Papers by Hiroshi Shamoto
Journal of Nutrition Health & Aging, Oct 16, 2018
Objectives: To investigate the impact of body mass index on activities of daily living in inpatie... more Objectives: To investigate the impact of body mass index on activities of daily living in inpatients with acute heart failure. Design: A retrospective cohort study. Setting: A hospital-based database contains Diagnosis Procedure Combination survey data from 100 participating acute-care hospitals. Participants: 11,301 inpatients aged 20 year or older who were admitted to the participating hospitals with a diagnosis of acute heart failure. Measurements: The Barthel Index score at discharge and hospital death. Results: The number of patients with a body mass index of <18.5 kg/m 2 (underweight), 18.5-22.9 kg/m 2 (low-normal weight), 23.0-24.9 kg/m 2 (high-normal weight), 25.0-29.9 kg/m 2 (overweight), and ≥30.0 kg/m 2 (obesity) were 1689 (15%), 4715 (42%), 1809 (16%), 2306 (20%), and 782 (7%), respectively. Median Barthel Index scores at admission and discharge were 65 and 100, respectively. Hospital death occurred in 101 (0.9%) patients. Lower body mass index was associated with lower Barthel Index score at discharge and higher mortality. Multivariable analysis adjusted for body mass index, age, sex, New York Heart Association classification, Barthel Index score at admission, the updated Charlson Comorbidity Index, length of hospital stay, number of drugs administered, and rehabilitation during hospitalization revealed that body mass index was independently associated with Barthel Index score at discharge (beta: 0.354; 95% confidence interval: 0.248-0.461) and hospital death (odds ratio: 0.926, 95% confidence interval: 0.877-0.978). Conclusion: Overweight and obese inpatients showed greater independence in activities of daily living at discharge and lower rates of mortality, indicating the obesity paradox. A combination of rehabilitation and improved nutrition seems to be important in underweight patients with acute heart failure.
Japanese Journal of Neurosurgery, 2002
Electromagnetic methods are the most important diagnostic tools in the presurgical evaluation of ... more Electromagnetic methods are the most important diagnostic tools in the presurgical evaluation of medically intractable epilepsy． Localization of the source of the epileptic discharge is essential ， in the presence or absence of structural lesions ． Scalp electroencephalography (EEG) ， intracranial EEG and magnetoencephalography provide temporal reso − lutions of millisecond − order that are adequate to evaluate the physiology of the disease ． The advantages and limita − tions of these electromagnetic methods are based on the folloWing characteristics ： 1)space − sampling and sensor position ；2)time − sampling and measurement time；3)effect of ambient − and brain − noises and ；4) source local − ization methods ． Combined and complementary use of these electromagnetic rnethods can provide the information essential for the surgical treatment of epilepsy ．
Journal of Child Neurology, Oct 1, 1997
Using high-resolution positron emission tomography (PET), we have recently described the normal p... more Using high-resolution positron emission tomography (PET), we have recently described the normal pattern of glucose utilization in 11 anatomical regions of the human cerebellum. In the present study, we evaluated the phenomenon of crossed cerebellar diaschisis in 40 patients (mostly children) with unilateral cerebral injury sustained at various periods of brain development. Diaschisis refers to a functional impairment at a remote site following injury to an anatomically connected area of brain and, presumably due to a loss of afferent input to the remote site. Of the 40 patients, 11 had sustained their cerebral injury prenatally, 7 in the perinatal period (± 24 hours of birth), and 22 postnatally (1 day to 15 years). Crossed cerebellar hypometabolism was seen in 22 patients; symmetric cerebellar metabolism was found in 16 subjects. The presence of crossed cerebellar hypometabolism was typically associated (75% of cases) with a postnatal injury, while symmetric cerebellar metabolism was seen only in patients with injury occurring prior to 4 weeks of age (13 of the 16 had prenatal or perinatal insults). A third pattern of cerebellar metabolism, consisting of paradoxical crossed cerebellar hypermetabolism, was seen in two patients; both had sustained their cerebral injury at 4 months of age. These findings suggest the presence of considerable plasticity, which is dependent on age at injury, in the cerebrocerebellar pathway of developing brain. (J Child Neurol 1997; 12:407-414).
Surgical Neurology, Sep 1, 2002
BACKGROUND Vertebral fracture caused solely by a convulsive seizure has rarely been reported in t... more BACKGROUND Vertebral fracture caused solely by a convulsive seizure has rarely been reported in the neurosurgical literature. CASE DESCRIPTION We describe a 34-year-old male with severe back pain from a thoracic fracture occurring in association with a seizure during hospitalization for treatment of temporal lobe epilepsy. Bone mineral densities in the lumbar spine and the femoral neck were decreased, possibly by longterm anti-epileptic medication. Muscle contractions during a seizure can result in vertebral fractures, especially at the thoracic levels. CONCLUSION A complaint of back pain after a convulsive seizure should prompt radiologic investigation for vertebral fracture, even in the absence of external trauma.
Neuroreport, Sep 1, 2000
A 23-year-old woman with refractory complex partial seizures underwent implantation of subdural g... more A 23-year-old woman with refractory complex partial seizures underwent implantation of subdural grid electrodes over the left hemisphere to map epileptic foci and language function. Aphasic symptoms occurred during stimulation of the basal temporal area, which were always associated with intrastimulus remote discharges (ISRDs) in the classical posterior language area. No sequential language de®cits occurred after anterior temporal lobectomy including the basal temporal area. These results suggest a close functional relationship between the basal temporal area and posterior language area in patients with temporal lobe epilepsy. ISRDs may explain the paradoxical observation that resection of the basal temporal language area results in no language de®cits. NeuroReport 11:2997±3000 &
CYRIC annual report, 1999
Summary A 31-year-old woman presented with a pleomorphic xantho-astrocytoma (PXA) manifesting as ... more Summary A 31-year-old woman presented with a pleomorphic xantho-astrocytoma (PXA) manifesting as epilepsy. The tumour was partially resected. Histological examination revealed cellular pleomorphism and cytoplasmic vacuolation consistent with PXA, but no mitoses, necrosis, or endothelial proliferation. Follow-up neuro-imaging showed the residual tumour had grown rapidly with dissemination in the spinal cord. The recurrent lesion was totally resected and was shown to be glioblastoma. The patient has survived without signs of recurrence for 36 months after adjuvant radiochemotherapy. The biological behaviour of PXA cannot be predicted based on the histological features and careful follow up is essential.
PubMed, Apr 1, 2002
A successfully treated case of intractable FLE, of which preoperative magnetoencephalography (MEG... more A successfully treated case of intractable FLE, of which preoperative magnetoencephalography (MEG) provided multiple spike localization and intraoperative corticogram (ECoG) confirmed the resection area. A 22-year-old male patient, with a history of subdural abscess at the age of 14 years, had suffered frequent simple (SPSs) and complex partial seizures (CPSs) and falling attacks since the age of 16 years. Although he underwent corpus callosotomy at the age of 17 years, additional surgical treatment was considered because of intractable and more frequent SPSs and CPSs. Magnetic resonance (MR) imaging demonstrated diffuse lesions in the right frontal lobe. Although, both interictal and ictal electroencephalography (EEG) failed to show focal epileptogenic localization, interictal MEG localized several clusters over the multiple anatomical lesions in the right prefrontal and frontal opercular regions. The patient underwent right fronto-temporal craniotomy, and anterior frontal lobectomy, followed by lesionectomy of the premotor area based on the intraoperative ECoG findings. The ECoG localized frequent spike discharges over the right prefrontal, frontal operculum and premotor cortices, which showed good correspondence with the MEG findings. MEG can be a useful noninvasive method for presurgical evaluation of intractable FLE.
PubMed, Jun 1, 1999
The dysembryoplastic neuroepithelial tumor (DNT), characterized by its favorable prognosis, must ... more The dysembryoplastic neuroepithelial tumor (DNT), characterized by its favorable prognosis, must be precisely differentiated from other gliomas to prevent overtreatment by radio/chemotherapy. We studied, here, pathological features of five surgical cases of DNT with intractable epilepsies. There were two males and three females with a median age of 20.4 years (range 12-41). We evaluated lesional topography, gross appearances and microscopic findings including immunohistochemical data. One tumor was located in the temporal lobe, another two in the parietal lobe, another in the occipital lobe, and the other one in the occipito-parietal junction. The lesions were predominantly intracortical in all cases. Macroscopically, two tumors were grayish-soft, another two were yellowish-elastic, and the other one was resected as soft-mucinous fragments. Microscopically, the main glial components were oligodendrocyte-like cells (OLCs) in all cases, except for one case in which atypical glial cells were also prominent. Histopathological characteristics of the DNTs included the specific glioneuronal elements (the mixture of OLCs and neurons) in four cases, alveolar pattern (all cases), microcystic degeneration (all cases), multinodular architecture (four cases), and adjacent cortical dysplasia (all cases). Immunohistochemically, Ki-67 labelling indices ranged from 0 to 0.8%. OLCs were positive for glial fibrillary acidic protein in two cases, for S-100 protein in all cases, for synaptophysin in two cases, and for class III beta tubulin in all cases. Pathological features of our cases were characterized by its heterogeneous histological appearances and divergent cellular differentiation.
Clinical Nutrition, Dec 1, 2015
Please cite this article in press as: Wakabayashi H, et al.Combined intervention of whey protein ... more Please cite this article in press as: Wakabayashi H, et al.Combined intervention of whey protein intake and rehabilitation in female patients with hip fracture in the early postoperative period, Clinical Nutrition (2015),
PubMed, Nov 1, 2001
Diffusion-weighted magnetic resonance imaging (DWI) provides one of the earliest demonstrations o... more Diffusion-weighted magnetic resonance imaging (DWI) provides one of the earliest demonstrations of ischemic lesions. However, some lesions may be missed in the acute stage due to technical limitation of DWI. We therefore conducted the study to clarify the sensitivity of DWI to acute brain stem infarctions. Twenty-eight patients with the final diagnosis of brain stem infarction(midbrain 2, pons 9, medulla oblongata 17) who had been examined by DWI within 24 hours of onset were retrospectively analyzed for how sensitively the initial DWI demonstrated the final ischemic lesion. Only obvious(distinguishable with DWI alone without referring clinical symptoms and other informations) hyperintensity on DWI was regarded to show an ischemic lesion. Sixteen(57.1%) out of 28 patients had brain stem infarctions demonstrated by initial DWI. In the remaining 12 cases, no obvious ischemic lesion was evident on initial DWI. Subsequent MRI studies obtained 127 hours, on average after the onset showed infarction in the medulla oblongata in 11 cases and in the pons in one case. Negative findings of DWI in the acute stage does not exclude possibility of the brain stem infarction, in particulary medulla oblongata infarction.
Journal of Neurosurgical Anesthesiology, 2002
Fentanyl-droperidol technique is the choice for epilepsy surgery. It requires intraoperative elec... more Fentanyl-droperidol technique is the choice for epilepsy surgery. It requires intraoperative electrocorticography (ECoG), but a large dose of fentanyl is needed for this technique. On the other hand, sevoflurane reportedly may be beneficial for intraoperative ECoG. To reveal whether the combined technique with fentanyl and sevoflurane is beneficial for epilepsy surgery, we investigated ECoG in 10 patients with intractable temporal lobe epilepsy without sevoflurane, with 0.5 minimum alveolar concentration (MAC) sevoflurane, and with 1.5 MAC sevoflurane under fentanyl-based anesthesia. The mean number of spikes for 1 minute decreased from 38.3 to 14.1 after 1.5 MAC sevoflurane was induced, which was statistically significant ( P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). Our results showed that balanced technique with neurolepto-analgesia (NLA) and sevoflurane is not suitable for epilepsy surgery requiring intraoperative ECoG. When epilepsy surgeries are performed under sevoflurane anesthesia, it is important to consider that sevoflurane may suppress electric activities when it is used with other anesthetic agents.
Nutrition, Mar 1, 2017
Swallowing dysfunction is related to long-term weight loss and reduced body mass index in patient... more Swallowing dysfunction is related to long-term weight loss and reduced body mass index in patients with head and neck cancer. We describe a 76-y-old woman who had severe sarcopenic dysphagia and atrophy of the reconstructed tongue for 17 mo after subtotal glossectomy due to tongue cancer and lost 14 kg during that period. Upon admission, the patient received diagnoses of malnutrition in the context of social or environmental circumstances with insufficient energy intake, loss of muscle mass, localized fluid accumulation, weight loss, and sarcopenia due to reduced skeletal muscle mass (skeletal muscle index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3.95 cm(2)/m(2)) and low walking speed (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.8 m/s). She was not able to eat anything and had a functional oral intake scale level of 1 and penetration-aspiration scale score of 7 points on video fluorography. We increased the nutritional intake to 1900 kcal/d and protein intake to 70.3 g/d by supplying sufficient excess energy, and provided physical therapy and dysphagia rehabilitation to improve sarcopenia, atrophy of the reconstructed tongue, and dysphagia. After 20 mo of treatment, she was considered to be no longer malnourished (11 kg weight gain) and without sarcopenia (skeletal muscle index 4.01 cm(2)/m(2)), and the volume of the reconstructed tongue was increased. Sarcopenia and atrophy of the reconstructed tongue may cause dysphagia after glossectomy due to tongue cancer. Additionally, nutritional support and rehabilitation could improve such dysphagia.
The Journal of Neuroscience, Mar 30, 2005
γ-Band activity (GBA) in electroencephalograms (EEGs) has been shown to reflect various cognitive... more γ-Band activity (GBA) in electroencephalograms (EEGs) has been shown to reflect various cognitive processes. GBA has typically been recorded in the 30-60 Hz range in scalp EEGs. Recently, task-related “high GBA” (HGBA) with frequencies up to 100 Hz has been observed in studies with invasive electrocorticograms (ECoGs). In the present study, we recorded ECoGs from the bilateral basal temporal cortices in a patient with epilepsy and evaluated the task-related HGBA (most prominently in the 80-120 Hz range) accompanying picture-naming and lexical-decision tasks. We examined picture naming using two categories (line drawings of animals and tools). The lexical-decision task was performed using words and pseudowords of two distinct Japanese writing forms, kanji (morphograms) and kana (syllabograms). Task-related HGBA was observed bilaterally during the naming task. Recordings from some electrodes revealed significant differences in HGBA between animal and tool pictures. In contrast to the naming task, there was apparent left dominance in the lexical-decision task. Furthermore, significant differences in HGBA were observed between the Japanese kanji and kana words and between the kanji words and kanji pseudowords. A number of differences in the HGBA observed in the recordings from the basal temporal area were consistent with previous findings from neuroimaging and patient studies and suggest that HGBA is a good correlate of visual cognitive functions.
PubMed, May 1, 2009
In the management of acute ischemic stroke, a diagnostic procedure is critically important. Howev... more In the management of acute ischemic stroke, a diagnostic procedure is critically important. However, till date, no guideline or consensus regarding a standard diagnosis procedure has been established. We hereby report an institutional manual for the consistent diagnosis of acute ischemic stroke. Methods: The institutional manual was based on the National Institute of Neurological Disorders and Stroke III classification; however, the criteria for each stroke subtype were clearly defined using a rating system that included the representative observations specific to each subtype. The present manual was prepared in order to clearly define the characteristics of the stroke subtypes, which are often ambiguous in the clinical settings, and to design a diagnostic procedure within the institute with more emphasis on standardization rather than achieving complete accuracy. Several characteristic points were considered while doing this: lacunar infarctions should be clearly differentiated from other small infarctions, subtypes of "suspicious cardioembolism," "atherothrombotic infarction (embolic mechanism)," and "infarction due to arterial dissection" should be determined separately in order to identify the causal mechanism to the extent possible. For a final diagnosis, the patients were examined 3 time points during: at admission, during the subacute stage (day 4-7), and at discharge or more than 2 weeks after the onset of stroke. The current version of the manual has been used since 2006 after a transitional phase from 2004 to 2005. Retrospective comparisons on stroke diagnoses and clinical outcomes were performed between the periods during which the present manual was used and those during which it was not. Results: The present manual was retrospectively applied for diagnosing 311 consecutive ischemic stroke patients who were admitted to our institute within 7 days after the onset in 2003; in the case of 85 patients (29%), the diagnosis was different from that made in 2003. Of all the lacunar infections reported in 2003, 17 were diagnosed as other conditions when the manual was used. Similarly, 45% of the cases of atherothrombotic infarction (thrombotic mechanism) and 24% of those of cardiac embolism in 2003 were diagnosed differently when the present manual was applied. The mean modified Rankin scale at discharge was 2.63 +/- 0.07 (mean +/- standard error of the mean) in patients in 2002 and 2003 (n=491), which was significantly different from 2.32 +/- 0.06 in patients in 2006 through March of 2008 (n=903; p=0.01). Conclusion: The present manual appears to be helpful to improve the uniformity of the diagnoses and the clinical results. It may also assist residents and their mentors in the educational field. The manual will require periodical evaluation and version upgrade in order to maintain its efficacy.
Journal of Neurosurgery, Mar 1, 2003
✓ The histological changes that occur in brain tissue have rarely been documented in patients wit... more ✓ The histological changes that occur in brain tissue have rarely been documented in patients with dural arteriovenous fistulas (AVFs). In this study the authors report on two patients with dural AVFs in the transverse—sigmoid sinus who presented with subarachnoid hemorrhage or progressive dementia. Histological studies of the cerebellar cortices showed a selective loss of Purkinje cells, indicating an ischemic insult caused by venous hypertension. Admission N-isopropyl-p-123I-iodoamphetamine single-photon emission computerized tomography scans demonstrated a decrease in cerebral blood flow, including flow through the cerebellum. Venous hypertension caused by transverse—sigmoid sinus dural AVFs provokes an ischemic condition severe enough to cause selective neuronal damage in the cerebellum.
Journal of Neurosurgical Anesthesiology, 2002
To clarify the epileptogenicity of sevoflurane, electrocorticograms were monitored in seven patie... more To clarify the epileptogenicity of sevoflurane, electrocorticograms were monitored in seven patients with unruptured cerebral aneurysm under sevoflurane anesthesia. They had no history of epilepsy or other complications. Spike activities on electrocorticography were seen in all seven patients at 3.3% end-tidal sevoflurane. These results suggest that further study is required to evaluate the suitability of sevoflurane for neurosurgical procedures.
Journal of the American Geriatrics Society, Nov 7, 2016
ObjectivesTo verify the reliability and validity and develop an English version of an instrument ... more ObjectivesTo verify the reliability and validity and develop an English version of an instrument (Kuchi‐Kara Taberu Index (KT Index)) to comprehensively assess and intervene in problems with eating and swallowing.DesignMulticenter cross‐sectional study.SettingNursing homes.ParticipantsIndividuals aged 65 and older (mean age 88.3 ± 6.8; 80.0% female) who had lived in a nursing home for longer than 1 month (N = 115).MeasurementsThe KT index consisted of 13 items: desire to eat, overall condition, respiratory condition, oral condition, cognitive function while eating, oral preparatory and propulsive phases, dysphagia severity, position and endurance while eating, eating, daily life, food intake level, food modification, and nutrition. Weighted kappa coefficients, Cronbach alpha, and Spearman rank correlation coefficients were determined.ResultsWeighted kappa values in the inter‐ and intrarater reliability tests ranged from 0.54 to 0.96 and 0.68 to 0.98, respectively. Cronbach alpha was 0.892. Spearman rank correlation coefficients (r) between the total KT index and external criteria were determined (Functional Oral Intake Scale, r = 0.790; Barthel Index, r = 0.830; Mini Nutritional Assessment Short Form, r = 0.582; Cognitive Performance Scale, r = −0.673; all P &lt; .001). Similar correlations were observed when some items related to each external criterion were removed from the total KT index. Translation‐retranslation procedures were conducted to develop an English version of the KT index.ConclusionThe study provided evidence of the reliability and validity of the KT index and developed an English version. Future studies regarding validation of health‐related quality of life indices and their effect on clinical courses of eating and swallowing conditions are needed.
Nutrition in Clinical Practice, Nov 24, 2016
Background: The association of sarcopenia with disability with ambulatory status is uncertain bec... more Background: The association of sarcopenia with disability with ambulatory status is uncertain because most studies have targeted people who could walk independently. This study explored the prevalence of sarcopenia regardless of ambulatory status and the impact of ambulatory status on sarcopenia. Materials and Methods: In total, 778 consecutive patients, aged ≥65 years and admitted to a hospital, were enrolled. Ambulatory status was divided into 4 grades according to mobility as described in the Barthel index. Sarcopenia was defined as a loss of appendicular muscle mass index (AMI) with bioelectrical impedance and decreased muscle strength with handgrip strength (HGS); cutoff values were adopted from the Asian Working Group for Sarcopenia. Results: The mean patient age was 83.2 ± 8.3 years; 37.8% were male patients. Mobility limitation was associated with higher age, underweight body mass index, malnourishment, and comorbidities (all P &lt; .001). AMI and HGS gradually decreased with declining ambulatory status (P &lt; .001). The prevalence of sarcopenia in the independent walk, walk with help, wheelchair, and immobile groups was 57.9%, 76.1%, 89.4%, and 91.7%, respectively. AMI prevalence declined and sarcopenia drastically increased in patients who were unable to walk independently compared with those who could walk independently (P &lt; .001). Multivariate regression analyses showed that mobility limitation was an independent indicator of decreasing AMI and sarcopenia after adjustment for confounders. Conclusion: Patients with dependent ambulatory status experienced a higher prevalence of sarcopenia compared with those with ambulation; in addition, decline in ambulatory status was an independent indicator for the presence of sarcopenia after adjustment for potential confounders.
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Papers by Hiroshi Shamoto