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Nakamura S.,Kagawa University | Kusaka T.,Kagawa University | Yasuda S.,Kagawa University | Ueno M.,Kagawa University | And 7 more authors.
Brain and Development | Year: 2013

Introduction: The purposes of this study are to compare two hypoxic/ischemic (H/I) insults using amplitude-integrated EEG (aEEG), alone or combined with cerebral blood volume (CBV), as a guide to control hypoxia and to determine which protocol most effectively produces a consistent degree of survivable neuropathological damage in a newborn piglet model of perinatal asphyxia. Methods: Eighteen piglets were subjected to H/I insult of 20-min low aEEG (LAEEG). After the 20-min, the aEEG group was maintained with low mean arterial blood pressure for 10 min. The procedure for the aEEG plus CBV group was stopped if CBV became the rated value after 20. min of LAEEG. We measured changes in CBV using a near-infrared time-resolved spectroscopy (TRS) and cerebral electrocortical activity using aEEG until 6 h post-insult. At 5 days post insult, the piglets' brains were perfusion-fixed and stained with hematoxylin/eosin. Piglets were grouped as undamaged or damaged; piglets that did not survive to 5 days were grouped separately as dead. Results: Among surviving piglets, CBV combined with aEEG resulted in significantly greater percentage of damaged piglets than aEEG alone. Conclusions: We conclude that combining CBV with aEEG may be a more effective guide to control H/I insult in a newborn piglet model than aEEG alone. © 2012 The Japanese Society of Child Neurology.

Kuboi T.,Tokyo Metropolitan Childrens Medical Center | Kusaka T.,Kagawa University | Okazaki K.,Kagawa National Childrens Hospital | Kaku U.,Tokyo Metropolitan Childrens Medical Center | And 3 more authors.
Pediatrics International | Year: 2013

Hypoxic-ischemic encephalopathy in neonates causes irreversible damage to tissue and organs and results in multiple organ failure and poor outcome. Therapeutic hypothermia is the most effective therapy in neonates with hypoxic-ischemic encephalopathy. We report here a case of subcutaneous fat necrosis (SCFN) after therapeutic hypothermia by selective head cooling. Selective head cooling was provided for 72 h after birth. SCFN developed on the patient's cheeks and back at the age of 21 days. Thus, SCFN may be caused by selective head cooling, similarly to whole-body cooling. Pediatrics International © 2013 Japan Pediatric Society.

Pooh R.K.,Clinical Research Institute of Fetal Medicine CRIFM | Pooh K.H.,Kagawa National Childrens Hospital
Donald School Journal of Ultrasound in Obstetrics and Gynecology | Year: 2011

Three-dimensional (3D) ultrasound is one of the most attractive modality in the field of fetal ultrasound imaging. In multiplanar imaging of the brain structure, it is possible to demonstrate not only the sagittal and coronal sections but also the axial section of the brain, which cannot be demonstrated from parietal direction by a conventional 2D transvaginal sonography. Parallel slicing provides a tomographic visualization of internal morphology similar to MR imaging. Fetal neuroimaging with advanced 3D ultrasound technology is easy, noninvasive and reproducible methods. It produces not only comprehensible images but also objective imaging data. It has been controversial whether ultrasound or MRI is more practical and effective in prenatal assessment of fetal CNS abnormalities. In the assessment of enlarged ventricles, no significant difference between dedicated neurosonography and MRI in detection of intracranial structure. However, MRI is superior to ultrasound in evaluation of the brainstem, posterior fossa and cortical development especially in the late pregnancy. Meanwhile, transvaginal high-frequent 3D ultrasound has superiority to MRI in detection of intracranial calcification, vascular anatomy, intratumoral vascularity, bony structure. For CNS anomaly screening scan, ultrasound is no doubt the first modality, and once CNS abnormality is suspicious, after considering each advantage and disadvantage of transvaginal 3D ultrasound and MRI, it is suggested to use those different technologies according to what to be detected and evaluated in each abnormal CNS case. Of course, those two technologies should be utilized as alternatives and complementaries as well. In terms of fetal neurological function analysis, four-dimensional ultrasound research on fetal behavior have been launched in multicenters, and it will be greatly expected to elucidate relations between antenatal behavior and postnatal neurological prognosis.

Okazaki K.,Kagawa National Childrens Hospital | Kusaka T.,Kagawa University | Kondo M.,Tokyo Metropolitan Childrens Medical Center | Kozawa K.,Japan Institute for Environmental Sciences | And 2 more authors.
Cytokine | Year: 2012

Objective: Granulocyte-colony stimulating factor (G-CSF) and vascular endothelial growth factor (VEGF) are thought to be associated with the pathophysiology of perinatal asphyxia. To clarify any such association, we analyzed the serum levels in neonates with perinatal asphyxia treated with head cooling. Study design: Temporal alterations of serum G-CSF and VEGF levels were measured within 24 h of birth in five neonatal cases of severe asphyxia treated with head cooling, five neonatal cases without head cooling, and four healthy neonatal cases. Results: G-CSF in sera markedly increased and sustained in severely asphyxiated neonates treated with head cooling, while VEGF decreased and remained low. Conclusion: G-CSF and VEGF levels in sera might be associated with an early phase of brain protection after birth in severe asphyxia treated with head cooling. © 2012 Elsevier Ltd.

Kageji T.,Kagawa National Childrens Hospital | Mizobuchi Y.,Kagawa National Childrens Hospital | Nagahiro S.,Kagawa National Childrens Hospital | Nakagawa Y.,Tokushima University | Kumada H.,University of Tsukuba
Applied Radiation and Isotopes | Year: 2011

The purpose of this study was to evaluate the clinical outcome of BSH-based intra-operative BNCT (IO-BNCT) and BSH and BPA-based non-operative BNCT (NO-BNCT). We have treated 23 glioblastoma patients with BNCT without any additional chemotherapy since 1998. The median survival time (MST) of BNCT was 19.5 months, and 2-year, 3-year and 5-year survival rates were 26.1%, 17.4% and 5.8%, respectively. This clinical result of BNCT in patients with GBM is superior to that of single treatment of conventional radiotherapy compared with historical data of conventional treatment. © 2011 Elsevier Ltd.

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