Revision Myringoplasty Using Thin-Sliced Cartilage for Postoperative Reperforation in Patients with Chronic Otitis Media

鼓膜形成術は耳科手術の基本的手技の1つであり，聴力改善のための重要な術式である．移植片には一般的に側頭筋膜が用いられるが，10～20%の症例で再穿孔が起こり，一度再穿孔を来した例では再度手術を行っても穿孔を繰り返す場合が多い．今回われわれは術後鼓膜再穿孔を来した慢性中耳炎患者7例8耳（男性3例，女性4例，13～80歳（平均53.9歳））に対する修正手術として，軟骨を移植片とする鼓膜形成術を行った．軟骨は耳珠から採取し，片面に軟骨膜を付けたまま0.3 mm厚に薄切した．大きさ・形状をトリミングした後，軟骨膜の付着面を外側にして鼓膜穿孔部にアンダーレイし，フィブリン糊で接着・固定した．前回手術の術式は，鼓室形成術Wullstein Ⅰ型が5耳，接着法による鼓膜形成術が3耳であり，移植片は7耳で側頭筋膜，1耳で皮下組織であった．術後経過観察は16～44ヶ月（平均30.0ヶ月）で，穿孔閉鎖率は87.5%であった．最終聴力成績は，術後聴力レベル≦30 dB，聴力利得≧15 dB，術後気骨導差≦15 dBのいずれかに該当するもの（日本耳科学会の基準に基づく聴力成績の成功例）は5耳（62.5%）であった．以上より軟骨は，術後再穿孔耳に対する鼓膜形成術に用いる移植片として，安定で優れた素材であると考えられた． Myringoplasty is one of the basic procedures in otologic surgery, and is important to achieve good hearing outcome. The temporal fascia is most widely used and considered to be a stable graft in this procedure, although 10-20% of patients develop reperforation after surgery, which is often hard to repair, even by revision surgery. We herein conducted revision myringoplasty using a cartilage graft to repair postoperative reperforation in 7 patients (8 ears) with chronic otitis media. The patients were 3 males and 4 females, aged 13-80 years with an average of 53.9 years. A cartilage graft was harvested from the tragus, sliced in 0.3 mm thickness with perichondrium attached on one side, and trimmed into an appropriate shape and size. The graft was then underlaid beneath the perforation and fixed with fibrin glue. The operation was Wullstein type I tympanoplasty in 5 ears and myringoplasty in 3 ears, using the temporal fascia in 7 ears and subcutaneous tissue in 1 ear. The postoperative follow-up period ranged from 16 to 44 months with an average of 30.0 months. Perforation of the tympanic membrane was successfully closed in 7 ears (87.5%). Hearing outcome was judged successful in 5 ears (62.5%) according to the criteria of the Otological Society of Japan (postoperative hearing level 15 dB, or postoperative air-bone gap < 15 dB). These results indicate that cartilage is a stable and reliable graft material for revision myringoplasty to repair postoperative reperforation in patients with chronic otitis media.journal articl

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)BACKGROUND: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. METHODS: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 >/= 0.60 during hyperoxemia). RESULTS: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). CONCLUSIONS: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. TRIAL REGISTRATION: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

ダイチョウ ガン テンイ キコウ ニ カンスル キソテキ オヨビ リンショウテキ ケンキュウ

京都大学0048新制・課程博士博士(医学)甲第9433号医博第2446号新制||医||790(附属図書館)UT51-2002-G191京都大学大学院医学研究科外科系専攻(主査)教授 鍋島 陽一, 教授 千葉 勉, 教授 山岡 義生学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

A Complete Response Case in a Patient with Multiple Lung Metastases of Rectal Cancer Treated with Bevacizumab plus XELIRI Therapy

It has been reported that many patients with lung metastasis of colorectal cancer (CRC) underwent chemotherapy with fluorouracil, folinic acid, oxaliplatin, irinotecan, or capecitabine. There is a small number of reports about the capecitabine and irinotecan (XELIRI) plus bevacizumab (BV) therapy for patients with metastatic CRC in Japan. We report a case of successful BV+XELIRI therapy for rectal cancer with multiple lung metastases as first-line chemotherapy. A 53-year-old female presented with advanced rectal cancer and metastatic lung tumors. Following surgery, the patient was treated with XELIRI+BV. After 6 courses, a computed tomography scan showed complete response of the lung metastases. No recurrence has occurred for 3 years after chemotherapy was stopped