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84 巻, 5 号
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米川 紘子1991 年 84 巻 5 号 p. 575-584
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーThe term “Reinke's edema” is widely used to describe varying degrees of a diffusely edematous swelling of the vocal folds. In a previous study (Yonekawa, 1988), the authors proposed a classification of the disease into three types: Type I, II, and III, which was often useful in analyzing the clinical features and evaluating the postoperative results. This disease is most common in patients above 40 years of age and has a chronic course with severe hoarseness and low-pitched voice. Many researchers have emphasized that smoking is an important causative factor. Endolaryngeal microsurgery has been the accepted treatment of this disease and some surgical techniques have been proposed recently. However, there has been little information on the efficacy of surgical techniques and no precise description of any long term follow-up investigations after surgery.
In the present study the surgical techniques reported in the literature are described briefly and a new surgical procedure, the “squeezing technique” proposed by the authors' group, is reported together with the postoperative results and long term follow-up.
In the squeezing technique, the mucous membrane covering the edematous swelling is removed preserving the mucoua on the free margin of the vocal fold, and the submucosal contents are squeezed out with a small cotton ball. This technique is considered to be the most appropriate for treating Type III cases.
Considerable improvement was noted in terms of subjective symptoms as well as in the voice quality as measured by phonatory analysis. In Type III female cases, the fundamental frequency of the voice tended to increase markedly after surgery. At the follow-up examination, the length of time until the speaking voice could maintain stability was prolonged in Type III cases. The incidence of recurrent edema of the vocal folds was significantly greater in patients who continued to smoke after surgery than in those who stopped smoking. Voice therapy should include the prohibition of smoking after surgery.抄録全体を表示PDF形式でダウンロード (1134K) -
熊澤 忠躬, 山下 敏夫, 辻 裕之, 立川 拓也1991 年 84 巻 5 号 p. 586-587
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1511K) -
浅井 美洋, 松井 和夫, 野末 道彦1991 年 84 巻 5 号 p. 589-593
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーA statistical analysis was conducted on 140 patients (48 males, 92 females) who visited our clinic complaining of vertigo and dizziness from June 1989 to March 1990. Vertigo and dizziness of peripheral origin accounted for 62.1%, of central origin 6.4%, others 10%, and of unknown origin 21.4%. BPPV (Benign Paroxysmal Positional Vertigo) was the most common type of vertigo seen in our clinic. In the 30 patients with disease of unknown origin (21.4%), we analyzed the reasons that we could not diagnose them and tried to classify them from the viewpoint of patterns of onset.抄録全体を表示PDF形式でダウンロード (485K) -
金子 賢一, 内藤 泰, 中村 一渉, 伊藤 壽一1991 年 84 巻 5 号 p. 595-599
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーA 41-year-old female visited our clinic complaining of right facial palsy. CT and MRI findings suggested a cholesteatoma in the petrous apex. It was extracted by a translabyrinthine approach. The facial nerve and the vestibulocochlear nerve were thought to have been injured at the level of the internal acoustic meatus. Preoperative diagnosis with CT and MRI were very useful for the operation. The macula utriculi from the involved ear was studied by electron microscopy. We found hair cell loss and degeneration.抄録全体を表示PDF形式でダウンロード (3921K) -
小林 一豊, 山岸 みどり, 児玉 広幸, 竹沢 裕之, 鈴木 敏夫, 形浦 昭克1991 年 84 巻 5 号 p. 601-606
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーAcute otitis media (AOM) is one of the most common infectious disease in childhood. The purpose of this study was to clarify the association between AOM and otitis media with effusion (OME). A nine-year retrospective study was conducted of 131 children with OME (219 ears).
The patients were classified into four groups according to the clinical course of hearing impairment.
The incidence of AOM in OME patients was 65.6% on the average, and a history of AOM was a significant risk factor for the development of chronic OME.
The diagnosis of AOM is difficult in young infants. Our results suggest that AOM in early infancy is a strong predictor of recurrent middle ear problems later in childhood.
In order to prevent this, AOM in young infants must be treated as effectively as possible. This therapy includes proper antimicrobial treatment, myringotomy, drainage of the middle ear and careful follow up.抄録全体を表示PDF形式でダウンロード (652K) -
―追跡調査―佐伯 忠彦, 藤原 康雄, 岡本 和憲, 丘村 煕, 柳原 尚明1991 年 84 巻 5 号 p. 607-614
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーDuring the past 4.5 years screening tests using tympanometry (TM) for otitis media with effusion (OME) were performed as part of the routine medical examination of 13, 315 children at one and a half-years of age in Matsuyama City.
1) In the first screening, B or C type TM was recorded in 3, 969 of the 13, 315 children (29.8%).
2) In the second screening, B or C type TM was found in 1, 475 of the 3, 969 children (11.1%).
3) In the third screening, 1, 067 (1, 804 ears) of the 1, 475 children could be followed in detail at the Ehime Prefectural Rehabilitation Center for the Physically Handicapped.
4) In 1, 015 of the 1, 804 ears, B or C type TM was noted at the first examination in the center.
5) Examinations were performed without treatment on 534 of the 1, 015 ears (52.6%). TM and ear drum abnormalities returned normal spontaneously in 526 of the 534 ears (51.8%).
6) 481 of the 1, 015 ears (47.4%) were treated in the offices of other otorhinolaryngists. The TM and ear drum findings were later restored to normal in 393 of the 481 ears (38.7%).
7) In the children who were followed for longer than three years, TM and ear drum findings were restored to normal within six months in 65.0%. However, 7.6% of those children have not yet been cured.抄録全体を表示PDF形式でダウンロード (928K) -
―サッカリンテストによる―石川 保之, 本庄 巖1991 年 84 巻 5 号 p. 615-619
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーThe etiology of otitis media with effusion (OME) is still unknown. However, an inflammatory reaction to a bacterial infection originating in the nasopharynx is thought to be one of the main factors responsible for OME, and impaired mucociliary clearance of the nose and nasopharynx may increase the chance of infection through the Eustachian tube.
Nasal mucociliary function was examined with the saccharin test in 115 noses of 61 patients with OME aged 8 to 92 years. Myringotomies were performed in almost all cases and aspirated middle ear effusions were classified into serous, mucoid and purulent types.
1) Prolonged saccharin times (over 11 minutes) were noted in 84.3% of 61 patients with OME.
2) The patients were divided into two proups; 35 patients had OME and chronic sinusitis (group A) and 26 patients had OME without sinusitis (group B). Prolonged saccharin times were found in 86.4% in group A and 81.6% in group B—not a statistically significant difference.
3) Greatly prolonged saccharin times (over 30 minutes) were found in 45.5% in group A and 14.3% in group B—a significant difference. Thus, mucociliary function in the nose was thought to be impaired more severely in group A than group B.
4) Bilateral OME and mucoid type effusion were found more frequently in group A than group B.
5) The main cause of impaired nasal mucociliary function in group A was thought to be chronic inflammation of the nasal mucosa. On the other hand, acute upper respiratory infection preceding the development of OME was assumed to cause impaired nasal mucociliary clearance in group B.
However, in group B, impaired nasal mucociliary function may be congenital in some cases without inflammatory findings by anterior rhinoscopy or episodes of acute upper respiratory infection抄録全体を表示PDF形式でダウンロード (544K) -
榊原 淳二, 藤田 明彦, 本庄 巖1991 年 84 巻 5 号 p. 621-626
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーPassive and active ventilatory functions of the tube were examined in 14 patients with patulous Eustachian tube syndrome by the inflation deflation test and the forced response test (FRT). The reported hyperpatency of the tube was confirmed by low opening pressure in the inflation test and low static tubal resistance in the FRT.
Both hypofunction of active ventilation in the deflation test and incomplete decrease in tubal resistance during swallowing indicated that active tubal function was impaired in this syndrome to the same extent as in other middle ear diseases.
A relatively fixed tubal resistance at three different air flow rates in the FRT suggested that the Eustachian tube in patients with this syndrome may not always be as compliant or floppy as reported before.抄録全体を表示PDF形式でダウンロード (494K) -
梅村 仁, 尾崎 正義, 北村 健, 荻野 敏1991 年 84 巻 5 号 p. 627-631
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーWe have often seen facial paralysis caused by herpes zoster, but peripheral facial paralysis following chicken-pox is very rare. The patient, a 16-month-old boy, had a skin rash diagnosed as chicken-pox on Jan. 25, 1990. Three days later, his mother noticed immobility of the right facial muscles. There were no other neurological abnormalities. The serum CF titers for varicella-zoster virus (V. Z. V.) were 1:256 (Feb. 6) and 1:64 (Mar. 7). He was treated with acyclovir, and his facial paralysis recovered completely in about 3 months. The pathogenesis was probably direct invasion of the facial nerve by V. Z. V..抄録全体を表示PDF形式でダウンロード (1755K) -
森島 夏樹, 中村 晴彦, 岸本 厚, 大森 琢也, 徳田 寿一, 西村 忠郎1991 年 84 巻 5 号 p. 633-638
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーOn August 8, 1989, a 56-year-old woman visited our hospital complaining of a boil in her nose. A tumor was found in the nasal cavity, high on the anterior nasal septum. Both middle nasal conchae were displaced laterally.
A CT scan showed a diffuse shadow in the root of the nose and a loss of nasal bone. Scintigraphy showed an abnormal mass in the middle of the face. The entire tumor was resected. Currently, 11 months after sungery, there is no sign of recurrence. However, strict monitoring will be necessary for some time to come.抄録全体を表示PDF形式でダウンロード (3753K) -
五十嵐 良和, 麻生 伸, 渡辺 行雄1991 年 84 巻 5 号 p. 639-644
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーAn accidental blow with a piece of iron caused a crushing injury of the left cheek of a 52-year-old woman. The patient had emergency surgery at a nearby hospital. Starting the next day there was bulging of the left cheek after eating. Since pressure bandaging for 10 days did not reduce the swelling, she was referred to our hospital. A 70mm wound was present along the midline of the left cheek. No salivary flow was seen from the ostium of Stenon's duct. Facial paralysis was not present. A sialogram and sialo-CT scan demonstrated obstruction of Stenon's duct and a sialocele. Under general anesthesia reoperation was performed. It was found that the distal end of the severed Stenon's duct had been ligated with silk and a sialocele had formed in the superficial part of the parotid gland. A silicone tube was introducted through the duct, and an end-to-end anastomosis of Stenon's duct was accomplished. The ruptured parotid gland was closed with silk sutures. On the 10th day the tube was removed, and salivary flow could be observed. A sialogram on the 14th day demonstrated slight constriction of the anastomosis. 99mTc scintigraphy indicated functional recovery of the left parotid gland 3 months after the operation.抄録全体を表示PDF形式でダウンロード (3296K) -
野々村 光栄, 児嶋 久剛, 大森 孝一, 平野 滋1991 年 84 巻 5 号 p. 645-649
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーIn microsurgery of the larynx, it is desirable for the surgeon during operation, to listen to the voice of the patient, observe the vibration of the vocal folds and perform the operation with simple procedures.
Such an operative method was devised, in which the operator can use both hands freely. Local anesthesia and a stroboscope are important elements. We named this method FIBER-OPTIC LARYNGO MICROSURGERY WITH STROBOSCOPE and describe it here.
Just as in conventional surgery under local anesthesia, the patient is in the sitting position and the nasal cavity, oral cavity, pharnx, hypopharynx and larynx are anesthetized with 4% xylocaine. An assistant insert the laryngeal fiberscope connected to a strobe light through the nasal cavity, and an endolaryngeal image is displayed on a monitor screen. The patient holds his tongue with one hand, so the operator can use both hands freely. Watching the monitoring screen, the doctor can operate with instruments in both hands and finish the operation when satisfactory phonation is obtained.
This operation was performed in 22 patients with vocal fold polyp or polypoid vocal fold. Acceptable phonation was obtained in all patients without suspension of the operation.
The advantages of this method are; 1) it can be applied in outpatients without laborious preparation; 2) it does not involve complex procedures; 3) it allows the doctor to observe vibrations of the vocal folds; 4) magnified images of the lesion can be observed; 5) both hands can be used freely.抄録全体を表示PDF形式でダウンロード (2883K) -
手塚 克彦, 山岨 達也, 菅澤 正, 浅井 昌大, 喜多村 健1991 年 84 巻 5 号 p. 651-657
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーA 53-year-old woman complained of a solid neck mass and left Homer's sign. Imaging studies, including CT scan, MRI, and angiography, revealed a tumor situated medial to the carotid artery and internal jugular vein extending to the skull base. The diagnostic imagings were compatible with neurinoma.
At surgery the tumor was found to originate from the left cervical sympathetic trunk. The histopathological report was ‘benign neurinoma containing mixed type A and B features according to Antoni's classification’. The patient's postoperative course was uneventful, and she is well three months after surgery.
There have been only 19 cases of neurinoma originating from the cervical sympathetic nerve reported in Japan. We discuss the clinical characteristics of these cases and three additional cases treated in our department during the past 25 years.抄録全体を表示PDF形式でダウンロード (5144K) -
松原 一仁, 岡本 宏司, 宇野 欽哉, 小池 聰之1991 年 84 巻 5 号 p. 659-665
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーThirteen patients with neurogenic tumor were seen from 1977 through 1989 in the Shikoku Cancer Center eight with Schwannoma and five with neurofibroma. Various surgical approaches were used: peroral, cervical, transparotid, resection of middle mandible and combined approach. The nerve of origin could be determined in two of the thirteen patients from the surgical findings. We select for description two patients with Schwannoma in the pterygopalatine fossa and in the parapharyngeal space, and three patients with neurofibroma one in the deep lobe of the parotid gland and parapharyngeal space, one in the cervical region and one in the nasal cavity.抄録全体を表示PDF形式でダウンロード (4502K) -
―とくに喉頭摘出後発癌例について―宮原 裕, 鶴田 至宏, 佐藤 武男, 吉野 邦俊, 馬谷 克則1991 年 84 巻 5 号 p. 667-671
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーThree patients developed hypopharyngo-cervical esophageal carcinoma, 6.5, 13, and 12 years after total laryngectomy.
The first patient had received irradiation (60 Gy) for hypopharyngeal carcinoma. The recurrent tumor was removed with total pharyngolaryngoesophagectomy and reconstruction was performed with a local skin flap. After 6 years and 6 months, she developed progressive dysphagia. A new cervical esophageal skin cancer was diagnosed by pharyngoesophagography and treated.
The second patient had had total laryngectomy for laryngeal carcinoma and received irradiation (100 Gy) post-operatively. After 13 years, he developed progressive dysphagia. Pharyngoesophagography revealed cervical esophageal carcinoma.
The third patient had received irradiation for laryngeal carcinoma (60 Gy) and underwent total laryngectomy because of recurrence. After 12 years she developed dysphagia, and was treated for hypopharyngeal carcinoma.
These three patients seemed to have radiation-induced carcinoma. Patients treated with total laryngectomy and irradiation who later complain of progressive dysphagia should be examined carefully to differentiate between postoperative stenosis due to scarring and a new carcinoma.抄録全体を表示PDF形式でダウンロード (3064K) -
真鍋 恭弘, 久保 富隆, 茂野 陽子, 斎藤 等1991 年 84 巻 5 号 p. 673-676
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーA patient with the medullary thyroid carcinoma showed no elevation of the plasma calcitonin level. Light microscopic findings confirmed typical medullary thyroid carcinoma. Calcium and gastrin infusion tests did not increase the calcitonin level. Immunoperoxidase study revealed very slight calcitonin within the tumor cells. Electron microscopy showed very few granules in the tumor cells.
This patient was considered to have a poorly differentiated type of medullary thyroid carcinoma different from the typical kind.抄録全体を表示PDF形式でダウンロード (3497K) -
―耳管機能障害と免疫抑制を組み合わせて―藤田 明彦, 倉田 響介, 中村 一, 本庄 巖, 高橋 晴雄1991 年 84 巻 5 号 p. 677-682
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーInflammation is now considered to be the main cause of otitis media with effusion. However, in experimental otitis media with effusion caused by secondary immune responses and iflammatory agents, the effusion is serous and temporary.
We induced otitis media with mucoid effusion in cats by impairing their active ventilatory function and administering immunosuppressant drugs. To cats with eustachian tube dysfunction caused by removal of the tensor veli palatini muscle, we gave cyclosporin and cyclophosphamide. When negative pressure due to tubal dysfunction was caused in the middle ear, otitis media with mucoid effusion resulted in all cases. On the contrary, OME was not observed when the tympanogram remained Type-A.
These results indicate that in the etiology of middle ear inflammation transtubal infection due to negative pressure caused by tubal ventilatory dysfunction is an important factor.抄録全体を表示PDF形式でダウンロード (2193K) -
徳増 厚二, 岡本 牧人, 藤野 明人, 吉尾 知, 澤木 修二1991 年 84 巻 5 号 p. 683-694
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーTwo hundred and thirty patients suffering from vertigo and/or tinnitus and neural deafness due to cerebrovascular disease, Ménière's disease, benign paroxysmal positional vertigo, etc., were treated with bifemerane hydrochloride (Celeport®) in the otorhinolaryngological departments of 17 hospitals in Kanagawa prefecture. A dose of 150mg/day was given for eight weeks to each patient in this open trial. The efficacy of the drug was: 7.8% marked improvement, 36.9% marked or moderate improvement, and 74.7% more than slight improvement. Only 4 patients (1.7%) complained of side effects: indigestion, nausea or dizziness.
It is concluded that this drug is useful in the treatment of vertigo of both central and peripheral vestibular origin. Bifemerane hydrochloride seems to activate brain metabolism rather than improve brain circulation. The pharmacological effects in improving ischemic brain disturbances and inhibiting the decrease of several important neurochemical mediators in the brain, such as norepinephrine, serotonin, glutamate and glutamate bindings have been reported in the literature. The metabolic and circulatory actions of this chemical in both the vestibular and auditory systems, including the inner ear, need further investigation.抄録全体を表示PDF形式でダウンロード (1118K) -
―Multi open trialによる検討―原田 康夫, 鈴木 衛, 平川 勝洋, 中田 将風, 竹林 脩文, 黒川 道徳, 野田 益弘, 吉岡 達生, 屋敷 建夫, 築家 大介, 佐 ...1991 年 84 巻 5 号 p. 695-709
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーComelian® was administered orally after meals to a total of 116 patients in a dosage of 2 tablets t. i. d. (300mg/day) for 8 weeks: 35 patients with central vertigo and 81 with peripheral vertigo.
1) Peripheral vertigo: subjective improvement, moderate or better, was reported by 84.0%, and objective findings of improvement, moderate or better, were noted in 72.5%.
The global improvement rate, moderate or better, was estimated to be 82.7%.
2) A stratified analysis showed a better result in younger than in older patients and in those with a relatively short duration of illness. Also, there was no difference in efficacy between those treated with one course of this drug and those treated for a long time.
3) Central vertigo: subjective improvement, moderate or better was reported by 68.6% and objective findings of moderate improvement or better were noted 43.8%.
The global improvement rate, moderate or better, was 60.0%.
4) A stratified analysis showed that efficacy tended to be slightly lower in those aged 70 years or over, as in the patients with peripheral vertigo, but the efficacy tended to be greater with long-term treatment.
5) Adverse reactions occurred in 5 patients (4.3%). Treatment was stopped in 3, continued in 2. All 5 had peripheral vertigo.
6) The global utility rate was 84.0% (satisfactory or better) in those with peripheral vertigo, and 60.0% in those with central vertigo.
It is concluded that Comelian® is generally useful treatment of both central and peripheral vertigo in the outpatient.抄録全体を表示PDF形式でダウンロード (1516K) -
川島 理, 川島 尚1991 年 84 巻 5 号 p. 711-716
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーA total of 1, 091 patients consulted our night emergency ear nose and throat clinic during the 3-year period from 1987 through 1989.
1) Between 5p.m. and 10p.m., 812 (about 74%) patients came to the clinic.
2) About 62% of these patients were under 10 years of age. Small children between 3 and 6 years of age accounted for most of them.
3) About 78% of the patients lived in the district in which our clinic was located, covered by the Shibukawa District Medical Association.
4) Common diseases included i) acute otitis media (47.0%), ii) acute upper respiratory tract infection (13.6%), iii) foreign body ingestion (11.5%) and nasal bleeding (10.4%).
The main problems were: 1) non-emergency cases, 2) some patitents with ENT emergencies, such as epistaxis or vertigo, were taken to general emergency hospitals.抄録全体を表示PDF形式でダウンロード (730K) -
小松崎 篤1991 年 84 巻 5 号 p. 718-719
発行日: 1991/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (308K)
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