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Biomedical subjects

T Mezaki

Publications and source records attributed to T Mezaki.

At least 55 records · Page 3Linked to original sources
PubMed1995

Comparison of therapeutic efficacies of type A and F botulinum toxins for blepharospasm: a double-blind, controlled study.

Type F botulinum toxin can be used for treating patients with dystonia who become refractory to type A toxin injection due to antibody development. We compared the therapeutic efficacy of type F botulinum toxin to that of type A toxin in a self-controlled, double-blind clinical trial. In nine patients with blepharospasm, we injected type A toxin on one side and the same units of type F toxin on the other side. Although the onset of clinical effect, maximal benefit, and adverse reactions were similar between type A and F toxins, the duration of the clinical effect was significantly shorter on the side injected with type F toxin. Although type F toxin proved its promise as an alternative to type A toxin, its usefulness is limited by the shorter duration of action.

Aged↗
PubMed1995

[The clinical usefulness of botulinum toxin type A for spasmodic torticollis and facial spasm].

We studied the clinical effectiveness of botulinum toxin type A for spasmodic torticollis and that for facial spasm by multicenter, non-blinded study. The freeze-dried crystalline botulinum toxin type A (AGN 191622; Allergan Inc., Irvine, CA) was injected into the hyperactive muscles and the clinical course was followed for 22 weeks. Repeated injections were done, if necessary, with an interval of 4 weeks. The toxin was highly effective in both disorders. In spasmodic torticollis, clinical severity improved in 38 (63.3%) and the global improvement was seen in 39 (65.0%) out of 60 patients. Subjective improvement was seen in 56 (93.3%). In facial spasm, 52 (92.9%) out of 56 patients improved after the treatment. Unfavorable reactions, mainly consisting of neck muscle weakness and dysphagia in torticollis and facial weakness in facial spasm, were mostly due to the excessive action of the toxin. They were usually mild and transient. No patients discontinued the trial because of side effects. Botulinum toxin injection is a very useful and safe method for the symptomatic treatment of spasmodic torticollis and facial spasm.

Adolescent↗
PubMed1995

[Dose-response relationship in the treatment of cervical dystonia with botulinum toxin type A (AGN 191622)--a phase II study].

Injection of botulinum toxin type A has been the treatment of choice for spasmodic torticollis for several years. Although previous reports demonstrate its effectiveness and safety, the treatment strategy has been empirical. The present study, using the freeze-dried crystalline botulinum toxin type A (AGN 191622; Allergan Inc., Irvine, CA), aimed to compare the efficacy among three treatment groups divided into low, medium and high dosage levels. Fifty-one patients who entered the study were grouped into low-dose (60 units/session), medium-dose (120 units/session) and high-dose (240 units/session) groups. Two patients (one in low-dose group and the other in high-dose group) were excluded from the assessment of efficacy because they dropped out in the early phase of the study. One experienced worsening of an existing psychosis and the other developed an acute respiratory infection. Injection sites were decided individually by palpation. If the clinical response was not satisfactory four weeks after an injection, the patient was re-injected with the same dose of toxin. The follow-up period was 14 weeks from the initial injection. The results showed that the high-dose group improved more than the other groups in the parameters of severity of symptoms and subjective benefit (p = 0.000). Also, fewer injections were required in the high-dose group to achieve substantial clinical benefit. Although the mean reduction in Tsui's score was not statistically significant among the groups, the "marked improvement" was seen more frequently in the high-dose group (p = 0.033). Unfavorable adverse effects including excessive weakness and dysphasia were always mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[A case report of pyomyositis--early diagnosis and follow-up by MRI].

We report a rare case of pyomyositis in a 28-year-old Japanese woman who was not immunocompromised. She was admitted because of high fever, sore throat, and severe tenderness and swelling of the right calf. Redness, swelling, and tenderness indicated presence of acute inflammation in the calf. CT of the lower extremities demonstrated low density areas in the right soleus muscle and surrounding fascia with marked swelling, which were of high signal on T2 weighted images of MRI. There was no finding of abscess formation. A tentative clinical diagnosis of acute pyomyositis was made, and antibiotics therapy with a combination of fosfomycin and sulbactam/cefoperazone was started although the arterial blood culture was negative for bacteria. Associated acute tonsilitis was the most probable focus of pyomyositis. Antibiotics relieved her symptoms, and the inflammation subsided in several weeks. No surgical procedure was necessary. MRI taken tree weeks after the onset demonstrated abscess formation between the soleus and gastrocnemius muscles. Slight high intensity indicating scar formation remained in the area of the former abscess six weeks after the onset. MRI was very useful not only in making the early diagnosis but also in the follow-up of pyomyositis.

Adult↗
PubMed1994

Optimisation of botulinum treatment for cervical and axial dystonias: experience with a Japanese type A toxin.

Twenty two patients with cervical and axial dystonias were treated with Japanese type A botulinum toxin. Injections were given repeatedly at intervals of 28-30 days to carefully chosen muscles with increased activities, with a maximum dose per session of 300 units. The maximum improvements in subjective and objective ratings were obtained only after repeated injections. No anti-toxin antibodies were detected; nor did any muscle fail to respond to the toxin. During the treatment, previously "silent" muscles were activated to reproduce the original abnormal posture, as if driven by a central motor programme. This resistance to treatment was overcome by injecting the toxin into newly activated muscles. Repeated injections are thus required to override central mechanisms in dystonias or to maximise drug delivery to large muscles. Antibody development may be controlled by the use of a less immunogenic toxin.

Adolescent↗
PubMed1994

[123I-IMP SPECT findings of visual perseveration in a patient with old hemorrhage in the right occipital lobe].

We report a case of visual presevertation in a 67-year-old man. He had been well until 66 years of age when he had brain hemorrhage in the right occipital lobe. After an operation for removal of the hematoma, visual hallucination occurred and persisted for about 6 months. One year and a half later, he had a convulsive seizure and diphenylhydantoin was started. During the two weeks following the convulsion, he several times experienced episodes of visual preservation, visual hallucination and metamorphopsia. MRI revealed an old hemorrhage in the right occipital lobe. 123I-IMP SPECT demonstrated increase of cerebral blood flow of the right medial occipital lobe one day after the episode of visual perseveration and decrease about three weeks after the episode. The mechanism which causes visual perseveration still remains to be clarified. The findings of 123I-IMP SPECT of the present case suggest that visual perseveration may be generated by postictal transient functional excitation of the right occipital lobe.

Aged↗
PubMed1994

[Intravenous immunoglobulin therapy in multifocal motor neuropathy].

We treated ten consecutive patients with multifocal motor neuropathy (MMN) with high-dose intravenous immunoglobulin. Ages ranged 18 to 58 years, with disease duration of 9 months to 8 years. We treated them with 0.2 g/kg of human immunoglobulin for 6 consecutive days. All but one showed a clinical improvement starting within a week after the first infusion. The functional improvement ranged from marked to mild degree. In six patients, the clinical effect abolished within 2 months. Improvement was persistent for more than 6 months in the other three. In only two patients conduction block improved after the treatment. The discrepancy may result from an increased threshold of remyelinated or chronically demyelinated fibers for excitation. Side effects were not documented. This pilot study indicates that immunoglobulin may be a safe and effective therapy for MMN.

Adolescent↗
PubMed1993

Pathological findings at the site of conduction block in multifocal motor neuropathy.

We report on 2 patients with multifocal motor neuropathy with focal conduction block involving motor but not sensory fibers at the site of nerve swelling. A nerve biopsy specimen from adjacent to the enlargement in 1 patient showed a perivascular area containing scattered demyelinated axons surrounded by small onion bulbs. The observed pathological findings are consistent with the conduction block considered characteristic of this neuropathy, although the underlying immunological mechanisms for selectivity and persistence remain undetermined.

Action Potentials↗
PubMed1993

A kindred of hereditary adult-onset leukodystrophy with sparing of the optic radiations.

We describe a family with hereditary adult-onset leukodystrophy with sparing of the optic radiations, shown clinically, neuroradiologically and electrophysiologically. All five affected members developed their leukodystrophy in their fourth decade and clinical features steadily progressed. The sparing of the optic radiations is not typical of other leukodystrophies. We suggest that this is a new clinical entity.

Adult↗
PubMed1993

[Brain SPECT by intraarterial infusion of 99mTc-HMPAO for assessing the cerebral distribution of carotid artery infusions in patients with brain tumor].

In order to assess the cerebral distribution of intracarotid chemotherapy, 17 postoperative patients with brain tumor underwent brain SPECT obtained by intraarterial infusion of 18.5 MBq of 99mTc-HMPAO. Injection methods were continuous (5.0 ml/min) or pulsatile infusion with supraor infraophthalmic catheterization. The findings obtained by brain SPECT were frequently different from those of angiography and/or DSA. In supraophthalmic catheterization with continuous infusion, only 2 of 10 studies (20%) had homogeneous distribution and 5 of them (50%) had maldistribution of 99mTc-HMPAO which appears in association with laminar flow effect. The remaining 3 studies showed localized distribution (two: tumor localization, one: healthy brain localization). On the other hand, all of 5 studies with pulsatile infusion had homogeneous distribution of 99mTc-HMPAO. In infraophthalmic catheterization, all but one of 5 studies had homogeneous distribution with continuous infusion. These results suggest that pulsatile infusion may be effective in eliminating maldistribution of 99mTc-HMPAO in supraophthalmic catheterization. In conclusion, we are convinced that 99mTc-HMPAO is a useful intraarterial agent for assessing cerebral distribution of intracarotid chemotherapy.

Adolescent↗
PubMed1993

[Reassessment of usefulness of salivary scintigraphy in diagnosis of Sjögren's syndrome].

Dynamic salivary scintigraphy using 99mTcO4- was performed in 95 patients (a total of 366 glands) suspected of Sjögren's syndrome (SjS) and the results were compared with SjS diagnostic criteria by the Japanese Welfare Ministry. Time-activity curve of ROI created over each salivary gland was classified into four patterns, that is, N, M1, M2, F pattern, depending upon trapping, accumulation and secretion response to the tartaric acid. In definite SjS patients, most of the patients had different patterns in the four glands, and classical F (flat) pattern in all of the four glands was uncommon (3/38, 8%). F and/or M2 (no response to secretary stimulation) patterns were seen in 68.5% (98/143) of the all glands. Provided that F and/or M2 patterns in 2 or more glands is scintigraphic criteria for diagnosis of SjS, sensitivity, specificity and accuracy were 82.9%, 59.5%, 70.8%, respectively. As for salivary uptake of 99mTcO4-, there is a significant difference between the patients with definite SjS and control subjects (parotis p < 0.05, submandibular gland p < 0.01), but there is no significant difference among the patients with definite SjS, suspected SjS and chronic sialoadenitis. In conclusion, the four patterns classification may have potential in screening patients with SjS.

Aged↗
PubMed1992

[Treatment of Guillain-Barré syndrome with "axonal" involvement by plasma exchange].

A 19-year-old man with Guillain-Barré syndrome (GBS), who had been bedridden, dramatically improved after plasma exchange despite electrophysiological evidence of severe axonal damage. We commenced the therapy at 24 days after the onset of illness. Each trial of plasma exchange improved the strength clinically and rapidly increased the amplitude of the compound muscle action potential. Four months later, muscle strength recovered to normal except for mild weakness of the distal limb muscles. The time course of such a prompt recovery precludes axonal regeneration as its underlying mechanism in our patient. We postulate that some humoral factor might have reversibly depressed the axonal excitability, causing clinical symptoms which mimic axonal degeneration. Plasma exchange is a choice of treatment even for patients with GBS showing electrophysiological findings suggestive of axonal involvement.

Adult↗
PubMed1992

[Botulinum toxin trial for spasticity].

We treated three patients with spastic paraparesis with botulinum toxin (BTX). Two of them had scissors gait reflecting the hypertonus of adductors. In both, an injection of BTX to the responsible muscles improved gait, albeit transiently. The effect was shortlived, probably because increased tonus in non-injected portions compensated for the weakness of injected portions. In the third patient with no abnormality in tonus of the adductors, BTX injection in quadriceps caused a weakness with exacerbation of gait disturbance. We concluded that, in selected cases, BTX therapy is useful for spastic paraparesis to alleviate hypertonicity of the adductors.

Adult↗
PubMed1992

[Reassessment of radionuclide-venography for deep vein thrombosis in the lower extremities and pelvic cavity using 99mTc-MAA].

We performed radioisotope (RI)-venography in 31 patients suspected of deep vein thrombosis (DVT), and 18 patients of them (58.1%) had abnormal findings. Out of the 18 patients, 14 satisfied the diagnostic criteria for DVT, that were interruption in the venous flow with the presence of collateral circulation. Sensitivity, specificity and accuracy of RI-venography for DVT were 100%, 76%, 87%, respectively. In all of the patients with chief complaints of edema and pain in the unilateral extremity DVT was found by RI-venography. Lung scan revealed multiple pulmonary perfusion defects in 4 (33.3%) of 12 patients with DVT. Out of the 4 patients, 3 (75%) had silent pulmonary thromboembolism. 99mTc-MAA accumulation was seen in the left lobe of the liver in a patient with occlusion of the IVC and common iliac veins. We are convinced that patients with PTE and/or edema and pain in the unilateral lower extremity should undergo routine RI-venography. In conclusion, RI-venography using 99mTc-MAA was reassessed and we obtained the result that it is useful for screening and monitoring DVT and pulmonary thromboembolism.

Adolescent↗
PubMed1991

Marked reduction in CSF lactate and pyruvate levels after CoQ therapy in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS).

Many CoQ trials for mitochondrial encephalomyopathy are reported, however, the action of CoQ in the central nervous system is unknown. We administered CoQ to a patient with MELAS, and decreasing CSF lactate and pyruvate levels were revealed. This reduction in CSF lactate and pyruvate may be evidence that CoQ acts directly on the CNS. There have been no other descriptions of evidence of CoQ effective action in the central nervous system, a finding unique to this report.

Acidosis, Lactic↗
PubMed1991

Spinocerebellar degeneration (SCD): cognitive disturbances.

The performance of 30 patients younger than 65 years with spinocerebellar degeneration (SCD) was compared with control subjects matched for age, sex, and education in standardized neuropsychological tests. SCD patients exhibited abnormalities in WAIS, in the recall test of anterograde verbal memory, in verbal fluency, in visuospatial function and on the depression scale. However, they exhibited no deficit in the recognition test of anterograde verbal memory. No patients showed impaired visual confrontation naming. The pattern of neuropsychological deficits exhibited by the SCD patients closely approximated the profile observed in other types of subcortical dementia. There were no significant differences between the SCD patients with pontine atrophy and those without pontine atrophy in any of the neuropsychological examinations.

Adult↗