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藤本 政明, Albert Pace-Balzan, John A Rutka
1993 年 1993 巻 Supplement64 号 p.
1-6
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Benign paroxysmal positional vertigo (BPPV) is generally regarded as a self-limiting peripheral vestibular disorder lasting several weeks to months. Although recurrent attacks are not infrequent, a small minority of patients experience continuous occurrence without remission which becomes incapacitating.
Based on the clinicopathologic finding of cupulolithiasis, a new surgical technique that involves posterior semicircular canal occlusion (PSCO), was recently described as an effective treatment of incapacitating BPPV. In this procedure, the posterior semicircular canal (PSC) is nonfunctional by occluding the non-ampullary portion during transmastoid exposure. The PSC is carefully blue-lined at the mid-portion and an approximate 3 mm opening into the canal is subsequently plugged with periosteum compressing the membranous labyrinth. In this manner, circulation of endolymph within the canal is prevented without causing deafferentiation.
We previously reported the results of PSCO in a prospective series of 5 patients with incapacitating BPPV. In this paper, we report the results in two recent cases. Both patients had vertigo relief immediately after PSCO and there was no post-operative hearing loss or tinnitus. There has been no recurrence of symptoms to date in the 5 previously reported cases.
Intraoparative electrocochleography demonstrated changes in waveform responses during mastoidectomy and while packing periosteum into the canal, but responses recovered completely by the end of the procedure. The development of a comparative caloric reduction (24% R/L excitability difference) postoperatively was seen in 1 patient.
We conclude that PSCO represents a technically simple procedure that is a safe and effective alternative to singular neurectomy, vestibular nerve section and labyrinthectomy in the treatment of patients with incapacitaing BPPV.
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西崎 和則, 杉原 博子, 白神 かおり, 馬場 雄三, 西岡 聡子, 増田 游
1993 年 1993 巻 Supplement64 号 p.
7-12
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Various surgical procedures have been used to eradicate cholesteatoma. The advantages and disadvantages of the open and closed methods are discussed. Having used both methods to treat cholesteatoma in children, we present the results obtained from each of these methods.
Thirty-three patients with middle ear cholesteatoma were treated surgically between January 1982 and December 1990 at the Department of Otolaryngology, Okayama University. All subjects were under the age of 15. All children were treated by either the closed method or the open method. Residual disease was found in 52.2% of the cases treated by the closed method and 30.0% of those treated by the open method, the overall rate of residual disease was 45.5%. The rates of recurrence were 26.1% and 0%, respectively, with a combined rate of 18.2% for all patients.
Overall,60.9% of the patients treated b y the closed method and 30.0% of those treated by the open method had residual and/or recurrent cholesteatoma. The combined rate of residual and recurrent disease for all patients was 51.5%. The hearing results obtained by the two methods were nearly the same. In the open method, the incidence of postoperative problems was insignificant and there were fewer surgical procedures per ear. From our results, we conclude that the open method is more useful in treating cholesteatoma in children.
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大道 卓也, 宇野 欽哉, 深澤 元晴, 冨永 進, 江草 憲太郎
1993 年 1993 巻 Supplement64 号 p.
13-18
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
The vasculature of the submandibular glands in experimental animals has been reported in detail. However, the microvascular architecture of the human submandibular gland has not yet been described. In this study, the vascular system of the human submandibular gland was examined by SEM of corrosion casts. The capillary network of the striated duct was dense and the capillaries were sinusoidal. Moreover, there were portal vessels which connected the capillaries of the acini and the striated ducts. These findings suggest a role not only in the absorption or secretion of saliva but also in the regulation of blood flow. The subepithelial capillary network around the excretory duct was also dense. There were veno-venous anastomoses and venous constriction. These findings suggested that the excretory duct also had absorptive and secretory functions. In addition, a species difference was observed in the submandibular gland vascularity, that is, the vessels were located among the interlobular connective tissues in the human. These vessels might be useful in maintaining a constant blood flow.
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flow-volume patternとその定量化について
西岡 慶子, 小川 晃弘, 中川 文夫, 斉藤 稚里, 岡野 光博, 増田 游, 目黒 忠道
1993 年 1993 巻 Supplement64 号 p.
19-26
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
We classified the flow-volume curves obtained from pulmonary function tests in patients with allergic rhinitis, and the significance of these classificaions in evaluating lower airway pathologic conditions is discussed. Type A, representing almost normal values, was scarce, while types B through E were found in significantly greater incidence. In nasal allergy patients, the lower airway was considered potentially hypersensitive and the flowvolume curve was suggestive of peripheral lower airway obstruction. In patients with pollinosis, symptoms suggestive of potential lower airway obstruction could be found throughout the year, while there was an additional finding of decline in vital capacity during the pollen season. However, the conventional indices of flow rates (V
75, V
50, V
25, and so on) did not demonstrate the differences in flow rates between healthy subjects and nasal allergy patients because of the minutes difference. However, pattern analysis or comparison of MEFV curves was sufficiently to detect minor changes. Further, we described the quantitative analysis and automatic drawing of flow-volume data in the MEFV curve, as well as the objective evaluation from classifying the automatic drawing.
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福田 章一郎, 井口 郁雄, 福島 邦博, 木村 宣彦, 杉原 博子, 松原 浄
1993 年 1993 巻 Supplement64 号 p.
27-35
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Group pure tone screening test was performed on kindergartners to efficiently screen for hearing disorders. Pure tones of 500,1000 and 4000 Hz in each ear were combined with a hand raising response. The test frequency of 500 Hz was added to screen for otitis media.
About 80% of children over 3 years and 6 months of age were capable of takin g the group screening test with hand raising response. At the same time, the ratio of children who could pass the screening test also increased considerably from 45.2% to 65.2%.
Although we used 500 Hz to screen for otitis media, it was difficult to di a g nose otitis media by hearing screening only. Therefore, hearing screening was mainly effective in determining moderate hearing loss and unilateral sensorineural hearing loss.
We found that a well-planned screening procedure and preparation b e fore the screening as well as decrease in the fail one rate on initial screening are necessary to examine large numbers of children rapidly and screen hearing disorders efficiently.
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福島 邦博, 深澤 元晴, 大原 信哉, 赤木 忠厚, 渡辺 周一, 宇野 欽哉, 増田 游
1993 年 1993 巻 Supplement64 号 p.
36-40
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Expression of c-
erbB-2 oncoprotein in salivary gland carcinomas was examined by immunohistochemical study to determine the incidence and significance of this protein. Six of 18 cases (33.3%) of primary salivary gland carcinoma showed positive membrane staining with a monoclonal antibody to the c-
erbB-2 oncoprotein on formalin-fixed, paraffin-embedd- ed sections. According to clinical follow-up data, regional lymph node metastasis was observed in 4 of 6 patients with overexpression of c-
erbB-2, but the frequency was not statistically significant. There was no clear evidence of an association between the demonstration of c-
erbB-2 protein and other prognostic factors such as tumor size, metastasis, recurrence of tumor or overall survival rate.
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永野 稔明, 岡野 光博, 後藤 昭一, 手島 裕之, 藤本 政明, 増田 游
1993 年 1993 巻 Supplement64 号 p.
41-47
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
We reviewed 465 cases of nasal allergy treated as outpatients at our allergy clinic between 1987 and 1991. The ratio of male/female was 1.1: 1.62.4% of patients were under 25 years old on the initial visit. The number of patients seen at the clinic had two peaks, one in March and the other in August. Eosinophils were found in nasal smears from 79.0%of for patients. Positive reactions to the allergen skin test for house dust, mites, grasspollen, Japanese cedar-pollen, ragweed-pollen, candida, and alternaria were 67.4%,54.5%,37.4%,32.6%,17.3%,10.0%,8.3%, respectively. A high frequency of allergic sensitization to grass-pollen appeard among people living in Okayama. The most frequent combined allergens were observed among types of house dust and/or mites and types of pollen. Patients who were only sensitized to house dust and/or mites were younger and male, while patients sensitized to pollen only were older and female. There was little difference in the severity of nasal symptom between perennial rhinitis and seasonal rhinitis. The rate of agreement between RAST (radioallergosorbent test) and skin test to house dust, mite, Japanese cedar-pollen, grass-pollen, ragweed-pollen, fungus were 71.1%,78.1%,69.9%,17.6% and 10-20%, respectively.
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笹木 収, 唐崎 一訓, 寺沢 和貴
1993 年 1993 巻 Supplement64 号 p.
48-51
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Maxillary radical surgery was undertaken in a patient showing an idiopathic fever for three month. Thereafter the fever dramatically vanished.
Only anaerobic bacteria were in fluid from the maxillary cyst. No marker, CBC, ESR, CRP, r-globulin demonstrated any infectious signs, however, the high grade fever continued.
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聴能訓練通園施設10年間の統計
山本 幸代, 中島 智子, 井口 郁雄, 林 眞実, 増田 游, 福田 章一郎
1993 年 1993 巻 Supplement64 号 p.
52-59
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
We investigated the etiology of hearing impairments in 279 of the 900 children attending Okayama Kanariya Gakuen who were diagnosed with bilateral sensorineural hearing impairment between April 1981 and March 1991. We compared these results with those collected during the previous 12-year period (between April 1969 and March 1981) and those of other studies.
The result s were as follows;
1) There were 35 patient s (12.5%) who were considered to have congenital hearing impairment. The rate was similar to that in the previous 12-year period.
2) There were 49 patients (17.6%) whose hearing impairmen ts developed in the prenatal period. Fourteen patients had a history of maternal Rubella during pregnancy. The incidence of Rubella had been high in that year.
3) There were 118 patients (42.3%) w hose hearing impairments were caused in the perinatal period. Thirty-nine patients were premature infants who developed hearing impairment because of anoxia.
4) There were 71 pa tients (25.4%) whose hearing impairments were acquired after birth. In 9 patients, the development of hearing impairment was seemed to correspond with the manifestation of other pathologies.5
) There were 59 pat ients (21.1%) who did not clearly fit in any category.
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簡易法の検討
前田 学, 結縁 晃治, 井口 郁雄, 川上 晋一郎, 増田 游
1993 年 1993 巻 Supplement64 号 p.
60-65
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Moire topography is a photographic technique that enables visualization of threedimensional surface information similar to contour lines on a geographic map. We applied moire topography to the evaluation of facial palsy. Using a moire camera of the lattice irradiation type, five moire photographs were taken with the patient performing specific actions, i. e., at rest, wrinkling the forehead, closing the eyes lightly, blowing out the cheeks and grinning. By monitoring typical changes of the moire stripes' pattern, we were able to visually recognize the degree of facial palsy in every part of the face in three dimensions. In clinical use, a quick method of evaluation is required. To simplify this usual method, instead of the above-mentioned five moire photographs, two moire photographs were taken, i. e., at rest and closing the eyes tightly while grinning simultaneously. Almost the same changes in moire stripes patterns due to facial palsy were observed on moire photographs taken by both methods. We concluded that this simplified method was in no way inferior to the usual method of evaluating facial palsy.
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青地 克也, 西岡 信二, 西川 邦男, 小池 聰之
1993 年 1993 巻 Supplement64 号 p.
66-71
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
A case of tracheoesophageal fistula in a 59-year-old man who had previously been treated for esophageal carcinoma and mesopharyngeal carcinoma was reported. Tracheoesophageal fistula was caused by poor blood circulation in the trachea after surgery and radiotherapy. Reconstruction of the mediastinal trachea for the tracheoesophageal fistula via partial sternectomy was carried out and a mediastinal tracheostoma was created using a musculocutaneous flap. The use of a musculocutaneous flap allows reliable closure of the resulting mediastinal and sternal defect.
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内籐 好宏, 白神 かおり, 古川 勝朗, 荻野 哲也, 中川 文夫, 大道 卓也, 渡辺 周一, 増田 游
1993 年 1993 巻 Supplement64 号 p.
72-78
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
A 59-year-old man complained of an abnormal sensation in the laryngopharynx. The patient had received an early-stage gastrectomy on February 6,1989.
The present illness, consisting of an abnormal sensation in the laryngopharynx, mild pain on swallowing, and dysphagia, began around July 1990. Because of these symptoms, the patient visited our clinic on October 22,1990, and was diagnosed by esophageal en- doscopy as having a geographical erosion and ulcer in a region beginning approximately 35 cmfrom the incisor teeth and continuing to the inlet to the esophagus. Biopsy was per- formed and a diagnosis of pemphigus vulgaris was made. The patient is being treated at the outpatient service with 5 mg predonine, and the clinical course is being monitored.
We conclude that patients who present with intractable stomatitis or an abnormal sensation in the laryngopharynx should receive endoscopy for early histological diagnosis and treatment.
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アンケート調査を中心にした検討
林 眞実, 井口 郁雄, 三浦 基志, 武田 靖志, 福田 章一郎
1993 年 1993 巻 Supplement64 号 p.
79-85
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Proper use of hearing aids is still controversial. In 1989, hearing aid clinic was opened to resolve these problems. During the past three years in our hearing aid clinic,176 outpatients have been examined and 143 tried to use hearing aids.
We used a questionnaire to survey their attitudes t o hearing aids, and statistically analyzed the results to reveal common problems among the patients. Sixtyfive point seven percent of patients were over 65 years old. Most of the patients had hearing levels ranging from 40 to 70 dB, and about 80% had perceptable hearing impairment. Patients using hearing aids in one ear tended to use them for a longer time, as the hearing levels and speech discrimination scores in the other ear deteriorated. According to these results, a hearing aid should not only be prescribed properly, but also fitted effectively to fill the individual need. In addition, the merits, demerits, and limitations of hearing aids should be explained precisely when they are first provided.
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側頭筋骨膜弁付き外板による頭蓋底再建
田中 文雄, 宇野 欽哉, 深澤 元晴, 渡辺 周一, 河内 正光, 衣笠 和孜
1993 年 1993 巻 Supplement64 号 p.
86-91
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
We treated a 47-year-old male with right frontal sinus carcinoma. MRI and 3-D CT imagings revealed that the tumor involved the right anterior ethmoidal cells. right orbit, and anterior cranial base. After 60 Gy pre-operative irradiation, cranio-facial resection was performed. A small defect of the dura matter was repaired with temporal fascia, and a large defect in the anterior skull base was reconstructed with vascularized outer table of parietofrontal calvarium. Resected facial skin and the superolateral wall of the nasal cavity were reconstructed using rectus abdominis myocutaneous flap. The surgical procedure and its advantages are discused in this paper.
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大道 卓也, 結縁 晃治, 増田 游
1993 年 1993 巻 Supplement64 号 p.
92-96
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Posterior canal plugging for BPPV (benign paroxysmal positional vertigo) was described as an alternative to singular neurectomy. Posterior canal plugging was performed on a 38-year-old woman who had suffered from intractable BPPV for more than 18 months. She remained free of vertigo without any hearing damage for 10 months. This procedure was very effective and safe.
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白神 かおり, 古川 勝朗, 内藤 好宏, 荻野 哲也, 冨永 進, 大道 卓也
1993 年 1993 巻 Supplement64 号 p.
97-101
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Malignant melanoma of the nasal cavity has a very poor prognosis and is resistant to radiotherapy and chemotherapy. The nasal and oral cavities in the head and neck are reported to be predisposed to this malignancy, though malignant melanona is very rare and accounts for 1.2-4.3% of the total cases of malignant tumors of the nasal and paranasal cavities. In the present study, we encountered three cases of primary malignant melanoma of the nasal cavity.
Case 1 w as a 72-year-old man who was postoperatively diagnosed with malignant melanoma and further treated with DAV (DTIC, ACNU and VCR) therapy. Because of a residual tumor, the patient had subsequent surgery. Case 2 was a 78-year-old man who was treated with DAV and CDV (CDDP, DTIC and VDS) therapies in combination with local administration of beta-interferon. After 2 courses of this combined therapy, the patient was surgically treated. Case 3 was an 82-year-old woman who declined our recommendation for surgical therapy.
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西崎 和則, 増田 游, 林 眞実, 大道 卓也
1993 年 1993 巻 Supplement64 号 p.
102-105
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
A patient with bilateral congenital ankylosis of the stapes caused by a bony bridge extending from the pyramidal eminence to the neck of the stapes is reported. She was 6-year-old and had a moderate degree of conductive hearing loss. After excision of the bridge, her hearing was almost normal.
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小川 晃弘, 西岡 慶子, 明海 国賢, 中川 文夫, 真鍋 武聡, 浅野 拓, 西尾 晋作, 立山 義朗, 松浦 博夫
1993 年 1993 巻 Supplement64 号 p.
106-112
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
A rare case of carcinoid tumor in the sphenoid sinus of a 65-year-old woman is reported. The clinical diagnosis was sphenoidal mucocele, but the second biopsy specimen revealed a probable diagnosis of pituitary adenoma.
Final diagnosis was performed by electron microscopy, using a surgical specimen. Grimelius stain (argyrophil) was positive and the ultrastructure demonstrated neuroendocrine granules in the cytoplasm.
The patient was treated with postoprative radiotherapy, and there has been no recurrence or distant metastasis of the tumor.
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斉藤 稚里, 横山 俊之
1993 年 1993 巻 Supplement64 号 p.
113-118
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
We carried out a bacteriological survery and evaluated the efficacy of antimicrobial therapy in 29 children with acute otitis media, ranging in age 1 to 12 years old, and 40 children with upper respiratory tract infection, ranging from 1 to 15 years old.
H. influenzae, α-streptococcus, St. pneumoniae, S. aureus and β-streptococcus were isolated in acute otitis media cases and
St. pneumoniae, H. influenzae, S. epidermidis and
S. aureus were isolated in upper respiratory tract infection cases.
We concluded that CCL, CXD, CUA/AMPC and NELX were effective for acute otitis media and CXD and CCL were effective for upper respiratory tract infection.
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中川 文夫, 小川 晃弘, 明海 国賢, 西岡 慶子
1993 年 1993 巻 Supplement64 号 p.
119-126
発行日: 1993/08/20
公開日: 2012/11/27
ジャーナル
フリー
Twenty patients with chronic sinusitis were given one tablet (150 mg) of roxithromycin (RXM) once a day for three months. Rates of improvement of subjective symptoms (disappearance or improvement) after the three-month therapy were: nasal obstruction 92.3% nasal dripping 81.25%, postnasal dripping 94.4%, sensation of foul odor 100.0%, and headache and dull headache 90.0%. Objective findings improved as follows: flare of the nasal mucosa 80.0%, edema and swelling of the nasal mucosa 85.0%, volume of nasal discharge 90.0%, property of nasal discharge 95.0%, and volume of postnasal dripping 87.5%. Average score of the subjective symptoms and objective findings in ten areas were significantly lowered after three-months of RXM therapy compared with those before therapy. Many aspects of the nonantibacterial actions considered inherent in RXM remain obscure, but this long-term, low-dose RXM therapy seemed to be effective in treating chronic sinusitis.
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