Biomedical subjects

H Tojima

Publications and source records attributed to H Tojima.

At least 37 records · Page 2Linked to original sources

PubMed1994

Effects of aging on hearing results in tympanoplasty.

The effects of aging on the preoperative and postoperative hearing results of tympanoplasty were assessed in 642 patients with chronic suppurative otitis media (COM) or cholesteatoma (CHL). Analysis focused on the correlation between hearing results and age for each disease and type of tympanoplasty. Data were evaluated by calculating the regression line, mainly using second order polynomial regression analysis. Averaged air and bone conduction thresholds (PTA) in patients were appreciably poorer in younger patients and increased with age, compared with physiological hearing impairment in old age (presbyacusis). Regression lines for PTA of air and bone conduction in patients and for normal data (air conduction) separated from each other after the age of 30 and hearing impairment gradually accelerated with age. Means of air-borne gap, however, were almost the same in each age group, though hearing thresholds in individual patients were distributed widely. This was more dominant in patients who had undergone type III or IV tympanoplasty than those with type I tympanoplasty, and in patients with COM than with CHL. Labyrinthine function thus appears to be gradually aggravated with age in patients with chronic inflammatory ear disease. Patients with chronic otitis media should be thus recommended to undergo tympanoplasty at an early age.

Adolescent↗

PubMed1994

Clinical advantages of electroneurography in patients with Bell's palsy within two weeks after onset.

One of the advantages of applying ENoG to patients with Bell's palsy resides in its quantitative determinability for the axons which do not undergo wallerian degeneration. The relation between the ENoG value each day after onset and during the recovery process was investigated in 551 patients with Bell's palsy within 2 weeks after onset in order to consider the diagnostic value of ENoG. It was discovered that ENoG on patients with Bell's palsy makes it possible to reveal the extent of wallerian degeneration by 7 days after the onset of palsy. Accordingly, treatment of Bell's palsy should be administered within the above 7 days; as early as 8 days after onset, exact prognostic diagnosis and judgment of therapeutic effect from ENoG values were concluded to be practicable.

Action Potentials↗

PubMed1994

Facial nerve palsy in children: clinical aspects of diagnosis and treatment.

Eighty-two children with facial palsy aged less than 6 years were examined. Sixty-four cases, excluding patients with congenital and traumatic palsy, were distributed through the ages, but a predominant tendency to symptomatic palsy for cases aged less than 2 years was observed. Facial movement scoring was not practical in prognostic diagnosis in cases aged under 4 years, while ENoG was useful in all age-groups. Of 58 cases of acute peripheral facial palsy, 29 were observed clinically but given no treatment, 9 were given steroids, and 16 were given vitamins and other drugs. In the patients with acute peripheral facial palsy in whom a follow up study was performed, 56 cases (96.6%) showed complete recovery. The time of recovery was independent of treatment. Facial palsy in children is considered to have a good prognosis regardless of treatment. Steroid administration thus does not appear to be necessary in children with acute facial palsy.

Acute Disease↗

PubMed1994

Diagnosis and treatment for Bell's palsy associated with diabetes mellitus.

The method of detecting diabetes mellitus and estimating the diabetic control status in patients with Bell's palsy, and the effect of high-dose steroid therapy for Bell's palsy accompanied by diabetes were investigated. From October 1987, hemoglobin A1c (HbA1c) was introduced to detect diabetes in 288 out of 372 patients with Bell's palsy, as a screening test for DM. Thirty-six diabetics with complete facial palsy were treated by high dose steroid therapy as described by Stennert. Hemoglobin A1c was useful in diagnosing diabetes and in assessing the diabetic control. Many patients under diabetic therapy kept their diabetes under good control. In cases of complete palsy, high-dose steroid therapy, at a cure rate of 97.4%, was highly effective in treating diabetes-accompanied Bell's palsy.

Adult↗

PubMed1994

Recording of single fiber electromyography in patients with peripheral facial palsy.

We determined muscle fiber density with single fiber electromyography (SFEMG) to discuss the condition of re-innervation after the recovery of facial movement in cases of peripheral facial palsy. Muscle fiber density was then compared with electroneurography (ENoG) which is thought to correlate with the severity of facial neuropathy in the early stage after the onset. The degree of neuropathy and subsequent recovery of innervation was also discussed. The subjects were 36 patients with peripheral facial palsy (30 patients with Bell's palsy and 6 with Hunt's syndrome), treated at our hospital, in whom ENoG could be recorded within 2 weeks after the onset. Muscle fiber density was determined after the recovery of facial movement. As a control, muscle fiber density was determined in 11 normal adults, and muscles on the healthy side in 23 patients with Bell's palsy. Muscle fiber density was 1.44 +/- 0.15 (mean +/- S.D.) in normal adults and 1.51 +/- 0.18 on the healthy side in patients, showing no significant difference. Data on the affected side were divided into 4 groups according to the minimum ENoG level within 2 weeks after onset and were compared with the normal group. In all cases with an ENoG level of 40% or more, muscle fiber densities were normal, and no significant differences were noted between the affected side and the healthy side. In cases with an ENoG level of less than 40%, muscle fiber density increased significantly with increasing severity of denervation. These findings suggest that collateral sprouting is absent in cases of peripheral facial palsy who show an ENoG level of 40% or more, or no wallerian degeneration.

Action Potentials↗

PubMed1994

Electrophysiological study on the pathology of synkinesis after facial nerve paralysis.

By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves.

Adolescent↗

PubMed1994

Facial nerve enhancement in Gd-MRI in patients with Bell's palsy.

The diagnostic value of a contrast enhanced MRI in patients with Bell's palsy was investigated. It was a characteristic finding that the internal acoustic meatal segment of the facial nerve was enhanced only on the affected side. The signal intensity ratio of the geniculate ganglion and the tympanic segment was significantly higher on the affected side than on the normal side. The severity of the facial palsy and the results of physiological examinations showed no relation to the results of MRI scans. Gd enhanced MRI thus appears to provide some useful findings for estimating the affected region of Bell's palsy, whereas it is not considered to be valuable in the diagnosis of severity.

Contrast Media↗

PubMed1994

Gd-DTPA enhanced MRI in Ramsay Hunt syndrome.

Ten patients with Ramsay Hunt syndrome underwent magnetic resonance (MR) scans. In many examinations, abnormal enhancement of the 7th nerve in the internal acoustic meatal segment through the mastoid segment was observed. Out of seven patients with cochlear and/or vestibular symptoms, only one showed abnormal enhancement of the 8th nerve, in addition to the 7th. The other 6 patients showed the same findings as in Bell's palsy, showing no enhancement of the 8th nerve. This suggests that clinical symptoms have no relation to the results of MRI. Enhanced MRI is the most sensitive means of making differential diagnoses between Hunt's syndrome and tumors, but it is impossible to detect all lesion sites corresponding to the symptoms in Hunt's syndrome.

Adult↗

PubMed1994

Deltopectral flap for one-stage reconstruction of pharyngocutaneous fistulae following total laryngectomy.

Postoperative pharyngocutaneous fistulae are troublesome complications after total laryngectomy. To manage this complication, we devised an operative method consisting of a one-stage repair using a deltopectal flap. With this technique we can immediately cover both skin and pharyngeal defects. We have applied this method to 5 patients all of whom have successfully recovered their swallowing function.

Aged↗

PubMed1994

Trapezius osteomyocutaneous flap in reconstructive surgery for mandibular and oral defects.

A scapular-trapezius osteomyocutaneous flap was used for mandibular reconstruction in 4 cases of oral cavity carcinoma after segmental resection of the mandible. In 3 cases, both the flap and bone took well, and the functional and morphological results were satisfactory. In one case, impaired venous return resulted in flap necrosis; a second reconstruction was performed using a rib-latissimus dorsi osteomyocutaneous flap. Functional disturbances of the donor site were minimal and, because the donor site was on the back, the cosmetic result was excellent. This flap is a bone-attached compound flap using the transverse cervical artery and veins as the vascular bundle, and is thought to be useful in the reconstruction of mandibular defects associated with extensive tissue defects of the oral cavity.

Aged↗

PubMed1994

Clinical evaluation of sizofilan as assistant immunotherapy in treatment of head and neck cancer.

Sizofilan (SPG), a simple glucan produced in a culture medium by Schizophyllum commune Feries, was used as an assistant immunotherapy in 15 patients with head and neck cancer. The cumulative 5-year survival rate was 86.7% in the SPG-treated group and 73.4% in the control group. Immunological parameters showed that the SPG group quickly recovered the cellular immunity damaged by radiation, chemotherapy and surgical procedure. SPG was found to be effective as an assistant immunotherapeutic agent in the treatment of head and neck.

Adult↗

PubMed1994

[A case of pulmonary, pleural, and renal tuberculosis associated with DIC and a prolonged increase in D-dimer].

A 26-year-old male who had been diagnosed as pulmonary tuberculosis three years ago with an antituberculous chemotherapy of only two months, complained of tiredness, exertional dyspnea and fever since a month ago. Bloody sputum, bloody stool and hematuria have developed three days before admission. Petechiae over the body trunk and lower extremities were observed on admission. Peripheral blood examination revealed lymphocytopenia (672/microliters), low hemoglobin content (6.2 g/dl), thrombocytopenia (3,000/microliters), elevated FDP (36.2 micrograms/ml) and D-dimer (25.0 micrograms/ml) values. Chest radiograph showed a massive pleural effusion in the right hemithorax, bilateral pulmonary infiltrates and a cavity on CT scan. Together with positive acid-fast bacilli in sputum, diagnoses of relapsed pulmonary tuberculosis, tuberculous pleurisy associated with DIC (disseminated intravascular coagulation) were made. Left hydronephrosis which was presumed to be a consequence of infundibulum stenosis due to renal tuberculosis, was detected by abdominal ultrasonography. Treatment with antituberculous drugs and protease inhibitors were started with thoracic tube drainage. DIC condition was improved by the 20th hospital day and sputum culture turned to be negative after the 4th week, however, fever up to 38 degrees C continued until the end of the 7th week and a D-dimer which is a representative marker for secondary fibrinolysis, continuously showed a high level up to the 10th week of hospitalization. The patient was uneventful during the three months follow up period after discharge. DIC is a well known complication of sepsis including miliary tuberculosis, whereas it is rarely associated with cavitary tuberculosis and no case of prolonged elevation of D-dimer have been reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

[A case of Wegener's granulomatosis with episcleritis, mediastinal lesions, and pleural effusion and without serum anti-neutrophil cytoplasmic antibodies].

We report a 63-year-old male case of Wegener's granulomatosis. His complaints were cough and fever, and chest X-ray showed subpleural infiltrative opacities in the bilateral lungs and small nodular lesions in the middle portion of the right lung. He had been treated as bacterial pneumonia at another hospital without any improvement and was referred to this hospital. Chest CT scan disclosed several small nodular lesions in the subpleural region of the right lung, consolidation in the posterior mediastinum, and the left pleural effusion. Transbronchial lung biopsy revealed inflammatory granulation with predominantly lymphocytes and micro-necrosis in the peribronchiolar region. Although these findings suggested Wegener's granulomatosis, open lung biopsy was performed because both antineutrophil cytoplasmic antibodies (ANCA) and antibodies to proteinase-3 were negative and ear, nose, and throat abnormalities were not found. Pathologic findings consisted mainly of granulomatous inflammation with lymphocytes, histiocytes, and multinucleated giant cells, and granulomatous vasculitis with micro-necrosis. Furthermore, the patient was diagnosed as having bilateral episcleritis by an ophthalmologist. No renal involvement was found. Standard treatment with cyclophosphamide and glucocorticoid resulted in marked improvement within a couple of weeks, and the patient was in complete remission eight months after initiation of therapy. This case is of interest in that the distribution of lesions was not typical and ANCA was negative.

Antibodies, Antineutrophil Cytoplasmic↗

PubMed1993

Suppression of hypoglossal motoneurons during the carbachol-induced atonia of REM sleep is not caused by fast synaptic inhibition.

The depression of upper airway motor activity that develops during the rapid eye movement (REM) stage of sleep is a major factor allowing upper airway obstructions to occur in patients with sleep apnea syndrome. Microinjections of carbachol, a cholinergic agonist, into the dorsal pontine tegmentum of chronically instrumented cats produce REM sleep. In acutely decerebrate cats, carbachol induces postural atonia, eye movements and a depression of the motor output to respiratory pump and upper airway muscles. In lumbar motoneurons, the depression of activity is due to a glycinergic inhibition that has the same characteristics during natural REM sleep in chronic cats and carbachol-induced atonia in decerebrate cats (Neurophysiology, 57 (1987) 1118-1129). The mechanisms that lead to the suppression of upper airway motoneuronal activity during REM sleep are unknown. In this study, we assessed whether the depression of hypoglossal (XII) nerve activity induced by pontine carbachol injections is caused by inhibitory amino acids acting within the XII nucleus. In decerebrate, paralyzed and artificially ventilated cats, we recorded the activities of both XII nerves (genioglossal branches), one phrenic and a cervical motor branch (to monitor postural activity). Postural atonia and respiratory depression were induced by pontine carbachol injections. The inhibitory amino acid receptor antagonists, strychnine (glycine receptors) or bicuculline (GABAA receptors), were injected (100-250 nl; 1.0-2.5 mM) into one XII nucleus (the other served as control) in an attempt to reduce or abolish the depression subsequently induced by pontine carbachol. Prior to the carbachol injections, both antagonists caused similar elevations of XII nerve activity on the treated side (30-40%). However, following carbachol, the XII nerve activity on the treated side was depressed to about 25% of the (pre-antagonist and pre-carbachol) control level, whereas the depression on the untreated side was slightly greater, to 10-15% of the control. Additional injections of antagonists during the carbachol-induced depression produced no further increase in nerve activity. This minor effect of the antagonists on the carbachol-induced depression of XII nerve activity was in contrast to the marked disinhibitory effects that both antagonists had on the XII nerve response to electrical stimulation of the lingual nerve. The latter was used as a control for the ability of strychnine and bicuculline to exert disinhibitory effects within the XII nucleus. Thus, there is little, if any, contribution of these inhibitory amino acids to the depression of XII motoneurons during the carbachol-induced, REM sleep-like postural and respiratory depression; mechanisms other than fast synaptic inhibition must be involved.

Animals↗

PubMed1993

Respiratory suppression by focal cooling of ventral medullary surface in anesthetized rats; functional and neuroanatomical correlate.

Bilateral cooling of the parapyramidal region in the rostral ventral medullary surface (VMS) elicited a reduction in respiratory frequency and phrenic inspiratory activity in halothane anesthetized rats. A distinct cluster of neurons (nucleus parapyramidalis superficialis) was found in a superficial layer (10-15 microns from the surface) just beneath the area where cooling produced suppression of respiration. The rat VMS layer contains neural substrates which regulate the respiratory rhythm generation and inspiratory neural output.

Anesthesia↗

PubMed1992

Behavior of VRG neurons during the atonia of REM sleep induced by pontine carbachol in decerebrate cats.

The microinjection of carbachol into the pons of acute decerebrate cats elicits a REM sleep-like atonia and a profound suppression of respiratory motoneuronal activity (J. Appl. Physiol., 69 (1990) 2280-2289). To assess whether this suppression is mediated by medullary neurons that provide respiratory drive to motoneurons of the respiratory pump muscles (diaphragm and intercostals), we studied the effect of pontine carbachol on the activity of neurons of the ventral respiratory group (VRG) in decerebrate, vagotomized, paralyzed and artificially ventilated cats. VRG neurons were recorded extracellularly along with the activity of phrenic and intercostal (external and internal) nerves. Both inspiratory (I) and expiratory (E) VRG neurons had incrementing, ramp-like bursts of activity during their firing periods and were not vagal motoneurons. Carbachol produced a depression of the peak firing rate in most (42/57) neurons studied. However, five cells showed no change and ten had an increase in activity in spite of consistent depression at the motoneuronal level. For the total population of cells (34 I and 23 E), the peak firing was reduced to 88.5% +/- 16.3 (S.D.) of control. The simultaneously recorded phrenic activity was reduced to 77.9% +/- 11.5, while inspiratory intercostal activity fell to 63.4% +/- 21.6 and expiratory to 23.2% +/- 21.2 of control. The carbachol-induced changes in peak firing of both I and E cells were quantitatively similar, and positively correlated to changes in peak phrenic activity. Analysis of this correlation suggested that phrenic and intercostal activities will be depressed to some degree by carbachol even when the average VRG cell activity remains unchanged. In addition, our data show that VRG cells may receive a combination of inhibitory and excitatory inputs during the carbachol-induced depression of respiratory motoneurons. Thus, although some disfacilitation from VRG cells may occur, there must be additional inhibitory or disfacilitatory pathways that mediate the decrease in activity of both phrenic and intercostal motoneurons that accompanies the REM sleep-like atonia.

Animals↗

PubMed1992

Serotonergic excitatory drive to hypoglossal motoneurons in the decerebrate cat.

In decerebrate, paralyzed, vagotomized and artificially ventilated cats, serotonin (5-HT) and its analogues, microinjected into the hypoglossal (XII) motor nucleus, altered the activity of the genioglossal branch of XII nerve. 5-HT, carboxamidotryptamine maleate (5-CT) and DOI (1-5 mM) increased the activity by over 200%. Methysergide reversed this increase. Methysergide, mianserin, or ketanserin (100-250 nl, 1 mM) reduced the spontaneous hypoglossal activity by 20-50%. Buspirone, 8-OH-DPAT and (-)-propranolol were without effect. Thus, 5-HT provides a substantial tonic excitatory drive to XII motoneurons. The 5-HT receptors involved are likely to be type 1C or 2, but uncertainty regarding the affinity profiles of the drugs used in in vivo conditions in the cat precludes a definite identification.

Animals↗

PubMed1992

Spontaneous ventilation and respiratory motor output during carbachol-induced atonia of REM sleep in the decerebrate cat.

Microinjections of carbachol into the pons induce a state that resembles rapid eye movement (REM) sleep in intact cats and, in decerebrate, artificially ventilated cats, produce postural atonia accompanied by a powerful depression of the respiratory motor output. In this study, pontine carbachol was used in decerebrate, spontaneously breathing cats to assess the effects of mechanical and chemical respiratory reflexes on the magnitude and pattern of the carbachol-induced depression of breathing, and to determine whether the depression is altered in those animals in which rapid eye movements are present. Phrenic nerve activity and tidal volume were only transiently depressed at the onset of the carbachol-induced postural atonia, whereas the decrease in respiratory rate and the depressions of hypoglossal and intercostal activities persisted until the response was reversed by a pontine microinjection of atropine 15-101 minutes after the onset of carbachol response. Ventilation was reduced to 70% of control during the steady-state conditions. The irregularity of breathing, characterized by the inter-quartile ranges of the distributions of the peak phrenic nerve activity and respiratory timing, did not increase following pontine carbachol. Neither vagotomy nor vigorous eye movements were associated with increased breathing irregularity. This contrasts with the irregular breathing (with minor average changes in ventilation) typical of natural REM sleep. We propose that the carbachol-injected decerebrate cat provides a useful model of the depressant effects that neural events associated with REM sleep may have on breathing.

Animals↗