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Biomedical subjects

Koichi Tsunoda

Publications and source records attributed to Koichi Tsunoda.

17 recordsLinked to original sources
PubMed2006

Neuro-Behçets/neuro-Sweets disease presents simultaneously with severe tonsillitis, and features mimicking bacterial meningitis with skin lesions.

The patient was hospitalized due to rapidly undulant fever and sore throat. Empirical antibiotic therapy was started, however, headache also occurred. Lumbar puncture disclosed polynuclear leukocyte-predominant pleocytosis indicating that the patient suffered from bacterial meningitis. The antibiotics therapy was increased, however, consciousness became impaired and erythema multiforme-like skin lesions appeared. T2-weighted brain magnetic resonance imaging showed high signal intensity in the brainstem. HLA testing revealed B54 and Cw1. The patient presented futures of Behçets disease at the same time as those of Sweets syndrome and it was difficult to distinguish between the two diseases. Administration of prednisolone showed remarkable effect.

Adult↗
PubMed2006

Long-term result of the new endoscopic vocal fold medialization surgical technique for laryngeal palsy.

OBJECTIVE: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap. STUDY DESIGN AND METHODS: In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold. RESULTS: This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery. CONCLUSIONS: This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.

Aged↗
PubMed2006

Clinical applications of commercially available video recording and monitoring systems: inexpensive, high-quality video recording and monitoring systems for endoscopy and microsurgery.

The exclusive charge-coupled device (CCD) camera system for the endoscope and electronic fiberscopes are in widespread use. However, both are usually stationary in an office or examination room, and a wheeled cart is needed for mobility. The total costs of the CCD camera system and electronic fiberscopy system are at least US Dollars 10,000 and US Dollars 30,000, respectively. Recently, the performance of audio and visual instruments has improved dramatically, with a concomitant reduction in their cost. Commercially available CCD video cameras with small monitors have become common. They provide excellent image quality and are much smaller and less expensive than previous models. The authors have developed adaptors for the popular mini-digital video (mini-DV) camera. The camera also provides video and acoustic output signals; therefore, the endoscopic images can be viewed on a large monitor simultaneously. The new system (a mini-DV video camera and an adaptor) costs only US Dollars 1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casualty setting, or on house calls for the purpose of patient education. In the future, the authors plan to introduce the clinical application of a high-vision camera and an infrared camera as medical instruments for clinical and research situations.

Computer Systems↗
PubMed2005

Endoscopic vocal cord medialization: a new surgical technique without neck incision for laryngeal palsy.

Different types of surgery have been reported for glottal insufficiency due to unilateral vocal cord paralysis. We recently developed a new surgical technique of fascia implantation known as vocal cord medialization. This new method achieves a wide glottal gap during phonation, without the use of an external approach. This new technique is described in detail herein, together with the satisfactory results we obtained in six cases of unilateral vocal cord paralysis with a wide glottal gap during phonation. We recommend this technique in cases of unilateral vocal cord paralysis in which both a satisfactory clinical result and an aesthetically pleasing cosmetic result are required.

Fascia↗
PubMed2005

High-quality video recording and monitoring system for endoscopes.

We have developed a new recording system for endoscope images with the popular mini digital video (mini DV) camera. A special adaptor screws onto the lens top, and either a flexible or rigid endoscope can be attached to the camera. Using this system, we can monitor not only the endoscopic images but also the patient's condition. Satisfactory images can be obtained even with the finest fiberscope. Nevertheless, our new system costs only USD 1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casual setting or for house calls for the purpose of patient education.

Equipment Design↗
PubMed2005

Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future.

OBJECTIVES: Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long-term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future. STUDY DESIGN: Prospective study. METHODS: We were able to obtain long-term results from 10 volunteer cases (2 female and 8 male, age: 15-71, mean 46.5 years old) who could be followed up for at least 3 years after transplantation. All were cases of pathologic sulcus vocalis.We measured maximum phonation time (MPT) and carried out pre- and postsurgical clinical observation and laryngeal stroboscopy in all cases. These measurements and observations were made before the ATFV and at 6 months, 1 year, 2 years, and 3 years after surgery. RESULTS: In stroboscopic observation 1 year after the ATFV, satisfactory glottal closure and excellent mucosal wave were observed for all cases, and there was no case with hyperadduction of the false vocal folds. MPT measures remained at an improved level 2 years and 3 years after the transplantations. Paired-sample t tests showed that the improvement relative to preATFV levels was significant for all postsurgical measurements up to 3 years. CONCLUSIONS: We conclude that ATFV is a successful surgical procedure for sulcus vocalis and scarred vocal folds. Other phonosurgical clinical applications may also be envisioned.

Adolescent↗
PubMed2005

Autologous replacement of the vocal fold: a new surgical approach for adduction-type spasmodic dysphonia.

Many surgical approaches have been developed for the treatment of adduction-type spasmodic dysphonia (SPD). We developed and performed a new type of surgical approach (autologous replacement of the vocal fold). Our new surgical technique increases the advantages and decreases the disadvantages of previous surgical procedures in three ways: (1) It has similar effects to the previous procedures in that it prevents contraction of the thyroarytenoid muscle. (2) It decreases vocal-fold tension, as in framework surgery. (3) It reduces glottal incompetence, as does fibrinogen-glue injection, but it is more suitable because it is autologous. Furthermore, it produces increases in the mass and volume of the vocal-fold body and is also safe because the replacement tissue is autologous. The short-term results appear encouraging in preventing spastic voice while also avoiding vocal-fold atrophy. Long-term follow up will be necessary to determine the actual efficacy. However, this is clearly a possible choice as a surgical approach for treating adduction-type SPD.

Fascia↗
PubMed2005

Aphonia and dysphagia after gastrectomy.

A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide.

Aged↗
PubMed2003

Hoarseness caused by unilateral vocal fold paralysis: how long should one delay phonosurgery?

We present a case of idiopathic right vocal fold paralysis which resolved completely 18 months after onset. Instead of using surgery to improve the hoarseness of our patient, our experience suggested that speech therapy might be effective. Although the voice can be improved by overadduction of the healthy vocal fold, as surgery is irreversible it is better to wait for 18 months after onset in case spontaneous recovery occurs. During this period, one should of course continue to investigate the origin of the paralysis.

Aged↗
PubMed2002

Detachable forceps for flexible fibre-optic surgery: a new technique for phonosurgery in cases where rigid laryngoscopy is contraindicated.

In phonosurgery, in cases where it is not possible to use a rigid laryngoscope, a flexible fibrescope with laryngeal-mask ventilation may be used. In flexible fibreoptic surgery, the forceps are normally inserted through a small channel in the fibrescope. Since only a small forceps tip can pass through this channel, a limited range of forceps has been available for use in fibrescope procedures. We have developed a new type of forceps for flexible fibre-optic surgery that allows this size limitation to be overcome. The new forceps is made up of two parts: (i) the forceps tip and its control wire assembly, and (ii) a detachable handle. A wide range of forceps can be used, including those with tips larger than the biopsy channel. We report a case that was treated with this new technique.

Adult↗