耳鼻咽喉科臨床　補冊

耳下腺上皮性悪性腫瘍の診断と治療

谷垣内由之, 吉田博一, 浅井忠雄, 長江大介, 森朗子, 田中晃, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 1-8
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_1

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Between May 1984 and March 1993,19 patients (male: 14, female: 5 average age 49.8)with malignant parotid gland epithelial tumors were treated in the Department of Otolaryngology. A clinical study of these tumor patients revealed the following:
21% of all parotid gland tumors were malignant epithelial tumors. Most of the malignant parotid gland tumors were diagnosed by present history (rapid growth of tumor), symptom (local pain) and local findings (adhesion, facial palsy and cervical lymph node swelling). Therefore, we must be attentive to such signs on the initial examination of patients with parotid gland tumors.
Total parotidectomy or extensive total parotidectomy was not necessary for all malignant epithelial tumors of parotid gland.
All three patients who had preoperative facial palsy died of distant metastasis and intracranial invasion, although they underwent extensive total parotidectomy, radical neck dissection, postoperative irradiation and chemotherapy.
There were three recurrent cases with i ntracranial invasion. When patients complained of double vision or nausea, we could not find obvious tumors in the surgical field, but Xray CT and MRI examination detected intracranial recurrence. This suggests that we must examine for intracranial invasion periodically with X-ray CT or MRI during the follow up period after therapy. When pathological diagnosis does not reveal the typical type of parotid gland tumor (for example squamous cell carcinoma), we must determine the primary region.

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鼻汁中および鼻粘膜中のEG2陽性細胞に関する臨床的検討

島田均, 吉田博一, 田中晃, 森朗子, 佐藤成彦, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 9-15
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_9

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We studied the number and the rate of EG1 and EG2 positive cells in the nasal discharge and the nasal mucosa of patients with nasal allergy using an immunohistochemical procedure. Twenty-two patients with HD mite nasal allergy and nine patients with seasonal Japanese cedar pollen allergy, totaling 31 patients were studied. Eosinophils were first stained with monoclonal antibodies (EG1 and EG2), and then counterstained with Hematoxylin or Hansel (TORII). EG1 and EG2 positive cells and the remaining cells were counted in one field of vision using a light microscope at 400 magnification, and the proportion of EG2 positive cells to all cells and the EG2/EG1 ratio were calculated. The relationship between EG2 positivecells and disease severity, skin test response, RAST score, total IgE, the proportion of Eosinophils in peripheral blood flow and the effect of therapy were examined. The ratio of EG2 positive cells in the nasal mucosa was higher in cases of Japanese cedar allergies than in cases of HD mite allergies (p <0.05). In patients with HD mite allergies, the ratio of EG2 positive cells in the nasal discharge was positively correlated with disease severity and RAST score. The EG2 ratio in the most severe affected group was 41.6 ± 8.5%, in the group with RAST scores above 4 the ratio was 42.5 ± 8.2%, which was significantly higher than that in the mild affected group or the gr oup with RAST scores below 2, which had ratios of 9.0 ± 3.1% and 7.4 ± 2.7%, respectively (p < 0.05).

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当科における末梢性顔面神経麻痺の統計的観察

長江大介, 田中晃, 谷垣内由之, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 16-21
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_16

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Statistical analysis of 140 of peripheral facial palsy patients treated in the Department of Otolaryngology of Dokkyo University Hospital between August 1986 and July 1993 was performed.
Of these,55 cases (39.6%) were diagnosed as Bell's palsy,36 (25.9%) as Ramsay-Hunt's syndrome,24 (17.3%) as surgical trauma,11 (7.9%) as otogenic palsy,10 (7.2%) as traumatic palsy and 4 (2.8%) as of other origin. There were 27 males and 29 females with Bell's palsy, and 18 males and 18 females with Ramsay-Hunt's syndrome. There were 26cases of Bell's palsy on the right side,29 cases on the left side,1 case was bilateral. There were 22 cases of Ramsay-Hunt's syndrome on the right side, and 14 cases on the left side. The average duration for Bell's palsy was 35.6 years, and Ramsay-Hunt's syndrome 46.2 years. There were no relationship between the number of cases and seasons in the patient with Bell's palsy and Ramsay-Hunt's syndrome.
According to the score of facial palsy determined at the first medical examination, patients were classified into Group (0-9), Group (10-19), Group (20-29) and Group (30-39).
The cure rate for Ramsay-Hunt's syndrome was poor in Group (0-9) (35.7%).
The patients with lower facial palsy scores tended to eventually became cure of disease.
The cure rate of the patients that right-left difference was over 3.5 mA in nerve excitability test (NET) was poor (22.2%). Patients with hypertention or diabetes mellitus complicating Ramsay-Hunt's syndrome (22.2%) outnumbered such patients with Bell's palsy (5.4%).

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慢性腎不全を持つ頸動脈小体腫瘍患者の手術経験

村井信之, 谷垣内由之, 中村昭彦, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 22-29
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_22

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We encountered a 42-year-old woman with carotid body tumor and complication of chronic renal failure. She did not undergo surgery to reconstruct the artery because of tumor size and location. Initially, we resected the tumor as a parotid tumor because of misdiagnosis from fine needle aspiration cytology. Enhanced CT was not done because of chronic renal Failure.
MRI demonstrated a hypervascular tumor differentiated from parotid tumor, moreover it appeared to widen the carotid bifurcation. Digital subtraction angiography was done to reduce tht contrast medium usage, and the tumor's main blood flow was determined to actually come from the vertebral artery.
We performed a preoperative Matas' test using balloon catheter to confirm cross circulation from the other internal carotid artery. For 30 minutes, the affected side intercarotid artery was blocked and on blood flow monitering electoroencephlogram, there was no evidence of brain damage.
The second surgery successfully achieved total resection of the tumor. During hospitalization, hemodialysis was performed 3 times a week. Renal failure did not affect the result of surgery, but caused difficulty in anesthesia and fluid therapy.

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ワルチン腫瘍とEpstein-Barrウイルスの関連について

平良晋一, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 30-35
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_30

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To evaluate the relation between salivary gland tumor and Epstein-Barr virus (EBV), the levels of EBV-related antibodies were examined, and detection of EBV nuclear antigen (EBNA) in the tumor tissue by the anti-complement immunofluorescence technique and of EBVDNA in the tumor tissue by polymerase chain reaction (PCR) and in situ hybridization was attempted.
The cases were subdivided into 26 cases of pleomorphic adenoma,7 cases of Warthin's tumor,5 cases of mucoepidermoid tumor,2 cases of adenoid cystic carcinoma,1 case of adenocarcinoma,4 cases of salivary gland of Sjogren's syndrome and 20 cases of normal salivary gland.
The mean VCA-IgG antibody level was increased to 925 (80-2560) in Warthin's tumor,496 (40-2560) in mucoepidermoid tumor, and 206 (40-640) in pleomorphic adenoma. The positive rate of EA-IgG was high in Warthin's tumor and mucoepidermoid tumor. VCA-IgA antibody was positive in 2 of the 7 cases of Warthin's tumor. EA-IgA antibody was negative in all cases.
EBNA was detected in only one case of pleomorphic adenoma.
EBVDNA was detected in 2 cases of pleomorphic adenoma,7 cases of Warthin's tumor,3 cases of mucoepidermoid tumor,2 cases of salivary gland with Sjogren's syndrome and 5 cases of normal salivary gland by PCR. The results of in situ hybridization studies confimed that EBV genomes were localized within the nuclei of the epithelial component of Warthin's tumor. The results of this study indicate a close relationship between EBV and Warthin's tumor.

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軟口蓋ミオクローヌスに伴う他覚的耳鳴の1症例

岡田真由美, 林振堂, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 36-40
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_36

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An 8-year-old girl complained of rhythmical high pitched tone tinnitus in both ears. The tinnitus became audible to the examiner by inserting an otoscope and was synchronized palatal myoclonus. There were no obvious abnormalities on pure tone audiometry, X-ray, MRI, EEG or other neurological examinations.
The contraction of the Eustachean tube due to palatal myoclonus was observed through a nasopharyngeal fiberscope. Tinnitus was attributed to the constraction of the tube because the sounds occurred when the tube opened.
Sound analysis of the tinnitus showed that the tinnitus had a duration of 10-20 ms, frequency of about 2 kHz and irregular rythme of 100-150 times per minute.
The literature on the origin and mechanism of objective tinnitus is reviewed. We consider the origin of tinnitus in this case was Eustachean tube contraction due to essential palatal myoclonus.

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耳鼻咽喉科治療前後での口腔・鼻腔細菌叢の検討

浅井忠雄, 田中晃, 荒川圭三, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 41-48
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_41

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Bacterial studies of nasal and oral flora were examinated before and after treatment of otorhinolaryngology.
Patients were classified into four groups: Group 1,2 and 3 were benign diseases and were treated with antibiotics after surgery. Group 1 included 30 patients with diseases of the paranasal cavity, Group 2 included 30 patients with ear diseases, and Group 3 included 20 patients with diseases of the oral cavity. Group 4 included 20 patients with sudden deafness who were treated with steroid hormones.
Bacterial studies were performed on the nasal and oral cavities before and after treatment in these four groups, and microbialflora were compared.
The results showed that the bacteria in the oral cavity increased in Group 1, whereas it decreased in Group 3. The fungal count in the oral cavity was elevated in Groups 1 and 3. In contrast, the patients in Group 2 and 4 showed little change in the fungal counts in the oral cavity. The studies on the nasal cavity revealed that there was little change in the bacterial flora in each of the four groups.
Next, we investigated the change of the fungi in the oral cavity and bacteria in the nasal cavity of patients with increased bacterial counts in the oral cavity. It was found that the fungal counts in the oral cavity also increased in Group 1. In Group 3, many cases showed a decrease in the bacterial count and an increase in the fungal count in the oral cavity after the treatment.

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鼻腔腫瘍32例の検討

森朗子, 浅井忠雄, 細川朋子, 谷垣内由之, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 49-55
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_49

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Between 1984 and 1992,32 cases of nasal cavity tumors were treated. There were sixteen benign tumors (ten papillomas, four hemangiomas, one angioleiomyoma and one hemangiopericytoma) and sixteen malignant tumors (three squamous cell carcinomas, one malignant mixed tumor, one acinic cell carcinoma, seven malignant lymphomas and three malignant melanomas). The mean age was 54 years for benign tumors and 63 years for malignant tumors. Among the patients with benign tumors, there were seven men and nine women, and among those with malignant tumors, there were eleven men and five women. The subjective symptoms were nasal obstruction, nasal bleeding and nasal discharge. All benign cases were treated with resection, and none have recurred to date. In malignant cases, three squamous cell carcinomas were treated with preoperative irradiation and resection. All were cured and none have recurred to date. Other epithelial tumors were treated with resection, irradiaiton and chemotherapy. One case of transitional cell carcinoma was fatal, but the others were cured. The malignant lymphoma cases were treated with combined therapy (irradiation and chemotherapy). Five of these patients survived without tumor. The malignant melanoma cases were treated with a combination of chemotherapy, immunotherapy, resection and irradiation. However, none were cured and a better treatment needs be found.

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当科におけるめまい患者の統計

林振堂, 岡田真由美, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 56-63
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_56

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A statistical analysis of 2305 patients complaining of vertigo and dizziness who visited our clinic between 1985 and 1991 was performed. Forty-three point seven percent of patients had not been referred by other hospitals or clinics. Moreover, this percentage has resecently been increasing. The ages of the patients were usually between 30-69 years and peaked between 50-59 years. The percentages of males and females were 46.9% and 53.1%respectively. Central disorder included 19% of the patients, peripheral vestibular disorders included 57%, unknown origin was 20% and other was 4%. There were more patients with Menieres disease, sudden deafness, benign paroxysmal positional vertigo than with other peripheral vestibular disorders. Cerebrovascular insufficiency accounted for about 55% of central disorders and the prevalence increased among patients over 40 years old. Hypertention, hyperlipidemia, diabetes mellitus comprised about 55.8% of all complications.

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スギ花粉総飛散数予想の再検討

栃木県の場合

吉田博一, 馬場廣太郎, 大原栄, 後藤治典

1994 年 1994 巻 Supplement70 号 p. 64-69
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_64

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Since 1979, we have recorded the daily Japanese cedar pollen count. We used average maximum temperature 7/11-8/4 as the main determinative factor to calculate the expected total seasonal pollen count. Recently, the expected total seasonal pollen count was very different from the actual count. Therefore, we reconsidered weather and other factors to define the best determinative factor. Consequently, we obtained good mutual relation of the average maximum temperature 7/6-7/20. We obtained good results by using this factor to predict the total seasonal pollen count in 1993.

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星状神経節ブロックによる深頸部膿瘍の1症例

池田聖, 島田均, 太田浩明, 谷垣内由之, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 70-73
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_70

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A 47-year-old male was diagnosed with right facial palsy and received a stellate ganglion block approximately ten times at a local hospital. Neck pain, dysphagia and fever subsequently developed. After cervical accord with defive SGB, a cystic lesion was detected by MRI and CT scan. Approximately 2 ml of pus was aspirated by exploratory puncture. Surgery was performed under the diagnosis of cervical abscess. Aspiration drainage was performed of on the third day after surgery. This case of cervical abscess was assumed to be a rare complication of SGB. MRI and CT scan was useful in the diagnosis of cervical abscess.

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滲出性中耳炎に対するオキサトミドの効果

佐藤成彦, 浅井忠雄, 熊谷陽子, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 74-78
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_74

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We administered Oxatomide to 32 patients (total 54 ears) with otitis media with effusion (OME) for eight weeks, and we investigated respective groups of patients with nasal allergy, sinusitis and adenoid vegetations. The efficacy of oxatomide evaluated by the appearance of the tympanic membrane, audiogram and tympanogram. The nasal allergy group improved by 18.2% and the non-allergy group by 50%. The sinusitis group improved by 33.3%, the non-sinusitis group by 36.6%. The group with adenoid vegetations grade I⋅II improuved by 25.7%, grade III by 80%. Based on these results, Oxatomide was considered effective in the treatment of OME.

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上咽頭癌と滲出性中耳炎

田中晃, 浅井忠雄, 吉田博一, 谷垣内由之, 馬場廣太郎, 池田聖

1994 年 1994 巻 Supplement70 号 p. 79-83
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_79

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We treated 17 patients (34 ears) with nasopharyngeal carcinoma (NPC) between January 1983 and January 1992. Seventeen ears in 17 patients (34 ears) were evaluated for serous otitis media (SOM) at diagnosis. These patients were also evaluated by computed tomography for the degree of tumor extension. The degree of nasopharyngeal extension of tumor, erosion of the petrous temporal bone, and obstruction of pharyngeal recess were related to the development of SOM. The nasopharyngeal space was evaluated with reference to 3 types of findings on CT scan: (1) Type 1; the tumor was not extended. (2)Type 2; The tumor was not extended beyond the line joining the medial pterygoid plate and the lateral border of the carotid artery. (3) Type 3; The tumor was extended over the line defined in Type 2.
We found a relation between SOM and the 3 types of NPC. As a result of our study, we have found that the more the tumor has extended, the more severe the NPC and the greater the prevalence of SOM.

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鼻中隔膿瘍の4症例

深美悟, 島田均, 長江大介, 村井信之, 田中晃, 谷垣内由之, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 84-88
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_84

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Nasal septal abscess has become rare since the development of antibiotics. However, prompt diagnosis and suitable treatment are necessary to prevent dangerous complications. We recently encountered 4 rere cases of nasal septal abscess. The first case was a 48-year-old man, the next case was a 6-year-old boy, and a 57-year-old man, and a 14-yearold boy. All four patients improved after local incision and drainage, with the use of antibiotics.

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呼吸困難を主訴とした上大静脈症候群の1症例

清水宏明, 平良晋一, 浅井忠雄, 谷垣内由之, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 89-93
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_89

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A case of SVCS (Superior Vena Cava Syndrome) is reported. The patient was a 66year-old man who complained of dyspnea and edema in the upper half of the body.
It was difficult to diagnose his disease due to his past history; embedded in his neck were about 60 small pieces of shrapnel. Chest computed tomography and subtraction angiography revealed obstruction of the superior vena cava. Blood tests showed high levels of tumor markers. A diagnosis of SVCS resulting from a malignant tumor of in the chest was made.
His symptoms were relieved by irradiation with Linac X-ray (total 75GY). Unfortunately, he died after 2.5 months in another hospital. No autopsy was performed.

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外耳道ハエ幼虫症の2症例

佐々木優子, 荒川圭三, 林振堂, 森朗子, 馬場廣太郎, 筏津裕美

1994 年 1994 巻 Supplement70 号 p. 94-99
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_94

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We encountered two cases of otomyiasis. The first case involved left external auditory meatus myiasis due to Sarcophaga peregrina (Robineau-Desvoidy,1830) in a baby girly approximately two months old. The second case was right external auditory meatus myiasis due to Sarcophaga similis Meade,1876, in a six-year-old girl. Both cases occurred in September 1993.
Previously myiasis was more common. Antimicrobial therapy and amelioration of public health has resulted in a decrease in the number of myiasis cases. Today, it is quite rare.
Recently, twelve cases of genuine myiasis have been reported in Japan. We report two cases of otomyiasis.

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咽頭後壁より発生した軟骨腫の1症例

中川由香, 森朗子, 岡田真由美, 平良晋一, 馬場廣太郎

1994 年 1994 巻 Supplement70 号 p. 100-104
発行日: 1994/04/20
公開日: 2012/11/27

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1994.Supplement70_100

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Among the benign tumors arising from the pharynx, chondroma is indeed rare. A case of chondroma originating from the posterior pharyngeal wall is reported. The patient was a 44-year-old woman who complained of a foreign body sensation in the throat. The tumor was removed surgically under general anesthesia. There has been no recurrence during 5 months follow up.

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