耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
93 巻, 12 号
選択された号の論文の17件中1~17を表示しています
  • ―聴力成績・術中術後合併症とその対策―
    小宗 静男
    2000 年 93 巻 12 号 p. 995-1003
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    We reviewed 313 cases in which stapes surgery was performed during the past 22 years. Operations were performed by one of four experienced otologists using the same surgical method of stapes surgery.
    When the criteria for success was defined as closure of the post operative air-bone gap to 10dB or less in the mean for 500, 1000, 2000Hz, the rate of success was 75.7% in the primary operations, which was fairly comparable with those in the literature. Hearing results achieved in this investigation did not differ between stapedectomy (76.7%) and stapedotomy (78.1%). The rate of success was poorer in use of gelform wire piston than in that of teflon piston. Hearing improvement was not achieved in 14 patients (4.5%) in the primary surgery. Incus (2.6%) or, both malleus and incus (0.6%) fixation was the major cause of failure in the primary operation. Sensorineural hearing impairment was the result in 4.5% of the operations, but half of these impairments showed air-bone gap closure of 10dB or less.
    Revision surgery was performed in 14 patients. Problems with the prosthesis, including displacement or shortness of the prosthesis, were the commonest cause of failure (50%). Cerebrospinal fluid otorrhea was found in 28.6%. The rate of success was 57.1% in the revision surgery.
  • 黒野 祐一
    2000 年 93 巻 12 号 p. 1004-1005
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 清水 義貴, 西原 信成, 佐藤 英光, 暁 清文, 柳原 尚明
    2000 年 93 巻 12 号 p. 1007-1012
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    In a 20 year period from 1977 to 1998 at Ehime University School of Medicine, 36 patients with clinical otosclerosis, including three bilateral cases, were operated on using one of the three types of surgical procedures; total stapedectomy (T-SDE) in 12, partial stapedectomy (P-SDE) in 14, and stapedotomy (STO) in 13 ears. Mean improvements in air and bone conduction hearing levels were 28.0dB and 9.7dB, respectively.
    The P-SDE and STO groups showed the best improvement of air conduction hearing at higher frequencies, while the T-SDE group showed the best improvement of bone conduction hearing at 1000 and 2000Hz. The percentage of ears in which the postoperative air-bone gap was within 10dB were 83% in the T-SDE group, 86% in the P-SDE group and 77% in the STO group. In 9 of 10 ears followed up for more than 2 years, postoperative hearing remained unchanged.
  • 瀬野 悟史, 鈴木 幹男, 北西 剛, 北野 博也, 矢沢 代四郎, 北嶋 和智, 園田 聡
    2000 年 93 巻 12 号 p. 1013-1018
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    A rare case of mastoiditis caused by botryomycosis is reported. The patient was an 11-year-old boy with swelling in the right retroaural region. He was affected with acute otitis media in April 1998. At that time, he was treated with antibiotics at another hospital. In July 1998, right retroaural swelling recurred, and he was diagnosed as having acute mastoiditis.
    For further examination of the recurrent acute mastoiditis, he was referred to our hospital. Computed tomography (CT) indicated granulation in the mastoid cavity, a cortical bone defect, and an abscess in the right retroaural region. Because the lesion was only in the mastoid air cells, we initially treated him with an intravenous injection of antibiotics. However, the postaural swelling did not disappear completely, and a mastoidectomy was performed on August 20, 1998. There was granulation tissue with purulent discharge in the mastoid process, but not in the antrum or tympanic cavity. The route between the air cells and the antrum was blocked by the granulation in the mastoid process. The histological diagnosis of the granulation was botryomycosis based on the findings of specific granules shown in the granulation tissue. Botryomycosis is rarely observed in the head and neck region, and the exact mechanism of botryomycosis remain unclear, though several hypotheses have been proposed.
  • ―EBMの考えを用いた試み―
    老木 浩之, 白石 浩, 村田 清高
    2000 年 93 巻 12 号 p. 1019-1030
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    Objective: To determine the efficacy and side effects of ventilation tube insertion in the treatment of otitis media with effusion in preschool children. Data sources: MEDLINE search [“human” in TG and “otitis media with effusion” in MESH] from 1966 through March 1999, and bibliographies of selected articles. Study selection: Articles were selected for seven outcomes; cure rates, hearing loss, language development, educational attainment, balance disturbances, histopathological sequelae, and side effects, by reviewers assessing study quality and suitability for inclusion. Four articles met inclusion criteria for the cure rates, 9 for hearing loss, 7 for language development, 0 for educational attainment, 6 for balance disturbances, and 1 for histopathological sequelae. There were no appropriate articles on side effcts. Data extraction: We abstracted quantitative data for each outcome measure. Data synthesis: In all data for 4 articles, cure rates in the treatment group were not higher compared with controls. Hearing loss was resolved within 6 months after ventilation tube insertion. Otitis media with effusion in children aged under 4 years did not seem to affect language development in children aged over 4 years. In regard to educational attainment, there were no appropriate trials for this study. According to several case-control studies, there was a relationship between otitis media with effusion in young children and balance disturbance. In regard to histopathological sequelae, ventilation tube insertion did not seem to reduce attic retraction and atelectasis. In regard to side effects, high incidences of otorrhea and tympanosclerosis were reported. The utility analyses of clinical decision analysis were thought to be necessary to determine the meanings of these sequelae. Conclusion: Although the data was insufficient to be conclusive evidence, we speculated that the effectiveness of ventilation tube insertion was very limited, that indications of ventilation tube insertion should be modified, and that large multi-center trials in domestic institutes should be conducted as soon as possible.
    Key words : meta-analysis, otitis media with effusion, middle ear ventilation, preschool child
  • 大野 孝一, 原渕 保明, 石川 忠孝, 郷 充, 形浦 昭克, 中尾 秀樹, 今井 富裕
    2000 年 93 巻 12 号 p. 1031-1035
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    We report a case of paranasal aspergillosis and brain abscess of the sphenoid sinus. The patient was a 47-year-old male with poorly controlled diabetes mellitus who complained of unilateral visual loss. He was admitted to our hospital and CT showed an isolated mass lesion in the sphenoid sinus. Therfore, he consulted our department. He was treated with endoscopic sinus surgery, and diagnostic tools histology and fungal culture, for Aspergillus confirmed the diagnosis. One week later, an MRI demonstrated that the invasive sphenoid aspergillosis invaded the skull base. The lingenhanced mass occupied the brain, and he lost unilateral eyesight.
  • 西野 裕仁, 劔 持睦, 岡田 智幸, 大橋 徹
    2000 年 93 巻 12 号 p. 1037-1039
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    Primary lymphocutaneous nocardiosis in the face and neck region appears to be rare in Japan. A 43-year-old woman presented with an erythematous papule at our clinic. Oral medication with FRPM was administered but, the pustule increased in size and the lesions spread to regional lymph nodes. Clinical examination revealed a 2×3cm induration with skin redness and a few small whitish pustules on the right side of the face and neck region. A general physical examination revealed no other abnormal findings. The laboratory investigation showed a white blood cell count of 9, 700 cells/μl, CRP 7.6mg/dl. After Nocardia was isolated from the aspirated pus, the patient was treated with sulfamethoxazole/trimethprim, minocycline. A CT scan revealed abscess foration in the right neck. An incision and drainage for the abscess was performed. The patient has remained asymptomatic for 15 months after discharge without medication.
  • 石川 敏夫, 戸島 均, 山田 智佳子
    2000 年 93 巻 12 号 p. 1041-1046
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    Actinomycosis is a chronic suppurative bacterial infection. Human actinomycosis is caused primarily by Actinomyces israelii.
    Recently, due to the abuse of antibiotics, patients with a chronic clinical course have been on the decrease, and differentiating this disease from a malignant tumor is often necessary.
    This report documents 4 patients with actinomycosis. Definitive diagnoses were made bacteriologically in 1 patient, and histopathologically in 3. Surgical removal was curative in 2 patients, and intravenous penicillin (Piperacillin) and oral penicillin (Amoxicillin) were curative in 2.
  • 角田 貴継, 池田 心, 伊藤 由紀子, 小西 邦彦
    2000 年 93 巻 12 号 p. 1047-1049
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    A 3-year-old boy complaining of snoring and dyspnea was admitted to our hospital because of a giant pendulous tonsil in the upper pole of the left tonsil. Tonsillectomy was scheduled on his left side under general anesthesia. However, the big pendulous tonsil disturbed the tracheal intubation, and temporary ventilatory failure occurred. Histological diagnosis revealed tonsil-like tissue. Infantile cases of big pendulous tonsils disturbing tracheal intubation have rarely been reported, and we believe that a sufficient pre-operative plan should be made in order to avoid anesthesiologic trouble in such cases.
  • 山本 典生, 北村 溥之, 高北 晋一, 松本 功, 前谷 俊樹, 岩橋 由佳, 宮崎 眞和
    2000 年 93 巻 12 号 p. 1051-1056
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    We reviewed 66 cases of previously untreated patients with oropharyngeal carcinomas experienced between 1966 and 1997 at Tenri Hospital. The follow-up duration was between 8 and 255 months. Cases were staged according to the UICC classification of 1987 (stage I, 3; II, 6; III, 20; and IV, 37 cases). Primary sites were as follows: tonsillar regions, 41; base of tongue, 12; soft palate, 8, and pharyngeal wall, 5.
    Our treatment policy for oropharyngeal carcinoma is a combination of preoperative radiotherapy and surgery. Radical radiation therapy was performed on a limited number of patients who were unresectable and inoperable due to systemic problems, or on those who rejected the operations.
    The overall actuarial 5-year survival rate was 42.3%. The actuarial 5-year survival rate and loco-regional control rate were significantly better for surgery patients (58.5% and 48.9%) than radical radiation therapy patients (13.1% and 6.0%). The treatment effect of the radical radiation therapy may be improved by shortening the overall treatment time.
    Six of the 66 patients had other carcinomas (double cancer) including 4 with hypopharyngeal and esophageal carcinoma. Especially the existence of hypopharyngeal and esophageal carcinomas should be screened by endoscopy because the treatment method for an oropharyngeal carcinoma is affected by them and vice versa.
  • 湯田 厚司, 小林 正佳, 清水 猛史, 吉村 栄治, 原田 輝彦, 田川 俊郎, 間島 雄一, 坂倉 康夫
    2000 年 93 巻 12 号 p. 1057-1060
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    We report a case of asynchronous triple malignant neoplasms limited to the jaw. A 57-year-old woman had an operation for right maxillary squamous cell carcinoma, then underwent a second operation for right submandibular mucosal squamous cell carcinoma at 59 years of age. These two tumors were treated well by the operations and chemotherapy. No radiation therapy was performed. Four years after the second operation, a small granulation was found at the edge of the operated maxillary bone. It gradually enlarged to 3cm in size in a couple of months. Surgical therapy was performed and a histological examination revealed an osteosarcoma of the maxillary bone. Including this osteosarcoma, she had three different cancers limited to the jaw. Triple malignant neoplasms are not rare. However, this case was extremely rare because three asynchronous malignant neoplasms were limited to the jaw.
  • 森園 健介, 西元 謙吾, 牛飼 雅人, 宮之原 郁代, 松崎 勉, 松根 彰志, 黒野 祐一
    2000 年 93 巻 12 号 p. 1061-1065
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    A dermoid cyst is one of the most common head and neck cystic diseases and is usually found in the submandibular area. We report a rare case of double dermoid cysts that occurred in submental and submandibular spaces at the same time in a 53-year-old woman who visited our hospital with the chief complaint of cervical swelling. MRI and CT scans revealed two tumors in the submental and submandibular spaces. The submandibular tumor had a calcified lesion. The two tumors were removed under general anesthesia. The submental tumor strongly adhered to connective tissue such as muscles and the hyoid bone. No adhesion to the surrounding tissues was observed in the submandibular tumor. Both tumors had a white muddy substance in the inside and were diagnosed as epidermal type dermoid cysts histopathologically.
  • 楯谷 一郎, 安里 亮, 庄司 和彦, 加茂 康樹, 岸本 正直, 児嶋 久剛, 白瀬 智之
    2000 年 93 巻 12 号 p. 1067-1074
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    A rare case of paraganglioma arising in the vagus nerve and carotid body is reported. A tumor occupying the right parapharyngeal space was revealed incidentally by computed tomography in a 46 year-old woman. The tumor was located between the common carotid artery and the internal jugular vein and was removed transcervically with vagus nerve. After the operation, Homer's symptom and hoarseness occurred and thyroplasty was performed. Six months after the operation, a right neck mass occurred and angiography showed a high vascular tumor in the widened carotid bifurcation. The tumor was resected transcervically. The patient's elder brother had also exhibited a glomus-jugular tumor and had died of intracranial invasion. This case is the first familial case and the third multiple case of vagal paraganglioma reported in Japan.
  • 赤沢 吉弘, 越智 健太郎, 渡辺 昭司, 西野 裕仁, 杉山 裕, 加藤 功
    2000 年 93 巻 12 号 p. 1075-1079
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    Tympanic temperature, thought to reflect the flow in the ipsilateral internal carotid artery, and reflect brain temperature, is commonly measured using tympanic thermometers. We investigated the stability of tympanic thermometers in four contorol subjects and found there was no significant right-left difference in tympanic temperature nor significant correlation between tympanic and axillary temperatures. There was also no significant difference in the stability of tympanic and axillary temperatures. Next, we investigated tympanic temperatures in pathorogical cases by mesuring the tympanic temperatures in 11 patients with Bell's palsy and found there was no significant difference in tympanic temperatures between the affected and unaffected sides, suggesting that Bell's palsy is not caused by a disorder of internal carotid artery as indicated by tympanic thermometer findings. Finally, we conclude that tympanic thermometer is useful for mesuring body temperature.
  • 白 石浩
    2000 年 93 巻 12 号 p. 1081-1095
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
    We evaluated the effects of estrogen on the parotid gland. Female rats were divided into 3 groups. Group 1 (aging group): Thirty-three rats were used, and the parotid gland was resected at the age of 19, 28 and 41 weeks (n=3 for each experimental group), 49, 55, 58 and 61 weeks (n=6 for each experimental group) to provide premenopause data. Thirty-six rats were used to supply postmenopause data. Menopause was confirmed by observation of vaginal smears, and the parotid gland was resected at 3, 6, 9, 12, 18 and 24 weeks (n=6) after menopause. Group 2 (ovariectomy group): Ovariectomy was performed at the age of 15 weeks in 36 rats, and the parotid gland was resected at the age of 18, 21, 25, 27, 33 and 39 weeks (n=6). Group 3 (ovariectomy+estrogen administration group): Ovariectomy was performed at the age of 15 weeks in 12 rats. Subsequently, an ALZET mini osmotic pump containing 17 β-estradiol dissolved in propylene glycol was subcutaneously implanted into the rat dorsum. The parotid gland was resected at the age of 27 and 39 weeks (n=6). The resected right parotid gland specimens were fixed with formalin, embedded in paraffin, and preparations were made in the plane showing a maximum area. After hematoxylin-eosin staining, images were incorporated into a computer, and the percentage of the fatty tissue area to the entire visual field of the tissue was calculated using NIH image.
    The percentage of fatty tissue increased with the course postmenopause in groups 1 and 2. In group 3, the percentage decreased. These results suggest that estrogen deficiency is involved in fatty degeneration in the parotid gland. Though the indirect association between salivation and ovarian hormones has been suggested, our results showed that the hormone involved in fatty degeneration in the parotid gland is estrogen.
  • 原渕 保明
    2000 年 93 巻 12 号 p. 1096-1097
    発行日: 2000/12/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 2000 年 93 巻 12 号 p. e1
    発行日: 2000年
    公開日: 2011/11/04
    ジャーナル フリー
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