Electroneurography in the acute stage of facial palsy as a predictive factor for the development of facial synkinesis sequela

Objective We investigated whether the value of ENoG is a predictive factor for the development of facial synkinesis in patients with facial palsy. Methods The degree of oral-ocular synkinesis was evaluated quantitatively by an asymmetry of the interpalpebral space width during the mouth movement (% eye opening). Twenty healthy volunteers without a history of facial palsy (12 men and 8 women; 25-65 years old; mean age: 42.3 ± 9.7 years) were included in the study to examine the normal range of % eye opening. Fifty-one patients with facial palsy including 38 with Bell palsy and 15 with herpes zoster oticus (28 men and 25 women; 11-86 years old; mean age: 54 ± 19 years) were enrolled to examine the relationship between the ENoG value 10-14 days after the onset of facial palsy, and the % eye opening 12 months later. Receiver operating characteristic (ROC) curve for the ENoG value was then used to decide the optimum cut-off value as a predictor of the development of oral-ocular synkinesis. Results We defined a % eye opening inferior to 85% as an index of the development of oral-ocular synkinesis. There was a significant correlation between the values of ENoG 10-14 days after the onset of facial palsy and those of % eye opening 12 months later (ρ=0.81, p<0.001). The area under the ROC curve for the ENoG value was the predictor for the development of oral-ocular synkinesis at 0.913 (95%CI: 0.831-0.996, p<.001). The optimum cut-off value of ENoG 10-14 days after the onset of facial palsy was 46.5% to predict the development of oral-ocular synkinesis 12 months after the onset of facial palsy (sensitivity 97.1% and specificity 77.5%). Conclusion The value of ENoG 10-14 days after the onset of facial palsy is a predictive factor for the development of facial synkinesis 12 months later. Since facial palsy patients with a ENoG value inferior to 46.5% have a high risk of developing synkinesis, they should receive the facial biofeedback rehabilitation with a mirror as a preventive therapy

When does facial synkinesis develop?

The objective of this study is to clarify when facial palsy patients with lower value of Electroneurography (ENoG) should begin the rehabilitation to prevent the development of facial synkinesis. For this purpose, we examined the relationship between the value of ENoG measured 10-14 days after facial palsy onset and the onset day of the development of oral-ocular synkinesis. Sixteen patients with facial palsy including 11 with Bell’s palsy and 5 with Ramsay Hunt syndrome (7 men and 9 women ; 15-73 years old ; mean age, 41.6 years) were enrolled in this study. There was no correlation between ENoG value and the onset day of the development of oral-ocular synkinesis (ρ = .09, p = .73). Oral-ocular synkinesis began to develop in 4.0 ± 0.7 months (mean ± SD ; range : 3.1-5.0 months) after facial palsy onset regardless of ENoG value. In conclusion, ENoG value cannot predict when facial synkinesis develops in patients with facial palsy. We recommend that facial palsy patients with a high risk for the development of synkinesis begin the biofeedback rehabilitation with mirror to prevent the development of facial synkinesis 3 months after facial palsy onset

ラムゼイ・ハント症候群症例の前庭蝸牛神経MRI造影効果と前庭蝸牛機能障害との関係

Objective: The correlation between enhancement of the vestibulocochlear nerves on gadolinium-enhanced magnetic resonance imaging (MRI) and vestibulocochlear functional deficits was examined in patients with Ramsay Hunt syndrome (RHS). Methods: Nineteen patients with RHS who showed herpes zoster oticus, peripheral facial palsy, and vertigo were enrolled. Canal paresis (CP) in the caloric test, abnormal response to ocular and cervical vestibular myogenic potentials (oVEMP and cVEMP), and refractory sensorineural hearing loss were evaluated. MRI images perpendicular to the internal auditory canal were reconstructed to identify the superior (SVN) and inferior vestibular nerves (IVN) and the cochlear nerve (CV). The signal intensity increase (SIinc) of the four-nerve enhancement was calculated as an index. Results: Among RHS patients, 79%, 53%, 17% and 26% showed CP in the caloric test, abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, respectively. SIinc rates of the SVN were significantly increased in RHS patients with CP in the caloric test, and with abnormal responses to oVEMP and cVEMP. SIinc rates of the SVN tended to increase in RHS patients with refractory sensorineural hearing loss ( p = 0.052). SIinc rates of the IVN were significantly increased in RHS patients with abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, but not in those with CP in the caloric test. SIinc rates of the CN were significantly increased in RHS patients with CP in the caloric test, abnormal response to oVEMP and refractory sensorineural hearing loss, but not in those with abnormal response to cVEMP. Conclusion: In patients with RHS, the origin of vertigo may be superior vestibular neuritis, which is affected by reactive varicella-zoster virus from the geniculate ganglion of the facial nerve through the faciovestibular anastomosis. The results also suggested that in some RHS patients, inferior vestibular neuritis contributes to the development of vertigo and that the origin of refractory sensorineural hearing loss is cochlear neuritis

多様なリン配位子架橋を利用した反応性多核金属錯体の創製

研究期間:平成15-18年度 ; 研究種目:基盤研究B ; 課題番号:15350035原著には既発表論文の別刷を含む

オリーブ油注入法による膀胱 CT scan

Computed Tomography (CT) による膀胱癌の診断は，非侵襲的な診断法であり，膀胱周囲臓器との関係を観察できるのみならず，腫瘍の形態，膀胱の性状の変化などを知りうることから，これによる術前診断が期待されている。しかし, 膀胱造影剤として，従来用いられてきた空気，低濃度陽性造影剤では，必ずしも腫瘍形態を満足に描出することができず，また造影剤によるartifact により，診断が困難になることが多く，種々の研究努力がなされているが，いまだ解決に至っていない。今回，われわれは，滅菌オリーブ油を膀胱内造影剤として用いることにより，腫瘍の膀胱内部分の行態，正常膀胱壁，および腫瘍の壁外浸潤を正確にとらえることを，実験的に確め，臨床に応用した。実験には，膀胱ファントムを作製し，遺影剤として, 空気, オリーブ油, 生食，１％アンギオグラフィン, 2%アンギオグラフィンを用い，検討を行なったが， CT膀胱造影剤として，オリーブ油が最適であると結論した。臨床的には，検査前にバルーンカテーテルを挿入，排尿を完全に行ない，空気の混入を避けながらオリーブ油100から120ccを注入の後，カテーテルを抜去し，仰臥位にてスキャンを行った。つぎに腫瘍の位置により，患者の体位変換をおこない，再びスキャンをおこなって，腫瘍の正確な描出を試みた。現在までに65例に滅菌オリーブ油注入によるCT膀胱スキャンを行なったが，副作用は全く認めず，この方法は膀胱癌の術前診断として高く評価されると考える。Staging of the urinary bladder neoplasms is based on precise demonstration of morphology of the tumor and surrounding structures including normal bladder wall. Computed tomography is recognized as an accurate non-invasive technique for evaluating urinary bladder tumors and its extravesical extensions on condition that the bladder is filled with appropriate -contrast materials. Although the gas filled method has been commonly used and it shows an appreciable diagnostic value, gas itself sometimes produces significant artifacts which mask the vesical wall and the extravesical structures. The authors proved the olive oil as a suitable contrast material for CT of the urinary bladder by experiment and clinical application. Our new method can demonstrate the intraluminal tumor, vesical wall and extravesical tumor extensions more precisely than the ordinary method using the gas or positive contrast materials