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94 巻, 10 号
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村上 信五2001 年 94 巻 10 号 p. 857-868
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーBell's palsy is the most common cause of facial paralysis; it has an incidence of 20 to 30 per 100, 000 people. Many events such as viral infection, is chemia and autoimmune reaction have been proposed as causes of Bell's palsy. However, to date there have been no reports of conclusive evidence of the etiological agent responsible for Bell's palsysince Sir Charles Bell described the disease in 1830. Because the etiological agent remains unknown, treatment of this condition is empiric, varying from observation alone to the use of steroids and surgical decompression.
Recent advancements in the molecular methods of in situ hybridization and polymerase chain reaction have revealed the existence of HSV-1 genomes in the involved facial nerve as well as the geniculate ganglion. In addition, animal experiments have shown that HSV-1 may induce facial paralysis and the beneficial effect of the antiviral agent of acyclovir for facial function has also been demonstrated. These findings provide the evidence that latently infected HSV-1 causes Bell's palsy when it reactivates and it is controversial whether we should continue using the term “Bell's palsy” to mean “idiopathic facial paralysis” or whether we should now recognize Bell's palsy as “herpetic facial paralysis”. However, currently, we have no reliable, widely available clinical test for the early identification of HSV-1 infection in Bell's patients. Methodological break-through will resolve this problem and data accumulation will datermine the percentage of patients with Bell's palsy in whom HSV-1 is the etiological agent.抄録全体を表示PDF形式でダウンロード (8812K) -
原渕 保明, 片田 彰博2001 年 94 巻 10 号 p. 870-871
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2170K) -
渡辺 太志, 本多 伸光, 白馬 伸洋, 暁 清文2001 年 94 巻 10 号 p. 873-877
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーWe report a case of ossicular fixation caused by bone pâté. A 57-year-old woman underwent staged tympanoplasty for right middle ear cholesteatoma. Bone pat6 was used for reconstruction of the scutum and for the prevention of the extrusion of an artificial ossicle at the second-stage operation. Although right hearing initially improved postoperatively, it gradually deteriorated 4 months after the operation. Revision surgery performed 1 year after the second-stage operation showed that the bone pâté used for scutumplasty had been incorporated with that used for eardrum augmentation, which resulted in ossicular fixation. After the removal of the part of the bone pat6 that was fixed to the artiflcial ossicle, both the mobility of the ossicle and right hearing markedly improved.抄録全体を表示PDF形式でダウンロード (2731K) -
中谷 宏章, 濱田 昌史, 竹田 泰三, 中平 光彦, 柿木 章伸, 楯 敬蔵, 関 博之, 岩井 満2001 年 94 巻 10 号 p. 879-889
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーFacial paralysis caused by neoplastic lesions is relatively rare, but these patients have more serious consequences than those with other etiologies. In this study, we investigated 46 cases of facial paralysis caused by benign or malignant tumors and discuss the clinical features. The incidence of neoplastic facial paralysis was 3.4% (46/1350) and the rate of malignant tumors was 65.2% over all. Of the various kinds of tumors that led to facial paralysis, acoustic and facial neurinomas, carcinomas in the parotid gland and in the external auditory canal, leukemia and malignant lymphoma were the most frequent origins. It took more than 1 month after the onset of paralysis to identify the causative tumors in 12 patients, and 7 of them were misdiagnosed with Bell's palsy at the early stage of paralysis. A total of 21 of 34 patients developed an unusual course, such as progressive, non-recovered and remittent palsy, different from Bell's palsy and Ramsay-Hunt syndrome. Since the courses of paralysis were different in each patient in this study, we suggest that careful confirmation of the accompanied symptoms, such as continuing or worsening pain, hearing loss, otorrhea and other cranial nerve palsies, is important. The prognosis of malignant tumors was markedly poor and no patient survived for more than 5 years. Based on this study, we consider that in order to save patients' lives in cases of malignancies and to prevent facial paralysis in benign tumors, the diagnosis of the neoplastic lesions should be performed as soon as possible.抄録全体を表示PDF形式でダウンロード (3449K) -
沖津 卓二, 近藤 芳史, 高橋 由紀子, 石井 清2001 年 94 巻 10 号 p. 891-898
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーRecently, excellent three-dimensional (3-D) images can be quickly and easily obtained using helical scan CT, a procedure of continuous scanning CT to acquire volume data. 3-D CT imaging was applied to 66 surgical cases of facial fractures and it was helpful not only to evaluate facial fractures, but also to plan operations except for in cases of blowout fractures.
The quality of 3-D CT image depended on the slice thickness and on the slice interval at CT scanning, and we also found that the threshold value of CT number at which 3-D images were reconstructed influenced the quality of the 3-D imaging.
However, 3-D imaging does not necessarily provide additional new information if two-dimensional (2-D) CT scans have been performed, and 2-D CT images also provide superior fracture details. Thus, based on our clinical experiences we suggest that 2-D CT image and 3-D image reconstructions are complementary procedures.抄録全体を表示PDF形式でダウンロード (7586K) -
―「顔面外傷センター」としての役割―山西 貴大, 木下 澄仁, 定永 恭明2001 年 94 巻 10 号 p. 899-903
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーBetween 1987 and 2000 we treated 68 cases (64 patients) of facial bone fracture in Kumamoto City Hospital. In 1997 we established a “Facial Trauma Center” which provided treatment from a team of otorhinolaryngologists, ophthalmologists, dentists and plastic surgeons, and since then, the number of cases referred to us for treatment has markedly increased. Young males, both teenagers and in their twenties in particular, were predominant, and of the elderly patients more females than males were treated.
Facial bone fracture can markedly affect the patients' quality of life (QOL), and we consider that prompt diagnosis, appropriate treatment and the recovery of normal function by postoperative rehabilitation and exercises are very important to improve QOL. Thus, the all-round team approach to treatment such as that used in the “Facial Trauma Center” plays a key role in allowing patients to return to thier normal lives.抄録全体を表示PDF形式でダウンロード (656K) -
西野 裕仁, 越智 健太郎, 渡辺 昭司, 新谷 敏晴, 中村 学, 大橋 徹2001 年 94 巻 10 号 p. 905-908
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーThe patient was an 1-year-old male infant with a soft palate injury from falling down. Oral bleeding was noted immediately after the accident, and he was treated conservatively by a local doctor. However, two weeks later, he was admitted to the Department of Otolaryngology St. Marianna University Touyoko Hospital with a mucosal fistula on the soft palate and a continuing low grade fever of unknown origin. An endoscopic examination of the nasal cavity did not show any marked pathological changes or any traces of a foreign body. ACT scan revealed no abnormal findings except for the edematous mucosal swelling in the maxillary sinus. Endoscopic observation revealed an wooden foreign body in the palate, which was subsequently removed successfully using the endoscope. Foreign bodies should be removed as soon as possible, because they may become a focus of severe infection. But because of the radiolucency of small wooden foreign bodies, plain radiographs and CT scan are often not useful in imaging the objects. The endoscope provides significantly improved diagnostic and therapeutic options in oral surgery.抄録全体を表示PDF形式でダウンロード (3977K) -
柳内 充, 荻野 武, 高原 幹, 小林 吉史, 林 達哉, 野中 聡, 原渕 保明2001 年 94 巻 10 号 p. 909-913
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーWe report a familial case of tonsil-related pustulosis palmaris et plantaris (PPP) and the HLA types. A 47-year-old female with a 18-year history of PPP visited our clinic for tonsillectomy in April 1999. She had additional symptoms of sternocostoclavicular hyperostosis (SCCH). Her elder sister underwent tonsillectomy for PPP in 1998 and her skin lesions showed a marked improvement. In this patient her skin lesions and thoracic pain were markedly improved without any medication 18 months after surgery. Although her parents did not have PPP, all 4 siblings (2 brothers and 2 sisters) and her second daughter were diagnosed with PPP. Human Leukocyte Antigen (HLA) typing revealed haplotypes A2, B46, Cw1, DR8 and DQ1 in 4 of 6 family members. We consider that these haplotypes are associated with PPP.抄録全体を表示PDF形式でダウンロード (630K) -
兵 佐和子, 河田 了, 山口 智子, 寺田 哲也, 李 昊哲, 今中 政支, 東川 雅彦, 竹中 洋2001 年 94 巻 10 号 p. 915-919
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーWe report a 51-year-old male patient with papillary cystadenocarcinoma in the parotid gland who presented a slowly progressive tumor in the left infraauricular region. The findings of several examinations including a fine needle as piration biopsy (FNA) suggested a malignant tumor of the parotid gland origin. The histopahtological diagnosis of the tumor via an open biopsy performed under local anesthesia was low grade carcinoma, such as acinic cell carcinoma, and low-grade adenocarcinoma. A superficial lobectomy of the parotid gland was performed 7 days later to preserve the facial nerve because the tumor was at least 10mm from the nearest nerve brunch. The final histopathological diagnosis was a subtype of adenocarcinoma; papillary cystadenocarcinoma.
It is often difficult to diagnose the histopathological type of the tumor since there are many different types of parotid carcinoma. Moreover, since the prognosis of parotid carcinoma also varies according to its histopathological type, accurate preoperative diagnosisis necessary to select the appropriate operation. An open biopsy should be performed to accurately diagnose patients with parotid carcinomas and to improve their prognosis when histopathological diagnosis by other examinations is difficult.抄録全体を表示PDF形式でダウンロード (7098K) -
安里 亮, 庄司 和彦, 遠藤 剛, 金子 賢一, 平野 滋, 楯谷 一郎, 児嶋 久剛, 伊藤 壽一2001 年 94 巻 10 号 p. 921-924
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーIn 289 benign thyroid tumor operations performed at our hospital between 1988 and 1999, we treated 8 patients with mediastinal goiter, 4 of which were adenomas and 4 were adenomatous golters.
It was possible to remove the goiter entirely via acervical approach in all 8 patients and even goiters extending to the aortic arch were safely removed without requiring sternotomy. There were no complications such as recurrent nerve palsy or postoperative hemorrage in those patients.
The surgical approach, operative technique and results of therapy are discussed and transcervical approach for resection is emphasized.抄録全体を表示PDF形式でダウンロード (2424K) -
坂本 雅之, 北原 伸郎, 浅沼 聡, 阿部 和也2001 年 94 巻 10 号 p. 925-928
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーThe patient was a 52-year-old woman with papillary carcinoma of the thyroid gland who underwent total resection of the thyroid gland, right radical neck dissection, and para-tracheal dissection. Three years postoperatively, she developed a fever and a painful mass was noted on her right chest. We considered that the symptom were due to a metastatic neoplasm in the paratracheal lymph nodes which had eroded the stemum and ribs. Radiotherapy was performed, and no recurrence was noted during a follow-up of 18 months. The findings in this case reemphasize the importance of para-tracheal dissection.抄録全体を表示PDF形式でダウンロード (2231K) -
吉崎 智貴, 小林 吉史, 片田 彰博, 林 達哉, 今田 正信, 野中 聡, 原渕 保明2001 年 94 巻 10 号 p. 929-934
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーCastleman's disease was first reported by Castlemann et al. in 1954 as localized large benign hyperplastic mediastinal lymph nodes histologically characterized by hyperplasia of lymphoid follicles and capillary proliferation with endothelial hyperplasia. In 1972, Keller et al. subsequently divided Castleman's disease into two types according to the pathologic findings: the hyaline-vascular type and the plasma cell type. We report a case of hyaline-vascular type of Castleman's disease in a 29-year-old female.
The patient presented with 11 years history of a large tumor on the right side of her neck. The tumor size had not increasad for 11 years and she had no symptoms except for neck swelling. CT and MRI showed a single mass (60×50×30mm), and laboratory data were within normal ranges. The tumor was surgically resected and histologically identified as a hyaline-vascular type of Castleman's disease. Postoperatively the patient is well with no recurrence for one year.抄録全体を表示PDF形式でダウンロード (5600K) -
中川 隆之, 高島 忠義, 富山 健太2001 年 94 巻 10 号 p. 935-940
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーIn this study we clinically reviewed the hospice in-patient records of 55 patients with terminal head and neck cancer. We focused on the dying process and strategies used for pain control, because the prediction of various events occurring during the dying process is crucial for the acceptance of death in patients and their families and relief from cancer pain is a central issue in the palliation of terminal head and neck cancer patients. The findings in this study indicated that the clinical course of 70% of patients with terminal head and neck cancer deteriorated gradually, but that death due to sudden change occurred in 30%, mainly due to hemorrhage. The mean duration of cancer pain was 14 weeks, and in the last 3 weeks patients had difficulty in ingestion. Pain management required administration of strong opioids by continuous subcutaneous infusion. Based on these findings, we suggest that it is important to pay particular attention to the high risk of sudden death and to pain management in terminal head and neck cancer patients.抄録全体を表示PDF形式でダウンロード (798K) -
石井 秀幸, 和田 哲治, 金井 直樹, 原渕 保明2001 年 94 巻 10 号 p. 941-946
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーAdenoid cystic carcinoma rarely arises in the larynx, especially in the subglottic region. We reported here, a case of adenoid cystic carcinoma arising in the subglottic region of the larynx. The patient was a 51-year-old female who developed hoarseness and dyspnea. Laryngeal fiberscopy revealed a tumor mass in the subglottic region and the histopathological diagnosis was adenoid cystic carcinoma, cribriform type. The patient underwent a total laryngectomy with subsequent 40 Gy localized irradiation. She has been well for the last year and four months without recurrence or metastasis.抄録全体を表示PDF形式でダウンロード (4578K) -
木原 紀子, 大出 茂典, 三須 俊宏, 枝松 秀雄, 渡辺 建介2001 年 94 巻 10 号 p. 947-952
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーThe aim of this study was to investigate the efficacy of suplatast tosilate prescribed before the pollen season and during the pollen season. Suplatast tosilate, 300mg/day, was prescribed for 10 patients before the start of the pollen season and for 6 patients during the pollen season. Patients kept a diary of nasal symptoms.
Based on the nasal symptom diaries a nasal symptom score was prepared. The rate of improvement was 70% with preseasonal administration and 33% with administration after pollen scattering.
Pollen levels showed three peaks (3/5, 3/14, 3/29) during the pollen season in 1998, and in the preseasonal administration, the symptoms were suppressed at these three peakses pecially at third peak in 70% of patients.
In the administration during pollen season, the symptom score was high at second and third peaks in the noneffective patient, but the symptoms were suppressed at the second and third peaks in the effective patients.
Based on these findings we suggest that suplatast tosilate should be administered more than one month before the first peak in pollen levels.抄録全体を表示PDF形式でダウンロード (2453K) -
井之口 昭, 内田 雅文, 松山 篤二2001 年 94 巻 10 号 p. 954-955
発行日: 2001/10/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (2504K)
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