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108 巻, 3 号
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論説
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西野 宏2015 年 108 巻 3 号 p. 163-173
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありIn Japan, malignant tumors of the nasal-paranasal cavities account for very few of all tumors of the head and neck. Sixty-two percent of those nasal-paranasal cavity tumors consist of malignant tumors of the maxillary sinuses. The best therapeutic approach for this malignancy remains under discussion. The reason for this is that surgical excision of advanced maxillary sinus carcinoma often entails complicated resections, such as that of the orbital contents, facial skin and oral palate. Given this background, attempts are being made to design a multidisciplinary approach to the treatment of maxillary sinus carcinoma with the objective of obtaining both cure and function. The multidisciplinary approach includes low-dose radiotherapy, intra-arterial infusion of anticancer agents and surgical excision with a minimum safety margin. This paper reports on the indications and methodology of multidisciplinary therapy for maxillary sinus carcinoma currently being applied by the Department of Otolaryngology - Head and Neck Surgery of Jichi Medical University. The 5-year over-all survival rates and local control rates for squamous cell carcinoma were 73% and 72%, respectively. For only squamous cell carcinoma cases, the 5-year local control rates as a function of the T classification were 71% for T2, 88% for T3, 60% for T4a and 56% for T4b. Among patients with middle skull base involvement, local recurrence of carcinoma in the base of the skull occurred in 1 of the 9 patients with invasion to the round foramen, 1 of the 3 patients with invasion to the oval foramen and 2 of the 3 patients with invasion of the the lacerate foramen.抄録全体を表示PDF形式でダウンロード (1456K)
カラー図説
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野村 泰之, 鴫原 俊太郎, 池田 稔, 大島 猛史2015 年 108 巻 3 号 p. 174-175
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありPDF形式でダウンロード (527K)
臨床
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山中 昇2015 年 108 巻 3 号 p. 177-186
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありWe conducted an epidemiological survey of patients with acute otitis media (AOM) and evaluated the effects of use of the protein-conjugated pneumococcal vaccine (PCV7) and of the newly developed antimicrobials tosufloxacin (TFLX) and tebipenem pivoxil (TBPM-PI) on the incidence of AOM and the frequency of myringotomy in Japan. The 7-year study between 2007 and 2013 was based on the Japan Medical Data Center (JMDC) Claims Database of neonates to children less than 15 years old. The number of AOM patients did not change significantly during the study period. On the other hand, the myringotomy rate showed a significant decline over time after 2010. In Japan, large-scale PCV7 vaccination was started in 2011 under public assistance, and the newly developed antimicrobials TFLX and TBPM-PI were introduced in the market in 2009 and 2010, respectively, before the large-scale PCV7 vaccination initiative was launched. The major antimicrobial agents used for AOM are amoxicillin, cefditoren pivoxil, and amoxicillin clavulanate, and rate of use these drugs did not change during study period. On the other hand, the number of prescriptions for TFLX and TBPM-PI increased over time, and also, the number of prescriptions for these drugs showed a significant negative correlation with the myringotomy rate. Based on this evaluation, while adoption of PCV7 vaccination may not have had a strong influence on the incidence of AOM or the myringotomy rate in Japan, wider use of the newly developed antimicrobials TFLX and TBPM-PI appears to have played an important role in the decline of the myringotomy rate over time.抄録全体を表示PDF形式でダウンロード (1135K) -
加藤 理紗, 杉本 寿史, 伊藤 真人, 吉崎 智一2015 年 108 巻 3 号 p. 187-190
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありWe report herein on a rare case of schwannoma of the chorda tympani with facial palsy. A 34-year-old woman was referred to our hospital because of right facial palsy which was resistant to steroid intervention and anti-viral drugs. In the physical examination, a white mass was observed in the posterior superior quadrant of the tympanic membrane and the facial palsy score was 0/40. Computed tomography revealed a tumor in the right chorda tympani, extending from the branch of facial nerve to the malleus. Based on the physical, physiological and imaging tests, the patient was diagnosed as having a tumor of the right chorda tympani with facial palsy. For the purpose of resection and definitive diagnosis of the tumor, a surgical intervention was performed. Histologically the tumor was diagnosed as a schwannoma, and immunohistochemically the tumor cells were positive for S-100. After surgery, the patient’s facial palsy completely resolved in six weeks. There has been no finding of recurrence two years after surgery.抄録全体を表示PDF形式でダウンロード (545K) -
能田 淳平, 佐伯 忠彦, 大河内 喜久, 渡辺 太志2015 年 108 巻 3 号 p. 191-199
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありWe investigated the data of 489 patients with epistaxis who visited our hospital between 2009 and 2013. Epistaxis was more frequent in males (298 cases) than in females (191 cases).
The mean age was 57.1 years, with the largest number of patients were in their 70s, 60s and 50s, in that order. Epistaxis occurred more often in the winter and spring, with a significantly lower number of patients in the summer and autumn. The most frequent onset time was in the morning from 6 am to 8 am. The sites of bleeding were Kiesselbach’s area (50.7%), followed by unidentifiable site (25.2%), nasal septum (11.5%), inferior meatus and turbinate (7.4%), and middle meatus and turbinate (3.7%). Of all the patients, 42.7% were treated by electrical coagulation with or without a rigid endoscope, 40.5% were managed by observation, and 16.6% by gauze packing. Of the 489 patients, 48 (9.8%) required hospitalization, and re-bleeding occuered in 64 (13.1%) cases. The major underlying disease was hypertension (32.5%), while 25.8% of all cases were receiving anticoagulant therapy.
It is most important to identify the bleeding site by flexible fiberoptic and/or rigid endoscopy. Electrical coagulation with a rigid endoscope was a very useful procedure in the treatment of epistaxis, especially that occurring from the posterior part of the nasal cavity.抄録全体を表示PDF形式でダウンロード (974K) -
岡宮 智史, 宮下 元明, 室井 昌彦, 平戸 純子, 近松 一朗2015 年 108 巻 3 号 p. 201-205
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありWe report herein on a rare case of a retropharyngeal abscess associated with infectious mononucleosis. A 7-year-old girl was admitted with symptoms of severe sore throat and dyspnea. Under an initial diagnosis of retropharyngeal abscess, we performed tonsillectomy of the left palatine tonsil and drainage of the abscess, and the patient recovered steadily. Unexpectedly, the resected tonsil revealed a pathological finding of acute Epstein-Barr virus infection which led us to reach a final diagnosis of retropharyngeal abscess associated with infectious mononucleosis.
Abscesses around the pharynx rarely occur concomitantly with acute Epstein-Barr virus infection. We must analyze the specific features of infectious mononucleosis in detail to reach the precise diagnosis of Epstein-Barr virus infection obscured by severe bacterial infections.抄録全体を表示PDF形式でダウンロード (695K) -
貴田 紘太, 藤井 隆, 喜井 正士, 鈴木 基之, 音在 信治, 須川 敏光, 北村 公二, 金村 亮, 小池 良典2015 年 108 巻 3 号 p. 207-212
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありPleomorphic adenomas most commonly arise in the major salivary glands and rarely in the larynx. We report herein on a case of pleomorphic adenoma of the larynx. A 65-year-old female complained of hoarseness for 6 months. Laryngoscopy revealed a tumor located under the mucosa of the left false vocal cord. Tumor resection was performed via an external approach. The tumor was 24×21×13 mm in diameter and consisted of a white solid mass. The histological diagnosis was pleomorphic adenoma. More than 4 years after surgery, the patient has shown no evidence of recurrence and no subjective symptoms. According to the anatomical location, we considered that the tumor had arisen from the laryngeal glands in the laryngeal ventricle. To treat pleomorphic adenomas of the larynx, surgical resection is primarily recommended. An external approach through the thyrohyoid membrane was selected because we thought it was possible to exfoliate the tumor easily from the surrounding tissue and transoral resection was difficult based on the size, location and shape.抄録全体を表示PDF形式でダウンロード (931K) -
山田 光一郎, 田中 信三, 平塚 康之, 隈部 洋平, 渡邉 佳紀, 吉田 尚生2015 年 108 巻 3 号 p. 213-220
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありObjective: Papillary thyroid carcinoma (PTC) is generally well-recognized as having a good prognosis. However, there are some cases in which the tumor becomes life-threatening for the patient. The aim of this study was to detect high-risk factors in PTC patients.
Patients and Methods: The study included 225 patients (mean age 57.0±14.6 years, 45 men and 180 women, mean follow-up 12.3±4.8 years) who underwent surgical treatment at Osaka Red Cross Hospital between 1991 and 2005. TNM classification and staging were based on the UICC 7th classification. Sixty-three patients were classified as T1–2, 121 as T3, and 41 as T4. One hundred six patients were classified as N0, 57 as N1a, and 62 as N1b. A total of 220 patients were classified as M0 and 5 patients as M1. Seventy-two patients were classified as stage I–II, 77 as stage III, and 76 as stage IV. Overall survival and disease-specific survival rates were calculated by the Kaplan-Meier method and were compared using the log-rank test.
Results: Eighteen patients died from PTC. The overall 10-year survival rate was 88.6%, and the 15-year survival rate was 74.4%. The disease-specific 10-year survival rate was 95.7%, and the 15-year survival rate was 91.3%. Univariate analysis revealed age (≧50), T4, N1b, M1 and stage IV were significant risk factors. T4, N1b and M1 were significant risk factors, based on the multivariate analysis.
Conclusion: PTC generally had a good prognosis. Age (≧50), T4, N1b, and/or M1 at diagnosis showed a clearly lower disease-specific survival. Multivariate analysis revealed T4, N1b and M1 were significant risk factors.抄録全体を表示PDF形式でダウンロード (478K) -
青井 二郎, 弘瀬 かほり, 小林 泰輔, 兵頭 政光2015 年 108 巻 3 号 p. 221-227
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありSalivary duct carcinoma (SDC) is a highly malignant salivary gland tumor. Because of its low incidence, it has been impossible to standardize the optimal treatment strategies for SDC including adjuvant systemic therapy. Recently, it has been reported that SDC resembles mammary ductal carcinoma (DC). Over-expression of human epidermal growth factor type-2 (HER-2) protein has been shown in SDC as in mammary DC. We report herein on a successful treatment experience for a patient with advanced SDC using trastuzumab, a humanized monoclonal antibody.
A 56-year-old male was hospitalized with lumbalgia. Radiological examination indicated a tumor in the right accessory parotid gland and multiple metastatic tumors in the left skull base, ribs, lumbar vertebrae and sacral bone. Incisional biopsy of the right accessory parotid gland revealed SDC. Immunostaining for HER-2 was highly positive. He underwent concurrent radiation- and chemoradiotherapy (intensity-modulated radiotherapy [IMRT 60 Gy], nedaplatin and docetaxel), which resulted in a poor response. Thereafter, trastuzumab was administered. He obtained a significantly effective response after 8 courses of treatment for the metastatic lesions.
In contrast to previous reports of a poor response to chemotherapy and poor survival rate of patients with SDC, our patient demonstrated that trastuzumab was a highly effective modality as a therapeutic choice for SDC.抄録全体を表示PDF形式でダウンロード (894K) -
春日井 滋, 渡辺 昭司, 赤澤 吉弘, 深澤 雅彦, 三上 公志, 齋藤 善光, 阿久津 征利, 肥塚 泉2015 年 108 巻 3 号 p. 229-235
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありRadical neck dissection (RND) has been used as a standard operative technique in the surgical management of lymph node metastases from head and neck cancer. To improve patients’ quality of life (QOL), various modifications to RND have been proposed. Several studies have demonstrated that spinal accessory nerve (SAN) damage causes deterioration of the QOL, and rehabilitation of the shoulder is very important in the recovery process after such surgical procedures. Also, lack of rehabilitation in the early stage after surgery leads to severe stiffness and constriction in the neck and shoulder not only in cases where the SAN was cut, but also where it was preserved.
We analyzed the presence or absence of significant differences before and after rehabilitation with regard to shoulder function, stiffness and constriction, focusing on whether the SAN was preserved or not, and how long after surgery rehabilitation was started.
We divided 29 patients into two groups, one of which was the group of 21 cases in 17 patients in whom the SAN was preserved in 16 and resected in 5. In this group, rehabilitation was started at an early stage after the surgery (group A). The other group was comprised of 18 cases in 12 patients, with SAN preservation in 7 and resection in 11, and in whom rehabilitation was started more than six months after surgery (group B). Those two groups were analyzed regarding range of motion (ROM) and a pain questionnaire.
In group A, flexion and abduction of ROM angles and the pain score significantly improved after rehabilitation, compared to group B. In those patients in group A in whom the SAN was preserved, the rehabilitation results was significantly better than those in the non-preservation group. On the other hand, no significant difference was found between these subgroups of patients in group B. When the SAN-resection cases were compared between groups A and B, improvement in the ROM data was seen after the rehabilitation in group A.
Rehabilitation should be begun in the early stage after neck dissection no matter whether the SAN was preserved or not.抄録全体を表示PDF形式でダウンロード (1221K) -
中島 正己, 加瀬 康弘, 関根 達朗2015 年 108 巻 3 号 p. 237-241
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありPrimary nasopharyngeal Hodgkin lymphoma (HL) is a rare, but important differential diagnosis of nasopharyngeal tumors. If not diagnosed early and correctly, it may cause life-threatening complications and be difficult to treat. We report the case of a patient with nasopharyngeal tumor, in whom the diagnosis of primary nasopharyngeal HL was established by partial resection. We also provide a review of published reports on primary nasopharyngeal HL. A 32-year-old Japanese man presented to us with the chief complaint of nasal obstruction, which was diagnosed as being caused by a nasopharyngeal tumor. The nasopharyngeal tumor biopsy was negative, therefore, partial resection of the nasopharyngeal tumor was performed. Histopathological examination of the resected specimen showed Reed-Sternberg cells and immunohistochemistry showed positive staining for CD30, which confirmed the diagnosis of classical HL, mixed cellularity type. He was treated by involved field radiation therapy (IFRT) alone, to avoid azoospermia. Until now, 10 months since the completion of treatment, good local control is maintained. Nasopharyngeal HL should be included in the differential diagnosis of a nasopharyngeal mass and may be diagnosed by partial resection in the event of failure of diagnosis at the initial biopsy.抄録全体を表示PDF形式でダウンロード (785K) -
石原 久司, 牧原 靖一郎, 宮武 智実, 津村 宗近, 假谷 伸2015 年 108 巻 3 号 p. 243-247
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありLongus colli calcific tendinitis is a secondary inflammation caused by the deposition of hydroxyapatite crystal in the longus colli tendon. It causes acute neck pain, limitations of neck movement and swallowing pain. The symptoms are usually resolved in 1 to 2 weeks when treated with analgesics and anti-inflammatory medications. A 45-year-old man visited our hospital with a complaint of severe neck pain and stiffness despite 3 days of therapy with loxoprofen prescribed by the first doctor he visited. Computed tomography (CT) imaging showed small calcification localized at the anterior C1-C2 level and a low density area in the retropharyngeal space without ring enhancement. A definitive diagnosis of longus colli calcific tendinitis was made. Cimetidine (100 mg twice daily) was added to his loxoprofen dosage. His neck pain improved remarkably in one day after commencing cimetidine treatment. And 3 days after starting the treatment his neck could be moved without limitation. On day 11 of the treatment, CT imaging showed reduction in the calcified deposit, and he was already completely asymptomatic. Cimetidine is an H2 receptor antagonist, and has been used for treatment of gastric ulcers. Furthermore, many studies have reported the treatment efficacy of cimetidine on calcific tendinitis of the shoulder. However, few studies have yet been reported on the longus colli tendon. Our report suggests that cimetidine may be effective against calcific tendinitis of the longus colli tendon as well as the shoulder. Because of the severe pain associated with this condition, patients often take large doses NSAIDs and need to be prescribed an anti-ulcer agent. In such a case, cimetidine may deserve consideration.抄録全体を表示PDF形式でダウンロード (558K)
研修ノート
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―甲状腺機能低下について―中島 寅彦2015 年 108 巻 3 号 p. 248-249
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありPDF形式でダウンロード (197K)
メディカル・エッセイ
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―耳鳴の治療研究に殉じた19世紀の耳科医―北原 正章2015 年 108 巻 3 号 p. 251-254
発行日: 2015年
公開日: 2015/03/01
ジャーナル 認証ありJoseph Toynbee, the father of otology in England, was born in 1815. He was still under 30 when he was elected as a Fellow of the Royal Society in 1842. On July 7, 1866, he subjected himself to the tinnitus test with fatal result. The Nineteenth Century was a time realized in otology that therapeutic progresses depended on the knowledge of pathology. In this paper, Toynbee’s devotion to otology during this period is described.抄録全体を表示PDF形式でダウンロード (395K)
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