著者
河野 敏朗 石戸谷 淳一 遠藤 亮 佃 守
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.100, no.11, pp.899-903, 2007-11-01 (Released:2011-10-07)
参考文献数
19
被引用文献数
1 1

We sometimes experience infant cases leading to unexpected deaths due to foreign bodies. It is often difficult to identify the cause or foreign body invasion by asking questions directly to a child. We experienced an infant case of a chopstick passing through the soft palate, reaching the parapharyngeal space near the inner carotid artery circumference. At the first medical examination, we could not detect the tip of the chopstick, in the pharynx. Using 3-directional-CT images, we could locate the tip of the chopstick in the parapharyngeal space near the inner carotid artery circumference. Under general anesthesia, we could remove the tip of the chopstick from the parapharyngeal space near the inner carotid artery with an endoscope trans-orally.It is important to investigate positional conditions between a foreign body and the vessels in the parapharyngeal space. Images such as enhancing 3-directional-CT before the operation is useful.Furthermore, we have to be careful of the late neurosis by pencil-injury in the region and pay close attention to respiratory tract management.
著者
清水 啓成 高橋 明洋 小口 直彦 石戸谷 淳一
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.90, no.12, pp.1409-1414, 1997-12-01 (Released:2011-11-04)
参考文献数
23
被引用文献数
1

Chronic paranasal sinusitis encompasses a variety of pathologies, and eosinophil infiltration of nasal polyps is characteristic of chronic sinusitis in which allergy is a strong etiologic factor (allergic paranasal sinusitis). Suplatast tosilate is an anti-allergy agent that suppresses production of IgE antibody and inhibits tissue infiltration by eosinophils. In the present study we assessed the efficacy of suplatast tosilate immunohistochemically in surgical specimens of nasal polyps before and after drug therapy to evaluate its efficacy in allergic sinusitis.The subjects were 8 patients with allergic sinusitis associated with nasal polyps. These patients were treated with suplatast tosilate for about three months. Nasal polyps were collected before and after treatment, and 5-μm frozen serial sections were prepared and stained with HE and by immunochemical methods. The number of eosinophils and eosinophil activation were assessed by using EG2 antibody, which recognizes secretory type eosinophilic cationic protein (ECP) alone, as the primary antibody, to investigate eosinophil activation.Infiltration by numerous eosinophils, predominantly in the superficial layer of the lamina propria, was observed in the nasal polyps of allergic rhinitis patients. Significant decreases in the number of eosinophils and the number of EG2-positive cells were observed in the nasal polyps after treatment with suplatast tosilate, and a significant decrease was also observed in the ratio of the number of EG2-positive cells to the number of eosinophils. Thus, suplatast tosilate was shown to have eosinophil tissue infiltration suppressing activity in human nasal polyps, and to also possess inhibitory activity against eosinophil degranulation. Based on these findings, suplatast tosilate suppresses allergic inflammation, which is predominantly manifested by eosinophil infiltration, and was found to be effective in the treatment of allergic paranasal sinusitis.
著者
藤枝 重治 坂下 雅文 徳永 貴広 岡野 光博 春名 威範 吉川 衛 鴻 信義 浅香 大也 春名 眞一 中山 次久 石戸谷 淳一 佐久間 康徳 平川 勝洋 竹野 幸夫 氷見 徹夫 関 伸彦 飯野 ゆき子 吉田 尚弘 小林 正佳 坂井田 寛 近藤 健二 山岨 達也 三輪 高喜 山田 奏子 河田 了 寺田 哲也 川内 秀之 森倉 一朗 池田 勝久 村田 潤子 池田 浩己 野口 恵美子 玉利 真由美 広田 朝光 意元 義政 高林 哲司 富田 かおり 二之宮 貴裕 森川 太洋 浦島 充佳
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.118, no.6, pp.728-735, 2015-06-20 (Released:2015-07-18)
参考文献数
21
被引用文献数
2 1

これまで本邦における慢性副鼻腔炎は好中球浸潤が主体で, 内視鏡鼻副鼻腔手術とマクロライド少量長期投与にてかなり治療成績が向上してきた. しかし2000年頃からそれらの治療に抵抗性を示し, 易再発性の難治性副鼻腔炎が増加してきた. この副鼻腔炎は, 成人発症で, 嗅覚障害を伴い, 両側に鼻茸があり, 篩骨洞優位の陰影があった. 末梢好酸球も多く, 気管支喘息やアスピリン不耐症の合併もあった. このような副鼻腔炎の粘膜には多数の好酸球浸潤が認められていたため, 好酸球性副鼻腔炎と命名された. 好酸球性副鼻腔炎は, 徐々に増加傾向を示してきたが, 好酸球性副鼻腔炎の概念, 診断基準はあまり明確に普及していかなかった. そこで全国規模の疫学調査と診断ガイドライン作成を目的に多施設共同大規模疫学研究 (Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study: JESREC Study) を行った. その結果, 両側病変, 鼻茸あり, CT 所見, 血中好酸球比率からなる臨床スコアによる簡便な診断基準を作成した. さらに臨床スコア, アスピリン不耐症, NSAIDs アレルギー, 気管支喘息の合併症, CT 所見, 血中好酸球比率による重症度分類も決定した. 4つに分類した重症度分類は, 術後の鼻茸再発と有意に相関し, 最も易再発性かつ難治性の重症好酸球性副鼻腔炎はおよそ全国に2万人いることが判明した. 治療法については経口コルチコステロイド以外まだ確立されておらず, 早急なる対応が急務と考えている.