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Biomedical subjects

H Hadeishi

Publications and source records attributed to H Hadeishi.

At least 19 recordsLinked to original sources
PubMed1992

Uncoupling between CBF and oxygen metabolism in a patient with chronic subdural haematoma: case report.

The regional cerebral blood flow (rCBF) and oxygen metabolism of a patient with a chronic subdural haematoma were examined quantitatively, using positron emission tomography (PET). Before operation, the rCBF was decreased slightly throughout the brain, whereas the regional oxygen extraction fraction (rOEF) was increased throughout the brain, with values ranging from 0.36 to 0.60. One month after operation, the rCBF had recovered remarkably in almost all regions and rOEF had decreased to within the normal range.

Blood Volume↗
PubMed1992

Ruptured anterior communicating artery aneurysm causing bilateral abducens nerve paralyses--case report.

A rare case of bilateral abducens nerve paralyses after rupture of an anterior communicating artery (AcoA) aneurysm occurred in a 56-year-old female after sudden onset of severe headache. Bilateral abducens nerve paralyses were present without additional neuro-ophthalmological signs. Computed tomography revealed subarachnoid hemorrhage (SAH). Angiography showed an AcoA aneurysm (15 mm in diameter, directed antero-inferiorly) that was successfully clipped. Postoperatively, the bilateral abducens nerve paralyses gradually recovered and disappeared 3 months after onset. Bilateral abducens nerve paralyses may occur after SAH due to ruptured AcoA aneurysm, and neurosurgeons should be alert to this possibility.

Abducens Nerve↗
PubMed1992

STA-MCA bypass surgery for internal carotid artery occlusion--comparative follow-up study.

Sixty-three patients with internal carotid artery occlusion manifesting as transient ischemic attack or minor stroke received superficial temporal artery-middle cerebral artery bypass surgery and medical treatment (n = 27) or medical treatment only (n = 36). Long-term follow-up showed that there was no significant difference in the outcomes. However, positron emission tomography studies suggested that patients with misery perfusion in the chronic stage benefited from extracranial-intracranial bypass surgery.

Adult↗
PubMed1992

[Clinical course in poor grade patients with ruptured intracranial aneurysms and extensive subarachnoidal clot].

Three hundred and eight cases with ruptured intracranial aneurysms and variable amounts of subarachnoidal clot were evaluated clinically with special emphasis on the natural course of poor grade patients. Clinical severity was classified according to the Glasgow Coma Scale (GCS); severe cases (score 3-8) and mild cases (score 9-15). Patients were further divided into four groups based on the preoperative clinical course, and on whether radical surgery was performed or not. Group A, severe cases without radical surgery (17 patients, mean GCS score 4.2); group B, severe cases (which had undergone) radical surgery (24 cases, mean GCS score 5.5); group C, patients considered as severe cases on admission that had improved to mild cases before radical surgery (3 patients, mean GCS score 11.7); group D, mild cases which had undergone radical surgery (254 cases, mean GCS score 14.3). CT findings after their last bleeding episode were evaluated in each group using subarachnoid hemorrhage (SAH) score from "0"-"3" according to the severity of SAH. In addition, the SAH-B (brainstem) score ("0"-"9") was also evaluated. In this score, the amount of SAH in each perimesencephalic cistern (a. prepontine or interpeduncular cistern, b. ambient cistern, c. quadrigeminal cistern) was considered with a possible score of "0"-"3" for each cistern. (No patient had a concurrent intracerebral or intraventricular hematoma causing a mass effect on CT scan). All cases in group A died except one patient that remained in a vegetative state. All of them had severe subarachnoidal clot (mean SAH score 2.9, SAH-B score 8.2). In group B, in patients with same scores (mean SAH score 2.8, mean SAH-B score 7.3), the outcome was as follows: 6 patients (33.3%) had full recovery or were capable of self-management, 6 patients (33.3%) were partially or fully dependent, and 12 patients (50%) were either in vegetative state or died. Patients in groups C and D with good outcome had significantly less amount of SAH, especially in the perimesencephalic cistern (group C--mean SAH score 2.3, mean SAH-B score 3.7, group D--mean SAH score 1.9, mean SAH-B score 3.3). It is concluded that duration and level of unconsciousness in the cases of SAH without concurrent hematoma causing mass effect, has a good correlation with the severity of SAH in the perimesencephalic cisterns.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Multiple medullary venous malformations decreasing cerebral blood flow: case report.

A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere. Single-photon emission computed tomography using N-isopropyl-p-(123I) iodoamphetamine demonstrated decreased cerebral blood flow in the right cerebral hemisphere.

Adult↗
PubMed1991

[Treatment for serious cases of ruptured intracranial aneurysms with severe subarachnoid clot].

Forty-one serious cases of ruptured intracranial aneurysms with severe subarachnoid clot were clinically analyzed, with special emphasis on the prognosis, pathophysiology, and surgical indications. All cases had thick subarachnoid clot without concurrent intracerebral hematoma and/or intraventricular hematoma causing mass signs on the CT scan. In this series, 23 cases underwent radical surgery while in the acute stage, 18 cases were treated conservatively (including 5 cases treated only by continuous ventricular drainage). The criterion for determining the degree of severity was defined as either a "semicoma" or "coma" state just prior to radical surgery for the radically-operated group, with the same designations for the conservative group at their time of admission. All patients except two in the conservatively-treated group died due to primary brain damage caused by massive subarachnoid hemorrhage. The two remaining cases died from other complications. On the other hand, the outcome for the 23 surgically-treated patients was as follows: Three (13%) fully recovered; three (13%) were capable of self-management; eight (34.8%) were partially or fully dependent. Nine (39.1%), died. In the radically-treated group, pre-operative factors that might predict clinical outcome were investigated. Those factors were the neurological grade, the brain-stem response, the response after the rapid administration of 20% Mannitol (300-900 ml), and the length of time from the last bleeding episode to the time that radical surgery was performed. It was recognized that there was no relationship between the neurological grade just prior to radical surgery and the outcomes in the serious cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Risks of surgical treatment for unruptured intracranial aneurysms].

The risks of surgical treatment for unruptured intracranial aneurysms, as well as the significance of evaluating cerebral blood flow (CBF), are here reported. Out of 72 patients who underwent unruptured aneurysm surgery without such complications as occlusion of the main trunk or perforating arteries, or brain contusion, and who according to CT scans, did not have new lesions related to the operations, 18 patients (25%) developed neurological deficits postoperatively. In 17 of these 18 patients, postoperative neurological deficits (frontal sign: 7, paresis: 4, and seizure: 6 cases) disappeared within 2 weeks following the operations. In the other patient, who was treated for subcortical hematoma in the left temporal lobe before aneurysm surgery, permanent speech disturbance appeared postoperatively. In the 18 patients with postoperative neurological deficits, the mean CBF value (36.2ml/100g/min) was statistically lower than that in the patients (46.2ml/100g/min) who had no postoperative neurological deficits (p less than 0.001). The rate of the patients with lower CBF values who developed postoperative neurological deficits, was statistically higher than that of patients with CBF values greater than 40ml/100g/min (p less than 0.002). In the patients with lower CBF values, common operative procedures for unruptured aneurysms such as craniotomy and mild brain retractions, may damage brain tissue. Careful perioperative management is needed for patients who undergo unruptured aneurysm surgery, because a lower CBF value may represent the degree of brain fragility.

Adult↗
PubMed1991

[Clinical study of growing up aneurysms: report of 25 cases].

Twenty-five cases of patients with growing up aneurysms are reported. Growth of the aneurysm was confirmed by repeated angiography within 1 month in 11 cases (short-term group), and for over 1 month in the other 14 cases (long-term group) following the initial angiography. Clinical history, shape and growth pattern of aneurysms, as well as hemodynamic factors that effect the growth were investigated in each group. The aneurysms were classified according to the shape into dome-type (smooth contour) and bleb-type (irregular contour). In all cases of the short-term group, the first angiography was performed because of rupture of the aneurysm. In this group, 4 cases bled again because of enlargement or the development of an aneurysmal bleb. Growth rate and the initial size of the aneurysm did not effect the potential of re-rupture. In the long-term group, 9 cases out of 14 (64.3%) had "non-ruptured aneurysm" at the time of first angiography. In the follow up, 5 cases were ruptured (two because of re-bleeding and three for the first time). In 3 out of these 5 cases, a bleb was demonstrated on initial angiography, and in another case, a bleb was demonstrated in follow-up angiography. Only one case ruptured because of the growth of the aneurysmal dome. Most of the aneurysms that rupture, in the follow-up survey, showed a larger growth rate in comparison with aneurysms that did not rupture. Many cases of this long-term group were associated with hypertension or vascular abnormalities which would effect the aneurysmal growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[A case of Klippel-Feil syndrome with crossed renal ectopia with fusion and unilateral vertebral artery occlusion].

A case of Klippel-Feil syndrome with crossed renal ectopia with fusion and unilateral vertebral artery occlusion is reported. A 61-year-old female was admitted because of having developed myelopathy, gait and sensory disturbance. The physical examination on admission revealed spastic gait and hypesthesia of the lower extremities. A hand size, elastic hard tumor mass was palpable at the right lower abdomen. The cervical radiogram showed fused 5th, 6th and 7th cervical vertebrae and severe spondylotic changes. Laminectomy was performed because of severe compressions of the cervical cord, evaluated by Metrizamide CT scans and MRI. The left subclavian angiogram showed occlusion of the left vertebral artery, and excretory pyelogram and abdominal CT scans showed crossed renal ectopia with fusion. 99mTc-DTPA renoscintigram revealed poor RI uptake and low glomerular filtering rate of ectopic kidney. The patients with Klippel-Feil syndrome are at greater risk of having a renal anomaly and a vascular accident of the vertebral artery. Examinations of urogenitary organs and vertebral arteries are necessary for the treatment of this syndrome.

Abnormalities, Multiple↗
PubMed1990

A case of medullary venous malformations with an arterial component coexisting with arteriovenous malformations.

We present a rare case of medullary venous malformations with an arterial component coexisting with two small arteriovenous malformations in the same area. The onset was abrupt with subcortical hematoma due to the rupture of one arteriovenous malformation in the frontal area. Single photon emission computed tomography using 99mTc-hexamethylpropyleneamine oxime showed a high-uptake area around the hematoma suggesting increased blood flow. Two types of vascular malformation coexisting in the same area support a theory of congenital malformation originating in intrauterine life.

Brain↗
PubMed1990

Contrast medium extravasation during cerebral angiography for ruptured intracranial aneurysm--clinical analysis of 26 cases.

Since 1976, the authors performed angiography on 837 patients with ruptured intracranial aneurysm, among which extravasation (EV) of contrast medium occurred in 26. Eleven patients underwent radical surgery within 3 hours after the EV, and four recovered well. The other 15 patients were conservatively treated, and all died. A large quantity of EV occurred when consciousness was severely disturbed and angiography was performed within 3 hours of the last attack. Most EV resulted in poor outcome. However, some patients with mildly disturbed consciousness before angiography, even with severe temporary disturbance of consciousness after the EV, recovered well after emergency radical surgery.

Adult↗
PubMed1990

Hyperdynamic therapy for cerebral vasospasm.

The effects of hyperdynamic therapy on patients with cerebral vasospasm following subarachnoid hemorrhage (SAH), under normal blood pressure (BP) and normal blood volume conditions, are reported. Forty-four patients, who underwent surgery for aneurysms in acute stage, received hydroxyethyl starch (500 ml/day) postoperatively to prevent dehydration. Twenty-four of the 44 patients with prominent SAH on the computed tomographic (CT) scan, anticipating to develop cerebral ischemia due to vasospasm, were given dobutamine (DOB). The BP was maintained within the normal range, and the heart rate was kept below 130/min. In the 24 patients treated with DOB, cerebral blood flow (CBF) was measured repeatedly by the 133Xe intravenous injection method. In 8 of these 24 patients, the cardiovascular function was monitored with Swan-Ganz (S-G) catheters. Twelve of the 44 patients (27%) developed delayed neurological deficits associated with cerebral vasospasm. The neurological deficits were reversed by the administration of DOB, at a dose of 8-25 (average 12.4) micrograms/kg/min. In 43 patients, the ischemic lesions associated with vasospasm did not appear on CT scan and the patients were of normal condition at discharge. However, one patient showed multiple low-density lesions on CT scan. This was because of the failure of hyperdynamic therapy due to pulmonary complications. No case of pulmonary edema or heart failure due to volume overload was noted. In the 24 patients with prominent SAH, CBF increased significantly by up to 20% following DOB administration, although the BP stayed in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Early surgery in elderly patients with ruptured intracranial aneurysms--preoperative clinical evaluation and prognosis.

Numerous clinical classification systems have been developed for patients with ruptured intracranial aneurysms. However, most systems do not take age into account and are less reliable in elderly than in younger patients in terms of indications for early surgery and predicting the clinical outcome. The authors have studied this problem using our clinical classification system and, present here the results of 38 elderly patients (greater than or equal to 65 years of age) who underwent neck clipping and implementation of continuous ventricular drainage within 3 days of aneurysm rupture. The clinical outcome at 1 year after onset was considered "good" if the patient was able to function independently and "poor" if he or she was partially or fully dependent or had died. The preoperative level of consciousness was not significantly correlated with the outcome according to Spearman's nonparametric statistical analysis. Age, however, was a significant factor: the incidence of poor outcome was significantly higher in patients over age of 70 years than in those between 65 and 70 (p less than 0.05). Postoperative complications, which were previously found to be significantly related to the outcome in elderly patients, were significantly more common in patients who had a history of cardiac, pulmonary, hepatic, and/or renal disease than in those without such a history (p less than 0.005). The authors found that the prognostic accuracy of clinical classification systems, based on preoperative level of consciousness, is improved in geriatric cases if one point is added for patients over age of 70 years or those with a history of systemic diseases. Additional relevant factors included computed tomographic findings and pre-existing cerebral dysfunction.

Aged↗
PubMed1990

[Combination of serial transcranial Doppler examinations and cerebral blood flow studies in the management of cerebral vasospasm after subarachnoid hemorrhage].

In 13 patients who had ruptured intracranial aneurysms, serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in order to evaluate the degree of cerebral vasospasm. All patients showed some extent of vasospasm on angiography, which was performed between Day 7 and 10. The flow velocities of either the middle cerebral arteries or the anterior cerebral arteries, measured by TCD, began to increase on post hemorrhage Day 5, and maximum flow velocities were recorded between Day 9 and 13, with normalization occurring within the following 2 weeks. In 5 cases of symptomatic vasospasm, a rapid increase of flow velocities preceded clinical manifestation of the vasospasm. Maximum flow velocities of the 5 cases were at a higher level in the range of 119-184cm/sec (mean 149cm/sec) that the cases where there were no symptoms. Consequently, serial TCD examinations were very useful for the early detection of vasospasm after subarachnoid hemorrhage. And it was confirmed that the change of flow velocities was more important than the value itself, and that the rapid increase of flow velocities indicated severe ischemia. However, for judging when vessel narrowing was resolving, the usefulness of the TCD examinations were doubtful. This is because flow velocities measured by TCD are thought to be fairly much influenced by multiple factors such as the change of blood pressure, blood volume, which were caused by the active treatment for the vasospasm. Serial measurements of CBF were also made 2-7 times (mean 3.1 times) during the first two weeks following subarachnoid hemorrhage using the 133Xe intravenous injection method.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Regional effects of craniotomy on cerebral circulation and metabolism: PET study on the un-ruptured aneurysmal surgery].

Regional effects of craniotomy on cerebral circulation and metabolism, such as regional cerebral blood flow (rCBF), regional cerebral oxygen consumption (rCMRO2), regional oxygen extraction fraction (rOEF), and regional cerebral blood volume (rCBV) were examined by a PET (positron emission tomography) study concerning surgery that was performed on unruptured aneurysm patients. Eight patients with intracranial un-ruptured aneurysms were studied pre- and post-operatively by the 15O labelled-gas steady-state method, using HEADTOME-III. All patients underwent aneurysmal surgery performed by the transsylvian approach. There was a significant increase in the mean OEF values taken from the whole-brains of 8 patients, but there was not a significant change in CBF, CMRO2 or CBV. The increase in OEF was caused by decrease of O2 content, which was caused by post-operative decrease in the Hb value. So, this OEF increase was not the direct effect of craniotomy. In 2 patients, the rCBF and rCMRO2, in the fronto-temporal region (where craniotomy was performed) increased post-operatively. This regional effect suggests transient reactive hyperemia following compressive ischemia during the operative procedure, and metabolic demands for recovery of brain function. In 2 other patients, who had relatively low rCBFs during the pre-operative study, rCBF and rCMRO2 in the bi-frontal region had decreased more at the post-operative study. This change appears to have been caused by removal of cerebrospinal fluid and depression of the frontal lobe. From this study, it becomes evident that the regional effect of craniotomy on cerebral circulation and metabolism is not so great, when adequate microsurgical techniques are used.

Adult↗
PubMed1988

Computerized monitoring system in neurosurgical intensive care.

A computerized monitoring and analyzing system for neurosurgical intensive care has been developed. The system continuously monitors the function of the central nervous, cardiovascular and respiratory systems. Correlation between such parameters can be analyzed automatically. The electroencephalogram (EEG) and intracranial pressure (ICP) were monitored as parameters for CNS function and condition. The cardiovascular and respiratory systems were monitored by heart rate, systemic blood pressure, central venous pressure, pulmonary arterial pressure, respiratory rate, and expiratory O2 and CO2 pressures. Body temperature was also monitored continuously. Sequential changes of those parameters were displayed on time-dependent trend graphs, and correlations between each parameter were automatically analyzed by linear regression equations. The clinical applicability of the system was demonstrated in the postoperative treatment of cerebral vasospasm following subarachnoid hemorrhage due to ruptured intracranial aneurysm. In such a case, EEG slowing was observed in this system prior to clinical deterioration, and had a correlation with a decrease of pulmonary arterial pressure. Thus, the necessity for restoration of intravascular volume was realized before clinical deterioration progressed.

Aged↗