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92 巻, 11 号
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―臨床効果と効果発現機序―大橋 淑宏, 田中 亜矢樹1999 年 92 巻 11 号 p. 1157-1166
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーImmunotherapy for allergic diseases is a time-honored method; it has been widely used for more than 90 years. However, in the opinion of many physicians, it represents a controversial treatment of allergic diseases. The exact working mechanisms behind the clinical efficacy of immunotherapy still remain to be definitively determined. In the present study, the current concept of the clinical efficacy and the working mechanisms of immunotherapy for allergic rhinitis were reviewed. Recent double-blind placebo-controlled studies have clearly demonstrated the clinical efficacy of immunotherapy for allergic rhinitis, and this therapeutic method has several unique advantages over conventional pharmacological treatment. Immunotherapy might be inferior to pharmacological treatment in the short term but, in the long term, Immunotherapy is substantially superior to pharmacological treatment in terms of clinical efficacy. The most fascinating advantage is that immunotherapy has the potential to permanentally alleviate the abnormal immunological responses and to cure the nasal symptoms for a long time even after discontinuation of the injection course. In addition, immunotherapy can prevent the onset of new sensitizations in allergic patients, and may prevent the progression of rhinitis to asthma. Therefore, immunotherapy has an interesting possibility to alter the natural history of allergic sensitization and clinical manifestations. These lines of clinical evidence would have an impact on the long-term therapeutic strategy of allergic rhinitis.
Modern molecular biological techniques have suggested that immunotherapy may affect allergen-induced Th responses or cytokine profiles, but there is no general agreement among different investigators. However, IL-5 is likely to be the most important cytokine involved in the clinical efficacy of immunotherapy, and the suppression of allergen-induced IL-5 synthesis is most likely to be involved in the working mechanisms of immunotherapy.抄録全体を表示PDF形式でダウンロード (3243K) -
高橋 廣臣1999 年 92 巻 11 号 p. 1168-1169
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1990K) -
瀬野 悟史, 鈴木 幹男, 北西 剛, 佐伯 紀子, 北野 博也, 矢澤 代四郎, 北嶋 和智1999 年 92 巻 11 号 p. 1171-1180
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリー212 patients diagnosed with sudden deafness between October, 1978 and April, 1998 were reported in our department. In order to clarify the relationship between sudden deafness and diabetes mellitus, the treatment course of 18 patients with sudden deafness, who were affected by diabetes, was analyzed retrospectively. The patients with sudden deafness were divided into two groups (diabetic and non-diabetic) and were analyzed. The following results were obtained:
1) The mean age of patients in the diabetic group was 51.8 years, approximately 8 years older than the non-diabetic group. The number of patients with diabetes mellitus increased markedly in the last 10 years.
2) There was no significant difference in hearing improvement after treatment as well as in hearing levels between the two groups.
3) The rate of patients with dizziness or vertigo in the diabetic group was significantly higher than in the non-diabetic group. The patients with dizziness or vertigo showed a poorer prognosis in their hearing loss.
4) There was no relationship between the duration of diabetes and the prognosis of hearing loss. The patients with retinopathy due to diabetes tended to show less hearing improvement.
5) Steroid therapy for sudden deafness patients with diabetes was executed without worsening the diabetic condition if insulin was administered adequately.抄録全体を表示PDF形式でダウンロード (1275K) -
高橋 將範, 硲田 猛真, 斉藤 優子, 十河 英世, 藤木 嘉明, 芝埜 彰, 嶽 良博, 榎本 雅夫, 阪上 雅史1999 年 92 巻 11 号 p. 1181-1186
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe have an interesting case of sudden sensorineural deafness of both sides with DM. The hearing loss of the left side and diabetic control were progressively aggravated by steroid therapy. We suspected that this was a case related to viral infection. Anti-parainfluenza 3 virus titer increased by anti-virus titer examination. Therefore, we changed from steroid to γ-globulin therapy and performed intensified conventional insulin treatment. Diabetic control was improved and the right side showed excellent recovery. However, the left side experienced deafness. In general, DM produces individual immune dysfunction. Thus, we consider that the hearing loss in both sides was progressively aggravated because of steroid therapy, which induced excessive individual immune dysfunction and viral activation.抄録全体を表示PDF形式でダウンロード (729K) -
山下 勝, 野々村 光栄, 菊川 達雄1999 年 92 巻 11 号 p. 1187-1190
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーAir bag deployment produces an intense noise when it inflates. We reviewed a patient suffering from unilateral hearing loss following air bag deployment. A 22-year-old woman was driving a car wearing her safety belt. Upon entering a crossing, the automobile collided with another on the left side. At the moment of the collision, the driver's air bag inflated with an intense noise. Since she was looking to her left at the time, the air bag deployment exposed the noise to her right ear. She noticed a hearing loss and tinnitus in her right ear soon after the accident. Physical examination was normal. Bilateral tympanic membranes were normal. An audiometric examination revealed a moderate sensorineural hearing loss (46.3 dB) in her right ear. A tapering course of methylpredonisolone was undertaken. Three days after the accident, she was relieved of the hearing loss and severe tinnitus, and audiometric tests showed no hearing impairment (8.8 dB) in the right ear.
All physicians should know that air bag deployment may produce hearing loss.抄録全体を表示PDF形式でダウンロード (371K) -
西野 裕仁, 越智 健太郎, 宮本 康裕, 渡辺 昭司, 杉山 裕, 今西 好正, 大橋 徹1999 年 92 巻 11 号 p. 1191-1194
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーMagnetic resonance imaging (MRI) is accepted as one of the most sensitive and specific measures currently available in diagnosing endocranial disorders. In a retrospective study, the clinical records and the results of MRI scans of 287 patients (105 men and 182 women) presented to the ENT department of St. Marianna University School of Medicine, Toyoko Hospital, were analysed. Inclusion criteria to receive an MRI scan included patients with sensorineural hearing loss (70 patients), tinnitus (78 patients) or vertigo (139 patients) between 1995 and 1997. Pathological conditions were detected in MRI scans in 12.9% of patients with sensorineural hearing loss, 6.4% with tinnitus and 7.9% with vertigo. There was no statistically significant difference between the three groups. Since many silent lacunar lesions were detected in this study, we investigated the morbidity rate of silent lacunar lesions. There were silent lacunar lesions in 10.0% of patients with sensorineural hearing loss, 15.4% with tinnitus and 20.1% with vertigo. There was no significant difference between the three groups. In this study, more than 50% of silent lacunar lesions were observed in patients whose ages were over 60 years. In addition, patients with hypertension or heart disease suffered silent lacunar lesions more frequently than patients without hypertension or heart disease. We believe that a patient's age and prevalence of hypertension or heart disease important factors when selecting patients for MRI study.抄録全体を表示PDF形式でダウンロード (571K) -
関 聡, 犬飼 賢也, 渡辺 一道, 橋本 茂久, 山本 裕, 佐藤 斎, 高橋 姿1999 年 92 巻 11 号 p. 1195-1200
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーFive cases of perilymph fistula (PLF) were classified into two groups: three cases of PLF identified surgically (confirmed group), and two cases treated conservatively (uncertain group). The recovery of hearing and the outcome of nystagmus between the groups were compared. In both groups, the improvement of hearing in the low-middle tone range was good, but that in the high tone range was poor. In the confirmed group, spontaneous and positional nystagmus decreased or diminished soon after the closure operation of PLF. On the other hand, in the uncertain group, both types of nystagmus continued for long periods. We considerd that some inner ear damage remained in this group. Furthermore, PLF was indicated if spontaneous or positional nystagmus persisted for long periods without vertigo in idiopathic sudden hearing loss or Ménière's disease.抄録全体を表示PDF形式でダウンロード (787K) -
中野 友明, 長 寛正, 杉田 雅彦, 塩谷 隼人, 松本 康, 山田 浩二1999 年 92 巻 11 号 p. 1201-1204
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーAn inverted papilloma is rare in the nasal cavity. Although surgery is usually performed, recurrence often occurs.
We report a case of 69-year-old female with an inverted papilloma in the nasal cavity. The inverted papilloma was made extremely small a week after a local injection of β-interferon (3 million units) was administered. Then, a local injection of β-interferon (3 million units) was performed once a month. There was no change in the papilloma size for the next 3 months.
We think interferon therapy should become the first choice of therapy for a papilloma in the nasal cavity. However, it is not established how to dispense interferon for patients with a papilloma. Longer observations and more cases are needed.抄録全体を表示PDF形式でダウンロード (4647K) -
吉福 孝介, 西園 浩文, 松崎 勉, 松根 彰志, 西元 謙吾, 黒野 祐一1999 年 92 巻 11 号 p. 1205-1209
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーA rare case with nasopharyngeal angiofibroma stalked from the posterior middle nasal meatus was reported. The patient, a 21 years old male, complained of recurrent bleeding and obstruction of the left nostril. Anterior rhinoscopy showed a tumor occupying the left middle nasal meatus and choanae. Histological examination was performed and the tumor was diagnosed as angiofibroma. Angiography showed that the feeding artery was the left maxillary artery. Angiographic embolization with gelf orm and a transpalatal approach were performed in order to remove the tumor four days after the embolization. The tumor was stalked from the posterior middle nasal meatus and was readily removed with electrocautery. Blood loss was 80ml.抄録全体を表示PDF形式でダウンロード (8283K) -
高野 信也, 荒牧 元1999 年 92 巻 11 号 p. 1211-1216
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe examined 944 patients who visited Tokyo Women's Medical University Daini Hospital Department of Otorhinolaryngology who had experienced abnormal sensations of the throat for three months or more, and who were able to be followed. The patients were examined between January 1993 and December 1997.
1) There were many cases of non-organic disease among women in their forties.
2) Numerous symptoms of mild illness were detected by the symptom classifications of nasal disease and rhinopharyngeal disease.
3) Symptoms often affected the cervical spine, the esophagus, and the stomach at deglutition.
4) It is insufficient to judge the presence of an organic disease only from the symptoms and the type of the symptoms.
5) The pattern of manifestation of symptoms is important for judging the site of involvement.
6) Endoscopic inspection is important for judging the presence of an organic disease.
7) It is necessary to recommend examination while keeping in mind organic disease, which can be concealed in cases where the cause is thought to be psychological.抄録全体を表示PDF形式でダウンロード (1630K) -
北村 守正, 結城 和央, 林 正彦, 楯谷 一郎1999 年 92 巻 11 号 p. 1217-1220
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーA case of a long-standing foreign body in extrapharyngeal space is reported. A 61-year-old male experienced pharyngalgia after eating a sea bream. The pharyngalgia disappeared after 3 days. Six months later, he visited our hospital complaining of hoarseness, pharyngalgia and dyspnea. On laryngeal fiberscopy, we observed paralysis of the left vocal cord and edema of the left arytenoid and the left side of the epiglottis, but we found no foreign body. A cervical soft X-ray film revealed the foreign body in extrapharyngeal space. After we mitigated inflammation by using methylpredonisolone and antibiotics and identified the position of the foreign body by CT scan, we removed it by laryngomicro surgery. It was a fish-bone measuring 20mm in length. Vocal cord paralysis disappeaed several days later.抄録全体を表示PDF形式でダウンロード (3078K) -
宮田 耕志, 楠井 隆1999 年 92 巻 11 号 p. 1221-1224
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of a 67-year-old female with a venous aneurysm of the internal jugular vein. She visited our hospital complaining of pharyngeal pain. A right thyroid mass was noted by chance. CT scan revealed focal dilatation of the right internal jugular vein next to the right thyroid tumor with lower left cervical lymph node metastasis. Although the sternocleidomastoid muscle was pressed outward by the venous aneurysm, no symptoms of venous aneurysm existed. MR angiography with contrast media was very useful for evaluating the venous aneurysm. A right thyroidectomy with left neck dissection was performed for the thyroid disease. As for the right side, neck dissection was avoided because of the risk of a venous aneurysm rupture. The patient has been observed carefully for 3 years without any symptoms of venous aneurysm or any signs of recurrence of thyroid cancer.抄録全体を表示PDF形式でダウンロード (5339K) -
金 泰秀, 山本 悦生, 辻 純, 篠原 尚吾, 宗田 由紀, 田辺 牧人, 坂本 達則, 寺下 健洋1999 年 92 巻 11 号 p. 1225-1228
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe retrospectively investigated recurrent cases of papillary thyroid carcinomas (PTCs) to find appropriate modes of neck dissection for PTCs. One hundred twenty-nine patients with thyroid cancer received surgical treatment at the department from 1987 to 1998, and 110 patients (29 males, 81 females) with papillary thyroid carcinomas were available for the present study. In our clinic, jugular modified neck dissection or modified radical neck dissection were applied, if jugular nodes were prominent in preoperative images, or if they proved to be metastatic lymph nodes in an intraoperative pathological study. Thus, jugular modified neck dissections were performed in 13 cases, and modified radical neck dissections, in 29 cases. In the remaining 68 cases, the ranges of dissections were within regional lymph nodes, or no lymph nodes were dissected.
Recurrence in jugular nodes occurred in 3 of 68 cases without jugular node dissection. Extra-capsular invasions at the primary lesions were observed in all of the 3 cases.
Metastases in lateral neck lymph nodes were present in 6 of 29 cases with radical modified neck dissection. In 5 of these 6 cases, swellings of the lymph nodes had been detected in preoperative images or by palpation.
The overall ten-year survival rate as determined by the Kaplan-Meier method as 94.4% over the entire series.
We consider that the application of jugular node dissection may be extended to patients with extra-capsular invasion at the primary lesion. We also conclude that lateral neck dissections should be performed if swellings of the lymph nodes are detected in preoperative study.抄録全体を表示PDF形式でダウンロード (502K) -
菊川 達雄, 野々村 光栄, 山下 勝1999 年 92 巻 11 号 p. 1229-1233
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーClinically, nodal metastases from well-differentiated thyroid papillary carcinoma usually present primarily in the pretracheal, paratracheal, and infraglandular groups of lymph nodes, secondly, along the ipsilateral jugular chain nodes, thirdly in the accessory nodes, and then in the other distant regional nodes such as the submandibular and submental groups.
We report two cases of rare metastases of thyroid papillary carcinoma.
Case 1: A 72-year-old male was referred to our hospital because of a right neck mass. A CT scan revealed that his right jugular nodes were swollen and involved in the deep cervical fascia, and that a minute calcification existed in the left lobe of the thyroid gland. This was a case of a minute carcinoma which metastasized only to the contralateral jugular chain nodes. No metastatic lymph nodes were found in the left side region. Thyroid carcinomas usually metastasize to the ipsilateral side at first. Metastases to the contralateral nodes without ipsilateral nodal involvement are unusual.
Case 2: A 57-year-old female was referred to us because of postoperative vocal cord paralysis, and a thyroid tumor was found by chance. Enhanced CT scan showed a high density mass in the retropharyngeal space. After surgery, this was diagnosed as being a lateral retropharyngeal nodal metastasis of a thyroid papillary carcinoma. Metastases to the lateral retropharyngeal nodes are rare.抄録全体を表示PDF形式でダウンロード (6583K) -
大谷 恵子, 一宮 一成, 児玉 悟, 鈴木 正志, 茂木 五郎, 大塚 慎一1999 年 92 巻 11 号 p. 1235-1239
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe describe a case of cervical tuberculous lymphadenitis with Eales' disease. A 23-year-old man was referred to our hospital because of a lump at the anterior region of his neck. He had a history of idiopathic retinal and vitreous hemorrhages. With a diagnosis of median cervical cyst, the lump was surgically removed. Because tuberculosis was suspected by intraoperative frozen section examination and Mycobacterium tuberculosis was identified by a polymerase chain reaction, rifampicin, isoniazid, and ethambutol were administered orally before tuberculosis was confirmed by culture. We suspect that Eales' disease is related to tuberculosis because the patient's eye symptoms improved with the treatment. A polymerase chain reaction is useful for the rapid diagnosis of tuberculosis and is the choice of treatment.抄録全体を表示PDF形式でダウンロード (5211K) -
三谷 健二, 吉田 淳一, 赤埴 詩朗, 富山 要一郎1999 年 92 巻 11 号 p. 1241-1245
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of bilateral chylothorax following left modified neck dissection, which is a rare operative complication of neck surgery.
A 69-year-old woman presented left neck mass three months after a local excision of tongue carcinoma. We performed a left modified neck dissection without injury to the thoracic duct and there was no evidence of chylous fistula of the neck postoperatively. On the fourth postoperative day she complained of general fatigue and mild dyspnea. A chest X ray examination showed massive left pleural fluid.
We diagnosed bilateral chylothorax by CT scan examination and thoracentesis on the eighth postoperative day. Pleural effusion decreased after fasting and removal of the suction drainage tube at the supraclavicular region that possibly disturbed the thoracic duct. Thus, we treated the patient conservatively following previously reported cases.抄録全体を表示PDF形式でダウンロード (4606K) -
―文献的考察―森田 武志, 内藤 泰1999 年 92 巻 11 号 p. 1247-1254
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーThis paper reviews the literature on the development of speech production after cochlear implantation in children. Prelingually deafened children gradually developed intelligible speech, which continued for more than 5 years after implantation. This developmental time course differs from postlingually deafened children who rapidly improve their speech during the first 6-12 months of implant use. Monophthongs are acquired earlier and more completely than dipthongs and consonants. The order of consonant acquisition follows similar courses in children with normal hearing. Labial sounds appear first. Nasals, stops, glides and liquids are acquired earlier and more completely than fricatives and affricates. An early application of the cochlear implant is necessary for acquring a better development of the spoken language in profoundly young deaf children.抄録全体を表示PDF形式でダウンロード (1219K) -
―マトリックスメタロプロティナーゼ-1の発現―楠 威志, 西甲 升三, 宮崎 和浩, 寺尾 恭一, 村田 清高, 戸村 隆訓1999 年 92 巻 11 号 p. 1255-1258
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーWe immunohistochemically examined expressions of metalloproteinase-1 (MMP-1) in both cholesteatoma and non-cholesteatoma granulation tissues. All 8 patients with cholesteatoma epithelia, 10 of 11 patients with cholesteatoma granulation, and 2 patients with cholesterin granuloma of 5 non-cholesteatoma patients exhibited expression of MMP-1. Histopathological examinations of these granulation tissues revealed proliferative fibroblast cells and many inflammatory cells with expression of MMP-1. Cholesteatoma subepithelial granulation (1 case) and noncholesteatoma granulation tissues without cholesterin granuloma (2 cases) did not exhibit expression of MMP-1. Collagen fibers occupied the granulative tissues on histopathological examinations. However, fibroblast and inflammatory cells were rarely found.抄録全体を表示PDF形式でダウンロード (3985K) -
西崎 和則1999 年 92 巻 11 号 p. 1260-1261
発行日: 1999/11/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2651K)
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