6 months postoperatively, she discontinued the oral antihistamine drug.
After 24 months follow up, there was no evidence of recurrence.抄録全体を表示PDF形式でダウンロード (874K) -
山本 大喜, 松澤 真吾, 長谷川 雅世, 新鍋 晶浩, 金沢 弘美, 吉田 尚弘, 飯野 ゆき子2014 年 107 巻 9 号 p. 697-701
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありHamartomas of the tongue in children are rare. We report herein on a 3-year-old Japanese boy with a hamartoma presenting with a pink smooth surface at the middle (15×7×7 mm) and lateral edge (20×30×15 mm) of the tongue.
The tumor was apparent from birth and had increased in size as the patient grew. He felt uncomfortable when he chewed food. There was no family history of tongue tumors. There were no abnormal findings in the mouth, nose, ear, head, neck and cervical lymph nodes and the laboratory data were normal. The tumors were resected with a safe margin of 3 mm under general anesthesia. The tumor had not invaded the tongue muscle. The pathological diagnosis was hamartomatous tissue with bundles of smooth muscle fiber. The remnant tongue has been operating well for 1 year after the surgical treatment, and the tumor has shown no evidence of recurrence.抄録全体を表示PDF形式でダウンロード (642K) -
杉浦 真, 飯田 達夫, 田中 英仁, 大竹 康敬, 内木 幹人, 高橋 正克2014 年 107 巻 9 号 p. 703-708
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありPeritonsillar abscesses are the most common deep neck infection in adults, however, bilateral cases are rare. We report herein on five patients who were diagnosed as having bilateral peritonsillar abscesses. In three of the five cases, we could not at first make a diagnosis of bilateral peritonsillar abscesses, but we suspected tonsillitis based on no laterality in the appearance of the pharynx before the CT scan.
However, the CT scan in these patients showed bilateral peritonsillar abscesses. Along with intravenous administration of antibiotics, removal of the abscesses was performed by needle aspiration in one case, and incision for drainage in four cases. Interval tonsillectomy was carried out in three cases.
Enhanced CT should be considered in patients presenting with high fever, severe throat pain, high values of C-reactive protein & white blood cells, and dyspnea.抄録全体を表示PDF形式でダウンロード (624K) -
清水 顕, 小川 恭生, 髙瀨 聡一郎, 清水 重敬, 鈴木 衞2014 年 107 巻 9 号 p. 709-714
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありTreatment targeting the androgen receptor and HER-2/neu of salivary duct carcinoma has recently attracted attention, however we have encountered a patient who was double negative for androgen receptor and HER-2/neu. The patient was a 78-year-old man. Skin metastasis and cervical lymph node recurrence were noted at six months after surgery. HER-2/neu and the androgen receptor in the surgical specimen were both negative. There was no metastasis at any other site. Irradiation at 50 Gy and of DOC 35 mg/m2 every two weeks were administered. The results showed complete response. There have been an only a few reports in which CR with chemoradiation for recurrent salivary gland duct carcinoma has been achieved. In addition, neck recurrence was noted in the present case at 11 months after CR, but showed a good reaction with re-administration of the DOC. Chemoradiotherapy and chemotherapy including taxanes may be an option in treatment of double-negative cases.抄録全体を表示PDF形式でダウンロード (1049K) -
池田 雅一, 佐藤 和則, 三浦 智広, 川瀬 友貴, 鈴木 俊彦, 大森 孝一2014 年 107 巻 9 号 p. 715-720
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありSchwannomas arising from the hypostatic cranial nerve origin occasionally occur in the parapharyngeal space. These are a benign tumors caused by proliferation of neoplastic Schwann cells. However, tumor enlargement or surgical procedures may induce paralysis of the nerve of origin. Furthermore, a schwannoma in the parapharyngeal space can cause paralysis of nerves other than the nerves of origin. This event is attributed to the anatomical complexity of the parapharyngeal space.
We report herein on a case of schwannoma of the vagus nerve origin, which caused only hypoglossal nerve paralysis.抄録全体を表示PDF形式でダウンロード (915K) -
下鑪 裕子, 嶋根 俊和, 中村 泰介, 川口 顕一朗, 渡邉 彩, 藤居 直和, 池田 賢一郎, 五味渕 寛, 小林 斉2014 年 107 巻 9 号 p. 721-728
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありIn elderly patients treated with concurrent chemoradiation therapy (CCRT), complications after initiation of therapy, such as delirium, as well as adverse events such as radiation mucositis and granulocytopenia, are considered to affect the subsequent therapy completion rate and treatment effect and may also lead to a poor performance status (PS). Various factors should be taken into consideration prior to the therapy, such as complications, estimated residual function, PS, life expectancy, and the family environment, along with sufficient informed consent. This study evaluated 100 subjects, including 30 elderly patients (age, ≧70 years) and 70 non-elderly patients (age, <70 years) who underwent primary therapy (S-1, nedaplatin with CCRT; SN therapy) for head and neck squamous cell carcinoma in our hospital from January 2005 to August 2011. The following variables were clinically compared between the elderly and non-elderly groups: primary site, staging, response to treatment, therapy completion rate, recurrence rate, adverse events, PS, and complications. In the elderly group, 90% of the patients achieved complete response (CR) while the remaining 10% achieved partial response (PR), giving a response rate of 100%. In the non-elderly group, 87.1% and 12.9% of the patient achieved CR and PR, respectively, again giving a response rate of 100%. The therapy completion rate was 73.3% in the elderly and 90.0% in the non-elderly group, with recurrence rates of 6.7% and 15.7%, respectively. With regard to adverse events, in the elderly group, 73.3% of the patients experienced hematological toxicities of grade 3 or higher, and 50.0% experienced non-hematological toxicities of grade 3 or higher. In the non-elderly group, 57.1% experienced hematological toxicities of grade 3 or higher and 42.9% experienced non-hematological toxicities of grade 3 or higher. Major complications occurring after initiation of therapy were reported in 20.0% of the elderly population and in 5.6% of the non-elderly population. Significant differences between the groups were found in the therapy completion rate, incidence of adverse events, and complications after therapy initiation. These results suggest that CCRT is as effective in the elderly as it is in non-elderly patients, but applying the therapy in the elderly requires careful consideration of pre-treatment care, management of complications during therapy, and post-treatment rehabilitation.抄録全体を表示PDF形式でダウンロード (780K) -
西山 崇経, 坂本 耕二, 伊藤 文展, 新田 清一, 小川 郁2014 年 107 巻 9 号 p. 729-734
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありWhen a thyroid nodule has malignant features found by some examinations (e.g. Echo, FNAC, CT), we perform surgical resection. But if the thyroid nodule does not have malignant feature, there is still the possibility of malignancy, especially when the nodule is large. In the case of large pre-operatively benign thyroid nodules, we therefore consider a diagnostic lobectomy. There is, however, no definite recommendation how large a nodule should be before a lobectomy is performed, and how many malignancies exist in pre-operatively benign nodules. In our hospital, we consider surgical resection when the diameter of the thyroid nodule is over 3 cm. In this study, we analyze pre-operatively benign thyroid nodules in which surgical resection was performed in our hospital, how many malignant nodules there were and what the characteristics were between benign or malignant nodule. From 2005 April to 2012 June, 351 patients underwent a lobectomy in our hospital, 70 of which were pre-operatively benign thyroid nodules with diameters of over 3 cm. We analyzed the pathological findings and compared the nodule diameters, serum thyroglobulin, FNAC’s classification and some characteristics of echography between pathologically benign and malignant cases. Fifty-eight patients (83%) had pathologically benign nodules, and 12 patients (17%) had malignant nodules. In 58 benign nodules, 33 nodules (47%) were adenomatous goiter, 24 patients (34%) had follicular adenomas and 1 nodule (1%) was an atypical adenoma. In the 12 malignant patients, 8 patients (11%) had papillary adenocarcinoma and 4 patients (6%) had follicular adenocarcinoma. Almost no significant characteristics were found concerning malignancy, in diameter, serum thyroglobulin, class of FNAC and features of echography. As for complications after surgery, hypothyroidism occured in 4 patients (6%), and neither hypoparathyroidism nor vocal fold paralysis occurred. We concluded that pre-operatively benign thyroid nodule that were over 3 cm in diameter had about a 17% possibility of malignancy. Examinations may not distinguish whether such pre-operatively benign tumors are benign or malignant before surgical resection. We should therefore consider whether to perform therapeutic surgery or not in such patients.抄録全体を表示PDF形式でダウンロード (587K)
薬物
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稲川 俊太郎, 麦 雅代, 清水 崇博, 星野 哲朗, 野々垣 絵羽, 平山 肇, 内田 育恵, 谷川 徹, 小川徹也 , 植田 広海2014 年 107 巻 9 号 p. 735-741
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありIn the present study, we assessed the efficacy of cefteram pivoxil in children with moderate or more severe acute rhinosinusitis. In addition, we evaluated the efficacy of clinical scoring systems based on clinical symptoms and the condition of the individual patient. Cefteram pivoxil administered at 18 mg/kg/day showed better efficacy and rapid onset of action. Moreover, clinical scoring systems enabled us to evaluate the condition and symptoms chronologically. This result suggested that the clinical scoring systems were useful for clinical efficacy assessment in acute pediatric rhinosinusitis.抄録全体を表示PDF形式でダウンロード (670K)
研修ノート
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中村 一博2014 年 107 巻 9 号 p. 742-743
発行日: 2014年
公開日: 2014/09/01
ジャーナル 認証ありPDF形式でダウンロード (554K)
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