Satoshi Yoshioka

In the 19th century, Politzer devised a method to measure passage of the Eustachian tube (ET) by pressurizing the nasopharyngeal cavity, which marked the beginning of the ET function test. Since then, various examination methods have been developed. While ET function testing is important, recent advancements in diagnostic imaging and treatments have renewed interest on its importance. In Japan, the main objective methods used for examining ET function include tubotympanoaero-dynamic graphy (TTAG), sonotubometry, and the inflation-deflation test. The Japan Otological Society (JOS) Eustachian Tube Committee has proposed a manual of ET function tests, which presents typical patterns of the normal ear and typical diseases and suggests the ET function test of choice for each disease. However, the diagnosis of each disease should be made based on a comprehensive history and various examination findings, with ET function tests playing a supplemental role in the diagnosis.

There are many methods and types of equipment for measuring the nasal airway, but there is no consensus regarding the results of various clinical studies on nasal obstruction. In this review, we discuss the two major methods of objectively assessing the nasal airway: rhinomanometry and acoustic rhinometry. The Japanese standard of rhinomanometry in Japanese adults and children was established by the Japanese Standardization Committee on Rhinomanometry in 2001 and 2018, respectively. However, the International Standardization Committee has proposed different standards because of differences in race, equipment, and social health insurance systems. The standardization of acoustic rhinometry in Japanese adults is making progress in several Japanese institutes, but the international standardization of acoustic rhinometry has not yet begun. Rhinomanometry is the physiological expression of nasal airway breathing, whereas acoustic rhinometry is the anatomic expression. In this review, we introduce the history and methods of the objective assessment of nasal patency and the physiological and pathological issues regarding nasal obstruction.

We report a case of phosphaturic mesenchymal tumor arising in the nasal cavity. The patient was a 38-year-old man who presented to his previous doctor with a 3-year history of progressively worsening bone pain. Laboratory examination revealed high blood levels of fibroblast growth factor-23 (FGF23), and the patient was referred to our hospital for further investigation and treatment. Based on our examination findings, we suspected tumor-induced osteomalacia. Systemic venous sampling for FGF23 and 68Ga-DOTATOC-PET revealed a tumor in the right nasal cavity as the lesion causing the osteomalacia. Complete removal of the tumor resulted in normalization of the blood FGF23 levels and dramatic improvement of the symptoms.

1972年に登場したCTは,生体の中を観察する夢を現実のものとした.耳鼻咽喉科領域においてもその恩恵に預かっていることは論を待たないが,近年,さまざまな革新的な技術が開発され,単に断面を撮影するツールとしての位置づけを凌駕するようになった.新しいCT技術と,その耳鼻咽喉科領域における応用について概説する.1980年代後半,らせん状にスキャンするという現在のCTの基本概念が確立した.一方,2006年頃,ADCTといわれる圧倒的に広い多列検出器を持つ機器が登場した.寝台移動なしに検出器が高速1回転で撮影するため,画像のどの部分でも同じ時相となる.被曝が低減し,極めて短時間で撮影ができる.また,連続スキャンによる動的な撮影(4DCT)が可能である.嚥下動態,呼吸動態,耳管の挙動,発声,関節運動,血流などの機能の評価に使用できる.さらに,本機による超低被曝での撮影は小児において特に有用である.関心領域の近傍に金属がある場合に発生する金属アーチファクトは,従来回避不能であったがこれを低減する技術がMARである.歯科金属の影響を受ける口腔咽頭(中咽頭,舌),唾液腺領域の撮影で威力を発揮する.極めて高精細な描出能を持つCTが2017年に開発された.従来機の倍密度の画素を有し,また小焦点管球を具有することで画像が極めてシャープとなり,最高空間分解能は0.15mmとなった.耳科領域で特に有用であり,耳小骨形態の評価,耳硬化症の診断,真珠腫の進展の態様の評価などに利用できる.舌癌の深達度診断,鼻副鼻腔の微細骨構造などにも有用である.人工知能やDeep learningの活用,デュアルエナジー撮影による画質向上と低被曝化,立位CTによる全く新しい生理学的評価など,次世代のCT技術開発がさらに進行中である.(著者抄録)

＜文献概要＞Point ◎口腔粘膜に発生した炎症により口腔・咽頭の粘膜に発赤,腫脹などの変化をきたすが,奇形や腫瘍にはよらないものを口内炎と呼ぶ.◎単純性(カタル性),アフタ性,潰瘍性に大別され,日常最も遭遇するのはアフタ性口内炎である.◎ほとんどは非特異的な経過で予後良好であるが,遷延・反復する場合はBehcet病をはじめとした特異的な疾患を鑑別する必要がある.

＜文献概要＞Point ◎口腔粘膜に発生した炎症により口腔・咽頭の粘膜に発赤,腫脹などの変化をきたすが,奇形や腫瘍にはよらないものを口内炎と呼ぶ.◎単純性(カタル性),アフタ性,潰瘍性に大別され,日常最も遭遇するのはアフタ性口内炎である.◎ほとんどは非特異的な経過で予後良好であるが,遷延・反復する場合はBehcet病をはじめとした特異的な疾患を鑑別する必要がある.

Severe bronchial asthma is a challenging disorder to treat and can impair quality of life (QOL) under conventional therapeutic modalities. We report the case of a 52-year-old woman with severe asthma associated with eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM). Although the patient was treated with a full dose of inhaled corticosteroid, leukotriene receptor antagonist (LTRA), theophylline, burst use of oral corticosteroids (OCS), her asthmatic condition aggravated, disrupting her daily life. ECRS and EOM symptoms were also getting worse despite treatment with topical application of corticosteroids to the nose and ears, LTRA, and occasional use of OCS. In addition to asthmatic symptom, the patient always suffered from intractable nasal obstruction and hearing disturbance, which contributed to the heavily impaired QOL. However, the administration of benralizumab showed rapid and remarkable improvement not only in her asthmatic conditions but also in the symptoms of ECRS and EOM within a month. These results suggest that the use of benralizumab for the treatment of severe asthma with intractable ECRS and EOM should be considered when the patient's QOL is severely deteriorated.

Objective: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. Design: Cross-sectional. Setting: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. Patients: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. Main Outcome Measures: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. Results: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant’s ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group (P =.0027). The organ-absorbed radiation doses were relatively lower than those previously reported. Conclusions: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable.

<title>Abstract</title> Background The aims of this study were to perform a four-dimensional assessment of velopharyngeal closure function in pediatric patients with cleft palate using 320-row area detector computed tomography (CT), and to estimate the organ-absorbed doses using Monte Carlo simulation. Methods We evaluated CT image data obtained between July 2018 and August 2019 from five pediatric patients with cleft palate (four boys and one girl; age range, 4–7 years) at Fujita Health University Hospital. The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area of VPI were evaluated. In addition, organ-absorbed doses were assumed in the Monte Carlo simulation. However, we did not perform statistical analysis because of the insufficient number of patients enrolled in this study. Results The existence of VPI and hypernasality were completely concordant. The VPC patterns were circular (two patients), circular with Passavant’s ridge (one patient), and unevaluable (two patients). The organ-absorbed doses were relatively lower than those in past reports. Conclusions Our method could be an alternative for patients who refuse the conventional nasopharyngoscopic evaluation.

咽頭痛は日常の臨床において高頻度に遭遇する愁訴である。多くは急性扁桃炎や急性咽頭炎といった、非特異的な上気道感染症の病態であるが、特異的感染症や、他の腫瘍性疾患、自己免疫疾患など多様な鑑別すべき疾患が挙げられる。本稿では口腔・咽頭の疼痛への対応について、感染症を中心に概略を解説する。急性扁桃炎では、起炎菌の推定と重症度に応じた対応が望まれる。扁桃周囲膿瘍は視診や画像所見から膿瘍の存在を診断し、穿刺もしくは切開排膿が行われる。特異的な感染症として伝染性単核球症、他のウイルス性疾患などが挙げられ、しばしば遭遇するものとして放線菌症が挙げられる。近年増加している性感染症への留意も必要である。また、悪性腫瘍にも留意しつつ対応が望まれる。これらの原疾患に対する丁寧なマネジメントとともに、全身状態の管理とともに、患者のQOLを著しく損なう疼痛に対してもそれぞれ適切な対処が求められる。(著者抄録)

Background: Nasopharyngoscopy is a common method to evaluate velopharyngeal closure in patients with cleft palate. However, insertion of a fiberoptic nasopharyngoscope causes discomfort in patients. The aim of this study was to estimate the reliability of short-time exposure images obtained using 320-row area detector computed tomography (320-ADCT) as a novel evaluation method for the assessment of velopharyngeal function. Methods: We evaluated five healthy adult volunteers and five postoperative adult patients with cleft palate. During a 3.3-s imaging exposure, the participants were asked to perform two tasks: nasal inspiration and subsequent oral expiration through a catheter into a water-filled cup. The movement of the velopharyngeal structures was recorded during each examination, and the presence of velopharyngeal insufficiency (VPI) and velopharyngeal closure (VPC) patterns were estimated. If VPI was detected, the cross-sectional area was also calculated. Cohen's kappa and weighted kappa coefficients were used to evaluate the concordance of nasopharyngoscopy and 320-ADCT evaluation. Results: Speech pathology evaluation did not reveal hypernasality in any study participant. Micro-VPI was detected by nasopharyngoscopy in one healthy volunteer and two patients. 320-ADCT detected micro-VPI in two more patients. The cross-sectional area of the VPI in these subjects ranged from 2.53 to 16.28 mm2. Nasopharyngoscopy and 320-ADCT were concordant in detecting VPI in eight participants (κ = 0.6) and in assessing VPC patterns in nine (κ = 0.82). Moreover, images obtained using 320-ADCT allowed for reduced dead angle and, thus, easy detection of micro-VPI and Passavant's ridges. Conclusion: Although the radiation exposure cannot be ignored, our novel evaluation method using 320-ADCT enables more detailed evaluation of VPC than nasopharyngoscopy. Future studies should investigate the relationship between 320-ADCT findings and speech pathology evaluations.

＜文献概要＞Point ▼医学用語としての「かぜ症候群」は,上気道,すなわち鼻腔から喉頭までの急性炎症による症状を呈する疾患であり,特に同部位の非特異的カタル性炎症のことを指す。▼概して自然治癒傾向をもつものを指した病名であり,特別な医学的治療を必要とせず,比較的短期間で回復するものを同症候群と呼ぶことが多い。▼診断にはまず臨床所見が大切である。症状の確認や,来院時における周囲の流行状態も参考にする。かぜ症候群を初発症状とした特異的疾患の鑑別も大切である。▼対症的に治療を行い,ウイルスに効果のない抗菌薬の使用は慎む。

Patulous Eustachian Tube (PET) is of increasing importance in otology. However, despite the abundance of diseases requiring a differential diagnosis from PET, such as superior semicircular canal dehiscence syndrome, perilymphatic fistula, acute low-tone sensorineural hearing loss, etc., there are currently no established diagnostic criteria for PET. In view of these circumstances, the Japan Otological Society (JOS) Eustachian Tube Committee proposed the diagnostic criteria for Patulous Eustachian Tube in 2012, in order to promote clinical research on PET. A revision was made in 2016, maintaining the original concept that the criteria should be very simple, avoid any contamination of “Definite PET” with uncertain cases. Moreover, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings (“Possible PET”). The criteria can be used by all otolaryngologists even without using the Eustachian tube function test apparatus. However, the use of such an apparatus may increase the chances of detecting “Definite PET”. The algorithm for the diagnosis of PET using the criteria has also been described. The JOS diagnostic criteria for Patulous Eustachian Tube will further promote international scientific communication on PET.

<p>Despite apparent ability of computed tomography (CT) in clinical practice, otology, which requires diagnosis and treatment of variaous diseases involve very small areas and sometimes entails a limitation on the performance of CT in depicting lesions located in such areas. Recently, ultra-high-resolution (UHR) CT, which can provide images at dramatically higher spatial resolution than ever before, has been developed and has become commercially available. UHRCT has a pixel size (0.25×0.25 mm) twice comparing dense in both vertical and horizontal directions as conventional high-resolution (CHR) CT and the maximum spatial resolution of 0.15mm or less in the axial direction. The maximum size image is 2048×2048 pixels. Here, we report our experience of the early stage development of UHRCT in the field of otology.</p><p>We performed UHRCT scan in otology patients and compared the images obtained from UHRCT with those obtained from CHRCT. Spatial resolution in UHRCT images was obviously improved. Tiny structures, such as the chorda tympani and ossicles, and small pathological changes caused by the progression of otitis media, etc. were clearly depicted. Due to an increase in the partial volume effect, improvements such as the performance of UHRCT in depicting soft-tissue lesions or lesions adjacent to the bone, were considered to be difficult to depict at CHRCT.</p><p>The tiny structures which had been indistinct before, became clearly visible due to UHRCT, indicating the possibility of providing important information for clinical practice. However, because the issues include the necessity of building infrastructure (including display) and a powerful computer system enough to save and handle huge volume of data, it is necessary to examine the further usage of UHRCT in the future.</p>

Herein, we report a case of pharyngeal/cervical trauma sustained due to an epileptic attack that developed while the patient was brushing her teeth. The patient was a 20-year-old woman with schizophrenia and epileptic psychosis, who was hospitalized at a local psychiatric hospital. She lost consciousness while brushing her teeth and fell down. A toothbrush was observed in the pharyngeal cavity and the patient was transported to our hospital for emergency treatment. The toothbrush was visualized by endoscopy; the brush side of the toothbrush was embedded in the right piriform sinus and the handle side had migrated into the pharynx. CT revealed subcutaneous and mediastinal emphysema and the brush located beside the right brachiocephalic artery. An emergency operation was performed on the same day; a tracheotomy was initially performed under intravenous anesthesia, followed by removal of the pharyngeal/cervical foreign body through a cervical incision under general anesthesia. The toothbrush had penetrated the right piriform sinus and reached the right brachiocephalic artery along the right common carotid artery. The tracheal fistula was closed on the 11th day after surgery, with oral intake by the patient resumed on the 25th day, and the patient transferred to the hospital psychiatric ward on the 41st postoperative day. It might be difficult to provide medical care smoothly for adults with severe mental illness.

中耳から補聴器のイヤモールド印象材を手術的に除去した2症例を報告した。症例1は持続的な耳漏を主訴とする78歳男性。当初は慢性中耳炎と診断され保存的療法を受けていたが耳漏の改善は見られなかった。その後の検査で鼓室に異物を認め、その異物の素材分析により印象材であることが判明した。その後の問診で患者は約15年前に補聴器のイヤモールドを調製したことを思い出し、鼓室形成術を受けて異物除去に成功した。症例2はcanal wall down型鼓室形成術を受けた84歳女性で、左耳に印象材を注入されたが、その除去を受けていなかった。検査で乳突腔に埋入した印象材を認め、耳介後部の切開による異物を摘出した。いずれの症例でも、患者の病歴の問診、鼓膜の十分な検査、術後の補聴器フィッティング関連のリスクへの注意、ならびに不注意による補聴器フィッティング時の印象材押し込みの回避が重要になると考えられた。

<p>Determining the correspondence between points on the area–distance curve derived from acoustic rhinometry and the anatomical landmarks in the nasal and nasopharyngeal airway is important for the clinical evaluation of obstructive sleep apnea in children. In this study, area–distance curves derived from acoustic rhinometry (SER-2000; Rhino Metrics Co., Ltd., Denmark) were measured in a life-size, artificial, soft-silicon, upper-airway model of a healthy 5-year-old child (Koken Co., Ltd., Japan). We created obstacles in both the nasal cavity and nasopharynx with clay, simulating various grades of adenoid hypertorophy. On the area–distance curve, the anterior portion of the inferior turbinate corresponded to the region between the second notch and third peak, the posterior end of the nasal septum corresponded to the third peak, and the adenoid corresponded to the region from immediately after the third peak to 8 mm posterior to the fourth notch. The measured adenoidal volume matched the actual volume of the simulated adenoid; however, the measured airway volume of the nasopharynx according to acoustic rhinometry was far greater than the actual volume of the model. We conclude that the landmarks identified on the area–distance curve and the changes in adenoid volume measured with acoustic rhinometry have potential clinical application. However, acoustic rhinometry measurements of nasopharynx airway volume could be improved.</p>

耳管は中耳における換気、異物排除、病原体からの防御といった機能を持ち、これらの障害によって各種疾患が惹起されるため、その形態学的評価は重要である。耳管は顔面深部に位置するため、管腔および周囲組織の形態学的評価に、CTやMRIの果たす役割は大きい。CTは耳管および周囲組織を高分解能、高速で描出することができ、バルサルバ負荷をかけると特にオリエンテーションがつきやすい。MRIは周囲組織を評価することができる。各画像診断ツールの特徴を解説し、次に耳管骨部・軟骨部の正常画像解剖についてそれぞれ詳説した。撮影においては、耳管の走行角度を意識して撮影し、耳管に沿って各部位を多断面再構成像(MPR)で描出・把握することが大切である。さらに耳管狭窄・閉塞例および耳管開放症症例について、実際の症例を呈示しながら詳説した。各部位の画像解剖を把握し、留意するポイントを把握したうえで、適切に読影することが重要である。(著者抄録)

<p>We report a case of bronchial foreign body which remained lodged over a long term. The patient was an infant boy aged 1 year and four months. He was brought to our hospital for a cough that had persisted for four months. He had been treated for pneumonia, but did not heal. By CT we diagnosed a bronchial foreign body in the chest and removed it by bronchoscope. The foreign body was cellophane tape. We believe that diagnosis of a bronchial foreign body was delayed because of the X-ray permeability of this particular foreign body, combined with failure of the doctor undertaking the initial medical examination to suspect a bronchial foreign body.</p>

Here we report a case of mucoepidermoid carcinoma of the parotid gland accompanied by invasion through an unusual route. A 46-year-old female visited our department complaining of a growth in the external auditory canal and a purulent discharge. She had no swelling in her parotid region. Repeated biopsies of the external ear revealed inflammatory granulations and they made it difficult to point out the neoplasm. Contrast enhanced CT and MRI findings showed a solid tumor of the parotid gland that extended to the cranial side of the gland. Finally, a low-grade mucoepidermoid carcinoma that had originated in the upper pole of the parotid gland had progressed to the external auditory canal via "Santorini's fissures," which is a notch in the cartilage of the auditory meatus. Both otolaryngologists and pathologists should pay attention to this kind of unusual route taken by a parotid gland tumor invasion.

<p>We presented our experienced, 44 year-old female, rare and severe case with lingual tonsillitis and multiple cysts infection of epiglottis which was necessary for receiving the tracheostomy.</p><p>The urgent tracheostomy was very useful for the patient. Against the hypertrophy of lingual tonsils and multiple cysts of epiglottis, we adopted lingual tonsillectomy and total removal of epiglottic multiple cysts by using KTP laser equipment.</p><p>In conclusion, we, otolaryngologist, should be familiar with the surgical procedure of urgent tracheostomy and will recommend for using the KTP laser against lingual tonsillectomy, because of the effect of bleeding stoppage being high and the operability being good.</p>

小児の耳管の成人との相違を形態面・機能面から概説した。形態的には、小児の耳管は短く、耳管咽頭口が小さく、耳管軟骨部が平坦である。機能的には、過度なコンプライアンスをもち、圧負荷による通過は良好であるのにフレーム構造は脆弱なため、陰圧や炎症で容易に閉塞し、能動的に開大しにくい。小児では中耳疾患が高頻度に発生するが、これらの特徴にその要因がある可能性がある。胃食道逆流現象の関与や特殊症例についても触れる。(著者抄録)

We conducted a retrospective epidemiological survey to clarify the current status of otitis media with effusion (hereafter, OME) at the time of primary cleft palate surgery at our otorhinolaryngology department. We selected a total of 227 patients (118 boys [52%], 109 girls [48%], mean age: 1. 89±0. 4 years old) who had undergone primary cleft palate surgery at the oral surgery department of our hospital during the 5-year period from December 2006 to November 2011. At our hospital, two-stage surgery is adopted for palatoplasty, and the primary surgery is usually performed when a patient is around one and half years old. Basically, all the patients undergo medical examination at the otorhinolaryngology department before palatoplasty, and any patients detected to have OME are subjected to myringotomy or ventilating tube insertion at our department." The prevalence of OME during the primary cleft palate surgery was about 60%. No relation was observed between the presence or absence of OME and the presence or absence of any factors, such as the type of cleft palate, gender, height, weight, or associated malformation. The morbidity of OME was significantly higher in the patients who had consulted a previous otorhinolaryngologist before visiting our department. Thus, the effectiveness of preoperative diagnosis of myringotomy was demonstrated. There were many cases of myringotomy, while cases of ventilating tube insertion accounted for only 16%, less than that reported from many other facilities. Since our department has conventionally limited medical treatment of OME to myringotomy, we actually had a low rate of it this procedure. The pros and cons of tube insertion are controversial, therefore, further consideration would be necessary to identify the factors influencing the occurrence of OME and to decide or validate the treatment course.

OBJECTIVE: The Eustachian tube is difficult to evaluate because it is located deep in the head. However, the introduction of 320-row area detector CT has made it possible to evaluate this region. In the present study, movement of the Eustachian tube during sniffing was visualized using area detector CT in patients with patulous Eustachian tube. METHODS: Four patients with patulous Eustachian tube were examined using an area detector CT scanner (Aquilion ONE, Toshiba). This scanner supports 320-row scanning of 0.5-mm slices at up to 0.275 s/rot., eliminating temporal mismatch between various parts of the acquired images and permitting 4-dimensional CT (4DCT) images to be obtained by continuous scanning. The scan conditions were 120 kV, 120 to 150 mA, 0.5 mm × 280 to 320 slices, and 0.35 seconds per rotation × 9 rotations. The patient was seated on a reclining chair tilted to 45 degrees and was instructed to sniff during continuous scanning. Images of the Eustachian tube were generated at 0.1-second intervals. CONCLUSION: At the start of sniffing, the cartilaginous portion of the Eustachian tube closed from the isthmus toward the pharynx. The starting point differed from patient to patient. In patients with patulous Eustachian tube, sniffing (an unconscious habit that helps to relieve ear discomfort) is an important factor in the development of middle ear diseases. We have successfully depicted this event for the first time, demonstrating various patterns of Eustachian tube closure during sniffing in patients with patulous Eustachian tube. This method may be useful for evaluating Eustachian tube dysfunction. Copyright © 2013 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.

Although modern multislice CT systems can quickly scan a wide range in fine detail, the high exposure dose and long examination time of CT studies are still important issues. CT is therefore generally considered to be unsuitable for screening. This is particularly true for pediatric patients, who are especially sensitive to radiation, and plain radiography is therefore frequently selected for examination of the temporal bone. We have developed an ultra-low-dose CT imaging method using a 320-row area detector CT (ADCT) scanner that may be suitable for screening for diseases of the ear even in pediatric patients.<BR>Temporal bone specimens were scanned with an ADCT scanner (Aquilion ONE^<TM>, Toshiba Medical Systems, Otawara, Japan) using various scan conditions. Image quality was evaluated, and the optimal scan conditions providing clinically acceptable images at the lowest possible exposure dose were identified. A human-body phantom was then scanned with ADCT using these scan conditions. Plain radiography using the Schu..ller method was also performed for the same phantom to acquire images of the temporal bones bilaterally. The CT and radiographic exposure doses were compared to assess the suitability of our ADCT method for screening.<BR>The gantry of the ADCT scanner includes an X-ray source unit and a detector (area detector) which is several times larger than that used in a conventional CT system. Three-dimensional data can be acquired over a wide range in a single high-speed rotation, making it possible to quickly obtain images in the same temporal phase.<BR>As the results, the optimal scan conditions were found to be tube voltage 100 kV, tube current 10 mA, and exposure time 1.5 s/rot. by 1 rotation. The CTDIVOL (standard dose) was 1.7 mGy, which is 0.7% of the usual value of 243.4 mGy. The maximum skin dose to the head in plain radiography of the temporal bones bilaterally was 2.12 mGy on average. The maximum skin dose to the external ear in CT scanning with the above conditions was 1.59 mGy on average, which was lower than that for the Sch&uuml;ller method. However, the dose in CT scanning was slightly higher at the front and rear.<BR>With our proposed CT imaging method, images are acquired in a very short time, three-dimensional image data is obtained, and the exposure dose is equal to or lower than that of plain radiography. This method is therefore expected to be a useful new tool for morphological screening examinations.

ヒト乳頭腫ウイルス(HPV)関連中咽頭癌はHPV非関連癌と比べ、化学療法や放射線治療に対する感受性が高く予後良好であるが、その理由は明らかでない。フルオウラシル(5-FU)の標的酵素であるThymidylate synthase(TS)の腫瘍内の過剰発現は、5-FUに対する抵抗性や予後不良因子となることが多数の癌腫で報告されている。そこで、当科で一次治療を行った未治療中咽頭癌54例を対象に、HPV感染とTS発現の相互関係および臨床像との関連について検討した。HPV陽性は22例(40.7%)、HPV陰性は32例(59.3%)で、TS高発現は25例(46.3%)、TS低発現は29例(53.7%)であった。TS高発現例の76.0%がHPV非関連癌(p=0.02)で、84.0%が多量喫煙者(p=0.012)であった。5年累積粗生存率はHPV陽性例で77.3%、HPV陰性例では29.0%とHPV陽性例が有意に予後良好であった(p=0.006)。また、TS高発現例が31.9%に対しTS低発現例は60.7%と予後良好であるも有意差は認めなかった(p=0.12)。多変量解析により早期のT、N stage、およびHPV陽性が独立した予後良好因子となっていた。結果として、TS発現と中咽頭癌治療の奏功性や予後との関連は認められなかったが、TSは興味深いバイオマーカーであり、その発現機序の解明が必要と思われた。(著者抄録)

For treatment of adenoid cystic cancer generated in the cervical trachea, we experienced a case in which extirpation was executed with a percutaneous cardiopulmonary support system (PCPS).<br>The case was a female 69 years of age. Her major complaints at initial visit were uncomfortable feeling in the pharynx and hoarseness of voice. Since no appreciable cause was observed in the pharynx or larynx, she was monitored at the internal medicine department. However, when stridor and respiratory discomfort worsened, she revisited our department after two months. We suspected an upper airway lesion and confirmed a tumor in the trachea right under the glottis by referred CT and bronchoscopy, and we found it was generated from the anterior wall and occupied a 4/5 radius of the inner cavity. We considered it might be difficult to execute intratracheal intubation and tracheotomy;therefore, we determined to use PCPS. In the surgery, we executed a transverse incision in the trachea at the fifth tracheal ring and confirmed the tumor from the lower side. We acquired a diagnosis of adenoid cystic cancer by intraoperative rapid pathological diagnosis. We removed approximately 1/3 around the trachea anterior wall side and confirmed a tracheal fistula with a height of the first-fifth tracheal ring. There was a positive margin in the upper anterior wall side. We executed a rigid reconstruction with the local flap using cartilage of the right ear after postoperative radiation therapy. Recidivation is not recognized at present.<br>A tracheal tumor is a relatively rare disease, but it would already have become enlarged and difficult to treat if found after increased respiratory discomfort. In addition, careful planning and treatment are necessary for some regions;but in this case it was considered a safe and assured operation would be possible by PCPS.

ラテックスアレルギー(以下LA)を有する掌蹠膿疱症患者に対して全身麻酔下に扁桃摘出術を行い、無事に治療を完遂しえたので報告した。周術期にはLAを防ぐために次のような対策を実施した。1)手術室の扉に「LA患者」と表示し、関係スタッフ以外の出入りを制限するとともに、予め手術室の換気を十分に行った。2)手術器具をまとめる輪ゴムを紐に変更した。3)麻酔器やスタッフの手袋、駆血帯などはラテックスフリーの製品を使用した。4)血圧計のマンシェットが直接皮膚に接しないように布を巻いた。5)病棟に入院中は、交差反応を有するとされるバナナやアボカドなどを食事から排除した。6)術後出血に備え、ラテックスフリーの止血器具(バイポーラ)を用意した。

Since impairment of functions of the Eustachian tube can lead to various diseases of the middle ear, it is considered that morphological and functional evaluation of the Eustachian tube is of clinical importance. However, it has been difficult to evaluate the Eustachian tube because it is located deep in the head, and most of the morphological studies conducted in the past have been based on the examination of specimens obtained from cadavers. One limitation of such studies is that dynamic processes in the living body cannot be evaluated. Multislice CT permits the Eustachian tube to be evaluate greater detail in living subjects and has provided new findings in morphological studies. Furthermore, the latest Area Detector CT systems allow dynamic studies to be performed. This report describes the basic principles of this examination technique and presents the latest findings obtained by analysis of the morphological and functional characteristics of the Eustachian tube using Multislice CT and Area Detector CT.