- 著者
- Takashi Asakawa Mieko Ogino Naomi Tominaga Naoto Ozaki Jin Kubo Wataru Kakuda
- 出版者
- The Japanese Association of Rehabilitation Medicine
- 雑誌
- Progress in Rehabilitation Medicine (ISSN:24321354)
- 巻号頁・発行日
- vol.8, pp.20230035, 2023 (Released:2023-10-03)
- 参考文献数
- 32
Objectives: One of the causes of death in patients with multiple system atrophy (MSA) is aspiration pneumonia caused by cough dysfunction. This study aimed to identify an effective approach to improve coughing and to explore the establishment of criteria for the use of gastrostomy based on cough and respiratory dysfunctions.Methods: Eighteen probable MSA patients participated in the study. They were categorized into air stacking and non-air stacking groups. First, we investigated how the inspiration volume changes by applying maximum insufflation capacity (MIC). Second, peak cough flow (PCF) was measured by different cough augmentation methods: 1) spontaneous coughing (SpC); 2) SpC with MIC (SpC + MIC); 3) SpC with manually assisted cough (MAC) (SpC + MAC); and 4) SpC with MIC and MAC (SpC + MIC + MAC). Among these four conditions, PCF values were compared to determine the most effective approach for cough augmentation. Receiver operating characteristic analysis was performed on percent forced vital capacity (%FVC) to determine an index for discriminating PCF below160 L/min, which indicates a high risk of suffocation, involving SpC and SpC + MIC.Results: Inspiration volume increased significantly with MIC in both groups (P < 0.05), and PCF increased significantly with MIC in the air stacking group (P < 0.01). PCF could not be maintained at 160 L/min when %FVC fell below 59%, even when MIC was applied.Conclusions: PCF increases with MIC in patients with MSA. It may be meaningful to consider the timing of gastrostomy introduction based on the severity of cough and respiratory dysfunction.
- 著者
- Yoshinori Abe Teiji Yamamoto Tomoko Soeda Tomohiro Kumagai Yoshihiro Tanno Jin Kubo Tetsuya Ishihara Soichi Katayama
- 出版者
- The Japanese Society of Internal Medicine
- 雑誌
- Internal Medicine (ISSN:09182918)
- 巻号頁・発行日
- vol.48, no.13, pp.1135-1141, 2009 (Released:2009-07-01)
- 参考文献数
- 35
- 被引用文献数
- 36 70
Background Unilateral movement disorders and contralateral neuroimaging abnormalities of the striatum have been sporadically reported as a rare syndrome associated with diabetes mellitus. Despite characteristic imaging findings and clinical manifestations, the mechanism underlying this syndrome is still unclear. Methods Six patients with this syndrome were studied clinically and subjected to MRI neuroimaging; one underwent biopsy of the striatum, and another underwent additional MR spectroscopy at 3.0T and FDG-PET. Results Neuroimaging findings were characterized by a T1-hyperintense unilateral lesion restricted to the striatum, contralateral to the symptomatic limbs. The biopsied striatum contained patchy necrotic tissue, severe thickening of all layers of arterioles, and marked narrowing of vessel lumens. Hyaline degeneration of the arteriolar walls, extravasation of erythrocytes, and prominent capillary proliferation were also notable, together with lymphocytic infiltration and macrophage invasion. In one patient, PET examination revealed decreased accumulation of FDG in the lesion. The MR spectrum for the diseased striatum revealed a decrease in the NAA/Cr ratio (1.35), normal Cho/Cr ratio (1.22), and a peak for myoinositol, while the spectrum on the contralateral site revealed a decrease in the NAA/Cr ratio (1.48), increase in Cho/Cr (1.32), but no peak for myoinositol. Conclusion The constellation of signs and symptoms and neuroimaging characteristics in previous reports and the six additional cases described here with neuropathological data and findings of MR spectroscopy appears unique enough to be termed "diabetic striatopathy." This syndrome appears in poorly controlled diabetics due to obliterative vasculopathy with prominent vascular proliferation, vulnerability to which is restricted to the striatum.