Biomedical subjects
Publications and source records attributed to K Kurihashi.
OBJECTIVE: The purpose of this study was to evaluate the clinical performance of newly implemented dynamic MR dacryocystography. CONCLUSION: Dynamic MR dacryocystography, which requires neither ionizing radiation nor chemical contrast media with high viscosity, may be a useful tool for depicting nasolacrimal obstructions.
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Dynamic magnetic resonance dacryocystography (MRD) was implemented using 1.5T superconductive imager with a standard head coil. Prior to MRD, a pair of polyethylene microcatheters were inserted into the lower lacrimal canaliculi. Injecting a mixture of 6 ml of saline and 4 ml of xylocaine (0.5%) as a substitute for contrast medium, repeated measurement of thick section heavily T2 weighted image using half Fourier single shot fast spin echo (SSFSE) sequence was performed. MRD could well depict the pathologies of the lacrimal sac and the lacrimal duct in five cases of epiphora. It pinpointed the level of lacrimal duct obstruction, which was confirmed by both X-ray dacryocystography and intraoperative findings. Dynamic MRD is a reliable method of diagnosing nasolacrimal duct obstruction without using ionizing radiation or chemical contrast medium.
Twelve cases with canalicular disorders were treated by a new technique using multiple traction sutures (MTS) under an operating microscope. The MTS using black silk or 5-0 nylon were applied at the medial canthus, near the upper and lower puncta and at the caruncle. Additional traction sutures were applied to locate a deep canalicular system if needed, resulting in a total of 5-10 traction sutures. The patient's face was turned sideways towards the left in the operation of the right eye, and to the right in the operation of the left eye. By using the new technique, the opening of the common canaliculus could easily be located without resorting to an open-sky technique requiring skin incision. A new canaliculus could easily be made using a free graft of oral mucous membrane between the common canaliculus and medial canthus with the help of MTS in 7 cases out of 12. As stents, a match-style silicone tubing, a nunachaku-style silicone tubing, an ordinary silicone tubing and a silicone tubing with a silicone sponge were used for 7, 1, 1 and 3 cases, respectively. After a mean follow-up 17.2 months, symptomatic relief and patency of the lacrimal passage were achieved in all cases.
While various techniques have been proposed for the treatment of dry eye, there have been no studies published evaluating the efficacy of the following wet gauze eye mask (WGEM) treatment of dry eye. One or two gauze mask(s) (9 x 12 cm) wetted with tap water and wrung were placed over both eyes during sleep. The treatment was performed on 30 patients with dry eye. Of these, 22 performed the treatment actively. In 14 (63.6%) out of the 22 patients, dry-eye symptoms were eliminated by the WGEM all day or until the evening. Of these 14, 7 were freed from eye drop treatment by the WGEM procedure. The WGEM treatment is safe, effective, simple and economical, and can be performed by the patients themselves. Moisture aid by the WGEM and/or a humidifier should be performed before resorting to punctal-plug insertion which may induce canalicular obstruction.
The special silicone tube (50-120 mm in length) consists of three pieces. One piece is the thinner central segment [20-40 mm long, 0.64 mm outer diameter (OD), 0.30 mm inner diameter (ID)], and the other two are thicker bilateral segments (10-50 mm long, 0.94 mm OD, 0.51 mm ID). Both ends of the three-piece silicone tubing (TPST) were sealed by the silastic medical adhesive with or without the silicone rod (2 mm long, 0.5 mm diameter) and diagonally cut to taper the end. To push the TPST from the upper and lower puncta into the lacrimal passage, a thin metal probe (0.4-0.6 mm diameter) was inserted into both sides of the tube through a small cut. In this new technique, there is no difficult procedure of retrieving the tip of a metal probe from the nasal cavity. The TPST requires no suture to secure it in position. The success rates were 63.6% (7/11), 100% (5/5) and 50% (1/2) for nasolacrimal-duct obstruction, canalicular obstruction, and canalicular and nasolacrimal-duct obstructions, respectively (follow-up: 3.4-12 months, mean 5.3 months).
Mesoscopic structures of the lacrimal drainage pathway were observed under an operating microscope in six cases of 5 adult cadavers. In all these cases the upper and lower canaliculi fused to form the common canaliculus. Two cases with a large common canaliculus showed large projections of mucosa which reduced the inner space of the common canaliculus. The remaining 4 cases with a small common canaliculus did not show any projections. These findings indicate that the human lacrimal system can function physiologically through a small narrow space of the common canaliculus.
To understand better the regional anatomy of the bony nasal window in dacryocystorhinostomy (DCR), anatomical dissections were performed on 28 cadaver specimens with an average age of 80.1 years. The distance between the point which is located 10 mm posterior to the medial canthus and the anterior cranial fossa floor was measured. The distance ranged from 1 to 30 mm with an average of 8.3 mm. There was no difference between males and females. Six cadavers out of 28 (21.4%) showed 3 mm or less in the distance. When a chisel was inserted through the medial canthus, the tip appeared near the anterior cranial fossa floor in cases with a short distance and a small frontal sinus but not in cases with a long distance and a large frontal sinus. It is obvious that, if a posterior nasal window is enlarged more than 3 mm above the medial palpebral tendon, a bony opening will be formed in the anterior cranial fossa floor in these 6 cases, resulting in cerebrospinal fluid leakage. In conclusion DCR should be done without severing the medial palpebral tendon to make a bony nasal window under the tendon.
Two methods of measuring lacrimation with a cotton thread and fluorescein have been described hitherto. Method 3 is intended for testing lacrimal flow in wearers of soft contact lenses. Fluorescent paper can be used to facilitate the measuring procedure. The method has been shown to be reliable in numerous control tests on subjects with normal eyes and in comparisons with the authors' methods 1 and 2. With the test, values of less than 5 mm indicate severe lacrimal deficiencies.
I have already reported the development of a method for measuring tear volume using a cotton thread (No. 82/3, about 0.2 mm in diameter). While this previous testing method proved useful, both in the diagnosis of lacrimal deficiencies, and in cases of slight to medium epiphora, it could not accurately measure the high volume of lacrimation produced in cases of strong epiphora because of the low absorption capacity of the thread. To overcome this shortcoming, I have developed a new system which utilizes a cotton thread enclosed in a soft, calibrated, silicone tubing. In subsequent testing of this new technique, eyes that exhibited a strong epiphora state gave a wetted length of 226.9 +/- 56.0 mm (mean +/- SD) in a 5- to 10-second test. This compares with 41.0 +/- 8.9 mm in tests using thread alone in a 5- to 10-second test (p less than 0.001).
Instead of filter paper, a fine cotton thread was used. One test consists of 3 or more consecutive measurements. Six patients with Hunt's syndrome were tested with this new method. All of the six showed lacrimal deficiency on the involved side.
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Fine cotton thread is used instead of the filter paper of the Schirmer test. One end stained with fluorescein is inserted into the lateral upper conjunctival sac for 5-30 seconds. The length of the soaked portion is measured in millimeters and the two eyes are compared with each other. One test consists of several consecutive measurements. This new method has many advantages over the conventional Schirmer test: (1) It takes less time (5-30 seconds, compared to Schirmer's method which takes five minutes); (2) It is less injurious to the eye than the stiff and rather large absorbing paper; (3) A diagnosis of lacrimal deficiency must be based on several consecutive measurements and the comparison between two eyes in each measurement (the lacrimation normally is very irregular in the same person). It is difficult to measure consecutively with filter paper; (4) The fine thread itself acts as a potent mechanical trigeminal stimulator and as absorbing agent; (5) The thread maintains a stable position in the eye, while the filter paper which hangs on the lower lid sometimes shifts out of place; (6) The fluorescein dye disappearance and dilution tests can be performed simultaneously; (7) This method can be applied to children.