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93 巻, 4 号
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黒野 祐一2000 年 93 巻 4 号 p. 259-265
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーTo elucidate the pathogenesis of otitis media with effusion (OME), the role of cytokines was investigated by analyzing the middle ear effusion (MEE) obtained from patients with this disease and from experimental animal models. Enzyme-linked immunosorbent assay (ELISA) of the MEE revealed that levels of IL-1β and IL-8 were higher in the mucoid type MEE than in the serous type MEE and were significantly increased in neutrophil-rich groups. Gene targets of those cytokines were also detected in pellets of the MEE by RT-PCR. However, the incidence of IL-6 and IL-8 detected by RT-PCR was lower than that detected by ELISA, suggesting that those cytokines were produced by the middle ear mucosa as well as inflammatory cells infiltrating the MEE.
In the animal experiment, OME was induced in mice by intra-tympanic inoculation with an endotoxin, and the levels of IL-1β in the MEE were significantly increased. Intra-tympanic inoculation with rIL-1β also produced the MEE and the cytological findings of the MEE as well as the histological findings of the middle ear mucosa were similar to those found in endotoxin-induced OME. Furthermore, an intra-tympanic injection with anti-IL-1 receptor antibodies reduced the incidence of OME induced by an endotoxin or rIL-1β, suggesting that IL-1β may play an important role in the pathogenesis of OME.
This clinical study demonstrated that macrolide was effective for OME and decreased the levels of inflammatory cytokines in the MEE including IL-1β and IL-8. Animal experiments also showed that co-administration of macrolide reduced the incidence of endotoxin-induced OME and the concentration of IL-1β in the MEE.
These findings suggest that cytokines play an important role in the pathogenesis of OME and that a cycle of the cytokine network might be associated with the persistence of this disease.抄録全体を表示PDF形式でダウンロード (987K) -
伊藤 八次, 森 充広2000 年 93 巻 4 号 p. 266-267
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2039K) -
岡野 高之, 高橋 晴雄, 船曳 和雄, 長谷部 誠司, 寶子丸 稔2000 年 93 巻 4 号 p. 269-273
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーWe report a patient with cerebellar abscess secondary to middle ear cholesteatoma. A 39-year-old man visited our clinic due to right otalgia of three days. Temporal bone CT revealed large bony destruction in the posterior fossa wall of the temporal bone. Ten days after the first visit to our clinic, he experienced severe vertigo with nausea. Suspecting intracranial complication, we performed brain CT, which revealed a cerebellar abscess with a midline shift of the cerebellum. Abscess drainage through the posterior fossa approach and the total removal of the cholesteatoma were performed simultaneously on an emergency basis. Now, two years after the surgery, the patient exhibits no neurological deficiency and has good hearing.
Otogenic cerebellar abscess can be lethal, even in this era of antibiotics, because the typical symptoms are often masked by preceding antibiotic therapy. Immediate brain CT and surgical treatment are necessary for treating cerebellar abscess associated with advanced middle ear cholesteatoma.抄録全体を表示PDF形式でダウンロード (2358K) -
堀部 よし恵, 田頭 宣治, 宮脇 浩紀, 石原 啓司2000 年 93 巻 4 号 p. 275-281
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーWe described a 50-year-old woman with a glomus tympanicum tumor limited to the middle ear. She complained of mild facial nerve palsy, otalgia, hearing loss, and pulsatile tinnitus on the left side. At first, she was diagnosed as having acute inflamation of the middle and inner ear, and she underwent conservative treatment. Facial nerve palsy improved after 1.5 months, but otoscopic examination (reddish tympanic membrane in the posterior portion) and hearing level were not changed. High-resolution computed tomography and magnetic resonance imaging showed a lesion in the meso-hypotympanum without bone destruction. She underwent left middle ear exploration through a postauricular approach. This revealed a vascular mass in the middle ear. Preoperative angiography and embolization was done and the tumor was surgically excised using the transmastoid extended facial recess approach, incurring a small amount of bleeding.
Up to 1 and a half years after operation, no recurrence of the tumor has been detected.抄録全体を表示PDF形式でダウンロード (6762K) -
松原 茂規2000 年 93 巻 4 号 p. 283-289
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリー1. Routine treatment of sinusitis in children using one antral puncture and irrigation and examination of pituitous bacteria were performed for 195 pediatic patients (122 boys and 73 girls, aged 3-15 years) and 145 adult patients with acute sinusitis (61 men and 84 women, aged 15-70 years).
2. There was little difference in causative bacteria or prognosis between sinusitis in children and acute sinusitis in adults.
3. More than half of the adult patients with acute sinusitis lived with children below third grade in elementary school. We therefore suspected that the adult patients with acute sinusitis had been infected by children with sinusitis in their family.
4. Of the 103 pediatric patients for whom causative bacteria and a prognosis could be determined, 28 (27%) were infected by multiple bacteria, both Haemophilus influenzae and Streptococcus pneumoniae. There were no adult patients with acute sinusitis infected by multiple bacteria. Of the pediatric sinusitis patients, many had acute or secretory otitis media, accompanied by cough while few adult acute sinusitis patients had these symptoms.
5. The pathogenesis of sinusitis in children was mainly considered acute.抄録全体を表示PDF形式でダウンロード (994K) -
古家野 智子, 山本 典生, 北村 溥之, 高北 晋一, 岩橋 由佳, 河田 恭孝, 宮崎 眞和2000 年 93 巻 4 号 p. 291-294
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーLipomas are common soft tissue neoplasms, but they are found rarely in the region of the parotid gland, and are observed in about 1% of tumors of the parotid gland. Deep lobe parotid lipomas are especially rare tumors. We present a 66-year-old woman with a deep lobe parotid lipoma treated by enucleation. We believe that this is only the sixth report in the literature of a lipoma in this location.
Magnetic resonance imaging (MRI) and fine needle aspiration were performed, and findings suggested a pre-operative diagnosis of lipoma. The fat suppression MRI technique suppressed the signal from the tumor and strongly confirmed the diagnosis.抄録全体を表示PDF形式でダウンロード (5345K) -
松田 美貴, 阪本 浩一, 大橋 淑宏, 名迫 佳郎, 中井 義明, 岡村 光英, 河邊 譲治, 越智 宏暢2000 年 93 巻 4 号 p. 295-299
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリー(Objective) The clinical application of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) for the differential diagnosis of parapharyngeal space tumors was attempted.
(Subjects) The subjects of this study were 10 patients with parapharyngeal space tumors who had visited our hospital between November 1993 and February 1999. They underwent diagnostic procedures of CT or MRI, Ga scintigraphy, and FDG-PET, and had an established histopathological diagnosis by methods such as biopsy and operation. There were 5 males and 5 females ranging in age from 29 to 83 years with a mean of 56.1 years.
(Methods) The PET apparatus used was a HEADTOME IV (Shimadzu, Kyoto, Japan), and FDG 185-370 MBq was injected intravenously, and immediately thereafter, data were collected up to 60 minutes, and the tumor was visualized for 40 to 55 minutes. FDG uptake was evaluated quantitatively using the standardized uptake value (SUV).
(Results/Conclusion) Histological types of tumors in 10 patients were pleomorphic adenoma in 4 patients, schwannoma in 4 patients, paraganglioma in 1 patient, and osteolipoma in 1 patient. There was no significant correlation between tumor size and SUV. Because of the large size of tumors, it was frequently difficult to determine whether the tumor was originated from the anterior or posterior styloid space. Except for 3 patients with pleomorphic adenoma and 1 patient with paraganglioma, Ga scintigraphy revealed no uptake areas. Mean SUV was 6.0±1.2 in pleomorphic adenoma, 2.7±1.0 in schwannoma, 5.3 in paraganglioma, and 1.1 in osteolipoma. SUV of pleomorphic adenoma was significantly higher than that of schwannoma, suggesting the usefulness of FDG-PET for differentiation of these tumors.抄録全体を表示PDF形式でダウンロード (3886K) -
小山 真司, 宮原 裕2000 年 93 巻 4 号 p. 301-305
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーA case of amyloidosis of the larynx is reported. The patient was a 50-year-old woman who complained of hoarseness. She had undergone laryngeal polypotomy surgery three times. Each time, the histological diagnosis was laryngeal polyp. This time, laryngeal fiberscopy showed yellow-red tumorous swelling at the bilateral false vocal cords. Polypotomy was performed by laryngomicrosurgery to obtain a histological diagnosis. In H. E. staining, eosinophilic materials existed beneath the epithelium. These materials were stained red by Congo-red stain and orange by Dylon's stain. This patient has been followed up for 19 months since the last operation, and has been taking cepharanthin (3mg/day).抄録全体を表示PDF形式でダウンロード (4228K) -
肥田 修, 中之坊 学, 磯田 幸秀, 伊藤 靖郎, 甲能 直幸, 北原 哲2000 年 93 巻 4 号 p. 307-310
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーNeurilemmomas of the hypoglossal nerve are rare. We report a neurilemmoma of the hypoglossal nerve located in the submandibular region.
A 58-year-old female was admitted for submandibular swelling. Paralysis and atrophy of the tongue were not exhibited. After the operation, paralysis of the tongue was recognized. Although this case is rare, neurilemmoma should be considered when encountering such a patient.抄録全体を表示PDF形式でダウンロード (2322K) -
和田 哲治, 金井 直樹, 荒川 卓哉, 川堀 眞一, 原渕 保明2000 年 93 巻 4 号 p. 311-316
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーA neonatal boy presented with a painless, smooth, round mass in the left side of his neck at birth. CT, MRI, and echo examinations revealed a solid tumor with calcification occupying the left upper neck. The levels of serum neuron specific enolase (NSE), urine homovanillic acid (HVA), and vanillylmandelic acid (VMA) were elevated, indicating a diagnosis of neuroblastoma. Surgical resection was performed 23 days later because of airway obstruction due to tumor progression. The resected tumor was 43×35×32mm and was diagnosed as a rosette-fibrillary type of neuroblastoma by histopathological analysis. The tumor was of a favorable histological grade and was classified as stage 2A according to the International Neuroblastoma Staging System. After surgery, the patient received systemic chemotherapy of a regimen including cyclophosphamide and vincristine. He is alive and disease free 4 years after diagnosis.抄録全体を表示PDF形式でダウンロード (4653K) -
楠 威志, 村田 清高2000 年 93 巻 4 号 p. 317-322
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーFour patients with cervical cystic lymphangioma were treated in our clinic. Three patients were surgically treated. In 2 of these patients, tumors were completely removed. These tumors showed no invasion of the oral floor, parapharyngeal space or sphenopalatine fossa. A tumor in the third patient could not be completely resected. The tumor had invaded the oral floor, parapharyngeal space and sphenopalatine f ossa. In this patient, the volume of the remaining tumor was decreased postoperatively by local injection of OK-432. One patient did not undergo surgery, and was treated with local injection of OK-432 as the first choice. Since this therapy the tumor has not been palpable. These results suggest that local injection of OK-432 may be the first choice in place of surgical treatment for cases in which incomplete resection or postoperative complications are predicted.抄録全体を表示PDF形式でダウンロード (8466K) -
安部 英樹, 坂下 英雄, 宮永 路子, 長山 郁生2000 年 93 巻 4 号 p. 323-326
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーA case of a thymic cyst is reported, and the literature from 1952 to 1998 was reviewed. A 19-year-old female was found to have a frontal neck mass. MRI demonstrated a cystic mass laterally to the right lobe of the thyroid gland, and pharyngography did not show a pyrif orm sinus fistula. At surgery, the cyst was found to be connected to the thymus, and was diagnosed pathologically as a cervical thymic cyst. Cervical thymic cysts are rare and clinically asymptomatic. The distributions of the age and sex of the patients are different between Japanese and Caucasian at this time.抄録全体を表示PDF形式でダウンロード (2419K) -
石永 一, 加藤 昭彦, 山田 弘之2000 年 93 巻 4 号 p. 327-330
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーFrequently, double cancer and distant metastases have been detected by means of therapeutic techniques for head and neck cancers. Between January 1997 and February 1999, we experienced 59 cases of head and neck Squamous cell carcinoma in the department of otolaryngology at the Yamada Red Cross Hospital. Eight patients of 59 (13.6%) had pulmonary metastases and/or primary lung cancers, detected by chest CT scans. However, such lesions in 4 patients of 59 (6.8%) were detected by normal Chest X-rays. Positive correlations were observed between T stage and positive CT scans.
CT scanning of the chest is more effective than chest X-ray, and is now used routinely in our department prior to undertaking major head and neck surgery.抄録全体を表示PDF形式でダウンロード (468K) -
―文献的考察―田辺 牧人, 高橋 晴雄2000 年 93 巻 4 号 p. 331-337
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーIt has been reported that patients with a cleft palate have a high incidence of middle ear and paranasal diseases. In these patients, an anatomical abnormality of the eustachian tube and its surrounding structures is one of the main causes of tubal dysfunction and middle ear diseases such as otitis media with effusion. In addition, the gas exchange function of middle ear mucosa, another ventilatory system for the middle ear, has recently been suggested to be poorer in patients with a cleft palate than in normal subjects. This poor gas exchange function might cause refractory middle ear diseases. However, more detailed investigation about the gas exchange function is necessary.
Nasal septal deviations are observed during the fetal period, and hypertrophy of the inferior turbinate on the concave side of the septal deviation is observed after birth in cleft palate patients. Because of them, nasal resistance is higher than in normal subjects. Also, nasal mucociliary transport has been reported to be impaired in these patients. However, the cause of this impairment is still unknown and further investigation is necessary. There was no significant difference in the development of the maxillary sinus of cleft palate patients compared to normal controls. The anatomical and functional abnormality seems to be one of the causes of the high incidence of paranasal sinusitis in cleft palate patients.抄録全体を表示PDF形式でダウンロード (916K) -
―即時扁摘を中心に―鈴木 正志2000 年 93 巻 4 号 p. 338-339
発行日: 2000/04/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2517K)
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