耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
85 巻, 1 号
選択された号の論文の23件中1~23を表示しています
  • ―その特殊性と時代性―
    冨田 寛
    1992 年 85 巻 1 号 p. 1-3
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 池田 稔, 生井 明浩, 冨田 寛
    1992 年 85 巻 1 号 p. 3-10
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 田中 正美
    1992 年 85 巻 1 号 p. 11-14
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 浅賀 英世
    1992 年 85 巻 1 号 p. 15-21
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 調所 廣之
    1992 年 85 巻 1 号 p. 21-23
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 斎藤 等, 鹿野 佳子, 涌井 慎哉, 藤枝 重治
    1992 年 85 巻 1 号 p. 24-25
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 菊守 寛, 長谷川 哲, 津田 守, 荻野 敏
    1992 年 85 巻 1 号 p. 27-34
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    We report a case of ASNHL (autoimmune sensorineural hearing loss) with systemic symptoms. The patient was a 64-year old female who consulted us with complaints of bilateral hearing loss and left tinnitus. Later, she had cranial polyneuropathy (L: V VII VIII, R: VIII XII), diabetes insipidus, headache and fever. Her blood sedimentation rate, CRP and γ-globulin were increased. Antinuclear antibodies and antihypophysis antibodies were found in her serum. Her general condition and hearing level were improved by steroid and cyclophosphamide therapy. Autoimmune vasculitis was suspected, but histopathological studies of granulation tissue around the left stapes and left superficial temporal artery were not specific. Steroid therapy is being continued.
  • 加藤 寛, 垣内 弘, 高野 郁晴, 寒川 高男, 田端 敏秀, 嶽良 博
    1992 年 85 巻 1 号 p. 35-40
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Histiocytosis-X is a rare disease presenting as 3 clinical syndromes; eosinophilic granuloma, H and-Schüller-Christian disease, Letterer-Siwe disease. Although the clinical expressions of the disease differ, the underlying histopathology appears to be the same. Our patient was a 3-year-old boy with a recurrent neck tumor, who had been treated for left temporal bone eosinophilic granuloma about one year earlier. Our diagnosis was a Hand-Schüller-Christian disease developing from an eosinophilic granuloma, but it was not typical. The pertinent literature on the signs, symptoms, diagnosis, and treatment of this disease is reviewed.
  • 田中 久哉, 村田 清高, 木村 裕毅, 石川 雅洋, 田中 かおり, 太田 文彦, 伊藤 浩行, 中村 吉伸
    1992 年 85 巻 1 号 p. 41-47
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    A 21-year-old female had chondroblastoma arising from the left temporal bone. Although 32 cases of temporal chondroblastoma have been reported, this is the first patient who had facial palsy as the initial symptom. The tumor extended to the dura, so the patient was treated with wide local excision through a combined extended transmastoid and middle cranial fossa approach. The bone defect was found in the horizontal to geniculate ganglia of the facial canal where it compressed the facial nerve. Removal of the tumor cured the facial palsy. This disease should be included in the differential diagnosis of facial palsy.
  • 石川 保之, 藤田 明彦, 本庄 巖
    1992 年 85 巻 1 号 p. 49-53
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    The mucociliary function of the nose and eustachian tube orifice was examined by the saccharin test in 46 patients with OME (otitis media with effusion), aged 12 to 79 years, to determine whether impaired mucociliary function of these areas plays a pathogenic role in OME. The control group included 29 normal subjects, aged 20 to 70 years, who had no diseases of the nose or ears.
    The saccharin test of the nose was performed as reported previously, and the normal upper limit was determined to be 11 minutes. For the evaluation of mucociliary function around the eustachian tube orifice, a nasoendoscope (Olympus ENF-type P) with a thin tube and syringe attached was used to apply the saccharin solution plus gentian violet. A drop of saccharin solution could be accurately placed at the eustachian tube orifice with the nasoendoscope monitor, and the time for the subject to report a sweet taste was recorded up to 15 minutes. The normal upper limit of the saccharin time around the eustachian tube orifice was determined to be 4 minutes. Both tests were performed on the right side in the normal controls, on the side of the affected ear in patients with unilateral OME, and on the right side in patients with bilateral OME.
    Mucociliary function around the eustachian tube orifice was found to be impaired significantly and correlated well with that of the nose. It is therefore possible that mucociliary dysfunction of these areas increases the risk of infection via the eustachian tube or prolongs inflammation in the middle ear.
  • 福山 つや子, 前山 忠嗣, 草場 靖, 江崎 秀夫, 宮崎 純二, 進武 幹
    1992 年 85 巻 1 号 p. 55-59
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Although persistence of the bursa pharyngea is observed in 4% of human adults, it is usually asymptomatic without inflammation. To date, there have been 10 reports of Tornwaldt's disease in Japan. In some of these reports, the authors confused the name of disease, so the actual number of cases of true Tornwaldt's disease is smaller. Our patient with Tornwaldt's disease is reported because of the rarity of the condition. A 41-year-old man complained of occipital and temporal headache with symptoms similar to cervical vertigo. Horizontal nystagmus was seen in suspending and rotaing head positions. A 1.5cm diameter round mass covered with slightly injected mucosa was present in the midline of the posterior nasopharyngeal wall. MRI revealed a well-defined oval cyst between the nasopharyngeal mucosa and the vertebrae. In the coronal image, the cyst was located in the midline between the longus capitis muscles, and in the sagittal image, the cyst had a tear-drop shape. The cystic mass was removed by a trans-palatal approach using a contact Nd-YAG laser. Histological examination revealed a cyst lined with ciliated columnar epithelium and the presence of numerous inflammatory cells. The patient was relieved of his symptoms 1 week after surgery. We considered that the cervical vertigo-like symptoms were caused by irritation of the sympathetic plexus surrounding the basilar artery induced by inflammation of the cyst, and that MR imaging was very useful in the diagnosis of Tornwaldt's disease.
  • 柳田 昌宏, 山下 敏夫, 加藤 勤, 牛呂 公一, 山内 康雄, 熊澤 忠躬, 田中 敬正
    1992 年 85 巻 1 号 p. 61-68
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Magnetic resonance images of 47 patients with postoperative maxillary cyst were analyzed for size, location, and signal intensity. The smallest cyst was confirmed at surgery to be 1cm×1cm×1cm and the largest 5cm×5cm×5cm.
    The cysts were usually found in the superomedial and inferomedial parts of the maxillary sinus (44%). Many patients (60%) had multiple cysts or bilateral cysts (30%).
    In most the signal intensiy was low in the T1-weighted SE (500/40) images and high in the T2-weighted SE (2000/80) images.
    Cysts with a hemorrhagic component, though rare, showed high signal intensity in both T1-and T2-weighted images.
  • 乾洋 史, 菊岡 政久, 藤田 信哉, 田中 治, 宮原 裕, 松永 喬
    1992 年 85 巻 1 号 p. 69-75
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Metastatic tumors to the nose and paranasal sinuses are relatively rare. We report a case of renal cell carcinoma metastatic to the maxillary sinus. The patient was a 55-year-old male with left nasal bleeding. Several ultrasonic and radiographic examinations revealed right renal cell carcinoma. Total nephrectomy was performed, followed by total maxillectomy.
    An analysis of 394 previously published cases showed that about 30% of metastases to the head and neck were from renal cell carcinomas, and the most common sites of matastases were the nose and paranasal sinuses. When we see frequent nasal bleeding and rare pathological findings, the possibility of metastatic tumor should be considered.
    The metastatic pathways to the head and neck are discussed briefly.
  • 山本 美奈子, 大築 淳一, 田中 一仁, 冨澤 郁子, 森永 正二郎, 行木 英生
    1992 年 85 巻 1 号 p. 77-82
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Lymphangiomas in parotid glands occur frequently in children younger than 2 years of age but are rare in adults.
    A 43-year-old female visited our hospital complaining of a swelling in the right parotid region. From the sialo-CT appearance, it was suspected that the tumor originated in the deep lobe of the right parotid gland and extended into the right parapharyngeal space.
    The tumor was confirmed at operation to originate in the deep lobe of the parotid gland.
    Pathological examination indicated that the tumor was a cavernous type lymphangioma.
  • 横山 晴樹, 平林 源, 納谷 裕, 山本 香列
    1992 年 85 巻 1 号 p. 83-88
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    A 58-year-old female was referred to us because of a bulge of the lateral pharyngeal wall and a mass at the angle of the mandible. CT scan showed a large tumor occupying the parapharyngeal space and extending intracranially. We suspected the tumor to be malignant because of destruction of the skull base, and performed an intraoral biopsy which showed benign schwannoma. The tumor was removed by a two-stage operation. The first stage was performed by neurosurgeons for the intracranial portion of the tumor. We performed the second stage for the parapharyngeal portion of the tumor, using an external approach with mandibulotomy at the angle of the mandible. The patient was discharged seven weeks after our operation with no complications.
    An external approach is recommended for removal of tomors in the parapharyngeal space.
    CT scan was useful in the diagnosis of the tumor in the parapharyngeal space.
  • 石津 吉彦, 竹内 裕一, 山田 理, 村上 博, 松田 英賢, 生駒 尚秋
    1992 年 85 巻 1 号 p. 89-94
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    A 64-year-old female had an adenoid cystic carcinoma (cribriform type) in the parapharyngeal space. The tumor was extirpated through a midline mandibulotomy.
    Twenty two patients with parapharyngeal space tumors were treated from 1960 to 1990. Malignant tumors were found in 8 (36.4%). This is a higher rate of malignancy than in other reports. Eighteen adenoid cystic carcinomas were found during the same time, and we could follow 12 patients.
    We think that an important prognostic factor is the clinical stage. Five-year, 10-year and 15-year survival rates were 77.8, 64.8 and 32.4%, respectively, in our 12 patients. Six had distant metastases, with lungs probably the most common site.
  • 角田 篤信, 山下 公一, 小松 崎篤
    1992 年 85 巻 1 号 p. 95-99
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Amyloidosis of the larynx is an uncommon disease which may occur in a localized pattern. A patient with laryngeal amyloidosis has been followed for 9 years. She was 63 years old when she developed severe hoarseness. A small mass was first seen on the left vocal cord, then observed on the left false cord and the arytenoid. Histological examination of Congo-red stained tissue under a polarized microscope revealed yellow-green birefringence. CO2 laser vaporization was performed. The wide surgical defect caused by the laser vaporization was covered with subglottic mucous membrane with the use of fibrin glue. The hoarseness was improved, and there has been no evidence of recurrence for one and a half years.
    Laser surgery is an effective and less invasive treatment for laryngeal amyloidosis.
  • 大川 剛, 森芳 郎, 伊藤 八次, 鈴木 智雄, 松原 茂規
    1992 年 85 巻 1 号 p. 101-105
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    A 6-month-old female had sudden onset of cough, stridor and dyspnea. A chest X-ray film showed emphysema of the left lung and deviation to the right of the mediastinum and trachea.
    Respiratory sounds were weak on the left. A small toy was missing, so we suspected bronchial foreign body and did a bronchoscopic examination.
    We could not find any foreign body, but saw granulation blocking the lumen of the left main bronchus and polypoid granulation in the right main bronchus. Bronchial tuberculosis was diagnosed by histological examination.
    She was treated with anti-tuberculosis medicines. Although she experienced repeated remissions and exacerbations, her dyspnea was suddenly relieved and she was free of emphysema. Now she is in good health.
  • 山口 忍
    1992 年 85 巻 1 号 p. 107-121
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    The relationship between the morphology of the levator muscle and the function of velopharyngeal closure or clarity of speech in patients with submucous cleft palate or congenital velopharyngeal imcompetence was investigated with an enzyme histochemical technique. The ultrastructure of the levator muscles was examined by transmission electron microscopy. The muscle fibers in the levator muscles of patients with these two diseases were classified into three types, red, white and intermediate, by SDH staining.
    Levator muscle with excellent velopharyngeal closure function or with those in patients with excellent speech contained red fibers. Poorly aligned muscle fibers with a wide range of diameters have been recognized in these two diseases. The histogram of the diameter of muscle fiber showed a wide spread and unimodal distribution pattern. The diameter of muscle fibers tends to be increased in patients with superior function of velopharyngeal closure or in old age. In patients with congenital velopharyngeal incompetence, however, small fibers are seen. Ultrastructural investigation revealed that the levator muscles in these two diseases consist of either normal or degenerative muscle fibers with misaligned myofibrils or vacuolation. Signs of necrosis, such as hypercontraction of myofibrils and degeneration of the nucleus and regeneration with central nuclei were also noted, suggesting segmental necrosis of muscle cells and the possibility of regeneration.
  • ―高齢者を対象として―
    杉本 和彦, 白石 孝之, 久保 武, 松永 亨
    1992 年 85 巻 1 号 p. 123-129
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    The therapeutic effect of bifemelane hydrochloride was studied in 38 patients over 50 years of age with tinnitus. The patients were given a 50mg tablet of bifemelane hydrochloride three times daily for 2 to 8 weeks.
    Evaluation of the final global improvement showed it to be very effective in 2 patients (5.3%), moderately effective in 9 (23.7%) and slightly effective in 5 (39.5%), giving a total efficacy rate of 68.4%. The improvement in patients with hypertension and tinnitus was especially good, with a total efficacy rate of 75.0%.
    No side effects were noted.
    Bifemelane hydrochloride is considered to be useful for aged patients with tinnitus.
    The origin of tinnitus in aged patients seems to be only in the peripheral auditory pathway but also in the neurons in the central auditory pathway, and this drug presumably activates the function of neurons in the central auditory pathway.
  • 森 望, 執行 昭男, 古田 浩, 渡辺 泰樹, 川原 孝文, 酒井 俊一
    1992 年 85 巻 1 号 p. 131-135
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    The serum and middle ear tissue concentration of enoxacin, a pyridone carboxylic acid derivative, was measured in 20 patients with chronic otitis media. The drug was given orally in a dose of 600mg 3 times a day for one to 24 days (average 6.3 days) on an average of 13.1 hours before the serum and tissue samples were obtained during tympanoplasty. In the 14 patients, for whom data of both serum and tissue concentrations were obtained, the concentrations were 0.90±0.66μg/ml and 3.32±3.50μg/kg, respectively. The tissue concentration was 384±236% times the serum concentration.
  • ―ノイロトロピン®併用減感作療法の検討―
    奥田 稔, 寺山 吉彦, 石川 和郎, 後藤 みずほ, 一林 正剛, 本村 昌一, 海野 徳二, 高橋 光明, 戸川 清, 今野 昭義, 高 ...
    1992 年 85 巻 1 号 p. 137-153
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
    Neurotropin®, an extract isolated from inflamed rabbit skin, has been used in Japan as an anti-allergic. We studied the effectiveness of the combined treatment of hyposensitization and Neurotropin® injections on perennial allergic rhinitis. Assessment was based on clinical effectiveness and changes in the serum levels of specific IgG, IgG1 and IgG4 antibodies against house dust mite in a multicenter well-controlled study. The control group was treated with specific hyposensitization alone.
    In the combined treatment (CT) group, house dust hyposensitization therapy and Neurotropin® in a dose of 3ml were administered simultaneously twice a week for 12 to 36 weeks. The number of patients treated for 12 weeks or more was 72 in the single treatment (ST) group and 68 in the CT group. The global improvement rating, determined by both subjective symptoms and objective examinations, of the CT group (88.2% of cases; improvement or better) was significantly superior to that of the ST group (66.2%). Among the subjective and objective findings observed, the improvement of disturbance in daily life, swelling of the inferior nasal concha, and the amount of nasal secretion in the CT group was significantly greater than the improvement in the ST group. No significant difference was observed in the frequency of side effects, including drop-outs, between the ST group (4 out of 73) and the CT group (5 out of 69). The effectiveness of treatment in the CT group was significantly greater than in the ST group, with more “remarkable improvement” cases being found in the CT group. However, Dermatophagoides pteronysis-specific IgG (s-IgG), s-IgG1 and s-IgG4 antibody levels did not differ significantly between the two groups, although they were somewhat higher after than before treatment. For both groups, no remarkable difference was found in changes in s-IgG, s-IgG1 and s-IgG4 antibody levels between those showing clinical effectiveness and those without a good response.
    The results indicate that Neurotropine treatment combined with hyposensitization was more beneficial than hyposensitization alone, but we failed to reveal whether or not Neurotropin® affects the mechanism by which hyposensitization therapy works.
  • 本庄 巖
    1992 年 85 巻 1 号 p. 154-155
    発行日: 1992/01/01
    公開日: 2011/11/04
    ジャーナル フリー
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