Construction and Quality Evaluation of the Japanese Sarcopenic Dysphagia Database.

OBJECTIVES: To describe the activity and evaluate the quality of the Japanese sarcopenic dysphagia database. DESIGN: Cohort registry study. SETTING: 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. PARTICIPANTS: 467 dysphagic patients, aged 20 years and older. MEASUREMENTS: The following indices were assessed at baseline: age, sex, main disease, sarcopenic dysphagia, whole body sarcopenia, Food Intake Level Scale (FILS), malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria, oral status assessed by the Revised Oral Assessment Guide or the Oral Health Assessment Tool, activities of daily living assessed by the Functional Independence Measure (FIM) or the Barthel Index (BI), Charlson comorbidity index, C-reactive protein and serum albumin levels, dysarthria, hoarseness, aphasia, pressure ulcers, bladder, bowel, and kidney function, respiratory status, polypharmacy, number of drugs, and involvement of health care professionals and rehabilitation nutrition team. FILS, FIM or BI, and outcome including discharge destination were assessed at follow-up. A simple comparison of cases and evaluation of the quality of data were performed. RESULTS: The mean age was 80.4 ± 11.4 yr. The variable input error was 0. The number of patients with missing data was high for estimated glomerular filtration rate, C-reactive protein, serum albumin, skeletal mass index, and tongue pressure. The prevalence of either probable, possible, or no sarcopenic dysphagia was 105 (23%), 182 (39%), or 179 (38%), respectively. Doctors including physiatrists, nurses, physical therapists, and registered dietitians were involved with most patients, while the rehabilitation nutrition team was involved in only 16% of patients. CONCLUSIONS: The quality of the database was relatively high. Sarcopenic dysphagia is common in patients with dysphagia.

Dysphagia in children with oculo-auriculo-vertebral spectrum.

Feeding difficulty necessitating tube feeding after the infantile period was seen in 3 children with oculo-auriculo-vertebral spectrum. Videofluorographic imaging showed impaired pharyngeal function, which was thought to result from dysplasia of the pharyngeal muscles. Note should be made of feeding difficulty in patients with oculo-auriculo-vertebral spectrum.

Interstitial laserthermia in neurosurgery.

Deep-seated brain tumor is difficult to treat surgically. Hyperthermia using various energy sources has been tried, but has failed to gain wide use because of equipment problems and poor temperature control. It is possible now to use Nd:YAG laser with a stable low-energy supply as an energy source for laser hyperthermia (laserthermia). Animal study and clinical study were done using SLT CL50, Computer-control Laserthermia System to treat deep-seated brain tumors. Experimental study revealed that laserthermia produced minimal edema, temperature control was satisfactory, and blood-brain barrier opened up for 6 days following laserthermia. Five patients with brain tumors were treated with laserthermia. Follow-up CT scan revealed disappearance of tumor in 4 patients and decrease in volume in 1 patient. Long-term neurological follow up revealed no deterioration. Laserthermia using Nd:YAG laser is safe and easy to use and it is beneficial to treat deep-seated brain tumors.

Photodynamic therapy using pheophorbide a and Nd:YAG laser.

The authors describe a new photodynamic therapy (PDT) method for malignant brain tumors. Pheophorbide a (Ph-a), the photosensitizer, has low toxicity, causes no skin sensitization and is activated with an acoustic Q switched neodymium yttrium-argon-garnet (Nd:YAG) laser which achieves deep tissue penetration. The Ph-a distribution in Fisher 344 (F344) rats bearing rat T9 glioma at 24 hours after intravenous injection was very low in the normal brain tissue, but significantly higher in the T9 glioma giving a tumor to normal brain tissue concentration ratio of 7.5:1. The in vitro survival rate of T9 glioma cells pretreated with Ph-a was 68.8 +/- 5.4% after laser irradiation for 20 minutes, significantly lower than in the control groups. This indicates that Ph-a was activated with the acoustic Q switched Nd:YAG laser causing the photodynamic effect. The survival rate after Ph-a pretreatment and laser irradiation in a waterbath at 44.0 degrees C was further reduced to 15.8 +/- 3.3%. In vivo PDT studies using T9 glioma cells inoculated into the dorsal region of F344 rats showed tumor eradication in four of six rats. The combination of PDT and laser hyperthermia produced tumor eradication in all six rats. The combination of PDT and hyperthermia is a promising method for tumor treatment.

Stereotactic interstitial laser-hyperthermia using Nd-YAG laser.

Laser hyperthermia using Nd-YAG laser was studied experimentally and clinically to treat deep-seated brain tumors. Histological changes, temperature profile, and modification of the blood-brain barrier were studied using cat and rat brains. In a clinical study 5 patients with brain tumors were treated with laser hyperthermia using this computed tomography-stereotactic technique. All tumors of these patients disappeared on computed tomography, and 3 of the 5 patients are still alive without recurrence. It was possible to make optimal lesion and to have accurate peripheral temperature control by using the combination of the Komai stereotactic method and the SLT Nd-YAG laser system. Interstitial laser hyperthermia using this method is easy and safe to use, and it is beneficial to treat deep-seated brain tumors.