Nihon Jibiinkoka Gakkai kaiho
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Nippon Jibiinkoka Gakkai Kaiho · Aug 2004
Case Reports[Clinical study on papillary thyroid carcinoma presenting with lymph node metastasi].
Papillary thyroid carcinoma (PTC) may metastasize to cervical lymph nodes. It is, however, uncommon for a palpable neck node alone to lead to the diagnosis of this disease when it is not apparent at presentation. Standard treatment for such cases has not yet been established. ⋯ Recurrence in the cervical area were observed in 1 whose neck dissection was insufficient. Based on these observations, we concluded that patients who undergo thyroid lobectomy and adequate neck dissection may enjoy longer survival than those treated with total thyroidectomy without sacrificing thyroid and parathyroid function. We therefore propose a prospective study on the effectiveness of thyroid lobectomy with neck dissection including positive nodes in patients with occult PTC presenting with lymph node metastasis.
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Nippon Jibiinkoka Gakkai Kaiho · May 2004
[Unattended automated titration to determine therapeutic continuous positive airway pressure in patients with obstructive sleep apnea].
Recently, devices which use a new technology that automatically titrates positive airway pressure have become available. Such devices continually adjust the pressure to maintain airway patency. In this paper, unattended automated titration to determine the therapeutic continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea was evaluated to ascertain of it was a feasible titration to determine the therapeutic CPAP. ⋯ Data obtained during the use of auto CPAP devices and polysomnography were used to provide a fixed single pressure for subsequent treatment. After determining the therapeutic continuous positive airway pressure, the efficacy of the patient's CPAP device was reconfirmed during full polysomnography. The results were, 1) Proper fixed single therapeutic pressure could be determined with this unattended automated titration, consequently apnea and sleep structure could be improved (Total sleep time, Sleep efficiency, %Stage 3 + 4, Apnea index, Apnea hypopnea index, Arousal index, Lowest SpO2, and Duration of SpO2 less than 90% were improved statistically (p < 0.05)). 2) The 95th percentile airway pressure of the auto CPAP device should be applied for the therapeutic pressure. 3) Automated titration during full polysomnography should be performed using auto CPAP devices. 4) After determining the therapeutic CPAP, the efficacy of the patient's CPAP device should be reconfirmed during full polysomnography. 5) This method of titration was useful at the institution without attendant technician intervention.
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Nippon Jibiinkoka Gakkai Kaiho · Sep 2003
[Temporal bone study of residual mastoid inflammation in ears with normally appearing tympanic membrane].
We examined 395 temporal bones with an intact tympanic membrane to explore the relationship between residual inflammation in the middle ear cavity and development of mastoid pneumatization. Histopathological changes were studied in the middle ear cavity. Mastoid pneumatization was classified as good or poor based on the extent of mastoid tip development to the lateral semicircular canal. ⋯ In contrast, no such incidence of inflammatory change was noted in poorly-pneumatized mastoid. Our findings indicate that an intact tympanic membrane does not always mean freedom from mastoid inflammation, especially when the mastoid is well-pneumatized. This makes it important to check for possible remaining otitis media in patients with a well-pneumatized mastoid, even if the tympanic membrane appears normal.
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Nippon Jibiinkoka Gakkai Kaiho · Mar 2002
[Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography].
With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. ⋯ The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper posterior alveolar margin, when conducting drainage or incision of PTA, we should advance sagittaLly from the point of incision to a depth of no more than 20 mm. If the tip of the instrument is kept medial to the sagittal plane of the upper posterior alveolar margin, effective treatment should be achievable without the risk of vascular damage.
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Nippon Jibiinkoka Gakkai Kaiho · Oct 2001
Case Reports[Direct laryngoscopic extirpation and wound suture for hypopharyngeal lipoma: a case report].
We report a case of hypopharyngeal lipoma. An 82-year-old woman referred to our clinic for 10 years of wheezing and intermittent breathlessness developing 1 month before admission was found on laryngoscopic examination to have a mobile mass arising from the hypopharyngeal region intermittently obstructing the laryngeal airway. After emergency tracheotomy, the tumor was removed under direct laryngoscopy, given the patients age and general status. ⋯ The operative wound was sutured under direct laryngoscopy using a specially designed probe with a U-shaped tip. The tumor was histologically diagnosed as lipoma. The surgical procedure enabled the operative wound to heal rapidly and oral feeding to start early.