JIBI INKOKA TEMBO
Online ISSN : 1883-6429
Print ISSN : 0386-9687
ISSN-L : 0386-9687
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Volume 52, Issue 3
Displaying 1-9 of 9 articles from this issue
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FEATURE ARTICLE
  • ISSUES OF EPISTAXES IN CASES OF HEREDITARY HEMORRHAGIC TELANGIECTASIA
    Keiichi Ichimura
    2009 Volume 52 Issue 3 Pages 138-152
    Published: 2009
    Released on J-STAGE: June 17, 2010
    DOIhttps://doi.org/10.11453/orltokyo.52.138
    JOURNAL FREE ACCESS
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    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disorder affecting blood vessels of the skin, mucous membrane and viscera. Epidemiologic studies have revealed a wide range of incidences, with agreement in Europe and Japan at rates between 1:5000 and 1:8000. Mutations in at least five genes can cause HHT, with the two major disease genes on chromosome 9 (endoglin) and chromosome 12 (ALK-1) responsible for HHT.
    HHT patients vary greatly in course and severity of epistaxes. Most patients have self-limiting nasal bleeding and do not require hospitalization, but about one-third have severe hemorrhage necessitating admission and treatment. Clinical diagnosis of HHT is made according to the four Curaçao criteria.
    A variety of treatment strategies have been employed. These include LASER coagulation, hormonal therapy, embolization, nasal dermoplasty (ND) and nostril closure. It is difficult to make specific treatment recommendations for a disease that may have a wide spectrum of clinical manifestations including minimal to life-threatening degrees of epistaxis. The LASER has been used as first line therapy or as additional therapy after more conventional therapies have failed. Our study demonstrated ND to be an effective procedure for HHT patients with moderate or severe nasal bleeding. The nasal mucosa of the anterior part of the septum, nasal floor and the lateral wall are removed. A split skin graft is usually used to cover the denuded area. ND can offer patients reduced frequency of bleeding. In severe and intractable cases, modified Young's procedure (nostril closure) has been shown to be most effective.
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ORIGINAL PAPERS
  • THE EFFICACY OF ELECTROCOAGULATION USING HIGH-FREQUENCY CURRENT FOR ALLERGIC RHINITIS AND TURBINATE HYPERTROPHY
    Junya Kojima, Tuyoshi Yoshimura, Daiya Asaka, Makoto Iida, Nobuyoshi O ...
    2009 Volume 52 Issue 3 Pages 153-158
    Published: 2009
    Released on J-STAGE: June 17, 2010
    DOIhttps://doi.org/10.11453/orltokyo.52.153
    JOURNAL FREE ACCESS
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    Allergic rhinitis has increased in prevalence in recent years. There are a variety of curative treatment is difficult QOL is the goal of improving treatments, although curative treatment is difficult; improvement of the QOL is the goal.
    While sneezing and watery nasal discharge can be treated, nasal congestion often the most hardship in the treatment is nasal congestion appears to be the symptom most difficult to treat.
    In patients with allergic rhinitis with almost no curvature of the nasal septum or sinusitis, the Board of Outpatient Day-Surgical techniques offers high-frequency submucosal electrocoagulation of the inferior turbinate on both sides. The postoperative course in 15 patients was observed for at least 12 months (range, 12 months to 2 years 2 months; average, 1 year 4 months). The patients consisted of 10 men and 5 women with an average age of 45.3 years (range, 24 to 71 years). There were 10 cases of allergic rhinitis (four with year-round symptoms perennial allergic rhinitis, one with seasonal rhinitis, and five with a mixture of both), and five cases of vasomotor rhinitis.
    Medical treatment consisted of bipolar radiofrequency thermotherapy (Cellon ENT), with the patients being followed up for at least 1 year. Evaluation of symptoms was performed using the Japan Standard Rhinitis QOL questionnaire (JRQLQ No1). In regard to objective evaluation, the swollen inferior turbinate mucosa was evaluated by endoscopy.
    Improvement in nasal congestion was more marked than that of sneezing or nasal discharge. (P<0.002)
    Objective findings confirm the significant difference in the findings in the nose evaluation confirmed significant improvement in the degree of swelling of the inferior turbinate.
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  • STATUS OF EMERGENCY MEDICAL SERVICES IN THE DEPARTMENT OF OTOLAYNGOLOGY
    Manabu Komori, Naomi Sekiyama, Matsusato Tsuyumu, Jirou Iimura, Yasush ...
    2009 Volume 52 Issue 3 Pages 159-165
    Published: 2009
    Released on J-STAGE: June 17, 2010
    DOIhttps://doi.org/10.11453/orltokyo.52.159
    JOURNAL FREE ACCESS
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    We report the status of use of the emergency medical services of the department of otolaryngology at our hospital from April, 2007, to March, 2008. A total of 1,033 patients attended the emergency medical service and 248 of these patients were transported by ambulance. Acute otitis media was the most frequently encountered condition in the emergency department, followed by epistaxis and foreign body in the ear. In regard to the use of the ambulance service, epistaxis was the most frequent reason, followed by foreign body in the ear, and vertigo. The most frequently encountered age group was the under-10 years old group. The ambulance use rate was higher in older age groups. The results showed an increase in the number of adults presenting with emergency conditions and of the ambulance use rate from midnight to early morning.
    Under these circumstances, we believe that there is a need to enlighten the population about emergency treatments at home, to establish an emergency transportation triage, and also establish an emergency counseling center.
    We hope to evaluate the current status of the emergency services provided at each hospital in the city, with the aim of establishing a more efficient emergency medical service.
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  • A CASE REPORT OF ENDOSCOPIC ENDONASAL RESECTION OF A JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
    Konomi Ikeda, Nobuyoshi Otori, Kensuke Aoki, Takakuni Kato, Norihito M ...
    2009 Volume 52 Issue 3 Pages 166-171
    Published: 2009
    Released on J-STAGE: June 17, 2010
    DOIhttps://doi.org/10.11453/orltokyo.52.166
    JOURNAL FREE ACCESS
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    The surgical approach to juvenile nasopharyngeal angiofibroma (JNA) is usually an open approach, such as lateral rhinotomy, midfacial degloving and the transpalatal approach, because of the vascular nature and site of the tumor. We report the case of an 18-year-old male who presented with the right nasal obstruction and repeated epistaxis and was transferred to our hospital with the diagnosis of JNA. Preoperative angiography showed that the external carotid artery was the main feeder of the tumor, with the possibility of partial supply from the internal carotid artery. Therefore, to reduce intraoperative bleeding, we conducted temporary clamping of the external and internal carotid arteries during the operation and clipped the right maximal artery by the transnasal endoscopic approach. One-third of the total septum (posterior) was removed to obtain adequate space for the endoscopic approach. The tumor was jutted pulled? out into the pterygopalatine fossa, and the root of the tumor was determined to be the sphenopalatine artery close to right aperture of the sphenoidal sinus. To achieve complete tumor resection, a navigation system was used that helped us to detect the orientation of the operative field.
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  • CARBON ION RADIOTHERAPY FOR SKULL BASE INVASION OF HEAD-AND-NECK TUMORS
    Azusa Hasegawa, Jun-Etsu Mizoe, Keiichi Jingu
    2009 Volume 52 Issue 3 Pages 176-181
    Published: 2009
    Released on J-STAGE: June 17, 2010
    DOIhttps://doi.org/10.11453/orltokyo.52.176
    JOURNAL FREE ACCESS
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    Between April 1997 and February 2007, 93 patients with skull base invasion of head and neck tumor were treated by carbon ion radiotherapy. The patients consisted of 51 males and 42 females aged from 23 to 78 years (average age 55.4 years). Histologically, the tumors are classified as follows: 43 with adenoid cystic carcinoma, 23 with malignant mucosal melanoma, 22 with adenocarcinoma, and 5 with other histological types of tumor. Although grade 3 acute reactions in normal tissues of skin and mucosa were appeared 4% and 10%,respectively. The late reactions were grade 2 or less. At the time of analysis, there were no evidence of any serious acute or late reactions.
    Five-year local control and overall survival rates were 73% and 39%, respectively. The therapeutic effectiveness of the carbon ion radiotherapy was particularly outstanding for locally advanced non-squamous cell carcinoma which a tumor intractable to photon radiotherapy.
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