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98 巻, 6 号
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その臨床と機序について飯野 ゆき子2005 年 98 巻 6 号 p. 429-437
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーIt has been well documented that sensorineural hearing loss with and without vertigo is sometimes associated with acute otitis media. In addition, there have been several reports that in cases of unilateral chronic otitis media, deterioration of the bone conduction threshold is significantly higher in the diseased ears than in the contralateral normal ears. Therefore, inflammation of the middle ear could influence the inner ear function or could cause inner ear damage. Otogenic inflammation in the inner ear is classified into two types; suppurative labyrinthitis and serous labyrinthitis based on the pathogenesis in the inner ear. Suppurative labyrinthitis is caused by bacterial invasion of the inner ear mostly via the round window membrane. It is characterized by infiltration of polymorphonuclear leukocytes in the perilymphatic space and eventually also in the endolymphatic space. Endolymphatic hydrops is also seen. In the later stage, fibrosis and new bone formation occurs in the labyrinth, resulting in profound loss of auditory and vestibular function. Serous labyrinthitis is defined as an irritation of the labyrinth caused by degradation of the tissue fluid environment of the inner ear by bacterial toxins and inflammatory mediators. When the disease is mild, recovery of function may be complete. Inflammatory mediators that have been detected in the middle ear, can pass through the round window membrane under physiological conditions as well as under pathological condition. Bacterial toxins such as LPS and pneumolysin, and mediators including PAF, cytokines and NO may alter the cochlear function, particularly disturbing the ion homeostasis maintained by fibrocytes in the cochlear lateral wall. The repeated invasion and persistent presence of toxins and mediators may lead to permanent morphological change in the sensory cells and stria vascularis of the inner ear.抄録全体を表示PDF形式でダウンロード (4557K) -
柴田 敏之, 坂下 哲史2005 年 98 巻 6 号 p. 438-439
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (2618K) -
須永 壮一, 角南 貴司子, 栩野 理恵, 大屋 美香, 井口 広義, 山根 英雄, 根来 伸夫2005 年 98 巻 6 号 p. 441-445
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーA 64-year-old woman consulted our hospital complaining of repeated attacks of vertigo over a six-year. We diagnosed granulomatous angiitis because P-ANCA titers were positive, CT and MRI examinations demonstrated granulation in the middle ear and histopathological study of the kidney demonstrated crescentic glomerulonephritis. We therefore administered the same treatment as for Wegener's granulomatosis but did not use immunosuppressive drugs.
Prior to treatment, the frequency of her vertigo attacks had gradually increased and mixed (conductive and sensorineural) hearing loss appeared. We considered these symptoms were mainly due to infection, which can trigger worsening of Wegener's granulomatosis. We therefore first administered antibiotics, then prednisolone (PSL) and sulfamethoxazole and trimethoprim (ST) complex drugs.
Cyclophosphamide (CY) was not used even though it has effects on autoimmune disease, since it may promote infectious disease.
In such patients, it is important to determine whether autoimmune disease should first be treated with PSL and CY or infection should first be treated with antibiotics.抄録全体を表示PDF形式でダウンロード (6816K) -
岩塚 和子2005 年 98 巻 6 号 p. 447-452
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーA 31-year old woman with Churg-Strauss Syndrome (CSS) including eosinophilic otitis media is presented. Other manifestations included an 11-year history of nasal allergy followed by bronchial asthma, sinusitis with nasal polyps, eosinophilic pneumonia accompanied by peripheral eosinophilia (34% of 6, 600/μl leukocytes), and erythema in both legs. Repeated episodes of painless right otitis media occurred without fever during the first stage of CSS characterized by an allergic state. This progressed to bilateral otitis media with gelatinous mucoid fluid accumulations shortly before the second stage of CSS characterized additionally by peripheral eosinophilia and eosinophilic pneumonia. Numerous eosinophils were found in gelatinous fluid within the tympanic cavity.
The patient was diagnosed with bilateral eosinophilic otitis media, which was controlled by nebulizer therapy with 2% fosfomycin and 0.2% betamethasone solution directed into the Eustachian tube and tympanic cavity. Hearing loss and vertigo have been avoided. This case strongly suggests that eosinophilic otitis media can be a manifestation of CSS.抄録全体を表示PDF形式でダウンロード (4968K) -
山田 浩二, 愛場 庸雅, 久保 武志, 中野 友明, 和田 匡史, 鵜山 太一, 福家 智仁, 岸 邦子2005 年 98 巻 6 号 p. 453-457
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーWe report a case of pleomorphic adenoma of the epipharynx. A 53-year-old female presented with bilateral nasal obstruction. Endoscopic examination showed a white round mass with vasodilation arising from the left lateral wall of the epipharynx. Computed tomography and magnetic resonance imaging demonstrated an enhanced round solitary mass in the epipharynx. The tumor was completely removed by transnasal endoscopic surgery using a KTP laser, and the specimen was diagnosed as Pleomorphic adenoma. The postoperative course has been uneventful without any signs of recurrence for 1 year after surgery.抄録全体を表示PDF形式でダウンロード (7788K) -
大浦 淳, 保喜 克文, 白崎 英明, 渡邊 一正, 山崎 徳和, 播摩谷 敦, 小柴 茂, 氷見 徹夫2005 年 98 巻 6 号 p. 459-463
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーHemangioma occurs in every systemic region, and in the head and neck region, it is often found in the tongue, the lip, and the buccal mucosa. However, intramuscular hemangioma in the head and neck region is relatively rare.
We treated two cases of hemangioma in the masseter muscle. Both the tumors contained various sizes of phlebolith. Combination of CT and MRI analysis was useful for identifying the tumor localization. Both tumors were excised by external incision, which enabled a secure enough field of operation and a certain extraction. Histologically, they were diagnosed as hemangioma.
Here, we report the diagnosis and surgical treatment of hemangioma in the masseter muscle with reference to the literature.抄録全体を表示PDF形式でダウンロード (7661K) -
Combined Approach による望月 高行, 廣瀬 肇, 望月 幸子, 佃 守2005 年 98 巻 6 号 p. 465-469
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーWe report 3 cases of blow-out fracture treated by a combination of transantral and infraorbital approaches with open reduction. Each case had facial trauma associated with enophthalmos and diplopia. CT examination revealed fractures of the orbital floor and blow-out of the orbiatal content toward the antrum. The transantral balloon technique combined with infraorbital open reduction using iliac bone grafting was applied in these 3 cases and the outcomes were quite successful in all cases. We consider that collaboration between otolaryngologists and plastic surgeons is important for the treatment of fractures of the orbital floor.抄録全体を表示PDF形式でダウンロード (4903K) -
神谷 恵理子, 鈴木 幹男, 櫻井 弘徳, 神前 英明, 北西 剛, 清水 猛史, 多賀 崇, 太田 茂2005 年 98 巻 6 号 p. 471-475
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーWe report a 48-year-old female with rhabdomyosarcoma in the maxillary sinus. She consulted our clinic with complaints of hemosputum and ophthalmalgia on the right side. Computed tomography and magnetic resonance imaging showed a well-enhanced mass in the superior-lateral portion of the right maxillay sinus with bone destruction of the orbital floor. Transantral biopsy of the tumor demonstrated embryonal rhabdomyosarcoma originating from the maxillary sinus. There was no evidence of metastases from rhabdomyosarcoma. The lesion was classified in group IIIA and stage II according to the Intergroup Rhabdomyosarcoma Study (IRS) classification, which is mostly used for pediatric cases. Treatment was performed according to the IRS IV protocol. She underwent chemotherapy with intravenous injection of vincristine, pirarubicin, cyclophosphamide, actinomycin D and ifosfamid, followed by surgical excision and radiotherapy (60Gy). There has been no evidence of local recurrence or distant metastasis 3 years post-operatively. Since rhabdomyosarcoma in adults is very rare, the standard treatment for the lesion has not been established. The present study suggested that chemotherapy combined with surgical excision and radiotherapy based on the Intergroup Rhabdomyosarcoma Study is also effective in the treatment of adult patients with rhabdomyosarcoma.抄録全体を表示PDF形式でダウンロード (8852K) -
木村 忠司, 村本 大輔, 徳野 潔, 村田 清高2005 年 98 巻 6 号 p. 477-482
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーAntrochoanal polyps arising in the maxillary sinus mucosa, are relatively common in children, and are thought to be caused by chronic maxillary sinusitis. To achieve a cure, the base of the polyp must not remain in the maxillary sinus, otherwise recurrence is likely. The Caldwell-Luc procedure was previously the standard technique for maxillary sinus surgery. It is associated, however, with postoperative complications such as maxillary mucocele and paraesthesia of the cheek. In paediatric patients, there are further concerns regarding impaired development of the maxilla or teeth. Functional endoscopic sinus surgery has therefore largely replaced the Caldwell-Luc procedure.
At this institution, we have for some time used the endoscopic nasolacrimal duct inferior turbinate swing technique for maxillary sinus lesions associated with chronic sinusitis. With this technique, we strip the mucosa from the nasolacrimal duct and inferior meatus anteriorly, then detach it from the wall of the maxillary sinus. The mucosa is then cleared from the walls of the maxillary sinus, opening up the antrum. This procedure has the advantage of creating a relatively wide visual field via the nasal approach alone, and procedures within the maxillary sinus can then be readily performed. In this paper, we report 2 cases in which favourable results were achieved using this nasolacrimal duct inferior turbinate swing technique, along with a discussion of the literature.抄録全体を表示PDF形式でダウンロード (8443K) -
成尾 一彦, 宮原 裕, 笹井 久徳, 松代 直樹2005 年 98 巻 6 号 p. 483-492
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーA 10-year-old boy complaining of severe sore throat, left cervical pain, left cervical swelling and high fever was referred to our hospital. Local findings demonstrated swelling of the posterior wall on the left side of the pharynx and swelling of the neck with severe tenderness. The patient had trismus and the distance between upper and lower molar on opening was only ten millimeter. Fiberscopy demonstrated that there was no swelling or edema in the larynx (epiglottis and arytenoids). The patient did not demonstrate dyspnea. Computed tomography (CT) demonstrated a massive soft tissue swelling in the retropharyngeal space. We could easily diagnose his disease as retropharyngeal abscess. It was supposed that transoral intubation into the trachea would be difficult due to trismus. Therefore, we did not schedule surgery on his first examination. Appropriate intravenous administration of antibiotics was performed. Trismus was improved and difficulty in transoral intubation into the trachea was supposed to have decreased. Seven days after the first examination, surgery was successfully performed via transoral incision under general anesthesia. The patient was discharged on the 7th day after surgery without complications such as mediastinitis.
We reviewed 50 cases of retropharyngeal abscess including our case reported in Japan since 1990. The incidence of retropharyngeal abscess in infants has decreased due to developments in antibiotic chemotherapy, however the incidence in adults has increased due to complications such as diabetes mellitus. The management of retropharyngeal abscess including surgical treatment was discussed. Although retropharyngeal abscess is rare, understanding of this disease and appropriate treatment are required.抄録全体を表示PDF形式でダウンロード (5974K) -
高木 伸夫, 越知 康子, 堀 祥子, 佐渡 文彦, 石坂 成康, 立本 圭吾2005 年 98 巻 6 号 p. 493-498
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーTracheostomy was performed in 7 patients during a 3-year period (2002-2004) at our hospital. The causative diseases were central nervous system disorders (3 cases), laryngo-tracheal stenosis (1 case), Edwards syndrome (trisomy 18) (1 case), Werdnig-Hoffmann disease (1 case), Trauma (1 case). Five cases were neonates less than one day old.
A vertical incision is made in the midline of the trachea. A 4-0 nylon suture is then placed through the tracheal wall on either side of the vertical incision.
Complications after surgery included 3 cases of stomal granulation. Staphylococcus aureus (MRSA) was detected in the peristomal region in 2 of these three. Therefore, MRSA infection seemed to be one of the factors precipitating the development of granulation.抄録全体を表示PDF形式でダウンロード (5624K) -
兵 行義, 和田 秀穂, 徳永 博俊, 粟飯原 輝人, 原田 保, 杉原 尚2005 年 98 巻 6 号 p. 499-503
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーPseudothrombocytopenia was identified as a phenomenon when it became possible to count platelets using an automatic blood cell counter. This phenomenon occurs when platelets become coagulated with ethylene diamine tetratic acetic acid; EDTA.
A 28-year-old-man presented with a history of sore throat and neck pain. Based on blood test findings, infectious mononucleosis was diagnosed. After he was hospitalized, the platelet count was decreased (5.2×104/μl). So we changed the anticoagulant from EDTA to heparin sodium. Since we suspected pseudothrombocytopenia (PTCP), we measured the platelet count again and found that the platelet count was elevated (21.0×104/μl). PTCP should be considered when Epstein-Barr virus infection is diagnosed. This is a rare case of pseudothrombocytopenia accompanied by Epstein-Barr virus infection.抄録全体を表示PDF形式でダウンロード (6822K) -
稲垣 太郎, 河野 淳, 小川 恭生, 吉田 知之, 清水 雅明, 中村 珠理, 船戸 宣利, 鈴木 衛2005 年 98 巻 6 号 p. 505-514
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーFrom July 2002 to June 2003, 3, 223 emergency patients (EP) with otolaryngology disease visited the emergency center of Tokyo Medical University. Of these, 2, 895 patients with analyzable clinical data participated in this study.
EP under 10 years old and in their twenties prevailed. On Saturdays or Sundays the number of EP was about twice that of weekdays. On holidays it was 3 times. Shinjuku-ku, Nakano-ku and Suginami-ku were the major areas that EP came from, and some were from the Santama-area and outside Tokyo. The most frequent disease was acute pharyngolaryngitis (18.7%), followed by acute otitis media (16.8%), nasal bleeding (16.0%) and foreign body (11.6%). EP arrived at the hospital most frequently from 21:00 to 3:00, amounting to 75.9% of all.
Eighty-seven EP were admitted. The major diseases for admission were acute pharyngolaryngitis, vertigo and nasal bleeding.
About 60% of EP were not of high emergency level, probably because we though our hospital has been approved as the supreme emergency center, it has also been selected as a primary emergency center or extra-time (night and holiday) care unit. This result suggests an acute shortage of primary emergency centers and the extra-time care units.
In the present state of affairs, the working environment of duty doctors is hard. It's necessary to review the system of duties.抄録全体を表示PDF形式でダウンロード (1333K) -
下甲介化学剤手術を中心に八尾 和雄2005 年 98 巻 6 号 p. 516-517
発行日: 2005/06/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (2634K)
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