耳鼻咽喉科臨床　補冊

前庭神経切断術

-症例報告ならびにアンケート調査-

喜多村健, 栫博幸, 石田孝, 菅澤正, 山岨達也, 佐々木富男

1992 年 1992 巻 Supplement59 号 p. 1-6
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_1

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A clinical case report of a 41-year-old man with a 4 year-history of Meniere's disease is presented. His vertiginous attack had not been controlled by steroid and lidocaine infusion to the middle ear or endolymphatic sac surgery. Vestibular neurectomy was performed and there have been no attacks of vertigo postoperatively.
A survey for the surgical treatment, inc l u ding the vestibular neurectomy for Meniere's disease was carried out. A questionnaire for the surgical treatment for Meniere's disease was sent to 15 foreign doctors. Their responses suggested the presence of some controversial aspects especially in the percentage of patients who require surgical treatment and the frequency of the presence of the cochleovestibular cleavage plane in the cerebellopontine cistern.

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当教室15年間のめまい患者の統計的観察

小松崎安美, 神永千織, 釣巻周子, 石田孝, 三好俊二, 喜多村健, 水野正浩

1992 年 1992 巻 Supplement59 号 p. 7-13
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_7

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A statistical analysis was made on 4,246 patients who visited our clinic complaining of vertigo and dizziness from 1974 to 1988. The annual number of patients has been increasing, especially those over 70 years old and females. Benign paroxysmal positional vertigo and sudden deafness with vertigo were predominant in the patients in their 50s, and a marked increase was noted between their 30s and 40s during the recent 5 years. The number of patients with acoustic neurinoma was 67, with predominance in the age group of 50s and in females. Patients with Meniere's disease have not changed in number, but their percentage has decreased. Vestibular dysfunction due to otitis media has decreased to less than 1% of all peripheral vertiginous patients.

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当科における末梢性顔面神経麻痺の保存的治療成績

菅原公明, 青山敬, 石田孝, 喜多村健

1992 年 1992 巻 Supplement59 号 p. 14-18
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_14

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Thirty six cases of peripheral facial palsy (Bell's palsy; 20 cases, Hunt's syndrome; 16 cases) were treated conservatively at our clinic from January,1988 through September,1990, and the outcome of the therapy was analyzed. Combined therapy of high-dose steroid and low-molecular dextran with or without stellate ganglion block (SGB) and administration of antiviral agents was performed within two weeks after onset of the palsy. The steroid (bethamethasone, initial dose; 8 to 12 mg/day) was drip-infused intravenously for 12 to 15 days (maximum total dose; 120 mg), and then all patients were followed up for 6 months. Facial movements were evaluated on a 40-point scoring system ( Japanese Society for Facial Nerve Research), and electrophysiological examinations such as impedance audiometry (stapedial reflex; SR) and electroneurography (ENoG).
These findings showed that high-dose (initial dose; 10 to 12 mg/day) intravenous administration of a steroid (bethamethasone) would be of benefit to obtain satisfactory( 12/13; 92%)return of facial movement in adults.

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突発性難聴に対するステロイド2クール療法の検討

石田孝, 神永千織, 安田豊稔, 菅原公明, 三好俊二, 平出文久

1992 年 1992 巻 Supplement59 号 p. 19-24
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_19

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One hundred and four patients with sudden hearing loss were treated with steroids.
After the first course of steroid therapy,17 patients showed recovery,30 show ed good improvement,27 showed fair improvement, and 30 showed no change. Ten of the 30 patients who showed no change were treated with the second course of steroid (group A). No further steroid medication was given to the other 20 patients (group B). Three patients in group A showed recovery or good improvement after the second steroid therapy, whereas three patients in group B showed good improvement without steroid. These findings in dicate that the second course therapy of steroids has no significant beneficial effect on hearing level improvement even though some patients exhibited response to the second course of steroid treatment.

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ABRにて異常を認めたCIDPの一例

石田孝, 平出文久, 城下裕

1992 年 1992 巻 Supplement59 号 p. 25-29
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_25

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A 37-year-old man with a 5-month history of CIDP experienced transient left hearing loss.
He had bilaterally prolonged I - V interpeak latencies of ABR but normal pure tone audiogram.
Caloric response was weak in both ears, whereas OKP (Optokinetic Pattern Test) and ETT (Eye Tracking Test) were normal.
These findings suggest that acoustic nerve conduction abnormalities caused by demyelination may occur in CIDP.

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肺転移能を有するヒト上顎癌細胞株の樹立と性状

五十嵐丈人, 宮田守, 森田守, 中村良博, 園田哲史

1992 年 1992 巻 Supplement59 号 p. 30-34
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_30

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The human maxillary cancer cell line, MMSI-1, was established from the xenograft which was implanted in nude mice and had been maintained for more than five years. Its characteristics were examined, MMSI-1 showed stable growth and the population doubling time was 1.9 days. Intravenous injection of MMSI-1 tumor cells produced lung metastases in nude mice. Southern blot hybridization showed seven-fold c-myc amplification; there was no overexpression of N-myc, erb B and erb B2. The lysate of MMSI-1 cells shortened the plasma recalcification time, but no thromboplastic activity was found in this lysate.
There has been no previous report on human head and neck cell lines w h ich can metastasize to the lung by intravenous inoculation of cancer cells. Therefore, the most conspicuous property of MMSI-1 seemed to be its metastasizing ability.

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当科における鼻副鼻腔手術の臨床統計

椿博幸, 西川和明, 喜多村健, 平出文久, 森田守

1992 年 1992 巻 Supplement59 号 p. 35-42
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_35

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A statistical study was made on 1502 cases who received surgical treatment for nose or sinus diseases between Apr.1974 and Dec.1990. Malignant tumor cases were excluded.
There were 999 males and 503 females, and they were most predominantly in their thirties (312 cases,20.8%).
Recently, the number of chronic sinusitis cases was gradually decreasing and the symptom of sinusitis became milder.
Therefore, the number of bilateral curative operation cases was decreasing and that of nasal cavity plastic operation cases, such as deviatomy and endonasal ethmoidectomy, has been increasing.
Polypotomy is a palliative measure but is useful for children and aged people.
Nasal allergy cases were increased in number and some of them had received deviatomy and conchotomy to alleviate nasal obstruction.

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副鼻腔嚢胞手術の臨床統計

椿博幸, 青山敬, 喜多村健, 平出文久, 森田守

1992 年 1992 巻 Supplement59 号 p. 43-52
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_43

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A statistical study was made on 392 cases who received surgical treatment for sinus cystic diseases between Apr.1974 and Dec.1990. Out of the 392 cases,307 cases were diagnosed as maxillary cyst (post operative cyst: 306 cases, primary cyst: 1 case). Most of the post operative maxillary cysts were observed 20-24 years after the previous operation. Out of the other 85 cysts,37 cysts were located in the frontal and anterior ethmoid sinus,28 cysts in the ethmoid cells and 20 cysts in the posterior ethmoid-sphenoid sinus. The etiology of the frontal and anterior ethmoid cysts was primary; 12 cysts, postoperative; 24 cysts and traumatic; 1 cyst. That of the ethmoid cysts was primary; 9 cysts and postoperative; 19 cysts. Most of the cases were successfully treated by endonasal operation. Among the posterior ethmoid-sphenoid cysts,3 were primary cysts and 17 were postoperative ones. Most of the patients complained of decrease of visual acuity and had consulted opthalmologists or neurosurgeons first. All of them were treated by an endonasal approach without recurrence.

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鼻・副鼻腔血管肉腫の一症例

宮田守, 安田豊稔, 西野宏, 菅原公明, 五十嵐丈人, 椿博幸, 森田守, 川井俊郎

1992 年 1992 巻 Supplement59 号 p. 53-59
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_53

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A 61-year-old male complained of left bloody rhinorrhea and swelling on the left side of the root of the nose for 6 months. Examination of the nose showed an irregular-surfaced and purple mass with a polypoidal configuration.
As frozen-section examination suggested a malignancy, we performed partial maxillectomy.
The histology of the specimen showed invasion by a malignant tumor composed of many irregular, interconnected small and large vascular spaces lined by pleomorphic endothelial cells. Using immunochemical staining, the tumor cells were positive for Factor MU reactive antigen comfirming the diagnosis of an angiosarcoma.
Review of the literature concerning angiosarcoma of the nose and paranasal sinuses revealed 17 previously published cases.
A recent follow-up examination of our case at 55 months revealed no evidence of local tumor recurrence or systemic spread.

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T4症例を減らすために

-第一報:患者の受診行動について-

安田豊稔, 五十嵐丈人, 宮田守, 喜多村健, 森田守

1992 年 1992 巻 Supplement59 号 p. 60-67
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_60

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We reviewed retrospectively some factors influencing the amount of elapsed time between the first symptom of cancer and the search for medical help in 123 patients with head and neck advanced cancer (T4), encountered at Jichi Medical School Hospital between 1974 and 1990.
Although 80% of the patients had consulted a doctor within 3 months after noticing the first symptom,50% of the patients had visited the medical school hospital within 3 months after the onset of symptoms, where treatment for cancer can be performed. We also analyzed the relation between the delay in seeking medical help and site of cancer, past history, family history, occupation, and area of residence. Patients with maxillary cancer sought help earlier than those with laryngeal and nasopharyngeal cancer. Patients who had a history of otolaryngeal disease and family history of cancer sought help earlier than the others.

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新生児の上顎体の一例

-その術後管理について-

神永千織, 菅原公明, 宮田守, 喜多村健

1992 年 1992 巻 Supplement59 号 p. 68-72
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_68

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We describe a case of neonatal epignathus. In this case the following problems were confronted.
1) aspiration pneumonia,2) difficulty of decannulation for subglottic stenosis, and 3) disorder of articulation
Post-operative management for the above problems are discussed.

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当科における異物症例の統計的観察

西川和明, 椿博幸, 森田守

1992 年 1992 巻 Supplement59 号 p. 73-79
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_73

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The total number of the cases was 437. The site of the foreign bodies was the ear (141), nose (94), oral cavity and pharynx (101) esophagus (84), trachea and bronchus (17).
The most frequent foreign bodies in the ear were toys in children under 5 years old and insects in adults.
The insects were common from July to September.
The most frequent foreign bodies in the nose were toys in children under 10 years of age.
The foreign bodies in the oral cavity and pharynx were mainly found in the oropharynx. Fish bones were most common.
Most of the foreign bodies of the esophagus were found at the cricopharyngeus.
Coins were the most frequent foreign bodies in children. Fish bones and prosthesis were the main foreign bodies in adults.
Most of the foreign bodies of the trachea and bronchus were in children under five years of age. There was no marked difference infrequency between right and leftbronchus.

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咽頭腔外長期嵌在異物の一症例

青山敬, 井上耕, 宮田守

1992 年 1992 巻 Supplement59 号 p. 80-83
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_80

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Clinical case report of a 61-year-old woman with retropharyngeal foreign body is presented. She noticed pharyngalgia just after eating a slice of mackerel. A neighbourhood otorhinolaryngologist prescribed medication, without pointed out the foreign body. Several days later, the pharyngalgia disappeared. Fifty days after eating mackerel, she began to complain of a lump sensation in the throat, and visited our hospital. On endoscopy, granulation was seen on the postpharyngeal wall, just above the right pyriform sinus. A cervical X-ray film revealed the foreign body in the retropharyngeal space. It could not be found by esophageal endoscopy and finally it was removed by a lateral neck incision. The foreign body was a fish bone and it had remained there for 88 days.

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頭頸部非ポジキンリンパ腫の免疫組織学的検討

井上耕, 森田守

1992 年 1992 巻 Supplement59 号 p. 84-88
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_84

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We retrospectively analyzed 52 patients to investigate pathological and immunohistological classification of non-Hodgkin's lymphoma in the head and neck and their clinical features were reviewed.
Diffuse large cell lymphomas were common in patients with Waldeyer's ring involvement.
All Waldeyer's ring lymphomas were found to express B-cell phenotype. Nodal and sinonasal lymphomas expressed T-cell phenotype in many patients.
Prognosis of sinonasal lymphoma was poor irrespective of T-cell or B-cell type.
It was important to choose chemotherapy based on histological type.

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当科における下咽頭癌の治療成績

西野宏, 中村良博, 井上耕, 五十嵐丈人, 宮田守, 森田守

1992 年 1992 巻 Supplement59 号 p. 89-93
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_89

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Between November 1974 and May 1991, 36 patients with hypopharyngeal carcinoma were treated with various combined therapy and their results were analyzed. The survival rate (Kaplan-Meier method) of the entire group was 38% at 5 years. The local control by radiation alone was very poor except in a few cases. The survival rate of patients by the combined preoperative radiation and surgery was best, being 52% at 5 years.

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Idiopathic plasmacytosis の2症例

五十嵐丈人, 西野宏, 宮田守, 森田守

1992 年 1992 巻 Supplement59 号 p. 94-98
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_94

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Two uncommon cases of idiopathic plasmacytosis are reported. Although their clinical findings were similar to malignant tumors, pathological findings revealed intense plasmacytic infiltration. The lesion of the first case was located in the maxillary sinus, and that of the second case in the larynx. These clinical and pathological features in the present two cases corresponded to idiopathic plasmacytosis originally reported by Timms and associates in 1988. According to their report, this disease was characterized by a tumor-like appearance, no aetiologic factors of local allergy, good response to steroid therapy, and nonspecific chronic inflammatory infiltration consisting mostly of plasma cells.
There has been no confirmed treatment for this disease, and our two cases were successfully treated by surgery.

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喉頭軟骨肉腫の一症例

玉川雄也, 藤本泰幸, 宮田守, 森田守

1992 年 1992 巻 Supplement59 号 p. 99-108
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_99

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A 69-year-old male with chondrosarcoma of the larynx is reported. The patient was admitted with a 5-year history of hoarseness and one month history of dyspnea. Laryngoscopy revealed a large submucosal mass involving the left hemilarynx, narrowing the laryngeal lumen. Laryngeal computed tomography and magnetic resonance imaging showed the presence of a massive lesion arising from the cricoid cartilage. Because of the large extent of the tumor, total laryngectomy was performed. Pathologic examination of the surgical specimen confirmed the diagnosis of low-grade chondrosarcoma. The characteristic features and the management of chondrosarcomas are discussed with a review of the literature.

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腕神経叢に発生した神経鞘腫の2症例

安田豊稔, 栫博幸, 宮田守, 喜多村健, 森田守

1992 年 1992 巻 Supplement59 号 p. 109-115
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_109

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Schwannoma arising in the brachial plexus is uncommon. Two cases of benign solitary schwannoma of the brachial plexus are reported.
One patient was a 33-year-old man and the other was a 54-year-old woman. Both patients complained of a solid mass in the lateral neck with pain to the shoulder by palpation. It is difficult to obtain an accurate diagnosis of this tumor prior to the surgery, but in our two cases the echogram proved to be of diagnostic value. These tumors were encapsulated and we could enucleate them without major postoperative neurological disturbance.

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自閉児の初期2語発話の構文的構造

高須賀直人

1992 年 1992 巻 Supplement59 号 p. 116-130
発行日: 1992/12/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1992.Supplement59_116

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The construction of early two-word utterances in Japanese autistic children was investigated. The subjects who participated in the collection of speech samples were two autistic children at the age of 4 years and 1 month old (female, PIQ64) and 6 years old (male, IQ 60). A speech sample was taperecorded during therapy, and transcriptions were made afterwards. Th e number of utterances of each subject amounted to more than 1,000 in analysis.
The numbers of two-word utterances and multiword (three or more words) utterances which were analyzed were 75 and 102 for each subject. In the analysis, only the different forms of these utterances were examined.
1) Early two-word utterance s were described according to eleven types such as 'connective', 'topic-comment', 'action sentence: agent, object, state of event', 'modifier of entity: possession', 'combined predicate'. In the descriptions of syntactic construction in pr evious studies, samples were not sufficiently analyzed. It is noteworthy that the type `topic-comment', not included in other studies, was necessary. This type is not syntactic but contextual. Moreover, the category of 'action sentence: agent', including experiencer and subject of attribution, is much broader in its meaning than the category agent in case grammar.
2) The characteristics of two-word utterances of autistic children were summ a rized as global delay compared with mental development or other aspects of language development. However, when examined closely, a) there were tendencies for 'action sentence; state of event' and 'modifier of entity' not to be differentiated yet, and b) there were many examples of 'incomplete action sentence'.
Discussion was made as to the description of syntactic constructions, the methodological problems in description, and the characteristics of autistic children and the suggestions for a clinical setting.

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