著者

甲斐 智朗

出版者

一般社団法人 日本耳鼻咽喉科学会

雑誌

日本耳鼻咽喉科学会会報 (ISSN:00306622)

巻号頁・発行日

vol.102, no.7, pp.898-906, 1999-07-20 (Released:2010-10-22)

参考文献数

25

被引用文献数

1

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(目的) 鼻粘膜の血管収縮・拡張が鼻腔由来の一酸化窒素 (NO) 濃度に及ぼす影響を局所への薬剤投与により検討した.(対象) アレルギー性鼻炎以外に特に鼻副鼻腔疾患を有しない健常人24名.(方法) 安静座位における鼻腔由来のNO濃度および鼻腔抵抗, 最小鼻腔断面積, 鼻腔容積を測定した後, 前者12名には血管収縮剤として硝酸ナファゾリン, 後者12名にはNO-cGMP系を介さない血管拡張剤として硫酸サルブタモールをそれぞれ定量噴霧器を用いて両側鼻腔内に投与し, それぞれの計測値の変化を測定した. NOの測定には, chemiluminescence法によるNOアナライザーを用いた. 鼻腔抵抗の測定は鼻腔通気度計を用いてアンテリオール法により, 更に最小鼻腔断面積と鼻腔容積の測定はアコースティックライノメトリーにより行った.(結果) 硝酸ナファゾリンの投与によりNO濃度は有意に低下し, 鼻腔抵抗は有意に減少した. 更に鼻腔容積は有意に増大した.硫酸サルブタモール投与により, NO濃度は有意に上昇し, 鼻腔抵抗も有意に上昇した. 更に最小鼻腔断面積および鼻腔容積は有意に減少した.(考察) 鼻腔抵抗および最小鼻腔断面積, 鼻腔容積の変化から, 各薬剤により鼻粘膜が収縮・拡張していることが示された. 硝酸ナファゾリンはα1レセプターを介して血管を収縮させ, また血管拡張作用を示した硫酸サルブタモールはβ2刺激剤であり, この血管拡張作用はNOを介さないことから, 鼻腔由来のNO産生量は, 血管の収縮・拡張に伴う基質の供給量の変化に影響される可能性が示唆された.(結論) 血管収縮・拡張剤により, 鼻腔由来のNO濃度は有意に減少・増加し, これは基質の供給量の変化に基づいている可能性があると考えられた.

著者

武田 広誠 中屋 宗雄 甲斐 智朗 堀内 正敏

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.95, no.2, pp.181-184, 2002-02-01 (Released:2011-11-04)

参考文献数

13

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To investigate the correlation between obstructive sleep apnea syndrome (OSAS) and obesity, 71 OSAS patients whose sites of obstruction were diagnosed based on sleep nasendoscopy findings were studied. The patients were subdivided into three groups by body mass index (BMI) as follows: Group A, 24 patients with BMI less than 25 (kg/m2); Group B, 19patients with BMI between 25 and 28; and Group C, 28 patients with BMI more than 28. Variables examined include the apnea index (AI), 4% O2 desaturation index (DI), nadir SpO2, and cephalometric data (SNA, SNB, PNS-U, MP-H, PAS). AT and cephalometric data were not correlated with BMI, but DI and nadir SpO2 were mutually correlated with BMI. These data suggest that OSAS may be worsened by obesity. Of the 71 patients, 45 were treated with surgery based on sleep nasendoscopy findings, and 33 patients, AI, DI, and nadir SpO2 were evaluated after surgery. There was a 77.4% and 72.7% improvement in the AT and DI respectively, but neither were correlated with BMI. The response rates were slightly better than previous reports. We believe that careful patient selection using sleep nasendoscopy data as well as avoiding surgery for extremely obese patients when possible may contribute to good results of surgical treatments.

著者

甲斐 智朗

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.95, no.7, pp.679-684, 2002-07-01

参考文献数

9

被引用文献数

2 1

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Two cases of psychogenic hearing loss in adults are presented with the process of their mental states. Case 1 was a 20-year-old male who complained of unilateral hearing loss and tinnitus on his left side after receiving a &ldquo;karate&rdquo; kick on his left temple. Considering the perforation of his left tympanic membrane, his left hearing level was much worse (77.5 dBHL). Later examination of ABR revealed the sensorineural system to be intact, and functional hearing loss was suspected. Further questions about his history disclosed that he was extremely unhappy in his job and wanted to leave his present employment. After discussion with psychiatrists, the diagnosis of psychogenic hearing loss was established.<br>Case 2 was a 23-year-old male who complained of right tinnitus after hearing rifle shooting during night time maneuvers in the Self Defense Forces. In spite of the normal appearances of his external and middle ear, his hearing level was 72.5dBHL. Being treated as acoustic trauma, ABR was performed and it resulted in a completely normal response. In this case, the diagnosis of psychogenic hearing loss was also established.<br>Especially in adults, psychogenic hearing loss is regarded as a kind of conversion disorder. In this disease, getting ill brings some &ldquo;gain&rdquo; to the patients. Admission to the hospital separates a patient from his unpleasant job and persons (secondary gain). This is almost compatible with the mental state of case 1. When their desires are converted to physical disorders and are appreciated by another person, they don't have to be concerned by their source of annoyance. Thus their mental states are stabilized (primary gain). This is almost compatible with the mental state of case 2.<br>When assessing patients of Psychogenic hearing loss, their mental states should be considered as there may be various processes involved in the disease.

著者

甲斐 智朗

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.95, no.7, pp.679-684, 2002-07-01 (Released:2011-11-04)

参考文献数

9

被引用文献数

1 1

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Two cases of psychogenic hearing loss in adults are presented with the process of their mental states. Case 1 was a 20-year-old male who complained of unilateral hearing loss and tinnitus on his left side after receiving a “karate” kick on his left temple. Considering the perforation of his left tympanic membrane, his left hearing level was much worse (77.5 dBHL). Later examination of ABR revealed the sensorineural system to be intact, and functional hearing loss was suspected. Further questions about his history disclosed that he was extremely unhappy in his job and wanted to leave his present employment. After discussion with psychiatrists, the diagnosis of psychogenic hearing loss was established.Case 2 was a 23-year-old male who complained of right tinnitus after hearing rifle shooting during night time maneuvers in the Self Defense Forces. In spite of the normal appearances of his external and middle ear, his hearing level was 72.5dBHL. Being treated as acoustic trauma, ABR was performed and it resulted in a completely normal response. In this case, the diagnosis of psychogenic hearing loss was also established.Especially in adults, psychogenic hearing loss is regarded as a kind of conversion disorder. In this disease, getting ill brings some “gain” to the patients. Admission to the hospital separates a patient from his unpleasant job and persons (secondary gain). This is almost compatible with the mental state of case 1. When their desires are converted to physical disorders and are appreciated by another person, they don't have to be concerned by their source of annoyance. Thus their mental states are stabilized (primary gain). This is almost compatible with the mental state of case 2.When assessing patients of Psychogenic hearing loss, their mental states should be considered as there may be various processes involved in the disease.

著者

甲斐 智朗 森田 一郎 臼井 信郎

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.92, no.3, pp.277-282, 1999-03-01 (Released:2011-11-04)

参考文献数

8

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The efficacy of cryotherapy for pharyngeal pain after tonsillectomy was studied.The pain of 10 patients after tonsillectomy was controlled by the usual methods; i. e., neck icing, povidone iodine gargling, inhalation of aerosols containing antibiotics and corticosteroids, and administration of mefenamic acid syrup perorally (control group). In addition to these treatment methods, another 10 patients received shaved ice orally 30 minutes before each meal (ice group).The pharyngeal pain of each patient was scored 5 times a day by the 10 cm analog scale and the 4 grades of classification. Scoring occurred at waking, 10, 14, 18, and 21 o' clock. The amount of food each patient could eat was also recorded.The pain scores at waking were significantly reduced in the ice group on the 2nd and the 4th post-operative day (p < 0.05; Welch's t-test). The pain was the most severe at waking, diminished during the daytime, and was somewhat increased at night again in both groups (p < 0.05; one-way ANOVA). The patients in the ice group were advanced to more solid and more nutritive diets earlier than those in the control group.We concluded that pharyngeal cryotherapy after tonsillectomy was useful for pain control after tonsillectomy, and the analog scale was suitable for continual recording of the pain levels of patients.