Yoshifuku K, Nishimoto K, Matsuzaki T
… +1 more, Matsushita S
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Nov · PMID 30035520
Immunogloblin A (IgA) vasculitis is the most common systematic vasculitis disorder characterized by leykocytoclastic vasculitis , for example, purpura with white blood cell destruction vasculitis caused by allergic mecha...Immunogloblin A (IgA) vasculitis is the most common systematic vasculitis disorder characterized by leykocytoclastic vasculitis , for example, purpura with white blood cell destruction vasculitis caused by allergic mechanisms. The main symptoms of this disease are purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. We report the case of a 66-year-old man with IgA vasculitis. He was diagnosed with hypopharyngeal cancer and underwent radio-chemotherapy at our department. On the following day, he underwent tracheotomy because of recurrent laryngeal nerve paralysis associated with cancer treatment. His wound infection remained after the tracheostomy, and he complained of purpura on both legs. On the basis of these clinical courses we diagnosed IgA vasculatis caused by wound infection. This case illustrates that it is important to consider the possibility of IgA vasculatis if skin eruption is observed concurrent with wound infection.
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Nov · PMID 30035518
Globus sensation is a common symptom seen daily in ear-nose-throat (ENT) clinics. Globus is affected by multiple factors, and of these, gastroesophageal reflux disease (GERD), has been recognized as a relatively more man...Globus sensation is a common symptom seen daily in ear-nose-throat (ENT) clinics. Globus is affected by multiple factors, and of these, gastroesophageal reflux disease (GERD), has been recognized as a relatively more manageable cause of globus than the other causes. However, we still commonly encounter globus patients with unclear backgrounds who require multiple diagnostic and therapeutic modalities. To provide an appropriate treatment approach and create favorable situations for these patients, we developed and applied an intramural algorithm to manage globus considering GERD, laryngeal allergy, and psychological problems as major factors of this pathology. Twenty-six patients with globus sensation who visited our voice clinic from June 2012 to March 2015 were enrolled in this study. All these patients had undergone general ENT examinations, including naso-pharyngo-laryngeal endoscopies and cervicothoracic computed tomographic scans. Upper gastrointestinal endoscopy revealed 2 cancers. Further study classified 23 patients into the GERD group and 1 patient into the allergy group. Proton pump inhibitor (PPI) therapy was successful in 11 patients of the GERD group (response rate, 47.2%). Improvement in subjective symptoms of globus were measured by the scores of questionnaires, including the F scale and Reflux Symptom Index. Significant improvement in these scores were observed 1 month after PPI prescription in the PPI-responder group in this study. Further assessment of medical history as well as the scores of questionnaires to measure the severity levels of depression (Self-rating Depression Scale) and anxiety (State-Trait Anxiety Inventory-Form JYZ, STAI) proved that relatively longer lasting symptoms (≥4 months) or relatively higher anxiety scores (STAI≥50 points) were predictive of PPI resistance. Our study results suggested that the pathology of globus is affected by multiple factors and that a multidisciplinary team approach is required for better management of this disease.
Takeda T, Ito T, Kawashima Y
… +4 more, Hatanaka A, Watanabe S, Kitamura K, Tsutsumi T
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Nov · PMID 30035515
Pediatric deep neck abscesses are a relatively rare and can lead to critical or life-threatening situations. However, the clinical characteristics of pediatric deep neck abscesses are not fully understood in Japan. We co...Pediatric deep neck abscesses are a relatively rare and can lead to critical or life-threatening situations. However, the clinical characteristics of pediatric deep neck abscesses are not fully understood in Japan. We conducted a retrospective study of the clinical characteristics of children presenting with pediatric deep neck abscesses at our hospital. All pediatric patients were diagnosed with deep neck abscesses on the basis of the clinical findings and computed tomography (CT) scanning of the neck between April 2009 and March 2014. The incidence, initial examining department, sex, age, presenting signs and symptoms, physical findings, duration between onset and admission, timing of CT scanning, abscess location, causative organism, and method of treatment were determined from the medical records. We identified a total of 20 pediatric patients with deep neck abscesses, with a mean incidence of 4.0±1.9 cases per year. Pediatric deep neck abscesses were more common during winter and spring. Most patients initially presented to the pediatric department before consulting an otolaryngologist. Fourteen (70%) patients were male and six (30%) were female, with no obvious peak age of onset. The mean duration between onset and admission was 7.2±3.9 days. The mean timing of CT scanning was 8.1±3.6 days after onset. The most commonly involved area was the retropharyngeal space in nine (45%) and the retro-cervical space in eight (40%) patients. The most frequent causative organism was Staphylococcus aureus (20%), with no cases of antibiotic-resistant bacteria infection observed. Majority of the children were initially managed with conservative treatment. Five patients who failed to improve within 48 h of treatment subsequently underwent surgical drainage. No significant complications such as descending mediastinitis and septic shock were observed in any of the patients.
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Oct · PMID 30035974
In the treatment of adult patients with acute otitis media (AOM), it has been assumed that >65 years of age or living with children attending a day nursery, are background factors for infection with drug-resistant Strept...In the treatment of adult patients with acute otitis media (AOM), it has been assumed that >65 years of age or living with children attending a day nursery, are background factors for infection with drug-resistant Streptococcus pneumoniae (DRSP). However, few reports have discussed the relationship between these background factors and adult patients with AOM. In this study, I reviewed 209 cases of adult patients with AOM in whom S. pneumoniae was detected via myringotomies performed between 1995 and 2015. I retrospectively analyzed the relationship between drug resistance and drug-resistant S. pneumoniae detection frequency on the basis of patient age range, whether patients had been coresiding with children who were attending a day nursery, and, if they were, the age composition of those patients. An extremely high percentage of these cases included patients between 30 and 39 years of age, among whom the number of patients who had been coresiding with children who attended group daycare was significantly higher than the number among those not in that age group. The patients who had coresided with children attending group daycare had significantly higher DRSP detection rates and significantly worse drug resistance than the patients who had not-coresided with children attending group daycare. Furthermore, among the patients who had coresided with children who attending group daycare, those with children <2 years of age had significantly higher DRSP detection rates and significantly worse drug resistance than the patients with children >2 years of age. No significant differences in drug resistance and DRSP detection rates were detected between patients <65 years of age and those >65 years of age. Therefore, we think that during examinations of adult patients with AOM, physicians should always confirm whether the patient is coresiding with children who attend group daycare and, if they are, determin the ages of those children.
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Oct · PMID 30035972
An S-shaped incision is most frequently used for surgeries on benign parotid gland tumors. Surgical procedures using a retroauricular hairline incision (RAHI) for parotid gland tumors was first reported in 2009, but no s...An S-shaped incision is most frequently used for surgeries on benign parotid gland tumors. Surgical procedures using a retroauricular hairline incision (RAHI) for parotid gland tumors was first reported in 2009, but no such case has been reported from Japan. Because RAHI leaves no trace of visible scarring in the face and neck, it is more favorable in terms of cosmetics than an S-shaped incision. We operated on 25 cases of benign parotid gland tumors using RAHI between February 2012 and June 2014. In this report, we give a detailed description of the RAHI procedure, and quantify and compare operative time, bleeding, and complication rate between RAHI procedure and conventional methods. The mean operative time was 150.2 min. Permanent facial paralysis was observed any RAHI case. However, transient facial paralysis was seen in 20.0% RAHI cases, and this value is similar to data reported previously. Because RAHI does not require a preauricular skin incision, unlike S-shaped and facelift incisions, it is difficult to gain an anterosuperior view of the parotid gland. In other words, tumors in the lower pole of the superficial lobe of the parotid gland are the best indication for RAHI. RAHI is a useful approach when performed by surgeons with sufficient experience with standard methods and when surgical indications are accurately determined.
Okuzumi S, Komatsu M, Matsuura M
… +7 more, Chiba A, Arai Y, Aiko K, Nishimura G, Takahashi M, Taguchi T, Oridate N
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Oct · PMID 30035934
The masticator space is located between the masseteric fascia and the pterygoid muscle fascia. Here we report two cases of masticator space abscesses spreading from infections of mandibular teeth. Case 1 is an 85-year-ol...The masticator space is located between the masseteric fascia and the pterygoid muscle fascia. Here we report two cases of masticator space abscesses spreading from infections of mandibular teeth. Case 1 is an 85-year-old lady who were referred to Yokohama City University Hospital with a left-cheek swelling and trismus. An enhanced CT scan revealed an abscess extending from the left infratemporal fossa to the temporal fossa. A purulent discharge was observed from her left lower gingiva. We performed surgical drainage under general anesthesia. After infection control, the affected teeth were extracted. Case 2 is an 82-year-old lady who was administered oral bisphosphonate for osteoporosis. She presented to another hospital with fever, trismus and swelling anterior to the right ear after right lower tooth extraction. Because MRI revealed persistent osteomyelitis of her mandible even after antibiotic treatment, she was referred to us. Enhanced CT showed an abscess in the right infratemporal fossa. After surgical drainage similar to Case 1, antibiotics were administered for approximately 4 months to control the osteomyelitis. It is important to recognize that infections of the mandibular teeth can cause an abscess in the masticator space through the pterygomandibular and infratemporal spaces.