著者

菅間 康夫

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.46, no.5, pp.375-379, 1995-10-10 (Released:2010-10-20)

参考文献数

8

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Aspiration pneumonia is caused by materials inhaled into the lower respiratory tract, such as gastric juice or food particles. In adults, most of the patients have a swallowing disturbance such as bulbar palsy or a consciousness disturbance as well as a reduced cough reflex.Acute aspiration pneumonia caused by gastric juice is sometimes referred to as the“Mendelson syndrome”, which is a chemical injury to the broncho-alveolar epithelium and vascular endothelium. Food particles from the oral cavity or stomach, which are usually contaminated with resident bacteria from the oral cavity or pharynx, subsequently cause bacterial infections and sometimes even lung abscesses. One kind of chronic aspiration pneumonia which is similar to diffuse pan-bronchiolitis (DPB), is called diffuse aspiration bronchiolitis (DAB), is due to continuous small amount of aspiration.It is important to diagnose aspiration pneumonia immediately and to start its treatment at an early stage.

著者

谷 亜希子 川瀬 友貴 仲江川 雄太 多田 靖宏

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.69, no.1, pp.7-12, 2018-02-10 (Released:2018-02-25)

参考文献数

8

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気管孔レティナは気管切開後の気管孔保持のために使用される。気管カニューレに比較し気管内腔への刺激が少ないこと,交換頻度が少なくて済むこと,ベルトでの固定が不要であることが利点である。今回,当科において気管孔レティナを使用している42例を対象に,レティナ管理の経過,合併症について評価した。男性23名,女性19名,レティナ使用開始時の年齢は11~83歳 (平均55.6歳) 。気管切開が必要となった原因は両声帯麻痺,気管狭窄症,喉頭腫瘍による気道狭窄,誤嚥防止手術後であり,レティナの使用期間は1~400カ月 (中央値18.5カ月) に及んだ。経過の中でレティナ使用を継続している症例は45.2%,気管孔閉鎖が得られた症例は33.3%,カニューレによる気管孔管理に変更された症例は19.0%,喉頭摘出のため永久気管孔を行った症例は2.4%であった。合併症は気管切開孔周囲の肉芽が16.7%,繰り返す脱落が14.3%,気管内腔側壁の瘢痕形成が9.5%であった。なかでも気管内腔側壁の瘢痕形成はレティナ使用による特異的な合併症と思われた。レティナには先に述べた利点があるが,合併症,特にレティナ脱落に対する理解と対応が必要である。定期的な観察と適切な対応を行えば多くの患者に安全な気道管理法と考える。

著者

太田 久彦

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.38, no.4, pp.374-384, 1987-08-10 (Released:2010-02-22)

参考文献数

29

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Cold environment may alter cardiopulmonary function. The alteration of pulmonary blood flow (QC), respiratory water loss (VH2O), convective heat loss (CHL) and respiratory heat loss (RHL) were studied with subjects exposed to cold environment (5°C) and to thermoneutral environment. QC varied according to posture (supine, sitting and standing) and there was no significant difference between cold and thermoneutral temperature at the same posture. Apparently cold exposure of short duration had no effect on QC At the same temperature, QC was larger in the supine position than in the other positions.Before, during and after stepwise exercise in normal subjects, there was no significant difference in QC between cold and thermoneutral temperature.CHL increased significantly during stepwise exercise in the cold environment in compared with those at the thermoneutral temperature, however, VH2O and RHL also increased no significant degree. At both temperatures, VH2O, CHL and RHL increased during exercise in compared with those before exercise. RHL was elevated according to the increment of ventilation, and this elevation was more marked in the cold environment.

著者

坂口 浩三

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.68, no.5, pp.339-347, 2017-10-10 (Released:2017-10-25)

参考文献数

36

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国際がん研究機関(IARC)はたばこ煙の中に70種類の発癌物質を同定している。発癌性の強い物質の代表にニトロソアミン類,多環芳香族炭化水素(PAHs)がある。日本人での喫煙によるによる肺癌の相対発生危険度は男性で4.4倍,女性で2.8倍といわれている。夫が喫煙者である場合,非喫煙者である妻の受動喫煙による肺腺癌発生リスクは2.03倍と報告されている。喫煙が扁平上皮癌,小細胞肺癌発生との関連が強いのは既知のことであるが腺癌や大細胞神経内分泌癌(LCNEC)の発生にも有意に関与していることがわかってきた。肺腺癌におけるK-ras遺伝子変異は喫煙と関連が強い。若年性肺癌ではCYP1A1多型等の代謝遺伝子的因子の関与がたばこ煙の感受性を高めている。COPD患者は非COPD患者と比べて3~4倍肺癌発生頻度が高く,肺癌を発症した場合は全生存期間が有意に悪い。IIPs合併肺癌の外科治療では術後のIIPs急性増悪(AE)のリスクがある。近年7項目よりなるリスクスコアにより適切な症例選択がなされるようになった。喫煙者の肺癌は悪性度が高い傾向があり周術期合併症の頻度も増す。同じIA期肺癌でも非喫煙者は全生存期間が長い。喫煙者でも中年以前に禁煙することによりたばこの身体への危険性はかなり回避できるといわれている。

著者

児嶋 久剛

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.45, no.5, pp.360-364, 1994-10-10 (Released:2010-02-22)

参考文献数

16

被引用文献数

1 2

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The literature on laryngeal function in the speech of aged persons is reviewed. Two major techniques have been used for the study of utterances in aged persons; one uses isolated voice sounds and the other conventional running speech for analysis.The former technique reveals aging-related changes in the vocal cords and in respiratory function. The voice of aged persons is characterized by hoarseness. That of males is also characterized by an increase in fundamental frequency, and that of females is characterized by a decrease. These changes are caused by an atrophy of the vocal folds in aged males and by an edematous change in aged females. However, this is only on among various aspects characteristic of the speech in aged persons.Other changes includes changes in the articulatory system and its movements. Aging affects the mobility of the tongue, pharyngeal wall and soft palate. In the production of a plosive, for example, aging leads to low intrapharyngeal pressure and poor glottal opening. As a result, the speech of aged person tends to be less clear.A combined study of isolated voice sounds and running speech is indispensable for the study of laryngeal function in aged persons.

著者

岡本 健

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.45, no.2, pp.87-89, 1994-04-10 (Released:2010-02-22)

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Recently, in terms of its medical content, bronchoesophagology as a lawful medical title has been hardly understood by patients. Although the future progress of bronchoesophagology as a science is indispensable and promising, the main question is whether it can maintain its identity as a clinical field. It seems to be more appropriate that bronchoesophagology remain the title of subspecialty of a medical field than a title of a clinical field.

著者

真栄田 裕行 鈴木 幹男 上里 迅 島袋 拓也 仲吉 博紀 嘉陽 祐紀 照喜名 玲奈 金城 秀俊 安慶名 信也 又吉 宣

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.70, no.4, pp.278-283, 2019

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<p>食道穿孔は日常診療において時に経験する病態であるが,多くの場合生じた穿孔は頸部や縦隔内と交通するため,頸部感染症や縦隔炎を誘発し,時に重篤となることがある。また開胸を伴う胸部外科手術と頸部手術の併施は,術直後の縦隔炎発生の可能性が高まるため,一般には敬遠されている。</p><p>今回われわれは胸骨正中切開を伴う大動脈弁置換術直後に,歯科用補綴物による頸部食道穿孔をきたした1例を経験した。症例は66歳の女性で主訴は頸部異物である。開胸手術直後に頸部に迷入した異物が確認され,直ちに頸部外切開による異物摘出術および瘻孔閉鎖術が施行された。異物は歯科用補綴物(クラウン)であり,金属製の突起を歯根に埋め込むタイプのものであった。本症例は開胸手術直後であったにもかかわらず頸部外切開手術を全身麻酔下に施行できたこと,異物を速やかに発見・除去できたこと,頸部創と胸部創が連続しないようにしたこと,気管切開を施行せずに術後も気管内挿管のまま気道管理をしたことが重篤な合併症を誘発しなかった理由としてあげられた。</p>

著者

福田 宏之 斎藤 成司 都築 達 牟田 弘 高山 悦代 藤岡 正 鈴木 理文 北原 哲 磯貝 豊 粉川 信行 市川 忠 牧野 克巳

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.35, no.2, pp.101-106, 1984-04-10 (Released:2010-02-22)

参考文献数

6

被引用文献数

4 3

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Nobody can deny that lubrication is one of the factors which influences the phonatory function of the larynx. However, no notable studies on the mechanism of lubrication have ever been carried out. This study is an effort to clarify how the larynx is lubricated.In the present study, it is revealed that the secretory fluid from the tracheal and subglottic spaces passes instantly through the glottis at the moment of the onset of phonation. Thus, the initiation of the lubrication is accomplished. The fluid from the subglottis is then mixed with the supraglottic fluid which comes mainly from the ventricular gland. A lubricant column is bilaterally made by the mixed fluid on the upper surface of the vocal folds. This lubricant column is rotating perpendicularilly to the free edge of the folds. The lubricant column may lubricate the folds which vibrate during phonation. At the end of phonation, the column decomposes and mostly flows backward to the subglottis. By this flow, the glottis is lubricated again.In this paper, the results mentioned above were discussed and analyzed from the viewpoint of phonodynamics.

著者

三枝 英人 小野 卓哉 林 明聡 豊田 雅基 新美 成二 八木 聰明

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.48, no.4, pp.297-302, 1997-08-10 (Released:2010-02-22)

参考文献数

14

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The treatments for patients with severe dysphagia and misdeglutition are very difficult. Some cases must have total laryngectomy or tracheo-esophageal separation to control their severe misdeglutition and prevent serious respiratory distress. However, in such cases, the phonatory function has to be sacrificed, resulting in a poor quality of life.In order to overcome this conflict between deglutition and phonation, we have developed an “artificial pharynx.” The artificial pharynx consists of a soft balloon and a plastic tube. The soft balloon is attached to a tube with an inlet hole. The whole assembly can be inserted through the patient's nose. The tip of the tube remains in the stomach and the balloon is inflated at the level of the pharynx to seal the airway. Our patient could breathe through a tracheal stoma which was created prior to using the artificial pharynx. The bolus was introduced through the inlet hole into the tube and moved down to the stomach by gravity. When the balloon was deflated, the patient could breathe and phonate with a speech valve of the cannula.We treated a patient using an artificial pharynx. He was a 62 years old male diagnosed as having terminal myotonic dystrophy and suffering from severe dysphagia. Because of his poor general condition, any surgical intervention for dysphagia and misdeglutition could not be performed without a tracheotomy. But, since he yearned to take some drinks and to preserve his phonatory function, the artificial pharynx was utilized with some success.

著者

古賀 慶次郎 川城 信子 荒木 昭夫 越永 重四郎

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.42, no.4, pp.323-329, 1991-08-10 (Released:2010-10-20)

参考文献数

10

被引用文献数

1

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During the period between 1971 and 1980, the postmortem examinations of 14 infants and young children, ranged from 9 months to 4 years of ages, averaged 1-year-7 month old, who died of foreign bodies in the airway were performed in the Tokyo Metropolitan Examiners Office. The clinical progress of these children was reviewed, and summarized as follows.1. The foreign bodies in these cases were several kinds of foods such as beans in 5 cases, orange or its skin in 2, other foods in 3 and a candy in one case.2. Among these, two chidren were eating foods while they were playing or running around, and 3children aspirated foreign bodies into the airway accidentally during vomiting or unknown cause and while changing their dipers.3. These accidents have tought us that it is very important to feed or give foods to children while they are quiet.4. Ten children have died at the day of accident, and 3 children have been transferred from clinic to clinic and died in several days after the accident. Every phisician who happens to see children presenting with wheezing or respiratory distress should be aware of foreign body in the airway.5. In 13 cases, foreign bodies were found in the trachea. The case of foreign body in the trachea usually shows a normal chest X-ray and this makes the precise diagnosis much more difficult than cases with a foreign body in the bronchus. The fiberscopic or bronchoscopic examinations are mandatory for making the exact diagnosis.

著者

福山 智子 湯田 厚司 山田 弘之 原田 輝彦 坂倉 康夫

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.45, no.6, pp.462-466, 1994-12-10 (Released:2010-02-22)

参考文献数

9

被引用文献数

1 1

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We report a case of esophageal perforation caused by a piece of glass in a 34-year-old woman suffering from sudden severe pharyngeal pain. We found a foreign body lodged at the esophageal wall 4cm below from the first esophageal constriction upon X-ray and flexible fiberscopic examination. The foreign body was removed using a rigid esophagoscope 39 hours after swallowing. The foreign body was an equilateral triangular piece of glass whose side was 30mm. Immediately after the foreign body was removed, we found an esophageal perforation, subcutaneous emphysema and pneumomediastinum. The perforation was closed using an external approach. The patient showed improvement after the operation.

著者

松塚 崇

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.69, no.4, pp.268-269, 2018-08-10 (Released:2018-08-25)

参考文献数

9

著者

佐藤 靖雄 森田 守 高橋 広臣 蔵内 祥博 黄川田 光夫

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.16, no.4, pp.160-167,en1, 1965 (Released:2010-10-20)

参考文献数

29

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Two cases of carcinoma of the larynx, which were found in teenagers, were reported: a fourteen year-old girl supralottic type, squamous cell carcinoma, Stage III (T2N1M0) and a seventeen year-old girl (glottic Type, carcinoma in situ, Stage I (T1N0)). The former was treated with irradiation followed by surgery, and in the latter, radiation only. The vocal cords were saved in both cases. No recurrance of tumor is seen for one and half year in the former case and six months in the latter after treatment. The followings are discussed: how to combine radiation therapy and surgical treatment, concerning skin incisions of partial resection, regional application of anti-cancerous drugs, and the functions of speech and swallowing after surgery.

著者

佐藤 公則 川口 壽郎 松岡 秀隆

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.41, no.4, pp.292-299, 1990-08-10 (Released:2010-10-20)

参考文献数

14

被引用文献数

4 4

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Four patients with esophageal or hypopharyngeal perforation caused by endoscopy treated from 1981 through 1989 at Kurume University Hospital, are reviewed.1) All the patients were adult, two were male and two were female.2) The cause was by flexible fiberscopy in two patients with hypopharyngeal perforation, by rigid esophagoscopy in two patients with esophageal perforation. The lesion of hypopharyngeal perforation was left piriform sinus and that of esophagus was entrance of cervical esophagus.3) All the patients were treated surgically. Primary suture of the peforation was done in one case.4) All the patients were cured.5) The most useful examination was a lateral view of the cervical X-ray.6) From our experience, the following treatment is recommended. Operation should be done as soon as possible, and primary suture of the perforation would be done if possible. The operative wound should be opened, and oral administration of foods would be started if possible. And the operative wound could be successively closed if there were no problems.

著者

村上 直子 原 浩貴 山下 裕司

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.55, no.1, pp.43-47, 2004

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喉頭肉芽腫は声帯突起部に好発する炎症性の腫瘤であるが,しばしば再発し治療に難渋することのある疾患である。今回我々は喉頭肉芽腫の9症例に対しレバミピドとセラペプターゼの2剤併用の内服加療をおこなった。その結果,9例中5例(56%)で肉芽腫が消失した。肉芽腫消失までの期間は最短で21日,最長で91日であった。5例中3例は術後再発の症例であった。また1例はPPIの無効例であった。また5例全例とも投与後に最短10日,最長28日で肉芽腫の縮小効果が確認された。消失した5例で,内服終了後に再発したものはなかった。<br>今回の結果から,喉頭肉芽腫が消失した原因は主として血中レバミピドの炎症抑制作用が喉頭粘膜に影響を及ぼしたためではないかと推察した。また無効であった4例では,血中濃度が充分でなかった可能性と,レバミピドでは胃酸逆流の防止が困難なほど重度なGERDが潜んでいた可能性を推察した。

著者

真栄田 裕行 嘉陽 祐紀 金城 秀俊 上里 迅 安慶名 信也 又吉 宣 鈴木 幹男

出版者

特定非営利活動法人 日本気管食道科学会

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.70, no.1, pp.30-37, 2019

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<p>今回われわれは気管内壁に再発した頸部気管支嚢胞腺癌の1例を経験した。症例は71歳の女性。甲状腺全摘術および頸部郭清術後ほどなく気管内壁に再発した。腫瘍切除後の気管再建には肋軟骨と歯科用印象材を用いた。構造体としての強度を得るため肋軟骨片により気管外枠を作成した。また歯科用印象材を充填した手術用ゴムグローブを気管内にステントとして留置した。術後3年目腫瘍の再発は認められず,十分な強度と呼吸道としての内腔が保持された気管が再建できた。歯科用印象材は気管内腔を形成するためのステントとして有用な材料である。</p>

著者

柵木 美紀 仁木 博文 田中 康夫

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.46, no.4, pp.314-317, 1995-08-10 (Released:2010-10-20)

参考文献数

12

被引用文献数

1 1

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A rare case of throat burn caused by the accidental inhalation of the flame of a toy firework was reported. A 13-year-old boy omplained of a sore throat with difficulty in swallowing and moderate hoarseness after meeting with the accident. A firework scaffold fell suddenly after ignition, and part of its flame entered the mouth of this boy who was standing 20m distant.When he visited our clinic, an indirect laryngoscopy showed that the epiglottis and the bilateral arytenoid regions were hyperemic and edematously swollen. He was under medical treatment of hydrocortisone sodium succinate and antibiotics. It was concluded that this throat burn was a thermal injury caused by the inhalation of a flame, probably of a paper casing. Two years observation revealed no cicatrical contracture.

著者

田中 信三 窪田 清己 田辺 正博

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.35, no.4, pp.287-292, 1984-08-10 (Released:2010-02-22)

参考文献数

9

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Living canine larynx was blown through the trachea with both arytenoid cartilages fixed in the median position. The sound pressure level and fundamental frequency of the voice were measured under various flow rates and subglottal pressures, with and without electric stimulation of the thyroarytenoid muscles. From this experiment, the role of the thyroarytenoid muscles in voice regulation was found to be as follows:1) When the glottis is sufficiently closed, contraction of the thyroarytenoid muscles does not affect the relationship between aerodynamic power (flow rate times pressure) and the sound pressure level, in spite of increased glottal resistance (pressure divided by flow rate).2) When the glottis is sufficiently closed, contraction of the thyroarytenoid muscles decreases the fundamental frequency in relatively large aerodynamic powers.

著者

平出 文久 井上 鉄三 都川 紀正 椿 康喜代 沢田 政道 田中 英一

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.31, no.3, pp.246-252, 1980

被引用文献数

8

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Cryosurgery is gaining more and more importance as a therapeutic modality within the field of head and neck surgery.<br>Cryosurgery was performed in two patients with hemangioma arising from the entrance of the esophagus.<br>Case 1: A 41-year-old woman was referred for the diagnosis of hemangioma in the entrance of the esophagus which had been present for approximately five years. The patient felt slight pain on deglutition and sometimes noticed hemoptysis. The lesion was treated with cryoapplication of -60°C on its surface through the direct laryngoscope under general anesthesia. Cryoapplications were repeated by overlapping frozen areas during treatment. The duration of the individual freezing cycles ranged from one and half to three minutes. Over a period of 3 weeks the patient received 2 cryosurgical treatments. Postoperative healing was uneventful. After 3 weeks following 2nd cryosurgery the lesion disappeared without leaving a remarkable scar. No recurrence was noted after one-year follow-up.<br>Case 2: A 54-year-old man was admitted to the hospital with a history of foreign body sensation in the throat. Endoscopic examination revealed a dark, blue swelling in the entrance of the esophagus, suggesting a hemangioma. The lesion was frozen in three applications of -60°C each time. The frozen region was overlapped to compass the entire tumor. After thawing the frozen areas began to swell. In 24 hours it was almost twice of its original size. Then the necrotic tissue was well demarcated from vital tissue and on the seventh postoperative day the brownish lump exfoliated and showed a persistent smaller tumor. Total regression of the hemangioma and overgrowth of normal mucosa followed with a satisfactory functional result. No further growth was observed after six-month follow-up.<br>The general treatment of the hemangioma in the larynx, hypopharynx and esophagus was briefly discussed.

著者

赤澤 仁司 小川 真 曺 弘規 細川 清人 中原 晋 堀井 新 猪原 秀典

出版者

The Japan Broncho-esophagological Society

雑誌

日本気管食道科学会会報 (ISSN:00290645)

巻号頁・発行日

vol.65, no.4, pp.322-329, 2014

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混合性喉頭麻痺とは,声帯麻痺に他の脳神経麻痺を合併したものであり,多彩な臨床症状を呈する。今回われわれは,頭部外傷の後,高度嚥下障害を発症した両側の混合性喉頭麻痺症例に対して手術的加療を行い,良好な結果を得たので報告する。症例は78歳男性。木から転落して頭部を打撲し,救急救命専門施設に搬送された。頭部CT検査において,くも膜下出血および右側頸静脈孔・舌下神経管周囲に骨折が認められた。全身状態および意識レベルの改善の後,失声・嚥下障害が判明した。嚥下障害の治療のため当科に紹介受診された。内視鏡検査下に,右声帯は傍正中位に,左声帯は中間位に完全固定していた。嚥下造影検査において,バリウム嚥下を試みるも嚥下反射は全く生じなかった。嚥下改善目的に両側輪状咽頭筋切断術・喉頭挙上術・気管喉頭分離術・喉頭閉鎖術を施行した。術後,肉の塊を除く多様な形態の食物が摂食可能となった。また後日プロテーゼを挿入して言語コミュニケーションが可能となった。以上より,複数の脳神経損傷に起因する咽喉頭の機能障害であっても,種々の機能外科的手術を適切に組み合わせることにより生活の質の改善が期待できると考えられた。