Yasuhide Makiyama

Magnetic resonance angiography in the management of childhood moyamoya disease: first choice for neurovascular scrutiny.

We performed magnetic resonance angiography (MRA) in 12 children with a suspected or angiographically proven moyamoya disease. MRA was performed by the three-dimensional, time-of-flight technique and, successfully depicted the primary abnormalities in the distal carotid arteries in 10 out of the 12 patients. In the other two patients, poor visualization of the intracranial vasculature strongly suggested the presence of the disease. On MRA, moyamoya vessels were visible in eight patients. The presence of anastomoses was also confirmed by MRA in seven of the 10 patients who had undergone encephalo-duro-arterio-synangiosis. Our findings suggest that MRA may be the tool of choice for selecting patients to undergo conventional angiography. However, establishing a definite diagnosis still requires some improvements in the delineation of the fine vasculature.

Dynamic changes in cytochrome oxidase activity in the rat somatosensory cortex following thalamocortical deafferentation

The changes in cytochrome oxidase (CYO) activity in the primary somatosensory cortex (SI) induced by unilateral lesions restricted to the posterior ventrobasal region of the thalamus were investigated by histochemical techniques and photometric semi-quantitation in the rat. The CYO activity decreased rapidly and dramatically in layer IV of the lesioned side, reaching its lowest level within 2 weeks, and remained depressed at 8 weeks post-lesion. Segmentations normally seen in layer IV corresponding to barrels remained absent. While less marked decreases were also noted in other layers, obvious recovery was subsequently observed, attaining levels comparable to those on the intact size at 6 or 8 weeks post-lesion. The persistent decrease in layer IV appears to reflect a reduced thalamocortical activation of the dendritic profiles and neuronal perikarya. The recovery in other layers may represent an increase in the resting level of the initially depressed neuronal activity near to the original levels. The persistent reduction of function in the inhibitory surround, which is normally activated by thalamocortical input, may contribute to the increase in CYO activity.

Massive intracerebral hematoma in a child with klippel-trenaunay syndrome

The authors describe a child who suffered from massive intracerebral bleeding due to rupture of a cerebral arteriovenous malformation associated with Klippel-Trenaunay syndrome (KTS). Neurovascular lesions have been regarded as uncommon in KTS; however, our case may indicate the need for neurovascular scrutiny in patients with this syndrome.

Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome

The aim of this study was to evaluate the relationship between pain intensities and psychosocial characteristics in middle-aged and older patients with temporomandibular disorders (TMDs) and burning mouth syndrome (BMS). Subjects were selected according to the Research Diagnostic Criteria for TMD (n = 705) and International Association for the Study of Pain criteria for BMS (n = 175). Patients were then divided into two age groups: 45-64 years (middle-aged, Group A) and 65-84 years (older, Group B). Pain intensity and depression and somatization scores were evaluated in both groups. In BMS patients, present and worst pain intensities were significantly higher in Group B than in Group A {4.6 [95% confidence interval (CI) = 4.0-5.2] vs. 3.5 [95% CI = 3.1-3.9] and 5.9 [95% CI = 5.2-6.4] vs. 5.0 [95% CI = 4.5-5.6], respectively; P < 0.05}, with no difference observed in TMD patients. The depression and somatization scores were significantly higher in Group A than in Group B among BMS patients [0.57 (95% CI = 0.45-0.69) vs. 0.46 (95% CI = 0.34-0.59) and 0.537 (95% CI = 0.45-0.63) vs. 0.45 (95% CI = 0.34-0.55); P < 0.05], with no difference observed in TMD patients. The results of the present study indicate that pain intensities and psychosocial characteristics in BMS appear to differ between middle-aged and older patients.

Auditory brainstem response and temporal bone pathology findings in a brain-dead infant

The criteria for assessing adult brain death have been already established, but those for infant brain death have not been yet established in Japan. We report auditory brainstem response (ABR) and postmortem pathology of the temporal bone and brain of a brain-dead 9-month-old female. During the comatose state, her ABR showed only waves I and II bilaterally. Autopsy revealed the presence of a left cerebellar astrocytoma, herniation and anoxic encephalopathy. The pathological examination of the temporal bone revealed the destruction of the inner ear particularly on the left side. In the auditory pathway of brain-dead patients, degeneration occurs first in the cerebrum, followed by the cochlear nerve. Thus, ABR is one of the useful means to assess brain death even in infants.

Changes of CSF Migration, Energy Metabolism and High Molecular Protein of the Neuron in Hydrostatic Intracranial Hypertension

In this paper, topographical changes of intraparenchymal CSF migration (Hayashi et al. 1987), microcirculation, and aerobic metabolism following acute and chronic hydrocephalus are presented. Ischemia sensitive dendrites and cell soma were studied with the specific high molecular protein; MAP 2 (microtubule associated protein) (Matus et al. 1981).

Prefrontal modulation during chewing performance in occlusal dysesthesia patients: a functional near-infrared spectroscopy study

ObjectivesNeuropsychological associations can be considerable in occlusal dysesthesia (OD) patients who routinely complain of persistent occlusal discomfort, and somatization effects in the superior medial prefrontal cortex and the temporal and parietal regions are also present. However, the relationship between physical activity, i.e., chewing, prefrontal cognitive demand, and psychiatric states in OD patients remains unclear. We investigated this relationship in this study.Materials and methodsOD patients (n = 15) and healthy control (n = 15; HC) subjects were enrolled in this study. Occlusal contact, chewing activities of the masticatory muscles, prefrontal activities, and psychiatric states such as depression and somatization, of the participants were evaluated. Functional near-infrared spectroscopy was used to determine prefrontal hemodynamics and the Symptom Checklist-90-R was used to score the psychiatric states.ResultsWe observed a significant association between prefrontal deactivation during chewing and somatization subscales in OD patients. Further, there were no significant differences with regard to the occlusal state and chewing physical activities between the OD patients and HC subjects.ConclusionsChewing-related prefrontal deactivation may be associated with somatization severity in OD patients.Clinical relevancefNIRS is a functional imaging method that uses the principal of neuro-vascular couplings. It is applicable for evaluation of psychiatric state based on prefrontal cortex blood flow in patients with psychiatric disorders.

Image Evaluation of Nasopharyngeal Mucosa Physical Change of Laryngopharyngeal Reflux Disease

Objectives: Evaluate a picture of narrow band imaging (NBI) examination for a diagnosis of laryngopharyngeal reflux disease (LPRD) using the image processing analysis objectively. Methods: Ten patients who underwent NBI were studied. Eight patients were LPRD and 2 patients were non-LPRD patients. We performed image processing for pictures after NBI examination by using the application software of a perfect translation invariance complex discrete wavelet transform (PTI-CDWT) developed at Toyohashi University of Technology and MATLAB (The MathWorks, Inc.). We looked into the nasopharyngeal mucosa physical changes that were detected by PTI-CDWT and analyzed by MATLAB. Results: Images with LPRD showed many round opaque dots mostly consistent with round wavelet transform. On the contrary, images without LPRD represented a small number of linear lines, and any other area showed no feature. Morphologic operation by MATLAB distinguished the difference of nasopharyngeal mucosa physical exchange between LPRD and non-LPRD. Conclusions: Though LPRD is a common disease for otolaryngologists to see, it may not yet be a definite diagnosis like gastroesophageal reflux disease. We have presented a correlation between LPRD and nasopharyngeal mucosa examination as mackerel cloud pattern at American Academy of Otolaryngology—Head and Neck Foundation annual meetings. We showed the possibility of image processing to diagnose LPRD with PTI-CDWT last year. Images which were implemented morphological operation by MATLAB may show representative for each nasopharyngeal mucosa physical change. MATLAB characterized images which were modified using PTI-CDWT. To use PTI-CDWT and MATLAB is not only useful in diagnosing LPRD but may possibly allow one to develop image diagnosis or an analysis instrument.

Image Processing by Using the Wavelet Transform (PTI-CDWT) to Diagnose Laryngopharyngeal Reflux Disease (LPRD)

Objectives: Develop Narrow Band Image (NBI) to diagnose LPRD by using a perfect translation invariance complex discrete wavelet transform (PTI-CDWT). Methods: 20 patients underwent NBI and Frequency scale for symptoms of GERD (FSSG). We performed image processing for pictures after NBI examination by using the application software of PTI-CDWT that was developed at Toyohashi University of Technology in Japan. We looked into a correlation between PTI-CDWT and NBI pictures. Results: Images detected by PTI-CDWT were distinguished from linear wavelet transform to round wavelet transform. Patients with high score in FSSG tended to show round wavelet transform. On the other hand, patients with low score represented linear wavelet transform. PTI-CDWT emphasized modulated nasopharyngeal epithelial cells with LPRD patients. Conclusions: LPRD is a common disease in the world. However, it does not have a definite diagnosis. Last year our group reported an applicability of NBI to diagnose LPRD. We showed one feature of nasopharyngeal mucosa pattern of NBI as mackerel cloud pattern. Wavelet transform are applied for signal and image processing of medical field. As image processing requiring a detail edge and directional components is important to estimate the images, one feature detection method of a discrete wavelet transform is to decompose the signal and image into each frequency component using low and high-pass filters. PTI-CDWT can detect more directions at various scales than previous wavelet transform. PTI-CDWT could be applied as a useful diagnostic tool for LPRD.

Applicability of Narrow Band Image to Diagnose Laryngopharyngeal Reflux Disease

Objective: 1) To develop the applicability of nasopharyngeal epithelial cell with Narrow Band Image (NBI) to diagnose laryngopharyngeal reflux disease (LPRD). 2) Estimate a correlation between a new questionnaire (Frequency Scale for the Symptom of the GERD; FSSG) and LPRD. Method: We have 88 patients who underwent NBI using FSSG. Because of the pattern of nasopharyngeal epithelial cell NBI image, we distinguished grade 1: nothing, grade 2: moderate, and grade 3: severe. All patients answered the FSSG questionnaire and were administered a PPI (rabeprazole10 mg). Student t test was used to compare each category out of 12 questions of FSSG for LPRD patients. Results: Average age of patients was 59.3 years old. Sixty-nine (78%) patients were detected with grade 2 (46 pts) and grade 3 (23 pts). Nasopharyngeal epithelial cell with NBI showed a specific feature, which nasopharyngeal epithelial round cells were modulated capillary cells raised among LPRD patients. We presumptively call the pattern mackerel cloud pattern. Patients who indicated grade 3 showed higher score in FSSG. “Do you have an unusual (eg, burning) sensation in your throat?” category of 12 questions of FSSG showed a significant difference. Conclusion: We could show that nasopharyngeal epithelial cell pattern with NBI would be a useful and specific feature to diagnose the LPRD. FSSG is not only used for GERD; it also may be used for LPRD clinically.We are currently confirming nasopharyngeal epithelial cell images using digital image analyzer (Wavelet analyzer).