Natsuki Morishima

Dynamic MRI diagnosis of sleep-disordered breathing.

According to the obstructive site, the different types of obstructive-type sleep-disordered breathing are classified as the soft palate type, palatine tonsil type, soft palate and depressed lingual root type, depressed lingual root type and epiglottis type. In this study, we conducted dynamic MRI examinations of the oral, pharyngeal and lingual root sites in patients with obstructive sleep-disordered breathing, and studied the usefulness of MRI as a diagnostic tool for the examination of such obstructive sites.

Comparison of the state of sleep in patients with sleep-disordered breathing before and after surgical treatment.

In 19 surgically treated patients with sleep-disordered breathing for whom electroencephalograms could be recorded before and after surgery, and in 10 patients who suffered from daytime lethargy as assessed using the Epworth Sleepiness Scale (ESS) score, correlations between the stages of sleep before surgery and the ESS score and apnea-hypopnea index (AHI) were evaluated, and changes in AHI and the stages of sleep after surgery were examined. Neither the preoperative severity of AHI nor the ESS score showed an association with the stages of sleep. The improvement in the quality of sleep tended to be greater as the percentage improvement in the ESS score increased.

Two Cases of Sleep Apnea Syndrome Caused by Primary Hypothyoidism.

Two cases of obstructive sleep apnea (OSAS) caused by primary hypothyroidism are reported.The first patient was a 66-year-old man who complained of sleep apnea with an apnea/hypopnea index (AHI) of 50.8 per night as assessed by all night monitoring. Hypothyroidism was subsegently suspected when he showed delayed recovery from general anesthesia following surgery involving UPPP (uvulo-palato-pharyngoplasty). Hypothyroidism was diagnosed on the basis of blood tests. His snoring and apnea improved after 2 months of levothyroxine sodium administration and the AuI changed from 50.8 to 13.0.The second patient was a 73-year-old man with an AHI of 41.3 per night as assessed by all night monitoring. Hypothyroidism was diagnosed on the basis of blood tests and was suspected because of his slow speech. He was similarly treated with levothyroxine sodium. The AHI did not decrease after treatment for 4 months. His desaturation time (the rate of O2 saturation less than 90%) improved however, from 56.6 to 31.9, and the symptoms of hypothyroidism also recovered markedly. In both patients, elevated creatine phosphokinase (CPK), dull facial expression, peripheral edema, and slow speech were recognized and these were suggestive of hypothyroidism. The type of sleep apnea was mainly obstructive in both patients.

Herpes Zoster with Oral Mucosa Symptom at the First Finding; A Case Report

A 61-year-old male visited our development because of a piercing sensation on his tongue. At the first examination, a fur (about 1 x 1 cm) on the right buccal mucosa revealed few findings. Four days later, however, the patient developed a papule on the right side of his face and an ulcer on the right half of the tongue. For this reason, he was admitted to our department. After admission, drip infusion of vitamin B and aciclovir therapy were administered. Although the initial symptoms disappeared in about 2 weeks, right facial palsy subsequently developed. Therefore, massive steroid therapy was initiated. About 2 months after admission, the right facial palsy was almost completely gone, and the patient was discharged. Hunt syndrome is a herpes zoster virus infection known in the field of otorhinolaryngology. Occasionally, patients with this syndrome develop multiple cranial nerve injury. In the present case, the initial sign was discomfort in the oral mucosa. The patient later developed a papule on the right side of his face and an ulcer on the right half of the tongue, followed by right facial palsy. Based on these sympoms, this case was diagnosed as herpes zoster, accompanied by injury of the V th, VlIth and lXth cranial nerves. The mode and route of the spread of herpes zoster infection are discussed.

Giant cell tumor in the nasal cavity; A case report.

On August 8, 1989, a 56-year-old woman visited our hospital complaining of a boil in her nose. A tumor was found in the nasal cavity, high on the anterior nasal septum. Both middle nasal conchae were displaced laterally.A CT scan showed a diffuse shadow in the root of the nose and a loss of nasal bone. Scintigraphy showed an abnormal mass in the middle of the face. The entire tumor was resected. Currently, 11 months after sungery, there is no sign of recurrence. However, strict monitoring will be necessary for some time to come.