耳鼻咽喉科臨床　補冊

中耳真珠腫術後の再発性真珠腫と予防処置法

赤池徹哉, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 1-12
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_1

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Recurrent cholesteatoma and techniques for its prevention were studied in 52 ears in patients who had undergone closed tympanoplasty for middle ear cholesteatoma.
The total incidence of recurrent cholesteatoma was 17.3%. The incidence of recurrent cholesteatoma in ears in which preventative techniques had not been performed was 33.3%, and it was 16.1% in ears in which reconstruction of scutum had been performed. Recurrent cholesteatoma was not observed in ears in which tympano-mastoid blockage had been performed, even in ears with severe retraction and adhesion of the tympanic membrane due to eustachian tube insufficiency.
It was found that reconstruction of scutum cannot prevent recurrence in ears with poor postoperative eustachian tube function, though it is useful for ears with good eustachian tube function. In ears with poor eustachian tube function, we found that tympano-mastoid blockage is the most effective preventative technique against recurrent cholesteatoma.
In assessing eustachian tube function, it is important to determine not only the condition of aeration but also preoperative tympanic membrane findings and intraoperative tympanic cavity findings.

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クモ膜下出血症例の側頭骨病理組織学的検討

宗田由美, 相川通

1991 年 1991 巻 Supplement43 号 p. 13-28
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_13

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We studied human temporal bone histopathology in 41 subarachnoid hemorrhage patients in order to clarify how the severity of hemorrhage and survival time after onset of subarachnoid hemorrhage influenced the red blood cells infiltration pattern of the inner ear and the facial nerve.
The results indicated that red blood cells tended to enter the peripheral region of the inner ear and the facial nerve when subarachnoid hemorrhage was severe. The extent of red blood cells infiltration was different in each structure. In particular, numerqus red blood cells frequently infiltrated the facial nerve and the vestibule from the internal auditory canal, and the cochlea from the cochlear aqueduct, but seldom infiltrated the cochlea and the semicircular canals from the internal auditory canal. In severe hemorrhage, however, red blood cells entered the scala tympani from the internal auditory canal. The presence of red blood cells in the peripheral resions of both structures was invariably found during the first 24 hours to 7 days following subarachnoid hemorrhage.

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側頭骨二次性悪性腫瘍の病理組織学的検討

相川通, 佐藤勇, 鈴木知子, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 29-34
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_29

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Secondary malignant tumors of the temporal bone in 20 patients with various diagnoses seen during the period from 1983 to 1989 were studied histopathologically. Six patients had been diagnosed as having carcinoma of the nasal and paranasal cavity,4 with carcinoma of the lung,3 with brain tumor, and 2 with carcinoma of the stomach, and one each as having carcinoma of the breast, pharynx, thyroid gland, and skin and one as having carcinoma of undetermined origin. Pathological findings indicating the route of tumor cell infiltration revealed that metastatic tumors had invaded the temporal bone through hematogenous dissemination in 11 patients, that there had been direct invasion of the temporal bone from adjacent areas in 5 patients, and that tumor cells had infiltrated into the internal auditory canal by diffuse metastatic leptomeningeal carcinomatosis in 4 patients. In addition, the existence of aural symptoms such as hearing impairment, tinnitus, dizziness and facial palsy was noted in 9 patients.

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内頸動脈の走行と頸動脈管の裂隙について

ヒト側頭骨標本での検討

小針仁美, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 35-40
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_35

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Human temporal bones from 175 ears from 110 individuals were sectioned horizontally to measure aberration in the course of the internal carotid artery and to observe dehiscence of the carotid canal.
Aberration in the course of the carotid artery was not observed, dehiscence of the cartoid canal was found in 56 ears (32%), and dehiscence of more than 0.4 mm in diameter was found in 24 ears (13.7%). The incidence of dehiscence increased with increasing age, and ears with dehiscence of the carotid canal of more than 0.3 mm showed a tendency to have been obtained from individuals with a history of hypertension.
The present findings highlight the frequent occurrence of dehiscence and indicate that during surgical procedures close attention should be paid to the eradication of inflammatory granulation tissue or cholesteatoma matrix from the tympanic orifice of the Eustachian tube.

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末梢性および中枢性眩量症におけるABR

大河内幸男, 小川洋, 大谷巌, 菅野秀貴

1991 年 1991 巻 Supplement43 号 p. 41-46
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_41

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Auditory Brainstem Response (ABR) in 211 patients with vertigo seen during the period from 1982 to 1988 was evaluated and compared with electronystagmography (ENG)results. Patients consisted of 117 with peripheral vertigo (33 with Ménière's diseases,10with benign paroxysmal positional vertigo,8 with vestibular neuronitis and 66 with vertigo of unknown) and 94 with cerebral vertigo (41 with cerebellopontine angle tumors,18 with other brain tumors,25 with cerebrovascular disorders, and 10 with systemic degenerative disorders). Few abnormalities in patients with peripheral vertigo could be detected with ABR which consequently we evaluated to be not very useful in the differential diagnosis of peripheral vertigo. On the other hand, in patients with cerebral vertigo, such as those with cerebellopontine angle tumors, abnormalities could be detected frequently with ABR, which when used together with ENG results was quite effective in diagnosis of cerebral vertigo.

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当科におけるメニエール病の統計的観察

小針啓生, 相川通, 大河内幸男, 鹿野真人, 柏原一成, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 47-58
発行日: 1991年
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_47

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We performed a statistical study of the clinical features of 32 patients with confirmed Meniere's disease who visited our clinic during the period from 1986 to 1989. The results were as follws: women were more often affected than m en; 31 patients (97%) had only unilateral involvement; right ears were significantly more often affected than left ears; and canal paresis and the degree of hearing impairment were not found to be significant factors in predicting the prognosis of Meniere's disease.

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‘Open’型先天性中耳真珠腫の‘Closed’化について

鈴木聡明, 小針啓生, 赤池徹哉, 鈴木知子, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 59-64
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_59

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We have previously reported on a patient with a type of congenital cholesteatoma which was not a closed pearl, but ‘open’. During subsequent post-operative exploratory surgery in this patient, we found a residual cholesteatoma which formed a ‘closed’ pearl, which we removed. Histopathological examination revealed inflammation in the matrix of the ‘closed’ cholesteatoma and the surrounding epithelial mucosa. Apparently the ‘open’cholesteatoma had closed due to the stimulation of the surgery or the otitis media. These findings indicate that when an ‘open’ congenital cholesteatoma is found during exploratory tympanotomy it is necessary to remove it completely.

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脳幹部動静脈奇形症例の耳科学的検討

小川洋, 小針啓生, 大河内幸男, 大谷巌, 沼沢真一, 菊池泰裕, 児玉南海雄

1991 年 1991 巻 Supplement43 号 p. 65-69
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_65

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Cerebral arteriovenous malformation (AVM) is frequently seen in the anterior circulation, but rarely in the brainstem. We recently examined a 19-year-old male who had been suffering from left hemifacial spasm for 1 year. Magnetic resonance imaging (MRI)demonstrated extensive AVM in the brainstem. Otologic examination especially auditory brain stemresponce, eye tracking test, and optokinetic pattern showed abnormalities.
Although the AVM was extensive throughout the left side of the brainstem, he exhibited only a few clincal signs.

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難聴,めまいで発症した脳幹部海綿状血管腫の一症例

佐久間仁, 大河内幸男, 馬場陽子, 大谷巌, 平山和美, 佐藤正憲, 児玉南海男

1991 年 1991 巻 Supplement43 号 p. 70-76
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_70

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A case of brainstem cavernous angioma associated with hearing loss and dizziness is reported. A 25-year-old female initially complained of hearing loss in the leftear and dizziness. Six months thereafter she suddenly developed additional symptoms, and was diagnosed as having hemorrhage in the brainstem on the basis of CT scan and MRI findings. Otological examination revealed low- and high-frequency hearing loss and abnormal ABR consisting of only wave I in the left ear. Follow-up MRI showed cavernous angioma, which was surgically removed.

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顔面神経麻痺を呈した小脳橋角部腫瘍の一例

Temporal Bone Pathogy

鈴木知子, 安斎友博, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 77-83
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_77

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Histopathological findings for the temporal bone in a case of cerebello-pontine angle astrocytoma associated with facial nerve palsy are reported, and their relation to clinical symptoms is discussed. The patient, a 79-year-old female, complained of right facial palsy and symptoms indicating right abducens nerve palsy. Audiometric tests showed her hearing to be almost normal. She underwent partial removal of the tumor by neurosurgery. However, the size of the tumor remnant increased, and her general condition deteriorated and she died. At autopsy, the tumor mass was found to occupy the pons, midbrain, cerebellar peduncle and medulla oblongata, and cranial nerve V, VI, VII, IX and XII were embedded in the tumor mass. Histopathological diagnosis was astrocytoma grade II. Findings for the right temporal bone indicated complete degeneration of the motor fibers of the facial nerve throughout its course. Tumor cells had not infiltrated into the temporal bones. These findings suggest that the facial nerve nucleus and the more central parts of the facial nerve were involved. The cochlear and vestibular nerves appeared to be normal. We believe that there are some cases in which a cerebello-pontine angle tumor does not cause hearing loss, even when the tumor mass is very large.

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非外傷性動脈瘤による鼻出血例と鼻出血統計

角田保雄, 安斎友博, 唯木享, 猪本雄一郎, 柏原一成, 渡部浩伸, 大石剛資, 相川通, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 84-92
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_84

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A case of massive epistaxis due to internal carotid aneurysm is reported. A 46-yearold female presented with the chief complaint of right epistaxis which had recurred during the past 9 years. The source of bleeding was not determined by routine ENT examination, but the diagnosis of epistaxis due to intracavernous carotid aneurysm was confirmed with the aid of carotid angiograghy. The internal carotid artery was ligatured. Recovery was uneventful, without further epistaxis.
We also performed statistical analysis of clinical feature of 327 out-patients and 39 hospitalized patients with epistaxis. The age distribution of the out-patients was negatively skewed to the under 21 age group. The monthly distribution of out-patients showed an increase in frequency in the winter season in those over 60, and in the spring and summer seasons in those under 10. Hospitalized patients showed increases in January, June, and October. Patients over 30 tended to have systematic diseases and to suffer from severe epistaxis requiring hospitalization.

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前頭洞・筋骨洞・蝶形骨洞嚢胞性疾患の検討

山辺習, 相川通, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 93-97
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_93

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Twenty-five patients (9 males and 16 females) with cystic lesions of the paranasal sinuses other than the maxillary sinus were surgically treated at Fukushima Medical College Hospital during the period from March,1980 to March,1990. The patients were classified into 5 groups according to the location of the cystic lesion, as follows: 1) frontal type,5 patients; 2) front-ethmoidal type,3; 3) ethmoidal type,12; 4) ethmoidsphenoidal type,3; and 5) sphenoidal type,2. Among the 25 patients,15 had previously undergone paranasal surgery. Apparently the development of these cystic lesions is affected by abnormality of nasal and paranasal structures, especially that associated with postoperative change.

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副鼻腔手術17年後に生じた鼻性髄液漏症例

佐藤勇, 大谷巌, 小針仁美, 相川通, 本田学, 三沢敬典, 足川力雄

1991 年 1991 巻 Supplement43 号 p. 98-103
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_98

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A 37-year-old male with delayed onset of cerebrospinal fluid (CSF) rhinorrhea attributed to an operation for chronic sinusitis is reported.
He developed CSF rhinorrhea and meningitis 17 years after the operation.
The fistula on the rt. ethmoid roof was closed trans-nasally using fascia, gelfoam and fibrin glue. He had had no recurrence of CSF rhinorrhea or meningitis during 19 months of follow up.
We suggest that delayed onset of CSF rhinorrhea should be managed by surgical methods.

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放射線照射の著効した口蓋扁桃のAILDの一症例

岡村洋沖, 安田秀男, 三沢敬典

1991 年 1991 巻 Supplement43 号 p. 104-107
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_104

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Angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) is known as a disease characterized by systemic lymph node swelling and various immunological disorders. There are few reports of this disease in which the tumor was located in the head and neck regions, and only two cases have been reported to date in which the tumor was in the palatine tonsils. Steroids are the main form of treatment, with antitumor drugs being used to treat malignant lymphomas in intractable cases. However, it has not been reported that radiation therapy is effective in AILD of the palatine tonsils. We experienced a case in which such a tumor disappeared due to irradiation with ⁶⁰Co 40 Gy. Therefore, radiation therapy appears to be effective at least in cases of AILD in which the lesions are localized.

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梨状陥凹癌に対する咽頭喉頭半側切除術の検討

鹿野真人, 松浦秀博

1991 年 1991 巻 Supplement43 号 p. 108-114
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_108

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This report described a surgical resection technique of hemilaryngopharyngectomy for piriform sinus carcinoma.
A patient w ith piriform sinus carcinoma staged T2NOMO was selected for the resection, which consisted of ipsilateral neck dissection and hemilaryngopharyngectomy which included partial resection of the cricoid cartilage. This covered the safety margin for the invasion to the apex.
For rec o nstruction, a pectoralis major myocutaneous flap was divided into two portions, of which one was used for the pharyngeal cavity and the other for the laryngeal cavity.
The patient can speak well postoperatively, except for slight hoarseness, with the new vocal cord located on the flap, which was made by mattress suture of the skin.
However, he cannot eat without pressing his upper neck with his finger to close the airway and prevent food aspiration.
He respirates through a tracheostoma.
In summary, we performe d hemilaryngopharyngectomy in a patient, whose voice was preserved, not by the construction of a speech tube, but by the construction of new vocal cord, and we described the surgical technique and its indication.

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副咽頭間隙腫瘍7症例の臨床的検討

馬場陽子, 小針仁美, 村上正文, 小針啓生, 安斎友博, 赤池徹哉, 竹内和郎, 大谷巌

1991 年 1991 巻 Supplement43 号 p. 115-119
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_115

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Seven patients with parapharyngeal space tumor were treated during the period from 1983 to 1990. Histopathological diagnosis was as follows: pleomorphic adenoma, three tumors; neurinoma, two; and malignant glomus tumor and malignant mixed tumor, one each.
This paper describes these tumors and diagnostic problems. CE-sialo CT and MRI are concluded to be useful in diagnosis of parapharyngeal apace tumors.

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耳下腺神経鞘腫の一症例と本邦報告例の検討

渡邉睦, 相川通, 岡村洋沖, 大谷巌, 本田学, 三沢敬典

1991 年 1991 巻 Supplement43 号 p. 120-126
発行日: 1991/04/25
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1991.Supplement43_120

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A case of neurinoma located in the right parotid gland is reported. The patient was a 62-year-old Japanese woman complaining of a painless lump in the right parotid gland region. Clinical examination revealed a tumor mass in the deep lobe of the right parotid gland. Facial nerve function was normal. The tumor was extirpated and did not show any apparent connection with the facial nerve. Histopathological examination revealed neurinoma. Thirty-one cases of neurinoma in the parotid gland have been reported in the Japanese literature. These cases as well as the present case are reviewed.

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