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109 巻, 1 号
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論説
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伊藤 壽一2016 年 109 巻 1 号 p. 1-5
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありThere are many excellent innovative basic studies from universities, institutes and hospitals in Japan. However, fundamental studies are not necessarily tied to clinical practice. It is sometimes difficult to use the latest medicine that has been already put to practical use abroad.
We have discussed the strategy to connect advanced technology with practical use on several occasions. In this paper the structure and process of clinical trials and advanced medical care will be introduced.抄録全体を表示PDF形式でダウンロード (1668K)
カラー図説
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白馬 伸洋2016 年 109 巻 1 号 p. 6-7
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありPDF形式でダウンロード (372K)
臨床
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柳 絵里子, 岸 俊行2016 年 109 巻 1 号 p. 9-15
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありHerein, we report the case of a 57-year-old woman diagnosed as having steroid-responsive sensorineural hearing loss who presented to us with nystagmus of many patterns. The major symptoms were bilateral hearing loss, tinnitus, and vertigo. Laboratory findings revealed increased serum levels of rheumatoid factor, IgG, IgM, and MMP-3, however, the patient had no other evidence of immune disorders or autoimmune disease. The symptoms improved after treatment with prednisolone. Based on this improvement with steroid treatment, the diagnosis of steroid-responsive sensorineural hearing loss was made, although association of vestibular dysfunction and absence of other evidence of immune disorders are rare with this disease. Patterns of nystagmus are different respectively. Nystagmus is only right direction, left direction, or combined right and left direction. The patient developed recurrence soon after discontinuation of the steroid, suggesting that the steroid should be tapered gradually in such cases, similar to the case in patient with autoimmune diseases.抄録全体を表示PDF形式でダウンロード (1349K) -
塚田 弥生, 丸山 裕美子2016 年 109 巻 1 号 p. 17-21
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありActinomycosis is an unusual inflammatory disease caused primarily by Actinomyces israelii, a Gram-positive anaerobic bacterium. The disease is characterized by board-like swelling with unclear borders, and multiple abscesses; since the swelling can have similar characteristics to those of malignant tumors, the diagnosis can be difficult.
We report one case of actinomycosis of the maxillofacial region associated with carious teeth and chronic osteomyelitis of the mandible.
The patient, an 88-year-old woman, complained of a swelling in the right maxillofacial region with pain and trismus. Purulent parotitis was suspected and treatment was started with a cephem antibiotic. However, the refractory parotitis became worse, with the formation of multiple abscesses in the parotid gland and destruction of the cheek skin. While histopathological examination revealed no evidence of malignancy and pus culture from the cheek abscess showed no significant bacterial growth, Actinomyces was detected on gram’s staining of the pus smear, and the two carious teeth, which were associated with chronic osteomyelitis and destruction of mandible in on the right side, were considered as the source of the infection. The carious teeth were extracted.
The patient was treated with oral AMPC for 4 months, and has since shown no evidence of recurrence of the infection.
Since the characteristics of the lesions in actinomycosis can be similar to those of malignant tumors and the condition is refractory to general treatments given for bacterial infections, it is important for clinicians to make a precise diagnosis of actinomycosis and provide prompt and appropriate treatment.抄録全体を表示PDF形式でダウンロード (522K) -
北村 貴裕, 竹林 宏記2016 年 109 巻 1 号 p. 23-27
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありWe report the case of a patient with allergic fungal rhinosinusitis presenting with vision loss. A 49-year-old man presented to the JCHO Osaka Hospital with acute loss of vision in the right eye. Computed tomography showed bony erosion of the right lateral wall of the Onodi cell, close to the optic canal. Emergent endoscopic sinus surgery was performed. Histopathology revealed eosinophilic mucin in the Onodi cell and the sphenoid sinus. The optic canal was not detected due to the edematous mucosa. After the operation, the patient was treated with a systemic steroid for about 1 month. Based on the clinical and histopathological findings, the patient was diagnosed as a case of allergic fungal rhinosinusitis. With treatment, eventually, the visual loss improved.
Histopathological examination is necessary to confirm the diagnosis of allergic fungal rhinosinusitis. Therefore, when endoscopic sinus surgery is perfoemed, the mucin should be examined to confirm its allergic nature. This disease often recurs, therefore postoperative observation is important.
While no cases of allergic fungal rhinosinusitis presenting with acute blindness have been reported previously from Japan, about 20 cases have been reported from foreign countries. The lesions in this condition mainly involve the sphenoid sinus, orbital apex and the cavernous sinus. No cases with Onodi cells have been reported. We have reported a prevalence of Onodi cells of 26% in our report, and of a pneumatized anterior clinoid process in the Onodi cells of 30%. We need to be aware of the presence of Onodi cells and pneumatized anterior clinoid processes so as to prevent damage to the optic canal.抄録全体を表示PDF形式でダウンロード (504K) -
松本 信, 青柳 安典, 秋月 浩光2016 年 109 巻 1 号 p. 29-33
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありLemierre syndrome is a life-threatening disease characterized by infectious thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection, and is frequently associated with multiple septic emboli and/or abscess formation in distant organs.
We describe the case of a previously healthy 17-year-old male patient who was admitted to our hospital with fever and chills, and sore throat caused by a peritonsillar abscess. Computed tomography showed thrombosis in the left internal jugular vein and numerous small nodules in both lungs. Based on these findings, the patient was diagnosed as having Lemierre syndrome. He was treated successfully with 6 weeks of antibiotic therapy and 4 weeks of anticoagulant therapy. The pus culture grew Fusobacterium necrophorum.抄録全体を表示PDF形式でダウンロード (569K) -
加納 孝一, 宮本 俊輔, 中山 明仁, 岡本 牧人2016 年 109 巻 1 号 p. 35-40
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありCancer of the nasal cavity is a rare tumor of the head and neck region. In general, multidisciplinary treatment is employed, including chemotherapy, radiation therapy and surgery. Surgical resection often results in defects of the external nose, which causes a significant deterioration of the quality of life. We report on the case of an elderly patient over 90 years old who underwent resection of cancer of the nasal cavity and successful reconstruction using a median forehead flap.
A 92-year-old woman visited us with the complaint of a nasal mass. Biopsy of the tumor revealed the diagnosis of squamous cell carcinoma. CT examination revealed a mass lesion in the left nasal cavity. Although we initially administered radiation therapy considering the age of the patient, the tumor showed little response to the irradiation. Therefore, we planned less-invasive surgery with simple reconstruction of the nasal defect after sufficient tumor resection. Consequently, the surgery was performed three weeks after completion of the radiotherapy and we utilized a median forehead flap for the one-stage reconstruction. The surgical time was 140 minutes and there were no postoperative complications. The patient remained alive and in good health until the age of 100. She and her family were satisfied with the cosmetic and functional results during the seven and a half years of life after the surgery.
Reconstruction using a median forehead flap is an easy and less-invasive technique. Therefore, it is a valid option for the reconstruction of the nasal defects, and is especially suitable for patients of advanced age with complications.抄録全体を表示PDF形式でダウンロード (1038K) -
井手 慎介, 後藤 隆史, 松田 圭二, 鳥原 康治, 東野 哲也2016 年 109 巻 1 号 p. 41-46
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありWe report a case of hypopharyngeal lipoma resected by transoral surgery. A 64-year-old woman who was found to have a throat abnormality in a screening examination performed 4 years ago consulted us. The abnormality could not be detected during an upper gastrointenstinal endoscopy performed at an internal medicine hospital in the patient’s neighborhood. However, two years later, a repeat upper gastrointestinal endoscopy at the hospital revealed a huge polypoid lesion in the thoracic esophagus to the esophageal inlet portion, it was removed to mouth side endoscopically. Since the patient had no subjective symptoms she was kept under observation. She developed discomfort again two years later, and as there was also a risk of suffocation, she was referred to our hospital. Based on the findings on CT, MRI and flexible endoscopy, the condition was diagnosed as hypopharyngeal lipoma. For ensuring complete endoscopic removal of a hypopharyngeal lipoma, it may be useful to insert the flexible endoscope under a curved-type Sato laryngoscope for obtaining a better field of view. The patient had an uneventful postoperative course. We may include this condition under expended indications of laryngoscopic surgery in the future.抄録全体を表示PDF形式でダウンロード (1065K) -
平田 結, 高原 幹, 野村 研一郎, 片田 彰博, 林 達哉, 原渕 保明2016 年 109 巻 1 号 p. 47-51
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありAngioleiomyoma is a benign tumor composed of smooth muscle cells and vascular endothelial cells that sometimes arises in the head and neck region. We treated a 68-year-old man with angioleiomyoma of the nasal vestibule. The patient visited our hospital because of a mass in his left nasal vestibule. MRI showed a well-circumscribed mass (T1WI low intensity, T2WI high intensity) in the same area. The mass was removed through an incision in the oral vestibule under general anesthesia. Grossly, the mass was an encapsulated solid tumor. Immunohistochemical study revealed positive staining of the tumor cells of α-SMA, desmin, vimentin, and CD31 based on which the diagnosis of angioleiomyoma was made. Follow-up examination performed one year after the surgery revealed no evidence of tumor recurrence.抄録全体を表示PDF形式でダウンロード (734K) -
金井 理絵, 田村 芳寛, 前谷 俊樹, 山下 勝, 西田 明子, 吉田 季来, 金丸 眞一2016 年 109 巻 1 号 p. 53-61
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありHerein, we report a rare case of metastatic sphenoid sinus tumor from hepatocellular carcinoma (HCC). Transcatheter arterial embolization to treat the metastatic sinus tumor resulted in a marked reduction of the tumor size in this case.
A 60-year-old male patient who had underwent several sessions of transcatheter arterial chemoembolization and radio-frequency ablation for multiple HCC, was referred to our department because of FDG accumulation detected in his left sphenoid sinus and portal lymph nodes by PET-CT. MRI and CT revealed surrounding bone destruction by the sphenoid sinus lesion. Although we attempted biopsy of the sphenoid sinus tumor under endoscopic guidance, sufficient tissue could not be obtained for diagnosis because of excessive bleeding. A subsequent angiography revealed that the tumor received good blood supply from the left maxillary artery, therefore, transcatheter arterial embolization of the maxillary artery with a platinum coil was performed to reduce potential bleeding during biopsy. On the day after the embolization, re-biopsy of the sphenoid sinus tumor was successfully performed without any significant bleeding. Since the obtained tissue revealed the same pathological features as the portal lymph nodes, the sphenoid sinus tumor was diagnosed as metastatic HCC.
Two months after from the embolization procedure, a MRI scan revealed a reduction of the size of the sphenoid sinus tumor to less than 50% of its original size. A follow-up PET-CT after additional palliative chemoradiotherapy no longer showed FDG accumulation in the sphenoid sinus tumor. The sphenoid sinus tumor showed no re-growth nor was associated with any symptoms during 4.5 years, follow up period until the patient’s death, which was due to recurrence of the portal lymph node metastases and femoral bone metastases.
It is suggested that the transcatheter arterial embolization for the metastatic sphenoid sinus tumor from HCC caused a reduction of the tumor size as well as minimized bleeding during a biopsy.抄録全体を表示PDF形式でダウンロード (1016K)
総説
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角田 篤信, 岡田 隆平, 角 卓郎, 秋田 恵一, 山口 久美子2016 年 109 巻 1 号 p. 63-67
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありThe fascinating program for training in clinical practice is not only valuable as a means of education itself, but also for recruitment of otolaryngologists. In this report, we introduce our trial of medical education in the field of otolaryngology. Before the examination for bedside training, that is, computer-based testing (CBT) and Objective Structured Clinical Examination (OSCE), we delivered an anatomy lecture using a cadaver. This training was expected to enable students to easily recognize the anatomy of organs during OSCE programs. During the lecture, we also provided important otolaryngological knowledge necessary for all clinicians. For better education, the cadavers were dissected by the young otolaryngologists. The dissection was carried out as a part of thyroidectomy, neck dissection, parotidectomy and mastoidectomy. These dissections are, of course, valuable for surgical simulation.
Since a variety of subjects must be covered in the otolaryngological field, anatomy education alone would not be sufficient. However, this anatomy lecture using a cadaver was not only effective for education of the medical students, but also invaluable for providing satisfaction to the students and surgical training to the young otolaryngologists. Senior otolaryngologists should devise more attractive education programs for both students and young otolaryngologists, which would contribute to progress in the field of otolaryngology.抄録全体を表示PDF形式でダウンロード (626K)
研修ノート
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家根 旦有2016 年 109 巻 1 号 p. 68-69
発行日: 2016年
公開日: 2016/01/01
ジャーナル 認証ありPDF形式でダウンロード (436K)
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