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  • About The Angina Epiglottica

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會厭軟骨部ニ限局スル原發性急性炎症ハ比較的稀ナリ.余ハ最近二年間ニ京都府立醫大耳科教室ニ於テ,該患者六名ヲ觀察シタレバ,其概要ニ付キテ述ベタリ.該患者ハ何レモ皆從來健康ナリシ成人ニシテ,突然咽頭痛,嚥下困難及發熱ヲ以テ發病シ,他覺的所見ハ會厭軟骨舌面ニ於テ著明ナリ.而シテ消炎療法ニヨリ,化膿スルニ至ラズシテ,其儘炎症ノ消退セルモノアルモ,其多クハ舌面ニ於テ,限局性ノ膿瘍ヲ形成セリ.而シテ何レモ豫後佳良ニシテ,自開或ハ切開ニヨリ發病後十數日ノ經過ヲ採リテ全快セリ.然レドモ該部位ヨリ其他ノ部位ニ炎症ノ蔓延シ,或ハ喉頭軟骨膜炎等ヲ招來スルコトナシトセザルヲ以テ本症患者ニ遭遇スルトキハ輕々ニ之ヲ看過スルコトナク周到ナル注意ヲ拂ヒ適當ナル治療ノ途ヲ講ジ,合併症ノ續發ヲ未然ニ防止スルニ努メザルベカラズ.而シテ患者ガ咽頭痛及ビ強キ嚥下痛ヲ訴ヘ其口腔並ニ口狭,口部咽頭等ニ他覺的變化ノ顯著ナルモノヲ見ズシテ自覺症ヲ説明スルニ苦ム時ハ必ズ喉頭鏡檢査ヲ行ヒ以テ本症ヲ看過セザル樣注意セザルベカラズ.而シテ本症ノ成因ニ關シテハ,此處ニ明言スルヲ得ザルモ,會厭軟骨舌面ノ食物嚥下時ニ損傷セラレ易キ解剖的位置關係ヲ有シ,加之其舌面ノ粘膜下織ハ喉頭各部位中最モ緩粗ナルヲ以テ,食物嚥下時ニ際シ,極メテ輕度ノ損傷ヲ蒙リ,此處ニ傳染ヲ招來シ以テ本症ヲ喚起セシモノト思惟スルヲ以テ穩當ナリト信ズ.
If we summarize the above-mentioned six cases, we may say that in each case the patient had been a healthy adult, who was suddenly attacked by a sore throat, accompanied by the difficulties of swallowing, and the bodily temperature going up to 37,3℃-38,5℃. The local observation showed that the mucous membrane of the epiglottis on the laryngeal surface was slightly reddened and swollen, while the reddening and swelling of the mucous membrane on the lingual surface was rather severe and remarkable, producing a state of oedema. In the first, the second, and the third cases any extraordinary symptom was hardly noticed but a pain by pressure at the lymphatic gland of the neck. No remarkable acute inflammation was detected at the vocal cords, the oral cavity, the pharynx, and any other part else of the larynx except the epiglottis. Moreover, there was no abnormal symptom by objective observation at any part of the body. Thus, the inflammation, limited chiefly to the epiglottis, especially to the lingual surface, increased gradually; and in the first, the second, and the fifth cases the swollen part of the epiglottis on the lingual surface was opened of itself between on the 4th and 6th days. In the third case the pus was discharged by operation. In the fourth and sixth cases it was proned to disappear by means of antiphlogistic treatment instead of undergoing the process of suppuration. Thus in all the cases the subjective symptoms obviously decreased without any complication, and then they almost completely disappeared in about two weeks since the outbreak of the disease, leaving a slight objective symptom or none behind; and finally in the course of time they came to retain no traces. Now, the purulent laryngitis may sometimes take place as so-called the spontaneous phlegmon of the larynx owing to the injury of the affected part, or the invasion of micrococcus pyogenes from the ulcerated surface, or the transmission of micrococcus pyogenes into the larynx from the suppurative focus in the other distant bodily parts, or in case of an acute infectious disease; and yet it is generally due to such inflammations that occur in the parts near the larynx as phlegmonic angina, peritonsillar abscess, suppurative lymphangitis, suppurative thyreoiditis, phlegmon of the neck, angina ludovici, retro-pharyngeal abscess etc., which spread as far as the larynx and attack it. In the first, the second, and the fifth cases we observed the swell and the pain by pressure at the lymphatic gland of neck besides the inflammation of the epiglotic part, and there is no doubt that the former occured succeeding to the latter, judging from the course of the symptoms, and that the inflammation originated acutely in the epiglottic part, for there was no phenomenon that another inflammation existed and spread to the larynx. Moreover, we could ascertain by the history of the disease that it was not due to the local ulceration or infectious diseases. It is an important question to be inquired by all means whether the afore-said inflammation is perichondritis of the epiglottis or an inflammation of the soft stratum covering it. Let us inquire a little further into the matter. The epiglottis is naturally different from the other cartilage in the anatomical character, for the perichondrium attaches tighty to the cartilage, and moreover the glandular tissues and the bloodvessels are found running through the substance of the cartilage, and accordingly the manner of its suporting nutrition is quite different from that of the other laryngeal cartilage whose nutrition is furnished only by the perichondrium. Therefore it may be impossible to disown the perichondritis at once, even if any discharge of pieces of the demolished cartilage should not be perceived in case of the inflammation of the epiglottic part. In the above-mentioned cases, the inflammation which originated at the epiglottic part is presumed to be an acute inflammation at the soft stratum, causing sometimes the submucous abscess, by judging from the facts that the disease was almost recovered with rather a short cource on account of the spontaneous rupture or the operation, and that the prognosis was so good as to leave no deformity or motile obstruction. It goes without saying that the original cause was the micrococcus pyogenes, but where should we look for the incentive? Mr. Caz made a report concerning two cases of the phlegmon limited to the fossa glosso-epiglottica, which was analogous to our cases. Messrs. Friedman and Greenfield have recently stated likewise about two cases very like our cases in the points of the manner of falling sick, local aspects and the course etc. These authors supposed that the injuries in case of swallowing might have to do with the outbreak of the disease. According to Leichtenstern, the acute and limited inflammation at the larynx may be regarded furunculosis laryngis diabetica, and analogous to furunculoris in the skin, for in diabetics a single or a multiple abscess is sometimes occasioned owing to the chemical toxin, the produce of metabolism-anomaly. Mr. Chiari said that the acute submucous inflammation that originated at the larynx might be regarded as a sort of glandular inflammations. If the above-mentioned opinions by Chiari and Leichtenstern could be applied to our cases, it would necessarily follow that the inflammation causes the abscess not only at the lingual surface, but also at the laryngeal surface. As the submucous tissues of the lingual surface are the most rough and loose of those in all the parts of the larynx, and the epiglottis is projected into the pharyngeal cavity, the anatomical relations make the lingual surface liable to be injured in case of swallowing. Taking the above-mentioned points into consideration, we rather agree with the opinions of Friedman and Greenfield more than those of Leichtenstern and Chiari, for it may be proper to judge that in our cases the lingual surface of the epiglottis was slightly injured on the occasion of swallowing food, and thus by infection giving rise to an acute inflammation and the formation of abscess. When we deal with such a patient, we must apply suitable treatments with deliberate circumspection and try to prevent complications to come; for it is possible the limited inflammation at this part may spread to plica ary-epiglottica or plica pharyngoepiglottica, which is loose and rough of submucous tissues, and prevail to the farther parts or cause perichondrits; even though a disease of this sort often tends to recovery by a spontaneous rupture or operation after the usual process of suppuration or formation of abscess in addition to it, and the other is also frequently prone to be healed to the disappearance of the inflammation, in stead of causing purulence, by an early examination and antiphlogistic treatment, and in either case it came to recovery with good prognosis in about two weeks. And we must take care not to overlook this disease, examining closely the deep part of the pharynx, especially the state of the epiglottis by using a laryngoscope without fail; when the patient complains of a sore throat and a severe pain by swallowing and yet the afore-said subjective symptoms can not be easily explained, as there is no remarkable objective ones at the oral cavity, isthmus and the oral part of pharynx.

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詳細情報 詳細情報について

  • CRID
    1570291227592526592
  • NII論文ID
    110007106267
  • NII書誌ID
    AN00061975
  • ISSN
    00236012
  • 本文言語コード
    en
  • データソース種別
    • CiNii Articles

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