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108 巻, 9 号
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論説
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堤 剛2015 年 108 巻 9 号 p. 661-666
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありFor the management of patients complaining of vertigo, less-invasive treatments should initially be selected. However, failure of conservative treatment necessitates consideration of more invasive procedures. These managements sometimes include surgical measures, which could be associated with some complications.
For benign paroxysmal positional vertigo, canal plugging surgery may be a valid treatment option. In the case of Meniere’s disease, ventilation tube insertion, endolymphatic sac decompression, intratympanic gentamicin injection, vestibular neurectomy and vestibulotomy can be used for critical cases. In cases with superior canal dehiscence, surgical treatment (re-surfacing of middle cranial fossa and anterior semi-circular canal plugging) is the only treatment option that offers the opportunity for resolution of symptoms. Recently, surgery for small tumors of the cerebellopontine cistern have tended to be avoided, although certain cases do need surgery. Devices to compensate for vestibular deficit, some of which need surgical device insertion, are also under research and development. It is necessary for physicians to be aware about the treatment options, including surgical procedures, with their benefits and risks, for appropriate treatment of vertigo. At the same time, we should be cautious about the selection, evaluation and establishment of surgical treatment procedures.抄録全体を表示PDF形式でダウンロード (544K)
カラー図説
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渡邊 健一2015 年 108 巻 9 号 p. 668-669
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありPDF形式でダウンロード (451K)
臨床
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玉木 望, 佐久間 康徳, 山下 ゆき子, 丹羽 一友, 折舘 伸彦2015 年 108 巻 9 号 p. 671-677
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありThe incidence of syphilis has decreased remarkably after the appearance of penicillin.
On the other hand sometimes we still see syphilis cases that were infected via sexual behavior. Very few of them manifest hearing impairment and vertigo like Meniere’s disease. We report herein on the case of an otosyphilis patient.
A 29-year-old man was referred to our department in order to evaluate bilateral progressive hearing impairment. Hearing loss in his right ear and left ear occurred suddenly 2 weeks previously and 1 week previously, respectively. On pure tone audiometry the patient showed mild and sensorineural hearing loss in the left and right ear, respectively. No rash was seen anywhere on his body. The serological and spinal fluid examinations were syphilis positive and the patient was diagnosed as having neurosyphilis. He was prescribed a 9-day course of betamethasone disodium phosphate and 14-day course of doxycycline. The hearing impairments in both of his ear improved partially. This case suggests that we must think of otosyphilis in patients with progressive bilateral hearing impairment.抄録全体を表示PDF形式でダウンロード (765K) -
高橋 正克, 内木 幹人, 杉浦 真, 大竹 康敬, 田中 英仁, 後藤 聖也2015 年 108 巻 9 号 p. 679-684
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありCarcinoma of the external auditory canal are a relatively uncommon entity, accounting for only 1% of all head and neck carcinomas, and the management of this tumor type is not fully established. The aim of this study was to analyze clinical outcomes following lateral temporal bone resection (LTBR) for external auditory canal carcinomas.
Between 1994 and 2012, we performed LTBR for 10 patients. The histopathological types were squamous cell carcinoma in 5 cases, adenoid cystic carcinoma in 3 cases and basal cell carcinoma in 2 cases. The clinical stages were T1 in 8 cases, T2 in a case and T3 in a case.
In the T3 case the temporo-mandibular joint (TMJ) was surgically resected via a transcranial approach because of tumor invasion of the TMJ. The resected tumor in all cases demonstrated a pathologically tumor-free margin. Two patients underwent post-operative radiotherapy because of the risk of recurrence: in one case because of a histologically diagnosed closed-surgical margin and in the case for an intraoperative cut-in into the tumor. The disease-specific 5-year survival rate was 100% using the Kaplan-Meier method.
This study revealed that LTBR is a good indication for the initial treatment of external auditory canal carcinomas in the early stages. Furthermore, it showed that postoperative radiotherapy is recommended for the cases with high risk of recurrence.抄録全体を表示PDF形式でダウンロード (282K) -
栢野 香里, 鯉田 篤英2015 年 108 巻 9 号 p. 685-691
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありPleomorphic adenomas occurring in the external auditory canal are very rare benign tumors, accounting for only 2–3% of benign tumors in this canal. A 29-year-old male visited our hospital with left ear fullness as the chief complaint. The left external auditory canal was filled with a tumor arising from the posterosuperior wall. Temporal bone CT showed a mass obstructing the left external auditory canal but no bone destruction or tumor extension to the middle ear cavity. Biopsy suggested a ceruminous or pleomorphic adenoma. The tumor was excised under local anesthesia using an endaural approach. The skin defect of the external auditory canal after the excision was covered with fibrin glue and a polyglycolic acid (PGA) sheet. The tumor (13×10 mm) was pathologically diagnosed as a pleomorphic adenoma originating from the ceruminous (apocrine) gland, and the surgical margin was negative. His postoperative course was favorable, showing epithelialization of the skin defect of the external auditory canal at about 1 month.
There are two theories concerning the origin of pleomorphic adenomas of the external auditory canal: they originate from myoepithelial cells of the ceruminous (apocrine) gland or from aberrant parotid gland tissue. Since this patient showed ceruminous glands around tumor cells but no parotid gland structures, the tumor was considered to be of ceruminous gland origin. The first treatment choice is surgery. In this patient, the tumor could be excised using an endaural approach that is minimally invasive. A PGA sheet was useful for wound healing in the external auditory canal and the prevention of scar contracture after tumor excision.抄録全体を表示PDF形式でダウンロード (1120K) -
嘉藤 秀章, 深美 悟, 伊藤 真人2015 年 108 巻 9 号 p. 693-698
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありFibrous dysplasia of the temporal bone (FDTB) is a rare clinical entity, the most common clinical manifestations of which are conductive hearing loss and secondary ear canal cholesteatoma caused by stenosis of the external auditory canal (EAC). Surgical intervention is appropriate in cases with functional deficits (such as conductive hearing loss) or complications (such as secondary cholesteatoma formation), however, postoperative re-stenosis of the EAC is observed at a high frequency. We present the case of a patient with FDTM in whom, despite canalplasty being performed four times during childhood, the lesion was slowly progressive and re-stenosis occureed 20 years after the last surgery. The female patient presented to our hospital with conductive hearing loss and canal cholesteatoma caused by stenosis of the EAC at the age of 40 years. Canal wall down tympanomastoidectomy and canalplasty were performed, and the extended ear canal was covered with normal bone paste and the temporalis fascia. Because FDTB is a slowly progressive benign bone lesion, complete resection is not necessary, however, a canal wall down approach with tympanomastoidectomy is recommended in cases in which the lesion extends into the middle ear and mastoid cavity.抄録全体を表示PDF形式でダウンロード (2262K) -
小林 隆一, 宮崎 総一郎, 森 望2015 年 108 巻 9 号 p. 699-702
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありAmong adults with obstructive sleep apnea (OSA) who required nasal continuous positive airway pressure (n-CPAP) ventilation treatment, we performed cauterization of the inferior turbinate by an argon plasma coagulation system® in 27 patients with hypertrophic rhinitis who complained of nasal obstruction. After the surgery, the nasal resistance decreased significantly from 0.42±0.28 to 0.22±0.13 Pa/cm3/sec (P<0.001). The score for sleepiness in the Japanese version of the Epworth Sleepiness Scale (JESS) decreased significantly from 10.6±4.2 to 6.0±3.0 (P<0.001). Furthermore, the nasal surgery improved the adherence to the n-CPAP treatment. Cauterization of the inferior turbinate is a minimally invasive surgery and effective as an adjuvant therapy for n-CPAP.抄録全体を表示PDF形式でダウンロード (559K) -
小野 英莉香, 山村 幸江, 野中 学, 吉原 俊雄2015 年 108 巻 9 号 p. 703-708
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありRenal cell carcinoma can metastasize to any part of the body, and recurrences and/or metastases of this tumor have been reported even after a long interval from the initial therapy. We report two cases of renal cell carcinoma with metastasis to the head and neck region.
The patient was a 51-year-old male who had undergone left nephrectomy for renal cell carcinoma. Five years later, he presented with nasal obstruction and epistaxis. A solitary tumor in the epipharynx was surgically removed; histopathology of the resected specimen revealed the diagnosis of metastatic renal cell carcinoma.
The other patient was a 61-year-old male who had undergone left nephrectomy for a renal cell carcinoma. Twenty years later, he noticed a swelling in the right parotid gland region that was surgically removed; histopathological examination of the resected specimen revealed the diagnosis of metastatic renal cell carcinoma.
Until date, 18 cases of parotid gland metastasis have been reported in the literature, however, there have been no reports yet of epipharyngeal metastasis. Metastasis from renal cell carcinoma should be included in the differential diagnosis of head and neck tumors, even if a long time has elapsed after treatment of the primary lesion.抄録全体を表示PDF形式でダウンロード (2016K) -
牧瀬 高穂, 大堀 純一郎, 宮下 圭一, 井内 寛之, 黒野 祐一2015 年 108 巻 9 号 p. 709-712
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありThe purpose of this study was to clarify the usefulness of the MCFP (mucosal defect covered with fibrin glue and polyglycolic acid sheet) technique in elderly patients undergoing partial glossectomy. The subjects were patients aged over 70 years old with tongue cancer who underwent partial glossectomy at our hospital between 2007 and 2014. The patients were divided into the simple suture group, consisting of patients who underwent partial glossectomy before 2010, and the MCFP group, consisting of patients who underwent partial glossectomy after 2010. We compared the length of hospital stay, duration of analgesic use and the interval until resumption of oral intake after the surgery. The interval until resumption of oral intake and the length of hospital stay were similar in the two groups. However, the duration of analgesic use was significantly shorter in the MCFP group than in the simple suture group. It is possible that the postoperative pain was less severe in the MCFP group, since the surgical wound surface was coated with glue and there was no added tension as in the simple suture group. Physiological functions, including renal function, are knowns to be deteriorated in elderly patients, therefore, the shorter duration of analgesic use after surgery in the MCFP group may be of relevance to avoid drug-induced renal dysfunction in patients undergoing glossectomy.抄録全体を表示PDF形式でダウンロード (341K) -
小山 哲史, 藤原 和典, 福原 隆宏, 竹内 英二, 北野 博也2015 年 108 巻 9 号 p. 713-718
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありBackground:
Concurrent chemoradiotherapy is one of the standard treatment for locally advanced head and neck cancer. Cisplatin is the most feasible regimen of concurrent chemoradiotherapy. However the clinical response has been less satisfactory favorable.
The favorable efficacy of chemotherapy with cisplatin and docetaxel, 5-FU (TPF) as induction chemotherapy for head and neck cancer have been reported. However the feasibility of concurrent chemoradiotherapy with TPF has been sparsely reported and has had many limitations. The purpose of this study was to identify the feasibility of TPF concurrent chemoradiotherapy.
Materials & Methods:
We retrospectively analyzed 60 head and neck cancer patients treated with definitive concurrent TPF chemoradiotherapy. We investigated the treatment completion rate, adverse events, average relative dose intensity, and causes of dose reduction.
Results:
The treatment completion rate was 98.3% and ARDI was 70%. Hematological adverse events over Grade 3 were observed as leukopenia 60.9%, neutropenia 60%, anemia 11.8%, and thrombocytopenia 6.4%. Febrile neutropenia was observed as 16.4% patients however no treatment related death was observed.
Conclusion:
Concurrent chemoradiotherapy with TPF was a feasible treatment for head neck cancer. We should continuously investigate the efficacy of this treatment.抄録全体を表示PDF形式でダウンロード (470K) -
小林 正史, 吉村 豪兼, 市瀬 彩, 塚田 景大, 海沼 和幸, 岩崎 聡, 宇佐美 真一2015 年 108 巻 9 号 p. 719-723
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありMyoepitheliomas are an uncommon tumor of the salivary gland. In this study, we report on a case of myoepithelioma of the larynx, which was extremely rare.
The patient, a 49-year-old female, presented initially with hoarseness. A submucosal tumor of the right false vocal cord was revealed. She was diagnosed as having myoepithelioma of the larynx based on the biopsy findings. She underwent surgery, a laryngofissure under temporary tracheostomy, with fat reconstruction for the deficit of the right vocal cord. Eighteen months follow-up showed no recurrence and a good functional result.
To our knowledge, this paper described the fourth reported case. We identified the surgical points and suggest the usefulness of fat reconstruction for a laryngofissure.抄録全体を表示PDF形式でダウンロード (605K) -
田村 理恵, 清水 顕, 鈴木 衞2015 年 108 巻 9 号 p. 725-731
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありThere are few reports of small cell carcinoma originating in the nasal and paranasal cavity, but in this paper, we report on a case we experienced, in which small cell carcinoma developed around the ethmoidal sinus.
A 57-year-old male with the major complaint of a left nasal obstruction and epistaxis consulted with his local doctor, and because a hemorrhagic mass filling the nasal cavity was observed, he was referred to our department. CT imaging showed a tumorous lesion was seen accompanying a contrast effect from within the anterior cranium to the nasal cavity. As a result of the biopsy, small cell carcinoma of the nasal cavity (T4bN0M0) was diagnosed, and treatment commenced.
We believed that it was impossible to avoid bilateral visual organ disorder, and after chemotherapy using irinotecan and cisplatin radiotherapy was concomitantly administered only after the tumor had shrunk.
In the imaging after treatment, because there was a possibility of there being some residual tumor, a PR (partial response) was determined, and for the purpose of evaluation, navigation accompanying an endoscopic biopsy was performed. For the right calcified portion, there were findings only of growth of fragmentary bone tissue, granulation tissue and blood vessels, and there were no obvious malignant findings, so from the above, the treatment results were judged to be pathological CR (complete response).抄録全体を表示PDF形式でダウンロード (1007K)
研修ノート
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―顔面神経本幹の同定方法を中心に―寺田 哲也2015 年 108 巻 9 号 p. 732-733
発行日: 2015年
公開日: 2015/09/01
ジャーナル 認証ありPDF形式でダウンロード (793K)
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