Biomedical subjects

Akihiko Hino

Publications and source records attributed to Akihiko Hino.

3 recordsLinked to original sources

PubMed2006

Cytologic diagnosis of brain metastasis from hepatocellular carcinoma by squash preparation.

Hepatocellular carcinoma (HCC) metastasizes to the brain is rare instances. In published series and case reports of metastatic HCC, diagnosis of central nervous system metastases has been determined by histologic methods. We present a case of metastatic HCC of brain diagnosed by squash cytologic preparation. A 69-year-old male, HCV positive, suffering from post-hepatitic cirrhosis, initially diagnosed at age 68 with HCC presented with headaches of increasing frequency and severity. A computed tomography scan confirmed a 3-cm nodule in the right parietal lobe of the brain. Squash cytology was performed intraoperatively and preparations of a small tissue fragment resected from the mass showed medium-to-large-sized, well-cohesive clusters or sheets of uniform tumor cells. The tumor cells are highly cellular and contain solitary tumor cells in loose groupings as well as many fragments. They also appear somewhat bizarre and contain large, round, or ovoid nuclei with prominent nucleoli. Cytologic diagnosis of metastatic HCC was rendered reported and confirmed by a subsequent frozen section examination. To the best of our knowledge, this is the first reported case in which HCC was reported as brain metastasis, by using squash cytology. We suggest that intraoperative squash cytologic examination be viewed as a useful initial approach in the diagnosis of metastatic brain tumor.

Aged↗

PubMed2006

[Clipping of upward projecting anterior communicating aneurysms via pterional craniotomy: approach from the side of A2 of anterior displacement].

The majority of anterior communicating artery(Acom) aneurysms can be approached via pterional craniotomy. When the fundus points superiorly, craniotomy in the side of A2 of posterior displacement may be advantageous for catching the aneurysm and both ACAs on the same plane. Sometimes, however, surgeons have to deliberately select a "contralateral" craniotomy to deal with other lesions in the same operative session. The first author has operated on 111 patients with Acom aneurysms during the last 8 years; 26 aneurysms projected superiorly, and 7 were approached via contralateral craniotomy because of the aneurysm multiplicity. We reviewed surgical problems in the 7 upward projecting aneurysms approached from the "contralateral" side. All aneurysms were successfully secured without any surgery related complication. However, in each case, aneurysm and both ACAs formed a straight line in the narrow surgical field, and it was difficult to handle the aneurysm behind the ipsilateral A2, particularly when it tightly adhered to the A2. Anticipating this prior to surgery allows the surgeon to know the possible problems in aneurysm dissection that may occur. Practically, wide separation of interhemispheric fissure with removal of the gyrus rectus, and dissection of the posterior aspect of the ipsilateral A2 facilitates the mobilization of A2 and exposure of the aneurysm neck. When the aneurysm is tightly adherent to the A2, however, isolation of the entire aneurysm risks tearing the aneurysm at its A2 junction. An aperture clip should be considered to avoid serious bleeding during dissection.

Adult↗

PubMed2003

Training in microvascular surgery using a chicken wing artery.

OBJECTIVE: Microarterial anastomosis is now seldom performed for treatment of atherosclerotic occlusive cerebrovascular disease. However, a small but significant number of procedures still require this technique. When a surgeon's clinical experience is limited, regular practice is required to maintain and improve surgical skills. The present training system involves passage from suturing of synthetic materials (such as Silastic tubes) to practice with experimental living animals or cadavers. However, these methods are neither convenient nor practical for daily exercises and rehearsals. I present a unique training exercise for microarterial anastomosis, using a chicken wing artery. METHODS: A brachial artery can be extracted from a chicken wing. The artery is 5 to 6 cm long and measures approximately 1 mm in diameter. The artery can be used to practice end-to-end, end-to-side, or side-to-side anastomosis under the microscope. RESULTS: Several advantages are noted: the materials are cheap, convenient to manage, and easy to obtain, and neither specific facilities to maintain living animals nor anesthesia is needed. Moreover, the diameter and structure of the material are identical to those of human cortical vessels, making the rehearsal quite similar to the actual surgical experience. CONCLUSION: This exercise is useful not only for young surgeons who wish to learn microsurgical techniques but also for more experienced surgeons who need to maintain or improve their skills.

Anastomosis, Surgical↗