耳鼻咽喉科臨床 補冊
Online ISSN : 2185-1557
Print ISSN : 0912-1870
ISSN-L : 0912-1870
1992 巻, Supplement57 号
選択された号の論文の37件中1~37を表示しています
  • 戸川 清, 山川 浩治, 今野 昭義, 宮崎 総一郎, 多田 裕之, 板坂 芳明
    1992 年 1992 巻 Supplement57 号 p. 1-26
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Sleep apnea syndrome (SAS) is a typical group of sleep disordered breathing. For the diagnosis of location and severity of sleep dyspnea, history taking from family, signs and symptoms, local and general physical findings including fiberoptic endoscopy, X-films of the profile upper airway, cephalometry, polysomnography were performed. Parameters we used for polysomnography were EEG, EOG, EMG, ECG, Sa02, tcPO2 & tcPCO2, in traesophageal pressure, mesopharyngel pressure, heart rate, and tidel volume.
    Based on the value of intraesophageal pressure, the patients were classified into 3groups; slight (16-20 cmH2O), moderate (21-40) and severe (over 40). These values corresponded well with the apnea index and the percentage of Sa.02 drop. The patients with severe obstruction are candidates for surgery of any kind. The location of stenosis was evaluated by comparing the data of mesopharyngel and intraesophageal pressures; mesopharynx 51%, base of tongue 31% and combined 18%.
    Treatment varies widely; conservative and surgical. For the patients with moderate obstruction, nasal CPAP, body weight reduction, medication of antibiotics or KANPO, mandibular prosthesis are used depend on their causes. For those with severe obstruction intranasal corrective surgeries, adenotomy and tonsillectomy, uvulopalatopharyngoplasty (UPPP), median partial glossectomy, tracheostomy are indicated depend on their causes.
    UPPP improved dyspnea definitely in 2/3 of the total. The remaining 1/3 were i m proved by median partial glossotomy.
  • 山川 浩治
    1992 年 1992 巻 Supplement57 号 p. 13-18
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Polysomnography is the most reliable diagnostic method for obstructive sleep dyspnea (OSD). A burden to all-night polysomnography is usually used to diagnose OSD, but this is both the patient and physician. Therefore, we tried the daytime polysomnography for the diagnosis of OSD.
    The patients were 2 female and 12 male adults, who complained of sleepiness in the daytime.
    The subjects consisted of 2 patients with normal intraesophageal pressure (EP),7 patients with mild and moderate OSD, and 5 patients with severe OSD.
    Daytime polysomnography with natural sleep posed many p roblems. The patients could not sleep sufficiently during the daytime and their sleep was less deep during the daytime than at night.5 patients with only severe OSD could be diagnosed by daytime polysomnography.
    Therefore, we performed the daytime polysomnography using sleep drugs to another 14 patients (all patients were male) with OSD.
    Zopicron at a dose of 7.5 mg was ad m inistered per os to the patient before daytime polysomnography. About one month later, all-night polysomnography was carried out.
    The mean sleep efficiency was 74.1% in the daytime with Zopiclone, which was close to the mean sleep efficiency (79.5%) in the night sleep. The intraesophageal pressure and apnea index during daytime sleep corresponded to those during night sleep except in 2 patients.
    In conclution, daytime polysomnography using Zopicrone was very useful for the screaning of OSD.
  • 板坂 芳明, 山川 浩治, 宮崎 総一郎, 多田 裕之, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 19-25
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Polysomnography was carried out to evaluate the effect of sleeping posture on obstructive sleep dyspnea. Twelve patients who complained of snoring or obstructive sleep apnea were examined for supine and lateral decubitus sleeping postures. Their mean age was 52.2 years (range 38 to 66 years). Intraesophageal pressure was monitored to assess the respiratory effort, in addition to the measurement of apnea plus hypopnea index and oxygen saturation in polysomnography. In the lateral decubitus position, the apnea plus hypopnea index was decreased (supine,55.6±27.0, lateral,34.9 ±31.3; p <0.01) and the mean decrease in oxygen saturation was improved (supine,10.7±4.45%, lateral,8.05 ±2.17%; p <0.05). In the lateral decubitus position, the amplitude of intraesophageal pressure was decreased but not significantly (supine,40.0±19.7 cmH2O, lateral,33.5±15.9 cmH2O; N. S. ). This suggests that sleep position adjustment may be a useful treatment for obstructive sleep apnea. However, as the amplitude of intraesophageal pressure remained high on the lateral decubitus position, the position changes may not be so benificial for some patients with severe respiratory disturbance during sleep.
  • 多田 裕之, 山川 浩治, 板坂 芳明, 宮崎 総一郎, 寺田 修久, 安宅 芳春, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 26-33
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Two cases of Pickwick syndrome are reported.
    Case 1) A 14-year-old man, weighting 106 kg, was admitted to the hospital with complaints of daytime sleepiness and dyspnea. Pa02 and PaCO2 in day time were 41.0 Torr and 80.6 Torr respectively, and monitoring records of oxygen saturation showed periodic hypopnea and hemoglobin desaturation at night. Since the site of upper airway obstruction to cause respiratory compromise was suspected to be the pharyngeal isthmus, uvulopalatopharyngoplasty (UPPP) was performed. His post-operative recovery was good and speedy.
    Case2 ) A 57-year-old woman with complaints of sleep apnea and obesity came to our clinic. A markedly high PaCO2 tension (78-5 Torr) and low Pa02 tension (29.7 Torr) was measured during spontaneous breathing without any sign of dyspnea. We performed a polysomnographic study. The esophageal pressure and the mesopharyngeal pressure was 40 cm H20 (mean) and 10 cm H20, respectively. This indicated that the site of airway obstruction is around the base of the tongue, which supports the indication of midline partial gossectomy. However she refused the operation because of no subjective dyspnea. Over the following a year course was complicated with congestion of the liver and disseminated intravasucular coagulation and eventually the patient died. Chronic course of Pickwick syndromis not well known, but this case may indicate that persistent hypercapnea will lead to be insensitive to hypercapnea.
  • 林 漢玄, 宮崎 総一郎, 横溝 道範, 宇佐神 正海, 桃生 勝巳, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 34-37
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    This paper presents a 38-year-old man with obstructive sleep apnea (OSA) and nocturnal arrhythmia. Tonsillar hypertrophy was the main cause of OSA in this case. Oxygen desaturation during sleep induced severe brady-cardia (under 12 beat/min. ) and premature ventricular contraction (PVC). After uvulopalatophatopharyngoplasty, his respiratory distress and arrhythmia during sleep disappeared completely.
  • 今野 昭義, 伊藤 永子, 寺田 修久
    1992 年 1992 巻 Supplement57 号 p. 38-45
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    An animal experiment was performed to elucidate the effects of systemic antigen sensitization followed by repeated nasal antigen challenges on nasal reactivity to histamine and its histopathological and immunopharmacological backgrounds. One hundred and eleven Hartley strain guinea pigs were sensitized with ovalbumin intraperitoneally 7 times every 2 weeks, followed by nasal antigen challenges once daily for 7 days. Nasal reactivity to histamine and to antigen was evaluated by recording the respiratory noises.1 week after repeated antigen challenges, single antigen challenge was performed. After recording of the respiratory noises, the animals were decapitated consecutively. The nasal mucosa of the left nasal cavity was removed immediately and the contents of LTC4 in the nasal mucosa were measured by radioimmunoassay combined with HPLC. The right nasal cavity including the nasal septum was cut vertically at a fixed level and the numbers of eosinophils and neutrophils in the nasal mucosa of an entire vertical section of the nasal cavity were calculated.
    During the 12 weeks of systemic sensitization, no change was observed in nasal reactivity to histamine. However it increased dramatically during the 1 week of repeated antigen challenge. The numbers of eosinophils and neutrophils increased significantly after a single antigen challenge, reaching a peak at the 12th and 3rd hour, respectively. Both LTC4 and LTD4 increased singnificantly in 15 minutes and lasted for 3 hours after the antigen challenge. However second peak corresponding to the peak of eosinophil infiltration in the nasal mucosa could not be observed. Increase of respiratory noise could not be observed at the time of maximum eosinophil infiltration. The present study revealed a close association between the development of nasal hyperreactivity and that of allergic inflammation in the nasal mucosa. However lack of findings to show degranulation of markedly infiltrated eosinophils in late phase indicated the possible participation of other factors besides degranulation of eosinophils in the late phase.
  • 寺田 修久, 今野 昭義, 白鳥 浩二, 戸川 清, 山下 哲次, 栗本 文彦
    1992 年 1992 巻 Supplement57 号 p. 46-51
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    The activation of basophils and mast cells both in the early and late phases was estimated by analyzing nasal lavage fluid. On 9 volunteers with Japanese cedar pollinosis, nasal lavages and determinations of nasal airway resistance (NAR) were carried out periodically for twelve hours after an antigen challenge using antigen disks. The amounts of histamine and tryptase in each of the nasal lavage fluid samples were determined. To evaluate the role of eosinophils, the amount of ECP in each nasal lavage fluid was also determined. Biphasic increases in NAR were observed both in the early and late phases. The amount of histamine and tryptase significantly increased in the early phase. In some cases the amount of histamine increased again in the late phase. On the other hand the amount of tryptase did not increase in any case. The amount of ECP significantly increased in both phases, but more markedly in the late phase.
    The numbers of both basophilic cells and eosinophils increased in both phases. The increases were prominant in the late phase.
    The correlation coefficient betw e e n the change in NAR and the numbers of eosinophils was significant. Other correlation coefficients were not significant.
    Considering the fact that during the pollen-free seaso n there are only a few basophilic cells in both the nasal lavage fluid and nasal mucosa, challenged antigen is assumed to enter the nasal mucosa and react with sensitized mast cells in the subepithelium. Histamine and tryptase released from the mast cells appeared in the nasal lavage fluids within 10 minutes.
    The accumulation of eosinophilsis assumed to be the most important cause of the onset of late phase reactions. In some cases basophils are contributed to the late phase reactions, but considering that only mast cells release tryptase, the role of mast cells in the late phase reactions must be minimum.
  • 寺田 修久, 今野 昭義, 多田 裕之, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 52-56
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    We evaluated the degranulation effect of interleukin (IL) 5 on eosinophils purified from peripheral blood in the subjects with nasal allergy.
    Eosinophils were incubated with IL-5, IL-3 and platelet activating factor (PAF) at 37°C for lhr. The release of eosinophil cationic protein (ECP) was measured by radio im munoassay as an index of degranulation. High concentrations of IL-5 and IL-3 induced a significant release of ECPfrom eosinophils, although the amount of ECP was small compared with that in the nasal lavage fluid after antigen challenge. PAF did not have any effect on eoinophil degranulation.
    These findings s uggest that the roles of IL-5 and IL-3 on eosinophil degranulation are minimum in vivo.
  • 寺田 修久, 今野 昭義, 多田 裕之, 安藤 英樹, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 57-62
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    We performed the nasal provocation test before and after anti-allergic treatment for the patients with a nasal allergy.
    1. There were n o relationships between the degree of improvement obtained by antiallergic drugs and the severities of allergic symptoms nor the degree of nasal responses to the antigen provocation before the treatment.
    2. The relationship betwee n the response in the nasal provocation test and the clinical symptoms was significant. The resting nasal airway resistance (NAR) reflected the clinical nasal obstruction score more than the percent changes in NAR after the provocation.
    3. Prediction of estimation for recurrence w a s not possible by clinical symptoms nor by the responses to the antigen provocation at the time of ceasation of drug administration.
    The group with a higher improvement rate in the provocation test t e nded to be in longer remission.
    We reconfirmed that the nasal provocation test was useful for the objective assessment of clinical symptoms. Moreover, the nasal provocation test may be useful in predicting the remission period following the ceasation of drug administration.
  • 今野 昭義, 寺田 修久, 石川 和夫
    1992 年 1992 巻 Supplement57 号 p. 63-74
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    The study was designed to evaluate the effects and limitations of aerosol therapy combined with intranasal operation for severe chronic sinusitis. Intranasal operation which exposes the maxillary and ethmoid sinuses widely to the middle meatus was performed on 6subjects to evaluate the amount of antibiotics to reach the maxillary sinus mucosa and serum during nasal nebulization of 2 ml of 5% dibekacine (DKB) using a jet nebulizer. DKB in the amount of 0.73 ± 0.79 jug/g was observed in the maxillary sunus mucosa which was sufficient to maintain the MIC level for sensitive bacteria. Intranasal operation was performed in 21 subjects with severe bilateral chronic sinusitis and 10 subjects with unilateral chronic sinusitis and 25 mg of DKB solution with 0.2 g of dexamethasone was nebulized 3 times a week for 3 months. Antral lavege was performed every 2 weeks. In subjects who showed purulent secretion in the antral lavege 1 month after the start of aerosol therapy, the antibiotic was changed depending on sensitivity of the bacteria. Effects of aerosol therapy on purulent rhinorrhoe, nasal obstruction, Xray findings, purulent secretion in the antral lavage fluid and the bacteria in the antral lavage were evaluated 1 month after termination of the therapy. In subjects with unilateral sinusitis, marked improvement was observed in each of the above parameters. However, the effects for severe bilateral chronic sinusitis were rather limited and more than marked improvement of purulent rhinorrhoe, more than moderate improvement of radiographic opacity of the maxillary sinus, and of purulent secretion in the antral lavage were observed in 52%,35.7% and 76% of the subjects, respectively, with negative culture of the antral lavage fluids in 71.4%.
  • 白鳥 浩二, 岡本 美孝, 工藤 和夫, 伊藤 永子, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 75-83
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Female Hartley guinea pigs (SPF) were divided into three groups. In the first group, Broncasma Berna®(B. B. ) solution was administered by Jet nebulization every day for one week and this treatment was repeated after an interval of seven days during a four-week period. In the second group,0.4% phenolsolution was administered acccording to the same schedule as the first group. The third group was the control group which received no treatment.
    Histologically, the lower airway did not show any changes suggesting inflammation such as bronchitis following the administration of B. B. Anti-B. B. antibody could not be clearly detected either in serum or in bronchial washing by ELISA or PCA reaction.
    On the other hand, the cells from paratracheal lymph nodes in the first gro u p exhibited a higher response to PHA than those in the other groups. Also, the culture medium of lung macrophages enhanced the proliferation of the fibroblasts.
    The in vitro study with human blood leukoc y tes or with normal human nasal mucosa, enhanced expression of TNF a was observed after the administration of B. B.
    These findings suggest that B. B. inhalation with Jet nebulization is safe a nd that B. B. influences the products of TNF a in the nasal mucosa.
  • 西平 茂樹, 山内 博幸, 松崎 全成, 江戸 雅孝, 眞崎 雅和
    1992 年 1992 巻 Supplement57 号 p. 84-90
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Although the Kirschner wire is widely used for internal fixation of the nasal bone fractures, we could find few detailes about it in the literature. In the present paper, the indication, advantages, disadvantages, complications and any other questions about the technique are discussed based on our clinical experiences.
  • 西平 茂樹, 山内 博幸, 井谷 修
    1992 年 1992 巻 Supplement57 号 p. 91-97
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Two cases of saddle nose correction with porus hydroxyapatite ceramics implant under open rhinoplasty technique are reported.
    Since hydroxyapatite ceramic s has been used successfully for the reconstruction of bony defects in recent years, its good affinity for tissue has already been admitted. Patients are satisfied with the outcome. No functional disorders and no changes were noted during follow-up periods of seven to eighteen months.
    This method has eliminated the d ifficulty of obtaining an adequate graft and has simplified the saddle nose correction procedure.
  • 岡本 美孝, 工藤 和夫, 白鳥 浩二, 中澤 操, 伊藤 永子, 石川 和夫, 東 紘一郎, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 98-104
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    The polymerase chain reaction was used for detection of RS viral sequences in middle ear effusion collected from children with otitis media. RS viral sequences were detected in 21 out of 34 samples tested These sample were collected during and/or the after natural outbreak of RSV infection in the community. The viral sequences were highly detectable (85.7%) in the effusions of the patients from whom the nasopharynx RSV was isolated. On the other hand, several immunoregulatory cytokines were present in the ME effusions during RSV infection and in vitro mucosal RSV infection up-regulated production of certain cytokines, paticularly those with inflammatory properties. These observations suggest that RSV is an important factor in the pathogenesis of otitis media with effusion and that exaggerated production of cytokines in association with RSV infection may lead to the development of infection-induced inflammation, and effusion.
  • 多田 裕之, 寺田 修久
    1992 年 1992 巻 Supplement57 号 p. 105-110
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A 40-year-old woman with Behcet disease with fluctuating hearing loss was followed. The pure tone audiogram revealed a loss of 75 dB on the average bilaterally. After audiologic examination, the inner ear and brain stem lesions were suspected to be the site of pathologic foci. The patient had had recurrent painful ulceration in the oral and genital legions for over 10 years. Steroid therapy was effective but these symptoms had become progressively worse, greater hearing loss and increase of immunecomplex also occurred. The pathogenesis of hearing loss in Behcet disease has not been clearly determined but may be related to autoimmunity. The perlinent literature is briefly reviewed.
  • 高橋 敏江
    1992 年 1992 巻 Supplement57 号 p. 111-120
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    γ-Aminobutylic acid (GABA) is involved in the pathway connecting the lateral vestibular nuclei (VL) and Purkinje cells. We investigated the change of GABA immunoreactivity during the course of vestibular compensation in 29 guinea pigs. The brain was obtained following vital perfusion 8-12 hours after unilateral labyrinthectomy in 10animals (group 1),40-48 hours thereafter in 9 (group 2), one week thereafter in 7 (group 3), and 6 months thereafter in 3 (group 4). PAP method with anti-GABA polyclonal antibody was employed; some specimens were observed with a light microscope, and the immunoreactivity of VL was measured using a microscopic photometer. Groups 1 and 2showed significantly higher GABA-like immunoreactivity of the VL on the labyrinthectomized side relative to that on the intact side, while groups 3 and 4 showed no significant difference in immunoreactivity of the VL on the two sides. The control group without the operation (n=3) and the sham operation group (n=2) also showed no difference in immunoreactivity. These findings suggest that GABA plays an important role as a neurotransmitter during vestibular compensation in guinea pigs.
  • 石川 和夫, 江戸 雅孝, 松崎 全成
    1992 年 1992 巻 Supplement57 号 p. 121-126
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A comparative study on both forward and backward gait in fourteen normal volunteers and twelve patients with acute vestibular disorders was performed. For the assessment of the gait, two foot switches were placed on each pedal to record each foot's movement. Gait related muscle activities of m. tibialis anterior and m. gastrocnemius on both legs were also recorded by surface electrodes, using a telemeter.
    In normal forward gait, the tibialis anterior muscle showed two phased contractions from the early swing phase to the early stance phase, and the gastrocnemius muscle showed monophasic contraction during the stance phase. Seemingly, those patterns of muscle activities have reversed and the activities of the gastrocnemius decreased during backward gait. All of the CV (coefficient of variation) values of parameters taken for the analysis have increased in the backward gait. In the patients with vestibular disorders, the occurence rate of the abnormality of the time from hindfoot strike to the forefoot strike was the highest in the forward gait and the time from forefoot off to hindfoot off was the highest in the backward gait. This indicate that the peripheral vestibular lesion affects the activities of tibialis anterior muscle rather than the gastrocnemius muscle.
  • 石川 和夫, 中澤 操, 桃生 勝己, 高橋 敏江, 眞崎 雅和, 今野 昭義, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 127-134
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Eleven cases of surgically confirmed acoustic neurinoma were analyzed clinically. They were four males and seven females, ranging from 49 years old to 69 years old the average of which was 59.7. Tumor sizes ranged from 8 mm to 30 mm. Five of the eleven cases had a history of slowly progressive unilateral hearing loss, and 6 had vertigo for which they referred to see our hospital.
    Two of the cases were operated on by the translabyrinthine approach and the others by the middle cranial fossa approach. The tumor arose from the inferior vestibular nerve in 8 cases and the superior vestibular nerve in 3 cases. No significant reduction of the caloric response was found in 4 cases in which the tumors arose from the inferior vestibular nerve. In most of the cases in which the tumor size were less than 15 mm, no remarkable abnormality in equilibrium examinations was obtained. Anatomical preservation of the facial nerve after the surgery was 73 percent. Most cases showed profound hearing loss on the lesion side. However 4 cases with moderate hearing loss showed more than a 50% speech discrimination. Preoperative hearing level was preserved in 2 of the 4 cases.
  • 吉野 泰弘
    1992 年 1992 巻 Supplement57 号 p. 135-144
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    We evaluated the utility of fibrin glue adhesive in experimental facial nerve anastomosis. The zygomaticopalpebral branch of the facial nerve in guinea pigs was transected and repaired with either fibrin glue or nylon suture. The course of recovery was evaluated electrophysiologically by measuring evoked electromyography and palpebral muscle contraction rate. No significant difference between the two groups was observed. Histopathologically, foreign body reaction to the fibrin glue was mild, and the glue had been almost completely absorbed by 4 weeks after the anastomosis. We conclude that the use of fibrin glue adhesive for facial nerve anastomosis is useful, simple, and less traumatic to the nerve than is nylon suture.
  • 今野 昭義, 持田 晃, 沼田 勉, 金子 敏郎, 寺田 修久, 岡本 美孝, 恒元 博, Kazuo Ishikawa
    1992 年 1992 巻 Supplement57 号 p. 145-153
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    On 20 patients who had adenoid cystic carcinoma of the nose and paranasal sinuses, the effects of difference of therapeutic modalities on the prognosis of the patients and the effects of preoperative fast neutron irradiation and intraarterial infusion of cisplatin microcapsule (CDDP m. c) on histopathological changes of the tumors were evaluated. Out of 13 patients for whom more than 5 years had elapsed after initial therapy, local recurrences and distant metastases without local recurrence were observed in 2 and 3 patients respectively. In the two patients with T1-2N0 carcinoma of the nasal cavities on whom en bloc resection could be performed easily and securely could survive free of cancer for more than 5 years after surgery alone. Both of the two patients who had operative procedures within the tumor developed distant metastases. Significant clinical and histopathological effect could not be induced by preoperative intraarterial infusion of CDDP m. c. (40-100 mg) and distant metastasis developed in one out of 3 patients. In 6 patients on whom the total dosis (TDF) of preoperative fast neutron irradiation was 100-120, histopathological effects were grade M in 3, grade II b in 2 and grade II a in one patient, classified according to Shimosato's criteria. However, in 5 patients on whom total dosis (TDF) of fast neutron irradiation was 60-80, histopathological effects were confined to grade M in one patient, grade II b in another and grade II a in 3 patients. One patient on whom irradiation effect was grade Ill, treated by irradiation alone, showed recurrence after one year. Although the present study could not clarify the effect of postoperative fast neutron irradiation on the residual tumor, the data suggested the sufficient inhibition effect of full dosis preoperative fast neutron irradiation on occurrence of distant metastasis which may be induced by the operative procedure.
  • 岡本 美孝, 吉野 泰弘, 松崎 全成, 工藤 和夫, 白鳥 浩二, 東 絋一郎, 花沢 秀, 戸川 清, 横溝 道範, 宇佐神 正海
    1992 年 1992 巻 Supplement57 号 p. 154-158
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    At our department, the 5-year survival rate for patients with maxillary cancer has been more than 70%. This has been achieved by a high dose irradiation (60 Gy) and aggressive radical surgery with subsequent primary reconstructive surgery. The wound over the widely exposed tendons of the pterygoid muscle and temporal muscle around the mandibula, middle cranial base, orbital content and the subcutaneous tissue of the face is covered primarily by the thick flap to prevent the post operative complications, such as trisums, cicatricial contracture of the face, necrosis of the cranial base and formation of facial fistula.
    Recently, the osteocutaneuous forearm flap has been preferred in the reconstruction to improve postoperative facial disfigurement and functional impairments. Advantages and disadvantages of the flap are discussed.
  • 花沢 佳代子, 花沢 秀, 岡本 美孝, 戸川 清, 今野 昭義
    1992 年 1992 巻 Supplement57 号 p. 159-165
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    To assess the effect of chemotherapy in the treatment of nasopharyngeal carcinoma,48previously untreated patients admitted from Jan.1972 to Dec.1990 were analyzed.
    The 5-year survival rate for 23 patients treated mainly with radiothera p y was 43.5%(Kaplan-Meier methods). The cause of death was mainly local-regional relapse and/or distant metastasis. Since 1982, we have adopted chemotherapy consisting of pepleomycin (5 mg intramuscular injection on days 1-7) and cisplatinum (50 mg/m2 by 24-hour continuous intravenous injection on day 8). We treated 25 patients (minimum follow-up duration was 13 months) with this chemotherapy,2-3 cycles prior to radiotherapy and/or more than 3 cycles after radiotherapy, every 3 weeks. One patient died of pulmonary fibrosis related to pepleomycin. The 5-year survival rate was 53.1% and the relapse rate 42.9%. In a group of 20 patients treated with induction chemotherapy, the 5-year survival rate and the relapse rate were improved to 59.7% and 29.4%, respectively, although the response rate to the induction chemotherapy was 55% (CR 3 cases, PR 8 cases). A new regimen will be needed to achieve a high CR rate.
    Two of 6 patients treated w ith radical neck dissection survived and the operation was considered to be of significant benefit in nasopharyngeal carcinoma.
  • 吉野 泰弘, 岡本 美孝, 江戸 雅孝, 花沢 秀, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 166-171
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A retrospective study was performed on 25 young adults (40 years old or younger) with oral cavity carcinoma at Akita University School of Medicine between June,1976 and March,1991. Most of the patients had tongue cancer (20 cases), and the others had cancer of the lower gum (2), upper gum (1), oral floor (1) and hard plate (1). On presentaiton,5cases were clinically T1,12 T2,7 T3 and 1 T4. Cervical lymph node swelling (N1_3) was seen in 8 cases (32.0%). Combined treatment of surgery after radio-chemotherapy was performed in 24 cases without one case of clear cell carcinoma of the hard plate, which was treated by only surgery. Recurrent lymph node metastasis during or after the treatment was observed in 4 of the 17 No cases, and pathological lymph node metastasis was observed in 1 patient. They were treated with radical neck dissection, but 2 patients died. There was a high incidence of nodal metastasis and recurrence in young adults, so its control is very important for the treatment. The 5-year survival rate in young adults was 79.8% in oral cavity cancer, and 74.7% in tongue cancer, which are similar to the rates in older patients. The prognosis of oral cavity cancer in young adults was not any worse than in older patients.
  • 更級 則夫, 岡本 美孝, 宮崎 総一郎, 花沢 秀, 石川 和夫, 東 絋一郎, 戸川 清, 今野 昭義
    1992 年 1992 巻 Supplement57 号 p. 172-177
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    During the past 20 years from 1971 to 1991,171 cases were hospitalized at the Department of Otolaryngology, Akita University Hospital for treatment of parotid gland tumors. Out of the 171 cases,135 cases were benign tumors, while 36 cases were malignant ones. We classified these tumors according to the WHO classification and investigated the incidence, location, surgical method and facial nerve paralysis of each tumor. The choice for treatment of parotid gland tumors is surgery, and the surgical methods with these tumors have been standardized. The surgical procedures should be recorded correctly according to the standard way and make postoperative evaluation accurately.
  • 西平 茂樹, 山内 博幸, 眞崎 雅和, 松崎 全成, 江戸 雅孝
    1992 年 1992 巻 Supplement57 号 p. 178-184
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A 23 year old man with cystic hygroma of the left side parotid gland was treated surgically. Two years after operation, there was no evidence of recurrence. Because of its invasive nature, it is very difficult to separate the tumor from the facial nerve macroscopical-ly. In order to avoid unnecessary expenses in surgery use of a surgical microscope is recommended.
  • 山内 博幸, 西平 茂樹, 眞崎 雅和, 松崎 全成, 江戸 雅孝
    1992 年 1992 巻 Supplement57 号 p. 185-190
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A case of pleomorphic adenoma extending to the parapharyngeal space is reported. The patient was a 40 year-old woman who had abnormal sensation in her throat. Subsequently she felt a growing mass in the parotid region. We pointed it out incidentally when she visited our clinic accompanying her son. Physical examionation revealed a giant mass lesion dislocating the side wall of the pharynx. CT and MRI revealed a giant tumor that seemed to have arisen from the parotid gland and extend to the parapharyngeal space. The tumor was removed by an external approach with ipsilateral extirpation of the submandibular gland. Histological examination revealed a pleomorphic adenoma.
  • 飯塚 桂司, 今野 昭義
    1992 年 1992 巻 Supplement57 号 p. 191-195
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    U-shaped removal of medial claviclar head and sternal manubrium is a new technique for the surgery of the lower neck and superior mediastinum. This technique provides a wide surgical field of superior mediastinum and good cosmetic results. Our experience with 13 patients who underwent this technique is presented. This technique was demonstrated to be safe, easy, and useful in head and neck surgery for continuity of the same operating field.
  • 西平 茂樹, 山内 博幸
    1992 年 1992 巻 Supplement57 号 p. 196-203
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Thyroid hemiagenesis is extremely rare in Japan. A 63 year-old female who had goiter in the left thyroid lobe associated with hemiagenesis of of the right lobe and lingual thyroid gland is reported. Thyroid function test was normal. The goiter was caused by follicular adenoma with cystic degeneration. Presence of the isthmus and the pyramidal lobe were confirmed by operation.123I and 201T1 cintigram, CT, MRI and ultrasonic scanning findings were investigated in detail.
  • 桃生 勝己, 花沢 佳代子, 山川 浩治, 戸川 清, 井谷 修
    1992 年 1992 巻 Supplement57 号 p. 204-209
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Four cases in our clinical experience of primary hyperparathyroidism are reported. All four cases were diagnosed as adenoma histologically. Computerized tomography (CT)was useful for the diagnosis of the location of the tumor. The minimum diameter of the adenoma identified by CT was 1.4 cm. There was one case in which the tumor was not identified by CT, but was found by catheter venous sampling of parathyroid hormone (PTH). The adenomas in all four cases were located in the lower glands. The removed tumors were all oval, their surface smooth, and color mostly dark red. In all cases, the serum calcium level before the operation was abnormally high. However, the level decreased immediately after the operation, and then gradually increased and eventually reached the normal value. In all cases the serum phosphorus level was abnormally low before the operation. However, immediately after the operation the level decreased, and then gradually increased and finally reached the normal value. The PTHN and PTHc of peripheral vein blood before operation showed a normal value and were not useful. However, the PTHN and PTHc of catheter venous sampling were very useful. PTHN using the ratio of catheter venous sampling to peripheral venous blood seemed to be more useful than PTHc in the diagnosis of an abnormal parathyroid gland with hyperparathyroidism.
  • 西平 茂樹, 山内 博幸
    1992 年 1992 巻 Supplement57 号 p. 210-216
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    An eight-year-old boy with a dark red color fluid containing cyst adjacent to the internal jugular vein beneath the carotid sheath is reported. He had had no operations or trauma on his neck before. Pathological examination of the cyst wall revealed its origin to be a medium-size vein. Although we could not find the term "cervical blood cyst" in the current classification of head and neck tumors, we found the term used in the Japanese literature before 1970.
  • 工藤 和夫, 岡本 美孝, 白鳥 浩二, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 217-220
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    At our depertment, head and neck cancers were treated by a combination of Linac Xray preoperative radiation, chemotherapy and aggressive radical surgery followed by primary reconstruction. After the operation, CEZ and FOM were used as prophylaxis of infection.
    In this study, we examined the bacteriologic changes of the airway during these treatmeants.
    Peudomonas aeruginosa and Serratia marcescens were most frequently isolated from the airway after the operation (57%) and even before the operation (14%). The immunological study exhibited the suppressed response to phytohemagglutinin or concanavalin A of the peripheral blood leukocytes of these patients, which may be responsible for the isolation of these bacteria mentioned above.
    However, they did not cause any wound i nfections when no surgical problems of skin flaps used for the reconstructions had occurred.
    These findings suggest that treatm e nt such as radiation and operation for head and neck cancer induces and immunocompromised state but not infection without surgical troubles. Also the prophylactic administration of CEZ and FOM also did not cause any problems.
  • 宮崎 総一郎, 横溝 道範, 桃生 勝己, 林 漢玄, 宇佐神 正海
    1992 年 1992 巻 Supplement57 号 p. 221-226
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A large tonsillolith in a 48-year-old woman is reported. The patient had complained of pharyngeal discomfort for three years. X-ray examination revealed a large calcification at the left supratonsillar fossa. CT revealed a high-density mass and MRI revealed a low density area in the same place. Tonsillectomy of the l e ft side was performed under general anesthesia. The stone was 20 X 16 mm and contained CaPO4 75% and CaCO3 25%. To date,18 cases of tonsillolith have been reported in Japan. The literature on tonsillolith is reviewed.
  • 横溝 道範, 宮崎 総一郎, 桃生 勝巳, 藤倉 輝道, 林 漢玄, 宇佐神 正海
    1992 年 1992 巻 Supplement57 号 p. 227-230
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    We recently experienced a patient complaining of sore throat and headache due to an elongated styloid process. Styloidectomy was performed with a good outcome. We describe this case briefly with review of the literature.
    A 30-year-old man had a sore throat and headache. A bone-like process was palpable in his left tonsillar fossa. The X-ray film revealed that his left styloid process abnormally extended to the lower inside, and the styloid process measured 90 mm. Under a diagnosis of elongated styloid process, styloidectomy was performed.
    After operation, his complaint disappeared completely. About 1 year after the operation, he remained symptomless without any recurrence.
  • 山田 昌次, 石川 和夫, 戸川 清, 相馬 譲二
    1992 年 1992 巻 Supplement57 号 p. 231-234
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Depressive state is considered to be one of the factors to cause abnormal sensation in the pharyngo-laryngeal region. We administered M a protilin to the patients who complained of abnormal sensation in the pharyngo-laryngeal region with scores of over 10 in SRQ-D test, and evaluated the efficacy of this drug.
  • 横溝 道範, 宮崎 総一郎, 林 漢玄, 宇佐神 正海
    1992 年 1992 巻 Supplement57 号 p. 235-238
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    Recurrent acute epiglottitis and chronic supraglottitis are rare. We recently treated a patient with chronic supraglottic edema by lingual tonsillectomy, with a good outcome. The patient was a 46-year-old female with the complaint of pain and abnorm a l sensation of the throat. The lingual tonsil and the epiglottis were edematously swollen. She had been treated conservatively for over two years, but, local findings were not improved. She started complaining of dyspnea during sleep. Then lingual tonsillectomy was performed under general anesthesia. About one year after the operation, the supraglottic edema is disappeared and she has remained free of symptoms.
  • 西平 茂樹, 山内 博幸, 江戸 雅孝, 田中 弘, 眞崎 雅和
    1992 年 1992 巻 Supplement57 号 p. 239-245
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    A rare case of cervical tracheal injury in Kendo match is reported. A 17 year old senior high school boy had sustained a shinai thrust injury to his throat during a Kendo match.
    At admission, X-ray examination revealed apparent mediastinal emphysema. In the neck, chest and axilla there was marked subcutaneous emphysema. Although the trachea did not appear to be torn, there was linear coagulation at the first to third ring and the posterior wall on the mucous membrane of the trachea under bronchoscopic examination. Transnasal intubation was performed under local anesthesia. Hypoxcemia occurred three hours after intubation. Computed tomography yielded excellent information of emphysema.
  • 松崎 全成, 更級 則夫, 山川 浩治, 岡本 美孝, 花沢 秀, 石州 和夫, 東 紘一郎, 今野 昭義, 戸川 清
    1992 年 1992 巻 Supplement57 号 p. 246-249
    発行日: 1992/11/20
    公開日: 2012/11/27
    ジャーナル フリー
    During the past 20 years from 1971 to 1991,71 cases of esophageal foreign bodies were treated in the department of otolaryngology, Akita university hospital. These patients were clinically analyzed. The youngest patient was 10 months old and the oldest was 79 years old. Out of 71 cases,27 cases (38.0%) were under 6 years of age. Fish bones were the most common (20 cases; 28.2%), followed by coins (16 cases; 22.5%). Coins were only found in children under 6 years of age. In 52 cases (73.2%), the foreign bodies were located at the first physiological constriction of the esophagus. In 10 cases (14.1%) the foreign bodies were removed by the external incision because of perforation and esophageal abscess.
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