耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
99 巻, 8 号
選択された号の論文の15件中1~15を表示しています
  • 2つの耳の形と機能を再建する
    加我 君孝, 朝戸 裕貴
    2006 年 99 巻 8 号 p. 607-619
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    In two stages of total ear reconstruction surgery for children with microtia and atresia, plastic surgeons and otologists have cooperated to reduce the number of surgeries and to achieve both esthetically and functionally better results. Ear elevation, external canal plasty and tympanoplasty are performed cooperatively in the second stage of surgery.
    In the past 5 years we have experienced 70 cases of combined surgery as the second stage of microtia reconstruction: 59 boys and 11 girls, 12 cases of bilateral microtia and atresia and 58 cases of unilateral microtia and atresia. Analysis of the 3D CT scan was useful to plan total reconstruction surgery for microtia and atresia, and was important for education and design of surgery. Esthetically and functionally combined surgery at the second stage is convenient to make a natural orifice of the external canal, elevate the external ear and reconstruct the ossicular chain.
    After bilateral reconstructive surgery, patients with bilateral microtia and atresia can localize sounds in the right and left auditory spaces.
  • 中山 明峰, 稲福 繁
    2006 年 99 巻 8 号 p. 620-621
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
  • 久米 淳子, 小川 恭生, 萩原 晃, 市村 彰英, 鈴木 衞
    2006 年 99 巻 8 号 p. 623-633
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    Cerebral infarction occurs predominantly in the elderly, but may occur in young adults, especially when complicated with collagen disease, heart disease, and dissecting aneurysm. Four patients (range: 31-47 years old) complaining of a sudden onset of vertigo and nausea without a history of trauma are presented. Emergency computed tomography was initially interpreted as normal, but subsequent magnetic resonance imaging and a magnetic resonance angiogram disclosed vertebral artery (VA) dissection. Arterial dissection resulting in embolic stroke in the area of the ipsilateral posterior inferior cerebellar artery was suspected. All patients were treated conservatively without sequelae. Spontaneous VA dissection should be suspected in young patients presenting with ischemic stroke but without predisposing risk factors or associated trauma.
  • 小林 一女, 洲崎 春海, 工藤 葉子, 鈴木 吾登武, 藤谷 哲, 岡部 英子
    2006 年 99 巻 8 号 p. 635-642
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    In 2001 and 2004-2005, in cooperation with clinics in the Johnan area in Tokyo, we conducted studies to evaluate bacteria isolated from epipharynx of acute otitis media patients aged 10 years old or younger. In this presentation, we report a comparison between the findings of these two studies. In addition, the results of evaluating of gene mutations in isolated bacteria and the efficacy of Cefrerm Pivoxil (CFTM-PI) in the treatment of otitis media will be discussed.
    In 2001, 191 strains of bacteria were isolated from a total of 123 ears. These isolates included 78 strains of Streptococcus pneumoniae (PSSP 37 strains, PISP 38 strains, PRSP 3 strains), 59 strains of Haemophilus influenzae (BLNAS 49 strains, BLNAR 10 strains) and 54 strains of Moraxella catarrhalis. Among Streptococcus pneumoniae isolated, 52.6% were drug-resistant strains, and 16.9% of Haemophilus influenzae, showed resistance. During the study conducted between 2004 and 2005, 223 strains were isolated. These isolates included 73 strains of Streptococcus pneumoniae (PSSP 28 strains, PISP 28 strains, PRSP 17 strains), 67 strains of Haemophilus influenzae (BLNAS 43 strains, BLNAR 20 strains, BLPAR 3 strains, BLPACR 1 strain) and 61 strains of Moraxella catarrhalis. 61.6% of Streptococcus pneumoniae and 35.8% of Haemophilus influenzae were drug-resistant strains. On the evaluation of gene mutations, 70 strains of Streptococcus pneumoniae showed gene mutations; especially, pbp2x mutations were observed in all of the strains. As for Haemophilus influenzae, there were 32β-lactamase-non-producing strains and 4β-lactamase-producing strains both with pbp mutations. In the evaluation of efficacy, CFTM-PI showed good antimicrobial activity with MIC of 0.25-1μg/mL against both pbp mutated strains of Haemophilus influenzae. The approved dosage for CFTM-PI is 9-18mg/kg, and it has a rather wide range. In the treatment of pediatric acute otitis media, if penicillin administration is not effective, CFTM-PI seems to be a useful option considering the potential of Haemophilus influenzae infection and the possibility of doubling the dosage.
  • 大島 昭夫
    2006 年 99 巻 8 号 p. 643-646
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    Patent eustachian tube patients are becoming increasingly rare.
    I proposed to classify these patients into a lighter grade I to severe grade III, according to their symptoms and examinations findings and used this to decide on an appropriate therapy.
    Grade I: Fullness of the ear. No finding in the tympanic membrane during Toynbee's maneuver.
    Therapy·Administer the Chinese medicine KAMIKIHITO. Pour a mixture of jel-foam, glycerin and 0.9% saline solution into the eustachian tube.
    Grade II: Grade I plus autophonia and tympanic membrane movement during Toynbee's or Valsalva's maneuver.
    Therapy·In addition to that proposed for Grade I, submembranous injection of dimethyl polysiloxan or aterocollagen into the nasopharyngeal tubal orifice.
    Grade III: Most severe case.
    Therapy·In addition to that proposed for Grade II, insertion of KOBAYASHI's eustachian tube pin into the tympanic orifice of the eustachian tube.
  • 岡本 伊作, 中村 一博, 吉田 知之, 竹之内 剛, 清水 重敬, 鈴木 衞
    2006 年 99 巻 8 号 p. 647-652
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    We report a case of leiomyosarcoma in the nasal cavity of a patient with a history of bilateral retinoblastoma.
    Leiomyosarcomas account for 7% of all soft tissue sarcomas, and they usually develop in smooth-muscle-rich organs such as the uterus, urinary bladder, and gastrointestinal tract, but they also occur at other sites, including the extremities, retroperitoneal space, mesenteries, kidneys, liver, orbits, pancreas, spleen, femoral veins, and heart. Most malignant tumors of the nose and the paranasal sinuses are carcinomas, and the incidence of sarcoma is low; leiomyosarcoma is even rare among the sarcomas in these regions. To the best of our knowledge, only 27 cases, including our own, have been reported in Japan.
    The patient was a 51-year-old male with a chief complaint of nasal obstruction. He had experienced nasal obstruction on the left side since about May 2004, and was told of the presence of a tumor filling the nasal cavity when he consulted a local otorhinolaryngologist. A CT scan showed a homogeneous tumor filling the inferior nasal meatus on the left, and the tumor was endoscopically removed towards the end of August. Because leiomyosarcoma was diagnosed as a result of istological examination, extirpation of the tumor was performed via the maxilla in the middle of September. Two cycles of a CYVADIC protocol were given postoperatively as adjuvant chemotherapy. There is no evidence of recurrence or metastasis at present.
    Retinoblastoma occurs when the Rb1 region is deleted in one of the responsible alleles and point mutation occurs in responsible alleles or when point mutation occurs in both of the responsible alleles. Patients with a history of retinoblastoma are known to manifest other primary tumors secondarily. These tumors are thought to develop because of a mutation in the Rb1 gene caused by irradiation, a genetic mutation or other factors that reduce the tumor suppressing function of the body. Osteosarcoma accounts for as much as 50% of sarcomas in patients with both a retinoblastoma and soft tissue sarcoma, but the incidence of leiomyosarcoma is very low. As far as we have been able to determine in a search of the literature in Japan and abroad, this condition has only been reported in the liver in one case and in the urinary bladder in two cases. Thus, this is the first report of a case in which primary leiomyosarcoma developed in the nasal cavity of a patient with a history of retinoblastoma. Because radiation therapy had previously been used in our case, we suspected that the leiomyosarcoma had developed secondarily to a gene-related abnormality such as that of the Rb gene.
  • 吉村 勝弘, 河田 了, 辻 雄一郎, 李 昊哲, 寺田 哲也, 竹中 洋
    2006 年 99 巻 8 号 p. 653-656
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    Surgical management of the mandibular branch of the facial nerve is important during excision of the mandibular triangle components. In general, there are two surgical approaches to preserve the nerve; the identified method and the non-identified method. We studied 45 patients who underwent excision of mandibular triangle components without malignancies. We used the non-identified method for all cases in this study. Facial paralysis occurred in 4 cases (8.9%) of pleomorphic adenoma, sialolithiasis, chronic inflammation and cyst, respectively. All paralyses were temporary. The non-identified method is likely to be more effective than the other method.
  • 河口 幸江, 荒木 進, 井上 斉, 萩原 晃, 高木 秀朗, 竹之内 剛, 鈴木 衞
    2006 年 99 巻 8 号 p. 657-660
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    von Willebrand's disease (vWD) is a frequent hereditary bleeding disorder due to a quantitative and/or qualitative deficiency of von Willebrand's factor (vWF). When surgery is considered coagulant therapies must be planned. There are several coagulant therapies. Factor VIII concentrates that contain von Willebrand's factor are most commonly used.
    We report a patient with von Willebrand's disease who underwent tonsillectomy. The patient was a 29 year old man diagnosed as having von Willebrand's disease at 7 year old. He had previously demonstrated massive hemorrhage of the liver following a fine needle biopsy. We selected the therapy using the factor VIII concentrates containing von Willebrand's factor. Factor VIII concentrates containing von Willebrand's factor were administered preoperatively and postoperatively for 6 days. Bleeding was successfully controlled during and after tonsillectomy.
  • 関連診療科へのアンケート調査から
    小林 隆一, 唐木 將行, 森 望
    2006 年 99 巻 8 号 p. 661-667
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    We conducted a questionnaire survey of internal physicians at seven hospitals to investigate the diagnosis and the treatment for sleep apnea syndrome (SAS) in Kagawa and the role of otolaryngologists in these processes. The diagnosis of SAS was made by polysomnography (PSG) at most institutions (six hospitals, 86%). In six hospitals (86%), patients with SAS were treated not only with CPAP but also by surgery and an oral appliance. These results confirm that the otolaryngologist plays important roles in diagnosing lesions in the upper respiratory tract and in providing combinaton therapy for SAS.
  • 池上 聰, 庄司 和彦, 鈴木 慎二, 岸本 曜, 児嶋 剛, 高橋 淳人
    2006 年 99 巻 8 号 p. 669-677
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    In this study we suggest that the velocity of water entering the cervical esophagus can be used as an index of pharyngeal swallowing function. In this article, the basic in vitro principles of water and viscous water flow velocity evaluation using ultrasonic methods are introduced. Water flow involving small gas bubbles passing through a silicon tube could be monitored in the B-mode images and the flow velocity could be measured by Doppler shift spectra produced by a medical ultrasound imaging (GE YOKOGAWA LOGIQ500 and linear convex probe 739L). By an in vitro experiment, we confirmed that the maximum water flow velocity (Vmax) obtained from Doppler shift spectra and actually measured water flow velocity showed a high correlation. The maximum velocity of viscous water flow measured from Doppler shift spectra and actually measured viscous water flow velocity also showed a high correlation.
    We measured Doppler spectra of water flow speed through the cervical esophagus of five subjects (two male, 41-50 y. o; three females, 28-42 y. o) without dysphasia 10 times and examined the coefficient of variation of Vmax. Values of the coefficient variation of Vmax were 3.4, 3.8, 8.8, 12.7, 15.5% (median 8.8%). It seemed that Vmax could be used as an index of the speed of water flow during swallowing. We suggest that the Doppler spectra of water flow speed through the cervical esophagus in swallowing analysis may be useful for assessing pharyngeal swallowing function, and that it may be useful in the diagnosis of pharyngeal swallowing disorders.
  • 岡野 渉, 佐藤 和則, 小川 洋, 松塚 崇, 松井 隆道, 横山 秀二, 大森 孝一
    2006 年 99 巻 8 号 p. 679-683
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    Two cases of cervical injury caused by metallic foreign bodies during mowing were treated. One foreign body was the edge of a grass cutter, and the other was a metal wire. Plain-radiograph detected the foreign bodies clearly, but it was difficult to clarify the relationship of the foreign bodies with anatomical structures. Computed tomography (CT) was useful to clarify the relationship, but the shape of both foreign bodies could not be identified by the metal artifact. By combining two imaging methods, we detected the anatomical positions and shapes of the foreign bodies without any complications.
  • 当教室における最近6年間の検討
    中本 哲也, 湯本 英二
    2006 年 99 巻 8 号 p. 685-691
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    Statistical analysis was performed on 271 patients with recurrent laryngeal nerve paralysis (RLNP) diagnosed at the Department of Otolaryngology-Head and Neck Surgery of Kumamoto university hospital between January 1999 and December 2004. There were 141 males (52.0%) and 130 females (48.0%). The left vocal fold was affected in 165 cases (60.9%), the right in 77 cases (28.4%) and both in 29 cases (10.7%). There were 124 cases of postoperative RLNP (45.8%), and 147 cases of RLNP not related to surgery (54.2%). The mean age of patients with RLNP not related to surgery was higher than that of those with postoperative RLNP for both males and females. With aging, RLNP due to malignant neoplasms decreased among males and that due to aneurysm or cerebral infarction increased. Among females, RLNP due to malignant neoplasms increased with age. We should be aware of such complications as aortic aneurysm and cerebral infarction as a cause of RLNP in addition to malignant neoplasms.
  • 小宅 大輔, 越智 健太郎, 高津 光晴, 斉藤 晋, 新谷 敏晴, 大塚 崇志, 肥塚 泉
    2006 年 99 巻 8 号 p. 693-696
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    We report a case of neck abscess in a infant. A 2-month-old female who presented with neck abscess was admitted the same day. CT demonstrated an abscess of the left submandibular triangle. She underwent drainage by nutrition catheter within six hours after admission, and was discharged from the hospital 8 days later. Although it is still thought that early open surgical drainage is the most appropriate method for treatment of cervical abscess, early treatment with a drainage catheter may replace the surgical method; this method avoids life-threatening complications while achieving good cosmetic results and rapid recovery.
  • 清 一哲, 坂野 立幸, 呉 孟達, 中山 明峰, 稲福 繁
    2006 年 99 巻 8 号 p. 697-704
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
    In otolaryngology at present, evidence-based medicine (EBM) has not yet been considered for antimicrobial prophylaxis. In this study, we examined the surgical site infection (SSI) rate based on the Center for Disease Control and Prevention (CDC) Guidelines and reviewed antimicrobial prophylaxis related to surgery.
    Subjects were 345 patients with CDC surgical wound classes I to III. Prophylactic antimicrobial agents were intravenously administered preoperatively. Postoperative administration days, wound conditions and general medical conditions of patients were entered in the SSI Surveillance Data Sheet. In principle, we aim to end the administration of prophylactic antimicrobial agents two days after surgery.
    The overall SSI rate was 5.5% and by wound class, the SSI rate was 5.1% in Class I, 3.6% in Class II and 28.0% in Class III. The SSI rate of patients to whom administration of antimicrobial agents was ended within two days after surgery was 0.4%, while that of the patients to whom antimicrobial agents were administered for three days or more was 12.6%. Regarding types of antimicrobial agent, the rate was 5.6% in the CEZ group and 4.5% in the PIPC group, showing no significant difference. There were some differences in SSI rates depending on the time required for surgery and preoperative general condition of the patient, but there were no differences depending on patients' smoking history or obesity.
    It would appear that the SSI rate cannot be reduced by intra- and post-operative administration of antimicrobial agents for a longer period; rather, postoperative administration for only two days is sufficient, provided that preoperative risk factors are thoroughly removed and/or the postoperative wounds are completely controlled. Consequently, reducing the unnecessary administration of agents will alleviate the burden on patients, as well as reduce medical costs under Diagnosis Procedure Combination (DPC).
  • 大久保 公裕
    2006 年 99 巻 8 号 p. 706-707
    発行日: 2006/08/01
    公開日: 2011/10/07
    ジャーナル フリー
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