Surgical Treatment for Cervical Carotid Artery Stenosis in the Elderly: Importance of Perioperative Management of Ischemic Cardiac Complications

Ischemic cardiac complication is one of the major perioperative complications of surgical treatment for cervical carotid stenosis, carotid endarterectomy (CEA), and carotid artery stenting (CAS), and may greatly affect surgical outcome, especially in elderly patients aged ≥ 80 years. We retrospectively analyzed the records of 259 patients (34 patients aged ≥ 80 years) treated by CEA and 61 patients (12 patients aged ≥ 80 years) treated by CAS at Aizu Chuo Hospital from January 2000 to September 2010. Preoperative ischemic heart disease screening was performed in all patients. If high risk of coronary atherosclerotic stenosis was detected, treatment for coronary lesion was performed prior to CEA or CAS. There was no preoperative ischemic cardiac complication in both the CEA and CAS groups. Perioperative complications (morbidity + mortality) occurred in 2.9% of patients aged ≥ 80 years and 1.7% of patients aged ≤ 79 years in the CEA group, and 8.3% and 8.1% of patients, respectively, in the CAS group. There was no statistically significant difference by age in either group. CEA could be safely performed with tolerable complication rates even in elderly patients. However, the complication rate in the CAS group was relatively high. New ischemic lesion on diffusion-weighted magnetic resonance imaging, both symptomatic and asymptomatic, tended to occur at a higher rate in the CAS group, especially in the elderly patients. Thorough perioperative management may minimize ischemic cardiac complications even in elderly patients. Efforts must be continued to minimize surgical complications, especially for CAS. Noninvasive medical treatment should also be considered for elderly patients.     

Dementia with Lewy Bodies is associated with higher scores on the Geriatric Depression Scale than is Alzheimer's disease

Background: Several reports suggest a higher morbidity of depression in patients with dementia with Lewy bodies (DLB) than in patients with Alzheimer's disease (AD). However, these results have not been duplicated consistently. The psychiatric symptoms of dementia, including depression, are important for its diagnosis and management. Thus, the aim of the present study was to clarify the characteristics of the depressive symptoms in DLB compared with AD using the Geriatric Depression Scale (GDS). Methods: We examined the GDS score for 86 patients with probable DLB (based on the Consensus Criteria for the clinical diagnosis of DLB) and 86 patients with probable AD (based on criteria of the National Institute for Neurological and Communicative Disorders and Stroke‐Alzheimer's Disease and Related Disorders Association), who were matched according to age, sex, education, and Mini‐Mental State Examination (MMSE) scores. We also examined correlations between GDS scores and age, sex, or MMSE scores in both groups. Correlations between GDS scores and metaiodobenzylguanidine (MIBG) scintigraphy were examined in patients with DLB. To characterize the GDS in DLB, its profile was examined using factor structures. Results: Scores for DLB patients were twice as high on the GDS as those for AD patients. There was no correlation between GDS score and age, sex, or MMSE scores in either group. Furthermore, there was no correlation between the results of MIBG scintigraphy and GDS scores in the DLB group. Using factor structures, the depression symptom profile of these diseases suggested that depression‐specific symptoms, such as mood, worry, or future outlook, were more frequent in the DLB group than non‐specific symptoms, such as lack of energy, decreased concentration, or apathy. Conclusions: The data suggest that depressive symptoms are highly specific symptoms of DLB, independent of other features of this disorder. The GDS could be used as a subsidiary tool in differentiating DLB from AD and is more useful than clinical observations of depression.     

Measuring masticatory performance using a new device and β‐carotene in test gummy jelly

Summary Objective methods for evaluating masticatory performance are invaluable for quantitative comparisons between various dental treatments as well as diagnosing masticatory disorder. The purpose of this study was to develop an accurate method for automatically measuring masticatory performance using a new measuring device consisting of light‐emitting diodes and a photodiode and test gummy jelly. First, the relationship between six known β‐carotene concentrations in aqueous solution and the voltage values exhibited on a photodiode was investigated. Mean voltage obtained by red light incident on the photodiode indicated a significantly high correlation (r = 0·999 in a cubic function, P < 0·01) with β‐carotene concentration in the aqueous solution. Second, to establish the optimal measuring conditions for evaluating masticatory performance, factors influencing mean voltage were investigated, such as water temperature and times for rinsing the gummy jelly and dissolving β‐carotene from the jelly. A stable mean voltage was obtained by measuring under the following conditions: rinsing water temperature, 35 °C; rinsing time, 30 s; water dissolving temperature, 35 °C; dissolving time, 10 s. Finally, the relationship between seven surface area values of divided gummy jelly and β‐carotene concentrations dissolved from the divided jellies was investigated. The increase in surface area of divided test gummy jelly particles was accurately calculated (r = 0·992, P < 0·001) from mean voltage on the photodiode to change with β‐carotene concentration dissolved from the jelly surface. This new method using test gummy jelly and an automatic measuring device appears useful for precisely evaluating masticatory performance.     

A Rare Case of Chiari Type-1 Malformation Accompanied by Symptomatic Cerebrospinal Fluid Hypovolemia: Comparison of Congenital Chiari Type-1 Malformation and Acquired Chiari Malformation Secondary to Cerebrospinal Fluid Hypovolemia: Case Report

A 23-year-old woman was injured in a rear-end collision. She had general malaise and posterior neck pain, which were more severe when she was in an upright position. Magnetic resonance imaging (MRI) revealed the presence of cerebellar tonsil descensus and syringomyelia in the spinal cord. Radioisotope (RI) cisternography showed signs of an early accumulation of RI in the bladder, and a delayed accumulation of RI in the cerebral fornix. We considered the possibilities of cerebrospinal fluid (CSF) hypovolemia and congenital Chiari type-1 malformation as being responsible for her headache. To obtain a definitive diagnosis, we performed gadolinium (Gd)-enhanced MR cisternography and found evidence of CSF leakage. We performed an epidural blood patch (EBP), and her symptoms resolved. In 2 years since the episode, her symptoms have not recurred, and additional treatment has not been required. In addition, MRI performed 2 years after the EBP did not reveal any changes. There seems no previous report which described successful differentiation of pre-existing congenital Chiari type-1 malformation from the acquired one caused by symptomatic CSF hypovolemia. Because treatment protocols differ between these two conditions, the establishment of a correct diagnosis is important.     

Role of mast cells, eosinophils and IL-5 in the development of airway hyperresponsiveness in sensitized mice

Background and objective In order to study the role of mast cells and IL-5 in allergen-induced airway hyperreactivity in mice, airway responsiveness in WBB6F₁-W/W^v mice (mast cell deficient) and the effects of anti-IL-5 monoclonal antibody (NC-17) and three anti-allergic drugs (N-556, ketotifen and amlexanox) on airway hyperreactivity in Balbc mice were studied. Methods Mice were immunized with an antigen (ovalbumin; OA) at intervals of 12 days. OA was inhaled 10 days after the secondary immunization. Twenty-four hours after the last inhalation, airway reactivity to acetyleholine was measured and broncho-alveolar lavage fluid (BALF) was obtained. Resutls Three inhalations of OA caused an increase in leucocytes (including eosinophils). accompanied by increases in IL-5 in BALF, and airway hyperreaetivity to acetylcholine in Balb/c and WBB6F₁- +/+ mice. In WBB6F₁-W/W^v mice, antigen inhalation resulted in increases in leucocytes and IL-5 in BALF but did not result in airway hyperreactivity. NC-17 at doses between 10 and 20μg (intratracheal injection) inhibited the antigen-induced eosinophilia but did not affect airway hyperreaetivity in Balb/c mice. Three ‘anti-allergie’ drugs clearly inhibited antigen-induced increases in IL-5 levels and the number of eosinophils in BALF, but did not alTect airway hyperreactivity in Balb/c mice. Conclusions These data suggest that mast cells play an important role in the onset of airway hyperreactivity but do not play a role in the production of IL-5 and eosinophilia. Furthermore., indicate that the inhibition of IL-5 is not always associated with a reduetion in antigen-induced airway hyperreactivity in mice.     

Concatenation of variations in plaque formation with variations in crevicular temperature

The hypothesis was tested that variations in the temperature of gingival crevices are linked to variations in plaque formation. Fifty-nine abutment teeth to removable partial dentures were studied during four experiments, under various conditions of plaque formation, i.e. not brushing the teeth whilst wearing and not wearing dentures, and performing ordinary and then specialized tooth brushing whilst wearing dentures. The collation of temperature curves with plaque curves revealed a proportional relationship between the rate and magnitude of plaque formation and the rate and magnitude of the recorded temperature changes. Furthermore, the removal of plaque resulted in a reversal of induced temperature rises. The lowest crevicular temperatures were obtained with the practice of the specialized tooth brushing.