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Education of New Otolaryngologists Regarding Otitis Media with Effusion to Enhance Their Understanding of Eustachian Tube Dysfunction
Get PDF浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集〜症例から学ぶ〜Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of MedicineObjective and method: From the viewpoint of new otolaryngologists, cases of otitis media with effusion (OME) caused by Eustachian tube dysfunction tend to be overlooked, while the mechanism of OME is gradually understood. Children in lower grades with tonsillitis, adenoid hyperplasia, sinusitis, and an immature Eustachian tube have been encountered. Children in upper grades with a habit of sniffing (HS), presenting for treatment by general practitioners, are also encountered. The training involved one case where insertion of a tympanic ventilation tube was requested by the general practitioner and another case with atelectasis. The conditions of the patients were assessed based on interviews, eardrum views, and assessment of the degree of ventilation of the Eustachian tube.
Result: The condition of children in lower grades improved with conservative treatment, and the condition of children in upper grades improved with cessation of HS.
Discussion: According to the 2015 medical treatment guidelines of OME, tympanic ventilation tubes should be inserted in cases of atelectasis, based on recommendation level A. However, the condition of the patients has been shown to improve with cessation of HS. Young otorhinolaryngologists often perform the insertion of tympanic ventilation tubes. It is important to consider not only the phenomena of hearing loss and exudate retention in the tympanum, but also the mechanism of exudate retention. We should make a careful judgement about whether to insert tympanic ventilation tubes or not, because the complications of tympanic ventilation tube insertion cannot be ignored.journal articl
先天性サイトメガロウイルス中枢感染
Get PDF大脳は先天性ヒトサイトメガロウイルス（human cytomegalovirus：HCMV）感染において重要な標的臓器である．神経前駆細胞は脳細胞の中でHCMVに対する感染感受性が最も高く，ウイルス増殖性・細胞溶解性感染を呈し，感染細胞は死滅する．妊娠初期(~15週)では脳室壁の神経前駆細胞の増殖・分化・移動による脳形成―大脳皮質板形成―が最も旺盛で，この時期に感染すると脳障害の頻度が高く小頭症等の重篤な脳奇形を発症し易い．マウスCMV(MCMV)を用いた胎内感染モデルでも同様の結果が得られている．一方，マウス新生仔脳内感染モデルでは，発育期大脳神経細胞において細胞破壊を伴わない一過性で特異な持続感染が認められる．この様な感染で機能障害を伴った神経細胞がその後も生存し，神経精神発達障害の要因となる可能性がある．同様の感染をヒト先天性HCMV感染症で明らかにした報告は未だなく，今後の検証が期待される．journal articl