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Biomedical subjects

A Hakuba

Publications and source records attributed to A Hakuba.

At least 55 records · Page 3Linked to original sources
PubMed1993

A simplified atrial catheterization technique for ventriculo-atrial shunt: puncture of the subclavian vein through the infraclavicular approach.

A simple technique to place an atrial catheter for ventriculo-atrial shunt has been developed. The subclavian vein is punctured percutaneously from the direction between the clavicle and the first rib by the same procedure used for central venous catheterization using the introducer designed for Fr. 7 catheter. The position of the tip of the catheter is determined by x-ray fluoroscopy. The technique was found to be simple, safe, and timesaving in two patients.

Catheterization↗
PubMed1993

[A case of metastatic spinal tumor from renal cancer reduced by interferon-alpha].

A case of metastatic spinal tumor from renal cancer reduced by interferon-alpha is reported. A 54-year-old man was admitted to Tane General Hospital on April 12, 1990, with the complaint of difficulty in walking. Abdominal CT scan revealed right renal carcinoma, and MRI demonstrated metastatic spinal tumor at Th6, which was mainly occupying the entire lamina, spinous process and right pedicle of Th6. Nephrectomy was performed and, instead of operating on the spinal lesion, the patient was given follow-up treatment with administration of interferon-alpha (5 million units twice a week) and steroid. 1 year and 6 months later the patient's walking ability began to deteriorate and paraparesis progressed, although the size of the metastatic spinal tumor had gradually reduced. This was thought to be because of atrophy of the legs due to prolonged bed rest and steroid administration. Laminectomy with total removal of the tumor was performed on January 16, 1992. In the 12 months postoperatively, there has been neither recurrence nor remote metastasis seemingly due to the administration of interferon-alpha. This appears to be the first report of metastatic spinal tumor from renal cancer reduced by interferon-alpha.

Carcinoma, Renal Cell↗
PubMed1992

Giant basal prolactinoma extending into the nasal cavity.

An unusual case of a giant prolactinoma extending to the nasopharynx and nasal cavity is presented. A 35-year-old man admitted for nasal obstruction and visual disturbances was found to have bilateral anosmia, right homonymous hemianopsia, and a right hemiparesis. The serum prolactin level was 13,300 ng/mL. Radiological examination revealed a large mass invading the skull base and extending into the suprasellar region and the left frontal lobe superiorly and into the nasopharynx inferiorly. Subtotal removal was done through a bilateral orbitofrontal craniotomy, which was followed by radiotherapy and bromocriptine administration. Immunohistochemical analysis confirmed a prolactinoma. The rarity of such a tumor, its location and extension, and the usefulness of magnetic resonance imaging and immunohistochemistry are stressed. Pertinent literature is reviewed.

Adult↗
PubMed1992

Intramedullary spinal cord tumors: significance of associated hemorrhage at MR imaging.

Magnetic resonance (MR) images obtained in 35 patients with intramedullary spinal tumors were reviewed. Hypointense areas on both T1- and T2-weighted images were seen within or around eight tumors, all of which were in the cervical cord. Hypointensity at the tumor margin was seen in seven cases. Hypointensity within the tumor was seen in two cases. (One case had both types of hypointensity). In seven surgically confirmed cases, hypointensity at the tumor margin was found to be a relatively firm pseudocapsule, and hypointensity within the tumor corresponded to intratumoral hematoma. All of the tumors with hypointensity were ependymomas at histologic examination. When MR imaging shows an intramedullary tumor with hypointensity at the tumor margin, it is suggestive, but not pathognomonic, of an ependymoma.

Adult↗
PubMed1992

Significance of gadolinium-enhanced magnetic resonance imaging in differentiating spinal cord radiation myelopathy from tumor. Case report.

A young woman with a fourth ventricular ependymoma underwent radiotherapy following tumor excision. Twenty months later she developed a progressive neurological deficit at the C-2 vertebral level. Gadolinium-enhanced magnetic resonance imaging, showed an intramedullary lesion at the C-2 level. Although radiation myelopathy was suspected, tumor recurrence could not be excluded. Re-exploration and histopathology both confirmed a diagnosis of radiation myelopathy. A retrospective review of the case indicated findings favoring radiation myelopathy. The pertinent literature is reviewed and the findings discussed.

Adult↗
PubMed1992

[Ischemic complications following parent artery occlusion with detachable balloons in the treatment of large carotid aneurysms: effectiveness of 99mTc-HMPAO SPECT and importance of postoperative management].

Three patients with large carotid aneurysms were treated by parent artery occlusion with detachable balloons. Of these, 2 had intracavernous carotid artery aneurysms and one had a carotid-ophthalmic aneurysm. All patients underwent a formal balloon occlusion test and tolerated it well. One patient with a carotid-ophthalmic aneurysm, however, developed postoperative ischemic effects. This case was that of a 55 year-old female with right visual disturbance. Her middle cerebral artery flow had been compromised during test occlusion under induced hypotension. Although initially intact after balloon occlusion, she was found to be hemiplegic 24 hours later. She subsequently developed multiple small infarcts which were shown on MRI and which corresponded exactly to the previously demonstrated region of decreased flow during testing. This ischemic complication is possibly due to hypoperfusion, but embolism from the thrombosed aneurysm can not be denied. To prevent these complications, an extracranial-intracranial artery anastomosis prior to parent artery occlusion should be considered if the preoperative 99mTc-HMPAO SPECT shows a compromised cerebral blood flow. In addition to this, postoperative anticoagulant therapy should be given even if test occlusion was well tolerated clinically.

Brain Ischemia↗
PubMed1992

[Changes in dementia after shunt surgery for normal pressure hydrocephalus].

In order to investigate the pathogenesis of normal pressure hydrocephalus (NPH), dementia was analyzed with regard to the characteristic preoperative picture, the time when dementia improved, and what aspect of dementia was improved, retrospectively. Twenty seven patients of NPH were divided into two groups; young adult group: patients under 64 years old and geriatric group: patients above 65 years old. We found that the only difference found between these two groups was severity in dementia grading, higher in geriatric group. Postoperative course or complications did not differ. Dementia in NPH was not an essential impairment of intellectual ability, but was characterized by the subset symptoms of dementia, such as decrease in spontaneity and interest, slowness and paucity of thought and action. Improvement of memory followed postoperative recovery of these subset symptoms which was observed at earliest three days after shunt surgery. We postulate that recovery of dementia in NPH is associated with not only a decrease in intracranial pressure but also an improvement in the microcirculation of the brain or an improved metabolism.

Adult↗
PubMed1991

Persistent primitive hypoglossal artery aneurysms--report of two cases.

The authors present two patients with subarachnoid hemorrhage caused by ruptured intracranial saccular aneurysms of the persistent primitive hypoglossal artery. A standard unilateral suboccipital approach in one patient resulted in incomplete neck clipping since the operative field was restricted by a protruding jugular tubercle. Successful aneurysmal neck clipping was achieved in the second patient via a unilateral-transcondylar-suboccipital approach with resection of the jugular tubercle and rim of the foramen magnum.

Adult↗
PubMed1991

Surgical treatment of the retethered spinal cord after repair of lipomyelomeningocele.

In a series of 75 patients with surgically treated lipomyelomeningoceles, the neurological condition of six patients deteriorated 6 months to 14 years after the operation due to repeat tethering of the spinal cord. The tethering resulted from postoperative dense adhesion between the cord and the overlying dura mater. Two of the six patients underwent conventional repeat untethering procedures, and the remaining four were successfully treated with a new surgical technique developed by the authors to prevent such dural adhesion. For this procedure, after complete untethering of the spinal cord, the lumbosacral cord is retained in the center of the dural sac by fine stay sutures between the pia mater of the conus medullaris and the ventral dura mater. In addition, the dura mater is tacked to the posterior arch which is reconstructed with bone grafts at one or two bifid vertebral levels. During a postoperative follow-up period of 1 to 3 years, no further deterioration has been observed and magnetic resonance studies have demonstrated a space filled with cerebrospinal fluid (CSF) around the lumbosacral cord. The authors conclude that long-term observation, both neurological and radiological, is essential even after successful repair of a lipomyelomeningocele. This new surgical procedure can maintain a CSF bath around the lumbosacral cord, thus preventing dural adhesion. Application of this technique will hopefully be beneficial in lipomyelomeningocele patients with a high risk of cord retethering after initial repair.

Adolescent↗
PubMed1991

[Inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus: report of three cases].

We treated three cases of inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus. Case 1 was that of a 36-year-old male with diplopia and right ptosis. Case 2 was that of a 40-year-old male with frontal headache. Case 3 was that of a 70-year-old female with left impaired vision and frontal headache. In the first case, MRI demonstrated a mass lesion extending from the right half of the sphenoid sinus to the cavernous sinus and retropharyngeal space. In the second case the granuloma extended from the right cavernous sinus to the right retroorbital space. In the last case, MRI demonstrated diffuse Gd-DTPA enhancement of the left cavernous sinus and the left half of the sphenoid sinus. In all cases an operation was performed using the sublabial rhinoseptal approach, and the tumor in the sphenoid sinus was removed. Histological examination revealed an inflammatory granuloma in all 3 cases. In the first case the clinical symptoms improved following administration of glucocorticoids. In the second case the mass in the cavernous sinus decreased in size postoperatively. In the last case, the clinical symptoms gradually improved with administration of antibiotics after surgery. Granuloma of the cavernous sinus is difficult to diagnose, but when a similar pathological lesion coexists in the sphenoid sinus, a definitive diagnosis can be easily made via the sublabial rhinoseptal approach.

Adult↗
PubMed1990

Fatal aneurysmal rupture: a survey of 60 grade-5 cases.

The purpose of the present study was to describe the clinical course of patients with Grade-5 ruptured aneurysms (WFNS grading). Among 250 consecutive cases of ruptured aneurysms, 60 Grade-5 patients were reviewed retrospectively, consisting of 24 males and 36 females with an average age of 58 years. Thirty-two patients were directly transferred to our clinic, while the remaining 28 were referred from other clinics. Duration from rupture to arrival at our clinic was within 1 hour in 25 cases and within 2 hours in 43 cases. Systolic blood pressure on admission was 186 mmHg on average. Obvious misdiagnoses by primary physicians were made in 7 cases. Ventricular drainage and clipping/trapping of the aneurysms were performed in 7 and 25 cases, respectively. Forty-nine patients died and the remaining 11 survived. One made a good recovery, 1 was moderately disabled, 8 severely disabled, and 1 in a vegetative state. The prognosis for Grade-5 patients is well known as being extremely poor, which also was the case in our series. Early referral and early surgical intervention have not changed this poor prognosis. Possible improvement of the outcome of this group might be expected by 1) public health and primary physician education on aneurysmal subarachnoid haemorrhage, and 2) control of blood pressure during referral.

Adult↗
PubMed1990

[A case of ectopic large pituitary adenoma].

Ectopic pituitary adenomas are very rare and only 17 cases have been reported. In this paper we present a case of large pituitary adenoma originating in the suprasellar region. A 26-year-old man was admitted to our clinic with a chief complaint of headaches. Neurological examination revealed slight disorientation and bilateral choked disk. Hormonal study revealed that the serum prolactin level was 3300ng/ml and serum growth hormone level was 29.5ng/ml. Computed tomography showed a large mass in the suprasellar region extending upward to the third ventricle and backward to the pons. T1-weighted MR imaging revealed that the intensity of the mass was the same as that of the cerebral cortex and the pituitary gland was showing high intensity in the pituitary fossa. The tumor was radically removed via the transpetrosal transtentorial approach. Histologically, the tumor was a prolactin-growth hormones producing pituitary adenoma. The literature was reviewed and the origin of the tumor was discussed.

Adenoma, Chromophobe↗
PubMed1989

A clinical analysis of 32 brainstem haemorrhages; with special reference to surviving but severely disabled cases.

Thirty-two patients with CT-documented primary brainstem haemorrhage were reviewed retrospectively to obtain a clearer overall clinical picture, especially of the severely disabled survivors. They were divided into 3 groups according to outcome: eleven cases (Group 1) died within 1 month following haemorrhage, 11 cases (Group 2) survived but became bedridden, necessitating full living support, and 10 cases (Group 3) showed minimal neurological deficits and resumed normal activities. Owing to CT and improved critical care, the survival rate was 66% for the whole series. Group 2 comprised 34% of all cases. These patients were mostly alert, quadruplegic, and communicated only with great difficulty. The most common initial symptoms and CT finding in each group were as follows; Group 1: unconsciousness, respiratory disturbance, negative light reflex, tachycardia, and haematoma greater than 3.0 cm; Group 2: disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0 greater than haematoma less than 3.5 cm; and Group 3: alertness or only slight disturbance of consciousness, normal respiration, positive light reflex, normal heart rate, haematoma less than 2.5 cm. Although there is an overlap among them, these findings will be useful to distinguish the three groups from each other. Patients with disturbance of consciousness, respiratory disturbance, positive light reflex, normal heart rate, and 2.0 greater than haematoma less than 3.5 cm, have a chance to survive, but in severely disabled condition, if they were treated with vigorous intensive care in the acute stage.

Adult↗
PubMed1989

Surgical treatment and radiological consideration of supergiant cerebral aneurysms.

We have collected four cases of supergiant cerebral aneurysm, each greater than 6.0 cm in diameter. Two of these cases were saccular aneurysms of the anterior communicating artery and middle cerebral artery, of which the necks were clipped with resection of the aneurysms. Another patient had a fusiform aneurysm of the middle cerebral artery, which was resected accompanied by a reconstructive procedure of cerebral blood flow. The last patient had a fusiform aneurysm of the internal carotid artery. Following internal carotid artery occlusion surgery with superficial temporal artery-middle cerebral artery anastomosis, the aneurysm completely disappeared radiologically within several months.

Adolescent↗
PubMed1989

A new microcatheter system for endovascular treatment of cerebral arteriovenous malformations.

A new microcatheter system was used for diagnostic and therapeutic purposes in three cases of arteriovenous malformation. This microcatheter is used with a steerable guidewire and provides high selectivity of the target vessels and greater catheter maneuverability than does balloon catheters. Tissue adhesive was safely injected for the therapeutic embolization in two of the cases. With this system, however, the utmost attention is necessary to prevent reflux of the tissue adhesive and to avoid lacerating the feeding vessels with the guidewire. This microcatheter system was found to be very useful for diagnostic and therapeutic procedures in endovascular treatment of cerebral arteriovenous malformations.

Adult↗
PubMed1989

Clivus and apicopetroclivus meningiomas--report of 24 cases.

The authors describe the clinical and radiological features, surgical procedures, and outcome of 18 cases of clivus meningiomas and six of apicopetroclivus meningiomas. There were 17 females and seven males, ranging in age from 26 to 69 years, with a mean age of 47 years. All except one showed cranial nerve deficits. Computed tomography accurately demonstrated tumor size and location. Cerebral angiography showed characteristic displacement of the basilar artery and its tributaries, with blood supply to the tumor largely via the meningohypophyseal trunk. Magnetic resonance imaging was excellent in delineating the relationship of the tumor to the brainstem and major vasculature. The surgical approaches used were transpetrosal-transtentorial (n = 9), combined transpetrosal-transtentorial-transzygomatic preauricular transpetrosal (n = 9), suboccipital-subtemporal (n = 2), suboccipital (n = 1), frontotemporal (first stage operation) followed by suboccipital (second stage operation) (n = 1), suboccipital-transpetrosal (n = 1), and orbitozygomatic-infratemporal preauricular transpetrosal (n = 1). Seventeen tumors were totally removed and seven subtotally. The operative mortality was 8% (two patients). Twenty patients developed new cranial nerve deficits within 1 month of surgery. The average follow-up period was 5 years, and the outcome was good or excellent in 12 cases. Transpetrosal approaches proved relatively safe and effective for radical tumor removal and, in two cases, permitted preservation of useful hearing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Magnetic resonance imaging of intracavernous pathology.

To evaluate the usefulness of magnetic resonance (MR) imaging of intracavernous pathology, T1-weighted spin echo images of four vascular lesions and 10 neoplastic lesions with surgically confirmed cavernous sinus (CS) invasion were reviewed retrospectively. In one case of traumatic carotid-cavernous fistula (CCF) and one of dural arteriovenous malformation (AVM), the internal carotid artery (ICA) and rapid shunted flow were depicted as signal voids, and the relationship between the ICA and shunted flow was clearly shown. Normal venous flow appeared as a low-intensity area and was observed even in the presence of the CCF and dural AVM. In two cases of thrombosed aneurysms, the thrombosis was clearly demonstrated, along with patent arterial flow in one case; in the other case, however, it was impossible to differentiate patent arterial flow from calcification. The intensity of all neoplastic lesions was similar to that of the cerebral cortex. The relationship between the ICA and the tumors was clearly demonstrated. The visual pathways were also plainly shown unless they were involved, or markedly compressed, by tumor. CS invasion was strongly associated with four findings: 1) encasement of the ICA by the tumor; 2) marked displacement of the ICA; 3) absence of low intensity, which reflects normal venous flow, in the CS; and 4) extension of extrasellar tumors to the medial wall or of intrasellar tumors to the lateral wall. MR imaging was judged promising in the evaluation of intracavernous pathology.

Adenoma↗