What I learnt from studying epilepsy: epileptology and myself

My life work with epilepsy has allowed me to learn a great deal. As an old soldier, I would like to give an account of some important milestones in my lifetime learning. The first factor that linked me to epilepsy was listening to a lecture delivered by Dr Yushi Uchimura on 'The pathogenesis of Ammon's horn sclerosis' at a conference of the Japanese Society of Neurology (now Japanese Society of Psychiatry and Neurology) in 1928 when I was a 4th year medical student at Tokyo University. The following year, I started to study under Dr Uchimura at the Department of Psychiatry, Hokkaido University School of Medicine. Another factor that linked me to clinical care and research of epilepsy as a psychiatrist was my encounter with the two volumes of 'Selected Writing of John Hughlings Jackson' edited by J. Taylor. Jackson's greatest asset and contribution to modern epileptology include (i) the discovery of 'Jacksonian epilepsy', (ii) 'conceptual revolution of epilepsy' by recognizing transient mental disorders as seizures, (iii) modern definition of epilepsy by defining epileptic seizures as discharges in the gray matter, and (iv) discovery of 'new epilepsy' (now temporal lobe epilepsy). In 1940, I reported clinical courses indistinguishable from schizophrenia in epilepsy cases. Through my studies, I disputed the then prevailing interpretation of this condition as epilepsy complicating schizophrenia, and proved that these cases were in fact epileptic mental disorders caused by epilepsy. Many patients with epilepsy require medical care as well as rehabilitation and welfare support. We need to further promote the facilities for rehabilitation and employment in the community for persons with epilepsy, such as co-operatives and welfare worksites. The issues that epileptology and epilepsy face in the 21st century is to realize the goals of liberating epilepsy from social stigma and protecting all the citizen's rights for persons with epilepsy.     

Observations on the structural changes according to aging of oral mucous membrane in the elderly--structure of buccal mucous membrane in the vicinity of angulus oris

The purpose of this research was to clarify the structural changes according to the aging of the buccal mucous membrane in the elderly. Thirty-eight Japanese adult cadavers (62-98 years) which dental students had used for anatomy practice were used as materials. Serial sections were made from the specimens of the buccal mucous membrane in the vicinity of angulus oris removed from the cadavers, and the sections were observed with a light microscope. The results were as follows: 1) As for the buccal mucous membrane in the vicinity of angulus oris in the elderly, the thickness decreases significantly with aging. 2) In the buccal mucous membranes of the elderly, the functional arrangement of the collagenous and elastic fibers distributed in the lamina propria and the submucous membrane disappears with aging, and the fibrosis tendency generally becomes remarkable. 3) The number of blood vessels distributed in the mucous membrane in the vicinity of angulus oris of the elderly decreases with aging, and the distribution of blood vessels changes, too. It seems that these changes suppress the circulatory system of the buccal mucous membrane in the very elderly. 4) The fatty change and the fibrosis of the small salivary gland progress among the very elderly. It seems that the structural change of such a glandular tissue causes dryness in the mouth. 5) The change in the thickness of the tunica muscularis according to aging was hardly seen among the elderly. However, the tendency toward thinness with aging was seen, as for the muscular fiber. The structural change of such a muscular fiber seems to cause depression such as that of the orbicular muscle of the mouth in the elderly.     

Efficacy of modified ultrafiltration in reoperation for valvular disease

We evaluated the efficacy of modified ultrafiltration (MUF) in reoperation for valvular disease. Fourteen patients were divide into two groups consisting of a control group (n = 6) and a MUF group (n = 8). MUF was carried out for fifteen minutes immediately after the completion of cardiopulmonary bypass. The blood flow through the ultrafilter was 300 ml/min and about 1,200 ml of water was removed. The hematocrit elevated significantly from 25% to 31% in the MUF group (p < 0.05). The percentage of the increase in body weight after the operation in the MUF group was significantly less than that in the control group (3.3 +/- 3.1% vs 8.3 +/- 4.3%, p < 0.05). The PaO2/FIO2 after the operation in the MUF group was significantly higher than that in the control group (376 +/- 125 mmHg vs 242 +/- 79 mmHg, p < 0.05). The duration of mechanical ventilation in the MUF group was significantly less than that in the control group (1.1 +/- 1.1 days vs 5.3 +/- 3.3 days, p < 0.05). In conclusion, MUF is useful to hemoconcentrate, reduce postoperative body weight gain and promote early recovery of pulmonary function in reoperation for valvular disease.     

Commissure holder: an innovative device for aortic valve-sparing technique

The key to obtaining maximal valve coaptation from the aortic valve-sparing procedure is in appreciating the optimal geometry of each component of the aortic root. We describe a new device called the Commissure Holder (patent pending) that aids in the selection of an appropriate graft size and in the determination of the optimal position at which each commissure should be sutured to the graft.     

Correlation between laminin-5 gamma2 chain expression and epidermal growth factor receptor expression and its clinicopathological significance in squamous cell carcinoma of the tongue

Recent investigations have revealed that growth factors may influence the invasive activity of tumor cells. Expression of laminin-5 gamma2 chain (LN-5 gamma2) and epidermal growth factor receptor (EGFR) in squamous cell carcinomas of the tongue in 104 patients with stage II, III, and IVA, B (excluding the cases with distant metastasis) was examined immunohistochemically to determine the correlation between the two molecules and the associations with the clinicopathological features of each tumor. LN-5 gamma2 expression was clearly demonstrated in the cytoplasm and EGFR in the cell membranes of cancer cells. A significant increase in positivity for LN-5 gamma2 was observed in tumors showing poor differentiation (p < 0.001), infiltrative growth (p < 0.001), and deep invasion (p = 0.038). In a multivariate analysis, increased positivity for LN-5 gamma2 was an independent predictor of an unfavorable outcome (p < 0.001). A significant increase in positivity for EGFR was observed in tumors showing infiltrative growth (p = 0.032) and poor prognosis (p = 0.008). The LN-5 gamma2 expression was correlated significantly with EGFR expression (p < 0.001). Patients with tumor positivity for both molecules showed the worst prognosis (p < 0.001). LN-5 gamma2 overexpression and EGFR overexpression is evident in tumors showing infiltrative growth, suggesting that EGFR may influence the invasive activity of tumor cells through overexpression of LN-5 gamma2.