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Biomedical subjects

Eiji Yumoto

Publications and source records attributed to Eiji Yumoto.

At least 19 recordsLinked to original sources

Dan is required for normal morphogenesis and patterning in the developing chick inner ear.

During vertebrate inner ear development, compartmentalization of the auditory and vestibular apparatuses along two axes depends on the patterning of transcription factors expressed in a region-specific manner. Although most of the patterning is regulated by extrinsic signals, it is not known how Nkx5.1 and Msx1 are patterned. We focus on Dan, the founding member of the Cerberus/Dan gene family that encodes BMP antagonists, and describe its function in morphogenesis and patterning. First, we confirmed that Dan is expressed in the dorso-medial region of the otic vesicle that corresponds to the presumptive endolymphatic duct and sac (ed/es). Second, we used siRNA knockdown to demonstrate that depletion of Dan induced both a severe reduction in the size of the ed/es and moderate deformities of the semicircular canals and cochlear duct. Depletion of Dan also caused suppression of Nkx5.1 in the dorso-lateral region, suppression of Msx1 in the dorso-medial region, and ectopic induction of Nkx5.1 and Msx1 in the ventro-medial region. Most of these phenotypes also appeared following misexpression of the constitutively active form of BMP receptor type Ib. Thus, Dan is required for the normal morphogenesis of the inner ear and, by inhibiting BMP signaling, for the patterning of the transcription factors Nkx5.1 and Msx1.

Animals↗

Sellar repair with resorbable polyglactin acid sheet and fibrin glue in endoscopic endonasal transsphenoidal surgery.

BACKGROUND: Cerebrospinal fluid leakage after transsphenoidal surgery represents a serious problem. Various methods to prevent postoperative CSF leakage are available, but immediate and tight dural closure is still difficult. The efficacy of a novel sellar repair was described. METHODS: The sellar repair using absorbable PGA sheet and fibrin glue was applied to 18 consecutive patients with sellar tumors that include 13 pituitary adenomas, 2 craniopharyngiomas, 2 Rathke's cleft cysts, and 1 meningioma within 135 patients who were treated with endoscopic endonasal transsphenoidal approach. The reaction speed and strength between PGA sheets and fibrin glue were examined in vitro. RESULTS: Polyglactin acid sheets were adhered to the rabbit skin with fibrin glue within 3 minutes and withstood a pressure of more than 220 mm Hg. Postoperative CSF leakage of the patients was not observed in any patients, and excellent adhesion of the PGA sheets to surrounding mucosa was estimated by endoscopic observation after the surgery. CONCLUSIONS: Repair of the sellar floor with PGA sheet and fibrin glue is a safe and effective method to prevent postoperative CSF leakage, which decreases the necessity for lumbar drainage after the operation.

Absorbable Implants↗

Concurrent chemoradiation therapy with low-dose CDDP and UFT for glottic carcinomas: evaluation using the sixth edition of the UICC TNM staging system.

We evaluated whether low-dose chemotherapy could improve effects of radiation therapy for glottic carcinoma with different prognostic factor based on the UICC 6th edition. Fifty-one patients with T2N0 glottic carcinoma classified by the UICC 5th edition underwent chemoradiation therapy with low-dose CDDP (4 mg/m(2)) and oral UFT (450 mg of tegafur) continuing for four weeks (CRT group). The historical control consisted of 49 patients treated with radiation therapy alone (RT group). Forty-six tumors with the adjacent sign, i.e. tumors located adjacent to the thyroid cartilage on radiological examinations, were classified as T3 according to the 6(th) edition. The 5-year local control and laryngeal preservation rates of the T2 (n=54) vs. T3 (n=46) lesions were 87% vs. 50% (p<0.0001) and 94% vs. 61% (p<0.0001), respectively. Among the T3 lesions, CRT (n=24) yielded significantly higher laryngeal preservation rates than did RT alone (n=22) (83% vs. 40%, p=0.0063), and the local control rates were higher in the CRT- than the RT group (62% vs. 36%, p=0.0882). While such benefits of CRT were not observed in patients with T2 lesions.

Adult↗

Effects of a nerve-muscle pedicle on the denervated rat thyroarytenoid muscle.

OBJECTIVES: To evaluate the effects of the nerve-muscle pedicle (NMP) method on the rat thyroarytenoid (TA) muscle after transection of the recurrent laryngeal nerve (RLN). STUDY DESIGN: Quantitative histologic assessment of the TA muscle after NMP implantation. METHODS: Thirty-six Wistar rats were divided into two groups: animals subjected to transection of the left RLN alone (DNV group) and animals subjected to transection of the left RLN followed by immediate transplantation of a NMP flap containing the sternohyoid (SH) muscle and ansa cervicalis nerve branch (NMP group). Animals were killed 2, 4, and 10 weeks after the treatments. The TA muscle stained with hematoxylin-eosin was evaluated quantitatively. The pre- and postsynaptic structures of the neuromuscular junction (NMJ) in the TA muscle were analyzed histochemically. The myosin heavy chain (MyHC) isoforms were evaluated using immunohistochemistry and reverse-transcriptase polymerase chain reaction (RT-PCR). RESULTS: In the NMP group, the TA muscle fiber recovered to almost normal at 10 weeks, and the ratio of the number of synaptophysin-positive nerve terminals to that of alpha-bungarotoxin-positive acetylcholine receptors recovered to 79.8 +/- 11.8% (P < .05, compared with the control). Immunohistochemistry and the RT-PCR method after laser capture microdissection revealed the expression of MyHC isoforms type 2B and type 2A; the latter was detected in the SH muscle but not in the normal or denervated TA muscle. CONCLUSION: The NMP method was effective for recovering from the atrophic changes of the TA muscle after transection of the RLN. This was attributed to successful reinnervation by reconstruction of the NMJ, which might change MyHC isoform expression.

Animals↗

Immediate recurrent laryngeal nerve reconstruction and vocal outcome.

OBJECTIVE: The objective of this prospective study was to assess the long-term effects of immediate reconstruction of the recurrent laryngeal nerve (RLN) during thyroid cancer extirpation on postoperative phonatory function. SUBJECTS AND METHODS: The subjects were 22 patients with advanced thyroid cancer who underwent resection of the primary lesion and involved RLN. RLN paralysis was seen in 12 patients preoperatively and involvement of the RLN was noted intraoperatively in 10. Immediate reconstruction of the RLN was performed on eight patients using the great auricular nerve and one underwent direct anastomosis of the RLN stumps (group I). Nine patients opted not to have phonosurgical procedures (group II). The remaining four had arytenoid adduction immediately after cancer extirpation (group III). Phonatory function (stroboscopy, maximum phonation time [MPT], mean airflow rate [MFR], harmonics-to-noise ratio [HNR], jitter, and shimmer) was followed for at least 9 months. RESULTS: Minimal or no glottal gap during phonation was observed in six patients in group I, whereas the patients in group II had a large gap along the entire fold. HNR, MPT, and MFR were significantly better in group I (17.7 +/- 3.6 dB, 15.1 +/- 6.3 s, and 100 +/- 32 mL/s, respectively) than in group II (12.1 +/- 2.9 dB, 5.4 +/- 3.1 s, and 430 +/- 207 mL/s, respectively). Patients in group III had a gap of varying degrees along the membranous fold. Although HNR, shimmer, and MPT in group III were comparable to group I, the other parameters were less favorable than in group I. CONCLUSION: Immediate RLN reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function.

Adult↗

A case of migratory fish bone in the thyroid gland.

Fish-bone foreign bodies represent a common condition readily identified in the pharynx. We encountered a case of fish bone in the thyroid gland. Only three other such cases have been reported in the English-language literature. This foreign body was identified by computed tomography and ultrasonography 16 days after onset, and removed through a cervical skin incision. The diagnosis and treatment of extrapharyngeal foreign bodies are discussed.

Bone and Bones↗

Prognostic factors of glottic carcinomas treated with radiation therapy: value of the adjacent sign on radiological examinations in the sixth edition of the UICC TNM staging system.

PURPOSE: To evaluate the predictive value of the adjacent sign, the tumor adjacent to the thyroid cartilage on radiologic examinations, in the new sixth edition of the International Union Against Cancer (UICC) staging system of glottic carcinoma. METHODS AND MATERIALS: Between 1989 and 1998, 130 patients with T1-2N0 glottic squamous cell carcinoma, classified according to the fifth edition of the UICC staging system and evaluated by computed tomography or magnetic resonance imaging, were treated with radiation therapy (RT). Factor analysis included clinical, radiologic, and treatment characteristics. Tumors with the adjacent sign, considered representative of paraglottic space invasion with or without minor thyroid cartilage erosion, were retrospectively classified as T3-stage tumors by the UICC sixth edition. RESULTS: The 5-year local control rate after RT was 76%. Univariate analysis showed that the T stage according to the UICC fifth edition, supraglottic extension, subglottic extension, tumor size, adjacent sign, total dose, fraction size, field size, and overall treatment time were significant factors for the local control rate. Multivariate analysis confirmed the adjacent sign as the only independent predictor. According to the UICC sixth edition, the 5-year local control, laryngeal preservation, cause-specific survival, and overall survival rates of the T3 (adjacent sign-positive) vs. T1 and T2 (adjacent sign-negative) lesions were 37% vs. 87% (p < 0.0001), 47% vs. 95% (p < 0.0001), 75% vs. 99% (p < 0.0001), and 54% vs. 81% (p = 0.0180), respectively. CONCLUSION: Factor analysis confirmed the adjacent sign as an independent prognostic factor. The UICC sixth edition appears to identify correctly patients with T3 lesions as a high-risk group.

Adult↗

Asymmetry of the vocal folds in patients with vocal fold immobility.

OBJECTIVES: To measure the vocal fold length (VFL) during inspiration and phonation and to determine the vertical difference of the vocal folds during phonation in patients with unilateral vocal fold immobility. DESIGN: Prospective study. SETTING: University hospital. Patients Thirty patients with unilateral vocal fold immobility. INTERVENTIONS: Each subject was asked to sustain the vowel /a/ and, after a short rest, to inhale slowly. The region over the larynx was scanned using multislice helical computed tomography during each maneuver; 3-dimensional endoscopic, coronal, and sagittal images were produced. MAIN OUTCOME MEASURES: The VFLs on each side and the vertical differences between the vocal folds were calculated. RESULTS: The inspiratory VFL on both sides was significantly longer in men than in women. It was significantly longer on the healthy side than on the immobile side in both groups. On the healthy side, the inspiratory VFL was significantly longer than the phonatory VFL in men, but there was no significant difference in women. In contrast, on the immobile side, the phonatory VFL was significantly longer than the inspiratory VFL in women, but there was no significant difference in men. The VFLs of the healthy and immobile sides varied in tandem. The immobile vocal fold was situated lower than the healthy vocal fold during phonation in 3 patients. CONCLUSIONS: Multislice helical computed tomography is a novel method to measure the VFL and the vertical level difference between the vocal folds. Application of this method might facilitate further understanding of laryngeal behavior in patients with unilateral vocal fold immobility.

Adult↗

Endoscopic endonasal reduction of blowout fractures of the orbital floor.

OBJECTIVES: The aim of this study was to document the usefulness of the endoscopic endonasal approach as a surgical treatment of isolated blowout fractures of the orbital floor. STUDY DESIGN: Retrospective study. SETTING: Between 1997 and 2003, using only an endonasal endoscopic surgical approach, we operated on 62 patients complaining of diplopia due to isolated blowout fractures of the orbital floor. In order to perform the endonasal reduction surgery, supplemental septoplasty and/or submucous conchotomy were done. Immediately following the reduction and the fixation, eye traction tests were performed to confirm the ocular motility improvement. Tampon gauzes or balloon catheters were used for the temporal fixation to support the orbital floor. RESULTS: Postoperatively, diplopia completely disappeared in 55 of the 62 patients (88.7%) that were followed over 6 months. CONCLUSION: The high success rate with regard to diplopia indicates that the endoscopic endonasal approach may be an alternative to extranasal methods. EBM RATING: B-3.

Adolescent↗

Frontal skull base surgery combined with endonasal endoscopic sinus surgery.

BACKGROUND: Postoperative infection remains a serious complication after radical resection of anterior skull base lesions because intracranial, nasal, and paranasal cavities are opened during surgery. To prevent complications from postoperative infection, we combined endonasal endoscopic sinus surgery (ESS) with the frontal transbasal approach in patients with skull base lesions. METHODS: Patients (n = 16) with anterior skull base lesions extending to the paranasal or nasal cavity underwent surgical resection via the frontal transbasal approach. After removal of the lesion via the transcranial approach, enlargement of the ostium or sinusotomy was performed bilaterally using our endonasal ESS procedure. The main purpose of ESS is the establishment of a wide drainage route to avoid dead space and postoperative infection. Furthermore, we confirmed the absence of residual lesion and leakage of cerebrospinal fluid (CSF), endoscopically. RESULTS: The frontal transbasal approach combined with endonasal ESS was performed in 16 patients with frontal skull base lesions. There were 8 malignant tumors, 6 benign tumors, and 2 mucoceles. Although 11 patients had preoperative active paranasal sinusitis, most frequently at the ethmoid sinus, none experienced postoperative infection. There was no complication related to ESS procedure. Furthermore, leakage of CSF and extracranial residual tumor were not found. CONCLUSION: Endonasal ESS after frontal skull base surgery is a highly useful technique for preventing postoperative infection, especially for the cases with large skull base tumors extending into other regions involving the paranasal sinuses or nasal cavity and with active paranasal sinusitis.

Adolescent↗

Effects of denervation on neuromuscular junctions in the thyroarytenoid muscle.

OBJECTIVES/HYPOTHESIS: To evaluate the effects of denervation on muscle fibers and neuromuscular junctions (NMJ) of the rat thyroarytenoid (TA) muscle with a histochemical method to monitor the status of degenerative NMJ. STUDY DESIGN: Quantitative assessment to monitor the status of degenerative muscle fibers and NMJ in the TA muscle. METHODS: Wistar rats were killed at 6, 12, 18, and 24 hours and at 2, 4, and 10 weeks after left recurrent laryngeal nerve (RLN) transection. Hematoxylin-eosin stain was used to evaluate the atrophic changes of the TA muscle. The pre- and postsynaptic structures of the NMJ were detected histochemically. These changes were evaluated by comparing the results between the treated (T) and untreated (U) sides (T/U ratio) in the same section. RESULTS: The atrophic changes in the TA muscle progressed gradually, and at 10 weeks, the T/U ratios of the entire muscle area and of the muscle fiber size decreased to 53.2 +/- 10.7% and 55.5 +/- 6.8%, respectively (P < .01). The number of nerve terminals decreased significantly at 18 hours (P < .01), and they disappeared completely by 24 hours. In contrast, at 10 weeks, 70.5 +/- 12.4% (P < .01) of acetylcholine receptors (AchRs) were preserved. CONCLUSIONS: In the rat TA muscle, denervation influences the presynaptic nerve terminals more than the postsynaptic AchRs and the muscle fibers. The results could be a basis for understanding the mechanism of laryngeal denervation and reinnervation processes in animal models.

Animals↗

[Clinical analysis of cervical metastatis from an unknown primary carcinoma].

From 1997 to 2004, 19 cases-18 men and 1 woman-with cervical lymph node metastasis from an unknown primary carcinoma were retrospectively investigated regarding the clinical observation and the treatment outcome. With respect to the histopathological types, 16 cases had squamous cell carcinoma, 2 cases had adenocarcinoma and 1 case had ductal carcinoma. As for the region of lymph node metastasis with maximum size, metastasis located in the upper deep cervical region arrounted for 84%. The presence of primary lesions was comfirmed in 11 cases (3 tonsil, 1 nasopharynx, 1 base of tongue, 2 hypopharynx, 1 esophagus, 1 larynx, 1 gallduct, 1 mammary gland) after the treatment of their metastatic leisions. Tonsillectomy and Blind biopsy were effective for 5 patients. Seventeen patients were treated with neck dissection. Eleven patients with neck dissection underwent radiotherapy. The overall 3-year survival rate as determined by the Kaplan-Meier method was 62%. The 3-year survival rate of the 17 cases whose metastatic leisions were treated with radical neck dissection was 66%. The 3-year survival rate of cases with known primary sites and cases with unknown primary sites after treatment were 55% and 83%, respectively. Radiotherapy with radical neck dissection was thought more effective than radical neck dissection for local and neck control.

Adenocarcinoma↗

Three-dimensional characteristics of the larynx with immobile vocal fold.

OBJECTIVES: To evaluate the 3-dimensional (3-D) characteristics of the laryngeal lumen in patients with unilateral vocal fold immobility (UVFI) during phonation with the aid of multislice helical computed tomography (MSHCT). DESIGN: A retrospective study. SETTING: University hospital. Subjects Thirty-seven patients with UVFI. INTERVENTIONS: Each subject was asked to sustain the vowel /a/ and then to inhale slowly. The region over the larynx was scanned using MSHCT during each maneuver for 5 seconds; 3-D endoscopic images and coronal multiplanar reconstruction images were produced and evaluated. Thirty-two subjects underwent videostroboscopy within 2 weeks of the MSHCT. MAIN OUTCOME MEASURES: Presence of thinning and paradoxical movement of the affected vocal fold, overadduction of the healthy fold, and vertical positional difference between the vocal folds during phonation were assessed based on 3-D and multiplanar reconstruction images. RESULTS: During phonation, the affected vocal fold was thinner in 31 subjects and was situated in a higher position in 21 subjects than the healthy fold. In 4 subjects, the affected vocal fold showed paradoxical movement and 3 other subjects had probable paradoxical movement. Overadduction of the healthy vocal fold occurred during phonation in 15 subjects. Videostroboscopy detected paradoxical movement in 2 of the 3 subjects with abduction of the affected vocal fold during phonation based on 3-D images, and overadduction in all 13 subjects examined. CONCLUSIONS: The combination of 3-D endoscopy with coronal multiplanar reconstruction images enables description of the 3-D characteristics of the unilaterally immobile larynx and supplements videostroboscopic findings exemplified by differences in vertical position and thickness between the vocal folds.

Adult↗

Aerodynamics, voice quality, and laryngeal image analysis of normal and pathologic voices.

PURPOSE OF REVIEW: The purpose of this review is to describe examinations of phonatory function and their relation to image analysis of the unilaterally immobile larynx. Special emphasis was placed on image analysis using three-dimensional endoscopic images produced from CT scans. RECENT FINDINGS: Developments in modern image processing technique have led to the quantification of various aspects of vocal fold vibration. Stroboscopic images of the vocal fold were digitized and, subsequently, the glottal gap area, amplitude, and degree of bowing were analyzed quantitatively in relation to phonatory function. Vocal fold vibration was observed with the aid of videokymography, during which images from a single transverse line can be recorded. Successive line images were shown in real time on a monitor, with the time dimension displayed in the vertical direction. This system enabled the assessment of left-right asymmetries, open quotient, propagation of mucosal waves, and forth. Three-dimensional endoscopic images derived from multislice CT scans provided a novel method for evaluating morphologic characteristics of the laryngeal lumen in relation to phonatory function. The combination of three-dimensional endoscopy and coronal reconstructed images supplemented stroboscopic findings exemplified by differences in vertical position and thickness between the vocal folds. SUMMARY: Depth information about the vocal fold as well as the presence of paradoxic movement of the affected vocal fold and overadduction of the healthy vocal fold during phonation should be taken into account when surgical intervention to improve hoarseness resulting from unilateral vocal fold immobility is performed. Phonatory function tests, videostroboscopy, and laryngeal image analysis are prerequisites to achieving this goal.

Humans↗

[The improvement of quality of life of patients with aspiration pneumonia after surgical therapy for intractable aspiration].

Sixteen patients with recurrent aspiration pneumonia that could not be controlled by appropriate medical therapies. These patients had no hope of recovering laryngeal function. Eight underwent laryngectomy, six underwent laryngotracheal separation and four underwent tracheoesophageal anastomosis. After surgery, we evaluated the efficacy of the therapy and the patients' satisfaction with therapy. Before and after surgery, the following clinical markers were examined to evaluate the efficacy of surgery: scores of aspiration pneumonia, WBC count, C-reactive protein, erythrocyte sedimentation rate, hematocrit, body mass index, total protein, albumin, and the Barthel index, an indicator of daily activity. Furthermore, the grade of Depression and mood, and satisfaction of patients and their carers among family members were scored using the Zung self-rating depression scale, a 20-picture face scale, the visual analog scale, and feeding status. After surgical therapy, we confirmed that aspiration was prevented in fourteen patients of sixteen, and the state of inflammation and nutrition, the state of depression and mood were improved. Thirteen patients from sixteen were able to ingest a meal orally. The quality of life of patients with intractable aspiration was improved.

Adult↗

[Videofluorography of the pharynx in patients suffering from aspiration pneumonia].

We evaluated videofluorographic recordings of the pharynx (VF) in patients suffering from aspiration pneumonia. The patients consisted of 55 men and 6 women who consulted the ENT Department at Kumamoto University Hospital between May 1994 and February 2002. Surgery for an upper alimentary tract malignancy (16 patients) was the most frequent background feature. The number of patients with cerebrovasucular disease and neuronal/neuromuscular diseases were 11 and 12, respectively. VF enabled the misswallowing of barium into the trachea to be visualized in 38 patients. Of these 38 patients, 20 exhibited misswallowing during or after the pharyngeal stage of swallowing. Among the 23 patients in whom misswallowing was not detected, 13 had upper alimentary tract diseases. The VF findings suggested the presence of gastroesophageal clearance after swallowing. Gastro-esophageal regurgitation may be a significant factor, in addition to the silent aspiration of oral and pharyngeal secretions during the night as a trigger of recurrent aspiration pneumonia.

Adolescent↗

[Survival of glottic carcinoma patients treated with definitive radiation therapy: value of the Sixth edition of the UICC TNM staging system].

PURPOSE: To evaluate the survival of glottic carcinoma patients treated with radiation therapy (RT). The predictive value of the new sixth edition of the UICC staging system was also evaluated. METHODS AND MATERIALS: 193 patients with T1-2N0 glottic squamous cell carcinoma, classified according to the fifth edition of the UICC staging system, were treated with definitive RT. Of them, 130 patients evaluated with pretreatment radiological examinations (CT and/or MR) were retrospectively classified according to the UICC sixth edition. RESULTS: According to the UICC fifth edition, 132 lesions were staged as T1 and 61 as T2. Thirty lesions were categorized as stage T3 according to the UICC sixth edition. Of all patients, 13 died of glottic carcinoma, 25 of second malignancy, and 20 of intercurrent disease. Second primary sites included lung (n=8), esophagus (n=4), liver (n=4), pancreas (n=3), and others (n=6). The 10-year overall survival rate was 66%, and cause-specific survival rates of glottic carcinoma and second malignancy were 91% and 86%, respectively. Multivariate analysis confirmed T-stage in the UICC sixth edition as an independent predictor for death from glottic carcinoma. Although there were no significant factors for second malignancy, there was no death from second malignancy in non-smoking patients. CONCLUSION: Second malignancy was the most frequent cause of death, and an association with smoking was suggested. The UICC sixth edition appears to correctly identify patients with T3 lesions as a high-risk group not only for local failure but also for survival.

Adult↗

Presenilin-dependent gamma-secretase activity mediates the intramembranous cleavage of CD44.

CD44 is the major adhesion molecule for the extracellular matrix components and is implicated in a wide variety of physiological and pathological processes including the regulation of tumor cell growth and metastasis. Our previous studies have shown that CD44 undergoes sequential proteolytic cleavages in the extracellular and transmembrane domains and the cleavage product derived from CD44 intramembranous cleavage acts as a signal transduction molecule. However, the underlying mechanism of the intramembranous cleavage of CD44 remains to be elucidated. In the present study, we report for the first time that CD44 is a substrate of the presenilin (PS)-dependent gamma-secretase. We demonstrate that the intramembranous cleavage of CD44 induced by 12-O-tetradecanoylphorbol 13-acetate (TPA) treatment or mechanical scraping is blocked by gamma-secretase inhibitors in U251MG cells and that this cleavage is also inhibited in PS-deficient mouse embryonic fibroblasts. Furthermore, we showed that PS1 is redistributed to ruffling areas of the plasma membrane similarly to CD44 after TPA treatment, supporting our biochemical observation that PS1 is involved in the intramembranous cleavage of CD44. Our present findings suggest important implications for understanding CD44-dependent signal transduction and a potential role of PS/gamma-secretase activity in the functional regulation of adhesion molecules.

Amyloid Precursor Protein Secretases↗