Publications (160)69.3 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Objective Spasmodic dysphonia (SD) is a complex neurological communication disorder characterized by a choked, strain-strangled vocal quality with voice stoppages in phonation. Its symptoms are exacerbated by situations where communication failures are anticipated, and reduced when talking with animals or small children. Symptoms are also reduced following selected forms of treatment. It is reasonable to assume that surgical alteration reducing symptoms would also alter brain activity, though demonstration of such a phenomenon has not been documented. The objective of this study is to reveal brain activity of SD patients before and after surgical treatment. Methods We performed lateralization thyroplasties on three adductor SD patients and compared pre- and post-operative positron emission tomography recordings made during vocalization. Results Pre-operatively, cordal supplementary motor area (SMA), bilateral auditory association areas, and thalamus were activated while reading aloud. Such activity was not observed in normal subjects. Type II thyroplasty was performed according to Isshiki's method and the strained voice was significantly reduced or eliminated in all three patients. Post-operative PET showed normal brain activation pattern with a significant decrease in cordal SMA, bilateral auditory association areas and thalamus, and a significant increase in rostral SMA compared with pre-operative recordings. Conclusion This is the first report showing that treatment to a peripheral organ, which reverses voice symptoms, also reverses dysfunctional patterns of the central nervous system in patients with SD.
- [Show abstract] [Hide abstract] ABSTRACT: This report describes a very rare case of myasthenia gravis (MG) localized to the larynx, with the onset of dyspnea requiring tracheotomy. The vocal cords of this patient were fixed in the paramedian position. Under fiberscopic observation, improvement of laryngeal function was demonstrated after intravenous injection of edrophonium. However, no voice change occurred. The posterior crico-arytenoid muscle has the sole responsibility of abducting the vocal cord; thus, it is concluded that the dyspnea was caused by the selective paralysis of this muscle. We suggest that MG should be considered in cases of vocal cord paralysis of unknown etiology.
- [Show abstract] [Hide abstract] ABSTRACT: A new operative technique for the treatment of floppy epiglottis is introduced in this report. Though its diagnosis is not so difficult by close observations using a flexible fiberscope, it is likely to be treated as an asthma attack or a paradoxical vocal cord movement. In previous reports of upper airway obstruction caused by adult floppy epiglottis: epiglottis prolapse during inspiration, the cause of this condition has been divided broadly into two categories: idiopathic cases and secondary cases. Partial or total epiglottectomy has been usually reported for the treatment of the relief of airway obstruction caused by a floppy epiglottis. It is very difficult to decide adequately how much volume of epiglottis to cut without postoperative sequelae. A V-shaped partial epiglottidectomy is described for its treatment. This technique is very easy, simple, and effective.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the effectiveness of hyperfractionation for T2 glottic cancer from a viewpoint of laryngeal preservation, we analyzed 21 patients (twice-a-day group) who were treated with hyperfractionation between 1992 and 1998 and compared the results with those of 27 patients (once-a-day group) treated with conventional once-a-day radiation between 1987 and 1992. In the twice-a-day group, radiation was performed with two fractions of 1.2 Gy/day up to a total dose of 72-74.4 Gy. In the once-a-day group, radiation was performed with a fraction of 2 Gy/day up to a total dose of 66 Gy. If radiation was ineffective at 40 Gy, it was stopped, and surgical treatment was carried out. Kaplan-Meier estimates were used for the analysis of the survival rate and laryngeal preservation rate, and the results were compared. In the once-a-day group, the 5-year survival rate was 92.3%. The 5-year laryngeal preservation rate was 51.8%, and it was 60.3% in 20 patients who had undergone full-dose radiation (once-a-day full-dose group). In the twice-a-day group, no major complication, such as laryngeal necrosis, was seen in any case, and the 5-year survival rate was 95.3%. The 5-year laryngeal preservation rate was 95.3%, and it was significantly better than that of both the once-a-day group and the once-a-day full-dose group. Hyperfractionation is considered to be useful for preserving the larynx for the treatment of T2 glottic cancer.
- [Show abstract] [Hide abstract] ABSTRACT: Since 1990, we have performed steroid injection into the vocal fold by fiberoptic laryngeal surgery (FLS) under local anesthesia. In this study, the usefulness of this method was evaluated in 28 patients with vocal nodules. Under monitoring using a fiberoptic laryngoscope, a curved injection needle was inserted via the oral cavity and steroid was injected. Endoscopic findings showed that the vocal nodule had disappeared in 17 patients of the 27 patients and decreased in 10 after injection. The maximum phonation time was 10.9 s before operation and 13.9 s after operation, showing a significant increase (P<0.05), and the mean flow rate also showed a significant improvement (P<0.05). The patients self-rating concerning hoarseness demonstrated great improvement after injection. This technique can be performed under local anesthesia in combination with voice therapy on an outpatient basis, and it is considered to be useful for treating vocal nodules.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of the present study was to evaluate the efficacy of cricoid regeneration via in situ tissue engineering in a canine larynx for the treatment of subglottic stenosis. As the tissue scaffold, a Marlex mesh tube coated by collagen sponge was used for a rigid airway framework and for tissue regrowth around the tube. On 5 dogs, the larynx was exposed and the anterior third of the cricoid cartilage was resected. The tube was anastomosed to the lower edge of the thyroid cartilage and to the first tracheal cartilage. By postoperative endoscopic examination at 3 to 7 months, no airway obstruction was observed in any of the dogs. There was granulation tissue in 2 dogs and slight mesh exposure in 1 dog, but they were asymptomatic. Confluent regeneration of the epithelium over the scaffold and good incorporation of the scaffold mesh into the host tissue were observed after surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Calcifying epithelioma (pilomatrixoma) is a relatively uncommon benign tumor. It usually presents as a slow-growing subcutaneous or intradermal nodule measuring less than 3 cm. In this report, we present a 20-year-old male with giant pilomatrixoma in the subauricular region. We performed en bloc resection of the tumor, which measured 12 x 9 cm. Histopathologically, this tumor did not show any malignant findings. There has not been any evidence of recurrence since the treatment.
- [Show abstract] [Hide abstract] ABSTRACT: Aneurysms of the superficial temporal artery are infrequent, and most of them are traumatic aneurysms located on the superior temporal line. We present a rare case of preauricular aneurysm of the superficial temporal artery. The patient was an 81-year-old woman who had a pulsating mass in the preauricular lesion. It was successfully removed by surgery. Histopathologically, it was suggested to be an aneurysm of the superficial temporal artery caused by atypical arteritis. She has not had active inflammatory findings, but follow-up is needed.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to regenerate the injured vocal fold by means of selective cultured autologous mesenchymal stem cells (MSCs). Eight adult beagle dogs were used for this experiment. Selective incubation of MSCs from bone marrow was done. These MSCs were submitted to 3-dimensional incubation in 1% hydrochloric acid atelocollagen. Three-dimensional incubated MSCs were injected into the left vocal fold, and atelocollagen only was injected into the right vocal fold of the same dog as a control. Four days after injection, the posterior parts of the vocal folds were incised. The regeneration of the vocal fold was estimated by morphological and histologic evaluations. Our results showed that 3-dimensional incubated MSCs were useful in the regeneration of the injured vocal fold. This study shows that damaged tissues such as an injured vocal fold would be able to be regenerated by tissue engineering.
- [Show abstract] [Hide abstract] ABSTRACT: The recurrent laryngeal nerve (RLN) does not regenerate well after it has been cut, and no current surgical methods achieve functional regeneration. Here, we evaluate the functional regeneration of the RLN after reconstruction using a biodegradable nerve conduit or an autologous nerve graft. The nerve conduit was made of a polyglycolic acid (PGA) tube coated with collagen. A 10-mm gap in the resected nerve was bridged by a PGA tube in 6 adult beagle dogs (group 1) and by an autologous nerve graft in 3 dogs (group 2). Fiberscopic observation revealed functional regeneration of the RLN in 4 of the 6 dogs in group 1. No regeneration of the RLN was observed in any dog in group 2. We also tested for axonal transport, and measured the compound muscle action potential. The RLN can be functionally regenerated with a PGA tube, which may act as a scaffold for the growth of regenerating axons.
- [Show abstract] [Hide abstract] ABSTRACT: We examined cortical activation by speech in patients with moderate inner ear hearing loss using PET to investigate the response of the language network to insufficient speech input. We made two word lists, well-perceived words and poorly-perceived words, and measured rCBF during monaural presentation of these words. Well-perceived words activated bilateral temporal lobes, bilateral inferior frontal gyri (IFG) and left angular gyrus (AG) regardless of the ear stimulated, Poorly-perceived words activated contralateral temporal lobe and bilateral IFG, while little or no activation was observed in the ipsilateral temporal lobe and left AG. Insufficient activation of the temporal lobe ipsilateral to the ear stimulated might correlated with less accurate word comprehension in patients with inner ear hearing loss.
- [Show abstract] [Hide abstract] ABSTRACT: Since 1990, we have performed steroid injections into the vocal fold under topical anesthesia using fiberoptic laryngeal surgery (FLS) in an outpatient clinic. The aim of this study was to retrospectively assess the usefulness of this treatment method in 44 patients with mild Reinke's edema. Using fiberoptic monitoring of the larynx, a curved injection needle was inserted via the oral cavity and triamcinolone acetonide was injected into Reinke's space of the bilateral vocal fold. Remission or improvement was observed in almost all patients in terms of both patients' self-rating of hoarseness and endoscopic vocal fold findings The maximum phonation time was a mean of 9.0 s before operation and 11.4 safter operation, and this increase was significant (p < 0.01). Voice pitch also improved, from 168 to 181 Hz, in female patients, and this increase was also significant (p < 0.05). Steroid injection is considered to be useful for treating mild Reinke's edema.
- [Show abstract] [Hide abstract] ABSTRACT: Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.
- [Show abstract] [Hide abstract] ABSTRACT: We developed a technique of fiberoptic laryngeal surgery for the treatment of vocal process granulomas. In this system, the granuloma can be removed relatively easily and repeatedly under topical anesthesia on an outpatient basis. We treated 27 patients for a total of 4 intubation granulomas and 23 contact granulomas. Ten of the 23 contact granulomas recurred after the initial surgery, but the intubation granulomas did not recur. Most of the recurrent lesions were resolved by fewer than 3 procedures, and all patients were finally cured. Although conservative therapies such as voice therapy and proton pump inhibitors have recently prevailed, surgical removal remains useful in treating vocal process granulomas. Fiberoptic laryngeal surgery facilitates repeated surgical procedures.
- [Show abstract] [Hide abstract] ABSTRACT: Congenital piriform sinus fistula, which is usually unilateral, is recognized as a cause of acute suppurative thyroiditis. We have encountered a rare case of bilateral piriform sinus fistulae. The patient, a 53-year-old female, was referred to our hospital because of right neck swelling, which improved after conservative treat. Three months later, an abscess of the left thyroid lobe was presented and was improved after incision and drainage. The diagnosis of bilateral piriform sinus fistulae was made by hypopharyngeal enhancement radiography. Total fistulectomies were performed. There was no recurrence observed six months after surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Recurrent laryngeal nerve injury is an important complication of thyroid cancer operation. Therefore, before surgery for thyroid cancer, it is important to establish whether the patient has non-recurrent laryngeal nerve (NRLN), which is an anomaly associated with the aberrant right subclavian artery.Our patient was a sixty-year-old female, in whom NRLN was detected prior to surgery for thyroid cancer. In this case, enhanced CT revealed a vascular image running behind the esophagus at the level of the upper margin of the aortic arch and subsequent MRA revealed the aberrant right subclavian artery.Enhanced CT scanning between the neck and the upper margin of the aortic arch can show aberrant right subclavian artery. Thus, in patient with thyroid cancer, enhanced CT is useful not only to evaluate lymph node metastasis but also to reveal the NRLN.
- [Show abstract] [Hide abstract] ABSTRACT: Polymorphous low grade adenocarcinoma (PLGA) is a low grade malignant neoplasm usually arising in the oral minor salivary gland. The prognosis of the disease has been reported to be excellent. There are some cases, however, which suffer from uncontrollable tumors. We report 3 cases of persistent or recurrent PLGA. Case 1: a 68-year-old woman first presented with a tumor in the soft palate at age 33. The tumor had recurred 4 times and had metastasized to the lung. Finally, the persistent tumor invaded the cavernous sinus. Palliative radiation therapy was carried out. Case 2: a 46-year-old man presented with a mass on the hard palate at age 29. In spite of several complete resections, the tumor has relapsed 4 times. Case 3: a 66-year-old woman presented with a left parotid tumor at age 50. Enucleation of the tumor was performed initially. It then recurred twice. Partial parotidectomy and extirpation of the recurrent tumor followed by postoperative irradiation was performed. Although PLGA is a low grade malignancy, resection with sufficient surgical margin should be considered, and careful follow-up over a long period is important.
- [Show abstract] [Hide abstract] ABSTRACT: We designed a new type of nonlinear digital hearing aid (TD-1) with near-instantaneous amplitude compression for sensorineural hearing-impaired people. The amplification method utilized by the TD-1 normalizes the signal waveforms within a time window bounded by two adjacent positive going zero-crossing points. The signals within this window are amplified so that the maximum amplitude reaches a preset value, thus allowing a consistent peak amplitude to be maintained. To test this, we examined the efficacy of the TD-1 device in 31 patients with sensorineural hearing loss. When tested for recognition of Japanese sentences in a quiet environment, 7 of 25 (28.0%) subjects wearing the TD-1 showed a 20% or greater increase in the maximum intelligibility score than that obtained when wearing their own linear hearing aids. In addition, 7 of 31 (22.6%) subjects showed the same increase with the TD-1 relative to that obtained when they wore HA70 or HA73 devices (Rion Co., Ltd., Tokyo, Japan), which are conventional analogue hearing aids. These results indicate that TD-1 can be effective for patients with sensorineural hearing loss.
Kioto, Kyoto, Japan
- • Graduate School of Medicine / Faculty of Medicine
- • Department of Plastic and Reconstructive Surgery
University of Wisconsin–Madison
Madison, Wisconsin, United States
- Department of Surgery
Osaka City University
Ōsaka, Ōsaka, Japan
- Graduate School of Medicine