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91 巻, 9 号
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八木 聰明1998 年 91 巻 9 号 p. 873-879
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーThe eye moves along three axes through the center of the eye ball. In addition to horizontal and vertical movements, eyes move torsionally. Thus, three dimensional analysis is essential for understanding eye movements properly, especially vestibular related eye movements which contain many torsional components.
Our new video-oculographic analysis system is presented and its usefulness for basic and clinical investigations of eye movements, including spontaneous nystagmus in patients with peripheral vestibular disorders, are discussed in this report.抄録全体を表示PDF形式でダウンロード (5077K) -
洲崎 春海, 大氣 誠道1998 年 91 巻 9 号 p. 880-881
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2001K) -
―聴力残存例を中心に―宮下 仁良, 磯野 道夫, 村田 清高, 饗場 和子, 田中 久哉, 石川 雅洋1998 年 91 巻 9 号 p. 883-888
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーUp to now the diagnosis of inner ear anomalies has been largely dependent on pathohistological studies. In clinical practice, however, imaging diagnostics are inevitably used to characterize inner ear anomalies. Imaging diagnostics has evolved through a number of steps: simple roentgenography, tomography, computed tomography (CT), high resolution CT and magnetic resonance imaging (MRI). Over the course of development of MRI and imaging diagnostics, pros and cons of these methods have been discussed. We have applied three-dimensional helical CT scanning (3D-CT), which has recently been put to use in clinical diagnosis, to observe shortening of the cochlear turn, which could not be visualized with conventional two-dimensional CT scanning (2D-CT). Case #1, a 17-year-old male, had an inner ear anomaly of the Mondini type, with hearing of 40dB HL in the frequency range for conversation. 2D-CT indicated an anomaly of the cochlea, but failed to reveal its detailed structure. On the contrary, 3D-CT clearly indicated that a part of the cochlear turn was missing. Case #2, a 35-year-old female, had fluctuating hearing levels in the left ear and hearing of 80-40dB HL in the frequency range for conversation. While 2D-CT suggested only a relatively minor anomaly of the inner ear without showing the developmental status of the cochlea in detail, 3D-CT pointed out a shortened cochlear turn. In this way, 3D-CT permitted identification of the cause of deafness, which could not be defined by 2D-CT. These observations suggest that 3D-CT is useful as a method of diagnosing inner ear anomalies and deafness of unknown cause.抄録全体を表示PDF形式でダウンロード (7862K) -
西川 益利, 西川 恵子1998 年 91 巻 9 号 p. 889-893
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of tuberculous otitis media in a 68-year-old man. The patient complained of left otorrhea, right otalgia and hearing loss. Chronic otitis media was suspected on his first visit, but Ziel-Neelsen staining of the aural discharge resulted in a diagnosis of tuberculous otitis media. Treatment with INH and RFP led to complete healing.
In the diagnosis of middle ear infections, it is necessary to bear in mind the possibility of tuberculous and to carry out Ziel-Neelsen staining if there is massive otorrhea in the ear canal. Examination for tuberculous should be done before medication with the new quinolones, some of which are effective against tuberculous.抄録全体を表示PDF形式でダウンロード (5495K) -
萩池 洋子, 小川 晴子, 山田 剛寛1998 年 91 巻 9 号 p. 895-898
発行日: 1998/09/01
公開日: 2011/12/12
ジャーナル フリーWe encountered a patient with bilateral simultaneous facial nerve palsy who was suspected to have idiopathic cranial polyneuropathy, but no change in the cerebrospinal fluid or evidence of infectious disease was detected. The patient displayed symptoms of palsy, but they were related only to the facial nerve. Consequently, he was diagnosed with Bell's palsy.
There are many different potential diagnoses in cases of facial palsy. This report discusses various forms of Guillain-Barré syndrome and Lyme disease which tends to be overlooked as a cause of facial nerve palsy.抄録全体を表示PDF形式でダウンロード (1941K) -
石川 浩男, 尾股 丈夫1998 年 91 巻 9 号 p. 899-904
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーBetween November 1985 and June 1997, 83 cases of foreign bodies in the external auditory canal were treated in our department. They represented 0.352% of the total number of outpatients during the same period. Forty-six of the cases were children under 10 years of age, which accounted for 55.4% of all cases. In total, there were 49 male patients and 34 female patients, including 46 right side cases, 36 left side cases and only one case affected on both sides. Biotic foreign bodies were seen in 20 cases mostly adults, with peak occurrence in July and August. Among nonbiotic foreign bodies, mineral foreign bodies were most numerous, and in 19 cases toy-globes were removed. In 50 of the cases mostly children foreign bodies had been inserted during play. A total of 27 cases were asymptomatic. At the time of removal, intravenous anesthesia with ketamine hydrochloride was very effective in keeping patients, especially children, quiet and still.抄録全体を表示PDF形式でダウンロード (743K) -
篠森 裕介, 有友 宏, 稲木 匠子, 杉本 晃1998 年 91 巻 9 号 p. 905-909
発行日: 1998/09/01
公開日: 2012/02/13
ジャーナル フリーA case of Langerhans' cell histiocytosis of the temporal bone is reported. A 9-year-old boy presented with a 17-month history of right otorrhea. His condition had been previously treated as a case of chronic otitis media. His right external ear canal was found to be obstructed by an aural polyp. A biopsy was performed and pathological findings suggested Langerhans' cell histiocytosis. A CT scan revealed an osteolytic lesion of the superior wall of the external ear canal. Other osteolytic lesions were not found. The polyp mass was surgically removed. The three types of Langerhans' cell histiocytosis cannot be differentiated pathologically. This case however, was diagnosed as an eosinophilic granuloma, one of the three types of Langerhans' cell histiocytosis, because it was a slow-growing solitary lesion. As the presence of an aural polyp is a common symptom in cholesteatoma, especially in children, biopsies and CT scanning should be performed in order to differentiate from cholesteatoma when aural polyps are found.
The prognosis of eosinophilic granuloma is generally favorable, but some cases have been reported to progress to the disseminated type in several years. Careful and long-term follow-up is necessary.抄録全体を表示PDF形式でダウンロード (4840K) -
小野 章子, 渡辺 道隆, 渥美 和江, 松本 俊治1998 年 91 巻 9 号 p. 911-914
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーThis report describes a case of small cell carcinoma which originated from the sphenoid sinus. A male patient aged 54, complaining of diplopia, right facial hypoesthesia and severe headache, was admitted to our hospital. A CT scan and MRI showed a tumor shadow occupying the entire sphenoid sinus and extending to the skull base and the epipharynx. The tumor was diagnosed as a small cell carcinoma based on a punch biopsy of the mucous membrane of the epipharynx obtained through the nasal cavity. As the tumor extended widely to the skull base, treatment by external irradiation and chemotherapy was selected. One year from the initiation of treatment, the tumor has been significantly reduced and the patient's neurological symptoms have improved.抄録全体を表示PDF形式でダウンロード (4742K) -
石光 亮太郎, 卜部 晋平, 片岡 真吾, 岩元 純一, 佐野 啓介, 川内 秀之1998 年 91 巻 9 号 p. 915-918
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of invasive aspergillosis of the maxillary sinus. A man, aged 84, complained of a headache and right visual disturbance. Radiographs and CT scans revealed opacification of the right maxillary sinus and destruction of the posterolateral bony wall.
The clinical diagnosis was optic neuropathy due to sinusitis. External antrotomy of the maxillary sinus and a transnasal ethmoidectomy was performed. Tyroid matter in the right maxillary sinus was subsequently shown to be aspergillus by histopathological examination. Aspergillus infection was accompanied by partial destruction of the posterolateral bony wall of the maxillary sinus.
Following surgery, fluconazole therapy was initiated and the patient responded relatively well. However, 2 months postoperatively, right temporalgia and unconsciousness gradually recurred. Three months postoperatively, the patient died due to sudden respiratory arrest.抄録全体を表示PDF形式でダウンロード (5630K) -
松本 秀, 中村 光士郎, 黒川 浩伸, 菊池 孝1998 年 91 巻 9 号 p. 919-923
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーEleven patients with a lesion localized in the sphenoid sinus, who were operated on in the last six years (April 1991-March 1997), were investigated clinically. Compared to 499 patients with chronic infection or cysts who were operated on in the same period, the frequency of this specific type of lesion was rare, accounting for only 2.2%. These 11 patients were classified into two groups, sphenoidal sinusitis and sphenoidal cyst, according to whether the sphenoid sinus wall was expanded or not in the CT findings. Six patients with sphenoidal sinusitis and five patients with sphenoidal cyst were compared with respect to symptoms and intraoperative findings. Six of 11 patients had complained of visual disturbances. Four of six patients, two from each group, experienced improved of visual acuity after surgery. The two patients in the cyst group had notably better results following immediate surgery than the two patients in the sinusitis group. The reason for this difference was considered to be the occurrence of chronic infection in the cases of sphenoidal sinusitis. Headache, nausea and cheek numbness were common complaints, in addition to visual disturbance, and could be cured by endoscopic sinus surgery.抄録全体を表示PDF形式でダウンロード (2268K) -
河田 恭孝, 倉田 響介, 野々村 光栄, 藤木 暢也, 菊川 達雄, 河田 桂1998 年 91 巻 9 号 p. 925-931
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーTo evaluate the relationship between sleep respiratory disorders (SRD), age and body mass index (BMI), oxygen saturation and nasal breathing during sleep, in addition to BMI, were measured in 81 patients (58 males and 23 females) who consulted us for SRD from September, 1990 to May, 1997. Thirty two patients were obese (BMI≥26.4kg/m2) and 25 patients were overweight (24.2≤BMI<26.4kg/m2). Obese patients had a significantly statistically higher oxygen desaturation index (ODI) than overweight and non-obese ones (p<0.01, Kruskal-Wallis rank test).
There were also significant differences in ODI between the younger group (10 patients whose ages were less than 30 years old) and the older group (71 patients whose ages were more than 30 years old), and the 56 patients with obstructive sleep apnea (OSA) (ODI≥5) were significantly older than the 25 patients without OSA (ODI<5) (p<0.01, Mann-Whitney U test). However, there were no differences in BMI between 5 age groups.
We concluded that age and overweight represented both independent and additive risk factors for SRD.抄録全体を表示PDF形式でダウンロード (691K) -
韓 相善, 北村 薄之, 高北 晋一, 前谷 俊樹, 岩橋 由佳, 山本 典生, 宮崎 眞和1998 年 91 巻 9 号 p. 933-936
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーFrom 1990 to 1997, 318 patients had undergone operations for thyroid carcinoma at our facility. We investigated the complications observed in these cases retrospectively, and summarized them in this report.
Postoperative recurrent laryngeal nerve palsy was observed in 70 cases; the palsy was temporary in 39 sides, but was permanent in 33 sides. There was no statistical difference in the frequency of recurrent laryngeal nerve palsy whether we performed a paratracheal dissection or not.
Postoperative hypoparathyroidism was observed in 124 cases; this was temporary in 59 cases and permanent in 65 cases. Surgeons should therefore preserve or transplant at least two parathyroid glands, if possible, especially during a total thyroidectomy.抄録全体を表示PDF形式でダウンロード (405K) -
島本 久美子, 杉本 太郎, 野口 佳裕, 根岸 達郎, 原口 秀俊, 小松 崎篤1998 年 91 巻 9 号 p. 937-944
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーCarcinoma arising in a thyroglossal duct remnant is relatively rare. We experienced a case of a papillary adenocarcinoma in a remnant of the thyroglossal duct. In Japan, only 45 such cases have been reported to date.
A 17-year-old male visited our hospital complaining of a mass in the anterior region of the neck. A well circumscribed and soft elastic mass was palpated in the midline of the neck at the level of the hyoid bone. Ultrasonography, computed tomography and magnetic resonance imaging revealed a mass of 4×3cm, in contact with the hyoid bone. The mass was cystic in structure and contained a calcific protrusion. This protuberance was intermediately enhanced in the CT image. Aspiration biopsy of the tumor, however, did not reveal atypical cells and the tumor was diagnosed as class I.
The mass was resected by Sistrunk's procedure. The tumor had adhered to the hyoid bone and the connective tissue around it, but no metastatic neighboring lymph nodes were found.
The histopathologic diagnosis of the tumor was papillary adenocarcinoma arising in a thyroglossal duct remnant. Neither invasion of the hyoid bone nor invasion of the surrounding connective tissue was evident, and the surgical margin of the resected specimen was negative.
The patient has been free from the disease for 18 months after surgery. In diagnosing this condition, preoperative assessment using CT, MRI, US and an aspiration biopsy smear was necessary. In most cases, however, malignancies are not suspected before surgery.抄録全体を表示PDF形式でダウンロード (7646K) -
郡山 智也, 白木 直也, 石神 寛道1998 年 91 巻 9 号 p. 945-950
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーThis report documents 4 cases of subacute necrotizing lymphadenitis which were confirmed by cervical lymphonodus biopsy. The patients included 3 females and 1 male, and the age of these patients at the first diagnosis ranged from 14 to 37 years old. With respect to symptoms, cervical lymphadenopathy with fever and tenderness was observed in all cases, pharyngalgia was observed in 3 cases, pharyngeal flare lasting 7-14 days was observed in 3 cases, definite tonsillitis was observed in 1 case, and papuloerythema was observed in 1 case. With respect to the examination findings, leukopenia was observed in all cases, the CRP was positive in 3 cases, an increase in LDH was observed in 2 cases, an increase in GOT and GPT was observed in 2 cases, 2 cases were positive for reumatoid factor (RF), all of the patients were negative for antinuclear antibody, and the presence of EBV antibody indicated previous infection. The tuberculin reaction was positive in 3 cases, but not intensely positive, and negative in 1 case. The period of fever lasted from 10 days to 6 weeks. In 3 cases, administration of an antibiotic drug and a non-steroidal antiphlogistic analgesic drug were curative. The remaining case required steroidal treatment.抄録全体を表示PDF形式でダウンロード (5224K) -
日域 洋子, 浅井 昌大, 海老 原敏1998 年 91 巻 9 号 p. 951-956
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーWe successfully reconstructed the airway after non-circumferential resection of a trachea invaded by tracheal cancer (adenoid cystic carcinoma) using a cervical skin flap. After the cricoid cartilage and eight tracheal rings were partially removed, a cervical skin flap was inserted into the defect, thus creating a transient tracheostoma. On the first postoperative day, the patient could walk and eat without any trouble. No postoperative complications occured. Two months later, the tracheostoma was closed with local skin flaps and postoperative radiotherapy was performed. As a local treatment for tracheal cancer, a cervical skin flap is very useful for reconstruction.抄録全体を表示PDF形式でダウンロード (9841K) -
―伝染性単核球症に続発した成人例―平 篤史, 原渕 保明, 久々湊 靖, 形浦 昭克1998 年 91 巻 9 号 p. 957-962
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーAn adult case of virus associated hemophagocytic syndrome (VAHS) which developed from infectious mononucleosis (IM) is reported. A 21-year-old-man visited our clinic with complaints of high fever, sore throat, and cervical lymphadenopathy. The palatine tonsils appeared to be swollen with white plugs on the surface. Hematological examination revealed mononucleosis with atypical lymphocytes in the peripheral blood. The serum LDH level was elevated. Serum antibodies to Epstein-Barr virus (EBV) showed a primary infection pattern. The patient, on the basis of these findings, was initially diagnosed with IM. The symptoms and laboratory data subsequently showed transient improvement; however, liver dysfunction, pancytopenia, and interstitial pneumonia ultimately developed. Bone marrow puncture was performed 29 days after admission and revealed inflitration of a number of mature histiocytes with erythrophagia, suggesting that VAHS had developed from IM. Combined chemotherapy with prednisolone, interferon, acyclovir, and VP-16, was not effective, and progressive liver dysfunction and pancytopenia advanced. He died 47 days later of disseminated intravascular coagulopathy.抄録全体を表示PDF形式でダウンロード (4976K) -
森 淳子1998 年 91 巻 9 号 p. 963-970
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーA total of 889 patients with olfactory disturbance who were examined at the Olfaction Clinic of Osaka City University Hospital from January 1982 to December 1996 were studied retrospectively using clinical records in order to investigate the relationship between the patient characteristics and prognosis. Etiologically the characteristic variables of head trauma and congenital olfactory disturbance were most strongly associated with poor prognosis. Among patients with rhinosinusitis and head trauma, the characteristic variables of female patients, those with a short period of olfactory disorder, and those with high olfactory acuity before treatment showed faster improvements in olfactory disturbance. None of the characteristic variables had any influence on prognosis in the patients with viral infection. The age and presence of abnormal smell sensations similarly did not have any significant influence on prognosis. Improvement was recognized in most patients within 6 months. Hence, patients with olfactory disturbances should be treated for at least 6 months.抄録全体を表示PDF形式でダウンロード (7112K) -
大橋 淑宏, 阪本 浩一1998 年 91 巻 9 号 p. 972-973
発行日: 1998/09/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1999K)
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