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83 巻, 2 号
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井上 鐵三1990 年 83 巻 2 号 p. 171-179
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーCO2 laser has been used widely in the treatment of various diseases in the head and neck area. We used CO2 laser in 36 patients with laryngeal cancer (glottis) and in 42 with allergic rhinitis.
CO2 laser was applied via laryngomicrosurgery to laryngeal cancers. Seven patients were not cured by laser and underwent laryngectomy. The patients were followed for 19 to 90 months (mean 48 months). Thirty-five patients (97%) survived without any evidence of recurrence. From this follow-up study we conclude that:
1) T1a can be treated by laser alone, 2) T1b can be treated by laser alone or by a combination of laser and radiation, 3) A careful selection of cases for laser use is required in T2 patients.
The inferior turbinates of allergic rhinitis patients were vaporized by CO2 laser. Improvement of nasal stuffiness was observed in 83% of the patients. Laser did not reduce rhinorrhea or sneezing as well as it did stuffiness. Laser was effective in controlling in 60% rhinorrhea in 54% of the patients treated in, and in controlling sneezing. Laser enables a surgeon to perform the operation with minimum hemorrhage. The patients die not complain of pain during or after operation. The operation can be done on an out-patient basis.抄録全体を表示PDF形式でダウンロード (4813K) -
丘村 煕, 末光 清貞, 稲木 匠子1990 年 83 巻 2 号 p. 180-181
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1985K) -
羽柴 基之, 本堂 潤, 馬場 駿吉1990 年 83 巻 2 号 p. 183-192
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe patient was a 22-year-old male student who developed dizziness and unsteadiness of gait. Neuro-otological examination two weeks later showed transient spontaneous down beat nystagmus, rotary nystagmus on bilateral gaze, and rebound nystagmus. The cold caloric test was normal, and the OKP showed a slightly irregular pattern under high speed stimulation. The pursuit movements of the eyes were slightly saccadic. He also had truncal ataxia without dysmetria of the extremities and no other neurologic abnormalities. Cerebro-spinal fluid was clear with no cells and a protein level of 38 mg/ 100 ml. CT scan was normal. Three weeks after onset, rotary gaze nystagmus and rebound nystagmus were absent. He developed intermittently irregular oscillations of the eyes with horizontal, vertical, and rotary components (opsoclonus) with oscillopia. He had no myoclonuc jerks elsewhere. His opsoclonus was precipitated by hyperextension of the neck and by vibration applied to the neck muscles. We observed that the caloric response at this time was suppressed intermittently by the opsoclonus, but the OKP was normal with DP toward the left. Five months after onset, he did not complain of dizziness, but opsoclonus persisted. CAG and VAG were performed but showed no abnormality. The opsoclonus precipitated by hyperextension of the neck disappeared 12 months after onset. The neuro-otological examinations of patients with opsoclonus are discussed. In our patient, opsoclonus was the only type of nonnystagmic abnormal ocular movements (NAOMs). We could not observed other NAOMs; ocular dysmetria, flutter-like oscillations of eyes, ocular myoclonus and lightning eye movements. Opsoclonus is caused by different abnormality in ocular control system from the other NAOMs.抄録全体を表示PDF形式でダウンロード (1065K) -
稲福 繁, 呉 孟達, 中山 明峰, 瀧本 勲1990 年 83 巻 2 号 p. 193-201
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーAlthough congenital vertical nystagmus is very rare, we treated on 6-year-old girl who had spontaneous eye movements and myopia. Down beat nystagmus was noted on forward gaze, and it increased in amplitude and frequency on downward gaze. The nystagmus disappeared when her eyes were closed in a lighted room and when her eyes were open in a dark room.
Eye tracking tests for slow and quick components in the horizontal plane were normal. Optokinetic nystagmus in the horizontal plane was within normal limits. Normal caloric responses were observed. No vertical optokinetic nystagmus was induced. The patient had complete loss of the slow pursuit function in the vertical plane. Therefore, we considered this to be a case of congenital vertical nystagmus due to a disturbance of the slow pursuit system of vertical eye movements.抄録全体を表示PDF形式でダウンロード (1117K) -
鰐渕 伸子, 石塚 洋一, 前田 秀彦1990 年 83 巻 2 号 p. 203-209
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe authors studied 136 patients with sudden deafness over a 6-year period, 44 patients with vestibular signs, such as vertigo or dizziness and 92 patients without vestibular signs.
Equilibrium function was abnormal in 70.5% of the patients with vestibular signs and in only 19.6% of those without vestibular signs, however, there was no significant difference between the two classes in pure-tone average improvement over 30dB.
Other relationships between the results of each examination and hearing improvement are discussed.抄録全体を表示PDF形式でダウンロード (897K) -
北野 仁, 山本 佳子, 北野 博也, 田中 寛1990 年 83 巻 2 号 p. 211-216
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーWe used the Acoustic Otoscope in patients with otitis media with effusion (OME), tubal stenosis, chronic otitis media with large perforation, and obstruction of the ear canal with cerumen in order to evaluate its ability to assess these middle ear conditions. Tympanograms were performed to confirm the diagnosis of these diseases. The diagnosis of OME obtained by Acoustic Otoscope showed a high degree of false negativity in comparison with the diagnosis obtained by tympanography, especially when there was a fluid level. Chronic otitis media with large perforation and obstruction of the ear canal with cerumen also showed considerable false negative results. It is impossible to diagnose tubal stenosis with the Acoustic Otoscope.抄録全体を表示PDF形式でダウンロード (2184K) -
―中耳腔の生理的変化と耳管の対応―大久 保仁, 小山 澄子, 奥野 秀次, 石川 紀彦, 臼居 洋行, 三宅 一範, 宮坂 宏江, 徐 柔笛1990 年 83 巻 2 号 p. 217-225
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe degree of opening and closing of the eustachian tube varied with changes in body position. However, neither the duration of auditory tube opening and closing nor the opening pressure varied.
The physiological reason for such findings appears to involve the anatomic course of the pharyngeal orifice of the auditory tube and of the auditory tube itself, protecting the middle ear cavity from invasion by secretions and from infections. When a patient with mild dysfunction of the auditory tube lies on his side, the middle ear cavity pressure becomes markedly positive. Involvement of congestion in the venous plexus of the middle ear cavity and of gas emission is suggested in this shifting of tympanic compliance to the positive pressure side with change in head position or when lying on the side. These findings, show that the ventilation of the middle ear cavity under environmental pressure, keeping the internal pressure of the middle ear cavity equal or slightly higher than atmospheric pressure at all times, serves to maintain the conductive efficiency of the middle ear cavity through adjusting of the internal pressure of the middle ear cavity to atmospheric pressure by the opening and closing of the auditory tube.抄録全体を表示PDF形式でダウンロード (2647K) -
原田 勇彦, 奥野 妙子, 山岨 達也1990 年 83 巻 2 号 p. 227-231
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーTwo cases of traumatic stenosis of the external auditory canal due to traffic accidents are reported here.
In Case 1, the stenosis occurred due to compression of the anterior bony wall by the fractured head of the mandible in the lateral portion of the ear canal. At surgery, perforation of the tympanic membrane was noted along with severe inflammation of the middle ear. Open method mastoidectomy and tympanoplasty were performed in order to obtain an adequately widened ear canal and improved hearing.
In Case 2, the stenosis was due to fracture of both the anterior and posterior bony walls of the medial portion of the ear canal. At surgery, dislocation of the malleus and incus was noted. Drilling and removal of the fractured bone fragments and tympanoplasty allowed adequate widening of the ear canal and improvement of hearing.
In previous reports of acquired stenosis of the external auditory canal, the problems were mostly prevention of re-stenosis or formation of cholesteatoma. In the present two cases, however, prognosis of the stenosis after surgery was rather good, and the important point at surgery was the management of the middle ear disorders.抄録全体を表示PDF形式でダウンロード (3295K) -
半田 徹, 山本 英一, 宮本 永祥, 折田 洋造1990 年 83 巻 2 号 p. 233-239
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーA 66-year-old woman was first seen in the Department of Otorhinolaryngology of Kawasaki Medical School Hospital on June 18, 1984. She had a persistent left auricular mass (20 × 20mm), which had been growing for 40 years.
The initial operation was performed on August 8, 1984. The initial pathological report was benign schwannoma. She was asymptomatic until 1985.
In January 1986, she again noticed a left auricular mass (17 × 15mm). She came to our hospital on June 14, 1986. A second operation was performed on July 31, 1986. During the second operation, we completely resected the tumor with enough margin for safety, and a complete postauricular rotation flap was done. The second pathological report was malignant schwannoma. Since the second operation, she has been tumor free for about 3 years.
There have been only a few reports of malignant schwannoma in the head and neck region. Therefore we reviewed the cases of malignant schwannoma in the head and neck region in Japan.抄録全体を表示PDF形式でダウンロード (5475K) -
藤田 豪紀, 高橋 光明, 金井 直樹, 大島 収, 海野 徳二1990 年 83 巻 2 号 p. 241-245
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーOsler's disease (=hereditary hemorrhagic telangiectasia) is an autosomal dominant genetically transmitted disease characterized by abnormal peripheral blood vessels. Intranasal dermoplasty and estrogen therapy have proved to be successful for nasal bleeding. However, these therapies have several complications and sometimes fail to control bleeding. Recently, Nd-YAG laser therapy has been reported to be effective in Osler's disease. We describe here a patient with Osler's disease who has had repeated nasal bleeding for about 10 years. We treated him with laser photocoagulation using a contact Nd-YAG laser at low power settings (30-35W, 0.5 sec). Laser therapy diminished the frequency and severity of hemorrhage without complications. Nasal mucosal tissue of the inferior turbinate showed massive fibroblastic infiltrations and capillary vessel clots with fibrin after laser operation. The Nd-YAG laser appears to be a useful therapeutic procedure for this disease.抄録全体を表示PDF形式でダウンロード (3437K) -
―簡易呼吸モニター・による術前後の検討―大藏 眞一, 石塚 洋一, 秋元 淑子, 鰐渕 伸子1990 年 83 巻 2 号 p. 247-254
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe Apnomonitor, which was developed to monitor respiration during sleep, was used to investigate nasal or pharyngeal disease in 69 patients. Among them, 23 patients with adenoid and tonsillar hypertrophy, 33 with chronic tonsillitis, and 13 with chronic sinusitis and deviation of the nasal septum were studied. The Apnomonitor was used to monitor tracheal sounds, nasal air flow and EGG parameters during sleep. Sleep apnea was found in 17 (24.6%) of the patients. Seven patients had adenoid and tonsillar hypertrophy, five had chronic tonsillitis, and five had chronic sinusitis and deviation of the nasal septum. After surgery snoring decreased in 15 (88.2%) of 17 patients, respiratory arrest during sleep decreased in 6 (85.7%) of 7 patients, and sleepiness during the day disappeared completely in 4 of 5 patients. Apnea indices were improved in all 11 patients tested. The Apnomonitor cannot differentiate waking from sleeping during apnea, or central apnea from obstructive apnea.
It simply shows the presence or absence of apnea during sleep. It can be used in the outpatient clinic. Since it is portable and simple to operate, it is useful in screening for sleep apnea syndrome.抄録全体を表示PDF形式でダウンロード (2614K) -
末野 康平, 山田 洋一郎, 永沼 正道, 蛇沢 晶1990 年 83 巻 2 号 p. 255-260
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーA 31-year-old female who had had tonsillectomy six months earlier developed recurrent sore throat, slight fever and general fatigue. Medical history and local findings were highly suggestive of focal infection due to chronic inflammation of tonsil-like tissue in the left lower tonsillar fossa. After surgical extirpation, there was marked improvement. Histological examination of the extirpated tissue showed palatine tonsillar tissue with ulcer formation of crypt epithelium and proliferation of lymphatic follicular tissue, which resembled the characteristics of focal tonsils.抄録全体を表示PDF形式でダウンロード (4044K) -
鎮西 邦彦, 岸本 誠司, 齋藤 春雄, 甲藤 洋一, 大月 出祐治, 園部 宏1990 年 83 巻 2 号 p. 261-265
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThis is the first case report of basal cell carcinoma of the hypopharynx in the world literature.
The patient was a 64-year-old male with hoarseness. A fixed left vocal cord and a smooth large mass protruding to the false vocal cord and piriform sinus were found. A CT scan demonstrated a mass occupying the left glottic region and the piriform sinus. No lesion of the mucous membrane was detected by any clinical examination. A biopsy specimen showed probable basal cell carcinoma on ordinary histological and electron microscopic studies.
A small ulcer was found in the piriform sinus, which was considered to be the original focus of the tumor. Total laryngectomy with hypopharyngectomy and left radical neck dissection were performed.
Light microscopic, electron microscopic and immunohistological studies of the extirpated specimen confirmed the diagnosis of basal cell carcinoma.
The histopathology of basal cell carcinoma is discussed in some detail.抄録全体を表示PDF形式でダウンロード (4032K) -
―CDDPを中心として―東川 雅彦, 牧本 一男, 宇野 功, 上杉 康夫, 柴田 伊十児, 西山 正信, 井上 功, 中井 健, 塙 力哉, 高橋 宏明1990 年 83 巻 2 号 p. 267-273
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーPatients with advanced and/or recurrent head and neck cancers were enrolled for the present studies to investigate the effectiveness and the toxic effects of our sequential combination chemotherapy including cis-platinum. The patients entered for the present protocol were divided into two groups: 19 patients for Regimen I (cis-platinum, vincristine and peplomycin) and seven patients for Regimen II (cis-platinum, adriamycin, and cyclophosphamide). Two patients were excluded because of diiculity in the evaluation of tumor response. The overall response rate of the remaining 24 patients was 35%. Six patients received the treatment as neo-adjuvant chemotherapy, and two of them achieved partial remission.
Side effects were nausea and vomiting (54%), decreased creatinine clearance (27%), leukopenia (23%) and anemia (3l%). We were obliged to discontinue the protocol after completion of the first course in six of the seven patients with decreased creatinine clearance. Elevation of the serum iron level was seen three days after cis-platinum administration in all patients. Since this elevation of the serum iron level was also noted after VBM and COP, we assumed that the effect of anticancer drugs on the ferrokinetics in the bone marrow could account for it.抄録全体を表示PDF形式でダウンロード (869K) -
―症例報告と本邦例の集計―木田 亮紀, 藤井 まゆみ, 穴澤 卯恭, 飯田 英信, 遠藤 壮平, 安田 正秀1990 年 83 巻 2 号 p. 275-286
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーDuring a 5-year period from 1984 to 1988, we treated five patients with vagal neurilemmoma in the neck, three males and two females with a chief complaint of a cervical mass. Diagnosis was based on ultrasound examination, enhanced CT and 67Ga scintigraphy. Neurilemmoma originating from the vagus nerve was confirmed by operation and by histopathological examination. In three of the five patients the vagus nerve was divided during surgery. In one patient, the tumor was removed, and most of the vagus nerve was preserved. This patient developed paralysis of the vocal cord on the affected side. In the fifth patient, the tumor removed, and the vagus nerve was preserved. This patient did not develop paralysis of the vocal cord after operation. These results and the knowledge that the function of the vagus nerve is unlikely to recover after division, even with end-to-end anastomosis or nerve grafting, indicate that it is necessary to preserve the vagus nerve during surgical removal of vagal neurilemmoma in the neck.抄録全体を表示PDF形式でダウンロード (5077K) -
古田 康, 川浪 貢, 飯塚 飯塚1990 年 83 巻 2 号 p. 287-292
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe thyroid gland is rich in lymph channels, and thyroid cancer frequently metastasizes to cervical lymph nodes. There are two main lymph channels, superior and inferior, from the thyroid gland to the deep cervical lymph nodes. However, it has not yet been clarified as to whether the lymph channels run anterior or posterior to the carotid vessels.
We treated three patients with advanced thyroid cancer and found that the lymph node metastases were located in a continuous chain from the thyroid gland to the inferior deep cervical lymph nodes. The lymph node metastases proceeded along the recurrent nerve, passed posterior to the common carotid artery and reached the inferior deep cervical lymph nodes.
Thus, the main lymph channel from the thyroid gland to the inferior deep cervical lymph nodes seems to pass posterior to the common carotid artery. Therefore, lymph node dissection must be done thoroughly in this region.抄録全体を表示PDF形式でダウンロード (2034K) -
―学校保健との関係―本橋 弘行, 檜 學1990 年 83 巻 2 号 p. 293-308
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーChildren (49 boys and 54 girls) at an elementary school in Mishima City, Shizuoka Prefecture, were trained to ride unicycle type vehicles, and the effects of the training were observed. 1) Equilibrium skills of both boys and girls improved as training progressed. They were able to acquire the fundamental skill of riding a unicycle and then to carry out more complicated tasks requiring advanced techniques. 2) The effects of training were tested by examining the airplane type one-legged standing posture. The righting reflex was found to have been improved by advanced training. 3) The neurological mechanisms of improved equilibrium following training are explained with reference to previous reports.抄録全体を表示PDF形式でダウンロード (3464K) -
大八木 章博1990 年 83 巻 2 号 p. 309-318
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーAutonomic innervations of the mucosa in the middle ear, Eustachian tube and pharynx were investigated by retrograde labelling of the autonomic ganglia with horseradish peroxidase (HRP). Of the sympathetic ganglia, the superior cervical ganglion (SCG), middle cervical ganglion (MCG) and stellate ganglion (StG) were examined, and of the parasympathetic ganglia, the pterygopalatine ganglion (PpG) and the otic ganglion (OtG) were examined.
1. The sympathetic innervation of the middle ear mucosa was by fibers originating in the ipsilateral SCG, but not by those originating in the MCG or StG. The parasympathetic innervation was by fibers originating in the ipsilateral PpG, but not by those originating in the OtG.
2. The sympathetic innervation of the Eustachian tube mucosa was by fibers originating in the ipsilateral SCG and MCG, but not by those from the StG; parasympathetic innervation was by fibers originating in the ipsilateral PpG, but not by those from the OtG.
3. The epipharynx received sympathetic innervation from the ipsilateral SCG, but not from the MCG or StG. Its parasympathetic innervation was from the PpGs bilaterally, but not from the OtG.
4. The sympathetic innervation of the mesopharynx was from the SCG, MCG and StG, but the parasympathetic supply was from neither the PpG nor the OtG. Sympathetic innervation was bilateral, but predominantly from the ipsilateral side.
5. The hypopharynx resembled the mesopharynx, but had more innervation from the MCG and StG.抄録全体を表示PDF形式でダウンロード (5403K) -
横山 道明, 寒川 高男, 中西 弘, 榎本 雅夫1990 年 83 巻 2 号 p. 319-326
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーThe level of cefuzonam (CZON) in otorrhea discharge was measured to evaluate the clinical effectiveness of this drug in the treatment of middle ear infection. The concentration of CZON ranged from 1, μg/g to 2μg/g for 4 hours after 1g single i. v. injection (SIV), 2μg /g to 6μg/g for 3 hours after 2g SIV, 1μg/g to 2μg/g for 2 hours after 1g i. v. drip infusion (IVD) over 30 minutes, and 2μg/g to 5μg/g for 2 hours after 2g IVD over 30 minutes. In the cases of chronic otitis media including cholesteatoma, the most commonly isolated bacteria were Staphylococcus aureus (25.6%) and Pseudomonas aeruginosa (25.6%), followed by Staphylococcus epidermidis (8.5%). In the literature, the MICgo of CZON is reported to be ≤ 1.56μg/ml for Staphylococcus aureus
except MRSA and 6.25μg/ml for Staphylococcus epidermidis. CZON is effective against all these bacteria except Pseudomonas aeruginoa.抄録全体を表示PDF形式でダウンロード (793K) -
―抗アレルギー剤効果への影響―高安 助次, 香取 公明, 香取 早苗1990 年 83 巻 2 号 p. 327-335
発行日: 1990/02/01
公開日: 2011/12/12
ジャーナル フリーAn investigation was carried out to identify autonomic nervous system factors which may be directly involved in the induction of attacks of pollinosis and to determine how an antiallergic agent is affected by changes in the autonomic nervous system.
Autonomic nervous system function was evaluated from the R-R interval trendogram pattern on the supine resting ECG and its changes in response to stimulation (i. e., rising and Aschner's ocular compression).
(1) The central autonomic nervous tension shifted to the parasympathetic side and the peripheral parasympathetic response was diminished only upon stimulation through baroreceptors; (2) the administration of the antiallergic agent Azeptin® (azelastine hydrochloride) which was started one week before the flowering of cedar trees completely inhibited attacks of pollinosis in 12 of 15 patients (80.0%) with a negative response to Schellong's test, but in none of 10 patients with a positive response. This findings suggested that pathological conditions in the autonomic nervous system which induce a positive response to Schellong's test are directly related to the occurrence of allergic reactions.
In a second study the next year (when cedar pollen was more densely distributed), Azeptine alone was administered to patients with a negative response to Schellong's test, and it was combined with Methylcobalamine for patients who tested positive. Attacks were completely inhibited in 30 of 33 patients (90.9%). In summary, the effect of antiallergic agents can be enhanced to a remarkable extent by the concomitant medical treatment of disorders of the autonomic nervous system.抄録全体を表示PDF形式でダウンロード (1063K) -
庄司 和彦, 福島 英行, 児嶋 久剛, 大森 孝一1990 年 83 巻 2 号 p. 337-341
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーTisseel® Kits were used instead of epidermal sutures in order to prevent suture marks in ten young patients with thyroid disease who were treated surgically from June 1988 to Feb. 1989. There were no complications due to Tisseel®. No suture marks were seen in the scars, but slightly hypertrophic scars were seen in two patients. The Use of Tisseel® instead of epidermal sutures is a useful and easy method to prevent suture marks in thyroid surgery, and it reduces the time required for operation and the duration of hospitalization.抄録全体を表示PDF形式でダウンロード (3803K) -
西村 忠郎1990 年 83 巻 2 号 p. 342-343
発行日: 1990/02/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (291K)
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