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73 巻, 6 号
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時田 喬, 宮田 英雄, 牧 達夫, 斉藤 富康, 橋本 正彦1980 年 73 巻 6 号 p. 885-897
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリーThis report summaries clinical studies on Meniere's disease (MD) performed in the Department of Otolaryngology, Gifu University School of Medicine.
I Criteria for the diagnosis of MD
Criteria for the diagnosis of MD are proposed. The criteria are composed of the following 3 steps. As a first step, a suspicious diagnosis of MD is made from the clinical history, i. e. (i) recurrent of paroxysmal vertigo, (ii) cochlear symptoms associated with vertigo, (iii) unknown causes, and, (iv) no other neurological symptoms, vestibulocochlear symptom only. Secondly, a definitive diagnosis of MD is made from the results of audiometric, equilibrium and neurological examinations. Finally endolymphatic hydrops is diagnosed by the glycerol test and the test related to negative SP in electrocochleogram.
II Studies on the natural course of MD
Forty patients suffering from MD were investigated.
1. The course of the disease was classified into the following 5 types from the patterns of the manifestations of the spells. Type 1: Recurrence of a definitive spell at long intervals changes to repeated slight spells at short intervals. Type 2: A definitive spell appears repeatedly in the same season once or twice every year. Type 3: Recurrence of spells gradually decreases with time. Type 4: A burst of spells occurrs continuously from the onset of the disease. Type 5: Repetition of single definitive spells and bursts of spells appear with irregular alternation.
2. On studies regarding clinical manifestation of MD, there was one patient whose diagnosis changed from Lermoyez disease to Meniere's disease. Three patients had a clinical history of sudden deafness long before the onset of vertigenous attacks of MD. Furthermore, there were eight patients with orthostatic dysregulation before the onset of MD and one patient with vertigo caused by a transient ischemic attack. These findings suggested a process of establishment of the inner ear disturbance in MD.
3. The average interval between spells distributed from less than 1 month to 29 months. It was very difficult to predict the next attack since the interval of spells in each patient was irregularly dispersed.
III Examination of predisposition to Meniere's Disease
The examination was performed in the following three steps. First general and local etiologic factors were investigated by using a questionaire made for this study. Second, internal and laboratory examinations were carried out. Third the loading equilibrium examination was done. As results, preexsistent hearing loss of long duration, head injuries long before the onset of the disease, hypotension, orthostatic dysregulation, hyperlipemia and anemia were found more frequently in patients with MD compared with control subjects. These abnormalities were estimated as predisposing factors to MD.
IV Evaluation of surgical treatment
Results of ultrasonic operation performed in our department were evaluated by the criteria of the AAOO committee on hearing and equilibrium. Ultrasonic operations were performed on twenty-five patients who were followed for from 1 to 12 years. The results were divided into four classes as follows: class A, 3(12%); class B, 10 (40%); class C, 12(48%); and class D, 0. The ultrasonic operation is applicable to patients with incapacitating vertigo non-fluctuating profound deafness and decreased labyrinthine excitability.抄録全体を表示PDF形式でダウンロード (1404K) -
天野 一, 山下 敏夫, 西谷 小枝, 熊沢 忠躬, 松村 浩, 河村 悌夫, 久保田 千晴1980 年 73 巻 6 号 p. 899-905
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリーA case of the subtotal removal of a large recurrent acoustic neuroma by translabyrinthine approach is reported. The operation has enabled the patient to return to her normal routine.
The translabyrinthine approach is usually indicated only for small tumors below 2cm in size and localized in the inner ear meatus. This report suggests that in the case of a patient of advanced age or poor general condition, the translabyrinthine approach can be used effectively, even when the tumor is large or recurrent, for the purpose of tumor decompression.抄録全体を表示PDF形式でダウンロード (4018K) -
栗山 博, 高橋 宏明1980 年 73 巻 6 号 p. 907-913
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリー55才女性の前頭蓋底に発生し篩骨洞に浸潤した髄膜腫の1例を経験したので報告した. 髄膜腫は脳外科領域ではしばしば遭遇する疾患であるが, それが副鼻腔へ進展する例は極めて珍しく, 本症例は過去40年間の報告の中で8例目である. ちなみに副鼻腔に原発する heterotopic type の髄膜腫を文献的に渉猟したところ, 15例の報告を見ただけである.抄録全体を表示PDF形式でダウンロード (4289K) -
横山 俊彦, 領木 郁子, 岡田 いく代1980 年 73 巻 6 号 p. 915-923
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリー正常聴力耳および各種聴力障害耳, 計1,470耳 (2才から15才) を対象に, Danplex ZA-20 を用いて記録した tympanogram のパターンを peak pressure, 最大振幅および tympanogram の形の3要素を組み合せて分類を行なった結果, 8つの型に類別でき, 便宜的にI型～VIII型と呼んだ. そのうち, 高陰圧, 高振幅を示したVI型, VII型は Jerger の分類に該当しなかったことに注目し, Jerger のC型と本質的に異なるものであるかどうかを, 病名, ピークの形, 鼓膜可動性, 他器種の impedance meter による tympanogram の clinical interpletations との比較, 聴力損失および伝音機能の6方面より検討を加えた.
1) VI型およびVII型は Jerger, Lidén のいうC型 (IV型, V型) と別個に取り扱うべき一群と見做され, これらの型を示すものは滲出性中耳炎, 耳管狭窄らのいわゆる耳管性難聴の治療中で, 鼓膜の弛緩したものに多くみられ (表1, 3), 聴力および伝音機能においてはIV型, V型のそれに比べて良好な傾向がみられた (図3). すなわち, VI型, VII型のパターンは主として滲出性中耳炎の治療中の症例に多く認められ, 滲出液の resolving stage の推定に役立つものと考察した.
2) VI型, VII型を示したうちの15耳に対して, 同時に Grason-Stadler otoadmittance meter 1720B を用いて tympanometry を行なったところ, B660-tympanogram のパターンがピークでW型に notching して (Lidén のD型), しかもピークが陰圧側に寄っている (Jerger. Lidén のC型), いわゆるC+D型という混合型が約40%に認められた (表4, 図2). このC+D型はVI型, VII型に対応する型と考えた.
3) tympanometry の面から, 幼小児の中耳滲出液の存在有無や耳管性難聴の程度を推定するには, negative pressue のみでは困難であり, peak compliance, ピークの形 (また gradient) を含める必要のあることを強調した.
4) 他国より輸入し, 市販されている impedance meter の測定条件, 表示はメーカーによってまちまちになされ, 国際的に規格の統一化が急がれるが, 現状として, これらの測定器の使用に際しては, 使用器種の種々の特性や使用上の特徴をよく知った上で臨床に役立てることが大切と思った.抄録全体を表示PDF形式でダウンロード (2883K) -
山本 悦生, 福島 英行, 岩永 迪孝, 森中 節子1980 年 73 巻 6 号 p. 925-932
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリー小児の鼓室成形術39耳 (3～15才) を検討し, 術後成績はほぼ満足すべきものであったが, 次の特異性を指摘した.
1) 手術時期は, 5～6才以上が望ましいが, 病態によってはそれ以前に施行してもよい.
2) 手術は, 全麻下低血圧下に行ない, 鼓膜処理はとくに慎重に行なうべきである. また, 病変の進展が高度の場合は, 外耳道後壁は落して病巣の徹底除去を行なうべきである.
3) 適応としては, (1) 鼻咽頭疾患の著明でない耳管機能良好な中等度以上の穿孔ある乾燥耳, (2) 真珠腫や肉芽性炎症の強い高度の病変を有する中耳炎, (3) 耳小骨奇形などである.
4) 術後管理の重要性を強調し, (1) 全身管理, (2) 耳内タンポンの2週間留置, (3) 鼻ネブライザーの施行の必要性を述べた.抄録全体を表示PDF形式でダウンロード (767K) -
野田 勝, 武藤 允人, 伴野 啓, 内田 敏夫, 馬場 駿吉1980 年 73 巻 6 号 p. 933-937
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリーAntibody assays for streptodornase B were done on a total of 58 patients with habitual angina together with assays for both blue ASO and anti SK·SD titers. The results are summarized as follows:
1) The antibody titer for streptodornase B ranged from 50 to 1, 600 times by means of the toluidine blue 0 method of Tiesler.
2) There was a low correlation between the antibody titer for streptodornase B and the blue ASO and anti SK·SD titers.
3) It was considered to be significant for diagnosis of streptococcal infection that antibody titers for streptodornase B were widely distributed in sera of patients with habitual angina.抄録全体を表示PDF形式でダウンロード (458K) -
北嶋 和智, 北原 正章, 斉藤 春雄, 竹田 泰三, 矢沢 代四郎, 松原 秀春, 北野 仁1980 年 73 巻 6 号 p. 939-941
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリー気管支用ファイバースコープの像をビデオ記録装置に接続して, 各部位の像を記録している. この装置は, 従来の診療用ユニットに組込まれており, いつでも手近に使用出来る様にしてある. 学生の教育上極めて有用である.抄録全体を表示PDF形式でダウンロード (1737K) -
Cephalexin との二重盲検比較試験馬場 駿吉, 本堂 潤, 和田 健二, 波多野 努, 村井 兼孝, 伊藤 博隆, 大屋 靖彦, 武藤 順子, 野田 勝, 内田 敏夫, 河合 ...1980 年 73 巻 6 号 p. 943-962
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリー小児の急性化膿性中耳炎に対し, 体重5kg以上12kg未満ではCEX1日400mgを対照薬とし, CCL1日300mg, 体重12kg以上ではCEX1日800mgに対し, CCL1日600mgによる二重盲検比較試験を実施し, 次の成績を得た.
1) 総合治療効果は, 主治医判定も委員会判定も両薬剤群間に推計学的な有意差を認めなかった.
2) 起炎菌の感受性別臨床効果の検討では, 低感受性群の主治医判定・委員会判定の著効率において, CCL群はCEX群に比し有意にすぐれていた.
3) S. aureus 分離菌における臨床効果は, 主治医判定の著効率でCCL群がCEX群に比し有意にすぐれていた.
4) 副作用発現例は両薬剤群ともに全くみられなかった.
5) 有用性判定は, 両薬剤群間に有意差を認めなかった.抄録全体を表示PDF形式でダウンロード (1764K) -
谷口 紀善, 吉田 政雄, 武田 一雄1980 年 73 巻 6 号 p. 963-968
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリーA new nutrient preparation for tube-feeding, HINEX-R, which is mainly made of rice and contains three well-balanced cardinal nutrients as well as minerals and vitamins, was administrated to 8 post-operative patients with malignant neoplasms in the head and neck region.
The results of this clinical study revealed the favorable nutritional condition of the patients, favorable effects on hepatic and renal functions, and no digestive disturbances, such as diarrhea or abdominal distention, which frequently occur with the use of other conventional preparations.
HINEX-R, therefore, seems to be a suitable preparation for the nutritional management of patients after major surgery in the field of otolaryngology.抄録全体を表示PDF形式でダウンロード (365K) -
川中 敏正1980 年 73 巻 6 号 p. 969-999
発行日: 1980/06/01
公開日: 2011/11/04
ジャーナル フリーQuantitative evaluation of Nitromin ototoxicity was examined in guinea pigs given one dose of the drug intravenously. Pathological changes in the cochlear sensory hair cells were then observed under a light microscope following surface preparation after cold phosphate-buffered 2% osmic acid solution fixation. Possibility of frequency specificity of tone pip electrocochleography and modification of input-output functions of cochlear whole-nerve action potentials in absence of outer hair cells were studied by examining the relationship between the degree of outer hair cell damage and the cochlear AP responses.
I) Degree of outer hair cell damage:
At the initial stage, the degeneration of the outer hair cells were the most extensive in the basal turn, and least in the third turn. With the advance of degenerative changes, the damage in the lower turns proceeded rapidly and became more extensive than that in the apical turns.
The outer hair cells in the first row were significantly more vulnerable in each coil. However, at the initial stage, the outer hair cells in the fourth coil were more vulnerable in the third than the first row.
II) Cochlear AP responses in guinea pigs treated with drugs:
Both the prolongation of minimum latency and increase in the width of the AP-SP wave form complex of AP responses to low-frequency (1, 2KHz) tone pip were more prominent than to high-frequency (4, 8KHz) one.
Decrease of the maximum amplitude of AP responses to low-frequency (0.5, 1, 2KHz) tone pip was greater than to high-frequency (4, 8KHz) one, comparing each decrease of that with the degree of the outer hair cell damage in respective coils. Therefore, changes of each parameter at high intensities indicated the decrease of the number and the degree of synchronization of the activity of the auditory units located in the lower turns, especially in the basal turn, regardless of the frequency of the stimulation tone.
The elevation of the threshold of AP response to each frequency tone pip was comparatively correlative with the degree of outer hair cell damage in each coil, respectively.
For the input-output curves of AP responses to 4 and 8KHz tone pips, the L-curve disappeared according to the advancement of the degenerative changes, after which the maximum output of the H-curve decreased respectively to 22.9% and 24.1% of each average output in the normal group, despite the finding that almost all the inner hair cells survived. Accordingly, it was considered that the outer-hair-cell units had a significant influence on the synchronous firing of the inner radial fibers connecting to the inner hair cell system, though the L-response and the H-response component mainly depended on the auditory units originating in the outer and inner hair cells, respectively.
At higher intensities, the polarity of SP as the earlier fraction of AP-SP wave form complex, changed to negative with 4 and 8KHz tone pips and click stimulations in case of severe outer hair cell damage in the lower turns.抄録全体を表示PDF形式でダウンロード (7997K)
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