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枝松 秀雄, 安田 真美子, 佐々木 優子, 川邉 文代, 小林 真由美, 瀬戸 由記子, 長舩 大士, 松島 康二, 山本 賢史, 八十島 ...
2015 年 143 巻 p.
1-7
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Endoscopic observation and treatment have been remarkably developed in so many fields of the medicine, because they are very clear to observe local disease and no traumatic. In otolaryngology, what is the reason that endoscopic application is very popular in rhinology and unpopular in otology? Working space may be important factor for limited use of endoscope in narrow external ear canal and middle ear. Another reason may be difficult operative skill to introduce an endoscopic ear surgery.
Our ear surgeon holds an endoscope with 2.7 or 4 mm diameter and 17 cm long in the left hand and handles surgical tools in the right hand. Both two devices are introduced into the middle ear through the external ear canal.
Merit of endoscopic-aided ear surgery is that its observation can give a full and clearly view of the middle ear cleft. Detailed observation can avoid an injury of the facial nerve or the inner ear. Moreover, endoscope can show a residual cholesteatoma under the ossicles or in the tympanic sinus which lesion might not be found with a microscopic observation. Therefore, an endoscope should be introduced more and more for ear surgery, especially in case of children. The anatomical feature may cause ear surgeon to hesitate the use of an endoscope in children. We have performed an endoscope-aided ear surgery in children for the last three years and endoscope was possible to apply for safe operation in every case of children.
Our conclusion is that endoscope should be used more in daily ear clinic for accurate diagnosis of ear disease and in ear surgery for safe operation with full view of middle ear cavity and to avoid residual disease.
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枝松 秀雄, 安田 真美子, 佐々木 優子, 末次 敏成, 井田 裕太郎, 松浦 賢太郎, 福生 瑛, 野池 美佳, 細野 祥子, 鹿島 由 ...
2015 年 143 巻 p.
8-13
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
In ear surgery, chronic otitis media or choleateatoma are very important training operations for ear nose and throat (ENT) residents. They are common ear disease and so young doctors can get a standard skill of ear surgery. Stapes surgery is relatively uncommon. It is also important training program for them. Because they can learn normal anatomy of the middle ear and treat ossicular conduction.
We have performed questionnaire survey to explore training condition of ear surgery for young ENT doctors. List of questions were sent to the committee members of the Japan Otological Society. Questions were the number of annual stapes surgery and operators, when to start ear surgery training, necessary or disadvantage items for their training, what ear surgery is appropriate for young doctors and so on. More than ninety percent leading doctors answered our survey. This seemed to be the result how important they were thinking ear surgery training was for residents.
Total number of ENT doctors has been decreasing and hospital available for ear surgery has been also limited recently. Even in this adverse circumstance, training for residents to learn ear surgery is very important and they should experience hearing improvement of the ear diseased patient after ear surgery. Therefore, anatomically normal operation like stapes surgery can be very useful training course for premature ENT residents.
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川邉 文代, 佐々木 優子, 安田 真美子, 小林 真由美, 瀬戸 由記子, 枝松 秀雄
2015 年 143 巻 p.
14-19
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Endoscopic observation of the tympanum is more clear and easy to use compared other optical devices, otoscope, head mirror, electro headlight, and microscope. In outpatient clinic of the ear, it is very important to look the tympanum of visiting patient carefully and in detail for the first step of inspection and precise diagnosis.
Recent progress of the video endoscope can offer clinical doctors in otology lots of fine visual information of ear disease. Endoscope is now available as flexible type and rigid one. They are able to easily insert into the external ear canal even in small children without pain or anesthesia. Photo medical progress of endoscope is also remarkable to record a clear picture or video file of the tympanum. Doctors can use these recordings to show their patients and explain what disease is suspected or how lesion should be treated.
In normal eardrum, pars tensa and flaccida should be viewed carefully with endoscope to check its color, tension, calcification deposit, vascularity and shape of malleus handle. In diseased ear, basic points are perforation, otorehea, bleeding, debris, deformity, traumatic and tumor. Endoscopic observation is also useful before and after ear surgery. Especially, narrow band imaging (NBI) endoscope represents vascular information of the drum and so should be used for glomus tympanicum tumor or postoperative graft.
Our conclusion is endoscopic observation is very important for understanding of normal anatomy and lots of ear disease of the drum.
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山本 賢史, 八十島 唯幸, 松野 栄雄, 枝松 秀雄
2015 年 143 巻 p.
20-23
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
One of the merits of endoscopic-aided medicine is that endoscopic observation can give a full and clear view in the narrow and small visual field of the ear, nose and throat (ENT). Detailed observation can give ENT doctors a quick and appropriate diagnosis easily and safely. Moreover, surgical procedures with an endoscope can avoid injury of the important organs for hearing, breathing, swallowing and speaking with offering less-invasive procedures for patients, compared with the operating microscope.
The endoscopic approach should therefore be introduced more and more into ENT surgery, even in case of children. The disadvantages of endoscopic-aided surgery are that the surgeon needs to hold the endoscope with one hand and use forceps or a suction tube with the other hand. It might be difficult to handle endoscope and surgical tools together in the narrow ENT surgical field. However, no special surgical tool or device is necessary for endoscopic medicine and less invasive medicine is useful not only for doctors but also patients. Therefore endoscopic out-patient medicine should be expanded and performed more and more.
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枝松 秀雄, 安田 真美子, 佐々木 優子, 小林 真由美, 瀬戸 由記子, 末次 敏成, 井田 裕太郎
2015 年 143 巻 p.
24-28
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
In 1791, Mondini wrote the Latin article entitled “Anatomica Surdi nati Sectio.” It became the first report of the dissection of the temporal bone in an eight-year-old boy with congenital deafness and reported the findings of the inner ear anomaly. Mondini’s original paper is a historical one for otological researchers, but it has been difficult, indeed rather impossible to read for a long time. We fortunately had the chance to review the original copy of the paper.
The summary of Mondini’s report described several conditions: there was a large opening of the vestibular aqueduct; labyrinth fluid was escaping from the enlarged vestibular aqueduct; and the cochlea consisted of only one and a half turns, among others. According to his paper, the common cavity is not an inner ear anomaly of the Mondini type. Currently, recent progress in three-dimensional imaging can detect and visualize the fine and detailed structure of the inner ear. Therefore, imaging diagnosis is able to discriminate Mondini anomalies from other types.
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小林 真由美, 瀬戸 由記子, 安田 真美子, 佐々木 優子, 八十島 唯幸, 枝松 秀雄
2015 年 143 巻 p.
29-32
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Endoscope is very useful for otosurgery of congenital cholesteatoma in children, because endoscopic observation can give a full view to find residual cholesteatoma in the tympanic sinus or behind the ossicles or to avoid any injury of the important structures.
In the middle ear, there is a region where microscopic observation is very difficult due to the anatomical feature. It is very dangerous to perform otosurgery without adequate observation of these structures.
We have experienced 7 children with congenital cholesteatoma in the past 6 years and obtained good results. We reported a case of the youngest one that was the most difficult to inspect througout the middle ear cavity.
Disadvantage of endoscope was that otosurgeon has to hold an endoscope with the left hand and handle forceps or suction tube with the right. It might be difficult to handle endoscope and surgical tools together in the narrow external canal. We think that otosurgeon needs some experience for endoscopic operation.
Our conclusion is that endoscope should be used in otosurgery of cholsteatoma in children to perform safe operation with a full view of the middle ear cavity and to avoid to overlook the residual lesions.
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鹿島 由貴, 小林 真由美, 佐々木 優子, 安田 真美子, 細野 祥子, 井上 彰子, 枝松 秀雄
2015 年 143 巻 p.
33-37
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
In our institution, we came across a 4-year-old boy suffering from recurrent meningitis due to an inner ear anomaly and it proved very difficult to stop CSF (cerebrospinal fluid) leakage from the abnormal ear with ear surgery. The boy had been treated twice for meningitis by a pediatrician. He had a drug allergy for many kinds of antibiotics and so his hospitalization was long. He was congenitally deaf but no other developmental problem was seen.
The patient was referred to us, as clinical otologists, to identify the original lesion causing the meningitis to evaluate his deafness. High resolution computed tomography (CT) showed ballooning enlargement of the right inner ear and a deficiency of the left inner ear. Auditory brainstem response and distortion product of otoacoustic emission were missing. An operation to stop the CSF leakage from the ear with the anomaly was performed with soft tissue obliteration, but a large volume of CSF gushed out from his right external ear canal. Reoperation was necessary four days after the initial surgery with a hard material, namely cortical bone.
The presence of inner ear anomalies may increase CSF pressure and produce leakage, followed by meningitis. CT of the inner ear is very important to identify the fistula from which CSF is leaking. The closure operation is necessary immediately and reoperation is sometimes necessary soon after the first surgery. A hard obliterating material, such as cartilage or bone, seemed to be better to block the severe leak completely rather than a soft material, such as a fascia graft.
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安田 真美子, 佐々木 優子, 小林 真由美, 瀬戸 由記子, 枝松 秀雄
2015 年 143 巻 p.
38-41
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
A case of rare middle ear anomaly is presented. Five year old boy had a congenital hearing impairment of the left ear. His audiogram was 62.5 dB in an average of the left air conduction hearing and the right ear was normal. He had normal ear drum with a relatively narrow external acoustic meatus and small pinna. He was diagnosed as middle ear anomaly and operated on July 2006.
Three dimensional (3D) CT before the surgery showed a bony bridge along the chorda tympani in the left ear and normal structure in the right. Operative findings was identical with 3D CT. A bone bridge fixed the malleus and ossicular mobility became smooth after drilling the bone. Other anomaly was not seen in the middle ear cleft. His left hearing has improved up to 26.7 dB. 3D CT after the surgery showed normal ossicular chain and disappearance of the abnormal bone.
Middle ear anomaly has a variety of findings and no typical common pattern. This kind of bone anomaly has rarely been reported and so it was an unexpected operative finding. However, 3D CT is very useful to detect such a rare anomaly and its imaging information can help ear surgeon to perform a safe operation.
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安田 真美子, 市島 龍, 佐々木 智, 枝松 秀雄
2015 年 143 巻 p.
42-49
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Distortion product otoacoustic emission (DPOAE) is originated at the outer hair cell of the inner ear. DPOAE has been used as a screening test of hearing for children. Because they can not be tested with pure tone audiogram (PTA). If frequency specificity of recordings of DPOAE is reliable and compatible with PTA, DPOAE can be used in infants or unstable hearing patients as an objective audiogram.
DPOAE and PTA were recorded and compared in 114 hearing impaired outpatients since May 2006 through October 2007. They were 59 male and 55 female, and their age were from 5 to 84 years old with the average of 68.5 years. ILO292 (Otodynamics
®) was used for the recording of DPOAE. In 51 patients, DPOAE could be clearly measured and represented as distortion product (DP) gram. The DP gram and PTA were classified as several type of hearing loss, dip type, high frequency loss, or low frequency loss.
In dip type of hearing loss, DP gram and PTA showed similar dip curve of frequency. Their correlation was good in 2 and 4 kHz dip, but not so well in 1 kHz dip. In middle and high frequency hearing loss, DP gram had an excellent similarity pattern with PTA. In low frequency hearing loss, DPOAE was not recorded due to noise contaminate.
Results of dip or high or middle frequency hearing loss indicate that DP gram can be used as an objective hearing test in children and adults who can not perform PTA.
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Mamiko Yasuda, Yutaro Ida, Toshinari Suetsugu, Kouji Matsushima, Hideo ...
2015 年 143 巻 p.
50-54
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
We encountered a case of conductive hearing loss due to stapes fixation, accompanied by broad thumbs, broad toes, and hyperopia. The patient was a 26-year-old man who had been using hearing aids for bilateral hearing loss since childhood. A detailed examination performed at our ENT department revealed conductive hearing loss and absence of the stapedial reflex, and otosclerosis was suspected as the cause of the conductive hearing loss. Physical findings included fusion of the second and third toes, broad thumbs, and proximal symphalangism in the left fifth finger and hyperopia, which led us to suspect the diagnosis of Teunissen-Cremers Syndrome, a genetic disorder first reported by Teunissen and Cremers in 1990. Teunissen-Cremers Syndrome is an autosomal-dominant inherited disorder presumably caused by mutations in the human noggin (NOG) gene. Our patient did not have a positive family history for the syndrome, although isolated cases have also been reported in the past. However, none of these cases were subjected to detailed genealogical research; therefore, the possibility of familial occurrence cannot be excluded.
There are approximately 50 genes believed to be associated with conductive hearing loss. If we could perform genetic testing with the patient’s consent and clarify the correspondence between the NOG mutations and the phenotypic patterns, we might be able to develop a new classification of conductive hearing loss.
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佐々木 優子, 川邉 文代, 安田 真美子, 長舩 大士, 井田 裕太郎, 末次 敏成, 枝松 秀雄, 周郷 延雄
2015 年 143 巻 p.
55-59
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Narrow Band Imaging (NBI) is an endoscopic technique which provides an optical highlight of the fine structure of the superficial mucosal capillaries. The light delivered through the endoscope is at specific wavelengths (415 nm visible blue and 540 nm visible green) both of which are readily absorbed by hemoglobin in the blood. Therefore, NBI can visualize and enhance local blood imagery more clearly than conventional endoscope.
A case of a tympanic glomus tumor was observed by NBI before and after the operation. A 48-year-old female had complained of pulsating tinnitus and right hearing loss. The eardrum was observed at her initial visit with NBI. The blue-green image of the blood vessels inside the eardrum was highly enhanced. We diagnosed her as having a right tympanic glomus tumor based on the NBI view of the eardrum and computed tomographic findings.
The operation was performed two days after embolization of the feeding arteries. After we had endoscopically removed most of the tumor, we observed the middle ear cleft with NBI. Ectatic blood vessels were seen in a small area around the orifice of the auditory tube. A tumor remnant was suspected and so additional excision was carried out.
NBI is an excellent endoscopic tool for observation of the local blood flow. In addition, it is very useful not only to detect early cancer of the head and neck area but also for identification of feeding arteries of glomus tumors, and identification of residual tumor vasculature.
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―手術時所見と手術前後の画像の比較―
佐々木 優子, 川邉 文代, 瀬戸 由記子, 小林 真由美, 松島 康二, 八十島 唯幸, 枝松 秀雄
2015 年 143 巻 p.
60-64
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
A 12-year-old boy with a congenital right ossicular anomaly underwent three-dimensional computed tomography (3D-CT) before and after the ear surgery. His anomaly was observed intraoperatively, comprising the dehiscence of the incus long processes and stapedial head, and dislocation of the anterior crus. TORP was used for reconstruction of air conduction hearing. The hearing improvement of 34 dB was successful.
3D-CT clearly showed the ossicular anomaly before the operation and the position of a total ossicular replacement prosthesis (TORP) was placed after reconstruction. Our case demonstrated that 3D-CT could be provide very useful imaging diagnosis for both preoperative observation of the middle ear and the postoperative status following reconstruction.
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佐々木 優子, 山本 賢史, 八十島 唯幸, 枝松 秀雄
2015 年 143 巻 p.
65-67
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Five patients with cervical lymph node tuberculosis have been diagnosed and treated in our ENT section. Three patients were female and two were male. Their age ranged from 24 to 78, the average being 58 years old. The polymerase chain reaction test was positive for the tubercle bacillus in a lymph node from one patient test. Another three patients were finally diagnosed from biopsies of the cervical lymph nodes. Tuberculosis could not be positively identified in the remaining patient but was strongly suspected.
The QuantiFERON-TB test (QFT) has recently proved very useful for the diagnosis of cervical lymph node tuberculosis. Two of our cases were positive in the QFT, although the pathological findings were not clear.
In conclusion, we believe that early diagnosis and treatment are needed to prevent the spread of tubercular infection into other parts of the body from affected cervical lymph nodes.
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松島 康二, 一色 信彦, 田邉 正博, 末次 敏成, 細野 祥子, 枝松 秀雄
2015 年 143 巻 p.
68-74
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Isshiki et al first reported the Type 1 Thyroplasty or Medialization Thyroplasty in the 1970s for treating voice disorders resulting from vocal fold paralysis or atrophy. Since then, this therapeutic modality has gained worldwide popularity, and a number of modified methods were also reported with generally satisfactory results.
Silicone block fabricated in situ had long been utilized to fix the window cartilage without any significant complication, however, containment failures from silicone bag breast implants and their resultant negative side-effect led to difficulties in obtaining silicone for any surgical treatment whatsoever. Gradually, Gore-tex, as used for correcting vascular problems, had replaced silicone, because of its ease in handling and of its excellent biocompatibility. However, it did not guarantee precision in the adjustment of medialization, especially when the window-cartilage was removed and/or when the Gore-tex sheet was packed in a wrong direction. In this respect, Titanium, well known for its excellent biocompatibility, seems better suited for precision and long-lasting effectiveness. Friedrich had already reported excellent results. Based on our abundant experience with Titanium Bridges in type 2 thyroplasty for spasmodic dysphonia, we utilized a simple thin and bendable Titanium plate so as to realize adequate medialization on site.
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松島 康二, 田邉 正博, 一色 信彦, 枝松 秀雄
2015 年 143 巻 p.
75-79
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
We have reviewed a clinical dissection of anterior commissure and Type II thyroplasty operative procedures. The handling of the anterior commissure is the most important point in this surgery. An inner perichondrium does not exist in the dorsal midline part of the thyroid cartilage, and the collagenous fiber of the anterior commissure tendon combines with the cartilage matrix of the thyroid cartilage at the vocal cord level. At the supraglottic level, the thyroepiglottic ligament connects with the thyroid cartilage through the collagenous fiber of the anterior commissure tendon, which extends to the supraglottics. In order to maintain a moderate glottis split with certainly and permanence, it is necessary not to exfoliate this tendon from the thyroid cartilage. It is necessary to split the tendon and to spread the glottis while the tendon is joined with the cartilage. For this purpose, the special spreader was made.
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Yukiko Seto, Toshinari Suetsugu, Mayumi Kobayashi, Kouji Matsushima, M ...
2015 年 143 巻 p.
80-83
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Reflux laryngitis and has been known to be caused by gastro-esophageal reflux disease (GERD). In severe case of laryngitis, a granuloma might be seen at the unilateral vocal cord and the lesion is very difficult to be controlled by surgery due to its high recurrence rate. Proton pump inhibitor (PPI) therapy can reduce the secretion of gastric juice. These drugs, therefore, have been generally used to relieve the symptoms of GERD, but their usefulness for laryngeal granuloma has not been clarified so far.
We have treated two cases of laryngeal granuloma with a PPI which were resistant to surgery and other medications including steroids. In both cases, remarkable improvement was seen following PPI treatment. These findings suggest that PPI could be useful in laryngeal granuloma patients with GERD before laryngomicrosurgery. In addition to its potential efficacy, PPI treatment is inexpensive and severe side effects are seldom seen.
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長舩 大士, 八十島 唯幸, 瀬戸 由記子, 松島 康二, 小林 真由美, 安田 真美子, 和田 弘太, 枝松 秀雄
2015 年 143 巻 p.
84-88
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Objective; Minimally invasive treatment for medial wall fracture of orbit can be well performed for traumatic outpatient under local anesthesia, even in children. Prompt recovery of damaged orbital movement and less invasive surgery are important for this kind of trauma.
Case and Method; Three outpatients were treated within a few days after trauma. They are 12 year old boy, 24 and 50 year old men. They claimed strong orbital pain to look medially rather than double vision and needed apparently prompt repair.
Local anesthesia was insertion of several pieces of small cotton gauze embedded 4% xylocaine and 0.5% epinephrine. With 4 mm diameter endoscopic aided surgery, the fracture part in the nasal middle meatus could be seen clearly and repaired with surgical elevator. They might feel small pain during the surgery, but pain and bleeding were well controlled and operation time was less than twenty minutes including anesthesia. Immediately after repair, they could feel no orbital pain and no other associated problem.
Result and Conclusion; Traumatic fracture between orbit and paranasal sinus needs prompt and adequate treatment for orbital movement and cosmetic appearance. The fracture is classified into two lesion, blow-out fracture of inferior floor of orbit and superior wall of maxillary sinus (inferior type), fracture of medial wall of orbit and anterior ethmoidal cell (medial type). Symptoms and treatments differ in those two types. Treatments also varied in two types between Rhinology, Plastic surgery and Ophthalmology.
Our strategy in surgical treatment needed case is trans-maxillary-sinus approach for inferior type under general anesthesia, and endoscopic nasal approach with local anesthesia in outpatient clinic for medial type.
The endoscopic observation of fracture part and careful repair under sufficient local anesthesia are necessary for this treatment. The surgical results are very safe and satisfied outcome for patients and our medical stuff.
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長舩 大士, 出張 玲子, 末次 敏成, 新井 千昭, 安田 真美子, 枝松 秀雄
2015 年 143 巻 p.
89-92
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Intracranial meningiomas are a common tumor accounting for 15–20% of all brain tumors. Extracranial meningiomas, however, are very rare, especially at the temporal bone. We report herein on a case of a meningioma in the middle ear with severe vertigo. The patient was a 78-year-old female. She visited our outpatient clinic complaining of persistent and severe vertigo. A white mass was seen beyond the right tympanic membrane. CT and MRI showed a tumor occupying the right middle ear and mastoid cavity. The patient was deaf and had canal paresis in the right ear. Vertigo could not be expected to improve with ear surgery because of no bony deficiency around the lateral semicircular canal. A cholesteatoma was not typically suspected and so operation was performed on the ear to make a pathological diagnosis. The unexpected result was an extracranial meningioma. The patient recovered very well after the ear operation and the preoperative vertigo had resolved. The relationship between the meningioma and the vertigo was not clear. No report has been found describing the operation on an extratemporal meningioma with no direct invasion of the vestibule and dura.
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―在日外国人患者への対応と医療ツーリズム症例―
末次 敏成, 安田 真美子, 小林 真由美, 瀬戸 由記子, 佐々木 優子, 新井 千昭, 枝松 秀雄
2015 年 143 巻 p.
93-98
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
The number of foreigners living in Japan has been increasing recently, some of whom will probably need treatments for diseases of the ear. We have performed ear surgeries in sixteen foreigners in the past four years. We have noticed clinical and social problems: those patients had difficulty in understanding ear disease, the necessity for surgery and the Japanese medical expenses and health care system because of poor language skills in Japanese or English.
Various nationalities were represented: the Philippines (5 patients), China (4), Korea (1), Nepal (1), Mongolia (1), Viet Nam (1), Russia (1), and mixed nationality (2). They had stayed in Japan for more than twenty years before ear surgery. The ear diseases comprised chronic otitis media (twelve ears), otosclerosis (three ears), and cholesteatoma (two ears).
We have to offer these overseas patients access to the good and stabilized medical system available in Japan. Ear surgery is one of the important medical issues, because such patients cannot get treatment in their country of origin.
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井田 裕太郎, 長舩 大士, 松島 康二, 枝松 秀雄
2015 年 143 巻 p.
99-102
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
The clinical pathway is being used increasingly as the standard hospital treatment policy for major disorders in Japan. Tonsillectomy accounts for most operations per year at many ear, nose, and throat facilities. Tonsillectomies accounted for 14.8% of 155 clinical pathway cases in the last 3 years at our hospital. The percentage of tonsil operations is second after ear surgery, at 18.4%, for the same number of nasal operations.
Medical intern doctors usually perform tonsillectomies under the direction of senior doctors, and guidelines are needed to standardize hospital treatment and ensure safety against risks such as postoperative hemorrhage.
It would also help to standardize team treatment to prevent preoperative infection in cooperation with health-care providers.
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井田 裕太郎, 佐々木 優子, 須田 稔士, 長岡 真人, 志村 英二, 枝松 秀雄
2015 年 143 巻 p.
103-106
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Sarcoidosis is a systemic granulomatous disease of unidentified cause, most commonly affecting the lungs, heart, eyes and skin; neurologic involvement is seen in approximately 5% of cases. Neurologic involvement in sarcoidosis could affect the brain parenchyma, meninges, or indeed any other site of the central nervous system; however, cranial nerve involvement is the most common site of neurologic involvement. The most frequently affected cranial nerve in neurologic sarcoidosis is the facial nerve, with 40–60% of cases manifesting facial paralysis.
We encountered a case of sarcoidosis in which facial paralysis was the presenting symptom. It is important to rule out intracranial lesions or neuromuscular disorders as the cause in patients presenting with facial paralysis, and evaluation by chest X-ray, electrocardiography, and brain MRI are important to identify relevant findings consistently, such as the shifted strain of the forehead.
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峯村 佐和子, 和田 弘太, 須田 稔士, 新井 千昭, 長岡 真人, 井田 裕太郎, 枝松 秀雄
2015 年 143 巻 p.
107-111
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Meningeal carcinomatosis is characterized by multifocal spread of tumor cells in the leptomeninges from distant solid tumors. It is the clinical condition that is relatively rare in intracranial metastasis. It is easy to suspect meningeal carcinomatosis when a variety of neurological symptoms appear in patient with a known malignancy. However, we may appear as presenting symptoms of a latent malignant tumor. The prognosis is very poor and often results in death after the onset for neurologic symptoms in 1–2 months.
We experienced a case of meningeal carcinomatosis associated with preceding symptoms of sensorineural hearing loss. Further examinations revealed gastric cancer and metastasis of the tumor cell.
We consider our experience was important to differentiate rare case of meningeal carcinomatosis for sudden sensorineural hearing loss and recurrent facial palsy.
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―高橋，森山式の鼻内手術のコンセプトを基に―
和田 弘太, 新井 千昭, 石垣 高志, 枝松 秀雄
2015 年 143 巻 p.
112-116
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
It is said that Grunwald, Hajek, Killian and Halle developed the endonasal sinus surgery in the world, but, in Japan, Kenzo Takahashi was the originator of the endonasal sinus surgery. Moriyama is the one of the pioneers who introduced endoscope into sinus surgery and also introduced 70 degrees endoscope. It is able to observe frontal sinus and maxillary sinus. Wormald organized the dissection around the frontal sinus from anterior ethmoid sinus. I describe my surgery for anterior ethmoid sinus and frontal sinus from these concepts.
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Kouta Wada, Takao Kobayashi, Yoshinori Matsuwaki, Hiroshi Moriyama, Hi ...
2015 年 143 巻 p.
117-126
発行日: 2015年
公開日: 2015/07/01
ジャーナル
認証あり
Fungi may be involved in asthma and chronic rhinosinusitis (CRS). PBMCs from CRS patients produce IL-5, IL-13 and INF-γ by
Alternaria. In addition,
Alternaria produces potent Th2-like adjuvant effects in the airway. Therefore, we hypothesized that
Alternaria may inhibit Th1-type defense mechanisms against virus infection.
Dendritic cells (DCs) were generated from mouse bone marrow. The functional responses were assessed by expression of cell surface molecules by FACS (MHC Class II, CD40, CD80, CD86 and OX40L. Production of IL-6, IP-10, I-TAC and IFN-β were measured by ELISA. TLR3 mRNA and protein expression were detected by quantitative Real time-PCR and Western blot.
Alternaria and poly I:C enhanced cell surface expression of MHC Class II, CD40, CD80, CD86 and OX40L, and IL-6 production in a concentration-dependent manner. However,
Alternaria significantly inhibited IP-10, I-TAC and IFN-β production induced by viral double-stranded RNA (dsRNA)-mimic poly I:C. TLR3 mRNA expression and protein production by poly I:C were significantly inhibited by
Alternaria. These reactions are likely caused by heat-stable factor(s) in
Alternaria extract with >100 kDa molecular mass.
These findings suggest that fungus,
Alternaria may inhibit production of IFN-β and other cytokines by DCs by suppressing TLR3 expression. These results indicate that
Alternaria may inhibit host innate immunity against virus infection.
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