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92 巻, 5 号
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暁 清文1999 年 92 巻 5 号 p. 455-463
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーL-Glutamate is believed to be a neurotransmitter in the first auditory synapse between the inner hair cells and the dendrites of spiral ganglion type I cells. It is released by a variety of mechanisms, such as anoxia, acoustic trauma and some ototoxic drugs. Although excessive release of glutamate is supposed to be toxic to the surrounding neurons, the exact mechanism of action in the cochlea remains unclear. In the first experiment, we investigated the effects of glutamate on hearing by the administration of AMPA, an agonist of glutamate, to the cochlea of guinea pigs. AMPA caused a reversible increase in the threshold of the compound action potential (CAP). Secondly, we studied the glutamate excitotoxicity induced by transient cochlear anoxia by means of occlusion of the bilateral vertebral arteries in gerbils. Five minutes of occlusion caused a drastic increase in the CAP threshold, which recovered after recirculation. The threshold returned to preischemic levels on the 3rd day, but in some animals it increased again after the 5th day, suggesting delayed neuronal death. Glutamate concentration in the perilymph increased following ischemic insult. Histological studies revealed that ischemic pathological changes were severe in the dendrites of the primary afferent auditory nerve, composing the synapse with the inner hair cell. In the 3rd experiment, the effects of noise exposure on hearing were studied in mice lacking the glutamate transporter GLAST (mutant mice). Continuous 4kHz pure tone exposure of 105dB for 30 minutes caused an increase in the CAP threshold in both mutant and wild mice. However, the increase was more severe and the recovery was later in mutant than in wild mice. Glutamate concentration in the perilymph was consistently higher in the former than in the latter. These results suggested that excessive glutamate released in the cochlea as a consequence of anoxia or acoustic trauma caused damage to the surrounding neurons, especially to the dendrites of the primary afferent auditory nerve. Glutamate excitotoxicity is, therefore, thought to underlie sensory hearing loss attributed to a variety of causes.抄録全体を表示PDF形式でダウンロード (5935K) -
窪田 哲昭, 門倉 義幸1999 年 92 巻 5 号 p. 464-465
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2282K) -
近藤 千雅, 土井 勝美, 執行 昭男, 森 克巳, 加藤 天美, 久保 武1999 年 92 巻 5 号 p. 467-474
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーThe mortality from otogenic intracranial complications has decreased markedly from the preantibiotic era to the present. However the mortality of cellebellar abscess cases remains high. This paper reports a case of cerebellar abscess associated with middle ear cholesteatoma, who was saved by a combination of intensive medical and surgical care with the cooperation of the Otology and Neurosurgery units.
The patient was a 53-year-old man who had right aural discharge, headache and vertigo. He visited a private hospital, where he underwent radical surgery for the middle ear cholesteatoma. After 2 months, he again suffered from severe headache and vertigo. He presented at our hospital, and Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) of the brain revealed two abscesses in the right cerebellar hemisphere and obstructive hydrocephalus. Emergency stereotactic drainage of the abscess, and endoscopic 3rd ventriculostomy was performed with local anesthesia by a neurosurgeon. After waiting until the patient's condition improved and the cerebellar abscesses were capsulated, we performed an operation for total removal of the cholesteatoma. The cochlea, vestibule and semicircular canals were all filled with a large quantity of purulent discharge, exuberant cholesteatoma and granulation.
After surgery, the patient lost right hearing acuity, but showed no neurologic sequelae and returned to previous levels of mental and physical health. Reduction of mortality from otogenic intracranial complications could be achieved with early diagnosis and interventions, including appropriate conservative therapy with antibiotics and appropriate neurosurgical and otological procedures.抄録全体を表示PDF形式でダウンロード (13174K) -
北尻 真一郎, 安里 亮, 庄司 和彦, 児嶋 久剛, 金子 賢一1999 年 92 巻 5 号 p. 475-479
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーA rare case of nasolacrimal duct carcinoma is reported. A 64 year-old man visited our hospital complaining of left lacrimation and a mass in his left medial canthus. CT and MRI showed a solid heterogenous mass lesion in the nasolacrimal duct which was projected into the orbita and maxillary sinuses. Part of maxillary sinus not occupied by the lesion was filled with effusion. A preoperative cytological study using fine needle aspiration revealed a class V carcinoma, and the mass was suspected to be an adenocarcinoma. The mass was removed surgically and the bulb of the eye was preserved. A histological examination revealed a squamous cell carcinoma. Radiation therapy was performed postoperatively with a dosage of 50 Gy. The patient has been free of tumor for 24 months after the surgery.抄録全体を表示PDF形式でダウンロード (7367K) -
菅原 一真, 沖中 芳彦, 下郡 博明, 緒方 洋一, 高橋 正紘1999 年 92 巻 5 号 p. 481-484
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーA rare case of primary bilateral maxillary cysts was reported. The patient was 46 year-old male, whose chief complaint was nasal obstruction. The case was diagnosed as primary bilateral maxillary cyst, on the basis of CT and MRI findings. The medial bony walls of the sinuses were destroyed. The bilateral maxillary sinuses were subsequently opened to the nasal cavity by endoscopic endonasal sinus surgery, and has been no sign of recurrence to date. Only two cases of primary bilateral maxillary cysts have been reported previously in Japan.抄録全体を表示PDF形式でダウンロード (2766K) -
川崎 克, 中村 英生, 樋口 豊, 高橋 姿, 五十嵐 文雄1999 年 92 巻 5 号 p. 485-489
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーToxic shock syndrome (TSS) is an uncommon, severe multisystem illness that may follow any surgical procedure. It usually occurs in the immediate postoperative period and is manifested by the sudden onset of high fever and a variety of other signs and symptoms. The reported incidence of TSS after nasal surgery is very low in Japan. We report a case of delayed TSS that occurred after sinus surgery. The patient was a 49-year-old male with abrupt high fever, sore throat and purulent rhinorrhea 11 days after sinus surgery. On the 12th postoperative day, he fell into unconsciousness, exhibiting hypotension and hypouria. A nasal culture revealed MRSA. Appropriate hydration, antibiotics, γ-globulin and irrigation of the infected sinus cavity were administered, the patient recovered within 1 month without any sequelae.抄録全体を表示PDF形式でダウンロード (537K) -
富山 要一郎, 吉田 淳一, 赤埴 詩朗, 三谷 健二1999 年 92 巻 5 号 p. 491-495
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーWe report an extremely rare case of a pleomorphic adenoma in the ethmoid sinus. A 46-year-old woman complaining of nasal obstruction was referred to our hospital for treatment. Rhinoscopy revealed a pink-gray tumor in the right nasal cavity. It was resected surgically via a lateral Rhinotomy approach under general anesthesia. The tumor was found to arise from the posterior ethmoid sinus. Histologically, it was diagnosed as a pleomorphic adenoma.
In Japan, there have been only two other case reports of pleomorphic adenoma definitely diagnosed in the ethmoid sinus.抄録全体を表示PDF形式でダウンロード (7853K) -
土井 彰, 赤木 博文, 服部 謙志, 西岡 信二, 益田 明美, 西崎 和則, 増田 游1999 年 92 巻 5 号 p. 497-501
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーParotid gland tumors are usually unilateral, and bilateral parotid gland tumors are rare, Warthin's tumor (adenolymphoma) being the most common. Warthin's tumor is the most common tumor of parotid gland except pleomorphic adenoma. Warthin's tumors in both parotid glands are found in 5 to 10% of all patients with Warthin's tumors in the parotid glands. We present a case with a total of 9 Warthin's tumors in both parotid glands. A 66-year-old male came to our department because of throat discomfort, and bilateral parotid tumors were subsequently revealed. CT-scan and MRI showed 8 solitary lesions in both parotid glands. The masses were removed surgically, with preservation of the facial nerves. There were a total of 3 tumors in the right parotid gland, and 6 in the left parotid gland. The histological diagnosis was Warthin's tumors in both parotid glands. Nine Warthin's tumors in a case are the most numerous ever reported in Japan.抄録全体を表示PDF形式でダウンロード (6642K) -
高木 誠治, 津田 邦良, 藤崎 亜矢, 澤津橋 基広, 進 武幹1999 年 92 巻 5 号 p. 503-508
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーOncocytoma of the parotid gland is a rare salivary gland tumor. The prognosis is usually favorable if the tumor can be removed surgically. We reported 2 cases of parotid gland oncocytoma and discussed the usefulness of radiographic findings in diagnosis. CT scans of the neck showed a well-defined homogenous parotid mass. MRI scans demonstrated a well circumscribed and lobulated mass of homogeneous intermediate signal intensity on T1-weighted images and hyperintensity on T2-images. The tumor was characterized by early enhancement following contrast injection. The tumor exhibited intense uptake and prolonged retention of Tc-99m pertechnetate.
Radiographic study revealed no specific imaging characteristics of oncocytoma. This tumor was similar in imaging characteristics to Warthin's tumor. Thus, close attention to the differential diagnosis is important when imaging is used as a diagnostic technique.抄録全体を表示PDF形式でダウンロード (9836K) -
寺田 聡広, 長谷川 泰久, 藤本 保志, 松浦 秀博, 高橋 正克, 中島 務1999 年 92 巻 5 号 p. 509-511
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーFrom October 1992 to April 1996, we performed major glossectomies using a modification of the Biller et al. method of laryngoplasty in elderly patients. In all cases, surgery included a hyolaryngeal suspension and a cricopharyngeal myotomy. All of the patients were over 69 years of age, and 3 of them were able to eat without aspiration and phonate after the operation. The one patient who was unable to eat, subsequently underwent laryngectomy because of aspiration due to opening of the laryngoplasty. In our modification of the Biller et al. method of laryngoplasty, the epiglottic closure was as tight as possible for prevention of aspiration, and the thyroid cartilage was broken along at the midline to prevent opening of the closure. We concluded that our modified Biller et al. method of laryngoplasty is useful in improving the quality of life of elderly patients that have undergone major glossectomies.抄録全体を表示PDF形式でダウンロード (2061K) -
松井 利憲, 朝倉 光司, 新谷 朋子, 小笠原 英樹, 氷見 徹夫, 形浦 昭克1999 年 92 巻 5 号 p. 513-519
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーWe report here three pediatric cases of obstructive sleep apnea syndrome (OSAS) treated successfully by uvulopalatopharyngoplasty (UPPP).
Case 1 was a 3-year-old boy who had multiple malformations. Cephalometric analysis using lateral radiographs showed that his obstructive regards were at the nasopharynx and lingual base. He was successfully treated by an adenotonsillectomy and UPPP.
Case 2 was a 5-year-old boy with cerebral palsy. His oropharynx was narrowed objectively. CT scanning demonstrated a stenosis at the lingual base, which was supported by an increase in the negative airway pressure at the hypopharynx during sleep. A bilateral tonsillectomy and UPPP resulted in an improvement of his OSAS.
Case 3 was a girl with Down's syndrome aged 15 years old. Cephalometric and CT examinations suggested an adenoid hypertrophy plus stenosis at the lingual base. An adenotomy alone was not sufficient to treat her sleep apnea. An examination of her airway pressure during sleep demonstrated an increase in the negative pressure at the oroharynx and lingual base. UPPP and a partial resection of the midportion of the lingual base using laser resulted in a remarkable improvement in her apnea-hypopnea index and daytime sleepiness.抄録全体を表示PDF形式でダウンロード (7705K) -
河田 了, 中井 茂, 福島 龍之, 丁 剛, 平田 行宏, 木村 隆保, 久 育男, 村上 泰1999 年 92 巻 5 号 p. 521-525
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーHead and neck cancer has been reported to be frequently associated with cancer of the esophagus and the stomach. Esophago-gastric endoscopy combined with esophageal iodine staining was performed in a total of 181 patients with head and neck cancer, and esophageal cancer was detected in 19 cases and gastric cancer in 16 cases. In 30 cases of hypopharyngeal cancer, esophageal cancer was detected in 9 cases and dysplasia of the esophagus in 6 cases. Twelve of 30 cases underwent total esophagectomy with reconstruction of the stomach or colon. All cases of hypopharyngeal cancer associated with esophageal cancer or dysplasia were of the piriform sinus type or the postcricoid type. On the other hand, no cancerous or dysplastic changes were detected in the esophagus in the posterior type of hypopharyngeal cancer. Therefore, total esophagectomy was necessary for treatment of the piriform sinus type and postcricoid type of hypopharyngeal cancer to improve prognosis.抄録全体を表示PDF形式でダウンロード (2409K) -
杉本 寿史, 寺西 重和, 三輪 高喜, 古川 仭1999 年 92 巻 5 号 p. 527-531
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of external carotid—external jugular fistula with clinical, radiological and surgical features. A 12-year-old female's clinical findings included a right neck mass and buzzing noise in the right ear. This patient was successfully treated with endovascular treatment using an interlocking detachable coil. This patient has shown no recurrence for a year after treatment.抄録全体を表示PDF形式でダウンロード (7321K) -
北野 博也, 藤村 昌樹, 平野 正満, 片岡 英幸, 小川 富美雄, 木下 隆, 舛田 誠二, 北嶋 和智1999 年 92 巻 5 号 p. 533-536
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーFor many patients undergoing surgery for neck tumors, postoperative scarring is a source of considerable distress. We have developed new techniques for endoscopic thyroid lobectomy. Using this techniques, only 4 small incisions (10mm and 5mm×3) were made in the anterior chest. Postoperative dermatogen or myogen contractures did not develop because this tecuniques did not required cutting of the neck skin or unnecessary cutting of neck muscles. The most common complication of this technique was emphysema. To avoid this complication, we insufdated low pressure carbon dioxide at 6mmHg and lifted the neck skin using hooks when we created an open space for removal of the mass. In addition, the scarring from this procedure was very small and could easily be covered by the patients undergarments, so the cosmetic results are very satisfying to the patient.抄録全体を表示PDF形式でダウンロード (5104K) -
金子 賢一, 庄司 和彦, 児嶋 久剛, 安里 亮, 平野 滋, 樋口 佳代子1999 年 92 巻 5 号 p. 537-540
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーWe retrospectively reviewed the data from elderly patients 70 years old and over with thyroid carcinomas, who had undergone thyroid surgery at the Kyoto University Hospital between 1988 and 1995. Of the 33 patients, 27 (81.8%) had papillary carcinomas, two (6.1%) had follicular carcinomas, two (6.1%) had undifferentiated carcinomas, one (3.0%) had a medullary carcinoma, and another (3.0%) had a squamous cell carcinoma. There were 23 patients (69.7%) with pT4 tumors. Preoperatively, 16 patients (48.5%) had general complications, whereas 12 patients (36.4%) had relatively minor postoperative complications. Curative operations could be performed in 29 (87.9%) of the 33 patients. The overall 3-year survival rate was 80.6%. None of the patients had local recurrences within the operative field with the exception of the one case of undifferentiated carcinoma. These data indicate that surgical treatment for thyroid carcinomas in elderly patients can be performed safely, with little morbidity, and results in a high local control rate of the tumors. We conclude that surgery should be considered as the first treatment for elderly patients as well as for younger patients.抄録全体を表示PDF形式でダウンロード (540K) -
丸山 純1999 年 92 巻 5 号 p. 541-548
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーThe effects of lidocaine on Basilar membrane vibration (BMV) and compound action potentials (CAP) of the cochlea were studied in young guinea pigs in order to determine the site of action of lidocaine in the cochlea. The BMV was measured with a laser doppler vibrometer through an opening made on the bony wall of the scala tympani at the basal turn.
Ten minutes after the local administration of lidocaine into the scala tympani, the BMV and CAP amplitude both decreased significantly at around the characteristic frequency (CF) of the measuring point (P<0.05); the average change was 4 dB in BMV velocity and 40dB in CAP threshold. In contrast, no such change was observed after an intravenous injection of lidocaine.
Since the BMV reflects the motility of the outer hair cells, the present results suggest that lidocaine acts not only on the cochlear nerve, but also on the outer hair cells when it is administered into the cochlea.抄録全体を表示PDF形式でダウンロード (1199K) -
―3主徴スコアを指標とした新臨床評価法―荻野 敏, 野入 輝久, 仙波 治, 馬谷 克則, 馬場 謙治, 入船 盛弘, 有本 啓恵1999 年 92 巻 5 号 p. 549-564
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーA double-blind study was conducted to assess the efficacy of 400μg/day of mometasone furoate nasal spray (MFNS) compared to a low dose of MFNS (50μg/day) in Japanese cedar pollenosis. Changes in the scores for the three main symptoms of allergic rhinitis were evaluated.
1. The change observed with 400μg/day of MFNS was -2.67±0.44 by intent-to-treat evaluation and -2.84±0.49 by per-protocol evaluation and was significantly superior to -1.32±0.41 by intent-to-treat evaluation and -1.20±0.46 by per-protocol evaluation observed with 50μg/day of MFNS.
2. MFNS 400μg/day was also significantly superior to 50μg/day in global improvement based on the physician's evaluation by per-protocol evaluation, and positive correlation was observed between the 5-grade global improvement rating and the scores for the three main symptoms.
3. MFNS 400μpg/day was also significantly superior in reducing sneezing, volume of rhinorrhea, nature of rhinorrhea, and eosinophils in rhinorrhea among nasal symptoms and nasal mucosal findings.
4. With MFNS 50μg/day, 8 episodes of side effects were observed in 8 patients (24.2%) and with 400μg/day, 3 episodes in 2 patients (6.9%) were observed. No side effects of particular concern were observed.
MFNS was therefore confirmed to be useful in the treatment of Japanese cedar pollenosis. The usefulness of clinical evaluation based on comparison of pre- and post-treatment scores of the three main symptoms of nasal allergy was also examined, and the results suggest that this evaluation method can reduce inter-physician bias and enhance the objectivity and reliability of clinical studies.抄録全体を表示PDF形式でダウンロード (1845K) -
黒野 祐一1999 年 92 巻 5 号 p. 566-567
発行日: 1999/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (362K)
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