尿毒症に合併せる耳性敗血症の1例

　緒言

　急性化膿性中耳炎は，最近の化学療法の進歩により，大いにその像を変え，手術的療法を要する場合は非常に少くなつたが，一方，その隠蔽作用によつて症状がかくされ，不知のうちに高度の合併症を起して，時期を失する場合がある事が注意されている．耳性敗血症もその一つであり，最近は非常に少くなつて来たが，その生命に対する予後の事を考えると，やはり耳鼻科医の最も注意を要する問題と思はれる．

　私共は，最近，内科医によつで慣性腎臟炎として治療されて居た患者で，その末期において，多量の耳漏の出現と同時に，一般状態の急激な悪化を来し，尿毒症なりや，急性中耳炎の合併症なりやの判断に迷つたが，手術を決行したところ，一時少康を得たが遂に死亡し，剖検した結果，尿毒症に合併した耳性敗血症であつた症例に接したので，こゝに報告させていたゞく次第である．

NIHO and his associates report a case of otitic septecemia in which the symptoms were masked by use of penicillin in large amounts. A man aged 55, who had been under the care of an internist for the period of 4 months previously for chronic nephritis. was consulted for the first time in a grave physical conditions. profuse aural discharges, rigidity of ex-tremities, aphonia and stertorous breathieg. There was difficulty in deciding whether this picture was the result of acidosis or complications of otitis med-ia. In spite of this indecision the operations, rad-ical mastoidectomy and petrosotomy, were perform-ed. Shortly after the operation the patient seemed improved but died on the thirh day thereafter.

Necropsy showed chronic arterosclerotic nephritis, carditis, pleurisy, gastritis and cerebral dehydra-tion, and, beside which there were evidences of generalized septic infection in the lungs, the hilus, bronchial tress. the liver and spleen. Examination of the bony specimens removed at operation sho-wed bony necrosis in various parts of the mastoid and petrous bones. Authors conclude that whenev-er indications warrant or patient's life appears to be jeopardized there should be no hesitation in perfor-ming the operation on the temporal bone.