眩暈の検討
神経耳科学および心身医学の見地から
伊藤 裕之
1989 年	32 巻	1 号	p. 9-24
DOIhttps://doi.org/10.11453/orltokyo1958.32.9
Ninety cases of vertigo, which consisted of thirty-eight males and fifty-two females, were studied neuro-otologicaly and psychosomatically. These cases showed inconsistent results in equibrium function test and were treated at vertigo clinic and psychosomatic clinic in the department of otorhinolaryngology of the Jikei University School of Medicine. Forty-two cases were neurologicaly normal but other forty-eight cases were neurologicaly abnormal. Psychogenic factors infl uencing on vertigo were found in fifty-seven cases but in other thirty-three cases, not found.
In the female cases psychogenic factors had larger influence on their onset of vertigo than that of males. In males their psychogenic factors were mainly based on their business, but in females psychogenic factors were mainly based on their family problem. This showed the social role of females in Japan: the number of Japanese females working are less than that of males. Forty cases with vertigo but without neurootologic findings were classified into the following categories.
1. Although vertigo was originally present at the beginning of vertigo, it disappeared by time of examination, leaving the patients only with psychosomatic disorders.
2. The vertigo was psychogenic in origin, and included anxiety neurosis, hysteria and other psychogenic disease.
3. The vertigo was attributable autonomic nerve disturbance. Vertegnous patlents with psychogeinic factors influencing on vertigo were classified into as follows.
1. Vertigo superimposed in patients with psychogenic factors.
2. Vertigenous disease produced mental stress and distubance in their normal life, which lead to psychogenic factors. But the existence of psychogenic factors had no significant relationship with psychosomatic medical condition except for psychosomatic disease.
Patients with A and C type of Yatabe-Guiluford Test did not have tendency to be influenced mentally by vertigo and psychogenic factors. As in the patients with equilibrium disorders, such as inner ear disturbance, psychosomatic disorders were found, it was pointed out that they had possibility to be caught by psychogenic disorders at same time. Psychosomatic care was required in treatment of vertigo. The importance of neuro-otlogic and psychosomatic care is required when rehabilitation for vertlgo is applied.
固有鼻腔の発育について
X線断層写真上の検討
嵐 裕治, 堤 昌己
DOIhttps://doi.org/10.11453/orltokyo1958.32.25
To determine growth and morphology of the nanal cavity, we measured the size of each portion of the nasal cavity using the X-ray tomographic films of a total of 1, 942 normal subjects consisting of 984 males and 958 females. The deta were analyzed statistically as follow.
1) Growth of height and width of the nasal cavity: In both males and females height and width of the nasal cavity grow till one reaches the age of about 14 years, but subsequently the growth rate slows down. From this finding it is considered that lateral wall of the nasal cavity as the outer frame is completed till the age of about 14 years.
2) Growth of width of ethmoidal sinuses: Width of the ethmoidal sinuses shows growth till the age of 16 years for males and the age of 17 years for females. As compared to the height and width of the nasal cavity completion of growth of width of ethmoidal sinuses delays.
3) Relation of width of the nasal cavity and width of the ethmoidal sinuses with height of the nasal cavity: Width and height of the nasal cavity grow with a certain ratio (66 to 70%) retained. On the other hand, the width of the ethmoidal sinuses show delay in growth as compared to height of the nasal cavity.
4) In majority of the cases, little or no difference is seen in width between left and right sides. When any difference was seen between both sides, the right side gave higher values. As to difference in width of the ethmoidal sinuses between right and left sides, the value of the left side was higher.
5) Relation of difference in width of the nasal cavity between right and left sides with septum deviation: There were many cases which showed greater width of the nasal cavity on of septum deviation. It could be shown that the lateral wall of the nasal cavity is caused by septum deviation.
6) Relation of difference in width of the ethmoidal sinuses between right and left with septum deviation: In many cases the value obtained for the left side was greater irrespective of septum deviation.
鼻腔に発生したOncocytoma
臨床像並びに電顕的観察
桐谷 伸彦, 児玉 実, 望月 元博, 春名 真一, 羽野 寛
A rare case of oncocytoma occurring on the left middle nasal meatus of a 33-year-old woman is reported. Only 14 cases of oncocytoma of the nasal cavity or paranasal sinuses have been reported in the world literature. This case was diagnosed by electron microscopy and histochemical examination. It showed the typical abundance of intracellular mitochondria.
Surgical treatment was performed. At eight months after the operation, there is no evidence of recurrence. Although oncocytoma is usually a benign tumor, several cases of malignant oncocytoma have been reported. Recurrence or metastasis sometimes occurs, so it is necessary to remove the tumor completely and perform careful follow-up.
神経難病の終末医療における嚥下障害
山口 龍二, 伊藤 裕之, 溝呂木 紀仁
Swallowing disturbance is one of severe complications in patients with spinocerebellar degenerations and Parkinsonisms.
A study was set up to identify the stage when the difficulty in swallowing had happened. A total of 96 patients entered the study. Medical histories and records were analyzed.
The study showed that swallowing disturbance had developed as patients were unable to move themselves and it had became worse as they used a wheelchair.
We should pay attention to the patient with gait disturbance while he eats in order to avoid aspiration pneumonitis and choking by food.
茎状突起過長症
一般患者群および咽喉頭異常感症群における検討
片山 昇, 穎川 一信, 柏木 博道, 太田 正治
Some patients with abnormal sensation in the throat were found to have an elongated styloid process. Now, there were 230 patients with normal sensation and 55 patients with abnormal sensation in the throat. We measured the length of styloid process on the X-ray filmes. As the result, in the patients with normal sensation 99 patients (43.0%) have elongated styloid process with the average length being 13.9mm. In the patients with abnormal sensation 74.5% showed the elongated process with the average length being 26.2mm. The patients with abnormal sensation were found to have it higher incidence of elongated styloid process.
最近のRadiation induced cancerについて
路 波, 佐藤 武男, 吉野 邦俊, 馬谷 克則, 高木 正, 八田 千広, 藤井 隆, 前谷 近秀
In recent practice, the authors experienced three cases of radiation induced cancer in the hypopharynx. Primary diseases irradiated previously were tuberculous cervical lymphadenitis. All three cases were treated with pharyngo-laryngo-esophagectomy.
The characteristic feature of the radiation cancer in recent years are as follows:
(1) Interval between irradiation and development of cancer in the hypopharynx showed about half a century, an average of 47 years.
(2) Neck scar due to irradation with this cancer was not so marked.
救急外来における小児急性中耳炎
安部 治彦, 井上 都子, 河原 秀明
We review 221 cases of children with acute otitis media, who were treated in the emergency outpatient clinic of Hiroo Metropolitan General Hospital during the past 5 years. The age distribution showed a peak between 3 and 4 years of age and the male-female ratio was 5: 4. The most frequent complaint was otalgia. 82% of the cases had no other than rubor as tympanic findings; and no more than 1% had perforation. In 19% of the cases paracentesis was indicated, where tympanic membranes were swollen, red, gray, blistering, or simply reddened with severe pain. Only 12% of the cases, however, underwent paracentesis in fact. 34% of the opposite ears of the cases showed acute otitis media; 17% showed exudative otitis media; the others were normal. We could follow up 25% of the cases until the disease has been cured. 14% of these followed-up cases were complicated with exudative otitis media, where paracentesis and insertion of tympanostomy tubes were perfor-med. It is noted that many of our cases are on the inflammatory stage, probably by reason that many of our patients came to our hospital within 1 or 2 hours of the onset of the symptom.
教室におけるベル麻痺, ハント症候群の臨床統計的分析
秋岡 勝哉, 松永 喬
Based upon observations on clinical manifestations of 114 patients with facial palsy during the seven years (April 1981-March 1988), the following results were obtained.All patients were seen at our clinic, Nara Medical University Hospital.
1.In 79.0% of cases with peripheral facial palsy, the lesions were within the temporal bone.
2.Bell's palsy predominates in the young adult and adult while Hunt's syndrome does in the young adult and old ages.Hunt's syndrome was rare under 10 years of age.
3.Cochlear and vestibular symptoms were more prominent in Hunt's syndrome than in Bell's palsy.
4.9.7% of cases with Bell's palsy and 60.0% of Hunt's syndrome had viral infections.All of those Hunt's syndrome were by only Herpeszoster virus.
5.Bell's palsy had a higher healing rate than Hunt's syndrome and had shorter mean periods to cure.
6.In both Bell's palsy and Hunt's syndrome, abnormalities of electrogustometry, stapedial reflex test and nerve excitability test will influence their prognosis.As for Bell's palsy, however, age of the patient will become an additional factor for the prognosis.
フルニソリド点鼻薬によるスギ花粉症抑制効果の判定
鼻用ディスクを用いた新方式の考案
梅田 悦生, 中嶋 美紀子, 椿 茂和
We examined the preventive efficacy of Cynaclin against pollinosis with the aid of the disk containing cedar pollen extract.
"Cynaclin" nasal drip was sprayed twice a day-two insufflations for each nostril each time. A total of three exposure tests using a disk of a given concentration were administered to one subject at one-week intervals. The efficacy was judged from the delayed onset and the reduced amount of nasal discharge. We explained our results in numbers ranging between 0 and 30, which led to the numerical realization of the preventive efficacy against pollinosis. We named our preventive Tsubaki method after the family name of one of the authors. We treated 25 cases, 20 of whom (80 percent) showed efficacy. Moreover, the reduction of sneezing and itching being taken into consideration, 90 percent of the subjects were relieved from pollinosis. We concluded that Cynaclin was clinically successful in preventing pollinosis.
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