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93 巻, 1 号
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本庄 巖2000 年 93 巻 1 号 p. 1-6
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーCharacteristics of hearing disorders due to retro-cochlear lesions have been recognized as disproportionally poor discrimination of speech to the hearing level in pure tone audiometry and disturbances in tone decay test, Bekesy audiometry and binaural hearing test. There have been numerous patients whom we diagnosed as having retro-cochlear hearing loss because they had these characteristic. However, we have encountered quite a few individuals who failed to obtain speech understanding after cochlear implantation (CI) in spite of poor speech discrimination before surgery.
From these clinical observations and review of recent literature, it appears that true retro-coc-hlear hearing disorder is far less frequent than we thought and that the retro-cochlear pathway may not have an important role in the process of speech recognition, although the cochlea plays an important role in transforming speech sound into electric signals. The main function of the retrocochlear tract may be to detect the direction of the sound source, as the vestibular tract contributes to equilibrium of the body in a reflex manner.
Thus, in perception of speech, the cochlea and the auditory cortex play more important roles than the retro-cochlear pathway does. From the clinical points of view, cochlear implantation can be indicated even for patients who have any discrepancy between the result of pure tone audiometry and speech discrimination test.抄録全体を表示PDF形式でダウンロード (2085K) -
宮原 裕, 家根 旦有, 上村 裕和2000 年 93 巻 1 号 p. 8-9
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1483K) -
鈴木 幹男, 北西 剛, 北野 博也, 矢澤 代四郎, 北嶋 和智2000 年 93 巻 1 号 p. 11-14
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーTo clarify the clinical features of sudden deafness in the elderly, we investigated patients' profile and the prognosis of sudden deafness retrospectively. Of 224 patients with sudden deafness between 1978 and 1999, twenty-five patients more than 65 years of age were studied. The following results were obtained:
1. The mean age of the patients was 70.8 years old, and there was no predominance in gender. The frequency of sudden deafness in the elderly has increased since 1998.
2. Of 25 patients, 10 (40%) carried other systemic diseases at the onset of sudden deafness, such as diabetes mellitus, hypertension and liver dysfunction.
3. The recovery of hearing loss in aged patients with sudden deafness was significantly worse than that in patients under 65 years of age.
4. The aged patients tended to have various hearing losses in the contralateral ears. A poor prognosis of sudden deafness was noted in patients with hearing loss in the contralateral ear.抄録全体を表示PDF形式でダウンロード (720K) -
柿木 章伸, 池永 弘之, 中谷 宏章, 竹田 泰三2000 年 93 巻 1 号 p. 15-18
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーForeign bodies of the ear canal are very common. However, it is uncommon that foreign bodies fully fill the ear canal. There are few reports on foreign bodies filling the external auditory canal. We present a patient with a cyanoacrylate foreign body in the external auditory canal and discuss the diagnosis and treatment. CT scanning was useful to evaluate the condition in the external and middle ear. We removed the foreign body under general anesthesia after we confirmed that the foreign body had no adhesion to the tympanic membrane. We emphasize that it is important to perform appropriate examinations and to make a proper therapeutic policy before operating.抄録全体を表示PDF形式でダウンロード (3671K) -
柿崎 景子, 飯田 崇, 角田 浩幸, 加納 有二2000 年 93 巻 1 号 p. 19-23
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーJuvenile nasopharyngeal angiofibroma is a relatively rare, benign and highly vascular tumor that almost exclusively affects adolescent males. We report a 17-year-old male who complained of right nasal obstruction and recurrent epistaxis of the right nostril. A rhinoscopic examination revealed a large mass filling the right choanal cavity.
A three dimensional CT scan revealed that the tumor filling the nasopharyngeal cavity extended into the sphenopalatine fossa and that it partially invaded the sphenoid sinus. Visual inspection and radiologic imaging suggested that the tumor was an angiofibroma. Preoperative embolization with gelfoam and coils was perfomed using the Seldinger technique one day prior to the surgery.
Complete removal of the tumor was accomplished with a blood loss of only 400ml. This unusually small amount of blood loss during the surgery confirmed the effectiveness of the preoperative embolization.抄録全体を表示PDF形式でダウンロード (5640K) -
木村 哲郎, 野々 山勉, 竹内 万彦, 間島 雄一, 坂倉 康夫2000 年 93 巻 1 号 p. 25-30
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーIncipient symptoms of multiple myeloma usually include such symptons as pain, anemia, malaise, and loss of body weight. A case of multiple myeloma occurring as a buccal mass is reported. The patient was a 65-year-old female. She visited our hospital complaining of a buccal mass with tenderness. A 4×4cm mass was observed the left buccal region. From CT and MRI findings, our preoperative diagnosis was a osteocartilaginous tumor. The buccal tumor with adjacent bone was removed surgically. Post-operative histological examination revealed proliferating plasmacytes in the tumor, and a pathological fracture in the right clavicula two days after the operation. The final diagnosis was multiple myeloma (IgA-κtype).抄録全体を表示PDF形式でダウンロード (5858K) -
向井 將, 向井 千珈子, 新田 暢圭2000 年 93 巻 1 号 p. 31-38
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーUPPP includes uvulotomy. Complications after removing the uvula were obstructive feelings in the throat, disorder of the sense of taste and difficulty in disgorging a fish bone while eating fish. Sometimes uvulotomy patients, complaint of burning their throat. Even after sensing that the food and/or soup was not too hot in the oral cavity, it is often too hot for the throat after swallowing. The uvula works as the pilot for eating and swallowing.
We performed an operation which left the uvula intact and opened the pharynx by Z opening the palate.
Twenty four patients were studied before and after ZPP.
No patients complained of symptoms after uvulectomy and no stenosis of the operated pharynx was observed. As for respiration, 79.2% felt an improvement, 20.8% experienced no change and 0% felt worse after the operation. As for sleeping, 75.0% felt well-slept after waking up in the morning, 25.0% experienced no change and 0% felt worse after ZPP. As for snoring, 50.0% reported an improvement, 4.2% experienced no change, 0% felt worse and 45.6% were unsure since could not hear their snoring during sleep.
As for the changes indicated by sleep monitoring, minimum SaO2 significantly increased (p=0.0026), pulse rate decreased significantly (p=0.0144), snore decreased (p=0.064) and the amount of hours slept when SaO2 was over 95% increased (p=0.0690) after ZPP.
ZPP takes less time and causes less bleeding than UPPP. We recommend ZPP for patients with sleep disorders.抄録全体を表示PDF形式でダウンロード (4825K) -
田中 研, 執行 寛, 北南 和彦, 吉田 真子2000 年 93 巻 1 号 p. 39-42
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーSubcutaneous emphysema and pneumomediastinitis are rarely reported as complications of tonsillectomy. A 18-year-old male with a long history of recurrent chronic tonsillitis received a tonsillectomy. About 3 hours after surgery, the patient complained of swelling of the left side of the face and neck. There was crepitus and local tenderness in the left side of the neck. CT-scan revealed subcutaneous emphysema and pneumomediastinitis. Although we could not determine the cause of the emphysema, we suspected it occurred as a direct result of surgical trauma.抄録全体を表示PDF形式でダウンロード (3648K) -
新田 暢圭, 向井 將, 向井 千珈子2000 年 93 巻 1 号 p. 43-47
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーCGL was performed on thirty adults who complained of sleep disorder. We studied the following six items by head and neck X-ray before and after CGL. The results are shown parentheses at the end of each item.
1) The shortest vertical length between the hyoid bone and mandible (+10.3mm)
2) Vertical length between the hyoid bone and the tangent of C2-4 (+4.6mm)
3) The shortest length between the hyoid bone and the chin (+2.9mm)
4) The angle of the hyoid bone and the tangent of C2-4 (+3.3 degrees)
5) The length of H-M (H is an intersection of a tangent of C2-4, vertical from the hyoid bone. M is an intersection of a tangent of C2-4 and mandibular.) (+7.4mm)
6) Width of the narrowest part of the hypopharynx (+3.0mm)
Every items showed a significant difference between before and after the CGL, (p<0.05).
After the operation, the hyoid bone moved downward and the cranial bone rotated forward. As a result, the hypopharynx and the oropharynx expanded. Expansion of the hypopharynx calculated that the resistance of flow decreased, whereas the airflow increase.抄録全体を表示PDF形式でダウンロード (4295K) -
平海 晴一, 田渕 圭作, 北尻 真一郎2000 年 93 巻 1 号 p. 49-52
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーHemangiomas of the hypopharynx are rare. In most reported cases, hemangiomas were situated just beneath the mucosa and easily diagnosed on inspection because of its specific color.
We report a unique case of a large cavernous hemangioma of the hypopharynx situated deeply, making diagnosis on inspection impossible. The hemangioma was accompanied with severe inflammation. At first, a retropharyngeal abscess was suspected. The final diagnosis was made with exploratory biopsy. The hemangioma was treated successfully with surgical resection.抄録全体を表示PDF形式でダウンロード (4485K) -
平野 滋, 児嶋 久剛, 庄司 和彦, 金子 賢一, 楯谷 一郎2000 年 93 巻 1 号 p. 53-60
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーWe assessed the surgical effects of Isshiki's thyroplasty on 10 functional voice disorder patients including seven with mutational voice disorder, two with spasmodic dysphonia and one with asthenic voice disorder. Our concept is to select and combine proper surgical procedures according to the laryngeal findings of each case. We conveyed thyroplasty type I and III for six patients, and type II and III for one with mutational voice disorder. For spasmodic dysphonia, thyroplasty type II and III was performed in one case with atrophy of the vocal folds accompanied by contraction of false vocal folds during phonation, while type II thyroplasty was selected for the other case without vocal fold atrophy and supraglottic contraction. One asthenic voice disorder was treated with thyroplasty type II and III. We showed the efficiency of framework surgery for functional voice disorders and discussed how to select the type of thyroplasty for each case.抄録全体を表示PDF形式でダウンロード (9144K) -
村川 哲也, 小坂 道也, 森 聡人, 深澤 元晴2000 年 93 巻 1 号 p. 61-69
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーA clinical study was made of 102 patients with previously untreated laryngeal cancer registered in our department for 15 years between 1984 and 1998.
Their mean age was 65.0 years, ranging between 39 and 83. The male to female ratio was 16:1. The proportion of non-smokers was 4.9%. The study consisted of 77 patients with glottic carcinoma (75%), 19 with supraglottic carcinoma (19%) and 6 with subglottic carcinoma (6%). The sexual difference with regard to the proportion of glottic carcinoma was 78% in males and 33% in females. Therefore, the male to female ratios according to the primary sites were 38:1 for the glottis and 5:1 for the supraglottis.
According to the TNM classification (UICC 1987), there was a marked differences in the distribution between the glottic type and the supraglottic type. For the glottic type, 46 patients (60%) were stage I, 19 (25%) were stage II, 10 (13%) were stage II and 2 (3%) were stage IV, whereas for the supraglottic type, 3 (16%) were stage I, 5 (26%) were stage II, 5 (26%) were stage III and 6 (32%) were stage IV. The overall 5-year cause-specific survival rate was 85%. The survival rates for the glottic type were significantly higher than those for the supraglottic type. The 5-year cause-specific survival rate for the glottic type was 94%, whereas the supraglottic type was 68%. The 5-year larynx preservation rate for the glottic T1 and T2 cancers were 96% and 79%, respectively. Those for the supraglottic T1 and T2 cancers were both 0%. To improve the 5-year larynx preservation rate, irradiation of the disease during primary treatment while preserving the larynx is essential. Factors to improve survival rates of carcinoma of the larynx are discussed.抄録全体を表示PDF形式でダウンロード (951K) -
池田 浩己, 熊澤 博文, 吉田 智子, 吉永 和仁, 李 進隆, 竹村 景史, 京本 良一, 山下 敏夫, 西川 光重2000 年 93 巻 1 号 p. 71-75
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーWe describe twenty patients with secondary hyperparathyroidism (SHP) treated with surgery. The causes of SHP were chronic renal failure with hemodialysis in all the patients. Twelve patients were male and eight were female, ranging in age from 35 to 63 years. The most frequent complaint before surgery was severe joint pain in the knees, feet, shoulders, back and ankles. Of these complaints, bone pain and pruritus such as irritability, diminished rapidly after surgery. Preoperative examinations with an echogram and scintigram were useful for indicating the number and location of parathyroid glands. Patients were treated with a combination of total parathyroidectomy and autotransplantation of autologous parathyroid tissue to the forearm. There were no complications, such as recurrent nerve palsy and bleeding. We conclude that the combination of total parathyroidectomy and retransplantation of parathyroid tissue is one of the best surgical approaches.抄録全体を表示PDF形式でダウンロード (2112K) -
西崎 和則, 赤木 博文, 福島 邦博, 前田 学, 武田 靖志, 小河原 利彰, 假谷 伸, 赤木 成子, 手島 裕之, 白神 かおり, ...2000 年 93 巻 1 号 p. 77-84
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーThirty-two adult cases of acute exacerbation of chronic otitis media (COM) were treated by high-dose (600mg/day) oral administration of levofloxacin (LVFX). Clinically, 27COM cases (84.4%) were effectively treated, and no apparent side effects were noted during this study protocol. Among 31 clinically isolated strains whose therapeutic outcomes were bacteriologically confirmed, 28 (90%) strains were not detectable after high-dose LVFX treatment. Bacteriological therapeutic failures in the treatment were observed in three COM patients with MRSA and a patient with coagulase-negative staphylococci. High-dose administration of LVFX was effective in the treatment of acute exacerbation of COM except in cases that were caused by drug resistant staphylococci.抄録全体を表示PDF形式でダウンロード (1084K) -
高橋 姿, 橋本 茂久2000 年 93 巻 1 号 p. 86-87
発行日: 2000/01/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (327K)
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