著者

山崎 ももこ 石井 正則 丹羽 洋二 谷口 雄一郎 森脇 宏人 濱田 幸雄

出版者

耳鼻咽喉科展望会

雑誌

耳鼻咽喉科展望 (ISSN:03869687)

巻号頁・発行日

vol.44, no.4, pp.284-288, 2001-08-15 (Released:2011-03-18)

参考文献数

13

被引用文献数

2

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咽頭異物は耳鼻咽喉科の外来において日常よく遭遇する疾患であるが, 頸部腫脹後に来院し異物が発見される症例も稀ではない。今回我々はイカ摂食後に咽頭痛が出現し, その後顎下部腫脹も出現したため4週間後当科を受診して, 頸部単純X線写真と頸部CTにて左顎下部に針金状の異物を確認し, 内視鏡及び放射線透視下で異物摘出術を施行した症例を経験した。頸部腫脹後に咽頭異物が発見された症例は他にも報告例があり, 日常診療で異物があるという訴えで受診する患者の中には, 今回の症例のように喉頭鏡検査や喉頭ファイバースコープで観察しても異物が発見できない場合も多い。しかし, 異物摂取の可能性のある症例には頸部単純X線写真を撮影するか, さらにCTを撮影するなどの検討が必要であると考えられた。

著者

中村 将裕 石井 正則 近澤 仁志 丹羽 洋二 山崎 ももこ 伊藤 洋

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.63, no.4, pp.335-345, 2004 (Released:2009-06-05)

参考文献数

21

被引用文献数

3 2

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Falls and falling accidents occurring in hospitals have become a problem in recent years, and some of those events have been documented to have occurred after patients ingested sleep-inducers (hypnotics). One of the pharmacological actions of hypnotics is muscle-relaxing activity, and it has been clarified in animal studies that this activity causes falls and falling accidents. However, this association has not yet been proven in humans.In this study, conducted in eight healthy adult volunteers, we compared the manifestation of balance disorders after ingestion of four test drugs, consisting of two ultra-short-acting hypnotics (zolpidem and triazolam), a long-acting hypnotic (qazepam) and a placebo (i.e., the control). Zolpidem and qazepam, which are said to express weak muscle-relaxing activity, both caused balance disorders. Also, strong correlations were found between the manifestation of balance disorders after drug ingestion and the plasma concentrations of zolpidem, triazolam and some of the metabolites of qazepam. In addition, in the case of zolpidem, which caused the most severe balance disor-ders, gaze deviation nystagmus was detected. For this reason, it was surmised that balance disorders occurring after ingestion of hypnotics involve some inhibition of the central nervous system, including the cerebellum and brain stem, rather than the mus-cle-relaxing activity of the drugs.Differences were observed among the tested hypnotics in relation to the time of occurrence of balance disorders postmedication and also to the severity of the symp-toms. Accordingly, for the prevention of falling accidents, it is considered necessary that the physician be fully cognizant of the patient's age, medical history and physical condition, as well as not only the characteristics of the hypnotics but also the time-course changes in their concentration in the blood. Then, adequate caution must be applied with regard to the time period in which the patient is in a half-awake state.